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    Medigap Plan N vs Plan G

    Medigap Plan N vs Plan G

    By Ed Crowe | General Articles | 0 comment | 11 August, 2025 | 0

    Medigap Plan N vs Plan G: Which Is Right for You

    When shopping for a Medicare Supplement (Medigap) plan, there are many options. Plan G and Plan N are two of the most popular choices for people looking to fill in the coverage gaps of Original Medicare. While they share many similarities, there are key differences in cost, coverage, and how they handle out-of-pocket expenses. Understanding Medigap Plan N vs Plan G can help you choose the plan that best fits your healthcare needs and budget.

    What Medigap Plans Have in Common

    Both Plan G and Plan N are standardized Medicare Supplement plans, meaning the basic benefits are the same no matter which insurance company offers them. With either plan, you get:

    • Coverage for Medicare Part A coinsurance and hospital costs (after the beneficiary uses up Medicare’s benefits) for up to 365 days
    • Coverage for Part B coinsurance or copayment (with exceptions for Plan N – explained below)
    • Blood coverage (first 3 pints per year)
    • Part A hospice care coinsurance or copayment
    • Skilled nursing facility coinsurance
    • Part A deductible
    • Foreign travel emergency coverage (up to plan limits)

    Key Differences Between Plan G and Plan N

    1. Part B Excess Charges

    • Plan G: Covers 100% of Medicare Part B excess charges (extra costs you may be billed if your provider doesn’t accept Medicare’s standard payment).
    • Plan N: Does not cover Part B excess charges; if your provider bills them, you’ll have to pay out of pocket.

    2. Office Visit & ER Copays

    • Plan G: No copays for office visits or ER (after Medicare pays its share).
    • Plan N: You may pay up to $20 for some doctor visits and up to $50 for emergency room visits (waived if admitted to the hospital).

    3. Monthly Premiums

    • Plan G: Generally has higher monthly premiums because it covers more.
    • Plan N: Often has lower monthly premiums but requires more cost-sharing through copays and the possibility of excess charges.

    4. Part B Deductible

    • Both plans require you to pay the annual Medicare Part B deductible before coverage kicks in (for 2025, it’s $257).

    Watch our YouTube video on Medicare Advantage vs Medicare Supplements

    Which Plan is The Best Fit

    • Choose Plan G if:
      • You want the most comprehensive coverage available to new Medicare enrollees.
      • You prefer predictable costs and don’t want to worry about excess charges or visit copays.
      • You see specialists who may charge more than Medicare’s approved amount.
    • Choose Plan N if:
      • You want a lower monthly premium and are okay with occasional copays.
      • You typically see Medicare-assigned doctors who don’t bill excess charges.
      • You’re healthy, visit doctors less often, and want to save on monthly costs.

    Both Plan G and Plan N are strong options that can protect you from high out-of-pocket costs not covered by Original Medicare. The right choice depends on how often you use healthcare services, whether your providers accept Medicare’s payment terms, and how much you want to pay each month in premiums versus at the point of care.

    When comparing, it’s smart to enlist the help of a licensed Medicare agent who get quotes for both plans from multiple carriers. Please note: premiums vary by carrier even though the benefits are standardized.

    If you are an agent who is ready to join the team at Crowe; click here for online contract.

    Agents don’t miss important events and information; click here to learn more

    Changing Medicare Supplement Plans

    Changing Medicare Supplement Plans

    By Ed Crowe | General Articles | 0 comment | 10 August, 2025 | 0

    Changing Medicare Supplement Plans: What to Know Before You Switch

    Medicare Supplement (Medigap) plans are a great choice for covering the portion of out-of-pocket costs that Original Medicare doesn’t. However, as health needs and financial situations change, beneficiaries might consider changing Medicare supplement plans. Whether it’s to reduce premiums or adjust coverage, making a change requires some thought and planning.

    Here’s what to keep in mind when considering a change to Medicare Supplement coverage.

    Why People Change Medigap Plans

    There are several reasons why someone might decide to change their Medigap plan:

    • Overpaying for coverage: The current plan might offer more coverage than needed, meaning the policyholder may not use as much coverage as much as expected.
    • Needing additional benefits: Health needs can change, and a different plan may provide better or more suitable coverage.
    • Shopping for a better rate: Even if the benefits remain the same, switching to a different insurance carrier offering the same plan at a lower premium makes sense.
    • Company dissatisfaction: Some beneficiaries want to change to a new insurer due to customer service or other experiences.

    When You Can Switch

    Changing Medigap plans isn’t quite as simple as enrolling in Medicare for the first time. There are only a few scenarios when someone can switch plans without facing potential roadblocks:

    • During their six-month Medigap Open Enrollment Period: This period starts the month they turn 65 and are enrolled in Medicare Part B. During this time, they can buy any Medigap plan offered in their state or switch plans. Insurance companies cannot deny coverage based on health.
    • 30 day free look period: After purchasing a new Medigap policy, you have 30 days to decide if you want to keep it. This allows beneficiaries to compare other plans with their your current plan. 
    • With guaranteed issue rights: These are special protections that allow someone to buy certain Medigap plans without medical underwriting. Common situations that trigger guaranteed issue rights include losing employer coverage or moving out of a plan’s service area. However, there are currently 4 states that offer guaranteed issue rights regardless of the circumstance.

    Please note: A new Medigap policy doesn’t automatically cancel the old one the way Medicare Advantage and PDP plans do. It is best not to cancel your old Medigap policy until you are sure you want to keep the new one.

    Watch a YouTube video on Medicare Supplement underwriting.

    Outside of the situations listed above, beneficiaries may need to go through medical underwriting to enroll in a new Medigap plan.

    Understanding Medical Underwriting

    Medical underwriting is a review process insurers use to assess an applicant’s health history and current conditions. Based on this review, a company can:

    • Approve or deny the application.
    • Charge a higher premium.
    • Apply a waiting period for coverage of pre-existing conditions.

    If a person applies for a Medigap plan outside their Open Enrollment Period and without guaranteed issue rights, their application could be declined based on health.

    One common underwriting consideration is tobacco use. Smokers often face higher premiums, even if they are otherwise in good health.

    No Waiting Period to Switch

    There’s a common misconception that people have to keep their Medigap plan for a set amount of time before switching. The truth is, once someone has a Medigap policy, they can apply for a new one at any time. As long as they’re willing to go through underwriting if required.

    Switching Medicare Supplement plans isn’t something to rush into, but with the right timing and a good understanding of the process, it can be a good idea for your health and finances. Whether it’s finding more appropriate coverage or simply lowering monthly costs, reviewing options regularly ensures your Medicare Supplement plan continues to meet your needs. It is best to speak with a licensed Medicare agent who can guide you through the options and find the best fit for your needs.A

    If you are an agent who is ready to join the team at Crowe; click here for online contract.

    Agents helping clients navigate this process; be sure they understand the importance of timing and potential underwriting challenges. They must understand how their health status could impact their options.

    Stay up-to-date on agent events and information; click here.

    Adding Ancillary Products to MA Sales

    Adding ancillary products to MA Sales

    By Ed Crowe | General Articles | 0 comment | 8 August, 2025 | 0

    Adding Ancillary Products to MA Sales – Why Agents Should Consider It.

    Medicare Advantage (MA) plans have been attractive to beneficiaries because of their low or $0 premiums and extra benefits like dental, vision, hearing, and OTC allowances. However, changes are coming in 2026 that may make those extras less generous; or even disappear in some plans. This shift creates a perfect opportunity for agents to make additional sales by adding ancillary products to MA sales to fill these gaps.

    Why Ancillary Products Matter in 2026 and Beyond

    CMS’s recent updates, combined with economic pressures on carriers, mean some MA plans will scale back or remove certain supplemental benefits starting in 2026. For example, dental allowances might shrink, hearing aid coverage could become more limited, and OTC card values might drop. These changes could leave clients with unexpected out-of-pocket expenses for everyday healthcare needs.

    By offering ancillary products alongside MA plans, agents can ensure clients still have access to comprehensive coverage while also boosting retention and cross-sell opportunities.

    Types of Ancillary Products That Fit Well

    When pairing ancillary products with Medicare Advantage plans, focus on coverage areas where benefits may be reduced or absent:

    1. Dental Insurance
      • Why it works: Standalone dental plans often have broader provider networks and higher annual maximums than MA dental riders.
      • Example: A plan offering two cleanings per year, plus $1,500–$2,000 toward major services like crowns and dentures.
    2. Vision Plans
      • Why it works: Even if MA plans include vision, it’s often limited to a small annual allowance for glasses or contacts.
      • Example: A vision plan that covers annual exams, multiple pairs of glasses, and larger frame allowances.
    3. Hearing Plans
      • Why it works: MA hearing coverage often only includes one device every few years at a fixed copay, and choices can be restricted.
      • Example: A plan offering coverage for top-tier hearing aids, rechargeable batteries, and annual testing.
    4. Hospital Indemnity Insurance
      • Why it works: Helps offset inpatient hospital costs, which are often the largest out-of-pocket expense for MA members.
      • Example: A policy that pays $200–$300 per day for each day hospitalized, plus an ambulance benefit.
    5. Cancer, Heart Attack, and Stroke Plans
      • Why it works: MA plans cover treatment, but beneficiaries may face significant copays, travel expenses, and lost income. Learn more about critical illness insurance.
      • Example: A lump-sum policy that pays $10,000–$20,000 upon diagnosis, with funds that can be used however the client chooses.
    6. Final Expense(Life Insurance)
      • Why it works: Provides peace of mind for covering funeral costs, especially for clients on fixed incomes.
      • Example: A $10,000–$15,000 whole life policy with simplified underwriting.

    How to Position Ancillary Products

    When discussing changes to MA benefits, avoid fear-based selling. Instead, focus on ensuring clients have complete and predictable coverage:

    • Review their 2026 Annual Notice of Change (ANOC) for benefit reductions.
    • Explain how ancillary products can “lock in” richer benefits regardless of MA plan changes.
    • Offer bundled solutions such as a dental + vision package or a hospital indemnity + cancer plan combination.

    Watch our YouTube video- Why and How to Sell Ancillary with Medicare in 5 Minutes

    The Takeaway

    As MA supplemental benefits become less generous in 2026, ancillary products will play a bigger role in protecting clients’ health and finances. By adding these products to your Medicare Advantage sales strategy, you’ll not only provide better coverage but also strengthen client relationships and create new revenue streams.

    Medicare agents who want to join the team at Crowe, click here

    Don’t miss industry events and information; click here to learn more.

    Now is the time to prepare; review your carrier contracts, identify gaps in MA coverage, and be ready to present clients with options that keep their healthcare truly comprehensive.

    Medicare Advantage VBID Termination

    Medicare Advantage VBID Termination

    By Ed Crowe | General Articles | 0 comment | 8 August, 2025 | 0

    Medicare Advantage VBID Termination: What Agents Need to Know

    The Centers for Medicare & Medicaid Services (CMS) announced the Medicare Advantage VBID termination. The Value-Based Insurance Design (VBID) Model will officially end after the 2025 plan year. This marks the end of a decade-long initiative aimed to innovate care delivery and cost management in Medicare Advantage. For agents, brokers, and plan sponsors, it’s important to understand what this change means and how to prepare.

    A Quick Recap: What Was the VBID Model

    Launched in 2017, the VBID Model was designed to test new approaches to delivering Medicare Advantage benefits. Its goal was to improve health outcomes and reduce costs. This allowed plans to tailor benefits based on chronic conditions, offer enhanced supplemental benefits, and experiment with cost-sharing structures that promoted high-value care.

    Over time, the model evolved to include features like:

    • Chronic Condition Special Needs Plan (C-SNP) enhancements
    • Reduced or waived cost-sharing for high-value services
    • Incentive programs for beneficiaries
    • Expanded telehealth access
    • Integration of Medicare hospice benefits (starting in 2021 as part of a separate Hospice Benefit Component pilot)

    Are you ready to join the team at Crowe; click here for online contract.

    Why Is CMS Ending the Model

    Although VBID showed promise in some areas, CMS reported mixed results in measurable improvement in cost savings and health outcomes. Despite some plans reported success, the model overall did not produce consistent, scalable results that justified its continuation beyond 2025.

    The separate Hospice Benefit Component, a key aspect of the VBID experiment since 2021, will also end in 2025. CMS plans to use the lessons learned from this model to inform future policy and innovation strategies.

    What This Means for Agents and Beneficiaries

    If you’ve worked with clients enrolled in VBID-participating Medicare Advantage plans, now is the time to start tracking changes for 2026. Although the VBID Model is ending, plans may still continue some of the supplemental and chronic condition benefits on their own; just outside of the CMS demonstration model.

    Here’s what to keep in mind:

    • No disruption for 2025: Plans participating in VBID will continue as usual for the rest of the plan year.
    • Prepare for benefit shifts in 2026: Expect changes in cost-sharing structures, supplemental benefits, and chronic condition management tools once the model concludes.
    • Watch for new CMS innovations: While VBID is ending, CMS may introduce new pilots or value-based initiatives influenced by VBID findings.

    The loss or reduction in benefits makes this a great time to put your cross selling skills to the test. Find out what products you can offer clients that will provide they coverage they need.

    Watch a YouTube video on Cross selling

    The sunsetting of the VBID Model is a significant development for the Medicare Advantage landscape. As an agent, staying proactive by reviewing carrier updates, analyzing plan adjustments, and educating clients about any changes will be critical. Although one model is ending, the pursuit of value-based care in Medicare is far from over.

    Stay up-to-date on agent events and information; click here to learn more.

    Stay tuned for more CMS announcements and be ready to pivot as the industry evolves.

    Medicare Educational Event Guidelines

    Medicare Educational Event Guidelines

    By Ed Crowe | General Articles | 0 comment | 5 August, 2025 | 0

    Medicare Educational Event Guidelines – CMS Rules for 2026

    As an agent, you will find that hosting an educational event is a great and inexpensive way to get out there and meet potential clients. However, it is imperative that you understand Medicare educational event guidelines before you do anything.

    Define: Educational Marketing

    CMS draws a firm line:

    • These events must be “educational” in name and intent, not promoting a specific plan, carrier, or agent.
    • Avoid mentioning brand names, plan details, incentives, or statements such as “call me to enroll.”
    • Agents also must not imply in any way that they work for Medicare itself.

    Must Include Event Disclaimers

    Advertisements and invites must clearly state:

    • “For accommodations of persons with special needs at meetings call [insert phone and‑TTY number].”
    • “This event is for educational purposes only and no plan‑specific benefits or details will be shared.”

    Content & Tone: Fact‑Based & Neutral

    • Cover Medicare basics; Parts A, B, C, D, eligibility, enrollment windows, general plan types.
    • Share objective tools, e.g., comparisons, eligibility calculators, and CMS (Centers for Medicare & Medicaid Services) resources.
    • No steering: Personal recommendations or showing plan-specific premiums/benefits are prohibited.

    Compliant Location & Registration

    • Host events in public venues (e.g., libraries, community centers); not in private offices or health‑care settings, unless you use a common area.
    • You may use a sign in sheet, however attendee use has to be optional.
    • Be sure to register your event with the plan sponsor/MA organization if required (per MA/Part D compliance rules).

    No Sales or Enrollment Activities

    • Sales-focused tactics are forbidden; no enrollment scripts, plan comparisons, or benefit highlights.
    • Do not take a SCOPE of appointment.
    • It’s OK to show general enrollment periods and eligibility rules, but not to finalize or process enrollment.

    Watch a YouTube video on Medicare Educational Seminar Best Practices

    What agents can do

    • Distribute generic materials such as business replay cards for attendees to request you contact them, but do not provide plan brochures or enrollment forms.
    • Provide a light snack; keep in mind the value of the food must not exceed $15 per person.
    • Offer promotional items as long as their value is $15 or less per person. Make sure they don’t include any plan information. They can however, include a carrier name, logo or toll free number.
    • Provide your business cards for anyone who may want to contact you at a later date to schedule an appointment.
    • Answer general questions; do not discuss specific plan details.

    2026 CMS Rule Updates: What Agents Should Know

    Expanded ADVERTISING Definition

    For 2026, CMS is broadening what counts as “marketing.” Any general message that could sway enrollment now requires pre‑approval from CMS.
    That means even “purely educational” ads could get flagged; plan carefully.

    Click here to view the CMS 2026 fact sheet for the proposed final rule

    Agents as Fiduciaries

    Following the Senate Wyden report, there’s talk of requiring brokers to act as fiduciaries, disclose compensation, and limit lead-gen tactics. CMS may follow up, so transparency is key.

    AI & Marketing Guardrails

    CMS is reviewing proposals to ensure AI tools used in marketing are fair, transparent, and not deceptive. If you use chatbots or scripts, make sure they’re compliant.

    CMS and IRA‑Driven Part D Changes

    Though not directly event-related, these changes may impact your educational content:

    • New Prescription Payment Plan (PPP) options—agents should know monthly cap letter tactics.
    • Drug cost-sharing updates (insulin, vaccines)—beneficiaries now get these at $0 through Part D.

    Agents stay up-to-date on the latest events and information

    Best Practices for Agents

    TipWhy It Matters
    Label all materials “Educational Only”Protects you under CMS rules.
    Disclaim at beginning and in invitesStay compliant with 2026 requirements.
    Use neutral visualsNo plan logos or comparison charts.
    Reference CMS toolkitsCMS provides model announcements and scripts.
    Train staff thoroughlyEnsure presenters understand non-marketing boundaries.
    Pre-approve marketing materialsIf unsure, submit to CMS for early review.
    Document everythingKeep event logs, handouts, and disclaimers dated and saved.

    What Agents Should Do Next

    1. Review and update event invites to include disclaimers and explicitly label them as educational.
    2. Audit presentation materials to ensure neutral content; avoid any plan-specific information or persuasive language.
    3. Train your team on the updated 2026 rules: no endorsements or marketing disguised as education.
    4. Pre-submit ads if they could influence plan choice; especially media buys or mailers.
    5. Stay informed on regulatory changes regarding fiduciary status and AI tools.

    If you are ready to join the Crowe team; click here for online contracting.

    In 2026, CMS is cracking down on the gray line between education and marketing. Agents must commit to clear, plan-neutral, fact-based events backed by proper disclaimers, transparent content strategy, and due diligence in marketing approach. Staying well-prepared now lays the foundation for trust, authority, and compliance down the road.

    Is SPAP Considered Creditable Coverage

    Is SPAP Considered Creditable Coverage

    By Ed Crowe | General Articles | 0 comment | 4 August, 2025 | 0

    Is SPAP Considered Creditable Coverage – Can Enrollees Use it With MA Only Plans

    For Medicare beneficiaries who also qualify for a State Pharmaceutical Assistance Program (SPAP), it’s important to understand how these state-run programs fit in with Medicare coverage. This is especially important in regard to prescription drugs. One question that comes up a lot is: Is SPAP considered creditable coverage for Medicare Part D? As well as; can beneficiaries use it with a Medicare Advantage (MA-only) plan?

    The answer depends on the state and the specific benefits the SPAP provides. Let’s break it down.

    What Is SPAP

    SPAPs are programs individual states put in place to help eligible residents; typically low- to moderate-income individuals, afford prescription medications. These programs vary widely but often help with:

    • Medicare Part D premiums
    • Deductibles and copays
    • Costs for medications not covered under Medicare

    Is SPAP Considered Creditable Coverage

    Yes, in some cases. Some SPAPs are considered creditable coverage for Medicare Part D, but not all.

    What Is Creditable Coverage

    Creditable coverage means the plan’s prescription drug coverage is expected to pay, on average, at least as much as Medicare’s standard Part D benefit. If you have creditable coverage when first eligible for Medicare, you can delay enrolling in Part D without facing a late enrollment penalty later on.

    How SPAPs May Qualify

    Some SPAPs meet this standard and notify both CMS and the enrollee that their coverage is creditable. These programs can help:

    • Avoid the Part D late enrollment penalty if you delay enrolling
    • Have peace of mind knowing you won’t be penalized for waiting

    However, not all SPAPs are creditable. Each program must notify you annually about whether your coverage is creditable, so it’s critical to keep that notice.

    Can You Use SPAP With a Medicare Advantage MA-Only Plan?

    Yes, but with limitations. MA only plans cover Medicare Part A and B services but do not include drug coverage (Part D). And here’s the important rule:

    You cannot enroll in both an MA-only plan and a standalone Medicare Part D plan (PDP) at the same time; unless you’re in a rare type of MA plan like a Medicare Medical Savings Account (MSA) or some PFFS plans.

    Learn how the Canadian Medstore can help with prescription costs – watch our YouTube video

    Three Common Scenarios:

    1. You Have a Creditable SPAP + MA Only Plan
      If your state’s SPAP is creditable, you may delay enrolling in Part D while using your MA only plan. SPAP may help with limited drug needs during this time without incurring the Part D penalty.
    2. You Need Comprehensive Drug Coverage
      If your SPAP is not creditable, or if you need more robust drug coverage, you should switch to a Medicare Advantage plan that includes drug coverage (MAPD). You can then use SPAP to help with cost-sharing.
    3. Temporary or Transition Use
      Some beneficiaries use SPAP temporarily (during a SEP or between Part D plan enrollments). SPAP can provide some assistance in the gap, but this depends on the program’s structure. It is important not to let creditable drug coverage lapse for a period of 63 days or more, or you will face a penalty for the lapse.

    If you are an agent who is ready to join the Crowe team; click here for our online contract.

    Helpful Tips

    • Check the SPAP’s creditable coverage status; this info should be provided to you in writing annually.
    • Use SPAP to reduce drug costs, even if you’re enrolled in a Medicare drug plan (Part D or MAPD).
    • Talk to a licensed Medicare agent or your state’s SHIP office to determine whether the SPAP coordinates well with your Medicare Advantage plan.

    SPAPs offer valuable help, but understanding how they work with Medicare is essential. Some SPAPs are considered creditable coverage and can help you delay enrolling in Medicare Part D without penalty. Others are not, and relying on them alone could leave you with late enrollment penalties.

    Individuals currently enrolled in a Medicare Advantage MA only plan should carefully weigh their prescription drug needs. In most cases, the safest route is to either enroll in a MAPD plan or verify that your SPAP qualifies as creditable coverage before delaying drug plan enrollment.

    Medicare agents stay up-to-date on events and information – click here.

    Medicare MA Only Plan Sales

    Medicare MA Only Plan Sales

    By Ed Crowe | General Articles | 0 comment | 4 August, 2025 | 0

    When to Use an MA-Only Plan Enrollment for Your Clients

    As a Medicare agent, one of the most important roles you play is helping clients find the right coverage to fit their unique needs. While many clients are familiar with Medicare Advantage plans that include prescription drug coverage (MAPD), there are specific scenarios where Medicare MA only plan sales are a great option.

    In this blog, we’ll explore when to clients should consider an MA only plan enrollment. This can be a good option if clients have creditable drug coverage through the VA, SPAP plan or other sources.

    What Is a Medicare Advantage (MA Only) Plan

    A Medicare Advantage (MA) plan without prescription drug coverage is commonly referred to as an MA only plan. This type of Medicare Advantage plan includes the benefits of Original Medicare, but does not include Part D coverage

    Watch a quick YouTube video on the SEP for discontinued MA plans

    When Should Agents Recommend an MA-Only Plan

    There are specific situations where enrolling in an MA only plan is the most appropriate or beneficial choice. These include:

    Client Has Creditable Prescription Drug Coverage (like SPAPs)

    Some clients may already have creditable drug coverage from another source, such as a State Pharmaceutical Assistance Program (SPAP). If that coverage is deemed creditable (at least as good as Medicare Part D), they do not need to enroll in a separate drug plan and can avoid the Part D late enrollment penalty.

    This makes them good candidates for an MA only plan. MA only plans provide added benefits (like dental, vision, or hearing coverage), but don’t include the drug coverage component.

    Remember: Always verify that the SPAP coverage is creditable. Many state SPAPs are, but it’s important to confirm. You can usually find this information in the plan’s annual notice of creditable coverage.

    Veterans with VA Drug Coverage

    Clients who receive prescription drugs through the VA often prefer to continue using their VA benefits for medications. Since VA drug coverage is considered creditable, they may want to enroll in an MA only plan to take advantage of broader provider access and supplemental benefits without duplicating their drug coverage. Please note; some carriers offer plans specifically for veterans.

    Clients Enrolled in Employer or Union Retiree Drug Plans

    Some retiree coverage includes drug benefits that are also creditable. These clients can pair their employer or union drug coverage with an MA-only plan to take advantage of enhanced benefits and local provider networks.

    Agents; click here to join the Crowe team or add a carrier to an existing Crowe contract.

    What to Watch Out For

    When considering an MA-only plan, keep these key reminders in mind:

    • No Built-in Drug Coverage: If your client loses their other drug coverage in the future and doesn’t enroll in a Part D plan when first eligible, they could face a late enrollment penalty.
    • Enrollment Timing Matters: Clients can typically enroll in an MA only plan during the same enrollment periods as MAPDs, such as the Initial Enrollment Period (IEP), Annual Enrollment Period (AEP), or with a Special Enrollment Period (SEP) if they qualify.
    • Provider Networks Still Apply: Be sure the client’s preferred doctors and hospitals are in-network, even if they’re saving money by not enrolling in drug coverage.

    Bottom Line

    An MA only plan can be an excellent choice for clients who already have creditable drug coverage through another source. It allows them to receive the benefits of Medicare Advantage; like extra services and care coordination, without paying for additional prescription drug coverage.

    Stay up-to-date on the latest agent event and information

    As an agent, taking the time to ask about all forms of coverage and confirming whether they’re creditable will help you guide clients to the most cost-effective and appropriate Medicare solutions.

    Need help checking if a client’s SPAP is creditable? Reach out to the plan provider for confirmation, or contact the SPAP directly. It’s always better to be safe than sorry to avoid Part D penalties!

    What Does Medicaid Cover

    What Does Medicaid Cover

    By Ed Crowe | General Articles | 0 comment | 29 July, 2025 | 0

    What Medicaid Covers: A Guide for Dual Eligibles and Younger Beneficiaries

    Medicaid is a vital safety net program that helps millions of Americans access health care, especially those with limited income or resources. While many associate Medicaid with lower-income families or children, it also plays a critical role in helping people on Medicare; often referred to as dual eligibles, afford the care they need. This post will answer the question; what does Medicaid cover.

    Whether you’re on Medicare and Medicaid or qualify for Medicaid under age 65, it’s important to understand what the program covers and how it can help you.

    Who Qualifies for Medicaid

    Medicaid eligibility is based on income and household size, but each state runs its own Medicaid program within federal guidelines. In general, you may qualify if you:

    • Have a low income and limited assets
    • Are pregnant
    • Are a child or teenager
    • Are disabled or blind
    • Are 65 or older
    • Receive Supplemental Security Income (SSI)
    • Receive Medicare and meet your state’s Medicaid income limits (dual eligible)

    Many adults under 65 who qualify for Medicaid do so through the Medicaid expansion under the Affordable Care Act.

    Medicare agents; watch a YouTube video on SEP changes for Dual, Partial Dual and LIS members

    What Medicaid Covers

    Medicaid coverage varies by state, but all states must cover a core set of benefits, including:

    For Everyone (All Beneficiaries)

    • Doctor visits
    • Hospital services – in-patient and out-patient
    • Emergency care
    • Lab and X-ray services
    • Nursing facility services
    • Preventive care and screenings
    • Prescription drugs (in most states – not all)
    • Family planning services
    • Mental health and substance use disorder services

    Click here for a full list of mandatory benefits that Medicaid must cover

    Additional Coverage for Medicare Beneficiaries

    If you qualify for both Medicare and Medicaid, Medicaid helps cover costs Medicare doesn’t. Depending on your income level and the Medicaid program you qualify for, it may pay for:

    • Medicare Part A and B premiums
    • Medicare deductibles, coinsurance, and copays
    • Long-term care services, such as nursing home care
    • In-home support services
    • Non-emergency transportation to medical appointments
    • Dental, vision, and hearing benefits (varies by state)

    This extra help is incredibly valuable, especially for seniors or those with disabilities who may struggle to afford out-of-pocket Medicare costs.

    Medicaid and Long-Term Care

    One of Medicaid’s most significant benefits is long-term care coverage. Medicare only covers short-term skilled nursing or rehab, but Medicaid may pay for:

    • Extended nursing home care
    • Assisted living in some states
    • Personal care services at home

    Many people spend down their assets to qualify for Medicaid when they need these services, as they can be extremely expensive without coverage.

    Learn about alternatives to long term care insurance

    Medicaid for Younger Adults and Children

    For individuals under age 65 who don’t yet qualify for Medicare, Medicaid may provide:

    • Comprehensive pediatric care through the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit
    • Maternity and postpartum care
    • Birth control and reproductive health services
    • Support for individuals with disabilities, including waivers for home- and community-based care

    How to Apply

    Individuals can apply for Medicaid at any time of year through their state’s Medicaid office or through Healthcare.gov in participating states. Those on Medicare with a limited income may also qualify for a Medicare Savings Program (MSP); a Medicaid-administered program that helps pay Medicare costs.

    Medicare beneficiaries who don’t qualify for full Medicaid may qualify for partial assistance through MSP; Medicare Savings Programs. These programs offer different levels of help such as: QMB, SLMB, or QI. These programs can make a major difference in managing healthcare expenses.

    If you are a Medicare agent looking for a supportive upline; click for Crowe contracting

    Stay up-to-date on the latest agent events and information.

    Need help applying or understanding what you qualify for? Your local Medicaid office, a Medicare agent, or a SHIP (State Health Insurance Assistance Program) counselor can provide free, unbiased guidance.

    Drug Plan Formulary Tiers Explained

    Drug Plan Formulary Tiers Explained

    By Ed Crowe | General Articles | 0 comment | 29 July, 2025 | 0

    Drug Plan Formulary Tiers Explained – Understanding Your Prescription Cost

    If you have either a Part D prescription drug plan or a Medicare Advantage plan that includes drug coverage; you’ve probably heard the term “formulary tiers.” But what exactly are these tiers, and how do they affect what you pay at the pharmacy? In this post “Drug Plan Formulary Tiers Explained” we break it down to provide a better understanding of how drug coverage works and ways to save money.

    What Is a Formulary

    A formulary is simply a list of prescription drugs that your Medicare drug plan covers. Each plan creates its own formulary and categorizes the drugs into different tiers based on cost and type.

    Understanding the Tier System

    Most Medicare drug plans divide their formularies into five tiers, though some may have more or less. Here’s a general breakdown:

    Tier 1: Preferred Generic Drugs

    • These are the lowest-cost medications.
    • Usually includes common generic drugs that treat routine health conditions.
    • Lowest copayment.

    Tier 2: Generic Drugs

    • Generic drugs that aren’t in Tier 1 but are still less expensive than brand-name options.
    • Slightly higher copayment than Tier 1.

    Tier 3: Preferred Brand-Name Drugs

    • Brand-name drugs that the plan has negotiated lower prices for.
    • These may be more expensive than generics, but cost less than non-preferred brands.

    Tier 4: Non-Preferred Drugs

    • These can include both brand-name and generic drugs.
    • They are more expensive and not favored by your plan.
    • Higher copay or coinsurance.

    Tier 5: Specialty Drugs

    • These are high-cost drugs used to treat complex or chronic conditions such as cancer, multiple sclerosis, or rheumatoid arthritis.
    • Usually require prior authorization.
    • Highest out-of-pocket cost.

    Why Tiers Matter

    Your copayment or coinsurance depends on the tier your drug falls into. For example, a Tier 1 medication might cost nothing or just a few dollars, while a Tier 5 drug could cost hundreds, even with insurance.

    Knowing your plan’s formulary can help you:

    • Choose lower-cost alternatives.
    • Talk to your doctor about switching to a lower-tier drug.
    • Avoid unexpected expenses.

    What If Your Drug Isn’t Covered

    If your medication isn’t on your plan’s formulary, you have options:

    • Request a formulary exception from your plan.
    • Ask your doctor if a similar drug is covered.
    • Use a discount program or Canadian pharmacy such as The Canadian Medstore, which offers medications at reduced prices for certain drugs not covered or affordable under your plan.

    Watch a quick YouTube video to learn more about the Canadian Medstore

    Tips for Managing Costs

    • Before you sign up for a plan, contact a local Medicare agent to compare plans to find one that best fits your medication needs and budget.
    • Review your plan’s formulary each year during the Annual Enrollment Period (AEP).
    • Use preferred pharmacies that may offer lower costs.
    • Consider applying for Extra Help if you may qualify based on income.

    Understanding how formulary tiers work can help you make smarter choices about your prescriptions and potentially save money. Don’t hesitate to speak with a Medicare advisor or pharmacist if you need help reviewing your options.

    Agents who want to join the team at Crowe; click here for online contracting

    Need help comparing Medicare drug plans
    I’m here to help. Contact me for a no-cost, no-obligation review of your coverage options.

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    What Medicare Plan N Covers

    What Medicare Plan N Covers

    By Ed Crowe | General Articles | 0 comment | 28 July, 2025 | 0

    What Medicare Plan N Covers: Is It the Right Supplement for You

    When it comes to supplementing Original Medicare (Part A and Part B), Medigap Plan N is one of the more popular options. It offers strong coverage at a lower premium than some other Medigap plans. This makes it an attractive choice for many Medicare beneficiaries. We will go over what Medicare Plan N covers, and why someone might choose it over other options.

    What Medicare Plan N Covers

    Medigap Plan N is a standardized Medicare Supplement Insurance plan, which means the benefits are the same no matter which insurance company offers it. Here’s what Plan N covers:

    1. Medicare Part A Coinsurance and Hospital Costs – Covers up to an additional 365 days after Medicare benefits are used up.
    2. Medicare Part B Coinsurance or Copays – Covers most of the 20% coinsurance beneficiaries would otherwise pay. This excludes copays; up to $20 for doctor visits and up to $50 for ER visits that don’t result in admission.
    3. Blood (First 3 Pints) – Covers the cost of the first three pints of blood needed for a medical procedure.
    4. Part A Hospice Care Coinsurance or Copays
    5. Skilled Nursing Facility Care Coinsurance
    6. Medicare Part A Deductible – Plan N covers this cost, which can save you over $1,600 per admission in 2025.
    7. Emergency Medical Care During Foreign Travel – Covers 80% (up to plan limits) for medically necessary care during international travel.

    What Plan N Does Not Cover

    There are a few out-of-pocket costs you may still be responsible for:

    1. Medicare Part B Deductible – You’ll need to pay this annually ($240 in 2025).
    2. Part B Excess Charges – If your doctor does not accept Medicare assignment and charges more than Medicare-approved amounts, Plan N does not cover those excess charges.
    3. Copayments – As mentioned earlier, you’ll pay small copays for some office and emergency room visits.

    Why Choose Medicare Plan N

    Here are some reasons why Plan N might be the right choice for you:

    Lower Monthly Premiums

    Plan N generally has lower premiums than Plan G or Plan F. This makes it a budget-friendly option for those who want solid coverage without a high monthly cost.

    Predictable Costs

    Aside from the Part B deductible and occasional copays, your out-of-pocket costs are minimal. This makes it easier to plan financially, especially for healthy individuals who don’t visit the doctor often.

    Access to Nationwide Coverage

    Like all Medigap plans, Plan N allows you to see any provider in the U.S. who accepts Medicare; no networks or referrals needed.

    Foreign Travel Coverage

    If you travel abroad, the emergency coverage provided under Plan N gives you added peace of mind.

    Ideal for Healthy Retirees

    If you’re in good health and don’t mind paying occasional small copays, Plan N can offer significant savings while still covering major expenses.

    Watch a quick video on Medicare enrollment periods

    Is Plan N Right for You

    Plan N is best for those looking to balance good coverage with lower monthly premiums. It’s especially attractive if you don’t anticipate frequent medical visits and prefer to avoid the higher costs of Plan G or Plan F.

    Agents; if you are ready to join the team at Crowe, click here for contract.

    Click here to stay updated on the latest agent events and information.

    As always, it’s important to review personal health needs, provider preferences, and budget with a licensed Medicare agent to determine if Plan N is your best fit.

    2026 Medicare Carrier Certifications

    2026 Medicare Carrier Certifications

    By Ed Crowe | General Articles | 0 comment | 28 July, 2025 | 0

    2026 Medicare Carrier Certifications: What Agents Need to Know

    It’s time to start your 2026 Medicare carrier certifications! As an independent Medicare agent, staying up-to-date with your certs is essential to ensure you’re ready to sell during AEP and beyond. From AHIP to carrier-specific training, this guide walks you through what you need to do to prepare.

    Why Certification is so Important

    Certification isn’t just a box to check; it’s your license to sell. Completing annual Medicare certifications shows you understand the latest CMS guidelines, marketing rules, enrollment procedures, fraud, waste, abuse (FWA) protocols and carrier specific plan information. Without these certifications, you won’t be considered “ready to sell” by Medicare Advantage and Part D plan carriers.

    Start Early to Stay Ahead

    Don’t wait until September to begin your certifications. Many carriers release their 2026 certification portals as early as June or July. AHIP typically launches in late June. Getting a head start allows you to complete training on your own schedule, avoid delays, and ensure you’re cleared to market plans by October 1.

    Complete AHIP Medicare Training

    The AHIP (America’s Health Insurance Plans) certification is required by most major Medicare Advantage and Part D carriers. Here’s what to expect:

    • Two Key Components:
      • Medicare Basics: Covers eligibility, benefits, and plan types (MA, PDP, MAPD).
      • Fraud, Waste, and Abuse (FWA): Identifies potential fraud and how to report it.
    • Exam Details:
      • 50 multiple choice questions
      • 3 attempts to score 90% or better
      • Failing all 3 attempts means you must repurchase the course; some carriers don’t let agents contract if they fail the first 3 attempts.

    Tip: Many carriers offer AHIP discounts through their agent portals. Pinnacle also provides agents a discount. Contact Crowe and Associates for access to Pinnacle’s discount link.

    Complete Carrier Certifications

    Each Medicare Advantage and PDP carrier has its own certification process. These certifications usually include:

    • Product training
    • CMS compliance and marketing rules
    • Carrier-specific tools and enrollment platforms

    Keep Track of Requirements:

    • Log into each carrier’s broker portal to check:
      • Certification launch dates
      • Required modules
      • Additional tests or attestations
    • Many carriers provide access to AHIP as part of their training

    Tip: Keep a spreadsheet of your carrier logins, certification statuses, and deadlines to stay organized.

    Use a Certification Checklist

    To streamline your process, consider building or using a checklist that includes:

    • AHIP registration and completion
    • Carrier 1 certification (e.g., Aetna, Humana)
    • Carrier 2 certification (e.g., UnitedHealthcare)
    • Carrier 3 certification (e.g., Wellcare)
    • Product training or market-specific training
    • Certification confirmations saved as PDFs

    Watch a YouTube video: What you need to know before a Medicare sale (phone or face-to-face).

    Don’t Forget Additional Requirements

    • Errors and Omissions (E&O) Insurance: Most carriers require active E&O coverage with minimum limits.
    • Background Check Authorization: New agents may be subject to background verification.
    • Contracting Updates: Keep your license, and E&O information current with each carrier.

    Getting certified early and staying organized gives you a competitive edge going into the 2026 AEP. If you’re working with an FMO or upline, use their support team to guide you through training and contracting. The sooner you’re certified, the sooner you can start pre-AEP marketing and helping clients find the plans they need.

    Ready to join the Crowe team; click here for online contracting

    Need help or a discounted AHIP link: Reach out to your FMO or email: teal@croweandassociates.com. Pinnacle /Crowe agents can find a list of carrier certification links on Pinnacle’s website; pfsinsurance.com, from there look under the services tab and click on the certifications link.

    Stay up-to-date on agent events and information; click here

    Medicare Part D Coverage Phases

    Medicare Part D Coverage Phases

    By Ed Crowe | General Articles | 0 comment | 25 July, 2025 | 0

    Medicare Part D Coverage phases 2026

    With significant changes enacted under the Inflation Reduction Act (IRA), Medicare Part D prescription drug coverage is now simpler and more predictable. Beginning in 2025, beneficiaries no longer experience a “donut hole,” and starting in 2026, cost thresholds slightly increase to keep pace with inflation. This blog explains the Medicare Part D Coverage Phases for 2026.

    Part D Coverage: Three Straightforward Phases

    1. Deductible Phase

    • In 2026, CMS will implement a maximum standard deductible of $615 (increased from $590 in 2025). Beneficiaries pay 100% of drug costs out of pocket until they meet the deductible. Keep in mind, plan providers have the option to offer a lower or zero deductible.

    2. Initial Coverage Phase

    • Once the beneficiary meets the deductible, they enter the initial coverage phase.
    • In this phase beneficiaries may pay up to 25% coinsurance on covered drugs. Pleas note; most drug plans do not charge coinsurance for tier 1 or even tier 2 drugs.
    • Beneficiaries continue to pay coinsurance until their total out‑of‑pocket spending reaches $2,100 in 2026 (previously $2,000 in 2025).
    • There is no Initial Coverage Limit (ICL) separate from your out‑of‑pocket threshold, so no “gap” in coverage.

    3. Catastrophic Phase

    • Once the beneficiary has spent $2,100 out of pocket on formulary (covered) drugs, they enter the catastrophic phase.
    • In this phase, beneficiary coinsurance drops to $0; they have no further cost-sharing on covered Part D drugs for the rest of the year.

    Watch a YouTube video on the Part D drug cap

    What Happened to the Donut Hole

    • The coverage gap (“donut hole”) was officially eliminated starting January 1, 2025.
    • Instead of transitioning from initial coverage to a gap, enrollees transition directly into catastrophic coverage once they reach the annual out-of-pocket cap ($2,000 in 2025; $2,100 in 2026).
    • This means no more confusing coinsurance changes mid‑year; just a smooth journey through three phases.

    Why No “Donut Hole”

    Before 2025, Part D had four somewhat confusing cost-share phases:

    • Deductible → Initial Coverage → Coverage Gap (“donut hole”) → Catastrophic Coverage.

    Thanks to the Inflation Reduction Act:

    • The donut hole was discontinued, coinsurance standardized at 25%, and a hard cap on TrOOP at $2,000 in 2025.
    • In other words: Simplified coverage and predictability was put in place.

    2026 Standard Benefit Summary

    Phase2026 ThresholdYour Cost‑Share
    DeductibleUp to $615100%
    Initial Coverage$615 to spending $2,100 TrOOP25%
    CatastrophicAfter $2,100 OOP$0

    TrOOP stands for out of pocket. The TrOOP includes: deductible, copays and coinsurance. However the TrOOP does not include; plan premiums or drugs not covered under Part D of your plan.

    Summary for Medicare Prescription Coverage 2026

    • The year begins with beneficiaries paying up to $615 out of pocket toward their deductible.
    • After that, they pay 25% of covered drug costs until their total out-of-pocket spending hits $2,100.
    • Once they hit the cap, they move into catastrophic coverage and pay zero out-of-pocket for covered drugs for the rest of the year.
    • As of 2025, the donut hole is gone, ensuring a smooth and straightforward benefit structure.
    • Beneficiaries can consider enrolling in the Medicare Prescription Payment Plan if it helps spread out drug costs.

    Medicare agents:

    Click here for updated agent events and information

    If you are ready to join the team at Crowe; click here for online contracting.

    2026 brings continued relief and clarity for Medicare Part D enrollees; no donut hole, no complicated phases, just predictable costs and peace of mind.

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