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Best Medicare Sales Meeting Questions

Successful Medicare agents need to be proficient in a number of areas.  One important skill for agents is understanding the prospect’s situation and making the right recommendations based on that situation.  The way to assess the client’s needs is to ask the best Medicare sales meeting questions.  There are a number of standard questions a good agent will be ready to ask.  Which ones they ask has a lot to do with the person they are meeting with.  This blog will go over all the information you need to make the right recommendations to clients and ultimately get the sale.

Basic questions the agent should start off with

There are specific questions you can start off with.  It may be a good idea to start off with a general question such as; “How can I help you today?” or “Would you mind going over your situation with me?”  That question will likely prompt them to provide answers to a many of the questions below.

Best Medicare Sales Meeting Questions:  Basic questions

• What zip code and county do they live in?  Some zip codes cross into multiple counties.  Also, you need to be sure which state they are a resident in.  That will determine which plans you can quote.
• Do you make your own health care decisions?
• What is the prospects date of birth?   This is important because you will need to know when they are turning 65
• Are you currently on Medicare or have you already applied for Medicare?  Some people may be already on Medicare due to disability.  It is important to know if they already have Medicare prior to age 65.  It is possible that they are turning 65 but have already received their Medicare card.
• Are you receiving Social Security payments?  People who receive SS payments prior to turning 65 will automatically get Medicare A and B.  If they are not receiving Social Security payments, you will need to tell them how to apply for Medicare A and B.  They can do this either online or at a local social security office.
• Are either you or your spouse actively working?  If so, do you plan to continue working past age 65 and do you get coverage through work?  If they are getting coverage through their employment or through a working spouse, they may want to waive Medicare Part B.  If they do, you may not get an initial sale but if you stay in touch with them, you will get a sale down the road.   It is important to know the Medicare Part B valid waivers.  If they are going to keep working and get coverage through work, you need to compare the work coverage and cost with the cost of Medicare part B and a private plan.  If the math comes out better with Medicare and the private plan, you may still get a sale.

Need more Medicare prospects?  Learn about our T-65 Medicare seminar program. (Averages 50+ T-65 Medicare prospects per seminar)

Best Medicare Sales Meeting Questions:  Provider care frequency and health questions

Note:  You are not allowed to ask direct health questions.  It is; however, important to understand the overall health of the prospect to make the right recommendation.  There are ways to get this information without asking direct health questions.

• How often do you go to the doctor?
• Have you had any inpatient stays or outpatient surgeries?
• Do you have any scheduled for the future?
• Please provide me with a list of your medications (name, dosage and frequency) as well as the names of the doctors you visit or have visited in the past

You need all this information for multiple reasons.  If they are a high utilizer of care, you may want to look at a Medicare supplement plan.  The medication list can be used to run both PDP and Advantage plan comparisons in Connecture or Sunfire to see which plans come out best.   The doctors list is needed if they are going to look at a Medicare Advantage plan.

Best Medicare Sales Meeting Questions:  Financial questions

Financial questions are important to determine if someone may qualify for Medicaid or help.  Medicaid and help (Medicare Savings Program) qualifications vary by state.  The programs are income and asset sensitive, in many cases.  Knowing the financial situation will let you know if they may be eligible for a dual plan.  It is also important as higher earners may be subject to an

IRMAA on their part Medicare Part B and Medicare Part D premiums.

• Ask the prospect what their monthly income is.  If married, find out what their combined income is?   Let them know you are asking to see if they qualify for any programs available to help them out with costs.
• If you are in an asset sensitive state, you should let them know what the asset limit is.  It is a little easier to do it that way than to ask them if they have any money….

Note: Some states have their own extra help programs (SPAP plans) that may not be asset sensitive.  Do the research ahead of time to know all the programs available in the state the client lives in

Prospects already on a Medicare Advantage plan,  Medicare supplement and/or a PDP plan

If the prospect is already on a Medicare plan of some type or maybe only Original Medicare, it is best to ask them how it has been working.  Ask for feedback from them.  The plan may not have been what they expected and you can help them find a better option.

• What type of plan are you on now?  Which company is it with?
• How did the plan work for you this year?
• What made you decide to go with this plan?
• Are there any doctors you would like to see but have not been able to with your current plan?
• How has the plan been covering your medications?

They may not remember why they chose their current plan.  Maybe someone sold it to them over the phone.   Many times people are enrolled in plans for no specific reason at all.  If they have an advantage plan and had a lot of copays, you may be able to move them to a supplement and drug plan (Depends on an underwritten state vs. a GI state). There may be advantage plans that have lower copays or a lower OOP.   They may be in a Medicare supplement but utilize medical care infrequently and would be better off on a MA plan….  You don’t know until you ask.

Best Medicare Sales Meeting Questions:  Other questions to ask

• Do you need dental care;  if so, do you currently have dental coverage?
• Does your plan provide additional benefits such as; OTC, Dental and vision?
• (If they are on a dual plan)  Have you used any of the extra benefits the plan offers?  Did you know some plans offer a number of extra benefits including grocery cards, utility and flex benefits?

The whole purpose here is to see if there is a plan that provides more benefits than the one they have.  Determine which benefits are important to them and see if there is a plan that can provide what they are looking for.

Conclusion:  One of the biggest mistakes we make as Medicare agents is assuming we know what people want.   Go into the meeting with an open mind.  Always ask questions as well as listen to the responses.  This helps you find out what is important to the prospect.  If you do this, it will lead to more sales and happier clients who stay on the books.   Medicare is all about recurring revenue. In fact, having clients in the best plan for them is the optimum way to maintain a book of business.

Agents can utilize our Medicare lead program to help with Medicare marketing, lead and advertising costs.  (No reduction in commission and can be used toward any type of Medicare marketing)

Braven Medicare Advantage NJ

Agents can contract and appoint to offer Braven Medicare Advantage NJ plans.  This includes Medicare Advantage, Dual and non-dual MA,  Medicare supplements and PDP plans.  The contract pays full CMS max allowable commission in NJ.  Read below to learn about the products, contracting and certification process. Braven Health is an affiliate of Horizons Blue Cross Blue Shield of New Jersey.

Braven Medicare agent and agency contracting

All agents must complete a contracting kit to sell either Braven Medicare Advantage, PDP or Medicare supplement plans.  Please email completed contracting to Lisa@croweandassociates.com  Call our office at 203-796-5403 with any questions.

Braven Medicare Advantage NJ Contracting 2023

Braven Medicare Advantage NJ:  Certification

Horizon Blue Cross Blue Shield of New Jersey/Braven Health is currently certifying and recertifying agents to sell our 2023 Medicare Advantage, PDP, D-SNP, and Medigap plans. To be certified to sell our 2023 Medicare Products, all agents must pass our 2023 Certification Program through the Miramar: Agent online certification link.

Please note; you must also upload your AHIP certificate.  If you have not taken AHIP for 2023, Click Here to take it for the discounted cost of $125    Watch a video on tips for completing 2023 AHIP

Log into: www.Miramar-agent.com      You will need to enter the code 2023HMA328 to access the certification

Log In/Register on the portal

On the right-hand side click on “Register new”

Enter code: 2023HMA328

Braven Medicare commissions 2023

Agent level “Street” commissions

Agent level commissions will be paid at the CMS max allowable compensation for 2023   CLICK HERE TO SEE MAX MA COMPENSATION 2023

Please note:  Agents may receive   initial and renewal commissions can be paid on a full advance or “as earned”.  Braven pays commissions the month after the effective date of the policy.

Agency level override amounts and requirements 2023

We have multiple agency level contracts available for qualifying agencies.  Please see the required “ready to sell” sub producers needed in order to qualify.

There are 5 agency override levels.  See below for the requirements for each level:

1.  Level 1;  25 ready to sell producers, initial $100.00, renewal $50.00
2.  Level 2; 15 ready to sell producers, initial $80.00, renewal $40.00
3.  Level 3; 10 ready to sell producers, initial $50.00, renewal $25.00
4.  Level 4; 5 ready to sell producers, initial $40.00, renewal $20.00
5.  Level 5; 3 ready to sell producers, initial $30.00, renewal $15.00

Braven Medicare Advantage NJ:  Product training for agents

Take a look at the Braven Medicare Advantage broker training and plan benefits 2023

Braven Medicare Advantage NJ:  Paper Application submissions

Click here- Braven sales kit and application 2023

Instructions for application submission

Paper Applications:

Note:  For those looking to enroll electronically, Braven has a site agents can utilize for electronic enrollments:  CLICK HERE FOR ONLINE ENROLLMENT

Agents are required to submit all  MAPD PDP, and SNP category applications within 24 hours of  being written.

You can securely email it in a PDF format to ADMIN@FJINS.NET or use this link https://medi-solutions-agent.com/contactsecure.php to upload the applications. It is mandatory that we receive any emails with private information securely.

After submitting the paper application (if emailed) you will receive a thank you email stating we received the email.

After the application is scrubbed, you will receive either another email which you will be CC’d on (Carbon Copied) showing who the application was sent to, or you will receive an email with a fax confirmation. If you do not receive this email/ fax confirmation within 24 hours of sending the application, PLEASE make sure to call immediately to make sure it was sent.

When emailing, put the clients name in the subject line along with the app type, i.e. Jane Smith UHC MA. Please only send 1 application per email/fax.  If you send more than 1 application in an email/fax it could poss. No one wants that to happen.

You can also fax the apps to 732-308-4555 / 732-984-9450.

Please make sure to look at any emails you receive with the subject line: REQUIREMENT FW: Jane Smith.

This is an indication that we need something further before we can submit the app to the company. We cannot submit the app until we’ve received the requirement.

Finally, as most of us living in the realm of MAPD’s know, there are no weekends in Medicare’s eyes, if you are working, so are we, weekends included.

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Create a Facebook Business Page

Agents looking to prospect for new Medicare clients through Facebook need to first creates a facebook business page.In this blog post, we’ll walk you through the steps for setting up a Facebook business page and using paid ads to promote your business on the platform. The ultimate goal will be to engage Medicare prospects and gain new clients.  We will discuss using paid ads later in the post but those using ads to drive traffic should keep the focus of the ads local to their geographic area.

Step 1: Create a Facebook Business Page

To create a Facebook business page, you’ll need a personal Facebook account. If you don’t already have one, go to www.facebook.com and sign up for an account. Once you have a personal account, you can create a business page by following these steps:

1. Click on the three lines in the top left corner of your home page and select “Create” from the dropdown menu.
2. From the “Create” page, select “Page”
3. Choose the type of business page you want to create. There are several options to choose from, including “Local Business or Place,” “Company, Organization or Institution,” and “Brand or Product.”
4. Enter the required information for your business page, including your business name, address, and phone number. You’ll also need to upload a profile picture and cover photo for your page. If your a looking for Medicare prospects it would be best to have your business page title reflect what you do.
5. Click “Continue” to finish setting up your business page.

Step 2: Optimize Your Facebook Business Page

Once you’ve created your business page, it’s important to optimize it for maximum visibility. Here are a few tips for optimizing your Facebook business page:

1. Fill out your “About” section with a detailed description of your business, including your products or services, mission statement, and contact information.  Keep in mind, most seniors or those approaching age 65 do not know how an independent Medicare agent does business.  As a result, the “About” section is a good place to make that clear.
2. Use relevant keywords in your page’s name, description, and posts to make it easier for people to find your business through search. Use keywords that people may search when looking for Medicare information.  You can use the Google Keyword planner to get an idea of how often any given keyword is searched CLICK HERE FOR THE PLANNER
3. Add a call-to-action button to your page, such as “Shop Now,” “Contact Us,” or “Sign Up.” This will make it easier for people to take action and engage with your business.  In the Medicare space, many agents will have Medicare 101 webinars or zoom meetings.  The call to action can help drive people to your registration page to increase the attendance at your next online session.  The call to action can also be used to drive people to an office location for an educational meeting or an educational seminar.   Crowe  offers agents a turnkey seminar program that averages more than 50 prospects per seminar.  Learn about our Medicare educational seminar program.

The importance of adding daily conent

Post regularly/daily to your page, sharing updates, promotions, and valuable content related to your business.  The rules for people signing up for Medicare can be overwhelming. You should post helpful information frequently. Examples would be “How to sign up for Medicare A and B”, “Who can waive Medicare part B”, how do Medicare Advantage plans work?”.  There are endless topics and helpful information you can post to help Medicare beneficiaries. An example of some topics can be found here. Engage with your followers by responding to comments and messages, and asking for feedback.

Step 3: Use Paid Ads to Promote Your Business

Once you’ve set up and optimized your Facebook business page, you can use paid ads to reach a wider audience and drive more traffic to your page. Here’s how to set up a paid ad campaign on Facebook:

1. Go to your business page and click on the “Create” button in the top right corner.
2. From the dropdown menu, select “Create an Ad.”
3. Choose your objective for the ad campaign. Options include “Boost Your Posts,” “Promote Your Page,” and “Send People to Your Website.”
4. Select your target audience, including demographics, interests, and location. If you are an independent Medicare agent, it makes sense to target people turning 65 in the next 3 to 24 months.  Why would you want to target people that are so many months away from turning 65?  Most people start researching Medicare up to 8 months prior to turning 65.  Insurance companies start sending them information about 6 months before they are 65.  As a result, it makes sense for you to make contact with them first and provide helpful information before everyone one else does.    In addition you should target people that are already age 65.
5. Set your budget and schedule for the ad campaign. You can choose a daily or lifetime budget, and set the start and end dates for the campaign.
6. Create your ad by choosing an image or video, and writing a compelling headline and description.
7. Review and submit your ad for approval. Facebook will review your ad to make sure it meets their advertising policies. Once your ad is approved, it will start running according to your schedule.

Create a Facebook business page: How paid ads work on Facebook

Facebook ads work by targeting a specific audience based on factors such as demographics, interests, location, and behaviors. When you create a Facebook ad, you choose the objective for your ad campaign, such as increasing page likes, boosting a post, or sending people to your website. You also select your target audience and set a budget and schedule for your ad.

Once you’ve created your ad, it will be shown to the people in your target audience as they browse Facebook or use other apps and websites that are part of the Facebook Audience Network. The ad may appear in their news feed, in the right column of their home page, or in other places on the platform.

Facebook uses an auction system to determine which ads to show to each person. The ads with the highest bids and the best relevance to the user are more likely to be shown. Facebook also uses algorithms to optimize the delivery of ads and maximize the return on investment for advertisers.

Agents you can receive a $500 discount on Social Waves Media’s Click to Close course. This is a lead generation course designed specifically for insurance agents! Learn how to create successful Facebook ads and run cost effective lead generation campaigns.

Click here for $500 discount

Create a Facebook business page: Pricing for Facebook ads

Facebook offers a variety of pricing options for ads, including cost-per-click (CPC), cost-per-impression (CPM), and cost-per-action (CPA).

• Cost-per-click (CPC) means you pay every time someone clicks on your ad. This is a good option if you want to drive traffic to your website or get people to take specific actions, such as making a purchase or filling out a form.
• Cost-per-impression (CPM) means you pay for every thousand times your ad is shown. This is a good option if you want to increase brand awareness and reach as many people as possible.
• Cost-per-action (CPA) means you pay every time someone takes a specific action, such as making a purchase or filling out a form. This is a good option if you want to drive conversions and focus on specific goals.

The cost of Facebook ads depends on several factors, including your target audience, ad format, and ad placement. Facebook provides a pricing calculator to help you estimate the cost of your ad campaign based on your budget and objectives.

It’s important to keep in mind that the cost of Facebook ads can vary widely, and it’s not always possible to predict how much you’ll need to spend to achieve your goals. It’s a good idea to start with a small budget and test different ad campaigns to see what works best for your business. You can then adjust your budget and targeting as needed to get the best results.

You can access a lead generation course specifically designed for insurance agents.

Sign up to learn how to generate your own exclusive leads and receive a $500 discount on Social Waves Media’s Click to Close course.  Learn how to create successful Facebook ads and run cost effective lead generation campaigns.

Click here for $500 discount

Boosting a Facebook page vs. paid ads

Boosting a Facebook page means paying to promote one of your posts on your business page to a larger audience. When you boost a post, it will appear higher in the news feed of the people in your target audience, increasing the chances that they will see it and engage with it. Boosting a post is a quick and easy way to reach a specific group of people on Facebook.

Using paid ads, on the other hand, involves creating a more comprehensive ad campaign with specific objectives and targeting options. When you use paid ads, you can choose from a variety of ad formats, such as images, videos, carousels, and slideshows, and you can target specific demographics, interests, and behaviors. Paid ads also allow you to set a budget and schedule for your campaign, and track the performance of your ads through Facebook’s Ad Manager.

In general, boosting a post is a good option if you want to quickly promote a specific piece of content to a targeted audience. Paid ads are a better choice if you want to create a more comprehensive ad campaign with multiple ad formats and targeting options, and track the performance of your ads.

Facebook paid ads to attract Medicare prospects

Using Facebook ads to attract Medicare prospects can be an effective way to reach a specific audience and promote your Medicare products or services. Here are some tips for using Facebook ads to reach Medicare prospects:

1. Identify your target audience: Start by determining who your ideal Medicare prospect is, including their age, location, interests, and behaviors. You can use Facebook’s targeting options to reach specific groups of people, such as those who are over 65, live in a certain geographic area, or have expressed an interest in health and wellness. While it can be productive to target local people over age 65, it is also a good idea to target people turning 65.   Target those turning 65 in the next month up to the next 24 months.
2. Create a compelling ad: To attract Medicare prospects, it’s important to create an ad that speaks to their needs and interests. Use a clear and concise headline, and include information about the benefits of working with an independent Medicare agent. You can also use images or video to grab people’s attention and showcase your offerings.  Remember, people turning 65 are looking for information when it comes to Medicare.  Providing them information that can clarify the process is a great way to engage your audience.
3. Choose the right ad format: Facebook offers a variety of ad formats to choose from, including images, videos, carousels, and slideshows. Choose the ad format that best fits your message and target audience. For example, if you want to showcase a variety of Medicare plans, a carousel ad with multiple images may be a good choice.

How much will you spend on the campaign?  Use our lead program to offset the cost 

Set a budget and schedule: Decide how much you want to spend on your ad campaign and how long you want it to run. You can choose a daily or lifetime budget, and set start and end dates for your campaign. Keep in mind that the cost of Facebook ads can vary depending on your target audience and other factors. It’s a good idea to start with a small budget and test different ad campaigns to see what works best for your business.

Keep track of what is and is not working

Track your results: Use Facebook’s Ad Manager to track the performance of your ad campaign and see how it’s reaching your target audience. You can view metrics such as impressions, clicks, and conversions to see how your ad is performing and make adjustments as needed.

By following these tips, you can use Facebook ads to effectively reach Medicare prospects.

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Medicare Sales After AEP

The Medicare AEP can be a crazy and busy time for insurance agents.  Once we recover, we need to come up with a strategy to generate Medicare sales after AEP.   This post will review some of common methods successful agents use and some of the not so common ones.   We will also address how the OEP (Medicare Open Enrollment Period) fits in with this strategy.

Medicare Sales After AEP:  Review results and get organized

Should we assume that all our enrollments have been correctly credited to us?  The quick answer is “NO”.  While it may be tempting to assume you have been correctly listed as the AOR on all your cases it will likely cost you money doing so. We have found there to be roughly a 5% to 10% error margin when it comes to carriers crediting agents on sales.  Over time, the amount of missed initial commissions and renewals will add up.   Make it a practice to review your book and make sure all cases are showing up in your agent portal.  Having a CRM (Agencybloc is an example) makes this practice easier but for those without a CRM a simple excel spreadsheet will work.  You could also use Connecture or Sunfire as a basic CRM.   Connecture and Sunfire both have call recording capabilities at no cost which can help with the new call recording rules

How can you handle the AEP more efficiently next year?

While the past AEP is fresh in your mind, take some time to think about what you could have done more efficiently.  Those with larger books of business can spend some or all of their AEP renewing what they have.  In some cases it may make sense to hire some help renewing the book so you can focus more attention on new sales.  Not to mention it will make life during AEP a lot more enjoyable.   Some other things to consider:

• Are you processing your plan changes over the phone?  It is much more efficient than face to face meetings
• Do you load all your clients medication and doctor info into Connecture, Sunfire or MyMedicarebot?  Doing so allows you to quickly run drug cost comparisons, plan comparison and save drug lists for next year
• Do you have someone helping you make all of your AEP calls to existing clients?  Adding an employee to make the calls, load all the clients drug information, book appointments and do all the post enrollment follow up can be a huge time saver.
• Organize current clients by plan.  This allows you to have a consistent message for the entire group in that plan.  Maybe the plan had a bad renewal and there are other options that may be better.  They may be in a plan that still looks good for next year.  If this is the case, there may not be a need to move many of them.

Strategy for the new year

How do you plan to start writing business during the OEP and for the remainder of the year?  Keep in mind, you cannot use the OEP as a marketing method.  This is not to say you cannot market during the OEP. (You certainly can)  You cannot use the OEP as the means of solicitation.  However, the OEP will give you the flexibility of moving someone from one MA to another or moving them from MA to original Medicare and possibly a supplement and drug plan.  (You cant go from a Medicare supplement and a PDP during the OEP)

Come up with a strategy to write business all year

Agents with large books of business tend to spend a lot of their AEP maintaining their current book.  They write a majority of their new business outside of AEP.  If you are a newer agent without a big book, you should be writing business during AEP and the entire lock in period.  Here are some of the more common successful strategies agents use.

T-65 Medicare educational seminars

Turning 65 educational seminars are one of the most consistent ways to write business outside of AEP.  As an added benefit, they work well during AEP too. When other lead methods suffer from lower returns due to all the AEP advertising, Educational seminars are largely unaffected.  Agents can run the seminars throughout the year specific to the area they like to work in.  Most of the prospects are turning 65 which means you will receive full new to Medicare compensation on MA plans and will have commission eligible GI for Medicare supplements.

The most difficult part of running seminars is getting people in the seats.  We offer agents a turnkey program that does all the work for the agents.  Seminars through our program are averaging 50+ T-65 prospects per seminar.  We provide agents with everything they need to run a successful seminar.  This includes access to sample presentations, guidance on how to run the event, what type of locations to hold the event in and everything else needed.  We also help agents with the cost of running each seminar.    CLICK HERE TO LEARN MORE ABOUT THE SEMINAR PROGRAM

WATCH A VIDEO ABOUT THE PROGRAM

Phone sales with online leads and live transfer leads

Selling Medicare plans over the phone has become the most popular method used by agents.  The skill set for phone sales is very different than face to face selling.  Agents need to be prepared in order to sell by phone. All non face to face sales now need to be recorded.  Recording and phone enrollment is availalbe to agents at no cost through Connecture and Sunfire.

Access to phone sales leads are will be needed to make this strategy work.  We give agents access to online and live transfer leads through our vendor LeadStar.  Learn more about Leadstar

Medicare sales after AEP:  Retail sales

Retail sales have been a consistent method of generating business for many agents.  While retail tends to be more productive during AEP and OEP, it can yield result throughout the year.  Agents can work a number of venues.  Some such as Walmarts, cost money and are on a bidding process that needs to be iniated by your upline/FMO.  Others are at no to low cost and are accessed through the companies agent/broker managers in their local areas.  This tends to be for locations such as Rite Aid, CVS, Walgreens and a number of other retailers.  A number of venues and locations are accessed simply by the agent having a relationship with the person who controls that location.  Examples are dollar stores, laundry mats, food pantries and any other type of venue that has Medicare and/or Medicaid populations.

The key with retail is keeping consistent hours at the locations and building relationships with the people working there.    Click here for a recorded webinar on working retail locations

Working mail reply cards

You may be surprised to hear that many agents still work mail.  They usually send mail for T-65 replies or for things such as dual plans, dental or vision.   A number of vendors will do the mail drops for the agents.  They usually charge around $500 per 1,000 pieces dropped.  The vendor usally handles all aspects of the mailing.  What the agent gets back for a response rate depends on who the mailed.   Two quick tips about mailers:   Mail replies will be very low if done during AEP.  Everyone will mailing during AEP so the card sent for you is one of 20 in the mail box.  As a result, the reponse rate is usually very low and often is below 1% response.   The other tip is with T-65 mailers.  To get a good response rate (“Good” meaning 3% or better) mail should be sent out to prospects turning 65 no sooner than 7 months from when they go out.

Learn more about mail reply card marketing

Medicare sales after AEP:  $500 a month lead program for all agents

We offer a Medicare lead,marketing and advertising program:  It provides for $500 a month to agents to help with cost of Medicare leads, marketing or advertising. No reduction in commission, no minimums to start.   Learn about the free Medicare lead program

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Medicare With Employer Coverage

There are a number of rules to be aware of when it comes to applying for Medicare with employer coverage.  It is important to understand the valid waivers for Medicare part B for individuals who are working at age 65 or older.  We will review the rules, how to apply for delayed Medicare Part B and how to determine the best solution for you.

Not understanding the options can lead to costly life-long delayed enrollment penalties for both Part B and D of Medicare.

If you would rather watch a video on this topic;  CLICK HERE FOR YOUTUBE VIDEO

Valid waivers for Medicare Part B

Let’s start with the Part B waivers for those actively working at age 65 and older.  These rules also apply to someone who has coverage through their actively working spouse.   There are 3 criteria to consider when figuring out if you can waive Part B of Medicare without having a future penalty. Those not electing Part B need to meet all 3 in order to waive it without a future penalty.  If at any time they are not meeting any of the 3, in most cases, they should apply for Part B.

• Employer size of 20 or more employees

  • The first requirement to waive part B when you have Medicare with employer coverage is; the size of the employer.  Those working with employers of 20 or more employees can waive B if they also meet the other 2 criteria.  Those working for employers of less than 20 employees should enroll in Medicare Part B.  The reason for this is based on primary coverage.  Medicare is primary for employer groups under 20.  As a result, Medicare Part B must be in place for those 65 and older in order for the secondary employer plan.  Without part B they run the risk of the secondary employer plan refusing to pay the 80% that Medicare should have covered.

• Actively working

  • The second requirement is actively working status.  In order to have a valid waiver for Medicare Part B the person must be actively working.  You can also waive part B if they are getting coverage through an actively working spouse.   This is the most common mistake that occurs.  Someone over the age of 65 is working and getting coverage through work.  They then stop working but maintain employer coverage or elect Cobra.  They do not currently have Medicare Part B and see no need to sign up for it since they are continuing with coverage.  The reality is if they are no longer working they must sign up for part B.  If they do not, they could miss their Part B election opportunity and will likely have a delayed Part B enrollment penalty when the do finally get it.

• Having coverage through the working spouses employer

  • The 3rd requirement.  The working spouse must be on coverage through the employer they are working for.  Often is it assumed that as long as you are working at age 65 or older and have coverage, it doesnt matter where the coverage is from.  Maybe the person is working but has coverage through their retired spouse.  Maybe they have it through the health exchange or an old employer.  The bottom line is the only coverage that allows for Medicare part B to be waived is the coverage offered by the employer you are working for/with.  The same applies for the spouse if they are getting coverage through the working person.

 Important things to know

Here are some common misconeptions when it comes to coverage that does not provide a valid reason to waive Medicare Part B.

• Cobra is not a valid waiver.  You must be actively working to waive B and those on Cobra are not actively working.  If you are working and getting coverage through Cobra it still would not count because you are not obtaining coverage through the employer you are working for.
• VA coverage is not a valid waiver for Part B.  Having VA drug coverage is a valid waiver for Medicare Part D however.
• Coverage through an employer other than the one you actively work with is not a valid waiver

Medicare with employer coverage: Penalty

So you didnt have part B when you should have. Unfortunately, there will be a penalty once you do enroll.  The penalty is based off every 12 month period you did not have Medicare part B when you should have.   The penalty is 10% of the standard part B premium ($164.90 in 2023) per every 12 month period you didnt have part B.  So if you went 3 years without Medicare Part B, you will have a 30% monthly lifetime penalty when you do enroll.

Delayed part B enrollment process

There are two ways to enroll in Medicare Part B on a delayed basis.  The first is with loss of employment or loss of group coverage which creates an 8 month SEP to enroll. The application can be done online or at a local Social Security office.  You will need both the employment verification form (CMS L564) and the Medicare Part B enrollment form (CMS 40B).  Both need to be completed prior to applying.

Delayed part B enrollment without a SEP

Those without a SEP to enroll in Part B will need to apply during the Part B GEP (General Enrollment Period) which runs from January 1 through March 31 every year.  The rule for GEP enrollments changes on 1-1-2023.  As of that date, applications will be effective the first of the next month.  They will no longer be delayed until July 1.   Learn more about changes to Medicare for 2023

Medicare with employer coverage:  Tips

• The MA SEP election for a delayed B enrollment is prior to the part B effective date.  You do not have 60 days after the effective date to put in an application.  The 60 days after B effective election is for loss of employer coverage.
• Enrolling in Medicare Part B is not an SEP for a part D drug plan.  Enrolling in Part A and loss of group coverage would be however.
• HSA contributions are not allowed for anyone enrolled in Medicare Parts A or B
• With a delayed Part B enrollment, Part A of Medicare will retro up to 6 months back.  For example, if someone turns 65 in June but applies for Medicare A and B in October, Part B will start November 1 but Part A will retro back to June 1 (first of the month you turned 65)

Are you a Medicare agent that would like to run T-65 seminars throughout the year?  Click here to learn about out turnkey T-65 Medicare seminar program

Medicare Part B Enrollment Rules 2023

There are a number of changes to the Medicare Part B enrollment rules 2023.  All the changes make it easier for a beneficiary to enroll in Part B if they are in a delayed B enrollment situation. We will go over the rules prior to the changes effective 1-1-2023 and how the new rules are beneficial.  CLICK HERE TO SEE ALL THE ENROLLMENT RULES FOR MEDICARE A AND B  This post focuses on Medicare Part B enrollment only.

Medicare Part B enrollment rules 2023:  Prior to 2023

The changes have an inpact on both the Medicare Part B IEP and the Medicare Part B GEP.  We will start with the current Medicare Part B IEP.  The Medicare B IEP starts 3 months before age 65, the month of the 65th birthday and 3 months after age 65.  Anyone who applies for Part A and/or B  3 months before their birthday month will have a Medicare A and/or B start the first of the month they turn 65. (You do not need to apply if you are drawing Social Security income payments prior to age 65).

Prior to 1-1-2023 those applying the month they turn 65 or the 3 months after, they have a delay in the Part B enrollment:  Unlike Medicare Part B, Medicare part A will retro back up to 6 months.

• Apply for Part B the month of the birthday:  One month B enrollment delay
• Apply for Part B the month after the birthday month:  2 month B enrollment delay
• Apply the 2nd or 3rd month after the birthday month: 3 month B enrollment delay

Medicare Part B enrollment rules: IEP rules on or after 1-1-2023

The rule will be changed as of 1-1-2023.   The 3 months prior to their birthday month are the same as before.  The change is for those applying on or after the birthday month.

• Anyone that applies for Medicare Part B on or after the birthday month will have an effective date of the 1st of the next month. There will no longer be a delay.  For example, someone turns 65 in the month of March and they apply for Part B in May.  The effective date for B will be June 1st.   (Note: Part A will retro back to the first of the month they turn 650

Medicare GEP (January 1 through March 31 every year)

Prior to 1-1-2023 people applying for Medicare Part B after their 7 month IEP would have a much larger delay.  Those that missed the IEP without a valid Medicare Part B waiver, would have to apply during the Medicare Part B GEP (General Enrollment Period).  The GEP runs from January 1 through March 31st every year.  Prior to 1-1-2023, those applying in that time would have a Part B start date of July 1.  This applies regardless of the month they applied in.  For example:  Bob turned 65 in February of 2021 and missed his Medicare B IEP. He will need to apply for Part B using the GEP which occurs January through March ever year.   If he applies for part B in January of 2022, the effective date of his Part B will be July 1 of 2022.  He obviously has a large delay in enrollment and may have a penalty for enrolling in Part B late. 

There are special enrollments for those that had a vaild waiver for Part B however. Those with a valid waiver can enroll in Part B using a special election period.  Watch a video about them here

Medicare GEP enrollment as of 1-1-2023

The new rule starting 1-1-2023 is much more forgiving to those enrolling in delayed Part B without a valid B waiver.   As of 1-1-2023, anyone applying for Part B in the GEP will have an effective date the first of the next month.   if Bob applied during the B GEP in February of 2023, he will have an effective date of March 1st 2023.  He may still be subject to Part B late enrollment penalties but he will no longer need to wait until July 1 2023 for his Medicare Part B to start

Part B special election periods starting 1-1-2023

There will be a number of new Medicare Part B SEP’s available in 2023.  They may make it possible for those without a valid B waiver to enroll in Medicare Part B outside of the IEP or GEP.  The list of possible special election periods includes the following below.  At this point, it is not determined how they will be vailidated.

• Emergency or disaster during other Part B enrollment periods
• Employer or health plan made a material error, omission or misrepresentation of the facts
• People incarcerated
• People that lose Medicaid

Are you an Independent Insurance Agent offering Medicare?   See the benefits we offer to Medicare agents!

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Medicare Seminar Sales NY

Our T-65 Medicare Seminar Sales NY program gives agents the ability to run seminars throughout the year including during AEP.   The program is turnkey and averages 50+ prospects per seminar.   This is a great way for agents to obtain high quality clients throughout the year.  Since the majority of the sales will be new to Medicare, agents will receive the full CMS max compensation for each sales with out being pro-rated.

How does the Medicare seminar sales NY program work?

With our program, agents do not invite any of the prospects to the seminar.  This allows agents to concetrate on running a smooth seminar that is as effective and efficient as possible. We put all the turning 65 prospects in the seats so the agent can work on closing sales.  Our average attendance is 50+ prospects per seminar.  The vast majority of them will be turning 65 and/or new to Medicare.     The agent needs to find the location for the seminar (We can give you suggestions on the best venues) and we do the rest.

Watch a recorded webinar on how the program works

How do I run the presentation and what do I present?

We can show you exactly how to run the presentation.  We provide all our agents with seminar best practices from start to finish.  This includes, where to have the seminar, how to set it up, best days and times to hold it and all other areas you will need to know.  We also have pre-made presentations that each agent can customize to meet their needs.   There is no reduction in agent commission and this program is eligible for our monthly lead cost reimbursement

Medicare Seminar Sales NY: How much do agents sell per seminar and what is the cost?

The amount of sales an agent makes varies depending on how well the information is presented and the amount of follow up done.  Having said that, our agents are averaging 15 new to Medicare sales per seminar with some agents writing over 20 per seminar.   15 new to Medicare MA sales results in roughly $9,000 of new agent commission and $4,500 of renewal commission. Keep in mind, renewals start paying in January regardless of when you write the case.  As a result, seminars run late in the year will be full commission and a renewal stream that starts in few months later.    If the commission part of this post didnt make sense to you, please watch this video about MAPD commissions.

Medicare Seminar Sales NY: Program cost

The program has two basic cost components.  The first is the cost to put the prospects in the seats.  This cost is $2,400 per seminar on average.  Crowe will pay 50% of the cost for the agents first seminar.   Additionally, agents can use our $500 a month lead reimbursement toward future Medicare seminar sales NY programs.

The seminars are filed as educational so meals can be served.   The max amount for a meal per CMS rules is $15 per attendee.   We can coach agents on how to get some or all of this meal cost covered without paying out of their own pocket.

Ready to get started?

Give us a call today at 203-796-5403 to learn more about the program and get started running T-65 seminars on a monthly basis.

Watch all our agent training videos on YouTube

Trinity Health Plan of New England

Trinity Health Plan of New England is a private health insurance plan that offers both HMO and PPO options at an affordable price.  These plans are available to Connecticut residents in the counties of Hartford as well as Tolland.

To learn more about Trinity Health Plans; Click here

Both Trinity’s HMO and PPO plans offer many value based benefits that include:

1. A $0 plan premium
2. Primary care visits with no co-pay
3. Mail order, Tier 1 & 2 drugs have a  $0 copay
4. No cost virtual care visits (see SOB for details)
5. Some plans offer $0 medical deductibles
6. A travel allowance of up to $3,500
7. Dental coverage
8. Over-the-counter allowance
9. Vision hardware allowance
10. Acupuncture treatments are covered
11. ED drug coverage
12. Meals delivered to your home after an in-patient hospital stay

For a look at the 2023 PPO Summary of Benefits; click here

HMO 2023 Summary of Benefits; click here

Another great benefit Trinity Health Plan of New England offers is the extra $600 annually in your Social Security check!

This benefit gives members an extra $50 in their social security check each month.  It is basically a partial reimbursement for their Medicare Part B premium.  Take a look at the SOB for each plan for more details.

These plans cover Every one of the top 100 drugs.

If you don’t see your drug on our formulary?  Trinity can either provide formulary alternatives or a one-time (30-day) transition fill during the first 90 days of enrollment.
You may also request a formulary exception if you need to.  You can check the formulary on TrinityHelathofNE.org/Medicare and check applicable drug requirements as well as quantity limits for specific drugs.

Insulin is covered at an affordable rate so members receive access to necessary care for their diabetes.  Members do not pay more than $35 for a 1 month supply of each insulin product covered by your plan.

Take a look at the 2023 OTC catalog – Click here

Trinity Health Plan of new England – Pharmacy network:

Trinity is partnered with over 66,000 retail chains as well as independent pharmacies nationwide.

Some of the pharmacies include:

Costco Pharmacy, Saint FrancisRx Pharmacy, CVS Pharmacy, Sam’s Club Pharmacy, Medicine Shoppe, Shoprite Pharmacy, Price Chopper Pharmacy, Stop & Shop Pharmacy, Walmart Pharmacy & Walgreens.

To view a complete list of pharmacies either visit us online at; TrinityHealthOfNE.org/Medicare of call 866-934-9524 (TTY:711).

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Medicare Insulin $35

The Medicare Insulin $35 copay Part D Senior Savings Model (SSM) will continue in 2023.   The recently passed program called the “Insulin Now Act” will continue a program that began in 2001.  The program puts a cap of $35 for a one month supply of certain brands and types of Insulin.

Part D costs with the program

The cost for Insulin in the program will be capped at $35 per month for a one month supply.  There are a number of pharmaceutical manfaturers participating in the program. (See list below) The fixed cost will provide substantial savings to those with Part D drug plans (Either through a stand alone Part D plan or a Medicare Advantage plan).  The Insulin prescriptions will not be subject to the usual cost aspects of a Medicare Part D plan.  This includes any initial plan deductible, Initial coverage phase and Part D Coverage Gap.  It does not apply during the catastrophic coverage phase so the cost may change at that time.

The Medicare Insulin $35 copay SSM: Participating Pharmaceutical Manufacturers
1. Eli Lilly and Company
2. MannKind Corporation
3. Mylan Specialty L.P.
4. Novo Nordisk, Inc. and Novo Nordisk Pharma, Inc.
5. Sanofi-Aventis U.S. LLC

Medicare Insulin $35 copay:  Quoting plans

Please note; the $35 program does not cover every type of insulin.  Some of the more expensive name brand drugs for diabetics such as Jardiance or Trulicity will not be capped at $35. You can access a list of the Insulins that will be capped at $35 Part D insulin saver program list 2023

Starting with the 2023 Medicare AEP, drug comparisons on a number of systems will reflect the $35 cost cap on Insulin.  Online comparison sites such as Connecture, Sunfire and  Medicare.gov plan finder will all reflect the new cap of $35.

Changes to Medicare for 2023

In addition to the Medicare Insulin $35 copay cap, there will be other changes to Medicare for 2023.  There are the usual changes to the Medicare premiums, deductibles and copays.  In addition, there is a new type of Medicare Part B and new rules for those with delayed Part B enrollments.

Learn about the changes to Medicare benefits, premiums and enrollments here

Watch a video about the changes here

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SilverScript SmartRx 2023 PDP Changes for 2023

The SilverScript SmartRx 2023 PDP plan will have some changes.  It will be important for Medicare agents to know what is changing and how to quote and compare the plans for 2023.  The plan will not pay commission on new sales for 2023.   As a result, some quote and comparison sites will not show the plan when running drug comparisons.  Read below to learn more.

Commission

Name Change

Premium 

SilverScript SmartRx 2023: Quoting and comparing  

The plan not being commissionable for new sales in 2023 creates some challenges for us as agents.  The plan will continue to have a very low premium for 2023.  Depending on the medication list of clients it may still come out the best for them in 2023. Luckily commissions will still be paid on existing cases.   The challenge is quoting and comparing the plan for existing clients.   Since the plan will not pay commission for new 2023 sales, it is not on a number of quote and comparison sites.  Here is where you can and cannot look to see the plan in 2023:

Connecture 

Sunfire

MyMedicareBot 

SilverScript SmartRx 2023: Register for a webinar on Connecture, Sunfire and MyMedicareBot

Medicare.Gov Plan Finder: 

In addition to access to Connecture, Sunfire and MyMedicareBot at no cost, Crowe and Associates offers a number of other agents benefits

Click here for agent benefits and programs

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Medicare Savings Program CT 2023

If you are either a Medicare beneficiary, eligible to receive Medicare or a Medicare agent who offers plans in CT, you need to understand the Medicare Savings Program CT 2023.  This can be a very useful tool for some clients who have a lower income.

The amount of extra help you receive depends on your gross income level.  Single people will use their gross income to determine eligibility and level of help.  Married couples’ eligibility depends on their combined gross income.  The monthly income limits in the chart below are effective as of March 1, 2022.

If your income falls either at or below the income levels listed below, If you are not sure if you are eligible to receive extra help; we have listed the income levels below:

There are 3 different levels of MSP:

The level of help you receive is based on your gross income.  Please see below for MSP levels and what they provide:

Click here for income level chart.

QMB – this level of extra help pays your Part B premium, all Medicare deductibles and co-insurance.

Income levels for QMB are as follows:  Individual, $2,390 of gross income per month,  couples, $3,220 per month.

SLMB – this level pays your Part B premium only.

The income levels for SLMB are as follows:  Individual, $2,617 of gross income per month, couples, $3,525 per month.

ALMB – this level will provide payment of your Part B premium and is subject to availability of program funds. If you receive Medicaid, you cannot participate in this program.

Income levels for ALMB are as follows:  Individual, $2,786 gross income per month and couples, $3,754 per month.

To apply online, please visit www.connect.ct.gov, under ‘Apply for Benefits.’

Formulario de Renovación de programas de ahorro de Medicare (W-1QMBS)

Click here to download a CT MSP application

If you receive any of these levels of MSP coverage, you are automatically enrolled in the Low Income Subsidy (LIS), also called “Extra Help” with Medicare.  Once you are enrolled in LIS, Medicare pays the full cost of your Medicare (Part D) prescription drug coverage i fit is a benchmark plan.  Medicare will pay a portion of anon-benchmark plan.  They will also provide payment of your annual Part D deductibles, co-insurance or co-pays.  This does not change if you hi the coverage gap (donut hole).

Once you have LIS, you have a special enrollment period to change either Part D or Medicare Advantage plan.

If you need more information about the LIS, please visit www.socialsecurity.gov or call 1-800-Medicare (TTY: 1-800-325-0778).