Short-term vs. long-term care coverage
In this post, we discuss short-term vs long-term care coverage. Most people have heard of long-term care insurance. This coverage pays the cost of care when a beneficiary has a chronic illness, disability, or injury. This coverage also helps individuals who require assistance due to the effects of aging. In general, long-term care insurance helps individuals pay the costs of custodial and personal care. Some people have never heard of short-term care which provides much of the same coverage for a shorter period of time.
Insurance agents, learn how to add ancillary products to your Medicare sales.
Long-term care insurance
Long-term care insurance provides help paying for custodial care for extended periods of time. The coverage this insurance provides is not provided by either Medicare or other health insurance policies.
Long-term care involves a variety of services designed to meet a person’s health or personal care needs when they can no longer perform everyday activities.
The companies that provide this benefit make money by investing the customer premiums they receive. Due to interest rates going down in recent years, these insurance carriers have lower stream of income. They are also losing revenue due to a rising number of beneficiary claims. This has caused a rise in cost and a lessening of benefits for those who wish to purchase a long-term care plan. Companies have also implemented a more difficult pre-qualification process for those who want to purchase coverage.
For most long-term care policy applications, the cutoff age is 79, while the cutoff age for short-term policies is 89. Long-term care policies have an elimination period, which is a specific number of days that the beneficiary pays for care until the policy starts to pay. A common elimination period for the plans to pay is 90 days.
Home-based care
Many individuals receive long-term care at home by either family members, friends, or neighbors. In most instances, home-based care involves help with “activities of daily living” which include bathing, dressing, eating, taking medications, and supervision for personal safety. This care is sometimes supplemented by paid formal caregivers. The professionals that provide these services include nurses, home health aides, and other professional care givers.
Does Medicare home health care.
Community and residential care
Individuals may receive some long-term care services in their community. There are adult day care services or senior center which may be equipped to provide some degree of care including meals, social activities, personal care, activities or transportation.
Residential facilities: assisted living or nursing homes also provide long -term care. Some facilities provide housing and housekeeping only. Others provide personal care, recreational activities, meals, and medical care.
Short-term care insurance
Short-term care insurance is very similar to long -term care in what it covers, Policies typically cover home care, assisted living, and nursing home care for those who cannot care for themselves. Recovery care is another name for short-term care, because it provides coverage for 12 months or less.
In some instances, short-term care insurance is used to cover gaps in Medicare coverage as a less expensive alternative to long-term care. Short-term care insurance is also a good choice to offset some long-term care expenses before long-term care kicks in.
Some benefits of short-term care insurance
Short-term care insurance does not usually have an elimination period; it generally pays benefits immediately. The cost for short-term insurance is less than log-term because it covers the beneficiary for much less time. Coverage options vary from days up to a year.
It’s easier for beneficiaries to qualify for short-term care insurance, there is no medical exam required. Some companies may ask a few yes-or-no questions. For those who are rejected or cannot afford a long-term care policy, short-term policies offer an alternative.
How to choose a coverage option
- Make sure you get quotes from several different insurance companies before you choose one.
- In this situation, it is a good idea to enlist the help of a licensed agent to be sure you get a plan that best meets your needs.
- Have a budget and understand all the out-of-pocket expenses to be sure the plan is budget friendly.
- Read the policy and be sure you understand what is covered and how it is covered.
Agents if you are looking for an FMO, see what Crowe has to offer.
Important: policy coverage differs by state and some coverage options are only available in specific states.
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Medicare donut hole 2025
There are some big changes coming to Medicare Part D (PDP) plans. This includes the discontinuation of the Medicare donut hole 2025. In January 2024, CMS released a draft of the Medicare Part D payment policies.
Starting next year, see what changes are being made to Part D (prescription drug) coverage.
The new design for prescription coverage will consist of three phases of coverage.
- The first phase will be the “Annual Deductible Phase”. In this phase the enrollee pays 100% of their prescription drug cost until they meet the deductible of $590.
- The second phase is the initial coverage or “Standard Coverage Phase”. This phase is the former initial coverage phase merged with the Donut Hole/Gap phase. During this phase. Once the enrollee meets the spending threshold(OOP) of $2,000 for CY 2025, they complete this phase of overage and move into the catastrophic phase.
- The third phase is the catastrophic phase. During this phase of coverage, the enrollee pays no cost sharing for covered Part D drugs.
As you can see, there is no donut hole (coverage gap) phase. It is merged with the “Standard Coverage Phase”.
Find out about the 2025 Medicare Drug cap
The changes in payment liability
This new plan design includes changes in payment liability of enrollees, plan sponsors, drug manufacturers and CMS.
- As stated above, in the first phase “Annual Deductible Phase”, the enrollee must pay 100% of the cost for prescription drugs until the deductible amount is met.
- In the second phase initial coverage “Standard Coverage Phase” enrollees pay 25% coinsurance for covered drugs while the plan sponsor typically pays 65% for applicable drugs and 75% for all other covered Part D drugs. Manufacturers usually pay 10% of the cost through the discount program.
- The third phase “Catastrophic Phase”, enrollees do not pay a cost share for covered Part D drugs. Drug plan sponsors normally pay 60% of the cost on covered drugs. Manufacturers pay a discount of about 20% and CMS pays a subsidy equal to 20% of the cost for applicable drugs. CMS pays about 40% of drug costs for some other Part D drugs.
Click here to learn more about PDP plans
Key points
- Removal of the Donut Hole/Gap phase – Merging together with the former initial coverage phase now the “Standard Coverage Phase”.
- There are now only 3 coverage phases: Deductible, Standard & Catastrophic.
- The Out of Pocket (OOP) threshold is dropping to $2,000 annually.
- The end of the Donut Hole/Gap discount program (CGDP) and the start of the Manufacturer Discount Program (Discount Program)changes what drugs get discounts and how they count towards the OOP. This also changes who is responsible for the cost beyond a set amount.
Watch a YouTube video on Medicare Part D changes
The drug plans will pay similar amounts as in previous years, although a larger part of their responsibility starts much earlier than in previous years. In other words, drug plans will pay more money on more enrollees overall.
Click here to learn all the details of the Medicare Part D redesign
It is expected that the added costs drug companies incur may result in either higher Part D plan premiums or possibly spread across other MAPD plan costs.
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Why Insurance Agents Fail
Anyone considering going into the field of insurance sales needs to understand why insurance agents fail. Hopefully our tips will help you avoid some of the pitfalls of insurance sales. Although insurance sales can be a profitable business, many new agents do not make if past the first year. There is a lot more to it than just getting your license and waiting for the checks to roll in.
Agents don’t understand the real reason some agents are successful
The most important thing agents need to keep in mind is that they are there to provide a service to their clients not just to make money. Unfortunately, too many agents are focused on how much they will make instead of how to provide a valuable service that people need. When the only objective is to make money, many agents fail. It is obvious to the clients when a person has their best interest at heart, and they appreciate that. When they find a good agent, they are more than happy to spread the word to their friends, co-workers or relatives. The same is true if they are unhappy. with the service they receive. Unhappy clients make is difficult to survive in the industry for the long term.
Expecting instant success
Many first-time agents think once they have their license, they will be making lots of money. In reality, it is not easy to get into the field of insurance sales and it can take a few years before you really start to see a large paycheck. The business is built one sale at a time and good agents keep their current clients happy as well as work at expanding their book every year. It is a good idea to set small goals that lead to reaching larger ones. There are many carrier certifications for products like Medicare, a newer agent may not be aware of the time and effort it takes to get set up to offer the number of carriers they need or to complete all the CMS certifications. They also need to know, these are things that they will need to complete annually in order to be ready to sell. It can be a bit overwhelming when first starting out.
Neglecting to make a business plan
It is imperative to build a business plan. Decide where you are going to work (home or in an office space). Get the proper tools to be successful, (computer, phone copier office supplies). Organize yourself, think about how you are going to track commissions and clients. Prepare a filing system and how you are going to build your book of business.
Not focusing on the client
There is no way to be successful in insurance sales if you don’t build good relationships with your clients. We cannot stress this enough! When your client has a question about a product you offer, your name needs to come to their mind. If they do not know you are there for any questions or concerns they have, they may ask someone else and then you lose that business. Be available to them as much as possible. Do not let another agent do the job you want.
The most important way to build a relationship is to understand the client’s needs and do your best to provide what they want. It is great to focus on the sale but if the client is unhappy, you lose not only the sale but the referral. That can cost you in the end. Great customer service promotes long-lasting relationships. If you don’t have these, you have no book of business.
Learn how to get referrals
Lack of focus on a specific product line
As an insurance agent, you may have licenses to sell several different products. When getting started, it is best to focus on one type of product. It is important that you understand any product you are trying to sell to someone else very well. This way you can answer any questions that come up and ensure that the client gets the product that best fits their needs.
Find out about how to start and insurance agency
It is easy to get carried away and want to offer every possible product. It is best to set yourself up as an expert in an area and add other products once you are ready.
Not finding good leads
Finding good leads is one of the biggest issues insurance agents face. Good leads usually do not come cheap and cheap leads don’t usually result in a large number of sales and require a lot of work and multiple attempts before a sale is made. Agents working leads need to be able to handle rejection and even anger at times. In other words, it costs money to make money. Good leads result in more sales but you need the capital to purchase them in the first place. The frustration of bad leads can cause an otherwise good agent to struggle and even give up on their business.
Watch a video on our pre-set lead program
Not using the tools available
Not staying up to date with the tools that are available can keep an agent from growing. In this industry there are always changes. There are new tools introduced that make life easier every day. This can save hours every day and give you the option to meet more potential clients and in turn make more sales. remaining aware of what’s going on will help agents stay current and provide the best service to clients.
Watch a YouTube video and Learn how to quote and enroll with Sunfire.
Technology adds so many options to reach a greater audience than it did just a few years ago. Things like Facebook, zoom meetings and other social media platforms allow agents to reach a wide audience. Employing these tools can make a huge difference in getting your name and business out in front of an audience. the more people know about your business the better chance you have a being recognized as an authority on the products you offer and your chances of making a sale increase.
They don’t understand how to network
It is imperative to build relationships with other professionals in the business. They provide a wealth of information and experiences, tips and ideas that can be invaluable. Other agents provide insights as to what works and does not and can save you from learning the hard way. Other agents know how difficult it is to get started and can provide encouragement. They can explain which tools are worth the time and which ones are not. Networking also includes other professionals in other fields that may have leads to send your way.
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Agents try and go it alone
Agents need support that goes beyond their network of professionals. A good mentor or upline is a great way to get advice who has your best interest at heart. These are people who are willing to invest time into your career and want you to succeed. A few things uplines can help you with are, contracting, answering any questions about carriers, products or sale. They also might help you figure out the best business plan for your personal sales style. A mentor is a great asset to have especially if they have been in the business a long time and have had success.
See what Crowe has to offer their agents
The support of friends and family helps ensure agents do not give up when they are frustrated and may also provide guidance when needed. There are many moving parts when it comes to the insurance industry, if an agent can navigate them and remain focused, positive, educated and compliant, they can have a successful career.
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Extra Help income limits 2024
Medicare Extra Help is a federal program put in place to help individuals whose income and financial resources are limited. It provides help for those who qualify to pay the costs of their Medicare prescription drugs. The subsidies provided by this program cover premiums, deductibles, as well as co-pays for the costs of Medicare prescription drug plans (Part D). To qualify for this program, individuals must meet the income criteria set by the federal government each year. In this post, we will go over the Extra Help income limits 2024.
How to Qualify for Extra Help
1. Be a U.S. citizen or legal resident
To enroll in Original Medicare, individuals must either be a United States citizen or a legal resident for at least 5 years. In turn, to enroll in Medicare’s Extra Help program, an individual must qualify for Medicare.
2. Enroll in Medicare Part A and/or Part B
Beneficiaries must be enrolled in at least one part of original Medicare. They do not need to enroll in Part D before applying for Extra help. If the beneficiary does not currently have Part D coverage, they are automatically enrolled in one once the Extra Help is approved.
3. Meet resource and income limits
Individuals cannot exceed the asset and income limits to qualify for Extra Help. If an individual is eligible for Medicaid or any of the Medicare Savings Programs, they automatically qualify for Extra Help. Individuals do not have to apply for Extra Help if they automatically qualify. They will be enrolled in the Extra Help program as well as a Medicare drug plan.
Extra Help Income and Resource Limits 2024
Important: the Extra Help income limits are based on the adjusted gross income reported on the individual’s tax return. Governmental assistance such as food stamps, housing or home energy assistance do not negatively impact your acceptance.
| Marital Rights | Resource Limit 2024 | Resource Limit with Burial Expenses 2024 | Extra Help Income Limit 2024 |
|---|---|---|---|
| Single | $17,220 | an additional $1,500 | $22,590 |
| Married | $34,360 | an additional $3,000 | $34,360 |
In some instances, individuals with income that exceeds the limit may still qualify for Extra Help. The following circumstances may allow for special consideration of Extra Help acceptance:
- If the individual provides financial support for other family members who reside with them.
- When the beneficiary earns money by working.
- Anyone who lives in either Alaska or Hawaii.
Because resource limits also count towards determining eligibility, we listed a few examples of what does and does not count below.
These are some things that count as resources:
1.Money in Checking or savings accounts
2.Real estate that does not include a primary residence.
3. Stocks, Bonds & Mutual funds, IRAs or cash
These are some things that DO NOT count as resources:
1. An individual’s primary residence
2. Any vehicles owned by the individual
3. Expense set aside for the individual’s burial; this includes interest on money set aside for burial
4. Personal belongings
For a comprehensive list of what does and does not qualify, contact the local Social Security office.
How to apply for Extra Help
- Apply online at www.ssa.gov/medicare/part-d-extra-help.
- Beneficiaries can call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) to either apply over the phone or request an application.
- Visit your local Social Security office to apply. Click here to locate a local office.
After the application is submitted, Social Security sends a letter to let the beneficiary know if they qualify and what level of Extra Help they will receive.
Extra Help is crucial for individuals who require assistance with the costs of prescription drugs. Understanding the requirements is the first step to finding the necessary help to ensure the needed coverage is received.
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Medicare leads
If you are a Medicare agent, one thing that you are always looking for is Medicare leads. There are many places you can find leads. The most valuable leads are T-65 leads. These leads are the best to get because insurance carriers pay the highest commissions for new to Medicare enrollments.
Watch a YouTube video on Medicare commission payments
Individuals turning 65 are also a great lead to get because an agent that does their job well, now has a new client on his books for quite a long time to come. As long as the agent provides useful guidance to the beneficiary and ensures they are happy with their plan choice, they can develop a mutually beneficial relationship.
Before you contact anyone, it is very important to understand the CMS rules of how to do it. Click here for details.
Click here to find out about our Medicare lead program.
In reality, many leads sources like online leads, inbound calls and pre-set leads do not produce many T-65 prospects. What they do provide is the contact information for current Medicare beneficiaries. In reality, many of the people already have an agent and are not seeking guidance, although agents may find individuals who are unhappy with their current plan and/or their agent. If you find a valid enrollment period, you can provide the assistance and coverage that the beneficiary is looking for.
If the potential client decides to enlist your assistance as an agent, you may need them to list you as their AOR. Some Insurnace carriers allow clients to designate an agent as AOR even if they do not write a plan at that time. When this happens, you have a client added to your book and can help them change their plan at a later date if it is appropriate. Learn how to make AOR changes.
T-65 Seminars
A great way to meet several individuals turning 65 is by hosting an educational event. Our seminar selling program is an effective tool to provide needed information to the people who need it. This is truly a turn-key program that guarantees agents get in front of T-65 leads. Find out more about the seminar program.
Watch a video on the T-65 seminar program
If you decide to host an educational event, it is important to follow CMS guidelines for hosting an educational event. If you decide to do a sales event, there are specific guidelines to follow as well.
Additionally, Crowe agents can access to a preset lead program. This program provides leads at a very good close ratio.
Watch a video on our preset lead program.
Free leads
Agents who put in the effort to ensure their clients are happy with their coverage choices can easily earn referrals. In order to ensure clients are happy, agents must be in contact with their clients and go over new plan options each year during the AEP. As well as other times during the year to maintain the relationship and ensure clients are happy and do not seek answers to Medicare questions elsewhere.
Read more about how to get Medicare referrals
Establish relationships with other local professionals
It is a great idea to introduce yourself to healthcare professionals, doctors and clinics in your area as well as other professionals who work with clients that may need your advice. Once they know you and are aware of the services you provide, it is easy to build a partnership and open doors to new lead prospects. This will help establish you as a knowledgeable resource for anyone who needs advice.
Take a look at a few more Medicare marketing ideas
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Medicare special enrollment period
If you have a client that needs a Medicare plan outside their IEP, you need a Medicare special enrollment period to get them the coverage they need. In this post, we go over the different special enrollment periods and how clients qualify.
Understanding Medicare Special Enrollment Periods
Medicare Special Enrollment Periods are designated times outside of the IEP (Initial Enrollment Period) or the AEP (Annual Enrollment Period) when individuals can make changes to their Medicare coverage. These periods are only allowed under specific circumstances. The SEP provides an opportunity for individuals to enroll in a Medicare plan or change their existing coverage.
Watch a YouTube video on SEPs
Qualifying Events for SEPs
There are several life events that provide Medicare beneficiaries an opportunity for a Special Enrollment Period. We have listed some of the more common events that qualifying for an SEP below.
Moving
If a beneficiary moves to a new location that isn’t served by their current Medicare plan, they are eligible for an SEP.
Losing employer coverage
When an employee or their spouse loses their existing employer-sponsored health coverage, they qualify for a SEP to enroll in Medicare.
Qualifying for Extra Help
If a beneficiary qualifies for either their state’s Extra Help program or Medicaid, they qualify for an SEP and have the ability to change their plan as much as 1 time per quarter for the first 3 quarters of each year.
Click here to view more SEP details
Maximizing Special Enrollment Periods
If your client qualifies for a Special Enrollment Period, it’s essential to act promptly to make sure they get the coverage they need within the time limits for the SEP. Here’s what you need to know to use the SEPs:
Know the deadlines
Each Special Enrollment Period has a specific deadline, so be sure to understand when the enrollment window opens and closes.
Review all plan options
Agents should take the time to review their client’s Medicare coverage options carefully. Consider factors such as premiums, deductibles, copays, network of providers as well as prescription drug coverage (when applicable) to find the plan that best fits their personal needs.
We provide many benefits to all our agents, including free quoting & enrollment tools. These quote engines make it easy to look at the top plans side by side for your clients review.
Learn about Connecture & Sunfire
Explore Additional Benefits
Medicare Advantage plans offer additional benefits beyond Original Medicare, such as dental, vision, otc benefits, and much more. Show the client a side by side comparison of the top plans and see e which one fits their needs.
Stay Informed
Keep yourself informed about changes to Medicare rules and regulations, as well as any updates to coverage options. Staying informed helps agents remain compliant and provide the best advice to their clients.
Find out about SEPs for Emergencies or Disasters
Medicare Special Enrollment Periods are valuable opportunities for individuals to changes their coverage outside of typical enrollment periods. By understanding who qualifies for a Special Enrollment Period and how to use it, you ensure that clients have the coverage they need.
It is important to review all the options available to your clients and be sure they make an informed decision. Click here to learn why you should contract with multiple Medicare carriers.
Hospital Indemnity plans
If you are a Medicare agent, it is a good idea to consider adding hospital indemnity plans to your product offerings. In the event someone becomes ill and is hospitalized, these plans provide clients an additional layer of coverage. Hospital Indemnity insurance provides policyholders a chance to protect their savings and lower their out-of-pocket costs.
It is important to note; when it comes to hospitalization, there are limits to what Medicare Advantage or Medicare supplement plans cover. When that happens, a hospital indemnity plan can provide an extra peace of mind for beneficiaries.
What is hospital indemnity insurance
Hospital indemnity insurance is additional health coverage that individuals can purchase and add an extra layer of protection. These plans have a monthly premium like other insurance coverage. If the beneficiary has to stay in the hospital, they receive a fixed payment amount they can use to cover any out-of-pocket costs members incur. Beneficiaries can use the payment to cover whatever they need such as, deductibles, co-pays, medication or for things like rehabilitation or home care expenses.
Unlike other insurance plans, hospital indemnity policies send payments directly to the policyholder. This gives beneficiaries more freedom to choose where their money goes. A good hospital indemnity plan should be easy to get, has no deductible or pre-certification and is not difficult to get payments from when you need them.
What hospital indemnity insurance covers
The coverage provided by a hospital indemnity plan depends on the plan chosen and the riders added. We have listed a few basic things these plans cover below.
- When a beneficiary has a hospital stays weather or not surgery takes place.
- If they are confined in an ICU (intensive care unit).
- In the event they are confined in a CCU (critical care unit).
Additionally, there are plans that offer coverage of all or some of the items listed below.
- If a beneficiary has medically necessary outpatient surgery , as opposed to an elective outpatient surgery.
- If they require outpatient diagnostic imaging procedures, x-rays or lab procedures.
- Some plans include payments for ambulance services.
- There are plans that event pay for emergency room visits or specific doctors office visits (not routine annual checkups).
Waiting periods for benefits
In most cases, there is a 30 day waiting period for illnesses that result in a hospital stay. The waiting period varies by carrier and the plan chosen. However, some plans will not have a waiting period for hospitalization for an accidental injury. It is important that enrollees understand all benefits of their plan choice, including waiting periods, before they decide on a policy.
Hospital Indemnity plan cost
Hospital indemnity plans charge a monthly premium like any other health insurance. The cost depends on several factors including the plan & company choice, as well as age, gender and location.
It is important to consider if hospital indemnity insurance is worth getting or not. The beneficiary needs to consider what their current health plan covers, their out-of-pocket cost including deductibles and co-pays and co-insurance and the cost for an average hospital stay. They also have to take into account their personal financial situation and if they can better afford the coverage or payment for the out-of-pocket expenses.
Opportunity for cross sales
Hospital indemnity plans provide a great opportunity for Medicare agents to make a cross sale. Many of your current clients could benefit by purchasing one of these plans. Clients who enroll in a Medicare advantage plan without a premium ($0) may want to add an affordable hospital indemnity plan that adds that extra layer of protection. Their Medicare advantage plan may leave them paying high co-pays or deductible for a hospitalization. Be sure to go over their budget and possible value of adding the coverage.
Agents should go over the average cost of a hospital stay and the possible out-of-pocket cost as compared to the cost of adding a hospital indemnity plan. Do the Math for them. Make sure it is a viable option before they sign up.
Are you an agent who wants to offer these plan to your clients; click here for online contracting.
Rules for hospital indemnity insurance sales
It is important to remember, there are rules to follow when you offer a hospital indemnity plan to a client. Agents cannot mention this or any other product at a Medicare appointment if it is not included on the scope of appointment.
Watch a YouTube video on the scope of appointment rules.
Medicare enrollment dates
If you are either getting close to your 65th birthday or are in Medicare sales, you should understand the Medicare enrollment dates.
Enrolling in Medicare can be confusing for beneficiaries and understanding the enrollment process is crucial to access the benefits your clients need. From IEPs to SEPs, the Medicare system is designed to accommodate various life circumstances. In this post, we go over several of the Medicare enrollment periods and how beneficiaries can use them to get the healthcare coverage they need.
Initial Enrollment Period (IEP)
The Initial Enrollment Period (IEP) is the first opportunity for most individuals to enroll in Medicare. IEP is a 7 month time frame that starts 3 months before the month of your 65th birthday, includes your birthday month, and ends three months after the month you turn 65. During this period, individuals can sign up for Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) if they choose to.
Learn more about enrollment periods
Special Enrollment Periods (SEPs)
Special Enrollment Periods (SEPs) are designated times outside the initial enrollment period when individuals can sign up for Medicare due to specific qualifying events. Some of the most common qualifying events include:
Loss of Employer Coverage
If a beneficiary is covered under a group health plan through their own or their spouse’s current employment, they are eligible for an SEP when they lose the employer coverage.
Moving out of the plans service area
When a client moves out of their plan’s service area, they qualify for an SEP to enroll in a new Medicare plan.
Becoming Eligible for Extra Help
Individuals who become eligible for Extra Help with Medicare prescription drug costs qualify for an SEP to enroll in a Medicare Prescription Drug Plan (Part D) or Medicare Advantage Plan (Part C) that includes prescription drug coverage.
General Enrollment Period (GEP)
For individuals who miss their initial enrollment period, the General Enrollment Period (GEP) provides another chance to enroll in Medicare. The GEP runs each year from January 1st to March 31st. Coverage obtained during this period begins the first of the month after you enroll. it’s important to note, beneficiaries who wait until the GEP may have to pay a late enrollment penalty.
Click here to learn about late enrollment penalties LEPs
Annual Enrollment Period (AEP)
The Annual Enrollment Period (AEP), also known as the Medicare Open Enrollment Period, runs each year from October 15th until December 7th. During this time, Medicare beneficiaries can make changes to their Medicare coverage. This includes; switching from Original Medicare and Medicare Advantage plans, as well as joining, dropping, or switching prescription drug plans.
How to best use the Medicare enrollment dates
- Stay Informed: Keep track of your eligibility and enrollment periods to ensure you don’t miss important deadlines.
- Review Your Coverage Needs: Regularly assess your healthcare needs to determine if current coverage is still suitable or if changes are necessary. Agents make sure you contact your clients regularly, especially during AEP to go over coverage options for the following year and ensure they are happy.
- Seek Assistance if Needed: If you have questions or need guidance regarding Medicare enrollment, it is best to reach out to a licensed insurance agent.
Medicare agents be sure to maintain your book of business, click here for some ideas.
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Understanding Medicare enrollment dates is essential for to ensure beneficiaries have access to the healthcare coverage they need. By familiarizing yourself with the various enrollment periods and their significance, you can navigate the Medicare system with confidence and peace of mind. Remember, staying informed and proactive is key to making the most of your Medicare enrollments.
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Medicare Supplement Free Look Period
If you are an agent who offers Medicare plans, it is important to understand opportunities to provide clients with the coverage they deserve. For those enrolled in Medicare, supplement plans offer an additional coverage option. Because choosing the right supplement plan is an important decision, sometimes a client may change their mind. To safeguard against errors, Medicare offers the free look period. In this post, we discuss the Medicare supplement free look period, why it’s important, and how beneficiaries can use it.
Learn the difference between Medicare Supplement and Medicare Advantage plans
What is the Medicare Supplement Free Look Period
The Medicare supplement free look period is a time beneficiaries can review their new Medicare supplement plan and, if unsatisfied, make changes without penalty. This period typically lasts for 30 days after the plan’s effective date.
If the client buys a Medicare Supplement policy during their 6-month Medicare Supplement OEP and are unhappy with it, they can change to another Medicare Supplement policy. When the client gets a new (second) Medicare Supplement policy, they have 30 days to decide if they are going to keep it. This time period is called the 30-day free look period. The client shouldn’t cancel the first Medicare Supplement policy until they are sure they want to keep the second Medicare Supplement policy. Unfortunately, they have to pay both premiums for the month they have both.
Reasons to change a supplement plan
- Paying for benefits you don’t need.
- Client needs more benefits.
- Do not like the insurance company
- They need a lower cost plan
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Why Does the Free Look Period Matter
Peace of Mind
Because choosing a Medicare supplement plan is overwhelming, sometimes beneficiaries make decisions in haste or without full understanding. This can lead to dissatisfaction. The free look period offers reassurance to beneficiaries, allowing them to thoroughly evaluate their plan and its benefits at their own pace.
Risk Mitigation
Mistakes in selecting a Medicare supplement plan can be costly, both financially and in terms of coverage gaps. The free look period serves as a safety net, enabling beneficiaries to rectify any errors or misunderstandings without facing financial penalties or being locked into a plan that doesn’t meet their needs.
Consumer Protection
The free look period is designed to protect Medicare beneficiaries from being pressured into purchasing plans that may not be suitable for them. It empowers individuals to make informed decisions about their healthcare coverage without feeling rushed or coerced.
Medicare supplement plan comparison – click here
Making the Most of the Free Look Period
Thoroughly Review the Plan
It is important to go over all aspects of the Medicare supplement plans your client is considering. Please remember, this not only includes coverage but all costs involved.
Compare Plans
To ensure the client has made the best plan choice, agents should comparing it with other available plans. This can help you identify any discrepancies or better alternatives.
Seek Guidance
Beneficiaries should reach out to a licensed insurance agent for assistance. They provide valuable insights and help navigate the confusing landscape of Medicare coverage.
Document Everything
Important: clients should keep detailed records of their conversations with insurance provider representatives. They need to include any changes made to their plan or communications regarding the free look period. This documentation serves as evidence in the event there are any disputes or discrepancies.
The free look period is an opportunity for beneficiaries to ensure they have the right coverage for their healthcare needs. Individuals who take advantage of the free look can make informed decisions. They can also, rectify mistakes, and achieve peace of mind regarding their healthcare coverage. Remember, health is invaluable, and the right Medicare supplement plan can make all the difference in accessing quality healthcare.
What is a Medicare Trial Right
Because there are so many Medicare enrollment periods, there are some that may get overlooked. One of the lesser-known yet significant enrollment opportunities is the Medicare Trial Right. We will go over what a Medicare Trial Right entails, and who qualifies.
When an agent has a client enrolled in a Medicare Advantage (MA/MAPD) plan and they wan to change back to Original Medicare, they may be eligible for a trial right. If this is the case, they have an opportunity to change their plan without having to wait for the AEP (Annual Enrollment Period). This enrollment period allows beneficiaries a chance to go back to Original Medicare or original Medicare and a Supplement and /or PDP plan. This gives beneficiaries a way to get the coverage they need if the plan they chose is not a good fit for their current healthcare needs.
How does a Trial Right work
Trail Rights apply to beneficiaries who enroll in a Medicare Advantage plan for the first time. The enrollee has a 12 month time frame to try a MA/MAPD plan. This enrollment period is very similar to the Medicare supplement free look although they each have their own qualifying rules and the time you have to use each one is different. New MA/MAPD beneficiaries have a Trail Right period of 12-months. On the other hand, enrollees of Medicare Supplement plans are entitled to a free look period of 30 days.
Watch a YouTube video on the differences between Medicare Advantage vs. Medicare Supplement plans
Who qualifies for a Trial Right
Beneficiaries Who Enrolled in an MA/MAPD plan when they first signed up for Medicare
It is important to understand the timelines associated with the Medicare Trail Right. If a beneficiary enrolls in a Medicare Advantage plan during their Medicare Initial Enrollment Period (IEP), they can change to Original Medicare anytime during the first 12 months of enrollment in the Medicare Advantage plan. Here’s an example: if a client turns 65 and chooses a MAPD plan for November 1st, the trail Right period runs until December 30 of the next year. This means they can opt to disenroll form the MA/MAPD plan and go back to Original Medicare anytime during those 12 months.
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Medicare Supplement beneficiaries who chose to enroll in a MA/MAPD plan for the first time
When Medicare Supplement plan enrollee decides to try a MA/MAPD plan for the first time. If they decided they do not like the MA/MAPD plan, they have 12 months to go back Original Medicare.
Important: beneficiaries who use the Trial Right can choose to enroll in a PDP plan as well as a Medicare Supplement plan. They do not have to go through underwriting for the Medicare Supplement plan.
Benefits of Medicare Trial Right
- Flexibility: It provides enrollees the ability to explore Medicare Advantage Plans or switch back to Original Medicare without penalty.
- Tailored Healthcare: Enables individuals to find the best plan for their healthcare needs, preferences and budget.
- Peace of Mind: Offers peace of mind in the event the chosen plan doesn’t meet expectations, the beneficiary can change their plan.
What to consider before using the Trial Right
- Beneficiaries need to understand their current plan, including coverage, costs, and provider network.
- Research alternatives: Compare coverage, costs, provider networks, and additional benefits.
- Make an informed decision: Assess healthcare needs, preferences, and budget to determine the best course of action.
- Enroll in the new plan: Once enrollment in the new plan is confirmed, inform your current Medicare Advantage plan that you are disenrolling.
Other enrollment periods
Please remember, beneficiaries can only use the Trial Right one time. However, there are several other options that provide an opportunity for a client to change plans.
Learn about other Medicare election periods
Disenroll from a Medicare plan
Enrollees can disenroll from a Medicare Advantage plan by contacting the provider directly or contacting your local Medicare office 1-800-MEDICARE (1-800-633-4227).
Many beneficiaries do not know about the Medicare Trial Right period. It is up to the agent to make sure clients are aware that they have options if they are unhappy. It is always important to be sure the client gets the healthcare they need.
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CT MSP income limits 2024
It’s important for agents and Connecticut residents on Medicare to stay up to date on changes in healthcare programs that impact their lives. One such program is the Medicare Savings Program (MSP). This program provides assistance to beneficiaries with limited incomes cover their Medicare costs. Understanding the CT MSP income limits 2024 is vital for beneficiaries. Especially when they depend on financial assistance to get the healthcare they need.
What is the Medicare Savings Program
The Medicare Savings Program (MSP) is a state-administered program. It helps individuals with limited income and resources pay for Medicare premiums, deductibles, coinsurance, and copayments. The program is available to those eligible for Medicare Part A (hospital insurance) and meets specific income and asset criteria. In Connecticut, the MSP is administered by the Department of Social Services (DSS) and provides critical financial assistance to eligible beneficiaries.
Income Limits for the CT Medicare Savings Program 2024
Because the Medicare Savings Program in Connecticut consists of 4 levels of help, the income limits vary based on each separate program within MSP. The state also adjusts the income limits based on the size of each household. The income limits for each MSP programs, as of 2024, are listed below.
QMB (Qualified Medicare Beneficiary) Program
The QMB program provides the highest level of help. Those who qualify for this program, have an income level of up to 100% of the Federal Poverty Level (FPL). This program helps pay for Medicare premiums, deductibles, coinsurance, and copays.
SLMB (Specified Low-Income Medicare Beneficiary) Program
The SLMB program provides assistance with Medicare Part B premiums. To qualify for this program, individuals should have an income level of between 100% and 120% of the FPL.
ALMB (Additional Low-Income Medicare Beneficiary) Program
The ALMB program provides payment assistance with the Medicare Part B premium for those who have income between 120% and 135% of the FPL.
QDWI (Qualified Disabled and Working Individuals) Program
To qualify for the QDWI program, individuals must be under age 65, disabled, working, and not eligible for Medicaid. These individuals must have income of up to 200% of the FPL. This program provides assistance for individuals paying their Medicare Part A premiums.
Please note: the income limits are subject to change annually. There are other factors that affect MSP eligibility including: household size and financial resources.
How to Apply for Connecticut’s Medicare Savings Program
Beneficiaries who want to apply for CT’s MSP program, can do so through the DSS (Department of Social Services). The beneficiary must provide information such as: income, assets, Medicare enrollment, and other relevant information. DSS provides help completing the application for anyone who needs it.
Individuals apply for benefits by completing a CT state application form. There are several ways to complete and return the form, including; online, through the mail, or dropped off at a local DSS Regional Office. An authorized person can do the application for the beneficiary if they need them to.
For a list of local DSS offices, click this link.
To apply online, visit www.connect.ct.gov, you will see a tab to ‘Apply for Benefits.’
Beneficiaries who wish to apply for MSP program only, please download and complete application below:
Medicare Savings Program Application (W-1QMB)
Formulario de Renovación de programas de ahorro de Medicare (W-1QMBS)
To apply for the MSP program as well as additional programs such as: SNAP (food stamps), Medicaid for Employees with Disabilities (MED-Connect), Medicaid for the Aged/Blind/Disabled (HUSKY C), and/or cash assistance, download the application below.
Click here to apply for Husky C and or Cash assistance program benefits
Haga clic aqui para Husky o asistencia en efective CW-1ES Solicitud de Beneficios
MSP in Connecticut provides an essential service to many individuals. It provides financial assistance to cover Medicare costs. It is necessary to be aware of the income limits. eligible individuals can take advantage of this valuable program and access the healthcare they need without undue financial strain. As we navigate the complexities of healthcare, let’s ensure that everyone has the opportunity to receive quality care and support.
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You have the right to a copy of the completed application. You can request a copy from DSS at any time in either in electronic or paper format.
For additional information on how to apply, please visit www.ct.gov/dss/apply.
Federal Communications Commission regulations
The new Federal Communications Commission regulations on lead generation will lead to changes in the insurance lead market. As of January 27th 2025, organizations must get “one-to-one” consent before contacting consumers. In other words, people buying leads must get explicit, individual consent before contacting the lead. The goal of this rule is to eliminate the sale of mass market leads to multiple agents.
Previous to the new rule clarification, the TCPA did not address the use of lead generation. The new rule focuses on the lead buyer and puts the emphasis on their need to obtain one to one consent when buying leads. It also states that leads must be related to the services the consumer showed an interest in. In other words, when a consumer goes online to get an auto quote, a agent cannot contact them about Medicare plans, credit cards, mortgages, etc. This also means, lead companies cannot sell consumer information to multiple buyers. This is a common practice with shared online leads.
Click here for proposed rule FCC document
What type of leads will the new rules apply to?
The new Federal Communications Commission regulations “one-to-one” consent and “related services” rule will make many of the leads insurance agents purchase today non compliant next January. The main types of leads this will be applicable to are:
- Shared online leads: lead companies sell shared leads to multiple agents and do not meet the “one-to-one” consent rule
- Aged leads of any type: because lead companies resell aged leads to other agents, they are not compliant
- Live transfer phone leads: It will be difficult to maintain one to one consent with live transfer leads. The marketer on the phone talks to the prospect and then transfers them over to the agent which will no longer be allowed
- Any lead that originated from a different advertisement: Many insurance leads did not originate that way. The consumer may be interested in another product, but their information was sold as an insurance lead.
Which type of leads will be allowed after the new Federal Communications Commission regulations?
Most of the lead types insurance agents use today will still be allowed. If the lead creation source sends the consumer directly to the purchasing agent, they will be allowed. This would include direct mail, exclusive online leads, consumer direct inbound call leads and social media advertising such as Facebook or Google ads.
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What does this mean for insurance agents and agencies buying leads?
Does this mean lead vendors will stop selling shared leads to insurance agents? Unfortunately not. The enforcement of the new rule focuses on the those who purchase them. Those selling the leads will likely continue to offer them after January 27th of 2025. This may lead to a scenario with agents continuing to purchase leads that do not have “one-to-one” consumer consent. Agents that continue to purchase leads without one-to-one consumer consent will be exposing themselves to demand letters and litigation from consumers and law firms.
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