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Medicare agent sales training

As the demand for Medicare coverage continues to grow, the role of Medicare agents becomes increasingly important. For that reason, Medicare agent sales training is crucial. Agents need to be prepared to provide guidance for beneficiaries to ensure they receive the health care coverage that fits their needs and budget.

There are various training programs available to equip agents with the necessary knowledge and skills. Agents need to take in a lot of information including; rules, contracting, benefits, quoting, certs and much more.  We will discuss some of those things below.

Initial Training Programs

Newer Medicare agents require comprehensive initial training programs.  These programs should provide a solid foundation of the Medicare system including eligibility, coverage options and enrollment periods as well as how they work together.  We provide a weekly zoom training for all our newer agents that need the extra time to get up and running.

Product-Specific Training

Because there are so many coverage options for Medicare beneficiaries,  including Original Medicare, Medicare Advantage (Part C), and Medicare Prescription Drug Plans (Part D), agents need product-specific training. This training ensures that agents are well-versed in the details of each plan, allowing them to match individuals with the most suitable coverage.  Each carrier provides it’s agents with product training opportunities.  We also offer training when a new product that shows potential is introduced into an area or if agents show an interest in learning more about a specific product.  Agents can either join one of our weekly zoom meetings or webinars or find information on our website or YouTube channel.  You can find links to this information on our website, just click on the link below.

Click here to view our updated Events and information post

Annual Training and Updates

Given the dynamic nature of  Medicare coverage options, agents must undergo annual training and updates. This ensures that agents stay current with any changes to Medicare regulations, coverage options, and compliance standards.  Agents can get helpful tips on the annual AHIP training on our YouTube channel as well as updated CMS regulations for Medicare sales.

Technology Training

Because technology is always advancing,  agents need updated tools and technology to remain competitive.  That is why we provide both Sunfire and Connecture for quoting and enrollment to our agents at no cost.  We offer one-on-one training and video instruction to agents who want it. These tools offer a built in CRM as well as the opportunity for agents to record their sales calls and remain compliant. Our technological resources enhance the agent’s ability to serve clients effectively.

Visit our YouTube channel and watch some free training videos on any of the above subjects you have questions about

Ethical and Compliance Training

Ethics and compliance are a big concern in the insurance industry. Agents undergo annual training on ethical sales practices and conduct, as well as updated regulatory requirements. This training ensures that agents operate with integrity and in accordance with industry standards.  Our zoom meetings and webinars often focus on updated CMS regulations to ensure our agents maintain their compliance.  All our informational webinars are recorded and put up on our YouTube channel.

If you want to join our team, click here for online contracting

Sales Skills Training

Many agents appreciate training programs that help focus on honing sales skills.  This training teaches agents how to educate clients, address concerns, and facilitate informed decision-making.  Some training programs we offer focus on different types of approaches and opportunities agents can use to generate sales.  Because each agent is an individual, we offer calls or meetings to discuss different approaches agents can use to generate sales.

Networking and Business Development Training

Agents require training programs that go beyond the technical aspects of Medicare.  They need guidance to building a successful business. This includes strategies for networking, lead generation, and business development to help agents establish and grow their client base.  We provide agents with information and guidance on lead programs as well as how to host sales events and much more.

Learn how to generate Medicare referrals

The landscape of Medicare agent training is diverse, this reflects the multifaceted nature of the Medicare business. Whether it’s mastering the benefits of Medicare plans, staying compliant with regulations, or developing essential sales skills, ongoing training is a must for Medicare agents.  This helps ensure they provide high-quality service to their clients.

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Late Medicare enrollment

Medicare can be confusing; understanding the rules and guidelines for enrollment is important to ensure you have access to the healthcare coverage you need. Although many people are aware of the initial enrollment period, there are situations when individuals may apply for late Medicare enrollment.  We will go over some reasons for late enrollment, the rules surrounding late enrollment, and how to apply for Medicare.

Reasons for Late Medicare Enrollment

Missing your IEP (Initial Enrollment Period) – If you neglected to sign up for Medicare during your IEP, which begins three months before your 65th birthday and extends to three months after, you may need to wait for the GEP to sign up.

Missed a SEP (Special Enrollment Period) – In some cases, a qualifying event such as loss of employer coverage or moving can trigger an SEP.  If you miss this opportunity, you may have to wait for the GEP.

You have employer Coverage after the age of 65 – If either you or your spouse continue to work past the age of 65 and have employer-sponsored health coverage, you may delay Medicare enrollment. Late enrollment is allowed without a penalty as long as you enroll in Medicare within eight months of losing the employer coverage.

Rules and Guidelines for late Medicare enrollment

General Enrollment Period (GEP) – The GEP runs from January 1 through March 31 each year. Those who enroll during this period may face a late enrollment penalty (LEP).  The LEP is added to your Medicare Part A, if you do not qualify for premium free Part A, and Part B monthly premium amount.   For each 12-month period you delay enrollment in Part B, there is a 10% penalty applied.  The penalty lasts for as long as the beneficiary has Part B coverage. That is one reason to enroll in Medicare as soon as you are eligible.

Learn more about the Part B LEP

Medicare Advantage with prescription coverage (MAPD) and stand-alone Part D plans – Individuals who did not have creditable prescription coverage while they were eligible, will also have to pay a Part D penalty for late enrollment.

How to apply for Medicare

Go to the Official Medicare Website – In some instances, beneficiaries can enroll in Medicare online.  This is the easiest way to enroll.  Just visit medicare.gov and you will see options to enroll.  This website provides comprehensive information for those enrolling in Medicare or if you have Medicare questions.

Visit your local Social Security Office – Beneficiaries can either apply for Medicare over the phone by calling 1-800-772-1213 Monday – Friday 8 am – 7 pm.  Tell the representative if you want to apply for Medicare A & B or Part A only.  Hearing impaired beneficiaries can call TTY 1-800-325-0778.

If you want to apply in person, click here to find a local social security office.

Once you have your Medicare coverage in place, it is important to get the help of a licensed Medicare agent who can guide you through the different coverage choices available to supplement your coverage.

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CMS proposed rule 2024

Because there are many rules and proposals we will clarify, this post explains the CMS proposed rule 2024 (CMS-4205-p).  This rule was proposed in early November 2023.

Some of the changes included in this proposal

Agent compensation adjustment

CMS is proposing putting a maximum allowable commission in place for all agents.  This amount will be based on national level of $611 for new Medicare Advantage enrollments and $306 for renewals of Medicare Advantage plans.

In some states the proposed amount is lower than the commissions agents are currently earning.  both CA and NJ, have current commission levels for new Medicare Advantage enrollments of $762.  In CA and NJ the renewal commissions are $381 annually.  The states of CT, PA & DC Medicare Advantage commissions rates for new enrollees is $689 and $345 for renewals.  The wording on this part is a little tricky so we are not sure if the commission rate would all remain as it is or if it will all be one standard amount no matter which state you sell in.

Learn about Medicare commissions 2024

CMS has also proposed the  addition of a $31 admin fee for each application.  This may seem like a good thing, but it is not nearly enough to replace the overrides and other monies they propose to eliminate.

Overrides and Admin fees

If CMS passes the proposed rule as it is written, it will have a much bigger impact on uplines than it will on individual agents.

The proposal includes the elimination of all administration fees as well as overrides at all levels (GA, MGA, SGA, FMO & NMO).  This means agencies at any level that have direct pay agents would lose all revenue eared through overrides.  That part of the proposal would essentially end the direct pay agency model.

Click here to learn about pro-rated Medicare commissions

How this effects agents

Agents would lose access to all the services provided by their uplines.  Some of what they stand to lose are:

1. Assistance with contracting.  Uplines make the contracting process much easier by providing a much more streamlined option to agents.  Some carriers currently do not contract directly with agents at all.
2. Connecture and Sunfire or any upline provided quoting and enrollment tools that their upline currently provides.
3. Education and training.  This is an important one.  A good upline provides agents with many different training options that can include in-person, telephonic or training through teams or zoom calls. Just to mention a few.  These trainings include updated CMS compliance information, carrier specific products or assistance with basic knowledge or sales practices.
4. Back office support, the back office provides agents with a myriad of answers to their questions as well as training to use enrollment portals or help processing applications as well as various other assistance.
5. Marketing reimbursements; these are a great help to agents, especially when they are trying to get up and running.

These are just a few examples of what an upline provides it’s downline agents.  The list may vary depending on the upline you are currently working with.

Click here to see the programs that Crowe has to offer

More of what CMS proposes to eliminate

CMS wants to eliminate all marketing money.  This includes marketing money from carriers weather it goes toward expenses or lead costs.  Reimbursement of expenses will not be permitted at any level.  This will effect; agents, agencies, FMOs and even NMOs.

They want to stop all payments agents receive for helping clients complete HRAs.

Take a look at a our YouTube video on this topic

Would any agency survive this

The proposal would not eliminate all agency models.  If the agency is LOA, they may be able to survive if they offer agents a lower commission rate and operate on a much smaller budget.  An agency that sells a large volume of ancillary products  such as; cancer, critical illness, life or annuities, may also remain viable.

If the main revenue source of the agency/FMO comes from the sale products such as  annuities, life P&C or other products and does not rely on Medicare sales, they could stay afloat.  Any business that uses Medicare sales as a secondary income source may suffer a loss but could still remain profitable.

Visit out Events and information page to see upcoming webinars or other informative information

When will this go into effect

Although the final draft of the proposal may be decided in January, the timeline of when we will know what it actually says may not be until the spring.  CMS was receiving comments on the proposal until Jan 5, 2024.  That window is now closed.  NABIP(a huge advocate for agents/agencies) was also collecting a 5 question survey on this proposal in an effort to get our voices heard.

If the current version of the rule remains as is, it will create a substantial impact in the entire industry.  It will effect everyone from NMOs to the clients.

To view the proposal in it’s entirety, go to  www.regulations.gov

You can download the entire 486 page document .  The pages that pertain to Medicare agents are 6, 236-248.  There you will be able to view the specifics on the agent compensation changes.

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Eligibility for Medicare Part B

Part B of Medicare provides coverage for medical services like doctors’ visits, preventative services, outpatient medical services, and other medically necessary items and services.  In this post, we will go over the rules for eligibility for Medicare Part B.

To be eligible for Medicare Part B, individuals must meet certain criteria

Medicare Part B is one part or original Medicare. and Part B is an integral part of this coverage. In General, individuals who are 65 or older qualify for Medicare.  However, there are other scenarios when an individual may be eligible to enroll.

Turning 65

The most common way to qualify for Medicare is when an individual turns 65 and is a U.S. citizen or legal permanent resident living in the U.S. for at least 5 continuous years.  This period of time is referred to as the IEP.  It is a good idea to enroll during the IEP (Initial Enrollment Period) to avoid a late enrollment penalty.

Disability

In some instances, individuals under 65 with a qualifying disability are eligible to enroll in Medicare Part B.  Individuals who receive either SSDI (Social Security Disability Insurance) or some Railroad Retirement Board (RRB) disability benefits for a period of at least 24 months may qualify for benefits.

End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS)

Individuals who suffer from either permanent kidney failure requiring dialysis or a transplant (ESRD) or Lou Gehrig’s disease (ALS) usually qualify for Medicare coverage.  This coverage includes Medicare Part B.

Watch a YouTube video on SEPs. OEP and Late Part B Enrollment

Enrollment periods

When enrolling in Medicare Part B, there are a few different enrollment periods available.  Once you are eligible to enroll in Medicare Part B, it is important to understand when and how to enroll.

IEP (Initial Enrollment Period)

The IEP is the seven-month period that begins three months before the individual turns 65.  It includes the month of their birthday and continues for three months after. As we stated earlier, enrolling during this period is recommended to avoid a late penalty.

SEP (Special Enrollment Period)

Some individuals may qualify for a Special Enrollment Period.  For those who delayed enrollment in Part B due to having employer coverage through their employment or a spouse’s employment an SEP allows them to enroll without facing a penalty.

Learn more about SEPs

GEP (General Enrollment Period)

If an individual missed their IEP and doesn’t qualify for a SEP, they can enroll during the General Enrollment Period.  This enrollment opportunity runs from January 1 to March 31 each year.   It is important to note; late enrollment penalties may apply for those who wait to enroll during this time.

Additionally, Medicare Part B is an important part of healthcare coverage for seniors and other qualifying individuals. Understanding the eligibility criteria and enrollment process is essential to ensure timely access to the benefits that Medicare coverage provides.

Medicare agents, click here to become part of the team at Crowe

A licensed Medicare agent can help navigate the ins and outs of Medicare coverage and ensure beneficiaries receive all the benefits necessary for their healthcare needs and budget.

Click here to see why a licensed Medicare agent is a great asset.

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How to get more Medicare referrals

Agents who generate a steady stream of referrals not only build their client base but also establishes their credibility in the industry.  We will go over how to get more Medicare referrals with a few ways agents can build their referral network and achieve sustainable growth.

Build good relationships with your existing clients

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.  Agents should use a good CRM to keep client information up to date.  This includes a list of their current doctors and medications so you can quickly update it each year when you run a plan comparison for AEP.

Watch a YouTube video on Sunfire and Connecture our quoting and enrollment tools

Collecting your clients email and phone number can be a good idea.  This way agents can send out a mass email that contains any pertinent information for your clients.  The phone numbers are useful not only to contact your clients in general but can be used as a tool if they want to opt in and receive text messages from you.

They also need to be available when a client calls with a coverage question.  If a client has confidence in the service they receive, they are more than happy to tell friends, neighbors or anyone else who asks.  This a very valuable source of new business.  It is also ok to ask clients for referrals, just find a way that is comfortable for both you and the client.

Click here to watch a quick YouTube video on AEP marketing rules

Establish relationships with local healthcare professionals

It is a great idea to introduce yourself to healthcare professionals, doctors and clinics in your area.  Once they know you and are aware of the service you offer, you can create a partnership. Establishing a good relationship with healthcare providers can open doors to a continuous stream of leads. Volunteer to attend healthcare events, workshops, and seminars to connect with providers who may refer individuals seeking Medicare coverage. Position yourself as a reliable and knowledgeable resource for their patients’ needs.

Build a strong social media and online presence

In today’s digital age, a strong online presence is essential. Agents should consider creating business profiles on social media platforms.  Once the profile is created, it is important to maintain the the platform with any pertinent information potential clients may find valuable.  Information about Medicare options and answers to common questions are a couple things to post on your platform to engage your audience. An online presence not only helps you reach a broader audience but also positions you as an expert in the Medicare field.

See how we can help you build an insurance website

Host free educational workshops

Host workshops or webinars to educate the community about Medicare coverage options and changes. If you provide valuable insights into the complexities of Medicare, you will gain status as a valuable resource.  Anyone who attends may be more inclined to refer friends and family to you when they are looking for guidance on their Medicare choices.

Want to learn the best practices for educational seminars, click here

Offer Referral Incentives

Create a referral program that rewards clients and other individuals for referring new clients to you. Incentives for clients can include a gift card or anything appropriate with a value of $15 or less. It is important to be complaint when offering referral gifts. By acknowledging and appreciating referrals, you encourage your existing network to actively promote your services.

Referral gifts for another agent or business professional (ACA agents, P&C agents, Medicare agents not licensed in a particular area) can be a cash payment of up to $100 per sale.  It is important to remember to pay them this so they will be more likely to refer other clients to you in the future.  Please note:  in most cases, financial planners cannot accept the referral gift.

Collaborate with Local Businesses

Explore partnerships with local businesses that cater to the senior population. Establishing connections with senior centers, fitness clubs, or retirement communities can be mutually beneficial. These businesses may refer clients to you, and in return, you can refer clients to them for services.

Find a FMO that will help you reach your full potential

Stay Informed

Because Medicare plans change each year, it is important to stay informed on any updates and adjust your strategy accordingly. Be sure you are up to date on compliance rules and attend product training sessions, workshops and conferences regularly.  This is a good way to build relation ships with broker managers and other agents in the industry who may send you a referral if they have a beneficiary who needs an advisor.  An informed and well known agent is more likely to attract referrals from clients and other professionals.

Click here for AHIP test tips

As a Medicare sales agent, building a large referral network is essential if you want to achieve long-term success. By focusing on client satisfaction, and following the other suggestions noted above, you can build a successful referral-based business that continually brings in new clients and opportunities.

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Medicare licensed agents

Medicare licensed agents provide a valuable service to beneficiaries.  If they stay up-to-date on product offerings and CMS rules, they can provide clients with a number of plan choices that will suite their needs. This is a great career if you are interested in becoming a valued member of your community and providing an important service to it’s members.

Where to start

The first thing you need to do is go onto the state insurance department website for your state.  From there, you can lookup the requirements to earn your health or health and life license.

There are several companies that offer the courses you need to study for your test.  Your states insurance department website will give you the available options. While you are studying for you resident state license, you will start to learn the rules for selling Medicare & other health plans.  Studying also provides valuable information about the different components of Medicare and how they work together.

Each state has different requirements for exam-prep. Some require in-person training while others allow self-study at your own pace.  There are also online options and options to order books if you are more comfortable with that.  There is a test at the end of the course that you must pass before you can take your actual licensing exam.  It is important to note; some states require agents to take a course on life as well as health while other states do not require agents to do both. If you think you may want to offer life products later, you can add the life course and do the testing at once.

Once you pass the exam, CMS reports your results to the National Insurance Producer Registry (NIPR).   Be sure you print and download a copy of your license.  You will find your  National Producer Number (NPN)on your license.  You need your license and NPN to contract with carriers.

Contract with an FMO

An FMO (field marketing organization) is an invaluable tool.  A good FMO not only provides it’s downline agents training, tools and contracting.  They provide continuous, back office support, they will answer your calls and make sure you get answers to your questions. Some of the things FMOs help; they get contracting requests processed, train downline agents on new CMS regulations and carrier products.  Agents need to take time and ask as many questions as you need to to feel comfortable before they choose an FMO.

 Watch a YouTube video on the programs Crowe has to offer

Having an FMO behind you , makes contracting with multiple carriers and products a much smoother process.  They should also provide guidance to new agents to put a plan of action in place and get up and running.  There may also be opportunities for leads, marketing money and other useful tools.

Join the team at Crowe – click here for online contracting

Purchase E&O insurance

In order to do business, carriers require all agents to have E&O insurance.  This insurance protects you in the event you make a mistake when you enroll a client an they take legal action against you to cover any financial loss your misinformation may have caused them.  Your FMO may provide a discounted plan to it’s downline agents.  If they don’t you can purchase a policy through an agent who provides property and casualty insurance.

Click here to learn about our discounted E&O

Complete AHIP

After you get our license, you should take the AHIP.  AHIP stands for America’s Health Insurance Plans.  Most carriers who offer PDP or MA/MAPD plans require agents to take this training and certification course.  Agents must take this test each year and get a 90% to pass.  The cost to take the AHIP course is $175, although many carriers offer a $50 discount if you take it through their portal when you do your carrier certifications(more on those below).

Click here to watch a YouTube video on AHIP test tips for 2024

Get contracted & appointed

Agents must complete carrier contracting before they are appointed to sell their products. In most cases, agents need a copy of their current state health insurance license for each state they plan to sell in.   A copy of their E&O certificate is also necessary.  Your FMO will will help with this process by providing other important information to the carriers.  Once the carrier has all the pertinent information, you must complete the carrier specific training for PDP and MA/MAPD plans.

It is a good idea to request only 4-5 good carriers in your area and get RTS (ready to sell).  With a good FMO, it is easy to add more in as you need them.  You do not want to be overwhelmed from the start. This can discourage anyone.

Find out about how Medicare commissions pay 

Moving forward

It is important to make sure you keep your license active.  This sounds like a no brainer but, some agents forget to renew and that can cause a number of problems with your carrier contracts. up to date.  In order to do this you will need to complete a specific number of CE credits before you can renew your license.  The amount of CE hours you need vary by your resident state.  You can choose any accredited CE course provider you like, again this is based on state specific requirements.

If there are updates with CMS requirements, both your FMO and the carriers you are appointed with should provide them to you.  It is essential that you follow all guidelines when making sales to avoid termination of your contracts.

If you want a career where you provide a valuable service to individuals and truly enjoy helping people, this could be a good fit for you.  In this business, we cannot stress enough how important it is to be organized and well informed to provide the best service to your clients.

Do you need a scope of appointment, click here and learn about the rules

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Medicare premiums

If you are either a Medicare beneficiary or a Medicare agent, you need to know the cost of Medicare premiums.  Each year the costs are subject to change.  Both enrollees and agents should stay updated on cost and coverage changes. Not having the correct information can be a costly mistake.

Medicare Part A

There is no premium ($0) for Part A for the majority of people most people.  Beneficiaries who worked or had a working spouse who paid Medicare taxes for at least 40 quarters (10 years) receive premium free Part A.

Those who do not qualify for the $0, premium free Part A may be eligible to purchase it.  Beneficiaries must sign up for Part B in order to purchase Part A.  For 2024, the monthly premium is either $278 or $505.  This depends on the length of time either the beneficiary or their spouse worked and paid Medicare taxes.

Please note:  Beneficiaries who do not purchase Part A when they are eligible (in most cases at 65 years old), may pay a penalty.  The penalty adds 10% to the monthly Part A premium and lasts for twice the number of years that you neglected to sign up for Part A.

Medicare Part B

The monthly premium for Part B is $174.70 in 2024.  This amount usually changes on January 1st each year. This premium may be higher for some individuals with a higher income level. This additional charge is called an IRMAA, and it effects about 8% of Medicare beneficiaries.  The Additional charge ranges from $69.90 up to $419.30 added to the monthly premium.

Medicare may charge a late enrollment penalty to anyone who did not enroll in Medicare Part B when they were first eligible or did not have creditable coverage in place at that time.  The LEP for failing to enroll in Part B is 10% for every year the beneficiary did not sign up for Part B.  This penalty is different than the Part A penalty; it will last for as long as the beneficiary has Part B.

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Extra help Medicare

Medicare provides programs and benefits to many people. This includes the Extra Help Medicare program that provides qualified beneficiaries help paying their Medicare Part D monthly premium, annual deductible, coinsurance and copays for their prescription medications.
To qualify for this program, individuals must meet income requirements.  Individuals who are accepted into this program do not have to pay any Part D late enrollment penalty they may have acquired.

How to apply for extra help

If you do not automatically qualify for Extra Help, you will need to apply.  You must meet the following qualifications to be eligible for Extra Help.

1. Applicants must have Medicare Parts A and B.
2. They must reside in the U.S. or the District of Columbia.
3. They do not have more than $34,360 in assets that include savings, investments & real estate if they are married, or $17,220 if they are single or not living with a spouse. If your assets are more than that, you are not eligible for Extra Help. Important; this amount does not include your home, cars or personal possessions.  It also does not include life insurance, irrevocable burial contracts or back payments from Social Security or SSI.

If you meet the qualifications specified above, you can apply for Extra Help online.

Click here to apply for Extra Help online

For help with the online application, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778).

Please note: Some people do not need to apply for Extra help.  If you have either Medicare and SSI (Supplemental Security Income) or Medicare and Medicaid, you do not need to apply for Extra Help.  You will automatically be enrolled.

Extra Help isn’t available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa. But there are other programs available in those areas to help people with limited income and resources. Programs vary in these areas. Call your State Medical Assistance (Medicaid) office to learn more

Who can get Extra Help

If you think you meet the financial requirements and have Medicare A & B as well as are a resident of the U.S. or District of Columbia, just complete the online application.  You will receive a letter notifying you if you are accepted into the program.

Important:  residents of Guam, Puerto Rico, the US Virgin Islands, Northern Mariana Islands or American Samoa are not eligible for the Extra Help program.  To find alternative programs in those areas, check your state’s Medicaid eligibility at Medicaid.gov to find resources.

Additional financial resources

Individual states also have financial resources available through Medicare Savings Programs for those who meet the income qualifications. Use this link to find additional information for financial help in your area.

Beneficiaries can also go to Medicare.gov  or call 1-800-medicare (TTY 1-877-486-2048)to find information on financial assistance programs.

Please be aware:  Extra Help is not a prescription drug plan.  Beneficiaries must enroll in either an MAPD plan or a stand alone PDP plan to have coverage for prescription medications.

Agents, learn how to run a Medicare PDP or MAPD plan quote using Sunfire or Connecture.  Watch our quick YouTube video

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Medicare Part B eligibility

How to compare Medicare supplements

It is important for Medicare insurance agents as well as Medicare enrollees to understand how to compare Medicare supplements.  Medicare supplements (Medigap) insurance provides coverage to fill the gaps after Original Medicare pays its share of covered medical expenses.

Medicare supplement plans are standardized

Because CMS standardizes all Medicare supplement plans, they must provide the same benefits.  It does not matter which company offers the plan or what state you live in. In many states, beneficiaries have a choice of ten different plan choices.  The plans are named by the letters: A, B, C, D, F, G, K, L, M & N. Please note, plans with the same letter name only differ by price.  Insurance companies decide the pricing of their plans based on letter name and coverage area.

Comparing Medicare supplement plans

Before a Medicare beneficiary signs up for a Medicare supplement plan, it is important to consider your health care needs and your budget.  When possible, future healthcare needs as well.  Choosing the right plan can save you money as well as provide peace of mind.

Because the cost for plans varies so greatly, it is a good idea to work with a licensed Medicare agent who has access to the most competitive plans in your area.  Licensed agents can provide a cost comparison and go over coverage details that you may not consider.

Find out the value of using a Medicare agent

Although friends and relatives are often a great help with many things, please remember, each individual has their own health care needs.  What works for one person may not be good for another.

Consider the customer satisfaction record of each carrier

Additionally, in some instances, it may be worth a few extra dollars to have peace of mind and feel confident with your choice of insurance carriers.

Because health care coverage is such an important decision, beneficiaries need to consider all their needs and the options available.

If you want to join the team at Crowe and Associates, click here for online contract.

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Tricare and Medicare

In this post, we explain how Tricare and Medicare work together to provide coverage for those who qualify.

What is Tricare

Tricare is a healthcare program available to active-duty service members, active-duty family members, National Guard and Reserve members and family members.  It is also available to retired service members and their families, survivors, and some former spouses. This program combines military healthcare resources (military hospitals & clinics) with civilian healthcare professionals to provide services to its members.

It is helpful for anyone eligible for both Tricare and Medicare to know how these benefits work together. Tricare For Life (TFL) is provided free of charge to U.S. military retirees and their qualified beneficiaries.  Medicare coverage is a separate program available to beneficiaries 65 or older as well as qualified disabled individuals.

Please note: Tricare does not provide insurance cards.  Military members should register in DEERS (Defense Enrollment Eligibility Reporting System) database to receive Tricare.  DEERS is a database of information on uniformed services members and their family members (sponsors), Once you register for DEERS, you receive a Uniformed Services ID card.  Is important to make sure your coverage information is up to date in the DEERS system to avoid problems with your health care benefits.

Members can also access proof of their coverage through milConnect, a website that provides military members with benefit information for insurance, including help finding a provider, proof of coverage, GI benefits and much more.

It is always a good idea to be sure any providers the beneficiary uses are in-network with the MA/MAPD plan chosen. If the providers are in network, beneficiaries could end up not having to pay any out-of-pocket costs after TFL pays its share.

Learn about the pros & cons of Medicare advantage plans

It is important to note, TFL members must fill maintenance drug prescriptions like, blood pressure or cholesterol, through Tricare’s mail order pharmacy.  TFL members can fill other prescriptions at any pharmacy they choose.  The beneficiary is responsible for any co-pays.

The benefits provided by Tricare Plus are similar to Tricare Prime.  They both work the same as regular Tricare in regard to Medicare because it is still primary coverage. It is important to confirm the military facility accepts Tricare Plus before scheduling care.  Tricare Plus is for Tricare eligible individuals not enrolled in Tricare Prime.

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Clover Health OTC catalog 2024

The Clover Health OTC catalog 2024 provides members with numerous choices to help them get the most out of their OTC benefit.  Members of Clover Health MAPD plans have the added benefit of the LiveHealthy Rewards Program.

To get started with your Clover benefits, just go to the clover member site and register for your My Clover account.  From there, you can check your reward status as well as your OTC benefit balance, shop online or find a local, participating store and much more.  Clover plan members can access both their OTC and LiveHealthy rewards benefits with their LiveHealthy Flex Plus card.

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OTC catalog benefits:

Clover provides all MAPD plan members with a quarterly OTC benefit allowance of between $30 and $75 (amount depends on the plan benefit).  At the beginning of each quarter, OTC and LiveHealthy rewards dollars are loaded onto the Live Healthy Flex Plus card automatically.

OTC Benefit amounts do not roll over to the next quarter. Plan members must use the benefits before the end of each quarter.  Cards are only valid at participating merchants for approved items.

To download o copy of the OTC catalog and how to use this benefit, Click here

Download the Clover OTC benefit and live healthy rewards guide

Existing Clover members:

Existing plan members will not receive a new LiveHealthy Visa Flex Plus card.  Their current card will have OTC as well as LiveHealthy rewards loaded onto it.  Any unused Livehealthy dollars roll over from 2023 to 2024.

If you need a replacement card, you can either order one online at cloverhealth.com/livehealthy or call 1-800-607-2348 (TTY711) 8:00 AM – 8:00PM, local time 7 days a week.

LiveHealthy Rewards:

Members who complete the following activities earn rewards.
1.  Earn $100 per year to complete the “Getting to Know You Survey”.  This survey is a modified health risk assessment.  Each member can complete the survey online, over the phone with member services or by filling out the paper form included in your welcome kit. Rewards are loaded onto the card 3-5 business days after survey is complete.  Rewards are not available to spend until after the plan start date.  Member may complete a survey each year to earn rewards.

Brokers please note; if you help a new member fill out the online survey within 72 hours of submitting the application earn $50.

To learn more about HRAs, click here.

2.  Members earn up to $50 annually for preventative care.  This includes $10 for receiving a flu vaccine, $20 for an A1C test and $20 for a retinal eye exam.  Clover validates completion through claim or by self-attestation for flu vaccine.  Clover loads reward dollars 3-5 business days after they receive the claim.

3.  Complete a LiveHealthy visit to earn $150 annually.  Members call the phone number on the back of the LiveHealthy Flex Plus Visa card to set up the appointment. The appointment takes place either in the office of a provider, in-home or via telehealth visit.  members are eligible to complete a Livehealthy visit each year.  Benefits are loaded onto the card within 3-5 business days after claim is received.  Please note: providers have up to 90 days to submit the claim.

4.  Get Active rewards are worth $25 per quarter ($100 per year).  Member must participate in one of the following to earn rewards:  SilverSneakers gym or class, either virtual or in-person.  Attend a Clover sponsored event or Clover poll.  Log into the Clover member portal at least 1 time per year.  Clover confirms member participation and rewards dollars are loaded 3-5 business days.

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The difference between the OTC benefit and LiveHealthy Rewards:

OTC benefits provide plan members a monthly allowance to purchase common health care items while members earn Live Healthy rewards by completing activities that promote good health.

The annual OTC benefit amount is between $120 and $300 per year while members can earn up to $400 in Healthy rewards benefits annually.

While there are restrictions on what members can purchase with the OTC card, members can use Rewards dollars to purchase of most items with the exception of alcohol, tobacco and firearms.  Members who go over the OTC limit, can use rewards dollars to complete the purchase if they are available.  Any purchase in excess of the Rewards dollar is the responsibility of the member.

Important: Members may not use LiveHealthy Rewards dollars to purchase alcohol, tobacco products, or firearms. Rewards are not redeemable for cash.  Some other limitations apply, members should check with Clover member services for more information.

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