UHC assisted living IESNP
The UHC assisted living IESNP plans are a great option for clients who are either moving into an assisted living, independent living, or memory care community and congregate housing. The plan is also available to people receiving care at home. Additionally, members that need help with Activities of Daily Living (ADL’s) or instrumental Activities of Daily Living (IADL) are likely eligible for the plan. A few examples of IADL’s are: housekeeping, managing money, food prep, transportation or even managing medications.
Click here for additional UHC Assisted Living Plan information
This is a 5 star Medicare Advantage PPO plan!
This plan provides much needed resources to help clients navigate the transition and make life much easier. Plans are available to both Dual and non-dual members.
It is very important to note:
These plans are exclusively offered by agents contracted with either Crowe and Associates or Pinnacle Financial Services!
If you would like to get contracted with Crowe and Associates to offer these plans; click this link
Click here for a map of the IESNP coverage area
Before you can offer these plans, there are 2 steps for training:
- Use the link below to complete the first step. Once you have completed the fist step ( IESNP training video) be sure you scan the code using the camera on your phone.
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Click here for IESNP training page (Need to be logged into the PFS site to access) (Training called “UHC Assisted Living Plan Training”)
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- After you complete the first step, you will receive a notification. In a couple days, the certs are loaded into your Jarvis portal. You will find the certification in Jarvis’ knowledge center in the “Invitation only” section.
Use this link for step by step screen shot instructions on the entire certification process
There are many great benefits offered with these plans:
The UnitedHealthcare Assisted Living Plan (IESNP) includes a dedicated care team– including a nurse practitioner and physician assistant- that help to customize a plan of care that covers your client’s needs. This team has over 20 years experience in care coordination. They work with both families and providers to keep everyone updated on the client’s healthcare needs. The care team is available by phone 24 hours a day, 7 days a week to help assure any concerns your client has are addressed.
To view the ALC flyer, click here
Another important benefit of these plans is the extremely low OOP. The OOP for the plans is between $1,500 and $1,600 annually! The plan has a very low OOP vs. other non dual Advantage plans. A member needs to be eligible for the plan but they DO NOT need to be a dual member to qualify. As a result, this can be an increadible option for those not receiving any type of help from the state or for members that are drug help only.
Take a look at some additional benefits including great dental coverage!
Verification of eligibility:
Option 1: Check eligibility in UHC Jarvis portal
You must have log in credentials for the PFS website to access the page:
CLICK TO ACCESS PAGE Click on “2023 LOC Process”
This plan has dual-type extra benefits but as well as a clinical element. Members have access to in-person care either at a facility or in their own home from a UHC employed nurse, nurse practitioner or PA. They also have a care coordinator that would organize the care from the clinician and help with things like medication management.
Access to WellSky once certifications are completed:
Registration
1. User will receive an email from WellSky (no-reply@wellsky.com) with information provided for
registration.
2. User will select the link in the email, provide the temporary password, and the user will be
prompted to create a new password.
3. Remember to save the URL, username, and password for future use. Users do not have to
access the portal to keep their account active.
Enhancements to Medicare Advantage for 2024
CMS is constantly looking at the regulations that govern the sale, provision, and use of Medicare and Medicaid. They examine the experiences of the insurers that are contracted by the government to provide the insurance plans. Additionally, they examine the experiences of the beneficiaries who purchase them. Any amendments they choose to make are intended to take effect the following year. In 2023, CMS looked at the rules surrounding Medicare Advantage in particular. What changes are planned for Medicare Advantage 2024?
CMS Final Rule
The CMS issued a final proposal on April 5th of 2023 for the enhancement of Medicare Advantage. They did not address the comments that the public had given on the proposed amendments. However, did say that they plan to address them at a later, more appropriate date. The amendments proposed have to do with prior authorization and how that affects beneficiaries’ access to healthcare. Previously, prior authorization meant that beneficiaries who had Medicare Advantage health insurance plans had to essentially request permission before receiving care. That indirectly means that beneficiaries could be denied care. (Traditional Medicare does not require prior authorization.) There were concerns that Medicare Advantage customers were not receiving the same quality of care as Original or Traditional Medicare beneficiaries because of these rules.
Changes to Medicare Advantage 2024
This is about to change, however, as the new rules proposed by CMS are designed to make sure that Medicare Advantage customers have the same access to necessary tests, scans, prescriptions, and procedures that their counterparts in Original Medicare to. The American Medical Association says that the new rules have, “taken important steps towards rightsizing the prior authorization process.” UnitedHealthcare, which is just one of the insurers with Medicare Advantage plans, says it plans to reduce their number of denials of care by nearly three million a year.
CMS’ new rule requires that prior authorization policies may only be used to confirm the presence of a diagnosis. This ensures that the treatment is medically necessary. CMS is also requiring that all Medicare Advantage plans develop committees to ensure that denials and approvals are working effectively to get beneficiaries the care they need within the new guidelines. Finally, the new rules require that a prior authorization approval is effective for the entire course of treatment as long as medically reasonable and necessary to avoid disruptions in care.
All together, beneficiaries and insurers alike hope that these new regulations will help ensure that Medicare Advantage plans provide equitable access to care moving forward.
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How CMS Makes Changes
Each year, the Center for Medicare and Medicaid Services (CMS) can make adjustments to guidelines and rules for the upcoming year. These regulations can make adjustments or modifications to many things, affecting both providers and beneficiaries. CMS’ proposed regulations can affect which services must be provided under law, how beneficiaries can access those services, and even which companies qualify to be contracted insurers under the law. Learn how CMS makes changes.
Because these rulings affect so much of the Medicare system, they must be published so that people can be informed of them. The Federal Register is the publication that CMS uses to disseminate the new rulings and information. While a rule is in the proposal stage, CMS allows public comment. The next step is for the CMS to send a set of proposed amendments to the Code of Federal Regulations (CFR). This does not, however, amend the CFR immediately.
Public Comment Period
Once the public comment period has ended for the proposed regulations and amendments, the CMS can develop and publish the final regulation. However, it is not immediately effective. If the new or amended regulation affects a large portion of the population or a large profit margin (typically defined as $100 million dollars or more), then the amended regulations are only effective 60 days after the publication date. If the regulation does not affect the margin of people or profit, then it is effective much sooner, at thirty days after publication.
When the CMS sends the regulation to have it published, it also forwards the information to the Government Accountability Office (GAO) as well as both houses of Congress for review. There are certain instances in which the amended regulations can be effective immediately. When the CMS thinks that the delay might cause further damage, that it is contrary to the best interest of the public, or if the delay is unnecessary, impractical, or otherwise not the best way forward, they can find cause to waive the normal delay period.
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Crowe and Associates Events and Information
The Crowe and Associates Events and Information page will be updated every Tuesday and Friday. We will post registration links to future agency Zoom meetings and Webinars along with links to recently recorded webinars. Additional information such as carrier updates and other notable Medicare updates will be posted as needed.
Upcoming Webinar topics and registration links
Canadian Med Store – Thurs. July 10 at 1:00 PM EDT CLICK HERE TO REGISTER
Lead Star TCPA & CMS Compliant Leads – Thurs. July 17 at 1:00 PM EDT CLICK HERE TO REGISTER
Medicare Express Leads – Thurs. July 24 at 1:00 PM EDT CLICK HERE TO REGISTER
Cross Selling current and prospective clients – Thurs. Aug 7 at 1:00 PM EDT CLICK HERE TO REGISTER
It is a good idea to register for our webinars even if you cannot attend. We will send you a recording so you can view it when you have an opportunity.
Some of our recent Webinars
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- Using HealthSherpa for ACA Enrollments CLICK HERE TO WATCH
- ACA Myths CLICK HERE TO WATCH
- Wellcare National HIDE/FIDE and DSNP Training CLICK HERE TO WATCH
- Advanced Diabetes Supply – US Med CLICK HERE TO WATCH
- Physicians Mutual Preventive Care and Silver & Fit CLICK HERE TO WATCH
- GTL Ancillary Products CLICK HERE TO WATCH
- Best Plan Pro CLICK HERE TO WATCH
- Reminder Media CLICK HERE TO WATCH
- Crowe & Associates ACA contracting for agents & agencies CLICK HERE TO WATCH
- Link to all recorded webinars CLICK TO VIEW
Crowe Agency Zoom Meetings
(Meetings will start with quick updates and then open to all attendees for questions and discussion)
Next Meeting: TBA
Recent Carrier, Product and Medicare Updates
- CMS has announced 2026 Medicare commission rates, click here for details
- AHIP 2026 is available to agents as of June 23, 2025, Pinnacle offers agents a $50 discount, to access the discount go to pfsinsurance.com, click on services, then certifications from there you will see the AHIP link. If you do not have a Pinnacle login, please contact our office 203-796-5403 for assistance.
- Do not wait until the last minute to do your 2026 carrier certs, click here to access the Pinnacle website to see which ones are available. Once you are logged in; click on the agent services tab, then choose certifications; from there you can access a list of carrier certs for 2026. Click on each carrier to view availability and instructions. If you need a Pinnacle login, contact our office 203-796-5403.
- Proposed Rule CMS 4208-P, click here to learn about new regulations for our industry
Up-Coming Events
Pinnacle 2026 CT AEP Kickoff
When: Wednesday, August 27, 2025; event runs from 10:00 AM until 2:00 PM
Where: The Riverhouse at Goodspeed Station, 55 Bridge Road, Haddam, CT 06438
See what’s in store for 2026. Meet team members, industry experts and network with other local agents. This is an opportunity to speak with the top carriers and have your questions answered.
Pinnacle Championship Series
When: September 18, 2025
Where: Kia Center in Orlando Florida
This will be a fantastic networking event for insurance pros! Join the all stars of the industry for a connections strategy and growth.
This event will include information on: Medicare, ACA , Annuities, Life and Ancillary Health Insurance. Last year this was a great event and this year has the potential to be even better; don’t miss your chance to attend!
Contracting
Click here to begin a new contract or add carrier to existing Crowe and Associates contract.
Click here for intent to move instructions. Not all carriers are listed. Call the office for carrier instructions not listed.
Training and Agent Benefits
Introducing – BOSS 4 Agents
This all-in-one platform is available to all our agents and providing a CRM, Sales, Marketing & Metrics in one convenient location. Call our office 203-796-5403 to learn more.
Click here to request a free agent website. You must own a site URL before making a request
Subscribe to our YouTube Channel.
$500 Free Medicare Lead program.
Learn more about agent programs including T-65 marketing seminars.
Cigna Medicare Supplements CT
Cigna is launching new plans in Connecticut. The Cigna Medicare Supplements CT have improved rates plus some added features which include a multi-policy discount and no application fee. The new prices will be in effect for 7-1-2023 start dates. Very soon you will start to see the new rates when you run a Med Supp quote.
Learn how to run a quote using Sunfire
Cigna Medicare Supplements CT: Agent incentives:
Cigna is offering a number of incentives for agents who sell their Medicare supplements in CT. The language in the incentives is geared toward an underwritten state and not a GI state like CT. We will try to get clarification on the incentive details. Take a look below and see what Cigna has to offer contracted agents:
Learn more about Medicare supplement sales
Cigna Medicare Supplement Contracting
Existing Crowe agents can add the Cigna Medicare supplement through this link: CLICK TO ADD PRODUCT
Agents not with Crowe can use this link to get contracted: CLICK FOR CONTRACTING
Find out why you should work with Crowe and Associates
What is the Medicare Supplement OEP
Access free training videos; Click here
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What is a pro-rated Medicare commission
Medicare commissions are an integral part of the healthcare insurance industry. That is why, understanding what is a pro-rated Medicare commission is something that is important for Medicare agents. Pro-rated Medicare commissions help ensure that both agents and brokers receive fair compensation. We will explain a little about what pro-rated commissions are, how they work, and why they are important.
What is a Prorated Medicare Commission:
A prorated Medicare commission refers to the proportional payment that an agent or broker receives for enrolling individuals in either a Medicare Advantage or Medicare Part D prescription drug plan. Once an agent submits an application for a beneficiary, the agent receives commission. The amount of commission is based on the number of months the enrollee remains active in that specific plan.
How Does Pro-rated Commission Work:
Pro-rated commissions are based on the principle of fairness. Agents/brokers receive a portion of the total commission for each month an enrollee remains on their plan. This is done instead of receiving the full commission upfront. This payment structure helps agents avoid chargebacks for unearned commissions. This structure also motivates agents to provide on going support to clients and ensures they retain their book of business. Once the initial enrollment is completed, if an agent provides continuous assistance, education and support to a client they are more likely to remain with that agent/broker.
To view more details on commission payments, click here
How do you Calculate a Pro-rated Commission:
To calculate a prorated Medicare commission, simply divide the total commission amount for a specific enrollment by the number of months the enrollee stays active in the plan. For example, if the total commission is $600 and the enrollee remains active for 10 months, the agent or broker would receive $60 each month.
Benefits for Beneficiaries:
Pro-rated Medicare commissions indirectly benefit beneficiaries by encouraging agents and brokers to maintain an ongoing relationship. In other words, beneficiaries have access to a reliable resource to guide them through plan changes, answer their questions, and assist with any issues that may arise during the coverage period.
Agent-Beneficiary Relationship:
Pro-rated commissions foster stronger relationships between agents and beneficiaries. Agents have a vested interest in delivering high-quality customer service, ensuring that beneficiaries have a positive experience throughout their Medicare coverage. Beneficiaries can rely on agents for personalized advice, plan comparisons, and assistance in navigating the complex Medicare system.
To sum it up, pro-rated Medicare commissions are a fair and transparent compensation structure for agents/brokers who enroll individuals in Medicare plans. By aligning incentives between agents and beneficiaries, prorated commissions contribute to better long-term relationships, ongoing support, and improved customer experiences. For individuals seeking Medicare coverage, partnering with an agent who receives prorated commissions can be a valuable resource for obtaining guidance and assistance throughout their healthcare journey.
Click here to view a YouTube video on Medicare commission payment details
If you are an agent looking to work with an FMO, click here and see what we can do for you.
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The Importance of Travel Health Insurance and Medical Insurance
As life expectancies increase and medical science improves, what was once the twilight of life is as lively and exciting as any other time. Those beneficiaries who are eligible for Medicare are still traveling, whether to see family, to adventure, or for business. For those who wish to travel internationally, however, their Original Medicare may not cover health emergencies that occur outside of the United States. There are several extremely specific emergency situations that Medicare may cover, but they are difficult to prove and the majority of medical situations do not qualify for coverage. Medicare Part D will not cover any prescription drug purchases at international pharmacies, nor will Medicare Advantage plans cover anything that Original Medicare does not cover outside of the United States. For these reasons, it is often imperative that beneficiaries purchase travel health insurance before an international trip.
Supplemental Travel Health Insurance and Medical Insurance
Travel medical insurance and medical evacuation insurance are both short-term insurance policies. They are supplemental and cover health care costs on a trip abroad. Best of all, they are relatively inexpensive, but could protect the beneficiary from a very large bill if they were to have a medical emergency while on vacation outside of the United States. For frequent travelers who make multiple trips outside of the United States every year, there are yearly policies available for purchase.
Medical evacuation insurance is particularly important when beneficiaries are traveling outside of major cities or areas where the health care is inadequate for their needs. Many rural areas the world over have no local hospital, and evacuation in an emergency can be the difference between life and death. The cost of evacuation can exceed $100,000.
To find a travel medical and medical evacuation insurance policy, beneficiaries should begin online. The following are resources for finding coverage that works for travelers:
When beneficiaries can rest assured that any medical assistance they need while abroad will be covered and available to them, they can relax and enjoy their travel.
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What is Indemnity Insurance
There is a lot of jargon, or context-specific, language surrounding insurance. As a result, those who are in the field often use language without thinking that can require definitions for their clients. One of the terms that keeps popping up in the health and medical insurance industry lately is indemnity insurance. What is Indemnity Insurance?
How it Works
As a general rule, indemnity insurance is the most traditional form of insurance. Although it used to be a very common form of insurance, it is no longer common. Indemnity health insurance is fee-for-service insurance. This means that beneficiaries have a greater range of choice in their doctors, hospitals, and medical centers. They can choose to change doctors at any point, without referrals. The insurance policy pays their share of the cost of service after they receive a bill for that service.
Like other modern insurance plans, once the beneficiary meets their deductible, the insurance policy pays for their share of the cost of service. Typically, this is 80% of the service, as long as the service is “usual and customary.” If the service costs more than the “usual and customary” amount, then the beneficiary is responsible for the copay and the difference in costs. Indemnity insurance policies sometimes do not pay for preventative care, but will cover medical tests and prescriptions.
Because this is a fee-for-service plan, beneficiaries often have to file claims in order to receive their insurance policy’s share of the service as well as save receipts for prescription costs and other purchases.
How to Get an Indemnity Policy in Connecticut
Although they are not as common as they used to be, indemnity insurance policies are still available in Connecticut under some larger insurance carriers. Some of the most recognizable names that provide indemnity insurance health and medical policies are Aetna U.S. Healthcare, Guardian Life Insurance Company of America, New England Life Insurance Company, and United Healthcare Insurance Company.
Licensed agents – What is Indemnity Insurance?
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Medicare Part B Excess Charges
Medicare Part B excess charges are, thankfully, not very common. However, they can be stressful for their beneficiaries when they occur. They are often a surprise cost and come at an already difficult time because of health trouble in the beneficiary’s life.
The majority of doctors and hospitals will “accept assignment” from Medicare Part B. This means that they accept the Medicare-approved amount as full payment or a service. When a doctor or hospital “accepts assignment,” they will send their bill directly to Medicare which will then pay 80% of the fee. The beneficiary is responsible for the remaining 20% (coinsurance).
How to Avoid Them
When a doctor or hospital does not accept Medicare assignment, that means they will charge more than the Medicare-approved total for the service. They may require the beneficiary to pay the bill upfront and then submit it to Medicare later for reimbursement. The beneficiary, in this case, is responsible for their coinsurance and the difference between the Medicare-approved amount and what the service actually cost.
Only 1% of non-pediatric physicians have opted out of the Medicare-approved costs for services. And, in the following states, it is illegal to charge more than the Medicare-approved amount: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont.
For beneficiaries who do not live in those states, Medicare Part B excess charges must be paid once they are charged. However, there are two steps that they can take next time to ensure they do not get charged again.
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Discuss Medicare reimbursement in advance with health care providers. Finding out beforehand if they accept assignment will save beneficiaries from excess Medicare Part B costs. If the healthcare provider does not accept assignment, the beneficiary can choose to go elsewhere for their services.
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Purchase a Medigap supplement policy. These insurance policies cover Part B excess charges if they are Plan F or Plan G.
While Medicare Part B excess charges are uncommon, when they do occur they can bring surprise costs and financial difficulty to beneficiaries. It is worth planning ahead to avoid them by discussing costs upfront with healthcare providers as well as purchasing a Medigap supplement policy that covers those fees if they occur.
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Connecticut AEP kickoff 2024
Be sure you save the date for the Connecticut AEP kickoff 2024! This will be an important event to attend and a great opportunity to meet the representatives from the area’s top carriers.
This a a chance to gain valuable insights to help you have a successful 2024. Come and enjoy the beautiful Mohegan Sun with Pinnacle and Crowe and start this AEP off right!
This year we will hold the kickoff on September 8th, 2023
This event begins at 10:00 am and runs until 5:00 pm.
Location:
Mohegan Sun Convention Center
1 Mohegan Sun Blvd, Uncasville, CT 06382
Don’t gamble with your success; click here to register now!
Attendees will learn things such as:
How to get your business noticed online with our SEO guidance.
Find out about NABIP.
Learn about the updates to Medicare legislation.
What the carriers are planning for 2024
Attendees can reserve a hotel room at a discounted rate and make a staycation out of it!
Please keep in mind, rooms are available on a first come first served basis. So be sure to reserve yours.
CLICK HERE FOR YOUR DISCOUNTED ROOM RATE
Meet the team members from Pinnacle and Crowe and see what we can offer you that will help grow your book of business!
Talk with some industry experts and find out how they grew their business.
See what Medicare products are proposed for the 2024 AEP.
It is always a good idea to know your Medicare carrier reps. This comes in very handy when yo have questions or need help.
We will go over much more, to see everything we have to offer, be sure to attend.
If you are still on the fence, remember:
Seats are limited so be sure you register soon and reserve your spot.
Connecticut AEP kickoff is a great way to find out what’s in store for 2024 and also get some insights from local Medicare experts
Learn what you can do for our clients during Medicare AEP
Find out more about Medicare commissions
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Humana Medicare supplements CT
Connecticut has several Medicare supplement plan options available including the Humana Medicare supplements CT which offer great rates and plan discounts.
Starting 6-1-2023, Humana is offering Medicare beneficiaries the lowest cost Medicare Supplement plans G and N in CT. They also offer a 12% household discount and a sales bonus program.
See below for rates, highlights, bonus program and household discount details:
- Very competitive monthly premiums for Medicare beneficiaries
- Credit card accepted for both initial and monthly premium payments
- 12% Enhanced Household premium discount (applicant need only reside with an adult 18+ years of age)
- Ability for clients to receive an additional $2 per month discount when choosing to pay their monthly premium with a credit card or via EFT
- Highly competitive bonus program for agents –see link below for details!
If you are already a Crowe agent who would like to get contracted with Humana: click here to add a carrier or state to your existing appointments
CLICK FOR CONTRACTING LINK
Click the following links to view the Connecticut Outline of Coverage and the App packets.
Connecticut statewide monthly premiums are as follows:
- Plan A- $453.84
- Plan F- $293.55
- Plan G-$226.92
- Plan HDG-$67.35
- Plan N- $169.56
Connecticut statewide monthly premiums are as follows: (12% household discount included)
- Plan A – $399.14
- Plan F – $258.08
- Plan G – $199.45
- Plan HDG – $59.03
- Plan N – $148.97
PLUS, earn a bonus on your first Humana Medicare Supplement sale!
The street commission for these plans is 18% with agency contracts pay at a slightly higher level.
Earn $100 for each application! No monthly minimum required to earn!
See Flyer for details
Click here to learn how to generate your own Medicare leads
Find out how much Medicare Advantage commissions are paying
Medicare Assignment of Benefits
Much like beneficiaries, healthcare providers can choose to participate in Medicare each year during an open enrollment period. For providers, this period is from mid-November to the end of December. Over 98% of doctors, hospitals, and healthcare providers choose to participate in Medicare. This Medicare assignment of benefits data is from as recently as 2022.
When a provider chooses to participate in Medicare, they are choosing to accept claims assignments for all Medicare-covered services to their patients. This means that they accept the amount that Medicare pays for these services as full payment. Healthcare providers may not collect more from the patient than the Medicare-approved assignment, or amount, in the deductible fee or Medicare copay. For participating providers, Medicare pays them directly and forwards their claims to Medigap insurance providers. For non-participating providers, Medicare pays them 5% less than the approved-amount. Those non-participating providers cannot charge their patients who are covered by Medicare more than 115% of the approved amount for the service according to the Medicare Physician Fee Schedule.
What’s the Impact to Beneficiaries?
For beneficiaries, there are different procedures for using a provider that does participate in Medicare, or accepts assignment, versus one who does not accept assignment. For providers who do accept assignment, the Medicare beneficiary may have lower out-of-pocket costs. They will only be charged their Medicare deductible and copay amounts, and then Medicare will pay their healthcare provider directly. The participating healthcare provider also submits the claim to Medicare on their own and does not charge the beneficiary a fee for doing so.
If a healthcare provider does not accept assignment, or opts out of Medicare participation, the beneficiary may be asked to pay the full fee for the service at the time of service. The healthcare provider can also charge up to 15% more for the service than if they were participating in Medicare.
For most beneficiaries, choosing doctors and hospitals who accept assignment can save them out-of-pocket costs. Additionally, for most providers, it makes good business sense to increase their clientele by participating in Medicare and accepting assignment.
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