SunFire Multi-Pharmacy Comparison
Technology is playing an increasingly important role in the enrollment of beneficiaries for all kinds of healthcare insurance plans. Whether it is having enrollment meetings over the telephone or using applications like SunFire Matrix. Over 50 million people use SunFire. It is a software that collects and distills data from more than 80 insurance carriers. This includes information from over 1300 Medicare Advantage and prescription drug plans (Medicare Part D). SunFire, with the information agents collect from their prospective clients, can quickly determine which plans offer their most ideal coverage with the lowest annual cost. Because of this, many agents are using SunFire Multi-pharmacy comparison tool in real-time enrollments and sales meetings.
Recently, SunFire announced to its partners a change in their software. The change, which they are calling an enhancement, will allow for simplification of the processes of comparing estimated annual drug costs and potential savings among pharmacies. This includes both retail chain and mail-order pharmacies. The enhancement is available as of June 13th, 2023 for agents who use the software.
SunFire Multi-Pharmacy Comparison Highlights
Some of the highlights of the SunFire multi-pharmacy comparison announcement include the following.
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The software will automatically add the nearest pharmacy as the “primary pharmacy” unless the agent adds a preferred location.
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The software provides a breakdown of the estimated drug costs. Prescription coverage is noted by plan.
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The software can now discover potential cost-savings that can be accrued by switching pharmacies. If the software does find these potential savings, it can notify the agent of the discovery and the monetary amount that would be saved.
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Under the “estimated annual drug cost” tab, the software will display the annual cost for the two closest alternative pharmacy chains, as well as the mail-order options available.
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To continue the comparison, the agent can select one of those alternatives and reload the page to see the potential savings for their client.
In today’s world, agents must be up to date on not only the latest insurance information but the latest technology advances in the field as well. This new enhancement from the SunFire Matrix software will help agents compare drug costs for their clients with more accuracy, ensuring they have a clear picture of their annual costs. Click here for a demo of the SunFire multi-pharmacy comparison.
Licensed Medicare agents
Get information about the new five star UHC ISNP. This plan is exclusive to Crowe and Associates agent. In order to sell this plan, agents need to complete an additional certification and training. Exclusive training will familiarize agents with all the components and properly represent the benefits of this ISNP.
Learn what working with one of the top FMOs gives you.
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Medicare Sales Meeting Questions
Medicare agents have a number of ways to reach prospective clients. One of those ways is to hold education and sales events. While education events cannot lead to enrollments, sales events can and should. With these Medicare sales meeting questions, agents will be able to learn about their prospective and offer them the best plans and support for their insurance needs.
Financial Medicare Sales Meeting Questions
Asking financial Medicare sales meeting questions is vital to discover if the prospective clients qualify for Medicaid or other financial assistance. It also determines what kind of premiums people can afford to pay. Medicaid and other financial assistance qualifying incomes vary by state, as they are state-funded programs. Some prospective clients, depending on their income and assets, might even be eligible for a dual enrollment plan, or DSNP.
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What is your monthly income?
This will determine if they qualify for any state or federal help with their premiums or even if they qualify for a DSNP.
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If you are married, what is your combined monthly income?
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Do you have any assets that may put you over the limit for this plan?
If the agent is looking at an asset-sensitive situation, it is easier to let the prospective client know what that asset limit is than ask if they have any assets. There are some states that are not asset-sensitive. As an agent, it is important to do research ahead of time to determine what the guidelines are for that particular location.
Other Medicare Sales Meeting Questions
If a prospective client already has a Medicare Advantage or Medicare Supplement, it is best to start by asking them how it has been working for their healthcare needs. They may have needs that are not covered and the agent may be in a good position to have them find more suitable coverage.
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What type of plan are you on right now?
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What company is it with?
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Why did you decide to purchase this plan?
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Are there doctors you would like to see that you currently cannot because of your network?
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Is this plan covering the medication you need and expect to need?
It is often the case that beneficiaries are on a plan that they didn’t feel enthusiastic about. There are many options to help get every prospective client the coverage they need and want.
Some other general Medicare sales meeting questions that may help the agent determine the most beneficial plans to offer might be:
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Do you have dental care? If not, do you want dental care?
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Does your current plan provide benefits like dental care, vision coverage, or over the counter medications?
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(For those on a dual plan) Have you used any of the extra benefits the DSNP offers?
These extra benefits can include grocery cards, utility assistance, and flex benefits, and many beneficiaries do not know how to utilize them.
With these Medicare sales meeting questions in mind, the needs of the prospective clients will be clear for the agent to see. This will help everyone end up with the coverage they want and a plan that suits their individual healthcare needs.
Licensed Medicare agents
Get information about the new five star UHC ISNP. This plan is exclusive to Crowe and Associates agent. In order to sell this plan, agents need to complete an additional certification and training. Exclusive training will familiarize agents with all the components and properly represent the benefits of this ISNP.
Learn what working with one of the top FMOs gives you.
Keep up with all of our current events by clicking here.
Ready to contract? GET STARTED.
Subscribe to our YouTube channel. We provide weekly training and informational webinars.
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Medicare field marketing organization
In this post, we discuss the advantages for downline agents to work with a Medicare field marketing organization.
What is a Medicare Field Marketing Organization (FMO)
An FMO is a specialized entity that works with both insurance carriers and brokers to educate, promote, and distribute Medicare plans. FMOs act as go-betweens for insurance carriers and independent insurance agents. They provide support and resources to improve the marketing and enrollment process.
They actively recruit independent insurance agents to join their downline and grow their agency. FMOs are always looking for knowledgeable, committed agents who enjoy providing great service to their clients.
Once an agent is onboarded, the FMO should provide them with the resources they need to be successful in the Medicare market.
See what a great FMO can provide
What does a Medicare field marketing organization do:
- An FMO establishes contracts with multiple insurance carriers. This allows agents to represent a broad range of Medicare plan options. In turn, this provides beneficiaries a better selection of plans to choose from, based on their needs and preferences.
- Smart FMOs will invest their time in their downline agents. They must provide training to ensure that agents are able to understand and give guidance beneficiaries who are interested in the product they are offering. Training can include in-person events, webinars, zoom meetings or any other way that gives the agents up-to-date plan/industry information.
- Assist agents with the enrollment process. This is done by offering invaluable technology platforms and other resources to help streamline the process. These platforms save time and allow agents to focus on providing the best possible plan options and service to their clients.
To view our free training videos; subscribe to our YouTube channel.
What else can a Medicare field marketing organization provide agents:
1. Provide both sales support and assistance with marketing. They can direct agents on where to get marketing materials, applications and other things such as; compliant call scripts, marketing support and strategies for lead generation.
2. Help choose the best carriers for each agent to offer based on both location and product type. Provide agents with information on new products available in their local market.
3. Make sure downline agents are updated on any new regulations, compliance issues or industry standards.
4. Provide guidance for agents who want to expand their business by boosting sales or recruiting downline agents. It is always good to recognize agents who continue to do well or those that are improving. Motivation is a key component in the FMO agent relationship.
5. One of the most important ways an FMO can show support to their downline team is by addressing any concerns or questions they have in a timely manner. Do not ignore an agent who calls in for support. Many agents request releases due to a lack or training or their up-line not addressing their concerns.
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A great Medicare field marketing organization will:
Create a collaborative and mutually beneficial relationship with their downline agents. They provide the resources that empower agents to effectively market and sell Medicare plans. This kind of relationship benefits both the agents and the Medicare beneficiaries they serve.
Provide the support downline agents need to thrive in the competitive Medicare market. When an FMO does it’s job correctly, they represent knowledgeable, compliant dedicated agents and entire Medicare system benefits. this incudes everyone from the beneficiaries to the carriers.
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What is the Medicare Part B penalty
The Medicare Part B penalty is often the result of someone who is eligible for Medicare not understanding the rules. Those who fail to follow them can end up paying the penalties for life. Read the information below to understand who needs to enroll in Medicare Part B and when. We will also review the valid waivers that would allow someone who is eligible for Medicare to waive Part B without a penalty when they enroll in the future.
To see how to calculate your Part B enrollment penalty click here
Eligibility for Medicare A and B
Many people sign up for both Medicare Part A (hospital Ins.) and Part B (medical Ins.) when they turn 65 and are first eligible. There are some possible problems that can occur if you sign up later. Although, in some instances it makes sense to wait to sign up until later.
Because most people do not pay a premium for Part A, this makes it a no brainer to sign up for Part A when you are first eligible for Medicare even if you are still working.
If you choose to sign up for Part B, you will need to pay a premium. For this reason, some people will wait to sign up for Part B.
- Generally, you won’t have to pay a Part B penalty if you qualify for a Special Enrollment Period. Learn more about Special Enrollment Periods.
- You’ll pay an extra 10% for each year you could have signed up for Part B, but didn’t.
- You may also pay a higher premium depending on your income, this is called an IRMAA, watch our YouTube video to understand what a IRMAA is.
More information about signing up for Part B:
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- Your 8-month Special Enrollment Period to sign up for Part B starts when you stop working, even if you choose
- If you lose your job-based health coverage before you or your spouse stop working, you have 8 months to sign up.
- If you want Medicare coverage to start when your job-based health insurance ends, you need to sign up for Part B the month before you or your spouse plan to retire. Your coverage will start the month after Social Security (or the Railroad Retirement Board) gets your completed forms. You’ll need to fill out an extra form showing you had job-based health coverage while you or your spouse were working.
- If you want more coverage, you have a limited time to get it.
- If you miss the 8-month special enrollment period, you will have to wait to sign up and go without Medical coverage. That is a dangerous gamble to take. The penalty you will pay will also continue to grow.
If you miss your initial enrollment in Medicare Part B have two possible election options:
The first is a Part B special election period and the second is the Medicare Part B general election period.
CLICK HERE TO LEARN MORE ABOUT THE MEDICARE GEP
Contract with Crowe and Associates.
If you are already contracted with us and would like to either add a carrier or state or order supplies:
Click here to add a carrier or state to your current Crowe and Associates contract.
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Click here for intent to move instructions. Not all carriers are listed. Call the office for carrier instructions not listed.
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Medicare Out of Pocket
Original Medicare provides broad healthcare coverage for senior citizens and those with certain disabilities in the United States. It consists of Part A, which is hospital insurance, and Part B, which is medical insurance. It is a fee-for-service health plan managed by the federal government. Learn what Medicare out of pocket expenses beneficiaries should expect.
For many people, it is a relief to qualify for Medicare. It is guaranteed healthcare coverage and the costs do not increase based on age like so many other insurance plans. The ability to get coverage also does not change based on any pre-existing conditions. However, there are costs associated with this service. Deductibles, premiums, co-insurance, and more can all cost a surprising amount. For people on a fixed income, it is particularly important to be aware of the following 5 out-of-pocket Medicare expenses.
Doctors who do not participate in Medicare
While it is rare, there are doctors who do not accept Medicare insurance plans for payment. This becomes a problem when beneficiaries need to see a specialist, as there are often fewer of those to choose from in their area. This issue is compounded if they need to see one sooner rather than later. These providers will nearly always cost more out-of-pocket than a participating provider in Medicare.
Providers that do not accept assignment
There are also providers and facilities that do accept Medicare for payment but they do not accept assignment. Assignment is the agreed-upon amount that Medicare will pay for a service, exam, or procedure. Doctors or other healthcare providers who do not accept assignment do not accept Medicare’s standard rates and may charge up to 15% more for their services.
Doctors who operate outside of a Medicare Advantage plan network
While Original Medicare has a nation-wide network of providers that are covered, Medicare Advantage plans are far more local. That means that if a provider does accept Medicare but is not within the beneficiary’s Medicare Advantage network, the beneficiary could still be paying more in cost-sharing for any services they receive. There are protections in place that do not allow those doctors who are out-of-network to charge more than they would under Original Medicare, however.
Inpatient versus observation stays in a hospital
Contrary to popular belief, staying overnight in a hospital does not mean that someone is admitted to a hospital, meaning they are not inpatient. Inpatient hospital stays are covered under Original Medicare through Part A (hospital insurance) and 20% Part B coinsurance for any physician services. If someone is placed under observation, however, they are responsible for 20% of any services they receive. That can add up very quickly.
Three day rule
Leaving the hospital does not mean someone is ready to go home. Often, people are transferred to a skilled nursing facility (SNF). If the beneficiary was in the hospital for three days as an inpatient, then Medicare will only cover a short-term stay in a SNF. If the person’s stay does not meet those requirements, they could be required to pay for a SNF stay on their own, out-of-pocket.
These are some of the possible unexpected major costs for Medicare beneficiaries. It makes financial sense to learn more about these and take steps to plan for the possibility that out-of-pocket costs could be higher than originally thought.
Licensed Medicare agents
In order to sell this plan, agents need to complete an additional certification and training. Exclusive training will familiarize agents with all the components and properly represent the benefits of this ISNP.
Learn what working with one of the top FMOs gives you.
Keep up with all of our current events by clicking here.
Ready to contract? GET STARTED NOW.
Subscribe to our YouTube channel. We provide weekly training and informational webinars.
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What is Balance Billing?
Codes of ethics and even regulations and laws govern medical billing. This is to ensure uniformity across the healthcare industry and to keep everyone, providers and patients alike, operating under the same moral guidelines. However, there are some exceptions to this uniformity.
Balance Billing occurs when a doctor or healthcare provider bills their client more than the amount that would be reimbursed by Medicare for the services that they provided to the client. Normally, Medicare beneficiaries would pay their deductible and coinsurance, and Medicare would pay the healthcare provider the agreed upon assigned cost of the procedure, test, exam, or service. With balance billing, the doctors or other providers try to recoup the portion of the bill that was written off by Medicare coverage. They charge the beneficiary a bill for more than the normal deductible and coinsurance out-of-pocket costs.
Luckily, balance billing is often prohibited. If the healthcare provider is a participating member with Original Medicare, they cannot balance bill any of their patients for any reason. At last count, over 93% of non-pediatric primary care providers are participating providers with Medicare, so balance billing is likely very rare. If a doctor or provider is in-network with a Medicare Advantage insurance plan, balance billing is also not allowed. Balance billing is excluded under their contract with the insurance carrier.
Non-participating Providers
Balance billing can occur when a physician or facility is not a participating provider but also hasn’t opted out of Medicare. These are called non-participating providers, and they can balance bill their clients. However, they cannot charge more than the original Medicare amount for the service plus 15%. Medicare will pay these non-participating doctors 95% of the Original Medicare assigned amount. The doctor can then charge up to 15% more to their patient. For doctors who have opted out of Medicare altogether, there is no such limitation. This is rather rare among primary care physicians, but can be common among specialties. Only 1% of doctors have opted out of Medicare, but over 37% of psychiatrists have opted out of Medicare.
For members, it is vital to be aware of their doctor’s opt-in or opt-out status. Knowing avoids surprise balance billing and limit their unexpected costs.
Licensed Medicare agents – What is Balance Billing?
Get information about the new five star UHC ISNP. This plan is offered only to Crowe and Associates agents. In order to sell this plan, agents need to complete an additional certification and training. Exclusive training will familiarize agents with all the components and properly represent the benefits of this ISNP.
Learn what working with one of the top FMOs gives you.
Keep up with all of our current events by clicking here.
Subscribe to our YouTube channel.
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Medicare Advantage Commissions 2024
Medicare Advantage commissions 2024 are now official. CMS releases the max allowable commission for MA and PDP plans every year. Carriers can pay agent level commissions up to the max listed amount. While this is the amount they can pay it does not necessarily mean they will pay the max. Traditionally most do pay at the max however. A number of carriers have been increasing the renewals to the max for new renewals and in many cases for renewals on existing business.
There are 4 different commission groups:
The Medicare Advantage and PDP commission are broken up into different state categories. They are staying the same for 2024. Categories are (PA, CT and DC), (CA and NJ), (Puerto Rico and US Virgin Islands) and the (national rate). The national rate is all the other states not in the previous categories. PDP commissions are the same for all states.
Watch our tips on taking AHIP for 2024:
Take the 2024 AHIP for the discounted rate of $125 using our link
Medicare Advantage and Part D referral fee for 2024
The max allowable referral fee for MA and PDP plan sales is remaining the same. ($100 MAPD and $25 PDP) This represents how much agents can provide to other agents for a referral fee. It should not be confused with the amount that can be given to to other Medicare beneficiaries which is $15 for a referral.
Here is the official CMS commission document
Medicare Advantage Commissions 2024
2024 max allowable compensation and historical amounts.
| Plan Year | Medicare Advantage | PDP | ||||||
| National Rate | PA,CT,DC | CA, NJ | National Rate | |||||
| 2009 | $400 | $200 | $450 | $225 | N/A | N/A | $50 | $25 |
| 2010 | $403 | $202 | $454 | $227 | N/A | N/A | $53 | $26 |
| 2011 | $403 | $202 | $454 | $227 | $504 | $252 | $53 | $26 |
| 2012 | $402 | $201 | $453 | $227 | $503 | $252 | $55 | $28 |
| 2013 | $413 | $207 | $466 | $233 | $517 | $226 | $56 | $28 |
| 2014 | $425 | $213 | $480 | $240 | $532 | $266 | $56 | $28 |
| 2015 | $408 | $204 | $461 | $230 | $510 | $256 | $56 | $28 |
| 2016 | $429 | $215 | $483 | $242 | $536 | $268 | $63 | $32 |
| 2017 | $443 | $222 | $498 | $249 | $553 | $277 | $71 | $36 |
| 2018 | $455 | $228 | $511 | $256 | $567 | $284 | $72 | $36 |
| 2019 | $482 | $241 | $542 | $271 | $601 | $301 | $74 | $37 |
| 2020 | $510 | $255 | $574 | $287 | $636 | $318 | $78 | $39 |
| 2021 | $539 | $270 | $607 | $304 | $672 | $336 | $81 | $41 |
| 2022 | $573 | $287 | $646 | $323 | $715 | $358 | $87 | $44 |
| 2023 | $601 | $301 | $678 | $339 | $750 | $375 | $92 | $46 |
| 2024 | $611 | $306 | $689 | $345 | $762 | $381 | $100 | $50 |
| Puerto Rico & US Virgin Islands | Referral Fees | |||||||
| MA Plans | $100 | |||||||
| 2020 | $350 | $175 | PDP Plans | $25 | ||||
| 2021 | $370 | $185 | ||||||
| 2022 | $394 | $197 | ||||||
| 2023 | $411 | $206 | ||||||
| 2024 | $418 | $209 | ||||||
How are commissions paid?
How much an agent receives for a MA or PDP sales depends on a number of factors. What type of sale is a full commission on a 12 month advance? When is commission a renewal only payment? Will you receive a pro-rated commission? We have a video explaining all the factors agents need to understand.
Crowe and Associates programs for Medicare agents
Crowe and Associates has a number of programs for insurance agents including a T-65 Medicare seminar program, Free Medicare lead program and a number of others.
ISNP United Healthcare
If you are a Medicare agent, you have probably heard about the ISNP United Healthcare or (UHC IESNP) product. Fortunately, this product is now available exclusively to Crowe and Pinnacle agents & agencies.
The UHC IESNP is now commissionable to our partners!
This is a great opportunity to our agents as it covers both dual and non-dual members either at home or institutionalized. The UHC IESNP plan offers benefits that rival the best dual plans. Clients are quickly and easily approved
Now is the time to get appointed to sell!
Why sell
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5-star plan (PPO plan)
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Big benefits advantage over non-dual plans
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Exclusively for PFS and Crowe partners
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$1,500 or $1,600 OOP
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$160 to $200 quarter OTC
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$2,400 to $3,500 dental
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Transportation benefit
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Both Dual and non dual, drug help or no help at all
Get contracted with Crowe to sell these plans
Click here to begin a new contract with Crowe and Associates.
Add a carrier or state to your current Crowe and Associates contract.
For intent to move instructions, click here. Please note; Not all carriers are listed. Call the office for instructions for unlisted carriers.
This plan is available in the following states: NY, NJ, PA, FL and CT and will be expanding into over 20 more states by the end of August.
See link below for coverage areas:
IESNP coverage area map
Who can enroll in this plan?
- Duals and people with drug help: Can check status on Jarvis
- Those that are institutionalized or cannot perform ADL’s or cannot perform iADL’s. A quick phone call can qualify your client in minutes!
Please check the list of ADLs (basic things you need to do to survive and be well) below:
Standard for defining the areas of Activities of Daily Living is the Occupational Therapy Practice Framework, The activities are broken down into nine areas.
- Bathing/showering
- Toileting and toilet hygiene
- Dressing
- Eating/swallowing
- Feeding (the setting up, arranging and bringing food to the mouth)
- Functional mobility (the ability to get from place to place while performing ADLs, either under one’s own power or with the assistance of a wheelchair or other assistive device)
- Personal device care (utilizing essential personal care items such as hearing aids, contact lenses, glasses, orthotics, walker, etc.)
- Personal hygiene and grooming
- Sexual activity
Some administrators narrow the essential living needs into six broader categories referred to as basic Activities for Daily Living (bADL)
- Ambulating (moving)
- Dressing
- Feeding
- Bathing/showering
- Personal hygiene
- Toileting
Instrumental Activities of Daily Living (IADLS) are the things you can do to enhance your personal interactions and/or environment.
IADLs are typically more complex than ADLs and are important components of both home and community living and are easily delegated to another person.
- Care of others
- Care of pets
- Child rearing
- Communication management
- Driving and community mobility
- Financial management
- Health management and maintenance
- Home establishment and management
- Meal preparation and clean up
- Religious and spiritual activities and expressions
- Safety procedure and emergency responses
- Shopping
Find out about upcoming webinars, zoom and agent events
Click here for more plan & training information
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UHC IESNP Plan
The UHC IESNP Plan is a 5 Star Medicare Advantage PPO plan.
It is important to note; the only agents/agencies who are eligible to offer these plans to clients are Pinnacle/Crowe agents and agency partners of PFS/Crowe.
See below for some examples of who can qualify for this plan:
◦Special Needs Plan available to institutionalized people and those that require assistance with activities of daily living
◦Assisted Living, Home Healthcare, Memory Care or Independent Living
◦Dual and non dual members
◦Can be sold to members at home who qualify based on needs
◦Difficulties performing ADL’s (eating, bathing, getting dressed, toileting, transferring and continence
◦Inability to perform IADL’s: Basic self-care tasks: Examples: housekeeping, managing money, food preparation, managing transportation, managing medications, etc.
Before enrolling a client in this plan , you must verify eligibility:
- The first place to check if your client is eligible is on the UHC Jarvis portal
- If you cannot determine eligibility, you will go to Wellsky, a third party TPA vendor, and they will conduct a phone verification with the individual.
Some of the key benefits of this plan are:
- This is a 5 star plan
- Plans include access to in-person (at home or a facility) care from a UHC employed nurse, nurse practitioner or PA as well as a care coordinator
- The maximum out of pocket cost is between $1,500 and $1,600 (this is based on the state).
- There is a $2,400 to $3,500 dental benefit included
- The over the counter benefit is between $140 and $200 per quarter
- Hearing benefit of $2,000
Click here to see everything you need to know about the IESNP plans
In order to sell these plans, you must complete a separate certification:
The first step is to use the link below to view the training video. Once you have finished, make sure you scan the QR code using your phone’s camera.
Click here for UHC Assisted Living Plan Training – IESNP training page . Please note; you must be logged into the PFS site to access the video.
Once you complete the first step, you will receive a notification and in a couple days, the certification will be loaded into your Jarvis portal. You will find it in the invitation only section of the knowledge center.
Additionally; this plan pays standard UHC Ma plan commissions.