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Medicare Sales After AEP

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

Medicare Sales After AEP:  Review results and get organized

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

How can you handle the AEP more efficiently next year?

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

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

Strategy for the new year

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

Come up with a strategy to write business all year

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

T-65 Medicare educational seminars

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

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

WATCH A VIDEO ABOUT THE PROGRAM

Phone sales with online leads and live transfer leads

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

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

Medicare sales after AEP:  Retail sales

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

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

Working mail reply cards

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

Learn more about mail reply card marketing

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

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

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Medicare With Employer Coverage

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

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

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

Valid waivers for Medicare Part B

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

• Employer size of 20 or more employees

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

• Actively working

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

• Having coverage through the working spouses employer

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

 Important things to know

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

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

Medicare with employer coverage: Penalty

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

Delayed part B enrollment process

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

Delayed part B enrollment without a SEP

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

Medicare with employer coverage:  Tips

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

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

Medicare Part B Enrollment Rules 2023

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

Medicare Part B enrollment rules 2023:  Prior to 2023

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

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

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

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

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

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

Medicare GEP (January 1 through March 31 every year)

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

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

Medicare GEP enrollment as of 1-1-2023

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

Part B special election periods starting 1-1-2023

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

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

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

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Medicare Seminar Sales NY

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

How does the Medicare seminar sales NY program work?

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

Watch a recorded webinar on how the program works

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

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

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

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

Medicare Seminar Sales NY: Program cost

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

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

Ready to get started?

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

Watch all our agent training videos on YouTube

Trinity Health Plan of New England

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

To learn more about Trinity Health Plans; Click here

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

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

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

HMO 2023 Summary of Benefits; click here

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

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

These plans cover Every one of the top 100 drugs.

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

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

Take a look at the 2023 OTC catalog – Click here

Trinity Health Plan of new England – Pharmacy network:

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

Some of the pharmacies include:

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

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

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Medicare Insulin $35

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

Part D costs with the program

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

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

Medicare Insulin $35 copay:  Quoting plans

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

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

Changes to Medicare for 2023

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

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

Watch a video about the changes here

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SilverScript SmartRx 2023 PDP Changes for 2023

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

Commission

Name Change

Premium 

SilverScript SmartRx 2023: Quoting and comparing  

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

Connecture 

Sunfire

MyMedicareBot 

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

Medicare.Gov Plan Finder: 

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

Click here for agent benefits and programs

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Medicare hierarchies and contracting

Medicare hierarchies and contracting provides a review of the sales structure for independent agents, agencies and top of hierarchy (TOH) organizations.  This focuses on Medicare Advantage plans but the general concept applies to most product types.  However, commissions, override amounts and structures will vary.  We will also cover general carrier contracting for all levels including; independent agent, agencies, TOH.

Independent Medicare Advantage and PDP contracted agent

Independent agents are able to hold contracts with multiple carriers.  In some cases the agents are able to contract directly with insurance carriers or go through a hierarchy (upline).  Some carriers only allow agents to contract through an upline.

CMS max allowable compensation for MA and PDP (street commission)

Every year CMS sets the maximum allowable commission an independent agent can receive for Medicare Advantage sales.  The amounts listed as the max amount for a new MA sale and the max amount for a MA renewal. The renewal is half the initial amount.  The PDP commissions work the same way.   CMS breaks the states up into 4 groups.  The comp for each group is different. Groups are:

• CA and NJ:  Highest compensation
• CT, PA and DC:  2nd highest compensation
• National:  All other states not listed above and 3rd lowest compensation
• Puerto Rico and the U.S Virgin Islands:  Lowest compensation

Click here for the max commission amounts for 2023

Top of hierarchy organizations (Called FMO’s or NMO’s)

FMO’s and NMO’s are companies that contract with insurance carriers.  They receive compensation above what Medicare lists as the max compensation.   Both independent agents and agencies (more on agencies later) can contract through an FMO instead of direct with the insurance company.  Some insurance companies will only contract agents through an FMO.  The agent can access multiple insurance company contracts through the FMO.  In most cases, the agent is paid directly by the insurance company at the max allowable CMS compensation.  This is the case even though they contract through the FMO.  That means, the agent owns the book of business.  If they left the FMO for another FMO or went direct to an insurance carrier, their renewals and book of business would go with them.

The FMO receives an override (an set amount of money per sale)

When insurance agents sell a Medicare plan the FMO receives an override.  As a result, the more an agent sells the more overrides the FMO receives. The concept is designed to incent the FMO to help the agent sell more. This is done through training, contracting assistance, marketing programs, incentives, leads, agent services or a number of other value added programs. The FMO also receives overrides when cases renew.

If the FMO contracts an independent agent to receive commissions directly from the carrier, the agent receives the full CMS commission from the carrier. (Street commission direct pay)  The FMO will then receive the full override.  Override amounts can vary from carrier to carrier but we will use $125 as an example.  Every time the street agent sells a policy the FMO will receive a $125 override payment.  In most cases, the override is half the amount for renewal payments.

Medicare hierarchies and contracting:  Agencies under FMO’s

In many cases an independent agent will contract through a local agency or an agency with a contract level below the FMO level.  If this is the case, it is still common for agents to paid the full CMS commission directly from the insurance carriers.   In some cases the agents have the carriers pay the commission to the agency and then the agency pays it out to the agents.  This is called an LOA or commission assignment arrangement. (More on this later)

In general there are 3 levels of agencies under an FMO.  The level determines how much the agency will receive as an override.   Please note: overrides are one pool of money, they are not additional amounts above what the FMO receives.  When an FMO has an agency under them, they are giving up the portion of their override the agency is receiving.

Agency contract levels

GA-General Agent:

An agency at the general agent level receives a $50 override per sale.  The amount of override on the renewal is usually half of the initial override.  In most cases, the general agent needs to have at least 5 contracted and certified sub agents in order to get the GA level with any carrier.

MGA- Master General Agency:

Override of $75 per enrollment and half that amount upon cases renewing:   Minimum of 10 contracted and certified sub agents to have the MGA level

SGA-Senior General Agency:

Override of $100 per enrollment and half that amount upon cases renewing:  Minimum of 20 contracted and certified sub agents to have the SGA level.  This level also requires production minimums in addition to the min number of sub agents.

The amount of override paid to the agency under an FMO is deducted from the amount of override they would receive with a street agent only.   Example:  Street agent under an MGA agency that works through an FMO.   Agent get the max allowable commission paid directly from insurance carrier.  The MGA gets a $75 override and the FMO gets a $50 override (assuming the FMO was getting a $125 override)

Levels:

The agency levels are all splitting one pool of money for overrides. (assuming a $125 FMO override level)   If an FMO has a GA under them, the GA gets $50 and the FMO gets $75)  If an FMO has an SGA under them, the FMO gets $25 and the SGA gets $100.   If the SGA has a GA under them, the SGA gets $50 and the GA gets $50)

• FMO ($125)
• SGA ($100)
• MGA ($75)
• GA ($50)
• Street agent (gets full CMS commission paid directly from the insurance company regardless of how many agencies in hierarchy)
• Note:  PDP plans also have override payments but they are substantially less than MA plans

Medicare hierarchies and contracting: commission payment methods

Direct pay:  In most cases, independent agents are paid directly from the carrier.  This is often the case for agents appointed directly with a insurance company and also often the case when contracted through an upline. (FMO,SGA,MGA,GA) When an agent is set up as direct pay from the insurance carrier, the agent owns the book of business and the commissions.

LOA contract/Commission assignment

In some cases an agent will not have their commission paid directly to them.  The agent is writing the business but the insurance company is not paying the compensation direct to the agent but to another agent or  an entity/agency.  The agent or entity receiving the commissions are then paying the agent based on some type of agreed upon amount. The amount paid is usually an amount below the CMS maximum amount.

This is often the case for a w-2 agent writing business for a company or agency.  It can also be used for a 1099 agent when the upline is providing some type of value in exchange for a portion of the commission.   In this case, the writing agent does not own the book of business.  If they leave the upline, the commissions will continue to be paid to that upline at whatever terms and conditions had been agreed upon.

Medicare hierarchies and contracting: Contracting agencies and sub agents

Any agency cannot contract another agency under them at the same level.  For example, if an SGA wants to bring on another agency, the highest level the agency could be is an MGA. IN other words; they must be one level below the upline.

Having commissions paid to an entity:

Medicare Advantage and Part D commission can pay to an entity.  In order for the entity to be paid, it must hold an insurance license.  Further, the entity must have a listed principal (person) and that principal must be contracted and certified with any given carrier for the entity to be able to receive commissions

Individual person as an agency: 

An individual can be considered either a GA, MGA or SGA.  This is the case when they meet the minimum amount of sub agents required by a carrier. An individual they can be given an agency contract as an individual.  Having an entity with an insurance license is not a requirement for most insurance companies

Agency with producers (sub agents) in other states

In order for an agency to receive overrides in any given state, that agency must hold an insurance license in that state and be appointed and certified with that carrier.  This can be problematic when an agency brings on a producing agent that is licensed in states the agency is not licensed in.

Medicare Savings Program CT 2023

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

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

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

There are 3 different levels of MSP:

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

Click here for income level chart.

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

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

SLMB – this level pays your Part B premium only.

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

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

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

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

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

Click here to download a CT MSP application

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

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

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

Medicare Changes 2023

The Medicare changes 2023 includes the 2023 benefits and major changes in Part B enrollment rules.   The standard benefit changes for 2023 Medicare A and B benefits are listed below.  This includes premiums, deductibles and copays.  In addition, there are some changes to part B enrollment time frames.  There are also some notable changes to the Medicare Part D model plan design which is detailed below.

Rather learn about this information via a recorded webinar?  Review our webinars on YouTube

Big changes to Medicare Part B enrollment

The Beneficiary Enrollment Notification and Eligibility Simplification Act (BENES ACT) creates some major changes for Medicare Beneficiaries effective 1-1-2023.

Changes to Part B enrollment

• Those in the last 3 months of their Medicare Part B IEP will be able to get a part B effective date the month after they apply!
• Those applying for Medicare Part B through the Medicare Part B General Election Period will have their Medicare B start the month after they apply.  They will no longer need to wait for a July 1 start date!
• There will be a number of Medicare Part B SEP’s for those applying outside of their IEP or the Medicare GEP
  • Those that had an emergency or disaster during their Medicare B IEP or Medicare B GEP
  • An employer or health plan made an error or material misrepresentation of information as it relates to the members Medicare enrollment
  • Those formerly incarcerated
  • Those that lose Medicaid

Medicare Agents!  Learn how to hold Medicare T-65 educational seminars to explain the important changes to Medicare prospects.  (Averaging 60 attendees per seminar)

Medicare Changes 2023:  Part A of Medicare

The Medicare Part A premium and deductible will be changing slightly for 2023.  Medicare Part A includes inpatient hospital, skilled nursing, hospice, inpatient rehab and some home health care services.

• Inpatient hospital deductible (if admitted): Changing from $1,556 in 2022 to $1,600 in 2023
• Co-insurance will be $400 per day from day 61 through 90  ($389 in 2022)

Medicare Part A monthly premiums

Medicare enrollees age 65 and over with fewer than 40 coverage quarters and people with disabilities may voluntarily enroll in Medicare Part A at no monthly cost. Those with at least 30 quarters of coverage or were married to someone with at least 30 quarters of coverage may buy into Part A at a monthly premium.  The premium will be $278 a month starting in 2023.  This is $4.00 more a month than 2022. Individuals without other coverage and less than 30 quarters of coverage and individuals with disabilities without other coverage or have exhausted other entitlement will pay the full premium. The amount in 2023 will be $506 a month.  This is an increase of $7.00 a month compared to 2022.

Medicare changes 2023: Part B of Medicare

• Medicare Part B premium for 2023:  Monthly B premium will be $164.90 which is a reduction of $5.20 a month compared to 2022
• Annual Medicare Part B deductible:  The deductible for 2023 will be $226 which is a reduction of $7.00 a month from 2022

Medicare Changes 2023: IRMAA (Income Related Monthly Adjustment Amount)

Those with higher incomes pay more for the monthly Medicare Part B premium.  Please keep in mind, IRMAA income is based on the income of the individual from 2 years prior to the current year.  It is adjusted every year going forward.

Immunosuppressive Drug Coverage only

Beginning in 2023, Medicare enrollees who are 36 months after kidney transplant and no longer eligible for Medicare , have the option to continue Part B to cover immunosuppressive drugs. There will be a premium of $97.10 to do so.  This program will coordinate with MSP for those eligible for the program.This is a limited Part B that will cover immunosuppressive drugs only.

The 2023 Part B monthly premiums for higher earning beneficiaries with immunosuppressive drug only Part B coverage are listed in the table below:

Premiums for high-income beneficiaries with full Part B coverage who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows:

Medicare Changes 2023: Higher earning beneficiaries with immunosuppressive drug only Part B coverage that are married and lived with their spouse at any time during the year, but file a separate return.

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Call Recording Connecture Sunfire MyMedicarebot

Connecture, Sunfire and MyMedicarebot are 3 different Medicare quote and enrollment platforms. Agents working with Crowe and Associates and PFS insurance have access to all at no cost. Agents can access all 3 through Connect4Medicare.com (You need a username and password to access the site).  Call or email our office if you do not have a username and password.

WANT TO GO STRAIGHT TO THE CALL RECORDING VIDEO EXAMPLES FOR EACH SYSTEM?  SCROLL TO THE BOTTOM OF THIS BLOG POST

All 3 systems work in a similar manner by letting agents quote and compare plans and enroll prospects without the need for a face to face meeting.  They will also have the ability to record calls compliant with the new CMS call recording rules.  READ ABOUT THE NEW MEDICARE CALL RECORDING RULES FOR AGENTS HERE  There are a number of features common to all 3 systems which are listed below.  The call recording features are further down the blog post.

Common features for Connecture, Sunfire and MyMedicarebot

• Basic CRM function that saves client contact information, applications, scope of appointment documents, drug lists, doctors lists and plan history
• Create plan comparisons and email or text them to prospects and clients
• Run drug and doctors lists against the plans to see what comes out best
• The system is similar to the Medicare plan finder.  The differences are you can save all the info and you are the selling agent when using one of the 3 platforms
• Record all phone calls to be compliant with the CMS call recording requirements.  (Saves recording for the 10 years required)
• Enroll prospects over the phone via text or email (Connecture and Sunfire)  MyMedicareBot is voice signature for the scope and enrollment without the need for email or text
• Access to PURL links that allows clients and prospects to quote and compare plans and ultimately enroll in a plan on their own.  (You will be the AOR if they do)  The PURL is specific to the agent and has the agents contact information.  It can be added to a website or sent as a link through email.  Learn about the PURL
• Ability to see and compare all plans available in the area even if agent is not appointed with the company
• Watch recorded webinar on Connecture, Sunfire and Medicarebot
• You can submit your health risk assessment through Connecture & Sunfire
  • Connecture HRA carriers 2023 – Click here
  • Sunfire HRA Carriers 2023 – Click here

Update: All platforms will provide call recording at no cost to the agent.  It was initially thought there would be an extra cost to for the recording feature through Connecture but PFS insurance has made the decision to cover the additional cost for agents

Access MyMedicarebot, Connecture and Sunfire through Connect4Medicare site

MyMedicarebot

• MyMedicarebot is voice signature:  No need to email or text scopes or enrollment links
• There is a downside due to the limited number of carriers available
• Current carriers available:
  • Aetna – Quote/Enroll
  • Cigna – Quote/Enroll
  • Humana – Quote/Enroll
  • UnitedHealthcare – Quote/Enroll
  • Wellcare – Quote/Enroll
  • Anthem – Plans to be Quote only by 10/15!
  • Agents will be able to quote and compare all plans doing business in a given county but will only be able to send quotes and enroll the ones listed above

Connecture

• Connecture if making a number of improvements for 2023.  This includes the ability to enroll prospects into ancillary products such as dental, vision and hospital indemnity plans.  It will also have a feature to show drug savings programs for off formulary medications.
• Connecture has a comprehensive number of carrier available for enrollment and the ability to see carriers that the agent is not contracted to sell
• Click to see new Connecture Features for 2023

Sunfire

• Sunfire has a large number of upgrades for 2023 such as ability to pre fill the entire SOA, Access to plan history, MBI, drug help and dual status and a number of other features by giving agents access to the Marx system (limited version but still incredibly useful)
• Ability to see all plan benefits and all extra benefits on the initial 3 plan comparison without the need to drill down on benefit details.
• Very user friendly platform for agents and prospects
• Ability to see agent ready to sell (RTS) with all carriers in all states

Call Recording Connecture Sunfire MyMedicarebot:  Videos of call recording features using the links below

CLICK FOR CONNECTURE RECORDING VIDEO 

SUNFIRE RECORDING VIDEO 1

SUNFIRE RECORDING VIDEO 2

MyMedicarebot RECORDING VIDEO 

Free Medicare lead and marketing program

Crowe and Associates offer a Medicare lead program to agents!  $500 per agent per month toward any Medicare lead or marketing costs

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CMS Call Recording Requirements

CMS call recording requirements for insurance agents are a result of the CMS Final Rule set for October 1, 2022.  The rule expands the definition of who is a TPMO to include independent Medicare agents, agencies and brokers. The rules are applicable to MA/MAPD and Part D products.  Because CMS does not regulate Medicare supplement products, CMS does not include them in the new rule.  TPMO stands for Third Party Marketing Organization and now includes NMO’s, FMO’s, agencies, brokerage, independent agents and brokers.   This blog will provide an outline of the changes from the Final Rule and also how agents can be compliant with them for the 2023 AEP.

The new rules

The new rules are applicable to all TPMO’s.  The definition of a TPMO has been expanded to include both independent agents and agencies. Agents need to be compliant with the new rules by October 1, 2022.  Here are the main points to know:

• Record all calls with Medicare beneficiaries in their entirety, including the enrollment call. The rule is including the entire “chain of enrollment” which requires agents to record inbound and outbound calls, enrollments calls and any calls leading up to the enrollment and post enrollment.  (If the call is going to lead to a Medicare Advantage or PDP or the attempt to make a sale)  The recording must be available for 10 years
• The addition of a TPMO disclaimer on enrollment phone calls and any marketing materials;  the agent must state the TPMO disclaimer within the first minute of the enrollment/sales call.
• TPMO disclaimer must also be displayed on all Medicare marketing materials (Not Medicare supplements) which includes emails, websites, newspaper ads, flyers, mailers or any other promotional advertising method
• NOTE:  Call recording is NOT required when meeting for a face to face meeting.  There is also no recording requirement for educational events
• Zoom Calls:  Some carriers are stating Zoom calls are a face to face meetings.  (CMS is stating Zoom calls are not face to face and recording is needed)

CMS call recording requirements: The TPMO disclaimer

Here is the disclaimer which must be used for sales calls and on all marketing materials as well as all marketing communications:

“We do not offer every plan available in your area.  Any information we provide is limited to those plans we do offer in your area.  Please contact Medicare.gov or 1-800 MEDICARE to get information on all options.”

Immediate steps for agents

Take the following steps to be compliant with the new rule for October 1, 2022.

• Add the TPMO disclaimer to your website
• Have the TPMO disclaimer on all email communications
• Easiest way is to add the disclaimer to your email signature line
• Add TPMO disclaimer to all marketing materials including print and TV ads.
• Use an enrollment platform that can record calls and keep them for the required 10 years  (We offer Connecture, Sunfire and MyMedicareBot at no cost)
• If you do not have access to an enrollment platform, add a service to record all calls at the office or home.  Many companies offer the service at a surprisingly low cost ($25 to $45 a month).

Connecture, Sunfire and MedicareBot offer call recording and 10 year recording storage at no cost to our agents! Learn about all three systems and watch 3 minute demonstration videos of the call solutions for each

CMS Call Recording Requirements:  Other questions and rule enforcement

Many agents are asking if they need to record all calls vs. recording only the enrollment calls.  The CMS rules make it clear; the expectation is to record all calls in the “chain of enrollment”.  This means you should record all calls leading up to the sale.  This includes the sale as well as post enrollment calls.  The unanswered question is;  how will CMS regulate it. It is reasonable to assume the carriers (They ensure compliance of CMS rules for TPMO’s) will only ask for the actual enrollment call when doing compliance checks.  Keep in mind; this is not guaranteed, so the way to be sure of 100% compliance is to record all calls.  There will likely be many agents that record the sales/enrollment call only.  Only time will tell if that is enough to stay in good standing with compliance checks.

Learn about our T-65 Medicare seminar program!  Averaging 65+ prospects per seminar!  Our agents and agencies can run seminars throughout the year using this turnkey seminar program.

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