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Medicare Enrollment: When It’s Automatic and When You Need to Sign Up

Medicare enrollment can be confusing, especially when it’s not clear whether you’ll be enrolled automatically or if you need to take the first step yourself. As either a Medicare agent or beneficiary, knowing when is Medicare enrollment automatic is critical to avoid late enrollment penalties and coverage gaps.

Here’s a breakdown of when Medicare enrollment happens automatically and when beneficiaries need to sign up on their own.

When Medicare Enrollment Is Automatic

Individuals are automatically enrolled in Medicare Part A and Part B at age 65 if:

They already receive Social Security or Railroad Retirement benefits

Individuals who collect either Social Security or Railroad Retirement Board (RRB) benefits for at least four months before their 65th birthday are automatically enrolled in:

• Medicare Part A (hospital insurance)
• Medicare Part B (medical insurance)

In most cases, These individuals receive their Medicare card about three months before their 65th birthday.

Those under 65 and have a qualifying disability

Individuals who receive Social Security Disability Insurance (SSDI) for 24 consecutive months, are automatically enrolled in Medicare once they reach the 25th month of disability benefits.

Please Note: Individuals with ALS (Lou Gehrig’s disease) receive Medicare automatically the month their disability benefits begin.

When You Need to Sign Yourself Up

Individuals must enroll themselves in Medicare if:

They’re not receiving either Social Security or RRB benefits

In many cases, people decide to delay the receipt of Social Security until after age 65 to maximize their benefit amount. Those individuals are not automatically enrolled in Medicare; they must sign themselves up during their IEP (Initial Enrollment Period).

The IEP is a 7-month window that starts 3 months before, includes the month of, and ends 3 months after the beneficiary’s 65th birthday.

Individuals who have employer coverage and delay Part B enrollment

Those still working and receive health coverage from a large employer (20+ employees) group health plan may choose to delay Part B and avoid paying the monthly premium. In that case, they must sign up later during a SEP (Special Enrollment Period). This is an 8 month window when individuals can sign up for Part B once their employer coverage ends or they stop working (whichever comes first).

Watch a YouTube video on OEP, SEPs and Late Part B enrollment

Important: COBRA and retiree coverage do not count as active employer coverage. Individuals may face penalties if they delay Medicare enrollment and rely on these plans.

What If You Miss Enrollment

If you miss your IEP and don’t qualify for an SEP, you’ll have to wait for the General Enrollment Period (GEP):

• January 1 – March 31 each year
• Coverage begins the month after you enroll
• You may owe a late enrollment penalty for Part B (and Part D if applicable)

Tips for Clients & Agents

• Mark your calendar: Your IEP starts 3 months before your 65th birthday.
• Enroll on time: Even if you’re healthy, missing the window can cost more later.
• Coordinate carefully: If still working, check with HR or your agent before delaying Medicare enrollment.
• Check coverage: Compare Original Medicare vs. Medicare Advantage (Part C) and add Part D or Medigap as needed.

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Need Help Enrolling

Whether you’re approaching 65 or advising clients, navigating enrollment can be tricky. Medicare.gov provides tools to check eligibility and apply online; agents can help guide clients through the process to avoid delays and penalties.

Knowing when Medicare enrollment is automatic and when you need to enroll yourself helps avoid costly mistakes. As an agent, walking clients through this process adds tremendous value. If you’re a beneficiary, planning ahead ensures a smooth transition into Medicare with the coverage you need.

Have questions about a specific situation? Reach out to a licensed Medicare agent who can provide personalized guidance based on your health needs and budget.

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Simplified Issue vs. Guaranteed Issue Life Insurance: What Agents Need to Know

As an insurance agent, especially one working with Medicare beneficiaries and seniors, it’s crucial to understand the nuances between Simplified vs Guaranteed Issue life insurance. Both products serve clients who may not qualify for traditional fully underwritten policies, but knowing when to recommend one over the other can make a big difference in value, affordability, and the suitability of coverage.

Let’s break down the key differences between these two life insurance types. This will enable agents to make an informed decision when figuring out which is the best fit for their clients.

Simplified Issue Life Insurance

Simplified Issue life insurance offers a streamlined underwriting process that doesn’t require a medical exam. Instead, the insurer evaluates eligibility based on answers to health questions and prescription or medical history checks.

Key Features:

• No medical exam, but a few health questions are required
• Faster approval—often within days
• Lower premiums than Guaranteed Issue
• More generous coverage amounts (e.g., $25,000–$50,000 or more)
• Ideal for clients in decent health who may have minor conditions but want quick coverage

Best for:

• Seniors who can truthfully answer “no” to key health questions
• Clients who want better rates and higher coverage without full underwriting
• People planning for final expenses or supplemental coverage

Watch a quick video on how to quote Final Expense

Guaranteed Issue Life Insurance

Guaranteed Issue life insurance is a no-questions-asked policy; approval is guaranteed regardless of health history or any current illnesses/conditions. This insurance is a valuable safety net for individuals who’ve been declined for other types of life coverage.

Key Features:

• No medical exam and no health questions
• Guaranteed approval for ages typically 50 to 85
• Higher premiums for lower face amounts (commonly $5,000–$25,000)
• Includes a graded death benefit (e.g., no full death benefit if death occurs within the first 2–3 years unless accidental)

Best for:

• Clients with serious or terminal health conditions
• Individuals recently declined for simplified or fully underwritten policies
• Those needing burial insurance with an easy qualification process

Side-by-Side Comparison

Feature	Simplified Issue	Guaranteed Issue
Medical Exam	No	No
Health Questions	Yes	None
Underwriting Time	Fast (days)	Instant to a few days
Coverage Amount	Higher (up to $50K+)	Lower (up to $25K)
Premiums	More affordable	Higher per $1K of coverage
Graded Benefit	Sometimes	Always
Who It’s For	Clients in fair to moderate health	High-risk or uninsurable clients

Which to Recommend

• Start with Simplified Issue: If clients can pass a basic health screening, they’ll get better rates and more coverage.
• Use Guaranteed Issue as a fallback: It’s the best option when a client is uninsurable elsewhere but still wants peace of mind.
• Educate about the graded benefit: Many clients don’t realize Guaranteed Issue policies won’t pay full death benefit for 2–3 years, except for accidental death. Be clear on this to avoid misunderstandings.
• Manage expectations: Emphasize that “guaranteed” doesn’t mean better; it means last resort in most cases.

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Understanding Simplified vs Guaranteed Issue life insurance can help you serve your clients with integrity and clarity. These are valuable tools for seniors who need coverage quickly with minimal hassle, but choosing the right product depends on honest conversations about health, budget, and goals.

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As an agent, your role is not just to sell a policy; it’s to provide the most suitable product available. That starts with understanding the distinctions and guiding clients with transparency.

How Medicare Covers Diabetic Supplies And Where to Get Help

Managing diabetes effectively is extremely important and requires reliable access to the necessary supplies. For Medicare beneficiaries living with diabetes, understanding what’s covered and how insurance pays for it is essential. As a Medicare agent, helping clients navigate these benefits can make a real difference in their quality of life. We will go over Medicare payment of diabetic supplies and provide information on how to get help locating and paying for them.

Diabetic Supplies Medicare Covers

Medicare Part B (Medical Insurance) covers certain diabetic supplies for all beneficiaries who have diabetes, whether they use insulin or not. Here’s what they typically cover:

• Blood glucose monitors
• Blood sugar test strips
• Lancets and lancet devices
• Glucose control solutions
• Continuous Glucose Monitors (CGMs) and related supplies

For beneficiaries who use insulin, Medicare also covers insulin pumps and pump-related supplies under Part B if the pump qualifies as durable medical equipment (DME).

Important: Insulin itself (unless used with a pump) syringes, needles, alcohol swabs, and gauze are generally covered under Medicare Part D (the prescription drug benefit).

How Much Medicare Pays

Under Medicare Part B, Medicare pays 80% of the Medicare-approved amount for covered diabetic supplies after the beneficiary meets the Part B deductible. The beneficiary is responsible for the remaining 20% unless they have additional coverage (like a Medigap plan or Medicaid) that helps with cost-sharing.

If diabetic supplies are obtained through a Medicare-enrolled supplier, the beneficiary avoids unnecessary out-of-pocket costs. That’s why it’s essential to work with reputable providers who are participating providers under Medicare.

Where to Get Supplies: Advanced Diabetic Supply Group

One of the most trusted names in diabetic supply delivery is the Advanced Diabetic Supply Group (ADS).

Here’s why Medicare beneficiaries and agents should consider ADS:

Watch a YouTube video on Advanced Diabetes Supply and how they can help your clients

• Medicare-Enrolled Supplier: ADS is an accredited Medicare DME provider, which means they meet strict compliance and billing standards.
• Home Delivery: Supplies are shipped directly to the beneficiary’s home—saving time and eliminating pharmacy trips.
• Bilingual Support: ADS offers customer service in English and Spanish, making communication easier for diverse clients.
• Insurance Coordination: They work directly with Medicare and many private insurance plans to verify coverage and handle paperwork.

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As an agent, you can refer clients to ADS knowing they’ll receive quality care and proper billing, which leads to better health outcomes and fewer surprises.

Tips for Agents and Beneficiaries

• Stay enrolled: Ensure your client’s Medicare coverage is active and updated.
• Verify suppliers: Always use Medicare-approved suppliers to avoid denied claims or excessive costs.
• Review needs annually: Reassess whether your client’s current plan covers all their diabetic needs, especially during the Annual Enrollment Period (AEP).

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Grassroots Marketing for Medicare Agents: Building Your Book of Business

In an increasingly digital world, there’s still no substitute for genuine, personal connection; especially in Medicare sales. Grassroots marketing for Medicare agents can be one of the most effective and affordable ways to grow your book of business, especially in local communities where trust and reputation go a long way. Whether you’re a new agent or looking to reinvigorate your outreach strategy, grassroots marketing tactics can build lasting relationships and drive referrals.

Volunteer in Your Community

Volunteering is a powerful way to connect with people on a personal level while giving back. Choose causes that align with your values and attract your target demographic; such as food banks, senior centers, or veterans’ organizations.

Consider wearing a name badge or shirt with your agency’s logo while volunteering, and carry business cards or branded leave-behinds. In these settings, people often ask what you do, giving you a natural way to mention your services.

Ask for Referrals from Satisfied Clients

Even in today’s world; word-of-mouth remains king. Clients who trust you are your best advocates. Don’t be afraid to ask for referrals, just be compliant and tactful in how you do it.

Tools:

• Create business cards for clients to pass to friends. It is a good idea to put a picture of yourself on your cards to help people become familiar with you.
• Follow up with a handwritten thank-you note and a small token of appreciation; such as a $10 coffee gift card or a some small token (keeping it under $15 to stay compliant).

Additionally: Consider including a line on your business card or email signature: “Know someone who has questions about Medicare? I’m happy to assist!”

Build Local Business Relationships

Partner with local businesses that serve your ideal clientele; pharmacies, barbershops, community banks, independent living facilities, senior centers, libraries, etc.

Strategies:

• Offer to leave business cards, flyers or brochures at the front counter.
• Cross-refer: If they refer customers to you, do the same for them.
• Host joint educational events (e.g., “Medicare and Medication Q&A” with a local pharmacist).

Leave-behind ideas:

• Branded pens, pill organizers, or reusable shopping bags are all affordable and practical.

Host Seminars and Educational Events

Educational seminars are a compliant and effective way to attract new prospects. People appreciate clear, unbiased information about Medicare—especially when it’s presented in an easy-to-understand format.

Watch a quick YouTube on Educational Seminar Best Practices

Some Ideas on Where to Host:

• Local libraries
• Senior centers
• Churches
• HOA clubhouses

What to Bring:

• Printed guides or FAQs
• Sign-in sheet (for permission-based follow-up) voluntary only
• Medicare-compliant presentation materials
• Small giveaways like notepads, magnifying glasses, or bookmarks (again, under $15 in value) with your logo and contact information

Be sure to check with carriers and CMS for current marketing rules around events and materials.

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Be Where Your Audience Is

Don’t wait for people to come to you; go where they already are.

A Few Ideas:

• Set up an information booth at a farmer’s market or community fair (with proper permission).
• Attend Chamber of Commerce or Rotary Club meetings.
• Sponsor a senior bingo night or lunch-and-learn event.

Use these opportunities to show up as a helpful resource, not a salesperson.

Consistency is Key

Grassroots marketing takes time but builds true connections. It’s not about flashy ad budgets; it’s about showing up, being authentic, and providing value. If you make it easy for people to refer you, remember you, and trust you, your Medicare book of business will grow; one interaction at a time.

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Suggested Leave-Behinds or Referral Gifts (All $15 or Less):

• Branded pill organizers
• Magnifying bookmarks
• Reusable grocery bags
• Hand sanitizers with your logo
• Small potted plants or succulents
• Coffee mugs
• $5–$10 gift cards (compliance-checked)
• Mini first aid kits
• Magnetic calendars with your logo and contact information

Looking to grow your Medicare practice? Start with your community; the most powerful marketing tool you have is you!

Final expense insurance; also known as burial insurance or funeral insurance, is one of the most practical and emotionally impactful products in the life insurance industry. It provides a straightforward solution for covering funeral and end-of-life costs. We will go over Final Expense Plan basics so you can get a general idea of the value of these plans.

This guide breaks down what agents need to know to confidently sell final expense insurance; from plan types and terminology to underwriting insights and a step-by-step sales process.

Final Expense Insurance

Final expense insurance is a type of permanent whole life insurance with a low death benefit, typically between $2,000 and $50,000. It’s designed to pay for funeral expenses, medical bills, debts, and other end-of-life costs. This helps provide peace of mind for the individuals who purchase the coverage and their loved ones.

Key Characteristics:

• Whole life insurance product (not term)
• Level premiums for life
• Guaranteed death benefit (as long as premiums are paid)
• No medical exam required (simplified issue or guaranteed issue)
• Cash value accumulation

Final Expense Terminology

Understanding the lingo is important when discussing plans with clients:

Term	Meaning
Face Amount	The death benefit amount the beneficiary receives
Simplified Issue	Underwriting involves health questions but no medical exam
Guaranteed Issue	No health questions, approval is guaranteed
Level Benefit	Full death benefit from day one
Graded Benefit	Partial death benefit for the first 2-3 years
Modified Benefit	Death benefit increases over time or excludes certain causes initially
Cash Value	A savings component that grows over time (part of whole life)

Watch a quick YouTube video on Life Insurance Basics

Final Expense Plan Types

Final expense plans generally fall into three categories:

1. Level Benefit Plans

• For healthy clients who qualify based on health questions
• Immediate full death benefit
• Lowest premiums

2. Graded Benefit Plans

• For clients with moderate health issues
• Limited death benefit in first 2–3 years (often 30%-100% of premiums refunded + interest)
• Full benefit kicks in after graded period

3. Guaranteed Issue Plans

• No health questions
• Suitable for high-risk clients (cancer, dementia, etc.)
• Always have a 2-year waiting period

Underwriting – What Clients Can Expect

Final expense underwriting is more lenient than traditional life insurance. Most policies are simplified issue, which means:

• No medical exam
• Short health questionnaire
• Carriers may use tools like:
  • Prescription history databases
  • MIB (Medical Information Bureau)
  • Height and weight tables
  • Phone interviews

Health Conditions That May Affect Plan Type

Condition	Impact
Controlled hypertension or cholesterol	Usually qualifies for level benefit
Diabetes with no complications	Often still qualifies for level benefit
COPD, CHF, recent cancer	May only qualify for graded or guaranteed issue
Terminal illness or dementia	Guaranteed issue only

Agents: It is important to ask questions that can bring up common risk flags to prepare the best plan quote for your client to ensure they receive the coverage they need.

Sales Process: From Lead to Close

1. Lead Generation

• Direct mail, Facebook, Google ads, or warm referrals
• Focus on individuals aged 50–85
• Consider grass roots community marketing, telemarketer or aged leads if on a budget

2. First Contact & Rapport Building

• Start by actively listening to them and getting to know them
• Focus on protection and peace of mind, not insurance jargon
• Example: “Many of my clients want to make sure their families aren’t left with bills or funeral costs. Do you have coverage for that?”

3. Fact-Finding & Budgeting

Ask about:

• Age, health conditions, and medications
• Existing coverage
• Budget comfort level (not just affordability)

4. Present the Plan Options

• Present a few options that fall within their budget; an online quoting tool like Best Plan Pro makes this easy
• Explain the difference between level, graded, and guaranteed issue plans
• Emphasize guaranteed premium amounts and lifelong coverage

5. Application Process

• Most carriers offer e-apps, telephonic apps, or paper apps
• Walk the client through health questions and disclosures
• Submit application

6. Follow-Up and Delivery

• Confirm approval
• Review the policy with the client
• Schedule an annual check-in
• Ask for referrals!

Learn more about Final Expense Sales 101

A Few Tips for Agents

• Educate first, sell second: Although clients make the purchase based on emotion, they need to feel informed and confident in their decision.
• Practice transparency: Ensure clients understand graded periods or waiting periods upfront.
• Respect the budget: Because many clients live on a fixed income, it is not a good idea to sell them a policy they cannot afford. This can lead to loss of trust between you and the client and policy cancellation and a chargeback.
• Focus on family protection: Present the policy purchase as a layer of asset protection and legacy, not just an expense.

Click here if you are ready to get contracted with Crowe

Final expense insurance offers security and simplicity for clients as well as an opportunity for agents. By mastering the product, understanding client needs, and delivering with compassion, you’ll not only increase your sales but also build a business rooted in service and trust.

Keep up with the latest events and information for Medicare agents; click here

Final Expense Sales 101 – How to Make the Sale

If you’re already helping clients with Medicare, you have a golden opportunity sitting right in front of you: final expense insurance. It’s a natural cross-sell that fits perfectly into your existing appointments and client relationships. This post walks you through final expense sales 101 and explains how to integrate this product into your business and add value without being pushy.

Why Add Final Expense to Your Medicare Business

1. You Already Have the Right Audience

Because final expense insurance targets people aged 50–85, it is a similar demographic to those you’re already serving with Medicare. Many of these individuals are on a fixed income, value peace of mind, and trust you as their insurance advisor.

2. You’re Already Having the Conversation

During your Medicare appointment, you’re already talking about:

• Health concerns
• Retirement income
• Budget constraints
• Planning for the future

Adding a conversation about funeral costs, protecting loved ones from unexpected expense and leaving a financial legacy is a natural extension, not a separate pitch.

Watch a quick YouTube video on Why and How to Sell Ancillary Products With Medicare

3. You Increase Your Value to The Client

Because you are already providing health coverage advice, why not offer additional value and increase your commissions. Selling additional products to a client helps solidify your relationship.

4. Increased Client Retention

Clients who purchase multiple products from an agent are more likely to stay with you long-term. Final expense policies also open the door for life-long renewals.

How to Introduce Final Expense

After Medicare Enrollment

Once you’ve helped the client enroll in a Medicare plan, say something like:

“Are there any other health or life products you would like to discuss? Many of my clients have asked about final expense coverage; they want to make sure loved ones aren’t left with a financial burden.

Ask if they already have something in place for that. If they say yes, say “That’s great, do you know if it’s term or whole life? Some people are surprised when they realize their policy might end before they need it.

If they say no or aren’t sure; offer to look at some options that fit their budget. Many people just want something to cover their final expenses (10,000 to 15,000) so their family is not stuck with a large bill. This frames the conversation as standard and proactive; not a sales pitch.

Position It As Peace of Mind

Avoid phrases like “life insurance” and instead say:

• “Funeral coverage”
• “Final expense plan”
• “A little extra protection for your family”

Make it about the emotional benefit, not just the policy.

How to Get Started

• Contract with final expense carriers like Mutual of Omaha, Aetna, Transamerica, or Foresters.
• Quoting tool (e.g., CSG Actuarial or Best Plan Pro).
• Short presentation script tailored for Medicare clients.
• Lead follow-up system or CRM (many Medicare CRMs support multi-line tracking).

Click here if you are ready to get contracted with Crowe

Medicare-Final Expense Agents

Final expense insurance is an easy and impactful way to help your clients and increase your revenue. You’re already meeting with the ideal audience, now it’s about offering a solution to a very real concern.

Start by asking simple, compassionate questions. Frame the coverage as peace of mind. Remember, your clients trust you, and they want your help.

Final expense isn’t a separate business; it’s a natural extension of the one you’re already building.

Important: Be sure to include this or any product you plan to discuss with potential clients on your scope of appointment to be compliant with CMS guidelines.

Keep up with the latest events and information for Medicare agents; click here

As a Medicare agent, you’re not just helping clients find the right plan, they depend on your advice to help them navigate through all the complexities of Medicare. One important thing agents do is explaining Medicare penalties, this ensures clients avoid costly surprises.

Educating clients early using understandable terms on how to avoid these charges helps build trust and reinforces your value as a trusted advisor. Here’s a breakdown of the most important penalties clients need to understand and how to help them stay ahead of the game.

Start with the Enrollment Timeline

Some clients are unaware of the IEP (Initial Enrollment Period) and how crucial timing is. As you know, the IEP is a seven-month window:

• Three months before the month of their 65th birthday,
• The birthday month,
• And three months after their birthday month.

If they don’t enroll in Medicare Part B or Part D during this period, and they don’t qualify for an SEP (Special Enrollment Period), they could face lifelong penalties.

Encourage clients to begin planning their Medicare enrollment early; at least 3 to 6 months before turning 65. Use this time to review their current coverage and explain how Medicare will coordinate (or replace) it.

Clarify Each Type of Penalty

Clients rarely understand the specific consequences of delaying enrollment. Be sure to cover these key penalties in your consultations:

Medicare Part B Late Enrollment Penalty

• What It Is: A 10% increase in the monthly premium for every full 12-month period the client delayed enrollment without other creditable coverage.
• How Long It Lasts: For life, and CMS will add it to their Part B premium.
• Common Misunderstanding: Clients often believe they can just delay Part B if they’re healthy or not using care without knowing there is a penalty and it keeps growing.

Watch a YouTube video on OEP, SEPs an Late Part B Enrollment

Part D Late Enrollment Penalty

• What It Is: 1% of the national base premium (currently $36.78 in 2025) multiplied by the number of full uncovered months they went without creditable prescription drug coverage.
• How Long It Lasts: For life, and it’s added to their monthly Part D premium.
• Common Misunderstanding: Clients are often unaware of this penalty and if they don’t need drug coverage now, they do not have to enroll in a plan. Although, not having creditable coverage triggers the penalty anyway.

Medicare Part A Penalty

Penalty: 10% increase in the premium for twice the number of years they delayed enrollment.

Applies only to clients who do not qualify for premium-free Part A (usually those with less than 10 years of Medicare-covered work history).

Explain Employer Coverage and SEPs

This is where your expertise can be very useful.

Many clients working past 65 assume they can delay Medicare without issue. However, eligibility for an SEP (Special Enrollment Period) depends on their employment and the type of coverage they have.

Key Points:

• Employer coverage must be from active employment (not COBRA or retiree plans).
• The employer must have 20 or more employees for the coverage to delay Medicare enrollment without penalty.
• They must enroll in Medicare within 8 months of losing employer coverage to avoid penalties.

Review your client’s group health plan documents or provide them with specific questions to ask their HR department. It’s critical they confirm whether their plan is considered creditable coverage for both Part B and Part D.

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Conduct Annual Reviews

Clients’ needs, income levels, and coverage can change year to year. Use the AEP (Annual Enrollment Period) that runs Oct 15–Dec 7 to:

• Verify their current coverage.
• Check for plan changes that could increase costs.
• Remind them of potential penalties if they drop coverage without a replacement.

Document Everything and Communicate Clearly

Because it is easy for some clients to misunderstand Medicare rules, it’s essential to:

• Take notes that summarize the appointment after each consultation, some clients may want a copy for their own records.
• Track enrollment deadlines and follow up as key dates approach.
• Encourage clients to keep copies of any employer or plan letters that state their coverage is creditable.

Medicare penalties are preventable; only if your clients have the right information at the right time. As an agent, your ability to explain these rules in simple terms and guide clients through timely enrollment is a key part of your value.

By proactively addressing fees and penalties in your process, you not only protect clients financially you also strengthen your reputation as a knowledgeable and trustworthy advisor in a competitive marketplace.

Stay up-to-date on the latest events and information for agents

Medicare beneficiaries who have a limited income may be eligible for help paying for some healthcare costs. That’s where a Medicare agent can provide some insight into understanding the Medicare savings program. This can be a great resource for individuals who qualify. The Medicare Savings Programs (MSPs) are state-run programs that help pay Medicare premiums, deductibles, copays, and coinsurance, depending on the individual’s financial situation.

There are four main MSP categories, each with slightly different income and resource limits; each provides a different level of help. We will break them down to provide a better understanding of each level.

QMB (Qualified Medicare Beneficiary)

QMB provides the most comprehensive benefits. It helps pay for:

• Medicare Part A premiums (if applicable)
• Medicare Part B premiums
• Medicare deductibles
• Medicare coinsurance and copays
• Help paying for prescription drugs (beneficiaries pay no more than $12.15 for each prescription covered by their Medicare drug plan).

If an individual qualifies at the QMB level, doctors and medical providers do not bill them for services covered by Medicare; except in very limited situations.

2025 QMB income and resource limits:

• Individual: monthly income limit $1,325; resource limit $9,660
• Married couple: monthly income limit $1,783; resource limit $14,470
  (Limits vary by state)

What counts in resource limits: Money in checking, savings and retirement accounts, stocks and bonds. States do not count: Your home, furnishings, household and personal items, one car, burial plots, up to $1,500 for burial expenses if that money is put aside.

SLMB (Specified Low-Income Medicare Beneficiary)

The SLMB Program is more limited than the QMB Program but still provides assistance. The only premium it helps pay for is the Medicare Part B premium (beneficiaries must have both Part A & Part B to qualify for the program).

The program also provides help paying for prescription drugs. Individuals pay no more than $12.15 for any drug covered by their Medicare drug plan.

This program is useful for people with limited income slightly above the QMB threshold.

2025 Income and resource limits:

• Individual: monthly income of $1,585 with a resource limit of $9,660.
• Married couple: monthly income of $2,135 with a resource limit of $14,470.

QI (Qualifying Individual)

The QI Program also helps pay the Medicare Part B premium, just like the SLMB program, but with slightly higher income limits. QI beneficiaries also receive extra help paying for their prescription drugs and pay no more than $12.15 in 2025 for any drug covered on their Medicare plan. The QI benefit is provided on a first come, first served basis, and individuals must apply every year to continue receiving benefits.

Important: Individuals who are eligible for Medicaid do not qualify for QI program.

2025 Income and resource limits:

• Individual: monthly income limit of $1,781 with resource limits of $9,660 (the same as QMB & SLMB).
• Married couple: monthly income limit of $2,400 with resource limits of $14,470 (the same as QMB & SLMB).

QDWI (Qualified Disabled and Working Individuals)

The QDWI Program is specifically for individuals under age 65 who are disabled but have returned to work and lost their Social Security disability benefits and premium-free Medicare Part A.

QDWI helps pay the Medicare Part A premium for these individuals.

2025 Income and resource limits:

• Individual: monthly income limit of $5,302 with resource limits of $4,000.
• Married couple: monthly income limit of $7,135 with resource limits of $6,000.

Please note: Income limits vary by states. The amounts listed in this post are federal limits. Individuals with slightly higher incomes may still qualify in their states.  Check your state to find out.

Apply for MSP (Medicare Savings Program)

Because MSPs are administered by each state’s Medicaid office; the application process varies by state. In general, individuals will need to provide:

• Proof of income (such as Social Security or pension statements)
• Information about assets (like savings, investments, etc.)
• Medicare card and ID

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Medicare Savings Programs can make a huge difference in the lives of people within the income limits. They provide assistance for important medical services that are essential for quality of life. It is free to apply, and the potential savings can be substantial.

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If you’re a Medicare agent, you know leads are an essential part of your business. But purchasing leads can be expensive as well as frustrating, with low contact rates and high competition. The good news? There are effective, low-cost Medicare lead sources to generate quality Medicare leads that build lasting client relationships.

Here are four strategies to help find leads that actually convert without emptying your wallet:

Grassroots Marketing Still Works

Even in the digital age, nothing beats local visibility and personal interaction. Although grassroots marketing may take some time, it’s cost-effective and builds genuine relationships.

• Community bulletin boards: Post flyers offering your services at grocery stores, libraries, pharmacies, and senior centers. Remember; use only general information and do not mention specific benefits or carriers on flyers.
• Local events: Set up a booth at farmers markets, church fairs, or health expos. Offer free Medicare information and assistance to attract interest. Free items of nominal value like pens or candy sometimes helps attract people and start the conversation.
• Business cards everywhere: Leave them at coffee shops, laundromats, grocery stores or anywhere seniors gather.

This method takes consistency, however, over time, it helps establish you as a valuable, local Medicare resource.

Click here for a Scope of Appointment Form

Host Medicare Educational Seminars

Educational events are a great way to build credibility as a knowledgeable community member and generate leads in a non-salesy setting. Many seniors are overwhelmed by Medicare choices and appreciate trustworthy advise.

• Partner with libraries, senior centers, or churches to host free events.
• Offer a clear, simple presentation explaining Medicare basics and common questions.
• Use voluntary sign-in sheets and follow-up cards to capture contact information for attendees.
• Bring printed materials like basic plan comparison charts or a “Medicare 101” guide they can take home.

Watch a Medicare Educational Event Best Practices Video

You don’t need a big crowd; even a small gathering can yield solid, qualified leads when people trust you from the start.

Leverage Professional Community Relationships

Think beyond individual clients; build relationships with people who serve your target audience every day.

• Pharmacists and independent pharmacies: Ask if you can leave materials or host a “Medicare Check-Up Day.”
• Financial advisors and tax preparers: Many of their clients are Medicare-aged. Offer to co-host an event or provide educational resources.
• Home health agencies and caregivers: These professionals regularly interact with people who need help with healthcare coverage.
• Faith leaders and community organizers: Trusted voices in the community can refer their members to you when Medicare questions arise.

These referral partners don’t have to sell for you; they just need to know you’re a trusted resource.

Referrals from Current Clients

Once your business is established, happy clients are often your best lead source. In most cases, all you have to do is ask; they are happy to recommend your services to friends and family.

• Ask at the right time: After helping a client enroll or during an annual review, simply ask, “Do you know anyone else who could use help with Medicare?”
• Send follow-up emails with referral reminders: Include a link to a referral form or offer a small incentive (where compliant).
• Provide extra business cards they can hand to friends or family.
• Stay top-of-mind with birthday cards, newsletters, or check-in calls. The more visible you are, the more likely they are to refer others.

Remember, a referred lead is already partially sold; they trust you because someone they know trusts you.

A few more strategies for Medicare agents

You don’t need a massive marketing budget to grow your Medicare business. With the right combination of grassroots outreach, community connections, educational events, and referrals, you can build a steady stream of qualified leads that cost very little and convert into sales.

Are you ready to join the team at Crowe; click here for online contract

It is important to be visible, approachable and a valuable resource for your community. If you do these things, the leads will follow.

To find upcoming agent events and webinar; click here

As America’s population ages, the demand for healthcare and those who can help people navigate it continues to grow. One very important and often misunderstood area of healthcare is Medicare. For those looking for a rewarding and potentially lucrative career, you might want to consider a Medicare sales career.

Why Consider a Medicare Sales Career

Growing Market

Every day, thousands of Americans turn 65 and become eligible for Medicare. That trend is not expected to slow down anytime soon. As baby boomers age into the program, the need for knowledgeable, trustworthy agents to guide them through their options has never been greater. This isn’t a short-term trend; it’s a long-term opportunity based on demographics.

Make a Meaningful Impact

Choosing a Medicare plan can be overwhelming. All the options can cause confusion for beneficiaries. Between Original Medicare, Medicare Advantage, Medigap, Part D, this is difficult for many to sort out. That is why they often need help to find the best fit for their unique medical and financial needs. As a Medicare sales professional, you’re not just selling a product; you’re offering clarity, confidence, and peace of mind at a critical point in life.

Quick Start Up with Great Earning Potential

For a determined individual, becoming a licensed Medicare agent can be accomplished in a relatively short amount of time when compared to many careers. Once certified (through licensing and passing the required exam), agents can complete the AHIP and add in carrier contracts and purchase E &O insurance. Once contracted and compliant, they can put together a plan to build their book of business. Top agents enjoy competitive commissions, including renewals, which creates an opportunity for recurring income over time.

Watch a quick YouTube of what Crowe has to offer agents

Flexible Career Options

Medicare sales can fit a wide range of career goals and lifestyles. Those who want to work independently and set their own schedule can do that. If you enjoy working as part of a larger agency or brokerage with support and resources?; that’s also an option. Whether you’re looking for a full-time career or a side hustle, the flexibility of Medicare sales is hard to beat.

Continuous Learning Keeps the Work Interesting

Because Medicare is constantly evolving, new plans, changing regulations, updates to benefits, there’s always something new to learn. For professionals who enjoy staying sharp and growing their expertise, Medicare sales offers a dynamic and intellectually stimulating environment.

Digital Tools Make It Easier

Medicare agents have access to powerful online quoting and enrollment platforms, including telephonically with voice recording systems, CRMs, and so much more. Agents no longer need to visit a prospect’s home unless they want to. Many successful agents run their business entirely online, serving clients across multiple states. Although some prefer the grass roots approach. There are options for many different types of agents.

Watch a quick video of Connecture & Sunfire quoting and enrollment tools

Click here for online contracting and join the team at Crowe!

A career in Medicare sales is about more than just earning commissions; it’s about becoming a trusted advisor for people facing important health coverage decisions. If you enjoy helping others, are driven to succeed, and want to be part of a growing industry with real impact, Medicare sales could be the opportunity you’ve been looking for.

For a look at upcoming agent events and to view our webinar schedule, click here

When it comes to navigating the maze of Medicare, choosing the right supplemental coverage can make a significant difference in both healthcare coverage and out-of-pocket costs. One option that remains popular is Medigap Plan N. We will outline the benefits of Medigap Plan N and highlight it’s balance of coverage and affordability. This post includes both the benefits and downsides of Medigap Plan N.

Medigap Plan N

Medigap (Medicare Supplement Insurance) helps pay for healthcare costs that Original Medicare (Part A and Part B) doesn’t cover, such as copays, coinsurance, and deductibles. Plan N is one of 10 standardized Medigap plans available in most states. It offers a good blend of coverage and cost savings, making it appealing to Medicare enrollees who want solid protection without having to pay the highest premiums.

Benefits of Medigap Plan N

Lower Monthly Premiums

In general, Plan N has lower premiums than more comprehensive plans like Plan F or Plan G. This makes it a good option for individuals who are relatively healthy and want to save on fixed monthly costs.

Plan N Covers Cost Gaps

• 100% of Part A coinsurance and hospital costs
• 100% of Part B coinsurance (with a few exceptions)
• Skilled nursing facility care coinsurance
• Part A deductible
• Emergency care during foreign travel (up to plan limits)

Nationwide Access

Like all Medigap plans, any provider that participates with Medicare will accept Plan N. Enrollees do not have to worry about provider networks or referrals. Enrollees can see any doctor or specialist who accepts Medicare.

Predictable Inpatient Costs

Because inpatient services are well covered by Plan N, beneficiaries can feel confident with their choice, if they are hospitalized or require skilled nursing care. Their costs should generally be predictable.

Downsides of Medigap Plan N

Copays for Doctor and ER Visits

While most Part B coinsurance is covered by Plan N, beneficiaries must still make some copays:

• Up to $20 for office visits
• Up to $50 for emergency room visits (waived if the patient is admitted)

These copays can add up for anyone who frequently requires the care of a doctor.

Doesn’t Cover Part B Deductible

Like all Medigap plans issued to new enrollees after January 1, 2020, Plan N does not cover the Medicare Part B deductible, which is $257 in 2025.

Excess Charges Not Covered

Plan N does not cover Part B excess charges. These are extra charges from providers who don’t accept Medicare assignment. These providers are allowed to bill up to 15% over the Medicare-approved amount. While this isn’t common, it can be a concern for those who live in or travel to areas where non-participating providers are prevalent.

Not Ideal for High Users of Care

Beneficiaries who require frequent doctor visits, lab work, or outpatient treatments may cause the recurring copays and potential for excess charges to outweigh the savings of the lower premiums. When that is the case, Plan G could be a better value despite higher monthly premiums.

Plan N can be an excellent choice for

• People in relatively good health
• Those who prefer lower monthly premiums
• Individuals who rarely see non-participating Medicare providers
• Enrollees who are comfortable paying small copays in exchange for premium savings

Plan N may not be ideal for

• People who visit the doctor frequently
• Those who live in areas where excess charges are more common
• Individuals who want the most comprehensive coverage available

Watch a video on Physicians Mutual Innovative Plan G

Medigap Plan N is a well-balanced choice for Medicare beneficiaries who want solid protection without paying top-dollar premiums. Its design provides comprehensive healthcare at an affordable rate. As always, choosing the right Medigap plan depends on health needs, budget, and lifestyle. Comparing Plan N with other options like Plan G can help beneficiaries make the most informed decision. A licensed Medicare agent can help compare plans and weigh all the options.

As the population ages, many individuals are seeking care while in the comfort of their own homes. One of the most common questions people ask is: how Medicare covers home healthcare? In some cases Medicare provides some coverage; although there are some important limitations and conditions Medicare enrollees and their families need to be aware of.

In-Home Health Care

In-home health care refers to a range of medical services patients may receive at home. This can include skilled nursing, physical therapy, occupational therapy, speech-language pathology, and certain types of personal care.

What Medicare Covers

Medicare Part A and/or Part B may cover in-home health services if the beneficiary meets specific conditions. These include:

1. They Must Be Homebound

Medicare defines “homebound” as being unable to leave your home without considerable effort or assistance due to illness or injury. The beneficiary may leave for things like medical appointments or religious services, however they must not be able to leave home on regular outings.

2. Care Must Be Medically Necessary

Any Medicare services received must be (medically necessary) a doctor or a qualified healthcare provider must order the care. They must also create and regularly review a care plan for the beneficiary.

3. Individuals Must Require Skilled Services

Medicare provides coverage for home health services such as; intermittent skilled nursing care, physical therapy, speech-language pathology, or continued occupational therapy. If a beneficiary requires services for personal care alone (dressing or bathing), Medicare will not cover them unless it’s part of a broader medical plan involving skilled care.

4. Only Medicare-Certified Home Health Agencies Can Provide Care

To receive coverage, services must be provided by an agency that is certified by Medicare.

What’s Covered

• Skilled nursing care (part-time or intermittent only)
• Physical, occupational, or speech therapy
• Medical social services
• Home health aide services (if you’re also receiving skilled care)
• Durable medical equipment (DME) like walkers, oxygen tanks, or wheelchairs (covered under Medicare Part B)

Please Note: Medicare does not cover; 24-hour home care, meals delivered to your home, or homemaker services if they are the only care you need.

Out-of-Pocket Costs

For most eligible home health services:

• Beneficiaries pay $0 for covered home health care services.
• Typically, the out-of-pocket amount for Medicare-approved durable medical equipment is 20% of the cost.

No copay or deductible is required for the care itself, assuming the beneficiary meets the qualifying criteria.

Examples of How Medicare Covers In-Home Health Services

Let’s say Jack, age 78, recently had hip surgery and his doctor prescribes in-home physical therapy for recovery. This is prescribed in-home because; he is temporarily unable to travel to outpatient therapy due to mobility issues. Because he meets the homebound requirement and the care is medically necessary and ordered by a doctor, Medicare will likely cover the services.

In contrast, if Leo needs help cooking, cleaning, and taking medications but does not need skilled nursing or therapy, Medicare would not cover a home health aide for him.

How to Initiate In-Home Healthcare Through Medicare

1. Beneficiaries must talk to their doctor. A doctor’s order is required before any service is authorized for payment.
2. Choose a Medicare-certified home health agency. Beneficiaries can request suggestions from their doctor’s office or their Medicare insurance carrier or the Home Compare Tool Link below.
3. The beneficiary’s provider and the agency will work together to develop a care plan.

The Medicare’s Home Health Compare tool to find certified agencies in the local area.

Medicare can be an important source of support for those recovering at home or managing chronic health conditions. However, its coverage of in-home health care comes with specific conditions that must be met. Understanding these rules helps beneficiaries and caregivers plan effectively and avoid unexpected expenses.