Part D late enrollment penalty appeal
Medicare beneficiaries who don’t sign up for Medicare Part D coverage during their initial enrollment period and go for a period of 63 or more continuous days without creditable prescription coverage may incur a late enrollment penalty. If the beneficiary receives an LEP and they believe it is in error, they can initiate a Part D late enrollment penalty appeal.
Once a beneficiary enrolls in a Part D plan, the plan notifies them in writing if it is determined that the enrollee has incurred an LEP. If plan administrators believe the enrollee has had a lapse in creditable prescription coverage for a continuous period of 63 days or more. The enrollee receives an LEP Reconsideration Notice and LEP Reconsideration Request Form with the written notification.
Learn more about enrollment in Part D
Either the enrollee or their representative can ask for a review, or reconsideration, of the LEP. The LEP reconsideration request form provides enrollees a list of circumstances when they can request a review.
LEP Reconsideration Notice
The Part D LEP reconsideration notice gives enrollees an explanation of their right to request a reconsideration of their LEP. Sponsors of Part D plans must complete the notice and send it to the enrollee with the letter notifying them of the imposition of a Late Enrollment Penalty.
To download a copy of the Sample late enrollment penalty reconsideration notice – click here.
Reconsideration Request Form
Part D plan enrollees should use the form, “Part D LEP Reconsideration Request Form C2C” to request an appeal of the LEP decision. The enrollee completes the form, signs it and then send it to One of the options below:
If you are sending via standard mail; C2C Innovative Solutions, Inc., Part D LEP Reconsiderations, P.O. Box 44165, Jacksonville, FL 32231-4165
Sending by courier or tracked mail; C2C Innovative Solutions ,Inc., Part D LEP Reconsiderations, 301 W. Bay St., Suite 600, Jacksonville, FL 32202
You can also send either by fax to; 833-946-1912 or upload the form to the website https://www.c2cinc.com//Appellant-Signup. Once you are on the website, you will need to create an account and follow the prompts from there.
If you have a friend, family member or doctor send the request, that person must be your representative. They can complete the last form in the reconsideration request form. The form is fillable online or you can print it out and fill it from there.
Click here to download the LEP Reconsideration Request Form
LEP appeal process
The LEP appeal process is conducted by an IRE (independent review entity) that has a contract with Medicare. The IRE notifies the enrollee of the final LEP decision within 90 days of receiving the request. This includes the dismissal of the request.
Please note: If you receive Extra Help, you do not have to pay a Late Enrollment Penalty. Click here to learn more about Extra Help programs.
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Medicare Part D 2024
In this post, we will discuss some important information about Medicare Part D 2024.
Medicare Part D plans cover the cost of prescription drugs for Medicare enrollees. Private insurance companies offer these plans to beneficiaries. In order to remain complaint, all plan providers must follow CMS’ rules.
Prescription plan costs
There are a few costs associated with Medicare prescription plan coverage. One of those costs include the monthly plan premium, this amount can range greatly depending on the plan and carrier. Beneficiaries can opt to have the premium deducted from their monthly Social Security payment. If the beneficiary has a greater than average income, they may be subject to an IRMAA, an adjusted premium amount based on income. The premium may also be adjusted for those who have a lower-than-average income and qualify for Extra Help.
Other costs associated with Part D prescription are co-pays and coinsurance amounts paid at the pharmacy. Many plans also include an annual deductible. In 2024, the maximum annual deductible has increased from $505 in 2023 to $545 for 2024.
For those who neglect to sign up for a Medicare Part D plan on time, a late enrollment penalty is added to the monthly cost. The penalty applies to anyone who goes without creditable Part D coverage for a period of 63 or more days. CMS applies the penalty for as long as the beneficiary has Part D coverage.
Changes for Medicare Part D for 2024
Because of the Inflation Reduction Act that was signed into law in 2022, there will be changes to the Medicare Part D program. One important change has to do with the cost Medicare beneficiaries pay for prescription drugs.
Click here to learn about prescription drug caps
Here are some of the changes in place for 2024:
In 2024, Medicare PDP members who reach the catastrophic phase ($8,000 in 2024) will not pay any additional out-of-pocket costs for the remainder of the year. This means they are no longer subject to a 5% copay.
PDP plans are no longer able to raise their premiums over 6% per year starting in 2024.
Beneficiaries who use insulin will pay no more than $35 for a 1-month supply for covered insulin brands. It is important to check your plan’s formulary to confirm which brands they include. This pricing is in effect until the end of 2025.
Medicare covers many adult vaccines at no cost to Medicare beneficiaries. this includes the Shingles vaccine as well as TDAP (tetanus vaccine), Covid, flu vaccine, Hepatitis A and many others.
More Medicare beneficiaries will qualify for Extra Help to pay for their health care needs in 2024. This is because beneficiaries with an income of up to 150% of the federal poverty level (up from 135% in 2023) may be qualified for the Part D Extra Help. This program pays the Part D annual deductible, monthly premium and ensures beneficiaries pay a lower cost for generic and brand name drugs.
A few changes to prescription drug plans in 2025 and 2026
In 2025, one of the changes to the Part D program is a $2,000 out-of-pocket maximum in place for PDP beneficiaries. CMS is also starting a prescription payment plan program. The program is referred to as “smoothing” and begins Jan 1, 2025. This program gives beneficiaries an opportunity the spread out the cost of prescription medications out over the year by using a payment plan.
Click here to learn more about the prescription payment program
In 2026 price negotiations will begin for expensive drugs that have no generic alternatives.
Learn the details of the price negotiation program
To view a comprehensive guide to all the ins and outs of Medicare for 2024, click this link and download a copy of CMS Medicare and You handbook for 2024. Information on Medicare Part D starts around page 79.
Watch a quick YouTube video on the drug cap proposed for 2025
Take a look at some of the other compliance updates CMS has in place or has proposed for agents :
Watch a quick YouTube video on the CMS proposed rule CMS 4205-P an how this could effect our business
Find out more about the 2024 CMS call recording requirements
Make sure you are up-to-date with the SOA rules – click here and learn more
Take a look at our video on TPMO rules for 2024
If you are unsure of the differences between an educational event and a sales event, click here. You may also want to read our blog on “Things you can’t say when selling Medicare“.
If you already have a contract with Crowe and want to add a carrier, click here
Agents who want to join the team at Crowe, click here for online contracting
Please note: agents who offer Medicare Part D plans need to complete annual carrier certifications as well as AHIP before they can offer the plans. AHIP is an annual certification that CMS requires. It includes marketing and compliance guidelines as well as FWA laws.
If you don’t follow the Medicare marketing rules, you risk losing commissions, termination of your contracts, losing your license and receiving fines.
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How to get a replacement Medicare card
If you find yourself in need of a replacement Medicare card due to loss, damage, or a name change, the process is straightforward. We will go over the process to get a replacement Medicare card, ensuring you have access to your necessary healthcare information when you need it.
Find out about Medicare premiums.
The importance of a Medicare card
Before we dive into the replacement process, it’s essential to recognize the significance of your Medicare card. This card contains valuable information, such a as your Medicare number as well as the effective dates of your Part A and Part B coverage. Beneficiaries need to have access to it as proof of Medicare coverage when they require necessary medical services. Whether you’ve lost your card, or it’s been damaged, it is important to obtain a replacement card quickly. This will help enrollees maintain their access to healthcare.
Ensure eligibility
If you are eligible for Medicare but have not enrolled yet, you need to complete the initial enrollment process before you request a replacement card. Once you complete your initial enrollment, you will receive your card within a few weeks.
Click here to learn about Medicare enrollment periods.
Ways to obtain a new Medicare card
There are a couple different ways to obtain a replacement Medicare card. Because of this, beneficiaries can choose the method that they are most comfortable with. The two ways to get the new card are:
Online:
Beneficiaries can log into their personal account on the official Medicare website www.medicare.gov. Once they are logged in, it is easy to follow the prompts and request the replacement card. This method is convenient and typically provides a quicker turnaround. Beneficiaries can print an official copy of their card from their online account to retrieve an immediate copy.
Over the phone:
To request a replacement card over the phone, contact Social Security Administration at 1-800-772-1213 (TTY 1-800-325-0778). Beneficiaries need to have their Medicare number as well as other pertinent information to verify your identity.
Provide necessary information
No matter what method you opt for, you need to provide personal information to verify your identity and facilitate the replacement of your card. It is imperative that you use only official channels to request the new card. Medicare will need details such as your full name, Social Security number, date of birth, and even your Medicare number to verify your identity before they can process the request.
Confirm Your Address
Because Medicare will send the replacement card to the address on record, it is important to make sure you update your current address in the Medicare system if you move. Keeping your records up to date will ensure you receive your new card a quickly as possible.
Learn the difference between Medicare Advantage and Medicare Supplement plans – watch a quick YouTube video
Be Patient
Once you submit your request your replacement card, it will take time for the request to be processed and sent out to you. The time required to process the request will vary depending on how busy the Medicare office is, so you need to be patient while you wait for the Medicare card to arrive.
Obtaining a replacement Medicare card is a straightforward process. Following these steps and keeping your information current, will ensure the process is smooth should you need a replacement card.
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Wellcare prescription plans
Because the ability to access affordable prescription medications is crucial to maintaining good health, beneficiaries must be aware of all their options. In order to help individuals make an informed decision, we will discuss some benefits of the WellCare prescription drug plans.
Important; CMS has guidelines in place to regulate the types of medications that prescription drug plan providers must cover. This includes a minimum standard of benefits for providers to follow. The formulary for each plan Each plan meets the requirements as required by law. Because each plan differs, the cost and drugs included in the formulary can vary.
Find out about the Medicare drug price negotiations
Although Wellcare offers three different plan choices, it is important to review each plan formulary and make sure it provides coverage to fit the prescription needs for anyone considering enrollment.
The three Wellcare PDP plans for 2024
- Wellcare Medicare Rx Value Plus – is a great option if you require more comprehensive prescription coverage. See what this plan has to offer, Wellcare RX Value Plus summary of benefits.
- Wellcare Classic PDP – those who receive Extra Help may be eligible to enroll in this plan for a$0 premium as well as a low co-pays, view the Wellcare Classic PDP summary of benefits.
- Wellcare Value Script – this plan provides low-cost coverage an dis a good choice for those that require few medications. For more details, look at the Wellcare Value script summary of benefits 2024.
Some features of the Wellcare prescription plans
Wellcare has no or low premium plans available to provide coverage for individuals who qualify for Extra Help. These plans are available in all states and offer low or no copays when enrollees purchase prescriptions from preferred pharmacies.
Some Wellcare plans include no deductible, so plans cover prescriptions on day one.
Wellcare has a nationwide network of preferred pharmacies that includes thousands of national, regional and local pharmacy chains. It also includes grocers and independent pharmacies as well. These relationships help plan members save money on prescription drugs.
Use this link to the Wellcare preferred pharmacy tool and find a local in-network pharmacy.
Find a preferred pharmacy tool to find a local pharmacy.
The member service representatives are available either online at wellcare.com/PDP or by phone at 866-822-1339 (TTY – 711) during the hours of 8am – 8pm EST Monday – Friday. They can provide answers to members coverage or medication questions.
If you want to view the plan formulary (complete list of drugs each plan covers), visit Wellcare’s website or contact their member services department.
Click here to download a 2024 Wellcare Summary of Benefits
Understanding PDPs
Comprehensive Coverage
Prescription Drug Plans( Medicare Part D or PDPs), provide coverage for a wide range of prescription medications. These plans are designed to complement Medicare coverage provided by Original Medicare and or a Medicare supplement plan. PDP plans offer a cost-effective way to manage prescription drug expenses.
Medication Formulary
Each prescription drug plan comes with a specific list of covered medications known as a formulary. It’s essential to review this list to ensure that the medications each member takes or may need in the future are covered under the plan. In most cases, PDP plan providers update their formularies each year. This means it is imperative that enrollees go over plan changes each year to ensure they are still on the best plan for their needs. In many cases, it is a good idea to enlist he help of a licensed Medicare agent to help go over all your coverage options.
Learn about the Part D drug cap
Pharmacy Network
Prescription drug plans have a network of preferred pharmacies where enrollees can fill their prescriptions. It’s important to check the pharmacy list to maximize cost savings. If you opt to use non-preferred pharmacies, your out-of-pocket costs may be higher.
Tiered Cost Structure
Prescription medications are categorized into different tiers, each with its own associated cost. Lower-tier medications generally have lower copayments or coinsurance, while higher-tier medications may have higher out-of-pocket costs. Understanding the tier structure can help you plan for and manage your prescription drug expenses.
When can you enroll in Medicare Part D
WellCare is dedicated to providing affordable healthcare solutions. Their prescription drug plans are designed to help individuals save on out-of-pocket costs for prescription medications. This can be beneficial for those who rely on multiple medications to manage chronic conditions. WellCare PDP Plans include the option for mail-order services. This convenient feature allows members to order a 90-day supply of medications. This saves trips to the pharmacy and potentially reduces overall prescription costs.
Please note:
It is important to always review plan details, this includes the formulary and preferred pharmacy network to ensure the best coverage for each individual enrollee is chosen. Beneficiaries should consider using the help of a licensed Medicare agent when making important Medicare coverage choices.
Click here to learn how a Medicare agent can help you
Medicare FMO companies
Because there are so many Medicare FMO companies to choose from agents need to carefully consider what each one has to offer before they choose one to contract with.
We will start by explaining what an FMO is. FMO stands for Field Marketing Organization. These organizations specialize in the support of independent insurance agents as well as agencies. They form partnerships with insurance carriers to provide marketing, sales and service resources to their downline agents/agencies.
The difference between an FMO, IMO & NMO
IMO or independent marketing organization operates similarly to an FMO, the difference is the compensation level. These terms are both top-tier levels of carrier hierarchies. Some marketing organizations use these terms interchangeably.
Just to make things more confusing, we will throw in the term NMO, this stand s for National Marketing Organization and is another top of hierarchy level. For many carriers this is the top level of contracting. Reaching the NMO level as with the FMO & IMO levels is no small achievement. Because each carrier has its own hierarchy levels, it can be tricky to define these terms. In the world of Medicare, some FMOs are not actually the top of hierarchy.
Find out why you should consider Crowe for your FMO
Other contracting levels
Some of the other contracting levels are Street, GA, MGA & SGA the name of the level depends on the carrier and each one signifies a level in contracting that provides higher overrides. If you have an agency, you need to decide how you pay your downline agents. They can receive full street commissions directly from the carriers or you can decide to contract agents as LOA and you can make any type of payment arrangement that both parties can agree on.
CMS currently has a proposal in the works that may change the way the entire industry is structured. The proposed rule we are talking about is CMS-4205-P. This rule could stop agents from using FMOs for product distribution and leave them without a support system.
Watch a video to see what this proposal could mean for the Medicare business
What does an FMO do
FMOs play a crucial role in providing support to their agents. Here are some of the ways an FMO provides this support:
- FMOs should provide training to their downline agents. Agents at every level need some type of training whether it is for the basics, product updates and additions compliance, or sales. Agents need to stay up to date on several areas, so they can provide clients with the best plan options. Crowe offers agents many types of training that include webinars, zooms, our website and YouTube channel as well as one on one phone consults and in-person meetings.
- They need to have partnerships with several local carriers that ensures their downline have a large variety of products to offer.
- FMOs provide help with contracting that make the entire process easier than trying to get it done on your own.
- Agents must be complaint with all CMS’ rules and regulations; therefore, it is important that FMOs make sure their downline agents are updated and equipped to conduct themselves in an ethical way. Click here for tips to pass the 2024 AHIP..
- The top FMOs invest in up-to-date technology and tools that make sales a smooth process for their agents. We offer online quoting and enrollment tools that include both Sunfire and Connecture.
- One important element in Medicare sales is marketing. An FMO offers tools that include marketing dollars, lead generation programs and provide help to agents in any way they can so they reach their full potential.
Join the team at Crowe – click here for online contracting
How to choose an FMO
Because there are so many FMOs who want to contract agents, it can be difficult to choose one. It is important that agents ask questions, so they are comfortable with their choice and do not need a release. Be sure the FMO offers the programs you feel will provide the best guidance for you. It is also important to discuss how you are paid. If you receive full street direct from the carrier or if you will be LOA.
Do you want to ensure you own your book of business or are you comfortable writing and building someone else’s book? Do they offer the most competitive carriers in your area, so you can provide clients the best options possible?
Does the FMO offer marketing money, lead money and guidance on how to make sales and maintain your book of business? Do they provide free tools to help you conduct your business in an efficient manner.
As you can see, there are many things to consider when choosing an FMO. This is a decision that needs to be considered carefully before you sing on the dotted line.
See what Crowe has to offer
Medicare FMOs play a pivotal role in the success of insurance professionals by helping them navigate the complexities of Medicare sales. By providing comprehensive support, training, and access to a variety of insurance products, FMOs help agents to better serve their clients and thrive in the ever-evolving Medicare market.
Choosing the right FMO is an important decision that can significantly impact an agent’s career. This means, it is essential to evaluate all the options and choose a partner that aligns with individual and business goals.
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Insurance sales training
Anyone who wants to enter the field of Medicare sales, will need to have insurance agent training before they meet with any potential clients. Crowe and Associates offers Medicare agents access to several types of training tools. We provide free information on our website, YouTube channel as well as weekly informational webinars and zoom meetings geared for either beginners or experienced agents.
Think about joining an FMO
Getting started in insurance sales can be confusing, especially if you are trying to get it done on your own. An good FMO provides guidance and support not only to new agents but to experienced agents as well. Agents receive back office support as well as resources and tools that can make your business run effectively. it is important to choose an FMO that provides the support you need. Be sure to ask as many questions as you need to and contact as many as you need. Agents need to feel comfortable with their upline and secure knowing they will be there to answer your questions when they arise.
See what we offer Medicare agents
Decide what products to offer
We will focus on Medicare products, because that is the largest part of what we offer. If you are unsure which products you are going to offer clients, your FMO should assist you in choosing a reasonable number of Medicare and ancillary products to get started. It is best not to overwhelm yourself and get discouraged. A good FMO will run a quote in the area you plan to sell in and provide you with a few of the top carriers in each product type to et you started. This is easy to do with a good quote engine and takes only a few minutes.
Join the team at Crowe – click here for online contracting
Contracting and Certifications
After you choose the products and carriers you are going to offer, you must complete contracting. Your FMO should be able to help get this done. Once you receive your contracting links, you can complete them along with your carrier certifications(carrier specific training you do to gain knowledge about the products you are offering). When this is done, you will receive your RTS (ready to sell) and you can now offer that product.
websites and blogs focused on Medicare sales. Here you will be able to access information regarding all aspects of Medicare sales. Our recorded webinars will hit on just about every area of Medicare sales. For those, very new to Medicare sales, be sure to access our Medicare sales quick guide to lean the basics about contracting, certifying and selling.
Because Medicare is a federal program, there are a lot of rules and regulations agents must adhere to. These rules protect the clients as well as the agents and ensure everyone conducts business in a compliant and fair way. CMS mandates that agents take annual training courses to stay up to ate with all the regulations. That is why agents need to take and pas the AHIP annually with a score of 90% or higher.
Watch a quick YouTube video for 2024 AHIP test tips
Sales training
New agents often need more guidance to get an idea of how to get started. Comprehensive training programs provide an understanding of things like; eligibility, enrollment and coverage options. We provide newer agents weekly zoom training to help them feel confident and build their knowledge base. We are also available for a one on one meeting or phone call. In some cases agents may have an opportunity to pair up with a local agent and go on sales calls.
Product training
In the Medicare field, clients have soo many types of coverage offered by many carriers to consider. This means agents must be aware of new products and changes in plan products as well what their client is looking for. That is why agents complete specific product training, so they can ensure their client receives the coverage they need and can afford. We provide the opportunity for agents to join one of our weekly zoom meetings or webinars to get updated information and ask questions if they are unsure about anything.
Anyone can find information on our website or YouTube channel. We update our Events and information page so agents can easily find a webinar or event information on our website, just click on the link below.
Click here to view our updated Events and information post
Access the recorded webinars on various topics on our YouTube channel, just click on the link below:
Subscribe to our YouTube channel and view all our recorded training and informational videos
Learn to use our free quoting and enrollment tools
We provide our agents with a few ways to quote and enroll clients in a CMS complain way. Sunfire and Connecture are two of the tools we offer at no cost to our agents. Both of these tools provide a CRM as well as the ability to record sales calls and remain compliant.
Take a look at a Sunfire enrollment demonstration
Networking and Business Development Training
Agents require more training once they have a handle on the ins and outs of Medicare and the carrier plans. Some people require advice to help the design a business plan. They may need a strategy for networking opportunities, leads, and business development. These tools will establish their place in the community and build a book of business.
Generate Medicare referrals
Medicare lead program
Our agents have an opportunity to participate in our Medicare lead program to. We provide agents up $500 a month to offset lead and marketing costs. There are no minimums to start and absolutely no reduction in compensation.
More info on our Free Medicare Lead Program
What does a Medicare agent earn
Each year CMS sets the maximum amount for Medicare commissions. Click here to see the commission rates for 2024
Watch a YouTube video to see the CMS proposed changes to agent compensation
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Aetna SilverScript
For Medicare beneficiaries who are on Original Medicare or Original Medicare and a Medicare Supplement plan, it is a good idea to add a Medicare prescription drug plan to cover your prescriptions. One prescription drug plan that provides coverage to many beneficiaries is the Aetna SilverScript Plan. In this post, we will go over some of the benefits these plans provide.
Aetna SilverScript Overview
Aetna SilverScript is a Medicare prescription drug plan provider. It is part of the Aetna family of medical insurance plans. These plans are designed to work with Original Medicare or Medicare supplement plans and cannot be sold to anyone who is currently enrolled in a Medicare Advantage plan and wants to remain on that plan.
Eligibility for prescription plan enrollment
In order for a beneficiary to eligible for enrollment in any PDP plan, they must be enrolled in either Medicare Part A or both Medicare Part A & Part B. Beneficiaries must also live in the service area of the plan they want to enroll in.
There are specific times you must use to enroll in a Medicare prescription drug plan (Part D).
- During your initial enrollment period (IEP).
- Enroll during the Annual Election period (AEP).
- If you have a Medicare Advantage plan, you can enroll during the Medicare Advantage Open Enrollment Period (MAOEP).
- When you qualify for a special election period (SEP).
Learn more about Medicare’s enrollment periods
Aetna SilverScript plans
In 2024, Aetna is offering 3 different plan choices:
- First, the SilverScript Smart Saver plan – This plan has an average monthly premium of $11.19, Please note, this cost is an average. Actual cost depends on the service area. This plan offers a $0 copay for a 30-day supply of Tier 1 drugs. There are almost 600 drugs that fall into Tier 1 and Tier 2 on this plan, drugs on tier 2 have a copay amount of $5. The SilverScript Smart Saver plan also provides members a low deductible of $280 for Tier 2 through Tier 5 drugs.
- Second, the SilverScript Choice plan – Members of this plan pay an average monthly premium of $46.59. Please note, this cost is an average and the actual cost depends on the service area. There is a $545 deductible applied to all tiers of this plan. The copay amount for Tier 1 drugs is $2 while the Tier 2 copay amount is $7. Beneficiaries who qualify for Extra Help do not have to pay a plan premium.
- Third, the SilverScript Plus plan – The premium for this plan averages $103.51 although the actual amount varies depending on the service area. This is a top-notch plan that offers members a $0 deductible for both Tier 1 and Tier 2 drugs. On this plan, there is a $0 copay for many prescription vitamins, minerals and some other types of drugs. members also receive additional gap coverage.
Watch a video on Drug plan changes for 2024
Features of Aetna SilverScript PDP plans
Variety of Plans
Aetna offers a wide range of prescription drug coverage options. This allows beneficiaries to choose a plan that aligns with their personal needs and budget. Each plan covers different medications at varying costs.
Extensive Network of Pharmacies
All Aetna SilverScript plans offer an extensive network of pharmacies. This gives beneficiaries the flexibility and convenience to choose where they fill their prescriptions.
Mail-Order Options
The Aetna SilverScript plans provide the option for mail-order prescriptions, allowing beneficiaries to receive a 90-day supply of their medications conveniently delivered to their door.
Members of Aetna SilverScript PDP plans can visit AetnaMedicare.com to access and print plan materials, pay their plan premiums, check coverage of their drugs or locate a local, preferred pharmacy.
Aetna also provides members a secure site, Caremark.com, to find prescription prices, see possible prescription savings options, sign up for mail delivery, check order status and more.
Click here to learn why you should use a Medicare agent
To see if these plans are right for you, check with a licensed Medicare agent who can ensure your coverage needs are properly met by either these plans or another one.
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Connecture vs Sunfire
Because we offer both platforms to our agents at no charge, we will compare the two, Connecture vs Sunfire, to help you choose which one to use based on your personal preferences and not our opinion. It is tough to decide which platform is better as each provides quoting and enrollment for MAPD, PDP, and Medicare Supplement as well as dental and vision sales.
Both platforms provide browser-based software that does not require agents to download anything on their computer.
Watch a YouTube video on how to use Sunfire and Connecture for enrollments.
Let’s start with Connecture
Here are a few of the features Connecture offers:
- This platform provides the user with a built in CRM. Agents enter client information such as, name address, email, phone number as well as medications, doctors and preferred pharmacy.
- There is the option to provide the client’s health status (Generally Healthy, Some Health Needs & Significant Health Needs). This helps you determine the type of coverage that best suite each individual.
- Connecture provides a personal PURL, this is a shopping link that agents can send to clients to self-enroll and credits the agent with the sale.
- There is an option to quote and enroll clients in DSNP plans.
- This website provides Blue Button functionality, it lets agents enroll clients through a government approved link to the carrier’s enrollment portal.
Learn why you should consider contracting with Crowe
Now we will go over Sunfire
Here are some things that make Sunfire different:
- Sunfire offers the ability to select different levels of LIS, this includes approximate premium deductions.
- Agents have the option to enter the client’s current plan to provide a side-by-side comparison so clients can make an informed choice.
- Enter the client’s health status by choosing Excellent, Good or Fair.
- Sunfire gives agents the option to highlight Dental, Vision and Hearing (DVH) benefits if they are included in a plan’s benefits.
- Use the enhanced provider search tool and check if a doctor is in network right on the quoting page. You do not need to use carrier specific tools.
Here’s why they are similar
- Each platform provides agents a way to quote and enroll clients over the phone, by sending a link or in-person online. This can eliminate a face-to-face meeting when it is not possible.
- Both platforms provide a basic CRM to save client information, enrollment information and scope of appointment forms.
- Connecture and Sunfire both provide the ability to record enrollments and scopes and save them.
- Agents can enter the client’s doctors or drug lists and run a plan comparison as well as download a copy to send their clients.
- Send clients information through either text or email.
- Either system lets agents add plans they are not contracted with in to compare.
Click her to watch a video on the CMS call recording rules
Although both these programs offer similar features, individual agents definitely have their opinions as to which they prefer. Crowe and Associates agents can access both of these tools through connect4medicare.com. This is a webpage provided by Pinnacle financial services for use by our agents. Agents are welcome to use one or both of these tools interchangeably as they choose. Because the systems are designed differently, each one offers a unique user experience.
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How to find my Medicare ID number
There are times when you need to have your Medicare ID number. For example, when it is time to enroll in a new Medicare plan, you need to have your Medicare ID to enter on the application. If you are a Medicare beneficiary, you may be wondering; how to find my Medicare ID number.
Please note: if you need to sign up for Medicare Part A and or Part B, you go through Social Security. Once you are enrolled, you will need to manage your benefits through Medicare.
Click here to learn about Medicare enrollment periods
How to get your Medicare ID number
If you need to get your Medicare ID number quickly, you can go to www.ssa.gov and sign in to your Social Security account. Once you are in there you can view your benefit verification letter.
There are a few ways to sign into your account
You could sign in with Login.gov if you created an online account with Social Security after September 18, 2021.
If you were not able to create an account with Login.gov, you may have created an ID.me account. When this is the case, you can log in with your ID.me credentials.
Sign in with your Social Security username if you made an online account with Social Security before September 18, 2021. You should also use this method if you have signed in in the past with a username and not an email address.
Watch a quick video on how Medicare works with employer coverage
If you need a replacement card
Just sign in to your Medicare.gov account and follow the prompts to print a new card. When you do not have a Medicare.gov account, you need to know your Medicare number as well as your Part A start date. This information is located on your benefit verification letter. We mentioned how to find this letter (at ssa.gov) in the beginning of this post. If you are unable to do this, call Medicare and ask for a replacement card. You can reach them at 1-800-633-4227. The representative will ask a few questions to verify your identity and then they will mail you a new card.
Why you need a Medicare agent
What else you can do at your local Social Security office or ssa.gov
Make changes to your personal information
Beneficiaries can change personal information such as name changes, or changes in address or phone number. Because Medicare uses the name, address, phone number, and date of birth that is on your record at Social Security record. This can be done online at ssa.gov. Sign in and click on “card and record” and choose the option you need and report the necessary changes.
To cancel enrollment in Original Medicare
If you decide to cancel Medicare Part A and or B (you can only cancel Part A if you do not receive it premium free) fill out form CMS-1763. Once you complete the form, you can either mail to your local social security office or fax it to them.
Use this link to find your local Social Security office.
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Medicare agent sales training
As the demand for Medicare coverage continues to grow, the role of Medicare agents becomes increasingly important. For that reason, Medicare agent sales training is crucial. Agents need to be prepared to provide guidance for beneficiaries to ensure they receive the health care coverage that fits their needs and budget.
There are various training programs available to equip agents with the necessary knowledge and skills. Agents need to take in a lot of information including; rules, contracting, benefits, quoting, certs and much more. We will discuss some of those things below.
Initial Training Programs
Newer Medicare agents require comprehensive initial training programs. These programs should provide a solid foundation of the Medicare system including eligibility, coverage options and enrollment periods as well as how they work together. We provide a weekly zoom training for all our newer agents that need the extra time to get up and running.
Product-Specific Training
Because there are so many coverage options for Medicare beneficiaries, including Original Medicare, Medicare Advantage (Part C), and Medicare Prescription Drug Plans (Part D), agents need product-specific training. This training ensures that agents are well-versed in the details of each plan, allowing them to match individuals with the most suitable coverage. Each carrier provides it’s agents with product training opportunities. We also offer training when a new product that shows potential is introduced into an area or if agents show an interest in learning more about a specific product. Agents can either join one of our weekly zoom meetings or webinars or find information on our website or YouTube channel. You can find links to this information on our website, just click on the link below.
Click here to view our updated Events and information post
Annual Training and Updates
Given the dynamic nature of Medicare coverage options, agents must undergo annual training and updates. This ensures that agents stay current with any changes to Medicare regulations, coverage options, and compliance standards. Agents can get helpful tips on the annual AHIP training on our YouTube channel as well as updated CMS regulations for Medicare sales.
Technology Training
Because technology is always advancing, agents need updated tools and technology to remain competitive. That is why we provide both Sunfire and Connecture for quoting and enrollment to our agents at no cost. We offer one-on-one training and video instruction to agents who want it. These tools offer a built in CRM as well as the opportunity for agents to record their sales calls and remain compliant. Our technological resources enhance the agent’s ability to serve clients effectively.
Visit our YouTube channel and watch some free training videos on any of the above subjects you have questions about
Ethical and Compliance Training
Ethics and compliance are a big concern in the insurance industry. Agents undergo annual training on ethical sales practices and conduct, as well as updated regulatory requirements. This training ensures that agents operate with integrity and in accordance with industry standards. Our zoom meetings and webinars often focus on updated CMS regulations to ensure our agents maintain their compliance. All our informational webinars are recorded and put up on our YouTube channel.
If you want to join our team, click here for online contracting
Sales Skills Training
Many agents appreciate training programs that help focus on honing sales skills. This training teaches agents how to educate clients, address concerns, and facilitate informed decision-making. Some training programs we offer focus on different types of approaches and opportunities agents can use to generate sales. Because each agent is an individual, we offer calls or meetings to discuss different approaches agents can use to generate sales.
Networking and Business Development Training
Agents require training programs that go beyond the technical aspects of Medicare. They need guidance to building a successful business. This includes strategies for networking, lead generation, and business development to help agents establish and grow their client base. We provide agents with information and guidance on lead programs as well as how to host sales events and much more.
Learn how to generate Medicare referrals
The landscape of Medicare agent training is diverse, this reflects the multifaceted nature of the Medicare business. Whether it’s mastering the benefits of Medicare plans, staying compliant with regulations, or developing essential sales skills, ongoing training is a must for Medicare agents. This helps ensure they provide high-quality service to their clients.
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Late Medicare enrollment
Medicare can be confusing; understanding the rules and guidelines for enrollment is important to ensure you have access to the healthcare coverage you need. Although many people are aware of the initial enrollment period, there are situations when individuals may apply for late Medicare enrollment. We will go over some reasons for late enrollment, the rules surrounding late enrollment, and how to apply for Medicare.
Reasons for Late Medicare Enrollment
Missing your IEP (Initial Enrollment Period) – If you neglected to sign up for Medicare during your IEP, which begins three months before your 65th birthday and extends to three months after, you may need to wait for the GEP to sign up.
Missed a SEP (Special Enrollment Period) – In some cases, a qualifying event such as loss of employer coverage or moving can trigger an SEP. If you miss this opportunity, you may have to wait for the GEP.
You have employer Coverage after the age of 65 – If either you or your spouse continue to work past the age of 65 and have employer-sponsored health coverage, you may delay Medicare enrollment. Late enrollment is allowed without a penalty as long as you enroll in Medicare within eight months of losing the employer coverage.
Rules and Guidelines for late Medicare enrollment
General Enrollment Period (GEP) – The GEP runs from January 1 through March 31 each year. Those who enroll during this period may face a late enrollment penalty (LEP). The LEP is added to your Medicare Part A, if you do not qualify for premium free Part A, and Part B monthly premium amount. For each 12-month period you delay enrollment in Part B, there is a 10% penalty applied. The penalty lasts for as long as the beneficiary has Part B coverage. That is one reason to enroll in Medicare as soon as you are eligible.
Learn more about the Part B LEP
Medicare Advantage with prescription coverage (MAPD) and stand-alone Part D plans – Individuals who did not have creditable prescription coverage while they were eligible, will also have to pay a Part D penalty for late enrollment.
How to apply for Medicare
Go to the Official Medicare Website – In some instances, beneficiaries can enroll in Medicare online. This is the easiest way to enroll. Just visit medicare.gov and you will see options to enroll. This website provides comprehensive information for those enrolling in Medicare or if you have Medicare questions.
Visit your local Social Security Office – Beneficiaries can either apply for Medicare over the phone by calling 1-800-772-1213 Monday – Friday 8 am – 7 pm. Tell the representative if you want to apply for Medicare A & B or Part A only. Hearing impaired beneficiaries can call TTY 1-800-325-0778.
If you want to apply in person, click here to find a local social security office.
You will need the following information: your Social Security number, where you were born (city, state, country) and start and end dates of your current health coverage. If you are applying for Part B only, you will need a valid email address and your existing Medicare number.
Find out why you should use a Medicare agent.
Once you have your Medicare coverage in place, it is important to get the help of a licensed Medicare agent who can guide you through the different coverage choices available to supplement your coverage.
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CMS proposed rule 2024
Because there are many rules and proposals we will clarify, this post explains the CMS proposed rule 2024 (CMS-4205-p). This rule was proposed in early November 2023.
Some of the changes included in this proposal
Agent compensation adjustment
CMS is proposing putting a maximum allowable commission in place for all agents. This amount will be based on national level of $611 for new Medicare Advantage enrollments and $306 for renewals of Medicare Advantage plans.
In some states the proposed amount is lower than the commissions agents are currently earning. both CA and NJ, have current commission levels for new Medicare Advantage enrollments of $762. In CA and NJ the renewal commissions are $381 annually. The states of CT, PA & DC Medicare Advantage commissions rates for new enrollees is $689 and $345 for renewals. The wording on this part is a little tricky so we are not sure if the commission rate would all remain as it is or if it will all be one standard amount no matter which state you sell in.
Learn about Medicare commissions 2024
CMS has also proposed the addition of a $31 admin fee for each application. This may seem like a good thing, but it is not nearly enough to replace the overrides and other monies they propose to eliminate.
Overrides and Admin fees
If CMS passes the proposed rule as it is written, it will have a much bigger impact on uplines than it will on individual agents.
The proposal includes the elimination of all administration fees as well as overrides at all levels (GA, MGA, SGA, FMO & NMO). This means agencies at any level that have direct pay agents would lose all revenue eared through overrides. That part of the proposal would essentially end the direct pay agency model.
Click here to learn about pro-rated Medicare commissions
How this effects agents
Agents would lose access to all the services provided by their uplines. Some of what they stand to lose are:
- Assistance with contracting. Uplines make the contracting process much easier by providing a much more streamlined option to agents. Some carriers currently do not contract directly with agents at all.
- Connecture and Sunfire or any upline provided quoting and enrollment tools that their upline currently provides.
- Education and training. This is an important one. A good upline provides agents with many different training options that can include in-person, telephonic or training through teams or zoom calls. Just to mention a few. These trainings include updated CMS compliance information, carrier specific products or assistance with basic knowledge or sales practices.
- Back office support, the back office provides agents with a myriad of answers to their questions as well as training to use enrollment portals or help processing applications as well as various other assistance.
- Marketing reimbursements; these are a great help to agents, especially when they are trying to get up and running.
These are just a few examples of what an upline provides it’s downline agents. The list may vary depending on the upline you are currently working with.
Click here to see the programs that Crowe has to offer
More of what CMS proposes to eliminate
CMS wants to eliminate all marketing money. This includes marketing money from carriers weather it goes toward expenses or lead costs. Reimbursement of expenses will not be permitted at any level. This will effect; agents, agencies, FMOs and even NMOs.
They want to stop all payments agents receive for helping clients complete HRAs.
Take a look at a our YouTube video on this topic
Would any agency survive this
The proposal would not eliminate all agency models. If the agency is LOA, they may be able to survive if they offer agents a lower commission rate and operate on a much smaller budget. An agency that sells a large volume of ancillary products such as; cancer, critical illness, life or annuities, may also remain viable.
If the main revenue source of the agency/FMO comes from the sale products such as annuities, life P&C or other products and does not rely on Medicare sales, they could stay afloat. Any business that uses Medicare sales as a secondary income source may suffer a loss but could still remain profitable.
Visit out Events and information page to see upcoming webinars or other informative information
When will this go into effect
Although the final draft of the proposal may be decided in January, the timeline of when we will know what it actually says may not be until the spring. CMS was receiving comments on the proposal until Jan 5, 2024. That window is now closed. NABIP(a huge advocate for agents/agencies) was also collecting a 5 question survey on this proposal in an effort to get our voices heard.
If the current version of the rule remains as is, it will create a substantial impact in the entire industry. It will effect everyone from NMOs to the clients.
To view the proposal in it’s entirety, go to www.regulations.gov
You can download the entire 486 page document . The pages that pertain to Medicare agents are 6, 236-248. There you will be able to view the specifics on the agent compensation changes.