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.
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Eligibility for Medicare Part B
Part B of Medicare provides coverage for medical services like doctors’ visits, preventative services, outpatient medical services, and other medically necessary items and services. In this post, we will go over the rules for eligibility for Medicare Part B.
To be eligible for Medicare Part B, individuals must meet certain criteria
Medicare Part B is one part or original Medicare. and Part B is an integral part of this coverage. In General, individuals who are 65 or older qualify for Medicare. However, there are other scenarios when an individual may be eligible to enroll.
Turning 65
The most common way to qualify for Medicare is when an individual turns 65 and is a U.S. citizen or legal permanent resident living in the U.S. for at least 5 continuous years. This period of time is referred to as the IEP. It is a good idea to enroll during the IEP (Initial Enrollment Period) to avoid a late enrollment penalty.
Disability
In some instances, individuals under 65 with a qualifying disability are eligible to enroll in Medicare Part B. Individuals who receive either SSDI (Social Security Disability Insurance) or some Railroad Retirement Board (RRB) disability benefits for a period of at least 24 months may qualify for benefits.
End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS)
Individuals who suffer from either permanent kidney failure requiring dialysis or a transplant (ESRD) or Lou Gehrig’s disease (ALS) usually qualify for Medicare coverage. This coverage includes Medicare Part B.
Watch a YouTube video on SEPs. OEP and Late Part B Enrollment
Enrollment periods
When enrolling in Medicare Part B, there are a few different enrollment periods available. Once you are eligible to enroll in Medicare Part B, it is important to understand when and how to enroll.
IEP (Initial Enrollment Period)
The IEP is the seven-month period that begins three months before the individual turns 65. It includes the month of their birthday and continues for three months after. As we stated earlier, enrolling during this period is recommended to avoid a late penalty.
SEP (Special Enrollment Period)
Some individuals may qualify for a Special Enrollment Period. For those who delayed enrollment in Part B due to having employer coverage through their employment or a spouse’s employment an SEP allows them to enroll without facing a penalty.
Learn more about SEPs
GEP (General Enrollment Period)
If an individual missed their IEP and doesn’t qualify for a SEP, they can enroll during the General Enrollment Period. This enrollment opportunity runs from January 1 to March 31 each year. It is important to note; late enrollment penalties may apply for those who wait to enroll during this time.
Additionally, Medicare Part B is an important part of healthcare coverage for seniors and other qualifying individuals. Understanding the eligibility criteria and enrollment process is essential to ensure timely access to the benefits that Medicare coverage provides.
Medicare agents, click here to become part of the team at Crowe
A licensed Medicare agent can help navigate the ins and outs of Medicare coverage and ensure beneficiaries receive all the benefits necessary for their healthcare needs and budget.
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How to get more Medicare referrals
Agents who generate a steady stream of referrals not only build their client base but also establishes their credibility in the industry. We will go over how to get more Medicare referrals with a few ways agents can build their referral network and achieve sustainable growth.
Build good relationships with your existing clients
Agents who put in the effort to ensure their clients are happy with their coverage choices can easily earn referrals. In order to ensure clients are happy, agents must be in contact with their clients and go over new plan options each year during the AEP. Agents should use a good CRM to keep client information up to date. This includes a list of their current doctors and medications so you can quickly update it each year when you run a plan comparison for AEP.
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Collecting your clients email and phone number can be a good idea. This way agents can send out a mass email that contains any pertinent information for your clients. The phone numbers are useful not only to contact your clients in general but can be used as a tool if they want to opt in and receive text messages from you.
They also need to be available when a client calls with a coverage question. If a client has confidence in the service they receive, they are more than happy to tell friends, neighbors or anyone else who asks. This a very valuable source of new business. It is also ok to ask clients for referrals, just find a way that is comfortable for both you and the client.
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Establish relationships with local healthcare professionals
It is a great idea to introduce yourself to healthcare professionals, doctors and clinics in your area. Once they know you and are aware of the service you offer, you can create a partnership. Establishing a good relationship with healthcare providers can open doors to a continuous stream of leads. Volunteer to attend healthcare events, workshops, and seminars to connect with providers who may refer individuals seeking Medicare coverage. Position yourself as a reliable and knowledgeable resource for their patients’ needs.
Build a strong social media and online presence
In today’s digital age, a strong online presence is essential. Agents should consider creating business profiles on social media platforms. Once the profile is created, it is important to maintain the the platform with any pertinent information potential clients may find valuable. Information about Medicare options and answers to common questions are a couple things to post on your platform to engage your audience. An online presence not only helps you reach a broader audience but also positions you as an expert in the Medicare field.
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Host free educational workshops
Host workshops or webinars to educate the community about Medicare coverage options and changes. If you provide valuable insights into the complexities of Medicare, you will gain status as a valuable resource. Anyone who attends may be more inclined to refer friends and family to you when they are looking for guidance on their Medicare choices.
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Offer Referral Incentives
Create a referral program that rewards clients and other individuals for referring new clients to you. Incentives for clients can include a gift card or anything appropriate with a value of $15 or less. It is important to be complaint when offering referral gifts. By acknowledging and appreciating referrals, you encourage your existing network to actively promote your services.
Referral gifts for another agent or business professional (ACA agents, P&C agents, Medicare agents not licensed in a particular area) can be a cash payment of up to $100 per sale. It is important to remember to pay them this so they will be more likely to refer other clients to you in the future. Please note: in most cases, financial planners cannot accept the referral gift.
Collaborate with Local Businesses
Explore partnerships with local businesses that cater to the senior population. Establishing connections with senior centers, fitness clubs, or retirement communities can be mutually beneficial. These businesses may refer clients to you, and in return, you can refer clients to them for services.
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Stay Informed
Because Medicare plans change each year, it is important to stay informed on any updates and adjust your strategy accordingly. Be sure you are up to date on compliance rules and attend product training sessions, workshops and conferences regularly. This is a good way to build relation ships with broker managers and other agents in the industry who may send you a referral if they have a beneficiary who needs an advisor. An informed and well known agent is more likely to attract referrals from clients and other professionals.
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As a Medicare sales agent, building a large referral network is essential if you want to achieve long-term success. By focusing on client satisfaction, and following the other suggestions noted above, you can build a successful referral-based business that continually brings in new clients and opportunities.
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Medicare licensed agents
Medicare licensed agents provide a valuable service to beneficiaries. If they stay up-to-date on product offerings and CMS rules, they can provide clients with a number of plan choices that will suite their needs. This is a great career if you are interested in becoming a valued member of your community and providing an important service to it’s members.
Where to start
The first thing you need to do is go onto the state insurance department website for your state. From there, you can lookup the requirements to earn your health or health and life license.
There are several companies that offer the courses you need to study for your test. Your states insurance department website will give you the available options. While you are studying for you resident state license, you will start to learn the rules for selling Medicare & other health plans. Studying also provides valuable information about the different components of Medicare and how they work together.
Each state has different requirements for exam-prep. Some require in-person training while others allow self-study at your own pace. There are also online options and options to order books if you are more comfortable with that. There is a test at the end of the course that you must pass before you can take your actual licensing exam. It is important to note; some states require agents to take a course on life as well as health while other states do not require agents to do both. If you think you may want to offer life products later, you can add the life course and do the testing at once.
Once you pass the exam, CMS reports your results to the National Insurance Producer Registry (NIPR). Be sure you print and download a copy of your license. You will find your National Producer Number (NPN)on your license. You need your license and NPN to contract with carriers.
Contract with an FMO
An FMO (field marketing organization) is an invaluable tool. A good FMO not only provides it’s downline agents training, tools and contracting. They provide continuous, back office support, they will answer your calls and make sure you get answers to your questions. Some of the things FMOs help; they get contracting requests processed, train downline agents on new CMS regulations and carrier products. Agents need to take time and ask as many questions as you need to to feel comfortable before they choose an FMO.
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Having an FMO behind you , makes contracting with multiple carriers and products a much smoother process. They should also provide guidance to new agents to put a plan of action in place and get up and running. There may also be opportunities for leads, marketing money and other useful tools.
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Purchase E&O insurance
In order to do business, carriers require all agents to have E&O insurance. This insurance protects you in the event you make a mistake when you enroll a client an they take legal action against you to cover any financial loss your misinformation may have caused them. Your FMO may provide a discounted plan to it’s downline agents. If they don’t you can purchase a policy through an agent who provides property and casualty insurance.
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Complete AHIP
After you get our license, you should take the AHIP. AHIP stands for America’s Health Insurance Plans. Most carriers who offer PDP or MA/MAPD plans require agents to take this training and certification course. Agents must take this test each year and get a 90% to pass. The cost to take the AHIP course is $175, although many carriers offer a $50 discount if you take it through their portal when you do your carrier certifications(more on those below).
Click here to watch a YouTube video on AHIP test tips for 2024
Get contracted & appointed
Agents must complete carrier contracting before they are appointed to sell their products. In most cases, agents need a copy of their current state health insurance license for each state they plan to sell in. A copy of their E&O certificate is also necessary. Your FMO will will help with this process by providing other important information to the carriers. Once the carrier has all the pertinent information, you must complete the carrier specific training for PDP and MA/MAPD plans.
It is a good idea to request only 4-5 good carriers in your area and get RTS (ready to sell). With a good FMO, it is easy to add more in as you need them. You do not want to be overwhelmed from the start. This can discourage anyone.
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Moving forward
It is important to make sure you keep your license active. This sounds like a no brainer but, some agents forget to renew and that can cause a number of problems with your carrier contracts. up to date. In order to do this you will need to complete a specific number of CE credits before you can renew your license. The amount of CE hours you need vary by your resident state. You can choose any accredited CE course provider you like, again this is based on state specific requirements.
If there are updates with CMS requirements, both your FMO and the carriers you are appointed with should provide them to you. It is essential that you follow all guidelines when making sales to avoid termination of your contracts.
If you want a career where you provide a valuable service to individuals and truly enjoy helping people, this could be a good fit for you. In this business, we cannot stress enough how important it is to be organized and well informed to provide the best service to your clients.
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Medicare premiums
If you are either a Medicare beneficiary or a Medicare agent, you need to know the cost of Medicare premiums. Each year the costs are subject to change. Both enrollees and agents should stay updated on cost and coverage changes. Not having the correct information can be a costly mistake.
Medicare Part A
There is no premium ($0) for Part A for the majority of people most people. Beneficiaries who worked or had a working spouse who paid Medicare taxes for at least 40 quarters (10 years) receive premium free Part A.
Those who do not qualify for the $0, premium free Part A may be eligible to purchase it. Beneficiaries must sign up for Part B in order to purchase Part A. For 2024, the monthly premium is either $278 or $505. This depends on the length of time either the beneficiary or their spouse worked and paid Medicare taxes.
Please note: Beneficiaries who do not purchase Part A when they are eligible (in most cases at 65 years old), may pay a penalty. The penalty adds 10% to the monthly Part A premium and lasts for twice the number of years that you neglected to sign up for Part A.
Medicare Part B
The monthly premium for Part B is $174.70 in 2024. This amount usually changes on January 1st each year. This premium may be higher for some individuals with a higher income level. This additional charge is called an IRMAA, and it effects about 8% of Medicare beneficiaries. The Additional charge ranges from $69.90 up to $419.30 added to the monthly premium.
Medicare may charge a late enrollment penalty to anyone who did not enroll in Medicare Part B when they were first eligible or did not have creditable coverage in place at that time. The LEP for failing to enroll in Part B is 10% for every year the beneficiary did not sign up for Part B. This penalty is different than the Part A penalty; it will last for as long as the beneficiary has Part B.