This year has been very confusing to say the least; as far as Medicare commisions 2025 go. As a result of recent lawsuits regarding the 2025 Medicare Final Rule, CMS issued updates to 2025 Medicare Advantage and Part D broker commissions on July 18, 2024. The newest amounts supersede those originally reported by CMS for CY 2025.
What you need to know
Please note; additional amounts previously stated have been removed. The one-time administrative increases of $100 to initial enrollments and $50 to renewals no longer apply.
This means, the additional money will not be added into the commission amounts anytime in the near future. If the judge approves CMS Final rule at some point in 2025, the commission rates will increase by $100 for initial enrollments and $50 for renewals.
Even without the increases listed above, CMS has increased commissions for both MA and PDP plans. This is due to an increase in the Fair Market Value (FMV). The maximum broker compensation below reflects the increase.
Maximum commissions 2025
It is important to note: commission rates vary by state.
In both CA and NJ, initial commission rates have increased from $762 per member for 2025 to $780 per member for the year. The renewal commissions for CA and NJ have gone up from $381 per member for the year to $390 per member for the year.
The states of CT, DC and PA have had an increase in initial MA commissions from $689 per member for the first year to $705 per member for the first year. Renewal commissions for CT, DC and PA have increased from $345 per member per year to $353 per member per year.
Both Puerto Rico and the U.S. Virgin Islands initial MA commissions have gone up from $418 per member for the year to $428 per member for the year. The renewal commissions have increased from $209 a member for the year to $214 per member for the year.
In all states not listed above, the initial MA commission amounts have increased from $611 per member per year to $626 per member per year. Renewal commissions have increased from $306 per member for the year to $313 per member for the year.
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Maximum commissions for PDP plans 2024:
The commission rates for PDP plans are the same in all states.
Initial commission rates for PDP plans have risen from $100 per member per year to $109 per member per year. Commissions for PDP plan renewals have also increased from $50 per member each year to $55 per member each year.
Medicare Advantage Commissions 2025
| Product | Region | 2024 | 2025 | %Increase | 2024 | 2025 | %Increase |
| MAPD | National | $611 | $626 | 2.45% | $306 | $313 | 2.19% |
| CT, PA, DC | $689 | $705 | 2.32% | $345 | $353 | 2.32% | |
| CA, NJ | $762 | $780 | 2.36% | $381 | $390 | 2.36% | |
| Puerto Rico, U.S. Virgin Islands | $418 | $428 | 2.39% | $209 | $214 | 2.29% | |
| PDP | National | $100 | $109 | 9% | $50 | $55 | 10% |
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When it comes to Medicare, most people have an understanding of the traditional options like Original Medicare and Medicare Advantage plans. However, individuals with certain chronic conditions, may want a specialized Medicare Advantage plan called a what is a Chronic Secial needs plan, or C-SNP. In this post, we answer the questions; what are Medicare C-SNP plans, who is eligible to enroll in them, and what they provide.an medicare
What Are Medicare C-SNP Plans
Medicare C-SNPs are a type of Medicare Advantage plan that serves individuals with specific chronic health conditions. Unlike typical Medicare Advantage plans, C-SNPs provide tailored coverage and care coordination to address the unique needs of individuals with specific health conditions. Just like regular Medicare Advantage plans, these plans are offered by private insurance companies and include all the benefits of Original Medicare. In addition, they cover the necessary services to managing chronic conditions.
Who Qualifies for a C-SNP
To enroll in a Medicare C-SNP, you must meet specific eligibility criteria:
Chronic Condition Diagnosis
You must have one or more chronic conditions that the C-SNP is designed to manage. Common conditions that C-SNPs cover include diabetes, chronic heart failure, cardiovascular disorders, chronic lung disorders (like COPD), and end-stage renal disease (ESRD).
Medicare Eligibility
You must be eligible for Medicare Part A and enrolled in Part B.
Living in the Service Area
Enrollees must reside in the service area of the C-SNP plan in order to join. Not all plans are available in every location.
Key Features of Medicare C-SNP Plans
Targeted Care Coordination
One of the primary benefits of C-SNPs is the focused care coordination tailored to the chronic condition. These plans offer a network of healthcare providers who specialize in managing specific illnesses. Additionally, C-SNPs may offer case managers who help navigate healthcare needs, ensure enrollees follow treatment plans, and connect with resources and support.
Customized Benefits
C-SNPs may offer additional benefits beyond what is covered by Original Medicare. These could include: specialized treatment plans, rides to appointments, a care coordinato, nutrition plans and much more.
Specialized drug formularies
C-SNPs often include a list of covered prescription drugs specifically tailored to manage your chronic condition.
Access to specialists
Enrollees have access to specialists and healthcare providers who have expertise in treating a specific condition.
Wellness programs
In some cases, these plans offer services designed to help manage the condition, such as nutrition counseling, exercise programs, or disease management education.
Lower Out-of-Pocket Costs
Because C-SNPs manage chronic conditions more effectively, they may offer lower out-of-pocket costs for common services and medications associated with treatments. This can be a significant financial benefit for those managing costly, ongoing medical care.
Why choose a Medicare C-SNP Plan
Personalized Care: The primary advantage of a C-SNP is the personalized care that aligns with your specific health needs. This targeted approach ensures that treatment is optimized for your condition and can lead to better health outcomes.
Comprehensive Coverage: C-SNPs provide all the benefits of Original Medicare and often include Part D prescription drug coverage, along with additional services tailored to your condition.
C-SNPs emphasize care coordination. This ensurs that all aspects of your healthcare are managed effectively. This can reduce the likelihood of hospitalizations and improve your overall quality of life.
Join the team at Crowe and provide guidance to Medicare enrollees – click here for online contract
what to consider before choosing a C-SNP
While C-SNPs offer significant advantages for those with chronic conditions, there are some considerations to keep in mind:
Network Restrictions: Like other Medicare Advantage plans, C-SNPs typically require you to use a network of providers. Ensure that your preferred doctors and specialists are within the plan’s network.
Plan Availability: Not all C-SNPs are available in every area, and the specific chronic conditions covered can vary by plan. Be sure to check if a C-SNP that fits your needs is available in your region.
Eligibility Requirements: You must have a qualifying chronic condition to enroll in a C-SNP. If your health needs change, you may need to switch plans, which could affect coverage.
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How to Enroll in a Medicare C-SNP Plan
If you think a C-SNP might be the right choice for you, follow these steps:
- Find a licensed Medicare agent to help show you plan options and explain differences in coverage. This will help you make a well-informed decision.
- See what’s available in our area. Consider the specific chronic conditions covered, the provider network, and the additional benefits offered.
- Look at the costs including; premiums, deductibles, and out-of-pocket costs associated with each plan.
- Ensure you meet the eligibility criteria for the C-SNP, including the diagnosis of a qualifying chronic condition.
- You can enroll in a C-SNP during your Initial Enrollment Period, the Annual Election Period (October 15 to December 7), or a Special Enrollment Period if you qualify.
Learn about enrollment periods for Dual and Partial Dual & LIS enrollees
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Medicare C-SNP plans offer a valuable option for individuals with chronic health conditions who need specialized care. By providing tailored coverage, enhanced care coordination, and access to specialized providers, C-SNPs help better manage some chronic conditions and improve overall quality of life.
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SEPs are important for both agents and beneficiaries to understand. Missing an SEP can cause a beneficiary to pay more for their medical care then necessary. We will discuss the disaster/emergency SEP requirements to make sure your plan is approved without delays.
It is important to note; disasters or emergency SEPs that are declared by a government entity are only applicable to beneficiaries who were unable to complete an enrollment during a valid election period that took place during the emergency or disaster. CMS has clear guidelines when beneficiaries can use this SEP.
How to qualify for this SEP
The beneficiary has to have missed a valid election period when the declared disaster or emergency occurred. They have to have been unable to make the desired plan change during the specified time period. SEPs for disasters or emergencies are only applicable to those who live in the affected area during the emergency.
CMS also states; beneficiaries who rely on the help of individuals who reside in an area where the disaster or emergency occurs for health care decisions, may also be eligible for the SEP
Some reasons for not using this SEP
This SEP is not valid in cases when the beneficiary has already used another valid election period during the time the SEP begins. This is the case when the disaster SEP occurs during another valid election period. For instance, if the disaster SEP begins at some point during the AEP and the beneficiary uses the AEP election period, they are not eligible to use the SEP. This is because they have already used an election period. Thye are now ineligible to switch plans again.
Watch a quick YouTube video on SEP Changes for Dual, Partial Dual and LIS members in 2025
Learn more about SEPs – click here to watch a video
How long does the SEP last
SEPs last for either at least 2 months after the end of the emergency or disaster or when the end of the incident is stated, the rules follow whatever date is later.
Here’s an example:
On August 8th through August 15th there is a wildfire that causes FEMA to declare a disaster/emergency in two counties. FEMA declares the SEP on August 20th; this means the start of the SEP is August 8th. This SEP would end two full months after the SEP is announced on August 20th. In other words, the end of the SEP would be October 20th because this is the later date.
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Managing healthcare online is not only easy but in some cases, a necessity. In this post we answer the question: why create an online Medicare account. We discuss some of the ways this makes accessing information easier.
The online Medicare account is tailored to each individual and provides personal information about benefits and coverage. This ensures beneficiaries receive updates and reminders in a timely manner.
Create an Online Medicare Account
It is not difficult to set up an online Medicare account.
- Go to the Medicare website; Medicare.gov
- Scroll down until you see the linbk to log in or create an account.
- Once you are in there, follow the prompts and enter your personal information. such as (Medicare number & birthdate).
- Once the account is set up, you can access all the tools and inforamtion you need.
Why create an online Medicare account:
Save current prescriptions and pharmacies to help keep track of your medications as well as easily compare health and drug plans in your service area.
Click here to watch a YouTube video on the new prescription payment program
- Enroll in digital information. This provides a quick and easy way to access materials without waiting for the mail to arrive.
- The site uses encryption and other security measures to ensure the safety of personal data. This proivides peace of mind to Medicare beneficiaries.
- In the event you can’t find your Medicare card, you can use this site to print out a copy of your card.
- Access all your Medicare information in minutes.
Fast and Easy
An online Medicare account provides easy access to important information. It also allows Medicare beneficiaries a way to manage health information from home anytime they like. They can check coverage, review claims, or update personal information with just a few clicks. There is no need to waste time on hold or fill out paperwork. All the Medicare information is accessible whenever it’s needed.
Medicare Coverage
The online account provides an up-to-date look at Medicare benefits. Beneficiaries can find out what their plan covers and keep track of deductible payments. It is easy to check on recent cliams without waiting for mail to arrive.
Claims and Payments
Online Medicare accounts are an easy way to track claims and payments. In addition, this can help beneficiaries spot discrepancies or billing errors. Finding mistakes early is a great way to correct them quickly and avoid delays in payments and aggrevation.
Replace a lost Medicare card
Losing your Medicare card can be stressful, but with an online account, requesting a replacement is simple and straightforward. You can order a new card online and have it sent to you without the hassle of phone calls or office visits.
Tools and Resources
Medicare’s online portal provides many tools and resources to help beneficiaries make informed decisions about healthcare. By entering an updated list of medications, beneficiaries can compare drug prices. They can view Medicare plan information or estimate out-of-pocket costs for specific services. These tools help beneficiaries understand what’s available and lets them look at plans that best suit their needs.
Please note: It is always a good idea to enlist the help of a licensed insurance agent to discuss coverage need and sort out all the options.
Paperless
When an individual sets up an online Medicare account, they can choose to recieve paperless communications. In other words, they can avoid some of the paper mail cluttering their counter tops. This provides a way to view important documents in a timely manor and eliminates the need to file them and search for them later.
Additionally; an online Medicare account is useful for Medicare beneficiaries. It is an easy and secure way to access important health coverage information.
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CMS will begin their Medicare drug price negotiations 2026 with 10 popular high cost prescription medications. CMS has announced the first 10 drugs that will be subject to price negotiations. The negotiations are part of the Inflation Reduction Act. Until recently, Medicare was able to negotiate prices for the medical care beneficiaries receive; this did not include the costs of medications. As of January 1, 2026, this will change and the negotiated drug prices begin to go into effect.
Watch a YouTube video on Medicare Part D changes
Medicare will negotiate the cost for some of the more expensive prescrption medications with drugmakers. Please note; the negotiations do no tapply to drugs that have a generic equivalent.
The first 10 medications CMS will negotiate are:
- Eliquis (a blood thinner)
- Enbrel (for rheumatoid arthritis)
- Entresto (for heart failure)
- Farxiga (for diabetes, heart failure & chronic kidney disease)
- Fiasp & Novalog (for diabetes)
- Imbruvica (for blood cancers)
- Januvia (for diabetes)
- Jardiance (for diabetes)
- Stelara (for psoriasis & Chron’s disease)
- Xarelto (a blood thinner)
As per CMS, the 10 drugs listed above make up about 20% of the Medicare Part D spending from June 2022 through the end of May 2023. Medicare Part D covers prescriptions beneficiaries take at home. Part D does not cover medications administered by medical providers in medical facilities. When this is the case, Medicare Part B covers the necesary drugs. This applies to treatment of cancer or other health conditions.
Take a look at the drug price negotiation fact sheet
Medicare beneficiaries spend billions on prescription drugs
Due to the incredibly high cost of some essential medications, some beneficiaries have to either forgo basic needs or the drugs that maintain their quality of life.
CMS has also put a prescrption payment program in pace to help spread out the cost of prescriptions for beneficiaries.
Learn about the Medicare prescription payment program.
The first 10 drugs are just the start
This list of 10 drugs is only the beginning of the price negotiations. In 2027, Medicare plans to add 15 more drugs and more in the following years. As long as the rug manufacturers continue to be unsuccessful in their attempts to stop price negtiations, the list will continue to expand each year.
Drug manufacturers
If the drug companies do not agree to the negotiations, they face possible tax penalties. Drug manufacturers can avoid the tax penalty if they remove their drug from the Medicare market. However, if they do that, they will take lifesaving drugs from Medicare beneficiaries as well as lose a large part of their market share.
Some large drug companies are seeking legal counsel to stop the drug price negotiations. They argue that the loss in income will affect their ability to fund necessary research and development and that in turn will reduce their ability to produce new medical treatments.
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In 2025, one of the changes to the Part D program is a $2,000 out-of-pocket maximum for MAPD/PDP beneficiaries. CMS will also put a prescription payment plan program in place. The program is referred to as “smoothing” and begins Jan 1, 2025. It is part of the Inflation Reduction Act of 2022. What is Medicare Smooothing; this program gives beneficiaries an opportunity to use a payment plan to spread out the cost of prescription medications over the year. CMS put this program together to help mitigate the cost of prescrption drugs.
Click here to learn more about the prescription payment program
What is Medicare Smoothing
Medicare Smoothing is a way to even out the out-of-pocket costs that Medicare beneficiaries may incur each year. Unlike other health insurance plan costs, such as premiums, coinsurance and co-pays that vary significantly each year, Medicare Smoothing provides a predictable expense for Medicare drug plan beneficiaries.
This approach spreads out medication costs over a period of time, rather than allowing them to spike in any given month. Beneficiaries who take advantage of this program can reduce the financial strain of sudden large medication expenses.
How Does Smoothing work
As of January 1, 2025, Medicare beneficiaries have the option of smoothing out-of-pocket costs for Part D coverage. Every Medicare Part D plan sponsor must provide plan enrollees the option to pay their cost-sharing in monthly payment amounts.
Beneficiaries can enroll in the smoothing program at the start of each plan year or any time during the plan year.
Once the beneficiary elects to use this option for payment of their covered medications, the carrier determines the first payment amount. This amount is based on a maximum monthly cap. The cap is determined by calculating the annual out-of-pocket maximum ($2000 in 2025), minus the out-of-pocket costs incurred to date, divided by the number of months left in the current year.
To determine payment amounts for subsequent months, the maximum monthly cap is calculated using the total remaining out-of-pocket costs from the previous month that the beneficiary has not been billed for and any additional out-of-pocket costs incurred divided by the number of months remaining in the plan year.
Benefits of Smoothing
Financial Predictability
By spreading out expenses, Medicare Smoothing provides beneficiaries with a clearer picture of their healthcare costs. This is one way to help them control the budget and also provides some peace of mind.
Reduced Financial Strain
Large, unexpected medical bills can be a burden for anyone on a fixed income. Medicare Smoothing helps mitigate some financial risks by providing a consistent cost structure.
Enhanced Access to Care
With more predictable costs, beneficiaries may be more likely to seek necessary medical care without fear of incurring overwhelming expenses.
Additionally
Medicare Smoothing is a great way to manage healthcare costs, especially for those on a fixed income. By spreading out expenses and using the advice of a licensed Medicare agent, beneficiaries can achieve greater financial stability. As with any financial strategy, a professional should consider individual needs to develop a plan tailored to each specific situation.
Medicare agents – watch a quick YouTube video on the Medicare commission 2025 final update
Please note: in 2026 price negotiations will start for expensive drugs that do not have a generic alternative.
Learn the details of the price negotiation program
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As of July 18 2024, CMS published an update on the Medicare Final Rule. The update states that all commission payments will stay as they were prior to the CMS Final Rule changes. Commissions payments for MA and PDP plans remain the same for the rest of 2024 and 2025 while the stay is in effect. This means, the addtional $50 and $100 payments to brokers and uplines is no longer an option. Uplines will continue to receive over ride payments as they do now.
At some point, in 2025, the will be a final decision on the CMS Final Rule. Once that happens, the commission payment structure is subject to change.
Click here to download commission chart for 2025
Due to the fact that; a lawsuit was filed against the validity of some provisions in the Medicare Final Rule. Many organizations feel that CMS and the Department of Health and Human Services does not have the authority to place restrictions on their income. The lawsuit also states parts of the rule are arbitrary and were put in place without following proper procedure.
A federal court in Texas put a stay on some provisions of the CMS contract rule 2025 Final Rule on July 3, 2024, to amend current broker compensation for Part D and Medicare Advantage plan sales. Medicare Advantage insurers and marketers now have to wait and see what the final outcome will be for their businesses.
Once the judge makes his decision, all parties involved will have an opportunity to appeal the decision. If this happens, there is no way to predict when we will know the final outcome.
The 2025 AEP and the carriers
There are only a few short months before the start of AEP on October 15th. Because of this, each carrier seems to be making an independent decision on how to proceed with their 2025 benefits. The decision how to pay agents/brokers until the court makes a final ruling also seems to depend on the carrier.
Many carriers have already decided to reduce benefits and plan service areas due to the increased financial burden CMS has placed on them. Some carriers may exit the market altogether and a few will expand into new markets.
What all this means for Agents
As of today, agents are feeling very uncertain as to what their future business looks like. No matter what the outcome, this AEP will be interesting with all the plan changes and the uncertainty of the PDP market
CMS designed specific policies to stop incentivizing the sale of one Medicare product over another. They aimed to pull back MA/MAPD marketing money that carrieres were providing agents. There is a some speculation that smaller companies do not have the same budget to work with as the large competitiors. This gives the bigger companies an unfair advantage.
Click here to learn more about the proposed compensation changes
Because carriers are responsible for the actions of anyone marketing their plans, all advertisements must pass CMS guidelines before they are approved for use.
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As of March 7, 2024, the FTC has put an update to the telemarketing sales rules in place. This update imposes additional record-keeping and prior-express-written consent requirements. These updates include new rules for the DNC registry. They ban almost all telemarketing robo calls to consumers. Important; the TSR prohibits robocalls that use voice cloning technology.
More about the TSR
In 1985, the FTC (Federal Trade Commission) put the TSR (Telemarketing Sales Rules) in place. The FTC enforces this regulation. It safeguards consumers from abusive telemarketing practices.
The rules have been updated due to the fact that; unwanted telemarketing calls have steadily increased and are a real annoyance for many people. The FTC recognized the need to protect individuals from the potential for these calls to lead to fraud.These updates represent an important step forward in consumer privacy and stopping unwanted telemarketing calls.
Click here to see the FTC’s amended rule
What the changes mean
Take a look below to review the amendments to the FTC’s telemarketing rules put in place to safeguard consumers.
Restrictions on Robocalls
One of the most important changes is stricter regulation on robocalls. Telemarketers must have specific recorded consent from consumers before they call. This is an effective way to make sure consumers have agreed to any contact. This cuts down on the number of unsolicited calls as well as reduces the risk of fraudulent calls reaching the individual.
Do Not Call Registry
With the added regulations, the protection the National Do Not Call Registry provides is even greater than before. This gives consumers a choice to opt out of receiving unwanted, telemarketing calls. As before, telemarketers must comply with this registry and cannot call numbers on the DNC registry. Although now, they can contact individuals who have given consent or are exempt.
Transparency
When a telemarketer places a call, they must let the recipient know who they are and why they are calling immediately. This allows the consumer to decide if they want to continue the conversation or to end it.
Penalties
In an effort to ensure compliance with updated regulations, the FTC has strengthened it’s enforcement of penalties for unlawful practices. Anyone who violates the laws will face penalties that include substantial fines. The FTC will hold anyone who is non compliant accountable for their actions. The TCPA is very clear on the fines and penalties for anyone who contacts a consumer on the DNC registry.
Agents
These regulatory changes may be a challenge if you use telemarketers as a lead source. It is important to use only lead companies that comply with all state and federal regulations. Anytime the lead company violates the rules, the agent can end up paying a hefty fine. This is because the person who hires the marketing service is held responsible for any non compliant acts.
It is imperative that all telemarketers obtain consent from the person they are calling.
Agents & agencies who offer Medicare coverage to clients must retain scopes of appointment as well as recorded voice enrollments for a period of 10 years. Click here to read the full CMS communications guide.
Learn what agents need to know before a Medicare phone sale – watch our Youtube video.
Telemarketing regulations
The TSR applies to all telemarketers who make outbound calls from within the United States as well as from overseas.
All records including call scripts, vendor contracts and promotional materials must be kept for a period of 5 years.
Any consent to contact record must include name, phone number and a copy of the request. The reason for the request as well as the consent and date it was provided.
If the call requires prior written consent, the consent must include the legal name of the person/seller who will receive the consent as well as the brand name of the product being offered. This ensures the consumer is aware who they are delaing with and for what reason.
Starting on October 15, 2024, telemarketers must keep call records with all call details. Click here to see the details. Section 310.5 (a)(2)
Summary
Telemarketing sales rule updates take a step further to prohibit deceptive or abusive practices. This includes, making false claims or misrepresenting material information to obatian payment for goods or services. TSR also prohibits telemarketers from making unsolicited calls that may be coercive or abusive. It restricts the times marketers can make calls to consumers. Telemarketers must clearly disclose the reason for the call.
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As of May 2024, several organizations including: the Americans for Beneficiary Choice, the National Association of Benefits and Insurance Professionals, the Council for Medicare Choice, and the Fort Worth Association of Health Underwriters filed a lawsuit to block CMS Final Rule. The organizations argued that CMS does not have the authority to put limits on their compensation.
As of July 3, 2024; the U.S. District Court for the Northern District of TX ordered a stay against the CMS Final Rule. Organizations claiming the Final Rule exceeds CMS’s statutory authority filed the lawsuit. Although the outcome of the Final Rule is yet to be decided, the stay provides Medicare Advantage insurers and marketers a little relief for the near future of their businesses.
What happens next
The plaintiffs in this case requested a ruling by the end of this month. When Judge Reed O’Connor granted the stay, he included his intention to provide a ruling as requested.
Whatever the judge decides, both parties are able to appeal the decision. If this is the case, it will cause a greater delay in the final outcome and more uncertainty.
2025 AEP
This year has not been easy with all the uncertainty the proposal of the Final Rule has caused. That has not changed with the outcome still undecided. Until there is a resolution, this year’s AEP continues to raise questions for all involved.
CMS Final Rule and the carriers
Carriers will have to scramble to decide what benefits to offer and how to navigate plan designs and whether to move forward with the proposed benefit cuts. The recalculations of the star ratings are also cause for concern with the carriers. Getting a handle on all the moving parts is tricky to say the least.
Because the Medicare AEP starts October 15th, Medicare Advantage insurers who decide to go back to paying compensation the way they did before may face the challenge of last-minute changes in the event the court rules in CMS’s favor.
Some Medicare carriers are considering a reduction in benefits as well as their service areas as an answer to growing medical costs and regulatory changes. While others may exit the market altogether. On the other hand, a few hope to gain a greater market share where others pull back.
Many carriers have outlined their strategy based on the implementation of the Final Rule. At this point, adding to third-party marketing spending contradicts their plans. It remains to be seen if insurers will implement a work around and provide incentives to agents/brokers for greater sales.
The effect of the Final Rule on Brokers/Agents
CMS designed specific policies to pull back some MA/MAPD plan marketing. The reason behind this is to lessen incentives that may cause brokers/agents to be biased and sell based solely on compensation instead of what’s best for the client. There is also the idea that this gives smaller companies, who cannot afford to pay as much in marketing incentives, an opportunity to compete on a more level playing field. CMS rules also state brokers/agents must keep records of all interactions with potential clients to protect them from unlawful practices.
Click here to learn more about the proposed compensation changes
Because Carriers are held accountable for the actions of anyone marketing their plans, all advertising must pass strict CMS guidelines before it is approved for use. Many carriers may lean more towards using in-house agents than independent agents as they are easier to manage.
So far, there has been no comment by CMS about the ongoing litigation.
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In many cases, long-term care insurance is an important financial planning tool. LTC policies provide financial assistance for the cost of care for chronic illnesses, disabilities or injuries associated with aging. Policies cover; nursing home care, assisted living facility care, home health aides, adult daycare and more. Although many older adults require long term care, there are some who do not. We will discuss; what happens with unused LTC policies.
Approximately 70% of Americans will need long-term care at some point. Although the level of care and length of time needed varies by individual. The likelihood of a need for long-term care increases with age. The premium for a LTC policy can be difficult to afford for many people especially on a fixed income.
Agents, click here to learn why you should offer ancillary health products
What happens if you don’t use the policy
If you spend your hard-earned money on a plan and never need it, do you just lose all that money? Is there any value in a LTC policy if you never use it? The answer to that question depends on the type of LTC policy the beneficiary chooses. 
Traditional LTC policies
Beneficiaries who opt for a traditional LTC policy can expect payment of the contracted amount if they require long term care. With these policies, if the beneficiary does not require these services, the policy has no value and can end up costing quite a bit.
Those who purchase traditional policies may have a difficult time maintaining coverage due to the rising costs as their age increases. Policies do not usually have a guaranteed premium amount. When this happens, many seniors find themselves unable to afford the policy and end up dropping the coverage.
There are partnership policy options for those who wish to purchase a traditional LTC policy. Partnership policies are a way for policyholders to protect assets if they exhaust long-term care benefits and must apply for Medicaid. Each state has specific requirements for partnership policies and provide protection against inflation.
Hybrid LTC policies
Hybrid LTC policies may be a good alternative to traditional policies. They provide value even if the beneficiary does not require long term care. Hybrid policies may be combined with either a life policy or an annuity. In other words, there is value in this option in different circumstances.
With a hybrid policy, beneficiaries who decide to discontinue coverage may be able to leave with some cash. Annuity based plans provide the annuity’s value less the surrender charges. Those who add a return of premium rider could leave with their entire plan cost back. In this scenario, the beneficiary does not lose. If the beneficiary dies without using the policy, their heirs may receive a tax-free death benefit similar to a life insurance policy.
What to consider when purchasing a LTC policy
The premiums for LTC coverage may be expensive, therefore think carefully about your budget when choosing a plan. Age, health, coverage amount, elimination period are a few things that contribute to the cost of coverage. Many plans offer optional features, like inflation protection or a non-forfeiture benefit, that may also be important to consider.
In some situations, there are discounts on coverage. Some examples include; if the enrollee is in good health or if the policy is purchased by a couple.
Information for Agents
We have a number of long term care products available to offer your clients. Options include: traditional as well as fixed annuity & long-term care rider, Life and long term care or chronic illness rider. We also have several, affordable short-term care plans available. To find out more about our products; contact our office at 203-796-5403 or email teal@croweandassociates.com.
Agents who want to join the Crowe team or add a carrier to your contract; click here
The bottom line
By comparing the different coverage options, elimination and benefit periods, as well as costs, beneficiaries can make informed decisions. A licensed insurance agent can also add valuable insights into benefit options and costs.