Extra help Medicare
Medicare provides programs and benefits to many people. This includes the Extra Help Medicare program that provides qualified beneficiaries help paying their Medicare Part D monthly premium, annual deductible, coinsurance and copays for their prescription medications.
To qualify for this program, individuals must meet income requirements. Individuals who are accepted into this program do not have to pay any Part D late enrollment penalty they may have acquired.
How to apply for extra help
If you do not automatically qualify for Extra Help, you will need to apply. You must meet the following qualifications to be eligible for Extra Help.
- Applicants must have Medicare Parts A and B.
- They must reside in the U.S. or the District of Columbia.
- They do not have more than $34,360 in assets that include savings, investments & real estate if they are married, or $17,220 if they are single or not living with a spouse. If your assets are more than that, you are not eligible for Extra Help. Important; this amount does not include your home, cars or personal possessions. It also does not include life insurance, irrevocable burial contracts or back payments from Social Security or SSI.
If you meet the qualifications specified above, you can apply for Extra Help online.
Click here to apply for Extra Help online
For help with the online application, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778).
Please note: Some people do not need to apply for Extra help. If you have either Medicare and SSI (Supplemental Security Income) or Medicare and Medicaid, you do not need to apply for Extra Help. You will automatically be enrolled.
Extra Help isn’t available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa. But there are other programs available in those areas to help people with limited income and resources. Programs vary in these areas. Call your State Medical Assistance (Medicaid) office to learn more
Who can get Extra Help
If you think you meet the financial requirements and have Medicare A & B as well as are a resident of the U.S. or District of Columbia, just complete the online application. You will receive a letter notifying you if you are accepted into the program.
Important: residents of Guam, Puerto Rico, the US Virgin Islands, Northern Mariana Islands or American Samoa are not eligible for the Extra Help program. To find alternative programs in those areas, check your state’s Medicaid eligibility at Medicaid.gov to find resources.
Additional financial resources
Individual states also have financial resources available through Medicare Savings Programs for those who meet the income qualifications. Use this link to find additional information for financial help in your area.
Beneficiaries can also go to Medicare.gov or call 1-800-medicare (TTY 1-877-486-2048)to find information on financial assistance programs.
Please be aware: Extra Help is not a prescription drug plan. Beneficiaries must enroll in either an MAPD plan or a stand alone PDP plan to have coverage for prescription medications.
Agents, learn how to run a Medicare PDP or MAPD plan quote using Sunfire or Connecture. Watch our quick YouTube video
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Medicare Part B eligibility
What is Medicare Part B
Medicare Part B is part of Original Medicare; enrollment in this coverage is optional. Medicare Part B covers outpatient medical services as well as some medications administered in a provider’s office.
Who’s eligible for Medicare Part B
Once an individual turns 65, if they are eligible for premium free Part A, they are eligible to enroll on Part B.
To be eligible for Part B if you are not eligible for premium free Part A, you must meet the following criteria:
- You must either be a U.S. resident and citizen or an alien who is a lawfully admitted, resident for 5 continuous years before filing for Medicare benefits.
- Be 65 years old or older.
If you are 65 and eligible – when to enroll in Part B
There is a 7 month window for anyone who is turning 65 to enroll. Beneficiaries can enroll 3 months before the month of the 65th birthday, the month of their birthday and for 3 months after your 65th birthday. There are a few different ways to get this done. Take a look below to see how to do it.
- Apply online at Social Security. Be sure to use the official Social Security site www.ssa.gov . This way is easy and quick. You can also apply for financial help form here, if you qualify.
- Make a call to Social Security at 1-800-772-1213 and they will help sign you up.
- You can also go directly to your local Social Security office where they will help you submit the application.
- If either you or your spouse worked for a railroad, give the Railroad Retirement Board a call to enroll at 1-877-772-5772.
Click here to learn more about the Medicare enrollment periods.
Disabled individuals under age 65 who receive Social Security benefits
Anyone who has a qualifying disability and receives either Social Security or Railroad Retirement Board disability benefits is eligible to enroll in Medicare Part B coverage.
Individuals with ESRD or ALS
If you are diagnosed with either ESRD (end stage renal disease) or ALS (amyotrophic lateral sclerosis), you can enroll in Medicare Part B. You do not have to be 65 to enroll with either one of these diagnoses. You can use any of the methods mentioned above to enroll in Medicare.
More information about Medicare Part B enrollment
It is important to be aware of enrollment deadlines. If you do not sign up on time, you may face a LEP (late enrollment penalty) unless you defer enrollment due to having other creditable coverage from either yours or a spouse’s employment.
Watch a quick YouTube video on Special election periods
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How to compare Medicare supplements
It is important for Medicare insurance agents as well as Medicare enrollees to understand how to compare Medicare supplements. Medicare supplements (Medigap) insurance provides coverage to fill the gaps after Original Medicare pays its share of covered medical expenses.
Medicare supplement plans are standardized
Because CMS standardizes all Medicare supplement plans, they must provide the same benefits. It does not matter which company offers the plan or what state you live in. In many states, beneficiaries have a choice of ten different plan choices. The plans are named by the letters: A, B, C, D, F, G, K, L, M & N. Please note, plans with the same letter name only differ by price. Insurance companies decide the pricing of their plans based on letter name and coverage area.
To view the benefits for each plan, see the chart below
Medigap Benefit |
||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Plan A | Plan B | Plan C | Plan D | Plan F* | Plan G* | Plan K |
Plan L |
Plan M | Plan N | |
| Part A coinsurance & hospital costs up to 365 additional days after Medicare benefits are used | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Part B coinsurance or copayment |
Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes*** |
Blood (first 3 pints) |
Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
| Part A hospice care coinsurance or copayment | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
| Skilled nursing facility coinsurance | X | X | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
| Part A deductible | X | Yes | Yes | Yes | Yes | Yes | 50% | 75% | 50% | Yes |
| Part B deductible | X | X | Yes | X | Yes | X | X | X | X | X |
| Part B excess charge | X | X | X | X | Yes | Yes | X | X | X | X |
| Foreign travel exchange (up to plan limits) | X | X | 80% | 80% | 80% | 80% | X | X | 80% | 80% |
Out-of-pocket limit** |
N/A | N/A | N/A | N/A | N/A | N/A |
($7,060 in 2024) |
($3,530 in 2024) |
N/A | N/A |
Another fact to consider, *Some states offer a high deductible plan option for supplement Plans F and G.
To learn about Medicare high deductible Plan G, watch our quick video
Third, ** Medicare supplement plans K and L show how much they pay for approved services before you meet your annual out-of-pocket limit and Part B deductible. Once both are met, the plan pays 100% of approved medical expenses.
Last, ***Plan N pays 100% of the costs for Part B Medicare approved services. One thing to remember; this excludes copays for some office visits and some emergency room visits.
To learn more about Plan N, click here
Comparing Medicare supplement plans
Before a Medicare beneficiary signs up for a Medicare supplement plan, it is important to consider your health care needs and your budget. When possible, future healthcare needs as well. Choosing the right plan can save you money as well as provide peace of mind.
Because the cost for plans varies so greatly, it is a good idea to work with a licensed Medicare agent who has access to the most competitive plans in your area. Licensed agents can provide a cost comparison and go over coverage details that you may not consider.
Find out the value of using a Medicare agent
Although friends and relatives are often a great help with many things, please remember, each individual has their own health care needs. What works for one person may not be good for another.
Consider the customer satisfaction record of each carrier
Additionally, in some instances, it may be worth a few extra dollars to have peace of mind and feel confident with your choice of insurance carriers.
Because health care coverage is such an important decision, beneficiaries need to consider all their needs and the options available.
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Tricare and Medicare
In this post, we explain how Tricare and Medicare work together to provide coverage for those who qualify.
What is Tricare
Tricare is a healthcare program available to active-duty service members, active-duty family members, National Guard and Reserve members and family members. It is also available to retired service members and their families, survivors, and some former spouses. This program combines military healthcare resources (military hospitals & clinics) with civilian healthcare professionals to provide services to its members.
It is helpful for anyone eligible for both Tricare and Medicare to know how these benefits work together. Tricare For Life (TFL) is provided free of charge to U.S. military retirees and their qualified beneficiaries. Medicare coverage is a separate program available to beneficiaries 65 or older as well as qualified disabled individuals.
TFL and original Medicare
Beneficiaries who are eligible for TFL, are automatically enrolled in TFL when they sign up for Medicare Part A and Part B. There is no need to fill out any enrollment forms. TFL beneficiaries must remain enrolled in Medicare Part B to maintain TFL enrollment. Medicare is the primary insurer for those enrolled in Medicare and TFL. In this case, TFL is the secondary insurer and covers costs the beneficiary would normally be left to pay. It covers the Part A deductible as well as Part B co-insurance costs.
Please note: Tricare does not provide insurance cards. Military members should register in DEERS (Defense Enrollment Eligibility Reporting System) database to receive Tricare. DEERS is a database of information on uniformed services members and their family members (sponsors), Once you register for DEERS, you receive a Uniformed Services ID card. Is important to make sure your coverage information is up to date in the DEERS system to avoid problems with your health care benefits.
Members can also access proof of their coverage through milConnect, a website that provides military members with benefit information for insurance, including help finding a provider, proof of coverage, GI benefits and much more.
TFL with Medicare supplements (Medigap)
TFL coverage is similar to a Medicare Supplement plan. Beneficiaries of TFL are eligible to enroll in a Medicare Supplement plan as long as they have both Medicare Part A & Part B. Enrollment in a Medicare supplement is not free and may not be necessary for members of TFL plans. It is best to consider all medical and financial needs before deciding on plan coverage choices. Beneficiaries who elect to enroll in Medicare, Medicare supplements and TFL have Medicare as the primary coverage, the Medicare supplement is secondary and the TFL pays after both the other options.
TFL and Medicare advantage
When TFL beneficiaries opt to enroll in Medicare Advantage (Medicare Part C) coverage, the Medicare advantage plan acts as the primary insurer. The TFL coverage is considered supplemental and will help cover costs for deductibles and co-pays as well as medically necessary out-of-network services.
It is always a good idea to be sure any providers the beneficiary uses are in-network with the MA/MAPD plan chosen. If the providers are in network, beneficiaries could end up not having to pay any out-of-pocket costs after TFL pays its share.
Learn about the pros & cons of Medicare advantage plans
Medicare Part D and TFL
Because TFL provides prescription drug coverage, beneficiaries do not need to enroll in Medicare Part D prescription drug coverage. TFL prescription coverage qualifies as creditable coverage. This means, if you decide to enroll in Part D later on, you will not receive a LEP (late enrollment penalty) from Medicare.
It is important to note, TFL members must fill maintenance drug prescriptions like, blood pressure or cholesterol, through Tricare’s mail order pharmacy. TFL members can fill other prescriptions at any pharmacy they choose. The beneficiary is responsible for any co-pays.
Tricare Prime and Medicare
Beneficiaries under age 65 who have Medicare and Tricare Prime, can remain on Tricare Prime for as long as they are eligible. Members receive a waiver for Prime enrollment fees or a refund for a prior enrollment fee.
Tricare Plus and Medicare
Tricare Plus provides beneficiaries a way to receive primary care in military hospitals or clinics. It is important to make sure the military facility accepts Tricare Plus before receiving care. To be part of this program, members must enroll.
The benefits provided by Tricare Plus are similar to Tricare Prime. They both work the same as regular Tricare in regard to Medicare because it is still primary coverage. It is important to confirm the military facility accepts Tricare Plus before scheduling care. Tricare Plus is for Tricare eligible individuals not enrolled in Tricare Prime.
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Clover Health OTC catalog 2024
The Clover Health OTC catalog 2024 provides members with numerous choices to help them get the most out of their OTC benefit. Members of Clover Health MAPD plans have the added benefit of the LiveHealthy Rewards Program.
To get started with your Clover benefits, just go to the clover member site and register for your My Clover account. From there, you can check your reward status as well as your OTC benefit balance, shop online or find a local, participating store and much more. Clover plan members can access both their OTC and LiveHealthy rewards benefits with their LiveHealthy Flex Plus card.
Agents, watch a quick YouTube video on how to choose carriers to contract with.
OTC catalog benefits:
Clover provides all MAPD plan members with a quarterly OTC benefit allowance of between $30 and $75 (amount depends on the plan benefit). At the beginning of each quarter, OTC and LiveHealthy rewards dollars are loaded onto the Live Healthy Flex Plus card automatically.
OTC Benefit amounts do not roll over to the next quarter. Plan members must use the benefits before the end of each quarter. Cards are only valid at participating merchants for approved items.
To download o copy of the OTC catalog and how to use this benefit, Click here
Download the Clover OTC benefit and live healthy rewards guide
Existing Clover members:
Existing plan members will not receive a new LiveHealthy Visa Flex Plus card. Their current card will have OTC as well as LiveHealthy rewards loaded onto it. Any unused Livehealthy dollars roll over from 2023 to 2024.
If you need a replacement card, you can either order one online at cloverhealth.com/livehealthy or call 1-800-607-2348 (TTY711) 8:00 AM – 8:00PM, local time 7 days a week.
LiveHealthy Rewards:
Members who complete the following activities earn rewards.
1. Earn $100 per year to complete the “Getting to Know You Survey”. This survey is a modified health risk assessment. Each member can complete the survey online, over the phone with member services or by filling out the paper form included in your welcome kit. Rewards are loaded onto the card 3-5 business days after survey is complete. Rewards are not available to spend until after the plan start date. Member may complete a survey each year to earn rewards.
Brokers please note; if you help a new member fill out the online survey within 72 hours of submitting the application earn $50.
To learn more about HRAs, click here.
2. Members earn up to $50 annually for preventative care. This includes $10 for receiving a flu vaccine, $20 for an A1C test and $20 for a retinal eye exam. Clover validates completion through claim or by self-attestation for flu vaccine. Clover loads reward dollars 3-5 business days after they receive the claim.
3. Complete a LiveHealthy visit to earn $150 annually. Members call the phone number on the back of the LiveHealthy Flex Plus Visa card to set up the appointment. The appointment takes place either in the office of a provider, in-home or via telehealth visit. members are eligible to complete a Livehealthy visit each year. Benefits are loaded onto the card within 3-5 business days after claim is received. Please note: providers have up to 90 days to submit the claim.
4. Get Active rewards are worth $25 per quarter ($100 per year). Member must participate in one of the following to earn rewards: SilverSneakers gym or class, either virtual or in-person. Attend a Clover sponsored event or Clover poll. Log into the Clover member portal at least 1 time per year. Clover confirms member participation and rewards dollars are loaded 3-5 business days.
Click here to contract with Crowe and offer Clover health plans.
The difference between the OTC benefit and LiveHealthy Rewards:
OTC benefits provide plan members a monthly allowance to purchase common health care items while members earn Live Healthy rewards by completing activities that promote good health.
The annual OTC benefit amount is between $120 and $300 per year while members can earn up to $400 in Healthy rewards benefits annually.
While there are restrictions on what members can purchase with the OTC card, members can use Rewards dollars to purchase of most items with the exception of alcohol, tobacco and firearms. Members who go over the OTC limit, can use rewards dollars to complete the purchase if they are available. Any purchase in excess of the Rewards dollar is the responsibility of the member.
Important: Members may not use LiveHealthy Rewards dollars to purchase alcohol, tobacco products, or firearms. Rewards are not redeemable for cash. Some other limitations apply, members should check with Clover member services for more information.
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Medicare Part D enrollment period
Medicare plans all have specific periods of time that beneficiaries can use to enroll in each type of plan. Medicare Part D (prescription drug coverage) is no different. There is more than one Medicare Part D enrollment period available to beneficiaries.
Please note: Beneficiaries can get Medicare Part D coverage from either a stand-alone PDP plan or from an MAPD plan.
Why enrolling in Part D is important
If your client asks why they should enroll in Part D coverage, you need to tell them about the late enrollment penalty (LEP). Once a beneficiary incurs a penalty, they have to pay it for as long as they have Medicare Part D coverage. It is added to The Medicare Part D plan premium. This penalty amount is determined by the number of months the beneficiary has gone without creditable drug coverage. The penalty applies after a beneficiary goes 63 days or more without creditable coverage. Creditable coverage means a drug plan that provides coverage at least equal to what Medicare part D provides.
Here are a few instances that can result in an LEP
- When a client Neglects to enroll in Part D as soon as they are eligible. Enrollment in Medicare Part A & Part B is a great indicator of when to enroll in part D coverage. It is important to enroll even if the client is not currently taking any prescription drugs.
- If the beneficiary loses other health coverage such as employer coverage, it is important beneficiaries do not go without creditable coverage for 63 days in a row.
- Once clients are eligible for Medicare, be sure they maintain records of creditable coverage in the event Medicare asks for proof of previous coverage.
The first enrollment period
For most beneficiaries who are aging into Medicare, their IEP for Medicare begins 3 months before the month they are turning 65. Their IEP ends 3 months after they turn 65. During this time, they may decide to enroll in Medicare Part A and Part B. Once they enroll in both Medicare Part A and Part B, they can choose a Part D prescription drug plan.
Annual enrollment periods
Every year during the AEP (Annual Enrollment Period), clients can add, change or drop Part D coverage. This period runs from Oct 15th through Dec 7th. Changes made during this period will go into effect Jan 1 of the following year.
There is also a Medicare Advantage OEP each year, it runs from Jan 1 through March 31st each year. During this enrollment period, beneficiaries can change their Medicare Advantage coverage. The changes include switching from one Medicare advantage plan to another. Thye can also disenroll from a MA/MAPD plan and enroll in Original Medicare as well as a supplement and stand-alone PDP plan (Part D). These changes go into effect the first day following the month they apply.
Special enrollment periods (SEPs)
Ther are other times clients can enroll in a new Part D coverage. These additional opportunities are called special enrollment periods or SEPs. There are many different types of SEPs.
Click here to learn more about SEPs
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How a licensed Medicare agent can help
No matter what election period a beneficiary chooses to use for their Part D enrollment, enlisting the help of a licensed Medicare agent can be a good decision. A Medicare agent can provide guidance to ensure clients choose the best coverage for their individual needs.
There are many plans available, and an accurate comparison can take some of the uncertainty out of choosing a plan. The wrong plan choice can be a very costly mistake, one that is not easily rectified. A good agent will take a list of the client’s medications, the dosage and the pharmacy they like to use. They enter this information into a quote engine that provides clients a comparison of the best plan choices for them.
Learn more about our quote engines, Sunfire and Connecture – watch a quick YouTube video
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Pro-rated Medicare commissions
Pro-rated Medicare commissions are something that all agents who offer Medicare products need to understand. The Medicare carriers pay pro-rated commissions to make sure agents do not end up owing the carriers too many chargebacks for disenrollments. This also protects the carriers from the chore of trying to collect unearned money from brokers who may not have it to pay back. It is better for both parties.
Agents receive pro-rated Medicare commissions for enrolling individuals in either Medicare Advantage or Medicare prescription drug (Part D) plans. Once an agent submits an application for a beneficiary, the agent receives commission. The amount of commission is based on the number of months the enrollee remains active in that specific plan.
How pro-rated commissions work
Agents receive a partial commission payment for every month their client stays in the carrier’s plan. This payment system is considered more equitable than carriers paying out the full commission at once. As we stated earlier, this avoids chargebacks for any unearned commissions. Agents may be motivated to give clients ongoing support to ensure they do not switch plans on the advice of another broker. On the whole, agents who are available to clients, maintain their book of business.
The way to figure out the amount of a pro-rated commission, divide the total commission for each enrollee by the number of months the member is enrolled in the plan. Let’s say the total commission for an enrollee is $600 and they stay in the plan for 10 months; this means the agent receives $60 for each month.
Find out more about commission payments
How beneficiaries benefit from this payment structure
We cannot stress enough how important forming a good relationship with your clients is. The pro-rated commission structure provides an incentive for agents to make the extra effort. Having a vested interest in providing a greater standard of customer service, helps beneficiaries develop trust toward their agent. If the agent continuously provides good advice and follow up, the client in turn provides an important service to the agent. In most cases, happy clients tell their friends and family. This is great benefit to the agent who receives new client recommendations and an opportunity to grow their book.
Watch a YouTube video on Medicare commissions
To Sum it up
The pro-rated Medicare commission system provides is a clear and fair way for Medicare companies to pay agents. It helps incentivize a good agent/client relationship. It can ensure agents provide the best plan options to their clients, so they receive coverage options that align with their healthcare needs. This helps everyone avoid dis-enrollments.
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Medicare OEP rules
Before we get into what the Medicare OEP rules are, we will discuss what the Medicare OEP is.
What is the Medicare OEP
The Medicare OEP is also called the Medicare Advantage OEP or (open enrollment period). This enrolment period is in addition to the Medicare annual enrollment period (AEP) that runs from October 15th through December 7th each year. The OEP is specifically enrollees of MA/MAPD plans. It begins January 1st and runs through March 31st each year. During this time, any MA/MAPD plan enrollee can switch to another MA/MAPD plan or Original Medicare and a PDP plan.
Find out more about the MA OEP
Clients who call you during the MAPD OEP and are unhappy with the coverage they chose, have one more opportunity to make a change. This can be helpful if they did not check their coverage options during the AEP. It is also useful when, your clients renew their coverage and find their plan has changed and no longer provides what they need for the new year.
To learn the differences between Medicare AEP vs. OEP
What agents can and can’t do during the MA/MAPD OEP
It is important to know; CMS has marketing guidelines in place for this enrollment period. Agents cannot knowingly target or send unsolicited marketing materials to members of MA/MAPD plans during this period.
A few things you should not do:
- Never send unsolicited marketing materials that mention the Medicare advantage OEP and the ability to change plans.
- Do not target Medicare enrollees by using a list of clients or lead list of beneficiaries who enrolled in a plan during AEP.
- Avoid using sales meetings that focus on the OEP to get beneficiaries to make plan changes.
Some things that are ok to do:
- If a beneficiary asks for information, you should send it to them or meet them to provide the requested materials.
- It is fine to continue marketing to anyone aging into Medicare who may need help going over their Medicare options.
- You can always market a 5-star plan if there are any available in your sales area. Click here to watch a video on an 5-star ISNP MA plan.
- Provide information to beneficiaries who qualify as either dual-eligible or LIS as they are able to make changes once during any of the first 3 quarters of the year.
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Cigna Medicare agent login
With your Cigna Medicare agent login, you have access to the information, tools, and resources to manage your Cigna business, in one convenient place. Once you have your Cigna writing ID, you can log into the Cigna site and check out all the great tools they offer.
If you want to add Cigna to your Medicare contracts, click here
Do you want to contract to sell Medicare, click here to begin a new contract with Crowe and Associates.
If you want to add Cigna to your current Crowe and Associates contract, click here.
The dashboard contains links for
Cigna Individual and Family
Quote and Enroll – Use this link to run a plan quote in a specific area and enroll your client.
Book of Business – Take a look at your book of business and view important enrolment details
Commissions – this link provides a commissions overview
Resource Center & Tools – With these links you can find a doctor, dentist, look up medications, view license & appointment information and make updates as well as access documents and forms.
Medicare Advantage
Quote and Enroll –
This link will take you to an enrollment site to run plan quotes and enroll clients.
Book of Business –
This link provides you with a list of your clients and lets you view enrollment details. If you are an agency, you can view your downline agents’ business as well as run reports with selected filters.
Commissions –
View Cigna’s compensation payment schedule and run reports by applying appropriate filters.
Click here to see the Medicare commissions for 2024.
MA Application Status –
This link allows you to view the status of nay Cigna applications you submit.
Request for Information –
From this link you can send an inquiry to the Cigna broker support team.
Tools –
This tab gets you access to so much useful information including:
Salesforce –
Use this part of the portal to manage potential client leads as well as view sales results.
Medicare Producers’ University –
This is an area full of useful information. Access Cigna learning courses several different ways, find instructor led events, the resource center, the media room offers multiple training videos. There are also links to, your transcript that shows courses you completed as well as provides a copy of course completion certificates.
Medicare /Medicaid Eligibility –
this tool lets you check your client’s eligibility for Medicare and Medicaid.
Online Provider directory –
This is an easy way to search providers for clients, this search can be modified to find providers narrowed down by specialty.
Custom Point –
From here agents have access to Medicare advantage marketing materials. This includes sales kits and much more.
Find Rx Medications 2024 –
Use this tool to lookup the cost and coverage for client medications.
Health Risk Assessment –
From here, agents have the ability to submit a client’s HRA after they complete the VBE HRA training in producers’ University.
Medicare Plan Finder –
Use this tool to look for and compare Medicare health plans for our clients.
Market Review Submission –
This tool provides valuable input to ensure the marketing materials you plan to use are compliant.
Watch a quick YouTube video on the Scope of Appointment rules for 2024
Cigna Learning Center –
This link takes agents to three different levels of training for help with Medicare sales.
YouTube –
Take a look at several Medicare Advantage videos Cigna provides to help clients understand the differences between the plans and which one might fit best.
Cigna Supplemental
Most of the information you can access from this section has a similar description to the tools above, except where noted.
Prescription Drug Plan
This link lets you shop and compare Cigna prescription drug plans as well as search for a local in-network pharmacy.
There are also links to access several different categories of messages
These are just some of the things you can access in the Cigna broker portal, there are many more great tools available to contracted/appointed brokers!
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Medicare drug price negotiations
Because of the high cost of some prescription drugs for Medicare beneficiaries, the CMS has announced the first 10 drugs that will be subject for Medicare drug price negotiations. The negotiations are part of the Inflation Reduction Act. Up until recently, Medicare has been able to negotiate prices for medical care beneficiaries receive but this did not include the costs of medications. This is about to change when the negotiated prices go into effect as of 2026.
Watch a quick video on the Medicare Part D changes
Medicare will negotiate with drugmakers over the cost for the some of the most expensive medications and does not apply to drugs that have a generic alternative. The first 10 medications chosen for negotiations 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)
According to the CMS, the 10 drugs above accounted for 20% of the Medicare Part D spending ($50.5 billion) during the period from June 2022 through the end of May 2023. Part D of Medicare covers prescriptions taken by beneficiaries at home. It does not cover medications administered by medical providers in medical facilities for treatment of things like cancer or other health conditions. In these situations, Medicare Part B covers the necessary drugs.
Click here to read the drug price negotiation fact sheet
Medicare beneficiaries spend billions of dollars for prescription drugs
Because of the high cost of some essential medications, beneficiaries sometimes have to either limit basic needs or go without the drugs that help maintain their quality of life. All the while, drug manufacturers rake in record setting profits.
These 10 drugs are just the beginning
This list of 10 drugs is just the starting point. In 2027 Medicare hopes to add 15 more drugs and even more in the years that follow. This list will grow each year as long as the drug manufacturers are unsuccessful in their attempts to stop the drug cost negotiations.
Find out about the Medicare prescription payment program.
What will drug manufacturers do
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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Medicare Prescription Payment Plan Program
As of January 1,2025, the Medicare Prescription Payment Plan Program will go into effect. This program is one of the changes CMS is making to the Medicare Part D prescription program. The new plan design is part of the Inflation Reduction Act. As part of the Biden administration’s effort to reduce the cost seniors pay for prescription drugs, they will have the option to spread their out-of-pocket costs out over 12 months.
CMS released draft guidance documents that outline the voluntary Medicare prescription payment plan program. The program begins January 1, 2025. This program provides beneficiaries the opportunity to enroll in a monthly payment plan that will spread the cost of their prescription out of pocket costs out over the course of the year. This is an effort to provide relief for Medicare beneficiaries who struggle with high upfront costs for prescriptions and ensures they have access to the life-saving medications they need.
More about the changes for 2025
Beginning in 2025, seniors can choose to pay their out-of-pocket drug costs through a capped monthly installment plan and do not have to worry about paying all at once at the pharmacy. This is especially helpful to beneficiaries who have a higher cost share at the start of the year. They can spread the cost out over the course of. This will also go into effect in 2025.the year.
Learn more about the Medicare drug cap
Click here to watch a quick video on potential changes to Medicare commission payments for 2025
In addition to the Medicare Prescription payment plan program, the Inflation Reduction Act will put an annual cap of $2,000 on out-of-pocket drug costs under Part D
Click here to read the CMS fact sheet on the program.
The CMS includes instructions on how prescription drug plans can identify patients who may benefit from the program. It also offers ways to notify them about the program with the use of their own pharmacy. There are also rules that ensure prescription drug plan carriers reimburse pharmacies promptly for the cost sharing amount beneficiaries would normally have to pay up front.
If a beneficiary decides to enroll in the new program, they can simply notify their insurer starting in 2025.
There are still some key pieces of information missing. CMS must specify how the new program impacts the insurers plan bids for 2025. CMS says the information will be available early in 2024 as part of the second draft guidance. The second draft guidance will also include details on beneficiary outreach as well as how insurance plans will be tracked and enforced. Please note: CMS normally does not release its bid guidance until spring.
The current guidance document provided by CMS enacts the drug pricing reforms passed under the Inflation Reduction Act. The $35 monthly insulin cap for Medicare beneficiaries has already been implemented by CMS. and the agency must release the first 10 drugs subject to Medicare and drugmaker price negotiations by Sept. 1.
Find out about the first 10 drugs subject to Medicare and drug manufacturer price negotiations.
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Think Agent Aetna login
Because Aetna is one of the leading Medicare carriers in several states, there are many agents who will need a Think Agent Aetna login. Think Agent is the electronic enrollment tool Aetna provides to help their agents enroll Medicare beneficiaries in their plans. Think Agent gives both agents and clients a quick and easy way to complete their enrollments. This tool is available several different ways including, desktop, laptop or a mobile app that agents can add to all their mobile devices including their phones.
How to access Think Agent
- Once you are ready to sell with Aetna, you will be able to download the Think Agent app from either the Apple App store or the Google Play store. Please note: The app is compatible with Android 5 or greater, version 11; or IOS 11.0 or greater, version 14.5; or on your desktop. To access think agent online click here.
- After you download the app, click sign up and submit your request for a new user account. To create your account, you need to provide your name, NPN and email address.
Click here for online contracting to offer Aetna or other Medicare products
When you finish, you will receive 2 registration emails from communication@email.thinkagent.com.
It will take between 24-48 hours for Aetna to process your request and then you will receive the first email with your username and a link to start your registration. The next email will provide you with a registration PIN. After you receive both emails, open the click here link in the first email and enter the PIN from the second email and then click validate. From there you will create a password and choose a security question from the drop down menu. Once that is completed, click on submit and you r account is all set up and ready to go.
Click here for a PDF of registration and login instructions
Think Agent tools and resources
- Enroll clients in all Aetna Medicare products
- Manage your retail events
- Verify your client’s MBI as well as their Part A & B effective
- Check the Medicaid & LI eligibility for clients
- Email clients an eKit to enroll online
- Send a SOA via text, email or face-to-face
- Do a provider search to check the clients doctors are in-network
- Check your clients prescriptions with the drug cost estimator. This tool allows you to save 3 pharmacies at once.
- Health risk assessment (HRA) available
- Verify your ready to sell status
Click here to watch a quick video on the SOA rules
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Agents can also RSVP to live Think Agent training. Just go to aetnamedicareagenttraining.com, look for Think Agent in the event titles and choose a training that is convenient for you. There are several other etrainings available such as; Sales 101( Introduction to sales), Sales 102 (Advanced Sales), Retail in Think Agent, Calculating Drug Costs with Think Agent, Medicare Supplements & Complimentary Plans, Broker Enrolled Health Risk Assessment (HRA)
If you have any questions, contact the Think Agent Support team. Their office hours are M-F 8AM through 5PM EST, (they are available on weekends during AEP). Just call 1-866-714-9301, prompt #5. You can also reach them by email at support@thinkagent.com.
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