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What Medicaid Covers: A Guide for Dual Eligibles and Younger Beneficiaries

Medicaid is a vital safety net program that helps millions of Americans access health care, especially those with limited income or resources. While many associate Medicaid with lower-income families or children, it also plays a critical role in helping people on Medicare; often referred to as dual eligibles, afford the care they need. This post will answer the question; what does Medicaid cover.

Whether you’re on Medicare and Medicaid or qualify for Medicaid under age 65, it’s important to understand what the program covers and how it can help you.

Who Qualifies for Medicaid

Medicaid eligibility is based on income and household size, but each state runs its own Medicaid program within federal guidelines. In general, you may qualify if you:

• Have a low income and limited assets
• Are pregnant
• Are a child or teenager
• Are disabled or blind
• Are 65 or older
• Receive Supplemental Security Income (SSI)
• Receive Medicare and meet your state’s Medicaid income limits (dual eligible)

Many adults under 65 who qualify for Medicaid do so through the Medicaid expansion under the Affordable Care Act.

Medicare agents; watch a YouTube video on SEP changes for Dual, Partial Dual and LIS members

What Medicaid Covers

Medicaid coverage varies by state, but all states must cover a core set of benefits, including:

For Everyone (All Beneficiaries)

• Doctor visits
• Hospital services – in-patient and out-patient
• Emergency care
• Lab and X-ray services
• Nursing facility services
• Preventive care and screenings
• Prescription drugs (in most states – not all)
• Family planning services
• Mental health and substance use disorder services

Click here for a full list of mandatory benefits that Medicaid must cover

Additional Coverage for Medicare Beneficiaries

If you qualify for both Medicare and Medicaid, Medicaid helps cover costs Medicare doesn’t. Depending on your income level and the Medicaid program you qualify for, it may pay for:

• Medicare Part A and B premiums
• Medicare deductibles, coinsurance, and copays
• Long-term care services, such as nursing home care
• In-home support services
• Non-emergency transportation to medical appointments
• Dental, vision, and hearing benefits (varies by state)

This extra help is incredibly valuable, especially for seniors or those with disabilities who may struggle to afford out-of-pocket Medicare costs.

Medicaid and Long-Term Care

One of Medicaid’s most significant benefits is long-term care coverage. Medicare only covers short-term skilled nursing or rehab, but Medicaid may pay for:

• Extended nursing home care
• Assisted living in some states
• Personal care services at home

Many people spend down their assets to qualify for Medicaid when they need these services, as they can be extremely expensive without coverage.

Learn about alternatives to long term care insurance

Medicaid for Younger Adults and Children

For individuals under age 65 who don’t yet qualify for Medicare, Medicaid may provide:

• Comprehensive pediatric care through the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit
• Maternity and postpartum care
• Birth control and reproductive health services
• Support for individuals with disabilities, including waivers for home- and community-based care

How to Apply

Individuals can apply for Medicaid at any time of year through their state’s Medicaid office or through Healthcare.gov in participating states. Those on Medicare with a limited income may also qualify for a Medicare Savings Program (MSP); a Medicaid-administered program that helps pay Medicare costs.

Medicare beneficiaries who don’t qualify for full Medicaid may qualify for partial assistance through MSP; Medicare Savings Programs. These programs offer different levels of help such as: QMB, SLMB, or QI. These programs can make a major difference in managing healthcare expenses.

If you are a Medicare agent looking for a supportive upline; click for Crowe contracting

Stay up-to-date on the latest agent events and information.

Need help applying or understanding what you qualify for? Your local Medicaid office, a Medicare agent, or a SHIP (State Health Insurance Assistance Program) counselor can provide free, unbiased guidance.

Drug Plan Formulary Tiers Explained – Understanding Your Prescription Cost

If you have either a Part D prescription drug plan or a Medicare Advantage plan that includes drug coverage; you’ve probably heard the term “formulary tiers.” But what exactly are these tiers, and how do they affect what you pay at the pharmacy? In this post “Drug Plan Formulary Tiers Explained” we break it down to provide a better understanding of how drug coverage works and ways to save money.

What Is a Formulary

A formulary is simply a list of prescription drugs that your Medicare drug plan covers. Each plan creates its own formulary and categorizes the drugs into different tiers based on cost and type.

Understanding the Tier System

Most Medicare drug plans divide their formularies into five tiers, though some may have more or less. Here’s a general breakdown:

Tier 1: Preferred Generic Drugs

• These are the lowest-cost medications.
• Usually includes common generic drugs that treat routine health conditions.
• Lowest copayment.

Tier 2: Generic Drugs

• Generic drugs that aren’t in Tier 1 but are still less expensive than brand-name options.
• Slightly higher copayment than Tier 1.

Tier 3: Preferred Brand-Name Drugs

• Brand-name drugs that the plan has negotiated lower prices for.
• These may be more expensive than generics, but cost less than non-preferred brands.

Tier 4: Non-Preferred Drugs

• These can include both brand-name and generic drugs.
• They are more expensive and not favored by your plan.
• Higher copay or coinsurance.

Tier 5: Specialty Drugs

• These are high-cost drugs used to treat complex or chronic conditions such as cancer, multiple sclerosis, or rheumatoid arthritis.
• Usually require prior authorization.
• Highest out-of-pocket cost.

Why Tiers Matter

Your copayment or coinsurance depends on the tier your drug falls into. For example, a Tier 1 medication might cost nothing or just a few dollars, while a Tier 5 drug could cost hundreds, even with insurance.

Knowing your plan’s formulary can help you:

• Choose lower-cost alternatives.
• Talk to your doctor about switching to a lower-tier drug.
• Avoid unexpected expenses.

What If Your Drug Isn’t Covered

If your medication isn’t on your plan’s formulary, you have options:

• Request a formulary exception from your plan.
• Ask your doctor if a similar drug is covered.
• Use a discount program or Canadian pharmacy such as The Canadian Medstore, which offers medications at reduced prices for certain drugs not covered or affordable under your plan.

Watch a quick YouTube video to learn more about the Canadian Medstore

Tips for Managing Costs

• Before you sign up for a plan, contact a local Medicare agent to compare plans to find one that best fits your medication needs and budget.
• Review your plan’s formulary each year during the Annual Enrollment Period (AEP).
• Use preferred pharmacies that may offer lower costs.
• Consider applying for Extra Help if you may qualify based on income.

Understanding how formulary tiers work can help you make smarter choices about your prescriptions and potentially save money. Don’t hesitate to speak with a Medicare advisor or pharmacist if you need help reviewing your options.

Agents who want to join the team at Crowe; click here for online contracting

Need help comparing Medicare drug plans
I’m here to help. Contact me for a no-cost, no-obligation review of your coverage options.

If you are an agent who wants to stay updated on events and information, click here

What Medicare Plan N Covers: Is It the Right Supplement for You

When it comes to supplementing Original Medicare (Part A and Part B), Medigap Plan N is one of the more popular options. It offers strong coverage at a lower premium than some other Medigap plans. This makes it an attractive choice for many Medicare beneficiaries. We will go over what Medicare Plan N covers, and why someone might choose it over other options.

What Medicare Plan N Covers

Medigap Plan N is a standardized Medicare Supplement Insurance plan, which means the benefits are the same no matter which insurance company offers it. Here’s what Plan N covers:

1. Medicare Part A Coinsurance and Hospital Costs – Covers up to an additional 365 days after Medicare benefits are used up.
2. Medicare Part B Coinsurance or Copays – Covers most of the 20% coinsurance beneficiaries would otherwise pay. This excludes copays; up to $20 for doctor visits and up to $50 for ER visits that don’t result in admission.
3. Blood (First 3 Pints) – Covers the cost of the first three pints of blood needed for a medical procedure.
4. Part A Hospice Care Coinsurance or Copays
5. Skilled Nursing Facility Care Coinsurance
6. Medicare Part A Deductible – Plan N covers this cost, which can save you over $1,600 per admission in 2025.
7. Emergency Medical Care During Foreign Travel – Covers 80% (up to plan limits) for medically necessary care during international travel.
   

What Plan N Does Not Cover

There are a few out-of-pocket costs you may still be responsible for:

1. Medicare Part B Deductible – You’ll need to pay this annually ($240 in 2025).
2. Part B Excess Charges – If your doctor does not accept Medicare assignment and charges more than Medicare-approved amounts, Plan N does not cover those excess charges.
3. Copayments – As mentioned earlier, you’ll pay small copays for some office and emergency room visits.
   

Why Choose Medicare Plan N

Here are some reasons why Plan N might be the right choice for you:

Lower Monthly Premiums

Plan N generally has lower premiums than Plan G or Plan F. This makes it a budget-friendly option for those who want solid coverage without a high monthly cost.

Predictable Costs

Aside from the Part B deductible and occasional copays, your out-of-pocket costs are minimal. This makes it easier to plan financially, especially for healthy individuals who don’t visit the doctor often.

Access to Nationwide Coverage

Like all Medigap plans, Plan N allows you to see any provider in the U.S. who accepts Medicare; no networks or referrals needed.

Foreign Travel Coverage

If you travel abroad, the emergency coverage provided under Plan N gives you added peace of mind.

Ideal for Healthy Retirees

If you’re in good health and don’t mind paying occasional small copays, Plan N can offer significant savings while still covering major expenses.

Watch a quick video on Medicare enrollment periods

Is Plan N Right for You

Plan N is best for those looking to balance good coverage with lower monthly premiums. It’s especially attractive if you don’t anticipate frequent medical visits and prefer to avoid the higher costs of Plan G or Plan F.

Agents; if you are ready to join the team at Crowe, click here for contract.

Click here to stay updated on the latest agent events and information.

As always, it’s important to review personal health needs, provider preferences, and budget with a licensed Medicare agent to determine if Plan N is your best fit.

2026 Medicare Carrier Certifications: What Agents Need to Know

It’s time to start your 2026 Medicare carrier certifications! As an independent Medicare agent, staying up-to-date with your certs is essential to ensure you’re ready to sell during AEP and beyond. From AHIP to carrier-specific training, this guide walks you through what you need to do to prepare.

Why Certification is so Important

Certification isn’t just a box to check; it’s your license to sell. Completing annual Medicare certifications shows you understand the latest CMS guidelines, marketing rules, enrollment procedures, fraud, waste, abuse (FWA) protocols and carrier specific plan information. Without these certifications, you won’t be considered “ready to sell” by Medicare Advantage and Part D plan carriers.

Start Early to Stay Ahead

Don’t wait until September to begin your certifications. Many carriers release their 2026 certification portals as early as June or July. AHIP typically launches in late June. Getting a head start allows you to complete training on your own schedule, avoid delays, and ensure you’re cleared to market plans by October 1.

Complete AHIP Medicare Training

The AHIP (America’s Health Insurance Plans) certification is required by most major Medicare Advantage and Part D carriers. Here’s what to expect:

• Two Key Components:
  • Medicare Basics: Covers eligibility, benefits, and plan types (MA, PDP, MAPD).
  • Fraud, Waste, and Abuse (FWA): Identifies potential fraud and how to report it.
• Exam Details:
  • 50 multiple choice questions
  • 3 attempts to score 90% or better
  • Failing all 3 attempts means you must repurchase the course; some carriers don’t let agents contract if they fail the first 3 attempts.

Tip: Many carriers offer AHIP discounts through their agent portals. Pinnacle also provides agents a discount. Contact Crowe and Associates for access to Pinnacle’s discount link.

Complete Carrier Certifications

Each Medicare Advantage and PDP carrier has its own certification process. These certifications usually include:

• Product training
• CMS compliance and marketing rules
• Carrier-specific tools and enrollment platforms

Keep Track of Requirements:

• Log into each carrier’s broker portal to check:
  • Certification launch dates
  • Required modules
  • Additional tests or attestations
• Many carriers provide access to AHIP as part of their training

Tip: Keep a spreadsheet of your carrier logins, certification statuses, and deadlines to stay organized.

Use a Certification Checklist

To streamline your process, consider building or using a checklist that includes:

• AHIP registration and completion
• Carrier 1 certification (e.g., Aetna, Humana)
• Carrier 2 certification (e.g., UnitedHealthcare)
• Carrier 3 certification (e.g., Wellcare)
• Product training or market-specific training
• Certification confirmations saved as PDFs

Watch a YouTube video: What you need to know before a Medicare sale (phone or face-to-face).

Don’t Forget Additional Requirements

• Errors and Omissions (E&O) Insurance: Most carriers require active E&O coverage with minimum limits.
• Background Check Authorization: New agents may be subject to background verification.
• Contracting Updates: Keep your license, and E&O information current with each carrier.

Getting certified early and staying organized gives you a competitive edge going into the 2026 AEP. If you’re working with an FMO or upline, use their support team to guide you through training and contracting. The sooner you’re certified, the sooner you can start pre-AEP marketing and helping clients find the plans they need.

Ready to join the Crowe team; click here for online contracting

Need help or a discounted AHIP link: Reach out to your FMO or email: teal@croweandassociates.com. Pinnacle /Crowe agents can find a list of carrier certification links on Pinnacle’s website; pfsinsurance.com, from there look under the services tab and click on the certifications link.

Stay up-to-date on agent events and information; click here

Medicare Part D Coverage phases 2026

With significant changes enacted under the Inflation Reduction Act (IRA), Medicare Part D prescription drug coverage is now simpler and more predictable. Beginning in 2025, beneficiaries no longer experience a “donut hole,” and starting in 2026, cost thresholds slightly increase to keep pace with inflation. This blog explains the Medicare Part D Coverage Phases for 2026.

Part D Coverage: Three Straightforward Phases

1. Deductible Phase

• In 2026, CMS will implement a maximum standard deductible of $615 (increased from $590 in 2025). Beneficiaries pay 100% of drug costs out of pocket until they meet the deductible. Keep in mind, plan providers have the option to offer a lower or zero deductible.

2. Initial Coverage Phase

• Once the beneficiary meets the deductible, they enter the initial coverage phase.
• In this phase beneficiaries may pay up to 25% coinsurance on covered drugs. Pleas note; most drug plans do not charge coinsurance for tier 1 or even tier 2 drugs.
• Beneficiaries continue to pay coinsurance until their total out‑of‑pocket spending reaches $2,100 in 2026 (previously $2,000 in 2025).
• There is no Initial Coverage Limit (ICL) separate from your out‑of‑pocket threshold, so no “gap” in coverage.

3. Catastrophic Phase

• Once the beneficiary has spent $2,100 out of pocket on formulary (covered) drugs, they enter the catastrophic phase.
• In this phase, beneficiary coinsurance drops to $0; they have no further cost-sharing on covered Part D drugs for the rest of the year.

Watch a YouTube video on the Part D drug cap

What Happened to the Donut Hole

• The coverage gap (“donut hole”) was officially eliminated starting January 1, 2025.
• Instead of transitioning from initial coverage to a gap, enrollees transition directly into catastrophic coverage once they reach the annual out-of-pocket cap ($2,000 in 2025; $2,100 in 2026).
• This means no more confusing coinsurance changes mid‑year; just a smooth journey through three phases.

Why No “Donut Hole”

Before 2025, Part D had four somewhat confusing cost-share phases:

• Deductible → Initial Coverage → Coverage Gap (“donut hole”) → Catastrophic Coverage.

Thanks to the Inflation Reduction Act:

• The donut hole was discontinued, coinsurance standardized at 25%, and a hard cap on TrOOP at $2,000 in 2025.
• In other words: Simplified coverage and predictability was put in place.

2026 Standard Benefit Summary

TrOOP stands for out of pocket. The TrOOP includes: deductible, copays and coinsurance. However the TrOOP does not include; plan premiums or drugs not covered under Part D of your plan.

Summary for Medicare Prescription Coverage 2026

• The year begins with beneficiaries paying up to $615 out of pocket toward their deductible.
• After that, they pay 25% of covered drug costs until their total out-of-pocket spending hits $2,100.
• Once they hit the cap, they move into catastrophic coverage and pay zero out-of-pocket for covered drugs for the rest of the year.
• As of 2025, the donut hole is gone, ensuring a smooth and straightforward benefit structure.
• Beneficiaries can consider enrolling in the Medicare Prescription Payment Plan if it helps spread out drug costs.

Medicare agents:

Click here for updated agent events and information

If you are ready to join the team at Crowe; click here for online contracting.

2026 brings continued relief and clarity for Medicare Part D enrollees; no donut hole, no complicated phases, just predictable costs and peace of mind.

How To Save On Prescription Drugs – Helping Medicare Clients

Prescription drug costs can be a major concern for Medicare beneficiaries, especially those on a fixed income. As a Medicare agent, helping your clients learn how to save on prescription drugs not only builds trust; it can also make a real difference in their overall healthcare experience.

Here are several effective strategies you can use to help your clients save on their prescriptions:

Review Medicare Part D Plans Annually

Encourage clients to compare Part D plans every year, especially during the Annual Enrollment Period (AEP). Drug formularies, pharmacy networks, and premiums can change annually, which may impact out-of-pocket costs.

Use Medicare’s Plan Finder tool or your quoting software to:

• Check if current medications are still covered
• Compare plan premiums, deductibles, and copays
• Identify preferred pharmacy networks for added savings

Look Into Medicare Advantage Plans with Drug Coverage

Some Medicare Advantage (MAPD) plans include prescription drug benefits that may offer lower costs than standalone Part D plans. Make sure to evaluate:

• Formulary tier placement for their medications
• Coverage phases (deductible, initial coverage, catastrophic)
• Extra benefits like mail-order options or pharmacy discount programs

Apply for Extra Help (LIS)

Let eligible clients know about Medicare’s Extra Help program, also known as Low-Income Subsidy (LIS). It helps cover:

• Part D premiums
• Deductibles
• Coinsurance

Each year, income and asset limits are updated. Help clients check eligibility and apply through Social Security or their state Medicaid office.

Check for State Pharmaceutical Assistance Programs (SPAPs)

Many states offer SPAPs that provide financial help with prescription drugs for low- to moderate-income seniors. These programs vary by state, so check what’s available locally and guide clients through the application process if applicable.

Request Generic and Therapeutic Alternatives

Encourage clients to:

• Ask their doctor if a generic version is available
• Discuss therapeutic alternatives that might work just as well at a lower cost
• Use formulary tools to find covered equivalents in lower tiers

This can result in significant monthly savings without sacrificing effectiveness.

Agents, if you are ready to join the team at Crowe; click here for online contracting

Use Preferred or Mail-Order Pharmacies

This one should be obvious, but some beneficiaries do not understand the possible savings. Help clients find pharmacies within their plan’s preferred network, where they’ll often get the lowest copays. In many cases, 90-day mail-order supplies are also more affordable and convenient for maintenance medications.

Explore Prescription Discount Programs

While they can’t be used in conjunction with Medicare, some clients may benefit from discount cards (like Glic, GoodRx or SingleCare) when paying cash. These may be helpful for:

• Medications not covered by their plan
• When the discount price is lower than their copay

Important: Remind clients that purchases using discount cards don’t count toward their Part D deductible or out-of-pocket threshold.

Consider Safe International Pharmacy Options

For some clients, especially those with high-cost brand-name prescriptions, licensed international pharmacies can provide considerable savings.

One popular and reputable option is The Canadian MedStore, which connects U.S. consumers with licensed international pharmacies in Canada and other Tier 1 countries. Key benefits include:

• Substantial savings on brand-name medications
• Licensed pharmacy partners
• Reliable customer service and refill support

Please note: Agents should advise clients to check with their doctors before switching sources and confirm that any international pharmacy is legitimate and properly licensed.

Watch a YouTube video with details on the Canadian Medstore

Saving on prescriptions doesn’t have to be complicated, sometimes all it takes is having the right resources. As an agent, you can guide clients toward cost-effective, safe solutions that help them stay healthy and financially stable.

Stay updated on the latest agent events and information

Whether it’s comparing plans, applying for Extra Help, or exploring alternative resources, your support can make a meaningful difference.

Understanding the Medicare SHIP Program

When navigating the complexities of Medicare, having expert, unbiased help can make all the difference. That’s where the State Health Insurance Assistance Program (SHIP) comes in. SHIP provides free, personalized counseling and assistance to Medicare beneficiaries and their families. Whether you’re enrolling for the first time or reviewing coverage options, Understanding the Medicare SHIP Program can be a valuable resource.

What Is SHIP

SHIP stands for State Health Insurance Assistance Program. Funded by the federal government and administered at the state level, SHIP offers free, objective, and confidential help to people with Medicare.

Each state has its own SHIP, staffed by trained counselors who are not affiliated with insurance companies. Their goal is to help Medicare beneficiaries make informed decisions based on individual needs; not sales goals.

Medicare beneficiaries may use SHIP in conjunction with their Medicare agent to access additional support with Medicare issues such as:

What Services Does SHIP Provide

• Understanding Original Medicare (Parts A and B)
• Comparing Medicare Advantage (Part C) and Part D drug plans
• Reviewing Medigap (supplemental insurance) options
• Explaining Medicare Savings Programs and Extra Help
• Appealing Medicare denials and billing errors
• Transitioning from employer insurance to Medicare
• Understanding coverage for long-term care

SHIP can provide guidance tailored to each specific situation.

Who Can Use SHIP

SHIP services are available to:

• Current Medicare beneficiaries
• People turning 65 soon or new to Medicare
• Caregivers or family members assisting someone with Medicare
• Individuals under 65 who qualify for Medicare due to a disability

There is no cost for SHIP counseling, and there is no pressure to choose a specific plan.

Need help getting diabetic supplies; watch a quick YouTube video to access assistance

How to Find SHIP Help

To contact your local SHIP office, visit www.shiphelp.org and use the locator tool. You can also call 1-877-839-2675 to be directed to your state’s SHIP.

Appointments may be available by phone, in-person, or virtually; depending on location and preference.

Why SHIP Matters

For beneficiaries who do not have a trusted Medicare agent; Medicare can be overwhelming when you’re trying to choose the right plan for your needs or help a loved one through the process. SHIP counselors offer unbiased, trusted advice. They exist solely to help Medicare beneficiaries make informed choices and avoid costly mistakes.

If you are a Medicare agent looking for a supportive upline; click for Crowe contracting

Stay up-to-date on the latest agent events and information.

Those unsure about Medicare coverage, billing, or eligibility; or just need someone to walk through the options; SHIP is an excellent place to start.

Get a Head Start on AEP: Prep Now for a Successful Enrollment Season

The Annual Enrollment Period (AEP) is one of the busiest and most profitable times of the year for Medicare agents. Between October 15th and December 7th, the demand for knowledgeable, trusted advisors skyrockets. But here’s the truth: agents who wait until the fall to prepare are already behind. It is best to get a head start on AEP before everything piles up.

The most successful Medicare agents treat the months leading up to AEP as preparation time. By getting a head start now, you’ll not only reduce stress but also position yourself to grow your book of business and serve clients more effectively when the rush begins.

Here are some steps you can take right now to set yourself up for your best AEP yet:

Complete Certifications and Training

Staying current with your certifications is critical. Most carriers require agents to complete either AHIP or NABIP certification and plan-specific training before they can begin selling Medicare Advantage or PDP plans during AEP.

• AHIP and NABIP typically launch in June, so mark your calendar.
• Many carriers offer a discount if you complete AHIP through their portal; take advantage of that!
• Start your carrier certifications as soon as possible so they do not pile up (they can be time consuming). This helps you minimize stress as it gets closer to the October deadline.

By getting these done early, you’ll be compliant, confident, and ready to hit the ground running.

Stay Updated on Industry Changes & Training Opportunities

The Medicare landscape is constantly evolving; plan changes, regulatory updates, compliance rules, and new technology are all part of the mix. That’s why staying informed isn’t just helpful; it’s essential.

Take time now to:

• Subscribe to carrier newsletters and CMS updates.
• Attend webinars, workshops, or local training events.
• Engage in forums or networking groups with other Medicare agents.

The more informed you are, the more value you bring to your clients—and the more confident you’ll feel going into AEP.

Click here to view the latest agent events and information.

Prepare and Update Your Marketing Materials

Your marketing materials are your first impression; make sure they’re working for you, not against you.

Before AEP begins, audit and refresh all your materials:

• Brochures
• Flyers
• Business cards
• Educational handouts
• Giveaways or branded items (under $15 for compliance!)

Make sure everything reflects your current branding, includes up-to-date contact information, and is tailored to your audience.

If you’re planning to promote yourself through social media, email, or your website, remember:

• Include all required disclaimers (especially for Medicare Advantage or PDP).
• Double-check whether your materials require HPMS filing and approval.
• For peace of mind, consider working with your compliance department to review and file your materials properly.

Watch a YouTube Video of the CMS proposed changes for CY2026

When in doubt; ask. Staying compliant now saves headaches later.

Test Lead Sources Before the Rush

Not all leads are created equal; the best time to figure out what works is before the pressure of AEP hits.

Now is the perfect time to test and evaluate:

• Digital leads (Google ads, Facebook campaigns)
• Direct mail campaigns
• Community referrals
• Educational events
• Grassroots marketing (partnering with local businesses or pharmacies)

Track metrics like cost per lead, contact rate, appointment set rate, and ultimately, conversion to sale.

Give yourself time to test, and refine your lead strategy so when AEP begins, you’re not guessing, you’re scaling.

Make a Marketing Plan

Don’t wait until October to promote yourself; start building awareness now. Consider:

• Planning grassroots marketing like community events or educational seminars.
• Designing print materials (postcards, flyers, business cards).
• Lining up email campaigns or social media content to build visibility.

Make sure your Permission to Contact (PTC) processes are compliant and ready to go.

Update Tools and Technology

Evaluate whether your current tools are working efficiently:

• Is your CRM user-friendly and up to date?
• Are your quoting tools and enrollment platforms ready?
• Do you need to upgrade your laptop, printer, or internet connection?

Watch a YouTube video on Connecture & Sunfire quoting and enrollment tools

A little tech prep now can save you major headaches later.

Check that your systems are:

• Updated and running smoothly
• Synced across devices
• Easy for both you and your clients to use

Key tools to have ready:

• Online quoting tools – for fast and accurate plan comparisons
• E-app platforms – for secure and paperless enrollment
• Video conferencing tools – for remote appointments
• Electronic scope of appointment (SOA) tools – for compliance

Also, make sure your email, calendar, and CRM are integrated so nothing slips through the cracks.

Learn about Pinnacle’s BOSS agent portal & CRM for agents

By mastering your tech tools before AEP, you’ll boost efficiency, reduce errors, and deliver a smoother experience to every client; earning trust and more referrals.

If you are ready to join the team at Crowe,; click here for online contracting

Take Care of Yourself

Don’t forget: you’re your biggest asset. AEP is a marathon, not a sprint. Use this pre-season time to get into a good routine; physically, mentally, and professionally so you can show up at your best every day during the rush.

Medicare Savings Program: What It Is, How It Works, and Who Qualifies

Healthcare costs can be overwhelming, especially for people living on a fixed income. That’s where Medicare Savings Programs (MSPs) come in. If you are either new to Medicare or a new agent, you might ask; what is the Medicare savings Program. This program is designed to help individuals who meet specific income requirements with Medicare-related costs such as; premiums, deductibles, and coinsurance.

Let’s break down what these programs are, how they work, and who qualifies.

What Is the Medicare Savings Program

The Medicare Savings Program (MSP) is a set of federally funded, state-run programs that help eligible individuals pay for some or all of their Medicare Part A and/or Part B costs. This includes:

• Monthly premiums
• Annual deductibles
• Copays or coinsurance amounts

There are four main types of MSPs, each with slightly different income and asset limits and benefits.

The Four Types of Medicare Savings Programs

1. Qualified Medicare Beneficiary (QMB) Program
   • Pays for Medicare Part A & Part B premiums
   • Also covers deductibles, coinsurance, and copayments
   • Very limited income and asset limits apply
2. Specified Low-Income Medicare Beneficiary (SLMB) Program
   • Helps pay for Part B premiums only
   • Slightly higher income limits than QMB
3. Qualifying Individual (QI) Program
   • Also helps with Part B premiums
   • Available on a first-come, first-served basis
   • You must reapply each year
4. Qualified Disabled and Working Individuals (QDWI) Program
   • Pays for Part A premiums
   • For people under 65 who lost their premium-free Part A due to returning to work

How the Program Works

If you qualify for any of the Medicare Savings Programs:

• Your state pays your Medicare premiums directly to Medicare.
• In the case of QMB, providers are prohibited from billing for services covered by Medicare (except for a small copay in some cases).
• Enrollment in an MSP automatically qualifies you for Extra Help, a program that reduces prescription drug costs under Medicare Part D.

Who Qualifies for a Medicare Savings Program

Eligibility is based on monthly income and assets. The exact limits vary slightly by state, but general federal guidelines for 2025 are:

1. QMB (Qualified Medicare Beneficiary)

• Income: Below $1,325/month (individual), $1,783/month (married couple)
• Resources: Below $9,660 (individual), $14,470 (couple)

2. SLMB (Specified Low-Income Medicare Beneficiary)

• Income: $1,585/month (individual), $2,135/month (couple)
• Resources: Same as QMB

3. QI (Qualifying Individual)

• Income: $1,781/month (individual), $2,400/month (couple)
• Resources: Same as QMB

4. QDWI (Qualified Disabled and Working Individual)

• Income: Up to $5,302/month (individual), $7,135/month (couple)
• Resources: $4,000 (individual), $6,000 (couple)

Note: These limits are approximate and may vary slightly by state and year. Some states do not count all income or resources when determining eligibility.

Another way to save is by using the Canadian Medstore for some non-formulary or higher cost medications. Click here to watch a video on this program.

How to Apply

You must apply through your state Medicaid office, even though the program is funded by the federal government. You can apply at any time during the year; there’s no annual enrollment window for MSPs.

When applying, you’ll typically need to provide:

• Proof of income (such as pay stubs or Social Security statements)
• Bank statements
• Medicare card
• Identification documents

Individuals living on Medicare with a limited income shouldn’t overlook the Medicare Savings Programs. These programs can save hundreds or even thousands of dollars annually, making it easier to access needed care without worrying about the financial burden.

Those who might be close to the income or asset limits should still apply. Some states have flexible guidelines or exclude certain resources from their calculations.

Medicare agents; stay updated on the latest events and information, click here.

If you are an agent who is ready to join the team at Crowe; click here for contracting

A licensed Medicare agent or your local State Health Insurance Assistance Program (SHIP) can provide guidance with the process.

Understanding Medicare Part B Coverage

Both Medicare Part B (medical insurance) and Part A (hospital insurance), make up Original Medicare and play a vital role in healthcare for millions of Americans. Because Part B provides essential coverage for outpatient care, doctor visits, preventive services, and more; understanding Medicare Part B coverage is essential.

What’s Covered by Medicare Part B

Part B helps pay for a range of services and supplies, including but not limited to:

• Doctor’s visits (primary care and specialists)
• Wellness and preventive visits
• Urgent care services
• Laboratory tests (e.g., blood work, urinalysis)
• Diagnostic imaging (X‑rays, scans)
• Emergency ambulance transportation
• Mental health services (outpatient therapy, counseling)
• Durable medical equipment/DME (e.g., wheelchairs, oxygen tanks)
• Rehabilitative services (physical, occupational, speech therapy)
• Preventive services (e.g., flu shots, pap smears, cancer screenings)

Beneficiaries may receive these services in doctors’ offices, hospitals, clinics, and other outpatient facilities.

Medicare Part B Costs (2025 Rates)

Premium

• Standard monthly premium: $185.00 in 2025; up from $174.70 in 2024.
• Beneficiaries who receive Social Security payments have this amount automatically deducted from their Social Security checks. Those who opt not to take Social Security payments receive a quarterly bill for $555.00.

High-income earners pay higher premiums under IRMAA (Income‑Related Monthly Adjustment Amounts), with surcharges ranging from an additional $74 to $443.90, depending on tax filing status and income level.

Deductible & Coinsurance

• Annual deductible: $257 for 2025, this amount is up from $240 in 2024
• Coinsurance: Once the beneficiary meets the deductible, they pay 20% of the Medicare-approved cost for most services after Medicare pays it’s share (80%).

Late Enrollment Penalty

Those who don’t sign up for Part B when first eligible (and don’t qualify for a Special Enrollment Period), incur a 10% penalty for each full 12 months they were eligible but didn’t enroll. This penalty is added to the monthly premium and lasts for as long as they have Part B.

Watch a YouTube video on OEP, Special Elections & Late Part B Enrollments

How to Enroll

You can sign up for Medicare Part B online via the Social Security Administration, by phone at 1-800-772-1213 (TTY: 1-800-325-0778), or in person at your local Social Security office.
Ready to sign up for Part B? Click here to enroll now.

We’re Here to Help

Medicare agents can be a valuable source of information and guidance. There is no fee for the appointment. Whether you’re new to Medicare or looking to optimize your coverage, licensed agents are ready to assist.

Agents: if you are ready to join the team at Crowe; click here for contract.

Get all the latest agent news and event information; click here!

Keeping up with annual updates, such as; Part B premiums and deductible as well as nay plan changes, can help you budget effectively and avoid surprises.