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For many agents, this year has been a bit frustrating and that is putting it mildly. The 2025 Medicare commissions have been the topic of many conversations. The commission amounts were up in the air for several months before the lawsuits that caused a federal judge to put a stay on a portion of the Medicare Final Rule that directly affects agent commission. As a result of the lawsuits, CMS issued some updates to 2025 Medicare Advantage and Part D broker commissions on July 18, 2024. The new amounts supersede those originally reported by CMS for 2025.

Medicare commission final update – YouTube Video

Important:

The additional administrative fee amounts of $100 for initial enrollments and $50 for renewals of both PDP and MA/MAPD Plans is no longer applicable. In other words, the additional money will not be added to commissions for 2025.

If the judge approves CMS Final rule at some point, the commission rates may increase by $100 for initial enrollments and $50 for renewals. This will be used as a one-time administrative fee to offset the loss of carrier marketing funds.

Although the increase we talked about in the previous paragraph will not be put in place, CMS has approved commission increases for both MA and PDP plan sales. This is due to a FMV (Fair Market Value) increase.

2025 Medicare Advantage commissions

Please keep in mind; the commission rates are not all the same and vary state to state.

In the states of CA and NJ, there will be an increase for initial commissions from $762 per member to $780 per member for 2025.  Renewal commissions for CA and NJ are going from $381 per member to $390 per member for 2025. 

For CT, DC and PA initial commissions will go from $689 per member for the first year to $705 per member.  Renewal commissions for CT, DC and PA will increase from $345 per member annually to $353 per member in 2025.

Puerto Rico as well as the U.S. Virgin Islands initial MA commissions will go from $418 per member annually to $428 per member for 2025.  The renewal commissions have increased from $209 a member for the year to $214 per member for the year.

For any state not listed above, initial MA commission amounts have increased from $611 per member annually to $626 per member for 2025. The commission rates for renewals have increased from $306 per member annually to $313 per member for 2025.

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PDP commissions for 2025:

In the case of PDP commissions, commission rates 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

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Medicare dental benefits

Most people have heard about the additional benefits offered on some Medicare plans.  One of the most asked about benefits are Medicare dental benefits.  Although dental care is an integral part of overall health, in the vast landscape of healthcare, dental benefits are often overlooked.

The state of Dental coverage in Medicare:

Medicare plays a crucial role in ensuring individuals over the age of 65 and qualifying individuals with disabilities.  Unfortunately, the comprehensive healthcare coverage Medicare provides is definitely lacking when it comes to dental coverage.

As we have already mentioned, Medicare provides a great deal of coverage for various health services, yet dental care has traditionally held a separate status.  Neither Part A nor Part B (Original Medicare) cover routine dental care.  This includes things like check-ups, cleanings, fillings, and extractions.  These services can be quite expensive and many people on fixed incomes simply do not have the resources to afford the costly dental care they require.  This lack of coverage frequently leaves beneficiaries looking for supplemental options that will cover their oral health needs.

Medicare Advantage Plans with dental benefits:

These days, many people look to Medicare Advantage plans (Part C) to provide some relief from the high cost of dental work.  Medicare Advantage plans are offered by private insurers and often provide additional benefits beyond Original Medicare. Many Medicare Advantage plans include dental coverage.  This coverage usually includes preventive and a few additional services.  In some rare instances, more extensive treatments like root canals or dentures are also covered to some extent.

Learn about some of the plan comparison tools that help clients sort out their options

Stand-alone Dental Coverage:

Many Medicare beneficiaries ask about dental coverage because they understand the importance of dental health.  This is where you need to explain that supplementary (stand-alone) plans cater specifically to dental care needs.  There are many different options available and many dental insurance carriers. Each carrier provides a few different coverage options that include things like checkups, cleanings, fillings and various other dental procedures. It is imperative that beneficiaries understand dental plans only work well if they use an in-network provider for dental care. As an agent, you need to check that their dentist is in network with any plan they are considering.

click here to learn about the NCD metlife dental plans

The Importance of Routine Dental Care:

While navigating Medicare and dental benefits, it’s imperative to understand how important routine dental care is. Oral health can significantly impact overall well-being.  There are several studies that link poor oral health to various systemic conditions. Maintaining regular dental visits preserves a healthy smile and also contributes to overall health and quality of life.

Advocating for Future Changes:

Because of the critical role oral health plays in overall well-being, there’s an ongoing call for expanding Medicare to include comprehensive dental coverage.  Both advocates and policymakers continue to push for changes within the program to include preventive and restorative dental services.  The goal is to provide better access to essential oral healthcare for Medicare beneficiaries.

As the healthcare landscape continues to evolve, understanding the importance of Medicare dental benefits remains pivotal for individuals seeking comprehensive healthcare coverage.  Although the current scope of dental coverage in Medicare has many gaps, exploring supplemental options like Medicare Advantage plans or standalone dental coverage offer some help addressing oral health needs.

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UHC OTC catalog 2021

Some UHC Medicare Advantage plans provide members with OTC benefits.  For anyone who is in one the participating MA plans,  the UHC OTC catalog 2021 is a useful tool. There will be a lot of great information included in the welcome packet you will receive.  This packet includes, your ID card, benefit information and a fulfillment by Walmart OTC card.

UPDATE:   CLICK HERE FOR THE 2022 CATALOG

Are you a Medicare insurance agent?  CLICK HERE TO LEARN ABOUT OUR FREE LEAD PROGRAM

Download  the health & Wellness catalog for 2021 here.

Members of specified UHC Medicare Advantage plans receive OTC credits every quarter to use on approved items.

On the first day of each new quarter, the credits will arrive in your UHC OTC account.  The amount of credits each member receives depends on the plan you are on.  The plan summary of benefits will specify the plan benefit amount. After that, your credits will expire at the end of each quarter and do not rollover.

Here are the ways you can use your benefit credits:

Go online and create an account at; MyUHCMedicare.com/HWP.  Once you have created your account, you can check your OTC balance, look for approved items and place your order.

Order over the phone at; 1-833-845-8798 TTY 711.  Please be sure you have your product number as well as name of item and your account number handy before you call.  The customer service representative will also ask you for the security code found on the fulfillment by Walmart card.

Place your order through the mail.  Just use the mail order form and the postage paid envelope you find in your health and wellness product catalog.

CLICK HERE FOR CATALOG

Medicare changes  2021

Image by Niek Verlaan from Pixabay

Have you thought about adding dental, vison or hearing coverage?

THE INFORMATION ON THIS PAGE HAS BEEN UPDATED.   CLICK HERE TO ACCESS THE NEW PAGE.

Aetna OTC catalog 2021

Are you a member of an Aetna Medicare advantage plan?  If you are, you need the Aetna OTC catalog 2021, because it offers many great products at no cost to you.  Not sure if your plan offers this benefit; check the summary of benefits for your plan.  If you do not have a summary of benefits, you can find out if your plan offers the OTC benefit by calling: 1-833-331-1573 (TTY:711).  Due to the fact that different Medicare Advantage plans offer different benefits, be sure to note if you have either a monthly or a quarterly benefit amount.

Members of participating plans can access both plan documents and the OTC catalog online: AetnaMedciare.com/OTCCatalog.

Once you are on the website; choose plan year 2021 and sue the drop down menu to fill in other necessary information.  Once this is done, you will be able to access all plan documents including the OTC catalog.

Download the 2021 OTC catalog

Members of the Aetna 2021 DSNP plan can click here for the OTC catalog.

Because people like to do things differently, Aetna gives members 3 ways to order OTC items:

Before you place an order, please have your Aetna member ID number ready.

To order by phone, call 1-833-331-1573 (TTY:711).  You can reach customer care representatives Monday-Friday, 9am- 8pm local time except in Hawaii.

Pick up your order in person at any participating CVS OTCHS-enabled pharmacy. To find a participating CVS; just go to the store locator at: cvs.com/otchs/myorder/storelocator.

Order online at: cvs.com/otchs/myorder.  The first time you  go to the site, you will need to create an account.

Do you need a paper copy of the catalog?  Just call member services; you will find this number on your member ID card.

If you are a D-SNP plan member, you will automatically receive an OTC catalog in the mail with your other plan documents.

If you would like to download a copy of the Aetna OTC catalog:

CLICK HERE – 2021 AETNA OTC CATALOG

CLICK HERE – 2021 AETNA DSNP OTC CATALOG

Should I choose a Medicare Advantage Plan or a Medicare Supplement Plan?

We can set up a time for you to speak with a licensed insurance agent, if you need help choosing an insurance plan.   Contact us either at (203-796-5403) or email admin@croweandasociates.com.

Learn more about Crowe and Associates

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Aetna Medicare Over The Counter Catalog 2019

The Aetna Medicare Over The Counter (OTC) Catalog 2019 is now available.

To view an updated post – Click here for details

Carriers now offer a Medicare over the counter (OTC) benefit  to their members.  In addition to your plan benefits, over the counter benefits  defray some of the cost of necessary healthcare items not covered as a medical or pharmaceutical expense.

Aetna Medicare offers members an Over-The-Counter benefit.

This benefit pays up to a $25 maximum amount every month for over the counter  (OTC) items.  The catalog lists eligible items.    Only items listed in the OTC catalog are covered by the over the counter benefit.  Many products you would normally purchase from a drugstore are critical to a healthy lifestyle.  These items may include non-prescription medications, vitamins,  and eye care.  In addition to these you can purchase every day items that impact your health, like hand sanitizer.  This benefit allows you to purchase these items from the catalog at no cost to you.  Accordingly, the cost of these items is part of your Medicare OTC benefit.

1. The over the counter benefit in 2019 is up to $25/member every month.  However, there are rules with regard to how items must be ordered.
2. The over the counter  benefit is included with all Aetna Medicare Advantage plans in 2019.
3. You must order from the catalog or online. Items purchased from a retail store are not part of the benefit.
4. Because this is a “use it or lose it” benefit,  benefit dollars do not carry over month to month.  Therefore,  be sure to check the catalog each months for items you will need.
5. You cannot use your CVS Extra Care card toward these purchases.
6. Free shipping!  There are no shipping or handling fees.
7. Orders typically take two weeks to arrive.  Plan ahead for adequate supplies.

You can place an Over the Counter order 2 ways.  You can order either by phone at 1-888-628-2770 Monday through Friday 9:00am to 8:00pm EST, or you can order online at visit:myorder.otchs.com.

Choosing a Medicare plan can be confusing!  Remember, that is what we specialize in!    If you still need help determining which Medicare option will suit you best,  call us at 203-796-5403 and schedule an appointment today.

Agents can click for a Medicare Scope of Appointment 

Medigap Plans CT

Medigap plans Ct are also called Medicare supplement plans.   They provides coverage for these “gaps” in your Medicare coverage and can save you money.  Medigap plans are not Medicare Advantage plans rather, they provide coverage after Original Medicare A and B benefits pay.  As a result, it is important to note that Medigap plans will only cover services that are approved by Medicare. They will not help cover costs that Medicare does not allow/approve.

Access all Medigap plans CT (Medicare supplement plans) with this link.  Site will show you all plans and rates in CT.

Are you a broker looking to sell Medigap plans?  If so, click here to learn more about Medigap sales.

Medicare supplemental plans are offered by private insurance companies.  These plans help to pay the ‘gap’ between costs covered by original Medicare and your out of pocket costs.  Medigap plans are regulated by national and state governments and therefore benefits are generally the same, regardless of the insurance company.   For example, Plan A has the same benefits regardless of the company you purchase it from.  As a result, rates and value add benefits are the only difference from company to company.

Medigap plans do not cover medication expenses.  If you enroll in a Medigap plan, you should also consider a Medicare Part D (prescription drug) plan.  The rule is different for drugs under medicare part B. As a result, it is important to pick the right part D drug plan.  The pharmacy you like to use and the specific prescriptions you take make all the difference when selecting a drug plan.  Call our office to learn more or use the CMS drug plan finder tool. 

Want to learn more about the differences between a Medigap plan and a Medicare Advantage plan? Click here to learn about all your medicare options.

We are one of Connecticut’s leading Medicare brokerage firms.  Please call us at 203-796-5403 or email us at edward@croweandassociates.com if you have questions.  Better yet, we can set a time to sit face to face and discuss all of your options.  If you aren’t able to travel to our office, we will gladly come to you.

Medicare Plans Connecticut

Medicare Plans Connecticut is a broad term that can refer to a number of companies or plan types in Connecticut.  Insurance companies offer either Medicare Advantage plans (MAPD), Medicare Supplement plans (Also called Medigap)  or Medicare Part D Rx plans.  A summary of both plans and companies has been provided below.  Choosing the right plan means matching up the needs of the insured (current health, doctors, as well as Medications and volume of care) with the strengths of the given plan type.

Medicare Advantage plans-

Managed Medicare plans offered with (MAPD) and without (MA) drug coverage.  Medicare Advantage plans take the place of Original Medicare.  They are the primary insurance and have a network as a result.  There  in network only (HMO) and out of network (PPO) plans available. In Connecticut, most plans are HMO style plans.  Connecticare, United Healthcare, Aetna and Wellcare as well as Anthem BCBS offer plans in Connecticut.

There are two plans with a $0 monthly premium. Both require referrals to specialists. There are a number of plans in the $29 to $44 a month range. The higher end HMO and PPO plans have a premium from $99 to $128 a month. The positive points with MAPD plans are, they have a very low to no monthly premium.  These plans include Medicare part D coverage and they offer some benefits that Original Medicare does not.  Some of the negatives can be, the copay for medical services, provider networks as well as referrals for specialists.  Click the links for plan designs of some of the more popular plans in CT.

Connecticut does not have medical underwriting which is important to consider.  Medicare rules allow someone to change plans every January 1st during OEP.  Without checking health, a member can change from a Medicare Supplement to a Medicare Advantage plan.  If someone develops a health condition, they could change to a supplement without any issues.

Medicare Plans Connecticut 

United Healthcare Medicare Complete Plan 1

UHC Medicare Complete Plan 2

United Healthcare Medicare Complete Plan 3

Aetna Medicare Plan HMO Connecticut

Anthem Mediblue Plus HMO

Anthem Mediblue Select HMO

Medicare Plans Connecticut can also be Medicare Supplement Plans (Medigap)– Medicare Supplement plans are offered by a number of companies in CT.  These plans are standardized. This means benefits are the same from company to company.  Common plans offered in CT are Plans F, High F, N, K, L and G.  AARP offered by United Healthcare tends to be the first choice in CT.  A number of companies including Humana, AARP, Anthem BCBS, Combined Life, United American and Cigna all offer a number of plan choices.

Click here for standardized Medicare supplement rates in CT

Medicare Part D plans (stand alone Rx plans)-  Medicare part D plans are offered by a number of companies in CT.  Some of the more popular choices are UHC branded Saver, UHC branded Preferred RX, Humana Walmart Rx, Silver Scripts, Express Scripts Rx.  There are too many plans to list them all.   You cannot purchase a stand alone Rx plan with a Medicare Advantage plan.  Clients can only purchase these plans along with a Medicare supplement.  You can also combine these plans with Medicare A and B.  If you buy a supplement plan, you do not have to use the same company for the Rx plan.  Clients can choose any company they feel is offering the best plan for them.  Note: The Humana Walmart Rx plan is  the current lowest cost (lowest monthly premium) plan in CT.

Need to sign up for Original Medicare A and B?  Click this link to sign up online through the Social Security Website.

States offer  programs to individuals in need of assistance.  In fact, you may qualify for assistance.  Click here to learn about programs offered and determine if you are eligible.

 If you have either additional questions or need a quote, Click here.

Anthem MediBlue Select HMO

Anthem MediBlue Select HMO is a Medicare Advantage plan with prescription drug coverage (MAPD).   In fact, Anthem Blue Cross Blue Shield offers this plan only in Hartford county in the state of Connecticut.   This, like all HMO plans, require that participants use in network providers.  If you choose to use out of network providers, this plan will not cover your expenses.  An exception to this would be urgent or emergency care which allows of of network services.

The plan has a monthly premium of $26. This would be in addition to the part B premium of $121.80.  There are no referrals required for this plan. Co-pays for a primary doctor are $15 and $40 for a specialist.  The plan has an annual out of pocket max of $6,100 per year.  Annual maximum indicates the most the insured would need to pay in medical claims for  the year.  You can not apply either Monthly premiums or cost-sharing for part D prescription drugs to the maximum out of pocket amount.

You can add dental services to the plan for an additional premium.  In Addition, Silver Sneakers is included in the $26 monthly premium and pays a local gym membership monthly fee.   If you use approved diabetic supply vendors your diabetic supplies are covered at 100%.

This plan offers prescription drug coverage with $220 annual deductible.  This deductible applies only to tiers 2-5.  The plan excludes both Tiers 1 and 6 from this deductible.  There is no limit to how much the plan will pay.

A Medicare Advantage plan should not be confused with a Medicare Supplement plan (also called Medigap).

MAPD plans offer both medical and drug benefits combined with the insurance company as the primary insurance.  With a Medicare Supplement, original Medicare is primary.  The insurance company would be the secondary insurance.  As a result, a Medicare Supplement plan does not have a network.  Because members may see any provider that participates with Original Medicare, it is different from an Advantage plan.

 HMO summary of benefits Anthem MediBlue Select

Anthem MediBlue Selelct HMO application

Click here to request a personal Medicare review.

United Healthcare Medicare Complete Connecticut:

United Healthcare Medicare Complete Connecticut plans are a series of Medicare Advantage plans offered by United Healthcare.  Medicare Advantage plans are also called Part C plans or Managed Medicare Plans.  United Healthcare offers 3 Medicare complete plans in Connecticut for 2016. They are Medicare Complete plans 1,2 and 3.  Each plan has a different monthly premium and benefits.  All three have Rx coverage included in the benefits.

Plan 1 is a $99 a month plan with the lowest copays of the three plans.   This plan has additional extras such as vision, dental and hearing benefits. Plan 2 is a $29 a month plan with slightly higher copays than Plan 1 and comes with vision, dental, hearing and Silver Sneakers benefits.  In Plan 3 there is a $0 month premium with the highest copays of the three plans and requires a specialist referral.  It has the additional vision, hearing and Silver Sneakers benefits. Silver Sneakers is available on the United Healthcare Medicare Complete Plan 1 but there would be additional monthly premium to add it.  Full plan summaries are available in the links below for more detailed benefit descriptions.

United Healthcare Medicare Complete plans

Participating providers can be accessed in both CT as well as NY as in network providers.  The plans also come with the Passport program which allows members to access doctors in other states as in network providers (Assuming the participate with United in the other states.) UHC does have some benefits at a 20% co-insurance level which can lead to substantial out of pocket for some procedures.  We include both a summary of benefits and an application for all plans in the links below.

Feel free to either call our office at 203-796-5403 or send an email to admin@croweandassociates.com with any questions.

United Healthcare Plan 1 Summary 2016

 Plan 2 Summary 2016 United Healthcare

 Plan 3 Summary 2016 United Healthcare

CT Medicare Advantage and Supplements

There are many choices when it comes to CT Medicare Advantage and Supplements.  These choices can confuse anyone. We can help you feel comfortable not only with your choice of health care plans but the cost as well.  Crowe and Associates is one of the region’s leading Medicare brokerages.  Are you looking for CT Medicare Advantage and Supplement information in Connecticut?  We can help. Crowe and Associates is an independent brokerage agency that works with all major Medicare Advantage and supplement plans.  We work with clients everyday to help them understand the difference between Advantage plans and supplements. We use that knowledge to choose the best plan and company for them.  The insurance companies pay us so you will never receive any type of bill or fee for our services.

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