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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administrative fee amounts of $100 for initial enrollments and $50 for renewals of both PDP and MA/MAPD Plans is no longer applicable.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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IRMAA Part D

Most people do not pay IRMAA part D and only pay their Part D premium.  Be aware if you do not sign up for Medicare part D when first eligible, you may have to pay a Part D late enrollment penalty.

Click this link, to see an updated IRMAA chart for 2022.

If your modified adjusted gross income (MAGI) is above a certain amount of income for you and/or your spouse, you may have a Part D income-related monthly adjustment (Part D-IRMAA). Medicare will use the MAGI   on your IRS tax return from 2 years prior to the current year. If the income is over the stated 2019 guidelines you will pay the Part D-IRMAA amount in addition to your monthly part D plan premium, this extra amount of monthly premium is paid directly to Medicare but is billed through your plan. The chart below shows the additional amounts and income for 2019 but is based on 2017 earnings.

IRMAA Part D

Social Security will send a notice stating the Part D-IRMAA, based on your income. The amount you pay is adjusted each year based off the prior two years earnings. If you do not agree with the IRMAA amount or make a lot less than you did two years ago you can appeal, just fill out this form and send it in to Social Security using the instructions provided.  If you have questions about your Medicare prescription drug coverage, contact our office.  Crowe and Associates phone number is 203-796-5403

The chart below shows your estimated prescription drug plan monthly premium based on your income as reported on your IRS tax return. If your income is above a certain limit, you’ll pay an income-related monthly adjustment amount in addition to your plan premium. 

Do you want to learn more about Medicare Part B IRMAA?   Click to learn more

Medicare Savings Program Connecticut 2018

About the Medicare Savings Program Connecticut 2018

Medicare Savings Program Connecticut 2018 (MSP) is available those below certain income levels. As a result, the program does not take assets into consideration for eligibility.  There are three levels of the program you may qualify for if your income is below the guidelines.

• QMB (Qualified Medicare Beneficiary):  Pays for your Medicare Part B premiums, as well as Medicare deductibles and/or coinsurance.  Most people do not pay a premium for Medicare Part A, although the QMB program will pay part A premium for those with a Medicare Part A premium.
  • the income limits for 2018 either single $2,135.32 a month or couple $2,894.92 a month.
• SLMB (Specified Low-Income Medicare Beneficiary): Will pay for your Medicare Part B premium
  • the income limits for 2018 either single $2,337.72 a month or for a couple $3,169.32 a month.
• ALMB (Additional Low-Income Medicare Beneficiary): Will pay for your part B premium;  You may not have any other type of Medicaid program while enrolled in the ALMB program
  • income limits for 2018 either single $2,489.52 a month or couple $3,375.12 a month

This program is subject to changes during the 2018 year. Click here for an update

Medicare Savings Program Connecticut 2018 Application

It’s easy to apply for the Connecticut Medicare Savings Programs. Simply complete an application and mail it in. The application is“Medicare Savings Programs Application/Redetermination,”.  There is no cost to apply for the program as well as no penalty for applying if you are not accepted.

Medicare Savings Program Application 

Formulario de Renovación de programas de ahorro de Medicare 

Please mail the completed application to:

DSS ConneCT Scanning Center

PO Box 1320

Manchester, CT 06045-1320

If you are having trouble printing the application; please call Crowe and Associates at 203-796-5403

MSP Connecticut – Apply through CHOICES

All three MSP programs are administered by the Connecticut DDS . To apply, you can complete the paper application (In the link above). You may also call CHOICES at 1-800-994-9422,

Medicare Savings Program  FAQ  CLICK HERE FOR MORE INFORMATION

Link to the DORS website

More basic information on MSP

DORS BENEFITS QUICK GUIDE

If you need help choosing a Medicare plan, feel free to contact us either by email teal@croweandasspociates.com or phone 203-796-5403.

To learn more about what we offer; click here.

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.

What is the Medicare Part D Penalty

If you have gone without Part D or other credible drug coverage for a period of 63 days or more after your initial enrollment period. You may owe a Medicare Part D Penalty.  What is the Medicare Part D Penalty –

With Medicare as with all insurance plans it is wise to know all the ins and outs before you start.  If you find a knowledgeable insurance agent to help you sort things out, you will be ahead of the game.  Here at Crowe and Associates our job is to help clients understand insurance.  We want you to feel confident that you have chosen the right policy for both your health needs and your budget.  That is why it is important that you are aware of any possible penalties that can cost you money.

The dollar amount of the penalty

Medicare will officially calculate your penalty based on the number of full months you went without coverage.   The penalty is 1% of the national base beneficiary premium multiplied by the number of uncovered months and then rounded to the nearest $0.10.  That amount will be added to your monthly part D premium.  (Note: Since the national benchmark premium may increase each year, the penalty amount will also change accordingly.

Click Here for a Part D Late Enrollent Penalty Reconsideration Request Form

You should mail both completed forms as well as supporting documentation to the address below:

MAXIMUS Federal Services
3750 Monroe Avenue, Suite 704
Pittsford, NY 14534-1302

Or faxed to:
Fax number: (585) 869-3320 or  toll free fax number: (866) 589-5241

Do you have questions or need assistance navigating the Part D late enrollment penalty reconsideration process?  Please contact the office at either 203-796-5403 or at admin@CroweAndAssociates.com if you have questions or require additional information about insurance.

You can order prescription medications (Non Narcotic based) over the phone.  A company called Teladoc has a process which allows you to call in and set up a  profile (Only need to set it up one time) from which you can consult with a licensed physician over the phone to get a script filled.  99% of orders are filled within 3 hours of the phone call. There is no cost per call or for the one time creation of your profil.e (Free if done online, but cost a one time fee of $12.00 if the profile is set up by phone)

Teladoc can be purchased on a monthly basis through the Careington Dental and Vision discount plan.  This plan provides discounts on Dental and Vision services and includes the Teladoc program.

The best feature of this program is the cost.  The whole package is available for $12.95 for single, $14.95 for two people and $16.95 for a family of any size.  You can review the benefits of this plan on line through this link CAREINGTON TELADOC PLAN BENEFITS  You may also apply for the plan through this site.  If applying, you will need to enter a broker/agent code in order to get to the application.  Our code is CROWE

Please call Crowe & Associates if you have any questions.

We always get a lot of questions on Medicare Part D.  Here are some commons questions that we hear and additonal information on part D.  If you have other questions, please email Ed Crowe at Edward@Croweandassociates.com

1.  Popular Summer Medicare Part D Coverage Questions

2.  More on your Medicare Part D Coverage and the 2012 Donut Hole

3.  Average Retail Drug Prices

1.  Popular Summer Medicare Part D Coverage Questions

 Question:  As we travel around this summer, will we still have Medicare Part D prescription coverage outside of our home state?

Yes.  You can use your Medicare Part D prescription drug plan at any of your plan’s network pharmacies, and most Part D plans include more than 50,000 pharmacies in their network.  If you are in a remote area of the country and are having trouble finding a network pharmacy, you can always telephone your Medicare Part D plan’s Member Services department and ask them to help you find the nearest pharmacy (the toll-free number is on the back of your Member ID card). 

Question:  If I purchase prescription drugs while outside of the United States, and bring them back with me, will my Medicare Part D plan reimburse me for these drugs if they are on my Part D plan’s formulary?

 Probably Not.  Although you can always ask your plan for more information, the Medicare Part D program does not anticipate coverage for medications purchased outside of the United States. 

Question:  We just moved from North Carolina to Florida and our Medicare Part D plan was cancelled because of our relocation.  Can we enroll back into our same plan now (in July) or do we have to wait until November/December?

 You can enroll now into a new Medicare plan.  Most people are not allowed to change Medicare Part D prescription drug plans outside of the annual Open Enrollment Period (or Annual Election Period) that runs from October 15 through December 7 of each year.  However, a Special Enrollment Period is available for people who move to a new Medicare plan service area during the plan year and allows people to join a new Medicare prescription drug plan or Medicare Advantage outside of the annual Open Enrollment Period.   

 Question:  I will turn 65 in September and will be eligible for Medicare.  When is the best time to join a Medicare prescription plan?

 It depends on when you need your Medicare prescription plan coverage to begin.  Initially, you have a seven (7) month window of time to join a Medicare Part D or Medicare Advantage plan.  So if you enroll in a Medicare Part D plan within the three (3) months before the month that you become eligible for Medicare (for example, the 3 months before you turn 65), your Medicare plan coverage will start on the first day of your birthday month (or Medicare eligibility month).  If you join a Medicare plan during your birthday (or eligibility) month, your prescription drug coverage will start on the first day of the next month.  Finally, if you join a Medicare plan during the three (3) months after your birthday (or eligibility) month, your drug coverage will start the first day of the month following the month when you enroll.

 Did you have a question that needs answered?  No problem, you can email Ed Crowe at Edward@Croweandassociates.com for answers.

2.  More on your Medicare Part D Coverage and the 2012 Donut Hole

 Question:  How do I find out how much more money I need to spend before I exit this year’s Donut Hole?

 The easiest way may be to check your monthly Explanation of Benefits letter.  Your Medicare Part D plan regularly sends you an Explanation of Benefits (EOB) statement detailing your Medicare plan coverage.  You will notice that the letter is separated into sections and in Section 2, you will find information on your current stage of coverage.  You will also see a box in Section 2 of your EOB letter that is entitled, “What happens next?”  In this box, your Medicare plan shows the details of how much more you will need to spend before moving into the next stage of your plan’s coverage. 

 So if you are in the Initial Coverage stage, the “What happens next” area will tell you exactly how far away you are from your Coverage Gap (or Donut Hole).  If you are in the Donut Hole, you will see how much more money you will need to spend before entering the Catastrophic Coverage portion of your Medicare Part D plan.   

Question:  I have already reached my Medicare drug plan’s initial coverage limit of $2,930 and entered the 2012 Donut Hole, so do I now pay the difference between the $4,700 out-of-pocket limit and my plan’s $2,930 initial coverage limit before exiting the Donut Hole?

 Not exactly.  You will stay in the 2012 Donut Hole until your total out-of-pocket costs exceeds the $4,700 threshold – less any name-brand drug discounts you receive while in the Donut Hole.  As a note, there are two different numbers that are used to define your Medicare drug plan’s Donut Hole or Coverage Gap: (1) The total negotiated retail value of your medications:  When the total value of the retail cost of your drug purchases exceeds $2,930, you go into the 2012 Donut Hole. (2) Total Out-of-Pocket Spending:  After your actual spending for covered medications has reached $4,700, you exit the Donut Hole.  (Remember, the brand-name discount counts toward meeting this total out-of-pocket spending amount).

 For example, if you are in your Medicare Part D plan’s Initial Coverage Phase, purchase a medication with a $100 retail cost, and only pay a $30 co-payment out of your own pocket (the plan pays the other $70), you get $30 credit toward the $4,700 Donut Hole exit point and $100 toward your $2,930 Initial Coverage Limit.

Now when you are in the Donut Hole and you buy the same $100 medication, and your plan does not have any Donut Hole coverage, you are responsible for the full $100 drug cost.  However, this year, you will get a 50% discount on all brand-name drugs bought in the Donut Hole, or a 14% discount on generic drugs purchased in the Donut Hole.

 If your $100 medication was a name-brand, then you will pay only $50 – but, you will get the full credit for the $100 purchase toward meeting your $4,700 out-of-pocket threshold or Donut Hole exit point.

 On the other hand, if the $100 medication was a generic drug, you would pay $86 dollars and get credit only for the actual $86 you spent toward meeting the $4,700 Donut Hole exit point or out-of-pocket threshold.

Question:  Will the Medicare Part D plan’s Coverage Gap or Donut Hole really ever go away?

 Yes, but only to the extent that you will still pay 25% in the Donut Hole.  As many people know, the Medicare Part D Donut Hole is scheduled to “close” in 2020.  But medications will not be free when the Donut Hole is finally “closed”.  In 2020, the co-insurance or cost-sharing for both generic and brand-name drugs purchased in the Donut Hole will be no more 25% of the plan’s negotiated retail price.  So, if your 2020 Medicare Part D plan follows the CMS standard Medicare Part D parameters with 25% co-insurance paid during the Initial Coverage Phase, you will pay no more in the Donut Hole than you would pay during normal coverage and the Donut Hole will be effectively eliminated.

 On the other hand, if your 2020 Medicare Part D plan has a $0 (or low) co-payment for your medications during the Initial Coverage phase, and then you find that you are paying 25% of your medication retail prices in the Donut Hole, it may not seem as though the Donut Hole is “closed,” although it technically is.  

3.  Average Retail Drug Prices

 Question:  What does the “negotiated” retail drug price mean and why is it important?

 The negotiated retail drug price is the amount that you would pay for your medication at a particular pharmacy when you have a Medicare Part D prescription drug plan.  The negotiated retail price for a certain medication may be different from the pharmacy’s regular price, and it can be different from pharmacy to pharmacy and from Medicare Part D plan to plan.

For example, if you purchase a formulary medication like Lipitor®, you may see on your receipt a negotiated retail price slightly more or slightly less than someone who is enrolled in another Medicare plan.  And, if you were to go to a different pharmacy using your same Medicare plan, the negotiated retail price could also be slightly different.

 The negotiated retail price is important to you because your total annual negotiated retail drug costs are used to determine the point when you enter into your plan’s Donut Hole phase.  So based on the differences in negotiated retail price between plans, you may meet someone using the same medications, but entering the Donut Hole a short-time before or after you.  Also, if you are in the Donut Hole, you will receive a discount on the negotiated retail price of your formulary medications.  So, based on the negotiated retail prices, people in different Medicare plans will pay different discounted prices in the Donut Hole.

I get a lot of questions about the various Medicare penalties and how much they cost.  I will summarize them here and then provide a link to a site which provides the specific detail.  Here is the overview.

Everyone who qualifies for Medicare does not need to pay for Part A of Medicare.  Some people do not qualify for part A and they need to pay a premium if they want the coverage.  For them, part A costs $451 a month but for most people it costs $0

Medicare Part B costs $99.90 a month for most people.  It can cost less for some people and more for higher income earners.  For example, an individual making over $85,000 a year will pay $139.90. The scale tops out at $319.70 a month for those that make over $214,000 a year.

If you sign up late for part B, you will pay a 10% penalty for every 12 months you didnt have part B, for life.   If you are over age 65, actively working and getting health coverage, you do not need to sign up for part B.  If you are not actively working and getting retirment coverage over the age of 65, you should sign up for part B because the penalty will count for you.

There are two Part D penalties.  The first is for those that sign up late for part D drug coverage.  The penalty is 1% of the average premium for every month you do not have a part D plan.  The average premium is about $31.00 a month which puts the penatly at about 30 cents for every month you do not have a plan.  The penatly never goes away.

There is also a Medicare Part D income penalty.   The penalty starts at about $11.00 a month for those that make over $85,000 a year.  It is added on to the insurance plans premium every month.   Here is a grid of the penalty levels

CMS has a very good page which summarizes this information.  You can see it by clicking here.

Crowe & Associates will holding a number of seminars for Untied Health Care Medicare Advantage plans  and AARP branded Medicare supplement plans.  The meetings will run from 10:30 am to 12:00 and will provide a review of the Medicare offerings by United Healthcare for 2013.  The review will include basic information on Medicare A and B and, reviews of the United products and the enrollment rules for 2013.

The sessions will be presented by Edward Crowe and Paul Smith of Crowe & Associates. There will be ample opportunity to ask questions before and after the presentation.  The meeting dates, locations and times are listed below.  You must call or email in order to reserve a seat at one of the meetings.  

You may call one of two numbers 860-992-4494,  203-241-7261 or email Edward@Croweandassociates.com to reserve your seat.

Location:  304 Federal Road,  Suite 107,  Brookfield, CT 06804

Dates:  Tuesday, October 2, 2012  –  Tuesday, October 9, 2012 – Tuesday, October 16, 2012 – Tuesday, October 23, 2012 – Tuesday, October 30, 2012 – Tuesday,  November 6, 2012 – Tuesday, November 13, 2012 – Tuesday, November 27, 2012

Time:  All meetings are from 10:30 am to 12:00 noon

Location: Danbury Library (170 Main Street, Danbury, CT 06810)

Dates: Tuesday, October 2, 2012  –  Tuesday, October 9, 2012 – Tuesday, October 16, 2012 – Tuesday, October 23, 2012 – Tuesday, October 30, 2012 – Tuesday,  November 6, 2012 – Tuesday, November 13, 2012 – Tuesday, December 4, 2012

Time:  All meetings are from 10:30 am to 12:00 noon

Call or email to reserve you seat(s) today!

Crowe & Associates will holding a number of seminars for Untied Health Care Medicare Advantage plans  and AARP branded Medicare supplement plans.  The meetings will run from 10:30 am to 12:00 and will provide a review of the Medicare offerings by United Healthcare for 2013.  The review will include basic information on Medicare A and B and, reviews of the United products and the enrollment rules for 2013.

THIS IS AN OLD POST PLEASE CLICK HERE FOR OUR CURRENT SCHEDULE OF MEETINGS

The sessions will be presented by Edward Crowe and Paul Smith of Crowe & Associates. There will be ample opportunity to ask questions before and after the presentation.  The meeting dates, locations and times are listed below.  You must call or email in order to reserve a seat at one of the meetings.  

You may call one of two numbers 860-992-4494,  203-241-7261 or email Edward@Croweandassociates.com to reserve your seat.

Location:  304 Federal Road,  Suite 107,  Brookfield, CT 06804

Dates:  Tuesday, October 2, 2012  –  Tuesday, October 9, 2012 – Tuesday, October 16, 2012 – Tuesday, October 23, 2012 – Tuesday, October 30, 2012 – Tuesday,  November 6, 2012 – Tuesday, November 13, 2012 – Tuesday, November 27, 2012

Time:  All meetings are from 10:30 am to 12:00 noon

Location: Danbury Library (170 Main Street, Danbury, CT 06810)

Dates: Tuesday, October 2, 2012  –  Tuesday, October 9, 2012 – Tuesday, October 16, 2012 – Tuesday, October 23, 2012 – Tuesday, October 30, 2012 – Tuesday,  November 6, 2012 – Tuesday, November 13, 2012 – Tuesday, December 4, 2012

Time:  All meetings are from 10:30 am to 12:00 noon

Call or email to reserve you seat(s) today!