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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administrative fee amounts of $100 for initial enrollments and $50 for renewals of both PDP and MA/MAPD Plans is no longer applicable.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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If you are a licensed health agent, you should consider adding GTL Ancillary Products to your offerings. GTL offers several product choices in most states.

GTL Supplemental Health Products- click here and see what’s available

Learn the benefits of adding ancillary health products to your sales.

Here are some of the products that GTL offers to individuals:

Important; product availability varies by state. If you want to check what’s available in your area;

click here for GTL product state approval lists.

Hospital Indemnity

GTL offers Advantage Plus Elite Hospital Confinement Indemnity Insurance to help with the expenses associated with a stay in the hospital such as co-pays, deductibles and other out-of-pocket expenses not covered by a health insurance plan. Medical costs can quickly add up and beneficiaries can use the cash benefit any way they like.

Beneficiaries receive a cash benefit if they are confined to a hospital or receive any other covered care. The Advantage Plus Elite plan pays between $100 and $750 per day. The amount depends on the plan selected. Plans provide coverage for a period of either 3-10 or 15 days The benefit period resets when the beneficiary is out of the hospital for 60 days. There are also plan options that offer a 1-day benefit period with a $2,500 daily benefit amount.

Click here for Crowe online contract and add GTL to your products.

Already a Crowe agent and want to add GTL – Click here

Cancer Insurance

Precision Care Cancer Insurance helps policyholders who are diagnosed with cancer access advanced treatments that may not be covered by insurance. Precision Care lets policyholders access TGen’s world class Cancer Physicians and their cutting-edge genomic sequencing services. It also provides cash to pay for the services and the specialized cancer treatments. Learn more about Precision Care, just go to: outsmartmycancer.com.

If the beneficiary is diagnosed with cancer, TGen (the Transitional Genomics Research Institute) an affiliate of City of Hope nonprofit medical research institute receives a biopsy of the tumor, and the DNA is sequenced in TGen’s lab. Once this is done, doctors use the findings to suggest treatments that have been used to target the same mutations. For more information about TGen, visit www.tgen.org.

Cancer Heart Attack & Stroke Insurance

GTL also offers Cancer, Heart Attack and Stroke Insurance that provides beneficiaries a lump-sum benefit amount paid directly to them regardless of other health coverage they may have upon diagnosis of cancer or if they suffer either a heart attack or stroke. The amount of the benefit can range to as much as $50,000 for any of the covered diagnoses. The amount depends on the coverage chosen at the time of enrollment.

Short-Term Care Insurance

Recover Cash is short-term care insurance that GTL offers to provide coverage for several care options. Options include assisted living facilities, nursing homes, or in the enrollee’s home. Because there are gaps in health insurance coverage, Recover Cash provides a way to pay out-of-pocket expenses. Policyholders have access to TCARE’s Family Caregiver Concierge Services. This service provides support to caregivers to help prevent burnout. Policyholders receive this cash benefit directly and can use it any way they like.

GTL helps with both financial support and family caregiver support from TCARE. This helps the beneficiary and their family member through a difficult time.

Short-Term Home Health Care Insurance

Short-Term Home Health Care Insurance helps cover deductibles and co-pays for home health care services. The policy offers several riders to choose from as well as a Short-Term Home Health Care Aide Benefit and a Prescription Drug Benefit.

GTL’s Short-Term Home Health Care Insurance pays a daily benefit for many types of home health care services. Benefit amounts depend on the plan selected. There is a maximum benefit period of 360 days. A Licensed health care provider must certify the cognitive impairment or inability to perform at least two of the six activities of daily living (bathing, dressing, eating, continence, toileting or transferring) without substantial assistance.

Critical Illness Insurance

Critical Provider Plus is critical illness insurance that helps alleviate the financial hardships that come with a critical illness or accident. Coverage options range from $10,000 up to $100,000. The coverage pays up to two times for two separate critical illnesses. GTL issues policies to anyone from age 18 to 64. Lifetime maximum benefit amounts are between $25,000 and $250,000.

Please note: the information in this post is for use by licensed insurance agents only and is not intended for use by consumers. If you are looking for an agent to assist with the purchase of one of the GTL products, please contact our office either by email at teal@croweandassocites.com or by phone 203-796-5403.

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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How to sell Medicare plans over the phone

It is not difficult to learn how to sell Medicare plans over the phone.  We will provide the blueprint in the article below.   If you do not have experience in Medicare sales, there are some steps to take prior to starting.

You will need a health insurance license to sell Medicare plans

Click here to see the steps to get a health insurance license

Starters guide for Medicare Contracting

After you have an insurance license, there are steps to take for contracting and certifications.  Use the link for step by step instructions.   Medicare contracting and certifications guide

How to sell Medicare plans over the phone- The set up

There are a number of ways to sell Medicare plans over the phone.   The most obvious option is to get set up as a call center/telesales agency.  While this set up can ultimately work very well, there are some obstacles to doing it which are time and cost.  Call scripts will need approval by the carriers. All calls will need to be recorded as well. The other negative is the cost to start the call center.  Those with funding and time to invest should call us to discuss the call center option further at 203-796-5403 or email Edward@croweandassociates.com.    For most people we will suggest a different approach.

Selling by phone in conjunction with online enrollment

A quicker and less expensive way to start is selling over the phone and processing enrollment online. The online enrollment function is available at no cost through our online enrollment portal Connect4Medicare  (C4M)  C4M provides agents with their own approved enrollment website and consumer facing URL.  Agents and prospects can quote and compare plans, run drug comparisons, search doctors and enroll prospects online without a face to face meeting.  The agent can enroll the prospect or the prospect can self enroll through the link sent to them by the agent. You can text or email the enrollment links.  CLICK HERE TO LEARN MORE ABOUT CONNECT4MEDICARE   Under this set up, agents can talk to prospects over the phone and then email or text them the link to complete the enrollment.

How to sell Medicare plans over the phone: Generating lead volume

You will need to generate prospects to try to close so figuring out the method to use is important.  There are a number of ways to do this but we will focus on two of them here.

Telemarket leads:  There are companies that will generate leads by phone at a set price per lead.  The calls are recorded and the information is sent to the agent to close the sale.  We have worked with a vendor to offer one of the best prices for teleleads.  With call back leads at $10.00 and live transfers at $16.00 a large amount of volume can be generated at a low cost.  CLICK HERE TO LEARN MORE

Online leads:  Online leads are also a good way to generate prospect volume at a low cost.  You can get online leads for $8 to $15 each depending on the lead aggregator/lead company.  Shared and exclusive leads are available but we suggest using shared leads due to the high price point of exclusive leads.

CLICK HERE TO LEARN MORE ABOUT USING ONLINE LEADS

We offer a free lead program to help off set your lead costs- Learn more about the Crowe and Associates Free Medicare Lead Program

How to sell Medicare plans over the phone: Other important things to know

Having the correct set up for phone sales is important but organization is also key. As a result, it will be important to have a good CRM. Connect4Medicare is a basic CRM but we suggest having your own in order to stay organized.  It will be important to keep all prospects in your database, schedule return calls and keep notes on each call.   In addition, you need to have a scheduled routine every day.  How many leads will you work? What time will you be contacting new prospects vs. calling existing prospects you are working with?   Other things to consider are: How much money will you have in your daily lead budget?  Do you have access to all competitive plans in the area/states you are working?   Thought and preparation is needed in order to be successful when starting any type of phone sales.

WORK WITH ONE OF THE NATION’S TOP FMOs.  CLICK HERE TO GET STARTED.

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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

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 

Medicare Advantage or Medicare Supplement Plan

Which is better, a Medicare Advantage or Medicare Supplement plan?  Medicare Supplements are also called Medigap plans.  This is a common question and the answer is “it depends”.  Medicare Advantage Plans and Medicare Supplement plans are very different.  They both have strengths and weaknesses.  The key is to know the difference between them as well as how they work with your situation.  We can start by pointing out how each plan works and how they are different.

Medicare Supplement plans

Medicare Supplement plans are private plans that insurance companies offer.  There are a number of different plans that range from A through N.  All have different benefit structures although they are standardized in most states. This means the benefits must be the same regardless of the company that offers the plan.  If 8 companies offer a plan N in a state, they must all have the same benefits. The only difference is price.

Medicare supplement plans are secondary to Original Medicare.  When someone goes to the provider, they show their Original Medicare card.  The provider bills the card and Medicare pays their portion of the benefits.  Your Medicare supplement company will receive a charge for the portion that is left over and they will then pay that portion. It is a very simply process and offers some big positives over an Advantage plan.  Below, we will list the advantages as well as disadvantages of using a Medicare Supplement.

• Advantages
  • No network. Since Original Medicare is primary, the person using a Medicare Supplement can go to any provider that accepts Medicare. The company offering the supplement makes no difference.
  • No Managed Care. This usually means you do not need to get prior authorization on services such as surgeries, major or advanced radiology, skilled nursing and other services.
  • You can determine the exact amount of Medicare coverage you want based on which supplement plan you choose.
• Disadvantages
  • Monthly premium. In addition to your monthly part B Medicare premium, you will also pay a monthly premium for the Medicare supplement.  Premiums can range from $35 a month to $270 a month depending on the plan and state you live in.
  • Medicare supplements do not include drug coverage.   Additionally, you must purchase a stand alone part D plan if you want drug coverage.

Medicare Advantage Plans

In fact, Medicare Advantage plans are also called MAPD’s, Medicare Replacement Plans and Managed Medicare Plans. Medicare Advantage plans are not secondary to Original Medicare.  The Medicare Advantage plan becomes the primary insurance.  The insured is still in the Medicare program but Original Medicare is not used for insurance. An advantage plan works in a similar manner to a group or individual health insurance plan. (they are not the same but have a similar set up.)  This means the client has set benefits which are in the form of co-pays and cost shares.  There are some major pro’s and Con’s with Advantage plans which we have listed below.

• Advantages
  • Advantage plans have little to no premium in most states.  The insured will still pay the monthly Medicare Part B premium of $134 a month, but there will be no additional charge for the advantage plan.
  • Advantage plans include a part D drug benefit.  There is no additional premium charge for the drug plan and you can use one ID card for both Medical and RX.
  • Advantage plans may have additional value added benefits that are not covered by Original Medicare such as; dental and vision benefits.
• Disadvantages
  • Advantage plans have networks.  On an HMO advantage plan you must stay in the network to have your expenses covered. (The exception to this would be emergency room visits and urgent care)
  • Advantage plans have co-pays which can lead to higher out of pocket costs.  The out of pocket max on many advantage plans is as high as $6,700.
  • Advantage plans have prior authorization requirements on some services.
  • Some advantage plans may require referrals to see a specialist.

Overall – Medicare Advantage or Medicare Supplement Plan

In general, someone with minimum health care needs may want to try an advantage plan.  They will not be laying out any premium on a monthly basis and will only pay a copay when they do see a provider.  If someone does not want to be limited by a provider network or if they utilize a lot of healthcare, they may want to consider a Medicare supplement instead. The supplement allows them to go to any provider they want (as long as they accept Medicare) and they can choose a plan that leaves them with very little out of pocket.  The negative is the premium they will pay for the supplement and Part D Rx plan regardless of if they utilize care or not.

Medicare Part D Enrollment Penalty

How much is the Part D penalty?

The cost of the Medicare part D enrollment penalty depends on how long you go without Medicare Part D or creditable prescription drug coverage.

How do I know if there will be a Medicare part D enrollment penalty?

After you join a Medicare drug plan, the plan will tell you if you owe a penalty and what your premium will be. Most people will have to pay this penalty for as long as you have a Medicare drug plan. The exceptions would be for those that drop coverage or are approved for a drug help program such as MSP.

What if I don’t agree that I have a penalty?

You may be able to ask for a “reconsideration.” Your drug plan will send you a letter explaining how to appeal.  All appeals will be sent to a company called Maximus that will review appeals.  Maximus is the only company that can review them. As a result, you will need to wait until they make a decision. You must do this within 60 days from the date on the letter telling you that you owe a late enrollment penalty. Also send any documentation that supports your case.

Do I have to pay the penalty even if I think it is wrong?

You must pay the penalty until a decision has been made on the appeal. Failure to pay the penalty could result in termination of your enrollment.

How long does it take to decide on the appeal?

In general, Maximus (Medicare contractor) has 90 days to make a decision.

What happens if Maximus decides the penalty is wrong?

If Maximus decides you should not have a penalty, they will send you a letter stating that fact.   Your drug plan will then stop charging you the penalty and will send details regarding a refund of the penalty amount you already paid.

What happens if Maximus decides the penalty is correct?

They will send you a letter stating the penalty is correct. You will be forced to continue paying the penalty if you want to maintain you drug coverage.

Do you have a Medicare supplement plan (also called Medigap)?  If so, a high deductible plan F supplement may be a way to save money compared to your current supplement plan. CLICK TO LEARN ABOUT HIGH DEDUCTIBLE F PLAN SUPPLEMENTS