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The 2026 Final Rule, released by CMS in April 2025, brings meaningful changes to Medicare Advantage (MA), Part D, and Special Needs Plans (SNPs). These updates aim to improve transparency, enhance care for high-needs populations, and modernize how payments are made to insurers. As a Medicare agent, staying informed helps you guide clients accurately and position your sales strategy for success

Key Changes Agents Should Know

1. Medicare Advantage Plan Payment Increase

CMS approved a 5.06% increase in average plan payments for 2026. This is expected to give insurers more room to offer richer benefits, reduce premiums, or expand supplemental services. Once the carriers release the 2026 plan designs, we will see if they have added enhancements.

2. Prescription Drug Reforms (Part D)

• Insulin Copays Capped: $35/month or 25% of the negotiated price; whichever is less.
• Vaccines: ACIP-recommended vaccines remain free (no deductible or cost-sharing).
• Prescription Payment Plan: Beneficiaries can spread out drug cost payments over the year.
  • New guidelines clarify enrollment, pharmacy coordination, and billing practices.

Agents; educate clients on enrolling in the payment plan; especially those with high drug costs.

3. Risk Adjustment Overhaul – Accuracy Takes Priority

CMS is completing its transition to the 2024 CMS-HCC risk adjustment model, which will be 100% in effect for 2026 MA plan payments. This model better reflects today’s healthcare needs by using updated diagnosis groupings and more current data.

Why It Matters:

• Plans with more chronically ill members (diabetes, COPD, heart failure) get higher CMS payments.
• Plans with healthier enrollees receive less.

Impact on Agents:

• Some plans may adjust benefits or premiums in response to expected payment changes.
• You may see enhanced offerings from plans that excel in care coordination and documentation.
• SNPs and plans serving dual-eligibles may experience meaningful shifts; pay attention to service area changes or new plan launches.

Bottom Line: This makes the system more fair, but you should monitor plan benefit designs closely in your key markets

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

4. D-SNP Simplification (Effective 2027)

CMS is improving integration for dual-eligible members with:

• One Medicare-Medicaid ID card
• Unified Health Risk Assessment (HRA)
• Faster HRA and care plan timelines

These changes make D-SNPs easier to explain and more attractive to clients. Prepare now by understanding how your D-SNP partners are adapting.

5. Inpatient Coverage Notification Rules

Plans must now notify both providers and beneficiaries at the same time about inpatient coverage decisions—helping ensure clear, real-time communication during hospital stays.

Watch a quick YouTube video on the Medicare 2026 Final Rule Proposal

6. What Didn’t Make the Cut

CMS did not finalize several proposed changes:

• No Part D coverage for anti-obesity drugs
• No new broker commission rules
• No restrictions on agent marketing or AI guardrails (yet)

Important: CMS has hinted that more agent-related changes may be proposed in the near future. Stay vigilant!

Updated 2026 Agent Commission Rates

CMS has announced significant increases in maximum allowable broker commissions for Medicare Advantage and Part D for Contract Year 2026 representing the largest MA commission bump in years

Click here for all the details

Action Steps for Agents

1. Study how your top plans may adjust benefits due to new risk adjustment payments.
2. Help clients understand the Prescription Payment Plan and insulin savings.
3. Stay tuned for more changes, especially around marketing, commissions, and AI regulations.
4. Start preparing D-SNP marketing materials ahead of the 2027 simplification rollout.

Find out about all the latest events and information for agents

Summary: CMS Final Rule 2026

Permission to Contact for Medicare Sales: What Agents Need to Know

As a Medicare agent, staying compliant with CMS marketing guidelines is critical. One of the most important aspects of compliance is obtaining Permission to Contact for Medicare sales (PTC) from potential beneficiaries before initiating sales calls or marketing activities. Failing to do so can result in regulatory violations, fines, and loss of certification with carriers.

In this blog, we’ll break down what Permission to Contact is, how to obtain it,and CMS rules that apply.

What Is Permission to Contact (PTC)

PTC is a CMS-required process that ensures beneficiaries give express consent before a Medicare agent can reach out to discuss plan options, answer questions, or schedule appointments. This rule protects Medicare beneficiaries from unsolicited contact and promotes ethical sales practices.

Crowe/Pinnacle agents can access online tools that help agents gather important client information including PTC with RetireFlo for Connecture or Sunfire’s BlazeSnyc:

Watch a video on RetireFlo for Medicare producers: Obtain client scopes, PTC, drug & doctor lists

Take a look at how the Sunfire BlazeSync customer intake form works

CMS Guidelines for Permission to Contact

According to CMS Medicare Communications and Marketing Guidelines (MCMG), agents may not:

• Cold call beneficiaries.
• Leave marketing materials in common areas (e.g., lobbies or libraries) to collect leads.
• Approach beneficiaries in healthcare settings or parking lots.

Agents must have documented permission from the beneficiary prior to outreach, unless the beneficiary initiates the contact.

Important: The PTC Permission to Contact form expires after 12 months or once it’s purpose has been fulfilled. If you need to contact the beneficiary after the original PTC expires, you must obtain a new one.

Acceptable Ways to Obtain Permission:

1. Permission to Contact (PTC) Form
2. Scope of Appointment (SOA) form
3. Inbound phone call from the beneficiary
4. Online request form (such as a lead form on your website)
5. Text or email initiated by the beneficiary
6. Business reply cards (BRCs)
7. Event sign-in sheets (when clearly marked as giving permission to be contacted)

Once permission is granted, it only applies to the scope and method defined. For example, if a beneficiary gives you permission to call about Medicare Advantage plans, you can’t use that to market life insurance or annuities.

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

What Must Be Included in a PTC Form

A compliant Permission to Contact form should include:

• Beneficiary name
• Date
• Type of contact permitted (e.g., phone, email)
• Reason for contact (e.g., Medicare Advantage plan information)
• Statement that the individual is not obligated to enroll
• Signature or consent checkbox (if digital)

The form must also make it clear that responding is optional and not a condition of enrollment.

Permission to Contact Form

First Name: ____________________
Last Name: ____________________
Phone Number: ____________________
Email (optional): ____________________
Preferred Contact Method: ☐ Phone ☐ Email
Reason for Contact:
☐ I would like to be contacted by a licensed insurance agent to discuss Medicare Advantage and/or Prescription Drug Plans.

By completing this form, you agree that a licensed sales agent may contact you about Medicare plan options. You are under no obligation to enroll. This is a solicitation for insurance.

Signature: ____________________
Date: ____________________

Note: Agents should keep a copy of all PYTC forms for 10 years as art of their CMS compliance record.

When you Do Not Need a PTC

Although there are strict rules regarding client communication, there are exceptions when the contact is for ongoing client communications. Agents can contact existing clients about other products as long as the have an active business relationship. You can also contact plan enrollees with information on their coverage as long as you are listed as AOR.

Digital Lead Forms and Compliance

If you use online marketing to generate leads, your form must:

• Clearly indicate that a licensed agent will be contacting the user
• Include disclaimers like: “By submitting this form, you agree to be contacted by a licensed sales agent by phone, email, or text message about Medicare plan options. You are not obligated to enroll.”
• Ensure proper data encryption and opt-out procedures

Click here to stay updated on agent events and information

Getting Permission to Contact is not just a CMS requirement; it’s a trust-building opportunity. It shows respect for your client’s privacy and helps you build a compliant, professional reputation.

Always follow the most current CMS guidelines (as they can update annually), and never cut corners when it comes to consent. Remember, ethical practices protect both your business and your clients.

2026 AHIP Certification Guide for Medicare Agents

Each year, Medicare agents must complete a series of certifications before they’re ready to sell to Medicare Advantage (MA/MAPD) or Prescription Drug Plans (PDPs) to their clients. One of the most important is the AHIP. Our AHIP 2026 certification guide should help you check this off your list.

The 2026 AHIP training is available on June 23, 2025, and it will cover any business written for the remainder of 2025 and all of 2026.

If you’re looking to stay compliant, contract with carriers, and be “Ready to Sell,” here’s everything you need to know to get started; including test tips, module breakdowns, discount info, and what happens if you do not pass.

What Is the AHIP and Why It’s Important

The AHIP (America’s Health Insurance Plans) certification is a CMS-compliant annual training course designed to ensure Medicare agents understand:

• The structure of Original Medicare
• How Medicare Advantage and Part D plans work
• Compliance and marketing rules
• Enrollment periods
• Fraud, waste, and abuse (FWA) prevention

Most MA/MAPD and PDP carriers, with a few exceptions (such as UnitedHealthcare, which has its own certification) require agents to pass AHIP. Completing it is often the first step toward certification with each carrier for the Annual Enrollment Period (AEP).

2026 AHIP Launch Date

• Course Available: June 23, 2025
• Covers: Remainder of 2025 and all of 2026
• Cost: $175 (discounts often available through major carriers)

Crowe/Pinnacle Financial Agents can receive a $50 discount by taking the course through PFSinsurance.com. Just log in, go to the Certifications tab, and scroll to the AEP Toolkit for the Pinnacle AHIP discount link.

2026 AHIP Test Tips

• The test includes 50 multiple choice questions
• Agents have 2 hours and 3 attempts
• Passing Score: 90%
• If you fail all three attempts, you must repurchase and retake the course
• Warning: Some carriers will not allow you to sell their plans for the year if you fail three times

Watch our AHIP Test Tips 2025 on YouTube

What’s in the AHIP Modules

The AHIP course is split into two main parts:

Part 1: Medicare Overview (5 Modules)

1. Module 1 – Overview of Medicare Program Basics: Choices, Eligibility and Benefits
2. Module 2 – Medicare Health Plans
3. Module 3 – Medicare PArt D: Prescription Drug Coverage
4. Module 4 – Marketing Medicare Advantage and Part D Pans
5. Module 5 – Enrollment Guidance Medicare Advantage and Part D Plans

Tip: Download the slides for all Modules. If you took the 2025 course, you do not have to complete all 5 modules, you can skip 1-3 (just do the review). You may only need to complete modules 4 & 5.

Because each module includes a 20-question practice test, it may not be a bad idea to go over all modules. The final exam questions are pulled directly from these quizzes. Pay close attention to any you got wrong to be sure you answer them correctly when it counts.

Part 2: Fraud, Waste & Abuse (FWA)

Part 2 of the AHIP certifications FWA consists of 3 Modules

1. Non-Discrimination Training; what qualifies as discrimination and what does not.
2. Medicare Fraud, Waste and Abuse; how to identify and report FWA, financial and ethical consequences and the impact of FWA.
3. General Compliance; legal tools and compliance requirements and who they apply to.

Each of these modules has a practice test and a final test when those are completed. You only need a score of 70 to pass this portion.

After You Pass: What’s Next

1. Download your AHIP certificate
2. Transmit your results to participating carriers through AHIP, or manually upload it to the carriers you are contracted with dashboards
3. Complete carrier-specific certifications for each MA or PDP product line

Helpful Reminders

• UnitedHealthcare (UHC) doesn’t require AHIP but does have its own certification
• AHIP 2026 is similar to 2025, but includes updates for new CMS rules, including changes related to Part D redesign and marketing compliance
• You must complete AHIP before you receive a RTS from most carriers even if you complete their certifications.

If you’re a new agent looking to join a supportive upline or an existing agent who wants to add a carrier to your existing contract:
Click here for online contracting

Getting AHIP-certified early is a smart move. It opens doors to carrier contracts, helps avoid delays, and gives you the confidence to serve your Medicare clients accurately and compliantly.

Click here to stay up-to-date on agent events and information.

Don’t wait until the last minute; take advantage of our AHIP 2026 tips, download the modules, and use the practice tests. Remember, three tries is all you get before you have to start over; so make your first try count!

Understanding the Different Types of Medicare Advantage Plans

Medicare Advantage (Part C) plans offer an all-in-one alternative to Original Medicare, often including additional benefits like dental, vision, hearing, and even prescription drug coverage. These plans are offered by private insurance companies approved by Medicare. Whether you’re a Medicare beneficiary or an agent helping clients make informed decisions, understanding the different types of Medicare Advantage plans is essential.

There are many types of Medicare advantage plans to consider when choosing coverage that best fits your needs. Here’s a breakdown of the main types of MA plans available:

HMO (Health Maintenance Organization) Plans

Key Features:

• Requires members to use a network of doctors and hospitals.
• Members must choose a Primary Care Physician (PCP).
• Referrals are usually needed to see a specialist.
• Most HMO plans include prescription drug coverage (Part D).

Best for: People who are comfortable with a coordinated care approach and staying within a specific provider network to keep costs low.

PPO (Preferred Provider Organization) Plans

Key Features:

• Offers more flexibility in choosing healthcare providers.
• You can see out-of-network providers, usually at a higher cost.
• No need to choose a PCP or get referrals for specialists.
• Often includes Part D prescription drug coverage.

Best for: Those who want the freedom to see any doctor or specialist without a referral and are willing to possibly pay a bit more for that flexibility.

SNPs (Special Needs Plans)

Key Features:

• Tailored for individuals with specific diseases, health conditions, or financial needs.
• Types include:
  • C-SNPs: For people with chronic conditions (e.g., diabetes, heart disease).
  • D-SNPs: For dual-eligible individuals (Medicare and Medicaid).
  • I-SNPs: For people in institutional care (like nursing homes).
• Always includes prescription drug coverage.
• Offers care coordination and case management.

Best for: Individuals with specific medical, financial, or living circumstances who need a personalized care approach.

PFFS (Private Fee-for-Service) Plans

Key Features:

• Allows you to see any Medicare-approved provider who agrees to the plan’s payment terms.
• No need to choose a PCP or get referrals.
• Some PFFS plans include drug coverage; others don’t.

Best for: People who want flexibility and are comfortable checking whether their provider will accept the plan’s terms.

POS (Point of Service) Plans

Key Features:

• A hybrid of HMO and PPO.
• You can go out-of-network for certain services, often with higher copays or coinsurance.
• Requires a PCP and referrals for specialists (when in-network).
• May include drug coverage.

Best for: Beneficiaries who like the care coordination of an HMO but want some out-of-network flexibility.

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

MSA (Medical Savings Account) Plans

Key Features:

• Combines a high-deductible health plan with a savings account that Medicare deposits money into.
• Funds can be used to pay for qualified medical expenses.
• Does not include Part D coverage; must be purchased separately.

Best for: Those who prefer managing their own health savings and expenses and are comfortable with high deductibles.

Watch a quick YouTube video on why agents should include ancillary products with MA sales

Choosing the Right Medicare Advantage Plan

When evaluating which type of plan is best for you or your client, consider:

• Provider access: Do you want to stay in-network or have more flexibility?
• Prescription needs: Is Part D coverage important?
• Cost preferences: Would you rather pay higher premiums for lower out-of-pocket costs or vice versa?
• Health conditions: Are there chronic conditions or Medicaid eligibility that might qualify for an SNP?

Each Medicare Advantage plan type offers different benefits, restrictions, and costs. Understanding these differences is the key to selecting the most suitable coverage.

Agents, stay up-to-date on the our latest webinars an agent events.

Medicare Part D Extra Help: What Agents and Beneficiaries Need to Know

When it comes to Medicare, prescription drug coverage can be a very confusing and expensive component for beneficiaries. Fortunately, there’s a federal program called Extra Help, also known as the Low-Income Subsidy (LIS), that can significantly reduce those costs. As a Medicare agent, you need to be able to answer the question; what’s Medicare part D Extra Help. Understanding and explaining this benefit can be a game-changer for your clients.

What Is Medicare Part D Extra Help

Extra Help is a program administered by the Social Security Administration (SSA) and Centers for Medicare & Medicaid Services (CMS) to assist individuals with limited income and resources in paying for their Medicare Part D prescription drug plan costs. This includes premiums, deductibles, and copayments.

The value of this benefit can be substantial—worth an average of about $5,300 per year (2024 estimate).

Who Qualifies for Extra Help?

To qualify for Extra Help, beneficiaries must meet certain income and resource limits. As of 2025 (these numbers are adjusted annually):

• Income Limits:
  • Individuals: Up to $23,715 annually
  • Married couples: Up to $31,965 annually
• Resource Limits (includes bank accounts, stocks, and bonds; excludes home, car, personal items):
  • Individuals: Up to $17,600
  • Married couples: Up to $35,130

Click here for a LIS Extra Help chart for 2025

Note: People who automatically qualify for Extra Help include those who:

• Have full Medicaid coverage
• Receive Supplemental Security Income (SSI)
• Qualify for an MSP (Medicare Savings Program)

What Extra Help Covers

Depending on the level of help a beneficiary qualifies for, Extra Help can:

• Reduce or eliminate monthly Part D premiums
• Lower or remove the annual Part D deductible
• Cap out-of-pocket drug costs

In most cases, those receiving Extra Help will pay:

• Low or no monthly premiums for a benchmark Part D plan
• A small deductible as low as $0
• Low copays (as little as $4.80 for generics and $12.15 for brand-name drugs in 2025) Full-Duals pay $1.60 for generic and $4.80 for brand name drug copays

Watch a quick YouTube video on the Quarterly SEP for Dual and Drug Help Elimination in 2025

How to Apply for Extra Help

• Online at www.ssa.gov/extrahelp
• By calling 1-800-772-1213 (SSA)
• Or by visiting the local Social Security office

As an agent, you can guide clients through the application process, help gather the right documentation, and verify eligibility.

Why Agents Should Care

Helping clients apply for Extra Help not only strengthens your relationship with them but also ensures they can afford necessary medications. When a client qualifies, they may be more willing and able to enroll in or stick with a Part D plan; making this an ideal opportunity to offer value and grow your book of business.

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

SEP for Extra Help Recipients

Don’t forget, beneficiaries who qualify for Extra Help are eligible for a Special Enrollment Period (SEP). This means they have an SEP to change their Medicare Part D plan once they are approved for extra help.

learn about the SEP Changes for Dual, Partial Dual and LIS members in 2025

Extra Help can be life-changing for Medicare beneficiaries who struggle with prescription drug costs. As an agent, your role in identifying eligibility and guiding your clients through the application process is crucial. It’s a win-win: clients get meaningful financial relief, and you build long-term trust and loyalty.

Stay updated on agent events and information; click here

What Does “Ready to Sell” Mean – A Guide for Medicare Agents

If you’re a Medicare agent gearing up for the Annual Enrollment Period (AEP) or planning your year-round sales strategy, you’ve likely heard the term “Ready to Sell” (RTS) from carriers, uplines and other agents. But what does ready to sell mean and why is it so important?

Here’s a breakdown of what “ready to sell” is, why it’s critical for your success, and how to make sure you’re always in good standing with Medicare carriers.

What Is “Ready to Sell”

Ready to Sell means you have completed all the carrier-specific requirements to legally and compliantly market and sell that carrier’s Medicare Advantage (MA), Medicare Advantage Prescription Drug (MAPD), or Prescription Drug Plans (PDPs).

Until the carrier officially marks you “Ready to Sell”, you cannot:

• Discuss plan details,
• Help clients enroll in a plan,
• Or earn commissions for sales.

What Does It Take to Become RTS

Requirements may vary slightly by carrier, but typically, agents must complete the following steps every year:

1. AHIP Certification
   Most carriers require agents to pass the AHIP (America’s Health Insurance Plans) certification with a score of at least 90%. This ensures they understand Medicare basics and CMS compliance rules.
2. Carrier-Specific Certifications
   Each carrier has its own product training, code of conduct, and compliance modules that must be completed, Usually agents can locate these in the carrier’s online portal.
3. Contracting and Licensing
   Agents must:
   • Be properly licensed in any state(s) they intend to sell in.
   • Complete contracting paperwork and submit background checks when required.
   • Maintain Errors and Omissions (E&O) insurance coverage.
4. State Appointments
   In any state you want to sell in, the carrier must appoint you before you can make a sale. Learn why you might want to add non-resident licenses.

Once you complete these steps and the carrier processes them, they’ll update your status to Ready to Sell.

Watch a quick YouTube video “What you need to know before a Medicare sale”.

When To Get Ready to Sell

Early preparation is key. Most carriers open their certifications in either June or July for the up-coming AEP. It is best to finish each one as soon as possible. If you are appointed with several carriers, you do not want to be over whelmed trying to get them all done at once. If you wait too long, you may miss valuable selling time during the busiest part of the year.

What If You’re Not RTS

If you try to present or enroll a client in a plan without a RTS status, you risk:

• Losing your commission
• Contract termination
• CMS compliance violation

Even if you’re well-intentioned, both the carrier and CMS takes these infractions seriously. Always check your RTS status before marketing or discussing plans.

If you are an agent who wants to join the team at Crowe; click here for online contract.

How to Check Your RTS Status

Most carriers notify you by email when you’re Ready to Sell. In most cases, you can find your RTS status on each carrier’s broker portal. Some FMOs (Field Marketing Organizations) also provide consolidated dashboards for multiple carriers, such as Pinnacle’s BOSS portal.

Stay on top of the latest agents events and information; click here

Why Consider a Non-Resident Insurance License

As a Medicare agent, you’re always looking for ways to grow your book of business and expand your earning potential, but what if the opportunity lies outside your home state? Adding a non-resident insurance license is a powerful tool that allows licensed agents to legally sell insurance in states they don’t live in. Whether you’re eyeing snowbird states, helping relocated clients, or expanding your digital reach, here’s why a non-resident license might be your next smart move.

What Is a Non-Resident Insurance License

A non-resident health insurance license allows an agent to sell Medicare Advantage, Medicare Supplement, and Prescription Drug Plans in a state other than where they live. Most states allow agents to apply online through the NIPR (National Insurance Producer Registry) for a streamlined approval process.

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

Reasons to Get Licensed in Other States

1. Follow Your Clients Across State Lines

Clients move, especially seniors who relocate for retirement, family, or health reasons. Having a non-resident license lets you retain your clients, continue to serve them legally, and maintain your commissions even after they move.

2. Target Snowbird States

States like Florida, Arizona, and North Carolina have large populations of retirees; many of whom split their time between two states. If you’re licensed in both their primary and secondary residences, it is easier to meet their unique Medicare needs wherever they are.

3. Take Advantage of Remote Selling

With telesales, Zoom, and electronic applications now standard in Medicare sales, geography is no longer an issue. A non-resident license lets you legally market and enroll beneficiaries remotely in multiple states. For agents who are willing to do the work, this can open the door to unlimited expansion.

4. Participate in Cross-State Lead Programs

Some lead vendors or FMOs offer high-quality leads in multiple states. Without the proper licenses, you’ll miss out. A non-resident license makes you eligible for more lead opportunities.

5. Diversify Your Market

Every state has slightly different demographics, plan availability, and competitive dynamics. Getting licensed in new areas lets you provide service in underserved or less saturated markets where you can stand out and grow faster.

Watch a YouTube video – Choosing the Right Type of Lead

How to Get a Non-Resident License

1. Check requirements on NIPR.com.
2. Have a resident license in good standing.
3. Apply and pay the state-specific fees.
4. Submit to any background checks or documentation requests.
5. Keep up with CE requirements (some states require additional courses).

Keep in Mind

• Carrier Appointments: Getting licensed isn’t enough, you also need to be appointed by each carrier you plan to offer in that state.
• Marketing Rules: Always follow state-specific CMS and state DOI regulations. What works in one state may not work elsewhere.
• Annual Renewal Fees: Each state has its own renewal process and costs. Be sure to check with each carrier you add to see if they also charge a non-resident appointment fee. tHis helps ensure our investment is worth the cost.

Agents; stay up-to-date on events and information

Think Bigger

As the Medicare landscape becomes more competitive, the agents who think strategically and act nationally get ahead. A non-resident license is an investment in flexibility, client retention, and revenue potential. Whether you’re selling virtually or preparing for client moves, now is the time to consider expanding your footprint beyond your home state.

Why Medicare Agents Should Be Selling Critical Illness Insurance

As a Medicare insurance agent, your goal is to ensure clients have the best protection for their individual needs. Although Original Medicare and Medicare Advantage plans provide essential healthcare coverage, there’s a critical gap often overlooked: the financial impact of a serious illness. This is where selling critical illness insurance can add real value to your clients’ health coverage as well as your business.

What is Critical Illness Insurance

Critical illness insurance pays a lump-sum cash benefit directly to the policyholder upon diagnosis of a covered condition, such as:

• Cancer
• Heart attack
• Stroke
• Organ transplant
• Kidney failure

Unlike traditional health insurance, this benefit can be used any way the insured chooses; covering deductibles, copays, for travel, in-home care, or everyday expenses like mortgage or groceries.

Why Medicare Isn’t Enough

Medicare (even with Medigap or Medicare Advantage) doesn’t provide coverage for non-medical expenses that often accompany a serious diagnosis. For example:

• Travel to specialized treatment centers
• Home modifications for accessibility
• Lost income for a spouse who becomes a caregiver
• Alternative treatments not covered by Medicare

Even with excellent coverage, a sudden illness can quickly lead to out-of-pocket expenses that drain savings and add financial stress to an already difficult time.

Watch a quick YouTube video on Why and How to Sell Ancillary with Medicare

How Selling Critical Illness Insurance Enhances Your Portfolio

Solves a Real Problem
Seniors are more likely to suffer from critical illnesses than younger individuals. Offering a solution that provides some financial protection and peace of mind differentiates you as a full service advisor; not just a Medicare agent.

Easy to Explain, Easy to Sell
This product is straightforward: “If you’re diagnosed with a serious illness, you get cash.” There’s no network, no complicated claims process, and no restrictions on how the money is spent.

Cross-Selling Made Simple
The Medicare appointment is the perfect opportunity. You’re already discussing health risks, costs, and coverage gaps. With a natural transition, you can introduce critical illness as a way to fill a major gap without additional appointments or paperwork hurdles.

Important: be sure you include any products you might discuss in each meeting in the Scope of Appointment.

Increased Revenue Per Client
Adding a critical illness policy boosts your earnings while strengthening your client relationship. It’s a win-win: more protection and value for them, more business for you.

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

Overcoming Common Objections

“I already have Medicare.”
Yes, but Medicare doesn’t pay you if you get sick. This policy provides money to help manage the non-medical financial impact of a serious illness.

“I’m on a fixed income.”
That’s exactly why this protection matters. A $20–$30 premium today could prevent thousands in financial burden tomorrow. Be sure you sell plans that fit in the client’s budget, do not over-sell. That only leads to distrust and chargebacks when they cannot afford to pay for the coverage.

Adding critical illness insurance to your Medicare sales is not just smart business; it’s the right thing to do for your clients. It shows you understand their broader needs, care about their financial security, and can offer solutions beyond the basics.

Click here to get up-to-date agent events and information

Grassroots Marketing for Medicare Agents: Building Your Book of Business

In an increasingly digital world, there’s still no substitute for genuine, personal connection; especially in Medicare sales. Grassroots marketing for Medicare agents can be one of the most effective and affordable ways to grow your book of business, especially in local communities where trust and reputation go a long way. Whether you’re a new agent or looking to reinvigorate your outreach strategy, grassroots marketing tactics can build lasting relationships and drive referrals.

Volunteer in Your Community

Volunteering is a powerful way to connect with people on a personal level while giving back. Choose causes that align with your values and attract your target demographic; such as food banks, senior centers, or veterans’ organizations.

Consider wearing a name badge or shirt with your agency’s logo while volunteering, and carry business cards or branded leave-behinds. In these settings, people often ask what you do, giving you a natural way to mention your services.

Ask for Referrals from Satisfied Clients

Even in today’s world; word-of-mouth remains king. Clients who trust you are your best advocates. Don’t be afraid to ask for referrals, just be compliant and tactful in how you do it.

Tools:

• Create business cards for clients to pass to friends. It is a good idea to put a picture of yourself on your cards to help people become familiar with you.
• Follow up with a handwritten thank-you note and a small token of appreciation; such as a $10 coffee gift card or a some small token (keeping it under $15 to stay compliant).

Additionally: Consider including a line on your business card or email signature: “Know someone who has questions about Medicare? I’m happy to assist!”

Build Local Business Relationships

Partner with local businesses that serve your ideal clientele; pharmacies, barbershops, community banks, independent living facilities, senior centers, libraries, etc.

Strategies:

• Offer to leave business cards, flyers or brochures at the front counter.
• Cross-refer: If they refer customers to you, do the same for them.
• Host joint educational events (e.g., “Medicare and Medication Q&A” with a local pharmacist).

Leave-behind ideas:

• Branded pens, pill organizers, or reusable shopping bags are all affordable and practical.

Host Seminars and Educational Events

Educational seminars are a compliant and effective way to attract new prospects. People appreciate clear, unbiased information about Medicare—especially when it’s presented in an easy-to-understand format.

Watch a quick YouTube on Educational Seminar Best Practices

Some Ideas on Where to Host:

• Local libraries
• Senior centers
• Churches
• HOA clubhouses

What to Bring:

• Printed guides or FAQs
• Sign-in sheet (for permission-based follow-up) voluntary only
• Medicare-compliant presentation materials
• Small giveaways like notepads, magnifying glasses, or bookmarks (again, under $15 in value) with your logo and contact information

Be sure to check with carriers and CMS for current marketing rules around events and materials.

Stay updated on agent events and information

Be Where Your Audience Is

Don’t wait for people to come to you; go where they already are.

A Few Ideas:

• Set up an information booth at a farmer’s market or community fair (with proper permission).
• Attend Chamber of Commerce or Rotary Club meetings.
• Sponsor a senior bingo night or lunch-and-learn event.

Use these opportunities to show up as a helpful resource, not a salesperson.

Consistency is Key

Grassroots marketing takes time but builds true connections. It’s not about flashy ad budgets; it’s about showing up, being authentic, and providing value. If you make it easy for people to refer you, remember you, and trust you, your Medicare book of business will grow; one interaction at a time.

Are you ready to join the team at Crowe; click here for contract

Suggested Leave-Behinds or Referral Gifts (All $15 or Less):

• Branded pill organizers
• Magnifying bookmarks
• Reusable grocery bags
• Hand sanitizers with your logo
• Small potted plants or succulents
• Coffee mugs
• $5–$10 gift cards (compliance-checked)
• Mini first aid kits
• Magnetic calendars with your logo and contact information

Looking to grow your Medicare practice? Start with your community; the most powerful marketing tool you have is you!

Final expense insurance; also known as burial insurance or funeral insurance, is one of the most practical and emotionally impactful products in the life insurance industry. It provides a straightforward solution for covering funeral and end-of-life costs. We will go over Final Expense Plan basics so you can get a general idea of the value of these plans.

This guide breaks down what agents need to know to confidently sell final expense insurance; from plan types and terminology to underwriting insights and a step-by-step sales process.

Final Expense Insurance

Final expense insurance is a type of permanent whole life insurance with a low death benefit, typically between $2,000 and $50,000. It’s designed to pay for funeral expenses, medical bills, debts, and other end-of-life costs. This helps provide peace of mind for the individuals who purchase the coverage and their loved ones.

Key Characteristics:

• Whole life insurance product (not term)
• Level premiums for life
• Guaranteed death benefit (as long as premiums are paid)
• No medical exam required (simplified issue or guaranteed issue)
• Cash value accumulation

Final Expense Terminology

Understanding the lingo is important when discussing plans with clients:

Watch a quick YouTube video on Life Insurance Basics

Final Expense Plan Types

Final expense plans generally fall into three categories:

1. Level Benefit Plans

• For healthy clients who qualify based on health questions
• Immediate full death benefit
• Lowest premiums

2. Graded Benefit Plans

• For clients with moderate health issues
• Limited death benefit in first 2–3 years (often 30%-100% of premiums refunded + interest)
• Full benefit kicks in after graded period

3. Guaranteed Issue Plans

• No health questions
• Suitable for high-risk clients (cancer, dementia, etc.)
• Always have a 2-year waiting period

Underwriting – What Clients Can Expect

Final expense underwriting is more lenient than traditional life insurance. Most policies are simplified issue, which means:

• No medical exam
• Short health questionnaire
• Carriers may use tools like:
  • Prescription history databases
  • MIB (Medical Information Bureau)
  • Height and weight tables
  • Phone interviews

Health Conditions That May Affect Plan Type

Agents: It is important to ask questions that can bring up common risk flags to prepare the best plan quote for your client to ensure they receive the coverage they need.

Sales Process: From Lead to Close

1. Lead Generation

• Direct mail, Facebook, Google ads, or warm referrals
• Focus on individuals aged 50–85
• Consider grass roots community marketing, telemarketer or aged leads if on a budget

2. First Contact & Rapport Building

• Start by actively listening to them and getting to know them
• Focus on protection and peace of mind, not insurance jargon
• Example: “Many of my clients want to make sure their families aren’t left with bills or funeral costs. Do you have coverage for that?”

3. Fact-Finding & Budgeting

Ask about:

• Age, health conditions, and medications
• Existing coverage
• Budget comfort level (not just affordability)

4. Present the Plan Options

• Present a few options that fall within their budget; an online quoting tool like Best Plan Pro makes this easy
• Explain the difference between level, graded, and guaranteed issue plans
• Emphasize guaranteed premium amounts and lifelong coverage

5. Application Process

• Most carriers offer e-apps, telephonic apps, or paper apps
• Walk the client through health questions and disclosures
• Submit application

6. Follow-Up and Delivery

• Confirm approval
• Review the policy with the client
• Schedule an annual check-in
• Ask for referrals!

Learn more about Final Expense Sales 101

A Few Tips for Agents

• Educate first, sell second: Although clients make the purchase based on emotion, they need to feel informed and confident in their decision.
• Practice transparency: Ensure clients understand graded periods or waiting periods upfront.
• Respect the budget: Because many clients live on a fixed income, it is not a good idea to sell them a policy they cannot afford. This can lead to loss of trust between you and the client and policy cancellation and a chargeback.
• Focus on family protection: Present the policy purchase as a layer of asset protection and legacy, not just an expense.

Click here if you are ready to get contracted with Crowe

Final expense insurance offers security and simplicity for clients as well as an opportunity for agents. By mastering the product, understanding client needs, and delivering with compassion, you’ll not only increase your sales but also build a business rooted in service and trust.

Keep up with the latest events and information for Medicare agents; click here