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Medicare and Dental Coverage: What You Need to Know

When people think of Medicare, they often assume it covers all their healthcare need; including dental. Unfortunately, that’s not the case. Original Medicare (Parts A and B) does not cover most routine dental care. This can come as a surprise to new Medicare beneficiaries, and as an agent, it’s important to help clients understand Medicare and dental coverage.

What Original Medicare Covers

Original Medicare only covers dental care in very limited situations; usually when it is part of a hospital stay or a medically necessary procedure. For example:

• Jaw reconstruction after an accident.
• Tooth extractions needed before certain surgeries, such as heart valve replacement.
• Oral exams done in the hospital before a covered procedure.

Routine services like cleanings, fillings, dentures, or root canals are not covered.

Why Dental Coverage Matters

Oral health is closely tied to overall health. Poor dental health can contribute to heart disease, diabetes complications, and infections; all of which are major concerns for Medicare-aged clients. Helping your clients plan for dental costs can protect both their health and their wallets.

Options for Dental Coverage

Here are the most common ways beneficiaries can get dental coverage:

1. Medicare Advantage Plans (Part C)
   Many Medicare Advantage plans include dental benefits. Coverage can range from basic preventive care (cleanings, x-rays) to more comprehensive services like crowns, root canals, and dentures. Make sure to compare networks, coverage limits, and annual maximums.
2. Stand-Alone Dental Insurance Plans
   These plans are separate from Medicare and can offer flexible options. Beneficiaries can choose plans based on coverage needs and budget.
3. Discount Dental Plans
   Not insurance, but these plans provide negotiated discounts with participating dentists. They can be a low-cost option for those who only need occasional care.
4. Paying Out-of-Pocket
   Some clients may choose to budget for routine care rather than purchase coverage. This may work for those with minimal dental needs, but it carries financial risk if major dental work is required.

Watch a YouTube video on Individual Dental Plan Sales

Tips for Agents

• Ask about oral health needs during your fact-finding process. This helps you recommend plans that fit your clients’ situation.
• Compare annual maximums carefully — dental coverage is often capped between $1,000–$2,000 per year.
• Educate clients about timing — enrolling in dental coverage early can help them avoid waiting periods for major services.

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

Medicare beneficiaries need to know that Original Medicare will not take care of their routine dental needs. By helping them understand their options Medicare Advantage plans, stand-alone dental insurance, or discount plans; you position yourself as a trusted advisor and help them maintain both their oral and overall health.

Stay up-to-date on Medicare agent events and information

Why Sell Life Insurance

For insurance professionals, adding life insurance to your portfolio is one of the smartest career moves you can make. Why sell life insurance; it’s not only a product in high demand, it’s also a powerful way to add income, expand and your client base. It has the ability to help build a business that provides stability for years to come.

High Demand Creates Opportunities

Life insurance isn’t a luxury; it’s a necessity. Every stage of life presents a need for coverage, from young families protecting their income, to seniors planning for final expenses, to business owners securing succession plans. This universal demand means a steady stream of prospects and opportunities for sales.

High Commissions and Residual Income

One of the biggest advantages of life insurance sales is the income potential. Many carriers pay competitive first-year commissions on policies, and renewals can create residual income year after year. By maintaining strong client relationships and policy retention, you’re rewarded with ongoing revenue without starting from scratch each year.

If you would like to contract with Crowe, click here

Expand Your Cross-Selling Potential

Selling life insurance opens the door to other products and services. Once you’ve earned a client’s trust with life insurance, you can position yourself as their go-to advisor for Medicare plans, annuities, long-term care, or other ancillary products. Every life insurance policy can become the foundation for a long-term client relationship and additional sales.

Build a Referral Network

When you provide families with peace of mind and financial security, you naturally create satisfied clients who are willing to refer friends and loved ones. Referrals are one of the strongest ways to grow your business, and life insurance sales generate them consistently.

A Recession-Resistant Career

In uncertain economic times, financial protection becomes more important, not less. Families want security and businesses need continuity. Selling life insurance puts you in a resilient market that remains in demand regardless of the economy.

Watch a YouTube video on Life Insurance Quoting and Sales

Professional Growth and Authority

Life insurance agents often become more than salespeople; they become trusted financial advisors. By helping clients understand coverage options, needs analysis, and long-term planning, you elevate your credibility and position yourself as an expert in your community.

Make a Meaningful Impact While Building Wealth

Yes, life insurance sales can provide significant income and residuals, but it also gives you the satisfaction of knowing you’re making a difference. Few careers allow you to both grow your wealth and leave a lasting positive impact on the lives of your clients.

Selling life insurance is one of the most profitable and sustainable opportunities in the insurance industry. It offers agents strong commissions, renewals, cross-selling opportunities, and a career path that is both financially rewarding and personally fulfilling.

Stay up-to-date on agent events and information

If you’re looking for a way to grow your book of business and secure long-term income, life insurance is a product you can’t afford to overlook.

ACA Changes for Plan Year 2026 – What This Means for Enrollees

Premium Increases Looming Large

In this post, we will go over some of the ACA changes for plan year 2026. The first one being; a median premium increase. Nationwide across ACA Marketplace plans, insurers have proposed median premium increases of around 18–20% for 2026; about double the rate change seen in 2025.

Enhanced Tax Subsidies Expire

The enhanced premium tax credits, a key feature under the American Rescue Plan and later extensions, could expire at the end of 2025, unless Congress acts. Their expiration may trigger both premium and enrollment shifts:

Over 75% increase in net premiums for many enrollees. Gross premiums also projected to climb, due to a less healthy remaining risk pool as healthier individuals opt out

Enrollment Process & Verification Tightened

Several regulatory changes taking effect in 2025 will reshape how people enroll in 2026 plans:

• Maximum out-of-pocket limits will rise: individual limit is $10,600 for 2026 and $21,200 for families.
• $5 monthly premium for auto-renewed $0 premium plans, unless eligibility is actively reconfirmed
• Auto-renewal from Bronze to Silver (for CSR-eligible individuals) is no longer allowed; this could lead to missed subsidies without active action
• SEP (Special Enrollment Period) applicants now face pre-enrollment eligibility verification in HealthCare.gov states—covering at least 75% of new enrollments; changes are temporary for 2026
• Monthly enrollment windows for low-income people, introduced under Biden, will be discontinued, and the open enrollment period will be shortened by a month

Watch a YouTube video on ACA contracting for agents and agencies

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

HSA Eligibility Expanded

• Starting in 2026, Bronze and Catastrophic Marketplace plans become HSA-eligible, high-deductible health plans (HDHPs). Additionally, direct primary care (DPC) membership won’t disqualify HSA contributions, and DPC fees become qualified medical expenses
• This provides greater tax-advantaged savings options and can help lower Modified Adjusted Gross Income (MAGI) to potentially retain subsidy eligibility

“One Big Beautiful Bill Act” & Medicaid Cuts

• The sweeping One Big Beautiful Bill Act (H.R.1) introduces:
  • $1.2 trillion in cuts to Medicaid and ACA subsidies, paired with stricter eligibility and verification requirements
  • Medicaid work requirements (80 hours per month), more frequent eligibility checks, reduced provider taxes, and limits on Medicaid for green card holders and immigrants
  • The CBO estimates up to 10 million will lose Medicaid, 2 million ACA coverage, and others become uninsured
  • The legislation also includes expansions like a Rural Hospital Fund, but critics say many will face access barriers

Reduction of Gender-Affirming Care & Legal Challenges

• The Trump administration’s proposed rule would remove gender-affirming care as an essential health benefit for ACA plans starting in 2026
• Other rules allowing insurers to deny new coverage if past premiums are unpaid, stricter income verification, and other barriers may cause 725,000 to 1.8 million people to lose coverage
• Mayors and doctor groups are suing, arguing these changes undermine ACA’s purpose; litigation is ongoing

Summary Table: What 2026 Holds for ACA

The 2026 ACA landscape is shifting dramatically. With rising costs, tighter eligibility, and policy rollbacks, coverage is becoming more complex and costly for many Americans. While expanded HSA access and some protections (like the Rural Hospital Fund) offer benefits, they don’t offset affordability challenges.

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

For consumers:

• Actively confirm eligibility during open enrollment—not auto-renew.
• Explore HSA-compatible options (like Bronze plans) to reduce taxable income and manage costs.
• Keep an eye on subsidy extensions; Congressional action could mitigate higher premiums.

For policymakers and advocates:

• Continuing subsidies and preserving access remain critical to maintaining ACA’s promise.
• Legal and policy responses to rollback rules (e.g., gender-affirming exclusions) could reshape outcomes before 2026.

Lead Sources for Medicare Agents

For Medicare agents, building a steady stream of quality leads is key to growing your business. Knowing where to find prospects and how to approach them can make all the difference. Below, we explore common lead sources including details on the types of leads that vendors provide, so you can decide what works best for you.

Referrals from Existing Clients

Satisfied clients can be your best source of warm leads. When they recommend you to family or friends, those referrals often come with built-in trust.
Tip: Always politely ask for referrals after helping a client enroll successfully.

Community Events and Educational Seminars

Hosting or participating in local events (grass roots marketing) helps you connect with Medicare-eligible individuals looking for information.
Offer free educational seminars on Medicare basics or plan options to build credibility and become a valued local resource.

Join the team at Crowe – click here for online contracting

Partnerships with Professionals

Collaborate with financial advisors, elder law attorneys, local doctors, pharmacies and other professionals who work with a similar client base.
Note: Provide them with clear information about your services so they can confidently refer clients and vice versa.

Online Marketing

Many seniors and their families research Medicare options online before contacting an agent.
It is a great idea to build a website with educational content, optimize for search engines, and use targeted ads on platforms like Facebook or Google.

Watch a quick YouTube video – How to Manage and Grow a Medicare Book

Purchased Leads and Lead Vendor Options

Lead vendors offer various types of leads to help agents connect with Medicare prospects. Understanding the types can help you choose the best fit for your sales style:

• Live Transfers:
  The vendor screens a prospect live and then immediately transfers the call to you. This means the lead is “hot” and ready to talk, but you must be ready to take the call in real time.
  Best for agents who can handle calls on-demand and want high conversion rates. These are the most costly, but delver the best return on investment.
• Warm Transfers:
  Similar to live transfers, but the prospect has been pre-qualified and warmed up before being transferred. Sometimes these calls are scheduled ahead of time to ensure availability.
  Good for agents who want quality leads but prefer some control over scheduling. These leads usually have a higher price, but the conversion rate is good.
• Direct Leads (Contact Info Only):
  The vendor provides contact details (phone number, email) of prospects who have expressed interest in Medicare plans. You then reach out on your schedule.
  Works well for agents who prefer to set their own pace but requires effective follow-up. Leads of this type are usually less expensive, but have a lower close rate. It’s worth a try if you’re on a budget.
• Internet or Web Leads:
  These leads come from online forms where prospects request information or quotes. These can be fresh but vary in quality. The cost depends on the source and varies.
  Best combined with quick follow-up to maximize conversion.

Note: Choose vendors with verified leads and transparent refund policies. Respond promptly to leads, especially live and warm transfers, since timeliness impacts conversion.

Here are a couple videos from some of our lead vendors:

Learn more about Medicare Express Leads

See what Lead Star has to offer agents

Local Networking Groups

Join your local chamber of commerce or senior-focused groups (senior centers) to build local connections. Be sure you focus on building relationships, not just sales pitches.

Current Book of Business

Cross-selling and annual plan reviews with existing clients can generate repeat business as well as maintaining your book of business. It is a good idea to stay in touch with your current clients through newsletters, birthday cards or check-in calls

Agents; don’t miss important events and information; click here for details.

A diverse lead generation approach works best. Combining referrals, community outreach, online marketing, and vendor leads. Additionally; understanding the nuances of lead types like live and warm transfers gives you flexibility and steadiness throughout the year.

Digital Marketing for Medicare Agents: Expand Your Reach Online

The Medicare market is competitive, and while traditional methods like grassroots marketing and referrals still work, today’s successful agents know that digital marketing is key to long-term growth. Whether you’re just getting started or looking to refine your strategy, here are some essential tips for digital marketing for Medicare agents.

Build a Professional Website

Your website is your digital storefront. It should be clean, easy to navigate, and mobile-friendly. Be sure to include:

• A simple explanation of what you do
• Your contact information
• An appointment scheduler or contact form
• Educational content (like blogs or videos)
• Compliance disclaimers (required by CMS)

Tip: Add an FAQ section to answer common Medicare questions; it boosts SEO and builds trust.

Learn about the free website design assistance we offer to our agents.

Start a Blog

Blogging helps you:

• Educate prospects and clients
• Rank higher on Google
• Position yourself as a local Medicare expert

Make your posts easy to read, and include a call to action like “Schedule a Free Medicare Review Today.”

Watch a YouTube video on how to create a successful blog

Use Email Marketing

Email is a low-cost way to:

• Keep in touch with leads and clients
• Share reminders about enrollment periods
• Deliver newsletters or tips

Segment your list (e.g., by age, status, or interest), and personalize your emails with tools like Mailchimp, Constant Contact, or SendGrid.

Always follow CMS guidelines; no marketing AEP-related products before October 1st!

Get Active on Social Media

Platforms like Facebook and LinkedIn are great for reaching seniors and their caregivers. Post regularly and mix up your content:

• Educational posts and videos
• Reminders for enrollment periods
• Client testimonials (with permission)
• “Medicare Tip of the Week”

Join local Facebook groups and community pages; just be careful not to promote directly in restricted groups. Focus on being helpful not on selling.

Use Video to Explain Complex Topics

Short videos are powerful tools. You can create:

• “Explainer” videos for Medicare Parts A, B, C, and D
• Plan comparison walkthroughs
• “Ask Me Anything” Q&A sessions

Use YouTube, Instagram Reels, or Facebook Live. Keep it down to a few minutes and include captions for accessibility.

Set Up a Google Business Profile

A Google Business Profile (formerly Google My Business) helps locals find you when they search “Medicare agent near me.”

Make sure to:

• Keep your hours and contact info updated
• Add photos of your office or events
• Ask clients to leave reviews (and respond professionally)

Join the team at Crowe; click here for online contracting

Use CRM and Automation Tools

Managing follow-ups is critical. A Customer Relationship Management (CRM) system like Blitz, AgencyBloc or our new addition: the all -in-one agent portal, BOSS (learn more about BOSS) these tolls help:

• Track leads and clients
• Automate birthday or policy renewal reminders
• Manage email campaigns
• Track downline production (for agencies) These last 3 are available with BOSS!
• Book of business reports
• Track your sales

Automation saves time while keeping your outreach personal and consistent.

Track Your Results

Use tools like Google Analytics, Meta Ads Manager, and your email platform to see what’s working and what’s not.

Track:

• Website traffic and page views
• Email open and click rates
• Facebook post engagement
• Number of appointments or contacts per campaign

This data will help you fine-tune your digital marketing strategy over time.

You don’t need to master every digital channel at once. Start small; maybe by building your website and writing one blog post per month. As you get more comfortable, expand into social media or email marketing.

Stay updated on agent events and information

Being present and professional online helps build credibility, reach more prospects, and stay top-of-mind with current clients. With the right tools and strategy, digital marketing can become one of your most powerful Medicare sales tools.

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.

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