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Medicaid is a crucial government program providing healthcare coverage to millions of low-income individuals and families. Although it is so important, many people do not understand how it works, who qualifies, and what services it provides. This post will help with understanding the basics of Medicaid so individuals can better navigate the program.

What is Medicaid

Medicaid is a joint federal and state program designed to offer healthcare coverage to eligible low-income individuals, including children, pregnant women, elderly adults, and people with disabilities. Unlike Medicare, which is primarily for disabled individuals and those 65 and older, Medicaid eligibility is based on income and other factors.

Each state administers it’s own Medicaid program. The states must follow federal guidelines but have flexibility to expand coverage and determine eligibility criteria. In other words, Medicaid programs vary significantly from one state to another.

Click here to find coverage in each state

Who Qualifies for Medicaid

In general, Medicaid eligibility is based on income and size of household. Although, factors such as disability, age, and pregnancy are also condsidered when determining qualification. In states that have expanded Medicaid under the ACA (Affordable Care Act), individuals with incomes up to 138% of the federal poverty level (FPL) qualify for Medicaid coverage.

In general, Medicaid provides coverage for individuals who have income levels that meet state qualifications. Those who may qualify are:

• Individuals, families, children and elderly individuals with limited income
• Pregnant women
• Individuals with disabilities

Each state has an online portal or office where individuals can apply for Medicaid benefits. Usually they can go to their state’s health department or the federal Healthcare.gov website.

What Medicaid Covers

Medicaid provides comprehensive healthcare services that include the following:

• Hospital and emergency care
• Doctor visits and preventive care
• Maternity and newborn care
• Prescription medications
• Mental health and substance abuse treatment
• Long-term care services (this includes; nursing home care and home health services)
• Dental and vision care (coverage varies by state).

Although federal guidelines require the states to provide coverage for essential services, each state has the ability to cover additional services.

How to Apply for Medicaid

Each state has it’s own process to apply for Medicaid coverage. In general, it is pretty straight forward. We have listed some of the common steps for the application below:

Check Eligibility: Use the state’s Medicaid website or the federal Healthcare.gov website to verify qualification.

Gather Necessary Documents: Applicants will need proof of income, identification, Social Security numbers, and information about household members.

Submit an Application: There may be several ways to submit an application; online, in person, by mail, or over the phone. This depends on the state the enrollee is in.

Wait for Approval: Processing times vary, but applicants will receive notification about their status and coverage details.

Medicaid and Other Health Programs

Many Medicaid beneficiaries qualify for additional assistance programs, such as the Children’s Health Insurance Program (CHIP), which provides coverage for children in families with incomes too high for Medicaid but too low for private insurance. Many states also offer food and housing and utilities assistance programs.

There are also specific Medicare programs that provide Extra Help to beneficiaires.

Learn the difference bewtween Medicare and Medicaid

For those who qualify for both Medicare and Medicaid (dual-eligible individuals), Medicaid helps cover Medicare premiums, copays, and additional services that Medicare doesn’t fully cover, such as long-term care.

Medicaid plays an important role in ensuring access to healthcare for millions of Americans. Understanding the eligibility requirements, coverage options, and application process help individuals and families access the benefits available to them. Because Medicaid rules and benefits vary by state, it’s essential to check the local Medicaid office for accurate and up-to-date information.

Understanding Medicare agency contracting levels can help agents who may want to expand thier business set clear goals for themselves. The contracting process determines the level of authority, commissions, and support that an agency or agent receives when selling Medicare Advantage (Part C), Medicare Supplement (Medigap), and Medicare Part D prescription drug plans. This blog provides some general information about the different levels of Medicare contracts.

Please keep in mind, each carrier has different requirements for contract levels. They may also have different names for contract levels than what we have listed here.

Levels of Medicare Contracting

Medicare sales agencies typically operate under a hierarchical contracting structure. Each level comes with varying degrees of responsibility and commission structure.

Most carriers will pay street level commissions directly to the downline/sub agent with the override paid to the agency. Overrides range from $50.00 to $150 per sale. This varies by company and agency level.   Many agents know what the annual street level compensation is and will not work with an agency if they will be taking any part of the street compensation.

Agents

At the entry level, individual agents contract directly with an Medicare agency and in some cases, with the insurance carrier. There are two main types of agent contracts:

• Captive Agents: Work exclusively for one carrier and can only sell that carrier’s Medicare products.
• Independent Agents: Have the flexibility to contract with multiple carriers, allowing them to offer a variety of Medicare plans to clients.

Individual agents can either receive street commissions or be LOA to the agency they work under.

General Agencies (GAs)

General Agencies (GAs) operate as intermediaries between independent agents and higher-level marketing organizations, such as FMOs and NMOs. GAs typically provide agents with carrier access, sales support, and some marketing resources, they may not offer the same level of training and tools an FMO can provide. The GAs recieve an override commission for business their downline agents write.

Managing General Agencies (MGAs)

MGAs function at a higher level than GAs, to be an MGA, you must have a greater number of downline agents than a GA. They may provide additional administrative support and agent oversight. structures. MGAs may have direct contracts with carriers, allowing them to receive greater overrides on downline agent sales than a GA level contract. This may provide them financing to offer agents advanced sales tools and training.

Senior General Agencies (SGAs)

SGAs operate at an even higher level than MGAs, typically overseeing some MGAs and GAs. They have strong carrier relationships, access to exclusive products, and higher commission opportunities. SGAs should provide large-scale support, including compliance oversight, marketing assistance, and leadership training for agencies beneath them.

Field Marketing Organizations (FMOs)

FMOs serve as intermediaries between carriers and independent agents or smaller agencies. They provide training, marketing resources, compliance support, and higher commission opportunities. FMOs typically contract with multiple carriers and offer agents the ability to represent various Medicare plans.

Take a look at the programs Crowe offers agents & agencies

National Marketing Organizations (NMOs)

NMOs operate at a level above FMOs and work with a broad network of agents, agencies, and FMOs. These organizations have high-level contracts with carriers, allowing them to negotiate competitive commission structures and access exclusive sales resources. NMOs focus on large-scale distribution and typically offer robust technology and compliance support.

Insurance Carriers

At the top level of the hierarchy, insurance carriers (such as UnitedHealthcare, Humana, and Aetna) contract directly with NMOs, FMOs, and, in some cases, GA levels or individual agents. Carriers set the terms of contracts, commission structures, and compliance guidelines that all agents and agencies must follow when selling Medicare plans.

Keep in mind; all agents and agencies must also folow CMS guidelines.

Contracting Considerations

Commission Structure: Higher-level contracts often provide better commission overridess, but require meeting performance thresholds and a specific number of downline/sub agents.

Training and Support: FMOs and NMOs often provide valuable training, lead generation, and compliance assistance.

Carrier Relationships: Access to multiple carriers gives agents flexibility to offer the best plan options for clients.

Compliance Requirements: Medicare sales are highly regulated, and agencies must ensure they follow CMS (Centers for Medicare & Medicaid Services) guidelines.

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

Understanding Medicare sales agency contracting levels is crucial for agents and agencies looking to optimize their business. Whether operating as an independent agent, partnering with a GA, MGA, or working under an SGA, FMO, or NMO, choosing the right contracting level can significantly impact commissions, resources, and overall success in the Medicare market. Agents should carefully evaluate their options to align with an organization that best supports their business goals.

As a Medicare insurance agent, maintaining a strong reputation and ensuring client satisfaction is essential for success. While providing the best possible service, agents must also be proactive in preventing client complaints that could damage their credibility, lead to compliance issues, or impact their business. We will explain how to avoid client complaints and build better client relationships.

Explain plan details and costs clearly

Many complaints arise from misunderstandings about plan coverage, costs, or network restrictions. To avoid this, agents should take the time to explain plan details, including premiums, deductible and co-pays. Do not forget to include out-of-pocket plan limits.

Remember to emphasize any network restrictions as well as provider availablity. This is extremely important for Medicare Advantage plans. It is helpful to provide a summary of benfits so clients can review them before enrolling in a plan.

Ensure clients enroll in the correct plan

Sometimes complaints occur if the client feels they were enrolled in a plan that does not fit their needs. The best ways to avoid this are; conduct a thourough needs assessment. Be sure you consider all medications, docotors and expected healthcare useage. Comparing mulitple plans and explaining the pros and cons of each helps the client make an informed decision.

Learn about rapid disenrollments

Be transparent coverage changes

Because Medicare plans can change every year, clients may be unhappy if they experience unexpected costs or coverage changes. To prevent this; be sure you procactively inform them of any modifications to their current plan, Remind them to take a look at their annual notice of change (ANOC). Offer an annual review during AEP to ensure thye are still in the best plan for their coverage needs.

Follow CMS compliance guidelines

The CMS has strict marketing and sales guidelines. Agents must avoid misleading or high-pressure sales tactics, use only approved marketing materials and be sure to obtain consent before discussing any pans. It is also important to never make unverified claims about coverage, benefits or plan costs.

Provide ongoing support

Clients appreciate agents who are accessible and responsive. To maintain trust; return calls and emails promptly. Offer assistance after enrollment, such as claims questions and benefit explanations. It is always a good idea to follow up to make sure clietns are happy and understand hw to use their plan benefits.

Handle issues and complaints professionally

Even with the best practices, complaints may still come up. When they do; be sure you listen attentively to the client’s concerns without interruption. It is important to acknowledge their frustration and provide a solution oriented repsonse. If it is necessary, escalate issues to the appropriate carrier rep or Medicare support services.

Document interactions

Keeping records of client communications, plan discussions, and enrollments helps protect agents and clients in case of disputes. Maintain notes from meetings, make note of any special concerns. Keep written enrollment confiramtions and copies of signed documents, authorizations especially the SOA.

Stay updated on Medicare rules and plans

Medicare regulations, plan offerings, and compliance rules change regularly. Stay informed by attending carrier training and webinars. Complete all annual certifications including AHIP. Join industry groups and network with other agents to stay updated on all industry and CMS rules.

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

Medicare agents play an important role helping clients navigate complex healthcare decisions. By being transparent, compliant, and client-focused, agents can minimize complaints, enhance client satisfaction, and build a strong reputation in the industry. Providing top-notch service not only leads to long-term client relationships but also increases referrals and business growth.

Licensed health agents who are looking to expand their revenue, may want to consider GTL ancillary product sales. GTL ancillary products provide agents with several affordable coverage options that are available in many states.

Because Medicare does not cover everything, ancillary products can fill many of the gaps in coverage. These products help set your apart from other agents and provide coverage for all of your cleint’s needs in one place. This builds stronger client relations and creates greater customer loyalty.

Watch a quick YouTube video on the value of ancillary product sales.

Some products GTL offers

Please note: This list is not all inclusive; GTL has other products available that are not listed here including life insurance products.

Hospital Indemnity

GTL offers Advantage Plus Elite hospital Indemnity Insurance . This plan provides financial assitance with expenses associated with a hospital stay; co-pays, deductibles and other out-of-pocket expenses not covered by health insurance. We all know medical costs can add up quickly possibly leaving benficiaries with financial hardships. Hospital indemnity plans allow beneficiaries to use the cash benefit any way they like.

If a beneficiary is confined to hospital or recieve any type of care that is covered under the plan, they receive a cash benefit. The Advantage Plus Elite plan pays a per day benefit depending on the plan selected. Plans cover a period from 1 up to 15 days. Benefit periods reset once the beneficiary is out of the hospital for 60 days. Some plan options provide a 1-day benefit period with a $2,500 daily benefit amount. Daily benefit amounts depend on the state the benficiary resides in.

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

Cancer

Precision Care Cancer Insurance helps policyholders diagnosed with cancer access advanced treatments that may not be covered by insurance. Precision Care lets policyholders access TGen’s world class Cancer Physicians as well as their cutting-edge genomic sequencing services. It also provides cash to pay for services and 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 similar mutations.

For more information about TGen, visit www.tgen.org.

Cancer Heart Attack & Stroke

Cancer, Heart Attack and Stroke Insurance provides beneficiaries a lump-sum benefit paid directly to them even if they have other health coverage that will pay for their treatment. The benefit amount can go as high as $50,000 for any of the covered diagnoses. The benefit amounts vary by the coverage chosen.

Short-Term Care

Recover Cash is short-term care insurance that provides coverage for several different types of care. Coverage includes; assisted living facilities, nursing homes, or the enrollee’s home. Recover Cash provides a way to pay out-of-pocket expenses and avoid gaps in health insurance coverage. An additional benefit of this coverage is access to TCARE’s Family Caregiver Concierge Services. This service provides support to caregivers and helps to avoid burnout. This policy gives beneficiaries a direct cash benfit touse any way they like.

Watch a video explaining some of the GTL ancillary products

Critical Illness

Critical Provider Plus critical illness insurance helps lessen financial hardships that come with a critical illness or accident. Coverage options range from $10,000 up to $100,000. These plans pay up to two times for two separate critical illnesses. GTL issues Critical Illness policies for ages 18 to 64. Lifetime maximum benefit amounts are between $25,000 and $250,000.

Please note; product availability varies by state. Click the link below to see what’s available in your area;

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

Click here for GTL products by state.

The Medicare Advantage market has experienced substantial growth in recent years, with Medicare C-SNP market growth one of the fastest-growing segments. C-SNPs cater to individuals with specific chronic illnesses, offering tailored benefits and care coordination. As healthcare costs rise and the over 65 population grows, C-SNPs are becoming the plan of choice for both beneficiaries and insurers.

What Are C-SNPs

Medicare Advantage Special Needs Plans (MA SNPs) provide targeted care and services to specific beneficiaries. Within this category, C-SNPs focus on beneficiaries with qualifying chronic conditions such as diabetes, cardiovascular disease, or chronic lung disorders. C-SNPs offer enhanced care management, specialized provider networks, and condition-specific benefits. These plans go beyond what traditional Medicare or standard MA plans provide.

Growth of the C-SNP market

Several factors are fueling the growth of the C-SNP market:

Chronic disease prevalence – Due to the aging U.S. population, the number of individuals with chronic conditions is rising. According to the CDC, six in ten adults have at least one chronic disease. This has increased the demand for tailored healthcare solutions.

Regulatory support – CMS continues to promote C-SNP expansion, offering increased flexibility in plan design and benefits to better meet the needs of chronically ill beneficiaries.

Increased insurer participation – As health plans recognize the financial and clinical benefits of offering C-SNPs, more insurers are entering the market. This leads to greater competition and plan innovation.

Improved care coordination – C-SNPs focus on the management or chronic conditions and care coordination, which aligns with the healthcare industry’s push towards value-based care.

Enhanced supplemental benefits – Many C-SNPs offer non-medical benefits, such as meal delivery, transportation, and in-home support services. This makes them attractive to eligible beneficiaries.

Challenges of C-SNPs

Regulatory issues – C-SNPs must meet stringent CMS requirements, including annual Model of Care (MOC) approvals and strict care coordination standards.

Enrollment requirements – Because C-SNPs require beneficiaries to have a qualifying chronic condition, plan enrollment may be more complicated than traditional MA plans.

Provider networks – Ensuring access to specialists and chronic disease management programs may be difficult in rural or underserved areas.

Watch a quick YouTube video on changes to DSNP & LIS members

The Future of C-SNPs

The future of the C-SNP market seems promising, with continued growth in personalized healthcare solutions and care coordination. As CMS allows flexibility in benefit design and insurers look for growth strategies, C-SNPs have an opportunity to become an even bigger part of the Medicare Advantage market.

Even with some challenges ahead, the potential for improved patient outcomes and cost efficiency make C-SNPs an important part of Medicare’s future.

In a memo dated March 20, 2025, CMS withdrawals DST SEP change. CMS announced the withdrawal of the changes to the enrollment process that were set to take place on April 1,2025. In other words, there will be no changes to the DST SEP policy that is currently in place.

Why this is good news

The reversal of this decision is great news for both agents and their clients. Because it takes the burden off of already stressed clients who have had to deal with a weather related or other FEMA declared area emergency.  This means, the current SEP will not change. Beneficiaries do not have to self-enroll using 1-800-Medicare to use this SEP.

As per the CMS memo of March 20, 2025, insurance carriers will accept enrollment applications submitted by licensed agents. This helps Medicare beneficiaries avoid both stress and confusion. It also allows agents to ensure the process is completed correctly and in a timely manor.

Medicare DST SEP

The DST SEP is an enrollment election period for qualified Medicare beneficiaries . CMS provides this SEP to those who miss a valid election period due to weather-related emergencies or FEMA declared disasters.

Only areas where state or local government officials declare an emergency or disaster can use this SEP. This SEP starts the date the incident occurs and continues for two months after it starts or the extension period begins. It can be in place for up to a year after the incident.   

Please note: Beneficiaries can either enroll in or disenroll from a Medicare plan using the DST SEP. New coverage goes into effect the first day of the month following the submission of the application.

Eligibility for the DST SEP

To qualify for this SEP, the beneficiary must live in the area the disaster occurred in. In addition, they must have missed a valid election period (AEP, IEP or OEP, or an SEP) because of the emergency.

In some cases, individuals use the SEP if they require help from a family member or caregiver who is impacted by a disaster. This can prevent them receiving the assistance they need during an enrollment period.

Watch a quick YouTube video on the changes to DSNP SEPs

A couple more reasons to use the DST SEP: When a disaster causes the inability to access Medicare plan information or submit an application. Another example is; when a disaster impacts a healthcare facility or provider. This can hinder the beneficiary’s access to information necessary to make an informed enrollment decision.  

Do you need a SCOPE – click here

Agents ready to get contracted with the Crowe team – click here

CMS has strick regulations in place for anyone offering Medicare plans over the phone. Agents who do not adhere to the rules could face strict penalties. Penalties can include; loss of contracts, monetary fines and damage to your professional reputation. To ensure compliance and build trust with potential enrollees, here are some tips for conducting compliant Medicare phone sales.

Obtain permission to contact

CMS rules strictly regulate how and when agents can contact potential enrollees. If you are calling about Medicare Advantage or PDP plans, to remain compliant; be sure to have documented permission to contact before making outbound calls. Do not cold call or use leads that did not provide consent for the call. Follow all CMS guidelines regarding unsolicited communications, this includes text messages and voicemails.

Comply with Do-Not-Call (DNC) regulations

Agents must respect consumer preferences regarding contact. To comply; make sure you use phone leads that are cross checked with the National Do-Not-Call Registry. Even when you do this, keep in mind the FTC updates the list constantly and you face a fine if you contact someone who is on that list.

Use approved scripts and disclosures

When discussing Medicare plans, agents must adhere to CMS-approved scripts and include required disclaimers.

Agents must clearly state that they do not represent or work for Medicare, but rather the specific carriers and plans they are contracted with. There are standard disclaimers that must be read to prospects. This includes: “We do not offer every plan avialable in your area”. It is always important to provide acurate plan information and do not mislead or pressure the consumer.

Watch a quick YouTube video on updates to the one-to-one consent rule

Avoid prohibited sales tactics

Medicare has strict guidelines against high-pressure sales tactics. Agents should not mislead beneficiaries into thinking they must enroll in a plan immediately (high pressure sales). They must not make unsupported claims about plan benefits or when comparing plans. Always allow the prospect to ask any questions they have and be sure they understand what is said.

Follow call recording and documentation rules

CMS requires that all Medicare Advantage and Part D sales calls be recorded in their entirety. In order to be complaint; calls must start with a disclosure that the conversation is being recorded, the prospect must give permission for this.

Agents must keep call recordings for a period of no less than 10 years as required by CMS and the carrier. It is important to document all client sales interactions; this protects both the agent and the client. A SOA is an important part of this process.

The SOA (Scope of Appointment)

When conducting a Medicare sales call, agents must adhere to the agreed-upon topics. Do not discuss additional products that are not included in the SOA. If the client wants to talk about other products, you must collect a new SOA that covers them. In order to be compliant, agents should keep the SOA for a period of 10 years.

Learn more about SOAs

Provide clear and accurate information

Misinformation or omitting critical details can lead to compliance violations. Make sure you know what the beneficiary is looking for. Discuss current coverage, doctors, medications and their needs and budget.

To maintain integrity, explain benefits, costs and network limitations clearly. Ensure enrollees understand the differences between the plan types (Medicare Advantage, Supplements & PDPs).

Ensure post-enrollment compliance

Your responsibility does not end after enrollment. To ensure your client is happy with their choice, make followup calls and discuss any questions or concerns they have. Make sure they understand their new plan benfits and how to use them. This helps keep clients happy and also helps avoid rapid disnerollments and chargebacks.

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

Staying compliant in Medicare phone sales is crucial to protecting consumers and maintaining your credibility as an agent. By following CMS regulations, using approved scripts, and respecting consumer rights, agents can foster trust and ensure ethical sales practices. Always refer to the latest CMS guidelines or seek guidance from a your upline.

Long-term care (LTC) insurance provides a solution for covering the costs of nursing homes, assisted living, and in-home care. However, due to rising premiums and strict underwriting, many individuals are seeking alternative insurance products to ensure they have financial protection for future care needs. Below, we explore some of the most viable alternatives to LTC insurance.

Hybrid Long-Term Care Insurance Policies

Hybrid policies combine LTC benefits with life insurance or annuities. These policies provide a death benefit if the beneficiary does not fully use the LTC benefits. This makes them a good option for those concerned about losing money on unused coverage.

Life Insurance with Long-Term Care Riders: These policies allow policyholders to use part of their death benefit to cover long-term care expenses.

Annuities with Long-Term Care Benefits: Some annuities offer enhanced payouts if funds are used for qualified long-term care expenses.

Short-Term Care Insurance

Short-term care (STC) insurance provides coverage for a limited time period. In most cases, up to one year. These policies are more affordable and have less strict underwriting than traditional LTC insurance. This makes them a good option for those who can’t afford a LTC policy. They are also an option for individuals who may not qualify for LTC coverage.

Critical Illness Insurance

Critical illness insurance pays out a lump sum upon the diagnosis of specific serious medical conditions. Policies cover conditions such as cancer, stroke, or heart attack. While critical illness insurance does not cover all long-term care costs, it can provide financial relief to help with medical expenses or caregiving services.

Learn more about critical illness insurance from Physicians Mutual

Life Insurance with Accelerated Death Benefits (ADB)

Some life insurance policies include an ADB rider. This rider allows policyholders to access a portion of their death benefit early if they develop a chronic or terminal illness. The ADB provides financial support for long-term care expenses without the need for a separate LTC policy.

Health Savings Accounts (HSAs)

HSAs allow individuals with high-deductible health plans to save money tax-free for medical expenses, including certain long-term care services. These funds can be a valuable resource to help cover the cost for care.

Please note: Although individuals can’t contribute to an HSA once they’re enrolled in Medicare, beneficiaries can still use funds already in an HSA to pay for qualified medical expenses.

Reverse Mortgages

A reverse mortgage enables homeowners aged 62 and older to convert home equity into cash, which they can use for long-term care expenses. While this option provides cash for expenses, it reduces home equity and can impact heirs’ inheritance.

Medicaid

For those who meet income and asset requirements, Medicaid provides comprehensive long-term care coverage, including nursing home care and home-based services. State-specific programs may also offer additional resources for long-term care support.

Choosing the best alternative

The best alternative to traditional LTC insurance depends on an individual’s financial situation, health, and long-term care needs. Consulting with a financial advisor or insurance professional can help individuals evaluate their options and develop a plan to ensure their coverage needs are met.

Agents who want to offer any of these products, click here for online Crowe contracting

Although traditional LTC insurance is a viable option for some, alternative insurance products provide flexibility and affordability. By exploring various coverage options and financial tools, individuals can secure financial protection and peace of mind for their long-term care needs.

The Best Plan Pro quoting tool provides both final expense and simplified issue life quotes. With this tool, agents can provide clients with a quick and accurate quote within minutes. Find otu how easy it is to quote, underwrite and enroll.   All from your own computer!

Quoting

Best Plan Pro gives agents the flexability to show all carriers availabel or only carriers they are appointed with or narrow it down to a select few.

Once you enter the client’s health information; birthdate, sex, height, weight, medications, health conditions and smoker status, the system will show only plans they qualify for. This saves time and aggrevation for agents and clients alike.

Run quotes for multiple face value amounts to compare prices and coverage. Additonally, you can run quoes based soley on a specific monthly budget amount. 

Click here to watch a Best PlanPro demo

Additionally; all client information and quotes are saved in the systems buildt in CRM.

Underwriting

Best Plan Pro offers a state of the art underwriting tool, offering more than just general health groupings:  best, non-tobacco, etc.  This system uses health conditions and prescription information to provide an accurate quote. 

Agents no longer need to waste time trying to figure out which carrier will offer a level policy based on a health conditions.  Sales Plan Pro instantly runs the health conditions and medications against all carriers to find the ones that offer level vs. graded/modified vs. GI.

Enrollment

Once the cleint decides on the plan type that best fits their needs, agents can easily enroll them from their computer. This system automatically takes you to the carirers site so you can proceed with an online enrollment.

How to get this fantastic software

Although the normal price for this software is $60 a month, agents whoare cotnracted with either Crowe or Pinnacle are eligible to recieve a deep disocunt of $19.95 per month. Addtionally; agents who write 5 or more cases get this tool at no cost!

To get the discount code, either email lifesales@pfsinsurnace.com or stephanie@croweandassocites or call 203-796-5403. You must be either a Crowe or Pinnacle agent to recieve this discount!

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

See what else Crowe and Associates has to offer our agents.

We will go over how to become a Medicare GA and what you need to set up a Medicare General Agency. A Medicare GA (General Agency) is an agency that has a contract with one or more Medicare carriers above street level. The GA has a Medicare contract and two or more licensed, producing sub agents.

Each year, CMS releases the maximum, street level commission that agents can receive for either a Medicare Advantage or Prescription Drug Plan  sale.  If an agency has a GA contract or higher, they are elgibile to receive compensation above the street level.  The additional compensation you receive is an override. GAs receive an override payment on every sale made by it’s sub agents.

How to become a Medicare GA

For an agency to receive a GA contract, they must work with an up line agency that is willing to provide a GA level contract.

 Agencies must also meet the qualifications for each carrier.  Each insurance carrier requires a specific number of sub agents in order to qualify as a GA.  For example; Aetna requires 3 total contracted producers (this can include the principal).  In other words, you need the agency and producer connected to it and 2 licensed, certified, producing sub agents. Please note; each company has it’s own requirements. In general, insurance carriers require anywhere from 2 to 5  licensed, certified and producing sub agents in order to get a GA contract.

Agency principals

In order to receive overrides, Medicare requires GAs to complete licensing and certifications.  This applies to their own production as well as production from sub agents. This is sometimes an issue if, the agency owner no longer writes business and has no desire to complete the certifications required to sell Medicare plans.

If the GA is an entity, the entity must be licensed.  Each agency must have a licensed, certified affiliated person.  (Even if they are not going to sell anything).  

Who can recieve GA compensation

An individual agent can receive an GA level agent contract as long as they meet the requirements. This means the compensation is paid to the individuals bank account. In some cases, an entity hold the GA contract (LLC, S-Corp, Corporation, etc..) with the compensation paying to the entity. Again, for an entity to receive payment, they must be connected to a licensed, certified agent.

Downline commission payments

Street level direct payments – Under this set up, the agent recieves street compensation directly from the insurance company.  This includes both initial commission and renewal comp. The GA receives overrides directly from the carrier.

LOA or Assigned Commission– In this scenario, all compensation (street commission and override) is paid to the agency regardless of who places the cases.

See what Crowe has to offer it’s agents

GA Contracting

Crowe and Associates can set up GA levels for just about any company and product type.  We use one contracting kit to appoint with almost all carriers.  The GA should notify our office if adding subagents. The sub agents fill out the online contracting link, check off the companies they want and add the name of their immediate upline so we can properly align them. Please have them note if they are an LOA agent. It is easy to put additional carrier requests in by either completeing a link, emailing or calling our office. There is no need to fill out additional paperwork.

Please note; many carriers take about a week to process contracts.  They process the GA contract first and then they process the sub agents.  As a result, this may cause a delay in the processing of the sub agent’s contracts.

Click here for online contract or to add a carrier to an existing Crowe contract

Adding Medicare to existing agencies

Agencies that already have a successful business may want to add Medicare as an additional revenue stream. In many cases, a good relationship with these clients gives them an opportunity to turn their existing book into a great source for leads. If they have clients nearing age 65 or over, they can easily transition into offering Medicare planning for those clients.