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Why use a Medicare agent

If anyone asks why people use Medicare insurance agents, we have a few good reasons below.

To start; Medicare agents complete hours of training on both compliance regulations.  They also complete hours of study and testing on the Medicare products available in their area.  They must be well versed on the plans and provide detailed information to clients. A good agent can provide comparisons of several plans and help find the Medicare plan to best fit their needs.

learn the difference between Medicare Advantage and Medicare Supplements,

Compare plan choices

Because health insurance coverage is such an important decision, it is important for clients to understand all their choices. Choosing the wrong plan can be a very costly mistake.  For this as well as many other reasons, the help of a licensed Medicare agent is essential. A Medicare agent can go over the client’s list of wants/needs for coverage and find plan options that are right for them. Agents help clients weigh the benefit of each plan. Medicare plan benefits, rules, and exceptions may be overwhelming to sort out without a trained professional.

To find out about our quoting tools, Connecture and Sunfire, click here

Consider the client’s current coverage

It is important to consider the client’s current Medicare coverage and find out what about the plan works or does not work for them.  With this information in mind, it is easier to find help them decide whether they should stay in their current plan or if there are better options available to them.

Agents do not charge for their service

As a Medicare agent, you cannot take money from the client for the advice you provide.  This means clients receive expert advice at no cost.  This service is provided for free.  That is one deal you cannot beat!

Medicare agents receive payment through a couple different ways depending on the type of agent they are.  Agents who are employed by and insurance company receive payment based on their agreement with their employer.  Many other agents who are not captive with a carrier, receive payments through the commissions they earn.  They may receive this payment directly from the carrier or if they are LOA, they receive payment from their up-line.  Either way, the amount they make is based on their total number of sales made.

Please note: commission amounts vary based on the plan type and carrier as well as the level each individual agent is contracted at.

Find out about commission levels for 2025

How clients choose a Medicare agent

Here are some things clients may consider when they choose a Medicare agent.

1.  The first way clients choose an agent is usually word of mouth.  If you have done a great job helping their friends, relatives or co-workers, believe me they will hear about it.  People love to tell their friends about an agent who really did a good job for them.  That is why all your clients need to know that you are there to answer any questions or concerns they have.
2. Clients feel better knowing they are working with an experienced agent someone who understands the plan benefits and how they work.  Be sure you are up to date on all the plans in the areas you sell in as well as what the rules for enrollment are.
3. Offer many different carries and plan types for each area you sell in.  Clients want to work with an agent who has access to all the best plans in their area.  Each client is an individual and one plan type may not be the best choice for every client. Do not offer only Medicare Advantage plans as some clients are better off with a Supplement and PDP plan.

Click here for a scope of appointment

A knowledgeable and caring Medicare agent is a very valuable resource for the community. If you make sure you are well informed and truly enjoy helping those who need advice on Medicare coverage, you can become a successful agent with the right amount of time, effort & training.

Hospital Indemnity plans

If you are a Medicare agent, it is a good idea to consider adding hospital indemnity plans to your product offerings.  In the event someone becomes ill and is hospitalized, these plans provide clients an additional layer of coverage.  Hospital Indemnity insurance provides policyholders a chance to protect their savings and lower their out-of-pocket costs.

It is important to note; when it comes to hospitalization, there are limits to what Medicare Advantage or Medicare supplement plans cover.  When that happens, a hospital indemnity plan can provide an extra peace of mind for beneficiaries.

What is hospital indemnity insurance

Hospital indemnity insurance is additional health coverage that individuals can purchase and add an extra layer of protection. These plans have a monthly premium like other insurance coverage. If the beneficiary has to stay in the hospital, they receive a fixed payment amount they can use to cover any out-of-pocket costs members incur.  Beneficiaries can use the payment to cover whatever they need such as, deductibles, co-pays, medication or for things like rehabilitation or home care expenses.

Unlike other insurance plans, hospital indemnity policies send payments directly to the policyholder.  This gives beneficiaries more freedom to choose where their money goes.  A good hospital indemnity plan should be easy to get, has no deductible or pre-certification and is not difficult to get payments from when you need them.

What hospital indemnity insurance covers

The coverage provided by a hospital indemnity plan depends on the plan chosen and the riders added.  We have listed a few basic things these plans cover below.

1. When a beneficiary has a hospital stays weather or not surgery takes place.
2. If they are confined in an ICU (intensive care unit).
3. In the event they are confined in a CCU (critical care unit).

Additionally, there are plans that offer coverage of all or some of the items listed below.

1. If a beneficiary has medically necessary outpatient surgery , as opposed to an elective outpatient surgery.
2. If they require outpatient diagnostic imaging procedures, x-rays or lab procedures.
3. Some plans include payments for ambulance services.
4. There are plans that event pay for emergency room visits or specific doctors office visits (not routine annual checkups).

Waiting periods for benefits

In most cases, there is a 30 day waiting period for illnesses that result in a hospital stay.  The waiting period varies by carrier and the plan chosen.  However, some plans will not have a waiting period for hospitalization for an accidental injury. It is important that enrollees understand all benefits of their plan choice, including waiting periods, before they decide on a policy.

Hospital Indemnity plan cost

Hospital indemnity plans charge a monthly premium like any other health insurance. The cost depends on several factors including the plan & company choice, as well as age, gender and location.

It is important to consider if hospital indemnity insurance is worth getting or not.  The beneficiary needs to consider what their current health plan covers, their out-of-pocket cost including deductibles and co-pays and co-insurance and the cost for an average hospital stay.  They also have to take into account their personal financial situation and if they can better afford the coverage or payment for the out-of-pocket expenses.

Opportunity for cross sales

Hospital indemnity plans provide a great opportunity for Medicare agents to make a cross sale.  Many of your current clients could benefit by purchasing one of these plans. Clients who enroll in a Medicare advantage plan without a premium ($0) may want to add an affordable hospital indemnity plan that adds that extra layer of protection. Their Medicare advantage plan may leave them paying high co-pays or deductible for a hospitalization. Be sure to go over their budget and possible value of adding the coverage.

Agents should go over the average cost of a hospital stay and the possible out-of-pocket cost as compared to the cost of adding a hospital indemnity plan.  Do the Math for them.  Make sure it is a viable option before they sign up.

Are you an agent who wants to offer these plan to your clients; click here for online contracting.

Rules for hospital indemnity insurance sales

It is important to remember, there are rules to follow when you offer a hospital indemnity plan to a client.  Agents cannot mention this or any other product at a Medicare appointment if it is not included on the scope of appointment.

Watch a YouTube video on the scope of appointment rules.

Medicare enrollment dates

If you are either getting close to your 65th birthday or are in Medicare sales, you should understand the Medicare enrollment dates.

Enrolling in Medicare can be confusing for beneficiaries and understanding the enrollment process is crucial to access the benefits your clients need. From IEPs to SEPs, the Medicare system is designed to accommodate various life circumstances. In this post, we go over several of the Medicare enrollment periods and how beneficiaries can use them to get the healthcare coverage they need.

Initial Enrollment Period (IEP)

The Initial Enrollment Period (IEP) is the first opportunity for most individuals to enroll in Medicare. IEP is a 7 month time frame that starts 3 months before the month of your 65th birthday, includes your birthday month, and ends three months after the month you turn 65.  During this period, individuals can sign up for Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) if they choose to.

Learn more about enrollment periods

Special Enrollment Periods (SEPs)

Special Enrollment Periods (SEPs) are designated times outside the initial enrollment period when individuals can sign up for Medicare due to specific qualifying events. Some of the most common qualifying events include:

Loss of Employer Coverage

If a beneficiary is covered under a group health plan through their own  or their  spouse’s current employment, they are eligible for an SEP when they lose the employer coverage.

Moving out of the plans service area

When a client moves out of their plan’s service area, they qualify for an SEP to enroll in a new Medicare plan.

Becoming Eligible for Extra Help

Individuals who become eligible for Extra Help with Medicare prescription drug costs qualify for an SEP to enroll in a Medicare Prescription Drug Plan (Part D) or Medicare Advantage Plan (Part C) that includes prescription drug coverage.

General Enrollment Period (GEP)

For individuals who miss their initial enrollment period, the General Enrollment Period (GEP) provides another chance to enroll in Medicare. The GEP runs each year from January 1st to March 31st. Coverage obtained during this period begins the first of the month after you enroll.  it’s important to note, beneficiaries who wait until the GEP may have to pay a late enrollment penalty.

Click here to learn about late enrollment penalties LEPs

Annual Enrollment Period (AEP)

The Annual Enrollment Period (AEP), also known as the Medicare Open Enrollment Period, runs each year from October 15th until December 7th. During this time, Medicare beneficiaries can make changes to their Medicare coverage.  This includes; switching from Original Medicare and Medicare Advantage plans, as well as joining, dropping, or switching prescription drug plans.

How to best use the Medicare enrollment dates

1. Stay Informed: Keep track of your eligibility and enrollment periods to ensure you don’t miss important deadlines.
2. Review Your Coverage Needs: Regularly assess your healthcare needs to determine if  current coverage is still suitable or if changes are necessary.  Agents make sure you contact your clients regularly, especially during AEP to go over coverage options for the following year and ensure they are happy.
3. Seek Assistance if Needed: If you have questions or need guidance regarding Medicare enrollment, it is best to reach out to a licensed insurance agent.

Medicare agents be sure to maintain your book of business, click here for some ideas.

Agents, are you ready to join a winning team, click here for Crowe contracting!

Understanding Medicare enrollment dates is essential for to ensure beneficiaries have access to the healthcare coverage they need. By familiarizing yourself with the various enrollment periods and their significance, you can navigate the Medicare system with confidence and peace of mind. Remember, staying informed and proactive is key to making the most of your Medicare enrollments.

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CT MSP income limits 2024

Medicare annual wellness visits

For Medicare beneficiaries, it is very important to stay vigilant with their health care.  Medicare annual wellness visits (AWV) are an essential tool to maintain good health.  Unfortunately, many beneficiaries are unaware of how significant this is and what it entails.  In this post, we discuss the importance of wellness visits and their benefits.

Understanding Medicare Annual Wellness Visits

Medicare Annual Wellness Visits (AWVs) are preventive care appointments.  These appointments help assess and maintain the overall health of Medicare beneficiaries. Unlike traditional annual physical exams, AWVs focus on preventive care planning, risk assessment, and health promotion.  The purpose of these appointments in not to diagnose or treat existing conditions. Please note; anyone who has has Medicare Part B for over 12 months, is eligible for an annual wellness visit.  It is important to understand; these visits are not a physical exam.

There is not cost for the visit as long as the provider accepts Medicare assignment and the Medicare Part B deductible does not apply. Although, if your provider preforms additional test, you may have to pay the Part B deductible as well as co-insurance.  In the event these services are not cover under the preventative visit.

Why are annual wellness visits so important

1. Prevention Over Cure: When providers use this approach, they prioritize preventive care, to detect potential health risks early on.  This helps prevent them from escalating into serious conditions. By identifying risk factors and developing personalized prevention plans, beneficiaries can take proactive steps towards better health outcomes.
2. Comprehensive Health Assessment: AWVs provide beneficiaries with a comprehensive overview of their current health status.  By taking a holistic approach that includes screenings for cognitive impairment, depression, and functional ability, all aspects of health are addressed and monitored.
3. Establishing a Baseline: Regular AWVs enable healthcare providers to establish a baseline of a beneficiary‘s health status.  This facilitates better care management and early detection of changes in health in subsequent visits.
4. Patient-Centered Care: ensures patient-provider communication is a priority.  This fosters open dialogue about health concerns, lifestyle factors, and goals. This collaborative approach allows beneficiaries to actively participate in their healthcare decisions and take steps toward good health.
5. Cost-Effective Care: Preventive care, as emphasized in AWVs, is proven to be more cost-effective in the long run compared to treating advanced diseases.  Medicare can reduce healthcare costs by investing in preventive measures to avoid chronic conditions.

Watch a YouTube video on the changes to Medicare Part D coverage

Components of an annual wellness visit

1. Health Risk Assessment: Beneficiaries undergo a thorough assessment of their medical history, current health status, and risk factors for chronic diseases.
2. Personalized Prevention Plan: Based on the health risk assessment, healthcare providers develop a personalized prevention plan that fits the individual’s needs and goals. This may include recommendations for screenings, vaccinations, lifestyle modifications, and community resources.
3. Health Education: AWVs offer an opportunity for beneficiaries to receive education on various health topics.  This helps them make informed decisions about their well-being.
4. Review of Medications: Healthcare providers review the beneficiary’s current medications to verify they are safe, effective, and appropriate for their needs.
5. Referrals and follow-up visits: If necessary, healthcare providers refer beneficiaries to specialists or other healthcare services for further evaluation or treatment. Follow-up appointments are scheduled, when needed, to check progress and adjust the plan accordingly.

To sum it up

Medicare annual wellness visits are an important tool for the promotion of good health and well-being of Medicare beneficiaries.  When we  prioritize preventive care, health assessments, and patient-centered approaches, beneficiaries have the information they need to be proactive in their healthcare and wellbeing.

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Insurance sales training

Anyone who wants to enter the field of Medicare sales, will need to have insurance agent training before they meet with any potential clients. Crowe and Associates offers Medicare agents access to several types of training tools.  We provide free information on our website, YouTube channel as well as weekly informational webinars and zoom meetings geared for either beginners or experienced agents.

Think about joining an FMO

Getting started in insurance sales can be confusing, especially if you are trying to get it done on your own.  An good FMO provides guidance and support not only to new agents but to experienced agents as well.  Agents receive back office support as well as resources and tools that can make your business run effectively.  it is important to choose an FMO that provides the support you need.  Be sure to ask as many questions as you need to and contact as many as you need.  Agents need to feel comfortable with their upline and secure knowing they will be there to answer your questions when they arise.

See what we offer Medicare agents

Decide what products to offer

We will focus on Medicare products, because that is the largest part of what we offer.  If you are unsure which products you are going to offer clients, your FMO should assist you in choosing a reasonable number of Medicare and ancillary products to get started.  It is best not to overwhelm yourself and get discouraged.   A good FMO will run a quote in the area you plan to sell in and provide you with a few of the top carriers in each product type to et you started.  This is easy to do with a good quote engine and takes only a few minutes.

Join the team at Crowe – click here for online contracting

Contracting and Certifications

After you choose the products and carriers you are going to offer, you must complete contracting.  Your FMO should be able to help get this done.  Once you receive your contracting links, you can complete them along with your carrier certifications(carrier specific training you do to gain knowledge about the products you are offering).   When this is done, you will receive your RTS (ready to sell) and you can now offer that product.

websites and blogs focused on Medicare sales.  Here you will be able to access information regarding all aspects of Medicare sales.  Our recorded webinars will hit on just about every area of Medicare sales.   For those, very new to Medicare sales, be sure to access our Medicare sales quick guide to lean the basics about contracting, certifying and selling.

Because Medicare is a federal program, there are a lot of rules and regulations agents must adhere to. These rules protect the clients as well as the agents and ensure everyone conducts business in a compliant and fair way.  CMS mandates that agents take annual training courses to stay up to ate with all the regulations.  That is why agents need to take and pas the AHIP annually with a score of 90% or higher.

Watch a quick YouTube video for 2024 AHIP test tips

Sales training

New agents often need more guidance to get an idea of how to get started. Comprehensive training programs provide an understanding of things like; eligibility, enrollment and coverage options.  We provide newer agents weekly zoom training to help them feel confident and build their knowledge base.  We are also available for a one on one meeting or phone call.  In some cases agents may have an opportunity to pair up with a local agent and go on sales calls.

Product training

In the Medicare field, clients have soo many types of coverage offered by many carriers to consider. This means agents must be aware of new products and changes in plan products as well  what their client is looking for.  That is why agents complete specific product training, so they can ensure their client receives the coverage they need and can afford.  We provide the opportunity for agents to join one of our weekly zoom meetings or webinars to get updated information and ask questions if they are unsure about anything.

Anyone can find information on our website or YouTube channel.  We update our Events and information page so agents can easily find a webinar or event information on our website, just click on the link below.

Click here to view our updated Events and information post

Access the recorded webinars on various topics on our YouTube channel, just click on the link below:

Subscribe to our YouTube channel and view all our recorded training and informational videos

Learn to use our free quoting and enrollment tools

We provide our agents with a few ways to quote and enroll clients in a CMS complain way. Sunfire and Connecture are two of the tools we offer at no cost to our agents. Both of these tools provide  a CRM as well as the ability to record sales calls and remain compliant.

Take a look at a Sunfire enrollment demonstration

Networking and Business Development Training

Agents require more training once they have a handle on the ins and outs of Medicare and the carrier plans.  Some people require advice to help the design a business plan. They may need a strategy for networking opportunities, leads, and business development.  These tools will establish their place in the community and build a book of business.

Generate Medicare referrals

Medicare lead program

Our agents have an opportunity to participate in our Medicare lead program to.  We provide agents up $500 a month to offset lead and marketing costs.  There are no minimums to start and absolutely no reduction in compensation.

More info on our Free Medicare Lead Program

What does a Medicare agent earn

Each year CMS sets the maximum amount for Medicare commissions.  Click here to see the commission rates for 2024 

Watch a YouTube video to see the CMS proposed changes to agent compensation

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Extra help Medicare

Medicare provides programs and benefits to many people. This includes the Extra Help Medicare program that provides qualified beneficiaries help paying their Medicare Part D monthly premium, annual deductible, coinsurance and copays for their prescription medications.
To qualify for this program, individuals must meet income requirements.  Individuals who are accepted into this program do not have to pay any Part D late enrollment penalty they may have acquired.

How to apply for extra help

If you do not automatically qualify for Extra Help, you will need to apply.  You must meet the following qualifications to be eligible for Extra Help.

1. Applicants must have Medicare Parts A and B.
2. They must reside in the U.S. or the District of Columbia.
3. They do not have more than $34,360 in assets that include savings, investments & real estate if they are married, or $17,220 if they are single or not living with a spouse. If your assets are more than that, you are not eligible for Extra Help. Important; this amount does not include your home, cars or personal possessions.  It also does not include life insurance, irrevocable burial contracts or back payments from Social Security or SSI.

If you meet the qualifications specified above, you can apply for Extra Help online.

Click here to apply for Extra Help online

For help with the online application, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778).

Please note: Some people do not need to apply for Extra help.  If you have either Medicare and SSI (Supplemental Security Income) or Medicare and Medicaid, you do not need to apply for Extra Help.  You will automatically be enrolled.

Extra Help isn’t available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa. But there are other programs available in those areas to help people with limited income and resources. Programs vary in these areas. Call your State Medical Assistance (Medicaid) office to learn more

Who can get Extra Help

If you think you meet the financial requirements and have Medicare A & B as well as are a resident of the U.S. or District of Columbia, just complete the online application.  You will receive a letter notifying you if you are accepted into the program.

Important:  residents of Guam, Puerto Rico, the US Virgin Islands, Northern Mariana Islands or American Samoa are not eligible for the Extra Help program.  To find alternative programs in those areas, check your state’s Medicaid eligibility at Medicaid.gov to find resources.

Additional financial resources

Individual states also have financial resources available through Medicare Savings Programs for those who meet the income qualifications. Use this link to find additional information for financial help in your area.

Beneficiaries can also go to Medicare.gov  or call 1-800-medicare (TTY 1-877-486-2048)to find information on financial assistance programs.

Please be aware:  Extra Help is not a prescription drug plan.  Beneficiaries must enroll in either an MAPD plan or a stand alone PDP plan to have coverage for prescription medications.

Agents, learn how to run a Medicare PDP or MAPD plan quote using Sunfire or Connecture.  Watch our quick YouTube video

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Tricare and Medicare

In this post, we explain how Tricare and Medicare work together to provide coverage for those who qualify.

What is Tricare

Tricare is a healthcare program available to active-duty service members, active-duty family members, National Guard and Reserve members and family members.  It is also available to retired service members and their families, survivors, and some former spouses. This program combines military healthcare resources (military hospitals & clinics) with civilian healthcare professionals to provide services to its members.

It is helpful for anyone eligible for both Tricare and Medicare to know how these benefits work together. Tricare For Life (TFL) is provided free of charge to U.S. military retirees and their qualified beneficiaries.  Medicare coverage is a separate program available to beneficiaries 65 or older as well as qualified disabled individuals.

Please note: Tricare does not provide insurance cards.  Military members should register in DEERS (Defense Enrollment Eligibility Reporting System) database to receive Tricare.  DEERS is a database of information on uniformed services members and their family members (sponsors), Once you register for DEERS, you receive a Uniformed Services ID card.  Is important to make sure your coverage information is up to date in the DEERS system to avoid problems with your health care benefits.

Members can also access proof of their coverage through milConnect, a website that provides military members with benefit information for insurance, including help finding a provider, proof of coverage, GI benefits and much more.

It is always a good idea to be sure any providers the beneficiary uses are in-network with the MA/MAPD plan chosen. If the providers are in network, beneficiaries could end up not having to pay any out-of-pocket costs after TFL pays its share.

Learn about the pros & cons of Medicare advantage plans

It is important to note, TFL members must fill maintenance drug prescriptions like, blood pressure or cholesterol, through Tricare’s mail order pharmacy.  TFL members can fill other prescriptions at any pharmacy they choose.  The beneficiary is responsible for any co-pays.

The benefits provided by Tricare Plus are similar to Tricare Prime.  They both work the same as regular Tricare in regard to Medicare because it is still primary coverage. It is important to confirm the military facility accepts Tricare Plus before scheduling care.  Tricare Plus is for Tricare eligible individuals not enrolled in Tricare Prime.

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Medicare OEP rules

Before we get into what the Medicare OEP rules are, we will discuss what the Medicare OEP is.

What is the Medicare OEP

The Medicare OEP is also called the Medicare Advantage OEP or (open enrollment period).  This enrolment period is in addition to the Medicare annual enrollment period (AEP) that runs from October 15th through December 7th each year.  The OEP is specifically enrollees of MA/MAPD plans.  It begins January 1st and runs through March 31st each year.   During this time, any MA/MAPD plan enrollee can switch to another MA/MAPD plan or Original Medicare and a PDP plan.

Find out more about the MA OEP

Clients who call you during the MAPD OEP and are unhappy with the coverage they chose, have one more opportunity to make a change.  This can be helpful if they did not check their coverage options during the AEP.  It is also useful when, your clients renew their coverage and find their plan has changed and no longer provides what they need for the new year.

To learn the differences between Medicare AEP vs. OEP

What agents can and can’t do during the MA/MAPD OEP

It is important to know; CMS has marketing guidelines in place for this enrollment period.   Agents cannot knowingly target or send unsolicited marketing materials to members of MA/MAPD plans during this period.

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