In order for agents to sell Medicare plans, one of the first things they need to understand are the Medicare enrollment periods. There are many different enrollment periods available to beneficiaries. Each one depends on their personal circumstances.
If a beneficiary already receives Social Security benefits, they will automatically be enrolled in Original Medicare. In other words, they do not need to sing themselves up for Medicare Part A or Part B. Beneficiaries who do not qualify for automatic enrollment should enroll during the Initial enrollment period.
The Medicare IEP (Initial Enrollment Period) is a seven-month window available to beneficiaries to enroll in Medicare Part A & Part B. The IEP is based on either your 65th birthday or once a qualified beneficiary receives their 24th Social Security disability payment. This enrollment period starts 3 months before the qualifying event and continues through the month of the event. The IEP ends 3 months after the month of the qualifying event. If the beneficiary’s birthday falls on the first of the month, The IEP begins 4 months before the 65th birthday of the beneficiary and ends 2 months after the beneficiary’s birth month.
Coverage for beneficiaries who enroll in the months before their birthday begins the first day of their birth month. If they enroll either during or after their birth month, coverage begins the first day of the month after they enroll.
During the IEP, beneficiaries can choose to either enroll in both parts of Original Medicare or they may choose to delay enrollment in Part B if they have other credible coverage such as from their own or a spouse’s employment.
The AEP starts each year on October 15 and runs until December 7. AEP is an opportunity for anyone on Medicare to make changes to their Part C or Part D coverage. Please note: changes made during this enrollment period will go into effect January 1 of the following year.
If a beneficiary neglects to enroll during their IEP and does not have other credible coverage, they may need to use the GEP to enroll in Medicare. The GEP starts January 1 and runs through March 31 each year. During the GEP, coverage begins the first day of the month after you enroll. Beneficiaries who enroll during the GEP may have to pay a late enrollment penalty depending how long they have gone without credible coverage.
There are still more enrollment periods available. There are the Medicare Advantage Open Enrollment Period as well as the Medicare Supplement Open Enrollment Period. Each if these enrollment periods apply to the specified type of coverage. Although some individuals qualify for one of the many SEPs (Special Enrollment Periods).
The Medicare Supplement Open Enrollment Period starts the day their Medicare Part B is effective and runs for 6 months. This enrollment period gives beneficiaries guaranteed issue right to enroll in any Medigap plan available to them. Several supplement carriers let beneficiaries apply for a plan up to 6 months before their Part B start date. The supplement will not start until the day Part B benefits are in place. If the beneficiary misses their Medicare supplement open enrollment period, they can apply for a Medicare supplement plan any time of year. Keep in mind, they may have to go through underwriting and can be denied coverage.
When a beneficiary first enrolls in Medicare Part A and Part B during their IEP, they are eligible to enroll in a Medicare Advantage plan. If they do not choose to enroll at that time, they have to wait until the AEP (Annual Enrollment Period) unless they have an SEP available to them.
There is a specific Medicare Advantage Open Enrollment Period available to those who are already enrolled in a Medicare Advantage change their coverage. This enrollment period runs from January 1 through March 31 each year.
The most difficult to understand enrollment period may be the Special Enrollment Period. This enrollment period can apply to several different circumstances and does not apply to all Medicare beneficiaries. SEPs may require the beneficiary to provide proof of eligibility.
The most common reason for enrolling during an SEP is loss of employer coverage due to the fact that many benficiares choose not to enroll in Medicare PArt B because they have employer coverage.
The Medicare GEP (general enrollment period) is a chance for eligible individuals to enroll in Medicare Part A and Medicare Part B. The GEP runs each year starting January 1st and ending March 31st. In years when the GEP ends on Saturday or Sunday, Social Security allows individuals to enroll the following Monday in one of their local offices. If they receive a written request for enrollment with a stamp dated by the last day of the GEP, Social Security will honor it.
If individual is eligible for Medicare benefits and has to pay a Medicare Part A premium, they can use the GEP to enroll in Medicare. If they are like most people and do not have to pay a Part A premium, they can enroll in Medicare Part A anytime. Eligible individuals who did not enroll in Part B during either their IEP or an SEP can use the GEP to enroll in Medicare Part B.
Eligible beneficiaries who went a year or more without Part B or Part A, if they have to pay a premium for it, may pay a late enrollment penalty when they use the Medicare GEP to enroll. Penalties for Part A and Part B differ. See below for details:
The penalty for Part A only applies to individuals who are not eligible for premium free Part A benefits. If a penalty applies, 10% is added to the premium cost. The penalty lasts for twice the number of years the enrollee delays Part A enrollment. For example, (If enrollment was delayed for 2 years, a penalty applies for 4 years).
Part B penalties add an additional 10% to the Part B premium each year the beneficiary delays Part B enrollment. An example is (a delay of 2 years will equal a 20% penalty). The Part B penalty lasts for as long as they have part B coverage.
Those who did not enroll in Medicare Part B because they had insurance coverage through theirs or a spouse’s employment, do not pay an LEP. There is also no penalty for beneficiaries who qualify for an MSP (Medicare Savings Program).
Before 2023, no matter what date beneficiaries enrolled in Medicare during the GEP, their coverage would start July 1. Since the CMS rule change that began is 2023, there are no longer delays in Medicare effective dates for beneficiaries who enroll during the GEP. In other words, coverage begins the first day of the month following the enrollment.
If you are an insurance agent or you have seen some of the Medicare commercials on tv, you have probably heard about dual eligible special needs plans or DSNPs. This might make you wonder, what is a DSNP.
DSNPs are Medicare Advantage plans that provide specialized healthcare benefits to qualified individuals who have both Medicare and Medicaid benefits.
For many beneficiaries who qualify for dual-eligible healthcare benefits, it may be difficult to coordinate their health care benefits between Medicare and Medicaid. That is why the DSNP (special needs plans) area a good choice. These plans provide members with an easy way to manage their healthcare coverage with the use of 1 plan as opposed to multiple plans and ID cards.
DSNP plans all include prescription drug coverage as well as some of the benefits in listed below.
Please note: each plan provides its own list of benefits. To view a full list of benefits for a particular plan, check the Summary of benefits or evidence of coverage.
DSNPs are offered to qualified beneficiaries through private insurance companies. The insurance companies that offer the plans are required to include all benefits that Original Medicare covers (Part A & Part B). Each individual state controls the extra benefits that providers can offer. These plans are not available in all states.
You can quickly find out which plans are available in each state by running a quote on Connecture or Sunfire.
Each type of DSNP is based on your level of eligibility for Medicaid. Insurnace carriers offer a limited choice of DSNP plans based on the service area. The level are as follows:
In order to receive Medicaid benefits, you must:
As a licensed insurance agent, you can help sort out all the plan choices as well as the additional benefits each plan offers so your clients feel confident in their plan choice.
If you are getting started in Medicare sales, there are plenty of terms that can be confusing. This list of common Medicare terminology can help you moving forward with your Medicare sales career.
These are plans are offered by private insurance companies outside of Original Medicare or Medicare Advantage. Some examples of Ancillary plans include life insurance, LTC policies, stand-alone dental or vision as well as many other stand-alone insurance products.
During this time from October 15 through December 7 each year eligible beneficiaries can either enroll in or change their current Medicare coverage.
Each year beneficiaries receive a letter from the plan they are enrolled in. This letter explains any changes that the plan will have in January when the plan year begins. It lets beneficiaries know about cost and benefit changes. This letter arrives each fall so beneficiaries can decide if they want to change plans during the Annual Enrollment Period that starts in October.
This is the amount, usually a fixed percentage, the insured must pay toward a covered claim after the deductible is satisfied.
The set fee a plan charges the insured at the time of each doctors visit or when you purchase prescription medication or other medical service.
A type of Medicare Advantage plan for beneficiaries with specific chronic conditions such as end stage renal disease (ESRD).
The pre-determined amount you have to pay before your insurance coverage begins to pay for covered services.
This refers to a gap in your Medicare Part D prescription drug benefit. This occurs when your prescription drug expenses exceed the initial coverage limit of your plan but have not yet reached the catastrophic coverage level.
DSNPs are specialized Medicare Advantage plans that provide healthcare benefits to beneficiaries who have both Medicare and Medicaid.
DME refers to medically necessary, prescription healthcare devices that Medicare Part B usually covers. This includes things like wheelchairs, infusion pumps and blood sugar monitors, to name a few.
These terms refer to a program that helps eligible Medicare beneficiaries with limited income pay for prescription drug coverage.
The list of drugs that each Medicare plan covers. Each plan separates the drugs on the formulary by tier the tier corresponds to the price the plan member pays.
Eligible beneficiaries who miss their Initial Enrollment Period, can use this time to sign up for Medicate. The GEP runs from January 1 through March 31 and is only available to first-time Medicare enrollees.
A type of Medicare Advantage plan that requires the selection of a primary care physician. Your PCP will coordinate your care and needs to provide a referral if you need to see a specialist.
This is a type of healthcare for terminally ill patients that provides pain management, counseling, hospital care, and more. Coverage for hospice is included in Part B of Medicare.
The time when eligible beneficiaries can first sign up for Medicare coverage. It begins three months before your 65th birthday and ends three months after. This is the time that most people enroll in Medicare.
When a provider (doctor, hospital, pharmacy, etc.) is in-network, they accept your Medicare plan. Beneficiaries who use in network providers are covered under their plan when you use in-network providers.
A type of Medicare Advantage plan for people living in nursing home institutions.
A Medicare plan offered by private insurance companies. These plans cover everything that Original Medicare covers as well additional benefits like prescription drugs, dental, vision, fitness, etc. When they are called MAPDs they refer to Medicare Advantage plans that include prescription drug coverage.
MSPs are Medicaid-run programs. These programs help cover Medicare premiums and other cost-sharing expenses for people with low incomes. Eligible Medicare beneficiaries receive help with premiums, copayments, and deductibles.
A separate, private insurance plan that helps pay deductibles, and copayments for Medicare covered medical services. These plans work with Original Medicare.
This enrollment period is available only to Medicare Advantage plan enrollees. It runs from January 1 through March 31. Enrollees can use it to switch between Medicare Advantage plans or to go back to Original Medicare and a PDP plan.
Many Medicare plans place a maximum dollar amount beneficiaries can spend out of pocket on their healthcare costs each year. Once they surpass the out-of-pocket limit, Medicare-covered services are 100% covered.
PDP plans provide coverage for prescription drugs and are offered by private companies.
A type of Medicare plan that provides care through a specific network of medical providers and facilities. Plan members can seek care outside the network, although it will usually cost more. In most cases, PPO plans don’t require referrals to see a specialist.
Eligible Medicare beneficiaries with special circumstances are entitled to enroll in Medicare plans outside of the traditional enrollment periods.
This is a healthcare benefit for both active duty and retired service members as well as their families.
If you are selling Medicare, you should think about how to meet all the coverage needs of your clients. That is why Medicare sales and cross selling go hand in hand. Before you try and do this, be sure you have the necessary product knowledge on anything you intend to offer.
A great way to get insight into your client’s potential needs is with a client needs assessment. Each agent should tailor the assessment to include the applicable product lines they are licensed to sell and have a good knowledge of.
If your client understands that you are able to offer them coverage for all their personal insurance needs, they will be inclined to call you when they decide to add to their current coverage. It is best to take care of their most urgent concerns before talking about additional items.
If you conduct a needs assessment or spend enough time speaking with your client, you will probably find out if your client has any illnesses that will prevent them for obtaining some types of coverage that they will not qualify for. If you ask about any recent claims they have had, this may be an indicator if they are a good candidate for some types of coverage.
Is the client or their spouse presently working? If the answer is yes, do they have any employer benefits and if so, what are they?
Have they ever served in the military (are they a veteran)? Sometimes veterans receive benefits. You need to find out if they do and what those are.
Because many people have a family history of either cancer, heart attack or stroke, this product is not difficult to sell. This product is sometimes called critical illness insurance. Be sure you understand the client’s budget before you show them quotes from companies that will fill their coverage need.
Most people do not have long term care coverage. Although LTC has changed over the years, there are still some good coverage options available. There are some short-term care policy options that include home health coverage. There are also some life policies that include an optional LTC rider. You can ask your client if anyone in the family has needed home health or nursing home care. If they have, ask them if they know how it was paid for. Do they have a way to pay for it if they need it?
Life insurance is not like LTC coverage because many clients have at least some life insurance coverage. If you want to start a discussion about life insurance, you need to find out if the client already has coverage and if so, how much. Once you get the answer, you can ask questions to determine if they have enough to cover what they need it for.
Here are some reasons people purchase life insurance:
To replace income lost due to the death of a family’s financial provider.
If they want to cover their final expenses. If they have a policy in place, it may not be enough to cover their final expenses. This means they may want to consider purchasing a policy that provides a bigger benefit amount.
Policies can help pay any outstanding debts owed by the policy holder.
In some cases, the policy holder wants to leave a financial gift to their chosen beneficiary.
If they do not have a policy, you may be able to help them decide if a policy could benefit their loved ones.
Final expense insurance is a kind of life insurance. If the client does not have life insurance in place, this type of policy can help family members pay for their final expenses and avoid leaving them with a large bill after you are gone.
These days many people want a safe place to invest their savings due to low interest rates at banks and stock market volatility. Simply ask your client if they are happy with their current rate of return on investments. Let them know a fixed indexed annuity can provide a dependable place to invest savings and a better return rate than many CDs. In many cases, you can offer them an annuity product that will provide a better return that what they currently have.
Now that we have given you a few products to consider adding to your portfolio, it is up to you to decide what will be the best value add.
Each time a Medicare agent meets a new client a Medicare fact finder is a great way to address what they want and what they need. This is a great tool to help you make personalized suggestions for coverage.
If you are in the senior market, your fact finder should focus on Medicare coverage. It may also include additional options like hospital indemnity, life products or other relevant products you offer. You should design your fact finder to fit your client’s needs and the services that you have to offer. The only way to know what the client is looking for is to ask questions.
This question is very important to ask. Clients need to understand the parts of Medicare and how they work to know what type of coverage they want and need. Your job is to make sure they know about all the coverage options available and make an informed decision. This includes what is covered by Part A, Part B, Part C and Part D.
When you ask this question as part of your fact finder, you gain valuable insight into what type of coverage the client is looking for. This will help sort out which benefits are important to them, and which are not. This can be very useful in sorting out MA/MAPD plan benefits as there are so many to choose from and they offer different benefit packages.
The answer to this question can help decide if a Medicare Supplement or a Medicare Advantage plan is a better option for your client. That is a reason to include it in your Medicare fact finder. Many of your clients’ plan choices will come down to simple mathematics. Medicare Advantage plans require a copayment for visits to either PCPs or specialists. The amount of each copay can make a difference in your client’s budget.
If a client uses medical care from several providers on a regular basis, they may have a difficult time finding a Medicare Advantage Plan that all their chosen providers participate with. It is your job to be sure they can continue to use the providers they want and are aware of the cost for each visit. In some cases, an MAPD plan may not be the best option for the client.
Please be aware, it is up to the client if they want to disclose this information. However, it is important to help them find the best coverage options for their needs and can be very costly if they make an ill-informed decision. Each MAPD and PDP plan has a specific formulary. This means they cover each medication differently. There can be very large differences in the cost for prescriptions that may place a burden on your clients when they are trying to maintain their health.
The cost of each prescription also depends on the pharmacy your client chooses to use. This must be explained to them as well. Carriers for Part D coverage often have preferred network pharmacies that can save the client money when they fill prescriptions there.
There are specific Medicare Advantage plans that provide coverage of certain chronic health conditions, such as ESRD. Although they cannot enroll in most Medicare Advantage plans, these SNP plans cover their specific needs, and they cannot be denied coverage for pre-existing conditions.
This may be an important question to include in you Medicare fact finder. Medicare supplement plans are good in any doctor’s office or facility that accepts Medicare assignment. On the other hand, Medicare Advantage plans have a local provider network and clients may not find an in-network provider when they spend months living out of their home state. This can end up costing quite a bit out of pocket for care. It is important to check the benefits of each plan for travel and residency coverage.
In some cases, client have retiree plans that work with Medicare to provide coverage for health care needs. If this is the case, the client should check with their company’s benefits coordinator to see how a Medicare plan affects their retiree coverage and how they work together.
These are just a few possible questions to use. It is important to decide which questions to add or subtract based on your personal preferences.
Let your client know what you are doing and why. This will help them understand that you see each client as an individual and will do your best to fill their personal health coverage needs. It is best to finish the questions and go over the answers before you try and make any sales presentation to the client. Making the suggestions at the end will let the client know you are listening to every answer and using all the information to make the most informed suggestions.
There are a lot of moving parts to selling Medicare plans including several choices for Enrollment opportunities. We will explain a little about the Medicare SEPs for emergencies or disasters. This SEP may be available to some of your clients.
It can be very helpful to know that in some instances, CMS allows a SEP (special enrollment period) for beneficiaries to enroll in or change either a Medicare Advantage or prescription drug plan. This SEP is available to individuals affected by either a disaster or a federal, state or local government declared emergency. The SEP can only be used if you missed a valid election period during the time of the disaster or emergency. It is important to check with each carrier to see if they are accepting the SEP for enrollments or plan changes.
If you have a beneficiary who may qualify for this SEP, be sure you check to see if the carrier of the desired pan is accepting this SEP. The beneficiary may need to verify they live in the area that was declared an emergency or disaster. You also need to be able to verify that they have missed a valid election period during the emergency/disaster. After you verify that they qualify, you can move forward with the application.
When you are filling out the application, you will look for the SEP choice that pertains to an Emergency or disaster declared by FEMA or other government agency. The application may ask for the dates of the valid enrollment period that was missed.
CMS will need to decide if the SEP election period is valid. If there are any questions, the carrier will contact the agent or the client or both with any questions.
If CMS approves the enrollment, the plan will start the first day of the month after you submit the application.
If you are just getting started in Medicare sales it can be overwhelming. I am sure there are many questions you have including why contract with multiple Medicare carriers. In this post we will provide an answer to that question.
As a Medicare agent, the main reason you chose this business should be to provide the best possible advice to individuals who are looking for Medicare coverage. In order to do that, you need access to the best options for each individual. In other words, you need to be able to offer plans from multiple Medicare carriers.
Providing beneficiaries the ability to compare the benefits of several plans lets them make a well-informed decision on their coverage. Many clients like to see as many options as possible. If you can provide information on many plans, they know you are giving them the best choices available, and they can feel more confident in their choice. There is no need to go to other agents to view other options. Contracting with several carriers gives you a broader knowledge of the Medicare market and that is good for both you and your clients. A diverse portfolio ensures potential clients you will truly find the best plan for their personal needs.
Agents who contract with only one carrier, leave clients wondering what else is available and are they getting the best coverage. In this instance, clients do not have all the information available to get the best coverage.
One important factor for Beneficiaries is the cost of the plan they chose. When you have many options available, it is far more likely to find a plan that offers the desired coverage at an affordable price. This provides your clients a chance to find the plan that does not stretch the budget too thin once you inform them of all the costs associated with each plan and available benefits.
Medicare beneficiaries need an agent they trust who provides knowledge as well as the best plan options. If your clients know you are available to address any concerns they have and you offer several great plan choices, they will tell their friends and family. Many Medicare beneficiaries are overwhelmed with information; bombarded by phone calls and mail. If they have an actual person they can trust for sound advice, this goes a long way and is appreciated. If your clients know you available to address any concerns they have and offer several great plan choices, they will tell their friends and family. This is a fantastic and free way to generate new leads. A good agent is a valuable asset and provides beneficiaries with peace of mind.
Any agent who does not offer multiple carriers is leaving money on the table. Our job as agents is to provide the coverage beneficiaries want. If you offer only 1 or 2 carriers, you are letting many opportunities slip through your fingers. Beneficiaries are presented with multiple plan choices every day and they know what benefits they want. They also know what they can afford. You need to be prepared to find them what they are looking for or someone else will.
The Medicare savings plan CT 2024 could make a big difference in the lives of many people struggling to pay their health care costs.
Connecticut provides financial assistance to eligible Medicare enrollees through Medicare Savings Programs.
Qualified beneficiaries receive help through one of three available Medicare Savings Programs. qualification for each level depends on your income. If you qualify for any of the three levels, DSS will pay your monthly Medicare Part B premium. In some cases, enrollees receive help paying both Medicare deductibles and co-insurance. Medicaid funds the MSP program in CT.
Each level of extra help is decided by your gross income. If you are married, your spouse’s income is included. Every level of the MSP program pays for your Part B premium. The monthly income limits are effective from March 1, 2023, until February 29, 2024. After that date, the new income limits take effect. When CT releases the new amounts, will add them in.
QMB – This level of help pays your Part B premium. Part B covers doctor visits, some preventative care and outpatient hospital services. QMB also covers your Medicare deductibles. The deductible is how much you pay before your Medicare insurance starts to pay. QMB benefits also cover Co-insurance payments. Co-insurance is the part of Medicare approved services that beneficiaries are responsible for paying.
The QMB is the only level of the Medicare Savings Program that acts like a Medicare Supplemental or Medigap plan. It will cover the costs of the deductibles or co-pays of Medicare Part A and Medicare Part B up to the Medicaid approved rate. It will also pay the premium for Medicare Part A for qualified adults 65 years of age or older when they are not eligible for premium free Medicare due to work earnings. You are protected by federal law from being “balanced billed” or billed for services after Medicare Part A and B pays its portion of the bill, if a provider agrees to treat you, whether or not the provider is a Medicaid provider.
ALMB – This level of extra help also provides payment for your Part B premium only. Help on this level is available on a first come first served basis as it is subject to available funding. Beneficiaries who receive Medicaid are not eligible for this program.
Every level of MSP automatically enrolls you into LIS (Low Income Subsidy) also referred to as Extra Help. Extra Help either pays the entire cost of a benchmark Medicare Part D plan, or part of a non-benchmark plan. It also covers the annual deductible, co-insurance and co-pays. Extra Help coverage stays the same even in the coverage gap (donut hole). Beneficiaries who receive the LIS also have additional SEPs to change Medicare Part D or Medicare Advantage plans if they want to.
You can apply for these benefits online, through the mail or by brining your application to a local DSS office. If you need help completing the application, you can authorize someone to do the application for you.
To apply for benefits online, go to www.connect.ct.gov, look for the ‘Apply for Benefits” and go from there. To apply for MSP only, complete the Medicare Savings Programs application/redetermination form below:
Social Security retirement age The age that an individual can receive their
Online Enrollment- Enroll prospects online without the need for a face to face appointment. Access to all major carriers with the ability to compare plan benefits and prescription drug costs. Link to recorded webinar https://attendee.gotowebinar.com/recording/2899290519088332033
All agents receive a personalized enrollment website. Prospects can use the site to compare plans, check doctors, run drug comparisons and enroll in plans. Agents are credited for all enrollments. Click Here