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Home Posts tagged "Health Insurance" (Page 4)
The differences between Medicare and Medicaid

The differences between Medicare and Medicaid

By Ed Crowe | General Articles | 0 comment | 31 October, 2023 | 0

The differences between Medicare and Medicaid

When we explain the differences between Medicare and Medicaid, we have to start with the fact that these are two very different programs.

Both programs provide an important service to the group that it serves.  Each of these programs receives funding and is run by different parts of the government.

What is Medicare:

The Medicare program is federal health insurance.  It is available to eligible people 65 or older as well as certain individuals under 65 who have certain disabilities. Medicare is run by the Centers for Medicare and Medicaid Services (CMS), a federal agency.

The CMS sets standards for the coverage Medicare programs provide as well as controlling the costs. In other words, people who are on Original Medicare will receive the same standard of coverage, it does not matter which state they reside in.

All payments for Medicare costs come from the two trust funds the U.S. Treasury holds. The trust funds receive money through payroll taxes and other funds authorized by congress.   Medicare beneficiaries also pay part of the cost for Medicare coverage by paying monthly premiums, deductibles and co-insurance for medical and prescription drug coverage.

Find out more about Medicare

What is Medicaid:

Medicaid is a joint federal and state program that helps cover medical costs for some people with limited income and resources.  Although each state is in charge of its own program, the federal government sets the rules that all state Medicaid programs have to abide by.  Every state decides on the requirement for the eligibility of its citizens therefore, income levels and other requirements vary from state to state.

There are several benefits that Medicaid provides that Medicare does not cover.  Some of these benefits include some nursing home care and personal care services. In most cases, Medicaid recipients don’t pay for covered medical expenses but may owe a small co-payment for some items or services.

Click here to see if you qualify for Medicaid benefits in your state.

Find out more about Medicaid benefits

To sum it up:

  1. Medicare is a program put in place by the federal government to provide health coverage for individuals 65 and over as well as qualified individuals with disabilities.
  2. Medicaid is a program that is provided by both state and federal governments for qualified individuals who have limited income and little financial means.

Please note:

Some individuals qualify for both Medicare and Medicaid.  These people are referred to dual eligibles.  These programs can work together to ensure qualified beneficiaries receive the health care they need.  A licensed Medicare agent may be able to direct you to getting extra help when you need it.  You can also contact your local social services office for more information on available extra help.

Agents watch some of our free training videos on YouTube

 

Medicare commissions 2024

Medicare commissions 2024

By Ed Crowe | General Articles | 0 comment | 26 October, 2023 | 0

Medicare commissions 2024

If you are a Medicare agent or thinking about going into the Medicare business, you should be aware of the Medicare commissions 2024.  We are happy to announce that CMS has released the maximum broker commission amounts for 2024.

It is important to note; insurance providers do not have to offer the maximum commission amounts.  It is just a guideline decided by CMS each year, what each insurance provider pays out is up to them.

The good news is; the amounts have gone up for the 9th consecutive year!

Maximum commissions for Medicare advantage plans 2024:

It is important to note: all commission rates are not the same.  They vary by state they are available in.

In the sates of both CA and NJ, the initial commission rates have increased from $750 per member for the year to $762 per member for the year.  This is an increase of 1.6% YOY.  The renewal commissions for CA and NJ have gone up from $375 per member for the year to $381 per member for the year.  This also adds up to an increase of 1.6%.

The states of CT, DC and PA have had an increase in initial MA commissions from $678 per member for the first year to $689 per member for the first year. This adds up to an increase of 1.62% YOY.  Renewal commissions for CT, DC and PA have increased 1.77%. Renewal commissions will go up from $339 per member per year to $345 per member per year.

Both Puerto Rico and the U.S. Virgin Islands initial MA commissions have gone up from $411 per member for the year to $418 per member for the year, this amounts to an increase of 1.7% YOY.  The renewal commissions have increased from $206 a member for the year to $209 per member for the year, this is equivalent to an increase of 1.46%.

In all other states not listed above, the initial MA commission amounts have increased 1.66% YOY from $601 per member for the year up to $611 per member for the year. Renewal commissions have also increased at a rate of 1.66% from $301 per member for the year to $306 per member for the year.

If you are interested in becoming a Medicare agent; click her to learn more

Maximum commissions for PDP plans 2024:

The commission rates for PDP plans are the same in all states.

Initial commission rates for PDP plans have gone up by 8.7% YOY.  This means commissions have gone from $92 per member for the year to $100 per member for the year.  Commissions for PDP plan renewals have also been increased by 8.7% YOY. Commissions have ow gone from $46 per member each year to $50 per member each year.

Click here to see CMS carrier commission chart for 2024

Take a look below to see the 2023 & 2024 commission rates side by side.

 

Product     Region 2023     2024    %  2023    2024 % 
MAPD National $601 $611 1.66% $301 $306 1.66%
CT, PA, DC $678 $689 1.62% $339 $345 1.77%
CA, NJ $750 $762 1.6% $375 $381 1.6%
Puerto Rico, U.S. Virgin Islands $411 $418 1.7% $206 $209 1.46%
PDP National $92 $100 8.7% $46 $50 8.7%

 

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Medicare Advantage Pros and Cons

Medicare Advantage Pros and Cons

By Ed Crowe | General Articles | 0 comment | 20 October, 2023 | 0

Medicare Advantage Pros and Cons

If you watch T.V., you have probably heard about Medicare Part C also known as Medicare Advantage plans. Private insurance companies contract with Medicare to offer Medicare Advantage plans. These plans must provide the same level of coverage as original Medicare. If you are considering a MA/MAPD plan, you should think about the Medicare Advantage pros and cons before signing up.

Because your healthcare is a very important decision, there is a lot to consider when choosing between Original Medicare and a Medicare Advantage plan.

 We will go over some of the features Medicare Advantage plans offer that may or may not provide the type of coverage you are looking for.

Medicare Advantage Pros:

Low premiums and cost shares

Many Medicare Advantage plans offer $0 plan premiums. There are plans with a premium, but they are usually quite reasonable.  It is important to note; you must continue to pay your Medicare Part B premiums when you enroll in a Medicare Advantage plan.  If you opt for Original Medicare and a supplement, the premium will cost you substantially more and you will also need to purchase a separate PDP (prescription drug plan).  Paying for two plans can add up especially compared to a $0 MAPD plan that also provides prescription drug coverage.

Some in-network doctor’s visits have a low or no cost share with a MAPD plan.  While the same visit with Original Medicare may leave you with a 20% co-insurance payment.

Medicare Advantage plans provide an annual maximum out-of-pocket expense limit. This means, when you reach the maximum, your plan pays 100% of your covered medical expenses for the rest of the year. You pay nothing.  There is no maximum out-of-pocket cap with Original Medicare.  In other words, there is no limit to what you could spend for medical treatment in any given year.

Comprehensive coverage

Medicare Advantage plans provide the same benefits Original Medicare, both Part A & Part B, offers. MA plans also provide additional benefits not offered by Original Medicare. Some MA plans offer vision, hearing, dental, OTC and more.  MAPD plans offer comprehensive prescription drug coverage.

Beneficiaries of MAPD plans only need 1 plan and 1 card for medical, hospital and prescription coverage. This is a convenient way for beneficiaries to cover all their needs.

Several Value-added benefits:

Medicare Advantage plans provide many additional benefits above and beyond what was already mentioned.  Some plans include fitness benefits like gym memberships or incentives for active lifestyles. Many plans offer rides to and from medical appointments to ensure you get the care you need. MA plans may also offer incentives for wellness visits or preventative services they may also cover chiropractic services or acupuncture.  These services are not usually covered by Original Medicare.

Please note:  additional benefits vary by plan and provider.  Beneficiaries should check their plan’s summary of benefits to view the full range of benefits available.

Some Medicare Advantage plans operate as managed care networks or HMOs.  This means beneficiaries must use in-network providers who often work together to coordinate care and can in turn save beneficiaries money. Plans also offer telehealth consultations with healthcare providers.

Medicare Advantage Cons:

Must use only in-network providers

Beneficiaries enrolled in Original Medicare or Original Medicare and a Medicare supplement plan can use any provider who accepts Medicare assignment.  On the other hand, enrollees in Medicare Advantage plans are limited to seeking care with in-network providers. Any services received out-of-network can be either denied coverage or may result in a higher co-pay amount. Additionally, the cost of your care may not apply to your out-of-pocket maximum.

Additional costs

Medicare Advantage plans may include additional costs.  These costs include co-pays, deductibles and co-insurance. These out-of-pocket costs can add up if you visit the doctor often.  The costs depend on the plan, provider, and the services received.

See below for some situations that can raise the out-of-pocket cost for a MA plan:

  1. Beneficiaries may have a copayment for doctor’s visits.  Co-pays also apply to some prescription drugs.
  2. In some instances, there may be coinsurance cost for some services.  This may apply to specialist visits or DME (durable medical equipment).
  3. Out-of-network charges.  Anytime a beneficiary visits an out-of-network provider there may be higher out-of-pocket costs (co-pays, coinsurance or the entire cost) for services received.
  4. Many plans have an annual deductible.  Beneficiaries must meet the deductible before some medical expenses are covered. This may also include cost of specific the prescription drugs.  This will depend on the tier of each medication.

Please remember; beneficiaries should be aware of the MA/MAPD plan’s summary of benefits to understand the potential costs associated with any plan.

Prior authorization

Because Medicare Advantage plans try to assure their plans are not misused, beneficiaries may need to have prior authorization for hospital stays, home health care, and some medical procedures as well as medical equipment. This may include a primary care doctor’s referral before a specialist visit is approved.

Additionally:

Because there is so much to consider, it is a good idea to seek the advice of a licensed Medicare agent when considering all your plan choices and comparing all the benefits that are important to you.

Click here for Generic Scope of apt

Agents who have questions – take a look at our YouTube channel

Humana OTC catalog 2024

Humana OTC catalog 2024

By Ed Crowe | General Articles | 9 comments | 19 October, 2023 | 0

Humana OTC catalog 2024

If you are a member of participating Humana Medicare Advantage plans you will have the added benefit of the Humana OTC catalog 2024.  In 2024, CenterWell Pharmacy will provide members of participating plans OTC products.

If you want to verify that your plan provides an over-the-counter benefit, you should check your plans summary of benefits or call the customer service number on the back of your card.  You can also call this number to check your Health and Wellness allowance.

Download a copy of the OTC catalog

There are a few different ways to place your order:

  1.  Order via mobile app.  Just go to either the APP store for Apple devices or from Google play for Android devices.  Once you are there, search for the CenterWell Pharmacy app and download it to your mobile phone.  With the app, you an order products whenever you like as long as you have an available balance.
  2. Place an order online.  You will need to go to CenterWellPharmacy.com Once you are in, you can either create an account by following the prompts or log in to an existing account.  You will then choose Over-The -Counter (OTC) items from the “Shop OTC & Supplies” drop down.
  3. Mail your order in.  If you choose this option, please allow for extra time.  Be sure to submit your order by the 2oth of the month to avoid orders going toward the following months benefit.  If you have a quarterly benefit amount, submit your order no later than the 20th of the last month of each quarter (March, June, September and December).  Fill out the order form you find in the OTC catalog and mail it to:  CenterWell Pharmacy, P.O. Box 1197, Cincinnati, OH 45201-1197.
  4. Send your order via fax. Send your order form to: 800-379-7617.

Things to know before you order:

Be sure you know your plan’s allowance.  Check the summary of benefits for your plan to find this information.  If you have a plan with a rollover allowance, any unused balance carries over to the following month or quarter.  Please note; all balances expire on December 31, 2024.  If you do not have a plan that offers a rollover, you must use your benefits by the end of each month or quarter depending on your plan.
Orders that exceed the plan’s allowance will require payment by check , money order or credit card.  Orders include sales applicable sales tax.
Orders that contain multiple items may arrive in more than one shipment.
If you have an OTC allowance or Healthy Options allowance, you must activate your prepaid card before making purchases from the catalog.  Activate your card either by phone at 855-396-0691, 24 hours a day, Seven days a week or go to HealthyBenefitsPlus.com/Humana.

If you have questions about your OTC benefit; call 855-211-8370 (TTY:711).  Customer care specialists at CenterWell pharmacy are available M-F from 8 AM until 11PM, and Saturday from 8 AM until 6:30PM EST.

Learn about Medicare Part D changes

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Become an Insurance Agent

Become an Insurance Agent

By Ed Crowe | General Articles | 0 comment | 17 August, 2023 | 0

Five Reasons to Become an Insurance Agent

We get it: the insurance industry isn’t most people’s first choice. However, it is a diverse and fast-growing field that affects nearly everyone in the nation. Most people have insurance coverage in some form or another. Becoming an agent uses a variety of skills, and most agents earn nearly double the national average yearly salary. Here are five more reasons that become an insurance agent.   It’s a solid career choice.

The abundance of opportunities

Not only does insurance touch nearly everyone’s life in the United States, but nearly 50% of the insurance industry workforce is estimated to be retiring in less than ten years. This will result in many more advancement or promotion opportunities than other industries have.

 

Ability to give back to community – become an insurance agent

If a job is only a paycheck, it just doesn’t feel the same. Having a job with a purpose and a paycheck is far more preferable. At its core, insurance is about protecting community members.  It  covers their healthcare needs and ensuring that their basic needs are met. When we all share risks, it helps protect all of us against tragedy.

 

Developing a broad skill set and using it

Yes, being good at sales is effective in the insurance industry. But that’s not all: an effective agent has high levels of communication skills and problem solving abilities. They need to be technology savvy, able to research and evaluate their own analytics. And they need to be organized enough to manage many accounts all at the same time. The industry is also constantly evolving, and people with cutting-edge skill sets in coding, digital marketing, and cybermedia are in high demand.

 

Job security – Become an insurance agent

During a recession, insurance has been shown to be far more stable than other fields. It is a centuries-old profession and it seems to be going nowhere fast. No matter what else is going on in the world, people will need healthcare and insurance policies can help them access it.

 

It’s east to get started

A college education is  not required. A high school diploma or the equivalent is enough. Between choosing a specialty, studying for and taking the tests, and getting a license, the whole process of becoming an agent can take as little as a few weeks time.

Already Licensed?

Become an Insurance agent:  Click here to see what Crowe and Associates has to offer 

Keep up with all of our current events by clicking here. 

Ready to contract?   Begin here.

Subscribe to our YouTube channel.   We provide weekly training.

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Medicare Sales Meeting Questions

Medicare Sales Meeting Questions

By Ed Crowe | General Articles | 0 comment | 11 July, 2023 | 0

Medicare Sales Meeting Questions

Medicare agents have a number of ways to reach prospective clients. One of those ways is to hold education and sales events. While education events cannot lead to enrollments, sales events can and should. With these Medicare sales meeting questions, agents will be able to learn about their prospective and offer them the best plans and support for their insurance needs.

 

Financial Medicare Sales Meeting Questions

Asking financial Medicare sales meeting questions is vital to discover if the prospective clients qualify for Medicaid or other financial assistance. It also determines what kind of premiums people can afford to pay. Medicaid and other financial assistance qualifying incomes vary by state, as they are state-funded programs. Some prospective clients, depending on their income and assets, might even be eligible for a dual enrollment plan, or DSNP.

  • What is your monthly income?

This will determine if they qualify for any state or federal help with their premiums or even if they qualify for a DSNP.

  • If you are married, what is your combined monthly income?

  • Do you have any assets that may put you over the limit for this plan?

If the agent is looking at an asset-sensitive situation, it is easier to let the prospective client know what that asset limit is than ask if they have any assets. There are some states that are not asset-sensitive. As an agent, it is important to do research ahead of time to determine what the guidelines are for that particular location.

 

Other Medicare Sales Meeting Questions

If a prospective client already has a Medicare Advantage or Medicare Supplement, it is best to start by asking them how it has been working for their healthcare needs. They may have needs that are not covered and the agent may be in a good position to have them find more suitable coverage.

  • What type of plan are you on right now?

  • What company is it with?

  • Why did you decide to purchase this plan?

  • Are there doctors you would like to see that you currently cannot because of your network?

  • Is this plan covering the medication you need and expect to need?

It is often the case that beneficiaries are on a plan that they didn’t feel enthusiastic about. There are many options to help get every prospective client the coverage they need and want.

 

 Some other general Medicare sales meeting questions that may help the agent determine the most beneficial plans to offer might be:

  • Do you have dental care? If not, do you want dental care?

  • Does your current plan provide benefits like dental care, vision coverage, or over the counter medications?

  • (For those on a dual plan) Have you used any of the extra benefits the DSNP offers?

These extra benefits can include grocery cards, utility assistance, and flex benefits, and many beneficiaries do not know how to utilize them.

 

With these Medicare sales meeting questions in mind, the needs of the prospective clients will be clear for the agent to see. This will help everyone end up with the coverage they want and a plan that suits their individual healthcare needs.

Licensed Medicare agents

Get information about the new five star UHC ISNP.   This plan is exclusive to Crowe and Associates agent.  In order to sell this plan, agents need to complete an additional certification and training.  Exclusive training will familiarize agents with all the components and properly represent the benefits of this ISNP.

Learn what working with one of the top FMOs gives you. 

Keep up with all of our current events by clicking here. 

Free leads!

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What Do Healthcare Customers Want

What Do Healthcare Customers Want

By Ed Crowe | General Articles | 0 comment | 7 May, 2023 | 0

What Do Healthcare Customers Want?

Healthcare is an unusual industry because the patient, or beneficiary, is also the customer.  What Do Healthcare Customers Want?  Customers, by and large, have an ever-evolving list of things they look for in choosing which products they want to purchase. In order to help best determine which supplemental insurance plans are best for your clients, you need to know what is important to them. Here are the top five things that healthcare consumers are looking for now:

 

Convenience

Life is busy, and it’s only getting busier.  People rely on convenience.   Automated tasks and obligations are necessary.    Healthcare is no exception.  Additionally, some are available online. If a task is not convenient, it is often put off. And when healthcare decisions or services are put off, there are often disastrous consequences. Luckily, increasing technology is making healthcare more convenient to access even as our lives get busier. Some of the ways healthcare companies are making their services more accessible are the following:

  • Online scheduling

  • Telehealth appointments and remote appointments are less time consuming.

  • Automated prescription refills

  • X ray and other scan access from a cloud rather than in person

  • Online pharmacies that can deliver medications to the patient’s home address

 

What Do Healthcare Customers Want? – Transparency

Health insurance is hard to navigate for most.  No one likes to feel like the wool is being pulled over their eyes. Today’s consumers want transparency from their healthcare. There is increasing demand for more clarity in billing.  Many beneficiaries do not know what they will be charged up front in a doctor’s office or facility. It is also not only about costs – beneficiaries want their medical advice to be transparent, too. This can include the pros and cons of a particular procedure, prescription alternatives, and second opinions. Transparency on all levels is about building trust.

 

Good Bedside Manner

Overly authoritative, dismissive, or just plain rude doctors and facilities can no longer sneak under the radar in the age of the internet. Negative reviews can have real adverse effects on a business or practice. Patients have special insights into their own bodies.  As a result, their own concerns and symptoms need to be listened to carefully and seriously and considered in the diagnosis and treatment process.

 

Access To Information

Beneficiaries want to know the answers to their questions and concerns – point blank. They expect information about their healthcare and supplemental plans to be readily available. Some ways insurance companies are beginning to provide online portals that allow beneficiaries access to their information from anywhere at any time. Consumers also want more accessible information regarding coverage. They need to understand any potential coverage gap in their supplemental plans.  The Medicare world is over flooded.  Provide access to solid information.   Teach clients to discern accurate information from marketing schemes.

 

What Do Healthcare Customers Want? – Options For Care

Beneficiaries want to be included in their insurance company’s deliberation processes.  Customer feedback is imperative.  They prefer to make collaborative decisions about their care, not simply be told what is covered and what is not. Healthcare providers and companies who take these desires seriously are more likely to have happier, more loyal consumers for a longer period of time.

Turning Back the Clock

Learn a brief history of Medicare and Medicaid.

Here is a history of Medicare RX plans.

How did Medicare Advantage come about?

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Does Medicare cover hospice

Does Medicare Cover Hospice

By Ed Crowe | General Articles | 0 comment | 14 April, 2023 | 0

Does Medicare Cover Hospice ?

How to Qualify for Hospice Care:

Your clients qualify for hospice care if they have Medicare Part A and meet the following conditions:

  • A hospice doctor (and regular doctor if applicable) certifies that they are terminally ill (defined as a life expectancy of 6 months or less).

  • They accept comfort care (palliative care) instead of continuing to try to cure the illness.

  • They sign a statement choosing hospice care instead of other Medicare-covered treatments for the terminal illness and related conditions.

Your clients can usually get Medicare-certified hospice care in their home or other live-in facility like a nursing home. They can also get hospice care in an inpatient hospice facility.

What is Hospice Care:

Depending on the terminal illness and related conditions, a hospice team will create a plan of care that can include any/all of these services:

  • Doctors’ services.

  • Nursing and medical services.

  • Equipment for pain relief and symptom management.

  • Medical supplies.

  • Drugs for pain and symptom management.

  • Aide and homemaker services.

  • Physical therapy services.

  • Occupational therapy services.

  • Speech-language pathology services.

  • Social services.

  • Dietary counseling.

  • Spiritual and grief counseling for you and your family.

  • Short-term inpatient care for pain and symptom management.

  • Inpatient respite care, which is care provided in a Medicare-approved facility (like an inpatient facility, hospital, or nursing home), so that the usual caregiver can rest.

  • Any other services Medicare covers as the hospice team recommends.

 

What it Costs in Medicare:

  • Clients pay nothing for hospice care.

  • Clients pay a copayment of up to $5 for each prescription for outpatient drugs for pain and symptom management. In the case the hospice benefit doesn’t cover a drug, the client’s hospice provider should contact the Medicare plan to see if Part D covers it.

  • The client may have to pay for board if they live in a facility and choose to get hospice care.

  • To learn more about what is covered under Hospice Care, visit Hospice Care Coverage.

Find out what Medicare covers

Click  here to learn 5 things Medicare does not cover.

If you would like more information on Medicare enrollment, you can find it at Medicare.gov.

Already a licensed Medicare agent?   Click here to contract with a better FMO.

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Medicare Supplement sales

Medicare supplement sales

By Ed Crowe | General Articles | 0 comment | 24 March, 2023 | 0

Medicare supplement sales

Although Medicare covers many medical expenses for qualified individuals, it doesn’t cover everything.  That is why many health care agents go into Medicare supplement sales. Medicare supplement plans, also known as Medigap plans, help fill the gaps in Medicare coverage.

If you want to offer Medicare supplement plans to your clients, there are several things you should know:

First, it’s important to understand the basics of Medicare as well as the different types of Medicare supplement plans.

This information will help clients choose the plan that best meets their needs. You may have to ask questions about your client’s health, budget, and preferred providers, as well as explaining the plan differences.

There are four parts to Medicare: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage). Medicare supplement plans are designed to work with Parts A and B.  There are 10 standardized Medigap plans available in most states.

There 10 Medigap plans available in most states are;  A, B, C, D, F, G, K, L, M, and N.

Each plan has its own set of benefits, so it’s important to understand what each plan covers and how it works with Medicare. Here are some of the key differences between the plans:

  • Plan F: This plan provides the most comprehensive coverage, covering all of the benefits listed above. However, it is no longer available to new enrollees as of 2020.
  • Plan G: This plan is similar to Plan F, but it does not cover the Part B deductible. It has become a popular alternative to Plan F since it provides similar coverage at a lower cost.
  • Plan N: This plan has lower premiums than Plans F and G, but it requires some cost-sharing.  This includes copays for doctor visits and emergency room visits.

Please note;  Medigap plans are standardized. This means that each plan must offer the same benefits, regardless of which insurance company is offering the plan.

Because supplement plans have their own benefits, it’s important to understand what each plan covers and how it works with Medicare. For example, some Medigap plans may cover deductibles, copayments, and coinsurance, while others may provide coverage for foreign travel emergency care or skilled nursing facility care.

In addition, it’s important to be aware of the rules and regulations surrounding Medicare supplement sales.

For example, there are strict guidelines around marketing and advertising, and it’s important to follow these guidelines to avoid any legal issues.

It is extremely important to build relationships with clients and provide any assistance you are qualified to offer.  This may include answering questions about Medicare and Medigap plan coverage and plan enrollment.

In conclusion, selling Medicare supplement plans can be a rewarding career path for salespeople who are passionate about helping others. By understanding the basics of Medicare, the different types of Medigap plans, and the rules and regulations surrounding Medicare supplement sales, salespeople can help clients make informed decisions and provide ongoing support and assistance.

Click here to learn more about how to become a Medicare agent

Visit our YouTube channel for free training videos

 

 

Minimum Coverage Health Insurance for Individuals

Minimum Coverage Health Insurance for Individuals

By Ed Crowe | General Articles | 0 comment | 28 March, 2018 | 0

Minimum Coverage Health Insurance for Individuals

The following post contains information about Minimum Coverage Health Insurance for Individuals.  If this is the type of insurance you would like to purchase, please use the information below to help you make an informed decision.

Minimum coverage health insurance (MEC) meets the Affordable Care Act requirements. In other words members of the MEC plans will avoid paying the “individual Mandate” penalty.  This plan gives you 100% coverage if you use a First Health Network Provider.  Please note:  there is NO coverage for out of network providers.  The Essential plans not only offer doctors visits, urgent care but emergency room coverage as well.

EBA MEC PLANS OFFER

Primary doctors visits have a cost of $25.00.

The cost for a specialist doctor visit is only $35.00.

If you require urgent care, you will pay  $50.00

In the event that you require the use of the Emergency Room, you will only pay $250.00.

The Essentials MEC plan offers it’s members a copay for primary and specialist doctor visits as well as urgent care visits prior to the deductible.

  • This plan pays 100% of the 63 required preventive services, if you use a participating First Health Provider.
    • There are 15 covered preventative services available to adults
    • Women receive coverage for 22 preventative services.
    • Children receive coverage for 26 preventative services.

If you would like to find a first health provider: CLICK FOR PROVIDERS

Rates and Benefits: CLICK FOR EBA ESSENTIALS BENEFITS AND RATES 2018

Additionally, This plan is available to people in all 50 states.

To access the EBA’s Enrollment Portal:

  • Go to essentialbenefitplans.com
  • Here you can download
    • Individual Applications
    • Employer Aplications
    • Census
    • Plans’ Summary of Benefits
  • Access Enrollment Portal for
    • Individual Clients
    • Group Clients

To view Health Insurance Benefits –  Click here

If you would like to learn more about these plans, you can contact the office either by phone at (203)796-5403 or by email at edward@croweandassociates.com.

If you wan to learn more about us;, click this link.

 

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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

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