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Medicare licensed agents

Medicare licensed agents provide a valuable service to beneficiaries.  If they stay up-to-date on product offerings and CMS rules, they can provide clients with a number of plan choices that will suite their needs. This is a great career if you are interested in becoming a valued member of your community and providing an important service to it’s members.

Where to start

The first thing you need to do is go onto the state insurance department website for your state.  From there, you can lookup the requirements to earn your health or health and life license.

There are several companies that offer the courses you need to study for your test.  Your states insurance department website will give you the available options. While you are studying for you resident state license, you will start to learn the rules for selling Medicare & other health plans.  Studying also provides valuable information about the different components of Medicare and how they work together.

Each state has different requirements for exam-prep. Some require in-person training while others allow self-study at your own pace.  There are also online options and options to order books if you are more comfortable with that.  There is a test at the end of the course that you must pass before you can take your actual licensing exam.  It is important to note; some states require agents to take a course on life as well as health while other states do not require agents to do both. If you think you may want to offer life products later, you can add the life course and do the testing at once.

Once you pass the exam, CMS reports your results to the National Insurance Producer Registry (NIPR).   Be sure you print and download a copy of your license.  You will find your  National Producer Number (NPN)on your license.  You need your license and NPN to contract with carriers.

Contract with an FMO

An FMO (field marketing organization) is an invaluable tool.  A good FMO not only provides it’s downline agents training, tools and contracting.  They provide continuous, back office support, they will answer your calls and make sure you get answers to your questions. Some of the things FMOs help; they get contracting requests processed, train downline agents on new CMS regulations and carrier products.  Agents need to take time and ask as many questions as you need to to feel comfortable before they choose an FMO.

 Watch a YouTube video on the programs Crowe has to offer

Having an FMO behind you , makes contracting with multiple carriers and products a much smoother process.  They should also provide guidance to new agents to put a plan of action in place and get up and running.  There may also be opportunities for leads, marketing money and other useful tools.

Join the team at Crowe – click here for online contracting

Purchase E&O insurance

In order to do business, carriers require all agents to have E&O insurance.  This insurance protects you in the event you make a mistake when you enroll a client an they take legal action against you to cover any financial loss your misinformation may have caused them.  Your FMO may provide a discounted plan to it’s downline agents.  If they don’t you can purchase a policy through an agent who provides property and casualty insurance.

Click here to learn about our discounted E&O

Complete AHIP

After you get our license, you should take the AHIP.  AHIP stands for America’s Health Insurance Plans.  Most carriers who offer PDP or MA/MAPD plans require agents to take this training and certification course.  Agents must take this test each year and get a 90% to pass.  The cost to take the AHIP course is $175, although many carriers offer a $50 discount if you take it through their portal when you do your carrier certifications(more on those below).

Click here to watch a YouTube video on AHIP test tips for 2024

Get contracted & appointed

Agents must complete carrier contracting before they are appointed to sell their products. In most cases, agents need a copy of their current state health insurance license for each state they plan to sell in.   A copy of their E&O certificate is also necessary.  Your FMO will will help with this process by providing other important information to the carriers.  Once the carrier has all the pertinent information, you must complete the carrier specific training for PDP and MA/MAPD plans.

It is a good idea to request only 4-5 good carriers in your area and get RTS (ready to sell).  With a good FMO, it is easy to add more in as you need them.  You do not want to be overwhelmed from the start. This can discourage anyone.

Find out about how Medicare commissions pay 

Moving forward

It is important to make sure you keep your license active.  This sounds like a no brainer but, some agents forget to renew and that can cause a number of problems with your carrier contracts. up to date.  In order to do this you will need to complete a specific number of CE credits before you can renew your license.  The amount of CE hours you need vary by your resident state.  You can choose any accredited CE course provider you like, again this is based on state specific requirements.

If there are updates with CMS requirements, both your FMO and the carriers you are appointed with should provide them to you.  It is essential that you follow all guidelines when making sales to avoid termination of your contracts.

If you want a career where you provide a valuable service to individuals and truly enjoy helping people, this could be a good fit for you.  In this business, we cannot stress enough how important it is to be organized and well informed to provide the best service to your clients.

Do you need a scope of appointment, click here and learn about the rules

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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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Pro-rated Medicare commissions

Pro-rated Medicare commissions are something that all agents who offer Medicare products need to understand.  The Medicare carriers pay pro-rated commissions to make sure agents do not end up owing the carriers too many chargebacks for disenrollments.  This also protects the carriers from the chore of trying to collect unearned money from brokers who may not have it to pay back.  It is better for both parties.

Agents receive pro-rated Medicare commissions for enrolling individuals in either Medicare Advantage or Medicare prescription drug (Part D) plans.  Once an agent submits an application for a beneficiary, the agent receives commission.  The amount of commission is based on the number of months the enrollee remains active in that specific plan.

How pro-rated commissions work

Agents receive a partial commission payment for every month their client stays in the carrier’s plan. This payment system is considered more equitable than carriers paying out the full commission at once.  As we stated earlier, this avoids chargebacks for any unearned commissions.  Agents may be motivated to give clients ongoing support to ensure they do not switch plans on the advice of another broker.  On the whole, agents who are available to clients, maintain their book of business.

The way to figure out the amount of a pro-rated commission, divide the total commission for each enrollee by the number of months the member is enrolled in the plan.  Let’s say the total commission for an enrollee is $600 and they stay in the plan for 10 months; this means the agent receives $60 for each month.

Find out more about commission payments

How beneficiaries benefit from this payment structure

We cannot stress enough how important forming a good relationship with your clients is.  The pro-rated commission structure provides an incentive for agents to make the extra effort.  Having a vested interest in providing a greater standard of customer service, helps beneficiaries develop trust toward their agent.  If the agent continuously provides good advice and follow up, the client in turn provides an important service to the agent.  In most cases, happy clients tell their friends and family.  This is great benefit to the agent who receives new client recommendations and an opportunity to grow their book.

Watch a YouTube video on Medicare commissions

To Sum it up

The pro-rated Medicare commission system provides is a clear and fair way for Medicare companies to pay agents.  It helps incentivize a good agent/client relationship.  It can ensure agents provide the best plan options to their clients, so they receive coverage options that align with their healthcare needs.  This helps everyone avoid dis-enrollments.

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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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Think Agent Aetna login

Because Aetna is one of the leading Medicare carriers in several states, there are many agents who will need a Think Agent Aetna login.  Think Agent is the electronic enrollment tool Aetna provides to help their agents enroll Medicare beneficiaries in their plans.  Think Agent gives both agents and clients a quick and easy way to complete their enrollments.  This tool is available several different ways including, desktop, laptop or a mobile app that agents can add to all their mobile devices including their phones.

How to access Think Agent

1.  Once you are ready to sell with Aetna, you will be able to download the Think Agent app from either the Apple App store or the Google Play store. Please note: The app is compatible with Android 5 or greater, version 11; or IOS 11.0 or greater, version 14.5; or on your desktop.  To access think agent online click here.
2.   After you download the app, click sign up and submit your request for a new user account.  To create your account, you need to provide your name, NPN and email address.

Click here for online contracting to offer Aetna or other Medicare products

Devoted broker portal

The Devoted broker portal is designed to provide all the tools you need to make selling Devoted products easy.  If you’re ready to sell with Devoted, you will receive an email from Devoted with the subject line “Devoted Agent Broker Portal Log-in Details”’.  This email contains a link to use to create a password for your account, your username is your NPN.  After the agent does this, they can login to the portal by going to agent.devoted.com.

What’s in the portal

Individual agents have access to the following tools in the portal:

1.  On the Home Page agents will find their ready to sell status.  They can also access sales tools, training and educational resources.

2.  Submit your client’s applications or HRAs online while you are with them in person or when they are on the phone with you.

3.  Send a digital scope of appointment via email.

4.  Check your client’s application or enrollment status.  You can also access member IDs from here.

5.  Check your commission statements.

6.  If you want to host either a Devoted sales or educational even, just submit an event request.

 To add Devoted to your Medicare sales products, click here for an online contract

Agency administrators have access to the following tools in the portal:

1. A summary of your downline agents; this includes their NPN, ready to sell status by state as well as application activity.
2. Agencies can verify the states they are actively contracted in.
3. View monthly commission statements for payments received by your agency.

Please note: agencies have access to one admin account.  This account is limited to read only access in the agent portal.  In other words, admins cannot create or edit applications in the portal.

Manage your clients

This portal allows agents to view client information including, client name, phone number, plan, effective date, end date (if applicable), member ID and status.  There are many ways to filter and sort your view of the client lists. 

Submit an electronic SOA

Agents can submit SOAs electronically, over the phone, by paper, or through email.  Take a look at a quick video on Devoted’s  Scope of appointment tool. 

If you need a scope of appointment, click here to download one

Online enrollment

Agents can quickly enroll a client through the portal.  Just click “Start enrollment” at the top of the page. Fill out the Create Contact page, click the orange “Start Application” button to complete the application.

Host a Devoted event

Just follow these easy steps:

1.  Log into your Devoted portal and go to the “Events” tab. Choose “Submit New Event Request”.
2. Enter your event information.  Please note, agents must answer items marked with a red asterisk before they can proceed.
3. After you fill out all the information and agree to the broker event guidelines (guidelines can be found in the broker manual) be sure you save the event.
4. Once you are done, the information goes to local market contacts for review.  If there are any questions, representatives contact the agent by email.
5. Agents can easily view the status of their request in the events tab.

Learn more about how to conduct a compliant sales event

Devoted has a new feature on the portal

Agents can request help through a support ticket system.  Agents receive a response to their questions within 48 hours.  Just follow the prompts and click on the Add to submit the ticket.  It is easy to track the progress of your request in the portal.  Once the Devoted representative solves the problem, the agent receives a confirmation email.

Because there are so many things agents can access in the portal, we listed some of the highlights.

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Why use a Medicare agent

If anyone asks why use a Medicare agent, we can provide you with some good reasons anyone should consider using a Medicare agent.

Because Medicare agents complete hours of training on both compliance regulations and the Medicare products available in their area, they are well versed on the plans available and provide valuable information to clients. They can provide clients and potential clients comparisons of several plan options and help find the Medcare plan that best fits their needs.

To learn the difference between Medicare Advantage and Medicare Supplements, click here

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 2024

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.

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Humana Vantage broker portal

The Humana Vantage broker portal is an invaluable tool for Humana appointed agents.  If you are appointed with Humana and have your Humana writing number, you can access the Vantage broker portal.  Just go to humana.com, go to the sign in and enter your username and password.  For new agents, just click to activate your online profile and use the prompts to setup your Humana portal access.

Click here to add Humana to an existing Crowe contract or to start a new contract with Crowe.

Licensing, Certification and Contracts

In this section of the portal agents find their status for licensing, certification and contracts. This helps agents stay up-to-date and ready to sell.

Education

The education section takes you to Humana MarketPoint University.  Once you are in MarketPoint, you have access to complete certifications and any training you need.  You can also access training webinars and job aids.

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What is a Medicare HRA

If you are in Medicare sales, you may have heard the term HRA.  In this post we will explain what is a Medicare HRA and why insurance carriers use this tool.

What is a Medicare HRA

HRA stands for Health Risk Assessment.  Medicare Advantage plans must do an HRA for every beneficiary within 90 days of their initial enrollment.  MA/MAPD plans require qualified health care professionals to conduct HRAs for existing members once a year.  These assessments are an important tool for both health plans and providers.  Insurance carriers use HRAs to identify the health status of members.  Once the HRA is completed,  insurance companies make risk adjustments and providers can put a managed care plan in place when necessary.  Clients may decide to have the HRA done either in a provider’s office or at home.

The HRA is required by CMS for all members of both Medicare Advantage and traditional Medicare fee-for-service plans.  If the member is enrolled in a traditional Medicare Fee-for-service plan, The member’s initial (welcome to Medicare) or preventative visit is used for the HRA.  When the member is enrolled in a MA/MAPD plan, the member will be asked to have the HRA.  Medicare advantage plans must make a “best effort” to have the member complete the HRA each year.

Click here to watch a quick YouTube video on Medicare Advantage vs. Medicare Supplement plans

HRAs (Health Risk Assessments) help collect important information

The information obtained through a HRA provides a view of the enrollee’s general health, health risk factors, as well as a glimpse into their ability to complete activities of daily living.  All these factors provide a view of overall health as well as find gaps in care and provide a basic diagnosis.

Any information obtained can help providers and health plans to create population health initiatives as well as to put an individual health plan in place.  The plan may include care management, coordination of care, identification of  high-risk individuals and the development of comprehensive care plans with referrals to suitable care team members.

Agents who want to offer Medicare Advantage plans, click here for online contracting

How to conduct a Health Risk Assessment

CMS has not put any specific format in place to conduct the assessments.  In many cases, a health care professional asks the beneficiary a series of questions. The questions cover a large range of topics that include family medical history, the beneficiaries current health, their lifestyle and their willingness to adapt behaviors that can improve their health.  The answers provided all correspond with a numerical value that determines the weighted risk value and health of the beneficiary.

Because Medicare Advantage companies receive payments from Medicare for each enrollee, Medicare uses this information to help calculate the payments. Health plans receive a prospective capitated payment that is based on the projected cost of care for each beneficiary.  Medicare adjusts the payment according to the amount of risk the company assumes per enrollee.  This helps ensure the company is able to cover the costs for the care for it’s enrollees.  That is why so many Medicare Advantage plan carriers offer their agents an incentive to ensure that new plan enrollees have the HRA completed.

For CMS to accept the HRA for the risk-adjusted payment, it must be either documented in the patient’s medical record or performed as a face-to-face visit with a licensed medical provider and the beneficiary.

Learn about CMS’ Part D drug cap

HRAs are an important tool

HRAs along with a good care management team are a great way to identify and support the specific health care needs of the individual to ensure improved health and better quality of life.

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