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Because there are so many regulations for Medicare sales, agents need to constantly be learning. That is why we will discuss Medigap Guaranteed Issue Rights in this post. This is a subject that is crucial to understand but often misunderstood.

Medigap Guaranteed Issue Rights

Guaranteed Issue (GI) Rights are protections under federal law that provide beneficiaries the right to purchase certain Medigap (Medicare Supplement) policies without having to go through medical underwriting. That means insurance companies can’t:

• Deny the beneficiary enrollment in a policy
• Charge enrollees more based on health
• Impose waiting periods for pre-existing conditions (in most cases)

These rights kick in during specific situations, often tied to changes in your health coverage or life circumstances.

When Guaranteed Issue Rights Apply

Here are some common scenarios that trigger GI rights:

Turning 65

Anyone who turns 65 has a 6 month period where they can enroll in a Medigap plan without having to go through underwriting.

Loss of Employer or Union Coverage

Individuals that have health coverage through an employer or union (including COBRA) that ends have 63 days from the end of that coverage to buy a Medigap policy using GI rights.

Medicare Advantage Plan Leaves a service Area

If a Medicare Advantage (MA) plan no longer provides service the enrollee’s area, is terminated, or they move out of the plan’s service area, they can return to Original Medicare and buy a Medigap policy under GI protections.

Beneficiary Tries a Medicare Advantage Plan for the First Time

Those who joined an MA plan when they were first eligible for Medicare at 65 and switch back to Original Medicare within the first 12 months can buy any Medigap policy offered in their state.

Medigap Insurance Company Goes Bankrupt or Misleads You

If the Medigap insurer goes out of business or the beneficiary is misled into buying a policy, they have GI rights to purchase another policy.

Trial Rights

In some cases, beneficiaries have “trial rights” that allow them to try out an MA plan and return to a Medigap plan under GI protections. This typically applies if they dropped a Medigap policy for an MA plan and want to switch back within 12 months.

Rules and Timelines

• Typically individuals have a 63-day window from the date previous coverage ends to use their GI rights.
• The plans that are guaranteed issue depend on eligibility and location. The standard Medigap plans are Plans A, B, C, F, K, or L.
• The federal government mandates guaranteed issue rights, although some states offer broader protections. It is important to check the rules for each state.

Watch a YouTube video on Medicare Supplement Underwriting GI & non-GI states

Why Guaranteed Issue Rights Matter

Without GI rights, applying for Medigap outside the initial enrollment period often means going through medical underwriting. Those who have pre-existing conditions could be denied coverage or charged more.

GI rights are a safeguard. They ensure that when life throws a curveball like; losing coverage, moving, or simply changing your mind, beneficiaries can access supplemental coverage without penalty.

Birthday Rule

There are 6 states that allow beneficiaries to change Medigap plans without underwriting during a specific period before/after their birthday each year on a GI basis. The states that have this rule are: CA, ID, IL,KY, LA, MD, NV, OK & OR. Each of these states has it’s own specific rules for this.

Important:

Some states allow beneficiaries to change Medigap plans any time or at specific times without undergoing medical underwriting. These states are: CT, NY, MA & ME.

In CT & NY enrollees change Medigap plans anytime of the year without underwriting. Massachusetts offers an annual open enrollment where beneficiaries do not have to go through underwriting. In Maine there is an open enrollment in June where Medicare Supplement enrollees can switch to a similar or lower benefit plan without underwriting.

Anyone applying under GI rights; insurance companies may request documentation (like letters from the former insurer). Keeping all notices and paperwork handy makes the application process smoother.

Medigap Guaranteed Issue Rights are an important part of the Medicare landscape, especially for those navigating transitions. Understanding when and how they apply allows you to help clients make informed choices and avoid gaps in healthcare coverage.

Each year, Medicare eligible indivduals wonder which type Mediare plan will cover their helath care needs best. Many beneficiareis wonder if they should enroll in a Medicare Supplement or a Medicare Advantage plan. Although both options provide comprehensive coverage, it is important for individuals to consider their needs and budget to make the best choice. In this post, we will go over some ways to decide the best candidates for MAPD Plans.

People Who Want All-in-One Coverage

MAPD plans are good for; anyone who prefers having all their healthcare benefits managed under a single plan. Plan enrollees only need to carry one ID card and pay for Part B and 1 plan premium. Although, some plans do not even charge a premium.

Private insurers offer Medicare Advantage plans (Part C) and bundle together:

• Part A (hospital coverage)
• Part B (medical insurance)
• Often Part D (prescription drug coverage)
• Plus extra perks like vision, dental, hearing, and wellness benefits

Budget-Conscious Individuals

Many MA plans offer low or even $0 monthly premiums. This is in contrast to Medigap plans (used with Original Medicare), which usually have higher premiums.

While enrollees are still responsible for copays and out-of-pocket costs, Medicare Advantage plans have annual out-of-pocket maximums. The maximums provide financial protection Original Medicare alone doesn’t offer. In other words, these plans are a great choice for those on a fixed income trying to cap their annual healthcare costs.

People Who Don’t Travel Often

Because Medicare Advantage plans generally have local provider networks, enrollees must see doctors and hospitals within the plan’s service area for non-emergency care.

These plans are a good choice for individuals who don’t travel often and usually receive care in their local area. MAPDs might not be a good fit for those who live in multiple states throughout the year.

Those Who Value Extra Benefits

Because Medicare Advantage plans usually offer additional benefits beyond what Original Medicare provides, some people prefer them over other options.

Some of the additional benefits (not included in Original Medicare) plans may offer are:

• Dental exams
• Vision exams and an eye wear allowance
• Hearing exams and hearing aid coverage
• Gym memberships
• Transportation to medical appointments
• OTC items
• Healthy food cards

Please note; this list varies by carrier plan type and area. Not all benefits are included in every plan.

Comfortable with Managed Care

Many Medicare Advantage plans involve managed care structures, like HMOs or PPOs, that coordinate your services and may require referrals or prior authorizations.

People who are comfortable navigating provider networks, or calling their plan for care coordination support may find these plans are a good option.

Those in Good Health

Because MA plans often come with copays for services, they may be more cost-effective for individuals who don’t expect to need frequent medical treatment. In other words, Medicare Advantage plans may be a good fit for healthy retirees who normally see a doctor a few times a year for annual checkups or minor services.

Best Candidates for MAPD Plans

Choosing the right Medicare plan depends on personal health needs, budget, and lifestyle. A Medicare Advantage plan can offer convenience, cost savings, and extra benefits,, only if it aligns with how much and where helathcare is needed.

Before enrolling, consider:

• Current doctors (are they in the plan’s network?)
• Medications (are they covered?)
• How often you travel
• Comfort level with managed care.

Medicare Advantage plans are not one-size-fits-all, but for the right person, they can be a useful, value-packed healthcare solution.

Agents click here to learn how Connecture and Sunfire can make quoting and enrollment easier

Before switching or enrolling for the first time, be sure to review options carefully. It is important to check each year during Medicare’s Annual Enrollment Period (AEP) for the plan that best suits current health care needs and budget. A licensed Medicare agent can provide options and help find the most suitable coverage option.

Health Savings Accounts (HSAs) offer a tax-advantaged way to save for medical expenses, but their benefits and rules change once you enroll in Medicare. Understanding HSAs and Medicare enrollment is crucial to avoid tax penalties and continue to benefit from the HSA.

How HSAs Work Before Medicare

An HSA is a tax-advantaged account that allows individuals with a high-deductible health plan (HDHP) to save and pay for qualified medical expenses. Contributions to HSAs are tax-free, in other words, any contributions lower taxable income. All investment growth and earnings are tax-free; indivduals can invest HSA money and will not pay taxes on any gains as long as the money is in the account. Additionally, money withdrawn for qualified medical expenses is tax-free. However, once an individual enrolls in Medicare, they can no longer contribute to an HSA.

Medicare Enrollment and HSA Contributions

Once enrolled in Medicare, the ability to contribute to an HSA stops. This includes enrollment in any part of Medicare, either Part A (hospital insurance) or Part B (medical insurance). Those who continue making HSA contributions after Medicare enrollment face tax penalties.

A few things to consider:

Medicare Enrollment Date Matters: HSA contributions must stop the month your Medicare coverage begins. If you enroll in Medicare mid-year, your contribution limit for that year will be prorated based on the number of months you were eligible to contribute before Medicare enrollment.

Retroactive Medicare Coverage: For those who enroll in Medicare after turning 65, Part A coverage may be retroactive for up to six months (but no earlier than the month you turned 65). This retroactivity can impact HSA contributions. Beneficiaries should stop contributing at least six months before applying for Medicare to avoid penalties.

Employer Considerations: Anyone working past 65 with employer-sponsored health insurance with an HSA option, may want to delay Medicare enrollment and continue contributing. However, once enrolled in Medicare, even retroactively, HSA contributions must stop.

Using HSAs After Medicare Enrollment

Although individuals can’t contribute to an HSA after enrolling in Medicare, they can still use the funds in their account. Benficiaries can use HSA funds tax-free for qualified medical expenses, including:

• Medicare premiums (except for Medicare supplement policies)
• Out-of-pocket medical costs such as copays, deductibles, and prescription drugs
• Long-term care services
• Some over-the-counter medications and medical supplies

Important: after age 65, HSA withdrawals for non-medical expenses are not subject to the 20% penalty that applies to those under 65. Although, those withdrawals are taxed as income.

Transition from HSA to Medicare

To avoid tax issues and optimize benefits, consider the following:

Time Your Medicare Enrollment: Those who plan to work past 65 and want to continue HSA contributions, consider delaying Medicare enrollment if employer coverage allows it.

Stop Contributions in Advance: Individuals planning to enroll in Medicare, stop HSA contributions at least six months before applying to avoid penalties due to retroactive Medicare coverage.

Maximize Existing HSA Funds: Plan the use of HSA funds for healthcare expenses, including Medicare premiums and out-of-pocket costs.

HSAs provide valuable benefits, but their rules change upon Medicare enrollment. Proper planning helps maximize savings and avoid unexpected tax penalties. Individuals approaching Medicare eligibility should consider consulting a financial or tax advisor to help ensure a smooth transition.

Medicare agents – watch some free training videos on our YouTube channel

If you are ready to contract with Crowe; click here for contracting

Understanding how HSAs and Medicare interact can help individuals make informed decisions that optimize healthcare savings and coverage.

As a licensed insurance agent, the goal is to help clients get the best coverage for their healthcare needs. In doing this, they are protected against financial loss. One product that can provide significant value to clients is hospital indemnity insurance. This coverage is an excellent addition to many health plans, particularly for individuals on Medicare Advantage plans or high-deductible health plans. In the post below, we answer the question; why offer hosptial indemnity insurance.

Hospital Indemnity Insurance

Hospital indemnity insurance is supplemental insurance that provides cash benefits to policyholders when they are hospitalized due to an illness or injury. Unlike traditional health insurance, which pays service providers, hospital indemnity insurance provides a lump sum or dialy benefit amount to the policyholder. Policyholders can decide how they use the money.

Benefits for clients

1. Fills coverage gaps: Many health insurance plans, including Medicare Advantage, have copays, deductibles, and out-of-pocket expenses that can add up quickly. Hospital indemnity insurance helps cover these costs, reducing financial strain.
2. Flexibility in use: Beneficiaries can use the cash benefits from a hospital indemnity policy any way they like. They can pay medical bills, household expenses, or travel costs associated with treatment.
3. Affordable premiums: Compared to major medical insurance, hospital indemnity plans are relatively affordable, making them accessible to many clients.
4. No network restrictions: Policyholders receive payment for a stay in any hospital, without worrying about network limitations.
5. Customizable plans: Many hospital indemnity policies let clients choose coverage amounts and additional riders. This can include; skilled nursing facility coverage or outpatient services.

Why and how to sell ancillary products – watch a quick YouTube video

Why agents should offer hospital indemnity insurance

1. Enhanced client protection: Offering hospital indemnity insurance demonstrates that you are proactive in helping clients manage potential healthcare costs that may not be covered by their primary insurance.
2. Increase client retention: When clients see the value in additional coverage, they are more likely to trust and stay with an agent who prioritizes their financial well-being. It is also helps build good client relations when all their coverage is provided by one agent.
3. Expand sales opportunities: Adding hospital indemnity insurance to your portfolio increases cross-selling opportunities, allowing you to provide more comprehensive solutions while expanding your revenue.
4. Stand out amoung competitors: Many agents focus solely on traditional health plans. Offering supplemental policies sets you apart and positions you as a more knowledgeable, full-service advisor.
5. Help seniors with Medicare Advantage Plans: Many Medicare Advantage plans have large hospital copay amounts. A hospital indemnity plan tailored to these costs provides clients with peace of mind.

Ready to add these products to your portfolio – click here for online contracting

How to introduce Hospital Indemnity Insurance to clients

Educate clients on coverage gaps: Explain how their existing health plan leaves them with a large out-of- pocket payment in the event of a hospital stay.

Provide real-life scenarios: If possible, use examples of how hospital indemnity insurance has helped individuals manage medical expenses.

Offer a needs-based approach: Assess each client’s unique situation and recommend hospital indemnity insurance as part of a holistic healthcare strategy.

Explain affordability: Break down the cost versus benefit so clients see the value of a small monthly premium compared to potential hospital expenses.

Some tips to maintain your book of business

Hospital indemnity insurance is a great way to protect clients against unexpected healthcare costs. As an agent, offering this coverage not only enhances your client’s financial security but also strengthens your reputation as a trusted advisor. Adding hospital indemnity insurance to your product offerings helps you provide a more complete approach to healthcare planning while expanding your business opportunities.

For veterans who qualify for both Medicare and VA (Veterans Affairs) benefits, understanding how these two healthcare systems work together is crucial. Although both programs provide coverage, they serve different purposes and operate independently. Coordinating Medicare and VA benefits can help maximize healthcare options and avoid unexpected costs.

Do Veterans need Medicare if they have VA benefits

VA benefits provide healthcare services through VA facilities, but do not cover care veterans receive outside the VA system. This is where a Medicare plan helps. While enrolling in Medicare is not mandatory for veterans, having both Medicare and VA benefits can expand healthcare choices. This helps ensure access to a variety of providers outside the VA network if needed.

Click here to find local VA facilities

How Medicare and VA benefits work together

It is important to note; Medicare and VA benefits do not coordinate directly. This means, one does not cover what the other does not. Instead, each program pays for services independently, depending on where veterans receive care:

VA Facilities

If you receive care at a VA hospital or clinic, only VA benefits cover the cost. Medicare does not pay for services at VA facilities.

Non-VA Providers

If you seek care outside the VA system, Medicare will provide coverage for approved services, but VA benefits will not. Without Medicare, veterans are responsible for the entire cost of care from non-VA providers unless you have other insurance.

How each part of Medicare interacts with VA benefits

Medicare Part A (Hospital Insurance): Covers inpatient hospital care. Many veterans qualify for premium-free Part A, making enrollment a good option even if they normally use VA facilities.

Medicare Part B (Medical Insurance): Covers outpatient care, doctor visits, and preventive services. Those who want access to non-VA doctors or specialists, enrollment in Part B is recommended.

Medicare Part C (Medicare Advantage): Private insurance plans that bundle Parts A and B, often including prescription drug coverage. Some plans offer additional benefits, although some may not work well with VA benefits since VA care providers are separate from Medicare Advantage networks.

Medicare Part D (Prescription Drug Coverage): VA benefits include prescription drug coverage, often with lower costs than Medicare Part D. However, enrolling in Part D can be beneficial for veterans who want access to non-VA pharmacies.

Tricare for Life and VA benefits

Some veterans also qualify for Tricare for Life (TFL), which serves as supplemental coverage for Medicare. In this case:

• Medicare pays first, then TFL covers remaining costs.
• VA benefits still work separately, covering care at VA facilities.

Should veterans enroll in Medicare

• Those who rely solely on VA benefits are limited to VA facilities, which could be problematic if they move or need non-VA care.
• Enrolling in Medicare Part B ensures access to non-VA providers and prevents late enrollment penalties.
• Individuals who plan to use VA prescription drug benefits exclusively can skip Part D enrollment without penalty, as VA drug coverage is considered creditable.

Although VA benefits provide excellent healthcare for eligible veterans, they have limitations, particularly when it comes to non-VA care. Medicare expands healthcare options and ensures comprehensive coverage in case of emergencies or provider preferences.

Veterans should carefully evaluate their healthcare needs and consider Medicare enrollment to maintain flexibility and avoid coverage gaps. A licensed Medicare agent can help go over all the options available and help find the best coverage for each individual.

Unfortunately, some beneficiaries incur unexpected penalties (LEPs) because they delay signing up for Medicare Part B or Part D coverage. However, they may have the right to appeal. In this post, we discuss how to appeal a Medicare LEP.

What is Medicare LEP (Late Enrollment Penalty)

Medicare imposes a Late Enrollment Penalty (LEP) when beneficiaries delay enrollment in Medicare Part B or Part D without having other creditable coverage (such as employer-based insurance).

Those who incur a Part B LEP pay a 10% increase in their monthly premium for every 12-month period they were eligible for Part B coverage but neglected to sign up.

The Part D LEP is calculated as 1% of the national base beneficiary premium multiplied by the number of months the beneficiary was not enrolled in a creditable Part D coverage. The provider of their Part D coverage adds this amount to their monthly premium.

Anyone assessed with one of these penalties will end up paying it for life (as long as they have Part B and/or Part D coverage). In other words, it is essential to enroll in coverage in a timely manner and act quickly if the penalty assessment may be an error.

Watch a YouTube video on OEP, SEPs & LEPs

When to appeal an LEP

Those who did not enroll in Medicare Part B and/or Part D but had creditable coverage should appeal the penalty. This happens when individuals have employment-based insurance. If this is the case, ask the employer for a letter proving enrollment and include it with the appeal forms.

In some cases, there could be a mistake and beneficiary was actually enrolled in Part B during part or all of the period in question. When this happens, they can use MSNs showing payment for care as proof of enrollment.

If the beneficiary is enrolled in an MSP plan, they are not charged LEPs.

In some instances, there are extenuating circumstances that prevent individuals from enrolling such as; natural disasters or health conditions. Sometimes individuals receive misinformation from either Medicare or a plan representative that causes them to miss an enrollment period.

How to appeal a Medicare LEP

Step 1: Review the penalty notice

If Medicare applies an LEP, you’ll receive a letter from your plan provider explaining:

• The reason for the penalty
• The amount
• How to appeal

Step 2: Complete the CMS LEP Reconsideration Request Form

Beneficiaries have 60 days from the date on the penalty letter to file an appeal. The LEP reconsideration request form comes with the notice. If you cannot locate one, call the plan provider and request one or use one below.

Click here to download a Part D LEP Reconsideration Request form

Download a copy of the Part B LEP Reconsideration Request Form

Step 3: Gather Supporting Documents

Include any relevant documents, such as:
Proof of prior creditable coverage (letters from past employers or insurers).
Records showing you received misinformation from Medicare or a plan representative.
Medical records or other documentation supporting an extenuating circumstance.

Step 4: Submit Your Appeal to C2C Innovative Solutions

The independent contractor handling Medicare LEP appeals is C2C Innovative Solutions, Inc.

• The address and contact details will be on your penalty notice.
• Send copies, not originals, of supporting documents.

Step 5: Wait for a Decision

C2C will review your appeal and issue a decision within 90 days. If the appeal is approved, the penalty is removed or adjusted. If denied, you may have further appeal rights.

Remember

Act quickly; there is limited time to appeal.
Keep copies of all documents you send.
Check your Medicare records to ensure accuracy.

Avoiding or appealing an LEP can save money in the long run. If there is any doubt that the penalty is justified, don’t hesitate to exercise the right to appeal.

Individuals getting started in Medicare sales or long time agents may be looking for the best FMO for Medicare agents to grow their business.   A good FMO can make all the difference in the world for an agent. They can provide invaluable knowledge, tools and support and expand on the agents value to their community.

Because we offer contracts with all the major carriers as well as many smaller carriers, we ensure the client receives the best coverage to fit their needs. Making sure the clients are happy should the agents top priority. Not only do we work with Medicare products but, we offer ancillary products. This ensures clients can shop for all their coverage in one place. Our ancillary products include dental, vision, final expense and several life insurance options.

Watch a YouTube video to see what we can offer you

When clients get all their coverage needs met in one place, it leads to better retention rates and stronger agent/client relationships. This helps agents maintain their book of business. It also ensures that clients go to the same agent with all their questions.

Click here for online contract and join the team at Crowe

It is easy to get selling with Crowe. There is no need for mountains of paperwork. Just fill out the online contracting kit. You will also need to send copies of your license, E&O , and a void check.  The contract has a section for agents to indicate which companies they want to contract with.  It is that easy.  Agents can easily add carriers to their contract by filling out a link or sending an email to us.

Best FMO for agents – What we have to offer

Agents receive full compensation

Every agent contract we offer is for the maximum allowable commission. Agents receive pay directly from the carriers; we do not take any part of the commission you earn.

Click here for Medicare commissions 2025

Our agents are independent

If you contract with us, you work for yourself and decide what hours you put in.  What you put in to your business is what you will get out of it. Because our agents receive their commission directly from the carriers, you own your book of business.  If you decide to ask for a release, you take your clients with you. Our job is to provide guidance and support when you need it.

Medicare lead program

Our agents are eligible to receive up to $500 per month as reimbursement for Medicare marketing and lead costs.  The only catch is; you must have all your Medicare contracts through Crowe. We do not impose production minimums to start and do not reduce your commission. 

 Click here to learn about our lead program.

Many ways to enroll a client

Due to the fact that we are partners with Pinnacle Financial Services, we can provide free quoting and enrollment tools. This allows clients to enroll in a plan in a way that is comfortable for them.

Voice signature

We offer many tools to quote and enroll that allow agents to use a voice signature. This includes Connecture, Sunfire and My Medicare Bot.

Click here to learn about My Medicare Bot.

Online enrollment with Connecture or Sunfire

Easily access online enrollment tools for Medicare Advantage, Supplement and Part D plans. All our agents have access to a personalized online enrollment platform.  There is no need to meet clients face-to-face if they are not comfortable doing so.  This saves valuable time for everyone when necessary.  Agents can send prospects a link to compare plans and self enroll from either site.

Find out about the updates in Connecture and Sunfire for 2025

Paper application processing 

Because some clients like to use paper applications, Pinnacle is one of the few uplines that still provides our agents application scrubbing & processing.

Additional product quotes

Agents who work with us have free access to Pinnacle’s online quote site.  The site not only quotes and compares Medicare Advantage, Medicare supplement and Part D plans but includes; Final Expense, Term, UL, Hospital indemnity, vision and dental plans.   Take a look at a site demo.

Turn-key seminar program

We offer agents a Medicare seminar program. This is a great option for agents who enjoy presenting invaluable information to those who need it.  Our seminar program allows agents to get out and meet at least 40 to 60 T-65 prospects at each event.  Many prospects are more comfortable when they meet an agent face-to-face and this is a great way to do it.

Each agent has access to a personal portal where the seminar registrants’ contact information is stored. This lets you follow up with those who want your help.  All invites are sent out for you and all you have to do is book a venue, present your information and close the sale!

Learn the Details of Our Seminar Selling Program

Training webinars

We send out weekly invites to any agent who wants to learn about new products and regulations. All our webinars are available on our YouTube channel so you can view them at your convenience.  Our videos cover many topics including:  Sales strategies, enrollment and marketing rules, product knowledge, and how to use the sales tools available to our agents.

Take a look at our YouTube channel for some free training videos.

Additionally:

If you want help growing your book or building an agency, we are here for you.  Agencies working with us can use our programs and tools to recruit and train agents.  This includes our Medicare lead program.  This program is a great help to new agents and provides incentive for them to join your agency.

Please note;  each carrier has specific requirements for the various agency levels.  We are here to help you get to the level you are want to be at.  Up-line levels include GA, MGA and SGA levels.

Learn about our discounted E&O coverage; both agents and agencies can purchase our E&O.

Our E&O covers multiple lines of business including; Life, Health, LTC  & FE as well as Annuities, both fixed and indexed

More Agency Programs and Benefits – Click here

If you’re a Medicare beneficiary with higher income, you may be subject to the Income-Related Monthly Adjustment Amount (IRMAA) for your Medicare Part B and Part D premiums. However, if your income has recently decreased due to qualifying life events, you may be eligible to appeal the IRMAA determination. Here’s what you need to know about how to appeal an IRMAA.

What is an IRMAA

The Medicare Income-Related Monthly Adjustment Amount (IRMAA) is an extra charge added to Medicare Part B and Part D premiums if the beneficiary’s income exceeds certain thresholds. The Social Security Administration (SSA) determines IRMAAs based on the tax return from two years prior. In other words, a 2025 IRMAA is based on 2023 income.

IRMAA brackets 2025

When you can appeal an IRMAA

Medicare beneficiaries may appeal an IRMAA redetermination if they experience a significant life-changing event that cause a reduction in income. Qualifying events include:

1. Marriage, divorce, or annulment
2. Death of a spouse
3. Retirement or reduction of working hours
4. Loss of a pension or settlement of an employers pension plan
5. Loss of income-producing property due to a disaster or other circumstance

Any of these situations may cause a decrease in income. This provides grounds for an appeal.

How to File an IRMAA Appeal

To file an appeal, beneficiaries must complete Form SSA-44, Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event. Here’s how to do it:

1. Download the Form – Obtain Form SSA-44 from the Social Security website or by at the local Social Security office.
2. Complete the Form – Provide details about the life-changing event, including supporting documentation (such as a marriage certificate, employer statements, or tax returns).
3. Submit the Form – Either mail or deliver the completed form and supporting documents to the local Social Security office.
4. Await a Decision – SSA will review the request and notify the beneficiary of the outcome. If they deny the appeal, the beneficiary may request a further review.

To Sum it up

If your income changes due to a qualifying event, don’t hesitate to appeal an IRMAA determination. Many beneficiaries successfully lower their Medicare premiums through this process. Be sure to gather all necessary documentation and submit the appeal as soon as possible to avoid overpaying.

For more details, visit the official Social Security Administration website or contact your local SSA office.

Medicare commissions are not as straight forward as we want them to be. Many agents are confused when they receive their commission deposits. That is why reading Medicare Commission Payments Explained may help unravel the mystery. It is important to note: commission payments require a certain amount of attention to detail.  

CMS and commissions

Each year the maximum allowable commissions for Medicare Advantage and PDP sales is set by CMS. The amounts vary by state and can usually be found online once they are available. Unfortunately, there are many different situations that determine how much of that commission an agent receives for each sale.

For the last several years, CMS has consistently raised the commission rates. The renewal amount differs from the amount agents receive for an initial enrollment. Renewal commission amounts also change annually and add up to half the amount of the initial enrollment commission rate. The rates are decided by state and each state is put into a group. The state groupings are (CA and NJ), (CT, PA and DC), (Puerto Rico and US Virgin Islands) and all the other states are in the “National” bucket.  The highest pay goes to CA and NJ, followed by CT,PA and DC, then the national bracket.  Puerto Rico and Virgin Islands pay the lowest amounts.

Watch a recorded webinar to learn more about commission payments CLICK HERE TO VIEW.

Initial payment, true up and pro-rata

In 2025, the max commission for an MAPD sale in CT is $705 with renewals at $353 for the year.  That sounds easy enough, but it is not that simple.  The amount of commission an agent receives depends on the situation.  We provide a breakdown below:

Medicare Advantage commission payments – new to Medicare 

If your client is new to Medicare, the carrier pays the full commission in two payments:  the intial payment, then the true up payment.  The two will total up to the full amount.  The renewal commission rate will be half of the full amount and pays over the course of 12 months starting in January. (Regardless of the effective date of the original sale).

New to Medicare Advantage but not new to Medicare 

If the client enrolls in a Medicare advantage plan for the first time, the commission is the same as a new to Medicare enrollment. The difference is how the carrier pays it out.  The commission is pro-rated.  In other words, the payment amount is based on the month the plan is effective.  So if someone is enrolled for a June 1 effective date, the agent receives 50% of the full commission. (They will be in the plan for 6 out of the 12 months.)  If the person is enrolled for a March 1 effective date, the agent receives 75% of the commission and so on. The renewal starts in January and the agent receives the full renewal amount.

Click here to find out what the 2025 commission rates are

Changing from one Medicare Advantage to another 

When your client changes from one MA/MAPD plan to another, the agent receives the same amount when they renew an MA/MAPD plan (half the new enrollment commission).  If you enrolled a PA client in an MAPD plan with a Jan 1 start date, the commission is $353. However, plan changes are also pro-rated and if you enroll a PA client in a plan with a March start date, you receive 75% of the $353. In other words, $264.75.

See what to do about non-commissionable PDP plans

Commission payments for AEP

The commission rules do not change during AEP although when agents receive their payment does.  Any clients agents enroll during AEP will not pay out until January. Insurance carriers are not permitted to pay them before then enrollment goes into effect. Therefore, most carriers pay out sometime during January.

Use the links below to learn more about our Medicare lead program and T-65 seminar program:

Medicare lead program

Medicare sales seminar program

Click here if you are ready to fill out an online contract and join the Crowe team

In some cases, Medicare beneficiaries miss an enrollment period due to a FEMA emergency. When this happens, beneficiaries may be eligible for a DST SEP. It is imperative that agents are aware of the New Medicare FEMA SEP rules to assist clients. The DST SEP is available to qualified individuals who miss an opportunity to enroll in a Medicare plan.

Medicare FEMA SEP  

The DST SEP is an enrollment opportunity CMS offers to Medicare beneficiaries affected by either weather-related emergencies or major disasters. The FEMA SEP lets those who miss a valid election period to either enroll in or disenroll from a Medicare plan. The enrollment takes effect the first day of the month after application is submitted.

This is only available in areas where FEMA, state or other local government officials declare an emergency or disaster. FEMA emergencies start when the incident occurs and lasts for two months up to one year after the start or the extension period begins.   

Important changes the the FEMA SEP

On December 3, 2024, CMS released a memo that announced changes to the DST election. These changes go into effect as of April 1, 2025.

If a beneficiary needs to submit an application using the DST election period either on or after April 1, 2025, the application must be submitted directly through CMS. Beneficiaries can call 1-800-MEDICARE or TTY 1-877-486-2048 to submit an application.

In other words, CMS will not accept applications that use the DST election even if they are broker assisted.

Any enrollment application that uses this election will be labeled as using an invalid election period. The plan will then attempt to contact the enrollee and obtain a valid election period. If the plan cannot verify a valid election period, the application will be denied.

Important: missing or invalid elections do not trigger the (RFI) Request for Information process. Therefore, beneficiaries do not have additional time to respond to the inquiry or correct their election.

Please note; applications and disenrollment forms will be updated to remove the DST election.

Reasons to use this SEP

There are varied opportunities to use the SEP. This ensures individuals have the coverage they need.

If the beneficiary resides where a natural disaster (earthquake, flood, wildfire, hurricane, tornado or other specific incident) resulting in a missed valid enrollment period. Sometimes disasters cause beneficiaries to have to leave their home. This may result in them missing their enrollment period and enable the use the FEMA SEP.

The SEP is sometimes available when a beneficiary relies on a family member or other caregiver who is impacted by a disaster and they are unable to assist them during their enrollment period. 

Other instances that allow for SEP use include; inability to access Medicare plan information or submit a timely enrollment due to a FEMA declared disaster. Enrollees may also use the SEP when the beneficiary’s healthcare provider of facilities are impacted by the disaster. This can result in the inability to receive necessary information to make an informed decision.

Rules for Eligibility for Medicare Disaster SEP  

In order to use the SEP, the beneficiary must live in the are where the disaster occurred. They must have missed a valid enrollment period (AEP, IEP, OEP) during the time of the incident as long as they did not already make a change during the enrollment period. It is also acceptable for those who need assistance from another person to complete the enrollment or make healthcare decisions.

Who cannot use this SEP

Anyone who has already changed their plan during a valid election period can’t use the FEMA election to change it again. Beneficiaries must call 1-800-MEDICARE or TTY 1-877-486-2048 to submit an application in a timely manner to avoid missing their window to enroll.