Blog

Although there are millions of people on Medicare, many find it a confusing subject especially since there are so many different parts to it. For individuals approaching 65 or anyone who or just wants to understand more about how this insurance works, here’s a brief answer to the question; what is Original Medicare and what does it cover.

What Is Original Medicare

The federal government established Original Medicare, a federal health insurance program, in 1965. The following individuals may qualify for Medicare benefits:

• People age 65 or older
• Certain younger people with qualifying disabilities
• People with End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s disease)

There are 2 parts of Original Medicare: Part A and Part B.

Medicare Part A

Medicare Part A is sometimes referred to as hospital insurance. It provides coverage for:

• Inpatient hospital care (once the enrollee is formally admitted)
• Skilled nursing facility care (following a qualifying hospital stay)
• Home health care (limited and medically necessary services)
• Hospice care for individuals with a terminal illness

For most people, Part A is free,there is no premium payment as long as eiither the beneficiary or thier spouse worked and paid Medicare taxes for a minimum of 10 years.

Please note: Although Part A covers hospital stays, it doesn’t cover long-term care such as; nursing homes, custodial care or unlimited days in a hospital or facility. There are limits to what it pays; beneficiaires must pay a portion of their expenses (cost-sharing), such as deductibles and coinsurance and copays.

Medicare Part B

Medicare Part B is also known as medical insurance. It provides coverage for the following:

• Doctor visits and outpatient medical care
• Preventive services such as; wellness visits, flu shots and cancer screenings
• Durable medical equipment (DME) this include things like; walkers, wheelchairs, oxygen as well as some diabetes supplies and more
• Lab tests and diagnostic imaging
• Mental health services
• Some home health care

Unlike Part A, beneficiaries do pay a monthly Part B premium. Fo rmost people, this is a standard amount although higher-income beneficiaries may pay an additional cost.

Click here to learn more about Part B eligibility

Part B coverage includes an annual deductible (this amount is adjusted annually). Typically beneficiaries pay 20% coinsurance for most covered services; in other words, Medicare pays about 80% of the cost leaving enrollees responsible for the remaining 20%.

What Original Medicare Doesn’t Cover

Original Medicare provides coverage for many medical expenses; although, they do not cover everything. Some important things to know about what Medicare does not cover:

• Prescription drugs (beneficiaries must enroll in separate Part D plan)
• Routine dental, vision, and hearing care
• Long-term custodial care
• Most care received outside the U.S.

In order to fill some of these coverae gaps, many people purchase additional insurance. Some of the plans people choose are; Medicare Supplement (Medigap) plans, Stand-alone PDP (prescprion Drug) plans, Medicare Advantage (Part C) plans. Beneficiaries also may opt for ancillary coverage like dental, vision and hearing or cancer heart attack and stroke plans.

Medicare agents; learn how to sell ancillary products with Medicare – watch a quick video.

Original Medicare provides valuable health coverage for millions of Americans, but it’s important to understand what it cover and what it doesn’t. Knowing the basics helps beneficiaries make informed decisions and avoid unexpected costs.

When helping clients plan for their healthcare coverage needs, it’s important to discuss not just what Medicare does cover, but also what it doesn’t. Understanding these gaps can help clients avoid unexpected expenses and make informed decisions about supplemental insurance options. Let’s take a closer look at some of what Medicare won’t cover.

Long-Term Care

One of the biggest misconceptions about Medicare is that it covers long-term care, like nursing home stays or in-home care for chronic conditions. In reality, Medicare only covers short-term skilled nursing care under specific conditions. Clients may need separate long-term care insurance or other financial strategies to cover these considerable costs. Learn about short-term care vs long-term care plans.

Most Dental Care

Routine dental services such as cleanings, fillings, tooth extractions, dentures, and dental implants are generally not covered by Medicare. If dental care is important to your client, you should explore standalone dental insurance or Medicare Advantage plans that offer dental benefits.

Learn about stand-alone dental coverage available in all 50 states

Vision Care

Medicare does not cover routine eye exams for glasses or contacts. It will, however, cover eye exams related to medical conditions like glaucoma or cataracts. Clients needing regular vision care might consider standalone vision insurance or a Medicare Advantage plan with vision coverage.

Hearing Aids and Exams

Original Medicare doesn’t cover hearing aids or exams for fitting them, which can be a significant expense. Some Medicare Advantage plans offer hearing benefits, so this is worth exploring based on client needs.

Routine Foot Care

Routine foot care, such as treatment for corns, calluses, or nail trimming, is not covered unless it’s deemed medically necessary due to a condition like diabetes.

Overseas Health Care

Most care received outside the United States is not covered by Medicare. For clients who plan to travel internationally, consider recommending a Medigap plan that includes foreign travel emergency coverage or a separate travel insurance policy.

Elective Surgery

Medicare won’t cover elective cosmetic surgeries, such as facelifts or liposuction. It will however, cover surgeries that deemed medically necessary, such as reconstructive surgery after an accident or some forms of cancer.

Key Takeaways for Agents

This is just an idea of what is not covered by Medicare, for a complete lists click here.

• Discuss Supplement Options: Educate clients on the benefits of Medigap (Medicare Supplement) plans, Medicare Advantage plans, or standalone insurance options for things like dental, vison & hearing or other ancillary products to fill the coverage gaps.
• Tailor Recommendations: Understand each client’s lifestyle and health priorities to recommend the right supplemental coverage.
• Plan for the Unexpected: Help clients build a financial plan that anticipates out-of-pocket healthcare expenses.

Being proactive about Medicare’s limitations helps clients better prepare for retirement. As agents, we can offer tremendous value by guiding clients through their options to ensure they have the comprehensive healthcare coverage they need.

To get some tips to maintain your book of business; click here

In this post, we discuss the basics of Medicare enrollment for those approaching 65 and for agents getting started in Medicare sales. Trying to navigate all the ins and outs of Medicare may be a bit confusing, but it does not have to be. Understanding when and how to enroll in Medicare is key to ensuring beneficiaries receive the best coverage for their needs.

Original Medicare

Original Medicare consists of Part A & Part B. It is a federal health insurance program put in place for individuals aged 65 and older or younger individuals with a qualifying disability or those with End-Stage Renal Disease (ESRD). Medicare provides coverage for many healthcare services, including hospital stays (Part A), and doctor visits (Part B).

It is important to note; Medicare covers approved expenses at about 80% after beneficiaries meet the Part B deductible.

The Parts of Medicare

Before diving into enrollment, it’s helpful to understand the different parts of Medicare:

• Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care.
• Part B (Medical Insurance): Covers outpatient care, doctor visits, preventive services, and some home health care services.
• Part C (Medicare Advantage): An alternative to Original Medicare (Parts A and B) offered by private insurers. Often includes additional benefits like vision, dental, and prescription drug coverage.
• Part D (Prescription Drug Coverage): Helps cover the cost of prescription medications. Beneficiaries may receive coverage through a Medicare Advantage plan or a stand-alone PDP plan.

Medicare Enrollment Periods

There are several enrollment periods to be aware of:

Initial Enrollment Period (IEP)

This is the first opportunity to sign up for Medicare. It lasts seven months:

• Begins three months before the month individuals turn 65
• Includes their birth month
• Ends three months after the month they turn 65

In most cases, those already receiving Social Security benefits are auto-enrolled in Original Medicare (Parts A and B). If they are not, they must enroll via the Social Security Administration.

General Enrollment Period (GEP)

Individuals who miss their Initial Enrollment Period can use the GEP to enroll between January 1 and March 31 each year. Coverage starts the first day of the month following enrollment. Please note; those who miss their initial enrollment period and don’t have other creditable coverage (usually through an employer) may face late enrollment pentalties.

Special Enrollment Period (SEP)

In some cases, individuals qualify for a Special Enrollment Period if they delayed Medicare because they had coverage through an employer or union. This SEP allows them to enroll without penalty when their other coverage ends.

Annual Enrollment Period (AEP)

AEP Each year from October 15 to December 7, beneficiaries can:

• Switch between Original Medicare and Medicare Advantage
• Switch from a Medicare Advantage plan back to Origianl Medicar
• Change from one Medicare Advnatage plan to another
• Join, switch, or drop a Part D plan

Medicare agents watch a YouTube video on marketing rules for AEP

How to Enroll in Medicare

There are a few ways to enroll in Medicare:

• Online at ssa.gov/medicare
• By phone by calling Social Security at 1-800-772-1213
• In person at your local Social Security office (call ahead for an appointment)

A Few Tips

• Beneficiaries should mark their calendar so they do not miss their enrollment window. Delaying enrollment can lead to gaps in coverage and penalties.
• Ask questions! Medicare can be complex, and there are plenty of free resources available to help. This is where it is important to have a reputable , licensed Medicare agent to provide guidance.
• Because Medicare does ot cover 100% of medical expenses, beneficiaries need to consider additional coverage options; Medicare Advantage or Medicare Supplement and Prescrption Drug plans.

Learn how to appeal a Medicare LEP

Understanding the basics of Medicare enrollment is a vital first step in managing healthcare needs. With a little preparation and the right information, beneficiaries can make good decisions that provide peace of mind and the coverage that best suits their needs.

Agents:

If you need a scope of appointment – click here

Ready to join the team at Crowe – click here for online contracting

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.

For individuals receiving SSDI (Social Security Disability Insurance), transitioning from SSDI and aging into Medicare is an important milestone. Although most Medicare beneficiaries become eligible at age 65, SSDI recipients qualify for Medicare after a 24-month waiting period. Understanding how SSDI benefits interact with Medicare eligibility helps ensure a smooth transition and access to essential healthcare services.

SSDI and Medicare

Social Security Disability Insurance (SSDI) provides financial assistance to individuals who are unable to work due to a qualifying disability. After receiving SSDI benefits for a period of 24 months, individuals become eligible for Medicare, regardless of age. This allows disabled individuals to access crucial medical care without waiting having to wait until they turn 65.

SSDI Recipients Medicare Milestones

24-Month Waiting Period: Most SSDI recipients must wait 24 months from the date they start to receive disability benefits before Medicare coverage begins.

Automatic Enrollment: After the waiting period, eligible individuals are automatically enrolled in both Medicare Part A and Part B.

Early Medicare: Individuals with specific conditions, such as End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis/Lou Gehrig’s Disease (ALS), automatically qualify for Medicare. They do not have to wait the standard 24-months.

SSDI Recipients and Medicare Coverage

Once enrolled, SSDI beneficiaries have access to Medicare benefits including:

Medicare Part A: Covers inpatient hospital care, skilled nursing facility stays, hospice care, and some home health services.

Medicare Part B: Provides coverage for outpatient medical services, doctor visits, preventive care, and (DME) durable medical equipment.

Optional Medicare Part D: These plans provide prescription drug coverage; are not part of Original Medicare and are offered by independent insurers. SSDI recipients can choose to enroll in these plans separately.

Medicare Advantage or Supplement Plan

SSDI recipients can choose to:

Keep Original Medicare (Parts A & B) and add a Medicare Supplement (Medigap) plan to help cover out-of-pocket costs. Plase note; Medigap options may be limited before age 65.

Enroll in a Medicare Advantage (Part C) plan, which often include additional benefits such as; prescrption drug coverage, dental, vision, otc, transportation and more.

Purchase a stand alone Medicare Part D plan those who choose to stay in Original Medicare either with or without a Medigap plan, may purchase a PDP plan to cover prescription medications.

Aging into Medicare

When SSDI recipients reach 65, they transition into the standard Medicare program. This gives them new coverage options and opportunities.

Medicare Supplement Open Enrollment Period

SSDI recipients under 65 have limited Medicare Supplement options because not all states require insurers to offer plans to those under 65. However, once the beneficiary turns 65, they enter a six-month Medicare Supplement Open Enrollment Period. During this time, they can choose any Medigap plan available in their state without medical underwriting. This is an important opportunity to purchase additional coverage without being denied due to pre-existing conditions.

Learn more about Medicare Supplement guaranteed issue rights

Medicare Advantage Plans

While SSDI recipients under 65 may have fewer Medicare Advantage plans available to them, turning 65 gives them access to more Medicare Advantage plans, often with enhanced benefits.

Lower Medicare Supplement Premiums

Medicare Supplement premiums for beneficiaries under 65 can be significantly higher due to their disability status. However, when they turn 65, they are eligible to enroll in a Medigap plan with standard premium rates.

Opportunity to Switch Plans:

SSDI beneficiaries who initially enrolled in a Medicare Advantage or Medicare Part D plan may find better options available at 65 that meet their healthcare needs or offer lower costs.

Employer or Retiree Coverage

Some SSDI recipients become eligible for employer-sponsored retiree health benefits at 65. If this is the case, they should evaluate how this coverage works with Medicare and whether they need any additional Medigap or Medicare Advantage coverage.

Learn more about Medicare and employer coverage

Prescription Drug Coverage

At 65, beneficiaries may have access to new Part D prescription drug plans that offer better coverage for their specific needs. Turning 65 is a great time to review all options and switch plans if needed. Please note; coverage changes each year and the Annual Enrollment Period is an important time to make necessary changes.

Agents watch a quick video on Sunfire and Connecture enrollment platforms

Medicare provides critical healthcare for SSDI recipients before age 65, but the process of aging into Medicare benefits requires careful planning. Understanding Medicare enrollment timelines, coverage options, and the opportunities available upon turning 65 can help SSDI beneficiaries maximize their benefits and avoid coverage gaps. Consulting a licensed Medicare agent can help ensure the best plan choices based on individual health needs and financial considerations.

Medicare Advantage (MA) plans are growing in popluarity as an alternative to Original Medicare, often attracting enrollees with low premiums, extra benefits, and all-in-one coverage. However, understanding the true Medicare Advantage Plan cost breakdown is crucial to avoid unexpected financial burdens. Here’s a detailed look at the key expenses associated with Medicare Advantage plans.

Premiums

Many MA plans advertise low or even zero-dollar premiums. However, enrollees must still pay the standard Medicare Part B premium ($185 per month in 2025) unless they qualify for financial assistance. Some plans may also charge an additional monthly amount for extra benefits, like dental comprehensive coverage.

Deductibles and Copays

Unlike Original Medicare, which has standardized costs, Medicare Advantage plans vary widely in deductibles and copay amounts. Enrollees of some MA plans must to meet an annual deductible before coverage kicks in, and they charge copays for doctor visits, hospital stays, and prescription drugs.

Out-of-Pocket Maximums

One advantage of MA plans is that they have an annual out-of-pocket maximum, unlike Original Medicare. In 2025, the maximum amount a MA plan CMS allows MA plans to charge for in-network services is $9,350. Please keep in mind, not all plans charge this amount for an out-of-pocket maximum; most plans have lower MOOPs. This is the most they are allowed to charge, the amount varies greatly by plan. Once this limit is reached, the plan covers all additional costs for the remainder of the year.

Out-of-Network Care

Most MA plans operate within a provider network. HMO plans require enrollees to use only in-network providers, while PPO plans allow some out-of-network visits at a higher rate. Please note; unless you are in a emergency situation, seeking care outside the network can lead to significant additional expenses.

Prescription Drug Costs

Many Medicare Advantage plans include Part D prescription drug coverage. The cost for prescrptions vary based on the plan’s formulary. Factors such as tiered formulary pricing and preferred pharmacy networks can influence out-of-pocket expenses for medications. Most plans also have a prescription deductible to meet for medications over a specific tier level.

Hospitalization and Specialist Care

While MA plans cover hospital and specialist care, costs can add up quickly. Some plans charge daily copays for hospital stays. Additionally, specialist visits usually have higher copays than PCP visits or require referrals, adding another charge.

Extra Benefits and Hidden Costs

Medicare Advantage plans often include extra benefits like dental, vision, and hearing coverage. However, these benefits may have limitations, such as caps on coverage or a restricted provider network, which can lead to unexpected out-of-pocket expenses.

Travel and Emergency Care Costs

Unlike Original Medicare, which offers nationwide coverage, most MA plans have geographic restrictions. If you travel frequently, you may face higher costs for out-of-network emergency care or require a plan with national coverage options.

Agents see how easy it is to compare MA plans with Sunfire and Connecture

Medicare Advantage plans can be a cost-effective option for some enrollees, but it’s essential to understand the full financial picture. By carefully reviewing plan details, including premiums, out-of-pocket limits, network restrictions, and prescription drug costs, enrollees can make informed decisions about healthcare coverage and avoid expensive surprises.

Need a scope; click here

There have been some important Medicare SEP changes in 2025 that both agents and enrollees need to be aware of. These regulations were put into effect by the CMS. We will explain those changes and how to navigate them. We’ve summarized the changes and how they could impact your clients.

SEPs for D-SNPs & LIS enrollees

As of January 1, 2025 CMS eliminated the quarterly SEP that let dual eligible individuals or those with LIS make MA/MAPD Medicare Advantage plan changes once each quarter during the first 3 quarters.

What replaced the quarterly SEP for D-SNP & LIS enrollees

Instead of a quarterly SEP, CMS has provided a monthly SEP (Code DEP). This allows DSNP and LIS beneficiaries to disenroll from their MAPD plan and enroll in Original Medicare and a standalone PDP. The SEP also allows LIS members to switch their current PDP coverage to another PDP plan.

There is also a monthly integrated SEP (INT-SEP). This SEP allows only full dual eligible beneficiaries to switch to or from one integrated D-SNP with aligned Medicaid plan to another.

Monthly INT SEP details

Full Dual Beneficiaries can use the INT-SEP once per month. The effective date of the new plan will be the first day of the following month.

Plans that are eligible for the INT-SEP include:

• FIDE SNP: Fully Integrated Dual Eligible Special Needs Plan
• HIDE SNP: Highly Integrated Dual Eligible Special Needs Plan
• AIP: D-SNP is an Applicable Integrated Plan 

Although dual eligible plan enrollees can change plans monthly, staying in their current plan allows them to avoid disruptions to their coordinated care plan.

Disaster (DST) SEPs

CMS has also changed the SEP (DST-SEP). The DST SEP is for those affected by an event that results in a government declared disaster or other emergency. The election process will change as of April 1, 2025.

Medicare beneficiaries who miss a valid election period due to a government declared disaster or emergency must follow these guide lines:

Beneficiaries who qualify for the DST SEP must submit applications directly through CMS by calling 1-800-MEDICARE or TTY 1-877-486-2048 to submit an application.

In other words, CMS will not accept broker assisted DST applications.

Despite the changes to these SEPs, full and partial dual eligible beneficiaries can continue to use other SEPs, if they are eligible (AEP, OEP, move, loss/gain of eligibility, etc.).

Residents of CT and Medicare agents who offer plans in CT need to be aware of the changes to the CT MSP income limits 2025. The MSP program provides assistance to beneficiaries with limited incomes to help cover their medical costs. Understanding the CT MSP income limits is extremely important for anyone on Medicare and has a limited income. Especially if they depend on financial assistance to access needed healthcare.

What is MSP (Medicare Savings Program)

MSP stands for The Medicare Savings Program. Each state administers this program and provides assistance with medical costs for individuals on Medicare with limited income and resources. It helps pay Medicare premiums, deductibles, coinsurance, and copays.

To participate in the program, you must be eligible for Medicare Part A (hospital insurance) and meet income and asset criteria. In the state of CT, DSS administers the Medicare Savings Program.

CT MSP Income Limits 2025

The MSP in CT provides 3 different levels of help. Each level has a separate income limit that qualifies beneficiaries. Please note; the income limit is adjusted based on household size.

The 2025 income limits for each level of MSP are listed below:

Qualified Medicare Beneficiary (QMB)

Those who qualify for the QMB level recieve the highest level of help.  Individuals who qualify for this program, have income of up to 100% of the FPL (Federal Poverty Level).  The QMB program pays the Part B Medicare premium, deductibles, coinsurance, and copays.

Individuals with a monthly income of $2,752 for an individual and $3,719 for a couple qualify as QMBs.

Learn about medicare Extra Help

Specified Low-Income Medicare Beneficiary (SLMB)

The SLMB level pays for the Medicare Part B premiums and does not cover deductibles or coinsurnae payments.

Individuals who have an income level of $3,013 per month for an individual or $4,072 a month for a couple. In other words, individuals must have an income level between 100% and 120% of the FPL.

Additional Low-Income Medicare Beneficiary (ALMB)

The ALMB is similar to the SLMB program; it pays the Medicare Part B premium only. It does not cover deductibles or coinsurance payments. It is availabel to those who have income between 120% and 135% of the FPL.

To qualify for this level of help; indivduals must have monthly income of $3,209 for single or $4,336 for a couple.

Please note: This program is subject to available funds and is issued on a first come first served basis

How to Apply for CT MSP

Those who want to apply for CT’s MSP program can do so through the Department of Social Services (DSS).

Individuals must complete a CT state (W-1QMB) application form. There are a few different ways to complete and return the form;  online, through the mail, or in-person at a local DSS Regional Office.  

Beneficiaries must provide information such as: Medicare enrollment status, income, assets, and other relevant information. DSS provides help with the application for anyone who needs it. Beneficiaries can also have an authorized person complete the application if needed.

Click here for a list of local DSS offices.

To apply online, visit www.connect.ct.gov, click on the ‘Apply for Benefits’ tab and apply as directed.

Those who wish to apply for MSP only; download and complete application below:

Medicare Savings Program Application (W-1QMB)

Formulario de Renovación de programas de ahorro de Medicare (W-1QMBS)

To apply for other assitance programs as well as the MSP program: SNAP (food stamps), Medicaid for Employees with Disabilities (MED-Connect), Medicaid for the Aged/Blind/Disabled (HUSKY C), and/or cash assistance, download the application below.

Click here to apply for Husky C and or Cash assistance program benefits

Haga clic aqui para Husky o asistencia en efective CW-1ES Solicitud de Beneficios

The CT MSP program provides an essential service to qualified individuals. It provides financial assistance to cover Medicare costs.

Agents who want to be part of the team at Crowe – click here for onine contract

Watch a YouTube video and learn about changes for Dual, Partial Dual and LIS SEP changes

For additional information on how to apply, please visit www.ct.gov/dss/apply.

Because Medicare agents have a large number of products to choose from when deciding what to sell, we explain why offer Physicians Mutual dental plans in the post below.

Dental products provide necessary coverage not offered by original Medicare. Because poor dental health can lead to serious health issues, regular dental checkups can help avoid health problems down the road.

There are 4 different dental plan options

Each plan provides coverage for over 400 procedures. The difference between the plans is the premium and the amount the plan pays for each covered service. There are plan choices to fit any budget.

All plans provide 100% coverage for preventive treatment at an in-network dentist. This includes; an exam, x-rays and a cleaning.

Take a look at the CT dental Brochure

Please note; There is a 12 month waiting period on major benefits.

All plans use the Ameritas network of providers. There are more than 5000,000 provider locations for member to access. All these plans are PPOs so members can receive out of network coverage for services, but it is always better to use in network providers for the best value.

Economy

As you have probably guessed; these plans are the lowest cost plans.

The Economy plans pay 25% of the maximum allowable charge for Basic treatments (fillings) and Major benefits, such as root canals or crowns.

Standard

Standard plans are another affordable option for dental coverage. They provide a payment of 40% of the maximum allowable charge for basic and major treatments.

Preferred

Preferred plans are similar to the other plans. The plan cost is a little more and so is the coverage percentage members receive. These plans provide 55% payment of the maximum allowable charges for basic and major benefits.

Premier

The Premier plans are the highest coverage level available at Physicans Mutual. This plan pays 70% of the maximum allowable charge for covered services..

Click here for product availability Map

A few more reasons to offer Physicians Mutual Dental Plans

These plans do not require members to pay a deductible. All preventative benefits are covered at 100% from day 1. One important aspect of this plan is; there is no maximum on cash benefits like other plans. That makes these plans a fantastic value no matter which plan beneficiaries choose.

Watch a video on the Physicians Mutual Dental plans

It is easy for members to add a vision and hearing rider to any plan. Once added members can use any participating provider.

See why you should offer ancillary products to your clients

Eye exams are covered up to $100 per year per member. The vision correction benefit of $150 includes prescription eyeglasses, sunglasses, sports glasses and contact lenses. There is a 3 month waiting period for this benefit. Members use the VSP network of providers to receive a discounted price for eye exams and lenses.

The hearing benefit provides up to $75 per member for covered hearing exams and as much as $500 per hearing aid per ear after a 12 month waiting period.

Click here for online contracting with Crowe

Understanding common Medicare acronyms is important weather you are getting ready to sign up for Medicare or a Medicare agent. As in any business, understanding the terminology is essential to help navigate the system.

General Medicare Terms

• CMS: Centers for Medicare & Medicaid Services
  The federal agency that administers the nation’s major healthcare programs, including Medicare and Medicaid.
• SSA: Social Security Administration
  The government agency responsible for administering Social Security benefits, including the processing of Medicare applications.

Parts of Medicare

1. Part A: Hospital insurance covers inpatient hospital stays, skilled nursing facility care, hospice care and some home health services.
2. Part B: Medical Insurance covers outpatient care, doctor services, preventative care and DME.
3. Part C: Medicare Advantage plans are an alternative to Original Medicare. They provide the same coverage as Original Medicare and often some added benefits. Private insurance companies offer these plans.
4. Part D: Prescription Drug Plans provide coverage for approved prescription medications. Private insurers offer these plans.

Medicare Plan Types

• MA: Medicare Advantage also called Part C provide the same benefits as Original Medicare (Part A & Part B).
• MAPD: Medicare Advantage Prescription Drug Plan provide the benefits of Original Medicare as well Part D.
• PDP: Prescription Drug Plan provides stand alone coverage of prescription drugs under Medicare Part D.
• HMO: Health Maintenance Organization is a type of Medicare Advantage plan. These plans require members to use a specific network of providers and referrals for specialists.
• PPO: Preferred Provider Organization is a type of Medicare advantage plan that offers out of network coverage. They are a more flexible option than an HMO.
• PFFS: Private Fee-For-Service is another type of Medicare advantage plan. It allows beneficiaries to see any doctor or hospital that accepts the plan’s terms. The costs and coverage are set by the plan.
• MSA: Medical Savings Account combines a high-deductible Medicare advantage plan and a savings account. The plan deposits money into the account each year to pay healthcare expenses before beneficiaries meet the deductible amount.
  

Enrollment Periods

• AEP: Annual Enrollment Period occurs from October 15 to December 7 annually. During this time, beneficiaries can enroll in or change their Medicare coverage.
• ICEP: Initial Coverage Election Period is the period when individuals first become eligible for Medicare benefits.
• SEP: Special Enrollment Period occurs outside normal enrollment periods and provides an opportunity to change plans due to a specific event. This includes things like moving or losing employer sponsored health coverage.

Learn more about Medicare enrollment periods

Notices and Forms

• ANOC: Annual Notice of Change
  A document sent by Medicare plans outlining any changes in coverage, costs, or service areas for the upcoming year.
• EOC: Evidence of Coverage
  A document detailing what the plan covers, how much members pay, and other rights and responsibilities.
• ABN: Advance Beneficiary Notice of Noncoverage
  Is a waiver of liability. A notice given to beneficiaries of Original Medicare when a service or item isn’t expected to be covered, allowing them to decide whether to receive and pay for the service.

Assistance Programs

• LIS: Low-Income Subsidy
  Also known as “Extra Help,” this program assists individuals with limited income in paying for prescription drug costs under Part D.
• MSP: Medicare Savings Program
  State programs that help pay Medicare premiums and, in some cases, deductibles and coinsurance for individuals with limited income.

A few more terms

• DME: Durable Medical Equipment
  Medical equipment like wheelchairs, walkers, or hospital beds that are ordered by a doctor for use in the home.
• EOB: Explanation of Benefits
  A statement from a Medicare plan detailing what was billed, what Medicare paid, and what the beneficiary may owe.
• HIPAA: Health Insurance Portability and Accountability Act
  A federal law that, among other things, protects the privacy of individuals’ health information.

Being well informed helps ensure that beneficiaries and professionals can navigate the Medicare system effectively.