Blog

Alignment 5 Star Medicare Plans

Alignment Health’s 5-Star Medicare Advantage plans are among the most valuable tools available to agents working in competitive Medicare markets. A CMS 5-star rating reflects the highest level of quality. This includes; performance in areas such as member experience, preventive care, chronic condition management, and customer service. For agents, these plans are helpful because they unlock the 5-Star Special Enrollment Period (SEP). This allows eligible beneficiaries to enroll once per year outside of AEP.

Why Offer Alignment Medicare Plans

Alignment Health Plans offer a broad portfolio of Medicare Advantage plans designed to meet diverse member needs. Plans options include PPOs, HMOs, HMO Special Needs Plans (SNPs), this includes HMO-POS D-SNP as well as C-SNP options. Many plans are built around coordinated care models that simplify access to doctors, specialists, and prescriptions under one integrated structure.

Watch a YouTube video on Alignment Medicare Plans

Why They Stand Out

A major strength of the plans are the variety of benefits included across Alignment’s 5-star offerings.

• Low or No Cost: Most Alignment MA plans have $0 premiums and low deductibles.
• Concierge Support: All members have access to an on‑demand concierge for telehealth, urgent care, and service navigation.
• Special Needs Plans: Offers enhanced benefits for members with chronic conditions or dual eligibility (Medicare + Medicaid).
• Wide Benefit Coverage: Includes dental, vision, hearing, prescription drugs, fitness, OTC allowances as well as chronic condition support and so much more.

Please note, benefits vary by plan and county availability.

Learn about the best Medicare Advantage leads for agents

Service area

Alignment Health’s Medicare Advantage plans are available in five states: California, Nevada, North Carolina, Arizona, as well as Texas. Within each state, availability varies by county. Some regions offer multiple plan options tailored to local provider networks and population needs. For example, California includes extensive county-level offerings across both Northern and Southern regions, while other states feature more targeted regional availability.

Alignment Health Plan continues to differentiate itself through its concierge-style care model, emphasizing care coordination, preventive health management, and support for high-need populations such as dual-eligible and chronically ill members. This creates a strong selling point for agents working with beneficiaries who want more personalized support than traditional Medicare or lower-rated MA plans typically provide.

Click here for an online contract and join the team at Crowe and Associates.

Why the 5 Star Rating Matters

From an agent perspective, Alignment’s 5-star designation is more than a rating, it is an enrollment opportunity. The combination of expanded service areas, competitive plan designs, strong supplemental benefits, and year-round SEP access makes these plans a great option to enusre client staisfaction.

If you are focused on long-term retention and consistent member care, consider Alignment’s 5-star Medicare Advantage plans. Enrollees receive a balance of quality, accessibility, and benefits that clients are lookig for. In other words, these plans are a strong competitor in todays Medicare market.

Click here for Agent events and Information

Healthfirst Medicare Advantage & Long-Term Care Plans in 2026

As you help clients navigate Medicare options, it’s important understand Healthfirst Plan Benefits 2026. The plan lineup serves diverse needs; from dual-eligible beneficiaries to those seeking broader provider choice or long-term care coordination. Healthfirst offers a range of Medicare Advantage (MA) and Special Needs Plans (SNPs), as well as long-term services supports (MLTC). Each plan is designed to provide more than Original Medicare alone.

Medicare Advantage Plans

Healthfirst Life Improvement Plan (HMO D-SNP)

Is a Dual-Eligible Special Needs Plan for members with both Medicare and Medicaid coverage. This HMO D-SNP combines hospital, medical and Part D drug coverage as well as extras like an OTC Plus card, dental, vision, hearing, and fitness benefits. Most plans offer a $0 monthly premium and low or no copays for most services

Healthfirst Connection Plan (HMO D-SNP)

This plan is another D-SNP option for dual-eligible members. It focuses on helping those with both Medicare and Medicaid cost-sharing assistance. It offers enrollees a $0 monthly premium, prescription drug coverage, an OTC Plus card as well as low or no copays for covered services.

Healthfirst CompleteCare Plan (HMO D-SNP)

Designed for dual-eligible members who need nursing home level of care or community-based long-term services, CompleteCare integrates Medicare and Medicaid benefits with extra support, including home care, adult day healthcare, a Care Team, and a robust OTC Plus card. Premiums and most copays are $0, and the plan includes dental, vision, and hearing benefits.

Click here for best Medicare Advantage leads for agents

Healthfirst Increased Benefits Plan (HMO)

This HMO is ideal for members who qualify for Extra Help (LIS). It offers $0 premium for those with LIS, Part D coverage, an OTC Plus card, and low or no copays all bundled with hospital and medical coverage. Premiums may vary if LIS status changes.

Healthfirst 65 Plus Plan (HMO)

A core HMO plan for those seeking comprehensive Medicare Advantage coverage, this $0 premium MAPD includes hospital, medical, and prescription drug coverage, an OTC Plus card, and enhanced benefits beyond Original Medicare.

Healthfirst Signature (HMO)

A popular HMO MAPD that includes hospital, medical, and Part D benefits with a $0 monthly premium and a Flex card to help cover dental, vision, hearing, fitness, and other out-of-pocket costs. No referrals are needed for in-network specialists.

Healthfirst Signature (PPO)

For clients who value provider flexibility, this PPO allows visits to in-network and out-of-network providers that accept Medicare. It typically carries a low monthly premium, includes Part D prescription coverage and core MAPD benefits like dental, vision, and hearing.

Watch a YouTube video on how to sell anicillary with Medicare in 5 Minutes

Long-Term Care & Managed Care

Healthfirst CompleteCare HMO D-SNP

In addition to regular Medicare Advantage SNP benefits, this plan includes Long-Term Services and Supports (LTSS), caregiver support, and coordinated care for members needing ongoing assistance to remain independent at home.

If you are ready to be part of the Crowe team; click here for online contracting

Senior Health Partners Managed Long‑Term Care Medicare Plan

This MLTC Medicaid Plan focuses on coordinating long-term care services like home care and adult day care. It’s tailored for those Medicaid-eligible members who require extended support beyond typical Medicare benefits.

As you can see, Healthfirst’s 2026 portfolio provides options for a range of member needs; from basic MAPD coverage to dual-eligible benefits and long-term care support. This makes it easy to match clients to plans that fit their clinical and financial profiles.

Agents: stay up-to-date on events and information.

Solis Medicare Advantage Plans: Comprehensive Coverage for Every Beneficiary

Solis Health Plans offers a variety of Medicare Advantage options designed to meet the diverse needs of beneficiaries across Florida. From Dual Eligible Special Needs Plans (D-SNPs) to Chronic Condition Special Needs Plans (C-SNPs) and general HMO coverage, Solis combines medical care, prescription coverage, and valuable supplemental benefits to help members live healthier, more independent lives.

Please note: Plan availability and benefits are subject to both service area and qualifying factors.

Who Can Enroll

You may be eligible for a Solis Medicare Advantage plan if:

• You have both Medicare Part A & Part B
• You live in the plan’s service area and will not be out for more than six months
• You are a U.S. citizen or lawfully present in the United States
• For D-SNP plans, you must also qualify for Medicare and Medicaid

Because of the clear enrollment criteria, it is easy for agents to determine which clients are eligible and guide them through the process.

Watch a YouTube video to learn more about Solis

Solis Medicare Advantage Plans and Highlights

Note: plan benefits vary by location;

Solis Guardian Plan (HMO D-SNP) – Designed for dual-eligible beneficiaries. $0–$4.80 monthly premium, $3,400 MOOP. Includes $200/month Healthy Living Allowance, $1,000 annual Flex Allowance for dental, vision, and hearing, $120 OTC allowance, and $4,000 annual dental coverage. Copays for PCP, specialists, urgent care, and emergency care are $0.

Solis Wellness Giveback Plan (HMO C-SNP) – Tailored for chronic conditions such as cardiovascular disease, heart failure, and diabetes. $0 premium, $185 monthly Part B giveback, $80 monthly Healthy Living Allowance, $115 OTC allowance, $0 copays for preventive dental, and up to $400 in annual rewards for wellness activities.

Solis Wellness Plan (HMO C-SNP) – $0 premium, $2,500 MOOP, $100 monthly Healthy Living Allowance, $1,000 annual Flex Allowance, $125 OTC allowance, $3,500 dental coverage. PCP and specialist visits $0, urgent care $0, emergency care $100.

Solis Healthy Living Plan (HMO) – $0 premium, $2,900 MOOP, $50 monthly Healthy Living Allowance, $800 annual Flex Allowance, $115 OTC allowance, $3,000 dental coverage. PCP and specialist visits $0, urgent care $0, emergency care $100.

Solis Balanced Plan (HMO C-SNP) – Available in Miami-Dade County for individuals with chronic or disabling mental health conditions. $3 monthly premium, $2,500 MOOP, $200 monthly Healthy Living Allowance, $1,000 annual Flex Allowance, $140 OTC allowance, $3,500 dental coverage. PCP, specialist, urgent, and emergency care copays are all $0.

Watch a YouTube video on DSNP SEP Changes

Additional Benefits Solis Plans May Offer

Some plans include the following benefits; Depending on the county:

• Insulin and diabetic supplies
• Dental for cleanings, fillings, extractions, and dentures
• Routine vision and hearing exams
• Transportation to doctor visits
• Monthly OTC allowances
• Fitness and wellness programs
• Papa™ in-home support and companionship
• Healthy Living Allowance
• Health management programs for chronic conditions
• Alternative therapies, including acupuncture and chiropractic services

If you are ready to be part of the Crowe team; click here for online contracting

Why Agents Should Consider Solis

Solis plans provide predictable costs, rich supplemental benefits, and tailored solutions for dual-eligible members, those with chronic conditions, or residents in specific counties. Agents can build long-term relationships and recurring revenue by helping clients access these meaningful benefits.

Service areas include: Miami-Dade, Broward, Palm Beach, Hillsborough, Pasco, Pinellas, Polk, Orange, Osceola, as well as Seminole counties.

With Solis Medicare Advantage plans, agents can confidently offer coverage that delivers real value while meeting the unique needs of their clients.

Agents stay up-to-date on events and information.

Proposed Medicare Advantage Changes 2027

The Centers for Medicare & Medicaid Services (CMS) recently released a proposed rule for the 2027 contract year that could reshape Medicare Advantage (MA) and Part D prescription drug coverage. The agency aims to “strengthen quality, improve access, and modernize benefits” while reducing administrative burdens on plans.

Here’s what beneficiaries, providers, and policymakers need to know.

Star Ratings Overhaul

CMS proposes removing 12 Star Rating measures that are largely administrative or show little variation between plans. The focus will shift to meaningful metrics, including clinical outcomes, preventive care, and patient experience.

• New focus on outcomes: Plans will be evaluated more on health results than paperwork.
• Mental health measure: CMS plans to introduce a “Depression Screening and Follow-Up” measure for future cycles.
• Health equity bonuses paused: The previously planned “Excellent Health Outcomes for All” bonus is postponed, though CMS invites feedback on equity initiatives.

Impact: Beneficiaries may find it easier to identify high-quality plans, while insurers may redirect resources toward improving actual care.

Enrollment Flexibility

The proposed rule adds a new Special Enrollment Period (SEP) for beneficiaries whose providers leave a plan’s network. This allows mid-year plan changes without waiting for the regular enrollment window. CMS also codifies other existing SEP policies, making the system more consistent.

Impact: This change ensures continuity of care for people with chronic conditions or preferred providers.

Watch a video on the discontinued Medicare advantage plan special enrollment period

Part D and Drug Coverage Updates

The rule formalizes Part D reforms started under prior legislation, including:

• Eliminating the coverage gap (donut hole) phase.
• Maintaining reduced out-of-pocket thresholds.
• Removing cost-sharing in the catastrophic phase.
• Adjusting how True Out-of-Pocket (TrOOP) costs are calculated.

Impact: Beneficiaries gain more predictable and affordable prescription drug coverage.

Agents, are you ready to join the team at Crowe; click here

Reducing Administrative Burden

CMS proposes measures to reduce paperwork and regulatory complexity, such as:

• Exempting certain account-based plans from creditable coverage disclosures.
• Lifting requirements for mid-year notices about unused supplemental benefits.
• Removing some health-equity reporting mandates for plans.

Impact: Plans may operate more efficiently, but some transparency and oversight could be reduced.

Why It Matters

1. Patient-focused quality: More emphasis on outcomes and experience could improve care.
2. Drug cost protection: Part D reforms continue to protect beneficiaries from high out-of-pocket expenses.
3. Flexible enrollment: The new SEP enhances access to care when providers leave networks.
4. Efficiency vs. oversight: Streamlined administration may improve plan operations but reduce some accountability.
5. Future reform: CMS is constantly making changes to improve MA plans, and stakeholders have the chance to provide input.

CMS’s 2027 proposed rule could bring meaningful improvements for beneficiaries while easing administrative burdens for insurers. The Star Ratings overhaul, enrollment flexibility, and Part D updates are poised to enhance care and reduce costs. However, reduced oversight and postponed equity initiatives highlight areas to watch as the public-comment process unfolds.

Agents, stay up-to-date on the our latest webinars an agent events.

Why Choose an HMO

When selecting a Medicare Advantage plan, one of the most common choices is a Medicare HMO (Health Maintenance Organization) plan. While Medicare Advantage plans come in different forms; such as PPOs, PFFS, and SNPs, HMO plans continue to be a popular option for many beneficiaries. But what makes them attractive, and why choose an HMO plan over other types of Medicare Advantage coverage?

Lower Monthly Premiums

HMO plans often come with lower monthly premiums compared to PPOs and some Medigap options. In fact, many HMO Medicare Advantage plans are available with a $0 monthly premium (though you must still pay your Part B premium). This makes them a budget-friendly choice, especially for retirees on fixed incomes.

Predictable Costs

With set copays for doctor visits, hospital stays, and prescriptions, Medicare HMO plans can make it easier to budget healthcare expenses. Instead of worrying about large unexpected bills, members often have a clearer idea of what their out-of-pocket costs will be.

Coordinated Care

The HMO plan designed encourages coordinated care. Beneficiaries select a primary care physician (PCP) who manages their overall health and provides referrals to specialists when needed. This system helps reduce unnecessary testing and ensures care is streamlined across providers.

Watch a YouTube video on how Advanced Diabetes Supply can help get needed diabetes supplies

Extra Benefits Beyond Original Medicare

Original Medicare (Parts A and B) does not cover certain benefits like dental, vision, hearing, or fitness programs. Many HMO Medicare Advantage plans include these extras, along with prescription drug coverage (Part D). This makes HMO plans a convenient “all-in-one” package for many beneficiaries.

Lower Out-of-Pocket Maximums

Unlike Original Medicare, which does not cap spending, Medicare HMO Advantage plans include an annual out-of-pocket maximum. Once this limit is reached, the plan pays 100% of covered costs for the rest of the year, offering an important layer of financial protection.

Local Network Focus

Because HMO plans require members to use a network of doctors and hospitals, they often negotiate better rates, helping keep costs down. For beneficiaries who primarily receive care close to home, an HMO network may be more than sufficient.

Is an HMO Right for You

While HMO plans offer many advantages, everyone is different and has their own coverage needs. The main limitation is that you must use providers within the plan’s network (except in emergencies). If you prefer flexibility to see specialists without referrals or want coverage that extends more broadly outside your area, a PPO or Medigap plan may be a better choice.

However, for Medicare beneficiaries looking for affordable, coordinated, and benefit-rich coverage, a Medicare HMO is often an excellent option.

Medicare agents:

Click here to fill out an on line contract and become part of the Crowe team!

Stay up-to-date on agent events and information

Understanding Medicare’s SSBCI Benefits: What They Are and Who They Help

If you’re a Medicare beneficiary or a Medicare agent working with clients you may have come across the term SSBCI. It stands for Special Supplemental Benefits for the Chronically Ill; it’s part of Medicare Advantage plans (not Original Medicare). Understanding Medicare SSBCI benefits is important. These benefits are designed to help people with certain chronic health conditions live healthier, more independent lives by addressing needs that traditional Medicare doesn’t usually cover.

Let’s break down what SSBCI is, how it works, and why it’s so important.

What Are SSBCI Benefits

SSBCIs allow Medicare Advantage plans to offer non-medical supportive benefits to enrollees with serious chronic illnesses. These can include things like:

• Preloaded grocery or utility cards
• Home modifications (e.g., grab bars, ramps)
• Air purifiers or pest control
• Meal delivery
• Social or physical activity programs

The benefits come with an important rule: each benefit must show a reasonable expectation of improving, or at least maintaining, the enrollees’ health or functional status. These targeted benefits can help prevent hospital visits and keep members healthier at home.

Who Qualifies for SSBCI Benefits

To be eligible, an enrollee must meet a three-part definition of “chronically ill,” including:

1. Having one or more complex or serious chronic conditions
2. Being at high risk of hospitalization or adverse outcomes
3. Needing intensive care coordination

Eligibility standards align with what qualifies for Chronic Condition Special Needs Plans (C-SNPs), though not all plans offer SSBCIs.

How SSBCI Differs From “Regular” Medicare Advantage Benefits

Most Medicare Advantage benefits are “primarily health-related.” SSBCI benefits expand that definition to include supports that aren’t strictly medical, as long as they address a specific health condition and can reasonably be expected to improve or maintain health.

Although regular supplemental benefits might include gym memberships or dental coverage for everyone in the plan, SSBCI benefits are customized to the needs of individuals who meet specific health criteria.

Why SSBCI Benefits Matter

Holistic Support: SSBCIs target real-life challenges; nutrition, safety, social connection, that can worsen health.

Flexibility: They can be customized to meet local needs and conditions.

Preventive Benefit: Reducing real-world barriers may lower healthcare costs down the line.

Personalized Care: Plans determine how SSBCIs are structured, shaping the benefits based on member needs.

Agents; if you are ready to join the team at Crowe; click here for online contracting.

What’s New in 2026

Stricter Rules on What Plans Can’t Offer

Starting in 2026, Medicare Advantage plans will face a tightened definition of SSBCI. CMS has codified a list of non-allowable benefits, meaning some popular extras are now prohibited under SSBCI, including:

• Junk food, unhealthy groceries
• Alcohol, tobacco, or cannabis-related items
• Life insurance or funeral benefits
• Cosmetic procedures not covered by Original Medicare
• Insurance discounts unrelated to health care
• Hospital indemnity or unrelated insurance products

Mandatory Mid-Year Notifications

Also beginning in 2026, MAOs (Medicare Advantage Organizations) must send personalized mid-year notices (between June 30 and July 31) to members who have unused supplemental benefit allowances. These notices must include:

• Which benefits the enrollee hasn’t used (from Jan 1–Jun 30)
• Eligibility criteria and limitations
• Instructions on how to access the benefits and provider networks

This ensures beneficiaries don’t miss out on benefits they’re entitled to because they weren’t aware of them.

Do your diabetic clients need help with supplies; watch our video on Advanced Diabetes Supply

Other Medicare-Wide 2026 Changes (Broader Context)

While not SSBCI-specific, here are some broader 2026 updates that complement the Medicare Advantage landscape:

• Automatic Renewal of the Medicare Prescription Payment Plan (MPPP); opt-outs must be processed within three days
• Part D Out-of-Pocket Cap increasing to $2,100 (up $100 from 2025)
• Part D Deductible capped at $615 (up by $25)
• Insulin Cost Cap: Still $35 or less, whichever is lower of negotiated or maximum fair price—now effectively enforced annually
• Adult Vaccines under Part D remain free with no cost-sharing as a permanent policy

Bottom Line

SSBCIs remain a powerful innovation within Medicare Advantage pushing beyond clinical coverage to tackle the lived experiences of chronically ill beneficiaries. But in 2026, plans must tighten the focus and communicate more clearly, including:

• No more non-health-related extras under SSBCI
• Required mid-year check-ins to help enrollees use their benefits effectively

Those who rely on SSBCIs, should:

Always review your 2026 ANOC for SSBCI benefit changes. Pay close attention to mid-year notices and unused benefits. Contact a licensed Medicare agent if you have questions about your current coverage or to look at your options during AEP or other available enrollment periods.

Agents stay up-to-date on events and information

Medicare OEP Open Enrollment Period

The Medicare Open Enrollment Period (OEP) runs annually from January 1 to March 31. It is specifically for individuals already enrolled in a Medicare Advantage (Part C) plan as of January 1.

This period does not apply to those with Original Medicare (Part A and B) only; it’s strictly for Medicare Advantage plan members who may want to make a one-time change.

What Changes Can You Make During OEP

Those enrolled in a Medicare Advantage plan, can make one change during the OEP. The options include:

• Switching to a different Medicare Advantage plan, with or without drug coverage
• Dropping your Medicare Advantage plan and returning to Original Medicare, with the option to add a Part D prescription drug plan

Changes You Cannot Make:

• Switch from Original Medicare to a Medicare Advantage plan
• Enroll in Part D drug coverage if you’re on Original Medicare and missed your IEP or AEP
• Make multiple changes; OEP only allows one switch

Watch a video on Medicare enrollment periods

Why Use the OEP

Here are a few common reasons beneficiaries take advantage of the Medicare OEP:

• Their current Medicare Advantage plan doesn’t cover a needed medication or provider
• They discovered higher costs or restrictions after using the plan in January
• They had a change in health and want a different plan with better specialist coverage
• They were unaware of better plan options during the Annual Enrollment Period (AEP), which runs from October 15 to December 7

How Is OEP Different from AEP

Important Considerations

• If you switch to Original Medicare during OEP, you may not be guaranteed Medigap (Medicare Supplement) coverage; unless you’re in a trial right or qualify for a Special Enrollment Period.
• Any changes made during the OEP become effective the first day of the month after the change is made (e.g., a change in February takes effect March 1).
• It’s important to review coverage early in the year to determine if your current plan still meets your needs.

Work with a Licensed Agent

The Medicare OEP is a valuable but limited opportunity to make corrections or improvements to your coverage. If you’re unsure whether your plan fits your health needs or budget, speak with a licensed Medicare agent. They can help you compare options, check provider networks and drug formularies, and make confident decisions about your healthcare.

Agents; if you are ready to join a winning team, click here for Crowe contracting!

Stay updated on agent information and events, click here

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.

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