Blog

Assisted Living FAQs

Because many people have questions about assisted living, we are providing answers to the most asked Assisted living FAQs in the post below.

What is an assisted living facility:

Assisted living facilities provide individuals assistance with the ADLs (activities of daily living).  These activities include; meal preparation, bathing, dressing as well as medication management to name a few.  All these activities are categorized as custodial care.

Click here to learn more about the activities of daily living

What is the difference between Medicaid and Medicare in assisted living coverage:

There are definitely difference in how Medicare and Medicaid provide coverage for assisted living.

1.  Medicare does not provide any coverage for assisted living facilities. Although it does short-term stays in a skilled nursing facility for rehabilitation purposes as long as specific requirements are met.  This criterion includes the exclusion of the need for long-term care.
2. In some states, qualified Medicaid enrollees may receive help from a waiver program they provide with the costs for personal care as well as some other support services beneficiaries receive in an assisted living setting.  This assistance can reduce the total cost of assisted living quite a bit.  However, Medicaid does not offer help with the costs of room and board in an assisted living facility.

Click here for more details on Assisted living coverage

Is there a way to get financial assistance for assisted living:

As stated above, several states provide help with assisted living costs for anyone who has limited financial resources and qualifies for help such as Medicaid.

Veterans may qualify for help through programs offered through their local VA.  These programs and VA benefits may offer help with the costs of assisted living.

Although Medicare does not cover assisted living facilities, it will cover cost for medical treatment provided by doctors or hospitals as well as some approved skilled nursing facility care. If prescription drugs are needed, they are covered by Medicare Part D.

Medicare agent application checklist

If you are a Medicare agent, you know there are some things you need to do to prepare before taking an application from a client.  Take a look at the suggestions in the Medicare application checklist below. are currently taking as well as their doctors. This is all important information that you need to run an accurate Medicare quote.

You can easily run a quote using one of our free online quoting and enrollment tools such as Sunfire or Connecture.  Both of these tools have a built in CRM that is free to use to our contracted agents.

Learn more about how to quote Medicare Advantage plans with our free quoting tools

Before you take the application

Be sure you get a signed SOA.  There are CMS guidelines agents must follow when taking a SOA.  Agents must take the SOA (Scope of Appointment) 48 hours before you meet your client to sign up for a Medicare plan.  Please note; a scope is good for 12 months from the date the client signs it.  After a 12-month period, you need a new scope signed before any Medicare enrollment discussions can take place.  You must keep a scope of appointment on file for 10 years weather or not you made a sale. per CMS guidelines.

Watch our YouTube video on Scope of Appointment rules starting 10/1/23

Click here to download a generic scope

It is important that the SOA is filled out correctly with the plan type that you are discussing during your meeting checked of or initialed.  There are a few ways to collect the SOA.  You can collect it on the phone, via voice recording, online by sending a link either by email or text and you can also collect a paper SOA.  This all depends on the client’s preference.

Using a paper application

It is important to write legibly in either black or blue ink.  This ensures what you submit is processed without delays.

1. If your client is enrolling in an MA/MAPD plan, be sure to include their PCP name and ID information requested on the enrollment form.  This is extremely important if they are applying for an HMO.  You should always check the client’s list of providers before enrolling them in any MA/MAPD plan.
2. In the event your client has to answer health questions, make sure they provide detailed explanations for any health questions they answer yes to.
3. If the client is enrolling during an SEP, be sure to include any necessary or required information.  If you try and skip this, it will only delay the processing and can result in a denial or enrollment.
4. Be sure the that not only the client signs wherever required but that you sign where needed as well. This goes for the scope of appointment too.
5. Submit the application on time.  Know the carrier rules for how long after you receive the application it must be submitted by.
6. Before submitting the application check everything over one last time so that there are not delays in processing and the client gets the coverage they need on time.  If you send you r application through Pinnacle, they will scrub it for you, but it is always better to double check before submitting it to them.

Submit the application electronically

One way to be sure the application is done correctly is to use one of our free online enrollment tools and submit the application electronically.  This will ensure that all information is provided, and that the application is filled in legibly.

Join the team at Crowe and Associates

Click here to view more images by this artist

Medicare sales permission to contact

When you have a potential clients you need to keep all the CMS guidelines in mind before you begin.  You need to be compliant and use a Medicare sales permission to contact.

What is Permission to Contact:

This process helps stop agents from contacting beneficiaries through the use of dishonest sales tactics. Unfortunately, in the past, some agents have pressured Medicare beneficiaries to get a Medicare sale.  Permission to contact is one way to help deter uninvited agents to approach beneficiaries when they are not prepared.

To avoid non compliance, it is important the beneficiary gives permission for the agent to contact them before you try and meet, call or email them for Medicare Advantage or PDP sales.

Here are some ways you can contact a potential client:

1. You can return their call if they request you do so.
2. Through email as long as there is an opt-out option clearly provided.
3. If they respond to a business replay card.
4. When they fill out an online contact form.

Here are some ways you cannot contact a potential client:

1. Do not knock on a potential client’s door without an invitation.
2. You are not permitted to send texts to anyone without their permission.
3. Directly contact through social media

When is permission to contact required:

Anytime you want to contact a potential client, you should obtain permission to contact.  This is very important if they may be considering a Medicare Advantage or Prescription Drug Plan enrollment. Please note; even if you contact a potential client for a Medicare Supplement plan which does not require permission to contact, they will most likely need a Prescription Drug Plan to go with it, therefore it is always a good idea to have permission to contact.  Be sure to include the following disclaimer “This is a solicitation of insurance” on the Permission to contact form.

Please note: If you are contacting your own clients; you do not need permission to contact.

It is acceptable to email potential clients as long as you include an opt-out option.  You cannot send anything that could be considered marketing material.  Marketing material includes specific plan information such as premiums, co-pay amounts or other benefit information. All communications must meet CMS guidelines as well as  CAN SPAM Act requirements.

How long is the permission to contact good for:

Once you have collected the permission to contact, you have 12 months to contact that beneficiary.  If you do not contact them within that time, you must collect another PTC before contacting them.

A couple more things to note:

If you employ a third party marketing organization for lead generation, it is important that they are compliant with all the CMS rules.  Do not forget, it is your name on the materials they are sending so you are the one who is ultimately responsible for what goes out to the public.  Beneficiaries need to be told either verbally, in writing or electronically depending how they are contacted, that their information will be given to a licensed Medicare agent who will contact them.

Do not confuse permission to contact with a Scope of appointment.

You still need to collect a scope of appointment from the beneficiary once you are able to set up a meeting or call to go over plan options.  It is important to follow all guidelines for Medicare sales in order to maintain compliance and maintain your ability to offer Medicare plans.

Download a generic scope of appointment form

Get contracted with the Crowe team!

To view more images by this artist; click here

Medicare HMO vs. PPO plans

If you are considering a Medicare advantage plan, you will need to weigh Medicare HMO vs. PPO plans.  The first thing we need to do is explain that HMO stands for Health Maintenance Organization plans.   On the other hand, PPO stands for Preferred Provider Organization plans. Each of these plans provide its own set of benefits.  The plan you choose will impact your healthcare experience.

Understanding the Basics:

Medicare HMO and PPO plans operate within the broader framework of Medicare.  Both types of plans cater to the healthcare needs of Medicare beneficiaries.  Although the share the goal of providing essential healthcare coverage, they function differently in terms of network flexibility, cost structure, and coverage options.

Medicare HMO Plans:

HMO plans typically require beneficiaries to choose a primary care physician (PCP).  The PCP coordinates their care as well as provides referrals to specialists within the HMO network. This approach supports a structured healthcare management system.  This ensures a comprehensive and coordinated approach to treatment.

Additionally, Medicare HMO plans often come with low premiums and lower out-of-pocket costs when compared to some PPO plans. They also may provide some benefits such as a Part B giveback that PPO plans typically do not. However, the trade-off for these cost savings is the restricted network access.  This may limit the choice of healthcare providers and facilities.  In most cases HMOs do not cover medical care received outside the HMO network, except in emergencies or urgent care situations.

Medicare PPO Plans:

On the other hand, PPO plans offer more flexibility in choosing healthcare providers and facilities.  This allows beneficiaries to seek treatment both in and out of the PPO network. Although there is a network of preferred providers, beneficiaries can still access care from out-of-network providers.  It is important to note; out of network services will have a higher cost to beneficiaries than in-network.

In general PPO plans may have a higher premium and greater out-of-pocket costs when compared to HMO plans. Nonetheless, the flexibility to see specialists or visit healthcare facilities without referrals can be advantageous.  This is helpful for those who require specialized care or have established relationships with trusted providers.

Key Considerations for choosing a plan:

When deciding whether an HMO or PPO plan best suits your needs, there are several key factors to consider:

1. What are your healthcare needs – Think about your healthcare requirements, this includes how often you require the care of a specialist.  You may need to go out-ot-network for some providers.
2. Cost Considerations – Compare the premiums, deductibles, and co-pays associated with both plans. Do not discount potential out-of-network costs for either plan.
3. Provider Network – Research the size and quality of the provider network. It is important to consider the availability of preferred doctors and specialists within each plan.
4. Network area – If you frequently travel or reside in multiple locations throughout the year, it is important to consider the geographic area of coverage available.
5. Prescription Drug Coverage – It is very important to research the prescription drug coverage provided by each plan.  This is imperative if you require regular medications.

Making the Right Choice:

Ultimately, the decision between a Medicare HMO and PPO plan hinges on your individual healthcare needs, financial circumstances, and preferences.

While HMO plans offer cost-effective, structured care within a limited network, PPO plans provide greater flexibility at a higher cost. Carefully evaluate your healthcare priorities and compare the specifics of each plan to make a well-informed decision.

It is a good idea to consult with a trusted healthcare advisor.  A licensed Medicare agent can help you review plan documents thoroughly and find the best option for you. A well informed agent can also answer your health coverage questions and is available to you when you need them.

Licensed agents get contracted with Crowe

To view more images by this artist; click here

Making Medicare AOR changes

Join the team at Crowe with an easy online contract

Medicare marketing ideas

Selling Medicare Advantage plans from home

Selling Medicare Advantage plans from home is both a viable and rewarding career option for those passionate about helping beneficiaries find the right healthcare coverage. Because of the growing demand for comprehensive plans, Medicare advantage carriers are offering more and more benefits.  this gives agents a fantastic amount of options to fit their client’s needs.

If you stay up-to-date with industry trends as well as your education of plan options and compliance standards, you can build a thriving home-based business.  You can also make a positive impact on the lives of Medicare beneficiaries.

The healthcare industry is constantly evolving, and with an aging population, the demand for Medicare Advantage plans is on the rise. For individuals who want a flexible and rewarding career, selling Medicare Advantage plans from home is an attractive option.  We will discuss the benefits of selling Medicare Advantage plans remotely.

What are Medicare Advantage Plans:

Medicare Advantage (Medicare Part C), is a private health insurance option offered to Medicare beneficiaries. The insurance companies must have their plans approved by CMS.  This is an alternative way for beneficiaries to receive Medicare benefits.  Plans often include additional coverage for services not covered by Original Medicare.  The additional benefits include things such as; dental, vision, prescription drug coverage, OTC coverage.

Growing Medicare Advantage Plan Market:

The popularity of Medicare Advantage plans has been growing steadily in recent years.  Because beneficiaries are looking for comprehensive coverage and additional benefits, the demand for these plans has increased greatly.  As a result, selling Medicare Advantage plans is a great opportunity for anyone who wants to start a home-based business.

Reasons to Sell Medicare Advantage Plans from Home:

1. The ability to set your own hours

One important advantage of selling Medicare Advantage plans from home is the flexibility it offers. As an independent agent, you can create your own schedule.  This will allow you to balance your work and personal life as needed.

2. Reasonable start-up costs

Starting a home-based business selling Medicare Advantage plans requires a much lower initial investment compared to a traditional store front. You’ll need a computer, phone, internet connection, and the necessary licenses in place to start.

3. Freedom to work from different locations

Because you are working from your computer, you are not bound by a physical location.  In other words, you can reach clients wherever you go.  This can expand your market reach.

Getting Started as a Medicare Advantage Plan Agent:

1. Licensing and Certification

Before you start selling Medicare Advantage plans, you need to obtain the required licenses aa well as complete the necessary certifications. This usually involves passing state-specific exams and completing relevant carrier training programs.

2. Partner with Insurance Carriers

It is very helpful to create good relationships with your local insurance carrier reps. Carrier reps can offer you important services such as help with applications, marketing money and opportunities to represent their product.  It is a good idea to run quotes for the area you plan to sell in and find the most competitive carrier choices to add to your offerings.

3. Building a Book of Business

Both networking and marketing play a crucial role in building a book of business.  Online platforms, social media, and community events are all good ways to reach potential clients. Building trust and rapport with people is key.  If you prove to be approachable, helpful and informative, you can expect clients to recommend your services to others.

Learn more about how to become a Medicare agent

Compliance and Regulations:

In order to sell Medicare plans, you must adhere to all rules and regulations set by the Centers for Medicare & Medicaid Services (CMS). It is very important to stay up-to-date with changes in the industry, as non-compliance can lead to severe penalties.

Ongoing Support and Training:

Continuing education and training are essential to stay relevant in the ever-changing healthcare landscape. Many insurance carriers and organizations offer ongoing support and resources to help you succeed in your role.  This is one of the many reasons independent insurance agents may want to consider an upline.

Click here to begin a new contract with Crowe and Associates.

View our free training and informational videos on our YouTube Channel.

Marketing Medicare Advantage Plans

Effectively marketing Medicare Advantage plans requires a multifaceted approach that combines an understanding of your audience, educational content, digital marketing, community involvement, and strong partnerships. If you use the strategies outlined below, you can reach and connect with your target audience and provide the best individualized healthcare coverage through Medicare Advantage plans.

It is important to adapt to industry trends as well as regulatory changes.  This will help you maintain a competitive edge in the Medicare market.  If you are both dedicated and current with your approach, you can provide Medicare clients the best plan options as well as build a successful business.

Understand your audience:

Before diving into marketing strategies, it’s crucial to understand your target audience.  The beneficiaries of Medicare Advantage plans are either Seniors aged 65 and over or other individuals with qualifying disabilities.  It is important to remember, within this demographic, there are distinct segments with varying healthcare needs and preferences. It is extremely important to tailor your marketing efforts to resonate with each segment.  This applies whether you are selling to either active seniors seeking fitness benefits or those with specific chronic conditions.

Client education is key for a successful agent:

Keep in mind, Medicare can be complex and overwhelming for many clients. Agents should create educational content that simplifies the process of choosing a Medicare Advantage plan.  There are several ways you can explain the MA plan benefits to potential clients.  Make use of any tool you have including; blog posts, infographics, and videos (YouTube) or side by side comparisons of plans. It is important that clients understand; coverage options, enrollment periods, and any recent changes to their plans.

Click here for Best Medicare Sales Meeting Questions

Digital marketing is important:

In the digital age, a strong online presence is vital for marketing success. It is a good idea to use various digital marketing channels to engage with your audience:

1.  Social Media: People of all ages use online platforms such as; Facebook, Twitter, and LinkedIn. These platforms are very useful to share many things including, educational content, updated plan offerings and so much more.
2. Email marketing is another good choice for some agents.  Personalized emails about plan updates, AEP reminders or whatever you think will engage either existing clients and/or prospects
3. You may wan to invest in paid online advertising on place like YouTube, Facebook or other various pay-per click opportunities.
4. If you have a website, be sure to use SEO optimization to drive visitors to your website and increase visibility with organic search results.

Partner with carrier representatives and healthcare providers:

We cannot stress enough how important it is to create a good relation ship with your local carrier reps.  These people offer a wealth of information as well as access to applications and marketing tools that may include marketing dollars.

If possible, form partnerships with local healthcare providers and medical facilities.  This is a great way to increase brand awareness and referral opportunities.

Community involvement:

Any opportunity to be at a public event will help to establish your brand and let people know you are happy to provide guidance.  Places to help out include; soup kitchens, local health fairs hosting educational events at your local senior center or church group.  The opportunities are endless once you look around.  You may also want to host seminars or webinars to educate seniors about the importance of Medicare Advantage and how it can fit their specific needs.

Happy clients can be very helpful:

Positive feedback from satisfied customers can make a big impact on potential clients. Encourage your clients to share their experiences with your business with their friends, family and  co-workers or through online reviews.  These referrals can bring in clients for years to come and truly expand you Medicare book.  If possible, have clients go to your social media page and write a review.  This helps build trust and credibility.

Keep in mind; The Medicare Annual Enrollment Period (October 15 – December 7) is a critical time for marketing MA plans.  Be sure to reach out to your clients and check for plan updates to be sure they are happy with their coverage.  It is imperative to maintain your book of business and keep clients happy by letting them know you will make sure their healthcare needs are met.

What are MA commissions for 2024

Learn why you should partner with Crowe

If you want to view more images by this creative artist; click here

Medicare Open Enrollment Period

Because there is some confusion as to what the Medicare Open Enrollment Period actually is, we will take a few minutes to explain it.

Many people confuse the term Medicare open enrollment period or OEP and the term Medicare Annual Enrollment or AEP.  It important to understand the differences between these two enrollment periods.

The Medicare OEP, Open Enrollment Period:

This enrollment period takes place each year from January 1 to March 31.  Anyone who is enrolled in a Medicare Advantage plan (Part C) can use this enrollment period to go over their current MA plan and make changes if they are necessary.

What can enrollees do during this time:

• Change from one MA or MAPD (Part C) plan to a different MA or MAPD plan.
• Drop your MA/MAPD plan and go back to Original Medicare (Parts A & B).
• If you go back to original Medicare, you can Enroll in a Medicare PDP prescription drug plan (Part D).

The new plan starts on the first day of the month following the submission of the member’s application.

Please note; the Medicare Advantage Open Enrollment Period is for Medicare Advantage plan members only.

Beneficiaries on Original Medicare cannot switch to a Medicare Advantage plan at this time. If that is what they want to do,  they must wait for the Medicare Annual Enrollment Period. 

The Medicare AEP,  Annual Enrollment Period:

During this enrollment period, it is wise to review your client’s Medicare coverage and make any changes they decide on.  The AEP runs from October 15th through December 7th each year.

What can beneficiaries do during AEP:

Switch from Original Medicare to Medicare Advantage (or vice versa).

If you’re enrolled in Original Medicare (Part A and Part B) and want to add benefits such as; prescription drug coverage, dental, vision, OTC and more, you may wan to try a Medicare Advantage plan.  On the other hand, if  you’re on a Medicare Advantage plan and want the flexibility of Original Medicare, you can return to it.

1. Change Medicare Advantage Plans: If you’re already enrolled in a Medicare Advantage plan that doesn’t fully meet your needs, you can explore different plan options in your area.
2. Enroll in a prescription drug plan (Part D): If you don’t have credible prescription drug coverage through your current plan or are in Original Medicare, you can join a standalone Medicare Prescription Drug Plan to help manage medication costs.
3. Enrollees can either switch or drop prescription drug plans: Beneficiaries already enrolled in a Part D plan should compare prescription drug plans each year to ensure they have the most suitable coverage for their needs.
4. Review Medicare Supplement Insurance (Medigap) Policies: Although Medicare Supplement plans are not part of the Annual Enrollment Period, it is a good idea to review these plans annually to assess whether they offer the best coverage for your needs.

Why are the Medicare Open Enrollment Period & Annual Enrollment periods important:

The significance of these enrollment periods is that they allow beneficiaries an opportunity to reassess their healthcare needs as their circumstances change.  This gives them a chance to potentially save money on premiums, deductibles, and copayments or purchase additional coverage.

Anyone who fails to take advantage of this window may be stuck in an ineffective or expensive plan for another year.  This can result in less coverage than they need and higher medical costs.

Tips to Help Clients Make Informed Choices:

1. Assess Current Coverage: Review your client’s current plan to identify any gaps in coverage or services they require. Consider their healthcare expenses over the past year and anticipate any potential changes in healthcare needs for the upcoming year.
2. Compare Plans: Use your resources through connecture or sunfire to compare the various plans available in the area. Look for plans that cover your specific medical needs, including prescription drugs, doctors, and hospitals.
3. Check for Plan Changes: Insurance providers can make changes to their plans each year.  This includes adjustments to premiums, drug formularies, and networks. Be sure you understand how these changes impact coverage and costs.
4. Consider Future Needs: While it’s essential to address current healthcare needs, try to anticipate possible medical events or changes that may require different coverage choices in the future.

Are you looking for the right FMO – click here to see why we are a good fit

Do you need a scope of appointment – click here

Visit our YouTube channel for free training videos

To view more images by this artist; click here