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Medicare licensed agents

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

Where to start

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

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

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

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

Contract with an FMO

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

 Watch a YouTube video on the programs Crowe has to offer

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

Join the team at Crowe – click here for online contracting

Purchase E&O insurance

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

Click here to learn about our discounted E&O

Complete AHIP

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

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

Get contracted & appointed

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

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

Find out about how Medicare commissions pay 

Moving forward

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

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

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

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

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Starting a Medicare Insurance Agency

If you enjoy helping others and  want to start your own business, starting a Medicare insurance agency could be a good fit for you.

The first thing you need to have is a solid understanding of Medicare:

You should familiarize yourself with the Centers for Medicare & Medicaid services (CMS) and their rules and regulations.  It is very important that you understand the various types of Medicare plans available and what they provide.

It is also a good idea to have Medicare sales experience. This will help you understand what it takes to be successful in the field and give you invaluable information to train your downline agents. Although there are some large Medicare agencies with owners that do not sell, they employ key people who do have sales experience that help ensure the success of the agency.

Some ideas to get you started:

1.  It is necessary to develop a business plan to help you get started
2.  Make sure you obtain all the necessary licenses and certifications to be complaint with all regulations.
3.  Establish a legal structure such as; sole proprietorship, partnership, limited liability company (LLC) or Corporation.  It is best to consult an attorney of advisor to help with this.
4.  Obtain all the insurance coverage you need including E&O, liability and in some cases, workers compensation.
5.  Develop a marketing strategy to promote your agency and gain public visibility. Create a website, social media platforms, print media and networking events.
6.  Decide what staff you need to run a business and make sure they are trained and ready to go.

Agency Contract levels:

The amount each contract level receives is regulated by CMS.  Each year, CMS puts a cap on the amount of commission paid for each sale.  This amount varies by state.

The different levels of contracts include:

1.  Street level – carriers pay the compensation directly to the sub agent with the override paid to the agency.  The amount of the override depends on the agency level.
2.  General agency or GA is the first agency level.  Agents at this level receive compensation above street level as well as overrides on any business written by downline agents.
3.  Master General Agency or MGA.  This level is achieved by meeting carrier requirements beyond that of the GA level for sales and downline agents.
4.  Senior General Agency or SGA.  There are even more sales requirements as well as a higher number of downline agents needed to achieve this level.

Please keep in mind, the number of subagents and sales that each carrier requires to reach the different contracting levels is determined independently by carrier.

If you have either a GA, MGA or SGA contract, your sub agents can still receive street level compensation with your agency receiving the override compensation.  Most carriers pay the street level  compensation directly to the sub agent while the agency receives the override payment.

More information about starting a Medicare Insurance agency:

Some agencies work with LOA (licensed only agents).  This means, the insurance carrier pays all compensation to the agency.  The agency then pays a agreed upon amount to the agent.  This model is commonly used by agencies who provide either low or no cost leads to their agents.  When this is the case, compensation levels can vary greatly, depending on what type of leads are offered.  Some agents receive compensation well below street when this is the model used.  With this set up, agencies generally own the book of business and may or may not pay out renewals.

Other agencies offer their agents street level contracts.  If this is the case, the agents receive compensation directly from the carrier as well as referrals.  In this instance the agent owns their own book of business.  Agent who are aware of the street level compensation amounts will rarely decide to work LOA under an agency.

You need agents to make up your agency::

To bring in new agents, you need to have something to offer them.  Provide them with leads or a lead program.  Make sure you offer training to them as well as be available to answer any questions they may have.

It is also a good idea to provide free tools that can help make writing business easier for them. Like online quoting and enrollment tools.

Click here to learn more about what to offer your downline agent

A proven training program helps your new producers build the confidence to get up and running. Training also helps low producing agents increase sales.  Many agents complain about uplines that do not provide the guidance they need to make sales.  Many agents are just looking for the support they need to become successful.

Most agencies use several strategies to recruit new agents.  Before you bring in anyone, decide if you are looking for agents who are already licensed and experienced or you want to bring on someone with no experience so you can train them from the ground up.  Whatever you decide, be sure you bring in someone who has the potential to help your agency grow.

How do I build the agency’s book of business:

The most important part of a Medicare business is finding qualified prospects and enrolling them in policies.  That is where finding a good source for leads is very important and finding the best way to work them.  Some agents do well on the phone while others may be great at presentations.  Maybe you like mailers.  This is something that you need to figure out.  Leads do not come with a guarantee.  Weather you make those sales or not depends on your ability.

The best lead source is word of mouth.  When you take good care of your clients, they tend to tell their friends and relatives.  This is free lead source and are invaluable.  That is why we cannot stress enough;  know your stuff!  Learn the plans and the enrollment periods.  Be aware of the marketing rules and everything in between.  This way you can ensure your clients get the best possible coverage and will stay on your books.

Learn about our T-65 Medicare Seminar Sales Program

Watch our YouTube video on best practices to build a Medicare agency

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Medicare Advantage sales

Medicare Advantage Sales: A Guide for Insurance Agents

Medicare Advantage plans, also known as Medicare Part C, are becoming a very popular choice for many Medicare beneficiaries. Because of this fact, many Medicare agents earn a good portion of their commission through the sale of MA plans.  These plans are an alternative option to the Original Medicare plans that Medicare offers.  In this blog, we go over a few things you need to know about the sale of MA plans.

Understanding Medicare Advantage Plans

Before we dive into Medicare Advantage sales, it is important to understand what these plans are. Medicare Advantage plans provide benefits similar to Original Medicare (Part A & Part B).  Original Medicare does not offer these plans.  Only private insurance companies can offer these plans to beneficiaries.  Most plans include additional benefits such as vision, dental and hearing coverage.  Many MA plans also provide prescription drug coverage (Part D).

These plans typically have either a low or no plan premium.  It is important to note;  MA plans have restrictions on which doctors and hospitals you can use. In addition, beneficiaries must continue to pay their Part B premium even while enrolled in a Medicare Advantage plan.

Eligibility for MA Plans

To be eligible for a Medicare Advantage plan, individuals must be enrolled in both Medicare Part A and Part B, and live within the plan’s service area. There are several instances when enrollment in these plans typically occurs.  They can enroll during their Initial election period (IEP) or during the Annual Enrollment Period (AEP) which takes place from October 15th through December 7th each year. However, individuals may also be able to enroll in a Medicare Advantage plan during certain special enrollment periods (SEPs).

Selling Medicare Advantage Plans

Now that you understand what Medicare Advantage plans are and who is eligible for them, let’s discuss how to sell these plans as an insurance agent.

1. Obtain the necessary licenses and certifications: In order to sell Medicare Advantage plans, you must be licensed as an insurance agent and certified to sell Medicare Advantage plans by both  the insurance carrier and Centers for Medicare and Medicaid Services (CMS).
2. Know your products: It’s important to understand the various Medicare Advantage plans offered by different insurance companies, as well as the benefits, costs, and restrictions associated with each plan. This knowledge will allow you to help clients choose the best plan for their needs.
3. Develop a marketing strategy: Medicare Advantage sales require a targeted marketing strategy. You may want to consider advertising in local newspapers or on social media, attending community events, and offering educational seminars.
4. Build relationships with clients: As with any sales business, building relationships with clients is key to success. Make sure to follow up with clients after they enroll in a plan to ensure they are satisfied with their coverage and answer any questions they may have.
5. Stay up-to-date with changes: Medicare Advantage plans can change from year to year, so it’s important to stay informed of any updates or changes to the plans you offer. This will ensure that you can provide accurate and up-to-date information to your clients.

 2023 MA commissions

Learn about our Medicare quoting and enrollment sites, they are free to our agents!

In conclusion, selling Medicare Advantage plans can be a rewarding business opportunity for insurance agents. By obtaining the necessary licenses and certifications, knowing your products, developing a marketing strategy, building relationships with clients, and staying up-to-date with changes, you can successfully sell these plans to Medicare beneficiaries.

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