Blog

Changing Medicare Supplement Plans: What to Know Before You Switch

Medicare Supplement (Medigap) plans are a great choice for covering the portion of out-of-pocket costs that Original Medicare doesn’t. However, as health needs and financial situations change, beneficiaries might consider changing Medicare supplement plans. Whether it’s to reduce premiums or adjust coverage, making a change requires some thought and planning.

Here’s what to keep in mind when considering a change to Medicare Supplement coverage.

Why People Change Medigap Plans

There are several reasons why someone might decide to change their Medigap plan:

• Overpaying for coverage: The current plan might offer more coverage than needed, meaning the policyholder may not use as much coverage as much as expected.
• Needing additional benefits: Health needs can change, and a different plan may provide better or more suitable coverage.
• Shopping for a better rate: Even if the benefits remain the same, switching to a different insurance carrier offering the same plan at a lower premium makes sense.
• Company dissatisfaction: Some beneficiaries want to change to a new insurer due to customer service or other experiences.

When You Can Switch

Changing Medigap plans isn’t quite as simple as enrolling in Medicare for the first time. There are only a few scenarios when someone can switch plans without facing potential roadblocks:

• During their six-month Medigap Open Enrollment Period: This period starts the month they turn 65 and are enrolled in Medicare Part B. During this time, they can buy any Medigap plan offered in their state or switch plans. Insurance companies cannot deny coverage based on health.
• 30 day free look period: After purchasing a new Medigap policy, you have 30 days to decide if you want to keep it. This allows beneficiaries to compare other plans with their your current plan. 
• With guaranteed issue rights: These are special protections that allow someone to buy certain Medigap plans without medical underwriting. Common situations that trigger guaranteed issue rights include losing employer coverage or moving out of a plan’s service area. However, there are currently 4 states that offer guaranteed issue rights regardless of the circumstance.

Please note: A new Medigap policy doesn’t automatically cancel the old one the way Medicare Advantage and PDP plans do. It is best not to cancel your old Medigap policy until you are sure you want to keep the new one.

Watch a YouTube video on Medicare Supplement underwriting.

Outside of the situations listed above, beneficiaries may need to go through medical underwriting to enroll in a new Medigap plan.

Understanding Medical Underwriting

Medical underwriting is a review process insurers use to assess an applicant’s health history and current conditions. Based on this review, a company can:

• Approve or deny the application.
• Charge a higher premium.
• Apply a waiting period for coverage of pre-existing conditions.

If a person applies for a Medigap plan outside their Open Enrollment Period and without guaranteed issue rights, their application could be declined based on health.

One common underwriting consideration is tobacco use. Smokers often face higher premiums, even if they are otherwise in good health.

No Waiting Period to Switch

There’s a common misconception that people have to keep their Medigap plan for a set amount of time before switching. The truth is, once someone has a Medigap policy, they can apply for a new one at any time. As long as they’re willing to go through underwriting if required.

Switching Medicare Supplement plans isn’t something to rush into, but with the right timing and a good understanding of the process, it can be a good idea for your health and finances. Whether it’s finding more appropriate coverage or simply lowering monthly costs, reviewing options regularly ensures your Medicare Supplement plan continues to meet your needs. It is best to speak with a licensed Medicare agent who can guide you through the options and find the best fit for your needs.A

If you are an agent who is ready to join the team at Crowe; click here for online contract.

Agents helping clients navigate this process; be sure they understand the importance of timing and potential underwriting challenges. They must understand how their health status could impact their options.

Stay up-to-date on agent events and information; click here.

Medicare Advantage VBID Termination: What Agents Need to Know

The Centers for Medicare & Medicaid Services (CMS) announced the Medicare Advantage VBID termination. The Value-Based Insurance Design (VBID) Model will officially end after the 2025 plan year. This marks the end of a decade-long initiative aimed to innovate care delivery and cost management in Medicare Advantage. For agents, brokers, and plan sponsors, it’s important to understand what this change means and how to prepare.

A Quick Recap: What Was the VBID Model

Launched in 2017, the VBID Model was designed to test new approaches to delivering Medicare Advantage benefits. Its goal was to improve health outcomes and reduce costs. This allowed plans to tailor benefits based on chronic conditions, offer enhanced supplemental benefits, and experiment with cost-sharing structures that promoted high-value care.

Over time, the model evolved to include features like:

• Chronic Condition Special Needs Plan (C-SNP) enhancements
• Reduced or waived cost-sharing for high-value services
• Incentive programs for beneficiaries
• Expanded telehealth access
• Integration of Medicare hospice benefits (starting in 2021 as part of a separate Hospice Benefit Component pilot)

Are you ready to join the team at Crowe; click here for online contract.

Why Is CMS Ending the Model

Although VBID showed promise in some areas, CMS reported mixed results in measurable improvement in cost savings and health outcomes. Despite some plans reported success, the model overall did not produce consistent, scalable results that justified its continuation beyond 2025.

The separate Hospice Benefit Component, a key aspect of the VBID experiment since 2021, will also end in 2025. CMS plans to use the lessons learned from this model to inform future policy and innovation strategies.

What This Means for Agents and Beneficiaries

If you’ve worked with clients enrolled in VBID-participating Medicare Advantage plans, now is the time to start tracking changes for 2026. Although the VBID Model is ending, plans may still continue some of the supplemental and chronic condition benefits on their own; just outside of the CMS demonstration model.

Here’s what to keep in mind:

• No disruption for 2025: Plans participating in VBID will continue as usual for the rest of the plan year.
• Prepare for benefit shifts in 2026: Expect changes in cost-sharing structures, supplemental benefits, and chronic condition management tools once the model concludes.
• Watch for new CMS innovations: While VBID is ending, CMS may introduce new pilots or value-based initiatives influenced by VBID findings.

The loss or reduction in benefits makes this a great time to put your cross selling skills to the test. Find out what products you can offer clients that will provide they coverage they need.

Watch a YouTube video on Cross selling

The sunsetting of the VBID Model is a significant development for the Medicare Advantage landscape. As an agent, staying proactive by reviewing carrier updates, analyzing plan adjustments, and educating clients about any changes will be critical. Although one model is ending, the pursuit of value-based care in Medicare is far from over.

Stay up-to-date on agent events and information; click here to learn more.

Stay tuned for more CMS announcements and be ready to pivot as the industry evolves.

Is SPAP Considered Creditable Coverage – Can Enrollees Use it With MA Only Plans

For Medicare beneficiaries who also qualify for a State Pharmaceutical Assistance Program (SPAP), it’s important to understand how these state-run programs fit in with Medicare coverage. This is especially important in regard to prescription drugs. One question that comes up a lot is: Is SPAP considered creditable coverage for Medicare Part D? As well as; can beneficiaries use it with a Medicare Advantage (MA-only) plan?

The answer depends on the state and the specific benefits the SPAP provides. Let’s break it down.

What Is SPAP

SPAPs are programs individual states put in place to help eligible residents; typically low- to moderate-income individuals, afford prescription medications. These programs vary widely but often help with:

• Medicare Part D premiums
• Deductibles and copays
• Costs for medications not covered under Medicare

Is SPAP Considered Creditable Coverage

Yes, in some cases. Some SPAPs are considered creditable coverage for Medicare Part D, but not all.

What Is Creditable Coverage

Creditable coverage means the plan’s prescription drug coverage is expected to pay, on average, at least as much as Medicare’s standard Part D benefit. If you have creditable coverage when first eligible for Medicare, you can delay enrolling in Part D without facing a late enrollment penalty later on.

How SPAPs May Qualify

Some SPAPs meet this standard and notify both CMS and the enrollee that their coverage is creditable. These programs can help:

• Avoid the Part D late enrollment penalty if you delay enrolling
• Have peace of mind knowing you won’t be penalized for waiting

However, not all SPAPs are creditable. Each program must notify you annually about whether your coverage is creditable, so it’s critical to keep that notice.

Can You Use SPAP With a Medicare Advantage MA-Only Plan?

Yes, but with limitations. MA only plans cover Medicare Part A and B services but do not include drug coverage (Part D). And here’s the important rule:

You cannot enroll in both an MA-only plan and a standalone Medicare Part D plan (PDP) at the same time; unless you’re in a rare type of MA plan like a Medicare Medical Savings Account (MSA) or some PFFS plans.

Learn how the Canadian Medstore can help with prescription costs – watch our YouTube video

Three Common Scenarios:

1. You Have a Creditable SPAP + MA Only Plan
   If your state’s SPAP is creditable, you may delay enrolling in Part D while using your MA only plan. SPAP may help with limited drug needs during this time without incurring the Part D penalty.
2. You Need Comprehensive Drug Coverage
   If your SPAP is not creditable, or if you need more robust drug coverage, you should switch to a Medicare Advantage plan that includes drug coverage (MAPD). You can then use SPAP to help with cost-sharing.
3. Temporary or Transition Use
   Some beneficiaries use SPAP temporarily (during a SEP or between Part D plan enrollments). SPAP can provide some assistance in the gap, but this depends on the program’s structure. It is important not to let creditable drug coverage lapse for a period of 63 days or more, or you will face a penalty for the lapse.

If you are an agent who is ready to join the Crowe team; click here for our online contract.

Helpful Tips

• Check the SPAP’s creditable coverage status; this info should be provided to you in writing annually.
• Use SPAP to reduce drug costs, even if you’re enrolled in a Medicare drug plan (Part D or MAPD).
• Talk to a licensed Medicare agent or your state’s SHIP office to determine whether the SPAP coordinates well with your Medicare Advantage plan.

SPAPs offer valuable help, but understanding how they work with Medicare is essential. Some SPAPs are considered creditable coverage and can help you delay enrolling in Medicare Part D without penalty. Others are not, and relying on them alone could leave you with late enrollment penalties.

Individuals currently enrolled in a Medicare Advantage MA only plan should carefully weigh their prescription drug needs. In most cases, the safest route is to either enroll in a MAPD plan or verify that your SPAP qualifies as creditable coverage before delaying drug plan enrollment.

Medicare agents stay up-to-date on events and information – click here.

When to Use an MA-Only Plan Enrollment for Your Clients

As a Medicare agent, one of the most important roles you play is helping clients find the right coverage to fit their unique needs. While many clients are familiar with Medicare Advantage plans that include prescription drug coverage (MAPD), there are specific scenarios where Medicare MA only plan sales are a great option.

In this blog, we’ll explore when to clients should consider an MA only plan enrollment. This can be a good option if clients have creditable drug coverage through the VA, SPAP plan or other sources.

What Is a Medicare Advantage (MA Only) Plan

A Medicare Advantage (MA) plan without prescription drug coverage is commonly referred to as an MA only plan. This type of Medicare Advantage plan includes the benefits of Original Medicare, but does not include Part D coverage

Watch a quick YouTube video on the SEP for discontinued MA plans

When Should Agents Recommend an MA-Only Plan

There are specific situations where enrolling in an MA only plan is the most appropriate or beneficial choice. These include:

Client Has Creditable Prescription Drug Coverage (like SPAPs)

Some clients may already have creditable drug coverage from another source, such as a State Pharmaceutical Assistance Program (SPAP). If that coverage is deemed creditable (at least as good as Medicare Part D), they do not need to enroll in a separate drug plan and can avoid the Part D late enrollment penalty.

This makes them good candidates for an MA only plan. MA only plans provide added benefits (like dental, vision, or hearing coverage), but don’t include the drug coverage component.

Remember: Always verify that the SPAP coverage is creditable. Many state SPAPs are, but it’s important to confirm. You can usually find this information in the plan’s annual notice of creditable coverage.

Veterans with VA Drug Coverage

Clients who receive prescription drugs through the VA often prefer to continue using their VA benefits for medications. Since VA drug coverage is considered creditable, they may want to enroll in an MA only plan to take advantage of broader provider access and supplemental benefits without duplicating their drug coverage. Please note; some carriers offer plans specifically for veterans.

Clients Enrolled in Employer or Union Retiree Drug Plans

Some retiree coverage includes drug benefits that are also creditable. These clients can pair their employer or union drug coverage with an MA-only plan to take advantage of enhanced benefits and local provider networks.

Agents; click here to join the Crowe team or add a carrier to an existing Crowe contract.

What to Watch Out For

When considering an MA-only plan, keep these key reminders in mind:

• No Built-in Drug Coverage: If your client loses their other drug coverage in the future and doesn’t enroll in a Part D plan when first eligible, they could face a late enrollment penalty.
• Enrollment Timing Matters: Clients can typically enroll in an MA only plan during the same enrollment periods as MAPDs, such as the Initial Enrollment Period (IEP), Annual Enrollment Period (AEP), or with a Special Enrollment Period (SEP) if they qualify.
• Provider Networks Still Apply: Be sure the client’s preferred doctors and hospitals are in-network, even if they’re saving money by not enrolling in drug coverage.

Bottom Line

An MA only plan can be an excellent choice for clients who already have creditable drug coverage through another source. It allows them to receive the benefits of Medicare Advantage; like extra services and care coordination, without paying for additional prescription drug coverage.

Stay up-to-date on the latest agent event and information

As an agent, taking the time to ask about all forms of coverage and confirming whether they’re creditable will help you guide clients to the most cost-effective and appropriate Medicare solutions.

Need help checking if a client’s SPAP is creditable? Reach out to the plan provider for confirmation, or contact the SPAP directly. It’s always better to be safe than sorry to avoid Part D penalties!

What Medicare Plan N Covers: Is It the Right Supplement for You

When it comes to supplementing Original Medicare (Part A and Part B), Medigap Plan N is one of the more popular options. It offers strong coverage at a lower premium than some other Medigap plans. This makes it an attractive choice for many Medicare beneficiaries. We will go over what Medicare Plan N covers, and why someone might choose it over other options.

What Medicare Plan N Covers

Medigap Plan N is a standardized Medicare Supplement Insurance plan, which means the benefits are the same no matter which insurance company offers it. Here’s what Plan N covers:

1. Medicare Part A Coinsurance and Hospital Costs – Covers up to an additional 365 days after Medicare benefits are used up.
2. Medicare Part B Coinsurance or Copays – Covers most of the 20% coinsurance beneficiaries would otherwise pay. This excludes copays; up to $20 for doctor visits and up to $50 for ER visits that don’t result in admission.
3. Blood (First 3 Pints) – Covers the cost of the first three pints of blood needed for a medical procedure.
4. Part A Hospice Care Coinsurance or Copays
5. Skilled Nursing Facility Care Coinsurance
6. Medicare Part A Deductible – Plan N covers this cost, which can save you over $1,600 per admission in 2025.
7. Emergency Medical Care During Foreign Travel – Covers 80% (up to plan limits) for medically necessary care during international travel.
   

What Plan N Does Not Cover

There are a few out-of-pocket costs you may still be responsible for:

1. Medicare Part B Deductible – You’ll need to pay this annually ($240 in 2025).
2. Part B Excess Charges – If your doctor does not accept Medicare assignment and charges more than Medicare-approved amounts, Plan N does not cover those excess charges.
3. Copayments – As mentioned earlier, you’ll pay small copays for some office and emergency room visits.
   

Why Choose Medicare Plan N

Here are some reasons why Plan N might be the right choice for you:

Lower Monthly Premiums

Plan N generally has lower premiums than Plan G or Plan F. This makes it a budget-friendly option for those who want solid coverage without a high monthly cost.

Predictable Costs

Aside from the Part B deductible and occasional copays, your out-of-pocket costs are minimal. This makes it easier to plan financially, especially for healthy individuals who don’t visit the doctor often.

Access to Nationwide Coverage

Like all Medigap plans, Plan N allows you to see any provider in the U.S. who accepts Medicare; no networks or referrals needed.

Foreign Travel Coverage

If you travel abroad, the emergency coverage provided under Plan N gives you added peace of mind.

Ideal for Healthy Retirees

If you’re in good health and don’t mind paying occasional small copays, Plan N can offer significant savings while still covering major expenses.

Watch a quick video on Medicare enrollment periods

Is Plan N Right for You

Plan N is best for those looking to balance good coverage with lower monthly premiums. It’s especially attractive if you don’t anticipate frequent medical visits and prefer to avoid the higher costs of Plan G or Plan F.

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

Click here to stay updated on the latest agent events and information.

As always, it’s important to review personal health needs, provider preferences, and budget with a licensed Medicare agent to determine if Plan N is your best fit.

Medicare Part D Coverage phases 2026

With significant changes enacted under the Inflation Reduction Act (IRA), Medicare Part D prescription drug coverage is now simpler and more predictable. Beginning in 2025, beneficiaries no longer experience a “donut hole,” and starting in 2026, cost thresholds slightly increase to keep pace with inflation. This blog explains the Medicare Part D Coverage Phases for 2026.

Part D Coverage: Three Straightforward Phases

1. Deductible Phase

• In 2026, CMS will implement a maximum standard deductible of $615 (increased from $590 in 2025). Beneficiaries pay 100% of drug costs out of pocket until they meet the deductible. Keep in mind, plan providers have the option to offer a lower or zero deductible.

2. Initial Coverage Phase

• Once the beneficiary meets the deductible, they enter the initial coverage phase.
• In this phase beneficiaries may pay up to 25% coinsurance on covered drugs. Pleas note; most drug plans do not charge coinsurance for tier 1 or even tier 2 drugs.
• Beneficiaries continue to pay coinsurance until their total out‑of‑pocket spending reaches $2,100 in 2026 (previously $2,000 in 2025).
• There is no Initial Coverage Limit (ICL) separate from your out‑of‑pocket threshold, so no “gap” in coverage.

3. Catastrophic Phase

• Once the beneficiary has spent $2,100 out of pocket on formulary (covered) drugs, they enter the catastrophic phase.
• In this phase, beneficiary coinsurance drops to $0; they have no further cost-sharing on covered Part D drugs for the rest of the year.

Watch a YouTube video on the Part D drug cap

What Happened to the Donut Hole

• The coverage gap (“donut hole”) was officially eliminated starting January 1, 2025.
• Instead of transitioning from initial coverage to a gap, enrollees transition directly into catastrophic coverage once they reach the annual out-of-pocket cap ($2,000 in 2025; $2,100 in 2026).
• This means no more confusing coinsurance changes mid‑year; just a smooth journey through three phases.

Why No “Donut Hole”

Before 2025, Part D had four somewhat confusing cost-share phases:

• Deductible → Initial Coverage → Coverage Gap (“donut hole”) → Catastrophic Coverage.

Thanks to the Inflation Reduction Act:

• The donut hole was discontinued, coinsurance standardized at 25%, and a hard cap on TrOOP at $2,000 in 2025.
• In other words: Simplified coverage and predictability was put in place.

2026 Standard Benefit Summary

TrOOP stands for out of pocket. The TrOOP includes: deductible, copays and coinsurance. However the TrOOP does not include; plan premiums or drugs not covered under Part D of your plan.

Summary for Medicare Prescription Coverage 2026

• The year begins with beneficiaries paying up to $615 out of pocket toward their deductible.
• After that, they pay 25% of covered drug costs until their total out-of-pocket spending hits $2,100.
• Once they hit the cap, they move into catastrophic coverage and pay zero out-of-pocket for covered drugs for the rest of the year.
• As of 2025, the donut hole is gone, ensuring a smooth and straightforward benefit structure.
• Beneficiaries can consider enrolling in the Medicare Prescription Payment Plan if it helps spread out drug costs.

Medicare agents:

Click here for updated agent events and information

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

2026 brings continued relief and clarity for Medicare Part D enrollees; no donut hole, no complicated phases, just predictable costs and peace of mind.

How To Save On Prescription Drugs – Helping Medicare Clients

Prescription drug costs can be a major concern for Medicare beneficiaries, especially those on a fixed income. As a Medicare agent, helping your clients learn how to save on prescription drugs not only builds trust; it can also make a real difference in their overall healthcare experience.

Here are several effective strategies you can use to help your clients save on their prescriptions:

Review Medicare Part D Plans Annually

Encourage clients to compare Part D plans every year, especially during the Annual Enrollment Period (AEP). Drug formularies, pharmacy networks, and premiums can change annually, which may impact out-of-pocket costs.

Use Medicare’s Plan Finder tool or your quoting software to:

• Check if current medications are still covered
• Compare plan premiums, deductibles, and copays
• Identify preferred pharmacy networks for added savings

Look Into Medicare Advantage Plans with Drug Coverage

Some Medicare Advantage (MAPD) plans include prescription drug benefits that may offer lower costs than standalone Part D plans. Make sure to evaluate:

• Formulary tier placement for their medications
• Coverage phases (deductible, initial coverage, catastrophic)
• Extra benefits like mail-order options or pharmacy discount programs

Apply for Extra Help (LIS)

Let eligible clients know about Medicare’s Extra Help program, also known as Low-Income Subsidy (LIS). It helps cover:

• Part D premiums
• Deductibles
• Coinsurance

Each year, income and asset limits are updated. Help clients check eligibility and apply through Social Security or their state Medicaid office.

Check for State Pharmaceutical Assistance Programs (SPAPs)

Many states offer SPAPs that provide financial help with prescription drugs for low- to moderate-income seniors. These programs vary by state, so check what’s available locally and guide clients through the application process if applicable.

Request Generic and Therapeutic Alternatives

Encourage clients to:

• Ask their doctor if a generic version is available
• Discuss therapeutic alternatives that might work just as well at a lower cost
• Use formulary tools to find covered equivalents in lower tiers

This can result in significant monthly savings without sacrificing effectiveness.

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

Use Preferred or Mail-Order Pharmacies

This one should be obvious, but some beneficiaries do not understand the possible savings. Help clients find pharmacies within their plan’s preferred network, where they’ll often get the lowest copays. In many cases, 90-day mail-order supplies are also more affordable and convenient for maintenance medications.

Explore Prescription Discount Programs

While they can’t be used in conjunction with Medicare, some clients may benefit from discount cards (like Glic, GoodRx or SingleCare) when paying cash. These may be helpful for:

• Medications not covered by their plan
• When the discount price is lower than their copay

Important: Remind clients that purchases using discount cards don’t count toward their Part D deductible or out-of-pocket threshold.

Consider Safe International Pharmacy Options

For some clients, especially those with high-cost brand-name prescriptions, licensed international pharmacies can provide considerable savings.

One popular and reputable option is The Canadian MedStore, which connects U.S. consumers with licensed international pharmacies in Canada and other Tier 1 countries. Key benefits include:

• Substantial savings on brand-name medications
• Licensed pharmacy partners
• Reliable customer service and refill support

Please note: Agents should advise clients to check with their doctors before switching sources and confirm that any international pharmacy is legitimate and properly licensed.

Watch a YouTube video with details on the Canadian Medstore

Saving on prescriptions doesn’t have to be complicated, sometimes all it takes is having the right resources. As an agent, you can guide clients toward cost-effective, safe solutions that help them stay healthy and financially stable.

Stay updated on the latest agent events and information

Whether it’s comparing plans, applying for Extra Help, or exploring alternative resources, your support can make a meaningful difference.

Understanding the Medicare SHIP Program

When navigating the complexities of Medicare, having expert, unbiased help can make all the difference. That’s where the State Health Insurance Assistance Program (SHIP) comes in. SHIP provides free, personalized counseling and assistance to Medicare beneficiaries and their families. Whether you’re enrolling for the first time or reviewing coverage options, Understanding the Medicare SHIP Program can be a valuable resource.

What Is SHIP

SHIP stands for State Health Insurance Assistance Program. Funded by the federal government and administered at the state level, SHIP offers free, objective, and confidential help to people with Medicare.

Each state has its own SHIP, staffed by trained counselors who are not affiliated with insurance companies. Their goal is to help Medicare beneficiaries make informed decisions based on individual needs; not sales goals.

Medicare beneficiaries may use SHIP in conjunction with their Medicare agent to access additional support with Medicare issues such as:

What Services Does SHIP Provide

• Understanding Original Medicare (Parts A and B)
• Comparing Medicare Advantage (Part C) and Part D drug plans
• Reviewing Medigap (supplemental insurance) options
• Explaining Medicare Savings Programs and Extra Help
• Appealing Medicare denials and billing errors
• Transitioning from employer insurance to Medicare
• Understanding coverage for long-term care

SHIP can provide guidance tailored to each specific situation.

Who Can Use SHIP

SHIP services are available to:

• Current Medicare beneficiaries
• People turning 65 soon or new to Medicare
• Caregivers or family members assisting someone with Medicare
• Individuals under 65 who qualify for Medicare due to a disability

There is no cost for SHIP counseling, and there is no pressure to choose a specific plan.

Need help getting diabetic supplies; watch a quick YouTube video to access assistance

How to Find SHIP Help

To contact your local SHIP office, visit www.shiphelp.org and use the locator tool. You can also call 1-877-839-2675 to be directed to your state’s SHIP.

Appointments may be available by phone, in-person, or virtually; depending on location and preference.

Why SHIP Matters

For beneficiaries who do not have a trusted Medicare agent; Medicare can be overwhelming when you’re trying to choose the right plan for your needs or help a loved one through the process. SHIP counselors offer unbiased, trusted advice. They exist solely to help Medicare beneficiaries make informed choices and avoid costly mistakes.

If you are a Medicare agent looking for a supportive upline; click for Crowe contracting

Stay up-to-date on the latest agent events and information.

Those unsure about Medicare coverage, billing, or eligibility; or just need someone to walk through the options; SHIP is an excellent place to start.

Get a Head Start on AEP: Prep Now for a Successful Enrollment Season

The Annual Enrollment Period (AEP) is one of the busiest and most profitable times of the year for Medicare agents. Between October 15th and December 7th, the demand for knowledgeable, trusted advisors skyrockets. But here’s the truth: agents who wait until the fall to prepare are already behind. It is best to get a head start on AEP before everything piles up.

The most successful Medicare agents treat the months leading up to AEP as preparation time. By getting a head start now, you’ll not only reduce stress but also position yourself to grow your book of business and serve clients more effectively when the rush begins.

Here are some steps you can take right now to set yourself up for your best AEP yet:

Complete Certifications and Training

Staying current with your certifications is critical. Most carriers require agents to complete either AHIP or NABIP certification and plan-specific training before they can begin selling Medicare Advantage or PDP plans during AEP.

• AHIP and NABIP typically launch in June, so mark your calendar.
• Many carriers offer a discount if you complete AHIP through their portal; take advantage of that!
• Start your carrier certifications as soon as possible so they do not pile up (they can be time consuming). This helps you minimize stress as it gets closer to the October deadline.

By getting these done early, you’ll be compliant, confident, and ready to hit the ground running.

Stay Updated on Industry Changes & Training Opportunities

The Medicare landscape is constantly evolving; plan changes, regulatory updates, compliance rules, and new technology are all part of the mix. That’s why staying informed isn’t just helpful; it’s essential.

Take time now to:

• Subscribe to carrier newsletters and CMS updates.
• Attend webinars, workshops, or local training events.
• Engage in forums or networking groups with other Medicare agents.

The more informed you are, the more value you bring to your clients—and the more confident you’ll feel going into AEP.

Click here to view the latest agent events and information.

Prepare and Update Your Marketing Materials

Your marketing materials are your first impression; make sure they’re working for you, not against you.

Before AEP begins, audit and refresh all your materials:

• Brochures
• Flyers
• Business cards
• Educational handouts
• Giveaways or branded items (under $15 for compliance!)

Make sure everything reflects your current branding, includes up-to-date contact information, and is tailored to your audience.

If you’re planning to promote yourself through social media, email, or your website, remember:

• Include all required disclaimers (especially for Medicare Advantage or PDP).
• Double-check whether your materials require HPMS filing and approval.
• For peace of mind, consider working with your compliance department to review and file your materials properly.

Watch a YouTube Video of the CMS proposed changes for CY2026

When in doubt; ask. Staying compliant now saves headaches later.

Test Lead Sources Before the Rush

Not all leads are created equal; the best time to figure out what works is before the pressure of AEP hits.

Now is the perfect time to test and evaluate:

• Digital leads (Google ads, Facebook campaigns)
• Direct mail campaigns
• Community referrals
• Educational events
• Grassroots marketing (partnering with local businesses or pharmacies)

Track metrics like cost per lead, contact rate, appointment set rate, and ultimately, conversion to sale.

Give yourself time to test, and refine your lead strategy so when AEP begins, you’re not guessing, you’re scaling.

Make a Marketing Plan

Don’t wait until October to promote yourself; start building awareness now. Consider:

• Planning grassroots marketing like community events or educational seminars.
• Designing print materials (postcards, flyers, business cards).
• Lining up email campaigns or social media content to build visibility.

Make sure your Permission to Contact (PTC) processes are compliant and ready to go.

Update Tools and Technology

Evaluate whether your current tools are working efficiently:

• Is your CRM user-friendly and up to date?
• Are your quoting tools and enrollment platforms ready?
• Do you need to upgrade your laptop, printer, or internet connection?

Watch a YouTube video on Connecture & Sunfire quoting and enrollment tools

A little tech prep now can save you major headaches later.

Check that your systems are:

• Updated and running smoothly
• Synced across devices
• Easy for both you and your clients to use

Key tools to have ready:

• Online quoting tools – for fast and accurate plan comparisons
• E-app platforms – for secure and paperless enrollment
• Video conferencing tools – for remote appointments
• Electronic scope of appointment (SOA) tools – for compliance

Also, make sure your email, calendar, and CRM are integrated so nothing slips through the cracks.

Learn about Pinnacle’s BOSS agent portal & CRM for agents

By mastering your tech tools before AEP, you’ll boost efficiency, reduce errors, and deliver a smoother experience to every client; earning trust and more referrals.

If you are ready to join the team at Crowe,; click here for online contracting

Take Care of Yourself

Don’t forget: you’re your biggest asset. AEP is a marathon, not a sprint. Use this pre-season time to get into a good routine; physically, mentally, and professionally so you can show up at your best every day during the rush.

Understanding Medicare Part B Coverage

Both Medicare Part B (medical insurance) and Part A (hospital insurance), make up Original Medicare and play a vital role in healthcare for millions of Americans. Because Part B provides essential coverage for outpatient care, doctor visits, preventive services, and more; understanding Medicare Part B coverage is essential.

What’s Covered by Medicare Part B

Part B helps pay for a range of services and supplies, including but not limited to:

• Doctor’s visits (primary care and specialists)
• Wellness and preventive visits
• Urgent care services
• Laboratory tests (e.g., blood work, urinalysis)
• Diagnostic imaging (X‑rays, scans)
• Emergency ambulance transportation
• Mental health services (outpatient therapy, counseling)
• Durable medical equipment/DME (e.g., wheelchairs, oxygen tanks)
• Rehabilitative services (physical, occupational, speech therapy)
• Preventive services (e.g., flu shots, pap smears, cancer screenings)

Beneficiaries may receive these services in doctors’ offices, hospitals, clinics, and other outpatient facilities.

Medicare Part B Costs (2025 Rates)

Premium

• Standard monthly premium: $185.00 in 2025; up from $174.70 in 2024.
• Beneficiaries who receive Social Security payments have this amount automatically deducted from their Social Security checks. Those who opt not to take Social Security payments receive a quarterly bill for $555.00.

High-income earners pay higher premiums under IRMAA (Income‑Related Monthly Adjustment Amounts), with surcharges ranging from an additional $74 to $443.90, depending on tax filing status and income level.

Deductible & Coinsurance

• Annual deductible: $257 for 2025, this amount is up from $240 in 2024
• Coinsurance: Once the beneficiary meets the deductible, they pay 20% of the Medicare-approved cost for most services after Medicare pays it’s share (80%).

Late Enrollment Penalty

Those who don’t sign up for Part B when first eligible (and don’t qualify for a Special Enrollment Period), incur a 10% penalty for each full 12 months they were eligible but didn’t enroll. This penalty is added to the monthly premium and lasts for as long as they have Part B.

Watch a YouTube video on OEP, Special Elections & Late Part B Enrollments

How to Enroll

You can sign up for Medicare Part B online via the Social Security Administration, by phone at 1-800-772-1213 (TTY: 1-800-325-0778), or in person at your local Social Security office.
Ready to sign up for Part B? Click here to enroll now.

We’re Here to Help

Medicare agents can be a valuable source of information and guidance. There is no fee for the appointment. Whether you’re new to Medicare or looking to optimize your coverage, licensed agents are ready to assist.

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

Get all the latest agent news and event information; click here!

Keeping up with annual updates, such as; Part B premiums and deductible as well as nay plan changes, can help you budget effectively and avoid surprises.