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For many people trying to navigate Medicare, understanding how and when out-of-pocket costs apply can be overwhelming. The terminology “first dollar Medicare services” may cause confusion for some individuals. We will explain what it actually means and how they work in the context of Medicare services.

First Dollar Coverage

First dollar coverage refers to insurance benefits that begin immediately. The enrollee is not required to, pay a deductible, copay, or coinsurance before the carrier provides coverage for a medical service. This coverage literally begins from the “first dollar” of a medical bill providing the highest level of financial protection.

With Original Medicare (Parts A and B), this kind of coverage is not included by default, although it may be accessed through either supplemental plans or Medicare Advantage plans in some circumstances.

Original Medicare: No First Dollar Coverage

Medicare is divided into Part A (hospital insurance) and Part B (medical/outpatient insurance).

Original Medicare enrollees are responsible for the following out-of-pocket costs:

• Deductibles: Part A ($1,632 per benefit period in 2025); Part B ($240 annual)
• Coinsurance: 20% for most Part B services after the deductible
• Copays: Varies depending on the service or provider

Please note; although Medicare covers a significant portion of approved healthcare costs, it does not offer first dollar coverage when used on its own. Beneficiaries are responsible for cost-sharing amounts unless they purchase supplemental coverage.

First Dollar Coverage for Medicare Services

In general, there are two ways Medicare beneficiaries receive first dollar coverage:

1. Medicare Supplement (Medigap) Plans

The Medigap plans listed below cover most or all out-of-pocket costs after Original Medicare pays its share.

• Plan F: Offers true first dollar coverage. This plan covers both Part A and Part B deductibles as well as all coinsurance and copays for approved medical expenses as well as excess charges.
• Plan C: Similar to Plan F but doesn’t cover excess charges. Important: Plans F and C are not available to individuals who were eligible for Medicare after January 1, 2020.
• Plan G: Covers all approved Medicare expenses; except the Part B deductible, making this plan very close to first dollar coverage.

Beneficiaries enrolled in a Plan F shouldn’t have to pay anything out-of-pocket for Medicare covered services.

2. Some Medicare Advantage (Part C) Plans

Medicare Advantage plans are an alternative to Original Medicare. Some Medicare Advantage plans offer enrollees:

• $0 monthly premiums
• $0 copays for primary care, lab work, preventive services, or telehealth
• Reduced out-of-pocket costs through annual limits

Although technically they are not considered “first dollar” coverage, some plan benefits can effectively eliminate upfront costs for specific services, depending the plan design.

Keep in mind: Medicare Advantage plans may include networks, referrals, and prior authorization requirements.

Watch a quick YouTube video on Medicare enrollment periods

Examples of First Dollar Medicare Service

• Example 1: A Medigap Plan F enrollee visits the emergency room. The bill is fully covered; no deductible, no copay, no coinsurance. This is real first dollar coverage.
• Example 2: A Medicare Advantage plan enrollee has a $0 copay for a primary care visit. Although the plan may have a deductible for other services, this specific visit is a first dollar service.
• Example 3: A individual with Original Medicare and no supplemental coverage uses the services of a specialist. This individual must meet the Part B deductible and then pay 20% for all approved charges. In other words, this is not first dollar coverage.

Why First Dollar Coverage Matters

• Predictable healthcare costs
• Easier budgeting for individuals on fixed incomes
• Reduces the risk of surprise bills
• Encourages timely medical visits and screenings

Possible Downside

• Higher monthly premiums (especially with Medicare Supplement Plans)
• Less flexibility (if beneficiaries opt for a Medicare Advantage Plan) they must use specific provider networks.
• Limited plan availability for more recent enrollees (Medicare Supplement Plan F and Plan C enrollment restrictions).

First dollar Medicare services are about financial peace of mind. While Original Medicare doesn’t provide this level of coverage on its own, many beneficiaries learn that Medicare Supplements or Medicare Advantage plans reduce or eliminate the high price of medical care.

Beneficiaries who like predictable expenses and minimal out-of-pocket costs, may opt for a plan that offers first dollar coverage. As a licensed Medicare agent, it is important to understand your clients healthcare needs and budget to offer plan choices that provided the best benefit options.

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

What Is Original Medicare

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

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

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

Medicare Part A

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

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

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

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

Medicare Part B

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

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

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

Click here to learn more about Part B eligibility

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

What Original Medicare Doesn’t Cover

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

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

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

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

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

Navigating the world of Medicare can be overwhelming, especially when it comes to choosing the right supplemental coverage. That’s why it is important to understand what Medigap standardized benefits are and how they work.

Medigap is a type of private insurance that helps beneficiaries cover the “gaps” in Original Medicare (Parts A and B). Medigap plans cover things like; deductibles, coinsurance, and copays. What many people don’t realize is that Medigap policies are standardized, meaning the benefits for each plan type are the same, no matter which insurer you choose.

What “Standardized” Means

Starting in 1992, federal law requires all Medigap policies to adhere to standardized benefit structures, designated by letters: Plans A through N. The only real difference in plans is the premium each carrier charges for the plan. Although insurance companies charge different premiums, the benefits for each plan letter must be identical no matter who the provider is. In other words, every Plan N has to provide the exact same coverage for medical expenses no matter what company offers it.

Standardization makes it easy for beneficiaries to compare plans without worrying about differences in coverage. They can simply compare cost and company ratings to find the best options.

Examples of Medigap Plan options

• Plan A: This is the most basic plan option. It provides coverage for Medicare Part A coinsurance and hospital costs, Part B coinsurance, and the first three pints of blood.
• Plan G: The most comprehensive plan available to those who turned 65 after 1-1-2020. It covers all Medicare approved expsnes with the exception of the Part B deductible.
• Plan N: Offers lower premiums than Plan G and covers a portion of the copays for doctor visits and hospital visits. The enrollee will still have a small copay for Medical services. This plan does not cover the Part B deductible or excess charges.

Some States Have Different Medigsp Standards

Although most states follow the federal standardization model, Massachusetts, Minnesota, and Wisconsin have their own versions of standardized Medigap plans. These states use their own benefit structures however, they still follow the principle of offering consistent benefits across insurers within their states.

Please Note

• Plan C and Plan F are no longer available to beneficiaries who became eligible for Medicare on or after January 1, 2020. These plans provided coverage for the Medicare Part B deductible, which new legislation phased out to cut back on the overuse of services.
• Beneficiaries must have both Medicare Part A and Part B to enroll in a Medigap plan. There is a premium for Medigap plans in addition ot the Part B premium.
• Medigap works with Original Medicare, beneficiaires cannot use a Medigpa plan with a Medicare Advantage (Part C) plan.

Why Standardization is Important

Standardization simplifies decision-making for Medicare beneficiaries. It eleiminates the need to decipher insurnace benefits accross multiple insurance companies; instead, the focus is on price, company reputation, and rate increase history.

Watch a quick YouTube video on Medicare Supplement Underwriting

This helps foster competition between companies based on cost and service quality instead of confusing plan designs.

Choosing a Medigap plan doesn’t have to be a guessing game. With standardized benefits, benficiaries can make apples-to-apples comparisons between insurers and choose the coverage that meets both healthcare and financial needs.

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As Medicare beneficiaries consider supplemental coverage to fill the gaps left by Original Medicare (Parts A and B), many turn to Medigap plans. Among them, The HDG (High Deductible Plan G) stands out for the comprehensive benefits it provides at a lower monthly premium, but with a catch: a high annual deductible. If your client is considering a HDG Plan, understanding the pros and cons of HDG Plans will help them make an informed decision.

What Is HDG

HDG or High Deductible Plan G provides the same benefits as standard Medigap Plan G; one of the most comprehensive Medigap options, but only after the beneficiary meets an annual deductible. Each year, CMS decided what that deductible amount will be; in 2025, the deductible is $2,800.

Once the beneficiary pays the deductible for the year, the plan pays 100% of covered Medicare expenses, just like a standard Plan G.

Pros of HDG

1. Low Monthly Premiums

The biggest selling point of the HDG plans is their affordability upfront. The premiums for HDG Plans is typically much lower than standard Plan G, in some cases, less than 1/3 of the price, making this a great option for healthy enrollees or individuals living on a fixed income who want to be prepared for unexpected health issues.

2. Full Coverage

Once the beneficiary meets the annual deductible, HDG covers:

• Part A coinsurance and hospital costs
• Part B coinsurance/copays
• Blood (first 3 pints)
• Skilled nursing facility coinsurance
• Part A hospice care coinsurance/copays
• Medicare Part A deductible
• Part B excess charges
• Foreign travel emergency care (up to plan limits)

3. Good Option for Health Individuals

Those who rarely seek medical care may not reach the annual deductible; in other words, out-of-pocket spending could stay well below the cost of a standard Plan G’s premium.

4. Standard Benefits

Just like all other Medicare Supplement plans; HDG is standardized. Therefore, after the deductible is met, the benefits are the same regardless of insurer. The only thing to compare are the premiums and service quality, not the coverage.

Cons of HDG

1. High Upfront Costs

Individuals who require frequent care (doctor visits, outpatient services, hospital stays) pay out-of-pocket until they reach the $2,800 (in 2025) deductible. For some, this could all happen early in the year, and the savings from lower premiums may not offset that.

2. Not Ideal for Some Budgets

For individuals on a tight or fixed income, facing unexpected out-of-pocket expenses could be difficult to manage before the deductible is met, even if the plan is technically cost-effective over time.

3. Premiums Aren’t Fixed

Although the premiums are much lower than standard Plan G, HDG premiums (like all Medigap plans) can still increase annually, leading to less savings over time. It may be a good idea to check the rate history of the insurer before choosing a plan.

4. Deductible Increases

Each year, CMS sets the annual deductible and it usually has a slight increase each year. This unpredictability can cause some issues with long-term budgeting when compared to standard plans.

Who May Be a Good Fit For HDG

• Healthy individuals with few healthcare needs
• Younger Medicare beneficiaries (e.g., age 65-70) not expecting major procedures
• Those comfortable with financial risk with the means to pay the deductible if necessary
• Budget-conscious individuals looking for low monthly expenses

Medicare HDG provides similar peace of mind to regular Plan G. It is just delayed until after the deductible is met. It’s a good option for those who can afford some out-of-pocket risk in exchange for lower premiums. As with all coverage options, it’s not a one-size-fits-all solution.

A licensed Medicare agent can help run the numbers and explore quotes tailored to an individual’s specific needs.

In the world of sales, one truth stays constant: people are much more likely to buy from those they know and trust. For that reason, agents who focus on local marketing are often more successful than those who sell exclusively over the phone or online. Although digital ads and lead vendors can be great tools, nothing builds long-term credibility and referrals like mastering local Medicare marketing and establishing yourself as the local Medicare expert.

So how can you, as a Medicare agent, have an impact on your local market? Take a look at some helpful tips below and grow your book of business.

Establish Yourself In The Community

Before you begin a marketing campaign in your community, make sure your branding reflects the local area. Use localized messaging in your advertising, website and even your business cards.

• Feature city or county names in your taglines (“Your Fairfield County Medicare Plan Enrollment Specialist”)
• Include popular landmarks or maps in mailers and flyers
• Mention that you work with several local plans and providers

Consider: Creating a dedicated landing page for each major city or zip code you serve. This can help improve website SEO and build credibility with local clients.

Community Involvement

People trust people they see regularly and are familiar with; especially when it comes to something as personal as healthcare. Make sure you show up where potential clients are. Here are a few suggestions:

• Volunteer at local food pantries
• Offer to help at local senior centers or events
• Sponsor a booth at community health fairs
• Provide free Medicare 101 presentations at libraries, churches, or senior centers

These events are not about a sales pitch; they’re about establishing yourself as a member of the community and a trusted, local resource.

Local Online Marketing

You don’t need a massive ad budget to be seen online. The important thing is to show up in local searches.

• Google Business Profile: Claim and optimize your listing. Add real client reviews, update your service area, and post updates.
• Facebook and Nextdoor: Participate in local discussions, share useful tips, and post your events and the services you provide.
• Local SEO: Include keywords like “Medicare agent in (City)” or “Help with Medicare plans near (ZIP code)” in your website content.

Additionally: Write blog posts about Medicare topics and include a local area in the name, such as: “Top Medicare Advantage Plans in (Your City)” or “What Seniors in (You County) Should Know About the Medicare Part B Giveback”.

Watch a Quick YouTube video on how to improve your website traffic with blogs

Build Relationships with Local Professionals

Other area professionals who serve your target audience can be excellent referral partners. Keep in mind; this relationship should work both ways:

• Independent pharmacists
• Local doctors
• Home health agencies
• Senior housing communities
• P&C Insurance agents
• Financial planners
• Social workers

Offer to co-host events, provide educational materials, or train their staff on Medicare basics or benefits. Providing free services to thier clients allows them to build trust and opens doors.

Mail or Flyers with Local Feel

Direct mail is sometimes an effective tool; especially when it feels personal. Do not end up in the waste basket:

• Use your photo (this helps you become recognizable) and a friendly message
• Reference a local community or event (“Join us at the Danbury Library Medicare Seminar!”)
• Offer a free consultation with your contact info

Be Available Year-Round

Some agents make the mistake of marketing only during AEP (Annual Enrollment Period), then disappear the rest of the year. However ther are many other opportunities to provide service to Medicare beneficiaries and grow your book:

• Offer help with SEPs (Special Enrollment Periods), or Medicaid, LIS (Extra Help).
• Follow up with clients after enrollment to ensure their questions or concerns are taken care of; provide ongoing support.
• Host workshops or Q&A sessions in a familiar location on a consistant basis.

Staying visible and providing helpful advice provides opportunities to earn referrals naturally; outside of AEP.

Final Thoughts

Local marketing isn’t about using aggressive sales tactics or decptive advertisements; it’s about connection and trust. Once an agent is established as a familiar, reliable, and helpful presence in the community, they don’t just get referrals, they build lasting relationships.

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

Master your local market by showing up, serving with integrity, and positioning yourself as a reliable Medicare resource.

Because so many people confuse the terms Medicare and Medicaid, we will discuss Medicare vs Medicaid and explain the difference between the two terms. Although the terms are often mentioned in the same sentence, these programs serve different populations, have different eligibility rules, and provide different types of coverage.

Medicare

Medicare is a federal health insurance program. In general, beneficiaries of Medicare are:

• Individuals who are 65 and older
• Those under 65 with specific qualifying disabilites
• People who have beendiagnosed with either ESRD (End-Stage Renal Disease) or ALS

The Parts of Medicare

1. Part A – Hospital insurance (covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care)
2. Part B – Medical insurance (covers outpatient care, doctors’ visits, preventive services, and durable medical equipment)
3. Part C – Medicare Advantage Plans (offered by private insurers as an alternative to Original Medicare, often including vision, dental, and drug coverage)
4. Part D – Prescription drug coverage

Medicare Cost

Medicare is not entirely free. Most people get Part A premium-free, but they pay a monthly premium for Part B. They also may pay a premium for Part C and/or Part D. There are also optional Medicare Supplement plans available which also have a monthly premium. Medicare costs include things like deductibles, co-pays and coinsurance. The out-of-pocket amounts differ depending on the plan or plans chosen.

Medicaid

Medicaid is a program that is put in place by both federal and state governments. Individuals who receive this coverage are:

• People with low income who meet the income threshold amount (this varies by state)
• Certain pregnant women and children who meet the income level required
• People with disabilities with income that falls into the state requirement
• Some seniors, including those who also qualify for Medicare

Because Medicaid is administered by each state, the programs vary by state, including eligibility requirements and the services that the program provides.

Medicaid generally covers

• Hospital and doctor visits
• Long-term care (nursing home care)
• Home and community-based services
• Preventive care, mental health services, and more

In many cases, Medicaid covers services that Medicare does not; such as long-term custodial care.

Medicaid Cost

In most cases, Medicaid is either free or very low cost for eligible individuals. States may charge small copays for some medical services.

Medicare vs Medicaid – Key Differences

Can Individuals Have Both

The short answer is, yes! Some individuals qualify for both programs. These are called “dual eligibles.” For these people:

• Medicare typically pays first
• Medicaid may help cover Medicare premiums, deductibles, and services that Medicare does not cover (like long-term care)

Seniors with limited income or disabled individuals who qualify as dual-eligible receive comprehensive coverage at little to no cost.

Additionally; Medicare and Medicaid both play crucial roles in our healthcare system. They each serve a different purpose and population. Understanding who qualifies and what each program covers helps agents, individuals and families make informed healthcare decisions.

For assistance with eligibility or enrollment, consider contacting:

• Medicare.gov or 1-800-MEDICARE
• Click here for each state’s Medicaid office
• A local State Health Insurance Assistance Program (SHIP) for free counseling

As an agent, helping clients navigate Medicare Supplement (Medigap) insurance can be both rewarding and challenging. One key aspect agents must understand and be able to explain to clients is what is Medicare supplement underwriting. Although Medigap plans offer standardized benefits, getting approved for coverage; especially outside of guaranteed issue periods, often depends on the underwriting process. Here’s what you need to know to guide your clients effectively.

Medicare Supplement Underwriting

Underwriting for Medicare Supplement plans refers to the process insurers use to evaluate an applicant’s health history before they issue a policy. This process determines whether an applicant qualifies for coverage and, in some cases, what premium they’ll pay. It typically includes a health questionnaire and a review of the applicant’s prescrption medications and medical history.

When Underwriting Is Required

Underwriting is generally required when a client applies for a Medigap plan outside of their open enrollment period or a guaranteed issue period. Here’s a breakdown:

Medigap Open Enrollment Period (OEP): This is a six-month window that starts the first month a client is 65 or older and enrolled in Medicare Part B. During this time, carriers must accept the applicant regardless of health status; CMS does not permit underwriting.

Guaranteed Issue Rights: These occur in specific situations (such as losing employer coverage or moving out of a Medicare Advantage plan’s service area). During this time, the client can enroll in certain Medigap plans without having to go through medical underwriting.

Learn more about Guaranteed Issue Rights

Unfortunately, outside of these periods, applicants are typically subject to underwriting and can be denied coverage based on pre-existing conditions.

Common Health Conditions That Affect Underwriting

While each carrier has it’s own underwriting criteria, common disqualifying conditions include:

• Congestive heart failure
• Insulin-dependent diabetes with complications
• Chronic obstructive pulmonary disease (COPD)
• Cancer within the past two years
• Alzheimer’s or dementia
• End-stage renal disease (ESRD)

In addition; some carriers may impose a waiting period for pre-existing conditions or adjust premiums based on health history.

Watch a quick YouTube video on Medicare Supplement underwriting

Navigating Medicare Supplement Underwriting

• Timing is everything: Try and encourage clients to apply during their OEP or another guaranteed issue window to avoid underwriting altogether.
• Pre-Qualify Applicants: Ask clients key health questions before submitting applications to avoid the disappointment of unnecessary declines.
• Know the Carriers: Different insurers have different underwriting guidelines. It is a good idea to familiarize yourself with each carrier you represent’s underwriting grids and health questions.
• Explore Alternatives: In the event the plan declines a client, they can opt for a plan that does not require underwriting, such as Medicare Advantage or other coverage options.

Understanding Medicare Supplement underwriting is essential to provide viable options to your clients. By staying informed about carrier guidelines and knowing how to time applications correctly, you can help clients get the coverage they need with fewer issues.

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When talking to clients about preparing for unexpected expenses in retirement, long-term care often takes center stage. In many cases clients should consider short-term care. Short-term care insurance is an underutilized but very valuable product that can offer peace of mind and financial protection for clients facing temporary health challenges.

Here’s a breakdown of why agents should consider introducing short-term care plans as part of a well-rounded retirement strategy.

Short-Term Care Insurance

Short-term care insurance is designed to cover care and services for a limited time, usually up to 12 months. It can be used for home health care, assisted living, or skilled nursing facility services following an illness, injury, or surgery. Unlike long-term care insurance, it is more affordable and easier to qualify for.

Benefits of Short-Term Care Plans

Affordable Premiums

Short-term care plans typically have lower premiums than traditional long-term care insurance, making them accessible for clients with tighter budgets or those who may not qualify for long-term care due to age or health issues.

Simplified Underwriting

Quick Benefit Triggers

These plans often come with simplified underwriting, which means no medical exams; just a basic health questionnaire. This is ideal for clients who may not qualify for more comprehensive long-term care plans.

Short-term care plans generally begin paying out benefits much sooner than long-term care insurance, often with little or no elimination period. This is crucial for clients needing immediate care after an unexpected health event.

Watch a quick YouTube video of why you should offer ancillary products with Medicare sales

Flexibility of Care Settings

Clients can use their benefits in a variety of settings, including at home or in a facility. This provides them greater choice and comfort during their recovery.

Bridges the Gap

For clients waiting for long-term care coverage to start or who may have gaps in their existing coverage (like Medicare), short-term care can provide vital coverage during this period.

When to Recommend Short-Term Care Insurance

• Clients nearing or already retired who don’t qualify for long-term care insurance may consider short-term coverage.
• Those concerned about high out-of-pocket expenses for short recovery periods.
• Individuals looking to supplement Medicare or a high-deductible health plan coverage.
• Clients who want a cost-effective safety net without having to commit to a more expensive long-term care policy.

Thoughts for Agents

Short-term care insurance isn’t just a backup plan; it’s a proactive solution. As agents, offering this option shows clients you understand all their retirement healthcare coverage needs. It’s also a great way to differentiate your services by providing options that are both practical and affordable.

We will use this post to discuss why use local Medicare agents as opposed to call center agents. When it comes to Medicare, one size doesn’t fit all. Choosing the right plan means considering health needs, prescriptions, doctors and even budget. So when trying to sort through all the options, who provides the advice can make all the difference.

Here are some reasons that using a local Medicare agent might be a smarter move than a call center representative:

Personalized, Face-to-Face Service

Local agents often offer in-person consultations, so beneficiaries are not just a number on a screen agents actually get to know their clients. This allows agents to better understand client’s healthcare needs and walk them through their options in a clear, personal way. For beneficiaries who prefer a handshake over hold music, a local agent wins every time.

Ongoing Support

Call center agents are usually focused on getting prospects enrolled, then moving on to the next call. Local agents, on the other hand, build relationships. They often provide support throughout the year. They can provide help with billing issues, coverage questions, or preparing for the next Annual Enrollment Period. Local agents can be a trusted advisor, not just a voice on the phone.

More Than Just Enrollment Help

Local agents can assist with:

• Plan comparisons
• Prescription drug coverage analysis
• Medicare Savings Programs
• Low Income Subsidy (Extra Help) applications
• Coverage questions that come up
• Annual plan reviews

They often go the extra mile to make sure clients understand their options; not just during enrollment, but year-round.

Independent Unbiased Advice

Many local Medicare agents are independent brokers who can compare plans from multiple insurers. That means they’re not tied to one company or incentivized to push a single product. Call center agents, by contrast, often work for a single insurer or are bound by contracts that limit what they can offer. Call center agents often work on meeting a quota for the carriers and do not have the ability to ensure prospects receive the best available, personal coverage.

Local agents also have quoting and enrollment tools to provide plan comparisons clietns can see plans side by side. This makes choosing the right coverage easy.

Watch a YouTube video on Sunfire BlazeSync customer intake form

Learn about the changes to Connecture and Sunfire for 2025

Understanding of Local Networks

Local agents know which doctors, hospitals, and pharmacies are in-network in the prospect’s local area. They’re familiar with regional plan availability, local provider preferences, and even which plans tend to have the fewest issues. That kind of insight is hard to get from a national call center.

No Cost – It’s Free

Here’s the kicker: local Medicare agents are typically free to use. They’re paid by the insurance companies (not out of the client’s pocket), and the price of a plan is the same whether enrolllees go through an agent or enroll themselves.

Agents; learn the value of maintaining your Medicare book

Medicare coverage is too important to leave to a rushed phone call with someone who may never talk to the beneficiary again. Local agents offer real relationships, local knowledge, and ongoing support that can help clients feel more confident about their healthcare coverage choices. This is a relationship that is on going not just for one day.

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

Original Medicare

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

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

The Parts of Medicare

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

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

Medicare Enrollment Periods

There are several enrollment periods to be aware of:

Initial Enrollment Period (IEP)

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

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

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

General Enrollment Period (GEP)

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

Special Enrollment Period (SEP)

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

Annual Enrollment Period (AEP)

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

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

Medicare agents watch a YouTube video on marketing rules for AEP

How to Enroll in Medicare

There are a few ways to enroll in Medicare:

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

A Few Tips

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

Learn how to appeal a Medicare LEP

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

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