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Vaccines covered by Medicare

Medicare prescription drug plans cover wide variety of prescription drugs, this includes several vaccines covered by Medicare.  Medicare covers vaccines in more than one way; either by Part D  or by Part B (medical coverage) or Part C MA/MAPD plans that may provide coverage for all the parts of Medicare.  It all depends on the type of vaccination and what facility the patient receives it at. As of January 2023, all vaccines covered by Medicare should be free to beneficiaries. This means they should not have any cost-sharing such as; co-pays, co-insurance or deductibles.

Find out about Medicare Part D enrollment periods

Part B covers vaccine coverage

In many cases, if the vaccination is part of a treatment for an illness or injury, it is usually covered by Part B.  In other words, if a beneficiary gets a puncture wound, they may need a tetanus shot. When this is the case, the vaccination falls under Medicare Part B coverage (Part C, if they have an MA/MAPD plan).  If the beneficiary opts to receive a tetanus booster shot, that charge falls under their Part D plan.

Watch a quick YouTube video on enrollment periods including Part B late enrollment

Here are some common vaccines that Part B covers:

*Flu

*Covid 19

*Pneumonia

*Hepatitis B – in cases where the individual is at high to intermediate risk.

*Some necessary vaccines needed to treat an injury, illness or exposure to a disease.

Part B covers some drugs

In some instances, Part B covers drugs beneficiaries do not normally give themselves.  In other words drugs that you receive either in a doctor’s office or in an outpatient hospital setting.

A few of the drugs covered by Part B

Part D vaccine coverage

Part D Vaccines are provided in an effort to prevent illness as opposed to treating one.  Medicare Part D plans cover commercial vaccines if they are reasonably necessary.

Some vaccines covered by Part D

1. Shingles vaccines
2. Tdap (tetanus-diphtheria-whooping cough) vaccines
3. In cases that a PDP plan’s formulary does not list a vaccine, it must provide coverage if a physician prescribes it as a prevention measure.

Learn about the Medicare Part D drug cap

As of January 2023, patients with Medicare Part D plans or MAPD plans pay no out-of-pocket costs for adult vaccines.  This is part of the Inflation Reduction Act of 2022.  If the patient is charged a vaccine administration fee at the time of service, they can submit this amount to their Part D plan for full reimbursement.

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Medicare supplement comparison

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Medicare financial assistance

Part D late enrollment penalty appeal

Medicare beneficiaries who don’t sign up for Medicare Part D coverage during their initial enrollment period and go for a period of 63 or more continuous days without creditable prescription coverage may incur a late enrollment penalty.  If the beneficiary receives an LEP and they believe it is in error, they can initiate a Part D late enrollment penalty appeal.

Once a beneficiary enrolls in a Part D plan, the plan notifies them in writing if it is determined that the enrollee has incurred an LEP.  If plan administrators believe the enrollee has had a lapse in creditable prescription coverage for a continuous period of 63 days or more. The enrollee receives an LEP Reconsideration Notice and LEP Reconsideration Request Form with the written notification.

Learn more about enrollment in Part D

Either the enrollee or their representative can ask for a review, or reconsideration, of the LEP.  The LEP reconsideration request form provides enrollees a list of circumstances when they can request a review.

LEP Reconsideration Notice

The Part D LEP reconsideration notice gives enrollees an explanation of their right to request a reconsideration of their LEP.  Sponsors of Part D plans must complete the notice and send it to the enrollee with the letter notifying them of the imposition of a Late Enrollment Penalty.

To download a copy of the Sample late enrollment penalty reconsideration notice – click here.

Reconsideration Request Form

Part D plan enrollees should use the form, “Part D LEP Reconsideration Request Form C2C” to request an appeal of the LEP decision. The enrollee completes the form, signs it and then send it to One of the options below:

If you are sending via standard mail; C2C Innovative Solutions, Inc., Part D LEP Reconsiderations, P.O. Box 44165, Jacksonville, FL 32231-4165

Sending by courier or tracked mail; C2C Innovative Solutions ,Inc., Part D LEP Reconsiderations, 301 W. Bay St., Suite 600, Jacksonville, FL 32202

You can also send either by fax to; 833-946-1912 or upload the form to the website https://www.c2cinc.com//Appellant-Signup.  Once you are on the website, you will need to create an account and follow the prompts from there.
If you have a friend, family member or doctor send the request, that person must be your representative. They can complete the last form in the reconsideration request form.   The form is fillable online or you can print it out and fill it from there.

Click here to download the LEP Reconsideration Request Form

LEP appeal process

The LEP appeal process is conducted by an IRE (independent review entity) that has a contract with Medicare. The IRE notifies the enrollee of the final LEP decision within 90 days of receiving the request.  This includes the dismissal of the request.

Please note:  If you receive Extra Help, you do not have to pay a Late Enrollment Penalty.  Click here to learn more about Extra Help programs.

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How to get a replacement Medicare card

If you find yourself in need of a replacement Medicare card due to loss, damage, or a name change, the process is straightforward. We will go over the process to get a replacement Medicare card, ensuring you have access to your necessary healthcare information when you need it.

Find out about Medicare premiums.

The importance of a Medicare card

Before we dive into the replacement process, it’s essential to recognize the significance of your Medicare card. This card contains valuable information, such a as your Medicare number as well as the effective dates of your Part A and Part B coverage. Beneficiaries need to have access to it as proof of Medicare coverage when they require necessary medical services. Whether you’ve lost your card, or it’s been damaged, it is important to obtain a replacement card quickly.  This will help enrollees maintain their access to healthcare.

Ensure eligibility

If you are eligible for Medicare but have not enrolled yet, you need to complete the initial enrollment process before you request a replacement card. Once you complete your initial enrollment, you will receive your card within a few weeks.

Click here to learn about Medicare enrollment periods.

Ways to obtain a new Medicare card

There are a couple different ways to obtain a replacement Medicare card.  Because of this, beneficiaries can choose the method that they are most comfortable with. The two ways to get the new card are:

Online:

Beneficiaries can log into their personal account on the official Medicare website www.medicare.gov.  Once they are logged in, it is easy to follow the prompts and request the replacement card. This method is convenient and typically provides a quicker turnaround. Beneficiaries can print an official copy of their card from their online account to retrieve an immediate copy.

Over the phone:

To request a replacement card over the phone, contact Social Security Administration at 1-800-772-1213 (TTY 1-800-325-0778). Beneficiaries need to have their Medicare number as well as other pertinent information to verify your identity.

Provide necessary information

No matter what method you opt for, you need to provide personal information to verify your identity and facilitate the replacement of your card. It is imperative that you use only official channels to request the new card.  Medicare will need details such as your full name, Social Security number, date of birth, and even your Medicare number to verify your identity before they can process the request.

Confirm Your Address

Because Medicare will send the replacement card to the address on record, it is important to make sure you update your current address in the Medicare system if you move.  Keeping your records up to date will ensure you receive your new card a quickly as possible.

Learn the difference between Medicare Advantage and Medicare Supplement plans – watch a quick YouTube video

Be Patient

Once you submit your request your replacement card, it will take time for the request to be processed and sent out to you. The time required to process the request will vary depending on how busy the Medicare office is, so you need to be patient while you wait for the Medicare card to arrive.

Obtaining a replacement Medicare card is a straightforward process.  Following these steps and keeping your information current, will ensure the process is smooth should you need a replacement card.

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Insurance sales training

Anyone who wants to enter the field of Medicare sales, will need to have insurance agent training before they meet with any potential clients. Crowe and Associates offers Medicare agents access to several types of training tools.  We provide free information on our website, YouTube channel as well as weekly informational webinars and zoom meetings geared for either beginners or experienced agents.

Think about joining an FMO

Getting started in insurance sales can be confusing, especially if you are trying to get it done on your own.  An good FMO provides guidance and support not only to new agents but to experienced agents as well.  Agents receive back office support as well as resources and tools that can make your business run effectively.  it is important to choose an FMO that provides the support you need.  Be sure to ask as many questions as you need to and contact as many as you need.  Agents need to feel comfortable with their upline and secure knowing they will be there to answer your questions when they arise.

See what we offer Medicare agents

Decide what products to offer

We will focus on Medicare products, because that is the largest part of what we offer.  If you are unsure which products you are going to offer clients, your FMO should assist you in choosing a reasonable number of Medicare and ancillary products to get started.  It is best not to overwhelm yourself and get discouraged.   A good FMO will run a quote in the area you plan to sell in and provide you with a few of the top carriers in each product type to et you started.  This is easy to do with a good quote engine and takes only a few minutes.

Join the team at Crowe – click here for online contracting

Contracting and Certifications

After you choose the products and carriers you are going to offer, you must complete contracting.  Your FMO should be able to help get this done.  Once you receive your contracting links, you can complete them along with your carrier certifications(carrier specific training you do to gain knowledge about the products you are offering).   When this is done, you will receive your RTS (ready to sell) and you can now offer that product.

websites and blogs focused on Medicare sales.  Here you will be able to access information regarding all aspects of Medicare sales.  Our recorded webinars will hit on just about every area of Medicare sales.   For those, very new to Medicare sales, be sure to access our Medicare sales quick guide to lean the basics about contracting, certifying and selling.

Because Medicare is a federal program, there are a lot of rules and regulations agents must adhere to. These rules protect the clients as well as the agents and ensure everyone conducts business in a compliant and fair way.  CMS mandates that agents take annual training courses to stay up to ate with all the regulations.  That is why agents need to take and pas the AHIP annually with a score of 90% or higher.

Watch a quick YouTube video for 2024 AHIP test tips

Sales training

New agents often need more guidance to get an idea of how to get started. Comprehensive training programs provide an understanding of things like; eligibility, enrollment and coverage options.  We provide newer agents weekly zoom training to help them feel confident and build their knowledge base.  We are also available for a one on one meeting or phone call.  In some cases agents may have an opportunity to pair up with a local agent and go on sales calls.

Product training

In the Medicare field, clients have soo many types of coverage offered by many carriers to consider. This means agents must be aware of new products and changes in plan products as well  what their client is looking for.  That is why agents complete specific product training, so they can ensure their client receives the coverage they need and can afford.  We provide the opportunity for agents to join one of our weekly zoom meetings or webinars to get updated information and ask questions if they are unsure about anything.

Anyone can find information on our website or YouTube channel.  We update our Events and information page so agents can easily find a webinar or event information on our website, just click on the link below.

Click here to view our updated Events and information post

Access the recorded webinars on various topics on our YouTube channel, just click on the link below:

Subscribe to our YouTube channel and view all our recorded training and informational videos

Learn to use our free quoting and enrollment tools

We provide our agents with a few ways to quote and enroll clients in a CMS complain way. Sunfire and Connecture are two of the tools we offer at no cost to our agents. Both of these tools provide  a CRM as well as the ability to record sales calls and remain compliant.

Take a look at a Sunfire enrollment demonstration

Networking and Business Development Training

Agents require more training once they have a handle on the ins and outs of Medicare and the carrier plans.  Some people require advice to help the design a business plan. They may need a strategy for networking opportunities, leads, and business development.  These tools will establish their place in the community and build a book of business.

Generate Medicare referrals

Medicare lead program

Our agents have an opportunity to participate in our Medicare lead program to.  We provide agents up $500 a month to offset lead and marketing costs.  There are no minimums to start and absolutely no reduction in compensation.

More info on our Free Medicare Lead Program

What does a Medicare agent earn

Each year CMS sets the maximum amount for Medicare commissions.  Click here to see the commission rates for 2024 

Watch a YouTube video to see the CMS proposed changes to agent compensation

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Medicare agent sales training

As the demand for Medicare coverage continues to grow, the role of Medicare agents becomes increasingly important. For that reason, Medicare agent sales training is crucial. Agents need to be prepared to provide guidance for beneficiaries to ensure they receive the health care coverage that fits their needs and budget.

There are various training programs available to equip agents with the necessary knowledge and skills. Agents need to take in a lot of information including; rules, contracting, benefits, quoting, certs and much more.  We will discuss some of those things below.

Initial Training Programs

Newer Medicare agents require comprehensive initial training programs.  These programs should provide a solid foundation of the Medicare system including eligibility, coverage options and enrollment periods as well as how they work together.  We provide a weekly zoom training for all our newer agents that need the extra time to get up and running.

Product-Specific Training

Because there are so many coverage options for Medicare beneficiaries,  including Original Medicare, Medicare Advantage (Part C), and Medicare Prescription Drug Plans (Part D), agents need product-specific training. This training ensures that agents are well-versed in the details of each plan, allowing them to match individuals with the most suitable coverage.  Each carrier provides it’s agents with product training opportunities.  We also offer training when a new product that shows potential is introduced into an area or if agents show an interest in learning more about a specific product.  Agents can either join one of our weekly zoom meetings or webinars or find information on our website or YouTube channel.  You can find links to this information on our website, just click on the link below.

Click here to view our updated Events and information post

Annual Training and Updates

Given the dynamic nature of  Medicare coverage options, agents must undergo annual training and updates. This ensures that agents stay current with any changes to Medicare regulations, coverage options, and compliance standards.  Agents can get helpful tips on the annual AHIP training on our YouTube channel as well as updated CMS regulations for Medicare sales.

Technology Training

Because technology is always advancing,  agents need updated tools and technology to remain competitive.  That is why we provide both Sunfire and Connecture for quoting and enrollment to our agents at no cost.  We offer one-on-one training and video instruction to agents who want it. These tools offer a built in CRM as well as the opportunity for agents to record their sales calls and remain compliant. Our technological resources enhance the agent’s ability to serve clients effectively.

Visit our YouTube channel and watch some free training videos on any of the above subjects you have questions about

Ethical and Compliance Training

Ethics and compliance are a big concern in the insurance industry. Agents undergo annual training on ethical sales practices and conduct, as well as updated regulatory requirements. This training ensures that agents operate with integrity and in accordance with industry standards.  Our zoom meetings and webinars often focus on updated CMS regulations to ensure our agents maintain their compliance.  All our informational webinars are recorded and put up on our YouTube channel.

If you want to join our team, click here for online contracting

Sales Skills Training

Many agents appreciate training programs that help focus on honing sales skills.  This training teaches agents how to educate clients, address concerns, and facilitate informed decision-making.  Some training programs we offer focus on different types of approaches and opportunities agents can use to generate sales.  Because each agent is an individual, we offer calls or meetings to discuss different approaches agents can use to generate sales.

Networking and Business Development Training

Agents require training programs that go beyond the technical aspects of Medicare.  They need guidance to building a successful business. This includes strategies for networking, lead generation, and business development to help agents establish and grow their client base.  We provide agents with information and guidance on lead programs as well as how to host sales events and much more.

Learn how to generate Medicare referrals

The landscape of Medicare agent training is diverse, this reflects the multifaceted nature of the Medicare business. Whether it’s mastering the benefits of Medicare plans, staying compliant with regulations, or developing essential sales skills, ongoing training is a must for Medicare agents.  This helps ensure they provide high-quality service to their clients.

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Eligibility for Medicare Part B

Part B of Medicare provides coverage for medical services like doctors’ visits, preventative services, outpatient medical services, and other medically necessary items and services.  In this post, we will go over the rules for eligibility for Medicare Part B.

To be eligible for Medicare Part B, individuals must meet certain criteria

Medicare Part B is one part or original Medicare. and Part B is an integral part of this coverage. In General, individuals who are 65 or older qualify for Medicare.  However, there are other scenarios when an individual may be eligible to enroll.

Turning 65

The most common way to qualify for Medicare is when an individual turns 65 and is a U.S. citizen or legal permanent resident living in the U.S. for at least 5 continuous years.  This period of time is referred to as the IEP.  It is a good idea to enroll during the IEP (Initial Enrollment Period) to avoid a late enrollment penalty.

Disability

In some instances, individuals under 65 with a qualifying disability are eligible to enroll in Medicare Part B.  Individuals who receive either SSDI (Social Security Disability Insurance) or some Railroad Retirement Board (RRB) disability benefits for a period of at least 24 months may qualify for benefits.

End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS)

Individuals who suffer from either permanent kidney failure requiring dialysis or a transplant (ESRD) or Lou Gehrig’s disease (ALS) usually qualify for Medicare coverage.  This coverage includes Medicare Part B.

Watch a YouTube video on SEPs. OEP and Late Part B Enrollment

Enrollment periods

When enrolling in Medicare Part B, there are a few different enrollment periods available.  Once you are eligible to enroll in Medicare Part B, it is important to understand when and how to enroll.

IEP (Initial Enrollment Period)

The IEP is the seven-month period that begins three months before the individual turns 65.  It includes the month of their birthday and continues for three months after. As we stated earlier, enrolling during this period is recommended to avoid a late penalty.

SEP (Special Enrollment Period)

Some individuals may qualify for a Special Enrollment Period.  For those who delayed enrollment in Part B due to having employer coverage through their employment or a spouse’s employment an SEP allows them to enroll without facing a penalty.

Learn more about SEPs

GEP (General Enrollment Period)

If an individual missed their IEP and doesn’t qualify for a SEP, they can enroll during the General Enrollment Period.  This enrollment opportunity runs from January 1 to March 31 each year.   It is important to note; late enrollment penalties may apply for those who wait to enroll during this time.

Additionally, Medicare Part B is an important part of healthcare coverage for seniors and other qualifying individuals. Understanding the eligibility criteria and enrollment process is essential to ensure timely access to the benefits that Medicare coverage provides.

Medicare agents, click here to become part of the team at Crowe

A licensed Medicare agent can help navigate the ins and outs of Medicare coverage and ensure beneficiaries receive all the benefits necessary for their healthcare needs and budget.

Click here to see why a licensed Medicare agent is a great asset.

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Medicare premiums

If you are either a Medicare beneficiary or a Medicare agent, you need to know the cost of Medicare premiums.  Each year the costs are subject to change.  Both enrollees and agents should stay updated on cost and coverage changes. Not having the correct information can be a costly mistake.

Medicare Part A

There is no premium ($0) for Part A for the majority of people most people.  Beneficiaries who worked or had a working spouse who paid Medicare taxes for at least 40 quarters (10 years) receive premium free Part A.

Those who do not qualify for the $0, premium free Part A may be eligible to purchase it.  Beneficiaries must sign up for Part B in order to purchase Part A.  For 2024, the monthly premium is either $278 or $505.  This depends on the length of time either the beneficiary or their spouse worked and paid Medicare taxes.

Please note:  Beneficiaries who do not purchase Part A when they are eligible (in most cases at 65 years old), may pay a penalty.  The penalty adds 10% to the monthly Part A premium and lasts for twice the number of years that you neglected to sign up for Part A.

Medicare Part B

The monthly premium for Part B is $174.70 in 2024.  This amount usually changes on January 1st each year. This premium may be higher for some individuals with a higher income level. This additional charge is called an IRMAA, and it effects about 8% of Medicare beneficiaries.  The Additional charge ranges from $69.90 up to $419.30 added to the monthly premium.

Medicare may charge a late enrollment penalty to anyone who did not enroll in Medicare Part B when they were first eligible or did not have creditable coverage in place at that time.  The LEP for failing to enroll in Part B is 10% for every year the beneficiary did not sign up for Part B.  This penalty is different than the Part A penalty; it will last for as long as the beneficiary has Part B.

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Think Agent Aetna login

Because Aetna is one of the leading Medicare carriers in several states, there are many agents who will need a Think Agent Aetna login.  Think Agent is the electronic enrollment tool Aetna provides to help their agents enroll Medicare beneficiaries in their plans.  Think Agent gives both agents and clients a quick and easy way to complete their enrollments.  This tool is available several different ways including, desktop, laptop or a mobile app that agents can add to all their mobile devices including their phones.

How to access Think Agent

1.  Once you are ready to sell with Aetna, you will be able to download the Think Agent app from either the Apple App store or the Google Play store. Please note: The app is compatible with Android 5 or greater, version 11; or IOS 11.0 or greater, version 14.5; or on your desktop.  To access think agent online click here.
2.   After you download the app, click sign up and submit your request for a new user account.  To create your account, you need to provide your name, NPN and email address.

Click here for online contracting to offer Aetna or other Medicare products