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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.

Agents, are you ready to join the team at Crowe; click here

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.

In this post, we discuss how agents can use the Advanced Diabetes Supply Agent Resource. As a Medicare agent, your clients rely on you for guidance not just on policy selection but for access to healthcare resources. For clients living with diabetes, managing their condition requires a constant supply of testing materials, continuous glucose monitors (CGMs), insulin pumps, and education. One valuable partner in supporting these clients is Advanced Diabetes Supply (ADS).

Advanced Diabetes Supply

Advanced Diabetes Supply is a specialized medical supply company focused exclusively on diabetes care. They are one of the nation’s leading suppliers of diabetes testing supplies and equipment, including:

• Continuous glucose monitors (CGMs) like the Dexcom G7 and FreeStyle Libre systems
• Insulin pumps and pump supplies
• Blood glucose meters, lancets, and strips
• Diabetes-friendly nutritional products – Click here for a Diabetes friendly food list

ADS also works with both Medicare and private insurance carriers, making them an excellent partner for agents looking to streamline care and support for their clients.

Watch a YouTube video to learn more about ADS – US Med program information

Why Recommend ADS to Clients

1. Expert Navigation of Insurance Coverage

Many clients struggle to understand what diabetes supplies are covered by Medicare or private insurance. ADS has a dedicated team that works directly with insurance providers to verify benefits and get authorizations; minimizing the stress and the wait for necessary supplies for your clients.

Important: If you have Medicare clients managing diabetes, ADS knows exactly how to process their CGM or testing supply orders in accordance with Medicare guidelines.

2. Home Delivery and Reorder Reminders

ADS ensures timely home delivery of diabetes supplies and provides helpful reorder reminders; an invaluable service for clients who may forget or have difficulty accessing a pharmacy.

3. Excellent Customer Service

Your client’s well being is important to you. That is why the ADS patient-centric service model is a great way to ensure clients are taken care of. Their trained representatives are knowledgeable, friendly, and make it easy for clients to get the support they need without confusion or delays.

4. Fast Enrollment Process

Agents can refer clients to ADS with a simple process:

• Fill out a referral form (available on the ADS website)
• Provide the client’s basic insurance and medical information
• ADS handles the rest—including contacting the physician, obtaining prescriptions, and setting up shipments

How to Refer Your Clients to Advanced Diabetes Supply Agent Resource

You can guide your clients to ADS in a few easy steps:

1. Visit: www.northcoastmed.com
2. Call: ADS’s dedicated phone line for new referrals: 1-866-422-4866
3. Fax: Completed referral forms to 1-866-551-2909
4. Email: For agent-specific questions or to request referral tools, contact their provider support team

Many agents also keep brochures or digital referral kits on hand to explain the benefits of using ADS.

Better Client Relationships

Helping clients manage chronic conditions like diabetes doesn’t stop at policy enrollment. By referring them to trusted resources like Advanced Diabetes Supply, you build stronger relationships and improve health outcomes; while reducing coverage confusion and service delays.

As a proactive, service-minded agent, adding ADS to your toolkit is a smart move that benefits both your clients and your business.

Agents who would like more information; contact us at 203-796-5403. We will provide contact information for an ADS representative.

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 helping clients plan for their healthcare coverage needs, it’s important to discuss not just what Medicare does cover, but also what it doesn’t. Understanding these gaps can help clients avoid unexpected expenses and make informed decisions about supplemental insurance options. Let’s take a closer look at some of what Medicare won’t cover.

Long-Term Care

One of the biggest misconceptions about Medicare is that it covers long-term care, like nursing home stays or in-home care for chronic conditions. In reality, Medicare only covers short-term skilled nursing care under specific conditions. Clients may need separate long-term care insurance or other financial strategies to cover these considerable costs. Learn about short-term care vs long-term care plans.

Most Dental Care

Routine dental services such as cleanings, fillings, tooth extractions, dentures, and dental implants are generally not covered by Medicare. If dental care is important to your client, you should explore standalone dental insurance or Medicare Advantage plans that offer dental benefits.

Learn about stand-alone dental coverage available in all 50 states

Vision Care

Medicare does not cover routine eye exams for glasses or contacts. It will, however, cover eye exams related to medical conditions like glaucoma or cataracts. Clients needing regular vision care might consider standalone vision insurance or a Medicare Advantage plan with vision coverage.

Hearing Aids and Exams

Original Medicare doesn’t cover hearing aids or exams for fitting them, which can be a significant expense. Some Medicare Advantage plans offer hearing benefits, so this is worth exploring based on client needs.

Routine Foot Care

Routine foot care, such as treatment for corns, calluses, or nail trimming, is not covered unless it’s deemed medically necessary due to a condition like diabetes.

Overseas Health Care

Most care received outside the United States is not covered by Medicare. For clients who plan to travel internationally, consider recommending a Medigap plan that includes foreign travel emergency coverage or a separate travel insurance policy.

Elective Surgery

Medicare won’t cover elective cosmetic surgeries, such as facelifts or liposuction. It will however, cover surgeries that deemed medically necessary, such as reconstructive surgery after an accident or some forms of cancer.

Key Takeaways for Agents

This is just an idea of what is not covered by Medicare, for a complete lists click here.

• Discuss Supplement Options: Educate clients on the benefits of Medigap (Medicare Supplement) plans, Medicare Advantage plans, or standalone insurance options for things like dental, vison & hearing or other ancillary products to fill the coverage gaps.
• Tailor Recommendations: Understand each client’s lifestyle and health priorities to recommend the right supplemental coverage.
• Plan for the Unexpected: Help clients build a financial plan that anticipates out-of-pocket healthcare expenses.

Being proactive about Medicare’s limitations helps clients better prepare for retirement. As agents, we can offer tremendous value by guiding clients through their options to ensure they have the comprehensive healthcare coverage they need.

To get some tips to maintain your book of business; click here

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.