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Home Posts tagged "Medicare sales"
Medicare OEP Open Enrollment Period

Medicare OEP Open Enrollment Period

By Ed Crowe | General Articles | 0 comment | 19 June, 2025 | 0

Medicare OEP Open Enrollment Period

The Medicare Open Enrollment Period (OEP) runs annually from January 1 to March 31. It is specifically for individuals already enrolled in a Medicare Advantage (Part C) plan as of January 1.

This period does not apply to those with Original Medicare (Part A and B) only; it’s strictly for Medicare Advantage plan members who may want to make a one-time change.

What Changes Can You Make During OEP

Those enrolled in a Medicare Advantage plan, can make one change during the OEP. The options include:

  • Switching to a different Medicare Advantage plan, with or without drug coverage
  • Dropping your Medicare Advantage plan and returning to Original Medicare, with the option to add a Part D prescription drug plan

Changes You Cannot Make:

  • Switch from Original Medicare to a Medicare Advantage plan
  • Enroll in Part D drug coverage if you’re on Original Medicare and missed your IEP or AEP
  • Make multiple changes; OEP only allows one switch

Watch a video on Medicare enrollment periods

Why Use the OEP

Here are a few common reasons beneficiaries take advantage of the Medicare OEP:

  • Their current Medicare Advantage plan doesn’t cover a needed medication or provider
  • They discovered higher costs or restrictions after using the plan in January
  • They had a change in health and want a different plan with better specialist coverage
  • They were unaware of better plan options during the Annual Enrollment Period (AEP), which runs from October 15 to December 7

How Is OEP Different from AEP

FeatureAEP (Oct 15–Dec 7)OEP (Jan 1–Mar 31)
Who Can Use ItAll Medicare beneficiariesOnly those enrolled in Medicare Advantage
Number of ChangesMultiple changes allowedOne change allowed
Types of ChangesSwitch plans, join/drop Part D, switch to/from Medicare Advantage or Original MedicareSwitch Medicare Advantage plans or drop MA to return to Original Medicare

Important Considerations

  • If you switch to Original Medicare during OEP, you may not be guaranteed Medigap (Medicare Supplement) coverage; unless you’re in a trial right or qualify for a Special Enrollment Period.
  • Any changes made during the OEP become effective the first day of the month after the change is made (e.g., a change in February takes effect March 1).
  • It’s important to review coverage early in the year to determine if your current plan still meets your needs.

Work with a Licensed Agent

The Medicare OEP is a valuable but limited opportunity to make corrections or improvements to your coverage. If you’re unsure whether your plan fits your health needs or budget, speak with a licensed Medicare agent. They can help you compare options, check provider networks and drug formularies, and make confident decisions about your healthcare.

Agents; if you are ready to join a winning team, click here for Crowe contracting!

Stay updated on agent information and events, click here

Medicare Commissions 2026

Medicare Commissions 2026

By Ed Crowe | General Articles | 0 comment | 19 June, 2025 | 0

Medicare Commissions 2026 for Medicare Advantage & PDP Plans

As the Medicare industry evolves, so do the rules and compensation guidelines set by CMS. For 2026, CMS has released updated Medicare commissions 2026 for Medicare Advantage (MA) and Prescription Drug Plans (PDPs). Every Medicare agent needs to be aware of the new amounts and the policy changes behind them.

Below is a breakdown of what’s changing and how it impacts your commissions heading into the 2026 Annual Enrollment Period (AEP).

2026 Maximum Commission Rates

Each year CMS sets a fair market value (FMV) for agent compensation. These rates represent the maximum allowable compensation carriers can pay agents for enrollments and renewals of Medicare Advantage and Part D plans.

Medicare Advantage (MA) Initial Compensation:

  • National base: $694 (up from $626 in 2025) this is the rate for any state not listed below.
  • Renewal compensation: $347 per renewal (up from $313)

Connecticut, Pennsylvania, District of Columbia:

  • Initial compensation: $781
  • Renewal: $391

California and New Jersey:

  • Initial compensation: $864
  • Renewal: $432

Puerto Rico and U.S. Virgin Islands:

  • Initial compensation: $474
  • Renewal: $237

Prescription Drug Plan (PDP) Compensation:

  • Initial enrollment: $114 (up from $100 in 2025)
  • Renewal: $57

These are maximums. Carriers are not required to pay this amount but may do so depending on their policies and agent contracts.

Join the team at Crowe; click here for online contracting!

Why CMS Raised MA Commissions

The substantial increase in MA commissions; particularly the national base, is part of CMS’s broader effort to:

  • Align compensation with the increased workload and compliance obligations placed on agents
  • Encourage transparency and fair practices in marketing and enrollments
  • Reflect rising healthcare costs and inflationary trends

Watch a video on Medicare commission payment details

Compliance Remains Critical

With higher compensation comes increased scrutiny. CMS continues to crack down on misleading marketing, aggressive sales tactics, and non-compliant enrollments.

Key compliance reminders for 2026:

  • Scope of Appointment (SOA) forms must be completed 48 hours before most marketing appointments
  • Call recordings of all Medicare-related sales calls are still required
  • Third-party marketing organizations (TPMOs) must clearly disclose affiliations and limitations of plan representation

As commissions rise, expect CMS and carriers to take a firmer stance on agent conduct, training, and documentation.

Stay updated on agent events and information

Agent Tips to Maximize Success

  1. Stay current on training: Complete your AHIP and carrier certifications early.
  2. Educate your clients thoroughly: Higher commissions can mean more scrutiny, make sure clients understand their options.
  3. Build long-term relationships: Renewal commissions continue to rise, rewarding agents who support their clients beyond initial enrollment.
  4. Diversify your offerings: Include PDPs and Medigap plans or ancillary benefits where appropriate; some clients may benefit more from a supplement and drug plan.
  5. Leverage compliant marketing: Use CMS-approved marketing materials and ensure your lead generation efforts are transparent and ethical.

The 2026 updated commission amounts are great news for agents who work hard to serve the Medicare community. Higher commissions and a continued emphasis on compliance and ethics mean; it is a good time to refine your strategy, refresh your knowledge, and recommit to providing excellent service.

Types of Medicare Advantage Plans

Types of Medicare Advantage Plans

By Ed Crowe | General Articles | 0 comment | 16 June, 2025 | 0

Understanding the Different Types of Medicare Advantage Plans

Medicare Advantage (Part C) plans offer an all-in-one alternative to Original Medicare, often including additional benefits like dental, vision, hearing, and even prescription drug coverage. These plans are offered by private insurance companies approved by Medicare. Whether you’re a Medicare beneficiary or an agent helping clients make informed decisions, understanding the different types of Medicare Advantage plans is essential.

There are many types of Medicare advantage plans to consider when choosing coverage that best fits your needs. Here’s a breakdown of the main types of MA plans available:

HMO (Health Maintenance Organization) Plans

Key Features:

  • Requires members to use a network of doctors and hospitals.
  • Members must choose a Primary Care Physician (PCP).
  • Referrals are usually needed to see a specialist.
  • Most HMO plans include prescription drug coverage (Part D).

Best for: People who are comfortable with a coordinated care approach and staying within a specific provider network to keep costs low.

PPO (Preferred Provider Organization) Plans

Key Features:

  • Offers more flexibility in choosing healthcare providers.
  • You can see out-of-network providers, usually at a higher cost.
  • No need to choose a PCP or get referrals for specialists.
  • Often includes Part D prescription drug coverage.

Best for: Those who want the freedom to see any doctor or specialist without a referral and are willing to possibly pay a bit more for that flexibility.

SNPs (Special Needs Plans)

Key Features:

  • Tailored for individuals with specific diseases, health conditions, or financial needs.
  • Types include:
    • C-SNPs: For people with chronic conditions (e.g., diabetes, heart disease).
    • D-SNPs: For dual-eligible individuals (Medicare and Medicaid).
    • I-SNPs: For people in institutional care (like nursing homes).
  • Always includes prescription drug coverage.
  • Offers care coordination and case management.

Best for: Individuals with specific medical, financial, or living circumstances who need a personalized care approach.

PFFS (Private Fee-for-Service) Plans

Key Features:

  • Allows you to see any Medicare-approved provider who agrees to the plan’s payment terms.
  • No need to choose a PCP or get referrals.
  • Some PFFS plans include drug coverage; others don’t.

Best for: People who want flexibility and are comfortable checking whether their provider will accept the plan’s terms.

POS (Point of Service) Plans

Key Features:

  • A hybrid of HMO and PPO.
  • You can go out-of-network for certain services, often with higher copays or coinsurance.
  • Requires a PCP and referrals for specialists (when in-network).
  • May include drug coverage.

Best for: Beneficiaries who like the care coordination of an HMO but want some out-of-network flexibility.

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

MSA (Medical Savings Account) Plans

Key Features:

  • Combines a high-deductible health plan with a savings account that Medicare deposits money into.
  • Funds can be used to pay for qualified medical expenses.
  • Does not include Part D coverage; must be purchased separately.

Best for: Those who prefer managing their own health savings and expenses and are comfortable with high deductibles.

Watch a quick YouTube video on why agents should include ancillary products with MA sales

Choosing the Right Medicare Advantage Plan

When evaluating which type of plan is best for you or your client, consider:

  • Provider access: Do you want to stay in-network or have more flexibility?
  • Prescription needs: Is Part D coverage important?
  • Cost preferences: Would you rather pay higher premiums for lower out-of-pocket costs or vice versa?
  • Health conditions: Are there chronic conditions or Medicaid eligibility that might qualify for an SNP?

Each Medicare Advantage plan type offers different benefits, restrictions, and costs. Understanding these differences is the key to selecting the most suitable coverage.

Agents, stay up-to-date on the our latest webinars an agent events.

Alternatives to LTC Plans

Alternatives To LTC Plans

By Ed Crowe | General Articles | 0 comment | 11 June, 2025 | 0

Exploring Alternatives to LTC Plans

Long-Term Care (LTC) insurance is designed to help cover the cost of services such as home care, assisted living, and nursing home care. However, traditional LTC insurance isn’t always the right fit for everyone. Whether it’s due to affordability, underwriting requirements, or changing needs, many people are looking for alternatives to LTC plans to prepare for future care costs.

Here’s a look at some viable alternatives to traditional LTC insurance agents can suggest to clients as an affordable option.

Hybrid Life Insurance with LTC Riders

What it is: A life insurance policy (usually whole or universal life) that includes a rider allowing policyholders to use part of the death benefit to pay for long-term care expenses.

Pros:

  • If the policy holder never needs care, beneficiaries still receive the death benefit.
  • Premiums are often guaranteed and cannot increase.
  • Easier to qualify for than standalone LTC insurance.

This is a good choice for Individuals who want both life insurance and LTC protection in one plan and are concerned about “use-it-or-lose-it” LTC premiums.

Annuities with Long-Term Care Benefits

What it is: Some annuities offer enhanced payouts if the owner needs long-term care, effectively doubling or tripling the monthly income benefit for a specific period of time.

Pros:

  • Guaranteed income stream.
  • Fewer underwriting requirements.
  • Can use qualified or non-qualified funds.

These annuities are an option for people with savings they want to protect or grow, who worry about future care expenses but don’t want traditional insurance.

Watch a quick video on Annuity basics

Short-Term Care Insurance

What it is: Short-term care policies cover care needs for a limited time; typically not more than 360 days. They are easier to qualify for and are more affordable when compared to traditional LTC policies.

Pros:

  • Lower cost.
  • Often no medical exam required.
  • Quick benefit payout.

Clients who may not qualify for traditional LTC insurance or those seeking a more budget-friendly option to cover a temporary care gap should consider short-term insurance coverage.

Self-Funding with Investments

What it is: Creating a personal plan to save and invest funds specifically designated for possible long-term care expenses.

Pros:

  • Complete control over assets.
  • No underwriting or monthly premiums.

Cons:

  • Requires discipline and adequate income.
  • May be insufficient if care is needed sooner than expected or costs exceed projections.

Best for: High-net-worth individuals or financially savvy clients who prefer autonomy over their funds.

Medicaid Planning

What it is: Strategic financial planning to qualify for Medicaid coverage of long-term care. This might include asset protection strategies such as irrevocable trusts and gifting.

Pros:

  • Medicaid is the largest payer of long-term care in the U.S.
  • Can help preserve some assets for heirs.

Cons:

  • Requires strict adherence to look-back periods and asset limits.
  • Planning must be done well in advance.

This may be an option for those with limited assets or those with time to plan ahead using an experienced elder law attorney or Medicaid planner.

Agents; if you are ready to contract with Crowe; click here.

Start the Conversation Early

The key to successful long-term care planning is starting early. Many of these alternatives become less viable with age or declining health. For agents, it’s important to offer a well-rounded view of options so clients can make informed decisions based on personal needs, health, and finances.

Remember: LTC planning isn’t one-size-fits-all. By exploring these alternatives, clients can have peace of mind; even if traditional long-term care insurance isn’t a viable option.

If you are an agent; Don’t miss important information or events; click here to stay current

Agent looking to expand your portfolio with LTC alternatives should consider contracting with carriers that offer hybrid products. It also helps to work with financial planners to create a comprehensive care funding strategy for your clients.

Should Life Agents Add Medicare Sales

Should Life Agents Add Medicare Sales

By Ed Crowe | General Articles | 0 comment | 11 June, 2025 | 0

Why Life Insurance Agents Should Add Medicare Sales to Their Portfolio

The insurance industry is constantly evolving, and agents who adapt tend to stay ahead. Should life agents add Medicare sales? For life insurance agents looking to diversify income, build long-term client relationships, and create a more full-service business, adding Medicare sales is one of the smartest moves you can make.

Here’s why now is the perfect time to bring Medicare into your practice and how doing so can elevate your business.

A Huge, Growing Market

Every day, thousands of Americans turn 65 and that trend is expected to continue for years. These individuals are entering Medicare eligibility and looking for guidance. As a trusted life insurance advisor, you’re in a perfect position to provide it.

Adding Medicare products means tapping into a huge and growing senior market that is eager for personalized advice.

Recurring Revenue Stream

Medicare Advantage and Medicare Supplement plans as well as PDP plans offer residual income. Once you enroll a client, you can receive renewal commissions every year they remain with the plan. This helps build long-term income stability and predictability.

Watch a quick YouTube video on Medicare Advantage & PDP commissions 2025

Cross-Selling Opportunities

Adding Medicare products opens the door to natural cross-sells:

  • Final expense insurance
  • Hospital indemnity plans
  • Critical illness and cancer policies
  • Dental, vision, and hearing plans
  • Annuities for retirement income

Your Medicare clients often need these products, and you already have the relationship and trust to help them.

Stay Connected To Your Clients

Clients turning 65 often reach out with Medicare questions. If you don’t provide help, they may turn to someone who does, and that someone may end up replacing other policies you wrote.

By adding Medicare, you become a one-stop resource for your clients’ as they enter retirement. This helps build trust and solidify the relationship. Get a few tips to maintain your book of business.

Simple Entry With the Right Support

Getting started in Medicare sales may seem intimidating, but it’s more straightforward than many life agents expect:

  • Get licensed in the states you plan to sell in
  • Complete AHIP certification
  • Contract with carriers (MAPD, PDP, Med Supp)
  • Partner with an FMO or upline who offers training, tools, and support

Learn about our $500 monthly lead and marketing program

With the right team behind you, the learning curve is manageable—and the long-term payoff is substantial.

Medicare Builds Your Business Year-Round

Although Medicare gives you a seasonal boost during the Annual Enrollment Period (AEP) every fall, it also provides a steady stream of opportunities throughout the year from:

  • Turning 65 clients
  • Special Enrollment Periods (SEPs)
  • Dual Eligibles and LIS recipients

You can keep your pipeline full even when life insurance leads dry up.

If you are ready to add Medicare; click here for online contracting

Adding Medicare sales doesn’t mean walking away from life sales; it is an opportunity to expand your business and your value to clients. You’ll gain:

  • A broader client base
  • Stronger retention
  • Recurring revenue
  • More cross-sell opportunities

Stay updated on Medicare agent events and information

If you’re a life agent looking to grow your business and secure your financial future, Medicare sales should be your next move.

What's Medicare Part D Extra Help

What’s Medicare Part D Extra Help

By Ed Crowe | General Articles | 0 comment | 9 June, 2025 | 0

Medicare Part D Extra Help: What Agents and Beneficiaries Need to Know

When it comes to Medicare, prescription drug coverage can be a very confusing and expensive component for beneficiaries. Fortunately, there’s a federal program called Extra Help, also known as the Low-Income Subsidy (LIS), that can significantly reduce those costs. As a Medicare agent, you need to be able to answer the question; what’s Medicare part D Extra Help. Understanding and explaining this benefit can be a game-changer for your clients.

What Is Medicare Part D Extra Help

Extra Help is a program administered by the Social Security Administration (SSA) and Centers for Medicare & Medicaid Services (CMS) to assist individuals with limited income and resources in paying for their Medicare Part D prescription drug plan costs. This includes premiums, deductibles, and copayments.

The value of this benefit can be substantial—worth an average of about $5,300 per year (2024 estimate).

Who Qualifies for Extra Help?

To qualify for Extra Help, beneficiaries must meet certain income and resource limits. As of 2025 (these numbers are adjusted annually):

  • Income Limits:
    • Individuals: Up to $23,715 annually
    • Married couples: Up to $31,965 annually
  • Resource Limits (includes bank accounts, stocks, and bonds; excludes home, car, personal items):
    • Individuals: Up to $17,600
    • Married couples: Up to $35,130

Click here for a LIS Extra Help chart for 2025

Note: People who automatically qualify for Extra Help include those who:

  • Have full Medicaid coverage
  • Receive Supplemental Security Income (SSI)
  • Qualify for an MSP (Medicare Savings Program)

What Extra Help Covers

Depending on the level of help a beneficiary qualifies for, Extra Help can:

  • Reduce or eliminate monthly Part D premiums
  • Lower or remove the annual Part D deductible
  • Cap out-of-pocket drug costs

In most cases, those receiving Extra Help will pay:

  • Low or no monthly premiums for a benchmark Part D plan
  • A small deductible as low as $0
  • Low copays (as little as $4.80 for generics and $12.15 for brand-name drugs in 2025) Full-Duals pay $1.60 for generic and $4.80 for brand name drug copays

Watch a quick YouTube video on the Quarterly SEP for Dual and Drug Help Elimination in 2025

How to Apply for Extra Help

  • Online at www.ssa.gov/extrahelp
  • By calling 1-800-772-1213 (SSA)
  • Or by visiting the local Social Security office

As an agent, you can guide clients through the application process, help gather the right documentation, and verify eligibility.

Why Agents Should Care

Helping clients apply for Extra Help not only strengthens your relationship with them but also ensures they can afford necessary medications. When a client qualifies, they may be more willing and able to enroll in or stick with a Part D plan; making this an ideal opportunity to offer value and grow your book of business.

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

SEP for Extra Help Recipients

Don’t forget, beneficiaries who qualify for Extra Help are eligible for a Special Enrollment Period (SEP). This means they have an SEP to change their Medicare Part D plan once they are approved for extra help.

learn about the SEP Changes for Dual, Partial Dual and LIS members in 2025

Extra Help can be life-changing for Medicare beneficiaries who struggle with prescription drug costs. As an agent, your role in identifying eligibility and guiding your clients through the application process is crucial. It’s a win-win: clients get meaningful financial relief, and you build long-term trust and loyalty.

Stay updated on agent events and information; click here

What does ready to sell mean

What Does Ready To Sell Mean

By Ed Crowe | General Articles | 0 comment | 8 June, 2025 | 0

What Does “Ready to Sell” Mean – A Guide for Medicare Agents

If you’re a Medicare agent gearing up for the Annual Enrollment Period (AEP) or planning your year-round sales strategy, you’ve likely heard the term “Ready to Sell” (RTS) from carriers, uplines and other agents. But what does ready to sell mean and why is it so important?

Here’s a breakdown of what “ready to sell” is, why it’s critical for your success, and how to make sure you’re always in good standing with Medicare carriers.

What Is “Ready to Sell”

Ready to Sell means you have completed all the carrier-specific requirements to legally and compliantly market and sell that carrier’s Medicare Advantage (MA), Medicare Advantage Prescription Drug (MAPD), or Prescription Drug Plans (PDPs).

Until the carrier officially marks you “Ready to Sell”, you cannot:

  • Discuss plan details,
  • Help clients enroll in a plan,
  • Or earn commissions for sales.

What Does It Take to Become RTS

Requirements may vary slightly by carrier, but typically, agents must complete the following steps every year:

  1. AHIP Certification
    Most carriers require agents to pass the AHIP (America’s Health Insurance Plans) certification with a score of at least 90%. This ensures they understand Medicare basics and CMS compliance rules.
  2. Carrier-Specific Certifications
    Each carrier has its own product training, code of conduct, and compliance modules that must be completed, Usually agents can locate these in the carrier’s online portal.
  3. Contracting and Licensing
    Agents must:
    • Be properly licensed in any state(s) they intend to sell in.
    • Complete contracting paperwork and submit background checks when required.
    • Maintain Errors and Omissions (E&O) insurance coverage.
  4. State Appointments
    In any state you want to sell in, the carrier must appoint you before you can make a sale. Learn why you might want to add non-resident licenses.

Once you complete these steps and the carrier processes them, they’ll update your status to Ready to Sell.

Watch a quick YouTube video “What you need to know before a Medicare sale”.

When To Get Ready to Sell

Early preparation is key. Most carriers open their certifications in either June or July for the up-coming AEP. It is best to finish each one as soon as possible. If you are appointed with several carriers, you do not want to be over whelmed trying to get them all done at once. If you wait too long, you may miss valuable selling time during the busiest part of the year.

What If You’re Not RTS

If you try to present or enroll a client in a plan without a RTS status, you risk:

  • Losing your commission
  • Contract termination
  • CMS compliance violation

Even if you’re well-intentioned, both the carrier and CMS takes these infractions seriously. Always check your RTS status before marketing or discussing plans.

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

How to Check Your RTS Status

Most carriers notify you by email when you’re Ready to Sell. In most cases, you can find your RTS status on each carrier’s broker portal. Some FMOs (Field Marketing Organizations) also provide consolidated dashboards for multiple carriers, such as Pinnacle’s BOSS portal.

Stay on top of the latest agents events and information; click here

Adding a Non-Resident Insurance License

Adding a Non-Resident Insurance License

By Ed Crowe | General Articles | 0 comment | 4 June, 2025 | 0

Why Consider a Non-Resident Insurance License

As a Medicare agent, you’re always looking for ways to grow your book of business and expand your earning potential, but what if the opportunity lies outside your home state? Adding a non-resident insurance license is a powerful tool that allows licensed agents to legally sell insurance in states they don’t live in. Whether you’re eyeing snowbird states, helping relocated clients, or expanding your digital reach, here’s why a non-resident license might be your next smart move.

What Is a Non-Resident Insurance License

A non-resident health insurance license allows an agent to sell Medicare Advantage, Medicare Supplement, and Prescription Drug Plans in a state other than where they live. Most states allow agents to apply online through the NIPR (National Insurance Producer Registry) for a streamlined approval process.

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

Reasons to Get Licensed in Other States

1. Follow Your Clients Across State Lines

Clients move, especially seniors who relocate for retirement, family, or health reasons. Having a non-resident license lets you retain your clients, continue to serve them legally, and maintain your commissions even after they move.

2. Target Snowbird States

States like Florida, Arizona, and North Carolina have large populations of retirees; many of whom split their time between two states. If you’re licensed in both their primary and secondary residences, it is easier to meet their unique Medicare needs wherever they are.

3. Take Advantage of Remote Selling

With telesales, Zoom, and electronic applications now standard in Medicare sales, geography is no longer an issue. A non-resident license lets you legally market and enroll beneficiaries remotely in multiple states. For agents who are willing to do the work, this can open the door to unlimited expansion.

4. Participate in Cross-State Lead Programs

Some lead vendors or FMOs offer high-quality leads in multiple states. Without the proper licenses, you’ll miss out. A non-resident license makes you eligible for more lead opportunities.

5. Diversify Your Market

Every state has slightly different demographics, plan availability, and competitive dynamics. Getting licensed in new areas lets you provide service in underserved or less saturated markets where you can stand out and grow faster.

Watch a YouTube video – Choosing the Right Type of Lead

How to Get a Non-Resident License

  1. Check requirements on NIPR.com.
  2. Have a resident license in good standing.
  3. Apply and pay the state-specific fees.
  4. Submit to any background checks or documentation requests.
  5. Keep up with CE requirements (some states require additional courses).

Keep in Mind

  • Carrier Appointments: Getting licensed isn’t enough, you also need to be appointed by each carrier you plan to offer in that state.
  • Marketing Rules: Always follow state-specific CMS and state DOI regulations. What works in one state may not work elsewhere.
  • Annual Renewal Fees: Each state has its own renewal process and costs. Be sure to check with each carrier you add to see if they also charge a non-resident appointment fee. tHis helps ensure our investment is worth the cost.

Agents; stay up-to-date on events and information

Think Bigger

As the Medicare landscape becomes more competitive, the agents who think strategically and act nationally get ahead. A non-resident license is an investment in flexibility, client retention, and revenue potential. Whether you’re selling virtually or preparing for client moves, now is the time to consider expanding your footprint beyond your home state.

Medicare Part B LEPs

Medicare Part B LEPs

By Ed Crowe | General Articles | 0 comment | 3 June, 2025 | 0

Understanding Medicare Part B LEPs: How to Avoid Them and Dispute Errors

Enrolling in Medicare is a crucial step to secure affordable healthcare for those who qualify. However, missing the enrollment window can be a costly mistake. If this happens, a beneficiary will face Medicare Part B LEPs (Late Enrollment Penalties). In this post, we explain what the penalty is, how to avoid it, and how to dispute it if it is applied in error.

Watch a video on OEP, SEPs & late Part B enrollment

What Is a Medicare Part B LEP

Medicare Part B covers outpatient services like doctor visits, preventive care, durable medical equipment, and more. If the beneficiary doesn’t sign up for Part B when they’re first eligible, and they don’t qualify for a Special Enrollment Period (SEP), they may receive a monthly penalty that lasts a lifetime.

Here’s how it works:

  • The penalty is 10% of the standard Part B premium for every 12-month period the beneficiary was eligible but didn’t enroll.
  • CMS adds it to the monthly premium as long as you have Part B; most likely for the rest of your life.

Example:

If the beneficiary delays Part B for 2 full years without a valid reason, the penalty will be 20% of the standard monthly premium.

When Can You Delay Enrollment Without Penalty

You can delay Part B without a penalty if you have creditable coverage. This generally means you receive coverage under an employer-sponsored plan through your (or your spouse’s) active employment.

You qualify for a Special Enrollment Period (SEP) if:

  • You or your spouse are still working past age 65.
  • You’re covered under a group health plan from that employment.
  • You enroll in Part B within 8 months of losing that coverage or stopping work; whichever comes first.

How to Avoid the Part B LEP

  1. Know Your Initial Enrollment Period (IEP). The IEP is a 7-month window. It begins 3 months before th emonth you turn 65, includes your birth month , and ends 3 months later.
  2. Enroll During a Special Enrollment Period (if eligible). Those working past 65 and have employer coverage shoul dkeep proof of coverage. This may qualify them for an SEP.
  3. Get Written Confirmation of Creditable Coverage. Keep documents from your employer or insurance provider to prove your coverage was creditable.
  4. Don’t Assume COBRA or Retiree Coverage Counts. These type of coverage do not qualify as creditable to delay Part B enrollment without a penalty.

What If You’re Penalized by Mistake

If you receive a notice of a Part B LEP and believe it’s in error, you have the right to appeal.

Steps to Dispute a Medicare Part B LEP:

  1. Request a Reconsideration
    Contact the Social Security Administration (SSA) and request Form CMS-L564 (Request for Employment Information) and Form CMS-40B (Application for Enrollment in Medicare – Part B).
  2. Gather Proof
    Obtain proof of your creditable coverage, such as:
    • Employer letters
    • Pay stubs showing active health coverage
    • Group health insurance policy documents
  3. Submit Documentation Promptly
    Include a letter explaining your situation and attach your documentation. Send it to your local Social Security office or follow instructions provided with the reconsideration request.
  4. Follow Up
    Appeals can take several weeks. Keep a record of all communication and follow up regularly.

Medicare Part B LEPs are more than just a financial nuisance; they’re a lifelong burden if not handled correctly. Fortunately, with proper planning and awareness of enrollment timelines, they are entirely avoidable. If a mistake does occur, don’t panic. There is a clear process in place for disputes, and with strong documentation, many errors can be successfully overturned.

If you’re approaching Medicare eligibility or navigating coverage options, consider consulting with a licensed Medicare agent to help guide you through the process.

Medicare agents

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Selling Critical Illness Insurance

Selling Critical Illness Insurance

By Ed Crowe | General Articles | 0 comment | 2 June, 2025 | 0

Why Medicare Agents Should Be Selling Critical Illness Insurance

As a Medicare insurance agent, your goal is to ensure clients have the best protection for their individual needs. Although Original Medicare and Medicare Advantage plans provide essential healthcare coverage, there’s a critical gap often overlooked: the financial impact of a serious illness. This is where selling critical illness insurance can add real value to your clients’ health coverage as well as your business.

What is Critical Illness Insurance

Critical illness insurance pays a lump-sum cash benefit directly to the policyholder upon diagnosis of a covered condition, such as:

  • Cancer
  • Heart attack
  • Stroke
  • Organ transplant
  • Kidney failure

Unlike traditional health insurance, this benefit can be used any way the insured chooses; covering deductibles, copays, for travel, in-home care, or everyday expenses like mortgage or groceries.

Why Medicare Isn’t Enough

Medicare (even with Medigap or Medicare Advantage) doesn’t provide coverage for non-medical expenses that often accompany a serious diagnosis. For example:

  • Travel to specialized treatment centers
  • Home modifications for accessibility
  • Lost income for a spouse who becomes a caregiver
  • Alternative treatments not covered by Medicare

Even with excellent coverage, a sudden illness can quickly lead to out-of-pocket expenses that drain savings and add financial stress to an already difficult time.

Watch a quick YouTube video on Why and How to Sell Ancillary with Medicare

How Selling Critical Illness Insurance Enhances Your Portfolio

Solves a Real Problem
Seniors are more likely to suffer from critical illnesses than younger individuals. Offering a solution that provides some financial protection and peace of mind differentiates you as a full service advisor; not just a Medicare agent.

Easy to Explain, Easy to Sell
This product is straightforward: “If you’re diagnosed with a serious illness, you get cash.” There’s no network, no complicated claims process, and no restrictions on how the money is spent.

Cross-Selling Made Simple
The Medicare appointment is the perfect opportunity. You’re already discussing health risks, costs, and coverage gaps. With a natural transition, you can introduce critical illness as a way to fill a major gap without additional appointments or paperwork hurdles.

Important: be sure you include any products you might discuss in each meeting in the Scope of Appointment.

Increased Revenue Per Client
Adding a critical illness policy boosts your earnings while strengthening your client relationship. It’s a win-win: more protection and value for them, more business for you.

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

    Overcoming Common Objections

    “I already have Medicare.”
    Yes, but Medicare doesn’t pay you if you get sick. This policy provides money to help manage the non-medical financial impact of a serious illness.

    “I’m on a fixed income.”
    That’s exactly why this protection matters. A $20–$30 premium today could prevent thousands in financial burden tomorrow. Be sure you sell plans that fit in the client’s budget, do not over-sell. That only leads to distrust and chargebacks when they cannot afford to pay for the coverage.

    Adding critical illness insurance to your Medicare sales is not just smart business; it’s the right thing to do for your clients. It shows you understand their broader needs, care about their financial security, and can offer solutions beyond the basics.

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