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Understanding Medicare agency contracting levels can help agents who may want to expand thier business set clear goals for themselves. The contracting process determines the level of authority, commissions, and support that an agency or agent receives when selling Medicare Advantage (Part C), Medicare Supplement (Medigap), and Medicare Part D prescription drug plans. This blog provides some general information about the different levels of Medicare contracts.

Please keep in mind, each carrier has different requirements for contract levels. They may also have different names for contract levels than what we have listed here.

Levels of Medicare Contracting

Medicare sales agencies typically operate under a hierarchical contracting structure. Each level comes with varying degrees of responsibility and commission structure.

Most carriers will pay street level commissions directly to the downline/sub agent with the override paid to the agency. Overrides range from $50.00 to $150 per sale. This varies by company and agency level.   Many agents know what the annual street level compensation is and will not work with an agency if they will be taking any part of the street compensation.

Agents

At the entry level, individual agents contract directly with an Medicare agency and in some cases, with the insurance carrier. There are two main types of agent contracts:

• Captive Agents: Work exclusively for one carrier and can only sell that carrier’s Medicare products.
• Independent Agents: Have the flexibility to contract with multiple carriers, allowing them to offer a variety of Medicare plans to clients.

Individual agents can either receive street commissions or be LOA to the agency they work under.

General Agencies (GAs)

General Agencies (GAs) operate as intermediaries between independent agents and higher-level marketing organizations, such as FMOs and NMOs. GAs typically provide agents with carrier access, sales support, and some marketing resources, they may not offer the same level of training and tools an FMO can provide. The GAs recieve an override commission for business their downline agents write.

Managing General Agencies (MGAs)

MGAs function at a higher level than GAs, to be an MGA, you must have a greater number of downline agents than a GA. They may provide additional administrative support and agent oversight. structures. MGAs may have direct contracts with carriers, allowing them to receive greater overrides on downline agent sales than a GA level contract. This may provide them financing to offer agents advanced sales tools and training.

Senior General Agencies (SGAs)

SGAs operate at an even higher level than MGAs, typically overseeing some MGAs and GAs. They have strong carrier relationships, access to exclusive products, and higher commission opportunities. SGAs should provide large-scale support, including compliance oversight, marketing assistance, and leadership training for agencies beneath them.

Field Marketing Organizations (FMOs)

FMOs serve as intermediaries between carriers and independent agents or smaller agencies. They provide training, marketing resources, compliance support, and higher commission opportunities. FMOs typically contract with multiple carriers and offer agents the ability to represent various Medicare plans.

Take a look at the programs Crowe offers agents & agencies

National Marketing Organizations (NMOs)

NMOs operate at a level above FMOs and work with a broad network of agents, agencies, and FMOs. These organizations have high-level contracts with carriers, allowing them to negotiate competitive commission structures and access exclusive sales resources. NMOs focus on large-scale distribution and typically offer robust technology and compliance support.

Insurance Carriers

At the top level of the hierarchy, insurance carriers (such as UnitedHealthcare, Humana, and Aetna) contract directly with NMOs, FMOs, and, in some cases, GA levels or individual agents. Carriers set the terms of contracts, commission structures, and compliance guidelines that all agents and agencies must follow when selling Medicare plans.

Keep in mind; all agents and agencies must also folow CMS guidelines.

Contracting Considerations

Commission Structure: Higher-level contracts often provide better commission overridess, but require meeting performance thresholds and a specific number of downline/sub agents.

Training and Support: FMOs and NMOs often provide valuable training, lead generation, and compliance assistance.

Carrier Relationships: Access to multiple carriers gives agents flexibility to offer the best plan options for clients.

Compliance Requirements: Medicare sales are highly regulated, and agencies must ensure they follow CMS (Centers for Medicare & Medicaid Services) guidelines.

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

Understanding Medicare sales agency contracting levels is crucial for agents and agencies looking to optimize their business. Whether operating as an independent agent, partnering with a GA, MGA, or working under an SGA, FMO, or NMO, choosing the right contracting level can significantly impact commissions, resources, and overall success in the Medicare market. Agents should carefully evaluate their options to align with an organization that best supports their business goals.

Health Savings Accounts (HSAs) offer a tax-advantaged way to save for medical expenses, but their benefits and rules change once you enroll in Medicare. Understanding HSAs and Medicare enrollment is crucial to avoid tax penalties and continue to benefit from the HSA.

How HSAs Work Before Medicare

An HSA is a tax-advantaged account that allows individuals with a high-deductible health plan (HDHP) to save and pay for qualified medical expenses. Contributions to HSAs are tax-free, in other words, any contributions lower taxable income. All investment growth and earnings are tax-free; indivduals can invest HSA money and will not pay taxes on any gains as long as the money is in the account. Additionally, money withdrawn for qualified medical expenses is tax-free. However, once an individual enrolls in Medicare, they can no longer contribute to an HSA.

Medicare Enrollment and HSA Contributions

Once enrolled in Medicare, the ability to contribute to an HSA stops. This includes enrollment in any part of Medicare, either Part A (hospital insurance) or Part B (medical insurance). Those who continue making HSA contributions after Medicare enrollment face tax penalties.

A few things to consider:

Medicare Enrollment Date Matters: HSA contributions must stop the month your Medicare coverage begins. If you enroll in Medicare mid-year, your contribution limit for that year will be prorated based on the number of months you were eligible to contribute before Medicare enrollment.

Retroactive Medicare Coverage: For those who enroll in Medicare after turning 65, Part A coverage may be retroactive for up to six months (but no earlier than the month you turned 65). This retroactivity can impact HSA contributions. Beneficiaries should stop contributing at least six months before applying for Medicare to avoid penalties.

Employer Considerations: Anyone working past 65 with employer-sponsored health insurance with an HSA option, may want to delay Medicare enrollment and continue contributing. However, once enrolled in Medicare, even retroactively, HSA contributions must stop.

Using HSAs After Medicare Enrollment

Although individuals can’t contribute to an HSA after enrolling in Medicare, they can still use the funds in their account. Benficiaries can use HSA funds tax-free for qualified medical expenses, including:

• Medicare premiums (except for Medicare supplement policies)
• Out-of-pocket medical costs such as copays, deductibles, and prescription drugs
• Long-term care services
• Some over-the-counter medications and medical supplies

Important: after age 65, HSA withdrawals for non-medical expenses are not subject to the 20% penalty that applies to those under 65. Although, those withdrawals are taxed as income.

Transition from HSA to Medicare

To avoid tax issues and optimize benefits, consider the following:

Time Your Medicare Enrollment: Those who plan to work past 65 and want to continue HSA contributions, consider delaying Medicare enrollment if employer coverage allows it.

Stop Contributions in Advance: Individuals planning to enroll in Medicare, stop HSA contributions at least six months before applying to avoid penalties due to retroactive Medicare coverage.

Maximize Existing HSA Funds: Plan the use of HSA funds for healthcare expenses, including Medicare premiums and out-of-pocket costs.

HSAs provide valuable benefits, but their rules change upon Medicare enrollment. Proper planning helps maximize savings and avoid unexpected tax penalties. Individuals approaching Medicare eligibility should consider consulting a financial or tax advisor to help ensure a smooth transition.

Medicare agents – watch some free training videos on our YouTube channel

If you are ready to contract with Crowe; click here for contracting

Understanding how HSAs and Medicare interact can help individuals make informed decisions that optimize healthcare savings and coverage.

As a Medicare insurance agent, maintaining a strong reputation and ensuring client satisfaction is essential for success. While providing the best possible service, agents must also be proactive in preventing client complaints that could damage their credibility, lead to compliance issues, or impact their business. We will explain how to avoid client complaints and build better client relationships.

Explain plan details and costs clearly

Many complaints arise from misunderstandings about plan coverage, costs, or network restrictions. To avoid this, agents should take the time to explain plan details, including premiums, deductible and co-pays. Do not forget to include out-of-pocket plan limits.

Remember to emphasize any network restrictions as well as provider availablity. This is extremely important for Medicare Advantage plans. It is helpful to provide a summary of benfits so clients can review them before enrolling in a plan.

Ensure clients enroll in the correct plan

Sometimes complaints occur if the client feels they were enrolled in a plan that does not fit their needs. The best ways to avoid this are; conduct a thourough needs assessment. Be sure you consider all medications, docotors and expected healthcare useage. Comparing mulitple plans and explaining the pros and cons of each helps the client make an informed decision.

Learn about rapid disenrollments

Be transparent coverage changes

Because Medicare plans can change every year, clients may be unhappy if they experience unexpected costs or coverage changes. To prevent this; be sure you procactively inform them of any modifications to their current plan, Remind them to take a look at their annual notice of change (ANOC). Offer an annual review during AEP to ensure thye are still in the best plan for their coverage needs.

Follow CMS compliance guidelines

The CMS has strict marketing and sales guidelines. Agents must avoid misleading or high-pressure sales tactics, use only approved marketing materials and be sure to obtain consent before discussing any pans. It is also important to never make unverified claims about coverage, benefits or plan costs.

Provide ongoing support

Clients appreciate agents who are accessible and responsive. To maintain trust; return calls and emails promptly. Offer assistance after enrollment, such as claims questions and benefit explanations. It is always a good idea to follow up to make sure clietns are happy and understand hw to use their plan benefits.

Handle issues and complaints professionally

Even with the best practices, complaints may still come up. When they do; be sure you listen attentively to the client’s concerns without interruption. It is important to acknowledge their frustration and provide a solution oriented repsonse. If it is necessary, escalate issues to the appropriate carrier rep or Medicare support services.

Document interactions

Keeping records of client communications, plan discussions, and enrollments helps protect agents and clients in case of disputes. Maintain notes from meetings, make note of any special concerns. Keep written enrollment confiramtions and copies of signed documents, authorizations especially the SOA.

Stay updated on Medicare rules and plans

Medicare regulations, plan offerings, and compliance rules change regularly. Stay informed by attending carrier training and webinars. Complete all annual certifications including AHIP. Join industry groups and network with other agents to stay updated on all industry and CMS rules.

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

Medicare agents play an important role helping clients navigate complex healthcare decisions. By being transparent, compliant, and client-focused, agents can minimize complaints, enhance client satisfaction, and build a strong reputation in the industry. Providing top-notch service not only leads to long-term client relationships but also increases referrals and business growth.

Licensed health agents who are looking to expand their revenue, may want to consider GTL ancillary product sales. GTL ancillary products provide agents with several affordable coverage options that are available in many states.

Because Medicare does not cover everything, ancillary products can fill many of the gaps in coverage. These products help set your apart from other agents and provide coverage for all of your cleint’s needs in one place. This builds stronger client relations and creates greater customer loyalty.

Watch a quick YouTube video on the value of ancillary product sales.

Some products GTL offers

Please note: This list is not all inclusive; GTL has other products available that are not listed here including life insurance products.

Hospital Indemnity

GTL offers Advantage Plus Elite hospital Indemnity Insurance . This plan provides financial assitance with expenses associated with a hospital stay; co-pays, deductibles and other out-of-pocket expenses not covered by health insurance. We all know medical costs can add up quickly possibly leaving benficiaries with financial hardships. Hospital indemnity plans allow beneficiaries to use the cash benefit any way they like.

If a beneficiary is confined to hospital or recieve any type of care that is covered under the plan, they receive a cash benefit. The Advantage Plus Elite plan pays a per day benefit depending on the plan selected. Plans cover a period from 1 up to 15 days. Benefit periods reset once the beneficiary is out of the hospital for 60 days. Some plan options provide a 1-day benefit period with a $2,500 daily benefit amount. Daily benefit amounts depend on the state the benficiary resides in.

Click here for Crowe online contract and add GTL to your products.

Cancer

Precision Care Cancer Insurance helps policyholders diagnosed with cancer access advanced treatments that may not be covered by insurance. Precision Care lets policyholders access TGen’s world class Cancer Physicians as well as their cutting-edge genomic sequencing services. It also provides cash to pay for services and specialized cancer treatments.

Learn more about Precision Care, just go to: outsmartmycancer.com.

If the beneficiary is diagnosed with cancer, TGen (the Transitional Genomics Research Institute) an affiliate of City of Hope nonprofit medical research institute receives a biopsy of the tumor, and the DNA is sequenced in TGen’s lab. Once this is done, doctors use the findings to suggest treatments that have been used to target similar mutations.

For more information about TGen, visit www.tgen.org.

Cancer Heart Attack & Stroke

Cancer, Heart Attack and Stroke Insurance provides beneficiaries a lump-sum benefit paid directly to them even if they have other health coverage that will pay for their treatment. The benefit amount can go as high as $50,000 for any of the covered diagnoses. The benefit amounts vary by the coverage chosen.

Short-Term Care

Recover Cash is short-term care insurance that provides coverage for several different types of care. Coverage includes; assisted living facilities, nursing homes, or the enrollee’s home. Recover Cash provides a way to pay out-of-pocket expenses and avoid gaps in health insurance coverage. An additional benefit of this coverage is access to TCARE’s Family Caregiver Concierge Services. This service provides support to caregivers and helps to avoid burnout. This policy gives beneficiaries a direct cash benfit touse any way they like.

Watch a video explaining some of the GTL ancillary products

Critical Illness

Critical Provider Plus critical illness insurance helps lessen financial hardships that come with a critical illness or accident. Coverage options range from $10,000 up to $100,000. These plans pay up to two times for two separate critical illnesses. GTL issues Critical Illness policies for ages 18 to 64. Lifetime maximum benefit amounts are between $25,000 and $250,000.

Please note; product availability varies by state. Click the link below to see what’s available in your area;

GTL Supplemental Health Products- click here and see what’s available

Click here for GTL products by state.

The Medicare Advantage market has experienced substantial growth in recent years, with Medicare C-SNP market growth one of the fastest-growing segments. C-SNPs cater to individuals with specific chronic illnesses, offering tailored benefits and care coordination. As healthcare costs rise and the over 65 population grows, C-SNPs are becoming the plan of choice for both beneficiaries and insurers.

What Are C-SNPs

Medicare Advantage Special Needs Plans (MA SNPs) provide targeted care and services to specific beneficiaries. Within this category, C-SNPs focus on beneficiaries with qualifying chronic conditions such as diabetes, cardiovascular disease, or chronic lung disorders. C-SNPs offer enhanced care management, specialized provider networks, and condition-specific benefits. These plans go beyond what traditional Medicare or standard MA plans provide.

Growth of the C-SNP market

Several factors are fueling the growth of the C-SNP market:

Chronic disease prevalence – Due to the aging U.S. population, the number of individuals with chronic conditions is rising. According to the CDC, six in ten adults have at least one chronic disease. This has increased the demand for tailored healthcare solutions.

Regulatory support – CMS continues to promote C-SNP expansion, offering increased flexibility in plan design and benefits to better meet the needs of chronically ill beneficiaries.

Increased insurer participation – As health plans recognize the financial and clinical benefits of offering C-SNPs, more insurers are entering the market. This leads to greater competition and plan innovation.

Improved care coordination – C-SNPs focus on the management or chronic conditions and care coordination, which aligns with the healthcare industry’s push towards value-based care.

Enhanced supplemental benefits – Many C-SNPs offer non-medical benefits, such as meal delivery, transportation, and in-home support services. This makes them attractive to eligible beneficiaries.

Challenges of C-SNPs

Regulatory issues – C-SNPs must meet stringent CMS requirements, including annual Model of Care (MOC) approvals and strict care coordination standards.

Enrollment requirements – Because C-SNPs require beneficiaries to have a qualifying chronic condition, plan enrollment may be more complicated than traditional MA plans.

Provider networks – Ensuring access to specialists and chronic disease management programs may be difficult in rural or underserved areas.

Watch a quick YouTube video on changes to DSNP & LIS members

The Future of C-SNPs

The future of the C-SNP market seems promising, with continued growth in personalized healthcare solutions and care coordination. As CMS allows flexibility in benefit design and insurers look for growth strategies, C-SNPs have an opportunity to become an even bigger part of the Medicare Advantage market.

Even with some challenges ahead, the potential for improved patient outcomes and cost efficiency make C-SNPs an important part of Medicare’s future.

In a memo dated March 20, 2025, CMS withdrawals DST SEP change. CMS announced the withdrawal of the changes to the enrollment process that were set to take place on April 1,2025. In other words, there will be no changes to the DST SEP policy that is currently in place.

Why this is good news

The reversal of this decision is great news for both agents and their clients. Because it takes the burden off of already stressed clients who have had to deal with a weather related or other FEMA declared area emergency.  This means, the current SEP will not change. Beneficiaries do not have to self-enroll using 1-800-Medicare to use this SEP.

As per the CMS memo of March 20, 2025, insurance carriers will accept enrollment applications submitted by licensed agents. This helps Medicare beneficiaries avoid both stress and confusion. It also allows agents to ensure the process is completed correctly and in a timely manor.

Medicare DST SEP

The DST SEP is an enrollment election period for qualified Medicare beneficiaries . CMS provides this SEP to those who miss a valid election period due to weather-related emergencies or FEMA declared disasters.

Only areas where state or local government officials declare an emergency or disaster can use this SEP. This SEP starts the date the incident occurs and continues for two months after it starts or the extension period begins. It can be in place for up to a year after the incident.   

Please note: Beneficiaries can either enroll in or disenroll from a Medicare plan using the DST SEP. New coverage goes into effect the first day of the month following the submission of the application.

Eligibility for the DST SEP

To qualify for this SEP, the beneficiary must live in the area the disaster occurred in. In addition, they must have missed a valid election period (AEP, IEP or OEP, or an SEP) because of the emergency.

In some cases, individuals use the SEP if they require help from a family member or caregiver who is impacted by a disaster. This can prevent them receiving the assistance they need during an enrollment period.

Watch a quick YouTube video on the changes to DSNP SEPs

A couple more reasons to use the DST SEP: When a disaster causes the inability to access Medicare plan information or submit an application. Another example is; when a disaster impacts a healthcare facility or provider. This can hinder the beneficiary’s access to information necessary to make an informed enrollment decision.  

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Agents ready to get contracted with the Crowe team – click here

CMS has strick regulations in place for anyone offering Medicare plans over the phone. Agents who do not adhere to the rules could face strict penalties. Penalties can include; loss of contracts, monetary fines and damage to your professional reputation. To ensure compliance and build trust with potential enrollees, here are some tips for conducting compliant Medicare phone sales.

Obtain permission to contact

CMS rules strictly regulate how and when agents can contact potential enrollees. If you are calling about Medicare Advantage or PDP plans, to remain compliant; be sure to have documented permission to contact before making outbound calls. Do not cold call or use leads that did not provide consent for the call. Follow all CMS guidelines regarding unsolicited communications, this includes text messages and voicemails.

Comply with Do-Not-Call (DNC) regulations

Agents must respect consumer preferences regarding contact. To comply; make sure you use phone leads that are cross checked with the National Do-Not-Call Registry. Even when you do this, keep in mind the FTC updates the list constantly and you face a fine if you contact someone who is on that list.

Use approved scripts and disclosures

When discussing Medicare plans, agents must adhere to CMS-approved scripts and include required disclaimers.

Agents must clearly state that they do not represent or work for Medicare, but rather the specific carriers and plans they are contracted with. There are standard disclaimers that must be read to prospects. This includes: “We do not offer every plan avialable in your area”. It is always important to provide acurate plan information and do not mislead or pressure the consumer.

Watch a quick YouTube video on updates to the one-to-one consent rule

Avoid prohibited sales tactics

Medicare has strict guidelines against high-pressure sales tactics. Agents should not mislead beneficiaries into thinking they must enroll in a plan immediately (high pressure sales). They must not make unsupported claims about plan benefits or when comparing plans. Always allow the prospect to ask any questions they have and be sure they understand what is said.

Follow call recording and documentation rules

CMS requires that all Medicare Advantage and Part D sales calls be recorded in their entirety. In order to be complaint; calls must start with a disclosure that the conversation is being recorded, the prospect must give permission for this.

Agents must keep call recordings for a period of no less than 10 years as required by CMS and the carrier. It is important to document all client sales interactions; this protects both the agent and the client. A SOA is an important part of this process.

The SOA (Scope of Appointment)

When conducting a Medicare sales call, agents must adhere to the agreed-upon topics. Do not discuss additional products that are not included in the SOA. If the client wants to talk about other products, you must collect a new SOA that covers them. In order to be compliant, agents should keep the SOA for a period of 10 years.

Learn more about SOAs

Provide clear and accurate information

Misinformation or omitting critical details can lead to compliance violations. Make sure you know what the beneficiary is looking for. Discuss current coverage, doctors, medications and their needs and budget.

To maintain integrity, explain benefits, costs and network limitations clearly. Ensure enrollees understand the differences between the plan types (Medicare Advantage, Supplements & PDPs).

Ensure post-enrollment compliance

Your responsibility does not end after enrollment. To ensure your client is happy with their choice, make followup calls and discuss any questions or concerns they have. Make sure they understand their new plan benfits and how to use them. This helps keep clients happy and also helps avoid rapid disnerollments and chargebacks.

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

Staying compliant in Medicare phone sales is crucial to protecting consumers and maintaining your credibility as an agent. By following CMS regulations, using approved scripts, and respecting consumer rights, agents can foster trust and ensure ethical sales practices. Always refer to the latest CMS guidelines or seek guidance from a your upline.

Due to the recent changes in DSNP SEPs, many agents are asking questions about the different levels of Medicare DSNPs. Medicare Dual-Eligible Special Needs Plans (D-SNPs) are a type of Medicare Advantage plan designed specifically for individuals who qualify. These plans offer specialized benefits tailored to meet the unique healthcare needs of dual-eligible individuals. However, not all D-SNPs are the same, and understanding the different types can help beneficiaries make informed decisions about their coverage.

We provide an overview of the DSNP models below:

CO-D-SNPs (Coordination Only D-SNPs)

CO D-SNPs meet the minimum CMS requirements for D-SNPs. All plans meet state requirements and hold a contract with state Medicaid agencies in the states they operate in. These plans also coordinate the delivery of Medicare and Medicaid services to their members. Because these plans do not qualify as HIDE or FIDE, beneficiaries cannot use the DSNP SEP to enroll in one of these plans. However, they can enroll in these plans during another valid election period.

Learn more about the DSNP SEP

AIP D-SNPs (Applicable Intergrated Plans) – Coordination Only EAE

AIP D-SNP is a fully integrated DSNP with exclusively aligned enrollment or a highly integrated DSNP plan with exclusively aligned enrollment and cover certain Medicaid benefits. To qualify as a AIP DSNP, plans must be either FIDE or HIDE SNP with EAE or a CO D-SNP with EAC that covers primary and acute care. It must also cover Medicare cost sharing and at least one of these home health services; medical supplies, equipment appliances or nursing facility services.

AIP D-SNPs must implement unified plan level appeals as well as grievance procedures.

Click here for full definition of DSNPs

HIDE SNPs (Highly Intergrated D-SNPs)

The HIDE SNPs provide Medicaid benefits to members either through the plan or an affiliated Medicaid managed care plan. Coverage includes LTSS (long term services and support), behavioral health care or both. Plans have a contract for Medicaid coverage with the state Medicaid agency. This may be accessed through the DSNP, the DSNP’s parent organization or another organization owned by the DSPs parent company. This contract must cover the entire service area.

FIDE SNPs (Fully Integrated D-SNPs)

These plans provide Medicare and Medicaid benefits under one entity that holds a Medicare advantage contract and a contract with the state Medicaid agency. FIDE SNPs must cover both Medicaid primary and acute care as well as LTSS, This includes at least 180 days each year of nursing facility coverage.

What is EAE

EAE is exclusively aligned enrollment which happens when states require DSNP enrollment be limited to only those who are fully dual eligible. Individuals must also receive coverage of Medicaid benefits through the DSNP or a Medicaid managed care plan owned by the same parent company as the DSNP. When a plan is exclusively aligned, it facilitates coverage integration ensuring better care for enrollees.

Why we need alignment

Alignment provides assurance that Medicare and Medicaid work together to provide comprehensive, coordinated coverage for dual eligible individuals. This provides members with a well organized system of care that improves health outcomes.

Watch a quick YouTube video on the new DSNP enrollment

How it works with D-SNPs

Aligned FIDE SNPs – these plans align Medicare and Medicaid under 1 carrier as 1 entity. Members access benefits with only 1 ID card. This helps members avoid confusion and ensures members easily get all the benefits they need.

Aligned HIDE SNPs – HIDE plans align Medicare and Medicaid under 1 carrier using 2 separate entities, possibly requiring members to use 2 different ID cards. In some cases, this may be confusing for members.

Unaligned HIDE SNPs – Unaligned plans operate as 2 separate managed care plans. The Medicare plan is managed by the Insurance Carrier while the Medicaid coverage is managed by the state Medicaid organization. This can result in at least 2 ID cards and in some cases, more.

Find out about other SEPs for Medicare enrollment

Choosing the Right D-SNP Plan

When selecting a D-SNP, it is crucial to consider the level of Medicaid eligibility, the extent of additional benefits, and the coordination of services. Since plan availability varies by state, beneficiaries should use licensed Medicare agents to review their options carefully to find a plan that best meets their needs.

For more information on Medicare D-SNP options in your state, consult Medicare.gov or your local Medicaid office.

Choosing the right Medicare Supplement (Medigap) plan is an important decision for individuals managing healthcare costs. In this post, we will answer the question; why enroll in a Plan N.

Medicare Supplement Plan N can be a great plan option due to its balance of affordability and comprehensive coverage. Individuals considering their Medicare Supplement options may find the Plan N is the perfect fit for their healthcare needs.

Lower monthly premiums

One of the biggest advantages of Plan N is its cost-effectiveness. Although Plan N provides many of the same benefits as other Medigap plans, its premiums are generally lower than Plan G. This makes it a good option for individuals who want solid coverage without paying a high premium for benefits they may not use too often.

Comprehensive coverage

Plan N covers many out-of-pocket costs that Original Medicare does not, including:

• Medicare Part A hospital coinsurance and hospital costs for up to 365 days after Medicare benefits are exhausted
• Medicare Part B coinsurance (except for small copays)once the annual Part B deductible is paid
• First three pints of blood
• Part A hospice care coinsurance
• Skilled nursing facility (SNF) care coinsurance
• Limited foreign travel emergency coverage (80% up to plan limits)

Out-of-Pocket costs

Plan N offers lower premiums in exchange for reasonable cost-sharing amounts. This includes:

• Up to a $20 copay for doctors visits
• Up to a $50 copay for emergency room visits (this copay is waived if the enrollee is admitted)

These low out of pocket amounts costs are predictable and manageable.

Please note: Unlike Plan G, Plan N does not cover Medicare Part B excess charges. Although, this is usually not an issue for beneficiaries who visit doctors that accept Medicare assignment, as they agree to charge only the Medicare-approved amount.

Plan N is a great choice for individuals who:

• Want the freedom to use any provider that accepts Medicare assignment
• Want to save on monthly premiums and still have great coverage
• Do not mind paying a nominal copay for medical services

Freedom to choose any provider that accepts Medicare assignment

Unlike Medicare Advantage plans, which have network restrictions, Medigap Plan N allows beneficiaries to see any doctor who accepts Medicare assignment. This is beneficial for individuals who seek care in more than 1 state and want greater flexibility in choosing healthcare providers. This is especially helpful if the individual uses several providers to treat medical conditions or illnesses.

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Protection from high hospital costs

Hospital stays can be expensive, but Plan N covers Part A coinsurance and hospital costs beyond Medicare’s limits. This ensures that beneficiaries do not face excessive out-of-pocket costs for extended hospital stays allowing beneficiaries to focus on recovery.

Alternative to more expensive Medigap plans

For those who want comprehensive coverage without the higher Plan G premiums, Plan N provides a good balance between affordability and comprehensive coverage.

Why enroll in Plan N

Medicare Plan N is a good choice for:

• Individuals who want lower monthly premiums
• Those who are comfortable with small copays for doctor and ER visits
• Beneficiaries who may use more than one Medicare-approved provider
• People looking for nationwide coverage without restrictive networks

Medicare Supplement Plan N is a great choice for those who want a balance of affordability and comprehensive coverage. With lower premiums, predictable cost-sharing, and strong hospital coverage, it offers a practical solution for many Medicare beneficiaries. Beneficiaries should consult with a licensed Medicare agent before enrolling in any Medicare Plan to ensure the plan aligns with healthcare and financial needs.

Because diabetes affects millions of Americans, understanding Medicare diabetes coverage is extremely important to both agents and those affected by diabetes. For diabetics, proper management and access to supplies is essential to maintaining health and quality of life. Fortunately, Medicare provides comprehensive coverage for diabetes-related services and supplies. It’s important to understand what Medicare covers and how to maximize benefits.

Medicare Part B

Medicare Part B covers a variety of diabetes-related supplies and services, including:

Blood Sugar Testing Supplies – This includes blood glucose monitors, test strips, lancets, and control solutions. Medicare generally covers up to 300 test strips and lancets every three months for insulin-dependent beneficiaries and up to 100 for non-insulin users.

Continuous Glucose Monitors (CGMs) – Medicare covers therapeutic CGMs and related supplies for qualifying individuals who meet specific criteria.

Insulin Pumps and Insulin for Pumps – Medicare covers insulin pumps as durable medical equipment (DME) and the insulin used in these pumps.

Medical Nutrition Therapy (MNT) – Beneficiaries with diabetes may receive MNT services, including nutritional assessment and counseling.

Diabetes Screenings – Medicare covers two diabetes screenings per year for beneficiaries at risk of developing diabetes.

Diabetes Self-Management Training (DSMT) – A critical education service that helps patients learn how to manage their diabetes effectively.

Medicare Part D: Prescription Drug Coverage

While Medicare Part B covers insulin used in pumps, Medicare Part D (Prescription Drug Plans) covers most other types of insulin, as well as oral diabetes medications, needles, syringes, and certain related supplies. Coverage may vary based on the specific Part D plan, so it’s important to review formulary lists and copayment amounts before enrolling in a plan.

Medicare Advantage (Part C) and Supplemental Coverage

Medicare Advantage (MA) plans must cover everything Original Medicare (Part A and Part B) covers but often include additional benefits, such as expanded prescription drug coverage, wellness programs, and cost-sharing assistance for diabetes management. Some plans may also offer broad access to CGMs and other advanced diabetes care.

How to get Medicare covered diabetes supplies

It is important to always use suppliers and pharmacies that are part of your Medicare plan’s network. Check with the plan provider for specific requirements and preferred providers. Beneficiaries must obtain a prescription from their doctor for blood sugar testing supplies.

Click here to download Medicare coverage of diabetes supplies, services & prevention programs

Medicare provides extensive support for individuals with diabetes, but navigating coverage details can be complex. Understanding what’s included under Medicare Part B, Part D, and Medicare Advantage plans helps beneficiaries make informed decisions and access necessary supplies for effective diabetes management.