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Wellcare prescription plans

Because the ability to access affordable prescription medications is crucial to maintaining good health, beneficiaries must be aware of all their options.  In order to help individuals make an informed decision, we will discuss some benefits of the WellCare prescription drug plans.

Important; CMS has guidelines in place to regulate the types of medications that prescription drug plan providers must cover.  This includes a minimum standard of benefits for providers to follow. The formulary for each plan Each plan meets the requirements as required by law. Because each plan differs, the cost and drugs included in the formulary can vary.

Find out about the Medicare drug price negotiations

Although Wellcare offers three different plan choices, it is important to review each plan formulary and make sure it provides coverage to fit the prescription needs for anyone considering enrollment.

The three Wellcare PDP plans for 2024

Some features of the Wellcare prescription plans

Wellcare has no or low premium plans available to provide coverage for individuals who qualify for Extra Help.  These plans are available in all states and offer low or no copays when enrollees purchase prescriptions from preferred pharmacies.

Some Wellcare plans include no deductible, so plans cover prescriptions on day one.

Wellcare has a nationwide network of preferred pharmacies that includes thousands of national, regional and local pharmacy chains. It also includes grocers and independent pharmacies as well.  These relationships help plan members save money on prescription drugs.

Use this link to the Wellcare preferred pharmacy tool and find a local in-network pharmacy.

Find a preferred pharmacy tool to find a local pharmacy.

The member service representatives are available either online at wellcare.com/PDP or by phone at 866-822-1339 (TTY – 711) during the hours of 8am – 8pm EST Monday – Friday. They can provide answers to members coverage or medication questions.

If you want to view the plan formulary (complete list of drugs each plan covers), visit Wellcare’s website or contact their member services department.

Medicare FMO companies

Because there are so many Medicare FMO companies to choose from agents need to carefully consider what each one has to offer before they choose one to contract with.

We will start by explaining what an FMO is.  FMO stands for Field Marketing Organization.  These organizations specialize in the support of independent insurance agents as well as agencies.  They form partnerships with insurance carriers to provide marketing, sales and service resources to their downline agents/agencies.

The difference between an FMO, IMO & NMO

IMO or independent marketing organization operates similarly to an FMO, the difference is the compensation level.  These terms are both top-tier levels of carrier hierarchies. Some marketing organizations use these terms interchangeably.

Just to make things more confusing, we will throw in the term NMO, this stand s for National Marketing Organization and is another top of hierarchy level. For many carriers this is the top level of contracting.  Reaching the NMO level as with the FMO & IMO levels is no small achievement.  Because each carrier has its own hierarchy levels, it can be tricky to define these terms.  In the world of Medicare, some FMOs are not actually the top of hierarchy.

Find out why you should consider Crowe for your FMO

Other contracting levels

Some of the other contracting levels are Street, GA, MGA & SGA the name of the level depends on the carrier and each one signifies a level in contracting that provides higher overrides. If you have an agency, you need to decide how you pay your downline agents.  They can receive full street commissions directly from the carriers or you can decide to contract agents as LOA and you can make any type of payment arrangement that both parties can agree on.

CMS currently has a proposal in the works that may change the way the entire industry is structured.  The proposed rule we are talking about is CMS-4205-P. This rule could stop agents from using FMOs for product distribution and leave them without a support system.

Watch a video to see what this proposal could mean for the Medicare business

What does an FMO do

FMOs play a crucial role in providing support to their agents.  Here are some of the ways an FMO provides this support:

1. FMOs should provide training to their downline agents.  Agents at every level need some type of training whether it is for the basics, product updates and additions compliance, or sales. Agents need to stay up to date on several areas, so they can provide clients with the best plan options.  Crowe offers agents many types of training that include webinars, zooms, our website and YouTube channel as well as one on one phone consults and in-person meetings.
2. They need to have partnerships with several local carriers that ensures their downline have a large variety of products to offer.
3. FMOs provide help with contracting that make the entire process easier than trying to get it done on your own.
4. Agents must be complaint with all CMS’ rules and regulations; therefore, it is important that FMOs make sure their downline agents are updated and equipped to conduct themselves in an ethical way. Click here for tips to pass the 2024 AHIP..
5. The top FMOs invest in up-to-date technology and tools that make sales a smooth process for their agents.  We offer online quoting and enrollment tools that include both Sunfire and Connecture.
6. One important element in Medicare sales is marketing.  An FMO offers tools that include marketing dollars, lead generation programs and provide help to agents in any way they can so they reach their full potential.

Join the team at Crowe – click here for online contracting

How to choose an FMO

Because there are so many FMOs who want to contract agents, it can be difficult to choose one.  It is important that agents ask questions, so they are comfortable with their choice and do not need a release.  Be sure the FMO offers the programs you feel will provide the best guidance for you.  It is also important to discuss how you are paid.  If you receive full street direct from the carrier or if you will be LOA.

Do you want to ensure you own your book of business or are you comfortable writing and building someone else’s book?  Do they offer the most competitive carriers in your area, so you can provide clients the best options possible?

Does the FMO offer marketing money, lead money and guidance on how to make sales and maintain your book of business?  Do they provide free tools to help you conduct your business in an efficient manner.

As you can see, there are many things to consider when choosing an FMO.  This is a decision that needs to be considered carefully before you sing on the dotted line.

See what Crowe has to offer

Medicare FMOs play a pivotal role in the success of insurance professionals by helping them navigate the complexities of Medicare sales. By providing comprehensive support, training, and access to a variety of insurance products, FMOs help agents to better serve their clients and thrive in the ever-evolving Medicare market.

Choosing the right FMO is an important decision that can significantly impact an agent’s career.  This means, it is essential to evaluate all the options and choose a partner that aligns with individual and business goals.

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Insurance sales training

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

Think about joining an FMO

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

See what we offer Medicare agents

Decide what products to offer

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

Join the team at Crowe – click here for online contracting

Contracting and Certifications

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

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

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

Watch a quick YouTube video for 2024 AHIP test tips

Sales training

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

Product training

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

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

Click here to view our updated Events and information post

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

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

Learn to use our free quoting and enrollment tools

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

Take a look at a Sunfire enrollment demonstration

Networking and Business Development Training

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

Generate Medicare referrals

Medicare lead program

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

More info on our Free Medicare Lead Program

What does a Medicare agent earn

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

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

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Connecture vs Sunfire

Because we offer both platforms to our agents at no charge, we will compare the two, Connecture vs Sunfire, to help you choose which one to use based on your personal preferences and not our opinion.  It is tough to decide which platform is better as each provides quoting and enrollment for MAPD, PDP, and Medicare Supplement as well as dental and vision sales.

Both platforms provide browser-based software that does not require agents to download anything on their computer.

Watch a YouTube video on how to use Sunfire and Connecture for enrollments.

Here’s why they are similar

1. Each platform provides agents a way to quote and enroll clients over the phone, by sending a link or in-person online.  This can eliminate a face-to-face meeting when it is not possible.
2. Both platforms provide a basic CRM to save client information, enrollment information and scope of appointment forms.
3. Connecture and Sunfire both provide the ability to record enrollments and scopes and save them.
4. Agents can enter the client’s doctors or drug lists and run a plan comparison as well as download a copy to send their clients.
5. Send clients information through either text or email.
6. Either system lets agents add plans they are not contracted with in to compare.

Click her to watch a video on the CMS call recording rules

Although both these programs offer similar features, individual agents definitely have their opinions as to which they prefer.  Crowe and Associates agents can access both of these tools through connect4medicare.com.  This is a webpage provided by Pinnacle financial services for use by our agents.  Agents are welcome to use one or both of these tools interchangeably as they choose.  Because the systems are designed differently, each one offers a unique user experience.

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How to find my Medicare ID number

There are times when you need to have your Medicare ID number. For example, when it is time to enroll in a new Medicare plan, you need to have your Medicare ID to enter on the application.  If you are a Medicare beneficiary, you may be wondering; how to find my Medicare ID number.

Please note:  if you need to sign up for Medicare Part A and or Part B, you go through Social Security. Once you are enrolled, you will need to manage your benefits through Medicare.

Click here to learn about Medicare enrollment periods

How to get your Medicare ID number

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Eligibility for Medicare Part B

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

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

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

Turning 65

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

Disability

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

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

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

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

Enrollment periods

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

IEP (Initial Enrollment Period)

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

SEP (Special Enrollment Period)

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

Learn more about SEPs

GEP (General Enrollment Period)

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

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

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

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

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

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How to get more Medicare referrals

Agents who generate a steady stream of referrals not only build their client base but also establishes their credibility in the industry.  We will go over how to get more Medicare referrals with a few ways agents can build their referral network and achieve sustainable growth.

Build good relationships with your existing clients

Agents who put in the effort to ensure their clients are happy with their coverage choices can easily earn referrals.  In order to ensure clients are happy, agents must be in contact with their clients and go over new plan options each year during the AEP.  Agents should use a good CRM to keep client information up to date.  This includes a list of their current doctors and medications so you can quickly update it each year when you run a plan comparison for AEP.

Watch a YouTube video on Sunfire and Connecture our quoting and enrollment tools

Collecting your clients email and phone number can be a good idea.  This way agents can send out a mass email that contains any pertinent information for your clients.  The phone numbers are useful not only to contact your clients in general but can be used as a tool if they want to opt in and receive text messages from you.

They also need to be available when a client calls with a coverage question.  If a client has confidence in the service they receive, they are more than happy to tell friends, neighbors or anyone else who asks.  This a very valuable source of new business.  It is also ok to ask clients for referrals, just find a way that is comfortable for both you and the client.

Click here to watch a quick YouTube video on AEP marketing rules

Establish relationships with local healthcare professionals

It is a great idea to introduce yourself to healthcare professionals, doctors and clinics in your area.  Once they know you and are aware of the service you offer, you can create a partnership. Establishing a good relationship with healthcare providers can open doors to a continuous stream of leads. Volunteer to attend healthcare events, workshops, and seminars to connect with providers who may refer individuals seeking Medicare coverage. Position yourself as a reliable and knowledgeable resource for their patients’ needs.

Build a strong social media and online presence

In today’s digital age, a strong online presence is essential. Agents should consider creating business profiles on social media platforms.  Once the profile is created, it is important to maintain the the platform with any pertinent information potential clients may find valuable.  Information about Medicare options and answers to common questions are a couple things to post on your platform to engage your audience. An online presence not only helps you reach a broader audience but also positions you as an expert in the Medicare field.

See how we can help you build an insurance website

Host free educational workshops

Host workshops or webinars to educate the community about Medicare coverage options and changes. If you provide valuable insights into the complexities of Medicare, you will gain status as a valuable resource.  Anyone who attends may be more inclined to refer friends and family to you when they are looking for guidance on their Medicare choices.

Want to learn the best practices for educational seminars, click here

Offer Referral Incentives

Create a referral program that rewards clients and other individuals for referring new clients to you. Incentives for clients can include a gift card or anything appropriate with a value of $15 or less. It is important to be complaint when offering referral gifts. By acknowledging and appreciating referrals, you encourage your existing network to actively promote your services.

Referral gifts for another agent or business professional (ACA agents, P&C agents, Medicare agents not licensed in a particular area) can be a cash payment of up to $100 per sale.  It is important to remember to pay them this so they will be more likely to refer other clients to you in the future.  Please note:  in most cases, financial planners cannot accept the referral gift.

Collaborate with Local Businesses

Explore partnerships with local businesses that cater to the senior population. Establishing connections with senior centers, fitness clubs, or retirement communities can be mutually beneficial. These businesses may refer clients to you, and in return, you can refer clients to them for services.

Find a FMO that will help you reach your full potential

Stay Informed

Because Medicare plans change each year, it is important to stay informed on any updates and adjust your strategy accordingly. Be sure you are up to date on compliance rules and attend product training sessions, workshops and conferences regularly.  This is a good way to build relation ships with broker managers and other agents in the industry who may send you a referral if they have a beneficiary who needs an advisor.  An informed and well known agent is more likely to attract referrals from clients and other professionals.

Click here for AHIP test tips

As a Medicare sales agent, building a large referral network is essential if you want to achieve long-term success. By focusing on client satisfaction, and following the other suggestions noted above, you can build a successful referral-based business that continually brings in new clients and opportunities.

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Medicare licensed agents

Medicare licensed agents provide a valuable service to beneficiaries.  If they stay up-to-date on product offerings and CMS rules, they can provide clients with a number of plan choices that will suite their needs. This is a great career if you are interested in becoming a valued member of your community and providing an important service to it’s members.

Where to start

The first thing you need to do is go onto the state insurance department website for your state.  From there, you can lookup the requirements to earn your health or health and life license.

There are several companies that offer the courses you need to study for your test.  Your states insurance department website will give you the available options. While you are studying for you resident state license, you will start to learn the rules for selling Medicare & other health plans.  Studying also provides valuable information about the different components of Medicare and how they work together.

Each state has different requirements for exam-prep. Some require in-person training while others allow self-study at your own pace.  There are also online options and options to order books if you are more comfortable with that.  There is a test at the end of the course that you must pass before you can take your actual licensing exam.  It is important to note; some states require agents to take a course on life as well as health while other states do not require agents to do both. If you think you may want to offer life products later, you can add the life course and do the testing at once.

Once you pass the exam, CMS reports your results to the National Insurance Producer Registry (NIPR).   Be sure you print and download a copy of your license.  You will find your  National Producer Number (NPN)on your license.  You need your license and NPN to contract with carriers.

Contract with an FMO

An FMO (field marketing organization) is an invaluable tool.  A good FMO not only provides it’s downline agents training, tools and contracting.  They provide continuous, back office support, they will answer your calls and make sure you get answers to your questions. Some of the things FMOs help; they get contracting requests processed, train downline agents on new CMS regulations and carrier products.  Agents need to take time and ask as many questions as you need to to feel comfortable before they choose an FMO.

 Watch a YouTube video on the programs Crowe has to offer

Having an FMO behind you , makes contracting with multiple carriers and products a much smoother process.  They should also provide guidance to new agents to put a plan of action in place and get up and running.  There may also be opportunities for leads, marketing money and other useful tools.

Join the team at Crowe – click here for online contracting

Purchase E&O insurance

In order to do business, carriers require all agents to have E&O insurance.  This insurance protects you in the event you make a mistake when you enroll a client an they take legal action against you to cover any financial loss your misinformation may have caused them.  Your FMO may provide a discounted plan to it’s downline agents.  If they don’t you can purchase a policy through an agent who provides property and casualty insurance.

Click here to learn about our discounted E&O

Complete AHIP

After you get our license, you should take the AHIP.  AHIP stands for America’s Health Insurance Plans.  Most carriers who offer PDP or MA/MAPD plans require agents to take this training and certification course.  Agents must take this test each year and get a 90% to pass.  The cost to take the AHIP course is $175, although many carriers offer a $50 discount if you take it through their portal when you do your carrier certifications(more on those below).

Click here to watch a YouTube video on AHIP test tips for 2024

Get contracted & appointed

Agents must complete carrier contracting before they are appointed to sell their products. In most cases, agents need a copy of their current state health insurance license for each state they plan to sell in.   A copy of their E&O certificate is also necessary.  Your FMO will will help with this process by providing other important information to the carriers.  Once the carrier has all the pertinent information, you must complete the carrier specific training for PDP and MA/MAPD plans.

It is a good idea to request only 4-5 good carriers in your area and get RTS (ready to sell).  With a good FMO, it is easy to add more in as you need them.  You do not want to be overwhelmed from the start. This can discourage anyone.

Find out about how Medicare commissions pay 

Moving forward

It is important to make sure you keep your license active.  This sounds like a no brainer but, some agents forget to renew and that can cause a number of problems with your carrier contracts. up to date.  In order to do this you will need to complete a specific number of CE credits before you can renew your license.  The amount of CE hours you need vary by your resident state.  You can choose any accredited CE course provider you like, again this is based on state specific requirements.

If there are updates with CMS requirements, both your FMO and the carriers you are appointed with should provide them to you.  It is essential that you follow all guidelines when making sales to avoid termination of your contracts.

If you want a career where you provide a valuable service to individuals and truly enjoy helping people, this could be a good fit for you.  In this business, we cannot stress enough how important it is to be organized and well informed to provide the best service to your clients.

Do you need a scope of appointment, click here and learn about the rules

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Medicare premiums

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

Medicare Part A

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

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

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

Medicare Part B

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

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

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Extra help Medicare

Medicare provides programs and benefits to many people. This includes the Extra Help Medicare program that provides qualified beneficiaries help paying their Medicare Part D monthly premium, annual deductible, coinsurance and copays for their prescription medications.
To qualify for this program, individuals must meet income requirements.  Individuals who are accepted into this program do not have to pay any Part D late enrollment penalty they may have acquired.

How to apply for extra help

If you do not automatically qualify for Extra Help, you will need to apply.  You must meet the following qualifications to be eligible for Extra Help.

1. Applicants must have Medicare Parts A and B.
2. They must reside in the U.S. or the District of Columbia.
3. They do not have more than $34,360 in assets that include savings, investments & real estate if they are married, or $17,220 if they are single or not living with a spouse. If your assets are more than that, you are not eligible for Extra Help. Important; this amount does not include your home, cars or personal possessions.  It also does not include life insurance, irrevocable burial contracts or back payments from Social Security or SSI.

If you meet the qualifications specified above, you can apply for Extra Help online.

Click here to apply for Extra Help online

For help with the online application, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778).

Please note: Some people do not need to apply for Extra help.  If you have either Medicare and SSI (Supplemental Security Income) or Medicare and Medicaid, you do not need to apply for Extra Help.  You will automatically be enrolled.

Extra Help isn’t available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa. But there are other programs available in those areas to help people with limited income and resources. Programs vary in these areas. Call your State Medical Assistance (Medicaid) office to learn more

Who can get Extra Help

If you think you meet the financial requirements and have Medicare A & B as well as are a resident of the U.S. or District of Columbia, just complete the online application.  You will receive a letter notifying you if you are accepted into the program.

Important:  residents of Guam, Puerto Rico, the US Virgin Islands, Northern Mariana Islands or American Samoa are not eligible for the Extra Help program.  To find alternative programs in those areas, check your state’s Medicaid eligibility at Medicaid.gov to find resources.

Additional financial resources

Individual states also have financial resources available through Medicare Savings Programs for those who meet the income qualifications. Use this link to find additional information for financial help in your area.

Beneficiaries can also go to Medicare.gov  or call 1-800-medicare (TTY 1-877-486-2048)to find information on financial assistance programs.

Please be aware:  Extra Help is not a prescription drug plan.  Beneficiaries must enroll in either an MAPD plan or a stand alone PDP plan to have coverage for prescription medications.

Agents, learn how to run a Medicare PDP or MAPD plan quote using Sunfire or Connecture.  Watch our quick YouTube video

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