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Preparing for AEP 2026: Boost Your Sales, Retain Clients, and Grow Your Book

The 2026 Annual Enrollment Period (AEP) isn’t just another enrollment season; it’s a golden opportunity to build stronger client relationships and grow your business. With more non–commissionable Prescription Drug Plans (PDPs) and Medicare Advantage (MA) plans in the market, preparing for AEP 2026 is more difficult than ever.

Here’s how you can maximize earnings, protect your clients, and position yourself as the go-to Medicare resource this AEP.

Turn Non-Commissionable Plans Into Revenue Opportunities

Yes, some PDPs and MA plans won’t pay you. But don’t let that stop you from helping your clients:

• Be the expert they trust. Walk them through all available options; even the ones you don’t get paid for. This honesty builds loyalty and keeps them coming back every year.
• Leverage the conversation. Once you’ve solved their drug plan or MA needs, introduce other solutions that can better protect them and generate income for you.
• Think lifetime value, not one commission. The client you help today (even for free) could be the one who buys a Medigap plan, final expense policy, or ancillary product tomorrow.

Promote Medicare Supplements

Medicare Supplements are a powerful tool for agents looking to grow their book with long-term, commissionable business.

• High Deductible Plan G (HDG): Sell the benefits of lower premiums, network freedom, and great cost protection once the deductible is met. Perfect for healthy, budget-conscious clients.
• Plan G or Plan N: Offer predictable out-of-pocket costs and peace of mind. Great for clients leaving MA plans or worried about networks shrinking.
• Target switching opportunities: Use the Medigap Open Enrollment period, guaranteed issue rights, and birthday rules where available to win new clients.

Cross-Sell Ancillary Products to Increase Income

Every client interaction is a chance to protect more of their health and finances. Cross-selling not only grows your revenue; it keeps competitors out of your book.

Products to focus on this AEP:

• Hospital Indemnity Plans – Cover MA plan hospital copays and reduce client financial stress.
• Cancer, Heart & Stroke Policies – Offer lump-sum protection for serious illness expenses.
• Dental, Vision & Hearing Plans – Fill in coverage gaps Original Medicare doesn’t touch.
• Final Expense Life Insurance – Help clients plan for end-of-life costs and leave a legacy.

Watch a YouTube video – Why and how to sell ancillary with Medicare in 5 minutes

Strengthen Client Retention with Education

AEP isn’t just about selling — it’s about proving you’re the trusted Medicare expert year-round.

• Send an AEP prep email or postcard to let clients know you’ll review their coverage.
• Host a quick webinar or local seminar on “What’s New for 2026.”
• Offer annual policy reviews to make sure they’re always in the best plan for their situation.

Education keeps your name top of mind and positions you as the advisor they call before making a move.

The agents who win this AEP will be those who combine client-first service with smart product recommendations. Help with the non-commissionable PDPs and MA plans, but don’t stop there; present Medigap, HDG, and ancillary products that protect your clients’ health and finances while boosting your bottom line.

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

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

Your clients get better coverage, you get stronger renewals, and your book of business grows. That’s a win-win AEP strategy.

The Medigap Birthday Rule: A Unique Opportunity for Medicare Beneficiaries

If you or your clients have a Medicare Supplement plan (Medigap), there’s a little-known rule that can save money and improve coverage and it’s called the Medigap Birthday Rule. This rule is an excellent opportunity for beneficiaries to switch Medigap plans without going through medical underwriting, but it only applies in certain states and during a very specific timeframe. Here’s what you need to know.

What Is the Medigap Birthday Rule

The Medigap Birthday Rule is a state-level regulation that allows Medicare beneficiaries to switch to another Medigap plan with equal or lesser benefits each year around their birthday, without answering health questions or going through medical underwriting.

Normally, after the initial Medigap open enrollment period (which happens when someone first signs up for Medicare Part B), switching Medigap plans could require underwriting; meaning the insurance company can deny coverage or charge more based on health history. The Birthday Rule removes that barrier, making it easier for people to shop for a better premium or a different carrier’s plan.

How the Rule Works

The details of the rule depend on the state you live in, but generally:

• Eligibility: You must already have a Medigap plan in place.
• When You Can Switch: You have a short window each year, usually starting on your birthday (some states give you up to 60 days, others 30).
• What You Can Switch To: You can move to a Medigap plan with the same or lesser benefits; for example, switching from Plan G with one company to Plan G with another, or from Plan F to Plan N.
• No Underwriting: You don’t have to answer health questions, so pre-existing conditions won’t prevent you from switching.

Watch our YouTube video on Medicare Supplement underwriting

States That Offer the Birthday Rule

As of 2025, the Medigap Birthday Rule is available in several states, including:

• California
• Oregon
• Illinois
• Nevada
• Idaho
• Louisiana
• Kentucky (newer version of the rule)

Each state’s version is slightly different, so it’s essential to check the exact length of the switching window and eligibility criteria.

Why the Birthday Rule Matters

For beneficiaries, this rule can mean:

• Lower Premiums: Shop for the same coverage at a better price.
• More Carrier Choices: If you’re unhappy with your current insurer, you can switch without worrying about being declined.
• Guaranteed Access: People with health issues who might otherwise be denied coverage can still change plans.

Tips for Agents

If you’re a Medicare agent, the Medigap Birthday Rule is a perfect client retention opportunity:

• Reach out proactively before a client’s birthday to review their coverage.
• Shop carriers and rates to see if they can save money without losing benefits.
• Build trust by showing clients you’re looking out for their financial well-being.

If you are an agent who wants to join the team at Crowe, click here for online contracting

This annual touchpoint can strengthen your book of business and help you stay top-of-mind with clients.

The Medigap Birthday Rule is a valuable consumer protection that gives beneficiaries a yearly chance to make their coverage more affordable; no health questions asked. If you or your clients live in a state that offers it, don’t miss this opportunity. Mark those birthdays on the calendar and be ready to take advantage of this unique enrollment period.

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Medicare Coverage of DME (Durable Medical Equipment)

When it comes to staying healthy and independent, many Medicare beneficiaries rely on durable medical equipment (DME). Whether it’s a walker, a hospital bed, or a CPAP machine, understanding Medicare coverage of DME is essential for many.

In this post, we’ll break down what DME is, how Medicare covers it, and what clients should know to avoid costly surprises.

What Is Durable Medical Equipment (DME)

Durable Medical Equipment is defined as reusable medical equipment that is:

• Medically necessary for the patient’s health condition
• Able to withstand repeated use
• Primarily used for a medical purpose
• Appropriate for use in the home

Examples of common DME include:

• Wheelchairs and scooters
• Walkers and canes
• Hospital beds
• Oxygen equipment
• Blood sugar monitors and test strips
• CPAP machines and supplies

How Medicare Covers DME

Medicare Part B

Most DME is covered under Medicare Part B (Medical Insurance). Here’s how it works:

• Doctor’s Order Required: A physician or other Medicare-approved provider must prescribe the equipment.
• Approved Supplier: The equipment must be purchased or rented from a Medicare-approved supplier that accepts assignment.
• Cost-Sharing: The beneficiary pays 20% of the Medicare-approved amount after meeting the Part B deductible.

Those who have a Medicare Supplement plan may pay as little as $0 depending on the plan they have.

Some equipment is available for purchase, while other items are only available for rental. For rentals, Medicare usually pays the supplier monthly for up to 13 months, after which the beneficiary typically owns the equipment.

Watch a YouTube Video on Advanced Diabetes Supply – Help clients get the supplies they need.

Prior Authorization and Competitive Bidding

In some cases, Medicare requires prior authorization for certain high-cost or frequently abused items (like power wheelchairs). Additionally, in certain areas, Medicare runs a competitive bidding program for DME, meaning beneficiaries must use specific contracted suppliers to get full coverage.

Medicare Advantage and DME

Medicare Advantage (Part C) plans also cover DME, but:

• Networks and suppliers may be different from Original Medicare.
• Some plans require prior authorization for more types of equipment.
• Cost-sharing may vary (some plans may have lower copays or coinsurance).

Agents should always remind clients to check their plan’s provider directory and approval process before ordering DME.

Tips for Agents and Beneficiaries

• Verify Coverage First: Always confirm that the prescribing provider and supplier are Medicare-approved.
• Check the Need: Make sure there’s documentation showing the equipment is medically necessary.
• Understand Costs: Explain that clients will still owe 20% coinsurance under Part B unless they have Medigap or other supplemental coverage.
• Watch for Scams: DME fraud is common – warn clients not to accept unsolicited equipment or offers.

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Durable Medical Equipment can be life-changing for Medicare beneficiaries, but coverage rules can be tricky. By helping your clients understand what Medicare covers, where to get equipment, and how to keep costs low, you can build trust and ensure they get the care they need without unexpected bills.

Medicare Supplement Underwriting Explained

When clients start exploring Medicare Supplement (Medigap) plans, one topic that often causes confusion is underwriting. Unlike Medicare Advantage plans, which don’t require medical underwriting, Medigap coverage can involve health-related questions and approval requirements; depending on when and how someone applies. That is why we hope, Medicare supplement underwriting explained will provide an understanding of the process so agents can better assist clients.

What Is Medicare Supplement Underwriting

Underwriting is the process insurance companies use to determine whether to accept an applicant for a Medigap policy, and sometimes the determine the premium amount. This process often involves answering health questions, reviewing prescription history, or even checking recent hospitalizations.

Not every applicant will face underwriting, many people qualify for guaranteed issue rights or are in their Medigap Open Enrollment Period, which means they can get a plan without medical review.

When Is Underwriting Required

Underwriting typically comes into play in these situations:

• Applying outside the Medigap Open Enrollment Period (which lasts six months after a beneficiary first enrolls in Part B at age 65).
• Switching from one Medigap plan to another outside of specific state-mandated open enrollment or “birthday rules.”
• Losing coverage without qualifying for guaranteed issue rights.

In these cases, insurance carriers can:

• Approve coverage at the standard rate,
• Charge a higher premium,
• Impose a waiting period for pre-existing conditions, or
• Deny coverage altogether.

Guaranteed Issue Rights (No Underwriting Required)

There are special circumstances where a beneficiary can enroll in a Medigap plan without facing underwriting, such as:

• Losing employer or union coverage.
• Their Medicare Advantage plan leaving the service area or ending coverage.
• Moving out of a Medicare Advantage plan’s service area.
• Taking advantage of certain state-specific enrollment protections (like California and Oregon’s Birthday Rule, or Missouri’s Anniversary Rule).

During these times, carriers must offer coverage, regardless of health status.

Watch a quick YouTube video on Medicare Supplement Underwriting

Common Health Questions in Underwriting

While exact questions vary by carrier, underwriting often includes:

• Recent heart attacks, strokes, or cancer diagnoses.
• Use of oxygen, dialysis, or organ transplants.
• Height, weight, and mobility concerns.
• Hospitalizations in the past 90 days.
• Use of certain expensive medications.

Carriers typically ask about conditions that are costly and ongoing. Clients with stable, controlled conditions may still qualify.

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Why Agents Should Understand Underwriting

As an agent, knowing the underwriting rules helps you:

• Advise clients on the best time to apply for Medigap coverage.
• Set realistic expectations about approvals, denials, or higher premiums.
• Protect clients by helping them avoid losing a plan they may not be able to requalify for later.

Stay up-to-date on Medicare agent events and information

Underwriting for Medicare Supplements can be straightforward if clients apply at the right time, but tricky if they wait too long or want to change plans later. By understanding the process and knowing when underwriting applies, you can help your clients secure coverage that supports their health and budget without unexpected roadblocks.

United American HDG Plan Sales – Why Consider Them This AEP

Why Add UA Now

The Annual Election Period (AEP) for Medicare runs each year from October 15 through December 7. It’s the window when beneficiaries can enroll in, switch, or drop Medicare plans. With all the changes to Medicare plans this year, agents might want to consider United American HDG Plan Sales.

What is a High-Deductible Plan G (HDG)

United American’s HDG plan offers the same benefits as a standard Plan G after enrollees meet the deductible ($2,870 in 2025). That means once the deductible is met, the plan pays 100% of Medicare-approved services, including:

• Hospital costs and Part A coinsurance
• Skilled nursing facility coverage
• Part A deductible
• Part B coinsurance and excess charges
• 80% of foreign travel emergencies

Because of the higher deductible, monthly premiums are significantly lower, making HDG an attractive choice for cost-conscious beneficiaries.

Watch a quick YouTube video on High Deductible Plan G

Why choose United American’s HDG plan this AEP

Fewer Medicare Advantage options, especially PPOs

Carriers are withdrawing some Medicare Advantage plans from the market, particularly PPOs, and many agents are reporting fewer plan choices this AEP. In some areas, commissions on Medicare Advantage plans are also being reduced or eliminated. For beneficiaries who want stability, freedom of provider choice, and nationwide access, an HDG plan offers an excellent alternative.

Great value for cost-conscious consumers

HDG balances affordability and coverage; lower monthly premiums without sacrificing comprehensive protection once the enrollee meets the deductible.

Nationwide flexibility

Unlike Medicare Advantage, which often restricts members to networks, United American’s HDG allows you to visit any provider that accepts Original Medicare, with coverage that travels across state lines.

Financial strength and trust

United American has been selling Medicare Supplements since 1966 and maintains strong financial ratings, including an A (Excellent) from A.M. Best. Their history of stability reassures clients looking for long-term reliability.

Consumer-friendly features

Guaranteed renewable: You can’t be canceled as long as premiums are paid.

30-day free-look period: Cancel within 30 days if not satisfied.

Switching flexibility: Start with HDG and, at your second anniversary, move to a standard Plan G without underwriting if you decide you want richer coverage.

Why HDG makes sense in today’s market

With Medicare Advantage options shrinking, especially PPOs, and rising uncertainty in benefits and provider access, many beneficiaries are reconsidering Medigap. HDG is a way to:

• Keep premiums affordable
• Retain freedom to choose providers nationwide
• Have peace of mind that coverage won’t change annually the way MA plans often do

Sample Comparison: Is HDG Worth It

• High Deductible Plan G: Lower monthly premium, pay the $2,870 deductible first, then full coverage.
• Standard Plan G: Higher premiums, but no deductible. Total yearly cost could be higher even with no deductible, depending on your health needs and provider use.

If saving on monthly cost is a priority—and you’re able to manage the deductible if needed—HDG offers strong value, especially during this AEP when you have the flexibility to enroll.

GET CONTRACTED

Contracting for UA is easy; just email lisa@croweandassociates.com, she will request the contract for you.  Those looking for a GA level contract will need to have a minimum of 5 sub agents and 100 Medicare supplement cases on the books. Call our office at 203-796-5403 with any additional questions.

If you would like to contract with Crowe for carriers other than UA; click here

Stay up-to-date on Medicare agent events and information

This AEP presents a unique opportunity. With fewer Medicare Advantage choices and increasing restrictions, United American’s High-Deductible Plan G stands out as a cost-effective, flexible, and stable solution. For beneficiaries who value freedom of choice, reliable coverage, and the ability to control their long-term costs, HDG is a smart move this enrollment season.

Why Offer Medicare HDG Plans

The question; why offer Medicare HDG Plans, because the Medicare market is changing rapidly. Agents must stay ahead of the curve to remain successful. Many major carriers are scaling back their Medicare Advantage (MA) offerings and even cutting commissions on some plans. This leaves agents with fewer options to present to clients. This is where HDG Plans can make all the difference.

The Current Landscape of Medicare Advantage

In recent years, Medicare Advantage has been one of the most popular plan options among seniors. However, for the last couple years, carriers are:

• Pulling plans from the market – especially PPOs, which have traditionally been popular for their provider flexibility.
• Reducing commissions – some carriers are paying no commission on certain MA products, leaving agents with fewer options to offer.
• Tightening supplemental benefits – carriers are scaling back some of the extra benefits that once attracted clients, making MA plans less competitive.

For agents, this creates a challenge: how do you provide value to your clients while maintaining a sustainable business model?

Click here to join the team at Crowe and Associates- online contract.

Why HDG Health Plans Stand Out

HDG Health Plans provide a strong alternative that agents should be offering. Here’s why:

1. Plan Stability

Unlike some Medicare Advantage carriers that are exiting markets or restructuring benefits, HDG Health Plans are built for long-term stability. This ensures agents can confidently enroll clients without worrying about sudden disruptions.

2. Expanded Client Options

As carriers discontinue PPOs and other MA plans, seniors need reliable choices that meet their healthcare and financial needs. HDG offers products that can help fill the gaps left by Original Medicare. This gives agents a competitive edge in retaining and growing their book of business.

3. Consistent Compensation

With some carriers cutting or eliminating commissions on MA plans, agents need products that continue to provide fair, reliable compensation. HDG Health Plans recognize the value of the agent’s role and support them with commission structures that make sense.

4. Strong Value Proposition for Clients

Carriers design HDG Plans with seniors in mind, balancing affordability, access to care, and flexibility. This makes them attractive alternatives for clients who may be frustrated with shrinking MA networks or reduced plan options.

5. Ability to seek care from most providers

Unlike MA plans, Medicare supplements allow the enrollee to seek care form any provider that accepts Medicare. This can be a huge advantage to any enrollee.

Agents learn why and how to sell ancillary products – watch a quick YouTube video

The Opportunity for Agents

As the Medicare market shifts, agents who adapt quickly will come out ahead. By offering HDG Health Plans, agents can:

• Differentiate themselves from competitors still relying heavily on shrinking MA offerings.
• Provide solutions to clients facing plan cancellations or limited coverage options.
• Build a more stable book of business with products that pay fairly and retain members long-term.

Stay up-to-date on agent events and information

The Medicare Advantage space is in transition, and relying solely on it may leave both agents and clients at a disadvantage. By incorporating HDG Health Plans into your portfolio, you can protect your business, serve your clients more effectively, and position yourself as a trusted advisor during a time of change.

Now is the time to diversify your offerings, and HDG Health Plans should be at the top of your list.

Medigap Plan N vs Plan G: Which Is Right for You

When shopping for a Medicare Supplement (Medigap) plan, there are many options. Plan G and Plan N are two of the most popular choices for people looking to fill in the coverage gaps of Original Medicare. While they share many similarities, there are key differences in cost, coverage, and how they handle out-of-pocket expenses. Understanding Medigap Plan N vs Plan G can help you choose the plan that best fits your healthcare needs and budget.

What Medigap Plans Have in Common

Both Plan G and Plan N are standardized Medicare Supplement plans, meaning the basic benefits are the same no matter which insurance company offers them. With either plan, you get:

• Coverage for Medicare Part A coinsurance and hospital costs (after the beneficiary uses up Medicare’s benefits) for up to 365 days
• Coverage for Part B coinsurance or copayment (with exceptions for Plan N – explained below)
• Blood coverage (first 3 pints per year)
• Part A hospice care coinsurance or copayment
• Skilled nursing facility coinsurance
• Part A deductible
• Foreign travel emergency coverage (up to plan limits)

Key Differences Between Plan G and Plan N

1. Part B Excess Charges

• Plan G: Covers 100% of Medicare Part B excess charges (extra costs you may be billed if your provider doesn’t accept Medicare’s standard payment).
• Plan N: Does not cover Part B excess charges; if your provider bills them, you’ll have to pay out of pocket.

2. Office Visit & ER Copays

• Plan G: No copays for office visits or ER (after Medicare pays its share).
• Plan N: You may pay up to $20 for some doctor visits and up to $50 for emergency room visits (waived if admitted to the hospital).

3. Monthly Premiums

• Plan G: Generally has higher monthly premiums because it covers more.
• Plan N: Often has lower monthly premiums but requires more cost-sharing through copays and the possibility of excess charges.

4. Part B Deductible

• Both plans require you to pay the annual Medicare Part B deductible before coverage kicks in (for 2025, it’s $257).

Watch our YouTube video on Medicare Advantage vs Medicare Supplements

Which Plan is The Best Fit

• Choose Plan G if:
  • You want the most comprehensive coverage available to new Medicare enrollees.
  • You prefer predictable costs and don’t want to worry about excess charges or visit copays.
  • You see specialists who may charge more than Medicare’s approved amount.
• Choose Plan N if:
  • You want a lower monthly premium and are okay with occasional copays.
  • You typically see Medicare-assigned doctors who don’t bill excess charges.
  • You’re healthy, visit doctors less often, and want to save on monthly costs.

Both Plan G and Plan N are strong options that can protect you from high out-of-pocket costs not covered by Original Medicare. The right choice depends on how often you use healthcare services, whether your providers accept Medicare’s payment terms, and how much you want to pay each month in premiums versus at the point of care.

When comparing, it’s smart to enlist the help of a licensed Medicare agent who get quotes for both plans from multiple carriers. Please note: premiums vary by carrier even though the benefits are standardized.

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Changing Medicare Supplement Plans: What to Know Before You Switch

Medicare Supplement (Medigap) plans are a great choice for covering the portion of out-of-pocket costs that Original Medicare doesn’t. However, as health needs and financial situations change, beneficiaries might consider changing Medicare supplement plans. Whether it’s to reduce premiums or adjust coverage, making a change requires some thought and planning.

Here’s what to keep in mind when considering a change to Medicare Supplement coverage.

Why People Change Medigap Plans

There are several reasons why someone might decide to change their Medigap plan:

• Overpaying for coverage: The current plan might offer more coverage than needed, meaning the policyholder may not use as much coverage as much as expected.
• Needing additional benefits: Health needs can change, and a different plan may provide better or more suitable coverage.
• Shopping for a better rate: Even if the benefits remain the same, switching to a different insurance carrier offering the same plan at a lower premium makes sense.
• Company dissatisfaction: Some beneficiaries want to change to a new insurer due to customer service or other experiences.

When You Can Switch

Changing Medigap plans isn’t quite as simple as enrolling in Medicare for the first time. There are only a few scenarios when someone can switch plans without facing potential roadblocks:

• During their six-month Medigap Open Enrollment Period: This period starts the month they turn 65 and are enrolled in Medicare Part B. During this time, they can buy any Medigap plan offered in their state or switch plans. Insurance companies cannot deny coverage based on health.
• 30 day free look period: After purchasing a new Medigap policy, you have 30 days to decide if you want to keep it. This allows beneficiaries to compare other plans with their your current plan. 
• With guaranteed issue rights: These are special protections that allow someone to buy certain Medigap plans without medical underwriting. Common situations that trigger guaranteed issue rights include losing employer coverage or moving out of a plan’s service area. However, there are currently 4 states that offer guaranteed issue rights regardless of the circumstance.

Please note: A new Medigap policy doesn’t automatically cancel the old one the way Medicare Advantage and PDP plans do. It is best not to cancel your old Medigap policy until you are sure you want to keep the new one.

Watch a YouTube video on Medicare Supplement underwriting.

Outside of the situations listed above, beneficiaries may need to go through medical underwriting to enroll in a new Medigap plan.

Understanding Medical Underwriting

Medical underwriting is a review process insurers use to assess an applicant’s health history and current conditions. Based on this review, a company can:

• Approve or deny the application.
• Charge a higher premium.
• Apply a waiting period for coverage of pre-existing conditions.

If a person applies for a Medigap plan outside their Open Enrollment Period and without guaranteed issue rights, their application could be declined based on health.

One common underwriting consideration is tobacco use. Smokers often face higher premiums, even if they are otherwise in good health.

No Waiting Period to Switch

There’s a common misconception that people have to keep their Medigap plan for a set amount of time before switching. The truth is, once someone has a Medigap policy, they can apply for a new one at any time. As long as they’re willing to go through underwriting if required.

Switching Medicare Supplement plans isn’t something to rush into, but with the right timing and a good understanding of the process, it can be a good idea for your health and finances. Whether it’s finding more appropriate coverage or simply lowering monthly costs, reviewing options regularly ensures your Medicare Supplement plan continues to meet your needs. It is best to speak with a licensed Medicare agent who can guide you through the options and find the best fit for your needs.A

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

Agents helping clients navigate this process; be sure they understand the importance of timing and potential underwriting challenges. They must understand how their health status could impact their options.

Stay up-to-date on agent events and information; click here.

What Medicare Plan N Covers: Is It the Right Supplement for You

When it comes to supplementing Original Medicare (Part A and Part B), Medigap Plan N is one of the more popular options. It offers strong coverage at a lower premium than some other Medigap plans. This makes it an attractive choice for many Medicare beneficiaries. We will go over what Medicare Plan N covers, and why someone might choose it over other options.

What Medicare Plan N Covers

Medigap Plan N is a standardized Medicare Supplement Insurance plan, which means the benefits are the same no matter which insurance company offers it. Here’s what Plan N covers:

1. Medicare Part A Coinsurance and Hospital Costs – Covers up to an additional 365 days after Medicare benefits are used up.
2. Medicare Part B Coinsurance or Copays – Covers most of the 20% coinsurance beneficiaries would otherwise pay. This excludes copays; up to $20 for doctor visits and up to $50 for ER visits that don’t result in admission.
3. Blood (First 3 Pints) – Covers the cost of the first three pints of blood needed for a medical procedure.
4. Part A Hospice Care Coinsurance or Copays
5. Skilled Nursing Facility Care Coinsurance
6. Medicare Part A Deductible – Plan N covers this cost, which can save you over $1,600 per admission in 2025.
7. Emergency Medical Care During Foreign Travel – Covers 80% (up to plan limits) for medically necessary care during international travel.
   

What Plan N Does Not Cover

There are a few out-of-pocket costs you may still be responsible for:

1. Medicare Part B Deductible – You’ll need to pay this annually ($240 in 2025).
2. Part B Excess Charges – If your doctor does not accept Medicare assignment and charges more than Medicare-approved amounts, Plan N does not cover those excess charges.
3. Copayments – As mentioned earlier, you’ll pay small copays for some office and emergency room visits.
   

Why Choose Medicare Plan N

Here are some reasons why Plan N might be the right choice for you:

Lower Monthly Premiums

Plan N generally has lower premiums than Plan G or Plan F. This makes it a budget-friendly option for those who want solid coverage without a high monthly cost.

Predictable Costs

Aside from the Part B deductible and occasional copays, your out-of-pocket costs are minimal. This makes it easier to plan financially, especially for healthy individuals who don’t visit the doctor often.

Access to Nationwide Coverage

Like all Medigap plans, Plan N allows you to see any provider in the U.S. who accepts Medicare; no networks or referrals needed.

Foreign Travel Coverage

If you travel abroad, the emergency coverage provided under Plan N gives you added peace of mind.

Ideal for Healthy Retirees

If you’re in good health and don’t mind paying occasional small copays, Plan N can offer significant savings while still covering major expenses.

Watch a quick video on Medicare enrollment periods

Is Plan N Right for You

Plan N is best for those looking to balance good coverage with lower monthly premiums. It’s especially attractive if you don’t anticipate frequent medical visits and prefer to avoid the higher costs of Plan G or Plan F.

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

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As always, it’s important to review personal health needs, provider preferences, and budget with a licensed Medicare agent to determine if Plan N is your best fit.

Prior Authorization For Original Medicare

Starting January 1, 2026, those on Original Medicare who reside in New Jersey, Ohio, Oklahoma, Texas, Arizona, or Washington, will be required to get a prior authorization for Original Medicare before you receive some covered services. This will cause a major shift in how some beneficiaries use their Medicare benefits.

Medicare is launching a pilot program called the WISeR Model; short for Wasteful and Inappropriate Services Reduction and with it comes something traditionally associated with Medicare Advantage plans: prior authorization.

What Is Prior Authorization

Think of prior authorization as an ok from Medicare. Before your doctor can move forward with certain procedures such as; back surgery, an epidural, or a knee replacement, they have to get Medicare’s approval first. If Medicare doesn’t approve the service, the beneficiary will be on the hook for the entire cost.

This step is designed to prevent beneficiaries undergoing unnecessary or risky treatments, but it also means more paperwork, potential delays, and a new layer of bureaucracy for Original Medicare beneficiaries.

Why Is Medicare Doing This

According to CMS, the WISeR model has three main goals:

• Cutting down on fraud and wasteful spending
• Protecting patients from unnecessary or potentially harmful care
• Using technology and expert review teams to promote high-quality, cost-effective treatment

Medicare emphasizes that the goal is not to deny care, but to ensure the care being provided is truly necessary.

Which Services Will Require Prior Authorization

The WISeR pilot affects 17 outpatient services Medicare has identified as potentially overused or subject to misuse. These include:

• Back and neck surgeries
• Knee and joint surgeries
• Epidural injections and other pain treatments
• Skin grafts
• Nerve stimulators

What You Need to Know if You Have a Medigap Plan

Even if you have a Medicare Supplement plan (Medigap) like Plan G or Plan N, this change still affects you:

Watch a quick video on High Deductible Plan G

• Medicare Must Approve First: Medigap only helps pay your portion after Medicare approves the service. If Medicare denies it, Medigap won’t cover anything.
• Longer Wait Times: Prior authorization can delay access to care while your provider waits for Medicare’s decision.
• Less Flexibility: Traditional Medicare has long been valued for its ease of access to services—this new layer limits that freedom for certain procedures.
• No Formal Appeals: Under the WISeR pilot, there’s no standard appeal process. If denied, your doctor can submit more info, but there’s no official right to appeal like there is in broader Medicare.

How Does This Compare to Medicare Advantage

If this sounds familiar, it’s because Medicare Advantage plans have used prior authorization for years. However, there are key differences:

• Traditional Medicare is administered by the federal government, while Medicare Advantage is offered by private insurers.
• The WISeR model only requires PA for 17 specific outpatient services, while Medicare Advantage may require approval for hundreds of services and medications.

What’s Next

Right now, this is a pilot program affecting just six states. But if it’s successful, Medicare could expand it nationwide or add more services to the list.

Even if you don’t live in one of the six pilot states, it’s wise to stay informed—these changes could affect you in the future.

What Medicare Beneficiaries Should Do

1. Talk to Your Doctor
   Ask if any upcoming procedures might require prior authorization.
2. Plan Ahead
   Build in extra time for possible delays when scheduling certain treatments.
3. Stay Informed
   Keep up with updates from CMS and talk to your Medicare agent, especially if you plan to travel or move to another state.

The WISeR model represents a big change for Traditional Medicare, especially for those who’ve enjoyed its simplicity and flexibility. While the goal is to protect patients and reduce waste, many worry it could delay care or add confusion.

Agents who are ready to join the team at Crowe; click here for online contracting

Stay up-to-date on agent events and information

For now, being proactive is your best defense. Know which services are affected, communicate clearly with your doctor, and keep up with Medicare updates. This pilot could be the first step in a broader transformation of how Original Medicare works.