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Why Switch from Medicare Supplement Plan F to Plan G

There are some good reasons to switch from Plan F to Plan G. We will compare Medicare supplement Plan F vs Plan G to help illustrate. For years, Medicare Supplement Plan F has been a popular choice for beneficiaries seeking comprehensive coverage. However, recent changes and market trends have led many to consider switching from Plan F to Plan G. While both plans offer great benefits, Plan G provides similar coverage at a lower premium cost.

Key Similarities Between Plan F and Plan G

Both Plan F and Plan G are Medigap plans designed to fill the gaps in Original Medicare (Part A and Part B). Both plans offer comprehensive coverage, including:

1. Medicare Part A deductible
2. Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are exhausted)
3. Medicare Part B coinsurance or copayments
4. Part B excess charges (the amount a provider can charge above Medicare’s approved amount)
5. The first three pints of blood
6. Skilled nursing facility (SNF) care coinsurance
7. Foreign travel emergency coverage (80% up to plan limits)

The only difference is that Plan F covers the Medicare Part B deductible, while Plan G does not.

Why Switch to Plan G

Plan F Is No Longer Available to New Beneficiaries

As of January 1, 2020, Plan F is no longer available to individuals who became eligible for Medicare after that date. This change, part of the Medicare Access and CHIP Reauthorization Act (MACRA), was implemented to reduce overall healthcare costs.

Due to the fact that Plan F is closed to enrollees who turn 65 after Jan, 1, 2020, its risk pool is aging. This can lead to higher premiums over time as the pool becomes more expensive to insure.

Lower Premiums

Plan G often has significantly lower monthly premiums than Plan F does. While Plan G requires beneficiaries to pay the Medicare Part B deductible out-of-pocket ($257 for 2025), the savings in premiums can more than make up for this cost.

For example, if Plan F costs $50 more per month than Plan G, you’d save $600 each year by switching to Plan G. The savings would easily offset the $257 deductible.

Similar Comprehensive Coverage

Aside from the Part B deductible, Plan G provides identical coverage to Plan F. After meeting the deductible, Plan G covers all Medicare-approved expenses just like Plan F does.

Premium Stability

Because Plan G is open to new enrollees, its risk pool is younger and more diverse compared to Plan F. This dynamic helps keep premiums more stable over time.

In contrast, Plan F’s closed risk pool may lead to disproportionately higher premium increases as it’s enrollee population ages.

Making the switch sooner rather than later ensures you can take advantage of Plan G’s cost savings without disruption to your coverage.

Things to consider

Health Underwriting

Beneficiaries outside their initial enrollment period or guaranteed-issue period, may need to go through medical underwriting to switch plans. This means, insurers evaluate health status and may deny coverage or charge higher premiums based on pre-existing conditions.

Evaluate Your Healthcare Needs and budget

All potential enrollees should carefully calculate out-of-pocket costs, including the Part B deductible, to ensure Plan G is a cost-effective choice.

Enlist the help of a licensed agent

Because navigating Medigap plan changes can be complex, a licensed Medicare agent can help compare premiums, evaluate options, and explain the implications of switching plans. Agents can help submit the application to ensure it is done correctly as well as advise clients when to cancel their current coverage.

It is very important to confirm eligibility to enroll in or change plans and be aware if underwriting will apply.

Learn about Medicare enrollment periods – watch a quick YouTube video

More thoughts on Plan G

Switching from Medicare Supplement Plan F to Plan G is a practical choice for many beneficiaries seeking to reduce their healthcare costs without sacrificing coverage. With lower premiums, stable pricing, and nearly identical benefits, Plan G offers exceptional value especially for those who don’t mind paying the Part B deductible.

Those considering the switch should consult a licensed Medicare agent to ensure a seamless transition and take advantage of the savings and benefits Plan G has to offer. Making an informed decision now can lead to significant cost savings and peace of mind in the years to come.

The question; why sell Medicare supplement HDG is easy to answer. As healthcare costs continue to rise, more Medicare beneficiaries are looking for affordable yet comprehensive medical coverage. High Deductible Plan G (HDG) has emerged as an attractive choice, combining the robust benefits of traditional Medicare Supplement Plan G with significantly lower premiums. For insurance agents, promoting HDG can be a win-win offering value to clients while providing a competitive edge in the Medicare market.

Understanding High Deductible Plan G

High Deductible Plan G works in a similar way to standard Plan G. Both plan options cover the same benefits once the beneficiary meets an annual deductible. For 2025, the deductible for HDG is set at $2,870. In other words, beneficiaries pay out-of-pocket for Medicare-covered expenses until they meet this threshold. Once the beneficiary reaches the deductible, the plan covers:

1. Medicare Part A coinsurance and hospital costs.
2. Medicare Part B coinsurance or copayments.
3. The first three pints of blood
4. Skilled nursing facility (SNF) care coinsurance.
5. Part A hospice care coinsurance/copays.
6. Foreign travel emergency coverage (up to plan limits).

The other difference between a standard Plan G and a HDG plan is the premium. HDG premiums are significantly lower than those for standard Plan G, making it an appealing option for cost-conscious beneficiaries.

Why agents should sell HDG

1. Appeal to cost-conscious clients: HDG is an excellent solution for beneficiaries who want comprehensive coverage and are willing to pay a higher deductible in exchange for lower monthly premiums. Many retirees on fixed incomes consider this a good option, especially those in good health who do not expect many healthcare expenses.
2. Growing market: With healthcare costs on the rise, there is a growing trend toward high-deductible health plans. Educating clients about HDG allows agents to tap into this expanding market of budget-conscious Medicare beneficiaries.
3. Competitive edge: Offering HDG plans show the agents ability to provide diverse options tailored to individual financial and healthcare needs. Agents who can explain the cost-benefit analysis of HDG effectively are more likely to earn trust and build long-term client relationships.
4. Cross-selling opportunities: Beneficiaries who choose HDG may still need assistance with other healthcare expenses. Agents can use this opportunity to cross-sell ancillary products such as dental, vision, and hearing plans, hospital indemnity or cancer heart attack and stroke coverage.
5. Client Retention: The affordability of HDGs are an excellent option for clients who might otherwise drop supplemental coverage due to cost concerns. By proactively offering HDG, agents can retain clients who might otherwise feel Medicare Supplements are unaffordable.

Click here to get some tips to maintain your book of business

How to Sell HDG Effectively

1. Be sure you educate potential clients. Clearly explain how HDG works. Be sure to emphasize the trade-off between lower premiums and the higher annual deductible. Use understandable examples to illustrate potential cost savings.
2. Explain the flexibility of the plans. Emphasize that HDG offers the same benefits as standard Plan G after the deductible is met. Clients can enjoy peace of mind knowing they’re protected against catastrophic expenses.
3. Put the focus on the plan’s affordability. Compare HDG premiums with standard Plan G and other Medicare Supplement plan premiums. Showcase how the premium savings can outweigh the deductible for clients who have minimal healthcare needs.
4. Use calculators or other tools to demonstrate potential savings with HDG, tailored to the client’s unique circumstances. This personalized approach can make the benefits of HDG more understandable.
5. Be prepared to address common objections, such as concerns about meeting the deductible. Highlight strategies for managing out-of-pocket costs and reassure clients about the plan’s comprehensive benefits.

Watch a quick YouTube video on selling ancillary products

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A few more things to consider

Medicare Supplement HDG Plans offer a winning combination of affordability and comprehensive coverage, making it a valuable option for many Medicare beneficiaries. For agents, HDG plans provide an opportunity to meet the needs of cost-conscious clients, differentiate themselves in a competitive market, and build lasting client relationships.

By focusing on education, affordability, and personalized service, agents can successfully position HDG plans as a smart choice for Medicare beneficiaries.

Because navigating Medicare enrollment period options can feel overwhelming, we will explain one specific enrollment opportunity. For beneficiaries seeking flexibility in healthcare coverage, Medicare supplements provide a good option. Because of this, the Medicare Supplement birthday rule is an important policy to understand. This rule, available in certain states, offers a window of opportunity to change Medicare Supplement (Medigap) plans without medical underwriting.

What Is the Medicare Supplement Birthday Rule

The Medicare Supplement birthday rule allows beneficiaries to switch Medigap plans annually around their birthday without undergoing medical underwriting. This means insurers cannot deny coverage or charge higher premiums based on health status during the designated timeframe.

Medicare supplement plans help cover out-of-pocket costs not paid by Original Medicare, such as copays, coinsurance, and deductibles. However, outside of the initial enrollment period, switching plans typically requires medical underwriting, which can be a barrier for those with pre-existing conditions. The birthday rule removes this obstacle during its specific enrollment window.

States That Have the Birthday Rule

As of now, the Medicare Supplement birthday rule is not a federal policy; it is enacted at the state level. Currently, 8 states including California, Idaho, Illinois, Kentucky, Louisiana, Maryland, Nevada and Oregon have implemented variations of this rule. Each state’s version differs slightly in terms of timing and eligible plans:

California

Beneficiaries have 60 days from the first day of their birth month to switch Medicare supplement plans to enroll in one with the same or a less benefits. They also have the option to switch insurance carriers during this period.

Idaho

Those who reside in ID have 63 days from their birthday to switch Medicare supplement plans with the either the same or less benefits. They can also switch to another insurance carrier if they like.

Illinois

Beneficiaries in IL have 45 days from their birthday to change Medicare supplement plans with either the same or less benefits. This rule only applies to plans with the existing insurance carrier or an affiliate of the current carrier. The affiliate carrier was added in 2024. In order to To qualify for the birthday rule in IL, beneficiaries must be between 65 and 75.

Kentucky

As of 1-1-24, KY allows Medicare supplement enrollees to switch to another supplement carrier that offers a plan with the same benefits as their current plan. They must switch within 60 days of their birthday.

Louisiana

In the state of LA, beneficiaries are given 63 days from their birthday to switch to another Medicare supplement plan with equal or lesser benefits. Enrollees are only permitted to enroll in a plan offered by either their current carrier or an affiliate of their current insurer.

Maryland 

As of July 1. 2023, beneficiaries have 30 days from their birthday to change Medicare supplement plans with either equal or less benefits than their current plan.

Nevada

In the sate of NV, the birthday rule allows beneficiaries 60 days form the first day of their birthday month to change supplement plans to one with the same or less benefits. It is also permitted to switch insurance carriers.

Oregon

Beneficiaries have 30 days from the first day of their birth month to switch Medicare supplement plans to another with the same or fewer benefits. They can also change insurance carriers.

Please note; beneficiaries and their agents must verify the state specific rules and timelines.

Watch a quick YouTube video on Medicare enrollment periods

How the Birthday Rule works

Each year plan enrollees should evaluate their current supplement coverage and decide if it still meets their needs. A licensed Medicare agent can help compare available plan options to find one that best suits the needs of the enrollee. They will also be able to advise of the applicable enrollment window using the appropriate birthday rule for each eligible state.

Beneficiaries must submit all applications before the enrollment period ends. Insurers cannot deny applications submitted during the birthday rule period. They are also prohibited from increasing premiums based on health conditions.

Benefits of the Birthday Rule

The birthday rule provides several advantages for beneficiaries. This includes the ability to adjust their coverage to better align with their healthcare needs and budget. It also allows enrollees an opportunity to change plans without fear of rejection.

Considerations for Beneficiaries

Although the birthday rule provides some significant benefits, there are a few important considerations:

State-Specific Rules: The availability and details of the birthday rule depend on where each beneficiary resides. It is not available in every state.

Plan Restrictions: In general, the rule applies only to plans that offer equal or lesser benefits, so beneficiaries cannot use it to upgrade coverage.

Timing: Those who miss the enrollment window must wait until next year’s birthday period to change plans.

Learn about Medigap guarantee issue rules; click here

The Medicare Supplement birthday rule is valuable for eligible beneficiaries. It provides an annual opportunity to change coverage without medical underwriting.

The 3 primary out-of-pocket costs to consider when you compare Medicare plans are; copays. coinsurance & deductibles. Medicare copays, coinsurance and deductibles all contribute to annual coverage costs for plan enrollees each year. These terms all describe the money beneficiaries pay towards health care services and prescription drugs when they have health insurance. 

Copays

A copay is a fixed amount of money beneficiaries pay for a specific service. They generally apply to: primary care provider visits, specialist visits, prescription drug refills (depending on the tier of the drug), and hospital services. Copays let the beneficiary know what they pay for each provider’s visit up front. Copays apply to most prescription drug plans, Medicare Advantage plans and some Medicare Supplement plans. Please keep in mind, sometimes there are other costs associated with a visit to a provider’s office.

Coinsurance

When a beneficiary and their health plan share the cost of approved medical services, that is coinsurance. Coinsurance payment amounts are based on a percentage of the cost. Beneficiaries enrolled in Original Medicare, will have to pay 20% of the cost for most services after they meet the annual deductible. After the enrollee meets the deductible, Original Medicare covers 80% of all approved costs.

Usually members of Medicare Advantage plans pay co-pays for medical visits instead of coinsurance. Although in many cases, MA/MAPD plan enrollees pay 20% coinsurance for Part B drugs (in-network).

Up until 2025, stand alone PDP plan enrollees could end up paying 25% coinsurance for drugs if they fell into the donut hole (coverage gap). The coverage gap was removed for 2025, therefore stand alone PDP enrollees do not pay coinsurance.

Click here to learn about the Part D prescription payment program

Deductibles

Deductibles are the amount plan enrollees pay out of pocket for most health care services before their plan starts to cover medical costs. The deductible does not apply to preventative services. Medicare plans cover preventative services at not cost to enrollees.

Once the deductible is met, enrollees are still required to pay copays and/or coinsurance costs.

There are 2 different deductibles for Original Medicare Part A & Part B, however many Medicare supplement plans cover the Part A deductible. There only 2 plans that cover the Part B deductible (Plan F & Plan C) neither plan is available to anyone who turns 65 after 1/1/2020.

Most MA/MAPD plans have separate deductibles; one for medical costs and one prescriptions. That means enrollees must meet their medical deductible before the plan pays for specific covered services. It also means enrollees must pay the deductible for prescriptions before the plan covers the cost of the medication. MA/MAPD enrollees still pay copays and coinsurance after they meet the deductible. Please note; each plan is different and deductible amounts are specified in a plan’s summary if benefits.

Watch a quick YouTube video on the $2,000 drug cap

Copays, coinsurance, and deductibles

Copays, coinsurance & deductibles are all factors to consider when discussing Medicare options. All these things contribute to the total cost of each plan a beneficiary chooses.

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

Just like the other Medicare coverage options, there are specific rules for Medicare supplement changes. In general, beneficiaries enroll in a Medicare Supplement plan during their Medigap Open Enrollment Period.

Those who wish to apply for or change Medicare Supplement plans outside the Medigap OEP, may have to go through medical underwriting. However, there are some instances when beneficiaries qualify for a guaranteed issue right. This depends on which sate a beneficiary lives in.

Medigap open enrollment

The suggested time to enroll in a Medicare Supplement is during the Medigap OEP. This is a 6-month period that starts when the beneficiary enrolls in Medicare Part B and is at least 65 years of age. Those who enroll during this time do not have to go through medical underwriting. Underwriting is when an insurance carrier can deny coverage due to an underlying medical condition.

Keep in mind, the Medicare Supplement Open Enrollment is entirely different than the Medicare Open Enrollment that takes place annually from October 15th through December 7th.

During the Medicare AEP, beneficiaries can change or drop their Medicare Advantage (Part C) or PDP (Part D) plan. Be sure not to confuse this with the fall Medicare open enrollment period. This period runs from October 15 to December 7 every year. During fall open enrollment, you can enroll in, change, or drop your Medicare Part D prescription drug plan or your Medicare Advantage (Part C) plan. In many states, enrollees do not use this enrollment period to change Medicare Supplement plans.

Guaranteed issue rights

Those who miss their Medicare Supplement OEP may still qualify for guaranteed issue to enroll in or change their Medicare Supplement without underwriting. There are specific circumstances that offer enrollees guarantee issue rights. Review some circumstances that allow for GI rights below:

1. Enrollees who live in one of the four GI issue states (CT, NY, NH or MA).
2. Individuals who have Medicare A and B as well as employer coverage and are losing their employer plan.
3. Beneficiaries who enroll in a MA/MAPD or PACE program when they are first eligible and change their mind within the first year of coverage.
4. Those who have a MA/MAPD plan and are moving out of their plan’s service area.
5. The MA/MAPD plan the beneficiary enrolls in leaves the service area.
6. The Medicare Supplement provider ends coverage through no fault of the enrollee.
7. Enrollees who left a Medicare Supplement plan to try an MA/MAPD plan for the first time can re-enroll in a Medicare Supplement within the first year of trying a MA/MAPD plan.

Click here to learn more about GI rights for Medicare Supplement enrollment

What if you don’t qualify for a GI right

Those who do not qualify for a guaranteed issue right but still wish to change their Medicare Supplement plan may need to go through underwriting. If the beneficiary is healthy, most likely they will pass medical underwriting and receive approval for a new plan.

Beneficiaries with pre-existing conditions may be approved for a new plan although they may pay higher premiums. In some instances, the carrier may deny the beneficiary coverage.

Free look period

A free look period is a 30-day window that some Medicare Supplement enrollees can use to decide if they are happy with their new plan choice. This free look is available if a beneficiary changes from one Medicare Supplement to another.

What to remember when switching Supplements

When considering making a change in Medicare coverage, it is a good idea to get advice from a licensed Medicare agent. A licensed agent understands all your coverage options as well as your needs. They can sort out area plans and help guide you to making an informed decision.

Those who enroll in a new plan should not cancel their old plan until their new enrollment is confirmed. Beneficiaries may also want to pay for both plans for the first month in the event they decide not to keep the new plan.

Once the beneficiary is accepted into the new plan, they must cancel their current Medicare Supplement plan. If they do not, they will be charged for both plans. Those who are unsure about keeping the new plan can wait a month and pay for both to make sure they are happy with the new coverage.

Beneficiaries can request cancellations over the phone or in writing. Those who request the disenrollment over the phone should record a reference number for the call. It is also a good idea to make sure payment for the old plan does not continue.

Learn more about Medicare enrollment periods

More Rules for Medicare Supplement changes:

If a beneficiary moves to another state, they can remain in their current Medicare Supplement plan even if it is not offered in the new state. Although the new state may have its own Medicare Supplements that offer a better price point. A licensed Medicare agent can help find plan options in the new area.

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This year many agents are wondering what to do about lost PDP commissions. We are offering a few solutions to help supplement the loss of commissions. Please note there are still many opportunities to earn income in the field of Medicare sales.

The first thing you need to remember is that clients rely on your assistance to find the best plan options each year. Stay with us for a few suggestions to help raise your income.

Look at your client’s current PDP plan

Although your client’s current PDP plan may not be commissionable, it may still be the best option for them. Remember they have other plans with you, and you must make sure they know they can rely on your guidance. When clients see that you are willing to help them without a commission, it may lead to increased trust and a boost to your reputation. This can even lead to more client referrals in the long run.

Although we understand this will not pay your bills, if you do not want to provide assistance, someone else might. A smart agent knows, there are plenty of opportunities to assist clients with other commissionable products.

Watch a quick video on the prescription payment program

It is also important to know; some carriers are still paying commissions on PDP sales. Be sure you are contracted with a variety of carriers and plans in your service area. The best choice for the client may be a commissionable plan and, in that case, it’s a win for you both.

Click here to add carriers to your current Crowe contract or start a new contract request

Look at making a Medicare Supplement plan change

As you know, clients who are enrolled in a standalone PDP plan are usually enrolled in a Medicare Supplement plan. Many clients do not think about changing their Medicare Supplement coverage. The plan just renews each year and goes unnoticed.

In some instances, the Medicare Supplement plan carrier may have raised the plan cost over the year, and clients may not realize it. This provides an opportunity to find them a savings opportunity with the same coverage at a better rate from a competitive carrier. Keep in mind, some states may require underwriting to make a Medicare Supplement change. If you are lucky enough to be selling in a GI state, changing plans is as easy as writing an app.

A MAPD plan could be an option

Clients may want to give a Medicare Advantage plan a try. For some enrollees, this a great way to save money and still receive the protection of comprehensive medical coverage. MAPD plans are a very popular choice and can add to your bottom line. MAPD plans pay a generous commission rate for both new and renewal business.

Click here to learn about 2025 Medicare commissions

If you offer PDP plans, you already need to complete your AHIP, so there’s no reason not to add MAPD plans to your business.

Having a variety of product offerings help protect your income stream and gives clients a greater choice of coverage options.

Offer other needs-based products

Before you meet with each client, you should conduct a thorough needs-based assessment. This often leads to cross-selling opportunities. Clients may want to purchase insurance that fills a specific coverage gap. If you plan to discuss these coverage options, be sure your SOA includes ancillary products. In some cases, you may need to collect an additional SOA and make a subsequent appointment.

Ancillary products such as dental, vision, hospital indemnity, critical illness, cancer, heart attack and stroke or even long- and short-term care or life insurance are a few options. These products can provide necessary coverage for your clients and a supplement to your income as well. These products can more than make up for lost PDP commissions.

Learn more about why you should add ancillary products

What qualifies as preventative under Medicare and how do you ensure you take full advantage of these benefits? Because preventive care is an essential part of staying healthy and managing potential health risks before they become serious, Medicare recognizes the importance of preventive care and offers a range of services to help beneficiaries maintain their health.

What Is Preventive Care

Preventive care refers to medical services that aim to prevent illness, detect conditions early, or promote overall good health. These services can include screenings, vaccines, counseling, and much more. By focusing on prevention, Medicare helps beneficiaries proactively manage their health and reduce the need for more costly treatments in the future.

Click here to download a copy of a comprehensive list or covered preventative services

Medicare Coverage for Preventive Services

Medicare provides a wide array of preventive services under Part B (Medical Insurance). Many of these services are available to beneficiaries at no cost. These services may help detect health problems early when treatment is sometimes more effective and less expensive.

Some common types of preventive care Medicare covers:

Wellness Visits

Within the first 12 months a beneficiary enrolls in Medicare Part B, they are entitled to a “Welcome to Medicare” preventive visit. This one-time visit includes a review of your medical and family history, as well as basic measurements like height, weight, and blood pressure.

After your initial visit, Medicare covers an annual wellness visit each year. This can help create or update a personalized prevention plan. This plan can help beneficiaries stay on top of their health by identifying risk factors and setting health goals.

Vaccinations and Immunizations

Medicare covers vaccines that help prevent serious illnesses, including:

1. Flu Shot (Influenza): Covered once per flu season, typically every fall or winter.

2. Pneumococcal Vaccines: Medicare covers two different pneumococcal shots. The initial shot as well as a second shot a year later if appropriate.

3. Hepatitis B Vaccine: Available to those at medium or high risk for Hepatitis B.

4. COVID-19 Vaccines and Boosters: Medicare covers COVID-19 vaccines and booster shots as recommended by health authorities.

5. The Shingles Vaccine: This vaccine is administered in two doses. The second dose is given two to six months after the first. Medicare covers the cost of both doses.

Read more about Medicare coverage of vaccines

Screenings and Tests

Medicare offers a variety of preventive screenings and tests to help detect health issues early, including:

1. Mammograms: Medicare covers mammograms for the purpose of screening once every 12 months for women aged 40 and older. Medicare may also cover diagnostic mammograms if medically necessary.

2. Colon Cancer Screenings: Medicare covers multiple types of colon cancer screenings, including fecal occult blood tests, multi-target stool DNA tests (like Cologuard), flexible sigmoidoscopy, and colonoscopy. The frequency of these tests depends on the specific test and risk factors.

3. Bone Density Tests: Covered once every two years (or more often if medically necessary) for individuals at risk for osteoporosis.

4. Diabetes Screenings: Medicare covers up to two diabetes screenings per year for individuals at risk. This includes those with a history of high blood pressure, high cholesterol, obesity, or a family history of diabetes.

5. Cardiovascular Screenings: Medicare covers a screening blood test every five years to check for conditions like high cholesterol and triglyceride levels.

Cancer Screenings

Because early detection of cancer can lead to better treatment outcomes. Medicare covers:

1. Cervical and Vaginal Cancer Screenings: Medicare covers pap tests and pelvic exams are once every two years, or every year for women at high risk

2. Prostate Cancer Screenings: Annual prostate-specific antigen (PSA) tests and digital rectal exams for men aged 50 and older.

3. Lung Cancer Screenings: Low-dose CT scans are covered annually for individuals at high risk, particularly heavy smokers or those who have quit smoking within the past 15 years.

Cardiovascular Health

Medicare covers several services to help maintain cardiovascular health, including:

1.Cardiovascular Behavioral Therapy: This includes counseling on diet and exercise to help reduce the risk of heart disease.

2. Blood Pressure Screenings: These are typically part of your annual wellness visit.

Diabetes Prevention Program

The Medicare Diabetes Prevention Program offers lifestyle coaching and resources to help beneficiaries at risk for diabetes prevent the onset of the disease. The program is designed to encourage weight loss, healthy eating, and regular physical activity.

Mental Health and Wellness

Medicare also covers preventive services aimed at mental health, including:

1. Depression Screenings: Medicare includes an annual screening for depression as part of the yearly wellness visit.

2. Alcohol Misuse Counseling: Medicare covers counseling for beneficiaries who are screened and found to have alcohol misuse issues.

3. Smoking Cessation Programs: Medicare covers up to eight counseling sessions per year to help beneficiaries quit smoking.

Obesity Screening and Counseling

For individuals with a body mass index (BMI) of 30 or higher, Medicare covers counseling sessions to help promote weight loss and healthy living. This coverage includes regular face-to-face meetings with a healthcare provider.

Screenings for Infectious Diseases

Medicare also offers coverage for screenings to detect infectious diseases, including:

1. HIV Screenings: Covered once every 12 months, or more frequently for individuals at higher risk.

2. Hepatitis C Screenings: Covered once if born between 1945 and 1965, or annually for those at high risk.

3. Sexually Transmitted Infections (STIs): Medicare covers both screenings and counseling sessions annually for individuals at risk.

Make the Most of Medicare Preventive Services

1. Schedule an annual wellness visit: This visit is a great opportunity to discuss overall health and get a personalized prevention plan. It’s also a good time to make sure you’re up to date on all the preventive services you’re eligible for.
2. Know What Medicare Covers: Familiarize yourself with the list of preventive services Medicare covers and discuss these options with your healthcare provider. They can help determine which screenings and vaccines are appropriate for you.
3. Keep Track of When You’re Eligible: Medicare covers some services once a year or every few years. Make a note of when you’re eligible for your next screening or vaccination.

Preventive care is an important part of Medicare coverage and can help you stay healthier, detect potential problems early, and avoid costly treatments. Whether it’s a simple flu shot, a cancer screening, or an annual wellness visit, Medicare makes it easy for beneficiaries to access a wide range of preventive services. Understanding what’s covered and taking advantage of these benefits can play a key role in maintaining health and well-being.

If you need help choosing a Medicare plan, click here to learn why you should use a licensed Medicare agent

SEPs are important for both agents and beneficiaries to understand. Missing an SEP can cause a beneficiary to pay more for their medical care then necessary. We will discuss the disaster/emergency SEP requirements to make sure your plan is approved without delays.

It is important to note; disasters or emergency SEPs that are declared by a government entity are only applicable to beneficiaries who were unable to complete an enrollment during a valid election period that took place during the emergency or disaster. CMS has clear guidelines when beneficiaries can use this SEP.

How to qualify for this SEP

The beneficiary has to have missed a valid election period when the declared disaster or emergency occurred. They have to have been unable to make the desired plan change during the specified time period. SEPs for disasters or emergencies are only applicable to those who live in the affected area during the emergency.

CMS also states; beneficiaries who rely on the help of individuals who reside in an area where the disaster or emergency occurs for health care decisions, may also be eligible for the SEP

Some reasons for not using this SEP

This SEP is not valid in cases when the beneficiary has already used another valid election period during the time the SEP begins. This is the case when the disaster SEP occurs during another valid election period. For instance, if the disaster SEP begins at some point during the AEP and the beneficiary uses the AEP election period, they are not eligible to use the SEP. This is because they have already used an election period. Thye are now ineligible to switch plans again.

Watch a quick YouTube video on SEP Changes for Dual, Partial Dual and LIS members in 2025

Learn more about SEPs – click here to watch a video

How long does the SEP last 

SEPs last for either at least 2 months after the end of the emergency or disaster or when the end of the incident is stated, the rules follow whatever date is later.

Here’s an example:

On August 8th through August 15th there is a wildfire that causes FEMA to declare a disaster/emergency in two counties. FEMA declares the SEP on August 20th; this means the start of the SEP is August 8th. This SEP would end two full months after the SEP is announced on August 20th. In other words, the end of the SEP would be October 20th because this is the later date.

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Because many people on Medicare require additional help at some point it is important to understand Medicare and home healthcare coverage. The main goal of home healthcare is help individuals recover from an illness or injury and regain independence.

Eligibility

In order for a beneficiary to qualify for home healthcare services under Medicare, the following criteria must be met:

1. A doctor or another licensed healthcare provider must have a face-to-face meeting with the beneficiary and certify that they require home health services.
2. The beneficiary must require part-time/intermittent skilled nursing care, physical therapy, occupational therapy or speech-language pathology services.
3. Patients must be homebound. In other words, it is difficult for them to leave the house without help due to their condition.
4. A Medicare certified home healthcare agency must provide the care.

Services Medicare covers

Once the eligibility criteria are met, Medicare covers many home health care services, including:

• Skilled Nursing Care: Provided on a part-time or intermittent basis.
• Therapy Services: Physical, occupational, and speech-language therapy to aid in recovery and rehabilitation.
• Home Health Aide Services: Assistance with personal care on a part-time basis if the patient is also receiving skilled care.
• Medical Social Services: Counseling and help finding community resources.
• Medical Supplies: Certain medical supplies like wound dressings.
• Durable Medical Equipment (DME): This includes equipment such as walkers or wheelchairs.

Services Medicare does not cover

• Full-time care: 24-hour-a-day care at home.
• Meals: Meals delivered to the home.
• Homemaker services: Medicare dose not cover services such as; shopping, cooking or cleaning if they are the only services needed.
• Personal care: If this is the only care required, Medicare will not pay a home health aide to provide basic personal care services such as bathing, dressing or using the bathroom (activities of daily living).

How to set up home healthcare services under Medicare

1. Make an appointment with your doctor or healthcare provider to go over your health needs and establish if home health care is a good choice.
2. Be sure you see your doctor face-to-face as required by Medicare.
3. Ask your doctor or insurance provider to help you find a Select a home health agency that is certified by Medicare.
4. Work with your doctor and the home health agency to develop a plan of care to fit your specific needs.

How Original Medicare covers home healthcare costs

In most cases, individuals enrolled in original Medicare pay nothing for covered home healthcare services. Although, there is a cost for DME durable medical equipment. In general, Medicare covers 80% of the approved amount while the individual is responsible for the remaining 20%.

Part A: Typically covers home health care services after the beneficiary has been in the hospital for a period of 3 days or more.

Part B: Covers home health services without the requirement of a prior hospital stay.

Watch a YouTube video the difference between Medicare Supplements and Medicare Advantage

Medicare Advantage Plans and Home Health Care

Medicare Advantage plans (Medicare Part C), are an alternative to Original Medicare. Private insurance companies that are approved by Medicare offer these plans. They must provide the same benefits as Medicare Part A and Part B. Many Medicare advantage plans also offer additional benefits that original Medicare does not cover, such as vision, dental, wellness programs, OTC as well as rides to medical appointments.

How Medicare Advantage plans cover home healthcare costs

Although Medicare Advantage plans must cover at least the same level of home health care services as Original Medicare, there are a few things you should know:

1. Network Restrictions: Unlike Original Medicare, Medicare Advantage plans often have network restrictions. Beneficiaries of most plans need to use home health agencies that are in the plan’s network.
2. Prior Authorization: Some Medicare Advantage plans require prior authorization for home health services. In other words, beneficiaries need approval from the plan before they receive certain services.
3. Additional Benefits: Many MA plans offer extra benefits beyond what Original Medicare provides. These could include additional support services, like caregiver support, home modifications, or wellness programs.
4. Cost Structure: Although Medicare Advantage plans must cover home health care at least as well as Original Medicare, the cost structure (copays, coinsurance, and deductibles) may be different. It’s important to understand your plan’s specific costs.

Find out how to cover the gaps left by Medicare advantage plans

Medicare’s home health care coverage can significantly benefit those who need medical care in the comfort of their own home. Understanding the eligibility criteria, the types of services covered, and how to initiate these services ensures that beneficiaries receive the appropriate care while minimizing out-of-pocket expenses.

Please note: before choosing a Medicare plan, it is best to consult a licensed healthcare agent to get accurate, personalized plan information.

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Because agents need to present all options to their clients, they need to be able to answer the question; why choose a Medicare Supplement. This is especially true due to Medicare Advantage plan changes scheduled to take place in 2025. Some of these changes will include discontinuing some added benefits and higher co-pays for some services. For this reason as well as some we list below, clients may be more inclined to enroll in a Medicare Supplement plan

Click here to watch a video on the MA plan changes for 2025

Reasons to choose a Medicare Supplement

Due to the fact that as people age their health care needs tend to grow, most individuals require more comprehensive healthcare coverage. For many people Medicare is the cornerstone of their healthcare plan. However, while Medicare offers substantial coverage, there are gaps that can leave individuals with unexpected medical expenses. This is where Medicare supplement (Medigap) plans, come into play. Here are some good reasons your clients might opt for a Medicare supplement plan.

Fill the Coverage Gaps

Medicare Parts A and B provide coverage for hospital stays, doctor visits, and approved medical services. However, they don’t cover everything. Because things like deductibles, coinsurance, and copays can quickly add up, Medicare supplement plans are designed to fill these gaps. They help cover expenses such as copays, coinsurance, and deductibles, thereby reducing out-of-pocket costs for beneficiaries.

Freedom to choose healthcare providers

One of the best benefits of a Medicare supplement plan is the freedom to choose your healthcare providers. Unlike Medicare Advantage plans that require enrollees to use only in-network providers or pay a higher price, Medicare Supplement plans allow enrollees to use any doctor or hospital that accepts Medicare assignment. In other words, they can use any healthcare provider they need without worrying about network restrictions.

Medical coverage while traveling abroad

Medicare supplement plans provide coverage for emergency medical expenses enrollees incur while traveling abroad. While Original Medicare typically does not cover healthcare services outside of the United States (with a few exceptions), certain Medicare Supplement plans provide coverage for emergency care during foreign travel. This is an important benefit for seniors who enjoy traveling or have family members living abroad.

Predictable costs

Because Medical expenses can be unpredictable, it can be a challenge to budget for healthcare costs, especially during retirement. With a Medicare supplement, enrollees know exactly what their monthly premium is, as well as any out-of-pocket costs for covered services. This predictability can provide peace of mind and financial stability, allowing you to focus on enjoying your retirement years.

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Guaranteed renewable

Medicare supplement plans are guaranteed renewable. This means the insurance company cannot cancel coverage as long as premiums are paid on time. This reassures that enrollees have continuous coverage, regardless of changes in health or medical history. Additionally, once enrolled in a Medicare supplement plan, beneficiaries have certain rights and protections, including the ability to switch plans without being subject to medical underwriting.

Find out about Medicare Supplement Guaranteed issue rights.

Enrolling in a Medicare supplement plan offers many benefits, including filling the coverage gaps left by Original Medicare, freedom to choose healthcare providers, emergency coverage for medical expenses while traveling abroad, predictable costs, and guaranteeing renewable coverage. By investing in a Medicare supplement plan, enrollees safeguard their health.

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