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

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

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

What Is a Medicare Part B LEP

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

Here’s how it works:

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

Example:

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

When Can You Delay Enrollment Without Penalty

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

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

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

How to Avoid the Part B LEP

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

What If You’re Penalized by Mistake

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

Steps to Dispute a Medicare Part B LEP:

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

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

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

Medicare agents

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Medicare Enrollment: When It’s Automatic and When You Need to Sign Up

Medicare enrollment can be confusing, especially when it’s not clear whether you’ll be enrolled automatically or if you need to take the first step yourself. As either a Medicare agent or beneficiary, knowing when is Medicare enrollment automatic is critical to avoid late enrollment penalties and coverage gaps.

Here’s a breakdown of when Medicare enrollment happens automatically and when beneficiaries need to sign up on their own.

When Medicare Enrollment Is Automatic

Individuals are automatically enrolled in Medicare Part A and Part B at age 65 if:

They already receive Social Security or Railroad Retirement benefits

Individuals who collect either Social Security or Railroad Retirement Board (RRB) benefits for at least four months before their 65th birthday are automatically enrolled in:

• Medicare Part A (hospital insurance)
• Medicare Part B (medical insurance)

In most cases, These individuals receive their Medicare card about three months before their 65th birthday.

Those under 65 and have a qualifying disability

Individuals who receive Social Security Disability Insurance (SSDI) for 24 consecutive months, are automatically enrolled in Medicare once they reach the 25th month of disability benefits.

Please Note: Individuals with ALS (Lou Gehrig’s disease) receive Medicare automatically the month their disability benefits begin.

When You Need to Sign Yourself Up

Individuals must enroll themselves in Medicare if:

They’re not receiving either Social Security or RRB benefits

In many cases, people decide to delay the receipt of Social Security until after age 65 to maximize their benefit amount. Those individuals are not automatically enrolled in Medicare; they must sign themselves up during their IEP (Initial Enrollment Period).

The IEP is a 7-month window that starts 3 months before, includes the month of, and ends 3 months after the beneficiary’s 65th birthday.

Individuals who have employer coverage and delay Part B enrollment

Those still working and receive health coverage from a large employer (20+ employees) group health plan may choose to delay Part B and avoid paying the monthly premium. In that case, they must sign up later during a SEP (Special Enrollment Period). This is an 8 month window when individuals can sign up for Part B once their employer coverage ends or they stop working (whichever comes first).

Watch a YouTube video on OEP, SEPs and Late Part B enrollment

Important: COBRA and retiree coverage do not count as active employer coverage. Individuals may face penalties if they delay Medicare enrollment and rely on these plans.

What If You Miss Enrollment

If you miss your IEP and don’t qualify for an SEP, you’ll have to wait for the General Enrollment Period (GEP):

• January 1 – March 31 each year
• Coverage begins the month after you enroll
• You may owe a late enrollment penalty for Part B (and Part D if applicable)

Tips for Clients & Agents

• Mark your calendar: Your IEP starts 3 months before your 65th birthday.
• Enroll on time: Even if you’re healthy, missing the window can cost more later.
• Coordinate carefully: If still working, check with HR or your agent before delaying Medicare enrollment.
• Check coverage: Compare Original Medicare vs. Medicare Advantage (Part C) and add Part D or Medigap as needed.

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Need Help Enrolling

Whether you’re approaching 65 or advising clients, navigating enrollment can be tricky. Medicare.gov provides tools to check eligibility and apply online; agents can help guide clients through the process to avoid delays and penalties.

Knowing when Medicare enrollment is automatic and when you need to enroll yourself helps avoid costly mistakes. As an agent, walking clients through this process adds tremendous value. If you’re a beneficiary, planning ahead ensures a smooth transition into Medicare with the coverage you need.

Have questions about a specific situation? Reach out to a licensed Medicare agent who can provide personalized guidance based on your health needs and budget.

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How Medicare Covers Diabetic Supplies And Where to Get Help

Managing diabetes effectively is extremely important and requires reliable access to the necessary supplies. For Medicare beneficiaries living with diabetes, understanding what’s covered and how insurance pays for it is essential. As a Medicare agent, helping clients navigate these benefits can make a real difference in their quality of life. We will go over Medicare payment of diabetic supplies and provide information on how to get help locating and paying for them.

Diabetic Supplies Medicare Covers

Medicare Part B (Medical Insurance) covers certain diabetic supplies for all beneficiaries who have diabetes, whether they use insulin or not. Here’s what they typically cover:

• Blood glucose monitors
• Blood sugar test strips
• Lancets and lancet devices
• Glucose control solutions
• Continuous Glucose Monitors (CGMs) and related supplies

For beneficiaries who use insulin, Medicare also covers insulin pumps and pump-related supplies under Part B if the pump qualifies as durable medical equipment (DME).

Important: Insulin itself (unless used with a pump) syringes, needles, alcohol swabs, and gauze are generally covered under Medicare Part D (the prescription drug benefit).

How Much Medicare Pays

Under Medicare Part B, Medicare pays 80% of the Medicare-approved amount for covered diabetic supplies after the beneficiary meets the Part B deductible. The beneficiary is responsible for the remaining 20% unless they have additional coverage (like a Medigap plan or Medicaid) that helps with cost-sharing.

If diabetic supplies are obtained through a Medicare-enrolled supplier, the beneficiary avoids unnecessary out-of-pocket costs. That’s why it’s essential to work with reputable providers who are participating providers under Medicare.

Where to Get Supplies: Advanced Diabetic Supply Group

One of the most trusted names in diabetic supply delivery is the Advanced Diabetic Supply Group (ADS).

Here’s why Medicare beneficiaries and agents should consider ADS:

Watch a YouTube video on Advanced Diabetes Supply and how they can help your clients

• Medicare-Enrolled Supplier: ADS is an accredited Medicare DME provider, which means they meet strict compliance and billing standards.
• Home Delivery: Supplies are shipped directly to the beneficiary’s home—saving time and eliminating pharmacy trips.
• Bilingual Support: ADS offers customer service in English and Spanish, making communication easier for diverse clients.
• Insurance Coordination: They work directly with Medicare and many private insurance plans to verify coverage and handle paperwork.

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As an agent, you can refer clients to ADS knowing they’ll receive quality care and proper billing, which leads to better health outcomes and fewer surprises.

Tips for Agents and Beneficiaries

• Stay enrolled: Ensure your client’s Medicare coverage is active and updated.
• Verify suppliers: Always use Medicare-approved suppliers to avoid denied claims or excessive costs.
• Review needs annually: Reassess whether your client’s current plan covers all their diabetic needs, especially during the Annual Enrollment Period (AEP).

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Grassroots Marketing for Medicare Agents: Building Your Book of Business

In an increasingly digital world, there’s still no substitute for genuine, personal connection; especially in Medicare sales. Grassroots marketing for Medicare agents can be one of the most effective and affordable ways to grow your book of business, especially in local communities where trust and reputation go a long way. Whether you’re a new agent or looking to reinvigorate your outreach strategy, grassroots marketing tactics can build lasting relationships and drive referrals.

Volunteer in Your Community

Volunteering is a powerful way to connect with people on a personal level while giving back. Choose causes that align with your values and attract your target demographic; such as food banks, senior centers, or veterans’ organizations.

Consider wearing a name badge or shirt with your agency’s logo while volunteering, and carry business cards or branded leave-behinds. In these settings, people often ask what you do, giving you a natural way to mention your services.

Ask for Referrals from Satisfied Clients

Even in today’s world; word-of-mouth remains king. Clients who trust you are your best advocates. Don’t be afraid to ask for referrals, just be compliant and tactful in how you do it.

Tools:

• Create business cards for clients to pass to friends. It is a good idea to put a picture of yourself on your cards to help people become familiar with you.
• Follow up with a handwritten thank-you note and a small token of appreciation; such as a $10 coffee gift card or a some small token (keeping it under $15 to stay compliant).

Additionally: Consider including a line on your business card or email signature: “Know someone who has questions about Medicare? I’m happy to assist!”

Build Local Business Relationships

Partner with local businesses that serve your ideal clientele; pharmacies, barbershops, community banks, independent living facilities, senior centers, libraries, etc.

Strategies:

• Offer to leave business cards, flyers or brochures at the front counter.
• Cross-refer: If they refer customers to you, do the same for them.
• Host joint educational events (e.g., “Medicare and Medication Q&A” with a local pharmacist).

Leave-behind ideas:

• Branded pens, pill organizers, or reusable shopping bags are all affordable and practical.

Host Seminars and Educational Events

Educational seminars are a compliant and effective way to attract new prospects. People appreciate clear, unbiased information about Medicare—especially when it’s presented in an easy-to-understand format.

Watch a quick YouTube on Educational Seminar Best Practices

Some Ideas on Where to Host:

• Local libraries
• Senior centers
• Churches
• HOA clubhouses

What to Bring:

• Printed guides or FAQs
• Sign-in sheet (for permission-based follow-up) voluntary only
• Medicare-compliant presentation materials
• Small giveaways like notepads, magnifying glasses, or bookmarks (again, under $15 in value) with your logo and contact information

Be sure to check with carriers and CMS for current marketing rules around events and materials.

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Be Where Your Audience Is

Don’t wait for people to come to you; go where they already are.

A Few Ideas:

• Set up an information booth at a farmer’s market or community fair (with proper permission).
• Attend Chamber of Commerce or Rotary Club meetings.
• Sponsor a senior bingo night or lunch-and-learn event.

Use these opportunities to show up as a helpful resource, not a salesperson.

Consistency is Key

Grassroots marketing takes time but builds true connections. It’s not about flashy ad budgets; it’s about showing up, being authentic, and providing value. If you make it easy for people to refer you, remember you, and trust you, your Medicare book of business will grow; one interaction at a time.

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Suggested Leave-Behinds or Referral Gifts (All $15 or Less):

• Branded pill organizers
• Magnifying bookmarks
• Reusable grocery bags
• Hand sanitizers with your logo
• Small potted plants or succulents
• Coffee mugs
• $5–$10 gift cards (compliance-checked)
• Mini first aid kits
• Magnetic calendars with your logo and contact information

Looking to grow your Medicare practice? Start with your community; the most powerful marketing tool you have is you!

Final Expense Sales 101 – How to Make the Sale

If you’re already helping clients with Medicare, you have a golden opportunity sitting right in front of you: final expense insurance. It’s a natural cross-sell that fits perfectly into your existing appointments and client relationships. This post walks you through final expense sales 101 and explains how to integrate this product into your business and add value without being pushy.

Why Add Final Expense to Your Medicare Business

1. You Already Have the Right Audience

Because final expense insurance targets people aged 50–85, it is a similar demographic to those you’re already serving with Medicare. Many of these individuals are on a fixed income, value peace of mind, and trust you as their insurance advisor.

2. You’re Already Having the Conversation

During your Medicare appointment, you’re already talking about:

• Health concerns
• Retirement income
• Budget constraints
• Planning for the future

Adding a conversation about funeral costs, protecting loved ones from unexpected expense and leaving a financial legacy is a natural extension, not a separate pitch.

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

3. You Increase Your Value to The Client

Because you are already providing health coverage advice, why not offer additional value and increase your commissions. Selling additional products to a client helps solidify your relationship.

4. Increased Client Retention

Clients who purchase multiple products from an agent are more likely to stay with you long-term. Final expense policies also open the door for life-long renewals.

How to Introduce Final Expense

After Medicare Enrollment

Once you’ve helped the client enroll in a Medicare plan, say something like:

“Are there any other health or life products you would like to discuss? Many of my clients have asked about final expense coverage; they want to make sure loved ones aren’t left with a financial burden.

Ask if they already have something in place for that. If they say yes, say “That’s great, do you know if it’s term or whole life? Some people are surprised when they realize their policy might end before they need it.

If they say no or aren’t sure; offer to look at some options that fit their budget. Many people just want something to cover their final expenses (10,000 to 15,000) so their family is not stuck with a large bill. This frames the conversation as standard and proactive; not a sales pitch.

Position It As Peace of Mind

Avoid phrases like “life insurance” and instead say:

• “Funeral coverage”
• “Final expense plan”
• “A little extra protection for your family”

Make it about the emotional benefit, not just the policy.

How to Get Started

• Contract with final expense carriers like Mutual of Omaha, Aetna, Transamerica, or Foresters.
• Quoting tool (e.g., CSG Actuarial or Best Plan Pro).
• Short presentation script tailored for Medicare clients.
• Lead follow-up system or CRM (many Medicare CRMs support multi-line tracking).

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Medicare-Final Expense Agents

Final expense insurance is an easy and impactful way to help your clients and increase your revenue. You’re already meeting with the ideal audience, now it’s about offering a solution to a very real concern.

Start by asking simple, compassionate questions. Frame the coverage as peace of mind. Remember, your clients trust you, and they want your help.

Final expense isn’t a separate business; it’s a natural extension of the one you’re already building.

Important: Be sure to include this or any product you plan to discuss with potential clients on your scope of appointment to be compliant with CMS guidelines.

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If you’re a Medicare agent, you know leads are an essential part of your business. But purchasing leads can be expensive as well as frustrating, with low contact rates and high competition. The good news? There are effective, low-cost Medicare lead sources to generate quality Medicare leads that build lasting client relationships.

Here are four strategies to help find leads that actually convert without emptying your wallet:

Grassroots Marketing Still Works

Even in the digital age, nothing beats local visibility and personal interaction. Although grassroots marketing may take some time, it’s cost-effective and builds genuine relationships.

• Community bulletin boards: Post flyers offering your services at grocery stores, libraries, pharmacies, and senior centers. Remember; use only general information and do not mention specific benefits or carriers on flyers.
• Local events: Set up a booth at farmers markets, church fairs, or health expos. Offer free Medicare information and assistance to attract interest. Free items of nominal value like pens or candy sometimes helps attract people and start the conversation.
• Business cards everywhere: Leave them at coffee shops, laundromats, grocery stores or anywhere seniors gather.

This method takes consistency, however, over time, it helps establish you as a valuable, local Medicare resource.

Click here for a Scope of Appointment Form

Host Medicare Educational Seminars

Educational events are a great way to build credibility as a knowledgeable community member and generate leads in a non-salesy setting. Many seniors are overwhelmed by Medicare choices and appreciate trustworthy advise.

• Partner with libraries, senior centers, or churches to host free events.
• Offer a clear, simple presentation explaining Medicare basics and common questions.
• Use voluntary sign-in sheets and follow-up cards to capture contact information for attendees.
• Bring printed materials like basic plan comparison charts or a “Medicare 101” guide they can take home.

Watch a Medicare Educational Event Best Practices Video

You don’t need a big crowd; even a small gathering can yield solid, qualified leads when people trust you from the start.

Leverage Professional Community Relationships

Think beyond individual clients; build relationships with people who serve your target audience every day.

• Pharmacists and independent pharmacies: Ask if you can leave materials or host a “Medicare Check-Up Day.”
• Financial advisors and tax preparers: Many of their clients are Medicare-aged. Offer to co-host an event or provide educational resources.
• Home health agencies and caregivers: These professionals regularly interact with people who need help with healthcare coverage.
• Faith leaders and community organizers: Trusted voices in the community can refer their members to you when Medicare questions arise.

These referral partners don’t have to sell for you; they just need to know you’re a trusted resource.

Referrals from Current Clients

Once your business is established, happy clients are often your best lead source. In most cases, all you have to do is ask; they are happy to recommend your services to friends and family.

• Ask at the right time: After helping a client enroll or during an annual review, simply ask, “Do you know anyone else who could use help with Medicare?”
• Send follow-up emails with referral reminders: Include a link to a referral form or offer a small incentive (where compliant).
• Provide extra business cards they can hand to friends or family.
• Stay top-of-mind with birthday cards, newsletters, or check-in calls. The more visible you are, the more likely they are to refer others.

Remember, a referred lead is already partially sold; they trust you because someone they know trusts you.

A few more strategies for Medicare agents

You don’t need a massive marketing budget to grow your Medicare business. With the right combination of grassroots outreach, community connections, educational events, and referrals, you can build a steady stream of qualified leads that cost very little and convert into sales.

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It is important to be visible, approachable and a valuable resource for your community. If you do these things, the leads will follow.

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As America’s population ages, the demand for healthcare and those who can help people navigate it continues to grow. One very important and often misunderstood area of healthcare is Medicare. For those looking for a rewarding and potentially lucrative career, you might want to consider a Medicare sales career.

Why Consider a Medicare Sales Career

Growing Market

Every day, thousands of Americans turn 65 and become eligible for Medicare. That trend is not expected to slow down anytime soon. As baby boomers age into the program, the need for knowledgeable, trustworthy agents to guide them through their options has never been greater. This isn’t a short-term trend; it’s a long-term opportunity based on demographics.

Make a Meaningful Impact

Choosing a Medicare plan can be overwhelming. All the options can cause confusion for beneficiaries. Between Original Medicare, Medicare Advantage, Medigap, Part D, this is difficult for many to sort out. That is why they often need help to find the best fit for their unique medical and financial needs. As a Medicare sales professional, you’re not just selling a product; you’re offering clarity, confidence, and peace of mind at a critical point in life.

Quick Start Up with Great Earning Potential

For a determined individual, becoming a licensed Medicare agent can be accomplished in a relatively short amount of time when compared to many careers. Once certified (through licensing and passing the required exam), agents can complete the AHIP and add in carrier contracts and purchase E &O insurance. Once contracted and compliant, they can put together a plan to build their book of business. Top agents enjoy competitive commissions, including renewals, which creates an opportunity for recurring income over time.

Watch a quick YouTube of what Crowe has to offer agents

Flexible Career Options

Medicare sales can fit a wide range of career goals and lifestyles. Those who want to work independently and set their own schedule can do that. If you enjoy working as part of a larger agency or brokerage with support and resources?; that’s also an option. Whether you’re looking for a full-time career or a side hustle, the flexibility of Medicare sales is hard to beat.

Continuous Learning Keeps the Work Interesting

Because Medicare is constantly evolving, new plans, changing regulations, updates to benefits, there’s always something new to learn. For professionals who enjoy staying sharp and growing their expertise, Medicare sales offers a dynamic and intellectually stimulating environment.

Digital Tools Make It Easier

Medicare agents have access to powerful online quoting and enrollment platforms, including telephonically with voice recording systems, CRMs, and so much more. Agents no longer need to visit a prospect’s home unless they want to. Many successful agents run their business entirely online, serving clients across multiple states. Although some prefer the grass roots approach. There are options for many different types of agents.

Watch a quick video of Connecture & Sunfire quoting and enrollment tools

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A career in Medicare sales is about more than just earning commissions; it’s about becoming a trusted advisor for people facing important health coverage decisions. If you enjoy helping others, are driven to succeed, and want to be part of a growing industry with real impact, Medicare sales could be the opportunity you’ve been looking for.

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As a Medicare agent, you’re always looking for ways to support your clients; especially those who have difficulty affording their medications. One of the most overlooked tools in your toolkit is the State Pharmaceutical Assistance Program (SPAP) and the Special Enrollment Period (SEP) it can trigger. This SEP can be a great opportunity for individuals with lower income levels. This post answers the question: what is an SPAP SEP and how you can use it effectively to provide clients the benefits they need and remain complaint.

What Is an SPAP

State Pharmaceutical Assistance Programs (SPAPs) are state-specific programs. Each state designs them to provide assistance to qualified residents; usually low-income seniors or people with disabilities, to pay for prescription drugs. Benefits may include help with:

• Part D premiums
• Deductibles
• Copays and coinsurance
• Coverage gaps (including the “donut hole”) Please keep in mind; the coverage gap was eliminated in 2025.

Important: Not all states offer SPAPs, and those that do have varying eligibility criteria. For example, Connecticut’s PACE, New York’s EPIC or New Jersey’s PAAD and Senior Gold, are a few of the better-known programs.

The SPAP SEP

Once a client becomes eligible for or enrolls in an SPAP, they qualify for an SEP (Special Enrollment Period). Eligible individuals can use the SEP to:

• Enroll in a Medicare Part D plan (if they haven’t yet)
• Switch from one Part D plan to another

The SPAP SEP is useful for:

• Individuals who miss their Initial Enrollment Period (IEP)
• Clients in unsuitable plans with high out-of-pocket costs
• Individuals who are newly eligible for financial help anytime during the year

Timing Rules For SPAP SEPs

• Trigger: The SEP is triggered by eligibility for or enrollment in an SPAP.
• Usage: Individuals can use this SEP only once per calendar year.
• Window: Clients have two full months after the month of SPAP enrollment/eligibility to make a change.

Example: If an individual is approved for their state’s SPAP in April, they can enroll in or switch Part D plans through June 30.

Why This SEP is Important to Agents

Some agents are unsure of how SPAPs work with Medicare timelines. Using the SPAP SEP can:

• Help your clients access more affordable drug coverage outside of AEP (the Annual Enrollment Period)
• Allows agents to proactively help clients who receive an SPAP approval notice
• Position an agent as a knowledgeable advisor who ensures clients receive the best coverage for their budget

Understanding SPAPs also gives you a competitive edge; especially when working in states that offer generous or well-known assistance programs.

Best Practices for Agents

1. Know Your State’s SPAP: Research the program(s) available in each state you are licensed in. Make sure you are aware of income limits and how the program coordinates with Part D.
2. Know the application process. Be sure you can provide assistance to clients to access the SPAP application and what they need to complete it.
3. Educate Your Clients: Many beneficiaries don’t know these programs exist. Include SPAP information in your annual reviews, especially when you have clients with low-income or high drug-costs.
4. Be aware of SEP Opportunities: If a client is approved for SPAP mid-year, this is an opportunity to review their current drug coverage and potentially move them to a plan that better suits their needs.
5. Coordinate with SHIPs: Partnering with your local State Health Insurance Assistance Program (SHIP) can help your clients apply for SPAPs and get extra help if needed.
6. Stay Compliant: Always document the SEP reason when submitting applications or plan changes, and be sure the client’s enrollment in the SPAP can be verified.

The SPAP SEP is an important but underutilized option for helping Medicare clients reduce prescription drug costs and access more suitable coverage. By understanding and using the guidelines correctly, you can serve clients better and potentially improve your retention and referral rate in the process.

Watch a YouTube video on 2025 SEP Changes for DSNP

Note: It is a good idea to bookmark your state’s SPAP website and use it as a resource when appropriate. Being the agent who knows the programs that can make a real difference in people’s lives builds long-term relationships and trust.

Success Strategies for Medicare Agents: How to Grow, Compete, and Thrive

The Medicare market continues to expand, with millions of Americans enrolled and thousands more becoming eligible every day. Although, with opportunity comes competition. Whether you’re new to the field or a seasoned agent looking to stay ahead, success in Medicare sales requires planning and effort. We will go over a few success strategies for Medicare agents that we hope will help your business reach it’s full potential.

Five Essential Success Strategies For Medicare Agents

1. Build a Strong Online Presence

Today’s consumers do their homework before making decisions; especially when it comes to healthcare. A professional, credible online presence isn’t optional; it’s essential.

• Website: Create an easy to use website that clearly explains your services, displays your contact info, and includes a few helpful blog posts or answers to FAQs. watch a video Improve Your Website Traffic With Blogs.
• Google Business Profile: It is important to claim and optimize your business listing so you show up in local searches. When possible have satisfied clients leave a review of your services.
• Social Media: Focus on platforms where your audience is active; in many cases, Facebook is a great place to connect with seniors who are looking for information. Post educational content, reminders about enrollment periods, and success stories.
• Email Marketing: Build and maintain a list of clients and potential clients who opt in to stay top-of-mind throughout the year with helpful updates and tips.

An active digital footprint helps establish your brand, help establish you as a trusted resource and expands your reach far beyond your immediate network.

2. Stay Educated – Commit to Continued Learning

Medicare is constantly changing. New plans, rule changes, and compliance updates roll out constantly. The most successful agents stay current and compliant by:

• Renewing AHIP certification annually
• Attending carrier training webinars
• Joining industry associations or local networking groups
• Subscribing to Medicare and healthcare newsletters
• Complete compliant sales and communication training courses

The more you know, the more confident and credible you become. Clients appreciate the guidance of a knowledgeable agent.

3. Use Up-To-Date Tools

Time is your most valuable asset. The right tools help you stay organized, work efficiently, and grow your business without burning out.

• CRM systems such as; AgencyBloc, BOSS for agents, or other systems help track leads, manage follow-ups, and retain client information securely.
• Quote and enrollment platforms like SunFire or Connecture, simplify side-by-side comparisons and digital applications.
• Automated email sequences can educate leads and onboard new clients with minimal manual effort.
• Calendar tools allow clients to book appointments online, reducing back-and-forth communication.

Automating routine tasks frees up your time and allows you to focus on what really matters: serving your clients and growing your book.

4. Invest in Marketing and Branding

In a crowded field, your personal brand sets you apart. What do people think of when they hear your name? Trustworthy? Knowledgeable? Accessible?

• Logo and branding adds professionalism, consistency and recognition across all communications channels.
• Clear messaging that speaks directly to your ideal client (e.g., veterans, low-income seniors, new-to-Medicare enrollees).
• Lead generation strategies like paid search, Facebook ads, community events, or referral partnerships.

Marketing is not a one-time effort; it’s an ongoing investment. If you’re not actively expanding your visibility, you’re losing ground.

5. Focus On Client Retention

Acquiring a client is just the beginning. Retaining them is where long-term income and reputation are built.

• Annual policy reviews help ensure clients are enrolled in the plan that best fits their current needs. Every year you have an opportunity to prove your value and build your client relationships.
• Birthday cards, holiday greetings, or “thank you” notes add a personal touch and help maintain contact.
• Client newsletters keep them informed and engaged throughout the year.
• Referral requests: A happy client is often your best source of new business, do not hesitate to tactfully ask for them.

Long term clients provide renewal income, referrals, and stability to your business.

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For many people trying to navigate Medicare, understanding how and when out-of-pocket costs apply can be overwhelming. The terminology “first dollar Medicare services” may cause confusion for some individuals. We will explain what it actually means and how they work in the context of Medicare services.

First Dollar Coverage

First dollar coverage refers to insurance benefits that begin immediately. The enrollee is not required to, pay a deductible, copay, or coinsurance before the carrier provides coverage for a medical service. This coverage literally begins from the “first dollar” of a medical bill providing the highest level of financial protection.

With Original Medicare (Parts A and B), this kind of coverage is not included by default, although it may be accessed through either supplemental plans or Medicare Advantage plans in some circumstances.

Original Medicare: No First Dollar Coverage

Medicare is divided into Part A (hospital insurance) and Part B (medical/outpatient insurance).

Original Medicare enrollees are responsible for the following out-of-pocket costs:

• Deductibles: Part A ($1,632 per benefit period in 2025); Part B ($240 annual)
• Coinsurance: 20% for most Part B services after the deductible
• Copays: Varies depending on the service or provider

Please note; although Medicare covers a significant portion of approved healthcare costs, it does not offer first dollar coverage when used on its own. Beneficiaries are responsible for cost-sharing amounts unless they purchase supplemental coverage.

First Dollar Coverage for Medicare Services

In general, there are two ways Medicare beneficiaries receive first dollar coverage:

1. Medicare Supplement (Medigap) Plans

The Medigap plans listed below cover most or all out-of-pocket costs after Original Medicare pays its share.

• Plan F: Offers true first dollar coverage. This plan covers both Part A and Part B deductibles as well as all coinsurance and copays for approved medical expenses as well as excess charges.
• Plan C: Similar to Plan F but doesn’t cover excess charges. Important: Plans F and C are not available to individuals who were eligible for Medicare after January 1, 2020.
• Plan G: Covers all approved Medicare expenses; except the Part B deductible, making this plan very close to first dollar coverage.

Beneficiaries enrolled in a Plan F shouldn’t have to pay anything out-of-pocket for Medicare covered services.

2. Some Medicare Advantage (Part C) Plans

Medicare Advantage plans are an alternative to Original Medicare. Some Medicare Advantage plans offer enrollees:

• $0 monthly premiums
• $0 copays for primary care, lab work, preventive services, or telehealth
• Reduced out-of-pocket costs through annual limits

Although technically they are not considered “first dollar” coverage, some plan benefits can effectively eliminate upfront costs for specific services, depending the plan design.

Keep in mind: Medicare Advantage plans may include networks, referrals, and prior authorization requirements.

Watch a quick YouTube video on Medicare enrollment periods

Examples of First Dollar Medicare Service

• Example 1: A Medigap Plan F enrollee visits the emergency room. The bill is fully covered; no deductible, no copay, no coinsurance. This is real first dollar coverage.
• Example 2: A Medicare Advantage plan enrollee has a $0 copay for a primary care visit. Although the plan may have a deductible for other services, this specific visit is a first dollar service.
• Example 3: A individual with Original Medicare and no supplemental coverage uses the services of a specialist. This individual must meet the Part B deductible and then pay 20% for all approved charges. In other words, this is not first dollar coverage.

Why First Dollar Coverage Matters

• Predictable healthcare costs
• Easier budgeting for individuals on fixed incomes
• Reduces the risk of surprise bills
• Encourages timely medical visits and screenings

Possible Downside

• Higher monthly premiums (especially with Medicare Supplement Plans)
• Less flexibility (if beneficiaries opt for a Medicare Advantage Plan) they must use specific provider networks.
• Limited plan availability for more recent enrollees (Medicare Supplement Plan F and Plan C enrollment restrictions).

First dollar Medicare services are about financial peace of mind. While Original Medicare doesn’t provide this level of coverage on its own, many beneficiaries learn that Medicare Supplements or Medicare Advantage plans reduce or eliminate the high price of medical care.

Beneficiaries who like predictable expenses and minimal out-of-pocket costs, may opt for a plan that offers first dollar coverage. As a licensed Medicare agent, it is important to understand your clients healthcare needs and budget to offer plan choices that provided the best benefit options.