Blog

For retirees, Required Minimum Distributions (RMDs) are an inevitable part of managing tax-advantaged retirement accounts, such as traditional IRAs and 401(k)s. While many focus on the tax implications of RMDs, fewer realize their potential impact on Medicare costs, Can RMDs increase Medicare premiums? More specifically, the Medicare Part B and Part D premiums. Understanding this connection can help retirees better plan their withdrawals and avoid increases in healthcare costs.

What Are RMDs

RMDs are mandatory withdrawals that individuals must take from their traditional retirement accounts starting at age 73 (as of 2024, per the SECURE 2.0 Act). The IRS determines the required withdrawal amount based on account balance and life expectancy. Because RMDs are considered taxable income, they can push retirees into higher income brackets, which can affect their Medicare premiums.

IRMAA’s (Income-Related Monthly Adjustment Amount)

Medicare Part B (medical insurance) and Part D (prescription drug coverage) premiums are income-based. This means higher-income individuals pay more due to the IRMAA. IRMAAs apply when modified adjusted gross income (MAGI) exceeds certain thresholds, as reported on tax returns from two years prior. In other words, RMDs taken in 2024 could impact Medicare premiums in 2026.

Can RMDs Increase Medicare Premiums

Because RMDs increase taxable income, they may push retirees above the IRMAA thresholds. This can lead to higher Medicare costs. For example:

In 2025, individuals with a MAGI over $106,000 (or $212,000 for married couples filing jointly) pay more than the standard Medicare Part B premium.

• In 2025, the base Part B premium is $185.00 per month, however those subject to IRMAA could pay as much as $594 per month depending on income.
• Similarly, Part D enrollees face IRMAA surcharges ranging from $12.90 to $81 per month, based on income.

Please note: taking large RMDs in a single year may increase Medicare costs, potentially taking away from retirement savings.

How to Lessen RMD Impact on Medicare Premiums

1. Qualified Charitable Distributions: Individuals over 70½ can donate up to $100,000 per year to a qualified charity from their IRA. This reduces taxable income without affecting RMD obligations.
2. Roth Conversions: Converting funds from a traditional IRA to a Roth IRA before RMD age can lower future RMD amounts. Roth withdrawals are not taxable or included in MAGI.
3. Strategic Withdrawals: Spreading withdrawals over multiple years or taking early withdrawals before RMDs begin can help manage taxable income levels.
4. Filing for IRMAA Appeals: If a significant life change (such as retirement, divorce, or loss of income) affects MAGI, individuals can request an IRMAA reduction.

Learn how to file an IRMAA appeal

While RMDs are an unavoidable part of retirement planning, their impact on Medicare costs must be considered. Understanding IRMAA thresholds and carefully planning withdrawals can help retirees control their Medicare premium costs. By using tax-efficient withdrawal strategies, retirees can minimize unnecessary healthcare expenses and maximize retirement savings.

Medicare provides essential health coverage for seniors and certain disabled individuals, but it doesn’t cover everything. That’s where Medicare Supplement plan (Medigap) come in. These policies help cover out-of-pocket costs like copays, coinsurance, and deductibles. Is a Medicare Supplement enrollment right for you? We will discuss who might be a good fit for one.

Medicare Supplements

Medicare Supplement policies are insurance plans provided by private insurance companies, designed to work with Original Medicare. They help cover the “gaps” in Medicare coverage, making healthcare costs manageable. However, beneficiaries cannot have a Medicare Advantage with a Supplement. Individuals must have Original Medicare to enroll in a supplement plan.

Who should consider a Medicare Supplement

Medicare Supplement plans are a great option for individuals who want more comprehensive coverage and predictable healthcare costs. Here are some reasons individuals may benefit from enrolling in a Medicare Supplement plan:

Lower Out-of-Pocket Costs

Original Medicare beneficiaries pay coinsurance, copays, and deductibles for medical services, which can add up. For those who prefer to minimize these expenses, a Medicare Supplement plan can significantly reduce out-of-pocket costs, providing greater financial security and predictable expenses.

Frequent Healthcare Users

For individuals with chronic conditions who require frequent doctor visits, or need ongoing medical treatments, Medicare Supplement can be an cost saving option. It covers costs that would otherwise be paid out-of-pocket, making medical expenses more manageable.

Travelers and Snowbirds

Unlike the network restrictions of Medicare Advantage plans, Supplement plans provide nationwide coverage. Some plans even offer foreign travel emergency coverage, making them ideal for those who travel frequently or live in multiple states throughout the year.

Flexibility in provider choice

Medicare Supplement plans allow enrollees to see any doctor or specialist who accepts Medicare assignment. There is no need for referrals or network restrictions. This is very attractive to those who want more freedom in their healthcare options.

Individuals who can afford the premiums

While Medicare Supplement plans reduce out-of-pocket costs, they come with monthly premiums in addition to the Medicare Part B premium. For individuals who can comfortably afford the premiums, a Supplement plan can provide peace of mind and financial protection against unexpected medical expenses.

New Medicare Enrollees

For most beneficiaries, the best time to enroll in a Medicare Supplement plan is during the six-month Medicare Supplement Open Enrollment Period, which begins when beneficiaries first enroll in Medicare Part B. During this time, beneficiaries have guaranteed issue rights. This means they can enroll in any Medicare Supplement policy available in their state without medical underwriting. Those who apply outside this period, may be subject to higher premiums or even denial based on health conditions. Please note; underwriting does not apply to those who live in one of the 4 guarantee issue states.

Who might not want a Medicare Supplement

Although Medicare Supplements are beneficial for many, they may not be a good choice for everyone. Those who might not benefit from a Medicare Supplement are:

• Enrolled in a Medicare Advantage Plan: Medicare Supplement cannot be used with Medicare Advantage.
• Individuals with employer or retiree coverage: Some employer-sponsored plans provide secondary coverage to Original Medicare, making a Medicare Supplement unnecessary.
• Those who rarely use medical services: Healthy individuals who don’t visit the doctor often may find the cost of a Medicare Supplement premium outweighs the benefit.

Watch a quick YouTube video Medicare Advantage vs Medicare Supplement

Beneficiaries should seek the advice of a licensed Medicare agent before enrolling in a plan. They can help compare plan option to ensure they make the best choice for the individual situation. Understanding healthcare needs and financial situation can help determine if a Medicare Supplement is the best plan choice.

Medicare Advantage (MA) plans are growing in popluarity as an alternative to Original Medicare, often attracting enrollees with low premiums, extra benefits, and all-in-one coverage. However, understanding the true Medicare Advantage Plan cost breakdown is crucial to avoid unexpected financial burdens. Here’s a detailed look at the key expenses associated with Medicare Advantage plans.

Premiums

Many MA plans advertise low or even zero-dollar premiums. However, enrollees must still pay the standard Medicare Part B premium ($185 per month in 2025) unless they qualify for financial assistance. Some plans may also charge an additional monthly amount for extra benefits, like dental comprehensive coverage.

Deductibles and Copays

Unlike Original Medicare, which has standardized costs, Medicare Advantage plans vary widely in deductibles and copay amounts. Enrollees of some MA plans must to meet an annual deductible before coverage kicks in, and they charge copays for doctor visits, hospital stays, and prescription drugs.

Out-of-Pocket Maximums

One advantage of MA plans is that they have an annual out-of-pocket maximum, unlike Original Medicare. In 2025, the maximum amount a MA plan CMS allows MA plans to charge for in-network services is $9,350. Please keep in mind, not all plans charge this amount for an out-of-pocket maximum; most plans have lower MOOPs. This is the most they are allowed to charge, the amount varies greatly by plan. Once this limit is reached, the plan covers all additional costs for the remainder of the year.

Out-of-Network Care

Most MA plans operate within a provider network. HMO plans require enrollees to use only in-network providers, while PPO plans allow some out-of-network visits at a higher rate. Please note; unless you are in a emergency situation, seeking care outside the network can lead to significant additional expenses.

Prescription Drug Costs

Many Medicare Advantage plans include Part D prescription drug coverage. The cost for prescrptions vary based on the plan’s formulary. Factors such as tiered formulary pricing and preferred pharmacy networks can influence out-of-pocket expenses for medications. Most plans also have a prescription deductible to meet for medications over a specific tier level.

Hospitalization and Specialist Care

While MA plans cover hospital and specialist care, costs can add up quickly. Some plans charge daily copays for hospital stays. Additionally, specialist visits usually have higher copays than PCP visits or require referrals, adding another charge.

Extra Benefits and Hidden Costs

Medicare Advantage plans often include extra benefits like dental, vision, and hearing coverage. However, these benefits may have limitations, such as caps on coverage or a restricted provider network, which can lead to unexpected out-of-pocket expenses.

Travel and Emergency Care Costs

Unlike Original Medicare, which offers nationwide coverage, most MA plans have geographic restrictions. If you travel frequently, you may face higher costs for out-of-network emergency care or require a plan with national coverage options.

Agents see how easy it is to compare MA plans with Sunfire and Connecture

Medicare Advantage plans can be a cost-effective option for some enrollees, but it’s essential to understand the full financial picture. By carefully reviewing plan details, including premiums, out-of-pocket limits, network restrictions, and prescription drug costs, enrollees can make informed decisions about healthcare coverage and avoid expensive surprises.

Need a scope; click here

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

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

Levels of Medicare Contracting

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

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

Agents

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

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

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

General Agencies (GAs)

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

Managing General Agencies (MGAs)

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

Senior General Agencies (SGAs)

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

Field Marketing Organizations (FMOs)

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

Take a look at the programs Crowe offers agents & agencies

National Marketing Organizations (NMOs)

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

Insurance Carriers

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

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

Contracting Considerations

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

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

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

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

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

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

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

How HSAs Work Before Medicare

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

Medicare Enrollment and HSA Contributions

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

A few things to consider:

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

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

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

Using HSAs After Medicare Enrollment

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

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

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

Transition from HSA to Medicare

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

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

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

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

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

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

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

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

As a licensed insurance agent, the goal is to help clients get the best coverage for their healthcare needs. In doing this, they are protected against financial loss. One product that can provide significant value to clients is hospital indemnity insurance. This coverage is an excellent addition to many health plans, particularly for individuals on Medicare Advantage plans or high-deductible health plans. In the post below, we answer the question; why offer hosptial indemnity insurance.

Hospital Indemnity Insurance

Hospital indemnity insurance is supplemental insurance that provides cash benefits to policyholders when they are hospitalized due to an illness or injury. Unlike traditional health insurance, which pays service providers, hospital indemnity insurance provides a lump sum or dialy benefit amount to the policyholder. Policyholders can decide how they use the money.

Benefits for clients

1. Fills coverage gaps: Many health insurance plans, including Medicare Advantage, have copays, deductibles, and out-of-pocket expenses that can add up quickly. Hospital indemnity insurance helps cover these costs, reducing financial strain.
2. Flexibility in use: Beneficiaries can use the cash benefits from a hospital indemnity policy any way they like. They can pay medical bills, household expenses, or travel costs associated with treatment.
3. Affordable premiums: Compared to major medical insurance, hospital indemnity plans are relatively affordable, making them accessible to many clients.
4. No network restrictions: Policyholders receive payment for a stay in any hospital, without worrying about network limitations.
5. Customizable plans: Many hospital indemnity policies let clients choose coverage amounts and additional riders. This can include; skilled nursing facility coverage or outpatient services.

Why and how to sell ancillary products – watch a quick YouTube video

Why agents should offer hospital indemnity insurance

1. Enhanced client protection: Offering hospital indemnity insurance demonstrates that you are proactive in helping clients manage potential healthcare costs that may not be covered by their primary insurance.
2. Increase client retention: When clients see the value in additional coverage, they are more likely to trust and stay with an agent who prioritizes their financial well-being. It is also helps build good client relations when all their coverage is provided by one agent.
3. Expand sales opportunities: Adding hospital indemnity insurance to your portfolio increases cross-selling opportunities, allowing you to provide more comprehensive solutions while expanding your revenue.
4. Stand out amoung competitors: Many agents focus solely on traditional health plans. Offering supplemental policies sets you apart and positions you as a more knowledgeable, full-service advisor.
5. Help seniors with Medicare Advantage Plans: Many Medicare Advantage plans have large hospital copay amounts. A hospital indemnity plan tailored to these costs provides clients with peace of mind.

Ready to add these products to your portfolio – click here for online contracting

How to introduce Hospital Indemnity Insurance to clients

Educate clients on coverage gaps: Explain how their existing health plan leaves them with a large out-of- pocket payment in the event of a hospital stay.

Provide real-life scenarios: If possible, use examples of how hospital indemnity insurance has helped individuals manage medical expenses.

Offer a needs-based approach: Assess each client’s unique situation and recommend hospital indemnity insurance as part of a holistic healthcare strategy.

Explain affordability: Break down the cost versus benefit so clients see the value of a small monthly premium compared to potential hospital expenses.

Some tips to maintain your book of business

Hospital indemnity insurance is a great way to protect clients against unexpected healthcare costs. As an agent, offering this coverage not only enhances your client’s financial security but also strengthens your reputation as a trusted advisor. Adding hospital indemnity insurance to your product offerings helps you provide a more complete approach to healthcare planning while expanding your business opportunities.

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

Explain plan details and costs clearly

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

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

Ensure clients enroll in the correct plan

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

Learn about rapid disenrollments

Be transparent coverage changes

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

Follow CMS compliance guidelines

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

Provide ongoing support

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

Handle issues and complaints professionally

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

Document interactions

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

Stay updated on Medicare rules and plans

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

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

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

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

What Are C-SNPs

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

Growth of the C-SNP market

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

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

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

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

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

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

Challenges of C-SNPs

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

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

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

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

The Future of C-SNPs

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

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

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

Why this is good news

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

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

Medicare DST SEP

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

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

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

Eligibility for the DST SEP

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

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

Watch a quick YouTube video on the changes to DSNP SEPs

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

Do you need a SCOPE – click here

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

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

Obtain permission to contact

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

Comply with Do-Not-Call (DNC) regulations

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

Use approved scripts and disclosures

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

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

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

Avoid prohibited sales tactics

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

Follow call recording and documentation rules

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

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

The SOA (Scope of Appointment)

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

Learn more about SOAs

Provide clear and accurate information

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

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

Ensure post-enrollment compliance

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

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

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