Published by Carolyn Portanova

If your clients have been through life changing events (divorce, loss of a spouse, loss of income) and are enduring financial hardships, you can help them lower their Medicare costs. There are numerous programs available to assist Medicare beneficiaries and we'll review them below.

There are four Medicare Savings Programs that can help offset your clients' costs:

The Qualified Medicare Beneficiary Program is another way to help clients lower their costs. This program provides coverage of Parts A and B premiums and utilizes cost sharing to lower income beneficiaries.

The Specified Low Income Medicare Beneficiary Program (SLMB) assists beneficiaries with their Part B premiums.

The Qualifying Individual Program (QI) helps beneficiaries pay for Part B premiums.

The Qualified Disabled Working Individual Program (QDWI) provides assistance for those under the age of 65 who are disabled and are no longer entitled to free Part A. These individuals have returned to work, have a lower income and are not eligible for Medicaid.

​Your clients can also request to have their IRMAA lowered - the amount they'll pay for Medicare Parts B and D. 

​Additionally, they can apply for the Medicare Part D Extra Help Program. This program helps those with lower incomes pay for their prescription drugs, deductibles and copays. Your clients can apply for the program online.

The Medicare Savings Program, available on the state level, provides assistance to Medicare beneficiaries with help paying their Part A and Part B premiums. If your clients qualifiy the program might also pay for their Part A and Part B deductibles, coinsurance, and copayments. Get help with Medicaid and CHIP by selecting your clients' state.

The State Health Insurance Assistance Program (SHIP) also provides help to Medicare beneficiaries and their families.

There is no shortage of resources and programs available to help offset the costs of Medicare. If your clients don't qualify for one program, they may for another. Be sure to utilize these tools to research the best options for your clients - and as always, if you need help, please reach out to us.

Published by Carolyn Portanova

When it comes to Medicare Supplement policies there are times and situations when your client has the right to enroll in a Medigap plan without answering any health questions. The most important of those times being during their six month Medigap Open Enrollment period. This occurs when your client turns 65 or when they first enroll in Medicare Part B. 

​​However, there may be times when you have a client who wants to enroll in a Medicare Supplement and they fall outside of their Open Enrollment period. Perhaps you have a client who's moving and they want to switch plans. ​Or you might have a client who was enrolled in a Medicare Advantage plan and they want to make the switch to a Medicare Supplement. Regardless of the situation, there may be Guaranteed Issue or Trial right available, allowing them to enroll in a Medigap plan without answering health questions. 

Examples of Guaranteed Issue & Trial Rights:

• Your client is in a Medicare Advantage Plan, and the plan is leaving Medicare or stops giving care in their area, or your client moves out of the plan’s service area.
• Your client has Original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays and that plan is ending. Note: In this situation, your client may have additional rights under state law.
• Your client has Original Medicare and a Medicare SELECT policy. If your client moves out of the Medicare SELECT policy’s service area. Call the Medicare SELECT insurer for more information about their options.
• Your client joined a Medicare Advantage plan or Programs of All-inclusive
  Care for the Elderly (PACE) when they were first eligible for Medicare Part A at 65, and within the first year of joining they decided they wanted to switch to Original
  Medicare. This is called a trial right.
• Your client dropped a Med Supp policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time, and they've been in the plan less than a year, and want to switch back. Again, this is a trial right.
• Your client's Medicare Supplement carrier goes bankrupt and they lose coverage, or their Medigap policy coverage otherwise ends through no fault of their own.
• Your client leaves a Medicare Advantage Plan or drops a Medigap policy because the company hasn’t followed the rules, or misled your client.

​​​If your client doesn't fall under any of the Guaranteed Issue/Trial Right situations listed above, there are certain states that have year-round open enrollment periods. There are also states that have birthday and anniversary rules which allow your client to switch plans without going through underwriting. Each state has its own regulations and guidelines so it's important to familiarize yourself with them before enrolling your client in a Medicare Supplement plan. ​

Update: Delaware and Indiana are enacting the Birthday Rule effective January 1, 2026.

If your client falls outside of their open enrollment period, doesn't live in a state with year-round open enrollment and doesn't qualify for guaranteed issue rights, they will likely have to go through underwriting; and that requires answering medical and pharmaceutical questions on the application as well as during a phone interview.

If you have any questions regarding Guaranteed Issue rights, birthday rules or getting your client through underwriting, please reach out to us and we'll be happy to assist you. Additionally, feel free to download our Medicare Enrollment Periods guide.