Becoming an independent insurance agent is a great career path and if you’re contemplating entering the senior healthcare market, you get the fulfillment of assisting seniors with their healthcare coverage. And when it comes to the senior healthcare market, Medicare is at the top of the list. Even if you’re a veteran and have been offering Medicare solutions for years to your clients, it can still be complicated. So, let’s discuss the top five mistakes new agents make and how to avoid them.

1. Confusing Open Enrollment vs. Guaranteed Issue
2. Not asking enough probing questions on underwritten cases
3. Using the wrong application
4. Using an invalid enrollment period or anniversary/birthday rule
5. Leaving a client uninsured when switching plans

​Confusing Open Enrollment vs. Guaranteed Issue
Many times, the terms Open Enrollment and Guaranteed Issue are used interchangeably. Much of this is because in both situations a client can acquire a new Medicare Supplement plan without undergoing Medical Underwriting. CMS and the carriers’ definitions of Open Enrollment and Guaranteed Issue are two different things.
 
An Example of a Client in their Open Enrollment Period:
Mr. Stewart is turning 65 and signs up for Part B and wants to purchase a Medicare Supplement plan. He is within his six-month Open Enrollment period (within 6 months from his Part B effective date) and can purchase a Medicare Supplement plan without any medical underwriting.
 
An Example of a Client Who is a Guaranteed Issue:
Mr. Smith signed up for Medicare Part B at age 65, but his wife is still working (more than 20 employees) and has great health benefits. Mr. Smith decides to enroll in Medicare Part B and remain on his wife’s health plan. Three years later when he is age 68 his wife retires, and they lose their group health coverage. Now Mr. Smith (and his wife) needs to sign up for a Medicare Supplement policy. He is no longer in that six month
period when he signed up for Part B and no longer qualifies for Open Enrollment. Instead, he is a Guaranteed Issue situation, and can only sign up for plans A, B, C*, D*, F*, G,*, K or L that are sold in his state by any insurance company (per MACRA rules).
 
Guaranteed Issue in Medicare Supplement Terms:
is defined as the rights a client has in certain, special situations when insurance companies are required to sell or offer the client a Medicare Supplement policy (these rights are listed in the 'Choosing a Medigap Policy’ booklet.
 
*Plans C and F are no longer available to people new to Medicare on or after January 1, 2020.
However, if your client was eligible for Medicare prior to January 1, 2020 (but not yet enrolled), they may be able to purchase Plan C or Plan F. People new to Medicare on or after January 1, 2020, have the right to purchase Plans D and G instead of Plans C and F.

​Not asking enough probing questions on underwritten cases
When a client must answer health questions to be considered for a Medicare Supplement policy it’s imperative that you ask questions and get detailed answers about the status of their health. Insurance companies have certain lookback periods that they use to determine whether a client will pass Underwriting. If you don’t have a thorough understanding of their current (and past) health situation, it causes delays with the application process. Keep in mind, you can always call the Underwriter to ask if the application should be submitted and you can also use the Underwriting feature in our quoting tool to see if your client will qualify.
If you’re selling Medicare Advantage plans, you don’t have to worry about asking probing health questions. Medicare Advantage plans are required to accept any Medicare eligible applicant regardless of health status.

​Using the Wrong Application
The easiest way to submit applications is electronically to avoid any issue with using an outdated or incorrect application. However, there are times when a paper application may be necessary. To avoid any complications, it’s important to make sure you’re using the correct application for your client. Always double check the carrier’s forms and materials to ensure you’re using the most up-to-date paper application to avoid any delays and headaches.

​Using an Invalid Period and/or Anniversary/Birthday Rule
Below we’ll go over the different enrollment periods and Anniversary and Birthday rules that are state-specific. It’s important to understand the differences and to know when your client can enroll or dis-enroll.
Medicare Annual Enrollment Period (AEP)
AEP runs from October 15th through December 7th each year. During this time, Medicare-eligible individuals can:

• Change from Original Medicare to a Medicare Advantage plan (or vice versa)
• Switch from one Medicare Advantage plan to another Medicare Advantage plan
• Switch from a Medicare Advantage plan that doesn't have drug coverage to one that does (or vice versa)
• Join a Medicare Prescription Drug Plan (PDP)
• Switch from one Prescription Drug Plan (PDP) to another

 
Initial Enrollment Period (IEP)
The Initial Enrollment period is a seven-month period when someone is first eligible for Medicare (Parts A and B). For those eligible due to age, this period begins three months before they turn 65, includes the month they turn 65, and ends three months after they turn 65. During this time, they are also eligible to enroll in Part D (Prescription Drug Plan) or Part C (Medicare Advantage Plan). If a consumer misses their Initial Enrollment Period, they may have to wait to sign up and will be
liable for late enrollment penalties. For those eligible due to disability or certain qualifying circumstances dates are calculated differently.
 
Medicare Advantage Open Enrollment Period (MAOEP)
Between January 1st and March 31st each year, individuals enrolled in a Medicare Advantage Plan (MA or MAPD) can:

• Switch to another Medicare Advantage Plan (with or without drug coverage).
• Dis-enroll from their Medicare Advantage Plan and return to Original Medicare. If they choose to do so, they'll be able to join a Medicare Prescription Drug Plan.
• Switch to another Medicare Advantage Plan (with or without drug coverage) or go back to
• Original Medicare (with or without drug coverage) within the first 3 months they have Medicare.

 
Special Enrollment Period (SEP)
Special enrollment periods are enrollment periods outside of the usual IEP, AEP or OEP when an individual may enroll in a plan or change their current plan. There are various types of SEPs, including SEPs for dual-eligibles (those enrolled in both Medicaid and Medicare), and for individuals whose current plan terminates, who change residency and who meet exceptional conditions. Depending on the nature of the special enrollment period, an individual can:

• Discontinue an enrollment in a Medicare Advantage (MA) plan and enroll in Original Medicare
• Switch from Original Medicare to a Medicare Advantage plan
• Switch from one Medicare Advantage plan to another MA plan

 
Medigap Open Enrollment Period (MOEP)
Medicare eligibles have a six-month open enrollment period that begins the month they turn 65 or older and are enrolled in Part B. During this one-time open enrollment period, they can enroll in a Medigap (Medicare Supplement plan) regardless of their health status, and they cannot be denied coverage. If they do not enroll during their six-month enrollment period, they will have t to answer health questions, may pay higher premiums and may be denied coverage all together.
 
Anniversary/Birthday Rule
Medicare Supplement enrollees can change their Medicare Supplement plan in certain states to another plan of equal or lesser benefits around the date of their anniversary/birthday each year without answering health questions. If your state does not have an underwriting exception such as the Medigap Birthday Rule, your client will likely have to go through underwriting. You must refer to the state’s and carrier’s rules regarding enrolling your clients under a Birthday or Anniversary rule.

​Leaving a Client Uninsured When Switching Plans
When moving a client from one plan to another it’s crucial to ensure that your client has coverage during the transition period. Not using the proper time frame set forth by the carrier or criteria to move a client can be disastrous. Each carrier has very specific rules about transitioning your client from one policy to another and they’re also state specific. Be sure to thoroughly go over all the parameters when it comes to re-writing your client into a new policy.
 
The world of Medicare can seem daunting to seniors and to new insurance agents as well, but with the proper training and education - and an FMO who will be there for you to answer any questions you may have - you’ll be destined for great success. Reach out to us today if we can assist you on your Medicare journey.

By Carolyn Portanova

Entering the Medicare insurance market requires partnering with a Field Marketing Organization (FMO) if you want to work with multiple carriers. An FMO acts as an intermediary between independent agents and insurance carriers, providing access to multiple carriers and products. This partnership enables you to offer diverse solutions to your clients without being captive to a single insurance company.

Selecting the right FMO is crucial for your success. Here are essential aspects to evaluate:

1. Industry Experience and Reputation - An FMO with a longstanding presence in the Medicare market often indicates stability and reliability. Research their history, agent testimonials, and industry standing.
2. Carrier and Product Portfolio - Ensure the FMO offers a broad range of carriers and Medicare products, including Medicare Advantage, Medicare Supplement, and Prescription Drug Plans. A diverse portfolio allows you to meet varied client needs.
3. Commission Structure and Vesting - Understand the commission levels offered and whether you're 100% vested. Confirm if commissions are paid directly by the carrier and inquire about any potential fees or deductions.
4. Training and Educational Resources - Continuous learning is vital. Evaluate the FMO's training programs, webinars, and resources that keep you updated on Medicare regulations and sales strategies.
5. Marketing and Lead Support - Assess the marketing assistance provided, such as co-branded materials, social media support, and lead generation programs. Determine if leads are complimentary or if there are associated costs.
6. Technology and Tools - Modern FMOs should offer tools like quoting systems, enrollment platforms, and Customer Relationship Management (CRM) software to streamline your operations.
7. Compliance and Support Services - Inquire about support for compliance, licensing, and back-office operations. A reliable FMO should assist in navigating regulatory requirements and administrative tasks.​

Before committing, ask the following:

• What is the commission structure, and am I fully vested?
• Are commissions paid directly by the carriers?
• What training and educational resources are available?
• Do you provide marketing support and lead generation?
• What technology tools do you offer?
• How do you assist with compliance and licensing?
• What is your policy on contract releases?
• Can I sell in multiple states through your organization?

With over 30 years of experience, The Brokerage Resource stands out as a full-service FMO committed to agent success. We offer:

• Access to top-rated carriers and a wide product range
• Competitive commissions with 100% vesting
• Comprehensive training and educational programs
• Robust marketing support and lead generation tools
• Advanced technology platforms, including MedicareCENTER and LifeCENTER
• Dedicated compliance and back-office support

​Our mission is to build lasting relationships and provide the resources you need to grow your insurance business. Ready to elevate your Medicare insurance business? Contact us today to learn how we can support your growth.

By Carolyn Portanova

As a busy insurance agent you need technology to help run and manage your business effectively, and our technology does exactly that. From the built-in CRM to manage prospects and clients, to the quote and enrollment capabilities for Life and Health products, to the Integrity for Agents mobile app that lets you work on the go, to the AI prompts that help you access information faster, Integrity Technology is here to help your business grow. MedicareCENTER, LifeCENTER, LeadCENTER and Ask Integrity are the pieces of the puzzle you've been searching for.

Let's get right into the details of MedicareCENTER. You can quickly quote and enroll clients in Medicare Advantage and Prescription Drug plans directly from a contact record. You're able to compliantly record and store phone calls for 10 years per CMS requirements. If you're looking to quote and enroll clients in Medicare Supplement plans, you can do so through the integrated CSG App. You're able to track all your clients and leads regardless of enrollment or quoting system. Easily batch import clients or create a new client on the fly with just an e-mail address or phone number in the CRM and use the dynamic tagging feature which allows you to filter and sort clients and leads by plan type, recommendations or any other important attribute. The robustness of MedicareCENTER, with new enhancements rolling out each quarter, is the most efficient way to manage your Medicare clients.

If you're selling Life products, you'll be able to save time and produce more with LifeCENTER. This platform allows you to quote and enroll clients in Simplified Indexed Universal Life (SIUL) and Final Expense products directly from a contact record. Searching for medical conditions based on medications and getting enhanced underwriting results for both SIUL and Final Expense products makes recommendations easier than ever. LifeCENTER, just like MedicareCENTER continues to evolve. In the coming weeks fully underwritten IUL products are launching, as well as DIME analysis to help you quickly find the right coverage for your clients. Just as MedicareCENTER helps you manage your Medicare clients, LifeCENTER is the key to managing your Life clients.

If you're starting out in the insurance industry or you're just looking to purchase leads, then LeadCENTER is your gateway to purchase exclusive, verified leads for Health and Life. All leads are 100% verified, TCPA compliant and are updated regularly. Utilizing the lead scoring feature to purchase leads based on their likelihood of converting, allows you to prioritize your budget. You have the capability to run real-time campaigns to have live leads funneled to you when you're able to take phone calls or receive live data leads. These leads are then fed directly into your MedicareCENTER CRM. Setting up custom ad campaigns with the ability to select from several different mailer types to target your preferred audience is a breeze in LeadCENTER. All of the marketing and advertising is done for you. All you have to do is login to LeadCENTER, select your preferred demographics and with a few clicks, begin growing your client base.

Get all the client information you need by utilizing the built-in, voice activated AI prompts. Ask Integrity is our proprietary AI software that has been built to help our agents be more efficient. Ask Integrity Shoppers assists you with carrier data and alerts you to clients who have a higher likelihood of shopping and may need to change their coverage. 

Client Connect is the built-in email marketing program that allows you to reach out to your clients to keep in touch with regards to their policies or simply to wish them a happy birthday. You also have the ability to use SMS from within the platform if your clients prefer to be contacted via text message.

The Integrity Technology platform that encompasses all of these elements is free to our contracted agents. Reach out to us today if you would like to learn more and to get started.

By Carolyn Portanova

When you have a client who needs to go through underwriting for a Medicare Supplement policy it's important to interview them beforehand. Typical health questions on a Medicare Supplement application will ask if your client has ever had certain health conditions during a specific period, and generally that look back period is two years. Every carrier is different and has their own specific underwriting guidelines, so it's important to know them before applying. Oftentimes answering "yes" to certain health questions can result in an automatic decline. To prevent that from happening, be sure to get a complete picture regarding your client's health. Below is an example of a typical underwriting question on a Medicare Supplement application:

​In the past two years have you been diagnosed with or treated for any of the following conditions?

• Atrial Fibrillation
• Cancer
• Chronic Obstructive Pulmonary Disease (COPD)
• Diabetes - Type 1 or 2
• Heart Conditions
• Hypertension
• Rheumatoid Arthritis
• Stroke

Certain conditions such as minor high blood pressure and even high cholesterol are typically not an issue for a Medicare Supplement application. Being overweight is also not usually an issue, if your client is not morbidly obese. 

Some insurance carriers require that a certain window of time has passed after a major surgery, before accepting an application. If your client has had recent surgery or is still being treated, you should wait before submitting the application. If your client has been hospitalized in the last few years, is receiving home health care, or if they live in a nursing home, they may also be declined for coverage. Again, every carrier is different, and you need to check their Underwriting guidelines.

​When it comes to cancer, Medicare Supplement carriers usually want your client to be cancer-free for at least two years before they will accept them. However, there are certain carriers who will approve clients with cancer or other serious conditions, but they will charge higher rates for coverage. Therefore, it's wise to run quotes for multiple carriers and review their underwriting guidelines to determine the best course of action.

Diabetes is a condition that could result in a decline, but it depends upon the situation. Underwriters look at the entire picture. For example, if your client has diabetes and high blood pressure and high cholesterol, it's much harder to get approved than if they just have diabetes without any other health conditions.

​It's important to advise your client that insurance carriers have access to national records with regards to prescription history. Encourage your client to remember any and all medications they've been prescribed. Reviewing their medical history is incredibly important. If their doctor has previously prescribed a medication for a certain condition, and you don't mention it on the application, that’s a red flag in the underwriting system. Even if your client never filled the prescription or never took the medication, it needs to be explained.

​When you're ready to submit the application be sure to make the policy effective date a few weeks in advance. This gives the Underwriter plenty of time to review the application and the answers to the medical questions. After the application has been reviewed, an Underwriter will call your client to conduct a phone interview which is a very important part of the decision process. It's important to remind your client to simply answer the questions that the Underwriter asks. Volunteering additional information or over-sharing could cause problems with the application process.

Be sure to let your client know that it's important NOT to cancel any current coverage until after you've been notified that their application was approved. Once it's approved, they will need to call and cancel their existing coverage. 
 
If your client gets denied, it's worth exploring other carriers. Always keep in mind that your client may be better off keeping their current coverage. In addition, remind them that there are no repercussions for applying for a new Medicare Supplement policy in the future.

If you have questions regarding underwriting, please reach out to us and we'll be happy to assist you.

By Carolyn Portanova

​The Medicare Advantage Enrollment Period runs from January 1st - March 31st which is beneficial to those clients who are currently enrolled in Medicare Advantage plans. They don't have to wait until the Annual Enrollment Period in October to make changes to their plans if they're not satisfied with them.​​ They can switch to another Medicare Advantage Plan (with or without drug coverage) or even dis-enroll from their current Medicare Advantage Plan and return to original Medicare. If they choose to do so, they'll be able to join a Medicare Prescription Drug Plan as well (Part D).

​Things to consider if your client wants to make a switch:

• Are their doctors and providers in the new plan network?
• Are their prescription drugs on the plan formulary?
• How do the premiums, deductibles, copays, and coinsurance stack up to their current MA plan?
• Does the new plan offer additional coverage such as Dental, Vision, and Hearing, fitness programs or OTC allowance?

​Remember, if your client enrolled in a Medicare Advantage Plan during their Initial Enrollment Period, they can change to another Medicare Advantage Plan (with or without drug coverage) or go back to Original Medicare within the first three months they have Medicare.

​If your client switches to a different Medicare Advantage Plan or they choose to go back to original Medicare their new coverage will start the first day of the month after their new plan receives the request for coverage. An important detail to remember though, if your client decides to go back to original Medicare and they want to enroll in Medicare Supplement plan, they will have to go through underwriting.

​Keep in mind, the best time for your client to enroll in a Medicare Supplement plan is during their six month Medigap Open Enrollment Period. During this time they can purchase ANY Medicare Supplement policy sold in their state, even if they have health issues. This period starts the first month they have enrolled in Medicare Part B and they're age 65 or older.

There are many details to consider, before assisting your client with new coverage. Creating a Pros & Cons list to review both plans' benefits is important before making any change.

By Carolyn Portanova