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How You Can Become a Medicare Insurance Agent in 2022

Written by Shelby Hudson

April 8, 2022

Have you ever considered adding Medicare products to your portfolio? Are you looking to dip your toes into the world of Medicare Insurance? There is no better time than now – public interest in Medicare Advantage (Part C) is rising.

Over the last decade, Medicare Advantage (Part C) enrollment has more than doubled, and it is projected to reach 51% of Medicare beneficiaries by 2030.

The variety of plans and carriers you can offer to clients is also increasing. The average client will be able to choose from a selection of 33 different Medicare Advantage (Part C) plans.

It’s safe to say this makes navigating Medicare Advantage (Part C) a confusing landscape for clients. The need for knowledgeable insurance agents looking to make a difference is higher than ever.

Initially, you will need to learn about all of the Medicare coverage options (outside of just Medicare Advantage (Part C) plans, such as the parts of Original Medicare and Medicare Supplement Insurance Plans and the rules for eligibility for each. You will also need to get licensed to sell (if you are not already an agent), complete required training, and get contracted with carriers. Although this may sound like a lot for someone new to the industry, this article will cover everything you need to know.

A Lucrative Career

Are you wondering if it is a good financial decision to add Medicare Advantage (Part C) to your portfolio? The answer is yes. An average Medicare Advantage (Part C) policy pays out about $287 each year for a plan renewal. For new clients, that number almost doubles at $573.

Consider one replacement policy to be $300 in commissions to simplify the math. If you sell 250 Medicare Advantage (Part C) plans in your first year, you will have made $75,000 in commissions alone. If you continue to maintain your client base and add to it each year, you could be looking at years where you earn six figures or more in commissions!

Getting Licensed and Completing Training

No matter how much insurance experience you bring, you must have proper Medicare sales training to complete the certification process.

The Importance of Training

When it comes to Medicare, products & regulations change annually; new plans come into new markets, existing plans shift what they offer, etc. However, changes are not always carrier-specific; sometimes, there are changes across all of Medicare Advantage (Part C). For example, click here to read about the Centers for Medicare and Medicaid Services (CMS) ‘s newly mandated cost-sharing for prescription drug payments.

Changes such as the above are why completing annual training is so important when you are a Medicare insurance agent. You will be more equipped to provide your clients with the help they need after finishing your yearly training.

How Much Time Do You Need for Training?

Set aside 2-3 weeks to complete all the training requirements if you are new to the Medicare market. No matter what time of year it is or how far away the Annual Election Period (AEP) is, it is good to get started early. You need to be knowledgeable about Medicare to earn the trust of prospective clients to close sales.

The sooner you get started, the more you can learn.

Also, the more you get prepared before Annual Election Period (AEP), you can set yourself up for better success and get ahead of the competition.

Necessary Licensure

Like with any other insurance product, you need to be licensed to sell health insurance if you are not already. While the specifics vary from state to state, you will need to have a resident license for your home state and non-resident licenses in any other states you plan to sell in. This information (including necessary documentation) can be found on each state’s insurance department website.Visit the National Insurance Producer Registry (NIPR) when you are ready to apply.

You will also have to complete America’s Health Insurance Plans (AHIP) certification, which helps protect beneficiaries & reward agents who do business compliantly.

AHIP

AHIP Certification is required by the Centers for Medicare and Medicaid Services (CMS). All agents who sell Medicare are required to take this certification test annually. AHIP training covers:

  •  Eligibility Basics
  • Available Benefits
  • Options for Prescription Drug Coverage
  • Marketing & Enrollment Regulations & Compliance

You only get three attempts at the AHIP test, so make sure to prepare well before taking the test. There are many self-study resources available online.

The test costs $175, but contact Agent Pipeline to learn more about how you can get AHIP Certified at a discounted rate. For more information on AHIP, visit their website.

Fraud, Waste, & Abuse (FWA) Training

FWA training is essential and covers topics including:

  • Tools and methods for detecting Medicare fraud
  • The human and financial cost of fraud, waste, and abuse
  • Proper reporting procedures

Before, agents had to take this training separately from AHIP, but they are both offered under the same umbrella. Like with contracting with carriers, you can get ahead of the competition by getting these certifications done early. Then you will have less to worry about as Annual Election Period (AEP) approaches.

Carrier Contracts

Once you get your license, you need to contract with Medicare carriers to sell their products. You will also see this referred to as “getting appointed.”

Some carriers will allow you to skip the contracting process if you sell their other product lines; others will require a contract for each product you sell. Once the paperwork is submitted, the turnaround time to be around 7-10 days. If the Annual Election Period (AEP) is approaching, the time could become as much as 4-6 weeks. Want to make your contracting process even easier? Agent Pipeline can make getting contracted with top Medicare Advantage (Part C) carriers more effortless than ever.

Read the contracts carefully, as they list everything you need to know about working with and selling this carrier’s products.

Carrier Courses and Staying Certified

You will often need to take product-specific courses from carriers alongside your AHIP training. Make sure to get clarification from each carrier you work with because specifics vary across all carriers. Keep in mind you will need to recertify annually with each carrier.

What Options Should You Offer?

Medicare Advantage (Part C)

Medicare Advantage (Part C) coverage combines the coverage of Original Medicare (Part A & Part B) with some enhancements. Some Medicare Advantage (Part C) plans include prescription drug coverage (Medicare Part D Prescription Drug Plan). This is a popular option for clients.

The CMS sets a limit on Medicare Advantage (Part C) commissions each year, and it is $573 per beneficiary (first-time enrollment) or $287 for renewals for 2022. Some states have higher limits.

Medicare Supplement (Medigap)

Clients better suited to Original Medicare can supplement it with Medicare Supplement Insurance Plans. Medicare Supplement Insurance Plans cover many of the costs left behind by Original Medicare, but the plans themselves tend to be more expensive.

Medicare Supplement Insurance Plans commissions are based on a percentage of the plan’s premium instead of flat rates like Medicare Advantage (Part C).

Medicare Part D Prescription Drug Plan

You can offer Medicare Part D Prescription Drug Plan plans separately for clients who do not enroll in Medicare Advantage plans that include drug coverage.

In 2022, these commissions are capped at $87 for first-time enrollment and $44 per renewal.

Ancillary Products

Selling ancillary products alongside Medicare can be a massive help for you and your clients. Many ancillary plans are specifically designed to fill in Medicare plans’ coverage gaps left behind. Some examples include long-term care insurance, dental plans, hearing and vision insurance, hospital indemnity, cancer, heart attack, and stroke plans.

Working with a Field Marketing Organization (FMO)

When it comes to getting appointed with carriers, it can be challenging to get a direct contract if you are not a captive or employed agent. However, working with an FMO (like Agent Pipeline) can help you acquire your contracts while also alleviating a lot of paperwork and stress.

Through Agent Pipeline, you can get access to top-level contracts and some of the best product offerings in the market. We have contracts with leading carriers, allowing you to offer your clients a wide range of product options. Our industry-leading broker and agent support team are there to help you alleviate a lot of the back-end stress of contracting.

Choosing Plans to Sell

It can become overwhelming to try and sell all of the carriers from day one. Our team can help you evaluate the offerings in your market and help you choose the best options for your business to start. Here are some tips to help you understand how to determine which plans to get appointed to sell:

Narrow it Down

Think about your target market and its needs. Consider the possible scenarios and what kind of products would best help them. Aim to get contracted with a good variety of plans to meet a wide range of needs. Make sure to look at the minimum product requirements for carriers as well – some require at least one enrollment per product to evade termination.

It is wise to start with brand name carriers such as UnitedHealthcare, Cigna, Aetna, or Humana. These carriers have more brand awareness and tend to be easier to sell. Some carriers may have multiple plans. Here are some criteria to help you evaluate Medicare Advantage (Part C) plans:

Star Ratings

Check out how each plan scores on Medicare’s Five-Start Quality Rating System, assessing them in five different areas.

  1. Preventative care
  2. Chronic illness management
  3. Plan responsiveness
  4. Customer service
  5. Member complaints and attrition

Care quality and customer service are two of the most important to pay attention to – they mean the most to your clients.

Premiums & Costs

Before you offer a client a plan, ensure you know its monthly premium and how that compares against the client’s budget. If you’re new to the business, compare it to similar plans to see how it compares.

Look at the plan benefits and see how those relate to copays and coinsurance, and compare that information across plans.

Sometimes clients don’t think of copays or coinsurance when setting aside their budget for their Medicare plan. Have a strategy to help clients understand and make them aware of the out-of-pocket costs for each plan; use different scenarios such as high vs. low need clients.

All clients will have their priorities regarding out-of-pocket costs, so offer a wide enough range of plans to make sure you can serve everyone from those who prioritize a high premium, low out of pocket to those who prioritize having a low premium over everything else.

Networks

If you are working with clients in existing Medicare plans, check if their current providers will be in the new plan’s network. For many clients, not switching doctors is very important.

Determine each plan network’s size and variety so that you can better advise new clients as well.

Drug Formulary

Your prospects will have questions about prescriptions, so find out:

What kind of prescriptions are in each plan’s formulary?

What are the costs at different tiers?

Each carrier divides its tiers differently, so pay close attention to this.

Additional Benefits

People often enroll in Medicare Advantage (Part C) plans because they sometimes offer benefits not included in Orignal Medicare, such as:

  • Gym memberships or discounted memberships
  • Transportation benefits
  • Over-the-Counter medicine benefits
  • Meal benefits
  • Dental, vision, and/or hearing benefits

Ordering Medicare Enrollment Kits

Each carrier will have an enrollment kit that includes everything the clients need when enrolling in Medicare. Kits can vary, but most contain:

  • A Medicare Advantage (Part C) enrollment application
  • A pre-enrollment checklist with information about the plan, network, copays, benefits, etc.
  • Most recent star ratings for different plan options
  • Guide on how to access standard services
  • Low-income subsidy information that helps clients understand if they qualify
  • County-specific coverage information

When you are first appointed, order enrollment kits for every area you cover – each county is different. For help with ordering supply kits, reach out to Agent Pipeline.

Tools

To start connecting with prospects and selling Medicare, you need a few tools to keep your business running smoothly. You will need a CRM to keep your customer information updated and housed to manage your book of business. It would be best to get an online quoting & enrollment tool. If you work with Agent Pipeline, you will get access to MedicareCENTER, our industry-leading all-in-one CRM, quoting, and enrollment tool.

E&O Insurance

Although you may have the best intentions, things may not always go as planned in the insurance industry. If a client feels like you have wronged them, they can take you to court. Errors & Omissions (E&O) insurance helps protect you from these lawsuits that could otherwise significantly impact your insurance agency’s ability to do business. Although it cannot stop the case entirely, it can help mitigate or eliminate the court costs or settlements.

 Although your job is mainly to protect your clients, it is essential not to forget about protecting yourself and your insurance agency.

Why Choose Agent Pipeline? We Help Agents Succeed.

For over 34 years, we have been providing insurance agents with the back-office support, technology solutions, compliance reviews & assistance, and marketing strategy development they need to help grow their business.

At Agent Pipeline, we meet agents where they are. Whether you’re brand new to the insurance industry, a veteran agent, or a start-up looking for support with an insurance agency, we can help!

  • We support agents with all of their insurance carrier needs, including supporting agents with member service issues, commission questions, contracting, or other escalated items that should be directed to the carrier.

  • We provide no-cost agent technology for business automation and provide consultations and guidance on tools that are a good fit for your unique business needs.

  • We enable agents to maximize their marketing efforts and objectives by supporting creative design, strategy development, guidance on compliance, and much more.

  • We have exclusive opportunities for co-op marketing funds and help guide agents to programs that will yield a high return on investment (ROI).

Agent Pipeline can help you every step of the way. If you are ready to get started, or have any questions, reach out to 800.962.4693.

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