Prior Authorization is Coming for Traditional Medicare in 2026?

Prior Authorization is Coming for Traditional Medicare in 2026?

Prior Authorization is Coming for Traditional Medicare in 2026?
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If you’re on Traditional Medicare and live in New Jersey, Ohio, Oklahoma, Texas, Arizona, or Washington, there’s a big change coming your way starting January 1, 2026. Medicare is rolling out a pilot program called the WISeR model (short for Wasteful and Inappropriate Services Reduction), and it’s introducing something many people associate more with Medicare Advantage: prior authorization.

So… What Is Prior Authorization?

Think of prior authorization as a permission slip from Medicare. Before your doctor can move forward with certain procedures, like back surgery or an epidural, they have to get Medicare’s okay first. If Medicare doesn’t approve it, you could be on the hook for the full cost.

It’s a step that can help reduce unnecessary or risky treatments, but it also means more red tape and possible delays in getting care.

Question: Why Is Medicare Doing This?

According to Medicare, the WISeR model is all about:

  • Cutting down on fraud and wasteful spending
  • Protecting patients from unneeded or potentially harmful treatments
  • Using tech and expert review teams to ensure high-quality, cost-effective care

They’re emphasizing that the goal isn’t to deny care, it’s to make sure the care provided is truly necessary.

Which Services Will Need Approval?

There are 17 outpatient services that will now require prior authorization. These include:

  • Back and neck surgeries
  • Knee and joint surgeries
  • Certain pain treatments, like epidural injections
  • Skin grafts and nerve stimulators

These procedures have been flagged by Medicare as being overused in some cases.

Got a Medigap Plan? Here’s What to Know

If you have a Medicare Supplement (Medigap) plan like Plan G or Plan N, these changes still affect you. Here’s how:

  1. Medicare Has to Say Yes First: Medigap only helps cover your costs (like deductibles and copays) after Medicare approves the service. If Medicare says no, Medigap won’t pay.
  2. It Might Take Longer to Get Care: Prior authorization can slow things down while your provider waits for Medicare to review and approve.
  3. Less Freedom Than Before: Traditional Medicare has always been known for its flexibility. This change adds a layer of control, at least for these 17 services.
  4. No Formal Appeal: If Medicare denies the request, your doctor can submit more info, but there’s no official appeals process in this pilot.

How Does This Compare to Medicare Advantage?

If this all sounds familiar, it’s because prior authorization is standard in Medicare Advantage plans. But there are a few key differences:

  • Traditional Medicare is run by the government, while Medicare Advantage is managed by private insurance companies.
  • Only 17 services are affected in this pilot for Traditional Medicare, Medicare Advantage often requires prior approval for a much wider range of services.

What’s Next?

For now, this is just a pilot program in six states. But if it works the way Medicare hopes, don’t be surprised if it expands to other states, or even more services.

Even if you don’t live in one of the pilot states, it’s a good idea to keep an eye on this. The changes may eventually impact you, too.

What Beneficiaries Can Do Right Now

  • Talk to your doctor: Before scheduling any procedures, ask if prior authorization is required.
  • Plan ahead: Some treatments may take longer to get approved.
  • Stay informed: Keep tabs on updates from Medicare, especially if you travel or relocate.

The WISeR model is a significant shift for Traditional Medicare. For beneficiaries, especially those with Medigap, it may feel like an unwanted dose of bureaucracy. However, Medicare views it as a means to rein in waste and ensure that care is truly necessary. Either way, it’s a good reminder to stay proactive, ask questions, and stay informed, because this pilot might just be the start of bigger changes ahead.

Contact your Pinnacle Financial Services team member today at 800-772-6881 or sales@pfsinsurance.com to get more information on Medicare selling.

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Bob Brzyski

Bob Brzyski

Vice President, Marketing

x7742 | bbrzyski@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881 support@pfsinsurance.com

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Always Be Marketing: The Mindset Shift Insurance Professionals Need in 2025

Always Be Marketing: The Mindset Shift Insurance Professionals Need in 2025

Always Be Marketing: The Mindset Shift Insurance Professionals Need in 2025
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Let’s get this out of the way upfront:
“Always Be Closing” “ABC’s” of Sales still has its place.

Asking for the sale is part of the job, and a critical one at that. Whether you’re helping someone enroll in a Medicare plan or choose the right life insurance policy, closing is how we turn conversations into clients and value into revenue.

But here’s the thing: in 2025, the way people buy insurance and the way they choose an agent has changed. It’s not about high pressure pitches or end, of, call ultimatums anymore.

It’s about trust. It’s about visibility. It’s about value.
And that’s why the new mantra is: 

Why “Always Be Marketing”, ABM Matters More Than Ever

Marketing isn’t just something you do when business slows down.
It’s what creates the business in the first place.

When you show up consistently, online, in your community, in people’s inboxes, you build familiarity and credibility long before someone picks up the phone or clicks “Schedule a Call.”

In today’s world, your marketing is your first impression.

The Modern Insurance Funnel: From Stranger to Superfan

Here’s how it works when you’re in the ABM mindset:

  1. A Facebook ad or short video catches someone’s eye.
  2. They download your “Medicare 101 Checklist” or sign up for your webinar.
  3. Your email series educates, answers questions, and builds trust.
  4. SEO Matters- They reach out, already feeling like they know you.
  5. You guide them to the right solution, and yes, you close the sale.

All of that? Marketing. And it works.

Social Media Is the New Warm Call

Let’s be honest, nobody’s picking up random phone calls these days.

But your potential clients are scrolling:

  • Facebook
  • LinkedIn
  • Instagram
  • YouTube

And when they see your face, hear your voice, and get real, helpful insights from you? You’ve already started the relationship.

Post consistently. Be authentic. Educate generously.
You don’t need to go viral; you just need to be visible.

Seminars Still Work, Snacks Optional, but Encouraged

Hosting a seminar or webinar is one of the most effective ways to connect.

In-person Medicare 101 sessions, virtual Q&As, and retirement workshops all provide value first. And when people trust you as a guide, the “sales” part feels natural, not pushy.

Bonus: People remember who fed them. Never underestimate the power of coffee and donuts.

Don’t Forget About Email (It’s Still Gold)

Think email is outdated? Think again.

A well-crafted email campaign is like a silent salesperson working around the clock. It can:

  • Welcome new leads
  • Share testimonials
  • Remind clients to review their coverage
  • Offer timely tips and updates

Automated, helpful, and consistent content is the unsung hero of the ABM strategy.

Yes, Closing Still Matters

Let’s not throw the baby out with the briefcase.

“Always Be Closing” isn’t wrong, it’s just not the whole story.

When your marketing has done the job of warming up your leads, asking for the sale becomes simple. You’re no longer a stranger; you’re the trusted expert they’ve been learning from for weeks.

The best closers? They’re backed by even better marketing.

Build the Brand, Fill the Funnel

In 2025, it’s not about pitching harder; it’s about showing up smarter.

  • Build your brand.
  • Stay visible.
  • Educate first.
  • Nurture leads.

Then, when the moment comes to say, “Are you ready to move forward?”, the answer will more often be: “Yes, I’ve been waiting to talk to you.”

So go ahead and close, but always be marketing.

Ready to Grow Your Brand?

At Pinnacle, we believe that marketing isn’t optional; it’s essential. Whether you need help building your funnel, creating content, running seminars, or standing out on social media, our marketing team is here to support you every step of the way.

Contact your Pinnacle Financial Services team member today at 800-772-6881 or sales@pfsinsurance.com to start growing your brand and taking your business to the next level.

Not Contracted with Pinnacle- Get set up today: Spot Sign

Need Proven Lead Program- Leads & Marketing

For more information, contact a Pinnacle Financial Services representative today 1 (800) 772-6881 x7731 | sales@pfsinsurance.com
Bob Brzyski

Bob Brzyski

Vice President, Marketing

x7742 | bbrzyski@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881 support@pfsinsurance.com

Contact Us

Contact a Pinnacle Financial Service representative today for assistance.

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2026 Medicare Advantage Commissions

2026 Medicare Advantage Commissions

2026 Medicare Advantage Commissions
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2026 Medicare Advantage Commissions have been announced. Commission increases will take place for 2026 Medicare Advantage and Medicare Part D sales per the announcement by the Center for Medicare and Medicaid Services (CMS)

FOR CA AND NJ

  • Initial MA commissions $864/member/year
  • Renewal MA commissions $432/member/year

FOR CT, DC, AND PA

  • Initial MA commissions $781/member/year
  • Renewal MA commissions $391/member/year 

FOR PUERTO RICO AND THE U.S. VIRGIN ISLANDS

  • Initial MA commissions $474/member/year
  • Renewal MA commissions $237/member/year

In all other states, initial MA commissions increased to $694/member/year.

Renewal commissions increased to $347/member/year.

 

Initial
Renewal
Product
Region
2026
2026
MAPD
National
$694
$347
CT, PA, & DC
$781
$391
CA & NJ
$864
$432
Puerto Rico & U.S. Virgin Islands
$474
$237
PDP
National
$114
$57
For more information, contact a Pinnacle Financial Services representative today 1 (800) 772-6881 x7731 | sales@pfsinsurance.com
Bob Brzyski

Bob Brzyski

Vice President - marketing & Business Development

x7742 | bbrzyski@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881 support@pfsinsurance.com

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Contact a Pinnacle Financial Service representative today for assistance.

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How to do SEO

How to do SEO

How to do SEO
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Let’s talk about something that can feel a little mysterious but is incredibly important: SEO. You’ve probably heard the term tossed around, especially when people talk about websites, Google rankings, or “getting found online.”

But what does it really mean? And more importantly, how do insurance agents like you grow your business in 2025?

Let’s break it down.

So, What Is SEO?

SEO stands for Search Engine Optimization. Basically, it’s the process of helping your website show up when someone searches for something on Google, Bing, or any other search engine.

Think of it like this: when a potential client types in “Medicare agent near me” or “best Medicare plans 2025,” Google scans the internet to find the most relevant results. It does this using little bots called crawlers that collect information from websites and organize it into a giant index.

Then, like magic (but through some serious algorithms), Google decides which sites to show first.

The goal of SEO? Get your website as close to the top of those results as possible. Let’s be honest: no one is clicking on page 5 of Google.

Why Should Insurance Agents Care?

Because your clients are already searching for you online.

The world has changed a lot over the past few years. In 2020, COVID-19 forced many of us to rethink how we connect with clients. Gone were the days of regular in-home appointments. So much has moved online, Zoom calls, e-apps, and remote enrollments.

And while some of that was temporary, much of it stuck around. Digital is the new normal.

That means your online presence isn’t just “extra”, it’s essential. If someone searches for Medicare help in your area, and you’re not showing up… that’s a missed opportunity.

So, How Does SEO Actually Work?

Here’s the simple version:

  1. Search engines crawl your website.
    They look at your content, keywords, headlines, links, and more.
  2. They index that info.
    Think of it like a massive digital filing system.
  3. They run it through an algorithm.
    That algorithm decides how useful your site is for specific searches.
  4. Then you show up in search results.
    Ideally, higher in the rankings. That’s where SEO helps.

Good SEO makes sure your site checks all the right boxes, so when someone’s looking for Medicare help, your name is front and center.

How Pinnacle Helps Agents with SEO

Now, if you’re thinking, “This all sounds great, but I’m not a tech expert,” don’t worry. That’s where we come in.

At Pinnacle Financial Services, we give our agents access to tools that help them look great online, without needing to become a digital marketer overnight.

One of our most popular features? A personalized agent website (with your own URL). It’s fully equipped with quoting tools, enrollment capabilities, and lead tracking, and the best part. It’s completely free for our contracted and ready-to-sell agents.

You can share it on social media, in emails, or link to it from ads. It’s SEO-friendly and helps get your name out there, where your clients are already looking.

 

In 2025, SEO isn’t just for big companies with fancy marketing teams. It’s for agents, like you, who want to stay competitive and grow their brand online.

Whether you’re hosting a seminar, posting on Facebook, or just trying to get your phone to ring, being findable online matters.

And the best part? You don’t have to do it alone.

Ready to Grow?

Our team at Pinnacle is here to help you build your online presence, attract leads, and close more business, all with tools that are easy to use and designed just for insurance agents.

Call us at 800-772-6881
 Or email us at sales@pfsinsurance.com

Let’s make sure people can find you when they need help with Medicare.

Not Contracted with Pinnacle- Get set up today: Spot Sign

Need Proven Lead Program- Leads & Marketing

For more information, contact a Pinnacle Financial Services representative today 1 (800) 772-6881 x7731 | sales@pfsinsurance.com
Bob Brzyski

Bob Brzyski

Vice President, Marketing

x7742 | bbrzyski@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881 support@pfsinsurance.com

Contact Us

Contact a Pinnacle Financial Service representative today for assistance.

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Best Medicare FMO for Growth

Best Medicare FMO for Growth

Best Medicare FMO for Growth
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The Medicare insurance market continues to grow, creating an exceptional opportunity for independent agents to scale their business. To succeed in today’s competitive environment, agents need to align with the Best Medicare FMO—one that offers high-quality lead programs, cutting-edge technology, comprehensive training, and unmatched agent support. That’s exactly where Pinnacle Financial Services delivers.

Why Pinnacle Financial Services Is the Best Medicare FMO for Independent Agents

With numerous FMOs and IMOs promising the world, selecting the right partner can be a challenging task. At Pinnacle Financial Services, we earn the title of Top Medicare FMO by consistently delivering results-driven tools and support that help agents grow faster and more efficiently.

We don’t just claim to be the best—we prove it every day through our focus on:

  • Proven Medicare lead generation programs
  • Innovative agent training and onboarding
  • User-friendly technology solutions
  • Dedicated back office and compliance support

Comprehensive Tools and Resources That Set Pinnacle Apart

Pinnacle Financial Services empowers Medicare agents with a robust suite of tools, training, and lead generation support—all offered at no cost to our partners:

Start strong with exclusive access to high-quality Medicare leads designed to help you book more appointments and close more sales.

  • State-of-the-Art Technology

Leverage advanced digital tools, including:

Ongoing Medicare Agent Training

Whether you’re new or experienced, our in-person and virtual training sessions provide up-to-date knowledge across Medicare Advantage, Medicare Supplement, and PDP plans. We also offer free CE (Continuing Education) credits to keep your license in good standing.

  • Top-Tier Medicare Commissions

Pinnacle partners benefit from competitive commission structures across all carriers, helping you maximize your earnings with every sale.

Our experienced staff is ready to guide you through every aspect of the Medicare sales process—from onboarding to retention—with personalized agent support and compliance assistance.

Ready to Grow? Join Pinnacle, Your Medicare FMO Partner

Whether you’re just starting started in Medicare sales or are already a top producer, Pinnacle Financial Services offers everything you need to scale your business—qualified leads, smart technology, continuous training, and support that puts agents first.

Contact Us Today

Get started with the #1 Medicare FMO by reaching out:

Phone: 1 (800) 772-6881 x7731
Email: sales@pfsinsurance.com

Pinnacle Financial Services is more than just an FMO—we’re your partner in Medicare sales success. Let us help you unlock your full potential as a high-performing Medicare agent.

 

For more information, contact a Pinnacle Financial Services representative today 1 (800) 772-6881 x7731 | sales@pfsinsurance.com
Bob Brzyski

Bob Brzyski

Vice President of Marketing

x7742 | bbrzyski@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881 support@pfsinsurance.com

Contact Us

Contact a Pinnacle Financial Service representative today for assistance.

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