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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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.

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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.

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