fbpx
2025 Part D Changes

2025 Part D Changes

2025 Part D Changes
j
Comments

For the plan year 2025, CMS has announced some massive changes to the Part D program. These changes are in an effort to both streamline and simplify the Part D program for seniors.

Key Changes for 2025

Some of the key changes for 2025 for the part D program include:

  1. Removal of the Donut Hole (Gap Phase) and Initial Coverage Phase- These 2 are being merged together and will be now referred to as the “Standard Coverage Phase.” This condenses the Part D program from 4 phases to 3 (Deductible, Standard, Catastrophic).
  2. The Annual Out of Pocket (OOP) threshold is now $2,000 (changing from the current $8,000) TrOOP.
  3. The sunsetting of the Coverage Gap Discount Program (CGDP) and the establishment of the Manufacturer Discount Program. This will impact what drugs receive discounts, how they are counted towards the $2,000 OOP, and who is responsible for the cost beyond the set amount.

Where does Pinnacle Financial Services come in?

Pinnacle Financial Services is a full-service “FMO” that will always keep you in the know on industry changes. Medicare is always changing yearly and it’s best to understand new rules and regulations. Outside of the industry knowledge, Pinnacle has full-service back office support, top-notch training, and the best technology in the business. Don’t hesitate and call us today about an exclusive opportunity to market an IE-SNP product!

Check out the 2025 CMS Final Rule regulations proposed Here.

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Author Position

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.

CallEmail

Understanding Dental Benefits in Medicare: A Simple Guide

Understanding Dental Benefits in Medicare: A Simple Guide

Understanding Dental Benefits in Medicare: A Simple Guide
Comments

Medicare is health insurance for people 65 or older. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease). 

Some people get Medicare automatically, others have to actively sign up — it depends if you start getting retirement or disability benefits from Social Security before you turn 65. 

It comprises various components, each of which addresses a distinct health requirement, much like puzzle pieces. We’re delving into Medicare’s treatment of dental benefits today, with a particular emphasis on Parts A and B and Medicare Advantage.

What are Parts A and B of Medicare?

On a high-level view, most of Part A is devoted to hospital insurance, skilled nursing care, and hospice care. Part B is dedicated to services from doctors and outpatient care.

Do Medicare Parts A & B Cover Dental?

This is where dental care can get a little complicated. Medicare Parts A and B typically do not cover routine dental care, including dental exams, cleanings, fillings, dentures, and the majority of tooth extractions.

There are a few exceptions, though. For instance, Part A might pay for dental care if you require it while in the hospital as part of a more extensive treatment plan. Consider that you are undergoing jaw surgery and that the procedure includes dental work. Since it’s seen as a component of your overall medical care in this instance, Medicare may be able to assist with the costs.

What About Medicare Advantage?

Things start to look up from here. Medicare Advantage Plans, sometimes referred to as Part C, are essentially an enhanced version of the original Medicare program. Medicare-approved private insurance providers provide these plans. One of its features is that many Medicare Advantage plans provide dental insurance. Keep in mind that Medicare Advantage Plans are not required to cover more than original Medicare Parts A and B, so not every MA plan will have dental.

Dental treatment for more involved procedures like crowns, bridges, and dentures as well as more basic procedures like cleanings, exams, X-rays, and fillings can be included in a Medicare Advantage Plan. It’s crucial to remember, though, that dental coverage varies greatly among Medicare Advantage plans. While some provide basic dental care, others might offer more extensive coverage.

Stand-alone Dental Coverage

Because they recognize how important dental health is, many Medicare beneficiaries inquire about dental coverage.  This is the point at which you can begin the dental coverage discussion through a stand-alone supplemental (stand-alone) dental plan.  There are numerous options, as well as dental insurance providers. Each plan offers a variety of coverage options, such as exams, cleanings, fillings, and other dental operations. It is important for beneficiaries to understand that dental plans work well only when they receive dental treatment from in-network providers. As an agent, you must confirm that the dentist they are thinking about is covered under that particular dental plan.

 

Delta Dental

Pinnacle Financial offers several options for stand-alone dental insurance. One such option, Delta Dental, is well-known for its strong network and benefits. Delta is also available in all 50 states and covers a wide variety of preventative and major services.  This can be a great option for individuals who have a Medicare Supplement plan as they do not cover any dental insurance.

To learn more about the different plan options available to your clients, contact a Pinnacle Financial Services team member today. They can be reached at 800-772-6881 x-7731 or by email at healthsales@pfsinsurance.com.

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Vice President- Marketing

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.

CallEmail

Humana Medicare Supplement Extra Services

Humana Medicare Supplement Extra Services

Humana Medicare Supplement Extra Services
j
Comments

Medicare Supplement plans provide are important for paying costs not covered by original Medicare Parts A and B. With a Humana Medicare Supplement with extra services Humana has gone one step further. This package of extra benefits is intended to improve members’ overall healthcare experiences in addition to covering the gaps left by Medicare as part of a traditional Medicare Supplement.

Let’s explore these additional services:

Discounts on services

Vision Care: Members can save with providers in EyeMed’s Select network including LensCrafters®, Pearle Vision®, and Target Optical®.

Prescription medicine: Discounts available on some medicines at the drugstore with a Humana member ID.

Hearing aids and services: Discounts available through HearUSA and TruHearing®.

Lifeline medical alert system: Members can choose from multiple fall detection service options from Lifeline® at discounted prices.

Managing health

  • Humana Well Dine®*: Members may get 14 nutritious meals delivered to their door after an overnight stay in a hospital or nursing facility. *Not available in Montana or North Dakota.
  • HumanaFirst® Nurse Advice Line: A 24-hour a day, seven days a week toll-free line where members can speak with a registered nurse about non-emergency illnesses or injuries.
  • SilverSneakers fitness program**: Basic fitness center membership at any participating SilverSneakers® facilities. Includes group classes and working with a trained adviser to develop an exercise plan. SilverSneakers Steps®, an at-home option, is also available. **SilverSneakers is not available with Humana Achieve Medicare Supplement plans.
  • MyHumana Mobile app and website: Access to Humana.com or our secure mobile app to view plan benefits, claims, and more.

The programs and services described are not insurance and are neither contractually offered nor guaranteed under Humana Medicare Supplement insurance policies. They may be provided by a third party, discontinued at any time and are subject to geographic availability.

Expert assistance is only a phone call away for agents who are interested in learning more about how Humana’s Medicare Supplement Extra Services can fit with their clients. To get more information, call 800-772-6881 x-7731 to speak with a Pinnacle Financial Medicare professional.

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Vice President- Marketing

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.

CallEmail

4 Ways To Harness the Power of Life Insurance in Estate Planning

4 Ways To Harness the Power of Life Insurance in Estate Planning

4 Ways To Harness the Power of Life Insurance in Estate Planning
j
Comments

While life insurance is commonly associated with providing financial protection for loved ones to cover final expenses, it can also serve as a valuable and versatile tool in estate planning. By understanding the various ways life insurance can be employed in estate plans, we can help our clients make informed decisions that align with their goals and objectives. Here are just four important ways life insurance can be used in retirement and estate planning:

1. Pay Estate Taxes

Estate taxes can pose a significant burden on the assets left behind. By incorporating life insurance into an estate plan, individuals can ensure that their beneficiaries have the necessary funds to cover these taxes.

In 2023, estates worth more than $12.92 million ($25.84 million for married couples) were subject to taxation of up to 40%. The tax bill is typically due within nine months of the estate owner’s death, which can create financial strain for heirs inheriting illiquid assets.

Life insurance proceeds can provide immediate liquidity, allowing heirs to address estate taxes without the need to sell assets at potentially below-market valuations.

2. Equalize Inheritance Distributions

In situations where there are multiple heirs and assets that are not easily divisible, life insurance can help equalize inheritance distributions.

A recent article from MassMutual highlights the example of a family business or valuable property that some heirs may wish to sell while others want to retain. By using life insurance, the heirs who wish to sell can be compensated with the death benefit proceeds, ensuring a fair and equitable distribution of assets. This approach helps preserve family harmony and the viability of the business or property.

3. Fund Irrevocable Trusts

Irrevocable trusts are commonly used in estate planning to protect assets and minimize estate taxes. Life insurance can be a powerful tool for funding these trusts.

By naming the trust as the beneficiary of a life insurance policy, the death benefit proceeds can be excluded from the estate, reducing potential estate tax liabilities. This strategy provides immediate liquidity to cover expenses or distributions outlined in the trust, ensuring that the intended beneficiaries receive their designated share.

4. Earmark Funds for Specific Purposes

Life insurance can also be used to earmark funds for specific purposes within an estate plan, like paying off divorce obligations or for child support.

By establishing a trust and designating the life insurance policy as the funding source, individuals can ensure that their financial obligations are met even after their passing. This approach provides a reliable source of funds and financial security for loved ones, alleviating potential financial burdens.

It’s crucial to have open and honest conversations with our clients about the benefits of incorporating life insurance into their estate planning. By understanding their unique circumstances and goals, we can help them make informed decisions that align with their needs. It’s important to emphasize that estate planning is a complex process, and consulting with an estate planning attorney is essential to ensure that the chosen strategies are appropriate and legally sound.

The Takeaways

Life insurance proceeds can provide immediate liquidity, allowing heirs to address estate taxes without the need to sell assets at potentially below-market valuations.

  1. By using life insurance, the heirs who wish to sell can be compensated with the death benefit proceeds, ensuring a fair and equitable distribution of assets.
  2. By naming an irrevocable trust as the beneficiary of a life insurance policy, the death benefit proceeds can be excluded from the estate, reducing potential estate tax liabilities.

Putting It Into Practice

Life insurance can be a powerful tool in estate planning, providing financial protection and flexibility for our clients and their beneficiaries. By educating ourselves and our clients about the various ways life insurance can be used, we can help them navigate the complexities of estate planning and achieve their goals.

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Senior Sales Director | Life, Annuity, and LTC

x7105 | gyodis@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.

CallEmail

How to Organize Your Life & Health Insurance Agency

How to Organize Your Life & Health Insurance Agency

How to Organize Your Life & Health Insurance Agency
j
Comments

When you think about how to organize your life and health insurance agency there are many items to consider. A new year lends itself to thinking about new ideas. New ideas on how to manage your business better, increase efficiencies, and grow sales and revenue through improved productivity. 

Using these tips, your agency can become more proactive with your efforts and ensure you’re perfectly positioned to handle any changes the industry throws your way.

4 Tips for Organizing Your Business

There are many ways to organize your business, but here are four ways that I recommend you start with:

  • Streamline your processes: Identify any bottlenecks or inefficiencies in your current processes. This might involve automating certain tasks, delegating more efficiently, reorganizing your workflow, or finding redundant tasks or processes that can be eliminated.
  • Implement an industry-specific customer relationship management (CRM) system: A CRM system can help you keep track of customer interactions and data, manage sales and marketing efforts, and improve communication within your agency. Working “smarter, not harder” is a statement to live by when running your business.
  • Use technology to your advantage: There are many tools and software solutions available that can help you streamline your processes and improve productivity. For example, you could use a digital file storage system to reduce the time spent searching for physical documents, or you could use a quote comparison tool to speed up the sales process. Implementing technology can be scary, but in the long run, it can increase sales and free up your team for other tasks.
  • Review and optimize your staffing levels: Make sure you have the right number of employees to handle the workload in a timely and efficient manner. If you have too few employees, your team may be overwhelmed, and productivity may suffer. Time studies are a great way to see if your team is spending too much time on just the urgent tasks and not enough time on the important ones that will grow your business.

Once you have made your agency more organized, you can start to create processes to tackle any changes and ensure your team is equipped to handle them.

6 Steps to Follow When Managing New Industry Changes

Making a solid plan for your insurance agency is the only way to ensure that everything goes according to plan and that you get the results you want. You can approach changes by following these steps:

  • Determine the issue: You must clearly define the issue you’re attempting to tackle before you can develop a solution. This could be looking at data, speaking with your staff/leadership members, or doing customer research.
  • Set specific objectives: After determining the issue, you can specify the outcomes you intend to attain by making the necessary adjustments. These objectives must be time-bound, meaningful, quantifiable, reachable, and explicit (SMART) goals.
  • Create a plan of action: Create a plan of action with your goals in mind. This could include alterations to your organizational structure or workforce numbers, process enhancements, and technological fixes.
  • Share the plan: It’s critical to share the strategy with all parties involved, including staff members, clients, and other partners. This will aid in educating them about the alterations and what to anticipate, as well as increase buy-in and support for the strategy.
  • Monitor progress and adjust: As you implement the changes, it’s important to monitor progress and adjust as needed. This might involve collecting data and analyzing it or talking to employees and customers to get feedback.
  • Continuously improve: Once the changes are in place, it’s important to constantly monitor and improve the process. This will help you identify new opportunities for efficiency and growth and make sure that the changes continue to deliver the desired results over time.

6 Ways to Improve Productivity in Your Agency

Now that you’ve organized your agency and put processes in place to be proactive, it’s time to look at your agency’s productivity.

A fantastic way to increase output and performance at your insurance agency is by investing in your employees. Here are some ways you may support your team:

  • Give your team members the chance to learn and grow: By giving your team members the opportunity to learn and grow, you may assist them in improving their performance in their current jobs and acquiring new skills and information. Online learning opportunities, live seminars, or guidance from more seasoned coworkers are a few examples.
  • Encourage your staff to do professional development: Reward your team members who continue their education. This might be done by paying for their college expenses/continued education classes or by giving them credit for their newfound knowledge and abilities.
  • Create an atmosphere of transparency and recognition: Fostering open communication, praising and rewarding outstanding work, and attending to any issues or concerns that may arise will help to create a happy and supportive work environment. Even a simple “thank you” note!
  • Offer incentives and rewards: Giving your employees incentives and prizes can inspire them and increase productivity. Bonuses, stock options, or other kinds of monetary incentives are some common options.
  • Provide possibilities for professional progression: Offer internal promotions or leadership development initiatives as means of career advancement inside your organization. This can aid in employee retention and enable them to perceive a clear route for professional advancement within your company.

Investing in your team can create a more engaged, motivated, and productive workforce that is better equipped to help your agency succeed.

Putting forth efforts to organize your agency, create processes that improve your efficiency, and invest in your team all help your agency become more productive and able to manage the ever-happening changes in the life and health insurance space. Follow these tips to set the groundwork, but ensure you make the process unique to your agency and your needs.

How Pinnacle Financial Services Can Help

Contact a Pinnacle team member today for assistance with all your business marketing, sales, technology, and compliance needs.  Pinnacle gives you the infrastructure and business know-how to grow your company.  We can be reached at 800-772-6881 or sales@pfsinsurance.com

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Vice President | Marketing

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.

CallEmail

Medicare OEP

Medicare OEP

Medicare OEP
j
Comments

Medicare’s Open Enrollment Period (OEP) is a time for individuals to review and adjust their Medicare coverage. Understanding the intricacies of Medicare OEP is essential for making informed decisions about healthcare plans. Below, we discuss the rules and opportunities with the Medicare OEP, which has replaced the previous Medicare Disenrollment Period.

Introduction to Medicare Open Enrollment Period (OEP)

The Medicare Open Enrollment Period, occurring annually from January 1st to March 31st, is pivotal for beneficiaries. It’s designed to offer flexibility and a chance to reassess one’s current Medicare coverage. This period is particularly significant as it replaces the former Medicare Disenrollment Period, which was limited to January 1st to February 14th each year.

Key Changes in OEP

One of the most notable changes in the OEP is its extended duration. Now, running for three months provides ample time for clients to consider their options without feeling rushed. During this period, beneficiaries have a one-time opportunity to change their existing plans. This flexibility is crucial for adapting to new healthcare needs or financial considerations that may have arisen since the initial enrollment.

Understanding “Like Plan” Changes

The OEP allows for changes to a “like plan.” Understanding what this means is crucial for making the right decision. The term “like plan” refers to a specific set of allowable changes. These include:

  • MAPD to MAPD: Beneficiaries can switch from one Medicare Advantage Prescription Drug plan (MAPD) to another. This option is ideal for those who wish to find a plan with different coverage details, network providers, or drug formularies.
  • MAPD to Original Medicare (and a Part D plan): For those who wish to return to Original Medicare, this option allows beneficiaries to switch from their MAPD plan. Additionally, they can enroll in a Part D plan for prescription drug coverage, ensuring they don’t lose prescription benefits.
  • MA Only plan to an MA Only plan: This change enables beneficiaries to switch from one Medicare Advantage (MA) plan to another. It’s an essential option for those satisfied with having their health and medical services under Medicare Advantage but seeking different coverage specifics.
  • MA Only plan to Original Medicare: This choice is for beneficiaries who prefer the flexibility and broad network of providers that Original Medicare offers, allowing them to move away from a Medicare Advantage plan.

Importance of Personalized Advice

While the OEP provides an opportunity to make changes, switching should be based on individual healthcare needs. It is advisable to consult with a healthcare advisor or use Medicare’s resources to understand the implications of each option. Personalized advice can help beneficiaries navigate the complexities of Medicare and make choices that align with their healthcare needs.

During the OEP, you may not: During the OEP, you may:
Send unsolicited materials advertising the ability/opportunity to make an additional enrollment change or referencing the OEP Market to age-ins (who have not yet made an enrollment decision)
Specifically, target beneficiaries who are in the OEP because they chose AEP by purchasing mailing lists or other means of identification Market to dual-eligible and low-income subsidy (LIS) beneficiaries who, in general, may make changes once per calendar quarter during the first nine months of the year
Engage in or promote agent/broker activities that intend to target the OEP as an opportunity to make further sales At a beneficiary’s proactive request, send marketing materials have one-on-one meetings, and provide information on the OEP
Call or otherwise contact former enrollees who have selected a new plan during the AEP Include general information on your website about enrollment periods, including OEP.

Medicare’s Open Enrollment Period allows beneficiaries to reassess and adjust their healthcare plans. By understanding the rules and options available, such as the ability to switch to a “like plan,” beneficiaries can make decisions that better suit their evolving healthcare needs. It’s a time for careful consideration and consultation with Medicare experts to ensure the choices are in the best interest of one’s health and well-being. However, navigating the complexities of Medicare can be challenging.

For personalized guidance and more detailed information on how OEP works, it’s advisable to contact a knowledgeable Medicare team member. Pinnacle Financial Services provides expert assistance and can be a valuable resource in this process. You can contact us at 800-772-6881 x-7731 or email support@pfsinsurance.com for support. For more comprehensive insights and updates, visit our OEP page. The team can help you understand the nuances of Medicare plans and ensure that your choices are in the best interest of your client’s health.

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Vice President, Marketing

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.

CallEmail