Understanding the Basics of the ACA: A Simple Guide

Understanding the Basics of the ACA: A Simple Guide

Understanding the Basics of the ACA: A Simple Guide
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Welcome! Let’s Talk About the ACA

Hey there! If you’re new to the Affordable Care Act (ACA)—also known as Obamacare—or just need a refresher, you’re in the right place. At Pinnacle Financial Services, we’re here to break it all down for you, from what the ACA is and who qualifies to how agents can sell plans. Let’s get started!

So, What Is the Affordable Care Act?

The ACA was created to make healthcare more accessible and affordable for individuals and small businesses. It provides financial assistance, like subsidies and premium tax credits, based on household income. The goal? To help those who don’t qualify for Medicaid and can’t afford private insurance get the coverage they need.

A Quick Look at the ACA’s Timeline

  • 2006: Massachusetts, under Governor Mitt Romney, developed a healthcare model that influenced the ACA.
  • 2010: The ACA officially became law, kicking off major healthcare reforms.
  • 2013: The health insurance marketplace launched, making it easier for people to buy affordable coverage.

Who’s Eligible for ACA Coverage?

The ACA is designed for people with incomes between 100% and 400% of the federal poverty level. To qualify, you need to:

  • Be a U.S. citizen or have lawful immigration status.
  • Not have access to affordable employer-based insurance.
  • Have a household income that falls within subsidy-eligible limits.

What’s Covered? The 10 Essential Health Benefits

All ACA-qualified health plans must include key benefits like:

  • Hospital stays
  • Maternity and newborn care
  • Mental health services
  • Preventative care
  • And more! This ensures you get comprehensive coverage no matter what plan you choose.

When Can You Enroll?

  • Open Enrollment: Typically runs from November 1 to December 31 (some states may have different deadlines).
  • Special Enrollment Periods: If you experience major life changes—like moving, getting married, having a baby, or gaining legal U.S. residency—you might qualify to sign up outside the normal window.

Want to Sell ACA Plans? Here’s What You Need to Know

If you’re an agent looking to sell ACA plans, here’s what’s required:

  • A life and health insurance license
  • Completion of the Federally Facilitated Marketplace Training via CMS.gov
  • Additional state-based certifications (if required)
  • Access to platforms like HealthSherpa to make enrollments smoother

Getting Advanced Certification for State Exchanges

Some states run their own healthcare marketplaces, which means additional certification might be needed beyond the federal training. While it takes a little extra effort, being certified in multiple states can help expand your client base and ensure compliance.

Key Takeaways for Agents

  • Get certified through CMS.gov and any necessary state exchanges.
  • Use HealthSherpa or similar platforms to streamline enrollments.
  • Stay on top of renewals and qualifying life events to keep your clients happy.

Wrapping It Up

We hope this guide gave you a clear picture of the ACA and what it takes to sell these plans. At Pinnacle Financial Services, we’re dedicated to helping agents succeed with training, resources, and support. Got questions? Want to collaborate? Reach out—we’re happy to help!

Stay in the Loop

For the latest updates on insurance trends and agent training, subscribe to our newsletter and follow our upcoming webinars. Thanks for joining us to learn about the ACA—let’s help more people get the coverage they need!

Watch the full webinar with our ACA Sales Director on YouTube: https://youtu.be/DQTFKcaIpA8

By Dave Gounis, ACA Sales Director at Pinnacle Financial Services

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

ACA Sales Director

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

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Navigating Change: A Chat with Assistant VP Nick Palo on Insurance 360

Navigating Change: A Chat with Assistant VP Nick Palo on Insurance 360

Navigating Change: A Chat with Assistant VP Nick Palo on Insurance 360
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Hey there, insurance pros! It’s Bob Brzyski here, your host of the Insurance 360 podcast and VP of Marketing at Pinnacle Financial Services. I get to have some pretty amazing conversations with industry experts, and in our latest episode, I sat down with none other than Nick Palo, our Assistant VP. Nick has been part of the Pinnacle family for a whopping 18 years and works with some of the top producers in the Medicare industry.

We covered everything from navigating industry changes to making the most of new opportunities. So, let’s dive into some highlights?

Planning and Strategy: The Name of the Game

Nick and I had a great chat about how critical strategic planning is in our ever-changing industry. With new rules rolling out, agents and agencies need to be a step ahead—especially when it comes to Special Enrollment Periods (SEP). Nick stressed that staying focused on both retaining clients and bringing in new business is key. A little planning goes a long way!

Tech to the Rescue!

Let’s talk tech. If you’re not using the latest tools, you’re missing out. At Pinnacle, we’ve got our own CRM system, Boss, and let me tell you—it’s a game-changer. Managing leads, automating communication, tracking client interactions—it does it all. Plus, with AI giving us deeper insights into market trends, agents can make smarter moves and expand their reach. If you haven’t embraced technology yet, now’s the time!

The Challenges (and How to Tackle Them)

Nick shared some real-world stories about the hurdles agents face, from recruiting to running successful in-person events. Not surprisingly, the agencies that adapt, plan and use tech wisely are the ones that thrive. Whether you’re trying to boost recruitment or fine-tune your marketing, having a solid game plan makes all the difference.

Community and Networking: Your Secret Weapon

One of my favorite parts of our chat was about the power of networking. Events like Pinnacle’s Championship Series aren’t just about shaking hands—they’re about learning, growing, and making connections that matter. If you’re skipping industry events, you’re leaving serious value on the table. Get out there and make those connections!

Looking Ahead: SEPs, AEP, and What’s Next

Before wrapping up, Nick and I took a peek into the future—what’s coming with SEPs, how to prep for the Annual Enrollment Period (AEP), and why being proactive is everything. The insurance world never stops evolving, and those who stay agile and open to learning will always stay ahead.

Want to hear the full conversation? Tune into Insurance 360 for the complete episode featuring Nick Palo. And if you’re looking for tools to level up your agency, check out Pinnacle Financial Services for all the latest resources.

Stay tuned, more expert insights are coming your way soon. Don’t forget to subscribe to Insurance 360 and swing by our website for the latest updates in the insurance world!

Listen to full podcast on Apple Podcasts, Spotify and more! https://insurance360.buzzsprout.com/

Watch the full Insurance 360 podcast episode here: https://youtu.be/IyM2eE90eBc

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

Vice President, Marketing

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

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Work life resilience building a legacy under pressure

Work life resilience building a legacy under pressure

Work life resilience building a legacy under pressure
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Angela Palo is COO of Pinnacle Financial Services, a leading National Medicare Brokerage, and member of the NABIP Medicare FMO Council.

My journey into the financial services industry was anything but planned. I envisioned a life as a stay-at-home mom, raising a large family. When life didn’t unfold as expected, I pivoted. I never imagined that my career would eventually lead to co-owning one of the most successful FMOs in the nation.

Looking back, I realize the lessons I’ve learned about resilience—both personally and professionally—are rooted in adapting to change. Whether it’s navigating personal struggles, managing a growing business or supporting a diverse team, resilience has been the cornerstone of my journey.

Building A Business Under Pressure

Pinnacle Financial Services wasn’t built overnight, and it certainly wasn’t built without challenges. When my business partner and I launched in 2003, there were just eight of us. Today, we’ve grown to a team of over 50 employees with a national footprint, serving agents and clients across the country.

The pressure to build and scale a business while maintaining a strong company culture is immense. Balancing innovation with the demands of the market is a constant challenge, especially when an industry faces rapid change.

For example, the rise of Medicare Advantage and ACA markets required us to pivot our services and acquire agencies that work in these areas. Our recent acquisition of a Florida-based multicultural agency reflects how intentional growth can open doors to new opportunities while maintaining the core values of an organization.

Resilience Starts At Home

Resilience isn’t just about professional grit—it’s deeply personal. For example, I adopted my son when he was nearly 3 years old. Raising a child with autism, ADHD and later a diagnosis of cerebral palsy taught me lessons in patience, perseverance and unconditional love. Juggling caregiving with professional responsibilities is never easy, but those experiences shaped my leadership style.

Family is my sanctuary. Holidays at my home are a lively affair with nearly 40 immediate family members gathered. Moments like these are important to daily balance for leaders and remind us why we work so hard. For my company, that is to create opportunities and a legacy for our families and the families touched by our work.

The Intersection Of Leadership And Resilience

Leadership in our industry demands resilience, especially as a woman in a historically male-dominated field. Early in my career, I promised myself I would always know more than anyone in the room to ensure my ideas were valued for their merit. This mindset served me well, especially during pivotal moments like presenting in front of industry leaders as one of the only women in the room.

Today, the landscape is changing. Women are no longer a rarity in boardrooms or on panels; we’re leading organizations and shaping the future of this industry. In fact, McKinsey found that “companies in the top quartile of gender diversity on executive teams were 25 percent more likely to experience above-average profitability than peer companies in the fourth quartile.” It’s important to foster an inclusive culture with your team, where everyone, regardless of background, has a voice.

Strategies For Building Resilience

For leaders navigating similar challenges, here are some strategies that have helped me sustain resilience and success:

  1. Find Your “Why”: Understanding your purpose is critical. For me, it’s my family and the agents we support. Knowing who and what you’re working for provides clarity during tough times.
  2. Embrace Change: Change is inevitable, whether it’s shifting industry regulations or personal life challenges. Viewing change as an opportunity rather than a setback has been essential to our growth.
  3. Invest In People: Surround yourself with a diverse, talented team. When it comes to building a diverse team, I’ve found that broadening hiring efforts makes a big difference. Posting job openings on platforms that reach underrepresented groups or partnering with diversity-focused organizations is a great start. I also make it a priority to create a culture where everyone feels valued. When people feel included, they can truly thrive. Our team’s success stories—like expanding into multicultural markets—prove the power of collaboration.
  4. Prioritize Self-Care:Resilience isn’t sustainable without self-care. For me, reading two books a week is my escape, a way to recharge and gain new perspectives. Schedule self-care into your day, just like you would any important meeting—whether it’s a workout, some reading or a few moments of quiet reflection. I also like to stack my habits, like listening to a favorite podcast while going for a walk, so I can fit self-care into my busy schedule without feeling overwhelmed
  5. Stay Passionate:Passion fuels resilience. Whether it’s advocating for better industry practices or mentoring new leaders, staying connected to what excites me keeps me going.

Leading Through Change

The financial services industry is at a crossroads. By 2030, all Baby Boomers will be age 65 or older, which could mark a significant shift in Medicare demand. Simultaneously, workforce demographics are evolving, with younger generations bringing fresh perspectives and technological acumen.

As leaders, it’s our responsibility to adapt while staying true to our values. For me, this means fostering innovation while supporting our agents with the tools they need to succeed. It also means recognizing the human element of our work—every policy we issue represents a family’s security and peace of mind.

Resilience As A Legacy

Resilience isn’t about avoiding pressure; it’s about thriving under it. Whether balancing motherhood and business ownership or navigating industry shifts, resilience has shaped both my personal and professional life.

As leaders, we have the privilege and responsibility to create environments where resilience is cultivated, not just for ourselves but for our teams and clients. It’s this resilience that allows us to not only weather challenges but emerge stronger, building a legacy that lasts.

 

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

Chief Operating Officer

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

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Navigating Medicare Changes in 2025: Key Insights for Agents

Navigating Medicare Changes in 2025: Key Insights for Agents

Navigating Medicare Changes in 2025: Key Insights for Agents
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In the ever-evolving landscape of Medicare, staying informed and adaptable is essential for agents aiming to provide the best possible service to their clients. As we move into 2025, significant changes are on the horizon, particularly concerning Special Enrollment Periods (SEPs) for dual eligible and low-income subsidy (LIS) populations. Let’s dive into what’s new, how it impacts the market, and what strategies agents can employ to navigate these changes effectively.

Welcome to 2025: Embracing Change in Medicare

The first episode of Insurance360 in 2025 brings to light the slew of changes set to impact Medicare agents, especially those dealing with dual-eligible plans. Traditionally, the Medicare landscape has been dynamic, with new regulations continuously reshaping how business is conducted. This year is no different.

Key Changes to SEPs

One of the most significant changes is the elimination of the quarterly SEP for dual eligible and LIS beneficiaries. In 2025, beneficiaries who qualify for LIS or dual special needs plans (DSNP) will no longer have the quarterly SEP option. This is a substantial shift that agents must adjust to, as it alters how they plan their business strategies throughout the year.

Additionally, the monthly Integrated Care SEP has been introduced. This is available to full dual eligible beneficiaries in areas where Fully Integrated Dual Eligible (FIDE) or Highly Integrated Dual Eligible (HIDE) plans are offered. Although not applicable in all states, agents need to understand the specifics of this SEP, as it provides monthly enrollment opportunities for eligible individuals.

Impact on Marketing and Strategy

For agents, these changes mean reassessing how they build and retain their client base. The absence of the quarterly SEP makes retention strategies even more crucial. Educating clients on these changes, ensuring they understand their options, and reminding them to consult their agent before making any changes are key components to maintaining a stable book of business.

Special Guest Nikki Skubal from Aetna emphasizes that while these changes seem daunting, they offer a chance for agents to focus on retention and strategic growth. She suggests leveraging tools like the Benefits Checkup program at https://benefitscheckup.org/, which helps identify clients eligible for LIS or other benefits, potentially opening new SEPs for enrollment.

Adapting to a New Normal

The landscape of Medicare is one where agents must always be ready to adapt. While these new rules present challenges, they also offer opportunities to redefine business strategies, deepen client relationships, and refine marketing tactics. With services like Aetna’s Benefits Checkup and support from both carriers and agencies, agents can navigate these waters effectively.

As Nikki advises, contacting support teams such as Pinnacle or Aetna broker managers is crucial when questions arise. Staying informed, being nimble, and maintaining a commitment to client service are the best ways to ensure success in this ever-changing market.

Looking Forward: Embracing 2025 and Beyond

The Medicare landscape continues to be one of complexity and opportunity. Embracing these changes with a proactive mindset will equip agents to meet the challenges of 2025 and excel within them. As always, the ultimate goal remains the same: providing the best possible service to those in need.

Follow Pinnacle’s YouTube channel and social media for ongoing updates and best practices. While the influx of information may seem overwhelming, leveraging these resources will help streamline and simplify the process for both agents and their clients.

 

Watch the full Insurance360 podcast episode here: https://youtu.be/x-aaj2sL_xM

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

Vice President of Marketing

Contact a Pinnacle Representative if you have any questions.

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

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Exploring the Power of the Nationwide Peak 10 Fixed Index Annuity:

Exploring the Power of the Nationwide Peak 10 Fixed Index Annuity:

Exploring the Power of the Nationwide Peak 10 Fixed Index Annuity:
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Securing a reliable retirement income is more important than ever in today’s volatile financial market. Understanding the various options available can make all the difference in ensuring a stable, comfortable retirement.  I’m passionate about equipping financial professionals with tools that deliver security and growth for their clients.

The Appeal of Nationwide Partnership

Partnering with a reputable company is critical when it comes to financial products. A Fortune 100 company, Nationwide is known for its robust business practices and trusted reputation. With over $123 billion in investments and recognition as a top annuity writer, Nationwide provides agents and clients with unparalleled reliability. Their commitment to fulfilling contractual obligations brings peace of mind, ensuring that clients’ retirement plans remain secure.

Why Choose Nationwide Peak 10 Fixed Index Annuity?

The Nationwide Peak 10 Fixed Index Annuity combines key benefits to help safeguard your client’s financial future:

  • Growth with Market Protection: This annuity offers growth potential without exposing investments to the risks of market downturns. Clients’ investments are protected no matter how the market fluctuates.
  • Lifetime Guaranteed Income: With the Peak 10, clients can enjoy a guaranteed income for life, ensuring they won’t outlive their savings.
  • Flexible Features for Clients: Tailored options such as single purchase payments and laddering across multiple annuities provide greater flexibility for diverse strategies.

Understanding the Product Details

Here’s a closer look at what sets this annuity apart:

  • Principal Protection with Upside Potential: The Peak 10 protects your principal while offering high caps and participation rates on indexes, ensuring clients benefit from market gains without the risk of losses.
  • Versatile Options: Clients can select from various indexes, such as the Value Balanced Index and JP Morgan Cyclical Index, to align with their goals.
  • Comprehensive Benefits: Features like joint annuitant options and spousal protection provide added security for clients and their families. 

Utilizing the Bonus Income Rider

One of the standout features of the Peak 10 is its bonus income rider:

  • Day-One Bonus and Interest: This rider includes a 20% bonus on the income benefit base, paired with an 8% simple interest growth for the first eight years or until income withdrawals begin.
  • Flexible Income Options: Clients can optimize their withdrawals based on their retirement timelines to maximize benefits.

How to Get Started

Agents looking to offer the Peak 10 product are encouraged to get appointed with Nationwide. Whether working with active cases or preparing for future inquiries, contracting with Nationwide positions you to help clients secure a stable retirement with guaranteed income solutions.

If you have questions or need personalized illustrations, feel free to reach out, we’re here to help. The Pinnacle Annuity team can be reached at 800-772-6881 x3302 or annuity@pfsinsurance.com

Don’t forget to subscribe for the latest updates and agent training tips.

Check out the video on YouTube:  https://youtu.be/0qKOepUKk50

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

Senior Sales Director - Life, Annuity, & LTC

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

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New Medicare FEMA SEP Rules

New Medicare FEMA SEP Rules

New Medicare FEMA SEP Rules
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By Ed Crowe 

In some cases, Medicare beneficiaries miss an enrollment period due to a FEMA emergency. When this happens, beneficiaries may be eligible for a DST SEP. It is imperative that agents are aware of the New Medicare FEMA SEP rules to assist clients. The DST SEP is available to qualified individuals who miss an opportunity to enroll in a Medicare plan.

Medicare FEMA SEP  

The DST SEP is an enrollment opportunity CMS offers to Medicare beneficiaries affected by either weather-related emergencies or major disasters. The FEMA SEP lets those who miss a valid election period to either enroll in or disenroll from a Medicare plan. The enrollment takes effect the first day of the month after application is submitted.

This is only available in areas where FEMA, state or other local government officials declare an emergency or disaster. FEMA emergencies start when the incident occurs and lasts for two months up to one year after the start or the extension period begins.

Important changes the the FEMA SEP 

On December 3, 2024, CMS released a memo that announced changes to the DST election. These changes go into effect as of April 1, 2025.  Short Video explaining the new SEP Rules- FEMA Emergency and Disaster Special Election Ending on April 1, 2025

If a beneficiary needs to submit an application using the DST election period either on or after April 1, 2025, the application must be submitted directly through CMS. Beneficiaries can call 1-800-MEDICARE or TTY 1-877-486-2048 to submit an application.

In other words, CMS will not accept applications that use the DST election even if they are broker assisted.

Any enrollment application that uses this election will be labeled as using an invalid election period. The plan will then attempt to contact the enrollee and obtain a valid election period. If the plan cannot verify a valid election period, the application will be denied.

Important: missing or invalid elections do not trigger the (RFI) Request for Information process. Therefore, beneficiaries do not have additional time to respond to the inquiry or correct their election.

Please note; applications and disenrollment forms will be updated to remove the DST election.

Reasons to use this SEP

There are varied opportunities to use the SEP. This ensures individuals have the coverage they need.

If the beneficiary resides where a natural disaster (earthquake, flood, wildfire, hurricane, tornado or other specific incident) resulting in a missed valid enrollment period. Sometimes disasters cause beneficiaries to have to leave their home. This may result in them missing their enrollment period and enable the use the FEMA SEP.

The SEP is sometimes available when a beneficiary relies on a family member or other caregiver who is impacted by a disaster and they are unable to assist them during their enrollment period.

Other instances that allow for SEP use include; inability to access Medicare plan information or submit a timely enrollment due to a FEMA declared disaster. Enrollees may also use the SEP when the beneficiary’s healthcare provider of facilities are impacted by the disaster. This can result in the inability to receive necessary information to make an informed decision. 

Rules for Eligibility for Medicare Disaster SEP  

In order to use the SEP, the beneficiary must live in the are where the disaster occurred. They must have missed a valid enrollment period (AEP, IEP, OEP) during the time of the incident as long as they did not already make a change during the enrollment period. It is also acceptable for those who need assistance from another person to complete the enrollment or make healthcare decisions. 

Who cannot use this SEP

Anyone who has already changed their plan during a valid election period can’t use the FEMA election to change it again. Beneficiaries must call 1-800-MEDICARE or TTY 1-877-486-2048 to submit an application in a timely manner to avoid missing their window to enroll.

For more information, contact a Pinnacle Financial Services representative today

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

President at Crowe & Associates

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1 (800) 772-6881
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