Advantages of Selling Medicare Supplements

Advantages of Selling Medicare Supplements

Advantages of Selling Medicare Supplements
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Medicare Advantage (MA) plans are subject to change every year, requiring licensed agents to guide beneficiaries through the maze of options. While Medicare Advantage plans often attract attention and continue to grow in market share, it’s essential not to overlook Medigap — Medicare Supplement insurance — as a pivotal part of your product portfolio.

With 23% of Medicare’s 65.1 million beneficiaries choosing a Medigap plan to cover their high out-of-pocket costs, understanding these products and offering them to your clients can significantly enhance your service to consumers seeking peace of mind in their healthcare coverage.

Why would someone prefer Medigap?

Medigap policies, crucial for filling the financial voids left by Original Medicare, offer a robust safety net for beneficiaries. These plans cover additional costs accompanying Medicare-covered services, such as copayments, coinsurance, and deductibles. Much like a hospital indemnity plan can help cover the out-of-pocket costs of MA hospital coverage, a Medigap plan helps a beneficiary pay for the extra costs associated with Original Medicare coverage.

However, unlike MA plans, Medigap plans offer the flexibility to see any doctor who accepts Medicare without the need for network restrictions or referrals. This aspect is particularly beneficial for those who require specialists or frequent medical care that may not be locally available or for beneficiaries who travel frequently or live in different states throughout the year.

The appeal of Medigap extends beyond just the broad provider access. Medigap plans are standardized, meaning the benefits for each plan type are the same regardless of the insurance company offering it. This standardization simplifies the decision-making process for beneficiaries and producers alike, as consumers can choose a plan based not on differing sets of benefits but on the reputation and service quality of the insurer. For example, a Plan G from one insurer will have identical medical coverage to a Plan G from another insurer, though premiums may vary.

Medigap’s consistency and predictability in coverage are also beneficial for financial planning. Beneficiaries can better anticipate their medical expenses without worrying about unexpected charges. For example, plans like Medigap Plan F and G cover Medicare Part B excess charges, which are the costs that providers can charge over what Medicare will pay. This coverage is critical for avoiding surprises in medical billing, ensuring that beneficiaries aren’t left financially vulnerable after routine or specialist care.

Knowing each plan’s specific strengths

Each plan has strengths, and choosing the right one depends on the individual’s health needs and financial situation. For instance, Plan G is a popular choice for new Medicare enrollees, as it offers comprehensive coverage except for the Medicare Part B deductible. And Plan N, while requiring copayments for doctor and emergency room visits, often has lower premiums, making it a cost-effective option for many beneficiaries.

Here is a more specific Medigap benefit breakdown from Medicare.gov:

Why should you prioritize Medigap knowledge?

It’s essential to understand the intricacies of Medigap as you field common objections to MA plans, such as fears about network restrictions and potential high out-of-pocket costs. By being knowledgeable about Medigap, you can provide a comprehensive overview of available options, helping people make informed decisions based on their specific health needs and financial situations.

Medigap’s lack of network restrictions offers a stark contrast to MA plans. It can be a critical selling point for beneficiaries who value the freedom to choose their healthcare providers or those who may require specialists not within a plan’s network. The standardized nature of Medigap plans means that once a person chooses a plan, they can be assured that the benefits won’t change annually, unlike MA plans, which may alter benefits, network structures, or provider agreements each year. This stability can significantly comfort those who desire more predictable healthcare coverage and costs.

Licensed agents and brokers with detailed knowledge of Medigap can also guide people through the nuances of plan selection, such as the implications of choosing a high-deductible plan versus a standard one. While high-deductible plans may offer lower premiums, they require beneficiaries to pay a significant amount out-of-pocket before coverage begins. Understanding these details allows you to tailor your recommendations to the financial realities and medical needs of those you serve.

Takeaways

  1. Medicare Supplement insurance (Medigap) fills the significant gaps in Original Medicare, offering peace of mind by covering out-of-pocket costs.
  2. Unlike Medicare Advantage plans, beneficiaries with Medigap plans aren’t restricted by network limitations and can see any doctor who accepts Medicare nationwide.
  3. Understanding the nuances of Medigap and its comparisons to MA can allow you to expand your product portfolio, better serve a broader range of client needs, and effectively address them.

 

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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.

 

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TPMO Marketing and Communications Guidance

TPMO Marketing and Communications Guidance

TPMO Marketing and Communications Guidance
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This bulletin provides an overview of CMS’s Medicare marketing and communications regulations as they pertain to Third-Party Marketing Organizations (TPMOs). The complete Medicare Communications and Marketing Guidelines (MCMG) can be accessed directly on the CMS website: Medicare Communications and Marketing Guidelines (MCMG)

Applicability of the Guidelines

The CMS Medicare Communications and Marketing Guidelines apply to a variety of entities, including all Third-Party Marketing Organizations (TPMOs). These guidelines are specifically relevant to Medicare Advantage (MA) and Prescription Drug Plans (PDPs). They do not apply to products such as:

  • Affordable Care Act (ACA) health plans
  • Medicare Supplement (Medigap) insurance
  • Other non-Medicare health insurance products 

Definition of a TPMO

CMS defines a Third-Party Marketing Organization (TPMO) as any individual or organization—including independent agents and brokers—who is compensated to perform lead generation, marketing, sales, or enrollment-related activities connected to the MA enrollment process. This includes entities designated as First Tier, Downstream, or Related (FDRs).

Do CMS Rules Apply to Lead Vendors?

Yes. Lead vendors fall under the definition of a TPMO because they are paid to generate leads and perform marketing functions related to MA plan enrollment. 

Understanding “Marketing Materials”

Under CMS regulations (§§422.2260 and 423.2260), “marketing” is defined as any communication or activity intended to influence a Medicare beneficiary’s decision to enroll in or remain enrolled in an MA or PDP plan.

Marketing materials are evaluated based on two criteria:

  • Intent: Designed to attract attention to, or influence decision-making about, a specific MA or PDP plan.
  • Content: Includes references to plan benefits, premiums, cost-sharing, incentives, or comparative plan information.

A material meets the Intent standard if it:

  • Aims to promote a specific MA or PDP plan.
  • Influences a consumer’s enrollment decision.
  • Encourages retention in a current plan.

A material meets the Content standard if it:

  • Mentions plan benefits, premiums, or cost-sharing.
  • Includes metrics like Star Ratings, plan comparisons, or rewards.

Examples of Communication Materials

Example 1:
“ABC Health is now offering Medicare Advantage coverage in Nowhere County. Call 1-800-MA-AGENTS for more information.”
→ This qualifies as a communication piece. However, the use of a carrier name may require submission for carrier review.

Important: Any use of a carrier’s logo must be submitted for carrier review and approval.

Example 2:
A flu shot reminder letter stating, “ABC Health enrollees can get their flu shot for $0 copay at a network pharmacy…”
→ While cost sharing is mentioned, the piece is intended only to inform current enrollees, not to market a plan, and is therefore considered communication, not marketing.

Examples of Marketing Materials

Example 1:
“ABC Health Offers $0 Premium Plans in Nowhere County”
→ This includes both promotional intent and benefit-related content, qualifying it as marketing.

Example 2:
“Call us to learn about plans that include hearing, dental, $0 premiums, and Medicare Part B givebacks.”
→ Even without naming a specific plan, the mention of plan features and premiums qualifies this as marketing.

Note: Any material that mentions benefits or costs is considered marketing and must be submitted for carrier and CMS approval before use.

Requirements for Marketing Materials

When a piece is classified as marketing, you must:

  • Submit the piece for pre-review to each carrier you represent.
  • File the material in HPMS (Health Plan Management System) and obtain CMS approval.
  • Ensure the material is used only for carriers that have explicitly opted in through HPMS.

Filing Requirements and Timeline

  • Marketing materials must be filed in HPMS annually for each Plan Year.
  • CMS typically opens HPMS for filing in June for the following plan year.
  • Materials submitted between June–September may not be used before October 1.
  • TPMOs must select the appropriate media type when submitting. 

Carrier Pre-Review and HPMS Filing

TPMOs should coordinate closely with carriers and uplines to ensure compliance with the required pre-review and CMS filing processes. Carrier-specific processes may vary, and most carriers issue annual marketing guidance.

To independently file with CMS:

  • Obtain consultant access to HPMS for your legal entity.
  • Once access is granted, request that each carrier add your User ID to their HPMS workflow to allow visibility and opt-in capability.

For access instructions, refer to:
 CMS Consultant Access Instructions (PDF)

Depending on your contract structure, you may also be able to request filing assistance from your upline or parent agency—but only for carriers within that agency’s hierarchy.

Shared Marketing Material and Unique SMIDs

If a TPMO uses a marketing piece originally created and approved by another TPMO, it must still be submitted in HPMS under its own unique SMID. Approval of the original piece does not extend to other TPMOs by default.

Can You Use an Unapproved Marketing Piece?

No. Marketing materials must not be used unless:

  • They have been approved by CMS, and
  • Each applicable carrier has opted-in via HPMS.

For further guidance or clarification, TPMOs should consult directly with their contracted carriers and compliance teams to ensure full adherence to CMS marketing standards.

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Lead Star Medicare Leads

Lead Star Medicare Leads

Lead Star Medicare Leads
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What You’ll Learn from Episode 26 of Insurance360: Smarter, Compliant Medicare Lead Generation with “Professor Leads”

If you’re in the insurance world, or just curious about where it’s headed, you’re going to love Episode 26 of our Insurance360 podcast. In this episode, we sit down with none other than Bill DeCourcey, a.k.a. “Professor Leads,” for an eye-opening conversation about what’s working right now in Medicare lead generation, and how to do it all by the book.

Let’s break it down. 

Setting the Scene

Bill, who’s well-known in the industry for his practical, no-fluff insights, joins our host for a deep dive into the evolving landscape of insurance. With his trademark energy and real-talk style, Bill shares what he’s seeing on the front lines and how both agents and agencies can adapt.

What You’ll Hear in This Episode:

How the Industry is Evolving

The insurance game is changing fast. Bill kicks things off by discussing the significant shifts occurring in the industry, driven by technological innovations and increasing consumer expectations. Whether you’re a carrier, an agent, or a client, these changes are touching everyone.

Customer Service is Getting an Upgrade

Next, Bill delves into how agents are enhancing their service offerings. From AI-driven tools to streamlined onboarding processes, he explains how smart innovation can make life easier for both agents and clients, and why staying ahead of these trends is essential.

 Navigating the Compliance Maze

Of course, no talk about Medicare lead generation would be complete without touching on compliance. Bill breaks down the current regulatory headaches, what might be changing, and how to stay on the right side of the rules while still growing your business.

Bill’s Big Takeaway

Bill wraps up the episode with a powerful reminder: in a space that’s constantly shifting, staying informed and flexible isn’t optional, it’s essential. If you’re an agent, a marketer, or just someone interested in the insurance space, you need to keep learning and evolving.

Why This Episode Matters

This isn’t just another industry podcast. Bill’s take is real, relatable, and refreshingly straightforward. He has a way of simplifying the complex stuff, so whether you’re a seasoned pro or just getting started, you’ll walk away with practical insights you can use.

Want More?

Don’t miss the full episode, it’s packed with more nuggets than we could fit here. Tune in, take notes, and subscribe to Insurance360 so you never miss a conversation that could change how you do business.

 [Listen to Episode 26 now]
Got questions or takeaways of your own? Drop us a comment or share the episode with someone in your network who should hear it!

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Understanding Referral Fees in Insurance: What Agents Need to Know

Understanding Referral Fees in Insurance: What Agents Need to Know

Understanding Referral Fees in Insurance: What Agents Need to Know
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Understanding the ins and outs of referral fees is key to staying compliant and protecting your insurance license. Whether you’re an agent or running an agency, knowing what you can and can’t do helps you avoid costly missteps. This guide breaks down the dos and don’ts, answers common questions, and shares practical tips to help you build ethical, compliant referral relationships with confidence.

What Is a Referral Fee?

A referral fee is any cash, gift, or compensation—direct or indirect—provided by a licensed agent or agency to an unlicensed individual or entity for the purpose of soliciting insurance business. This practice is highly regulated, and any missteps can result in severe penalties.

What’s Allowed vs.  What’s Not

Here’s a clear breakdown to help agents stay compliant with state insurance laws and Medicare Marketing Guidelines.

You Can:

  • Receive compliant referrals from providers (if initiated by the provider and compliant with CMS guidelines)
  • Pay referral fees to other licensed agents or agencies (check state rules for any variations)
  • Accept nominal gifts (up to $15 per person, $75 annually) from or give them to customers, as long as they are not cash or monetary
  • Receive referral fees from licensed Medicare Advantage organizations (up to $100 for MAPD/MA and $25 for PDP plans in 2025)
  • Provide beneficiaries with non-monetary nominal gifts

 You cannot:

  • Pay referral fees to providers, consumers, or unlicensed individuals
  • Offer cash or rebates to consumers in exchange for referrals
  • Use or accept patient lists from providers without proper written consent
  • Provide any compensation for a referral from someone who is not licensed to sell insurance

Rebating: Know the Risks

Rebating is the act of offering financial incentives to influence the sale of insurance. This includes giving back a portion of your commission or offering anything of value to entice a customer. Rebating is illegal in most states and may result in license termination or other disciplinary actions.

Examples of Rebating:

  • Paying a customer for a referral
  • Offering to waive part of a premium
  • Giving gift cards or cash for enrolling in a plan 

Best Practices to Stay Compliant

  • ✔ Always confirm the license status of anyone you’re exchanging referral fees with
  • ✔ Check your state’s rules before paying or receiving referral fees—even between licensed agents
  • ✔ Get written authorization before contacting any referred individual
  • ✔ Keep detailed records of all referral sources and communications

 

Need Help Navigating Referral Compliance?

Understanding the nuances of referral fee regulations can be complex, but you don’t have to figure it out alone.

      Schedule a consultation with our compliance experts.
      Request more information on staying compliant with Medicare and state guidelines.

Protect your license. Grow your business the right way.

[Contact Us Today] – Let’s ensure your referral strategy is fully compliant.  Information is subject to change without notice.  Always check with compliance.

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Successful Retirement Seminar

Successful Retirement Seminar

Successful Retirement Seminar
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How to Host a Successful Retirement Seminar (and Turn Social Security Prospects into Clients)

Hosting a retirement seminar isn’t just about putting on a presentation — it’s about making real connections with people who are looking for guidance. Whether you want to educate your community, grow your business, or both, this guide will walk you through exactly how to plan a retirement seminar that leaves a lasting impression (and brings new clients through the door).

Start Strong: Welcome Your Audience

First impressions matter. Start your seminar with a warm, genuine welcome. Introduce yourself, thank everyone for coming, and share a little bit about your background. If you have any co-hosts or guest speakers, make sure they’re introduced too. People are more likely to listen and engage when they feel comfortable right from the beginning.

Why Retirement Seminars Are So Important

There’s a huge need for financial education right now. In fact, 95% of retirement savers say having a financial plan is critical, but 81% worry they haven’t saved enough. Hosting a retirement seminar can position you as the expert who helps solve these worries.

Know Who You’re Talking To

Before you dive into planning, think about your audience. Are you targeting retirees, pre-retirees, high-income earners, or middle-income families? Tailoring your content to their specific needs will make your seminar more effective and engaging.

Focus Your Content on What Matters

Keep your topics sharp and highly relevant. Make sure you cover key areas like:

Bonus tip: Bringing in guest speakers (like a CPA, Medicare expert, or estate planner) adds credibility and variety to your presentation.

 

Get the Word Out: Promote Your Seminar

Promotion can make or break your event. Use direct mail, email marketing, and social media to create excitement. Companies like Leading Response can help you fill your seats by targeting the right people.

And don’t be afraid to sweeten the deal — offering small incentives or giveaways can drive up attendance.

Choose a Great Venue

Location is key. Make sure your venue is easy to find, has plenty of parking, and fits the size of your expected crowd. Also, double-check that it has the audiovisual equipment you’ll need for a smooth presentation.

Keep It Interactive

Nobody wants to sit through a boring lecture. Get your audience involved by asking questions, encouraging small group discussions, or using quick surveys. Handouts and worksheets also keep attendees engaged and give them something to take home.

Follow Up After the Seminar

The magic happens after the seminar. Send a thank-you email or handwritten note and invite attendees to schedule a one-on-one meeting. Following up quickly shows that you value their time and keeps the conversation going.

Practice Makes Perfect

Finally, don’t wing it. Practice your talk several times, especially with your guest speakers if you have them. Also, consider your audience’s schedule when planning the day and time for your event — evenings and weekends often work best.

Final Thoughts

Retirement seminars are an incredible way to connect, educate, and grow your client base. With thoughtful preparation, targeted content, and strong follow-up, you’ll not only host a successful event, you’ll also build lasting relationships.

Need help getting your seminar off the ground? Contact us to get expert support on planning, promoting, and presenting an unforgettable retirement seminar.

Seminar Planning Video- Seminar Systems with Jennifer DeBuhr from LeadingResponse

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Senior Sales Director - Life, Annuity, & LTC

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