Maximizing Medicare: Unlocking Opportunities in Ancillary Insurance

Maximizing Medicare: Unlocking Opportunities in Ancillary Insurance

Maximizing Medicare: Unlocking Opportunities in Ancillary Insurance
j
Comments

Welcome to Insurance 360!

Hey there, and welcome back to another exciting deep dive into the world of insurance! Today, we’re peeling back the layers of Medicare Advantage and exploring the game-changing role of ancillary products. And trust me—you don’t want to overlook these hidden opportunities.

Joining us is the ever-knowledgeable Jamie Sarno from AmeriLife, who’s here to break it all down: where Medicare Advantage plans fall short and how smart insurance professionals can step in to bridge the gaps.

A City Still Buzzing

First off, let’s take a moment to soak in the energy—because here in Philadelphia, the excitement is still in the air. The Super Bowl may be behind us, but the celebrations remind us of something important: community, strategy, and making the most of every opportunity. And that’s exactly what we’re talking about today—opportunity—in the world of Medicare Advantage and beyond.

The Medicare Advantage Playbook: Finding the Gaps

If you’re an insurance agent, you know the Open Enrollment Period (OEP) is a hectic time. But many overlook just how many coverage gaps exist in Medicare Advantage plans. Hospital stays? Surprise copays? Uncovered dental, vision, or hearing expenses? These can be major pain points for clients.

Jamie emphasizes one key takeaway: Being proactive is everything. Medicare changes constantly, and those who stay ahead of the game are the ones who win—both for their clients and their own businesses.

The Smart Way to Sell Ancillary Insurance

Let’s be real—no one likes feeling blindsided by medical expenses. That’s why the best agents don’t just sell Medicare Advantage plans; they set their clients up for success from day one.

Jamie shares a simple strategy: Make ancillary products a natural part of the conversation. Instead of treating them as optional add-ons, introduce them as essential solutions that make the entire insurance plan more complete and stress-free.

Think of it like this: If you were buying a car, you wouldn’t skip out on insurance, right? The same logic applies here—a solid insurance plan should protect against unexpected costs, not just the basics.

Why Ancillary Products Are a Bigger Deal Than Ever

Ancillary products used to be the underdogs, but not anymore. With more guaranteed issue periods and expanded product offerings, they’re becoming must-have components of well-rounded insurance plans.

Some of the most valuable ancillary products include:
Hospital indemnity plans – Cover those sneaky hospital copays.
Dental, Vision, and Hearing (DVH) insurance – Because Medicare doesn’t fully cover these essentials.
Critical illness plans – Extra financial protection for major health events.

And here’s the kicker: Not only do these products protect clients, but they also help agents build stronger, long-term relationships—increasing retention and trust along the way.

Tech Tools Are Changing the Game

Good news—technology is making all of this easier than ever. With digital tools for rate comparisons, policy management, and claims processing, agents can spend less time on paperwork and more time helping their clients make smarter choices.

Final Thoughts: The Future is Bright

We’re in an exciting time for insurance professionals. The industry is evolving, and those who adapt, diversify, and educate their clients are the ones who will thrive.

A huge thank you to Jamie Sarno for sharing his expertise! If you’re looking to level up your approach to Medicare and ancillary products, now is the time to dive in.

Let’s keep the conversation going because when we work together, we can truly make a difference in our clients’ lives.

Got questions? Need resources? Reach out, and let’s make sure no client is left unprotected.

 

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

Succession Planning for Insurance Agents

Succession Planning for Insurance Agents

Succession Planning for Insurance Agents
j
Comments

Why I Believe in Succession Planning and Strategic Acquisitions (with Christian Brindle)

:In the ever-changing world of insurance, especially within the Medicare space, staying ahead means thinking beyond just the day-to-day. Recently, Rob and I had the pleasure of sitting down with Rob and Christian Brindle for a conversation that really resonated with me: succession planning and business acquisition.

This wasn’t just another episode of Insurance 360; we got personal, we got practical, and we touched on topics that every agent, especially those who’ve been in the game a while, needs to consider seriously.

My Take on the Industry Today

As someone who’s seen this industry evolve, I’ve noticed a shift. More young agents are entering the field, and the dynamics of agency ownership are changing rapidly. In our conversation, Christian shared his own story of how he got into the business, built his agency, and started thinking long-term from early on. His perspective on generational succession really stuck with me. He’s not just talking theory, he’s living it.

Succession Planning: Not Optional Anymore

One of the biggest takeaways from this episode was the importance of having a clear succession plan. Christian laid it out in a way that makes complete sense. He talked about the risk of leaving your book of business vulnerable if you haven’t incorporated or created a transition strategy. His advice? Get your business structured. Consider getting your spouse licensed. Take steps now so your life’s work doesn’t disappear overnight if the unexpected happens.

What Christian Taught Me About Buying a Book of Business

When we shifted gears to talk acquisitions, Christian really brought the goods. He’s done it; he’s bought books of business and knows what to look for. He walked us through what makes a book valuable: client demographics, policy types, policy age, and more. What stood out to me was how methodical he is; he’s not just grabbing whatever’s available. It has to align with his business model and location. That’s smart business.

Timing (and Tech) Is Everything

I asked Christian about the best time to make a move on a book of business. He prefers the first two quarters of the year- smart move, considering the chaos that is AEP. We also dove into how technology has made all of this easier. With better CRMs and digital tools, the acquisition process is way more efficient than it used to be.

Advice for Fellow Agents

We wrapped up the episode with some real-world advice. Christian stressed the importance of staying plugged into the industry, going to events, networking, and building relationships. That’s how doors open. He also emphasized using tech not just for operations but to stay connected with clients year-round. If you’re not doing that yet, you’re already behind.

Final Thoughts

Look, succession planning and strategic acquisitions aren’t just buzzwords, they’re essential if you want your agency to outlive you. This conversation wasn’t just helpful, it was a wake-up call. Christian Brindle is a guy who gets it. He’s walking the walk and proving that with the right mindset and moves, you can build something lasting.

If you haven’t heard the episode yet, I highly recommend giving it a listen. Whether you’re thinking about the next stage of your career or just trying to build smarter, Christian’s insights are pure gold.

Let’s start planning not just for today but for the legacy we want to leave behind.

Stay informed, stay connected, and keep exploring the dynamic world of insurance.

Succession Planning:  Whitepaper

 Watch here: YouTube

Listen here: Insurance 360 Podcast

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

Contact Us

Contact a Pinnacle Financial Service representative today for assistance.

CallEmail

2026 CMS Final Rule

2026 CMS Final Rule

2026 CMS Final Rule
j
Comments

The Centers for Medicare & Medicaid Services (CMS) has released its final rule for Contract Year 2026, bringing significant updates to Medicare Advantage (Part C), Medicare Prescription Drug (Part D), Medicare Cost Plan, and Programs of All-Inclusive Care for the Elderly (PACE). This rule, rooted in provisions from the Inflation Reduction Act (IRA) of 2022, codifies cost-sharing improvements, enhances beneficiary protections, and imposes new requirements on plan sponsors and pharmacies.

While the rule encompasses various critical policy updates, marketing and communication practices receive a partial overhaul. Let’s dive into the changes with a deeper look at the updated marketing standards.

Key Provisions of the 2026 Final Rule

  1. Vaccine Cost-Sharing Reforms: CMS codifies that all adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) must be offered under Part D with zero cost-sharing. This rule applies to both in-network and out-of-network settings, effective from January 1, 2023, and continuing forward.
  2. Codification of SSBCI Oversight: CMS has codified guidelines for Special Supplemental Benefits for the Chronically Ill (SSBCI), reinforcing that benefits must be medically appropriate and aimed at improving or maintaining health. Non-allowable items—such as tobacco, alcohol, and firearms—are now explicitly excluded, ensuring that SSBCI focuses on meaningful, health-related interventions. Plans must adhere to stricter documentation and compliance standards.
  3. Insulin Cost-Sharing Cap: Beginning in 2026, insulin costs under Part D will be limited to the lesser of $35/month, 25% of the drug’s Maximum Fair Price, or 25% of the negotiated price.
  4. Medicare Prescription Payment Plan: This provision allows all Part D enrollees, including those receiving subsidies, to pay their out-of-pocket costs in capped monthly payments rather than upfront at the point of sale.
  5. Enhanced Protections for Dually Eligible Beneficiaries (D-SNPs): New federal requirements mandate that applicable integrated D-SNPs issue integrated ID cards that cover both Medicare and Medicaid benefits and conduct a combined Health Risk Assessment (HRA) for both programs.
  6. Prescription Drug Event (PDE) Timeliness Requirements: Initial PDEs must be submitted within 30 days, adjustments and deletions within 90 days, and selected drugs have a 7-day window.
  7. Pharmacy Requirements in the Drug Price Negotiation Program: Pharmacies must enroll in the Medicare Transaction Facilitator Data Module (MTF DM) to ensure accurate pricing and claims for drugs with negotiated prices.

Spotlight: Marketing and Communication Reforms

One of the most impactful sections of this final rule is CMS’s ongoing effort to strengthen marketing oversight and ensure beneficiaries receive accurate, accessible, and meaningful information.

Integrated Member ID Cards: For CY 2027, all integrated D-SNPs must issue a single, integrated ID card that serves as the enrollee’s Medicare and Medicaid card. This aims to reduce confusion, enhance the member experience, and support seamless care navigation. Plans must incorporate these changes into marketing and communication materials starting October 1, 2026.

Medicare Prescription Payment Plan Communications: Marketing and outreach materials must now include eligibility criteria and enrollment details, monthly payment cap explanations, instructions for opting in or out, and changes in timing for renewal and election notices. Telephonic notices must meet revised content requirements, long-term care pharmacies are tasked with delivering a “Likely to Benefit” notice, and pharmacies are no longer required to provide OOP estimates at the point of sale.

Transparency and Clarity in Plan Information: Though not finalized in this rule, CMS reiterated its watchful eye on third-party marketing organizations (TPMOs). It continues to monitor misleading advertising, inadequate disclaimers, and aggressive marketing practices targeting seniors. CMS also emphasizes its commitment to promoting culturally and linguistically appropriate services, ensuring websites include up-to-date and accessible plan information, and educating pharmacists and physicians on reimbursement and direct member reimbursement (DMR) protocols.

Financial Impact Summary

  • Vaccines: No expected financial impact.
  • Insulin: Estimated $1.2B increase in transfers from 2026-2035.
  • Payment Plan: No significant financial impact expected.
  • D-SNP Integration: Minor administrative costs only.

 

Conclusion

CMS’s 2026 final rule represents a significant step forward in improving affordability, access, and accountability across Medicare Advantage and Part D programs. For insurance professionals, these updates, especially the enhanced marketing and communication requirements, underscore the critical responsibility you hold in ensuring beneficiaries receive clear, accurate, and timely information.

As trusted advisors, your expertise will be pivotal in helping individuals navigate the evolving landscape, understand their options, and choose plans that best align with their unique health and financial needs. The introduction of features like the Medicare Prescription Payment Plan and integrated member ID cards present new opportunities to streamline the enrollee experience but also demand precise communication and personalized support.

Stay engaged as further guidance is released, particularly around implementation timelines and materials, so you can continue to deliver exceptional service and uphold your role as a key resource in the Medicare journey.

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

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
j
Comments

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

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
Work life resilience building a legacy under pressure

Work life resilience building a legacy under pressure

Work life resilience building a legacy under pressure
j
Comments

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

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
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
j
Comments

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

Contact Us

Contact a Pinnacle Financial Service representative today for assistance.

CallEmail