HealthFirst | Medicaid Basics – Understanding the Dual Market
Healthfirst Learning Corner
Visit the Healthfirst Learning Corner for in-depth trainings- held on alternate Fridays from 11am to 1pm.
Webinar | Mastering Medicare Marketing in Your Own Backyard
Mastering Medicare Marketing in Your Own Backyard
Ready to grow your Medicare business without relying on expensive leads or impersonal digital ads? Join us for this session where we’ll show you how to maximize your local presence and build a strong pipeline through grassroots Medicare marketing strategies that work. This webinar is perfect for agents looking to connect with their communities, establish trust, and generate long-term client relationships—right in their own neighborhoods. What You’ll Learn:
– Community-Based Outreach Strategies
– From senior centers to local events
– Low-Cost Marketing That Gets Results
– Flyers, partnerships, referrals, and more
– Building Trust Through Personal Branding
– Become the “go-to” Medicare expert in your area
– Leveraging Providers, Pharmacies, and Local Businesses
– Collaborations that drive enrollments
– Tracking Success & Staying Compliant – Grow responsibly and sustainably
Whether you’re a new agent or an industry veteran, this session will give you practical tools to take your grassroots marketing to the next level—and help you master Medicare sales in your own backyard.
Medicare Supplement Selling
Medicare Supplement Selling
Comments
As an agent, Medicare Supplement Advantages are sometimes overlooked. Selling Medicare Supplements is an important part of an overall offering from an agent. In this blog we will discuss Medicare Supplement Advantages and Medicare Supplement Selling.
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 Selling, 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
- Medicare Supplement insurance (Medigap) fills the significant gaps in Original Medicare, offering peace of mind by covering out-of-pocket costs.
- Unlike Medicare Advantage plans, beneficiaries with Medigap plans aren’t restricted by network limitations and can see any doctor who accepts Medicare nationwide.
- 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.
Get started with Medicare Sales today- Spot Sign
Medicare Training- Navigating the End of AEP: Insights and Projections for Medicare Sales with Jeff Palo
For more information, contact a Pinnacle Financial Services representative today
1 (800) 772-6881 x7731 | sales@pfsinsurance.com
Vice president - Health Sales
“
Contact a Pinnacle Representative if you have any questions.
1 (800) 772-6881
support@pfsinsurance.com
C-SNP Basics: A Beginner’s Guide for Medicare Agents
C-SNP Basics: A Beginner’s Guide for Medicare Agents
Are you new to Chronic Special Needs Plans (C-SNPs) or looking for a refresher on how they work? This beginner-friendly webinar is designed to give agents a solid foundation in C-SNPs—what they are, who qualifies, and how to effectively present them to eligible clients.
We’ll walk through the core features of C-SNPs, the most common chronic conditions that trigger eligibility, and how to navigate the certification and enrollment process with confidence. You’ll also learn tips for identifying prospects, avoiding compliance pitfalls, and maximizing your impact (and commissions) in this often-overlooked market.
What You’ll Learn:
– What qualifies a beneficiary for a C-SNP, and how to verify eligibility
– Key benefits and differences between C-SNPs and standard Medicare Advantage plans
– How to position C-SNPs as a solution, not just a product
– Sales and retention strategies
Whether you’re expanding into Medicare for the first time or looking to round out your toolkit, this session will help you unlock the potential of C-SNPs and better serve a growing population in need.
Cigna | Disaster SEPs in FL, KY, NJ, NM, NC, OK, TX, UT and VA
Cigna | Disaster SEPs in FL, KY, NJ, NM, NC, OK, TX, UT and VA
Comments
Disaster Special Election Periods (DST-SEPs)
DST-SEPs in Florida, Kentucky, New Jersey, New Mexico, North Carolina, Oklahoma, Texas, Utah, and Virginia.
This communication is an important announcement for those with customers and business in the following states/commonwealths/districts: Florida, Kentucky, New Jersey, New Mexico, North Carolina, Oklahoma, Texas, Utah and Virginia.
The counties, parishes, boroughs, tribes, cities, municipalities, and/or villages noted below are under a federal or state-designated Special Enrollment Period (SEP) due to an emergency/disaster (DST).
Review the DST-SEP guidelines at the bottom of this email to ensure you stay compliant.
Florida
Declaration information Renewed
Declaration #384
State declaration: May North Florida Tornadoes
SEP incident dates: 05/10/2024 – 07/25/2025
This SEP declaration is effective: 05/10/2024 – 08/31/2025
Impacted counties for SEP purposes: Baker, Columbia, Escambia, Gadsden, Hamilton, Jefferson, Lafayette, Leon, Liberty, Madison, Okaloosa, Santa Rosa, Suwannee, Taylor, and Wakulla
Kentucky
Declaration #732
FEMA declaration: Severe Storms, Straight-line Winds, Tornadoes, Flooding, Landslides, and Mudslides
SEP incident dates: 04/02/2025 – 04/24/2026
This SEP declaration is effective: 04/02/2025 – 06/30/2026
Impacted counties for SEP purposes: Anderson, Butler, Carroll, Christian, Clark, Franklin, Hardin, Hopkins, Jessamine, McCracken, Mercer, Owen, and Woodford counties.
New Jersey
Declaration #731
FEMA declaration: Jones Road Wildfire
SEP incident dates: 04/22/2025 – 04/24/2026
This SEP declaration is effective: 04/22/2025 – 06/30/2026
Impacted counties for SEP purposes: Ocean County
New Mexico
Declaration #729
State declaration: Fire Rio Grande
SEP incident dates: 04/17/2025 – 06/18/2025
This SEP declaration is effective: 04/17/2025 – 07/31/2025
Impacted counties for SEP purposes: Valencia County
North Carolina
Declaration information Renewed
Declaration #713
State declaration: Wildfires
SEP incident dates: 03/19/2025 – 06/21/2025
This SEP declaration is effective: 03/19/2025 – 07/31/2025
Impacted counties for SEP purposes: Alexander, Alleghany, Ashe, Avery, Buncombe, Burke, Cabarrus, Caldwell, Catawba, Cherokee, Clay, Cleveland, Gaston, Graham, Haywood, Henderson, Iredell, Jackson, Lincoln, Macon, Madison, McDowell, Mecklenburg, Mitchell, Polk, Rowan, Rutherford, Stanly, Swain, Transylvania, Union, Watauga, Wilkes, Yancey, as well as the tribal lands in the State of North Carolina held by the Eastern Band of Cherokee Indians
Declaration #733
FEMA declaration: Sam Davis Road Fire
SEP incident dates: 04/18/2025 – 04/20/2026
This SEP declaration is effective: 04/18/2025 – 06/30/2026
Impacted counties for SEP purposes: Swain County
Oklahoma
Declaration #734
State declaration: Heavy Rain, Flooding, and Severe Storms
SEP incident dates: 04/19/2025 – 06/26/2025
This SEP declaration is effective: 04/19/2025 – 07/31/2025
Impacted counties for SEP purposes: Cleveland, Comanche, and Cotton
Texas
Declaration information Renewed
Declaration #715
State declaration: Severe Storms and Flooding
SEP incident dates: 03/27/2025 – 06/25/2025
This SEP declaration is effective: 03/27/2025 – 07/31/2025
Impacted counties for SEP purposes: Cameron, Hidalgo, Starr, and Willacy Counties
Utah
Declaration #730
State declaration: Drought Conditions
SEP incident dates: 04/24/2025 – 06/21/2025
This SEP declaration is effective: 04/24/2025 – 07/31/2025
Impacted counties for SEP purposes: Washington, Iron, San Juan, Kane, Juab, Emery, Grand, Beaver, Garfield, Piute, Millard, Tooele, and Uintah
Virginia
Declaration information Amendments include counties in bold
Declaration #727
FEMA declaration: Severe Winter Storms and Flooding
SEP incident dates: 02/10/2025 – 05/27/2025
This SEP declaration is effective: 02/10/2025 – 06/30/2025
Impacted counties for SEP purposes: Buchanan, Buckingham, Campbell, Carroll, Charlotte, Craig, Cumberland, Dickenson, Floyd, Franklin, Giles, Grayson, Halifax, Lee, Lunenburg, Montgomery, Nottoway, Page, Pittsylvania, Powhatan, Prince Edward, Pulaski, Rockingham, Russell, Scott, Smyth, Tazewell, Washington, Wise, and Wythe Counties and the independent city of Bristol
Please note: A DST-SEP application is only valid while the SEP declaration is in effect. If an end date is not listed, please refer to our Ongoing SEP tracker in Producers’ University for the most up-to-date information. Any SEP applications submitted outside of the SEP’s declaration date will be rejected.
IMPORTANT: Please be aware
- This does not mean that active marketing can occur.
- The SEP is only available for individuals that reside or resided at the start of the SEP eligibility period where a federal, state, or local government entity declared a disaster or other emergency.
- The individual was eligible for another election period at the time of the DST eligibility period and did not make an election during that other valid election period due to the disaster or other emergency.
- This does not mean that Cigna Healthcare initiated waiving of authorization or referral requirements.
- This does not extend waiving of prior authorizations, referrals, etc.
SEP for individuals affected by a government-entity declared disaster or other emergency
42 CFR §§ 422.62(b)(18) and 423.38(c)(23)
Please review this link to refer to the guidance from the Centers for Medicare and Medicaid Services (CMS) on DST-SEPs.
Updates to our DST application process
Two key updates:
1.The date of the disaster is no longer required on any DST applications.
2.The missed election period is not required on most applications. See clarification below.
Keep in mind: Some missed election periods will still require you to input the missed election period AND the date of the missed election period on the application. Some examples include MOV (moving) or LEC (losing group coverage). The application will contain an “open” date field next to the SEP selections that still require a date to help you know when it is required.
Please read below for important application instructions.
For all applications, ensure that the following fields are completed:
- Select “SEP” in the Select Enrollment Periodfield.
- Enter code “DST” in the SEP Codefield.
- If applicable, enter the date associated with the missed election period. For example, a date is needed only if the missed SEP already required a date, such as moving, losing group coverage, losing or gaining Medicaid, etc. If the missed SEP or election period does not require a date, you do not need to include it. However, adding it may expedite the review process. (i.e., AEP, OEP, LIS, MDE).
DST is not a standalone election period. If you have questions about DST eligibility, please review the Ongoing SEP Tracker in the Resource Center of Producers’ University.
For more information, contact a Pinnacle Financial Services representative today
1 (800) 772-6881 x7731 | sales@pfsinsurance.com
“