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YourMedicare SunFire: Voice Scope & Signature For Field Agents

Posted by www.psmbrokerage.com Admin on Wed, May 31, 2023 @ 04:03 PM

Sunfire Voice Sig


Starting on 6/2, SunFire will make Voice Scope and Voice Signature capabilities available, automatically, to agents on recorded calls using SunFire's Voice Recording Solution.


When on a recorded call using SunFire's voice recording solution, the platform will automatically remove the "Complete scope" in-person option for Scope of Appointments, and replace it with the ability to complete a compliant Voice Scope:

Similarly, when the agent clicks "enroll" they will automatically be shown our CMS-filed, compliant Enrollment Script with voice, text, and email signature options:

This functionality is currently only available to agents that utilize SunFire's Voice Recording Solution within our BlazeConnect field agent platform. Please reach out to your Account Manager if you have questions or feedback, or would like to enable Voice Recording for your agents.

Don't have access to SunFire's enrollment tool? Request details today.

Download the PDF here.

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Tags: SunFireMatrix, Voice Signature

Corebridge Final Expense Plans

Posted by www.psmbrokerage.com Admin on Wed, May 31, 2023 @ 09:40 AM


Tags: Final Expense, aig, Corebridge

Honoring the Service of America's Heroes

Posted by www.psmbrokerage.com Admin on Thu, May 25, 2023 @ 10:41 AM

memorial day 2023

Honoring the Service of America’s Heroes

“Our debt to the heroic men and valiant women in service of our country can never be repaid. They have earned our undying gratitude. America will never forget their sacrifices.”

President Harry S. Truman

Memorial Day takes on a more-solemn tone than many of the other federal holidays we celebrate as it’s the day set aside to remember the men and women who died while serving in our country’s armed forces.

America’s military members make a commitment to protect the freedoms our founders fought to put in place. And sadly, many make the ultimate sacrifice for their service. We thank them for their dedication, patriotism and unfailing loyalty to the United States.  

Please take a moment over this holiday weekend to remember the service members who put duty, honor and country first.

PSM will have an early release* at 1 p.m. local time on Friday, May 26.
Our offices will be closed on Monday, May 29 in observance of Memorial Day.


memorial day 2023 FOOTER-1

Mutual of Omaha: Great rates on top plans in Texas — and a new bonus!

Posted by www.psmbrokerage.com Admin on Thu, May 25, 2023 @ 09:56 AM

Mutual Texas header

Thanks to Mutual of Omaha's new Enhanced Broker Bonus, you'll now earn an extra $100 cash per issued underwritten policy - ON TOP OF the money you'll earn from our existing Broker Bonus program.

Talk about a win-win! You can now offer customers amazing rates on our most popular plans – Plan G and Plan N – and put more cash in your pocket when you sell these plans and others.

Mutual Bonus-2

View the Texas Outline of Coverage →

Not appointed with Mutual of Omaha? Request details here.

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Tags: Mutual of Omaha Medicare Supplement, Bonus Program

Your Questions About CMS’s New Rules, Answered

Posted by www.psmbrokerage.com Admin on Mon, May 22, 2023 @ 02:47 PM

New CMS Rules QandA

On April 5, 2023, the Centers for Medicare & Medicaid Services (CMS) issued long-awaited rules pertaining to, among other matters, the marketing of Medicare Advantage (MA) plans. YourMedicare and its partners had been anticipating these changes and have activated a task force to study the newly published rules in detail and clarify their implications for our affiliated agents’ businesses.

The FAQ is the culmination of that effort. Here you will find answers to a number of questions we have received since April 5, as well as clarification on the new rules our team is proactively providing.

CMS New Rules FAQs
Please bookmark this page
for future reference. As new information and interpretations become available, we will add those to this page.

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Tags: Medicare Advantage, CMS, medicare changes, medicare marketing guidelines

Unlock the Power of Emotional Intelligence - The Secret to Sales Success

Posted by www.psmbrokerage.com Admin on Thu, May 18, 2023 @ 01:00 PM

Unlock the Power of Emotional Intelligence

Unlock the Power of Emotional Intelligence

- The Secret to Sales Success -

Emotional intelligence (EQ) is more important than ever because it helps individuals and teams navigate an increasingly complex and interconnected world. It is an essential skill for building strong relationships, managing stress, and achieving success both in personal and professional life.

We could look at emotional intelligence as the GPS for our emotional and social navigation. Just like a GPS is more important today with the fast-paced and ever-changing world, emotional intelligence has become more important than ever to navigate through the complex and dynamic aspects of our personal and professional lives.

Psychologist and author Daniel Goleman, one of the most prolific writers on emotional intelligence, discovered a handful of competencies while studying high performers. When he looked at what set top leaders apart, the skills that made the difference were those within emotional intelligence. In other words, EQ isn’t just a nice-to-have for high performance; it’s the distinguishing factor.

It’s easy to see why professional success today depends on EQ.

Emotional intelligence is directly related to resilience – our ability to engage with challenges, sustain performance, rebound quickly from adversity, and learn and grow from our experiences.

When you’ve developed EQ, you can cope with stressful conditions, maintain a positive outlook and are less likely to burn out.

Nevertheless, just because some individuals seem to naturally possess a high level of emotional intelligence does not mean that it can’t be learned or developed over time.

Similar to how you can develop skills to be a stronger leader, anyone can increase their EQ. Learn the strategies, and practice them until they become second nature.

Let’s look at what kind of sales strategies an individual with a high emotional intelligence (EQ) might use.


Active Listening:

Active ListeningA high EQ individual would actively listen to the customer, paying close attention to their concerns and needs. They would be able to pick up on nonverbal cues and respond accordingly, which can help to build trust and credibility with the customer.

Active listening is an important component of emotional intelligence that can help improve your sales process in several ways:

  1. Understanding the customer: By actively listening to your clients, you can better understand their needs, concerns, and buying motivations, which can inform your sales pitch and help you tailor it to their specific circumstances.

  2. Building trust: By showing your clients that you are genuinely interested in their needs and concerns, you can establish yourself as a trustworthy and dependable advisor, which can lead to increased customer loyalty and repeat business.

  3. Identifying objections: Active listening can also help you identify any potential objections or concerns that your clients may have about your product or service, allowing you to address them proactively and overcome them.

  4. Problem solving: By listening closely to your clients, you can help them understand the problem, and present them a solution that will address their concerns and give them value.

  5. Personalization: Active listening can also allow you to personalize your sales pitch and tailor it to the specific needs and preferences of your clients, which can help increase their engagement and willingness to buy.

  6. Negotiation: The more you understand about the client and his need, the more effectively you can negotiate and seal the deal.

Overall, active listening is key to building a strong relationship with your clients, understanding their needs and concerns, and ultimately closing more sales.



Self AwarenessSomeone with high EQ would be self-aware, they would be able to recognize their own emotions and how they impact their behavior. They would be able to manage their emotions during sales interactions, making sure not to let any negative emotions affect their communication with the customer.

Here are a few ways that self-awareness can help:

  1. Staying calm and composed: By being aware of your own emotions, you can better manage them, which can help you stay calm, composed, and in control during sales meetings and presentations. This can help you build trust and credibility with your clients, and make them feel comfortable working with you.

  2. Communicating effectively: By understanding your own communication style, you can adapt it to match the style of your clients, which can help improve your ability to connect with them and communicate effectively.

  3. Understanding body language: Self-awareness also helps you recognize and respond appropriately to the nonverbal cues of clients.

  4. Building rapport: By understanding your own behavior and emotions, you can better understand those of others and build rapport with clients more easily.

  5. Reflecting and adjusting: Self-awareness also allows you to reflect on how a meeting or conversation went, and adjust your approach for next time, which can help you become a more effective salesperson over time.

  6. Conflict resolution: Self-awareness also can help in resolving conflicts with clients by understanding the root of the conflict and resolving it amicably.

Overall, self-awareness is an important skill for any salesperson, as it can help you stay calm and composed, communicate effectively, build rapport with clients, and improve your sales process over time.



EmpathyAn individual with a high EQ would be able to understand and appreciate the customer's perspective, and respond in a way that shows that they genuinely care about the customer's needs. They would be able to put themselves in the customer's shoes and understand their wants, needs, and concerns.

Empathy can help improve your sales process in several ways:

  1. Building rapport: Demonstrating empathy helps create a sense of trust and understanding between the salesperson and the customer. This can make the customer feel more comfortable and open to the sales process.

  2. Identifying needs: By actively listening and trying to understand the customer's perspective, a salesperson who uses empathy can more easily identify the customer's needs and tailor their pitch accordingly.

  3. Addressing objections: Understanding the customer's perspective can also help a salesperson anticipate and address any objections the customer might have.

  4. Improving customer experience: Empathetic salespeople are better able to create a positive and personalized experience for their customers, which can improve customer satisfaction and increase the likelihood of repeat business.



FlexibilityHigh EQ individuals are able to adapt to different situations and changing circumstances. They would be able to adjust their approach to different customers and different situations, which can be critical in sales where one size does not fit all.

Let’s look at a few ways’ flexibility can help you succeed:

  1. Adapting to changing customer needs: By being flexible in the sales process, a salesperson can adjust their approach and strategy to better meet the changing needs and concerns of the customer. This can help improve the overall customer experience and increase the likelihood of making a sale.

  2. Handling objections: Salespeople who are flexible can respond to customer objections in a creative and effective way, that can help to persuade the customer to take an action.

  3. Building trust: Flexibility in the sales process can also help build trust with customers. It can show that the salesperson is willing to work with the customer to find a solution that meets their needs.

  4. Tailoring the Pitch: Flexibility in the sales process can help the salesperson to tailor their pitch and presentation to the customer's preferences, making it more personalized and engaging, increasing the chances of making a sale.

  5. Considered as a resource: A flexible salesperson is seen as a resource for the customer, who can help them to navigate through the buying process, this will enhance the customer's trust and increase the chances of making a sale.


Building relationships:

RelationshipsA high EQ person would focus on building long-term relationships with customers, rather than just trying to make a sale. They understand that the customer's satisfaction and trust is the key to a successful sale and customer retention.

Here are a handful of ways’ building relationships will improve your business:

a. Increased revenue: Strong relationships with customers can lead to upselling and cross-selling opportunities, resulting in increased revenue for the business.

b. Enhanced trust: Building trust with customers through relationship building can lead to increased loyalty and customer retention, which can translate into long-term growth for the business.

c. Access to valuable customer insights: Building relationships with customers can provide the business with valuable insights into customer needs and preferences, allowing it to improve its products and services, and develop more effective marketing strategies.

d. Referral generation: Happy and satisfied customers are more likely to refer their friends and family to the business, which can help it to acquire new customers at a low cost and increase the customer base.


Communicating effectively:

Communicate EffectivelyHigh EQ individuals are able to communicate effectively, both verbally and non-verbally. They would be able to express their ideas clearly and persuasively, and be able to read the customer's cues and respond in a way that is appropriate to the situation.

Let’s look at how effective communication will help your sales process:

  1. Building trust and rapport: Effective communication is a key factor in building trust and rapport with customers. By communicating clearly and listening actively, salespeople can establish a strong connection with the customer and create a positive, human connection.
  2. Addressing concerns and objections: Effective communication can help salespeople anticipate and address any concerns or objections the customer might have. It allows to answer questions and provide information that can help the customer make an informed decision.
  3. Personalizing the sales pitch: Through effective communication, salespeople can gather information about the customer, such as their needs, goals, and pain points, and tailor their pitch and approach to better align with the customer's specific needs.
  4. Improving the overall customer experience: Effective communication helps the salesperson to create a positive and personalized experience for their customers, which can improve customer satisfaction and increase the likelihood of repeat business.
  5. Closing deals: Effective communication also helps salespeople to effectively negotiate and close deals, by providing clear and persuasive information that can help the customer to make a purchase decision.

Customer-centric approach:

Focus on NeedsA high EQ individual would take a customer-centric approach, focusing on meeting the customer's needs and exceeding their expectations. They would understand that keeping the customer happy is the key to success in sales.

So, how does a customer-centric approach help grow my business?


  1. Personalization: A customer-centric approach allows you to tailor your sales process to the specific needs and preferences of each individual customer, rather than using a one-size-fits-all approach. This can increase the effectiveness of your sales efforts and lead to higher conversion rates.

  2. Building trust: By focusing on the needs and concerns of your customers, you can build trust and establish a positive relationship with them. This can lead to repeat business and positive word-of-mouth marketing.

  3. Identifying new opportunities: A customer-centric approach can help you identify new opportunities for sales and expansion. By listening to and understanding the needs of your customers, you may be able to identify new products or services that they would be interested in.

  4. Improve customer retention: Understanding your customer's pain points, preferences and providing solutions for them not only increase the chances of repeat business, but also drives loyalty.

  5. Problem solving: By putting the customer at the center of your process, it allows you to understand their problems and challenges and provide solutions that addresses their needs. This can help increase the effectiveness of your sales process, as you are able to identify and address customer pain points more effectively.

Wrapping it up

Using emotional intelligence in your sales process can be a powerful tool for growing your business. By being able to understand and connect with your customers on an emotional level, you can build stronger relationships, increase customer loyalty, and identify new opportunities for sales and expansion.

By developing their emotional intelligence, salespeople can unlock the power to achieve greater success in their sales efforts. This can be done through various means such as self-reflection, training, and seeking feedback.

Emotional intelligence is not just something that one is born with, it is something that can be developed over time. By making it a priority, salespeople can achieve a competitive edge in the marketplace and take their sales performance to the next level.

Tags: Sales Tips

2024 AHIP Medicare Training Details

Posted by www.psmbrokerage.com Admin on Thu, May 18, 2023 @ 12:57 PM

Tags: AHIP, Training, 2024

Medicare Supplement Plan N is Rising in Popularity

Posted by www.psmbrokerage.com Admin on Tue, May 16, 2023 @ 03:43 PM

plan n

In today’s marketplace, consumers want more control over their healthcare decisions and expenses. Popular plans, like a high-deductible health plan, offer lower monthly premiums and encourage consumers to take an active role in managing their own healthcare costs.

Similarly, Medicare Supplement Plan N is gaining traction as seniors opt to have lower monthly premiums. With Plan N, enrolled individuals only pay the Part B deductible when they access medical care. Additionally, the individual might incur copayments or Part B excess charges.

In a recent study by America’s Health Insurance Plans (AHIP), Plan F continues to lose market share declining from 46% of all Medigap enrollments in 2020 to 41% in 2021. This decline is because F is no longer available to people new to Medicare on or after January 1, 2020. However, Plan G and Plan N are gaining popularity, with 32% and 10% market share, respectively.

Plan N is the third most popular Medicare Supplement plan, and as of 2021, more than 1.38 million people chose Plan N over other Medicare Supplement coverage options.

Help Your Clients Save Money With Plan N

The popularity of Plan N is largely due to the coverage benefits. This plan includes many of the Medicare benefits, but is structured in a way to keep plan costs low.

Plan N offers similar benefits to Plan G. With both plans, individuals are subject to incur the annual Part B deductible of $226, copayments up to $20 for doctor appointments, and $50 for emergency room visits.

Plan N highlights include:

Skilled nursing facility
Part A deductible
Foreign travel emergency

Plan N highlights exclude:

× Part B deductible
× Part B excess charges

For clients who are looking to save money, Plan N might be a great solution. Let’s look at an example:

Jane Smith is currently enrolled with a Plan G which costs her $180 a month in premium. By moving to a Plan N, she pays $120 a month. By switching to a lower premium plan, Jane saves $60 a month or $720 total a year. Jane can use the money saved to cover out-of-pocket medical expenses including the Part B deductible or copayments. Or, she can use the savings to purchase additional coverage like a Cancer, Heart Attack and Stroke policy or an Accident plan. With Plan N, Jane is in more control of her healthcare decisions and how she chooses to spend her money.

If you have a client who does not visit the doctor often, Plan N may be a great fit for them. Next time you are evaluating coverage options with your clients, take a look at Plan N. They might be a great fit for this affordable Medicare Supplement option.

For a list of carriers that offer Medicare Supplement Plan N, Please request details today or call us at  (800) 998-7715 and ask to speak to a marketing representative.

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Tags: Plan N, Medicare Supplement plans

Best Practices For Working Insurance Leads

Posted by www.psmbrokerage.com Admin on Tue, May 16, 2023 @ 11:52 AM

Best practices for working leads blog header

Best Practices for Working Insurance Leads

One of the most common questions we receive is, “What are your top producing agents doing, and how do I replicate it?”

This is a good question and an understandable one. As a licensed insurance agent you are trying to build a business for yourself and are looking for ways to make that business more successful. 


Unfortunately, there isn’t a perfect lead source or an infallible script. A good agent will sell regardless. The question is, how. What are the successful agents doing that makes them so successful.

After speaking with thousands of agents over the past 15 years I’ve noticed what separates the top producing agents from the rest of the pack is, their mindset. 

A mindset can be defined as a “Habitual or characteristic mental framework that determines how you will interpret and respond to situations”.

This is really great news, because building habits that create a winning mindset is free. It takes time and discipline, but it doesn’t take any money. 

So, if that’s you’re goal, what habits do you focus on?

Well, here are 3 key habits that you can adopt, to help you build a proven mindset for success.

1.    They have the Drive to be consistent as they strive for success
2.    They have a Growth Mindset
3.    They genuinely Care about their clients 

Don’t discount them because of their simplicity. Many agents do, and that’s why they continue to ask the same questions.

Let’s dig into each of these, an pull out some take-aways that you, the agent, can use in your business:


1.    They have the drive to be consistent as they strive for success:

As an independent agent you don’t have a boss. You don’t have someone telling you what to do or when to do it. Most importantly you don’t have anyone checking to make sure you did what you were supposed to do when you were supposed to do it. 

You have to act as your own manager, setting a daily schedule and following it. Top producers have the mindset that they are running a business and this means that they section off their day and know what they are going to be doing every day, and when they are going to be doing it. 

For example, if you have blocked off the first half of your day to call leads and the first person you call purchases a policy from you, it is easy to say “I’ve made my sale for the day” and move on to something else. 

This is a mindset that many agents fall into. The inconsistency that comes out of that will really hamper your success.

The best agents don’t have that mindset though. They know that those leads they purchased work best when they are fresh and that they have allotted that portion of their day to calling those leads. 

Most importantly, that mindset allows them to consistent repeat that pattern day after day. They don’t give themselves an easy out or allow themselves to slow down because of an early success.  

As an agent, you have to have the mindset that you are going to drive yourself to be as successful as you possibly can, and consistency is key.

You must outline standards and practices that will make you successful and hold yourself accountable to those every day, without exception.


2.    They have a Growth Mindset:

In a growth mindset, people believe that their most basic abilities can be developed through dedication and hard work – brains and talent are just the starting point.  (Dweck 2015)

This view creates a love of learning and resilience that is essential for great accomplishment.  Virtually all great people have these qualities. 

In a fixed mindset, people believe their basic qualities, like their intelligence or talent, are simply fixed traits. This often leads to stagnation and frustration.

Agents that have a growth mindset are always learning about their industry and themselves, while trying to improve their craft.

Whether it’s learning about sales, products they sell, or technology that can help their business, they don’t stop looking for ways to improve.

This becomes a constant state of mind that quickly separates them from the masses, and propels them to the top of their industry.


3.    Genuinely caring about your clients is paramount.

I’ve never spoken with a high-volume producer who didn’t have a clear passion for making sure their clients were fully taken care of.

Your clients are trusting you to help them make a decision that directly affects their health and finances.

Those clients need to know that you care about their health as much as they do. Your clients get post-card after post-card every month from agents who could easily sell them a policy.

You aren’t just selling them a policy. You are protecting them. You are listening, advising, and befriending them. You are giving them peace of mind. 

Once you start really connecting with and taking a true interest in the well being of the people you serve, you will notice a much stronger relationship with those clients. 

Your sales will increase, your persistency will increase, your referrals will increase, and the fulfillment you get from helping your clients will also increase. 

I realize everything I’ve said to you is not new. Work hard, continue bettering yourself, and care about others. Not exactly rocket science, right?

Unfortunately, many agents don’t understand that those simple habits put together with consistency, is what creates a winning business. Assuming simple things don’t matter, or are beneath you, is a Fixed Mindset, and rarely leads to success. 

With the right mindset in place, your clients will see you as a dependable friend they can trust. Your colleagues will see you as a professional, and a leader in your industry. 

Don’t underestimate the power of your mindset. Your success depends on it.
Thanks for your time, and if you have any questions, we’re happy to help.


Download the Guide as a PDF here


Helpful Resources:


Tags: Leads, Best Practices

New Portfolio Additions: Zing Health and Lasso Healthcare

Posted by www.psmbrokerage.com Admin on Mon, May 15, 2023 @ 03:30 PM

lasso zing

We are happy to introduce Zing Health and Lasso Healthcare to our powerful lineup of Medicare Advantage options. 

Who is Zing Health?


Zing Health was founded in 2019 to address inadequacies in the healthcare system by creating collaborative, community-based Medicare Advantage plans.

In 2020, Zing Health served Medicare beneficiaries in Cook County, Illinois, and in 2021 expanded to additional counties in Illinois, Michigan, and Indiana. In 2022, Zing Health will begin serving additional counties in Illinois and offering new plan types as well as enhancements to existing plans.

If you are interested in representing Zing Health Medicare Advantage plans, please request details here.

Why Lasso Healthcare?


With additional tax-advantages, the MSA has unique features not typically found in Medicare. It’s time to partner with Lasso Healthcare and offer a different type of Medicare Advantage plan!

What is the Lasso Healthcare MSA: A high-deductible health plan paired with a tax-advantaged savings account.

If you are interested in representing Lasso Healthcare Medicare Advantage plans, please request details here.

We take pride in providing our agents with high quality senior insurance products that bring a sense of security and peace of mind to the nation's exploding senior population. Our experienced insurance marketing team provides our agents with a robust product portfolio, game-changing technology and unrivaled support.


Tags: Cigna, Medicare Advantage

Cigna: Value-Based Enrollment (VBE) Updates

Posted by www.psmbrokerage.com Admin on Mon, May 15, 2023 @ 11:54 AM

cigna vbe

At Cigna Healthcare, we believe in the primary care provider (PCP) and patient relationship. That’s why our model of care is PCP-focused, regardless of product. We know this model of care drives better health outcomes and increases customer satisfaction.

With that in mind, we are making a change in how our brokers earn payments through our VBE digital application program. This change applies to June 1 effectives and beyond.

Brokers can still earn up to $50 per electronic application (app), but they will need to include a valid in-network PCP and/or the customer’s email address to receive payment. We will no longer pay brokers $20 for the electronic app submission itself. Instead, we are increasing the payments for collecting the valid PCP and email information.

New VBE payment amounts
Applies to June 1 effectives and beyond

Brokers can earn up to $50 per approved digital application for new Cigna Healthcare Medicare Advantage (MA) customers and voluntary MA customer plan changes.

  • $30 if the digital app includes a valid in-network PCP
  • $20 if the digital app has a valid customer email address

How this benefits the broker

When a broker captures the PCP and email address at the time of enrollment, they give us the information we need to provide better care to the customer.

Better care leads to happier, healthier customers who are more likely to stay with Cigna Healthcare. That means brokers can focus on new customer growth rather than book maintenance.

So, in addition to the immediate monetary reward (i.e., VBE payments), they will also benefit from our higher retention rate and net promoter score (NPS).


Tags: Cigna, Medicare Advantage

CMS Memo: Definition of Marketing

Posted by www.psmbrokerage.com Admin on Mon, May 15, 2023 @ 11:24 AM

CMS Memo- Definition of Marketing

Date: May 10, 2023

To: Medicare Advantage Organizations, Medicare Advantage-Prescription Drug Plans, Prescription Drug Plan Sponsors, and Section 1876 Cost Plans

From: Kathryn A. Coleman, Director

Subject: Definition of Marketing

📑 Download the official announcement

In order to ensure Medicare beneficiaries are making enrollment decisions based on up-to-date and accurate information, the Centers for Medicare & Medicaid Services (CMS) is issuing this memo to clarify the definition of marketing for Medicare Advantage-Prescription Drug Plans, stand-alone Prescription Drug Plans, 1876 Cost Plans, and Third-Party Marketing Organizations (TPMOs).

Regulations at 42 CFR §§ 422.2260 and 423.2260 define marketing as communication materials and activities which meet specific intent and content standards.

  • The intent component of the definition of “marketing” is met when any material or activity is intended to draw a beneficiary's attention to plan or plans, influence a beneficiary's decision-making process when selecting a plan, or influence a beneficiary's decision to stay enrolled in a plan (that is, retention-based marketing).

  • The content component of the definition of “marketing” is met when any material or activity includes or addresses plan benefits, benefits structure, premiums, or cost sharing; measuring or ranking standards; or rewards and incentives.

To date, CMS has permitted the mentioning of widely available benefits (i.e., vision, dental, premium reduction, and hearing) in materials or activities without those materials or activities being considered marketing subject to the marketing regulations. We did not believe the general descriptions were made with sufficient intent to draw attention to a particular plan or subset of plans. This interpretation was predicated on the assumption that a beneficiary would be unlikely to make an enrollment decision based on widely offered benefits advertised without information on the associated costs for enrollees. CMS monitors both organization and TPMO marketing by reviewing marketing and communication materials and activities, reviewing complaints received through 1-800-Medicare, and listening to marketing and enrollment calls.

Due primarily to the recent proliferation of TPMO advertising, we have found, however, through our surveillance, reviews, and discussions with interested parties that many beneficiaries do inquire and some enroll based on the original advertisement of these types of benefits. Beneficiaries have contacted agents, made calls to 1-800 numbers, and responded to flyers asking about the dental, vision, hearing, and cost-savings being marketed. Therefore, we are expanding our interpretation of the regulatory definition of “marketing” to include content that mentions any type of benefit covered by the plan and is intended to draw a beneficiary's attention to plan or plans, influence a beneficiary's decision-making process when selecting a plan, or influence a beneficiary's decision to stay enrolled in a plan (that is, retention-based marketing) and thus subject to review.

As stated above, marketing requires both intent and content. Content that beneficiaries can receive benefits such as dental, vision, cost-savings, and/or hearing services is sufficient information about plan benefits, benefits structure or cost sharing to meet the content standard in the definition of marketing in §§ 422.2260 and 423.2260. Further, the use of these statements in advertisements and activities directed to Medicare beneficiaries clearly meets the intent standard. Therefore, beginning July 10, 2023, any material or activity that is distributed via any means (e.g., mailing, television, social media, etc.) that mentions any benefit will be considered marketing and must be submitted into HPMS. This clarification, along with the new marketing safeguards codified in the Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly final rule (CMS-4201-F), will help ensure that beneficiaries have accurate information when shopping for Medicare coverage and are protected from potentially misleading marketing activities.

Questions may be sent to marketing@cms.hhs.gov. Please copy your Marketing Reviewer.

Tags: CMS, Compliance, Marketing

Avoid These 5 Common Compliance Mistakes

Posted by www.psmbrokerage.com Admin on Thu, May 11, 2023 @ 10:20 AM

Compliance Mistakes-1

Here are five common mistakes and what you can do to remain in compliance with the Centers for Medicare and Medicaid Services (CMS) when working with Medicare beneficiaries on their coverage.



1. Not Keeping SOAs on File
Beneficiaries must sign a scope of appointment before discussing Medicare Advantage or Part D plans. Remember to have your client sign an SOA at every appointment, and keep the forms on file for 10 years.

2. Not Determining Health Care Providers
Before you can help someone with their Medicare plan, you need to know every physician and specialist that client sees. Compare current providers with those in their chosen plan’s network so their service isn’t disrupted.

3. Not Reviewing the Drug Formulary
An unexpected increase in prescription prices can quickly change the client-agent relationship. Be sure to review enrollment data and fix it on the spot so the application isn’t returned.

4. Not Discussing Summary of Benefits
Provide your client with this at the time they enroll, summarizing key features, such as covered benefits and cost sharing. This summary needs to be discussed prior to signature collection and verification of intent to enroll.

5. Not Submitting Applications on Time
Be sure to submit all applications in the required 24-48-hour time frame, after doublechecking all the details and ensuring the application is complete.

In this industry, we’re busy year-round, and unintentional mistakes can always happen. It’s important to stay on top of the application process and to know exactly what’s needed to remain compliant as we do business.


Tags: Compliance

Lead Generation Advice for Today’s Savvy Agents

Posted by www.psmbrokerage.com Admin on Thu, May 11, 2023 @ 10:01 AM

Lead Generation Advice for Today’s Savvy Agents

The number one question facing agents in today’s complex lead generation environment is, “what lead generation technique is best?” What we’ve learned is that the most effective Medicare lead generation approach involves a smart mix of techniques to attract, engage, and nurture customers across a variety of channels. This approach ensures you are reaching customers in the places and spaces where they're most comfortable communicating. Remember: be where your customers are.


The most successful agents start with a compassionate understanding of a customer’s life journey and demonstrate empathy and knowledge.

People eligible for Medicare can find navigating the process complex. Therefore, it's critical to employ a comprehensive approach to building a thoughtful content strategy to communicate and inform. Effective lead generation starts by providing your target audience with education. Approaching your content marketing strategy by understanding the customer journey and motivations puts you in a stronger position to answer the most meaningful questions.


Traditionally, conventional marketing materials such as direct mail, print ads, referral programs, and educational brochures were sent directly to the customer’s home address. TV or radio spots were market-specific, but still targeted customers in their hometowns. Over the past ten years, a different dynamic has emerged.

It’s no secret that the internet has changed everything, and social media platforms are now viewed as the primary source of mainstream news and information across all age demographics, even the aging population.

The adoption of social media by the aging population can supercharge your online marketing efforts when they are shared with your target’s entire social networks, exponentially expanding your potential customer base.


Building a content strategy is the process of establishing your personal brand, defining your relationship goals with target audiences, and creating a plan to deliver valuable and engaging content.

There are six key steps in developing a robust, effective content strategy:

  1. Determine what you want to achieve with content and define your goals
  2. Identify what your customers are looking for and build your content around this critical question
  3. Review your existing content bank to identify what you can reuse to build credibility and bring customers into your funnel
  4. Create an annual content plan, and outline the types of content you'll create and the channels you'll use to distribute it
  5. Establish your space. With your plan in place, start creating your content. Make sure it is high-quality and engaging, and always relates back to your target audience
  6. Analyze and optimize: Regularly track and measure the performance of your content and adjust your content strategy based on these insights

Most agents make the mistake of thinking of offline and online marketing as two entirely separate marketing approaches. The most-successful agents understand that using precise online data is a force multiplier for boosting the effectiveness of traditional
Medicare lead generation campaigns.


  • Medicare lead generation isn't about whom you reach; it’s about what you teach
  • Understand your target audience and their life journey. Remember that a small amount of empathy and understanding will go a long way in relationship building
  • The most effective Medicare lead generation approaches involve a mix of techniques to attract, engage, and keep customers
  • Establishing an online presence is essential for any business looking to reach new customers
  • Creating a content strategy is the process of defining your goals and creating a plan to deliver valuable and engaging content to Medicare eligible customers
  • Think about data differently and apply it across all marketing efforts



Tags: Lead Generation, Marketing

New CMS Rules To Impact Medicare Advantage Marketing

Posted by www.psmbrokerage.com Admin on Thu, May 11, 2023 @ 09:02 AM

New CMS Rules To Impact

On Wednesday, April 5, the Centers for Medicare & Medicaid Services (CMS) issued long-awaited rules pertaining to, among other matters, the marketing of Medicare Advantage (MA) plans. These rules were developed with the intention of protecting Medicare beneficiaries from misleading or deceptive advertising practices. Our leadership quickly activated a task force to study the newly published rules in detail and clarify their implications for our agents' businesses.

The new rules go into effect on June 5 and will be applicable on Sept. 30 for coverage beginning January 1, 2024. This means that they will impact activities that will take place during this year’s Medicare Annual Enrollment Period (AEP), which begins on Oct. 15.

What can you do now?

While the new CMS rules are applicable on Sept. 30, there are steps agents and agencies can start right now.

  • Audit lead generation and marketing materials and evaluate against the newly issued CMS regulations. Lead generation and marketing materials include:
    • Internet ads
    • Direct mail pieces
    • Call scripts
    • Web pages
    • Emails
  • Identify marketing materials, including materials that mention plan benefits, premiums, and cost-savings; and evaluate.
  • Be cautious where the Medicare logo is used on any advertising or in a misleading manner when used for MA or PDP marketing.

PSM anticipates rolling out insight and guidance over the coming weeks. While these efforts are underway, please continue to adhere to current compliance guidelines and submit any marketing materials developed over the normal course of business through your usual approval processes.

Should you have questions related to the CMS announcement, please email them to info@psmbrokerage.com



Tags: Medicare Advantage, CMS, Marketing

LifeShield Medicare Supplement | Now Available In Kansas and North Dakota

Posted by www.psmbrokerage.com Admin on Mon, May 08, 2023 @ 02:22 PM

Life Shield KS and ND-1

Medicare Supplement is now available in Kansas and North Dakota 

LifeShield National Insurance Co. Medicare Supplement plans are now available in Kansas and North Dakota! Applications will be accepted as of May 8th through both paper applications and eApp.

As of May 8th, Kansas and North Dakota clients will benefit from:

  • A 7% household discount on Medicare Supplement plans.
  • A 10% multi-product discount is applied to the DVH plan when combined with an approved Medicare Supplement policy*.
  • Policyholders can enjoy market leading rates across Plans F, G, and N, while producers can enjoy a great commission rate that’s paid daily.

The Kansas and North Dakota state-specific materials are available on the Digital Agent Kit. No need to remember your portal credentials - the Digital Agent Kit is just a click away, with immediate access to all your sales resources. Visit lifeshieldcombo.com to get your materials now!incentive

Expedite your client’s application with same day processing – no longer will your client need to wait days or weeks for their coverage to start. Point-of-sale underwriting decision notification for clean apps and declines, with 48-hour turnaround for referred underwritten cases.

LifeShield National Insurance Co. is an Oklahoma City-based life and health insurance company, and a member of the LifeShield National family of insurance companies. Together with its affiliates Individual Assurance Company Life, Health, & Accident, and Life Assurance Company, LifeShield has been protecting families for nearly 50 years with affordable life, health, and accident insurance solutions to help you live the life you choose. LifeShield National Insurance Co. is rated B++ (Good), the 5th highest rating possible out of a total of 16 by AM Best, a widely recognized independent insurance industry ratings firm. For the latest rating information, visit www.ambest.com


Tags: LifeShield

Important Cigna PDP Commissions Update

Posted by www.psmbrokerage.com Admin on Thu, May 04, 2023 @ 02:47 PM

Tags: Cigna, Medicare Part D

How to Build Better Habits

Posted by www.psmbrokerage.com Admin on Wed, May 03, 2023 @ 01:52 PM

How to Build Better Habits-1

Building better habits is an important part of personal growth and self-improvement.

Here are some tips to help you build better habits:

  1. Set clear goals: When setting goals, it's important to be specific and measurable. For example, instead of setting a vague goal like "increase sales," set a specific goal like "increase sales by 10% in the next quarter." This will help you measure your progress and stay motivated.

  2. Prioritize: One way to prioritize tasks is to use the "Eisenhower Matrix." This involves categorizing tasks into four quadrants based on their importance and urgency. Quadrant 1 contains urgent and important tasks that require immediate attention, while quadrant 4 contains tasks that are neither urgent nor important and can be eliminated or delegated.

  3. Create a routine: A routine can help you establish good habits and stay on track. Start by identifying your most productive hours and scheduling your most important tasks during that time. Be sure to also schedule breaks and time for rest and relaxation.

  4. Use a planner: A planner can help you stay organized and on top of deadlines. Consider using a digital planner or app that can sync across devices and send you reminders.

  5. Practice self-discipline: Self-discipline involves making a conscious effort to stay focused on your goals and avoid distractions. This can involve setting boundaries, avoiding multitasking, and using time-blocking to schedule your tasks.

  6. Learn from mistakes: Mistakes are a natural part of the learning process. When you make a mistake, take time to reflect on what went wrong and how you can improve. Use this information to make changes and adjust your habits as needed.

  7. Stay positive: Positive thinking can help you stay motivated and focused on your goals. Practice gratitude and focus on the progress you've made, rather than dwelling on setbacks.

  8. Surround yourself with supportive people: Building a successful business can be challenging, so it's important to surround yourself with people who can offer support and encouragement. This can include mentors, peers, and family members who believe in your vision.

By incorporating these habits into your daily routine and staying consistent, you can build a strong foundation for your business and achieve your goals.



Half of All Eligible Medicare Beneficiaries Are Now Enrolled in Private Medicare Advantage Plans

Posted by www.psmbrokerage.com Admin on Wed, May 03, 2023 @ 10:35 AM

Half of All Eligible Medicare Beneficiaries Are Now Enrolled in Private Medicare Advantage Plans

According to recently released data from the Centers for Medicare & Medicaid Services (CMS), Medicare Advantage now provides Medicare coverage for just over half of eligible beneficiaries. In January 2023, 30.19 million of the 59.82 million people with both Medicare Part A and Part B were enrolled in a private plan.

Medicare Advantage, the private plan alternative to traditional Medicare, covers Medicare Part A and B benefits (and typically Part D benefits), often for no additional premium (other than the Part B premium). Insurance companies contract with the Medicare program and receive payments for providing these services.

Enrollment in Medicare Advantage has increased dramatically in recent years. In 2007, less than one in five (19%) eligible Medicare beneficiaries were enrolled in a private plan. The growth in enrollment is due to a number of factors, including the attraction of extra benefits offered by most plans, such as vision, hearing, and dental services, and the potential for lower out-of-pocket spending, particularly compared to traditional Medicare without supplemental coverage.

Read the full article here.

Source: https://www.kff.org/policy-watch/half-of-all-eligible-medicare-beneficiaries-are-now-enrolled-in-private-medicare-advantage-plans/ 



Tags: Medicare Advantage, Medicare Part D, CMS, star ratings

Corebridge Final Expense Agent Bonus Program

Posted by www.psmbrokerage.com Admin on Wed, May 03, 2023 @ 10:16 AM

Corebridge bonus

Final Expense Agent Bonus Program - Get a maximum bonus of $2500 on your SimpliNow Legacy simplified issue whole life sales!

The Final Expense Agent Bonus Program runs from January 1 to December 31, 2023 and you’re automatically enrolled. Just sell SimpliNow Legacy Max (level death benefit) or SimpliNow Legacy (graded death benefit) and receive a bonus after writing one qualifying application.

Write ten applications and earn $2500!
Not appointed with Corebridge? Request a contracting link here.

Corebridge bonus amounts

Prepare to sell and earn your bonus today. Make sure you’ve registered on Connext, completed your required AML training, and can access the SIWL eApp under “Start Your Application” section in Connext. Check out our Agent Site for how-to videos and more!

SIWL Guide  Underwriting Guide


Kick off your SimpliNow Legacy sales!

Review the following list of program rules.





Tags: Final Expense, aig, Bonus Program, Corebridge

2024 Medicare Advantage and Part D Final Rule (CMS-4201-F)

Posted by www.psmbrokerage.com Admin on Mon, May 01, 2023 @ 11:56 AM



On April 5, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that revises the Medicare Advantage (MA or Part C), Medicare Prescription Drug Benefit (Part D), Medicare Cost Plan, and Programs of All-Inclusive Care for the Elderly (PACE) regulations to implement changes related to Star Ratings, marketing and communications, health equity, provider directories, coverage criteria, prior authorization, network adequacy, and other programmatic areas. This final rule also codifies regulations implementing section 118 of Division CC of the Consolidated Appropriations Act, 2021, and section 11404 of the Inflation Reduction Act, and includes provisions to codify existing sub-regulatory guidance in the Part C, Part D, and PACE programs. 

In this final rule, CMS is not addressing comments received on the provisions of the proposed rule that we are not finalizing at this time. Rather, the agency will address them at a later time, such as in possible future rulemaking, as appropriate.

This fact sheet discusses the major provisions of the final rule. The final rule can be downloaded here: https://www.federalregister.gov/public-inspection/current.

Enhancements to Medicare Advantage and Medicare Part D


Ensuring Timely Access to Care: Utilization Management Requirements

CMS has received numerous inquiries regarding the use of prior authorization by Medicare Advantage plans and the effect on beneficiary access to care. In the rule, CMS finalizes impactful changes to address these concerns and to advance timely access to medically necessary care for enrollees.

The final rule clarifies clinical criteria guidelines to ensure people with MA receive access to the same medically necessary care they would receive in Traditional Medicare. This aligns with recent Office of Inspector General (OIG) recommendations. Specifically, CMS clarifies rules related to acceptable coverage criteria for basic benefits by requiring that MA plans must comply with national coverage determinations (NCD), local coverage determinations (LCD), and general coverage and benefit conditions included in Traditional Medicare regulations. CMS is also finalizing that when coverage criteria are not fully established, MA organizations may create internal coverage criteria based on current evidence in widely used treatment guidelines or clinical literature made publicly available to CMS, enrollees, and providers. In the final rule, CMS more clearly defines when applicable Medicare coverage criteria are not fully established by explicitly stating the circumstances under which MA plans may apply internal coverage criteria when making medical necessity decisions. CMS believes that permitting the use of publicly accessible internal coverage criteria in limited circumstances is necessary to promote transparent, and evidence-based clinical decisions by MA plans that are consistent with Traditional Medicare.

The final rule also streamlines prior authorization requirements, including adding continuity of care requirements and reducing disruptions for beneficiaries. CMS’ final rule requires that coordinated care plan prior authorization policies may only be used to confirm the presence of diagnoses or other medical criteria and/or ensure that an item or service is medically necessary. Second, this final rule requires coordinated care plans to provide a minimum 90-day transition period when an enrollee currently undergoing treatment switches to a new MA plan, during which the new MA plan may not require prior authorization for the active course of treatment. Third, to ensure prior authorization is being used appropriately, CMS is requiring all MA plans establish a Utilization Management Committee to review policies annually and ensure consistency with Traditional Medicare’s national and local coverage decisions and guidelines. Finally, to address concerns that the proposed rule did not sufficiently define the expected duration of “course of treatment,” the final rule requires that approval of a prior authorization request for a course of treatment must be valid for as long as medically reasonable and necessary to avoid disruptions in care in accordance with applicable coverage criteria, the patient’s medical history, and the treating provider’s recommendation.

Together, these changes will help ensure enrollees have consistent access to medically- necessary care while also maintaining medical management tools that emphasize the important role MA plans play in coordinating medically-necessary care.


Protecting Beneficiaries: Marketing Requirements

The final rule also takes critical steps to protect people with Medicare from confusing and potentially misleading marketing while also ensuring they have accurate and necessary information to make coverage choices that best meet their needs. The proliferation of certain television advertisements generically promoting enrollment in MA plans has been a specific topic of concern. To address these concerns, CMS is prohibiting ads that do not mention a specific plan name as well as ads that use words and imagery that may confuse beneficiaries or use language or Medicare logos in a way that is misleading, confusing, or misrepresents the plan. In the rule, CMS also reinstates important protections that prevent predatory behavior and finalized changes that strengthen the role of plans in monitoring agent and broker activity. CMS is also finalizing requirements to further protect Medicare beneficiaries by ensuring they receive accurate information about Medicare coverage and are aware of how to access accurate information from other available sources.

CMS is finalizing 21 of the 22 provisions we proposed, with 17 of the 21 provisions being finalized as proposed. The four provisions CMS is finalizing but modifying include: permitting agents to make Business Reply Cards available at educational events; requiring an agent to tell prospective enrollees how many plans are available from the  organization for whom the agent sells; extending the length of time agents are able to re-contact beneficiaries to discuss plan options to twelve months; and allowing an agent to meet with a beneficiary without waiting the full 48-hour cooling off period when the timeframe runs up against the end of an election period, or a beneficiary faces transportation or access challenges, or the beneficiary voluntarily walks into an agent’s office. CMS will continue to explore including the provision that is not being finalized in this rule in possible future rulemaking.


Strengthening Quality: Star Ratings Program

CMS continues improvements to the Star Ratings program by finalizing new methodological enhancements to further drive quality improvement for all enrollees. In this rule, CMS finalizes a health equity index (HEI) reward, beginning with the 2027 Star Ratings, to further encourage MA and Part D plans to improve care for enrollees with certain social risk factors. CMS also reduces the weight of patient experience/complaints and access measures to further align with other CMS quality programs and the current CMS Quality Strategy. In addition, CMS includes an additional rule for the removal of Star Ratings measures and removes the 60 percent rule that is part of the adjustment for extreme and uncontrollable circumstances. The changes will further drive quality improvement and health equity in MA and Part D.

Advancing Health Equity

CMS is committed to advancing health equity for all, including those who have been historically underserved, marginalized, and adversely affected by persistent poverty and inequality.[1] CMS is clarifying current rules, expanding the example list of populations that MA organizations must provide services in a culturally competent manner. These include people: (1) with limited English proficiency or reading skills; (2) of ethnic, cultural, racial, or religious minorities; (3) with disabilities; (4) who identify as lesbian, gay, bisexual, or other diverse sexual orientations; (5) who identify as transgender, nonbinary, and other diverse gender identities, or people who were born intersex; (6) who live in rural areas and other areas with high levels of deprivation; and (7) otherwise adversely affected by persistent poverty or inequality.

Studies demonstrate low digital health literacy, especially among populations experiencing health disparities, continues to impede telehealth access and worsen care gaps particularly among older adults. CMS is finalizing requirements for MA organizations to develop and maintain procedures to offer digital health education to enrollees to improve access to medically necessary covered telehealth benefits. In addition, CMS is enhancing current best practices by requiring MA organizations to include providers’ cultural and linguistic capabilities in provider directories. This change will improve the quality and usability of provider directories, particularly for non-English speakers, limited English proficient individuals, and enrollees who use American Sign Language. Finally, CMS is requiring that MA organizations’ quality improvement programs include efforts to reduce disparities.  

Improving Access to Behavioral Health

CMS recognizes the importance of building strong MA behavioral health networks that improve timely access to services. CMS is finalizing policies strengthening network adequacy requirements and reaffirming MA organizations’ responsibilities to provide behavioral health services. Specifically, CMS will: (1) add Clinical Psychologists and Licensed Clinical Social Workers as specialty types for which we set network standards, and make these types eligible for the 10-percentage point telehealth credit; (2) amend general access to services standards to include explicitly behavioral health services; (3) codify standards for appointment wait times for primary care and behavioral health services; (4) clarify that emergency behavioral health services must not be subject to prior authorization; (5) require that MA organizations notify enrollees when the enrollee’s behavioral health or primary care provider(s) are dropped midyear from networks; and (6) require MA organizations to establish care coordination programs, including coordination of community, social, and behavioral health services to help move towards parity between behavioral health and physical health services and advance whole-person care.

Implementation of Certain Provisions of the Consolidated Appropriations Act, 2021 and the Inflation Reduction Act of 2022

The final rule also makes changes to the Part C and D programs stemming from the Inflation Reduction Act (IRA) of 2022 and the Consolidated Appropriations Act (CAA), 2021.

Making Permanent: Limited Income Newly Eligible Transition (LI NET) Program

LI NET currently operates as a demonstration program that provides immediate and retroactive Part D coverage for eligible low-income beneficiaries who do not yet have prescription drug coverage. In this final rule, CMS is making the LI NET program a permanent part of Medicare Part D, as required by section 118 of the CAA.

Enhancing Financial Stability: Expanding Low-Income Subsidies Under Part D

CMS is finalizing regulations to expand eligibility for the full low-income subsidy (LIS) benefit (also known as “Extra Help”) to individuals with incomes up to 150% of the federal poverty level who meet eligibility criteria. Beginning January 1, 2024, this change will provide the full low-income subsidy to those who currently qualify for the partial subsidy. This implements section 11404 of the IRA and will improve access to affordable prescription drug coverage for approximately 300,000 low-income individuals with Medicare. 

Implementation of Certain Provisions of the Bipartisan Budget Act of 2018 and the Consolidated Appropriations Act, 2021

Finally, the rule finalizes several changes stemming from federal laws related to the Part C and D programs—including the Inflation Reduction Act (IRA) of 2022, the Consolidated Appropriations Act (CAA) of 2021, and the Bipartisan Budget Act (BBA) of 2018.

Source: https://www.cms.gov/newsroom/fact-sheets/2024-medicare-advantage-and-part-d-final-rule-cms-4201-f 



Tags: Medicare Advantage, Medicare Part D, CMS, star ratings, Marketing

The Lesser Known Benefits of Original Medicare

Posted by www.psmbrokerage.com Admin on Mon, May 01, 2023 @ 10:36 AM


As a Medicare sales agent, it is important to stay informed about all of the benefits Medicare provides to ensure that you are delivering the best possible service to your clients. While many beneficiaries may be aware of the basic benefits provided by Medicare, some of the lesser-known benefits are often overlooked.

These lesser-known benefits can provide valuable coverage and support for your client's healthcare needs. Additionally, discussing these lesser known benefits can help you build trust and rapport - leading to stronger, longer-lasting relationships

Although there are certainly more, here are a few examples of the lesser known benefits that we'll cover today: 

•    Durable Medical Equipment (DME) 
•    Mental Health Services 
•    Diabetes Management 
•    Home Health Services 

Durable Medical Equipment (DME) 
To qualify for Durable Medical Equipment (DME) under Original Medicare. a beneficiary must have a medical need for the equipment and a doctor's prescription. The DME must also be considered medically necessary and reasonable for the treatment of a specific medical condition. Some examples of DME covered by Medicare include wheelchairs, oxygen equipment, walkers. and hospital beds. This benefit helps reduce out-of-pocket expenses for beneficiaries who would otherwise have to pay for DME on their own. 

Mental Health Services 
To qualify for Mental Health Care under Original Medicare, a beneficiary must have a mental health condition that requires treatment and a doctor's referral for the services. Medicare covers a range of mental health services, including individual and group therapy, psychiatric evaluations and medication management. Beneficiaries can receive these services in a variety of settings, including outpatient clinics, hospitals and community mental health centers. 

Diabetes Management 
The Diabetes Prevention Program (DPP) and Diabetes Self-Management Training (DSMT) are two distinct programs under Original Medicare that address different aspects of diabetes care. 

  • The DPP is a lifestyle change program designed for individuals who are at high risk for developing type 2 diabetes. It focuses on healthy eating, physical activity. and other lifestyle changes to prevent or delay the onset of diabetes. To qualify for the Diabetes Prevention Program (DPP) under Original Medicare. a beneficiary must be at high risk for developing diabetes. have a body mass index (BMI) of 25 or higher. and receive a referral from their doctor for the program.

  • On the other hand, DSMT is a program designed for individuals who have already been diagnosed with diabetes. It focuses on educating patients on how to manage their diabetes. including monitoring blood sugar levels. taking medications. and making lifestyle changes. DSMT also provides patients with individualized support and guidance on how to manage their condition effectively. To qualify for DSMT under Original Medicare. a beneficiary must have diabetes and a referral from their doctor for the training.

Home Health Services 
To qualify for home health services under Original Medicare. a beneficiary must meet the homebound status requirements set by Medicare. They must also have a plan of care established and their doctor will need to re-evaluate and recertify their plan of care every 60 days

To be considered homebound, your client must:

  • Require the assistance of medical equipment or another person to leave their home. This could include using crutches. a walker. or a wheelchair. Additionally, their doctor may determine that their health could worsen if they leave their home.

  • Secondly. it must be difficult for your client to leave their home, and they must typically not be able to do so without assistance.

By staying informed about these and other lesser known benefits. you can ensure you are providing the best possible service for your clients' healthcare needs all while building trust and rapport leading to stronger. longer-lasting relationships.




Tags: medicare a & b

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