Reclaim Your Peace and Privacy!
Are you tired of incessant telemarketing calls or piles of unwanted mail cluttering your mailbox? Look no further. Use this roadmap to reclaim control over your communication channels. Learn how to leverage the Do Not Call Registry and discover effective strategies to remove yourself from pesky mailing lists.
Broker Tools
Your go-to resource for essential downloadable forms designed to streamline your workflow. Explore our user-friendly tools. You’ll find a collection of practical templates and documents that simplify your workflow. Access what you need quickly and efficiently, ensuring you can focus on what matters most—serving your clients.
Agents Answered
This is your opportunity to talk about what's going on, what you need help on, and get your questions answered. We’ll use this time to do whatever we can to help. Remember if you're facing a challenge, somebody else is likely experiencing it too. Conversely, please share your wins, what went well, and what you experienced.
Webinars
Are you interested in learning more about Medicare Insurance sales? ICBN is proud to offer a range of insightful webinars designed to empower insurance brokers with the knowledge and skills they need to excel in their field. Explore our webinars, gain practical insights, and enhance your expertise with our expert-led sessions.
ADR - Additional Documentation Request
A request by CMS for additional information or documentation from Medicare insurance agents or beneficiaries to verify eligibility or claims.
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AEP - Annual Enrollment Period
The time frame when Medicare beneficiaries can make changes to their Medicare coverage, typically from October 15th to December 7th each year.
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AHIP - American Health Insurance Plans
It is a national trade association that represents the health insurance industry in the United States. It serves as a resource for both the industry and consumers, providing information, advocacy, and education on a wide range of healthcare-related topics.
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ANOC - Annual Notice of Change
A document sent by Medicare Advantage and Part D plan providers to inform beneficiaries of any changes in their plan’s costs and coverage for the upcoming year.
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Appointed
The successful outcome of completing the “Appointment Process”. Appointed, agents can legally sell Medicare insurance plans on behalf of the insurance carrier. An agent must be “appointed” by each insurance carrier they represent.
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Appointment Process
This is a multi-step process. It typically includes vetting and contracting, ensuring agents meet the carrier’s requirements and standards. Once appointed, agents can legally sell Medicare insurance plans on behalf of the carrier.
Captive Agent
An insurance agent who works exclusively for a single insurance company or carrier. Captive agents are often limited to selling the insurance products and plans offered by their parent company and are not permitted to represent products from other insurance carriers.
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Certification (or informally Product Training)
Each insurance carrier requires an agent/broker to successfully complete annual product training courses. Courses must be completed prior to selling their products/ plans; specifically, Medicare Advantage and Part D plans. Courses and requirements will vary by insurance carrier.
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CMS – Centers for Medicare & Medicaid Services
The federal agency that administers the Medicare program and sets regulations for insurance providers.
E&O – Errors and Omissions Insurance
E&O insurance is an essential protection for professionals and businesses, as it can help safeguard their financial stability in the event of lawsuits or claims related to professional errors. It provides peace of mind and allows professionals to focus on their work, knowing they have a safety net in place to handle legal challenges that may arise in their professional practice.
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EOC – Evidence of Coverage
A document that details the terms and conditions of a Medicare insurance plan, including coverage, costs, and rules.
FMO – Field Marketing Organization
A company or organization that contracts with insurance agents to sell Medicare insurance products.
HMO – Health Maintenance Organization
A type of Medicare Advantage plan that typically requires members to use a network of healthcare providers.
IMO – Independent Marketing Organizations
Independent Marketing Organizations serve a crucial role in the insurance industry by connecting insurance carriers, agents, and consumers. They help agents access a wide range of insurance products, stay informed and compliant, and grow their businesses. This partnership benefits both agents and insurance carriers, contributing to the overall efficiency and effectiveness of the insurance distribution system.
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Independent Agent
Independent Medicare insurance agents, also known as Medicare insurance brokers, are licensed professionals who operate independently and are not tied to a specific insurance company or carrier. They have the freedom to offer a wide range of Medicare insurance products from various insurance companies. Their independence, expertise, and client-centric approach make them a trusted resource for those seeking Medicare insurance coverage.
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IRMAA – Income-Related Monthly Adjustment Amount
An additional amount that higher-income Medicare beneficiaries must pay for Medicare Part B and Part D premiums.
LIS – Low Income Subsidy
Low Income Subsidy, also known as Extra Help, is a program designed to assist those with limited financial resources in affording their prescription medications. It provides subsidies to help pay for premiums, deductibles, and copayments associated with Medicare Part D prescription drug plans. Eligibility for this program is determined based on a person’s income and resources.
MA – Medicare Advantage
Private health plans that provide Medicare benefits, often including prescription drug coverage, and may offer additional services like vision. dental and credits for over the counter (OTC) products.
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Med Supp – Medicare Supplement Insurance
Also known as Medigap, it is a type of private insurance that helps cover costs not paid by Original Medicare.
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MOOP – Maximum Out-of-Pocket
The highest amount a Medicare Advantage plan member will pay in out-of-pocket costs for covered services during a plan year.
NPN – National Producer Number
A unique identifier issued to individuals and entities involved in Medicare insurance sales.
OEP – Open Enrollment Period
A period when individuals with Medicare Advantage plans can make a one-time switch to another Medicare Advantage plan or return to Original Medicare, typically from January 1st to March 31st.
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Open Release Policy
A practice in the insurance industry that pertains to the relationship between insurance agents or brokers and the insurance companies with which they are contracted. It specifically concerns the ability of agents to access and retain client or policyholder information, especially when the agent leaves one insurance agency or company to work with another.
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It’s important to note that the specific terms and conditions of an Open Release Policy can vary among insurance companies and agencies. Insurance agencies may have their own policies, and some states may have regulations governing these practices. Agents should be aware of the specific policies and agreements in place with their employers and clients, and they should consult legal and compliance experts as needed to ensure a smooth transition when changing affiliations.
Part A – Hospital Insurance
Medicare Part A covers inpatient hospital care, skilled nursing facility care, and some home health care services.
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Part B – Medical Insurance
Medicare Part B covers outpatient medical services, doctor visits, and preventive care.
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Part C – Medicare Advantage
Part C, or Medicare Advantage, combines Parts A and B and often includes prescription drug coverage.
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Part D – Prescription Drug Coverage
Medicare Part D provides prescription drug coverage through private insurance plans.
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PDP – Prescription Drug Plan
A stand-alone plan that provides prescription drug coverage for Medicare beneficiaries who have Original Medicare.
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PPO – Preferred Provider Organization
A type of Medicare Advantage plan that offers more flexibility in choosing healthcare providers but may have higher costs for out-of-network care.
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PSAO – Pharmacy Services Administrative Organization
Independent and community pharmacies can benefit from membership in a PSAO as it allows them to gain more negotiating power, stay compliant with regulations, offer expanded clinical services, and improve the overall quality and efficiency of their operations. These organizations play a significant role in helping independent pharmacies remain competitive in the rapidly changing healthcare landscape.
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PTC – Permission to Contact Beneficiaries
Permission to Contact once signed by the beneficiary may grant permission for Medicare plan providers to contact them with marketing materials and information. This form typically includes opt-in and opt-out options for various communication channels. PTCs are part of the establiised ethical framework in healthcare and the Medicare system.
RTS – Ready to Sell
Ready to Sell refers to the status of an insurance agent or broker who has met certain requirements and completed the necessary training to sell Medicare Advantage (MA) and Medicare Part D (PDP) plans to eligible beneficiaries.
SOA – Scope of Appointment
Scope of Appointment is an important document used to clarify and confirm the scope of a meeting or appointment between a Medicare beneficiary and an insurance agent, broker, or sales representative. This form ensures that the discussion and presentation during the appointment are limited to the topics the beneficiary wants to discuss.
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SEP – Special Enrollment Period
A specific time outside of the Annual Enrollment Period when individuals can make changes to their Medicare coverage due to qualifying life events.
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SNP – Special Needs Plan
A type of Medicare Advantage plan designed for beneficiaries with specific needs, such as chronic conditions or dual eligibility for Medicare and Medicaid.
TPMO – Third Party Marketing Organization
An entity or organization that contracts with a Medicare Advantage (MA) or Medicare Prescription Drug Plan (PDP) sponsor to conduct marketing and sales activities on their behalf. These activities typically include marketing, enrollment, and customer support related to MA and PDP plans. TPMOs must adhere to specific regulations and guidelines set by the Centers for Medicare and Medicaid Services (CMS) to ensure the beneficiaries receive accurate and compliant information about Medicare plans and options.