Fixed indemnity coverage pays set cash amounts for covered events. It is not major medical, and CMS has emphasized that point in its fact sheet on excepted benefits. For Medicare Advantage clients facing copays, it can be a useful complement when it is sold and explained correctly.
I'm Justin Brock. Brock has helped agents serve 250,000+ Medicare beneficiaries. For how one product is built, read Andrew Saul's breakdown of Everest Fixed Indemnity for Medicare Advantage Agents on justinbrock.com. Here is what your upline should provide for this category.
What agents must get right
- What it is not. It does not replace Medicare or MA coverage.
- How the cash maps to costs. Matching benefits to the client's actual MA copays from the Evidence of Coverage.
- Design points for 65+. Issue ages, benefit levels and any limits for Medicare-age clients.
- Disclosures. Clear explanation that benefits are fixed amounts.
What your upline should provide
- Product training on how benefits are structured.
- Tools or worksheets for mapping benefits to MA copays.
- Compliance guidance on Scope of Appointment and disclosures.
- Carrier access to fixed indemnity options in your states.
Questions to ask an upline
- Which fixed indemnity products can I offer to Medicare clients?
- Do you train agents to map benefits to MA copays?
- What compliance guidance do you provide for these products?
How Brock helps
Brock covers fixed indemnity in product training and offers a broad ancillary shelf. See our companion on ancillary product support.
Want to pair ancillary coverage with MA the right way? Book a call with the Brock team.
Frequently asked questions
What is fixed indemnity insurance?
Fixed indemnity insurance pays a set cash amount for covered events, such as a hospital stay, regardless of the actual bill. It is not major medical coverage and does not replace Medicare or a Medicare Advantage plan.
Why do Medicare Advantage clients consider fixed indemnity?
Many MA plans have copays for hospital stays and other services. A fixed indemnity plan can pay cash that helps cover those costs. Whether it makes sense depends on the client's plan, health, budget and the product's terms.
What should agents verify before selling fixed indemnity?
Verify issue ages, benefit amounts, waiting periods, exclusions, state availability and how benefits compare with the client's MA copays. Read the carrier's materials and give clear disclosures.
What compliance rules apply to fixed indemnity sales?
Follow Scope of Appointment rules when discussing non-Medicare products, use required disclosures and avoid implying the product is major medical coverage. Your upline should help you follow CMS and state rules.