The Medicare Advantage program is expanding and becoming increasingly diverse, serving as an affordable healthcare option for many Medicare-eligible seniors in America. This growth is driven by the program's ability to offer comprehensive coverage, including additional benefits such as vision, dental, and wellness programs, which are not typically covered under traditional Medicare.
Currently, a record 33.8 million seniors and individuals with disabilities have chosen Medicare Advantage, making up nearly 55% of the Medicare population. This significant enrollment reflects the program's appeal and effectiveness in meeting the diverse healthcare needs of its beneficiaries. Additionally, 30% of Medicare Advantage beneficiaries identify as Black, Latino, or Asian, compared to only 18% in Fee-For-Service Medicare.
This demographic shift highlights the program's success in reaching and serving a more diverse population, ensuring that a broader spectrum of individuals can access quality healthcare tailored to their specific needs.
Important Update: CMS’s New One-to-One Consent Regulations for 2025
Effective October 1, 2024, CMS will enforce a new one-to-one consent rule for Third-Party Marketing Organizations (TPMOs), including independent agents and brokers. This rule requires TPMOs to obtain prior express written consent from consumers before sharing their personal beneficiary data with another TPMO for marketing or enrollment purposes. The goal is to protect consumer privacy and prevent aggressive marketing tactics, such as reselling leads or cold-calling.
Under this new regulation, agents must ensure that all leads have a valid, CMS-compliant one-to-one consent in place. The consent must be clear, prominent, and specific to the TPMO using the data, with consumers explicitly agreeing to share their information with each listed TPMO. Verbal consent will be allowed for real-time transfers, but only when the transfer is conducted on a recorded line and the consumer agrees to speak with the next TPMO by name.
It’s important to note that leads obtained prior to October 1, 2024, without compliant consent cannot be used for outreach after the effective date, and failure to comply may result in penalties or contract termination. This rule does not apply to direct inbound calls, but all outbound calls must meet these new requirements.
We are here to support you in understanding and navigating these changes. If you have any questions or need guidance on how to ensure compliance with these new regulations, please reach out to our team.
Looking for a compliant lead source? LeadStar Marketplace is a self-serve platform that allows agents to acquire new customers at scale.View details
AgencyBloc and SunFire To Forge New Integration that Empowers Insurance Agencies
AgencyBloc and SunFire are set to integrate their platforms, connecting AgencyBloc’s agency management system with SunFire’s Medicare quoting and proposal tool. This integration aims to streamline the Medicare quoting process, enhancing efficiency for insurance agencies in the senior market. Users will be able to securely transfer client data to SunFire with a single click, reducing manual data-sharing efforts.
Tim Robinson, CEO of AgencyBloc, emphasized that this partnership supports their mission to equip insurance agencies with essential tools for success. Similarly, SunFire's CEO, David Graf, expressed excitement about the collaboration, noting it will improve operational efficiency for their shared clients.
Understanding the Annual Notice of Coverage (ANOC) Letters
A Guide for Insurance Agents
As an insurance agent, it’s crucial to stay informed about the Annual Notice of Coverage (ANOC) letters that your Medicare clients receive each year. These letters, typically sent out by Medicare Advantage and Part D plans in September, provide important updates on changes to the clients’ current plans for the upcoming year. By understanding the contents of these letters and their significance, you can position yourself as a valuable resource for your clients, helping them navigate their options and ensure they have the right coverage.
What is an Annual Notice of Coverage (ANOC)?
The Annual Notice of Coverage (ANOC) is a document that Medicare Advantage and Part D plan providers are required to send to their enrollees each year. This notice outlines any changes to the plan’s costs, benefits, or rules that will take effect in the new plan year. It’s designed to help beneficiaries understand how their coverage will change and whether their current plan will continue to meet their needs.
The Annual Notice of Coverage typically covers several critical areas that clients need to review:
Plan Costs:
Changes in monthly premiums, deductibles, and copayments for covered services and prescriptions.
Adjustments to out-of-pocket maximums, which can significantly impact your clients’ financial planning.
Benefits and Coverage:
Modifications to the benefits offered by the plan, such as changes in coverage for specific services or the introduction of new benefits.
Updates to the list of covered prescription drugs (formulary), which may include changes in tier placement or removal of certain drugs from the formulary.
Provider and Pharmacy Networks:
Changes in the plan’s network of doctors, hospitals, and pharmacies. If a client’s preferred provider is no longer in-network, it may be time to consider other options.
Rules and Restrictions:
Updates to any plan rules, such as prior authorization requirements, step therapy, or quantity limits on medications.
Why the ANOC is Important for Your Clients
The ANOC is a crucial tool for Medicare beneficiaries to assess whether their current plan will continue to meet their healthcare needs in the coming year. It allows them to compare their plan’s changes against their healthcare requirements and decide if they need to switch plans during the Medicare Open Enrollment period, which runs from October 15th to December 7th.
How You Can Use the ANOC as an Opportunity
As an insurance agent, the ANOC offers a prime opportunity to strengthen your relationship with your clients and provide them with valuable guidance. Here’s how you can leverage the ANOC to be a resource for your clients:
Proactive Communication:
Reach out to your clients as soon as the ANOC letters are sent out. Let them know you’re available to help them review the changes and understand how their coverage will be affected.
Offer to schedule a one-on-one consultation to go through the ANOC together. This personal touch can help reassure clients that you’re invested in their well-being.
Reviewing Plan Changes:
Assist your clients in understanding the specific changes outlined in their ANOC. For example, if their plan’s formulary has changed, help them determine if their medications are still covered and at what cost.
Use this as an opportunity to discuss any new healthcare needs your clients may have developed over the past year. This ensures that their plan continues to align with their current situation.
Comparing Alternatives:
If the ANOC reveals significant changes that may negatively impact your clients, such as increased costs or the loss of a preferred provider, offer to compare alternative plans.
Provide a detailed comparison of other Medicare Advantage or Part D plans that may better suit their needs, emphasizing any cost savings or additional benefits they could gain by switching plans.
Education and Empowerment:
Educate your clients on the importance of reviewing their ANOC each year, even if they’re generally satisfied with their plan. Circumstances and plans can change, and staying informed is key to maintaining the best possible coverage.
Empower your clients to make informed decisions by providing clear, concise explanations and answering any questions they may have.
Facilitate the Enrollment Process:
If your clients decide to switch plans, guide them through the enrollment process during the Medicare Open Enrollment period. Ensure that all necessary paperwork is completed accurately and submitted on time.
The Annual Notice of Coverage (ANOC) is more than just a routine letter—it’s an essential tool for ensuring that your clients continue to receive the healthcare coverage that best meets their needs. By proactively engaging with your clients about their ANOC, you can demonstrate your commitment to their health and financial well-being, solidify your role as a trusted advisor, and ultimately help them make the best possible decisions during the Medicare Open Enrollment period.
This Annual Enrollment Period (AEP) is poised to redefine the landscape of Medicare Advantage and prescription drug plan sales, presenting unprecedented challenges and changes that demand adaptability from industry professionals as consumers shop plans like never before.
The richness of value-added benefits that carriers traditionally offer consumers will see a notable reduction due to the Centers for Medicare & Medicaid Services (CMS) funding adjustments and legislative impacts from the Inflation Reduction Act (ACT).
These adjustments include a significant decrease in annual out-of-pocket expenses for prescription drugs (from $8,000 to $2,000) and introducing an option for beneficiaries to manage their Part D out-of-pocket costs through capped monthly payments on a new Medicare Prescription Payment Plan. CMS will also impose strict regulations on sharing personal beneficiary information among TPMOs, requiring prior express written consent for one TPMO to share personal beneficiary information data with another TPMO.
And, of course, the lead generation domain won't be spared from these sweeping changes. The new Third-Party Marketing Organization (TPMO) rule enforces a one-to-one ration for lead generation, effectively eliminating the resale of leads. Thus fundamentally alters lead generation and distribution methodologies, coupled with new restrictions on sharing personal beneficiary data, reshaping how agents manage and use leads.
In the face of these sweeping changes to AEP 2025, working with the right partner is more important than ever. At PSM, we provide agents with the resources, one-on-one mentorship, and hands-on support they need to navigate these complexities confidently. From regulatory guidance to lead generation strategies, we are fully committed to helping you adapt, grow, and succeed in this evolving landscape. We ensure you have the tools and expertise to thrive in this unprecedented AEP season.
2025 AEP Readiness Resources
PSM is your one-stop-shop for valuable resources including:
Certifications: An entire page devoted to certification links and instructional guides
Training: Medicare training, from basic to advanced
Compliance: Notes and bulletins on important compliance considerations
Enrollment Solutions: Scope, Quote and Enroll on a single compliant platform
Guides: Complete guides on selling Medicare Advantage, Medigap and more
4 Ways to Keep Medicare Client Data Safe During AEP
With the increased activity and sensitive client information exchanged during AEP (Annual Enrollment Period), it’s crucial for agents to take the necessary steps to protect Medicare client data. Breaches not only harm clients but can also lead to hefty fines and damage to your reputation.
Here are four essential ways to ensure client data is secure during this busy period:
1. Use Secure Communication Channels
During AEP, you’ll be exchanging a lot of personal information with clients, including Social Security numbers and health records. Ensure you’re using secure communication methods, such as encrypted email or client portals, to share sensitive data. Avoid using standard email or texting, as these can be easily intercepted.
Tip: Consider using a CRM system that provides secure messaging features to keep communication confidential.
2. Follow CMS Regulations on Data Sharing
The Centers for Medicare & Medicaid Services (CMS) have implemented strict regulations on how client data can be shared, especially with the introduction of new rules surrounding Third-Party Marketing Organizations (TPMOs). Agents must obtain prior express written consent before sharing any personal beneficiary information with another entity.
Tip: Educate your team on the latest CMS rules to avoid accidental violations and ensure proper data handling protocols are in place.
3. Implement Strong Passwords and Multi-Factor Authentication
Ensure that all systems, client portals, and software that contain sensitive Medicare client data are protected with strong passwords and multi-factor authentication (MFA). This adds an extra layer of security, making it harder for unauthorized users to access client information.
Tip: Regularly update passwords and encourage the use of password management tools to prevent weak password usage.
4. Secure Physical Documents
Even in the digital age, many agents handle physical paperwork that contains sensitive client information. Ensure that any physical documents are stored securely, such as in locked cabinets or shredding them when no longer needed. Be cautious of leaving documents in shared or unsecure areas.
Tip: Establish a "clean desk" policy to minimize the risk of exposing client data unintentionally.
Protecting Medicare client data is more than just a compliance requirement; it’s a critical part of building trust with your clients. By implementing secure communication methods, adhering to CMS regulations, using strong digital security measures, and safeguarding physical documents, you can ensure a safe AEP for both your clients and your business.
10 common Medicare misconceptions every agent should clarify for their clients:
Medicare is Free Many people think Medicare is free, but most parts require premiums, deductibles, and co-payments, particularly for Part B and Part D.
Medicare Covers All Health Care Costs Medicare doesn’t cover everything. There are gaps in coverage, such as dental, vision, hearing, and long-term care, that clients need to plan for.
Medicare and Medicaid Are the Same Medicare and Medicaid serve different purposes. Medicare is primarily for people 65+ and some younger individuals with disabilities, while Medicaid is a state and federal program for low-income individuals.
Medicare Automatically Includes Prescription Drug Coverage Medicare Part A and Part B do not cover prescription drugs. Clients need to enroll in a standalone Part D plan or choose a Medicare Advantage plan that includes drug coverage.
You Can Sign Up for Medicare Anytime After 65 There’s a limited enrollment window. Missing it can result in late penalties, particularly for Part B and Part D.
Medicare Advantage Plans Are Always the Best Option Medicare Advantage plans can be great, but they aren’t for everyone. Some clients may prefer the flexibility of Original Medicare with a Medigap plan for broader provider access.
Medigap Covers Everything Medicare Doesn’t While Medigap fills in some gaps, it doesn’t cover all additional costs, such as prescription drugs, dental, or vision care.
You Don’t Need Medicare if You Have Employer Coverage Some assume they can skip Medicare if they’re working past 65. However, enrolling in Medicare when eligible is often the best move, depending on the size of the employer and coverage offered.
Medicare Covers Long-Term Care Medicare only covers short-term stays in skilled nursing facilities after a hospital stay. It doesn’t cover custodial care or long-term care.
You Can’t Change Medicare Plans After Signing Up Medicare has specific enrollment periods, such as the Annual Enrollment Period (AEP), that allow clients to switch or modify their plans if their needs change.
These clarifications help clients make informed decisions and avoid costly mistakes.
Your Step-by-Step Guide to Mastering the Medicare Annual Enrollment Period.
Why AEP Success Matters
The Annual Enrollment Period (AEP) is a crucial time for Medicare agents. Success during this period can significantly impact your business for the entire year. AEP runs from October 15th to December 7th, and it's essential to be well-prepared, compliant, and proactive.
This guide provides a detailed, day-by-day action plan for the 30 days leading up to AEP, ensuring you’re fully prepared to maximize your success.
Assess Your Resources: Review your current tools, systems, and resources. Ensure your CRM, enrollment platforms, and marketing materials are up-to-date and ready for AEP.
Compliance Check: Verify that all your marketing materials, including emails, websites, and brochures, are CMS-compliant. Obtain necessary approvals and SMID codes.
Client Segmentation: Use your CRM to segment your client list. Identify clients who may need to review their plans and those who may benefit from new plan offerings.
Set Goals: Define clear goals for the AEP, including the number of clients to contact, enrollments to achieve, and marketing campaigns to launch.
Lead Generation Strategies:
Referrals:Leverage your existing client base for referrals. Provide incentives for clients who refer others to you.
Digital Marketing:Launch targeted digital ad campaigns focusing on Medicare beneficiaries. Use Facebook, Google Ads, and LinkedIn to attract new leads.
Community Events:Host educational webinars or in-person events to attract and engage potential clients.
Lead Qualification:
Use your CRM to qualify leads based on factors like age, location, and plan preferences. Prioritize those most likely to enroll during AEP.
Implement a lead scoring system to ensure you’re focusing on the highest quality leads.
Understanding CMS Regulations: Review the latest CMS guidelines to ensure all your activities, from marketing to enrollment, are compliant.
SMID Codes: Ensure all marketing materials have been submitted to CMS and have received the necessary SMID codes. Place these codes prominently on all relevant materials.
Training: Attend compliance training sessions or webinars to stay up-to-date on regulations. Ensure your team is also well-trained and aware of the latest rules.
Documentation: Keep detailed records of all client interactions, marketing activities, and enrollment processes to ensure you’re covered in case of an audit.
Enrollment Platforms:
Selecting the Right Platform: Choose an enrollment platform that is user-friendly, secure, and integrates with your CRM.
Training and Setup: Ensure you and your team are fully trained on the platform’s features. Set up test enrollments to familiarize yourself with the process.
Online Enrollment:
Promote online enrollment to clients who prefer a digital experience. Highlight the convenience and speed of enrolling online.
Provide step-by-step guides or tutorials to help clients through the online enrollment process.
Troubleshooting:
Have a support plan in place for any technical issues that arise during the enrollment process.
Offer clients easy access to help if they encounter problems.
CRM Setup:
Automate Follow-Ups: Set up automated email sequences in your CRM to follow up with leads and clients. Include reminders, check-ins, and personalized content.
Task Management: Use your CRM to assign tasks, track progress, and ensure that no lead or client is overlooked during AEP.
Personalization:
Tailor your communications based on client preferences and past interactions. Use CRM data to send personalized recommendations and plan options.
Tracking and Analytics:
Monitor your CRM dashboard to track your progress toward your AEP goals. Adjust your strategy as needed based on real-time data.
Branded Materials:
Create Custom Marketing Materials: Design custom-branded brochures, flyers, and digital ads that reflect your brand’s identity. Ensure consistency across all platforms.
Social Media: Develop a content calendar for your social media channels. Share educational posts, client testimonials, and timely updates about AEP.
Email Campaigns:
Personalized Outreach: Send targeted email campaigns to different segments of your client list. Include valuable content like plan comparisons, tips for choosing the right plan, and reminders about key AEP dates.
Interactive Content: Use quizzes, surveys, or calculators to engage clients and help them identify the best plan options.
Client Education:
Webinars and Workshops: Host branded webinars or workshops to educate clients about Medicare changes, new plan options, and the benefits of enrolling during AEP.
Print and Digital Resources: Provide clients with branded guides, checklists, and FAQs to help them navigate their options confidently.
Review and Revise:
Double-Check Compliance: Review all marketing materials, CRM automations, and enrollment platforms to ensure everything is compliant and ready to go.
Final Team Meeting: Hold a team meeting to review your AEP strategy, address any last-minute questions, and ensure everyone is aligned.
Client Outreach:
Send a final reminder to your clients about the start of AEP. Offer to answer any last-minute questions and schedule appointments for those who need additional help.
Set Up Tracking:
Ensure all systems are in place to track your progress throughout AEP. Set up alerts for key milestones, such as the number of enrollments or completed follow-ups.
Launch Your Campaign:
Kick-Off AEP:Launch your AEP marketing campaigns, start your follow-up sequences, and begin enrolling clients. Monitor your progress closely.
Stay Responsive:
Client Support:Be available to address any questions or concerns from clients. Provide quick responses to ensure a smooth enrollment process.
Ongoing Engagement:Continue to engage with your clients throughout AEP, offering support, information, and encouragement.
Post-AEP Follow-Up:
Plan for post-AEP follow-up to ensure client satisfaction and address any lingering issues. Use this time to strengthen relationships and lay the groundwork for future success.
By following this 30-day AEP plan for success, you’ll be well-prepared to navigate the busy enrollment period, provide exceptional service to your clients, and achieve your business goals.
With careful preparation, compliance, and the right tools in place, you can turn AEP into a time of growth and opportunity for your insurance business.
The National Association of Benefits and Insurance Professionals (NABIP) CEO Jessica Brooks-Woods issued a statement on the recent decision by some health plans to discontinue Medicare Part D compensation to health insurance agents. She emphasized that these decisions threaten the livelihoods of Medicare agents and the seniors who rely on them.
“We have reached out to WellCare/Centene senior leadership as they are setting a precedent. We invite these leaders to discuss how these decisions will impact Medicare beneficiaries and their families. NABIP is committed to protecting our members and the communities they serve.
“Medicare Part D plans are complex, and agents invest significant time in training and educating their clients. Their work includes ensuring affordable medication options and resolving claim issues. For less than $4.60 a month per client, agents are dedicated professionals committed to their clients’ well-being.
“We urge the responsible leaders to join us for solution-driven dialogue to avoid disruption in support for our most vulnerable populations. NABIP remains committed to our Healthcare Bill of Rights and our broader mission to promote healthcare.”
NABIP is the preeminent organization for health insurance and employee benefits professionals, working diligently to ensure all Americans have access to high-quality, affordable healthcare and related benefits. NABIP represents and provides professional development opportunities for more than 100,000 licensed health insurance agents, brokers, general agents, consultants, and benefit professionals through more than 200 chapters across America.
NAIFA urges members to oppose Medicare plan agent commission cuts, emphasizing the crucial role of licensed professionals in assisting beneficiaries with plan options and coverage. Discussions with Congress and CMS aim to highlight the potential negative impact on beneficiaries. Despite market turmoil, agents hope to secure fair compensation for 2025 sales amidst concerns over benefit changes and insurer strategies to manage costs and margins. CVS Health, Elevance Health, and Centene's WellCare have already adjusted their enrollment and commission structures in response to market shifts.
Founded in 1890, the National Association of Insurance and Financial Advisors is the preeminent association for financial service professionals in the United States of America. NAIFA members, in every Congressional district and every state house, subscribe to a strong Code of Ethics and represent a full spectrum of practice specialties to promote financial security for all Americans. Complimented by its professional development and consumer divisions, the Society of Financial Service Professionals and Life Happens, the association delivers value through advocacy, service, and education.