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
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 Centers for Medicare & Medicaid Services (CMS) recently released preliminary technical Medicare Part D bid information for the 2025 contract year to assist Part D plan sponsors in finalizing their Part D and Medicare Advantage (MA) offerings. This preparation is crucial for the upcoming Medicare Open Enrollment period. Additionally, CMS has announced a voluntary demonstration to support the implementation of the redesigned Part D benefit, aiming to improve stability for Medicare beneficiaries in 2025. Preliminary average Part D premiums will be released later this summer, with the finalized 2025 landscape available in mid-to-late September.
The Inflation Reduction Act (IRA), also known as the prescription drug law, introduces several significant improvements to the Part D drug benefit, projected to save Medicare beneficiaries an average of 30% in annual out-of-pocket prescription drug costs by 2025. This will result in a reduction of approximately $7.4 billion in out-of-pocket prescription drug spending for people with Medicare Part D. Key changes include a $2,000 cap on out-of-pocket spending, the elimination of the coverage gap phase ("donut hole"), and the introduction of the Manufacturer Discount Program, which replaces the Coverage Gap Discount Program. The reinsurance payment amount will decrease, with more upfront costs and subsidies shifted to plans.
The base beneficiary premium for 2025 will be $36.78, an increase of $2.08 from 2024. CMS is also conducting a voluntary demonstration to test premium stabilization and revised risk corridors for stand-alone prescription drug plans (PDPs). This demonstration includes a uniform reduction of $15 to the base beneficiary premium, a $35 limit on year-over-year premium increases, and changes to the risk corridors for greater government risk sharing. The demonstration aims to ensure stability and predictability in the Part D market as the IRA changes are implemented.
Overall, these changes shift the government subsidy to Part D plans from reinsurance payments to upfront payments, encouraging better cost management. The national average monthly bid amount for 2025 will be $179.45, reflecting these shifts. CMS aims to provide stability across the Part D market through this demonstration, which is voluntary and open to all stand-alone PDP sponsors.
As we approach the Annual Enrollment Period (AEP), it’s crucial to stay informed about significant changes in the Medicare landscape. These changes, influenced by various market dynamics and regulatory adjustments, could impact your clients' plans and coverage. Here’s a comprehensive overview of what to expect and how to strategically navigate the AEP.
Key Changes to Expect
Insurance carriers are strategically reassessing their plans to mitigate potential financial risks. This involves making tough decisions such as pulling out of specific markets, reducing certain benefits, and even designating some Prescription Drug Plans (PDPs) as non-commissionable. These adjustments reflect a proactive approach to ensuring the long-term sustainability and viability of the plans offered to Medicare beneficiaries.
Important CMS Update: Inflation Reduction Act and Medicare - View
Strategic Plan for AEP:
In August, kick off your AEP preparations by sending out personalized AEP letters to your clients. Tailor these letters to two specific groups:
For your Medicare Supplement members, reassure them that their trusted Medicare Supplement plan will remain unchanged, but remind them that adjustments to their Part D plan may be on the horizon. Let them know that you are available to assist them through this process and encourage them to use tools like SunFire to ensure their Rx drug lists are up to date.
When addressing your MAPD members, be transparent about the potential of negative changes in most plans. Set clear expectations that these changes will come into effect on January 1, 2025, and promise to keep them informed through email as more details become available.
To further support your clients' understanding, create engaging and informative content where you walk through the Annual Notice of Change (ANOC) step by step. Share these resources to ensure that only your clients have access to this important information.
As October approaches, schedule emails to be sent out on the 1st of the month. These emails should outline the upcoming plan changes and offer a preliminary diagnosis of how these adjustments may impact each client. Ensure that carrier representatives provide you with the ANOC by September so that you can accurately communicate these changes to your clients in a timely manner.
Client Engagement
To enhance client engagement and ensure a smooth AEP process, consider hosting informative and interactive events such as in-person group meetings and Q&A sessions. These sessions can provide a platform for clients to ask questions, voice concerns, and gain a deeper understanding of their plan options. Additionally, personally reaching out to each member in the early days of October to guide them through the re-enrollment process can offer a personalized touch and instill confidence in their plan decisions.
Sending out Scope of Appointment (SOA) forms to all current clients is a proactive step to prepare for upcoming appointments starting on October 15. By reaching out to clients in September to gather their Rx drug lists and then following up in October to review their plans, you can streamline the enrollment process and ensure that their coverage aligns with their healthcare needs.
These personalized touchpoints and strategic planning efforts can help build trust with clients, demonstrate your commitment to their well-being, and ultimately lead to a successful AEP season for both you and your clients.
Efficiency Tips
When it comes to efficiently managing your client base during AEP, it's essential to make the most of your time and resources. Utilizing bulk meetings and phone calls allows you to reach as many clients as possible in a streamlined manner. By identifying clients who have decided to stay on their current plan, you can easily cross them off your list and focus your attention on those who may need assistance with plan changes.
Instead of time-consuming home visits, consider inviting clients to visit you at a designated location for personalized consultations. This not only saves you time but also provides a professional setting for productive discussions about their plan options.
In today's digital age, leveraging social media can be a powerful tool for client updates and support. Consider creating a private Facebook group where clients can access important information, ask questions, and engage with each other. This interactive platform can enhance communication and foster a sense of community among your clients.
Handling Non-commissionable PDPs
When handling non-commissionable Prescription Drug Plans (PDPs), it is essential to prioritize your clients' best interests above all else. Regardless of commissions, your primary focus should be advising clients on the plan that suits their healthcare needs and budget most effectively. Position PDPs as a complementary service for your Medicare Supplement clients, emphasizing the importance of comprehensive coverage. By guiding clients towards the most beneficial plans without being influenced by commissions, you can build trust, loyalty, and satisfaction among your client base.
ANOC Highlights
When focusing on deductible and copay/tier changes, it's important to delve into the specifics of how these adjustments could impact your clients' out-of-pocket costs and overall healthcare expenses. By highlighting the potential changes in deductibles, copayments, and tier structures, you can help clients understand the financial implications of their plan choices and make informed decisions. Additionally, as each Annual Notice of Change (ANOC) will provide updates on Rx drug changes, it's crucial to thoroughly review these updates with your clients and explain any modifications to their prescription drug coverage.
Summary
By following this strategic plan, you can efficiently manage the AEP period, keep clients informed, and ensure they are enrolled in the best possible plans for their needs. By staying ahead of the curve and proactively addressing any potential changes or challenges, you demonstrate your dedication to ensuring that your clients have access to the most beneficial and cost-effective healthcare coverage options available.
The Biden-Harris Administration, through the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS), has released the final part two guidance for the Medicare Prescription Payment Plan under the Inflation Reduction Act.
This plan allows Medicare beneficiaries to spread their prescription drug costs over the year starting in 2025, capping annual out-of-pocket expenses at $2,000. The initiative aims to provide financial relief and prevent high upfront costs. CMS is also enhancing outreach and education to ensure beneficiaries are aware of these changes.
These efforts complement other measures like the $35 insulin cap and expanded eligibility for the Extra Help program, further alleviating prescription drug costs for Medicare enrollees.
Welcome to SunFire's email series designed to help agents prepare for AEP. SunFire combines quality data and smart tools to help brokers, carriers, and providers work more efficiently and effectively. You can learn more about the SunFire Enrollment Platform here.
Phoenix Rising - Customer Intake Form!
As part of the rebuild of the Direct to Consumer (DTC) experience, Phoenix, we are rolling out a new feature that will allow agents to collect key client information:
Permission to contact
Collect Provider and Prescription information
Complete a Scope of Appointment form
Access the responses in the SunFire platform to begin an enrollment
View a Demo
Below is a glimpse at the SunFire updates being made over the next few weeks. Be sure to follow our weekly emails for more!
Drug & Doctor Pre-Fill
Save time and improve enrollment quality with Drug & Doctor prefill built into our Customer Lookup feature. With suggested medications and providers based on historical information, you can spend less time collecting data and more time adding value. Drug Prefill launching 8/1. Doctor Prefill following shortly!
Direct-to-Consumer Refresh
A completely rebuilt our direct-to-consumer (DTC) platform, Phoenix, to create a cleaner, more intuitive quote and enroll experience. Build customer trust with a customized, agent-forward interface that streamlines field underwriting, quoting, and enrollment for your customers.
Medicaid Lookup
Medicaid Lookup tool helps you quote and enroll much more quickly and confidently by validating the beneficiary’s Medicaid level directly in SunFire. We’re continuing to improve this tool with Change Health going live by AEP, with expanded states!
Spanish Materials
Provide a great, compliant customer experience to new populations with consumer-facing materials in Spanish. Coming soon in Blaze and Blaze Connect.
Core Flow Enhancements
Made the underwriting and quoting engine work smarter for you with significant enhancements to our core flow:
Updated annual cost calculation
SNP recommendations
SEP recommendations in Customer Lookup
New Flex Benefit filter
Provider updates
Med Supp Carrier Expansion
Med Supp platform is leading the industry with end-to-end quoting, field underwriting, and enrollments. We’re adding new carriers regularly, with enrollments from HCSC, Humana, and Aflac coming soon!
DVH Carrier Expansion
Access a variety of Dental, Vision, and Hearing (DVH) products with our integrated DVH quoting and enrollment. Enrollments with Aflac products will be rolled out soon!
No-Sale Benefit Activation
Generate revenue and create an excellent customer experience even when it’s not the righttime for the customer to enroll. Benefits from SelectRx and Perry Health are coming soon!
Using an Annual Enrollment Period (AEP) assessment form with Medicare clients offers several benefits. It allows for personalized plan recommendations by gathering detailed information about clients’ current medications, healthcare providers, and preferred pharmacies. This process helps identify any gaps in existing coverage, ensuring clients are fully protected without unexpected costs.
The form also streamlines decision-making by organizing client information, simplifying the comparison of different plans, and making the selection process more efficient. Additionally, it ensures all interactions and recommendations are well-documented, aiding in regulatory compliance and providing a clear record of advice given. These benefits lead to better service quality, stronger client relationships, and enhanced client satisfaction.
Independent agents play a vital role in helping seniors secure the most cost-effective Medicare plans for their individual needs. This comprehensive tool simplifies the sales process with multi-carrier shopping and enrollment platforms wrapped into a single online experience.
And best of all, this platform is available at no cost to PSM agents. Request details today and make sure you have access to this cutting edge technology at your fingertips.
2025 AEP Preparation Guide
Get ready to elevate your game and make the most out of this AEP with our comprehensive guide. Read online or Download it in printable PDF format and start preparing for a successful enrollment season ahead.
The Medicare Advantage (MA) market has experienced remarkable growth in recent years, with more seniors opting for the alternative to traditional Medicare. In 2024, enrollment trends continued to show substantial numbers, albeit slower than in previous years.
According to a March report from Chartis, MA enrollment likely peaked in 2020, with a significant increase of 1.5 million new Medicare enrollees compared to only 1.3 million new enrollees this past year. While MA remains a popular choice for seniors, the enrollment growth rate has tempered since 2020, indicating a potential shift in the pace of growth.
Agents must understand these current trends as they prepare for the 2024/2025 MA Annual Enrollment Period (AEP). Let’s dive into the data and explore what it means for the future of MA.
Enrollment trends in 2024
MA plans have become increasingly popular, with about half of Medicare-eligible individuals enrolled. According to the Chartis report, the market has grown by 1.7 million beneficiaries since 2023, reaching a total enrollment of 33 million individuals. This represents a 5.4% increase over the previous year.
Special Needs Plans (SNPs) have experienced substantial growth, adding 1.2 million members in 2024—representing a 21.5% increase from the previous year. Nearly seven in 10 new MA enrollees opted for SNPs, with Chronic Condition SNPs (C-SNPs) leading the way. The increasing popularity of SNPs highlights the importance of catering to the unique needs of specific populations within the MA sector and presents a significant growth opportunity for health plans.
While the number of plan options remained relatively flat in 2024, with the average senior having access to 44 plans, the exponential growth trend in plan options observed in previous years has slowed down. Preferred Provider Organizations (PPOs) have seen an increase, constituting 43% of all plans offered, up from 31% in 2019.
As shown in the Chartis report, MA enrollment can be closely related to social vulnerability, with counties with higher vulnerability scores showing greater penetration rates. Quality ratings, however, have been a concern, as plans need help maintaining their average star ratings. About a quarter of beneficiaries are enrolled in plans with less than four stars, which could indicate a decline in quality performance in 2024.
Future market outlook and dynamics
Despite the challenges the MA market faces, plan executives remain optimistic about the future. A Chartis survey of industry leaders revealed that 84% expect their plan’s membership growth to be consistent or higher over the next year. While concerns about overall profitability, medical cost growth, and star quality reductions persist, the outlook for MA remains positive.
These trends will affect the upcoming 2024/2025 Medicare selling season. As the Annual Enrollment Period nears, and with the growth in MA enrollment slowing down, the competition among health plans during AEP may intensify. We’ll all need to carefully evaluate our strategies to attract and retain beneficiaries in a market that is becoming more saturated.
"Focusing on member engagement, offering innovative plan options, and emphasizing the unique benefits of MA over traditional Medicare will be essential for success during this year’s AEP."
Overall, 2024 MA enrollment trends provide valuable insights into the market’s current state and future trajectory. While growth has slowed since 2020, MA remains a preferred choice among Medicare-eligible beneficiaries. The increasing popularity of SNPs and the plateauing of plan options highlight the need for healthcare professionals to focus on sustainable growth, member engagement, and diversification strategies. As the MA market evolves, stakeholders must adapt strategies to navigate an increasingly complex and competitive landscape.
Takeaways
According to a recent report from Chartis, Medicare Advantage enrollment continues to grow despite mounting obstacles, with half of Medicare-eligible individuals now opting for these plans.
The report also demonstrated that Special Needs Plans (SNPs) are experiencing significant growth, particularly in the Chronic Condition SNPs (C-SNPs) segment.
Plan options have plateaued, and quality ratings remain a concern, emphasizing the need for sustainable growth strategies and member engagement efforts.
AEP Resources
We are excited for the 2025 Annual Enrollment Period (AEP) and the incredible opportunities it brings! At PSM Brokerage, we are dedicated to helping our agents succeed, stay productive, and remain compliant throughout this crucial time. Our comprehensive support includes up-to-date training, valuable resources, and expert guidance to navigate the complexities of the AEP. Learn More.
The Inflation Reduction Act, a significant piece of legislation, is poised to bring substantial changes to various sectors of the economy, including healthcare. For Medicare beneficiaries, this act promises to address several critical issues, potentially improving access to affordable healthcare and reducing out-of-pocket expenses.
One of the most impactful provisions of the Inflation Reduction Act is the reduction in prescription drug costs for Medicare beneficiaries. For years, seniors have struggled with the high costs of medications, which often force them to choose between essential medications and other necessities. The act aims to alleviate this burden by allowing Medicare to negotiate prices for certain high-cost drugs directly with pharmaceutical companies. This negotiation power is expected to lead to significant savings for beneficiaries.
Caps on Out-of-Pocket Expenses
The act introduces a cap on out-of-pocket expenses for prescription drugs under Medicare Part D. Starting in 2025, there will be a $2,000 annual cap on out-of-pocket spending. This is a monumental change, as it provides a clear limit to what seniors will have to pay each year for their medications, offering financial predictability and security.
Insulin Cost Reductions
For beneficiaries who rely on insulin, the Inflation Reduction Act brings particularly welcome news. The act caps insulin costs at $35 per month for Medicare beneficiaries, effective in 2023. This measure is crucial for the millions of seniors who manage diabetes, as it ensures they can afford this life-saving medication without facing financial hardship.
Expanding Subsidies
The act also extends the enhanced subsidies for low-income Medicare beneficiaries through 2024. These subsidies, initially expanded under the American Rescue Plan, help cover premiums and out-of-pocket costs, making healthcare more affordable for those with limited incomes. By continuing these subsidies, the Inflation Reduction Act ensures that vulnerable populations maintain access to necessary healthcare services.
Preventative Services and Vaccine Coverage
Preventative services and vaccines play a critical role in maintaining the health and well-being of seniors. The Inflation Reduction Act eliminates cost-sharing for adult vaccines covered under Medicare Part D, such as the shingles vaccine. Additionally, it improves access to other preventative services, encouraging beneficiaries to take advantage of screenings and early detection services without worrying about additional costs.
Addressing Health Disparities
The act includes provisions aimed at addressing health disparities among Medicare beneficiaries. By increasing funding for community health centers and expanding telehealth services, the act ensures that underserved populations have better access to healthcare. This focus on equity helps to close the gap in healthcare access and outcomes for minority and low-income seniors.
Conclusion
The Inflation Reduction Act represents a significant step forward in making healthcare more accessible and affordable for Medicare beneficiaries. By lowering prescription drug costs, capping out-of-pocket expenses, and expanding subsidies, the act provides much-needed financial relief to seniors. Additionally, its emphasis on preventative care and addressing health disparities ensures that all beneficiaries can enjoy better health outcomes. As these changes take effect, Medicare beneficiaries can look forward to a more secure and manageable healthcare experience.
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