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.
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
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.
As an insurance agent, marketing Medicare plans requires not only a deep understanding of the products you offer but also a strict adherence to the regulations set forth by the Centers for Medicare & Medicaid Services (CMS). These rules are designed to protect Medicare beneficiaries and ensure that their choices are informed, fair, and free from pressure. In this blog, we’ll explore the key rules you need to follow when marketingMedicare plans, as well as best practices for conducting meetings with potential clients.
Respecting Privacy and Personal Information
When representing Medicare plans, it’s crucial to safeguard your clients’ personal information. You are prohibited from asking for sensitive details like bank account or credit card numbers over the phone unless it’s necessary to process an enrollment request. Remember, you don’t need personal information just to provide a quote.
If a client has applied for Extra Help paying for Medicare prescription drug coverage and there’s missing information, you may contact them to complete the application, but only under these specific circumstances.
Avoiding Unsolicited Contact
One of the most important rules is that you cannot approach potential clients at their homes uninvited to sell or endorse a Medicare plan. Similarly, you’re not allowed to call individuals unless they are already members of the plan or have given you explicit permission to contact them. If a client is already a member, you, as their agent, may reach out to them directly.
It’s also important to note that you cannot require potential clients to speak to a sales agent in order to receive information about a plan. Transparency and voluntary engagement are key.
Prohibited Marketing Practices
When marketing Medicare plans, there are several practices that are strictly prohibited:
Incentives: You cannot offer cash or gifts worth more than $15 as an incentive for joining a plan, nor can you provide free meals during a sales presentation.
Payment Requests: It’s against the rules to ask for payment over the phone or online. Instead, the plan must send a bill to the client.
Misrepresentation: You must not claim that Medicare Advantage plans are the same as Medigap policies, or try to sell unrelated products like life insurance or annuities during a Medicare presentation.
Appointments and Plan Discussions: You cannot discuss other plans during an appointment unless the client has specifically requested to learn about them and completed a separate appointment form.
Inappropriate Venues: You are not allowed to market Medicare plans or enroll clients in locations where they receive health care, such as exam rooms or pharmacy counters, nor during educational events like health fairs.
Misleading Advertising: All advertising must clearly identify the plans being marketed and must not use confusing language, images, or unauthorized Medicare logos.
Guidelines for Meetings with Clients
When meeting with clients, it’s essential to adhere to the rules set by CMS to ensure a compliant and ethical process:
Permitted Actions: You can provide plan materials, explain plan options, give enrollment forms, collect completed forms, and leave business cards for referrals.
Prohibited Actions: You must not charge a fee for enrollment processing, steer clients toward specific plans, give false information, or pressure clients with statements like “you must join this plan to have coverage next year.” Additionally, you cannot ask for personal contacts to solicit new clients or ask clients to sign an enrollment form before they are ready.
After the meeting, the plan will follow up with the client to confirm their enrollment and ensure they understand how the plan works. As the agent, you may contact the client to discuss additional plan options, but always with respect for their autonomy and decision-making process.
Special Rules for Medicare Private-Fee-For-Service Plans
If you’re selling Medicare PFFS plans, there are additional rules you must follow:
Provide Clear Information: Offer written details explaining how the plan operates, including the fact that there’s no guarantee that a client’s doctor or hospital will accept the plan’s terms.
Follow-Up Communication: If you cannot reach the client by phone, you must send a letter explaining how they can disenroll if they change their mind.
Availability for Questions: Ensure that clients, as well as their healthcare providers, have access to resources to answer any questions about the plan.
Adhering to these marketing rules not only keeps you compliant with CMS regulations but also builds trust with your clients. By conducting your business with transparency, respect, and integrity, you can help your clients make informed decisions about their Medicare coverage while fostering long-term relationships built on trust. Always stay updated on the latest regulations and continue to refine your approach to ensure you are providing the best possible service to those who depend on your expertise.
As an insurance agent, when it comes to selling Medicare plans, one of the most critical aspects of your compliance toolkit is the Permission to Contact (PTC) form. This form is not just a regulatory requirement—it’s a vital step in building trust with your clients and ensuring that your interactions with potential enrollees are transparent and respectful. In this blog, we’ll break down the key requirements for the Permission to Contact form, why it’s important, and how to use it correctly to stay compliant while maximizing your success.
What is the Permission to Contact Form?
The Permission to Contact form is a document that grants you, the agent, the legal right to reach out to a potential client regarding Medicare plans. Whether it’s for a Medicare Advantage (MA) plan, a Part D prescription drug plan, or other related Medicare products, the PTC form must be completed and signed by the individual before you initiate any form of contact, including phone calls, emails, or home visits. View sample
Why is the PTC Form Important?
The Centers for Medicare & Medicaid Services (CMS) has stringent rules in place to protect Medicare beneficiaries from unsolicited and potentially confusing or misleading marketing practices. The PTC form is a safeguard that ensures beneficiaries are only contacted when they have explicitly agreed to receive information about Medicare products. For agents, adhering to this requirement is essential not only to remain compliant but also to maintain the trust and confidence of your clients.
Key Requirements for the Permission to Contact Form
To ensure you’re using the PTC form correctly, it’s important to understand the specific requirements set by CMS:
Voluntary Consent: The form must be filled out voluntarily by the potential client. There should be no pressure, coercion, or misleading information provided during the process of obtaining consent.
Specific Contact Information: The PTC form should clearly indicate the type of contact the beneficiary is agreeing to—whether it’s a phone call, email, home visit, or another form of communication. It’s crucial that the client understands what they are consenting to.
Valid Time Frame: The PTC form is not an indefinite consent. Typically, it’s valid for a specific period, often up to 12 months. After this period, if the client wishes to continue communication, a new PTC form must be obtained.
Scope of Permission: The PTC form should specify what products or services the client is interested in discussing. This means that if a client consents to being contacted about a Medicare Advantage plan, you cannot use that consent to discuss unrelated products, such as life insurance or annuities, unless separately agreed upon.
Documentation and Record-Keeping: Once the PTC form is signed, it’s important to maintain accurate records of the consent. This documentation must be kept on file and available for review if required by CMS or other regulatory bodies. Keeping these records organized and accessible is essential for demonstrating compliance.
How to Use the Permission to Contact Form Effectively
To make the most of the PTC form while ensuring compliance, follow these best practices:
Educate Your Clients: Take the time to explain the purpose of the PTC form to your clients. Ensure they understand that it protects their rights and gives them control over who contacts them about Medicare products.
Ensure Clarity and Transparency: When presenting the PTC form, be clear about what the client is agreeing to. Avoid industry jargon or confusing terms that might lead to misunderstandings.
Follow the Scope of Permission: Stick strictly to the topics that the client has consented to discuss. If during the conversation the client expresses interest in other products, you can ask for permission to discuss those areas and update the PTC form accordingly.
Respect the Client’s Decision: If a client chooses not to sign the PTC form or later decides they no longer wish to be contacted, respect their decision without pressuring them. Their autonomy is paramount.
Stay Organized: Keep all signed PTC forms organized and easily accessible. Regularly review your records to ensure that all your communications are within the allowed time frame and scope of permission.
Conclusion
The Permission to Contact form is a vital component of the compliance framework for Medicare plan marketing. By understanding and adhering to the CMS requirements for this form, you not only protect yourself and your business but also foster a relationship of trust with your clients. Remember, the PTC form is more than just a piece of paperwork—it’s a commitment to ethical and transparent business practices. By using it correctly, you can confidently guide your clients through their Medicare choices while ensuring you stay on the right side of the regulations.
Contact us for custom outreach pieces at (800) 998-7715.
Each year, CMS publishes the FMV amounts for initial and renewal compensation as well as referral fees. For 2025, the amounts are as follows:
NOTE: CMS rounded the FMV amounts for CY 2025 up to the nearest dollar. The Initial Year amount is the maximum allowable amount that organizations may pay for enrollments during compensation cycle-year 1. The renewal amount is the maximum allowable amount that organizations may pay for enrollments during compensation cycle-years 2 and beyond, for a like- plan type.
Our 2025 Annual Enrollment Period (AEP) Guide is here, and we couldn't be more thrilled to share it with you! Carefully curated and packed with valuable insights, this guide is your key to success as you navigate the upcoming enrollment season. From tips on maximizing your productivity to strategies for optimizing your performance, this essential resource has everything you need to excel during this critical time of the year. View Resources.
.png?width=600&height=300&name=Eblast%20Header%20600x300%20(45).png)
.png?width=600&height=300&name=Eblast%20Header%20600x300%20(44).png)
