Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to Medicare three sixty, where the world of Medicare
is simplified and you are empowered to make informed healthcare choices.
With over two decades of experience and insurance and financial
solutions with host licensed insurance agents Jennifer Lee, you are
guided through the ins and outs of Medicare, whether you
(00:22):
are nearing retirement, navigating your options, or just curious about
what's available. Everything you need to know is covered. Tune
in for knowledgeable insights, tips and answers to your Medicare
questions so you can take charge of your health and
your future. And Now Medicare three sixty.
Speaker 2 (00:44):
Welcome to today's Medicare three sixty show. I'm your host,
Jennifer Lee, and we are going to get started. It
is October thirteenth, and so are two more days out
from annual enrollment for Medicare. Today, I'll be talking about
(01:05):
annual period and what's changing for Medicare in twenty twenty six.
So today we're going to unpack everything beneficiaries and agents
need to know for the annual enrollment period twenty twenty six.
We're going to talk about government rule changes, care. You're in,
(01:26):
star rating shifts, new tech trends and how agents and
agen sees should adapt stick around, and I'll end with
actionable steps and how to book a personalized review. So
why this matters? Annual Enrollment is a once a year
(01:47):
window that determines coverage for the next calendar year, so
that would be an effective date of January first, twenty
twenty six. For twenty twenty six. The open enrollment period
also called annual Enrollment period runs from October fifteenth through
(02:09):
December seventh. That's when beneficiaries can change Medicare advantaged plans,
join or switch a Part D drug plan, or go
back to original Medicare As mentioned, coverage changes take effect
January first, twenty twenty six. Of course, there is the
(02:33):
open enrollment period that starts January first to March thirty first,
and that could be one more change to your Medicare
advantage plan or drug plan.
Speaker 3 (02:49):
If you are.
Speaker 2 (02:50):
An agent, these months are mission critical if you're a beneficiary,
Small timy mistakes can cost money and act access.
Speaker 3 (03:00):
So we'll walk.
Speaker 2 (03:02):
Through the policy and marketplace shifts you must know before
you pick up the phone or hit the mailbox. So
let's talk about the government and regulatory headlines for twenty
twenty six. With these headlines, CMS finalize a set of
(03:26):
contract year twenty twenty six policy changes that touch Medicare
Advantage Part D D SNIPS, which is your special needs plans,
Star ratings, and prescription drug programs. These are not minor tweaks.
They're intended to modernize benefit design and enforcement across the board.
(03:52):
So on payments, Center of Medicare Services expect government payments
to Medicare vantaged plans to increase. Payments were projected to
rise on average twenty twenty six updates, which changes economics
for carriers and could influence plan design premiums offered to beneficiaries.
Speaker 3 (04:15):
So keep in.
Speaker 2 (04:16):
Mind with these Medicare advantage plans, the insurance carriers definitely
do have to send in approval every single year to Medicare,
and that's why there's always changes every single year, because
the insurance carriers try to make the benefits better or
(04:37):
however they seem justly for their company and they send
it up to Medicare. One more big regulatory shift to
flag Center Medicare Services adjusted measure weights in the Star
ratings calculation for twenty twenty six, notably decreasing the weight
of some patient experience and access measures That changes affects
(05:02):
help plans emphasize patient surveys versus clinical process measures. Agents
should expect carriers to respond by rebalancing member outreach and
quality improvement investments. So with the star ratings, the higher
(05:22):
the star rating, the more money the insurance company gets
for Medicare for the level of care. Right sometimes though
the star ratings are just tweaked, they're not.
Speaker 3 (05:39):
It doesn't show maybe the whole picture.
Speaker 2 (05:42):
And where there was a few insurance companies that actually
sued Medicare for unjust star ratings because they had said
Medicare changed their criteria along the year. And some of
them actually won and got more money and turn you
pass it on to the consumer, but there were companies
(06:06):
that did not get it adjusted as well. So now
let's talk about the costs and beneficiary impact and what
consumers need to budget for. We've seen projected increases in
beneficiary costs for twenty twenty six CMS. Projections and multiple
analysis indicate higher part B premiums and part DEEP based
(06:30):
costs for many beneficiaries, figures that could be substantial for
people on fixed incomes. Experts are recommending agents proactively talk
about budgeting and IRMA, which is income based adjustment planning.
So what does that mean on the ground. Even Benish
fisheries that are happy with a current plan should review it.
(06:54):
Changes to premiums, formulas or provider networks could change total
out of pocket costs material definitely true. I would say
that the Part B premium costs probably be higher the
(07:15):
Part BD. The max out of pocket for your prescription
drugs was two thousand, it will increase.
Speaker 3 (07:24):
To twenty one hundred.
Speaker 2 (07:26):
And then there are some deductibles that are increasing as well,
So like there are carriers that are definitely increasing deductibles
or having a deductible. So that's the thing that patients
(07:51):
should keep in mind. Their plan might have been great
last year this year.
Speaker 3 (07:56):
But things are changing. Benefits are changing.
Speaker 2 (08:00):
Formulais which is really what prescription drugs the insurance company takes,
will also change. So let's talk about the carriers and
the marketplace dynamics heading into twenty twenty six, the big
national carriers say United Health, CVS, sash Etna, Humana, Elevants
(08:22):
which is Anthem, Signin Santeen which is Weldcare, continue to dominate.
The Medicare advantage market share, but expect more tactical moves.
They may narrow their networks. In some markets, they may
target benefit packages for specific populations, such as chronic care,
(08:45):
and continued investment in value based arrangements with health systems.
The competitive race on supplemental benefits and cost sharing design
will be intense, so some regional players are getting squeezed
but can still win with local provider ties and superior
member experience in specific counties for agents to know which
(09:09):
carriers dominate your county and why, and that's often what matters.
Speaker 3 (09:13):
Most to beneficiaries. So the thing is, I would say.
Speaker 2 (09:19):
Blanket statements of what insurance companies best for you. It's
going to really depend on your geographical area. Every part
of the country is just going to be different. Different
carriers really target and focus on different types of patients.
Speaker 3 (09:41):
Example, like your chronic care.
Speaker 2 (09:43):
The biggest ones is diabetes and heart conditions is a
big one, so carriers may get more money from Medicare
for helping clients with those conditions. However, in the past
it has been really lax who has a chronic condition,
(10:04):
but now that is definitely tightening up, meaning that insurance
companies may have more requirements. They will check your prescription
drugs if you do have that chronic condition, or they
will have a call to your doctor or request your
(10:25):
doctor to a test that you do have that chronic condition.
So things like that in the marketplace where many were
relying on utility cards and grocery cards, and that might
be going away for you. So that's something you definitely
need to make sure on that. Let's go back to
(10:48):
star ratings why they matter to beneficiaries and insurance companies.
Star ratings drive consumer perception like the government bonuses and
marketing opportunity unities that these insurance companies have. So for
twenty twenty six, a majority of Medicare advantage in worldies
(11:08):
are still in higher rated plans, but the distribution shifted.
Some carriers moved up in others downs. So plans that
lose stars may lose bonus payments and marketing advantages, which
in turn can affect year's benefits and network choices. So
agents use a twenty twenty six star list when you
(11:32):
present options to clients. Okay, so yeah, I just can't
stress the amount of changes that are occurring and that
may affect you. Let's talk about technology trends affecting medicare
in twenty twenty six, so tech is changing how members
(11:55):
engage expanded telehealth coverage, remote monde, nitoring for chronic disease,
digital prior authorization pilots. I've talked about that in other episodes,
and more provider billing data flowing into plan analytics, CMS,
guidance and pilot programs have encouraged telehealth access and digital tools.
(12:18):
Beneficiaries increasingly expect virtual care options and digital plan tools.
Agents should be ready to discuss telehealth availability, remote services,
and how plants support virtual visits or home health. Tech
I is appearing more in marketing and operations from chatbots
(12:40):
or carryer websites to predictive outreach for star measures, but
keep in mind privacy, KIPPA and regulatory oversights still remain.
Agents should confirm how carees use member data before recommending
tech heavy plans.
Speaker 3 (12:55):
YEP, so.
Speaker 2 (12:57):
You never know if you're calling your insurance company and
really an AI person is actually the.
Speaker 3 (13:04):
One you're talking to. It's crazy. Some of them sound
really good, but I'm.
Speaker 2 (13:11):
Still old school and i still want my clients to.
Speaker 3 (13:15):
Talk to a real person. So we will see.
Speaker 2 (13:21):
With TEP two, it's not going to be one hundred
percent accurate. Sometimes when you use quoting engines, your doctors
may still not be in or out of network. Your
prescription drugs may not be the same price on there.
So really please do your diligence on that. Okay, So
(13:44):
let's talk about prescription drug landscape and your part DE
negotiation impact. So twenty twenty six continues to reflect the
odder national conversation about prescription drug pricing CMS has furthered
(14:06):
price negotiation programs and the Part D framework continues to evolve,
which impacts formularies in tiering. For many beneficiaries of Part D, Premium,
deductible and code pas could shift, and some medications may
move tiers to require new utilization edits. So action items
(14:26):
for agents, pull the twenty twenty six formulary and run
a personal drug check.
Speaker 3 (14:31):
For each client.
Speaker 2 (14:32):
Small changes in tier placement or preferred generic substitutions can
change costs significantly. Big thing, guys, Yes, due to the
Inflation Reduction Act that happened this year in twenty twenty five,
with a cap of drugs being two thousand versus eight thousand,
(14:55):
that definitely put in a squeeze with insurance companies. That's
why they have changed their drug formularies.
Speaker 3 (15:04):
Benefits. There's just a lot going on this instance.
Speaker 2 (15:12):
There's a lot of plans terminating or exiting or changing
their name or not being discontinued and not being offered.
Speaker 3 (15:22):
There's just a lot going on, and it's been happening
for the last.
Speaker 2 (15:27):
Few years and hopefully things will definitely stabilize in a
few years. So agents and agencies, compliance, marketing, and opportunity.
What does this regulatory and market terminance mean for agent
in agencies? Definitely more compliance that's going to intensify with
(15:50):
more CMS guidance. Carriers will enforce agent appointment and marketing rules,
keep your contract paperwork current and document scope of appointment
and marketing disclosures. So some of this is not new,
but enforcement tends to tighten years with major policy changes. So, seniors,
(16:15):
the scope of appointment is a form that you do
have to sign before an agent talks to you about
Medicare plan options. So there's a forty eight rule where
you do have to sign that before they talk to you.
So when you have these cold callers calling you without
(16:35):
a scope of appointment, they are not in compliance and
they are not the ethical agents that you want in
your life. We have rules, we should follow them, and
it's not fair for those that follow the rules that
others don't.
Speaker 3 (16:54):
Of course, if you.
Speaker 2 (16:55):
Are walking in or calling in, that forty eight hour
rule does not apply, but you still need to get
that scope of appointment verbally or in writing.
Speaker 3 (17:08):
So marketing shifts.
Speaker 2 (17:11):
Digital channels also are growing targeted outreach with that agents
you know definitely could use that and show comparisons and
so forth.
Speaker 3 (17:26):
So definitely the opportunity.
Speaker 2 (17:30):
I believe about fifty percent of seniors will look into
reviewing their plan and then that next fifty percent will
definitely change your plan. So how agents structure AP operations
so we do standardize our process. We definitely could prepare
(17:54):
digital kits like the scope of appointments, plan can comparisons
and so forth. We're dealing with a licensed independent agent. Definitely,
they need to know how to find plans for you,
how to personalize plans for you, and good agents are
(18:19):
busy agents, so keep that in mind. So the biggest
thing is benefits first, right, So we are offering plan
(18:40):
option changes and just a benefit guide, fifteen minute review
of your drug and provider coverage to see if we
can't save you money or improve access. So we definitely
need to run drugs to make sure your drugs are
on the formulary for your currents. So if they are
(19:01):
generic or preferred generic, they should be very little or
zero cost. But your drug could be a say a
Tier three versus a Tier two depending on the plan providers.
We definitely do have to confirm primary care and specialists
(19:22):
remain in network because you don't know doctors and medical
groups do change their contracts. Medical groups are always in
negotiation with.
Speaker 3 (19:33):
These insurance companies.
Speaker 2 (19:36):
Comparing premiums. Premiums could definitely increase, Deductibles could definitely increase,
and the estimated annual out of pocket costs increases. So
that's going to be the big surprise when some insurance
companies are charging a deductible on your Tier three prescription drugs.
That's what I've been noticing the most. And then just
(19:59):
examining bene like the supplemental benefits like the dental, vision, hearing,
transportation meals, telehealth. Although some are eliminating those, some are
drastically changing, and a few are actually increasing.
Speaker 3 (20:15):
So how do you know?
Speaker 2 (20:16):
You got to review? So if anything looks off. Definitely
present alternative plans and exact dollar differences.
Speaker 3 (20:24):
You know, I know.
Speaker 2 (20:26):
Everyone would want concrete numbers based on their individual.
Speaker 3 (20:31):
So some commonly.
Speaker 2 (20:34):
Ask questions recently, should I stay in my Medicare advantaged
plan if my premium goes up? Well, let's not focus
on premium as a whole. We got to compare the
total expected yearly cost, provider access and drug coverage. Am
I going to lose coverage if my plan loses STARS?
Well not immediately. Star changes influences bonuses and payments which
(20:58):
can affect next year's benefits or plan offerings. But members
don't automatically lose coverage mid year, so find actionaal steps.
Bottom line, Definitely mark your calendar for October fifteenth to
December seventh for annual enrollment period. Change goes infect January. First,
(21:18):
run your drugs early, and then really understand how the
Part D and the Part B cost changes and IRMA
apply for a client. So definitely, I mean, I urge
you two more days coming up for the annual enrollment period,
(21:42):
find that trusted insurance agent as myself in my company
Premiere three sixty and just make sure be it a
just five minute phone call to make sure you are
on the right plan, that you're costs are not going
to skyrocket, that your benefits are just not going to
(22:05):
decrease dramatically is the biggest thing. And of course if
you want to keep your doctors your medical groups, it
is also important to check. And then also the biggest
thing is like if you do it all online, if
you're a do it yourself for your online is not
(22:26):
going to show if your doctors online in a medical
group what medical group they're in. So that's kind of
the biggest thing. Sometimes a client will show me all
their all the homework they did to come to find out.
I tell them, yes, maybe it's a great plan, but
your doctor is not in that plan, or it's geared
(22:50):
to a specific Medicare group medical group, so things like that,
it's just not the things that.
Speaker 3 (22:58):
You read right with.
Speaker 2 (23:01):
Having an experienced, licensed independent agent that actually knows the
plans in an out could guide you in that process.
Speaker 3 (23:12):
Is going to make a big difference.
Speaker 2 (23:16):
Can't stress it enough. Do not talk to those cold
callers that call you because they're not incompliant. If you
did not ask them to call you, they shouldn't be
calling you. And it hurts and effects the agents and
agencies that are trying or that are doing this right,
(23:39):
that are following compliance guidelines from Medicare. So I hope
you enjoy today's Medicare three sixty show. Definitely, if you
are a client or just a senior that wants to
review their Medicare, please don't hesitate to reach out to us.
(24:05):
And if you are agents, we definitely could help you
guide you along the process as some agencies may not
help you as much to.
Speaker 3 (24:19):
Go over and learn the ins and.
Speaker 2 (24:21):
Outs on how to have a successful annual enrollment period.
Speaker 3 (24:27):
Well, this is a great episode.
Speaker 2 (24:29):
I look forward to seeing you in the next have
a great one.
Speaker 3 (24:36):
Thanks, bye bye.
Speaker 1 (24:39):
Thank you for joining the program Medicare at three sixty.
Hope you found today's episode insightful and empowering. Remember understanding
your Medicare options is key to making the right choices
for your health and financial well being. If you have
questions or topics you would like cover it in future
episodes of Medicare three SI, don't hesitate to reach out
(25:02):
and speak with our licensed insurance agent. Until next time,
stay informed and take charge of your health care journey.
This has been Medicare three point sixty, your trusted source
for all things Medicare. Take care,
Welcome to Medicare three sixty, where the world of Medicare
is simplified and you are empowered to make informed healthcare choices.
With over two decades of experience and insurance and financial
solutions with host licensed insurance agents Jennifer Lee, you are
guided through the ins and outs of Medicare, whether you
(00:22):
are nearing retirement, navigating your options, or just curious about
what's available. Everything you need to know is covered. Tune
in for knowledgeable insights, tips and answers to your Medicare
questions so you can take charge of your health and
your future. And Now Medicare three sixty.
Speaker 2 (00:44):
Welcome to today's Medicare three sixty show. I'm your host,
Jennifer Lee, and we are going to get started. It
is October thirteenth, and so are two more days out
from annual enrollment for Medicare. Today, I'll be talking about
(01:05):
annual period and what's changing for Medicare in twenty twenty six.
So today we're going to unpack everything beneficiaries and agents
need to know for the annual enrollment period twenty twenty six.
We're going to talk about government rule changes, care. You're in,
(01:26):
star rating shifts, new tech trends and how agents and
agen sees should adapt stick around, and I'll end with
actionable steps and how to book a personalized review. So
why this matters? Annual Enrollment is a once a year
(01:47):
window that determines coverage for the next calendar year, so
that would be an effective date of January first, twenty
twenty six. For twenty twenty six. The open enrollment period
also called annual Enrollment period runs from October fifteenth through
(02:09):
December seventh. That's when beneficiaries can change Medicare advantaged plans,
join or switch a Part D drug plan, or go
back to original Medicare As mentioned, coverage changes take effect
January first, twenty twenty six. Of course, there is the
(02:33):
open enrollment period that starts January first to March thirty first,
and that could be one more change to your Medicare
advantage plan or drug plan.
Speaker 3 (02:49):
If you are.
Speaker 2 (02:50):
An agent, these months are mission critical if you're a beneficiary,
Small timy mistakes can cost money and act access.
Speaker 3 (03:00):
So we'll walk.
Speaker 2 (03:02):
Through the policy and marketplace shifts you must know before
you pick up the phone or hit the mailbox. So
let's talk about the government and regulatory headlines for twenty
twenty six. With these headlines, CMS finalize a set of
(03:26):
contract year twenty twenty six policy changes that touch Medicare
Advantage Part D D SNIPS, which is your special needs plans,
Star ratings, and prescription drug programs. These are not minor tweaks.
They're intended to modernize benefit design and enforcement across the board.
(03:52):
So on payments, Center of Medicare Services expect government payments
to Medicare vantaged plans to increase. Payments were projected to
rise on average twenty twenty six updates, which changes economics
for carriers and could influence plan design premiums offered to beneficiaries.
Speaker 3 (04:15):
So keep in.
Speaker 2 (04:16):
Mind with these Medicare advantage plans, the insurance carriers definitely
do have to send in approval every single year to Medicare,
and that's why there's always changes every single year, because
the insurance carriers try to make the benefits better or
(04:37):
however they seem justly for their company and they send
it up to Medicare. One more big regulatory shift to
flag Center Medicare Services adjusted measure weights in the Star
ratings calculation for twenty twenty six, notably decreasing the weight
of some patient experience and access measures That changes affects
(05:02):
help plans emphasize patient surveys versus clinical process measures. Agents
should expect carriers to respond by rebalancing member outreach and
quality improvement investments. So with the star ratings, the higher
(05:22):
the star rating, the more money the insurance company gets
for Medicare for the level of care. Right sometimes though
the star ratings are just tweaked, they're not.
Speaker 3 (05:39):
It doesn't show maybe the whole picture.
Speaker 2 (05:42):
And where there was a few insurance companies that actually
sued Medicare for unjust star ratings because they had said
Medicare changed their criteria along the year. And some of
them actually won and got more money and turn you
pass it on to the consumer, but there were companies
(06:06):
that did not get it adjusted as well. So now
let's talk about the costs and beneficiary impact and what
consumers need to budget for. We've seen projected increases in
beneficiary costs for twenty twenty six CMS. Projections and multiple
analysis indicate higher part B premiums and part DEEP based
(06:30):
costs for many beneficiaries, figures that could be substantial for
people on fixed incomes. Experts are recommending agents proactively talk
about budgeting and IRMA, which is income based adjustment planning.
So what does that mean on the ground. Even Benish
fisheries that are happy with a current plan should review it.
(06:54):
Changes to premiums, formulas or provider networks could change total
out of pocket costs material definitely true. I would say
that the Part B premium costs probably be higher the
(07:15):
Part BD. The max out of pocket for your prescription
drugs was two thousand, it will increase.
Speaker 3 (07:24):
To twenty one hundred.
Speaker 2 (07:26):
And then there are some deductibles that are increasing as well,
So like there are carriers that are definitely increasing deductibles
or having a deductible. So that's the thing that patients
(07:51):
should keep in mind. Their plan might have been great
last year this year.
Speaker 3 (07:56):
But things are changing. Benefits are changing.
Speaker 2 (08:00):
Formulais which is really what prescription drugs the insurance company takes,
will also change. So let's talk about the carriers and
the marketplace dynamics heading into twenty twenty six, the big
national carriers say United Health, CVS, sash Etna, Humana, Elevants
(08:22):
which is Anthem, Signin Santeen which is Weldcare, continue to dominate.
The Medicare advantage market share, but expect more tactical moves.
They may narrow their networks. In some markets, they may
target benefit packages for specific populations, such as chronic care,
(08:45):
and continued investment in value based arrangements with health systems.
The competitive race on supplemental benefits and cost sharing design
will be intense, so some regional players are getting squeezed
but can still win with local provider ties and superior
member experience in specific counties for agents to know which
(09:09):
carriers dominate your county and why, and that's often what matters.
Speaker 3 (09:13):
Most to beneficiaries. So the thing is, I would say.
Speaker 2 (09:19):
Blanket statements of what insurance companies best for you. It's
going to really depend on your geographical area. Every part
of the country is just going to be different. Different
carriers really target and focus on different types of patients.
Speaker 3 (09:41):
Example, like your chronic care.
Speaker 2 (09:43):
The biggest ones is diabetes and heart conditions is a
big one, so carriers may get more money from Medicare
for helping clients with those conditions. However, in the past
it has been really lax who has a chronic condition,
(10:04):
but now that is definitely tightening up, meaning that insurance
companies may have more requirements. They will check your prescription
drugs if you do have that chronic condition, or they
will have a call to your doctor or request your
(10:25):
doctor to a test that you do have that chronic condition.
So things like that in the marketplace where many were
relying on utility cards and grocery cards, and that might
be going away for you. So that's something you definitely
need to make sure on that. Let's go back to
(10:48):
star ratings why they matter to beneficiaries and insurance companies.
Star ratings drive consumer perception like the government bonuses and
marketing opportunity unities that these insurance companies have. So for
twenty twenty six, a majority of Medicare advantage in worldies
(11:08):
are still in higher rated plans, but the distribution shifted.
Some carriers moved up in others downs. So plans that
lose stars may lose bonus payments and marketing advantages, which
in turn can affect year's benefits and network choices. So
agents use a twenty twenty six star list when you
(11:32):
present options to clients. Okay, so yeah, I just can't
stress the amount of changes that are occurring and that
may affect you. Let's talk about technology trends affecting medicare
in twenty twenty six, so tech is changing how members
(11:55):
engage expanded telehealth coverage, remote monde, nitoring for chronic disease,
digital prior authorization pilots. I've talked about that in other episodes,
and more provider billing data flowing into plan analytics, CMS,
guidance and pilot programs have encouraged telehealth access and digital tools.
(12:18):
Beneficiaries increasingly expect virtual care options and digital plan tools.
Agents should be ready to discuss telehealth availability, remote services,
and how plants support virtual visits or home health. Tech
I is appearing more in marketing and operations from chatbots
(12:40):
or carryer websites to predictive outreach for star measures, but
keep in mind privacy, KIPPA and regulatory oversights still remain.
Agents should confirm how carees use member data before recommending
tech heavy plans.
Speaker 3 (12:55):
YEP, so.
Speaker 2 (12:57):
You never know if you're calling your insurance company and
really an AI person is actually the.
Speaker 3 (13:04):
One you're talking to. It's crazy. Some of them sound
really good, but I'm.
Speaker 2 (13:11):
Still old school and i still want my clients to.
Speaker 3 (13:15):
Talk to a real person. So we will see.
Speaker 2 (13:21):
With TEP two, it's not going to be one hundred
percent accurate. Sometimes when you use quoting engines, your doctors
may still not be in or out of network. Your
prescription drugs may not be the same price on there.
So really please do your diligence on that. Okay, So
(13:44):
let's talk about prescription drug landscape and your part DE
negotiation impact. So twenty twenty six continues to reflect the
odder national conversation about prescription drug pricing CMS has furthered
(14:06):
price negotiation programs and the Part D framework continues to evolve,
which impacts formularies in tiering. For many beneficiaries of Part D, Premium,
deductible and code pas could shift, and some medications may
move tiers to require new utilization edits. So action items
(14:26):
for agents, pull the twenty twenty six formulary and run
a personal drug check.
Speaker 3 (14:31):
For each client.
Speaker 2 (14:32):
Small changes in tier placement or preferred generic substitutions can
change costs significantly. Big thing, guys, Yes, due to the
Inflation Reduction Act that happened this year in twenty twenty five,
with a cap of drugs being two thousand versus eight thousand,
(14:55):
that definitely put in a squeeze with insurance companies. That's
why they have changed their drug formularies.
Speaker 3 (15:04):
Benefits. There's just a lot going on this instance.
Speaker 2 (15:12):
There's a lot of plans terminating or exiting or changing
their name or not being discontinued and not being offered.
Speaker 3 (15:22):
There's just a lot going on, and it's been happening
for the last.
Speaker 2 (15:27):
Few years and hopefully things will definitely stabilize in a
few years. So agents and agencies, compliance, marketing, and opportunity.
What does this regulatory and market terminance mean for agent
in agencies? Definitely more compliance that's going to intensify with
(15:50):
more CMS guidance. Carriers will enforce agent appointment and marketing rules,
keep your contract paperwork current and document scope of appointment
and marketing disclosures. So some of this is not new,
but enforcement tends to tighten years with major policy changes. So, seniors,
(16:15):
the scope of appointment is a form that you do
have to sign before an agent talks to you about
Medicare plan options. So there's a forty eight rule where
you do have to sign that before they talk to you.
So when you have these cold callers calling you without
(16:35):
a scope of appointment, they are not in compliance and
they are not the ethical agents that you want in
your life. We have rules, we should follow them, and
it's not fair for those that follow the rules that
others don't.
Speaker 3 (16:54):
Of course, if you.
Speaker 2 (16:55):
Are walking in or calling in, that forty eight hour
rule does not apply, but you still need to get
that scope of appointment verbally or in writing.
Speaker 3 (17:08):
So marketing shifts.
Speaker 2 (17:11):
Digital channels also are growing targeted outreach with that agents
you know definitely could use that and show comparisons and
so forth.
Speaker 3 (17:26):
So definitely the opportunity.
Speaker 2 (17:30):
I believe about fifty percent of seniors will look into
reviewing their plan and then that next fifty percent will
definitely change your plan. So how agents structure AP operations
so we do standardize our process. We definitely could prepare
(17:54):
digital kits like the scope of appointments, plan can comparisons
and so forth. We're dealing with a licensed independent agent. Definitely,
they need to know how to find plans for you,
how to personalize plans for you, and good agents are
(18:19):
busy agents, so keep that in mind. So the biggest
thing is benefits first, right, So we are offering plan
(18:40):
option changes and just a benefit guide, fifteen minute review
of your drug and provider coverage to see if we
can't save you money or improve access. So we definitely
need to run drugs to make sure your drugs are
on the formulary for your currents. So if they are
(19:01):
generic or preferred generic, they should be very little or
zero cost. But your drug could be a say a
Tier three versus a Tier two depending on the plan providers.
We definitely do have to confirm primary care and specialists
(19:22):
remain in network because you don't know doctors and medical
groups do change their contracts. Medical groups are always in
negotiation with.
Speaker 3 (19:33):
These insurance companies.
Speaker 2 (19:36):
Comparing premiums. Premiums could definitely increase, Deductibles could definitely increase,
and the estimated annual out of pocket costs increases. So
that's going to be the big surprise when some insurance
companies are charging a deductible on your Tier three prescription drugs.
That's what I've been noticing the most. And then just
(19:59):
examining bene like the supplemental benefits like the dental, vision, hearing,
transportation meals, telehealth. Although some are eliminating those, some are
drastically changing, and a few are actually increasing.
Speaker 3 (20:15):
So how do you know?
Speaker 2 (20:16):
You got to review? So if anything looks off. Definitely
present alternative plans and exact dollar differences.
Speaker 3 (20:24):
You know, I know.
Speaker 2 (20:26):
Everyone would want concrete numbers based on their individual.
Speaker 3 (20:31):
So some commonly.
Speaker 2 (20:34):
Ask questions recently, should I stay in my Medicare advantaged
plan if my premium goes up? Well, let's not focus
on premium as a whole. We got to compare the
total expected yearly cost, provider access and drug coverage. Am
I going to lose coverage if my plan loses STARS?
Well not immediately. Star changes influences bonuses and payments which
(20:58):
can affect next year's benefits or plan offerings. But members
don't automatically lose coverage mid year, so find actionaal steps.
Bottom line, Definitely mark your calendar for October fifteenth to
December seventh for annual enrollment period. Change goes infect January. First,
(21:18):
run your drugs early, and then really understand how the
Part D and the Part B cost changes and IRMA
apply for a client. So definitely, I mean, I urge
you two more days coming up for the annual enrollment period,
(21:42):
find that trusted insurance agent as myself in my company
Premiere three sixty and just make sure be it a
just five minute phone call to make sure you are
on the right plan, that you're costs are not going
to skyrocket, that your benefits are just not going to
(22:05):
decrease dramatically is the biggest thing. And of course if
you want to keep your doctors your medical groups, it
is also important to check. And then also the biggest
thing is like if you do it all online, if
you're a do it yourself for your online is not
(22:26):
going to show if your doctors online in a medical
group what medical group they're in. So that's kind of
the biggest thing. Sometimes a client will show me all
their all the homework they did to come to find out.
I tell them, yes, maybe it's a great plan, but
your doctor is not in that plan, or it's geared
(22:50):
to a specific Medicare group medical group, so things like that,
it's just not the things that.
Speaker 3 (22:58):
You read right with.
Speaker 2 (23:01):
Having an experienced, licensed independent agent that actually knows the
plans in an out could guide you in that process.
Speaker 3 (23:12):
Is going to make a big difference.
Speaker 2 (23:16):
Can't stress it enough. Do not talk to those cold
callers that call you because they're not incompliant. If you
did not ask them to call you, they shouldn't be
calling you. And it hurts and effects the agents and
agencies that are trying or that are doing this right,
(23:39):
that are following compliance guidelines from Medicare. So I hope
you enjoy today's Medicare three sixty show. Definitely, if you
are a client or just a senior that wants to
review their Medicare, please don't hesitate to reach out to us.
(24:05):
And if you are agents, we definitely could help you
guide you along the process as some agencies may not
help you as much to.
Speaker 3 (24:19):
Go over and learn the ins and.
Speaker 2 (24:21):
Outs on how to have a successful annual enrollment period.
Speaker 3 (24:27):
Well, this is a great episode.
Speaker 2 (24:29):
I look forward to seeing you in the next have
a great one.
Speaker 3 (24:36):
Thanks, bye bye.
Speaker 1 (24:39):
Thank you for joining the program Medicare at three sixty.
Hope you found today's episode insightful and empowering. Remember understanding
your Medicare options is key to making the right choices
for your health and financial well being. If you have
questions or topics you would like cover it in future
episodes of Medicare three SI, don't hesitate to reach out
(25:02):
and speak with our licensed insurance agent. Until next time,
stay informed and take charge of your health care journey.
This has been Medicare three point sixty, your trusted source
for all things Medicare. Take care,
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