For agent use only. This information is subject to change.
“There are going to be some things that are going to be changing in our industry, but we want to make sure we’re ready and prepared for it.”
Ronnie James
Regional Sales Director, Tidewater Management Group
Our November Office Hours call was a great mid-AEP check-in. During the session, Ronnie James shared the latest industry insights, focus strategies, and key tips to help you navigate the rest of this season with confidence.
Whether you joined us live or couldn’t make it, this recap has everything you need to catch up and guide your success this enrollment season.
Main Points Covered
The main topics Ronnie covered during October’s call include:
- Medicare Advantage Updates
- Carrier News
- Hospital Updates
- Diversify your Portfolio
- Miscellaneous Information and Reminders
Medicare Advantage Updates
Chronic Special Needs Plans
Chronic Special Needs Plans (C-SNPs) are performing really well this AEP. Ronnie believes this growth is simply due to increased consumer awareness; they are asking more questions and showing greater interest in these plan types. When writing these plans, it is important to remember that C-SNPs are HMO products.
HRA
Remember to take advantage of the HRA dollars you can collect on Medicare Advantage plans. Many agents are getting some great paychecks as a result. Agents seeing success don’t stop the appointment to bring them up; rather, they flow right into it.
For example, “State to your client that the carrier would like to ask a few more questions, mention that it’s voluntary, and the conversation will naturally flow right into it.” – Ronnie James
There are a number of Medicare Advantage carriers paying for Chronic Special and Dual Eligible plans. Check with us for a list of carriers who are and are not at 888-622-9122 or [email protected].
*You can complete an HRA with Integrity Tech. If you are interested in more HRA information, we can provide extra resources.*
Carriers Reducing Footprint
Some Medicare Advantage plans are starting to confront an awkward reality. There are too many consumers, which can be bad for business. As a result, National Carriers are looking to reduce their footprint by eliminating plans. In fact, in 2026 alone, National Carriers footprints declined by 3%. They are doing so by reducing commissions and suppressing plans from the enrollment platforms to limit enrollments. Single state carriers are also taking a step back, with a 5% reduction in the number of counties they offer plans.
Although national and single-state carriers are scaling back, regional carriers are stepping up and filling the gaps. We are seeing a 6% growth by the regional players and increased satisfaction because agents and clients are getting more localized service.
Carrier News
Devoted
This year, the Devoted Giveback plan is gaining traction. We are seeing more applications written than in the past years. If you’re looking to expand your offerings, this would be a good product to look into.
Blue Cross Blue Shield of North Carolina
Blue Cross Blue Shield of North Carolina offers the Blue-to-Blue option. This allows clients to switch from one Blue Cross NC Medicare plan to another Blue Cross NC Medicare plan without answering any health questions. Clients favor the Blue-to-Blue option because it gives them flexibility to switch plans if their health needs change.
HealthSpring
HealthSpring, formally known as Cigna, is seeing steady movement so far this AEP. However, it is doing exceptionally well in Baltimore/overall Maryland area, so for our agents there – this is a great product to share with clients.
It is also important to remember there will be no contract between UNC and HealthSpring next year.
UnitedHealthCare
Despite some of the changes made this year, UHC is seeing good movement and written applications. It is important to note that next year, UHC will require referrals. However, nationwide, agents are saying their clients don’t seem to be struggling with the idea of referrals. So, this may not be as big a stumbling block as we thought.
In the Raleigh area, it looks like WakeMed is an issue for UHC. We are monitoring these negotiations and will get you the contract updates as they are released.
Humana
Humana sales are doing very well, especially in South Carolina. Ronnie attributes their success to their strong benefits, which they packaged in some market areas.
There has been no update on the UNC network issue. Therefore, Ronnie encourages agents to do one of two things:
- Start moving people to other plans
- Remind clients that their plan is only a one-year commitment so by choosing a plan with UNC in-network, they won’t lose them and can always switch back to their current plan if things work out next year.
- Tell them to wait it out
- If clients choose to wait it out, they may not be able to see their providers in January, but if things work out, they can get coverage during OEP.
With either option, do what is best for your clients based on your experience.
Hospital Updates
Nationwide, hospital networks are experiencing pressure from all angles. Whether that’s from Medicare cuts or too few providers to match the number of patients, they are dealing with a lot. Ronnie discussed these pressures in greater detail.
Medicare Money Cuts
CMS reports that $1.77 trillion was spent on patient care this year alone. However, over the next three years, Medicare is looking to cut hospital funding by over eight billion dollars. Hospitals rely on Medicare and Medicaid to cover the cost of treating patients who can’t pay for their care. More than 40% of hospitals say they are now in the danger zone because they anticipate an increase in the uninsured (due to marketplace changes), and they fear uncompensated care costs will be a reality.
Hospitals are looking for solutions. They are looking to provide hospital-level care where patients live, so patients can stay in their home, but will be considered inpatients. 150 health systems across the country have already secured a Medicare acute hospital care at home waiver. In Charlotte, North Carolina, 90 people per day are seen in their homes with an inpatient status. The areas already implementing this are seeing great results. For instance, they are seeing higher patient satisfaction and fewer readmissions.
Labor Shortages
Nationwide, hospitals can’t seem to employ enough staff to keep up with the demand for care. Because providers are in such high demand, hospitals are having to pay very high salaries to keep good staff, and this is starting to be a real struggle.
Hospital Network and Carrier Disputes
As of September 1st, there were 79 conflicts between insurers and providers (about half were related to Medicare Advantage). These arguments are taking place nationwide, so it’s not just a UNC and Humana dispute (as we discussed above).
Diversity your Portfolio
“Survival in this industry means we are going to have to learn to diversify more,” Ronnie said.
Whether it’s decreased loyalty to plans, reduced agent commissions, or other industry changes, agents must be offering clients more than one product. Not only will you add to your portfolio by doing so, but you will also increase your potential for extra commissions.
Ronnie stressed the importance of “building deeper relationships with clients beyond Medicare Supplement and Advantage plans”.
“When we get clients in our office, we need to be talking to them about dental plans, hospital indemnity, annuities, cancer plans, short-term plans, etc. There’s so much more we can do beyond Supplement and Advantage sales,” Ronnie said.
You can view all of our carrier products here.
Miscellaneous Information and Reminders
Oakstreet Health
Oakstreet Health intended to expand nationwide. However, they have stopped all expansions (resulting from industry uncertainties). Instead, they are transitioning to a value-based care approach at doctors’ offices. Because of this transition, sixteen offices will be closing nationwide -including two in Charlotte, NC. So you need to start transitioning your clients from Oakstreet to other offices, like Centerwell in the Charlotte market.
Medicare and You Booklets
Agents are having more success moving people off Supplements this year using the Medicare and You booklet. This booklet includes Medicare benefits, costs, rights, and protections, health and drug plans, and answers to common questions. Ronnie recommends showing clients this book so they feel more confident making a switch since they are seeing information in a Medicare-published book.
Announcement for Agents who use Nationwide Networks
UnitedHealthCare and Humana both confirmed they will not be in-network with the Mayo Clinic starting January 1, 2026. Your Medicare Advantage clients should have been made aware, but please continue to inform, support, and provide any assistance they may need.
Next Year by the Numbers
It has been finalized that Medicare beneficiaries will get a 2.8% pay raise next year. Everything else is just a proposed amount due to the government shutdown. Once the government opens back up, we will know more definite numbers for other benefits.
Ronnie did inform us that in 2026, the Part B premium is projected to be $206.50. Beneficiaries’ Income-Related Monthly Amount (IRMAA) will range from $83 to $496 per month, depending on their income.
*If you’d like more cost predictions, please refer to CMS.gov and remember that things will be finalized when the government reopens.*
Enrollment Reminder
With all the changes in the market, remember you can work with clients until December 31st if they are in a service area reduction. Ronnie gave some tips/strategies to deal with these situations:
- Communicate with these clients and let them know they are an exception and later than December 7th to enroll
- Push these clients to a later date so you can get to your other clients before December 7th
- Do not push out later than December 15th, to ensure clients get their ID card by January 1st
- Although the service area reduction enrollment will carry over into the new year, don’t push people too late, because if you do, they will enter 2026 with no drug plan
Don’t be Afraid of Technology
Medicare beneficiaries are taking advantage of technology more than ever. In fact, over the past year:
- 75% of 65+ used a healthcare app to manage their care in the past year
- 60% say they use tech tools to manage their prescription drugs
- 50% have used it to make an appointment with a doctor
- 30% used it for a health portal with a doctor
*Check out more of these stats here.*
It is trending to use technology among clients and can save you a lot of valuable time because you can use tech for call recordings, to text out scopes, complete virtual appointments, text and email out apps, and so much more!
Start using Integrity technology and save time while growing your business!
Tidewater is Here For You
Despite industry changes and whatever this season may bring, “We need to be our clients’ calm in the storm,” Ronnie said…but don’t forget that Tidewater is here for you. We know you are working nonstop for your clients, and we are for you. We are available anytime for questions and to offer support as we take on this last stretch of AEP together.
*Remember, you have access to the Agent Playbook, a great resource to have during AEP. Gain access here, if you haven’t already.*
For agent use only. This information is subject to change.
