Start Planning Now for AEP 2024

BY MAGGIE STEDT C.S.A, LPRT

This coming Annual Open Enrollment Period (AEP) is promising to be one of the most challenging and crazy times. And that’s saying something after the last few we have slogged through!!! Now more than ever independent agents need to plan, budgeting, and learn as much as they can prior to the start of AEP.

There is still much uncertainty as to the support that FMO’s will be able to provide and if there will be a cost for programs and systems and for what financial support the carriers will be providing to the FMOs and the agents. There is still the need for clarity for our commissions that we will be receiving for initial sales and renewals here in California for the Medicare Advantage and the Stand-alone Part D plans.

Drug Coverage

The biggest impact this year will be for the prescription drug coverage. Under the Inflation Reduction Act of 2024 as of January 1, 2025, there will be an annual limit of $2,000 for prescription drug costs in Part D. In 2026 and beyond the annual limit will be adjusted based on inflation. It is important to note that the $2,000 does not apply to out-of-pocket costs for Medicare Part B drugs. Medicare Part B covers drugs are administered by a doctor, nurse, or other healthcare provider in an outpatient setting such as a doctor’s office.

The Centers for Medicare and Medicaid (CMS) will be providing guidelines for the establishment of the Medicare Prescription Payment Plan which provides for Part D beneficiaries to opt into a monthly payment program. The payment program will be administered by the Part D carriers. More information will be coming from the carriers once they have more guidelines from

CMS. CMS will be developing monthly calculators to help beneficiaries to estimate what their monthly costs will look like, and to determine if enrolling in the Medicare Prescription Payment Plan makes sense for them.

Under the Inflation Reduction Act a greater amount of the costs for prescription drugs has shifted to carriers. This means there is strong potential for a change in the supplement benefits offered under the Medicare Advantage plans. The Stand-Alone Part D plans will greatly impacted due to the cost shift. We expect to see changes in the premiums, plan formularies, what plans will be offered or closed to new enrollees and what plans will be available for agents to enroll their clients in and receive commission payments.

Marketing During SEP

Your first step is to figure out the budget for your fall campaign. You may or may not have marketing dollars available to you. You do have to pay for AHIP or the NABIP certifications as no reimbursement can be provided under the new CMS Marketing Rules. Calculate your mailing costs both for your book of business and if you want to wage a community campaign. If you haven’t purchased a platform like Zoom or GoToMeeting now may be the time. Plus, you will need time to learn to use the system. Look at email campaign systems to help reach more people. Make sure the program has an opt out feature for the recipients.

Client Retention

Every client that has Part D coverage (MAPD or Stand-alone Part D plans) will need to review their prescription drug coverage for 2025. Many agents may decide to opt out of assisting their Stand-alone Drug plan clients and send them off to the mercy of Medicare. gov. Many of us prefer to continue to assist our clients. One effective way to meet this challenge is to provide the means for clients to input their own drugs and information into online platforms such as Connecture so that we can then assist them with the selection of a plan. For example, in Connecture you click on your name on the upper right to access Account overview and then in the left-hand corner you can click on copy 2024 link to link to your website. You will need to reset it for 2025 business.

New for 2025

This AEP is most likely to see a greater opportunity for the enrollment into Medicare Supplement Plans on a guaranteed underwritten basis from MAPD plans due to several changes in the Medicare Advantage plans for drug copays, hospital copays, plan premiums and physician copays by 15% or more (reduced benefits or increased costs). This will trigger guarantee issue into any carrier’s Medicare Supplement plan. In addition, if the carrier offers both MAPD and Medicare Supplement plans, and the MAPD plan reduced any of its benefits or increased the amount of cost sharing or premium then the beneficiary may change to their carrier’s Medicare Supplement Plans (under the company’s GI guidelines) without any underwriting.

AEP and You

Make sure to review Medicare Supplement Guaranteed Acceptance Guides for each carrier that you represent. These Guides provide information as to which situation applies, what plans may be offered, what documentation is required with the carrier’s application and the time frame for application submission. Each carrier’s Broker Services or local Broker Representative will be happy to assist you. In a later article this year we will take a deeper dive into Medicare Supplement Guidelines.

Complete your certifications and plan reviews as quickly as possible so you are ready to sell and can plan more effectively for your AEP activities. You need to understand the plan offerings and formularies to be able to confidently assist your clients in finding the plan that

best fits their needs. There may be some delays in the Carrier meetings schedules as many are refiling their plans due to the change in CMS’ calculation of the star ratings.

Start planning your community outreach initiatives. Doctors, community groups, senior centers and so on need to know about the major changes coming. Lunch and learns are a great offering for physicians’ offices. You may want to think about offering carrier specific zoom sales meetings or community meetings. I like to mix clients and prospects and encourage clients to bring their friends. Start thinking outside the box! Make sure to do everything with CMS compliance guidelines. Make sure you are using CMS approved scripts, presentations, and other materials. Your FMO is a great resource for these! Securing Scopes of Appointments and recording calls requirements continuing into this AEP.

With planning, training and realistic expectations you can have a successful AEP this fall. Take care of yourself and don’t overdo! You got this!

MAGGIE STEDT C.S.A, LPRT, is an independent contractor/licensed agent and consultant. She is a certified senior advisor and lifetime member of NAHU’s Leading Producers Roundtable at the Soaring Eagle Level. She has over 40 years of experience in essential areas of the insurance industry including sales and sales management, product development and product management. A dedicated leader, Maggie currently serves on the NAHU Medicare Advisory Committee. Founder of the annual Senior Medicare Summit, attendance grew from 200 in 2010 to close to 1,000 attendees in 2022. She served as past president of CAHIP; NAHU Region 8 Membership Chair 2014 – 2018 and past president of OCAHU, serving two terms.

maggiestedt@gmail.com