AEP brings new opportunities and new challenges to the Medicare landscape. As always, we’re here to help you adapt with confidence, minimize client concerns, and stay ahead of the curve.
The Inflation Reduction Act (IRA) was passed in 2022 to benefit vulnerable populations, including your Medicare clients, and its impacts are being felt across the industry. From eliminating the “donut hole” coverage gap to redesigning Part D plans and beyond, these changes are reshaping how agents support their clients.
In this read, we’ll break down what these updates mean for you and how you can continue to serve your clients with clarity and care in this ever-changing market during the rest of this AEP season and the years to come.
2025 Changes
As a result of the IRA, 2025 introduced updates to Part D drug coverage, and these will continue to shape how beneficiaries pay for their prescription drugs in 2026 and beyond. Here’s what’s new so far:
- Donut Hole Coverage Gap Eliminated
- Beneficiaries now have an annual out-of-pocket maximum of $2,000
- Members can spread their out-of-pocket costs evenly throughout the year
- Part D Redesign and Reinsurance Changes
- Part D plans now pay 65% of applicable drugs and 75% of all other covered drugs during the inital coverage phase
- Part D plans cover 60% of costs (up just 20% from before 2025) in the catastrophic phase – reducing costs for both beneficiaries and the federal government
- Manufacturer Discount Program Adjustments
- Under the updated Manufacturer Discount Program, manufacturers must offer a 10% discount on brand-name drugs during the initial coverage phase and 20% during the catastrophic phase
You can read more about the changes already in effect by referring to the Agent IRA Medicare Impact Flyer inside the Tidewater VIP Portal Resource Hub.
*Remember, as a TMG partner, you have access to the TMG Quoting Tool, which allows you to search and save prescription drug and pharmacy data. This would be a good resource for you with these changes as well.*
Furthermore, the IRA’s changes have already started affecting carriers and plans. Some are cutting back on plans to manage operating costs, while others are leaving low-performing market areas completely. Click here to read more about carrier impacts.
Preparing to Move Forward
Adapting to these industry changes requires intentional strategies to help you continue serving your clients effectively. Here are a few ideas to help you get started:
- Leverage your Personal Agent Website (PlanEnroll)
- Offer prospects the value of a PlanEnroll profile
- Help your clients keep their data updated
- Use LeadCENTER to Plan Your Lead Generation Strategy
- Choose from many lead types and target audiences
- Create your own campaigns
- Maximize your Staff’s Strengths
- Admindistrative staff can run retention campaigns to do prework, recover “lost leads”, or work with current leads to obtain Permission to Contact
- Schedule a Combination of In-Person and Virtual Meetings
- Increases your capacity while allowing clients to choose thier preferred format
These are just a few ways to position yourself for success in the ever-changing Medicare landscape. You can head over to our VIP Portal to see a full list of actionable strategies designed to help you navigate IRA changes and better serve your clients this AEP and beyond.
