For agent use only. This information is subject to change.
“Despite the circumstances we’ve faced this year, we as a team, you as agents, have endured.”
Ronnie James
Regional Sales Director, Tidewater Management Group
During our December Office Hours call, Ronnie James shared confidence-boosting encouragement for agents, guidance to wrap up AEP, important carrier updates, and valuable insights as we head into 2026.
Whether you joined us live or couldn’t make it, this recap has everything you need to catch up and guide your success through the rest of AEP and the new year.
Encouragement Message
Ronnie began this month’s call with a moment of reflection.
“I have never been prouder of our collective efforts this year because it has really not been easy, but when the dust settles, and AEP is done, I think I’ve found several things to be true. We’ve adapted, adjusted, and overcome every challenge – proving once again that we are winners. Our clients need us more than ever, and as the Medicare market continues to grow, so do the opportunities for agents.”
Before you continue reading, we encourage you to pause and allow Ronnie’s words to sink in. You’ve worked very hard this season, and one thing is clear: your resilience stands out.
Main Points Covered
The main topics Ronnie covered during December’s call include:
- The Final Days of AEP & What’s Next
- Carrier Updates
- Looking Towards 2026
- Trends and Market Shifts
- Medicare Supplement Updates
- Medicare Advantage Network Requirements
- ACA Market Notes
- Life Insurance Insight
- Hospital Reimbursment Changes
The Final Days of AEP & What’s Next
AEP Ends This Sunday
Just a reminder: AEP ends this Sunday. Electronic applications must be submitted by midnight, while paper applications have until Monday. But opportunities do not end on December 7th. Starting December 8th, agents can write 5-star plans through the end of the year (which will have a January 1st effective date). Two carriers in North Carolina are offering 5-star plans this year. Agents working in another state should check local availability.
There are also continued enrollment opportunities with Chronic Special Needs Plans affected by service area reductions, AGNs (those aging into Medicare), Medicare Supplements, Hospital Indemnity plans, and cancer plans. Supplements in particular have been strong this year – and it is safe to say Medicare Supplement is still thriving.
- You may already have clients who are good candidates for Hospital Indemnity and Cancer plans. You can absolutely see business growth without searching for new clients, by offering more products to the clients you already have.
Before closing the season, take time to review all submitted applications and check for pending cases, as anything unresolved may not get issued for a 1/1 effective date.
Carrier Updates
Humana
In North Carolina, there has been no movement on the ongoing UNC Health network negotiations. Clients affected will need to decide whether to switch plans during OEP or move now.
Please Note
- For Humana CSNP or DSNP members seeking food card benefits through SSBCI, completing the HRA is required. Humana has extended the HRA deadline for applications submitted before November 28th through the end of AEP. Any applications written after that date have a 10-day window to complete them.
During last month’s call, Ronnie reminded us that you can earn an additional $35 for submitting HRAs on Medicare Advantage plans. 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
Like Humana, there are several Medicare Advantage carriers paying for Chronic Special and Dual Eligible plans. Check with us for a list of carriers at 888-622-9122 or support@tidewatermg.com.
*You can complete an HRA with Integrity Tech. If you are interested in more HRA information, we can provide extra resources.*
FAQ: HRAs for Non-Changing Clients & Food Cards
Agents are not required to complete an HRA for current clients who are making no plan changes. Carriers already have records about doctor visits and prescription data, so completing the HRA is not necessary for these members to receive food cards.
Humana specifically requires an HRA for food card eligibility if a change is made. Feel free to contact us if you need more guidance or information on HRAs or Humana plans in particular.
Blue Cross Blue Shield of NC
Blue Cross of North Carolina has suppressed enhanced HMO and PPO plans from online enrollment platforms for the remainder of AEP, including MedicareCENTER, Connecture, and SunFire. However, you can still enroll individuals through their PayBall system or via paper applications (though we do advise caution, as these can have delays due to faxing). These plans are commissionable, and you can contact our team with any PayBall questions.
Devoted
We are seeing strong performance from Devoted’s PPO plans this year. Their PPO Dental benefit operates on a reimbursement program – clients pay up front and submit a claim. Also, remind your clients that their OTC card is only accepted at CVS or through the online catalog.
Looking Towards 2026
CMS has released final numbers for 2026:
- Part B Deductible: $283
- Standard Part B Premium: @202.90
- COLA increase: 2.8%, resulting in an average of $40 monthly increase for beneficiaries
CMS has also proposed some new rules for 2026 that would be very positive adjustments for agents. These would be expected to begin on October 1, 2026. Proposals include eliminating the 48-hour SOA rule, reducing telesales recording requirements from 10 years to 6, allowing SEPs for network provider exits, removing the 12-hour wait between educational and marketing events, and allowing agents to collect SOAs at educational events. SHIP language may also no longer be required. These are just proposals, so agents must continue following current guidelines until they are finalized.
Trends and Market Shifts
Eye-injections – covered by Part B – are on the rise, driven by the increasing rates of eye conditions and new products. Advantage members will face a 20% coinsurance until they reach their max out-of-pocket (MOOP), whereas Supplement members will receive full coverage, making this an important client discussion.
The usage of GLP-1 drugs (Ozempic, Wegovy, Zepbound, etc.) is rising nationwide, but they continue to be very expensive. Pricing negotiations are expected in 2027, with some projections estimating reductions to around $274 for certain Medicare beneficiaries. Although Medicare does not cover weight loss drugs, changes would make them more affordable for clients.
Medicare Supplement Updates
A bill is in motion to phase out Medicare’s inpatient-only list over the next three years. Beginning in 2026, there are going to be 285 musculoskeletal procedures – currently inpatient only, that could shift to outpatient. While this may save Medicare money, it could lead to higher claims exposure for Supplemental carriers, potentially resulting in heavy rate increases. We are monitoring this and will inform you when we have an update.
Another Supplement update to note is the new testing model called the ACCESS model (Advancing Chronic Care with Effective, Scaleable Solutions). This model will target beneficiaries with chronic conditions and offer more digital-health-focused care solutions. This model will create opportunities for agents working with Original Medicare members, as it will only be used with those clients.
Medicare Advantage Network Requirements
CMS enforces network adequacy standards, requiring Medicare Advantage plans to contract with at least 29 provider types and 14 facility types within certain distances and travel times. Carriers must meet these standards to participate in the market, and they want to because plans were paid an estimated $494 billion last year to care for patients.
ACA Market Notes
ACA premiums have risen, and consumers will face higher costs this year. President Trump has suggested a potential alternative to the ACA that may come out by January 30th. For now, Ronnie suggests agents explore alternative products and programs (ex: short-term care plans and share ministries). Ronnie also mentioned that tax credit changes remain a possibility.
As updates come, your Tidewater team will communicate them to you.
Life Insurance Insights
If you have clients who were declined for preferred life insurance rates, especially Medicare Advantage members, it may be worthwhile to have them review their medical records for accuracy. Incorrect records can impact pricing and underwriting outcomes.
Hospital Reimbursment Changes
Medicare reimbursements for hospital outpatient and surgery centers will increase by 2.6% next year. However, home health care is expected to see decreased reimbursements.
Tidewater is Here For You
As we head into the final weekend of AEP, we hope you have a strong and successful finish. Remember, you’re never alone-reach out to us anytime with questions, support, or guidance. We’re here for you every step of the way, in every season.
For agent use only. This information is subject to change.
CMS 2026 Medicare Updates: Costs & Premiums
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