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“It’s going to be important to hit the ground running this year and separate yourself from your competition – and the best way to do that is through knowledge and education.”
Ronnie James
Regional Sales Director, Tidewater Management Group
Our final Office Hours with Ronnie James before AEP kicks off on October 15th was packed with valuable insights, updates, and tools to set you up for success this season. From key AEP information to resources available, the call was designed to help you navigate this busy time of year with confidence.
Whether you joined us live or couldn’t make it, this recap has everything you need to catch up and head into AEP fully prepared.
Main Points Covered
The main topics Ronnie covered during October’s call include:
- General Information Regarding AEP
- Carrier News and Updates
- Including North Carolina Specific Information
- Food Cards
- Government Impacts
- Including the Government Shutdown and Announcements from President Trump
- AEP Agent Resources
- Enhance your Portfolio with Annuities
General Information Regarding AEP
Medicare season is here!
It’s officially October and that means AEP begins in just a few short weeks! “Pre-AEP” season began on October 1st – meaning you can get out and market, but remember you cannot sign a plan until October 15th. So, get out there now and get ahead of the curve!
Deft Research Study:
Usually around 17% of people look to change Medicare Advantage plans every year. In fact, in 2025, just over 20% of consumers changed their plans. Deft Research conducted a study to predict what this year’s statistic would be, and the findings were quite astonishing.
This year, experts are predicting 9.8 million Medicare Advantage members to switch plans – equaling 28%!
Why is that? Some of it is due to the landscape of the industry right now…we are seeing plans pulling out of some markets, service area reductions, and negative ANOC letters prompting clients to change plans.
Carrier Materials
A lot of carriers have been slow about getting materials out. If you have not received your supplies yet, don’t be fearful, they will get to you – they may just arrive a little later than expected.
- Carriers are really wanting agents to utilize their digital platforms this year to download pdf versions of needed information because it saves them money. However, every carrier Ronnie has talked to has said materials will arrive to agents by the start of AEP on October 15th.
Hospital Indemnity
This time of year is a great opportunity to enhance your portfolio and offer Hospital Indemnity alongside Medicare Advantage plans. We are seeing inpatient hospital co-pays going up and plans expecting more from the consumer. Hospital Indemnity plans could help offset this cost and are a great way to protect clients in case of the unexpected.
Ronnie recommends agents consider GTL and Mutual of Omaha this year:
GTL is going to have a nice 4th quarter bonus on their HI plans:
- $50 per app if you write between 5-10
- $75 per add if you write between 11-25
- $100 per app if you write 26 or more
Mutual of Omaha has announced their new Hospital Indemnity product in the following states: Pennsylvania, Ohio, North Carolina, Tennessee, Alabama, Georgia, Mississippi, and Kentucky
Features of this product include: Guarantee issue, Benefits for hospital and ICU admission and confinement, and more which you can read about here, and on the Mutual of Omaha website.
Medicare Drug Price Negotiations
CMS published a list of 10 drugs that will be covered by Medicare Part D in 2026. Those drugs include: Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and NovoLog/Fiasp.
In 2027, they will 15 drugs will be covered! Drugs being considered include: Ozempic, Trelegy, Wegovy, Linzess, and Breo
*Remember, you can access TierPlus to plug in drugs and it will tell you what tier each carrier has that particular drug in, and if there was an increase from year to year*
*Scriptkeeper also works with medicare.gov to save prescription drug lists over the year*
Certification and Commission Reminders
Remember:
- If a client wants a plan with a certain carrier you did not complete a certification with, the safest thing you can do is refer them to medicare.gov because you are not authorized to offer products from that carrier.
- A lot of prescription drug plans (and even some MA plans) are non-commissionable this year. However, you do assume some responsibility and liability for writing those policies even though you’re not getting paid for them.
Carrier News and Updates
Make sure you’re knowledgeable about all the carriers and products you will be offering this AEP. Here’s some carrier news to keep you up-to-date:
Aetna
- All Medicare Advantage members will get a new extra benefits card in 2026
- Commissions have been cut on the value plans in the majority of Western North Carolina counties and several in South Carolina
- In North Carolina, Duke Medical Center will be out-of-network for 2026
- Other North Carolina carriers are also looking to be out-of-network with Duke. Alignment Health in Wake County is looking attractive for clients who want a plan that includes Duke as an in-network provider
- This refers to Duke NOT Duke LifePoint
BlueCross BlueShield of North Carolina
- Will not be paying commissions on their PDP plans for 2026
- Will be paying renewals
*Carriers in NC paying commissions on PDP plans include HealthSpring and Humana*
HealthSpring
Formally known as Cigna
- The ANOC did not mention dental – but there will be dental plans available
- Remember, if the ANOC doesn’t list a plan that means the plan did not change, not that they are not offering it
- Will be paying HRA on all their plans
- Make sure you complete HRA’s because you can gain lots of bonus money and potentially lose money if you did not complete them
- Bonuses earned from HRA’s could offset losses from PDP plan commissions
- In North Carolina, UNC Health will be out-of-network for 2026
- Other North Carolina carriers like Humana and WellCare are also looking to be out-of-network, but have not announced a decision yet because they are trying to work it out
Humana
- Some plans in some states will not be paying commissions
- You can visit each carriers website to see exactly which plans will be paying commissions
- Will be paying call center agents less than they do field agents for their sales
- Visit the Humana website for more information on this
UnitedHealthcare
- All members will get new ID cards this year, printed in red
- Requires referrals on their HMO plans
- Referrals are the responsibility of your clients (they need to schedule an appointment with their primary care doctor and that is who will refer them)
- The referral is only good for 6 months, so the client may have to go back to their primary care doctor more than once this year
- Clients have a grace period to obtain referrals – until May 1st
- Remind your clients to get these appointments made now so they are not turned away from an HMO plan just because they missed getting seen before the grace period
Food Cards
The federal government has mandated 23 medical conditions under the SSBCI benefit enabling an individual to receive a food card.
From that list, each carrier could select 20 conditions they would cover, but they can add more if they choose. For example, Aetna has a total of 26 qualifying conditions, which you can view here.
Once a client qualifies for one or more of the SSBCI conditions, they will fill out a form provided by their carrier to receive their food card. This is an example of Alignment Health’s paperwork.
If clients do not have one of the qualifying conditions on their chosen carriers list, they cannot get a food card. However, many carrier have split the OTC benefit from the food cards so a client without qualifying chronic conditions can still receive OTC benefits.
*Remind your clients not to use food cards for utilities, rent, or OTC benefits because it could be calculated as income, and their Medicare costs could increase as a result.*
Government Impacts
The government shutdown is not going to affect what we do on the Medicare side of things:
- Medicare Advantage and Annual Enrollment Periods are not changing
- Clients will still get Social Security checks
*The amount of time it takes for someone to get their Medicare card could take longer.*
The ACA market is going to be more affected by the shutdown. In fact, Healthcare.gov is starting a webinar series to discuss the changes for 2026 in the marketplace. Currently, the Kaiser Family Foundation is expecting a change in out of pocket premiums – to rise as much as 114% in 2026. This comes as a result of tax credits being lost and an average of 18% premium increases by the carriers. The government shutdown is partially due to this argument over the premium tax credits. Stay tuned for more information regarding the shutdown impacts, and remember ACA enrollments open on healthcare.gov on November 1st.
President Trump announced a deal with Pfizer:
Trumprx.gov will be released in early 2026:
- This will be a website Pfizer has agreed to sell name brand drugs directly to consumers at discounted prices, or what’s known as “favored nation prices”
- Drugs will still be expensive and will only really help those not using insurance
- This is primarily for those who don’t have insurance or have high deductible plans
*If your client has a Medicare Part D plan or a Marketplace plan, they may find a better deal using their insurance to buy drugs.*
AEP Agent Resources
IntegrityCONNECT is here!
IntegrityCONNECT is your all-in-one solution, linking you to everything that matters and empowers you to work smarter, not harder. This is a revised version of MedicareCENTER that has been updated to elevate your success even more in 2026.
This platform makes it easier for you to obtain scopes, send out summary of benefits, do side-by-side comparisons, and SO much more. Think of it as your point of entry for everything that you’re contracted through with Integrity.
Click here to login to this game changing platform!
Click here for more information.
TMG LinkTree
As a Tidewater partner, you have an abundant amount of resources…our Linktree makes it easy for you to access each of those at just one click!
Join our Linktree today for quicker and easier access to your resources.
*If you’re interested in making it even easier to access our Linktree, give us a call and we can walk you through adding it as an app on your smartphone.*
“What’s Covered”
If you’ve ever wondered what Original Medicare covers, the CMS tool, called the “What’s Covered” app is for you. Simply plug in the name of the item or service you’re curious about and the app tells you if Original Medicare covers it.
Enhance your Portfolio with Annuities
This year, we are expecting to see a lot more demanding clients than we’ve seen in the past. This is largely due to the fact that we are in the middle of a Peak65 year – we are seeing more people retiring than ever before. Many of these retirees may have 401(k)s or CD’s sitting in the bank they either haven’t touched or want to put someplace safe. As agents, it is your role to take care of clients and value the security of their money. A great way to do so for retiree’s is to offer annuities. Annuities are a great way to protect your clients future and help them feel more secure.
You can start offering Annuities with confidence thanks to Tidewater’s Life and Annuity Resource Center (LARC). This is your all-in-one platform for everything life and annuities. Another great opportunity to learn more about annuities is taking place on October 8th – Tidewater and Broker’s International will be hosting a webinar to discuss a new referral program that is being offered to agents.
Make sure you join us on October 8th if you want to learn more about these products. Stay tuned for an email regarding registration.
*Ronnie discussed Peak 65 on previous calls, refer to our other blog recaps for more on this topic*
Tidewater is Here For You
“The knowledgeable agent is going to be the one who comes out on top this year,” Ronnie said.
Contact us anytime with any questions we head into AEP. The Tidewater team is here to make sure you’re knowledgeable and prepared to take on this season with confidence. Our support is available 24/7 and we assure you, you are not walking through this season alone.
*The Agent Playbook is a great tool to access before AEP begins, and will be a great resource for you during AEP. Make sure you gain access now, so you have it when you need it most.*
For agent use only.
