For agent use only.
“We’re headed for some turbulent waters during this annual enrollment period, but my confidence is still strong in this industry. I believe the market is still going to be there for agents.”
-Ronnie James
September’s Office Hours call was very special…It marked one of the final opportunities for agents to hear directly from Ronnie and get answers to their pressing questions before the upcoming Annual Enrollment Period (AEP).
Our call was packed with valuable insights, essential updates, and clarifications on critical topics to help you feel confident and prepared for the season ahead. Whether you joined us live or couldn’t make it, we’ve got you covered.
Today, we’re breaking down the most important topics Ronnie covered and information that will help prepare you for AEP. Keep reading to stay informed and ahead.
Main Points Covered
The main topics Ronnie covered during August’s call include:
- Preparing for AEP
- CMS Enhancements
- J.D. Power and Associates Medicare Advantage Study Findings
- Industry Updates
- UnitedHealthcare Commissions
- Consulting Fee Federal Regulation
Preparing for AEP
Here’s some important reminders as we approach the Annual Enrollment Period…
- The Integrity Agent Playbook is NOW AVAILABLE
- This is a free resource that is going to help you tremendously during the enrollment period
- Expect to find Medicare Supplement information, SEP commission charts, Ancillary product insights and so much more
- Get your playbook today!
- Complete certifications NOW
- The sooner you get certifications completed, the better
- Remember, you cannot order supplies from carriers until those certifications have been completed
- Most carriers have opened portals to order supplies
- Order immediately when available, so you have them when you need them
- Remind clients of their unused OTC benefits when meeting with them for AEP (they can use these benefits for the remainder of the year)
- Star Ratings will be announced October 1st
- Any plan that achieves a 4-star rating or better will receive a 5% bonus for being a high-quality plan from CMS (potentially giving you an agent bonus as well)
CMS Enhancements
On August 26th, CMS announced three enhancements to Medicare.gov and Medicare Plan Finder.
The enhancements include:
- Medicare Plan Finder will include a Medicare Advantage provider directory on the platform
- The consumer won’t have to toggle back and forth between multiple websites to find doctors who fit their plan
- Supplemental benefits displays will get a major upgrade
- More of the DVH and OTC benefits will be shown on the website
- CMS will launch a Personalized Drug Search Feature in the Fall of 2025
- Authenticated users will be able to find the lowest cost pharmacies in their area for specific medications quicker and easier
J.D. Power and Associates Medicare Advantage Study Findings
J.D. Power and Associates performed a study to examine the experiences of Medicare Advantage members across 10 states (including North Carolina).
The study overall found that member satisfaction with MA plans is based on many factors, including, level of trust, saving time and money, product coverage meeting needs, and more.
More specifically, the research concluded that:
- Members lack of trust in their MA plan has led to dropped satisfaction
- New members are dissatisfied with their plans
- Digital channels can help with satisfaction
To read more about this study, you can visit this website.
Industry Updates
North Carolina Specific Updates Regarding State Retiree’s
State Retiree’s are now getting information in the mail for 2026 plan options. Some of these mailers do not include all the plan options that consumers could choose from. That’s why it’s important for you to get to clients NOW, and help them determine what their best fit is.
Remember, the enrollment period for state retirees that are Medicare eligible is October 13th-31st. These retirees can either choose the Humana group Medicare Advantage plan or the Aetna 70-30 traditional plan. If they choose the Aetna traditional plan, you can enroll them in an additional individual Medicare Advantage plan up until December 7th. Stay tuned for a webinar hosted by Ronnie discussing this further.
This year, enrollment will be passive. This means a retiree will keep the same plan unless they request a change.
- EX: If a customer already had the Aetna 70-30 plan, they will keep that same plan this year unless they call to opt out and make a change.
Additionally, there is a new website for state retirees to find information. It is now SHPNC.gov.
Elevance Health is Exiting the Part D Market
The news of Elevance Health exiting the Part D market was big news. Elevance alone had 400,000 standalone Part D members, which made them the sixth largest provider in the nation for standalone Part D plans.
In 2025, they were 1 of only 7 companies that offered standalone drug plans. Now, we have reduced to six carriers nationwide that are offering Part D standalone plans.
“This news means that the pool of competition is shrinking, which is never good news for agents or consumers” – Ronnie
Medicare Advantage Plans seem to be Shunning PPO Plans in 2026
More and more carriers are resisting PPO’s. In fact, UnitedHealth Care, Aetna, and HealthSpring announced that their PPO plans are non-commissionable. However, not all carriers are against them – Devoted and Aetna are committed to their plan this year. Ronnie says the reason for opposition is because it costs more to run a PPO, and the easiest way for carriers to save the money is to place restrictions on them to discourage contracts.
Mid-Year Commission Cuts are Predicted
Experts are predicting to see more mid-year commission cuts in 2026 because carriers are concerned they will have more expenses (health expenses) with customers who joined plans mid-year. Last year, carriers tried to discourage agents from writing mid-year by taking away electronic applications, only offering paper applications and even stopped paying commissions.
This is your reminder to get out NOW and LOCK everything down during AEP and OEP so you don’t have to look into mid-year contracts unless clients are aging into Medicare.
UnitedHealthcare Commissions
We’re seeing big changes with United this year. UHC is reducing compensation and renewals, and it’s going to affect agent pocketbooks.
In 2026, UHC will not pay commissions on PDP plans and ISNPs.
Based on commissions charts, UHC does not really want PPO’s written either, as they are also reducing agent commissions there. So, if you move a PPO customer from another carrier to UHC this year, you will take a reduction.
Renewal commissions are being cut down as well. Whether customers had a United plan last year and plan to renew for next year or maybe were on another carriers plan and decided to move to UHC (from one MA to another for example), agents will receive a reduced commission.
United is NOT changing initial enrollment commission. If you have a client brand new to MA, HMO, or SNP plans, you’re going to get full CMS compensation.
If you’re writing UHC Medicare Supplements:
The UHICA plan will pay a flat commission of $100 on the first year and $50 on renewals. *(this has decreased form previous years)*
If writing the UHIC plan, commission looks good and of fair value.
*As a contracted agent, you should have gotten an email to sign the amendment on UHC commissions. If you are going to offer UHC products this year, you had no choice than to sign.*
Consulting Fee Federal Regulation
Federal regulations has clarified that insurers’ beneficiaries are not charged marketing consulting fees when considering an enrollment to Medicare Part D plans. So, agents cannot charge a consulting fee when writing Part D plans where they do not receive carrier commission. If agents do charge beneficiaries directly for the consulting of their Part D plans (including MADP and Part D), they will face risk of regulatory enforcement and contract termination.
*Every carrier should have if they are offering commissions and on what plans on their website. If you need help finding this, contact us at Tidewater.*
Tidewater is Here For You
We’ll be hosting one more Office Hours call with Ronnie James before AEP kicks off at the beginning of October – stay tuned for the date and registration link.
In the meantime, don’t hesitate to reach out with any questions about what was covered during September’s call, or anything that comes up as you get ready for the Annual Enrollment Period. We’re here to support you and help you succeed in the ever-evolving industry.
For agent use only.
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