Office Hours with Tidewater April Recap

For agent use only. This information is subject to change.

This statement captures the theme of this month’s Office Hours call. As the healthcare and Medicare landscape continues to shift, agents are navigating a mix of challenges and opportunities – from landscape changes and rising costs to network disruptions and evolving carrier strategies. While the industry can feel uncertain at times, one thing remains: Tidewater agents stay informed, pivot when needed, and continue delivering value to their clients.

Whether you joined us live or couldn’t make it, this recap has everything you need to catch up and guide your success this year.

Main Points Covered

The main topics covered during April’s call include:

• Healthcare Costs Under Pressure
• Medicare Advantage Updates
• Original Medicare Update
• Medicare Supplement Market
• Additional Product Updates
• IntegrityCONNECT Enhancements
• Pilot Program Information

Healthcare Costs Under Pressure

Right now, there are growing legislative efforts to cap what hospitals can charge for services. Lawmakers are increasingly focused on controlling rising healthcare costs, and they believe this would reduce the financial burden many clients experience with out-of-pocket costs.

At the same time, hopsitals are pushing back and the numbers expalin why:

• Commercial insurance plans pay hospitals roughly 2.5 times what Medicare would pay for the same inpatient and outpatient services (as of 2022)
• Some outpatient services see up to 290% markup with commercial plans versus Medicare
• Physician payments range from 124% to 163% of what they would make with Medicare

*This is driving many of the tensions we see across the industry, from network disruptions to doctors limiting Medicare patients.*

Medicare Advantage Updates

Medicare Advantage Oversight

There is now more oversight on Medicare Advantage (MA) than ever before, and it’s creating a lot of additional effects:

• Medicare Advantage is projected to cost 14% more than Original Medicare in 2026
  • This is an improvement from 20% last year, but still is high
• The government is spending an estimated $76 billion more annually on MA plans than on Original Medicare

Increased Network Disruptions

Contract disputes between carriers and hospital networks are becoming more public and more frequent. In fact:

• 82 disputes were reported in the news in one quarter (up 50 from the previous year)
• Hospitals and insurers are both under financial strain
  • Hospitals spent $43 billion last year to collect payments from insurers (including 18 billion to overturn denials)
  • Insurance companies want proof of why denial costs are necessary

Network impacts include:

• As of April 15th, Spartanburg Regional Hospital and Aetna will no longer be in network
• ECU providers and UnitedHealthcare are having major network problems
  • These clients may be forced to change doctors or plans mid-year
  • 5-Star Plans and Chronic Special Needs Plans are good options for those affected
• Humana and UNC are still having issues and have not yet come to a decision

A Bright Spot: Alignment & Novant

There is some good news – especially for agents in North Carolina.

Alignment Healthcare and Novant have aligned networks!

This creates strong opportunities in the following counties:

• Guilford
• Forsyth
• Davidson
• Davie
• Wilkes

Remember, Alignment is a 5-star plan (allowing year-round MA enrollment), and it is gaining traction following the agreement. If you’re an agent in these markets, this is a major growth opportunity with a strong network and competitive product.

Rules & Potential Future Changes

Hosts on our call discussed the impacts and potential changes of the proposed CMS 2027 Medicare Advantage and Part D Final Rule. Now that the final rule has been announced, we will dive into these impacts during May’s call. Please refer to CMS for final rule information, and feel free to reach out to us with questions.

Devoted Helathcare

Devoted recently decided to eliminate commissions in Arizona for the remainder of the year. With another carrier exiting the market, Devoted is doing so to limit rapid enrollment and protect service quality and star ratings. They are not cutting renewals, so keep that in mind.

At the same time, Devoted is expanding into 8 new states! They are planning to move into Connecticut, Michigan, New York, New Jersey, New Hampshire, Nevada, Maine, and Wisconsin. They are also looking into more states. Devoted is one of the largest Medicare Advantage providers in the nation, and if you don’t currently have a contract, we would love the opportunity to help you add Devoted to your portfolio.

Original Medicare Update

A bipartisan bill has been introduced to cap physician reimbursement cuts under Medicare.

Currently:

• Physicians are facing 2.5% reimursement cuts
• No increase expected for primary care next year
• No cap currently exists on how large cuts can be

Why this matters:

• Doctors may stop accepting Medicare assignment
• Doctors may begin charging up to 15% above Medicare-approved amounts

The concern is for agents writing Medicare Supplement Plan N. Plan N does not cover Part B excess charges, and if more doctors stop accepting assignment, clients could face unexpected costs. For agents offering Plan N, you must be adamant about clearly explaining excess charge exposure.

Medicare Supplement Market

Medico/Wellabe Udpate

Medico/Wellabe’s Medicare Supplement has seen strong growth. They have, however, announced that to help keep the rate increases from being too large on their Medicare Supplements, they are going to give agents a 2% rate reduction starting May 1.

*Affecting new business, not renewals. The 2% will come from your compensation rate (based on your contract) on new business.*

INA Udpate

INA continues to be an impressive Medicare Supplement producer. With INA, remember that the consumer has 180 days to get a Medicare Supplement plan without underwriting, and that does not always fall within 6 months. Applications outside 180 days may require underwriting.

Blue Cross Blue Shield of North Carolina Udpate

Blue Cross Blue Shield of NC has released their 2026 Medicare Supplement rate increases. We are seeing rate increases up to 35% on some plans, and there are higher rate increases for those aged 65-70. Although this is causing significant client disruption, it creates marketing opportunities for agents to share different plan options with clients.

*Remember, the DOI has to approve the rate increases for each state.*

Med Supp Sales Opportunities & Incentives

Humana Bonus

• $150 per underwritten application
• Minimum of 3 applications
• Available in NC and surrounding states

View Humana Bonus details here!

BCBS South Carolina

• Guaranteed issue Medicare Supplements with no underwriting available this month
  • If someone in SC has a Med Supp plan, they can move over to BCBS SC (with the same plan letter), and no underwriting is required

Indiana

• Indiana is now a birthday rule state, which means there could be a new opportunity to write Medicare Supplements in that state.

Additional Product Udpates

UNL introduced a brand new Final Expense product that is available in almost every state and adds another option for portfolio diversification. UNL also offers a guaranteed issue Hospital Indemnity plan, which is another great solution for many clients.

Liberty Bankers introduced a fairly new Hospital Indemnity plan with great benefits, including: pet boarding, rider for outpatient therapy and medical devices, home modifications, medical equipment and appliances, outpatient diagnostic testing, heart attack and stroke rider, premium upon death, and more.

IntegrityCONNECT Enhancements

IntegrityCONNECT has introduced an upgrade for agents by adding automated confirmation emails when clients complete and sign applications. Agents can now submit quotes and allow clients to enroll directly for Medicare Advantage, Medicare supplements, and more. In return, agents will receive an email confirmation with the client’s name, confirmation number, and a direct link to view the submission in the dashboard. This update eliminates the need to manually check application status, making it easier to track submissions. In addition, agents who submit 10 life insurance applications through the platform by the end of April can earn a $1,000 bonus.

Pilot Program Information

Two pilot programs were discussed on the call that could be of interest to agents.

Pilot Program for CBD Medicare Coverage

A new pilot program is being proposed that would allow Medicare beneficiaries to access CBD through their doctors, with costs covered by insurance. Dr. Oz indicated the program could launch this month, with participation limited to states where medical marijuana is legal. Eligibility has not been finalized, but if approved, this could provide millions of Medicare recipients with access to these physician-recommended products at no cost, marking a potential breakthrough in Medicare coverage.

The Balance Model

A second program, known as the Balance Model (Better Approaches to Lifestyle and Nutrition for Comprehensive Health), is designed to expand Medicare coverage for GLP-1 medications – something Medicare does not currently cover for weight loss. The program includes a temporary Bridge phase beginning in mid-2026, allowing eligible beneficiaries limited access to certain GLP-1 drugs at a flat monthly cost, followed by a full implementation of the Balance Model in 2027 if enough Medicare Part D plans participate. If approved, this program could improve access to GLP-1 therapies for those with qualifying medical conditions, while giving Medicare time to evaluate long-term health and cost outcomes.

Final Takeaway: The Industry Rewards Informed Agents

April’s call proved that this is a complex and evolving market, but with that comes opportunity. Agents who succeed in this industry will stay educated, communicate proactively with their support team (Tidewater!), diversify their portfolio, and adapt quickly to industry changes.

While we aim to equip you with the insights you need to stay ahead during our monthly calls, we know questions can arise – and as Ronnie said, “if we didn’t answer all your questions today, we’ll be committed to doing the research and getting back to you”, because supporting your success is at the core of everything we do.

For agent use only. This information is subject to change.