Office Hours with Tidewater June Recap

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

Ronnie’s quote from June’s Office Hours served as a reminder that success in our industry isn’t built on occasional bursts of motivation…it’s built on consistent habits, ongoing education, and a commitment to serving clients well.

As we move closer to the Annual Enrollment Period (AEP), agents who are preparing now will be better positioned to navigate industry changes, support their clients, and finish the year strong.

June is officially here, and with it comes the unofficial kickoff to AEP preparation season. During this month’s call, Ronnie James covered a wide range of industry developments impacting Medicare, ACA, and the broader health insurance market.

From Medicare Supplement trends and Medicare Advantage updates to ACA enrollment changes and growing scrutiny of the agent community, this month’s call focused on helping agents stay informed, prepared, and ready to serve clients throughout the remainder of the year and into 2027.

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

Main Points Covered

The main topics covered during May’s call include:

• AEP Preperation Starts Now
• Prescription Drug Costs
• Client Coverage While Traveling
• Healthcare Costs and Hospital Tranparency
• Understanding Medicare Fee Schedules
• Medicare Supplement Market Facing Change
• Medicare Advantage Market Updates
• ACA Market Challenges Continue
• Certification Season Is Here

AEP Preperation Starts Now

Ronnie opened the call with a reminder that success during AEP doesn’t begin in October – it starts with preparation months in advance.

One key takeaway was the importance of developing habits of continuous learning and staying on top of industry changes. Agents who consistently invest time in education and market awareness position themselves for greater success when enrollment season arrives.

What you can do now:

• Review certificaiton information
  • See additional information below
• Reach out to the Tidewater team for support
• Be sure to join July Office Hours
  • Registration will come later this month

Prescription Drug Costs Continue to Shape the Market

Prescription drugs are one of the largest healthcare expenses facing Medicare beneficiaries.

Some notable statistics shared during the call include:

• The average Medicare beneficiary fills approximately 55 prescriptions a year
• Average annual prescription costs exceed $5,000
• With the current Part D out-of-pocket cap, insurance carriers are absorbing a significant portion of overall medication expenses

GoodRx Expands Beyond Discounts

Ronnie encouraged agents to be aware of GoodRx’s new healthcare subscription offering, GoodRx Companion, which provides access to prescription discounts, telehealth services, and diagnostic care.

While it’s not considered “credible coverage,” the program may serve as a temporary solution for some ACA consumers or those between coverage options.

*Reminder: Although GoodRx discounts can lower immediate medication costs, purchases made through GoodRx do not count toward a Medicare beneficiary’s annual Part D out-of-pocket cap.*

Client Coverage While Traveling

As summer travel ramps up, Rommie highlighted an often-overlooked topic: Medicare Coverage while cruising.

A few key rules to remember:

• Original Medicare generally does not cover healthcare services when a cruise ship is more than six hours from a United States port.
• Medicare Supplement plans and many Medicare Advantage plans may provide emergency travel benefits.
• In many cases, beneficiaries may have to pay upfront and seek reimbursement later.

The summer months present a great opportunity for agents to discuss travel-related healthcare protection with clients…reach out to your clients today, before their vacation!

Healthcare Costs and Hospital Transparency

Healthcare affordability continues to dominate industry discussions.

Ronnie shared ongoing concerns surrounding:

• Hopstial consolidation
• Rising provider costs
• Price tansparency intitiatives
• Legislative efforts to increase visbility into healthcare pricing

According to recent discussions, hospitals have accounted for a significant portion of healthcare spending growth in recent years, leading lawmakers to increase pressure for transparency reforms.

Agents can expect these conversations to become more prominent as election season approaches and healthcare affordability remains a national issue.

Understanding Medicare Fee Schedules

One practical resource highlighted during the call was the Medicare fee schedule available through CMS.

Agents can access Medicare-approved reimbursement amounts for procedures and services, allowing them to better understand:

• Provider reimbursment levels
• Medicare-approved charges
• Consumer cost expectations

This can be valuable when helping clients understand bills, procedure costs, and coverage expectations.

Medicare Supplement Market Facing Change

Arguably, one of the most important discussions from Office Hours centered around developments in the Medicare Supplement market.

Birthday Rule Expansion

West Virginia officially became a Birthday Rule state on June 1.

The Birthday Rule allows eligible beneficiaries to switch Medicare Supplement carriers during a specified period around their birthday without medical underwriting.

While beneficial for some, Ronnie noted concerns that expanded guaranteed issue opportunities may lead to higher premiums, reduced carrier participation, lower agent commissions, and increased market instability.

Closed Block Business Continues to Grow

A major trend impacting Medicare Supplement pricing is the growth of closed blocks of business.

According to industry data shared during the call:

• Closed-block Medicare Supplement business now represents approximately $11.3 billion in earned premium
• Roughly 3.7 million beneficiaries are enrolled in closed blocks
• Nearly 28% of the Medicare Supplement market falls into this category

As healthier members leave closed blocks for newer plans, carriers are often left with higher-risk populations, creating additional rate pressure.

Agents were encouraged to stay proactive in reviewing clients’ Medicare Supplement options and identifying opportunities if needed.

Will Medicare Supplements Remain Long-Term?

A question from attendees sparked discussion about the future of Medicare Supplements.

Ronnie’s outlook was clear: Medicare Supplements are not going away.

However, the market may evolve through:

• High Deductible G plans
• Hybrid coverage approaches
• Ancillary products paired with Medicare Supplements
• Potential future policy changes

There’s no need to worry – the overall demand for comprehensive healthcare protection remains very strong.

Medicare Advantage Market Updates

Reinsurance Spending

One interesting trend involves insurance carriers purchasing more reinsurance protection.

Several major carriers increased reinsurance spending in 2025 in response to concerns about claims costs, market uncertainty, and future profitability.

While the market remains challenging, Ronnie expressed that the industry will eventually stabilize.

Scope of Appointment Clarifications

CMS recently clarified several Scope of Appointment (SOA) requirements.

Electronic Signatures are Still Acceptable

“In writing” does not require a physical “wet” signature.

Virtual First Appointments Remain Valid

If the initial appointment occurs by phone or video, the recorded SOA can remain valid for future meetings.

Generic SOAs may Offer Greater Flexibility

Agents using broader SOA forms may avoid the need to collect additional documentation later when discussing other Medicare-related products.

2027 Medicare Advantage Commissions Announced

CMS announced the maximum allowable 2027 agent compensation levels.

For most states:

• Initial enrollment: $725
• Renewal compensation: $363
• PDP initial compensation: $130
• PDP renewal compensation: $65

If you are an agent in Connecticut, Pennsylvania, the District of Columbia, California, New Jersey, Puerto Rico, or the U.S. Virgin Islands, please refer here for your specific amounts.

Ronnie cautioned agents that carriers are not required to pay the maximum CMS-approved compensation amount, so be aware of this.

*This could be an important topic in the coming months as carriers finalize 2027 plans and rollout meetings later this year.*

Medicare Advantage Under Increased Scrutiny

One of the most passionate portions of the call (from both Ronnie and attendees) centered around a recently published article examining Medicare Advantage broker compensation.

The article questioned whether broker commissions align with beneficiary interests and highlighted growing attention on agent compensation structures.

Ronnie strongly defended the value agents provide, emphasizing:

• Ongoing client service
• Claims assistance
• Coverage education
• Enrollment guidance
• Long-term relationships

His message was clear, and attendees couldn’t agree more:

“Agents are the backbone of this industry. We take care of people, and we leave people better than we found them. We proved during COVID we were essential to our clients.”

– Ronnie James

ACA Market Challenges Continue

The ACA market continues to face enrollment pressure.

Topics discussed during the call included:

• Falling enrollment projections
• Rising consumer premiums
• Higher deductibles
• Increased non-renewals
• Lower participation among younger adults

North Carolina, in particular, is one of the states experiencing enrollment declines.

For agents working in both Medicare and under-65 markets, these changes may create opportunities to discuss alternative coverage options with eligible consumers.

Certification Season is Here

Several important certification dates were announced.

UnitedHealthcare Fast Track: Available now for eligible agents: eligible agents will see “2027 Fast Track” as an option in the Learning Lab

AHIP: Opens June 22

NABIP: Opens June 22

Aetna Certifications: Expected June 23

Humana Certifications: Expected July 2

Devoted Health: Expected July 23

Agents are encouraged to complete certifications early to reduce stress and maximize readiness heading into AEP. We will update carrier certification dates as they become available.

Summary and Moving Forward

June office hours reinforced an important theme: the insurance industry continues to evolve rapidly, and agents who stay informed will be best positioned to succeed.

Whether it’s understanding Medicare Supplement changes, preparing for AEP certifications, navigating Medicare Advantage shifts, or helping clients manage rising healthcare costs, education remains crucial.

We look forward to seeing you on our next Office Hours call in July, where we’ll continue learning and growing together!