Office Hours with Tidewater May Recap

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

Ronnie’s statement set the tone for our May Office Hours call and perfectly captured what this month’s conversation was all about: clarity, preparation, and navigating change in a rapidly shifting health insurance landscape.

As always, we covered a lot of ground – from Medicare Advantage uncertainty and shifting commission structures to Medicare Supplement trends, GLP-1 disruption, compliance updates, why diversification is no longer optional, and more. Whether you joined us live or couldn’t make it, this recap includes everything you need to catch up and guide your success this year.

Main Points Covered

The main topics covered during May’s call include:

• Medicare Advantage Updates
• Carrier and Commission Updates
• Prior Authorizations, Facility Fees, and Site-Neutral Payments
• The Bridge Program and GLP-1 Expansion
• Medicare Supplement Market
• Liberty Bankers Lead Doctor Program
• ACA Market Snapshot
• Final Rule Updates
• Diversification is No Longer Optional
• New: Integrity Health Insurance for Agents

Medicare Advantage Updates

The call opened up with some positive news as hosts announced that CMS revised its initial proposal from a 0% Medicare Advantage rate increase to a 3.48% increase, resulting in approximately $13 billion in additional payments to plans. However, Medicare Advantage remains under pressure, as rising medical costs, changes to risk adjustment, and lower quality bonuses continue to weigh on carriers.

Notably, a key insight from the call was that since 2024, Special Needs Plans (SNPs) have been the only segment of the Medicare Advantage market to see growth.

In fact:

• DSNPs, CSNPs, and institutional plans are leading the way
• Nearly 25% of all Medicare Advantage enrollees are now in SNPs
• Many carriers that previously did not offer CSNPs are planning to enter the market next year

The takeaway: Agents may need to rethink their strategy and consider engaging with and offering SNP plans as traditional MA options begin to tighten.

Carrier and Commission Updates

Carriers are continuing to navigate uncertainty and concerns about overgrowth.

Carriers specifically discussed on the call include:

Humana

Humana expanded tremendously, adding over 1 million new MA members; however, their rapid growth came with consequences. Roughly 70% of those new Humana members have no prior history with the carrier, making future loss ratios harder to predict.

Humana’s reported medical loss ratio reached 89.4%, and as a result, they have announced:

• Cuts to supplemental benefits next year
• New non-commissionable products (effective immediately in many areas)
  • Continued renewals on existing business, but no commissions on new enrollments for certain plans

HealthSpring

HealthSpring followed with similar announcements, including:

• Non-commissionable products effective June 1
• Plan suppression, requiring enrollment through the carrier platform only

Office Hours hosts reminded agents not to “fall in love with one carrier”, emphasizing that these are one-year contracts and flexibility matters now more than ever – especially amid commission cuts.

Prior Authorizations, Facility Fees, and Site-Neutral Payments

Nearly 50 health insurance companies announced some encouraging news about prior authorizations.

• There has been an 11% reduction in prior authorizations compared to 2024
• A goal of a standardized electronic submission process by 2027 is in the works

While that is good news, we are seeing concern over facility fees, particularly at hospital-owned outpatient centers. These surprise charges are confusing and frustrating for beneficiaries.

As a result, CMS is considering site-neutral payment policies, which would give patients peace of mind to know they are paying the same amount regardless of where services are performed. Until a decision is made, agents are encouraged to educate clients about these fees and encourage clients to dispute them if they encounter them.

The Bridge Program and GLP-1 Expansion

One of the hottest topics discussed on the call was the Bridge Program for GLP-1 medications.

While we’ve mentioned this program on previous Office Hours calls, we now have new updates.

Here’s what agents need to know:

• The program starts July 1 and will now run for 18 months (through the end of 2027)
• Covers Wegovy and Zepbound for Medicare beneficiaries at $50 per month
• Requires Medicare Part D (stand-alone PDP or MAPD plan)
• Does not count toward Part D deductibles or max out-of-pocket (MOOP)
• Eligibility typically begins at BMI 30, with acceptance of lower BMIs if chronic conditions are present

The program has been extended through 2027 to allow the federal government more time to study outcomes and the long-term effectiveness of GLP-1 drugs.

Outside of Medicare and the Bridge Program, the GLP-1 space continues to build momentum nationwide. Amazon launched a new weight-loss medication program through One Medical, offering competitive pricing for both insured and uninsured individuals.

Medicare Supplement Market

Despite popular belief, the Medicare Supplement market is not dying – in fact, it just had a record year.

• Nearly $40 billion in premiums were paid in 2025
• $4.7 billion in new premiums (an all-time high)
• Loss ratios climbed to 85.6% (driving significant rate increases)

Right now, we are seeing a trend of rate increases (around 30%) among some Medicare Supplement carriers like BCBS of North Carolina, UnitedHealthcare, and Aetna. For years, healthier clients were placed on Advantage plans, while less healthy individuals moved to Supplements, which often paid less than the moop on Advantage plans. Now, carriers are raising premiums to offset losses from higher-risk business.

Looking ahead, with Medicare Advantage benefits being reduced, network disruptions, and shrinking commissions, we may see a revival in Medicare Supplement plans, creating new opportunities for agents and clients.

Liberty Bankers Lead Doctor Program

Liberty Bankers has released a new underwriting tool called Lead Doctor, designed to help agents manage rising Medicare Supplement carrier rate increases more effectively and evaluate alternative client options.

Through Lead Doctor, contracted agents can submit a simple spreadsheet with basic client information (name, ZIP code, date of birth, and gender). Within one business day, Liberty will respond, indicating whether the client is likely a “diamond” (strong approval potential), “coal” (unlikely to pass underwriting), or a no-match (if additional details are needed).

Liberty Bankers’ goal is to bring in healthier, underwritten business to improve loss ratios, which ultimately helps support long-term rate stability. This opportunity is a valuable resource for agents looking to proactively help clients combat premium increases and remain competitive.

For more information, download the Liberty Bankers Lead Doctor FAQ sheet.

ACA Market Snapshot

The ACA market continues to face high loss ratios, ongoing carrier disruptions, and a growing number of people choosing to go without coverage. One major update to have on your radar: Cigna is exiting the ACA market in 11 states, impacting roughly 370,000 members. However, benefits and networks will remain unchanged for the rest of the year, creating potential opportunities during enrollment – especially in markets where Cigna has been competitive.

Staying aware of carrier exits like this allows you to help clients proactively rather than reacting later in the year.

Final Rule Updates

The CMS 2027 Final Rule has brought good news, especially surrounding compliance relief.

The ruling includes:

• No more 48-hour SOA waiting period
• SOAs allowed at educational events
• Elimination of the 12-hour buffer between educational and sales events
• Simplified call-recording (6 years total)
• TPMO disclaimers no longer required upfront
• Greater clarity around SSBCI benefits and marketing language

You can read more about the 2027 CMS Final Rule here and download the Tidewater Agent Final Rule Compliance checklist here.

*As a reminder, these changes will be implemented for 2027 plans, with operational rollout beginning this October.*

Diversificaiton Is No Longer Optional

A clear and consistent message of the call was that agents must diversify. With commissions under pressure and benefits shifting, becoming a true one-stop shop matters more than ever.

This includes offering:

• Ancillary coverage
• Life insurance
• Dental
• Annuities and wealth conversations

Additional Opportunites

The Importance of Offering Necessary Products Training

To help you diversify with confidence, we’ll be hosting a webinar next Wednesday, May 13, at 10 AM EST. The webinar will be led by Gaylan Hendricks, Integrity’s “Queen of the Bundle,” alongside Tidewater’s own Ronnie James. During the training, hosts will cover key questions to ask clients, how to build greater wealth by offering necessary products, and the how-to aspects of cross-selling.

Save your seat for this must-attend training!

Blue Cross Blue Shield of North Carolina to Host Tidewater Agent Training

BCBS of North Carolina will be hosting an in-person event on May 14, and we’d love to see our North Carolina agents there. This is an event for Tidewater agents only, offering a unique opportunity for one-on-one time with the carrier.

Details: May 14 | 10 AM -12 PM EST | Marriott Crabtree, Raleigh, NC

Register today for the BCBSNC Tidewater agent in-person training!

Physicians Mutual

Physician Mutual is rolling out a new term and whole life combination product beginning May 11 in most states (note this will not be available in NC at launch). This product includes a cash-value whole life component. Agents must have anti-money laundering (AML) training completed in their state to offer it. For details, product availability, and contracting information, visit our Physicians Mutual carrier page.

Aetna Dental Plan

Implants are not typically covered in most dental plans. However, Aetna Senior Supplemental stands out by offering two dental plan options that include implant coverage, with up to $2,000 in lifetime benefits. Additionally, these plans offer up to $500 per year for teeth whitening, making them a strong option for those seeking more benefits. To learn more, be sure to visit our Aetna Dental page and download this guide to compare plans and benefits.

New: Integrity Health Insurance for Agents

Integrity has officially launched a new group health insurance option designed specifically for contracted Tidewater agents.

This coverage allows agents to:

• Access competitive group health coverage
• Enroll any time during the year
• Explore options directly through IntegrityCONNECT under My Benefits

We are proud to be an Integrity FMO offering this benefit, and we see this as a way to support agents financially and professionally. For agency owners, this also opens the door to offering group health coverage as a benefit to your downline – adding even more value to your organization!

Summary and Moving Forward

This month’s Office Hours call reinforced the idea that although the market is changing, agents who stay informed, adaptable, and diversified will thrive.

Preparation truly does shape expectations, and our goal at Tidewater always remains the same: ensuring you’re equipped, confident, and ready to serve the Medicare community, no matter what changes come.

Be sure to reach out to us with any questions or help navigating the ins and outs of the industry – we are here to support you!

We look forward to seeing you on our next Office Hours call in June.