For agent use only. This information is subject to change.
The moment you quit, you prove the pain was stronger than your purpose.
Ronnie James
Regional Sales Director, Tidewater Management Group
As we head into the stretch before AEP, Ronnie James reminded agents of a motivating truth on September’s Office Hours call: this business isn’t always easy, but the impact you make for your clients makes the hard work worthwhile.
With major industry changes, carrier updates, and new compliance requirements on hte horizon, preparation will be key to navigating a successful enrollment season.
Whether you joined us live or couldn’t make it, this recap includes everything you need to catch up and guide your success.
*As a Tidewater partner, you can also watch the Office Hours Call here.*
Main Points Covered
The main topics covered during August’s call include:
- Get Your Certifications Completed Now
- Don’t Overlook Supplemental Opportunities
- SSBCI Changes Require More Attention This Year
- Watch for ANOCs, Non-Renewals, and Service Area Reductions
- Give Part D Plans The Attention They Deserve
- Be Cautious with PPO Conversations
- New Medicare Advantage Enrollment Caps
- Important Carrier Updates
- Home Health Care Plans Continue to Gain Momentum
- ACA and Life Insurance Opportunities
Get Your Certifications Completed Now
If you haven’t completed your AHIP or NABIP training, now is the time. Carrier certifications cannot be completed until AHIP/NABIP is finished, and without certifications, you cannot order enrollment materials. Waiting until the last minute could leave you without the supplies you need when AEP begins.
Complete your AHIP Certification
Complete your NABIP Certification
If you have completed the AHIP/NABIP, proceed to carrier certifications, so you’re ready to hit the ground running come October 15.
Don’t Overlook Supplemental Opportunities
As Medicare Advantage maximum out-of-pocket amounts rise, supplemental products are becoming increasingly important. Ronnie encouraged agents who haven’t yet added supplemental coverage, such as hospital indemnity, cancer plans, or heart attack and stroke coverage, to consider expanding their portfolios. These products can help fill coverage gaps and provide valuable financial protection when clients need it most.
Explore supplemental coverage options to add to your portfolio.
Ronnie’s advice was simple: pick a product, learn it well, and start discussing it with clients.
SSBCI Changes Require More Attention This Year
Special Supplemental Benefits for the Chronically Ill (SSBCI) are an important topic heading into AEP.
Key reminders include:
- Qualification requirements are becoming more strict.
- Eligibiligty cannot be assumed when switching carriers.
- Benefits will not begin until vertification has been completed.
- Agents should avoid guaranteeing SSBCI eligibility during enrollment discussions.
To help you navigate these conversations, Tidewater has created a must-have SSBCI resource, found in our VIP Portal.
Watch for ANOCs, Non-Renewals, and Service Area Reductions
Between now and the end of September, clients will begin receiving Annual Notice of Change (ANOC) letters and, in some cases, non-renewal notices. These documents will play an important role in enrollment conversations.
Agents should remind clients to keep these notices, especially non-renewal letters, because they may create guaranteed issue opportunities for Medicare Supplemental coverage.
Ronnie also emphasized the importance of understanding the difference between:
- Crosswalks, where enrollment transitions automatically to a new plan.
- Service Area Reductions, which require the client to select new coverage.
Understanding these differences can help prevent enrollment mistakes and ensure clients maintain appropriate coverage.
ANOC Resources for Tidewater Partners:
Agents can download a pre-ANOC letter template to help clients understand their ANOC. Additionally, agents can customize ANOC social media templates to promote awareness and encourage client engagement.
Be sure to also explore our blog, 5 Conversations You Should Be Having with Clients During ANOC Season, to help prepare beneficiaries for AEP.
Give Part D Plans The Attention They Deserve
While stand-alone PDP (Prescription Drug Plan) business may not always be commissionable, Ronnie stressed that agents cannot afford to ignore Part D reviews this year.
Premium increases, formulary changes, and carrier adjustments could significantly impact clients. One example shared during the call was a substantial preojected premium increase on an Aenta SilverScript plan in North Carolina.
Agents should carefully review drug plans and formularies to help clients avoid unexpected costs in 2027.
Be Cautious with PPO Conversations
Many beneficiaries are attracted to PPO (Preferred Provider Organization) plans because of their out-of-network flexibility, but Ronnie reminded agents that out-of-network access is not always guaranteed.
Providers must still:
- Accept Medicare
- Accept the Medicare Advantage plan’s terms and conditions
- Accept new patients
Before recommending a PPO for clients who frequently see out-of-network providers, agents should verify provider participation and document those conversations when possible.
New Medicare Advantage Enrollment Caps
One of the most important updates discussed was CMS allowing carriers to establish enrollment caps for certain Medicare Advantage plans. Once a plan reaches its approved enrollment limit, carriers may suppress or close the plan to additional enrollments.
This presents a new challenge during AEP, as plans available early in the season may not remain available later.
While agents should never use enrollment caps as a pressure tactic, staying informed and monitoring carrier communications throughout AEP will be more important than ever.
Please refer to CMS Medicare Managed Care Eligibility and Enrollment for more information.
Important Carrier Updates
Several carrier developments were highlighted during the call, including:
Humana
- Agents must complete Member Benefit Activation (MAI) training this season.
- 1) Login to the Humana Agent Portal and open Humana MarketPoint University
- 2) Find the “Agent Advocate: MAI for Partner Field Agents” banner near the top of the home page
- 3) Click launch to start and finish the module
- New administrative bonus opportunities are available through health risk assessments and related activities.
- Agents should closely monitor upcoming Human Producer Partnership Plan (PPP) communications as significant commission changes and plan rules are taking effect.
- To access the official guidelines and check specific plan rules, view the Commissions section on the Humana Vantage Agent Portal.
Wellcare
- Many Medicare Advantage plans are being suppressed as the company refocuses on specific markets.
- Hawaii, Oklahoma, and Tennessee are seeing complete plan exits.
Aetna
- Certain Medicare Advantage plans across multiple states will become non-commissionable in 2027.
- Georgia agents, in particular, should review affected plans carefully.
UnitedHealthcare
- Members will receive new identification cards as UCard benefits are split into seperate cards for medical coverage and supplemental benefits.
Alignment Health
- Ronnie highlighted Alignment as one carrier whose 2027 benefits appear especially competitive in several markets and emphasized that those not currently contracted may want to explore available Alignment opportunities before AEP begins.
To view our entire list of carriers and products, click here.
To get contracted with any of our carrier partners, click here.
Home Health Care Plans Continue to Gain Momentum
Home health care products are a very strong conversation starter, especially for Medicare Supplement clients.
These plans can help with expenses related to home care needs while also offering prescription drug reimbursement benefits that may offset or even cover plan premiums. Considering the growing costs associated with caregiving and dementia care, these products may provide meaningful value to clients and their families.
To learn more about the benefits of offering home health care plans, click here.
To see which home health care carrier contracts are available through Tidewater, click here.
ACA and Life Insurance Opportunities
Agents working in the ACA marketplace should prepare for upcoming Marketplace enrollment changes, including new consumer authorization requirements and updates to enrollment procedures.
We will also be introducing ACA enrollment to IntegrityCONNECT soon, allowing agents to manage ACA and Medicare clients on one platform. Stay tuned for more information!
Ronnie also encouraged agents not to overlook life insurance conversations. Recent industry data shows increasing consumer interest in life insurance products, creating additional opportunities to serve clients and strengthen long-term relationships.
Final Thoughts
As AEP approaches, one key takeaway from this month’s Office Hours call stands out: knowledge creates opportunity.
From service area reductions and enrollment caps to SSBCI changes and carrier updates, agents who stay informed will be best positioned to serve their clients and grow their business this season.
If you have questions, need contracting assistance, or want guidance on any of the topics covered during Office Hours, the Tidewater team is here to help.
Together, let’s finish preparations strong and head into AEP with complete confidence!
For agent use only. This information is subject to change.
