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Home 2025 December
Best Medicare Coverage for Travelers

Best Medicare Coverage for Travelers

By Ed Crowe | General Articles | 0 comment | 18 December, 2025 | 0

Best Medicare Coverage for Travelers: What Agents Should Know

For clients who love to travel; whether across state lines or around the world, having the right Medicare coverage is essential. As an agent, helping beneficiaries understand what their plan does and doesn’t cover can prevent costly surprises and strengthen your value as a trusted advisor. Below is a breakdown of the best Medicare coverage for travelers and what makes them stand out.

One of the most common misconceptions is that Original Medicare offers extensive travel protection. While Part A and Part B provide nationwide coverage, they offer very limited benefits outside the United States. This is why many travelers lean on Medigap or specific Medicare Advantage plans for more robust protection.

Medigap Plans: The Gold Standard for International Travel


For clients who spend time abroad, certain Medigap plans; specifically Plans C, D, F, G, M, and N include limited foreign travel emergency benefits. These plans typically cover 80% of approved emergency medical costs after a small annual deductible, giving travelers peace of mind during unexpected situations. Medigap also shines for domestic travelers since it works with any provider who accepts Medicare, making it ideal for RVers, snowbirds, and retirees who move between states.

Watch a YouTube video on Medicare Supplements vs Medicare Advantage Plans

Medicare Advantage Plans for Travel Flexibility


While Medicare Advantage plans can be restrictive due to network rules, some MA plans are designed with travelers in mind. PPO and Regional PPO plans often allow out-of-network coverage at higher cost-sharing, which can be helpful for clients who split time between locations. Some plans also include worldwide emergency or urgent care benefits, a valuable feature for international travel. Agents should review network strength, coverage areas, and emergency care provisions when guiding clients who are on the move.

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Part D and Prescription Access on the Road


Prescription drug access is another key consideration. Clients traveling domestically should choose a Part D plan with a broad pharmacy network or strong mail-order benefits. For travelers abroad, emphasize traveling with sufficient medication, since Part D does not cover drugs purchased outside the U.S.

Helping Clients Choose the Right Fit


Understanding a client’s travel habits helps you recommend the best Medicare option. Long-term international travelers may lean toward Medigap, while domestic travelers with predictable patterns may find strong value in certain Medicare Advantage PPOs.

By highlighting the coverage differences and asking the right questions upfront, agents can confidently guide their travel-savvy clients to Medicare solutions that protect their health no matter where the journey takes them.

Stay up-to-date on the latest webinars an agent events.

Avoiding Medicare Enrollment Mistakes

Avoiding Medicare Enrollment Mistakes

By Ed Crowe | General Articles | 0 comment | 18 December, 2025 | 0

Avoiding Medicare Enrollment Mistakes: What Every Beneficiary Should Know

Enrolling in Medicare is one of the most important steps adults take as they approach age 65, yet it’s also one of the most common areas for costly mistakes. With multiple parts, deadlines, and coverage choices, it’s easy to feel overwhelmed. The good news is that with the right information, avoiding Medicare enrollment mistakes is easy. Here are the top mistakes to watch for and how to prevent them.

Missing Your Initial Enrollment Period

One of the biggest Medicare enrollment mistakes is missing the Initial Enrollment Period (IEP). Your IEP starts three months before your 65th birthday month and ends three months after. If you miss this window and don’t qualify for a Special Enrollment Period, you may face lifelong Part B late-enrollment penalties. To avoid this, mark your calendar early and begin evaluating your options at least three to six months before turning 65.

Watch a YouTube video on Medicare OEP, SEPs and Late Part B Enrollments

Assuming Employer Coverage Automatically Delays Medicare

Many people continue working past age 65, but not all employer coverage allows you to delay Medicare. If your employer has fewer than 20 employees, Medicare becomes primary, meaning you must enroll in Part B to avoid coverage gaps. Always confirm whether your employer’s plan is considered creditable coverage before delaying enrollment.

Not Checking Creditable Drug Coverage

Medicare Part D also has its own late penalty if you go 63 days or more without creditable prescription drug coverage. Many people assume their employer or retiree plan counts, but not all do. Request a creditable coverage notice from your plan administrator each year and keep it for your records.

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Choosing a Plan Without Reviewing Networks and Formularies

Selecting a Medicare Advantage or Part D plan without checking provider networks and drug formularies can lead to higher costs and unexpected denials. Plans change annually, so a review during the Annual Enrollment Period (AEP) is essential; even if you’re happy with your current coverage.

Overlooking Out-of-Pocket Costs

Monthly premiums are only part of the equation. Deductibles, copays, and maximum out-of-pocket limits vary widely. Beneficiaries often choose the lowest-premium option only to discover higher costs later. Compare plans based on your actual health needs, not just the price tag.

Forgetting to Reevaluate Coverage Each Year

Your health needs and plan benefits change over time. Failing to review your coverage during AEP can lead to paying more than necessary or losing access to preferred providers or medications. A yearly comparison ensures your coverage stays aligned with your needs.

Not Working With a Licensed Medicare Agent

Medicare can be confusing, and many mistakes happen simply because beneficiaries don’t fully understand their options. A licensed Medicare agent can help you navigate enrollment periods, compare plans, and avoid penalties; all at no cost to you.

Stay up-to-date on the latest webinars an agent events.

Avoiding Medicare enrollment mistakes starts with awareness and preparation. By understanding your deadlines, verifying creditable coverage, reviewing networks and costs, and seeking expert guidance, you can make confident decisions that protect your health and your wallet.

GTL Hospital Indemnity Plans

GTL Hospital Indemnity Plans

By Ed Crowe | General Articles | 0 comment | 17 December, 2025 | 0

GTL Hospital Indemnity Plans: A Smart Supplemental Solution for Agents

GTL hospital indemnity plans offer agents a practical way to help clients manage rising out-of-pocket healthcare costs while expanding their own product portfolio. Designed to pay cash benefits directly to the policyholder, these plans work alongside major medical coverage. This means; Medicare Advantage, or Medicare Supplement plans.

What Is a Hospital Indemnity Plan

A hospital indemnity plan provides a fixed cash benefit for covered events such as hospital admissions, daily confinement, ICU stays, and certain outpatient services. GTL’s hospital indemnity plans are known for simple plan designs, guaranteed renewable coverage, and predictable benefits. Because clients recieve payments directly, they can use funds for co-pays, deductibles or everyday expenses.

Why Agents Should Offer GTL Hospital Indemnity Plans

For agents, hospital indemnity plans are easy to explain and easy to position. As Medicare Advantage plans continue to shift cost-sharing to beneficiaries, clients are increasingly exposed to unexpected hospital expenses. Hospital indemnity coverage helps fill these gaps without replacing existing insurance.

Key agent-friendly advantages include:

  • Straightforward underwriting with limited health questions
  • Affordable premiums that appeal to budget-conscious clients
  • Flexible use of benefits, increasing perceived value
  • Year-round sales opportunities, not limited to AEP or OEP

If you are ready to join our team; click here for online contracting

These features make GTL plans ideal for cross-selling to Medicare beneficiaries, individuals with high-deductible health plans, and clients concerned about hospitalization costs.

Ideal Clients for Hospital Indemnity Coverage

GTL hospital indemnity plans are especially effective for Medicare Advantage enrollees facing daily hospital copays, retirees on fixed incomes, and working individuals seeking extra financial protection. Agents can position the plan as a financial safety net rather than traditional insurance, which resonates strongly with today’s consumers.

Watch a YouTube video – Why agents should include ancillary products with MA sales

Final Thoughts

Adding GTL hospital indemnity plans to your product lineup allows you to address a real client need while generating consistent commissions. With simple benefits, broad appeal, and strong supplemental value, these plans can strengthen client relationships and help agents stand out in a competitive market.

Stay up-to-date on the latest webinars an agent events.

Understanding Life Insurance Basics

Understanding Life insurance Basics

By Ed Crowe | General Articles | 0 comment | 17 December, 2025 | 0

Understanding Life Insurance Basics: A Guide for Agents

Life insurance remains a cornerstone of financial planning, and as an agent, your ability to clearly explain its value is essential to helping clients make informed decisions. Whether you work with young families, retirees, or business owners, understanding life insurance basics and having the ability to explain them to potential cleints builds trust and supports sales. This overview highlights the key points agents should emphasize when educating clients on life insurance.

What Life Insurance Really Provides


At its core, life insurance is a financial safety net. Clients pay premiums, and in exchange, their beneficiaries receive a tax-free death benefit that can cover funeral expenses, mortgage payments, income replacement, debt, and other essentials. Agents should reinforce how life insurance provides long-term security and protects the financial stability of loved ones.

Term vs. Permanent Life Insurance


Helping clients choose the right policy starts with explaining the differences between the two main products:

Term Life Insurance


Term life offers affordable, straightforward protection for a set period; typically 10, 20, or 30 years. It’s ideal for families needing coverage during peak financial responsibility years. Agents should highlight conversion options, renewal features, and how term can complement other financial products.

Permanent Life Insurance


Permanent life insurance provides lifetime coverage and includes a cash value component that grows tax-deferred. Options like whole life, universal life, and indexed universal life offer flexibility, stable premiums, and long-term financial benefits. Agents can position permanent coverage as part of a broader wealth-building or legacy planning strategy.

Watch a YouTube video on Life Insurance Basics

Matching Clients With the Right Coverage


Agents play a critical role in assessing client needs. Key factors to review include income replacement goals, outstanding debt, number of dependents, financial obligations, and long-term objectives. While the general guideline suggests coverage equal to 7–10 times annual income, personalized assessments help agents deliver tailored recommendations that strengthen client confidence.

If you are ready to join our team; click here for online contracting

The Importance of Educating Clients


Today’s consumers want clarity and transparency. Agents who break down complex insurance concepts into simple, relatable explanations tend to build stronger relationships. This helps agents maintain their book of business. Emphasizing the real-life value of life insurance and how it fits into financial planning helps clients understand why the coverage matters.

Stay up-to-date on the latest webinars an agent events.

Understanding life insurance basics is essential for guiding clients toward the right protection. By explaining policy types, assessing needs, and positioning coverage as a long-term financial tool, agents can better serve their clients while growing their book of business.

Medicare Supplement Costs and Coverage

Medicare Supplement Costs and Coverage

By Ed Crowe | General Articles | 0 comment | 15 December, 2025 | 0

Medicare Supplement Costs and Coverage: What Beneficiaries Need to Know

If you’re exploring ways to reduce out-of-pocket medical expenses, a Medicare Supplement Insurance plan (Medigap) can help fill the gaps left by Original Medicare. These standardized plans are designed to make healthcare costs more predictable, offering peace of mind and broader financial protection. We will go over the Medicare supplement costs and coverage and help you decide if this is right for you.

What Medicare Supplement Plans Cover

Medigap plans labeled A, B, D, G, K, L, M, and N offer the same benefits no matter which insurance company sells them. While the level of coverage varies by plan letter, most include:

  • Part A coinsurance and hospital costs
  • Part B coinsurance or copayments
  • Blood (first 3 pints)
  • Hospice care coinsurance
  • Skilled nursing facility coinsurance (many plans)
  • Part A deductible
  • Foreign travel emergency benefits (select plans)

Today’s most popular option, Plan G, offers broad protection by covering nearly all Medicare-approved costs except the Part B deductible.

What Medigap Does Not Cover

It’s important to understand what Medicare Supplement plans exclude. Medigap policies do not cover:

  • Prescription drugs (Part D is required separately)
  • Routine dental, vision, and hearing care
  • Long-term care or custodial care
  • Services not approved by Medicare

Beneficiaries often pair Medigap with standalone dental, vision, and hearing plans for more complete coverage.

Watch a YouTube video on Medicare Advantage vs. Medicare Supplement

How Much Medicare Supplement Plans Cost

Medigap premiums vary widely. The main factors that influence cost include:

Plan Type

Plans with more benefits typically cost more. Plans with cost-sharing features often come with lower premiums.

Age and Rating Method

Carriers price Medigap plans using:

  • Community-rated premiums
  • Issue-age-rated premiums
  • Attained-age-rated premiums

The rating method affects how your premium changes over time.

Location

Medigap costs vary by state and even by ZIP code due to regional healthcare expenses.

Tobacco Use and Enrollment Timing

Carriers may charge higher rates for tobacco users or applicants enrolling outside their guaranteed-issue period.

Available Discounts

Household or multi-enrollee discounts may lower monthly premiums.

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Why Many Beneficiaries Choose Medigap

Medicare Supplement plans are favored for their predictable costs, nationwide provider access, and minimal out-of-pocket expenses. With no networks or referrals required, Medigap offers flexibility that many retirees value.

A Medicare Supplement plan can significantly reduce healthcare costs and eliminate many gaps in Original Medicare. Reviewing coverage options, comparing premiums, and pairing your plan with Part D ensures you get comprehensive protection tailored to your needs.

Stay up-to-date on agent events and information

Medicare commission Dispute Update

Medicare commission Dispute Update

By Ed Crowe | General Articles | 0 comment | 15 December, 2025 | 0

Medicare Commission Dispute Update: CMS’ Repsonse What Agents Need to Know

The growing conflict between insurers and state regulators has caused federal officials to step in to clarify who controls Medicare Advantage (MA) marketing practices. The latest Medicare commission dispute update dives in to CMS’ response to the current status of broker commissions. Several insurers have reduced or eliminated commissions and restricted access to enrollment tools. Therefore, state commissioners are pushing back, arguing these actions harm both agents and beneficiaries. CMS’ latest memo signals that the debate is far from over.

Medicare Advantage Enrollment Suppression

In recent months, multiple insurers have attempted to limit what they view as costly Medicare Advantage enrollment by adjusting broker compensation and curbing access to online enrollment portals. These moves have prompted roughly a dozen states to urge insurers to reverse course. Some state departments even issued cease-and-desist orders, sparking lawsuits from carriers.

On December 4, CMS issued a memo stating; regulation of Medicare Advantage and Part D ultimately rests at the federal level. The agency emphasized that federal law likely preempts state law on matters related to MA compensation and marketing. CMS also reminded stakeholders that commissions are negotiable annually, as long as they fall within federal limits.

Access to Enrollment Forms

Importantly, CMS did clarify one requirement: enrollment forms must remain accessible on insurers’ websites. This comes amid concerns that restricted access to online tools could limit beneficiaries’ ability to make informed choices.

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Agent Compensation

While CMS’ memo reaffirmed federal authority, states are unlikely to stay silent. Several state regulators have said they lack the authority to mandate compensation changes but continue urging insurers to restore commissions. Industry observers expect states to keep applying public pressure, even if their legal power is limited. Some also suggest states could focus attention on the Medicare Supplement market, which is regulated at the state level, especially as some carriers consider commission changes in that space as well.

Agents and brokers have voiced growing frustration as certain insurers have reduced or eliminated commissions; sometimes even retroactively. Many argue that these cuts ultimately hurt beneficiaries by reducing access to professional guidance during enrollment.

Watch a YouTube video – Multiple Medicare Advantage Plans going non-commissionable

The dispute has escalated significantly. Insurers have filed lawsuits in response to state actions, claiming that limiting commissions is part of their strategy to maintain plan stability amid rising costs. Meanwhile, regulators in several states have urged insurers to reinstate compensation, warning of the broader impact on consumers.

Let’s Sum it Up

With the 2025 Annual Enrollment Period now over and the 2026 window on the horizon, the tension between state regulators, insurers, and federal authorities is shaping what could become a pivotal policy fight. CMS’ memo clarifies federal preemption but leaves the door open for continued pressure from states. For agents, the message is clear: the debate over Medicare Advantage commissions is far from settled. The outcome will have meaningful implications for how the industry operates moving forward.

Stay up-to-date on agent events and information

What Medicare Part D covers

What Medicare Part D Covers

By Ed Crowe | General Articles | 0 comment | 11 December, 2025 | 0

What Medicare Part D Covers: A Clear Guide for Medicare Beneficiaries

Medicare Part D is essential for millions of beneficiaries who rely on prescription medications to manage chronic conditions and maintain their health. Understanding what Medicare Part D covers can help you choose the right plan, avoid unexpected costs, and make the most of your Medicare benefits. This guide breaks down the key features of Part D coverage so you know exactly what to expect.

What Is Medicare Part D

Medicare Part D is prescription drug coverage offered by private insurance companies approved by Medicare. Beneficiaries can enroll in a stand-alone Prescription Drug Plan (PDP) with Original Medicare or choose a Medicare Advantage plan (MA-PD) that includes drug benefits. Every plan must follow Medicare’s minimum coverage rules, but formularies and pricing vary.

What Medicare Part D Covers

Prescription Drugs in Essential Categories

All Medicare Part D plans must cover drugs across major therapeutic classes, including medications for:

  • Diabetes
  • High blood pressure
  • High cholesterol
  • COPD and asthma
  • Depression and anxiety
  • Osteoporosis

This ensures beneficiaries have access to commonly used medications for chronic conditions.

Watch a quick YouTube video on the prescription payment plan

Protected Class Medications

Medicare Part D also requires plans to cover “protected class” drugs, which include:

  • Antidepressants
  • Antipsychotics
  • Anticonvulsants
  • Antiretrovirals
  • Immunosuppressants
  • Certain cancer medications

These protections ensure that people with serious or complex health needs can access the full range of necessary treatments.

Vaccines Not Covered by Part B

Part D covers many important vaccines, including the shingles (Shingrix) vaccine, RSV vaccines, and most travel immunizations. Under current Medicare rules, beneficiaries typically pay $0 out of pocket for recommended vaccines.

Insulin and Diabetic Supplies

Thanks to recent updates, Medicare Part D limits monthly insulin costs to $35 for covered insulin products. Many plans also cover diabetic supplies such as test strips, lancets, and pen needles.

Specialty and High-Cost Medications

Part D covers a wide range of specialty drugs used for conditions like multiple sclerosis, rheumatoid arthritis, and autoimmune disorders. These medications may fall into higher cost tiers but are included in most formularies.

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What Medicare Part D Does Not Cover

Medicare Part D does not cover over-the-counter drugs, vitamins and supplements, cosmetic medications, fertility treatments, or drugs for weight loss.

Medicare Part D provides comprehensive, affordable access to prescription medications. By reviewing your plan’s formulary, comparing costs, and choosing a plan that matches your medication needs, you can maximize your coverage and save money throughout the year.

Stay up-to-date on agent events and information

Medicare Advantage OEP 2026

Medicare Advantage OEP 2026

By Ed Crowe | General Articles | 0 comment | 11 December, 2025 | 0

Medicare Advantage OEP 2026: What Beneficiaries Need to Know

As in previos years, the Medicare Advantage OEP 2026 runs from January 1 to March 31, giving Medicare beneficiaries a valuable second chance to fine-tune their health coverage. While the Annual Enrollment Period (AEP) in the fall gets the most attention, OEP is just as important; especially with the growing number of changes expected in Medicare Advantage benefits, Star Ratings, utilization management, and supplemental offerings in 2026.

Here’s an overview of what OEP is, how it works, and why 2026 may be an especially important year to review plan choices.

What Is the Medicare Advantage OEP

The Medicare Advantage OEP is a once-per-year enrollment window designed specifically for people already enrolled in a Medicare Advantage plan. It allows beneficiaries to:

  • Switch to a different Medicare Advantage plan (with or without drug coverage)
  • Drop Medicare Advantage and return to Original Medicare
  • Enroll in a stand-alone Part D prescription drug plan if switching back to Original Medicare

However, OEP does not allow someone on Original Medicare to join a Medicare Advantage plan. It is strictly for current MA members who want to make a change.

Why OEP Matters in 2026

Medicare Advantage plans are expected to see continued adjustments in 2026, including:

More Care Management Controls

Many carriers are tightening prior authorization, utilization management, and cost-sharing rules. Some beneficiaries may find their 2026 MA plan more restrictive than expected once the new year begins.

Shifts in Supplemental Benefits

Non-medical extras like dental, vision, hearing, transportation, and OTC allowances are being closely reviewed by CMS. Some plans reduced benefits for 2026 to balance rising medical costs.

Watch a quick video on the differences between Medicare Advantage vs Medicare Supplements

Star Rating Modifications

With CMS proposing changes to the Star Ratings program, some plans entered 2026 with lower ratings than previous years. Lower ratings can mean reduced rebates, resulting in trimmed benefits or higher out-of-pocket costs for members.

Provider Network Adjustments

Every year brings hospital and physician network changes. Beneficiaries often don’t notice these changes until January, making OEP their opportunity to switch to a plan with more compatible providers.

With these shifts, OEP 2026 will be especially important for those who discover their new coverage doesn’t meet their expectations.

Who Should Consider Making a Change

A Medicare Advantage member may want to explore options during OEP if:

  • Their plan dropped key doctors or specialists for 2026
  • Prescription costs or formularies changed
  • Supplemental benefits were reduced or removed
  • Prior authorization requirements increased
  • Their total out-of-pocket costs are higher than anticipated
  • They enrolled in a new plan during AEP but are experiencing “buyer’s remorse”

Even a small change; like a different tier placement for a medication can significantly impact annual healthcare expenses.

How to Review Medicare Advantage Options During OEP

During OEP, beneficiaries should:

  1. Review their 2026 Evidence of Coverage (EOC) to understand changes.
  2. Compare local plan alternatives, focusing on doctors, drug coverage, and copays.
  3. Check Star Ratings, but also evaluate real-world factors like provider access.
  4. Consider switching back to Original Medicare if they prefer provider flexibility; though Medigap underwriting rules may apply depending on the state.

Working with a licensed Medicare agent is the quickest way to compare plans side-by-side and avoid unexpected coverage gaps.

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The Medicare Advantage Open Enrollment Period is a valuable opportunity for beneficiaries to correct course after the new plan year begins. With ongoing regulatory changes and shifting benefits in 2026, OEP gives Medicare members the flexibility to ensure their plan still aligns with their healthcare needs, budget, and preferred providers.

Whether it’s a minor adjustment or a full switch, the OEP helps ensure beneficiaries start the rest of 2026 with confidence in their coverage.

Stay up-to-date on agent events and information

Using Annuities for Retirement Income

Using Annuities for Retirement Income

By Ed Crowe | General Articles | 0 comment | 8 December, 2025 | 0

Using Annuities for Retirement Income: A Simple, Reliable Strategy

For many Americans nearing retirement, one fear rises above all others: outliving their savings. With people living longer and traditional pensions becoming rare, retirees need income sources they can count on. That’s why using annuities for retirmenet income is gaining attention as a dependable way to create steady retirement income.

An annuity is a contract with an insurance company. You contribute a lump sum or make periodic payments, and in return, the insurer provides growth, protection, or guaranteed income. While annuities come in several forms, their main purpose is simple; turning savings into predictable income.

Types of Annuities

Fixed Annuities

Fixed annuities offer a guaranteed interest rate for a set term. They work like a secure, tax-deferred CD alternative and can later be converted into income.
Best for: Retirees who want stable, predictable returns.

Fixed Indexed Annuities

These annuities earn interest tied to a market index, such as the S&P 500, but protect your principal from market losses. Many include optional riders that provide guaranteed lifetime income.
Best for: People who want growth potential without risking their savings.

Immediate or Lifetime Income Annuities

These convert your investment into guaranteed monthly income that can last for life. They function like a personal pension.
Best for: Anyone who wants dependable, never-ending income.

Variable Annuities

Variable annuities invest in market-based subaccounts. They offer more growth potential but also market risk. Some add income riders for future stability.
Best for: Investors comfortable with market swings.

Agents watch an Annuity Rate Watch Demonstartion – Pinnacle’s Annuity quoting tool

Why Use Annuities for Retirement Income

Guaranteed Lifetime Income

Few financial products can provide income you cannot outlive. Annuities help create a reliable foundation for retirement.

Protection from Market Declines

For retirees, early losses can severely reduce long-term income. Many annuities protect your principal, which helps preserve your savings during downturns.

Tax-Deferred Growth

Earnings inside an annuity grow tax-deferred, making it easier for your funds to compound over time.

Complements Other Income Sources

Annuities can fill income gaps by working alongside Social Security, pensions, or withdrawals from retirement accounts.

Are Annuities Right for Everyone

Annuities may not be ideal for people who need high liquidity or want full access to their funds. They are best suited as part of a diversified retirement plan; not a replacement for all other investments.

In today’s retirement landscape, steady income matters more than ever. Annuities help retirees create predictable, long-lasting income while reducing risk. Whether you want stability, lifetime payments, or protection from market volatility, annuities can be an effective tool for building long-term financial security. A licensed agent can provide important guidance to create a long term strategy to secure your future income.

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Proposed Medicare Advantage Changes 2027

Proposed Medicare Advantage Changes 2027

By Ed Crowe | General Articles | 0 comment | 5 December, 2025 | 0

Proposed Medicare Advantage Changes 2027

The Centers for Medicare & Medicaid Services (CMS) recently released a proposed rule for the 2027 contract year that could reshape Medicare Advantage (MA) and Part D prescription drug coverage. The agency aims to “strengthen quality, improve access, and modernize benefits” while reducing administrative burdens on plans.

Here’s what beneficiaries, providers, and policymakers need to know.

Star Ratings Overhaul

CMS proposes removing 12 Star Rating measures that are largely administrative or show little variation between plans. The focus will shift to meaningful metrics, including clinical outcomes, preventive care, and patient experience.

  • New focus on outcomes: Plans will be evaluated more on health results than paperwork.
  • Mental health measure: CMS plans to introduce a “Depression Screening and Follow-Up” measure for future cycles.
  • Health equity bonuses paused: The previously planned “Excellent Health Outcomes for All” bonus is postponed, though CMS invites feedback on equity initiatives.

Impact: Beneficiaries may find it easier to identify high-quality plans, while insurers may redirect resources toward improving actual care.

Enrollment Flexibility

The proposed rule adds a new Special Enrollment Period (SEP) for beneficiaries whose providers leave a plan’s network. This allows mid-year plan changes without waiting for the regular enrollment window. CMS also codifies other existing SEP policies, making the system more consistent.

Impact: This change ensures continuity of care for people with chronic conditions or preferred providers.

Watch a video on the discontinued Medicare advantage plan special enrollment period

Part D and Drug Coverage Updates

The rule formalizes Part D reforms started under prior legislation, including:

  • Eliminating the coverage gap (donut hole) phase.
  • Maintaining reduced out-of-pocket thresholds.
  • Removing cost-sharing in the catastrophic phase.
  • Adjusting how True Out-of-Pocket (TrOOP) costs are calculated.

Impact: Beneficiaries gain more predictable and affordable prescription drug coverage.

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Reducing Administrative Burden

CMS proposes measures to reduce paperwork and regulatory complexity, such as:

  • Exempting certain account-based plans from creditable coverage disclosures.
  • Lifting requirements for mid-year notices about unused supplemental benefits.
  • Removing some health-equity reporting mandates for plans.

Impact: Plans may operate more efficiently, but some transparency and oversight could be reduced.

Why It Matters

  1. Patient-focused quality: More emphasis on outcomes and experience could improve care.
  2. Drug cost protection: Part D reforms continue to protect beneficiaries from high out-of-pocket expenses.
  3. Flexible enrollment: The new SEP enhances access to care when providers leave networks.
  4. Efficiency vs. oversight: Streamlined administration may improve plan operations but reduce some accountability.
  5. Future reform: CMS is constantly making changes to improve MA plans, and stakeholders have the chance to provide input.

CMS’s 2027 proposed rule could bring meaningful improvements for beneficiaries while easing administrative burdens for insurers. The Star Ratings overhaul, enrollment flexibility, and Part D updates are poised to enhance care and reduce costs. However, reduced oversight and postponed equity initiatives highlight areas to watch as the public-comment process unfolds.

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Online Enrollment- Enroll prospects online without the need for a face to face appointment. Access to all major carriers with the ability to compare plan benefits and prescription drug costs. Link to recorded webinar https://attendee.gotowebinar.com/recording/2899290519088332033

All agents receive a personalized enrollment website. Prospects can use the site to compare plans, check doctors, run drug comparisons and enroll in plans. Agents are credited for all enrollments. Click Here

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