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
- Patient-focused quality: More emphasis on outcomes and experience could improve care.
- Drug cost protection: Part D reforms continue to protect beneficiaries from high out-of-pocket expenses.
- Flexible enrollment: The new SEP enhances access to care when providers leave networks.
- Efficiency vs. oversight: Streamlined administration may improve plan operations but reduce some accountability.
- 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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Wellabe Hospital Indemnity Plan Sales – An Opportunity for Medicare Agents
As Medicare Advantage benefits continue shifting and out-of-pocket costs trend upward, 2026 is shaping up to be a year where supplemental protection becomes more important than ever. That’s why Wellabe Hospital Indemnity plan sales are emerging as a strong add-on product. This is helpful for agents looking to boost client value, deepen relationships, and increase commissions all while solving real coverage gap issues for Medicare beneficiaries.
Below is an original, agent-focused breakdown of why Wellabe HI plans deserve a top spot in your sales strategy.
Why Hospital Indemnity Plans Matter in 2026
Even with Medicare Advantage coverage, your clients face unpredictable and sometimes steep costs when they’re admitted to a hospital. MA plans commonly include:
- Daily inpatient copays
- Emergency room copays
- Observation stay costs
- Ambulance fees
- Rising maximum out-of-pocket (MOOP) limits
Hospital Indemnity plans fill these financial gaps by providing cash benefits paid directly to the member, which can be used for anything; copays, transportation, lodging for family members, or simply covering monthly bills.
With many MA carriers adjusting benefits and tightening budgets for 2026, more clients are feeling the strain of increased cost-sharing. This shift creates a prime selling opportunity for Wellabe’s Hospital Indemnity Plan.
Why Agents Love Wellabe’s HI Product
Wellabe (formerly Great Western Insurance Company) has structured their HI plan to be flexible, easy to present, and competitive nationwide.
Simplified Issue for Most Ages
Clients can often qualify without medical exams or lengthy underwriting. Fast approvals mean a smoother sales process for both you and the client.
Highly Customizable Benefits
You can tailor benefits based on a client’s specific MA plan design. Options include:
- Daily hospital confinement benefits
- Ambulance coverage
- Observation stay riders
- Skilled nursing facility benefits
- ER coverage
- Lump-sum outpatient surgery benefits
This allows you to build a package that aligns perfectly with their needs.
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Affordable Monthly Premiums
Wellabe’s pricing remains competitive, especially for clients in their late 60s and early 70s. HI plans are one of the easiest cross-sell items because premiums are low and the value is easy to demonstrate.
Ideal Cross-Sell with Medicare Advantage
Whenever you review a client’s MA plan and see hospital copays or multi-day confinement fees, you have a natural opening to present Wellabe HI as a cost-protection solution.
Learn how to cross sell – watch our quick YouTube video
Sales Positioning That Works
Here are proven strategies you can use during AEP, OEP, or everyday sales conversations:
Create Security
Highlight the unpredictable nature of hospital expenses with MA plans. Clients appreciate having fixed, guaranteed cash benefits.
Protect Your Retirement Income
Explain how a short hospital stay could wipe out a month, or more, of income. A low-cost HI plan helps stabilize finances.
Match Benefits to Plan Gaps
Show them the exact hospital copay amounts in their MA plan and how a Wellabe HI benefit can cover it dollar-for-dollar.
Bundle Approach for Agents
Many agents use wording similar to the following:
“If you choose an MA plan, you might wan to consider pairing it with a Hospital Indemnity plan so your hospital costs are fully covered.”
This increases client satisfaction and reduces future complaints or surprise bills.
Why Selling Wellabe HI Plans Builds Long-Term Business
- Strong customer service and claims reputation
- Additional commission without added complexity
- Deepens your advisory role with every client and allows them to use one resources for their coverage needs
Clients who feel fully protected are less likely to shop around, helping you retain business year after year.
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Medicare Part B Enrollment Periods
Medicare Part B is a vital part of your healthcare coverage, helping to pay for doctor visits, outpatient care, preventive services, and medical supplies. However, knowing when to sign up is just as important as understanding what Part B covers. Enrolling at the right time ensures you avoid costly late penalties and gaps in coverage. Here’s a breakdown of the key Medicare Part B enrollment periods and what each means for you.
Initial Enrollment Period (IEP)
Your Initial Enrollment Period is your first chance to enroll in Medicare Part B. It lasts seven months — beginning three months before, including your birth month, and continuing three months after you turn 65.
- If you enroll before your birthday month, your Part B coverage starts the month you turn 65.
- If you enroll during or after your birthday month, coverage begins the month after you enroll.
Tip: Even if you’re still working, check with your employer’s HR department to see whether you should enroll right away or delay Part B to avoid duplicate coverage.
Special Enrollment Period (SEP)
If you or your spouse are still working past 65 and have employer-sponsored health coverage, you can delay enrolling in Part B without penalty. Once that coverage ends, you qualify for a Special Enrollment Period.
The SEP lasts eight months from the date your employment or group coverage ends — whichever comes first. Enrolling during this window ensures you don’t face the Part B late enrollment penalty, which can increase your premium by 10% for every 12 months you were eligible but didn’t sign up.
Important: COBRA or retiree coverage doesn’t count as active employer coverage, so your SEP clock may start ticking sooner than you think.
Watch a YouTube video on Medicare OEP, SEPs and Late Part B Enrolllments
General Enrollment Period (GEP)
If you missed both your Initial and Special Enrollment Periods, the General Enrollment Period gives you another chance. The GEP runs every year from January 1 to March 31.
- Coverage begins the first day of the month after you enroll.
- You may owe a late enrollment penalty added to your monthly premium for as long as you have Part B.
While this period can be a helpful safety net, it’s best to avoid relying on it if possible due to potential penalties and delayed coverage.
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Medicare Advantage (Part C) and Other Related Enrollment Periods
Once you have Part B, you can explore Medicare Advantage (Part C) or Medigap plans to supplement your coverage. Enrollment in these plans often depends on your Part B effective date, so timing your Part B enrollment correctly is crucial for coordinating your full Medicare coverage.
Understanding Medicare Part B enrollment periods can save you money and prevent headaches down the road. Whether you’re turning 65 soon, working past retirement age, or helping a loved one with their coverage decisions, planning ahead is key.
If you’re unsure when to enroll, a licensed Medicare agent can review your situation, explain your options, and help you avoid penalties or coverage gaps.
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Medicare General Enrollment Period – Who Can Use It
Medicare offers several enrollment windows, and knowing which one applies to your situation is essential for avoiding coverage gaps and late-enrollment penalties. One key enrollment period; especially for those who missed their initial opportunity, is the Medicare General Enrollment Period (GEP).
For those who didn’t sign up for Medicare when first eligible, the GEP may provide a second chance to enroll. Let’s break down what the GEP is, who qualifies to use it, and what to expect.
Understanding the Medicare General Enrollment Period
The Medicare General Enrollment Period runs every year from January 1 to March 31. It exists to help individuals who:
- Did not enroll in Medicare Part A and/or Part B during their Initial Enrollment Period (IEP), and
- Do not qualify for a Special Enrollment Period (SEP)
During the GEP, eligible individuals can sign up for Medicare Part A (if they have to pay a premium for it), Medicare Part B, or both.
Watch a YouTube video on Medicare Enrollment Periods
Who Can Use the GEP
You may be able to use the Medicare General Enrollment Period if:
- You turned 65 and missed your Initial Enrollment Period
- You left employer coverage and did not enroll during a Special Enrollment Period
- You declined Medicare when first eligible and later changed your mind
- You were not automatically enrolled and never completed enrollment
You cannot use the GEP if
You already enrolled or declined Medicare during your IEP or SEP
You currently qualify or applied for a Special Enrollment Period (for example, due to loss of employer coverage)
When Coverage Begins After Enrolling
Unlike past years when coverage began in July, Medicare’s updated rules mean that coverage starts the first day of the month after you enroll during the GEP.
For example:
- Enroll in January – Coverage starts February 1
- Enroll in March – Coverage starts April 1
What About Late-Enrollment Penalties
If you’re enrolling during the GEP because you didn’t qualify for a Special Enrollment Period, be aware that late-enrollment penalties may apply:
- Part B penalty: 10% increase for each full 12-month period you didn’t enroll when eligible
- Part A penalty: Applies if you’re required to pay a premium and delayed enrollment
These penalties typicallylast for a lifetime, so enrolling as soon as you’re eligible; or using a SEP if qualified, is critical.
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Can You Enroll in Medicare Advantage or Part D After the GEP
Yes. After enrolling in Medicare during the GEP, you have a Medicare Advantage and Part D enrollment window from April 1 to June 30 each year.
During this time, you can:
- Join a Medicare Advantage (Part C) plan
- Enroll in a standalone Part D prescription drug plan
Missing your Initial Enrollment Period doesn’t mean you’re out of options. The Medicare General Enrollment Period offers an important second chance to gain coverage, but acting promptly is key.
If you’re unsure whether you qualify for the GEP or a Special Enrollment Period, consider speaking with a licensed Medicare agent who can help you understand your enrollment options and avoid unnecessary penalties or coverage delays.
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Canceling Medicare Part B – What You Need to Know
Medicare Part B helps cover doctor visits, outpatient services, preventive care, and durable medical equipment. It’s a cornerstone of healthcare for many older adults. Although, there are some situations when cancelling Medicare Part B is the best option for you
Whether due to employer coverage, cost concerns, or personal circumstances, canceling Part B is a decision that needs careful consideration. Here’s what you should know before making the move.
Why Someone Might Cancel Part B
Most people keep Part B once they enroll, but in certain situations, canceling may make sense, such as:
- Returning to Employer Coverage
If you or your spouse returns to work and gains coverage through a credible employer health plan, you may choose to cancel Part B to avoid paying the monthly premium. - Cost Concerns
Individuals on a fixed budget may reconsider Part B due to premium costs. However, this should be carefully weighed against healthcare needs. - VA Benefits Only
Some veterans rely solely on VA benefits and opt to drop Part B, though this comes with some risk if VA access is delayed or preferences change later.
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How to Cancel Medicare Part B
Canceling Part B isn’t as simple as clicking a button online. The Social Security Administration requires a signed request, and often a Form CMS-1763 must be completed. Typically, you will need to:
- Contact Social Security by phone or visit your local office to request cancellation.
- Complete Form CMS-1763 in person or by phone with a Social Security representative.
- Confirm your disenrollment once processed.
This extra step is intentional; Medicare wants to be sure beneficiaries understand the consequences before dropping coverage.
Watch a YouTube video on Medicare Enrollment Periods
Important Considerations Before Canceling
Canceling Part B can have long-term implications. Here are key points to consider:
- You May Pay a Late Enrollment Penalty Later
If you cancel and don’t have other credible coverage (like large-group employer insurance), you may face a permanent surcharge if you re-enroll later. - Limited Re-Enrollment Windows
You can’t re-enroll anytime. Most people must wait for the General Enrollment Period (January 1 – March 31), with coverage beginning July 1; potentially leaving gaps. - Future Coverage Access
If your health needs change unexpectedly, getting back into Medicare Part B isn’t immediate. - Medigap Implications
Canceling Part B can impact your ability to retain or buy a Medicare Supplement plan, since Part B is required to maintain Medigap coverage.
When Not to Cancel Part B
Avoid canceling Medicare Part B if:
You do not have other credible employer-based coverage
Your VA benefits are your only backup and you want broader provider access
You plan to enroll in a Medicare Advantage or Medigap plan; both require Part B
If you’re unsure, speak with a licensed Medicare agent before making changes.
Canceling Medicare Part B is possible, but it’s not a decision to take lightly. With potential penalties, waiting periods, and the importance of ongoing medical access, it’s essential to make sure you have another qualifying form of coverage in place first.
Stay up-to-date on the our latest webinars an agent events.
If your circumstances have changed and you’re considering this step, be sure to talk with a Medicare expert who can help you understand the rules and avoid costly gaps in coverage.
Medicare Excess Charges: What They Are & How to Avoid Them
When navigating Medicare, many beneficiaries are surprised to learn about a lesser-known cost called Medicare excess charges. While not everyone will encounter them, knowing how they work, and how to avoid them, can help protect your wallet and ensure you receive the most value from your healthcare coverage.
What Are Medicare Excess Charges
Medicare excess charges occur when a healthcare provider charges more than the Medicare-approved amount for a service under Original Medicare Part B. In most cases, providers who accept Medicare agree to bill only the amount that Medicare approves. However, some providers do not accept Medicare assignment, meaning they can legally charge up to 15% more than the approved rate. This extra amount is known as the excess charge.
For example, if Medicare approves $200 for a service and pays 80% ($160), you’re responsible for the remaining 20% coinsurance ($40). If the provider adds a 15% excess charge ($30), you would owe $70 total instead of $40.
When Do Excess Charges Apply
Excess charges apply only to Medicare Part B services when a provider:
Accepts Medicare but
Does not accept Medicare assignment
These providers still treat Medicare patients, but they can bill above the standard Medicare fee schedule.
Learn about Medicare High Deductible G Plans – Watch a YouTube video
Where Excess Charges Do Not Apply
You do not need to worry about excess charges if:
- You see a doctor who accepts Medicare assignment
- You receive care in a Medicare-participating facility
- You live in a state that bans excess charges (see below)
- You have a Medigap Plan G or Plan F (these plans pay excess charges)
States That Prohibit Medicare Excess Charges
Some states have passed laws to protect Medicare beneficiaries. In these states, providers cannot charge more than the Medicare-approved amount:
- Connecticut
- Massachusetts
- Minnesota
- New York
- Ohio
- Pennsylvania
- Rhode Island
- Vermont
If you live in one of these states, you are fully shielded from excess charges.
How to Avoid Medicare Excess Charges
Here are simple steps to ensure you don’t pay more than necessary:
- Choose providers who accept Medicare assignment
- Confirm billing practices before receiving care
- Consider a Medigap plan (especially Plan G or Plan F) if you’re on Original Medicare
- Use Medicare’s provider finder tool to verify assignment status
What About Medicare Advantage Plans
If you’re enrolled in a Medicare Advantage (Part C) plan, excess charges typically do not apply, as long as you stay within the plan’s network. Medicare Advantage plans negotiate rates with providers directly, separate from Original Medicare rules.
Medicare excess charges aren’t common, but when they do occur, they can add up. The good news is that with the right knowledge and a little planning you can easily avoid them. Whether you choose Original Medicare with a Medigap plan or enroll in Medicare Advantage, being proactive about your provider choices helps ensure your healthcare is both high-quality and cost-effective.
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Why Sell Critical Illness Insurance
When it comes to protecting clients from financial hardship, health coverage alone isn’t always enough. The big question is; why sell critical illness insurance. The answer is: as an insurance agent, you already know the cost of a serious illness can go far beyond hospital bills. That’s where this insurance comes in. Offering this valuable coverage to your clients not only strengthens their financial safety net, but also helps your business grow.
What Is Critical Illness Insurance
Critical illness insurance is a supplemental policy that provides a lump-sum cash benefit if the policyholder is diagnosed with a covered illness such as:
- Heart attack
- Stroke
- Cancer
- Organ failure
- Major surgery
Unlike health insurance, which pays doctors and hospitals, critical illness insurance puts money directly in your client’s hands to spend however they need.
Why Agents Should Offer It
Fill a Major Coverage Gap
Even clients with excellent health insurance can face substantial out-of-pocket costs; deductibles, co-pays, non-covered treatments, travel expenses for care, and lost income during recovery. Critical illness benefits can bridge that gap, giving clients peace of mind.
Protect Clients’ Financial Well-Being
A major diagnosis can derail a family’s finances. This coverage can help with:
- Mortgage or rent payments
- Childcare
- Utility bills
- Transportation to treatment
- Alternative or experimental treatments not covered by insurance
Helping your clients plan for these “hidden” costs builds trust and shows you care about their full financial picture.
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Create a New Revenue Stream
Critical illness policies are generally affordable and easy to quote. Adding them to your portfolio can boost your sales without requiring significant additional effort. Many carriers offer simplified underwriting and electronic applications, making the process smooth for both you and your clients.
Cross-Sell Opportunities
Critical illness coverage is a natural add-on for clients purchasing:
- Health insurance
- Medicare Advantage or Supplement plans
- Life insurance
- Disability income insurance
By bundling solutions, you create a comprehensive protection plan and increase client retention.
Watch a quick YouTube video on why sell ancillary products with Medicare
Stand Out from Competitors
Many agents overlook supplemental health products. Offering critical illness insurance shows that you go beyond the basics and are committed to providing complete risk protection for your clients.
Positioning Critical Illness Insurance with Clients
When discussing this coverage, focus on real-life scenarios and emphasize flexibility:
- “If you were diagnosed with cancer tomorrow, would you have enough savings to cover your expenses while you focus on getting better?”
- “This policy gives you cash you can use however you want – not just on medical bills.”
Simple, empathetic conversations often lead to meaningful sales.
Selling critical illness insurance is more than an opportunity to increase commissions – it’s a way to help clients face one of life’s biggest challenges with confidence. By offering this coverage, you can:
- Strengthen your client relationships
- Provide real financial security
- Build a more resilient, profitable business
Stay up-to-date on Medicare agent events and information
Helping clients prepare for the unexpected is what great agents do. Critical illness insurance is an essential piece of that puzzle.
Why Choose an HMO
When selecting a Medicare Advantage plan, one of the most common choices is a Medicare HMO (Health Maintenance Organization) plan. While Medicare Advantage plans come in different forms; such as PPOs, PFFS, and SNPs, HMO plans continue to be a popular option for many beneficiaries. But what makes them attractive, and why choose an HMO plan over other types of Medicare Advantage coverage?
Lower Monthly Premiums
HMO plans often come with lower monthly premiums compared to PPOs and some Medigap options. In fact, many HMO Medicare Advantage plans are available with a $0 monthly premium (though you must still pay your Part B premium). This makes them a budget-friendly choice, especially for retirees on fixed incomes.
Predictable Costs
With set copays for doctor visits, hospital stays, and prescriptions, Medicare HMO plans can make it easier to budget healthcare expenses. Instead of worrying about large unexpected bills, members often have a clearer idea of what their out-of-pocket costs will be.
Coordinated Care
The HMO plan designed encourages coordinated care. Beneficiaries select a primary care physician (PCP) who manages their overall health and provides referrals to specialists when needed. This system helps reduce unnecessary testing and ensures care is streamlined across providers.
Watch a YouTube video on how Advanced Diabetes Supply can help get needed diabetes supplies
Extra Benefits Beyond Original Medicare
Original Medicare (Parts A and B) does not cover certain benefits like dental, vision, hearing, or fitness programs. Many HMO Medicare Advantage plans include these extras, along with prescription drug coverage (Part D). This makes HMO plans a convenient “all-in-one” package for many beneficiaries.
Lower Out-of-Pocket Maximums
Unlike Original Medicare, which does not cap spending, Medicare HMO Advantage plans include an annual out-of-pocket maximum. Once this limit is reached, the plan pays 100% of covered costs for the rest of the year, offering an important layer of financial protection.
Local Network Focus
Because HMO plans require members to use a network of doctors and hospitals, they often negotiate better rates, helping keep costs down. For beneficiaries who primarily receive care close to home, an HMO network may be more than sufficient.
Is an HMO Right for You
While HMO plans offer many advantages, everyone is different and has their own coverage needs. The main limitation is that you must use providers within the plan’s network (except in emergencies). If you prefer flexibility to see specialists without referrals or want coverage that extends more broadly outside your area, a PPO or Medigap plan may be a better choice.
However, for Medicare beneficiaries looking for affordable, coordinated, and benefit-rich coverage, a Medicare HMO is often an excellent option.
Medicare agents:
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Why Offer Medicare HDG Plans
The question; why offer Medicare HDG Plans, because the Medicare market is changing rapidly. Agents must stay ahead of the curve to remain successful. Many major carriers are scaling back their Medicare Advantage (MA) offerings and even cutting commissions on some plans. This leaves agents with fewer options to present to clients. This is where HDG Plans can make all the difference.
The Current Landscape of Medicare Advantage
In recent years, Medicare Advantage has been one of the most popular plan options among seniors. However, for the last couple years, carriers are:
- Pulling plans from the market – especially PPOs, which have traditionally been popular for their provider flexibility.
- Reducing commissions – some carriers are paying no commission on certain MA products, leaving agents with fewer options to offer.
- Tightening supplemental benefits – carriers are scaling back some of the extra benefits that once attracted clients, making MA plans less competitive.
For agents, this creates a challenge: how do you provide value to your clients while maintaining a sustainable business model?
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Why HDG Health Plans Stand Out
HDG Health Plans provide a strong alternative that agents should be offering. Here’s why:
1. Plan Stability
Unlike some Medicare Advantage carriers that are exiting markets or restructuring benefits, HDG Health Plans are built for long-term stability. This ensures agents can confidently enroll clients without worrying about sudden disruptions.
2. Expanded Client Options
As carriers discontinue PPOs and other MA plans, seniors need reliable choices that meet their healthcare and financial needs. HDG offers products that can help fill the gaps left by Original Medicare. This gives agents a competitive edge in retaining and growing their book of business.
3. Consistent Compensation
With some carriers cutting or eliminating commissions on MA plans, agents need products that continue to provide fair, reliable compensation. HDG Health Plans recognize the value of the agent’s role and support them with commission structures that make sense.
4. Strong Value Proposition for Clients
Carriers design HDG Plans with seniors in mind, balancing affordability, access to care, and flexibility. This makes them attractive alternatives for clients who may be frustrated with shrinking MA networks or reduced plan options.
5. Ability to seek care from most providers
Unlike MA plans, Medicare supplements allow the enrollee to seek care form any provider that accepts Medicare. This can be a huge advantage to any enrollee.
Agents learn why and how to sell ancillary products – watch a quick YouTube video
The Opportunity for Agents
As the Medicare market shifts, agents who adapt quickly will come out ahead. By offering HDG Health Plans, agents can:
- Differentiate themselves from competitors still relying heavily on shrinking MA offerings.
- Provide solutions to clients facing plan cancellations or limited coverage options.
- Build a more stable book of business with products that pay fairly and retain members long-term.
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The Medicare Advantage space is in transition, and relying solely on it may leave both agents and clients at a disadvantage. By incorporating HDG Health Plans into your portfolio, you can protect your business, serve your clients more effectively, and position yourself as a trusted advisor during a time of change.
Now is the time to diversify your offerings, and HDG Health Plans should be at the top of your list.
The Value of Cancer Insurance – Why Medicare Agents Should Offer It
When working with Medicare clients, it’s easy to focus on the basics; Original Medicare, Medicare Advantage, Part D, and Medigap plans. However, one area that often gets overlooked is cancer insurance. The value of cancer insurance is something that should not be overlooked. This type of supplemental coverage can be a valuable addition to a client’s overall healthcare strategy, offering peace of mind and financial protection when it’s needed most.
Why Cancer Insurance Matters for Medicare Clients
While Medicare provides solid coverage for hospital stays, doctor visits, and treatments, it does not cover all of the costs associated with a cancer diagnosis. Beneficiaries may face:
- High out-of-pocket costs for chemotherapy, radiation, or specialty medications.
- Prescription drug expenses, especially for oral cancer drugs under Part D.
- Costs outside of Medicare coverage, such as lodging, transportation, and home assistance.
Cancer insurance offers clients a lump-sum benefit or scheduled payments that they can use however they choose; whether for medical bills, experimental treatments, or everyday living costs.
The Benefits for Medicare Clients
- Financial Protection: Cancer treatments can be lengthy and expensive. A supplemental policy can help fill gaps and reduce financial stress.
- Flexibility: Benefits are often paid directly to the policyholder, so they decide how to use the funds.
- Peace of Mind: Clients know they have extra support if faced with a cancer diagnosis.
- Complements Medicare: Even with a Medigap or Medicare Advantage plan, out-of-pocket costs can add up quickly.
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Beyond Medical Bills: Everyday Expenses Cancer Insurance Can Help Cover
One of the biggest advantages of cancer insurance is that it isn’t restricted to healthcare bills. Many policies allow beneficiaries to use the funds however they need. This flexibility can help cover:
- Travel expenses to and from treatment centers.
- Lodging and meals if treatment requires staying overnight away from home.
- Lost income if the policyholder or a spouse reduces work hours to accommodate treatments.
- Childcare or caregiver costs for clients who need extra support at home.
- Home modifications (ramps, stair lifts, etc.) if mobility becomes an issue during treatment.
- Everyday bills like utilities, rent, groceries, or car payments, so clients don’t fall behind financially while focusing on recovery.
These are real-world expenses that traditional health insurance, including Medicare, does not cover, but cancer insurance can help pay for.
Why Agents Should Offer Cancer Insurance
For agents, cancer insurance is more than just an add-on product; it’s an opportunity to:
- Protect your clients’ financial wellbeing by addressing a risk area that Medicare alone doesn’t fully cover.
- Build stronger client relationships by showing you’re thinking beyond the basics.
- Diversify your portfolio and increase cross-selling opportunities with products that provide real value.
- Differentiate yourself from other agents by offering a more comprehensive healthcare strategy.
Take a look at our YouTube video on why and how to sell ancillary with Medicare in 5 mins
Riders That Can Enhance Cancer Insurance
Many carriers offer optional riders that make cancer insurance even more customizable. Some examples include:
- Heart Attack & Stroke Rider: Expands coverage to other major health events.
- Return of Premium Rider: Refunds premiums if the client never files a claim.
- Wellness Rider: Pays a small benefit for completing preventive screenings (mammograms, colonoscopies, etc.).
- Intensive Care Rider: Provides additional benefits for ICU stays.
- Hospital Confinement Rider: Offers daily benefits for hospital stays, helping offset non-covered costs.
The Bottom Line
Cancer insurance may not be top-of-mind for your clients, but it should be. With the rising cost of treatment and the financial gaps left by Medicare, this coverage can make all the difference. Not only can it help cover medical expenses, but it also provides funds for everyday living costs that traditional health insurance never touches.
For agents, offering cancer insurance, especially with customizable riders, means providing a higher level of service, protecting clients’ financial futures, and strengthening your business.
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Helping your clients prepare for the unexpected is one of the most valuable things you can do. Adding cancer insurance to your portfolio ensures you’re offering them the complete protection they deserve.
Understanding Medicare’s SSBCI Benefits: What They Are and Who They Help
If you’re a Medicare beneficiary or a Medicare agent working with clients you may have come across the term SSBCI. It stands for Special Supplemental Benefits for the Chronically Ill; it’s part of Medicare Advantage plans (not Original Medicare). Understanding Medicare SSBCI benefits is important. These benefits are designed to help people with certain chronic health conditions live healthier, more independent lives by addressing needs that traditional Medicare doesn’t usually cover.
Let’s break down what SSBCI is, how it works, and why it’s so important.
What Are SSBCI Benefits
SSBCIs allow Medicare Advantage plans to offer non-medical supportive benefits to enrollees with serious chronic illnesses. These can include things like:
- Preloaded grocery or utility cards
- Home modifications (e.g., grab bars, ramps)
- Air purifiers or pest control
- Meal delivery
- Social or physical activity programs
The benefits come with an important rule: each benefit must show a reasonable expectation of improving, or at least maintaining, the enrollees’ health or functional status. These targeted benefits can help prevent hospital visits and keep members healthier at home.
Who Qualifies for SSBCI Benefits
To be eligible, an enrollee must meet a three-part definition of “chronically ill,” including:
- Having one or more complex or serious chronic conditions
- Being at high risk of hospitalization or adverse outcomes
- Needing intensive care coordination
Eligibility standards align with what qualifies for Chronic Condition Special Needs Plans (C-SNPs), though not all plans offer SSBCIs.
How SSBCI Differs From “Regular” Medicare Advantage Benefits
Most Medicare Advantage benefits are “primarily health-related.” SSBCI benefits expand that definition to include supports that aren’t strictly medical, as long as they address a specific health condition and can reasonably be expected to improve or maintain health.
Although regular supplemental benefits might include gym memberships or dental coverage for everyone in the plan, SSBCI benefits are customized to the needs of individuals who meet specific health criteria.
Why SSBCI Benefits Matter
Holistic Support: SSBCIs target real-life challenges; nutrition, safety, social connection, that can worsen health.
Flexibility: They can be customized to meet local needs and conditions.
Preventive Benefit: Reducing real-world barriers may lower healthcare costs down the line.
Personalized Care: Plans determine how SSBCIs are structured, shaping the benefits based on member needs.
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What’s New in 2026
Stricter Rules on What Plans Can’t Offer
Starting in 2026, Medicare Advantage plans will face a tightened definition of SSBCI. CMS has codified a list of non-allowable benefits, meaning some popular extras are now prohibited under SSBCI, including:
- Junk food, unhealthy groceries
- Alcohol, tobacco, or cannabis-related items
- Life insurance or funeral benefits
- Cosmetic procedures not covered by Original Medicare
- Insurance discounts unrelated to health care
- Hospital indemnity or unrelated insurance products
Mandatory Mid-Year Notifications
Also beginning in 2026, MAOs (Medicare Advantage Organizations) must send personalized mid-year notices (between June 30 and July 31) to members who have unused supplemental benefit allowances. These notices must include:
- Which benefits the enrollee hasn’t used (from Jan 1–Jun 30)
- Eligibility criteria and limitations
- Instructions on how to access the benefits and provider networks
This ensures beneficiaries don’t miss out on benefits they’re entitled to because they weren’t aware of them.
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Other Medicare-Wide 2026 Changes (Broader Context)
While not SSBCI-specific, here are some broader 2026 updates that complement the Medicare Advantage landscape:
- Automatic Renewal of the Medicare Prescription Payment Plan (MPPP); opt-outs must be processed within three days
- Part D Out-of-Pocket Cap increasing to $2,100 (up $100 from 2025)
- Part D Deductible capped at $615 (up by $25)
- Insulin Cost Cap: Still $35 or less, whichever is lower of negotiated or maximum fair price—now effectively enforced annually
- Adult Vaccines under Part D remain free with no cost-sharing as a permanent policy
Bottom Line
SSBCIs remain a powerful innovation within Medicare Advantage pushing beyond clinical coverage to tackle the lived experiences of chronically ill beneficiaries. But in 2026, plans must tighten the focus and communicate more clearly, including:
- No more non-health-related extras under SSBCI
- Required mid-year check-ins to help enrollees use their benefits effectively
Those who rely on SSBCIs, should:
Always review your 2026 ANOC for SSBCI benefit changes. Pay close attention to mid-year notices and unused benefits. Contact a licensed Medicare agent if you have questions about your current coverage or to look at your options during AEP or other available enrollment periods.
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What Medicare Doesn’t Cover: Avoid Costly Surprises
When you think about Medicare, it’s easy to assume it covers everything you might need as you age, but that’s far not quite the truth. While Medicare provides important and often lifesaving benefits, there are several healthcare services and items that Original Medicare (Parts A and B) simply doesn’t pay for. If you’re not aware of these gaps, you could face unexpected bills. Let’s take a closer look at what Medicare doesn’t cover and how you can protect yourself from high out-of-pocket costs.
Long-Term Care (Custodial Care)
One of the biggest misconceptions about Medicare is that it covers long-term care. In reality, Medicare does not cover custodial care, which includes help with daily activities like bathing, dressing, or eating; if it’s the only care you need.
Medicare may cover short stays in a skilled nursing facility after a hospital stay, but not ongoing assistance in a nursing home or at home.
How to plan: Look into long-term care insurance or other alternatives, such as life insurance with long-term care riders or setting aside personal savings.
Most Dental Care
Original Medicare doesn’t cover routine dental cleanings, fillings, extractions, root canals, dentures, or implants.
It will only cover dental procedures if they’re medically necessary as part of another covered procedure; like jaw surgery in a hospital.
Your options: Some Medicare Advantage (Part C) plans include limited dental coverage. Standalone dental plans are also available.
Vision Care
Medicare doesn’t cover routine eye exams for glasses or contact lenses. It also won’t pay for eyeglasses or lenses unless you’ve had cataract surgery.
Exceptions: Medicare does cover exams for certain conditions like glaucoma, diabetic retinopathy, or macular degeneration.
Your options: Many Medicare Advantage plans offer some vision benefits and like dental plans there are stand alone options as well as dental & vision packages.
Hearing Aids and Exams for Fitting Them
Hearing loss is common with age, but Medicare won’t cover hearing aids or the exams needed to fit them.
This can be a big financial hit, with hearing aids often costing thousands of dollars per pair.
Your options: Check Medicare Advantage plans or look for a stand alone plan, discount programs and clinics offering more affordable devices.
Routine Foot Care
Unless you have a qualifying condition like diabetes, Original Medicare doesn’t cover routine foot care like callus removal, nail trimming, or orthotics.
Your options: Some Medicare Advantage plans may cover podiatry services.
Over-the-Counter Medications and Most Prescription Drugs
Medicare Parts A and B don’t cover most prescription drugs or any over-the-counter medications. For that, you’ll need to enroll in a Medicare Part D plan (Prescription Drug Plan) or choose a Medicare Advantage plan that includes drug coverage.
Important: Even with drug coverage, some expensive medications may not be on your plan’s formulary; always check!
Foreign Travel Emergency Care
Generally, Medicare doesn’t cover healthcare you receive outside the U.S., except in very limited circumstances.
Your options: Some Medigap plans (like Plan G or Plan N) include limited foreign travel emergency benefits. You can also buy standalone travel insurance.
Cosmetic Surgery
Medicare doesn’t cover cosmetic procedures unless they’re needed due to accidental injury or to improve function from a deformity or illness (e.g., breast reconstruction after a mastectomy).
Acupuncture (Beyond Limited Use)
Medicare only covers acupuncture for chronic lower back pain, and only under specific guidelines. Other types of acupuncture, or treatment for other conditions, aren’t covered.
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How to Fill the Gaps
To protect yourself from unexpected expenses, consider:
- Medigap (Medicare Supplement Insurance): Helps pay for deductibles, copays, and coinsurance.
- Medicare Advantage (Part C): May include extra benefits like dental, vision, hearing, and wellness.
- Prescription Drug Plan (Part D): Adds drug coverage to Original Medicare.
- Dental, Vision, and Hearing Insurance: Available as standalone policies.
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Medicare is an important program, but it’s not all-inclusive. Being proactive and understanding what it doesn’t cover can help you make smarter choices and avoid surprise bills. Talk to a licensed Medicare agent to help assess your needs and explore coverage options that close the gaps.