Medicare Advantage Unused Benefit Rules – What Agents Need to Know
Medicare Advantage (MA) plans can be a great choice for clients; especially because of their extra perks like dental, vision, hearing, OTC allowances, and fitness memberships. But these benefits often go unused, which can lead to client dissatisfaction and plan switching. Recently, CMS has put some Medicare Advantage unused benefit rules in place.
Here’s what you need to know to guide your clients.
Key Points About Unused Benefits
- Most benefits expire monthly, quarterly, or annually; no rollovers.
- OTC allowances are among the most commonly missed benefits.
- Dental/vision/hearing dollars disappear at year-end if not used.
- Provider networks matter — clients must follow plan rules or they risk missing out on some benefits.
CMS’ Mid-Year Notification Rule
CMS recently finalized a rule requiring MA plans to send personalized mid-year notices (June 30–July 31) showing members which supplemental benefits they haven’t used and how to access them.
However, enforcement is paused for 2026, so most plans will not send these reminders. Some may do so voluntarily, but agents should not assume clients will get them.
Watch a YouTube video: Why agents should include ancillary products with MA sales
Why This Matters for Agents
- Client Retention: Clients often switch plans because they feel they aren’t getting value; even when benefits were available.
- Education Opportunity: Helping clients understand and use their benefits builds trust and keeps them engaged.
- Competitive Edge: Agents who proactively remind clients about OTC orders, dental visits, and other benefits stand out.
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Agents
- Review each client’s benefits during mid-year check-ins.
- Send reminders about quarterly OTC allowances and annual dental/vision appointments.
- Explain provider network requirements to avoid frustration.
- Track CMS updates; when they enforce the rule, you can align your outreach with plan notices.
Stay updated on agent events and information
Even with CMS’ rule delayed, agents can fill the gap by educating clients and helping them use the benefits they signed up for. Proactive communication strengthens client relationships, improves satisfaction, and keeps your book of business stable.