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2025 AEP Disruptions: Updates to The Inflation Reduction Act

The question at hand- what IF commission go to zero. What do we do?
We are all at different stages of our career. If I am at the beginning/middle stages of my career and building and growing my biz, I would handle the PDP.
I am at the later stage of my career. I am not in growth mode. There is no way that I will be doing PDP's like I did in the past. I do not plan on spending my January, February, March and April fielding Part D questions and problems 8 hours a day. Nope, not doing it, especially since I am not getting paid.
 
The question at hand- what IF commission go to zero. What do we do?
We are all at different stages of our career. If I am at the beginning/middle stages of my career and building and growing my biz, I would handle the PDP.
I am at the later stage of my career. I am not in growth mode. There is no way that I will be doing PDP's like I did in the past. I do not plan on spending my January, February, March and April fielding Part D questions and problems 8 hours a day. Nope, not doing it, especially since I am not getting paid.
Who the heck spends 4 months dealing with Part D questions?
 
You will be spending 4 months dealing with Part D questions and problems and upset clients next year. Bank on it.
 
I guess I've always done it different than most. I start notifying clients in late August/early September that AEP is around the corner and we need to update their medication list. And for those on MAPD, I add in updating their doctors. The majority get me this information prior to October 1st. On October 1st, I begin running comparisons. The goal is always to have everyone's recommendation to them by October 15th (doesn't always happen, but that's the goal). For those who need to make a change, they typically get a link to electronically sign their prefilled application (Ritter's system makes that very easy).

I touch the majority of my clients during AEP which means I am "shopping" greater than 70% of my book each year. A lot of times, on the MAPD side, it's:

"Mrs. Jones, unless you just aren't happy with your plan, I don't recommend we change anything".

The only potential difference this year may be:

"Mrs. Jones, XYZ company has made some changes that aren't for the better so I'm recommending ABC company for you in 2025"

But again, I run comparisons for all clients each year to make sure there are no surprises. We're mainly looking for the Rx costs on both MAPD and PDP. Here's just one example. Client is on Neupro. His 2023 MAPD plan was no longer covering that medication in 2024. He was content to stay on the plan until I explained he would then have to pay the full cost of Neupro ($800+ per month). So we changed him to a plan that does cover it. This is exactly why I run comparisons for every client. This man had no changes in medications or doctors. It's easy for the client to think since there are no changes on his end, then he should just stay on the same plan. That clearly isn't always the case. And had he been left to his own devices, he would have stayed put.

All that to say, if 70% want to shop, I won't see any changes to my workload other than maybe having to complete more applications if changes are warranted.
And i do the same . If people happy i don’t move them . And no i never have run medications again if they’re happy on mapd. I’ve not once had one client who was on a plan one yr that kep it that there drugs weren’t covered the next yr . But that changes in 2025 . I’ll have to run all non dual lis drug plans this yr. How do you send a prefilled app ?Ritter is an integrity company now . Is that thru connecture or sunfire?
 
And i do the same . If people happy i don’t move them . And no i never have run medications again if they’re happy on mapd. I’ve not once had one client who was on a plan one yr that kep it that there drugs weren’t covered the next yr . But that changes in 2025 . I’ll have to run all non dual lis drug plans this yr. How do you send a prefilled app ?Ritter is an integrity company now . Is that thru connecture or sunfire?

I’ve had several where a medication is not covered the next year or a medication has moved to a higher tier.

Ritter has a CRM whereby you have the clients info and populate it to an app. Go in and check appropriate boxes and the app and then email to the client to electronically sign. Or you can email a link and have them fill it out. Since their data is already in the system, I choose to refill everything so all they have to do is check the box agreeing to the terms and type their name twice. And this was all prior to them joining Integrity. Nothing has changed since joining either.
 
I guess I've always done it different than most. I start notifying clients in late August/early September that AEP is around the corner and we need to update their medication list. And for those on MAPD, I add in updating their doctors. The majority get me this information prior to October 1st. On October 1st, I begin running comparisons. The goal is always to have everyone's recommendation to them by October 15th (doesn't always happen, but that's the goal). For those who need to make a change, they typically get a link to electronically sign their prefilled application (Ritter's system makes that very easy).

I touch the majority of my clients during AEP which means I am "shopping" greater than 70% of my book each year. A lot of times, on the MAPD side, it's:

"Mrs. Jones, unless you just aren't happy with your plan, I don't recommend we change anything".

The only potential difference this year may be:

"Mrs. Jones, XYZ company has made some changes that aren't for the better so I'm recommending ABC company for you in 2025"

But again, I run comparisons for all clients each year to make sure there are no surprises. We're mainly looking for the Rx costs on both MAPD and PDP. Here's just one example. Client is on Neupro. His 2023 MAPD plan was no longer covering that medication in 2024. He was content to stay on the plan until I explained he would then have to pay the full cost of Neupro ($800+ per month). So we changed him to a plan that does cover it. This is exactly why I run comparisons for every client. This man had no changes in medications or doctors. It's easy for the client to think since there are no changes on his end, then he should just stay on the same plan. That clearly isn't always the case. And had he been left to his own devices, he would have stayed put.

All that to say, if 70% want to shop, I won't see any changes to my workload other than maybe having to complete more applications if changes are warranted.

Do you review plans for people who don't reply with an updated list? i.e. everyone, even the "dis-engaged?"
 
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You will be spending 4 months dealing with Part D questions and problems and upset clients next year. Bank on it.
Not going to happen.

Especially if you do it properly.

Sell them "estimates" and you're in for a ride... Answering questions about stuff you shouldn't have said.

Stick to the summary of benefits and you're golden.

Post-AEP: "Yes, John, your Eliquis was Tier 3 - just like we discussed: 25% coinsurance. After $545 deductible. They wanted $670 @ CVS? Sounds about right."

During AEP: "No, no no... I do not know what they're going to charge you for it. It'll be 25%. If Eliquis is $100 (it's not), you'll pay $25. If it's $1,000 - you'll pay $250. After the deductible, of course."

"What was that? No... I don't have a better option. Did you want to enroll? Or would you prefer your current plan which will have you pay 40%?"

Not saying I get no calls, because I do, but not a lot. I rigidly stick to what I can rely on - the SoB. And when they try to bring up other stuff (remember Cigna showing everything low estimates on MCGov last year?) - I simply point to facts.
 
You will be spending 4 months dealing with Part D questions and problems and upset clients next year. Bank on it.
Maybe you're more referring to higher premiums. That might be an issue no matter how we slice it.
 
You will be spending 4 months dealing with Part D questions and problems and upset clients next year. Bank on it.
Nah.

No ID card by 12/15, they better email me.

Switching plans? Get everything filled the last week in Dec. January in a pharmacy is full of grumpy and sick people


Every client gets a printout. The only calls I get is when an all generic person is suddenly paying the deductible.

I respond with “so they put you on something fancy and expensive”?

Client: “Oh yeah, you told me this could happen”

And anyone who enrolls in the cockamamie payment plan will do so against my advice.

You do it right in Oct/Nov and eliminate those calls in 1st quarter
 
Nah.

No ID card by 12/15, they better email me.

Switching plans? Get everything filled the last week in Dec. January in a pharmacy is full of grumpy and sick people


Every client gets a printout. The only calls I get is when an all generic person is suddenly paying the deductible.

I respond with “so they put you on something fancy and expensive”?

Client: “Oh yeah, you told me this could happen”

And anyone who enrolls in the cockamamie payment plan will do so against my advice.

You do it right in Oct/Nov and eliminate those calls in 1st quarter
That’s the difference . In 2025 all tiers could have the deductible . Unless you talk to every client ( even if you do ) the calls will be nonstop in January . Joe Biden didn’t understand with the inflation reduction act carriers never lose . The $2000 max moop screwed 80% of the rest who never hit over $2 k . Now the 50% of Medicare beneficiaries who had little to no out of pocket will have significant out of pocket in 2025 .
 
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