What's Happening in Ohio as a Result of CMS

Here’s a simplified breakdown of what’s happening in Ohio with Medicare Advantage plans, why it's causing problems, and what insurance agents can do to handle the situation:

What’s Happening?

Medicare in Ohio: There are 2.5 million people in Ohio who use Medicare, and over half of them (about 54%) are enrolled in Medicare Advantage (MA) plans. These plans are private insurance alternatives to traditional Medicare, often offering additional benefits like dental, vision, and prescription drug coverage.

Changes by Insurance Companies: Two major insurance companies, Anthem and Medical Mutual of Ohio, have decided that insurance agents can no longer use their usual electronic tools to submit and present these plans to customers. This happens just three weeks before the end of the Annual Enrollment Period (AEP), the busiest time for signing people up for next year’s coverage.

Impact of the Inflation Reduction Act: At the same time, the government has introduced changes under the Inflation Reduction Act that impact healthcare. With all this happening at once, many seniors are finding it harder to get the help they need to make informed decisions about their healthcare.

Hospital Negotiations: Some hospital systems are in negotiations, warning seniors that their current doctors and hospitals might not be covered under their MA plans next year. This adds another layer of stress and confusion for seniors.

Why is This a Problem?

Confusion for Seniors: Seniors, especially those who are older, may struggle to understand what’s happening. For an 85-year-old, these sudden changes, negotiations, and the limited help available make it nearly impossible to navigate their choices. They may not be comfortable or able to use online tools like Medicare.gov, leaving them to call insurance companies directly—often a frustrating and lengthy process.

Financial Impact on Seniors: These MA plans can save seniors hundreds of dollars each year, so making the right choice is crucial. But without agents guiding them, some may end up with plans that don’t fit their needs or cost them more.

Challenges for Insurance Agents: Agents have traditionally been trusted guides who help seniors pick the best plan. Now, with these restrictions, they can’t use electronic tools to enroll people, which complicates their work. Agents are also losing commissions—money they’ve worked hard to earn for helping seniors. These cuts are happening just before the holidays, making it even harder for agents who have staff to pay.

What Caused This?

CMS Oversight and Carrier Decisions: The Centers for Medicare & Medicaid Services (CMS) oversee Medicare and Medicare Advantage plans. While there are no specific CMS rules that forced these insurance companies to make these changes, it appears the carriers (like Anthem and Medical Mutual) made their own business decisions that limit how agents can operate.

What Can Insurance Agents Do?

Educate and Support Clients: Agents should proactively reach out to their clients, especially seniors, to explain the changes. Offering clarity during this confusing period can help maintain trust and show that the agent is still a valuable resource.

Diversify Services: Agents can start offering more than just Medicare Advantage. For example, they could provide information on Medigap (supplemental insurance) or other health-related policies. This could help recover some of the lost income and provide a wider range of services to clients.

Community Engagement: Hosting local events, seminars, or informational webinars can help agents connect with current and potential clients. These events can be a way to address confusion, offer support, and attract new business.

Build Relationships with Local Healthcare Providers: If agents collaborate with local doctors, clinics, or senior organizations, they can provide better support to seniors during this complex time and potentially create referral networks.

Advocate for Change: Agents should document their challenges and losses due to these changes. Joining with other agents, senior advocacy groups, or industry associations can help push for more fair and transparent practices from insurance companies.

In short, the situation is challenging, but by adapting and finding new ways to support their clients, insurance agents can both protect their business and continue to serve the needs of Ohio’s seniors.