Inside the Industry: Getting Involved with the Formal Medicare Bulletins to CMS
Inside the Industry is a recurring video series hosted by AgencyBloc to take an insider's look at the health, group benefits, and senior insurance industry. Learn more about what's happening right now, what it means for your agency, and how your team can stay ahead of these changes.
Transcript for the Episode
Note: AB denotes Allison Babberl, and CB denotes Calvin Bagley.
Allison Babberl: Welcome, everyone. Thanks for joining us for another edition of Inside the Industry. Again, I'm Allison Babberl, Content Marketing Manager here at AgencyBloc, and I am joined by a new guest, Calvin Bagley. He is the founder of Nuvo Health. You're out in California, right Calvin?
Calvin Bagley: I am in a suburb of California called Las Vegas. You've heard of that suburb? We're like a suburb of LA.
AB: Okay, yeah, I've heard of that place, too. You know what, I feel the same. I'm in Iowa, and we're kind of like a suburb of Chicago at this point, or Minneapolis, depending which way you want to look at it.
CB: Well, I lived in Chicago for a while. It's a great city. I love Chicago. It is windy and cold.
AB: Very windy, but it is a great city. Well, thanks so much for joining me, Calvin. I know there's been a lot going on this enrollment season, definitely one for the books, a lot of different things coming out, a lot of things to keep up with. Just all the news bulletins going out is just pretty crazy. But one of the things I wanted to talk to you about, I know you've been really involved with these bulletins coming out. I think you and I were talking, we're up to almost 10 states now with these bulletins they're putting out to the carriers about the choices they have made here in the enrollment season. Do you want to explain more about these bulletins and what they mean?
CB: Yes, I would love to. you know, we are in the middle of AEP, middle, you know, to maybe two thirds in. And we're at the point right now where, pretty soon, based on history of the last couple of years, we're probably going to get the Final Rule for 2027 very soon. So it's kind of crazy to think that that could be happening any minute. And I'm hoping that these bulletins have some impact on that, even though it's very last minute here. But what's happening with the states is it started with the state of Idaho, which is, I'm very proud to say, my father-in-law lives in Idaho and is very involved in what's happened there as well. So very happy with his influence and others up there. what happened in Idaho is that some of the insurance agents there were able to finally reach the Department of Insurance at a level to show what's happening with choice for seniors that seniors don't have choice if they can't find the plan. They don't have choice if the plan is suppressed, by removing plans from platforms, etc. And so, when the Department of Insurance in Idaho finally caught this vision and understood what was happening to the market there and the seniors weren't getting access to insurance plans through these tactics, they realized this is a problem and they issued a very, very strong statement. It was it was a cease and desist, which is by far the strongest statement that we've seen from states that said that insurance companies needed to make sure that access of their plans was available to seniors. When we saw that, I'm part of the Medicare Advisory Group the Council of Advisors for NABIP that direct NABIP on on Medicare policy nationally, and when we saw that, we said this is a great opportunity. First of all, we were so excited to, with the local NABIP branch there and the local NABIP group in Idaho, help make this happen. Let's take this out to everybody. Let's get the word out as much as we can and let's help other Departments of Insurance through our local chapters see what is happening. And other states have now joined. You know, it was one, then it was two, then it was four, then it was five, and now it's close to 10 that have come on board. Now, the other memos have not been as strong in their wording as Idaho. Instead of cease and desist, you know, type of language, it has been more of a memo and more directional saying, hey, this is the we're keeping an eye on this. That it's not permitted to suppress plans in these ways, etc. And so they're not as strongly worded, but they still have major impact because it's showing this united, you know, group of insurance commissioners that are seeing that choice is being limited to seniors.
AB: And I think some of it's a little difficult because each state, correct me if I'm wrong, each state has slightly different laws about whatever it is that has to do with insurance. So not every state can replica exactly what Idaho has done with the cease and desist, depending on their laws. I've heard many other states from different people, part of different NABIP, regional ones or local ones, state-based ones that they can't do the exact same thing as Idaho because of X, Y, or Z. So they're going at it in different ways. But why is this so impactful for the Final Rule coming up with enrollment season ending? Is it going to get extended? Why is this so impactful?
CB: Well, first of all, it's an attention campaign. We were trying to get attention to something that's really, really important. And to have multiple Departments of Insurance and insurance commissioners now speaking out says, hey, this isn't about agent's compensation. This isn't about agents getting paid. This is about what it's always been about, which is choice for consumers. Listen, we have incredible insurance partners, and we've had longstanding relationships with them. They're going through tough times and having some challenges, and we understand that. We understand where they're coming from. But ultimately we have to put the seniors first. And that's what this is about. And it's getting that attention to say, hey, this is a problem. Yes, agent compensation is one of the levers that's being used, but the issue is not the lever, it's the result, access for consumers. And so getting that attention is massive. It brings the attention to legislators, it brings attention to regulators at CMS and others to say this is a problem. Now there is some discussion and some concern about, and I hear a lot of people saying this, well you know Medicare Advantage is a federal program administered by CMS, aren't the state DOIs somewhat powerless? Is this just pomp and circumstance? Is there actually going to be any change affected by this? And I would say absolutely there will be change because again it's about the attention to it. And, you know, if it comes down to a question of whether or not states have authority in this situation, that ultimately is not what I'm concerned about. What I'm concerned about is increasing the visibility to the problem that we're trying to solve here.
AB: And taking care of our seniors. The senior population we know is a very, very large population. And they're nervous. They want to make sure they have the right coverage. They're getting older. I have parents in the Medicare space, and I would assume you do too, unless yours are very, very young. But they're in that space, and it's scary not knowing what insurance is covering and if they don't have an agent, it's just a hard place. So the more we can do to protect them and make sure they have the plans they need to walk into this next phase of their life is really, really critical.
CB: Well, here's what's happening right now is something that we haven't seen since Medicare Advantage started. We are in a situation of contraction rather than expansion. And so a lot of the rules that have been written, especially by CMS, are about expansion. Manipulation of the market because of expansion. And so there isn't a lot that's been done about, what about manipulating the market in a situation of contraction? Five years ago, there were 6,100 prescription drug plans available in the United States. Now, there are 363. In just 5 years, 6,100 to 363. So this massive contraction, the average consumer now, a person with Medicare, has access to 8 prescription drug plans. It used to be, I look back to when I was sitting at the kitchen table with people and helping them with their Medicare insurance, itt was 70, 90 prescription drug plans. 8 is what most people have access to. And if you can even find them, and if they're all suppressed, and on quoting and enrollment platforms, you can only find two of them? This is a massive crisis in choice, and it's not something that CMS has seen since prescription drug plans, and since the Modernization of Medicare Act came into existence and brought about Medicare Advantage and prescription drug plans. We've never seen anything like this, and so, that's really the message that the Medicare Advisory Group at NABIP and others, we put together this whole document with some ideas and thoughts on legislation and things that we're advancing towards both to our legislative partners and to CMS. And I can't go into all the details on what that is because we're rebuilding it and we want to formally announce it and what have you. But I do want to say that there is work, real work being done behind the scenes because CMS has not seen this type of situation before because we've always been legislating for bad actors in expansion, not contraction.
AB: Yeah, that's a really good point. I hadn't thought about the fact that we have been in an expansion and this really is quite the turning point and no one quite knows how to address that. And I think that's a really critical piece. You know, there's so many states that are working on this, whether you're one of the almost 10 states that have put out your own formal bulletin or you're one of the many states working on it, but how can agents throughout the country, whether they're involved with NABIP or not, how can they get involved? How can they help fight this good fight to make sure our seniors are taken care of and the choice is there?
CB: I would say number one is take what has been, and if you don't know what these different things look like, you could follow me, you could follow some of my fellow influencers in Medicare, like Amanda Brewton and others. We are trying to get the word out. And we're trying to help everyone to see what's happening. Take the letters that have been issued by other departments of insurance and send it to yours. Because if multiple people are sending this up to your own state Department of Insurance and contact them and share what has happened because it's very challenging when you're labeled as a sales agent to explain how critical these issues are but when you can just send a letter from other Departments of Insurance and I think that I think it's starting to really take fire and be shared but that would help get involved with your with the groups that are advocating on your behalf like NABIP and NAIFA and others because they are also helping to push these up to the State Department of Insurance. So this isn't really a good time to be on the sideline. Everyone should do something. And I always say there's a couple of things you can do. Number one, you can get involved and work directly like I'm talking about sending information to these, you know, Department of Insurance or your local legislator, etc. But if that is not comfortable for you, then the other thing you can do, number two, is at least join NABIP, NAIFA, HAFA, join these organizations and support them with your money. If you can't support them with your voice, at least support them financially, at least with membership, if not more. So that we can continue to advocate. You know, I'm a volunteer with NABIP, as all of us are. You know, I do this out of my passion for the industry and my passion and belief that the independent insurance agent is the best place for seniors to receive advice on their Medicare. And so I'm doing this to the benefit of the entire industry, all of my friends, partners, and competitors. So support people like me who are giving by joining your local chapter of NABIP, NAIFA, HAFA, etc.
AB: And start following people. Calvin has got a very big LinkedIn where you post all the time. I have learned so much from following you and people like, just like you in other states, you mentioned Amanda Brewton she's a great one to follow as well. And reshare, share this information, because we all get better when we all have access to that education, just like we all get better when we have a choice. Thank you, Calvin. I really appreciate you coming on. We would love to have you back for another edition of the Inside the Industry. And I hope this helped everyone better understand what is happening and how you can be a part of it. Thanks. Have a great day.
Posted
on Monday, November 17, 2025
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Inside the Industry
- industry news