INSIDE THE INDUSTRY HEALTH INSURANCE VIDEO SERIES

The One Big Beautiful Bill for Medicare Insurance Agents with Chalen Jackson

Join Chalen Jackson, Key Accounts Specialist & Compliance Officer for Senior Marketing Specialists, and Allison Babberl, Content Marketing Manager at AgencyBloc, for a discussion about the One Big Beautiful Bill and AEP. We discuss how the OBBB affects Medicare, how agents can prepare for the 2026 AEP season, and where agents can set themselves apart in service and education.

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Inside the Industry: The One Big Beautiful Bill for Medicare Insurance Agents with Chalen Jackson

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 CJ denotes Chalen Jackson.

Allison Babberl: Welcome, everybody. And we're back for another edition of Inside the Industry. Today, I am joined by Chalen Jackson of Senior Marketing Specialist. You're the Compliance Officer & Key Account Specialist over there. And thanks so much for joining me today, Chalen.

Chalen Jackson: Hey, I am so glad to be here, Allison.

AB: Awesome. Well, I know I had Janet Trautwein on recently to talk about the One Big Beautiful Bill and the impacts of that for the group and individual market, but I would really love to ask you because I know you're an expert much more than me. You're big into the compliance side, but what are some of those impacts for the Medicare side. And really, how can we set Medicare agents up for success this enrollment season? Because I mean, I'm sure you've seen it as well. All over media is talking about the One Big Beautiful Bill, what it means, what it doesn't mean, whether it's going to do this, that and the other. And I'm sure a lot of beneficiaries are really worried. So I'll turn it over to you and kind of give us the download.

CJ: Yeah, absolutely. So the One Big Beautiful Bill passed back in July really set in motion a lot of the things we're seeing in the industry now. The good news for the Medicare side is it really caused limited disruption. There were only a couple of key provisions in the One Big Beautiful Bill that directly impacted Medicare. One being the changes to the Medicare Savings Program. So your beneficiaries that are low income qualifying for QMB, SLMB, you folks that are typically dual eligible. There were provisions on the books to start allowing a more streamlined process to enroll in those Medicare Savings Programs, saving a little bit of time and giving them access to those additional benefits a little more quickly.

The One Big Beautiful Bill did prevent that from happening, and it is putting a pause on any of that data sharing and streamlining for the next nine years. So, you're folks that are, yes.

AB: I know a few months ago I talked to John Green and he was talking about how DSNPs, dual eligible plans were becoming, you know, bigger and more prevalent this enrollment season. Is this kind of pulling that back or how does that affect?

CJ: It's not necessarily going to pull it back. It's mostly going to impact people who are new to the program. So folks that are qualifying for the first time for a Medicare Savings Program. There were some plans in place to allow for better data sharing between state agencies and Medicare that would have made that process of enrolling in the Medicare Savings Program a little bit more automated, giving them better access to those dual eligible or DSNP plans a little bit quicker.

So at the end, it's not necessarily going to disincentivize DSNP enrollments. It's not going to make it more challenging. It may slow the process down a little bit for someone who's qualifying for the first time, but it really shouldn't have a major impact on someone who's currently on a DSNP plan, currently enrolled in a Medicare savings program. No major impact to those folks, predominantly just those folks that are new to the program.

AB: That's reassuring, especially for agents to talk to their beneficiaries who are currently on them, because they might be worried and hearing about, that's getting pulled back 9 years. I don't even know if I have 9 years. But you said there was a second thing. That was the first, what was the other one?

CJ: So anytime we have a big tax bill come up, we always look at the receipt at the end and the numbers coming into the federal government. And due to some of those tax cuts and other financial finagling within the One Big Beautiful Bill, it did trigger some future cuts to Medicare known as sequestration. So anytime there's an imbalance or a change in the budgetary process, we do have to have a specific amount of cuts from various federal agencies. Now, what I will say is when sequestration has been triggered by other spending bills, typically Congress comes in and implements some kind of stopgap measure to prevent those cuts from occurring or passes some other bill to make up for that shortfall elsewhere without having to provide cuts to Medicare. So yet to be seen how that will play out in the long run, but right now, technically, there are Medicare cuts on the table to make up for some of those budgetary changes under the One Big Beautiful Bill.

AB: What was that word again? Sequestration? Man, I hope that never comes up in my spelling bee, because that sounds really complicated. Well, what else do agents need to know going into this enrollment season to better prep beneficiaries on what they can expect going into 2026 and looking at their plans?

CJ: Yeah, so I think the biggest thing is all the things that agents should not be scared of. So many of the parts of the One Big Beautiful Bill say the ACA marketplace integrity rule, even some the Medicare rules that we've seen this year, a lot of things have been, the can's been kicked down the road, things that aren't being actually implemented until the end of 2026 or into plan year 2027. So obviously a lot of changes, this AEP massive disruption in the Medicare marketplace. We've seen a lot of skyrocketing Med Supp rates due to increased loss ratios in the Med Supp market. We're seeing a lot of disruption in the MA market with an anticipated 2 million+ service area reductions again this year. So a lot of folks that are going to be forced into choosing a new plan of some kind this year. So it's opportunity in the sense that there's a lot of folks out there that are going to really need the assistance from quality agents that know how to best communicate. And so many of these changes are going to be very confusing to beneficiaries.

So not just the service area reductions, not just these changes to the MSP program that we just talked about, but also things like the end of value-based insurance design, which is similarly impacting that lower income typically, or polychronic community with benefits that they were qualifying for through that value-based insurance design program. Now, many of those may shift over to being offered under SSBCI or Special Supplemental Benefits for the Chronically Ill, but they're going to have to qualify for those benefits based on one or more chronic conditions. So a lot of those specifically, again, lower income or polychronic individuals are really going to have to look at how do I work with my agent more closely this year? How do I make sure I'm not losing benefits, that I'm still in a plan of best fit, making sure that I'm still getting access to everything I deserve? And for agents, it's going to be work that maybe you're not used to doing. Making sure that folks fill out that extra step of that extra paperwork. We're contacting their doctor, making sure that you're communicating to folks ahead of time.

Similarly, we're seeing across the country a lot of plans that are maybe changing around benefits, even if the plan's staying in the market, they're substantially changing benefit designs, maybe zero premium plans that would have a premium next year and vice versa. So if you're an agent that has clients on a plan that's going from $0 to having a premium, making sure you're getting in front of those folks. They may want to roll over and stay on that plan for the following year, but they're going to have to have a way to pay those premiums. And if they have not adequately set that up, think agents that have poor communications with their clients are going to be at the highest risk for large numbers of complaints that we have seen in the past decade. So everything is going to come down to really good client communication. And for the agents that are prepared, that have built a system within their office to communicate effectively with clients, help a large number of people in a short amount of time, I think there's never been a year that has had an opportunity for growth, but you've got to be prepared to take care of the folks you have and make sure you've still got time to accommodate that.

AB: You got to get your tools in order. You know, I think two things you said really stuck out to me. And the first one was helping your clients, right? And I know earlier this year, I talked to Marcie Strouse about the changes with UHC and or just commission cuts in general. I know we keep saying UHC, that was just the first one to come out. That's what everyone keeps talking about, commission cuts, right? That's hard. But I think this is such a great opportunity for agents to come in and showcase their value. Why am I here? Why do you not go straight to Medicare.gov? And it's the education piece, helping your beneficiaries find the right coverage, because otherwise they're just finding it on their own. And it's probably not going to be the coverage they need. And or they're listening to the media and getting the wrong impression or not getting the full story. Nothing against the media, but unless you fully understand this stuff, you're not going to get a good picture. And I talk to my parents all the time. My parents are Medicare age. I don't know about your parents, my parents are old as dirt. And they asked me these questions. Like, you got to talk to your Medicare rep, you got to talk to your Medicare rep, because that is why they're there. That is such a great opportunity to showcase your value here.

And I think the other piece with the tools, a thing that's really coming out this year that I've heard a lot, I know here at AgencyBloc we've talked a lot, I've heard about it in the industry, kind of started last year but it's coming even more, is getting that prescription data. Having that on hand, knowing what your client, your beneficiaries are taking, what are their prescriptions, who are they working with, providers, pharmacies, all of that. Whether you use our tool, Rx Collect, you use something else in the industry, it is so critical to have that information so that you can bring the plans that make the most sense, provide the best coverage for your beneficiaries in a time when they're really nervous, right? And if you're not doing that, trust me, there's a Medicare agent down the street that is happy to come in and do that, right? And we think that's really critical this year as well.

CJ: No, I absolutely agree. I think there's a lot of opportunity for agents to prove just how valuable they can be to a client, not only by collecting that data, providing thorough analysis, really looking at the options and educating folks on why they might choose one plan over another. But I also think there's a big opportunity to value add through those additional products that we like to offer. So whether that's hospital indemnity, critical illness, whether it's taking that time to set up a Q1 appointment to about Final Expense or financial planning, there's a lot of opportunity to work within, you know, color inside the lines that we have as Medicare agents and still make a great living, provide the best possible service to our clients. And, you know, you're exactly right on the technology and systems piece. I tell agents constantly, you know, same on the product side. The right product is the one you're willing to actually show your clients. The right technology tool is the one that you're willing to utilize appropriately and actually integrate with your agency. So there's a lot of opportunity that you know we're definitely hitting a critical mass of get with the program or get out of the business and there's a lot of agents that I think after this AEP they're either gonna say I've got to change something or I've got to figure out a way to retire and that's exciting in some ways because every time that we have had an experience like that in the industry it's been kind of a big leap forward for the industry where we're able to serve beneficiaries more effectively, more efficiently than ever before. So I think we've got huge opportunity going into this AEP to really revolutionize the way we do business with our clients to help even more people.

AB: Yeah, and I love how you touched on diversification, right? Diversifying into other lines of business to help keep all of that with you, right? The stickier your client is, the more policies they have with you, the less likely they're going to move, right? My home and auto guy, he's got my home, he's got my auto, he's got my umbrella, he's got life insurance, like I have so much, it'd be so much work to move. And I also know where he is. He's down the street from me so I can go talk to him in person. And I think, really taking that idea into the health space, the life space, the Medicare space, that's going to bring some great efficiency. So maybe, Chalen, we can have another chat in the future about diversification.

CJ: Absolutely.

AB: I think we'll end it there today. I feel like you and I could probably talk for quite a while about this stuff, but everyone's busy. Enrollment season's nearly here. Thank you so much, Chalen, for joining me today. And we'll see you all next time on the next edition of Inside the Industry.

CJ: Thanks for having me.

Posted on Wednesday, September 17, 2025 in Inside the Industry