How Changes to Medicare in 2019 Can Increase Sales

With over 58 million people receiving Medicare benefits in 2018, and nearly 10,000 Baby Boomers aging into Medicare each day, the potential to increase Medicare sales in 2019 will be unprecedented, but agencies will need to adjust to some changes in the market.1 Agencies can take advantage of these vast sales opportunities by understanding the changes introduced by the Centers for Medicare & Medicaid Services (CMS) and how they may affect 2019 sales in Medicare Advantage, Medicare Supplement (Medigap), and Medicare Prescription Drug Plans.

As the fastest growing market, the spending power of the Baby Boomers can have a direct impact on your 2019 revenue through Medicare sales. Commissions for first-time Medicare buyers increased in 2018 to $455 nationally for Medicare Advantage with prescription drug coverage and $222 for renewals, so you may already be aware of the potential for substantial gain.2 Understanding changes to Medicare in 2019 will help you re-prioritize your sales and marketing efforts and take advantage of new flexibility and efficiency.

Changes Coming to Medicare

The Centers for Medicare & Medicaid Services finalized the 2019 policy updates and changes to Medicare Advantage and the Prescription Drug Benefit Program with the intent of “promoting innovation and empowering MA and Part D sponsors with new tools to improve quality of care and provide more plan choices for MA and Part D enrollees.”3 In addition to changes in Medigap offerings for 2019, current programs facing revisions include Medicare’s Open Enrollment Period, unnecessary limits in Medicare Advantage plans, dual-eligible passive enrollment, Part D Special Enrollment Periods, and Medicare marketing guidelines, among others.

Let’s review five of the biggest changes for 2019:

The Restoration of the Medicare Open Enrollment Period.

With the 21st Century Cures Act, a new Medicare Open Enrollment Period (OEP) will take place from January 1st through March 31st annually, allowing individuals enrolled in a Medicare Advantage (MA) plan, including newly MA-eligible individuals, to make a one-time election to switch to another MA plan or to drop their MA plan and return to Original Medicare. Individuals using the OEP to make a change may make a coordinating change to add or drop Part D coverage. This will eliminate the existing Medicare Advantage Disenrollment Period.

Unnecessary limits for Medicare Advantage Plans will be eliminated.

By eliminating the requirement that MA plans offered by the same organization in the same county comply with unnecessary limits requiring differences among the organization’s plans, CMS hopes to improve plan options for Medicare beneficiaries. This policy will begin with CY 2019 MA bid submissions.

Passive enrollment opportunities and Part D Special Election Period for dual-eligible beneficiaries will be revised.

If a beneficiary’s enrollment is disrupted by changes in a health plan’s participation, CMS will allow for passive enrollment for full-benefit dually eligible beneficiaries from a non-renewing integrated dual-eligible Special Needs Plan (D-SNP) to another comparable plan.

The Special Election Period (SEP) for dual-eligible and Low Income Subsidy beneficiaries will move from from an open-ended monthly SEP to one that may be used only once per calendar quarter during the first nine months of the year. This new policy will also establish separate SEPs that can be used within a certain period of time after a CMS or state-initiated enrollment and within a certain period of time after a change to an individual’s LIS or Medicaid status.

Changes to Medicare marketing guidelines.

In an effort to make it easier for plans to communicate with beneficiaries, CMS is streamlining government review and approval of marketing materials used by plans. CMS is changing the definition of “marketing materials” to only include materials that are most likely to lead a beneficiary to make an enrollment decision.

 Medigap Plan C and Plan F and Medicare Cost Plans will be eliminated.

Due to a recent law that prohibits Medigap policies for newly eligible beneficiaries from covering the Medicare Part B deductible after January 1, 2020, two of the most popular Medicare Supplement policy options are being eliminated. Medigap Plan C and Plan F have millions of enrollees, so if your clients want to retain their coverage but change carriers, they will want to do so before 2020.

Medicare Cost Plans, on the other hand, will not be offered after 2018. Clients with Medicare Cost Plans may have their plans converted to a Medicare Advantage plan by their union or employer group, or they may opt to return to Original Medicare. If they return to Original Medicare, they will want to consider adding a Medigap policy and/or Prescription Drug Plan to their portfolio of coverage.

Agencies that want a competitive edge in Medicare should revise marketing and sales strategies to prepare prospects and clients for these changes, including Medicare recipients eligible for Special Enrollment Periods, or individuals making changes to their Medicare health insurance during the Annual Enrollment Period (October 15 – December 7) or during the new Open Enrollment Period (January 1 through March 30).

Consider these ways to increase Medicare sales in the midst of the changes for 2019:

Become a Medicare Expert

Medicare sales can be the key to increasing revenue in 2019, but success will depend on your understanding of the changing Medicare market and your agents’ commitment to a fluid learning process that requires continued attention to industry updates and annual training.

Compliance – Your agency will have to navigate the laws and regulations that govern Medicare marketing, including the recent changes to the CMS Medicare Marketing Guidelines, and licensed sales agents must exhibit strict compliance with CMS regulations.  The Medicare Marketing Guidelines reflect the Centers for Medicare & Medicaid Services (CMS) requirements for Medicare Advantage, Medicare Supplement (Medigap) and Medicare Prescription Drug Plans and must be adhered to in any marketing materials as defined by CMS.

Trust – Selling Medicare plans for the first time? Encourage your agents to put themselves in the shoes of someone looking for Medicare insurance. Knowledge of plans, benefits, costs, and marketing regulations simply isn’t enough. Agents need to become trusted advisors for Medicare recipients and their caregivers. In an extremely competitive market, the most successful sales agencies build a reputation as a go-to resource in the Medicare arena. Use your knowledge and understanding of recent Medicare changes to strengthen your brand as a leader in the industry.

Expertise – Learning the best lead generation and sales tactics for the Medicare market is important, but in order to close sales successfully and retain those clients, leading to ancillary product sales and referral business, agents need to work closely with clients to help them find the right Medicare insurance plan at the right price. Medicare options, plans, benefits, and costs can be complicated, but at the core of Medicare sales success is the relationship between an agent and client. Agents who successfully prove themselves to their clients will open up the possibility for ancillary product sales and referral business in the years to come.

Use Technology to Increase Medicare Sales

Innovative technology can serve a multitude of purposes. The right solution can streamline lead generation, management, and distribution, and can help you meet your Medicare sales goals in 2019. A comprehensive online solution can help you maintain compliance with CMS regulations, decrease cost per sale, and include a robust CRM and agency management tool.  Specifically designed for insurance carriers and brokerages, customizable online solutions can help optimize operations, automate sales and marketing, and track campaigns. Real-time reporting can change the way you manage your book of business, giving your agents more time to focus on the ultimate goal – selling.

These powerful tools will also allow you to create customer-facing platforms that can integrate a quoting engine with plan comparisons, premium calculators, and application submission capabilities.

One easy-to-use solution focusing on meeting your Medicare marketing and sales goals can change the way an agency operates. It should assist in the sales process and give your agents an edge over competitors in the Medicare space.

Get Involved in the Community

With a level of trust already built into the client relationship, referrals are one of the best sources of quality leads. Keep in touch with existing clients by hosting events to keep them aware of changes in the market. How can you tap into the community of Baby Boomers and seniors aging into Medicare or looking to make a change in their Medicare coverage?

  • Develop a friendly rapport with local senior organizations
  • Participate in fundraising events, recreation center activities, and sponsorships
  • Introduce yourself to local professionals who work with seniors in your area, including financial advisors, lawyers, real estate professionals, and CPA’s.
  • Host informational events in local senior living communities or libraries

Before participating in any events or promotions, please refer to federal, state and local laws to make sure you are in compliance with Medicare-related regulations when it comes to any activities, marketing, or referral rewards programs.

Support Your Agents

Selling Medicare can be challenging, especially if your agency is branching out into this market for the first time. Having an agency’s support can relieve some of the stress on agents venturing into Medicare sales for the first time.

How can an agency make a difference?

  • Provide training and inform agents of required training
  • Manage agent certifications so they can sell specific plans in specific states
  • Contact carriers to request hosting certification courses onsite for agents to attend (when face-to-face training is required)
  • Provide toolkits and guides to help agents navigate the ins and outs of selling Medicare
  • Help interpret guidelines and protocols from CMS and carriers
  • Provide CMS-approved templates for easy marketing
  • Offer a diverse portfolio of plan types to appeal to a variety of client needs

Medicare recipients have an array of different needs, and an agent with a broad scope of products to offer will be better equipped to find the Medicare insurance coverage that is best for their client.

For instance, when first eligible for Medicare, recipients will have the option of choosing to get their benefits from Original Medicare or through a Medicare Advantage plan. Depending on the needs and preferences of an individual client, there are financial and health-related factors that may determine the benefits of one or the other. An agency that sells Medicare Advantage, Medicare Supplement (also known as Medigap), and Prescription Drug Plans will give their agents and their clients more options to choose from.

Take Advantage of Outsourcing

Consider the benefits of using an outside call center to funnel Medicare leads into, allowing your current agents to continue selling the other insurance products they are more comfortable with. Until your onsite agents are knowledgeable enough to sell Medicare products, you may have more overall sales success by purchasing leads and sending referrals from your current agents to the outside call center.

Sales Opportunities in 2019

With Medicare enrollments increasing thanks to the influx of Baby Boomers into retirement, 2019 might be your agency’s best year to date. The potential increase in profits from Medicare sales can be worth the time and effort it takes to embrace new tactics and tools and to understand the upcoming changes introduced by the Centers for Medicare & Medicaid Services. Get started by implementing strategies that will prepare your agents for unrivaled success in Medicare sales in 2019. For more detailed information regarding CMS policy changes and updates, visit www.cms.gov.


1) The Growth of the U.S. Aging Population; Seniorcare.com; https://www.seniorcare.com/featured/aging-america/
2) Agent Broker Compensation; Centers for Medicare & Medicaid Services;  https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/AgentBroker.html
3) CMS Finalizes Policy Changes and Updates for Medicare Advantage and the Prescription Drug Benefit Program for Contract Year 2019 (CMS-4182-F), April 2, 2018, Centers for Medicare & Medicaid Services; cms.org