December National Call – Quick Recap

During our recent National Call, we covered several timely Medicare updates and action items every agent should have on their radar as we close out the year and prepare for what’s ahead. Read below for the quick recap!

• 2026 Medicare Part B Updates
  • The standard Part B premium will increase from $185 in 2025 to $202.90 in 2026.
  • The Part B deductible will increase from $257 in 2025 to $283 in 2026.
  • Please also remember to review IRMAA (Income-Related Monthly Adjustment Amount) levels—those amounts will be higher as well.
• Opportunities Through December 31
  There are still plenty of ways to help clients this month, including several Special Enrollment Periods (SEPs):
  • 5-Star plans like Devoted in many markets
  • Individuals leaving employer coverage
  • Those eligible for the FEMA disaster SEP
  • C-SNP and D-SNP opportunities, depending on the market
• Plan Exits
  Many beneficiaries still don’t realize their plans are ending.
  • You can enroll these clients through December 31.
  • Additionally, individuals affected by a plan exit have a Special Enrollment Period that extends through February 28, during which they have guaranteed-issue enrollment into a new plan.

Open Enrollment Period (OEP) – January 1 through March 31

We also reviewed Medicare Open Enrollment (OEP) and what agents can and cannot do:

• What OEP Is:
  OEP runs from January 1 to March 31, and anyone with a Medicare Advantage (MA) or MAPD plan may make one plan change during this time.
• Who Can Use OEP:
  Only individuals currently enrolled in a Medicare Advantage plan.
  • Clients on Original Medicare only cannot enroll in MA during OEP unless they qualify for a separate SEP.
• What Changes Are Allowed:
  • Switch from one MA/MAPD plan to another.
  • Drop MA/MAPD and return to Original Medicare, with the option to add a standalone Part D plan.
    • Important: If a client plans to pair Original Medicare with a Medicare Supplement, ensure the Med Supp is approved first. Writing the Part D before Med Supp approval can cancel their MA plan. If they are denied Med Supp, they could be left without healthcare coverage.
• Effective Dates:
  Any OEP change becomes effective on the first of the following month:
  • Written in January → Effective February 1
  • Written in March → Effective April 1
• Compliance Reminder:
  CMS has strict rules surrounding OEP.
  • Agents cannot actively market or advertise OEP.
  • You can assist clients who contact you seeking help or expressing dissatisfaction.
  • Clients receive only one election during OEP.

Please reach out to your local DSM or RD if you have any questions or need support.

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