Disruption = Opportunity | How Top Agents are Thriving in 2026 | Insurance 360 Ep. 33

AEP, SARs, Commissions & the Future of Medicare Advantage | Insurance360 Podcast
In this special AEP edition of the Insurance360 Podcast, Bob and Rob join special guests, Angela Palo, Jeff Palo, and Nick Palo of the Pinnacle Executive team, in a high-level Pinnacle "Cabinet Meeting" to break down the most critical issues agents and agencies are facing in this year’s Annual Enrollment Period (AEP).

📌 Topics include:
* The fallout from SAR notices and non-commissionable plans
* Medicare Advantage disruption and what it means for agents
* Medicare Supplement (MedSupp) & PDP as key options
* How to pivot with hospital indemnity and ancillary products
* The growing importance of C-SNPs as SEP opportunities
* The 2025 Final Rule: HIDE vs. FIDE explained
* Why technology, AI, and Connect4Insurance are crucial this AEP
* A strong message to agents: "Disruption = Opportunity"

Whether you're an agent, SGA, MGA, or just trying to navigate Medicare chaos — this episode is packed with insights, strategies, and encouragement to help you thrive in this volatile landscape.

Agents: Need help navigating AEP or setting up ancillary contracts? Contact your Pinnacle Sales Director or visit https://pfsinsurance.com

#insurance360  #aep2026  #medicareadvantage #insuranceagents #SAR #csnp  #medicaresupplement  #HospitalIndemnity #Connect4Insurance #insurancemarketing  #insurancepodcast  #pinnaclefinancialservices  #medicarechanges  #fmotraining  #agentsupport  #medicareeducation

Transcript

Bob: Hey everybody. Welcome to another episode of Insurance 360. We're keeping 'em rolling, Rob, it's AEP. We don't care. We have all the time in the world to get things done. 

Rob: Dark day in Philadelphia, though.

Bob: Ah, this after yesterday. This is actually alcohol. Don't, don't, don't tell Angela.

Rob: Dark day in Philly, man. We're struggling a little bit, but, uh, you know what? AEP's around the corner. I'm pretty, I'm pretty stoked.

Bob: There you go.

Special episode today as we're coming into AEP, we're actually gonna do. What I like to coin is, is a really a Pinnacle Cabinet Meeting. You're gonna get an inside look at the Pinnacle War Room as we have really conversations that we're having day in and day out with agents and agencies as we're not only preparing for AEP, but also for 2026 because, of course, we're gonna roll right into OEP and everything happening now is gonna impact the entire year.

So with that being said, we have special guests: Angela, Jeff, and Nick, welcome to Insurance 360. I love the background. I'm gonna say that was my idea to set that up.

Well, welcome to the episode you guys are never this quiet when I'm around you, but... 

Angela: Can't get a word in edgewise so far, Bob. 

Bob: Yeah, I know. All those dramatic pauses I'm having is your turn, just so you know.

Angela: Okay, okay. We got it, we got it.

Bob: Just kidding. Hey, but really we just had our big kickoff event, our AEP championship event and we wanna talk a little bit about that because that was an event I feel like over the last couple of years has just grown in leaps and bounds. We had it at the Kia Center down in Orlando, and if you haven't seen any of the video yet it was really off the hook.

So Ang: this was your brainchild from a couple of years ago. So when we talk about the championship event, we really wanted to take it to be more than just conversations about product, it was really about "how do we grow our business? How do we take agents and agencies to the next level? What were the topics that were important?"

Now I feel like we've come to a point where the speakers are just better than ever. We've got conversations about...

Rob: such a good speaker.

Bob: About marketing and about, AI these days and about technology.

And then of course this year I think it was just off the hook with the opening of the Anthem, with Gabriela. I mean, that was pretty-

Rob: Gave me goosebumps.

Bob: That was pretty- that was pretty exceptional.

Rob: Gave me goosebumps.

Bob: Yeah, and we have to give thanks to Susan, who is one of our key partners down there. She provided our Anthem speaker, right? 

Angela: That's correct. It's uh, her Niece, Milady's daughter. Uh, she's actually on 'Dominican Republic's Got Talent' and she actually got the gold button and advanced right along. 

Bob: Oh, that's, that's great. 

Angela: We were very happy to have her there. 

Jeff: Hopefully that's not a Spoiler Alert or... 

Bob: Has that aired yet? Wait a minute. Wait, is this on?

Yeah. No, that fantastic. And then Don Yeager keynote speaker. Great presentation. I think we got more feedback on that.

I think those keynotes have been great each and every year. This one was no exception , from Don, so he did a great job and there's some video coming on all the presentations here shortly, but you know, as that ends, we grow right into our AEP season and, and there's just tons of changes this year. I mean, it's just been crazy.

So. You know, let's, take us, take us back. I mean, we always get the final rule.

We always talk about what's gonna be new this year and hitting us right in the face, right out the get go is the SAR information. So, you're an agent, you're an agency, and all of a sudden you're finding out that a couple of million members across the country are just gonna lose their plans. So how do we talk about what an agent, an agency should be doing, taking that into account? 

Angela: It's a tough situation, Bob. You know, we had, yesterday, I had conversations with three or four of our support team agents are literally calling in and saying, you know what, I'm not even gonna certify. I don't care.

I'll lose my renewals. It's terrible. So we're trying to turn the conversation around. We're trying to get them engaged with other products, with other conversations. We're trying to remind them there's always original Medicare. There's always that with a standalone PDP. And then next year if MA's back and, and it's the right product, you can help your clients that way.

It's just a tone in the air and it, it's difficult when every time the agents turn around, somebody else is changing the roadmap for them. Uh, we've attended a, a bunch of the agents', parties and they're all excited and, you know, people are happy. And then I got a call this morning, oh my gosh, guys, we were out here three days ago in this change.

So I think for us and for Jeff and Nick's teams. The answer is we're talking, talking, talking every day, and we're trying to give the agents alternatives. Um, we we're not gonna share on the podcast, but we have a lot of things that are gonna be our secret sauce this year that we're offering as special incentives to the agents to help keep them engaged and, uh, we're to help them reach their clients, to help them have these conversations.

So we're doing that here. And Jeff and Nick can share with you, you know, various areas of the country. How the impact is. Like, you know, Nick, when Nick was a sales director, before he was promoted, Nevada was his state. Well, I don't know what the heck they do in Nevada, but it's like they're in a bubble. And Nick, you wanna share how their plans aren't impacted.

Nick: Yeah, their plans are incredible. They still have done a really good job at sustaining, uh, everything in the market out there. Uh, but I have to say this year really is where our role as an fm o has become more critical and ever and working with our agents. The conversations I'm hearing are marketers have, with the agents are just so much more in depth and meaningful and critical to the agents' actual business this year.

Um. Our marketers are the one that have all that product info, all the info on the sars. Um, what's being impacted the most, along with all the products that are going non-commissionable this year. So, um, it's, it's been tough, but it's also, uh, been nice working that closely with our agents and helping them build that marketing plan to kind of get through a year like this.

Angela: So Jeff came from the Northeast before he was promoted, and I think that's like ground zero for agony this year. You wanna expand a little bit, Jeff? 

Jeff: Yeah, the Northeast is, especially some of the, uh, you know, the states like Connecticut, up through Vermont, New Hampshire probably got hit the hardest. It's a shame really, because I think for the second or third year in a row, there's a lot of SAR's as, as comparative to other years before that, but what should have been maybe a banner year to be able to pick up additional business has become more of a down year because of the changes the carrier's made with not making the plans commissionable.

And it's really about adapting, I think, more than anything else. If your area's not gonna have anything available, protect your book as much as you can first, but use some of those skills that we all got during COVID and target some of the other areas of the country that are still good, you know, there's some things like the MMPs going away in a couple of different states that are huge opportunities and I think whether it's a different product line or a different area of the country or whatever it is, right? We all just have to know how to get out in front of it and, and rather than just being defeated.

Tucking our tails and running, get in front of it and figure out a different way to help our clients and help us all keep the money that we were making. 

Angela: So, Bob and I started working together in long-term care. Back then, it was a heyday, 90% commission, 90% issue rate, and it dried up and we pivoted and we're bigger, better, stronger. Way more successful than when we were the top IMO in the long-term care market.

So that's the message we're trying to give the agents. Look, this is not the end of the world, this is actually an opportunity.

You can expand your skills, you can learn new products, you can do more things. You can have three products in the house, and the next year, if the in MA comes back, who are they gonna call? So... 

Rob: Hey, I'm just happy my last name's not PPO because uh, I'd be on the chopping block. That's all I'm saying. 

Bob: And to your point, I mean, it does. Coming from the carriers, they talk about why they're doing some of this, obviously their product profit margins are limited 2 to 4% on MA what they say, and they've made a lot of money over the last couple of years.

But it seems as though they didn't take into account changes. They didn't take into account the COVID burst of people getting services done and the claims exposure.

They certainly didn't take into account the fact that the star ratings were gonna change in where they were getting billions of bonuses that they were required to put half of that back into the plans. At least half of it. They aren't getting that money any longer.

So what's going to give? Carriers making decisions on commissions being cut, carriers are making decisions on plans not being available to be sold and people getting kicked off of plans.

The whole ecosystem is sort of at a reset point right now with a lot of these changes going on. And I think it's, it. It's a great point that you guys bring up that it, it really depends on the area of the country, where certain areas like Connecticut, obviously the provider groups there aren't playing nice with the Med Advantage companies, but in Nevada it seems to be everything's a hundred miles ahead.

So in Connecticut, what are they gonna do? We talk about the other plans, so they go back to What? Original Medicare fee for service? Are they gonna get a Medicare Supplement? Connecticut's lucky, they're a guaranteed issue state anyway. But in most of the country, it's my understanding, they do have some guaranteed issue rights.

Right? They can-

Angela: If it's a SAR they get a guaranteed issue right. 

Bob: That's what I'm saying, and you have other parts of the country, they get a guaranteed issue right.

You wanna talk a little bit about how that works? If it doesn't have to be a state where there is a guaranteed issue state. If they're in a SAR they get a guaranteed issue right so we have to look at MedSupp as an option too now. 

Angela: Absolutely. We went out and lemme tell you, all of our carrier partners were great. We did a little survey and we said, Hey. What's your opinion? How are you gonna address anyone that gets a SAR this year? Are you gonna honor the federal law that says they have a guaranteed right to back to original Medicare?

And each and every one of the companies basically said absolutely, and then gave us like the little twists and turns what made their approach a little bit different, but that's what we're trying to impart to the is an answer.

It might not be, you know, what you wanna hear, but there's absolutely an answer. There is something you can do to help your client and don't lose sight of that.

Last year, it was funny, when Wellcare PDP commissions went away, I'm getting the reports and I'm seeing all these Wellcare plans get sold so I go to these two, "Hey, we're selling a ton of this Wellcare stuff, even though it's non-commissionable. So we survey the agents and they said that's what's right to do for the clients. We're gonna sell it.

But the difference is this year the plans are suppressed. Even if it was non-commissionable, the agents would've probably still sold, but it's suppressed. They don't have access to the apps and that's what changes the game even more this year. 

Bob: Yeah, it makes, it makes it really challenging, obviously, and I, I think it's one of those things where we feel like if we're looking at what the ultimate goal is for not only CMS, but the carriers and the agents we talk about is it what's best for the beneficiary? And if we know what's best for the beneficiaries, having an agent involved in the conversation, why not look at the agent commission as one of those parts of the benefits that has to be built in and factored into the cost.

The plan should be structured around the fact the consultation is a big part and a big benefit that the clients need to make sure that they're in the best plan and that's always been the conversation about best plan for the individual. Right? And that's why we have things like fair market value of commissions, which fair market value. I feel like that's just maximum commissions at this point.

That's not even the standard commission anymore. That's like, "Hey, you can't pay more than this, but you can pay anywhere from nothing to that" and we're seeing all across the board that happening.

Jeff: Yeah. The fair market value, which if you think about it comparatively to other products, it's one of the best things that, that you've seen in terms of fairness for the agent, for the beneficiary because there's no incentive, or at least there had been no incentive to look at anything other than what the best plan is because everybody was paying you the same.

So I think getting away from that may hurt, some of that fairness that was supposed to be building with that, but for the first time in a lot of years you're seeing plans have somewhere in the middle, right? Not just care market value or non-commissionable.

I think it's, at least half of them at this point have certain options that are, anywhere from keeping it last year's rate all the way down to half of the rate.

Even on the new to Medicare plans with some of the carriers, they're keeping them at the renewal rate so it's a lot to try and keep track of where it was something that agents didn't really have to think about before and we're hearing that it's a one year thing and it's not supposed to be a trend for the future, but, you know, it's, it's definitely something that we all need to keep an eye on even as we get into AEP, right?

Because things change all the time right up until, Monday I think we had one of the other carriers change their commissions. 

Bob: Exactly, and this is what's crazy. I mean, we do these trainings all the time and Rob, you, you know this, we have all these trainings, the agents attend all the training, the agents that are ones that are the licensed certified individual, they've been doing this for years. They're the number one place you would want any family member to go to.

You know, it's great that the disclaimer says, Hey, call medicare.gov, call your ship counselor, but God love, some of the ship counselors- they wanna do a good job, but they don't have the expertise and the experience that you.

An agent's gonna have in doing this, trying to call medicare.gov you think 45 minute hold times, wait till this year when you can't get anybody on the phone. That's gonna become irrelevant at this point. Think about Medicare plan finder. We use the services through our Connect4Insurance, but Medicare Plan Finder? Try and send somebody there and try and find whether your doctor's in network. That's not even part of it, you need an agent to be able to do that. What's the 80-year-old client of yours Gonna call every insurance company. So when you talk about Plan Finder, I mean we know that's been a mess for the last couple of years, but we're using our Connect4Insurance and this is where I think the agent has up to give the best possible option for each individual's circumstance, right?

And that's what we train our people to do.

Angela: One of the big issues, too, when you go medicare gov? The drugs. What plans have deductibles? What plans are gonna cover your drugs and all that? It's a nightmare.

Navigating those waters and picking your election period. I have somebody that is a family member that went ahead and enrolled themselves and picked the wrong election period, and that person graduated Summa Cum Laude from college. It still confused them. 

So Bob you mention 80 year olds, it's not just unique to 80 year olds, it's confusing at any age. 

Jeff: Yeah, and I don't think what Bob said can be understated too in terms of the volume- you know, how long it took before and the volume versus what it's gonna be this year. I mean,

Angela: Absolutely.

Jeff: Some of the carriers I heard have upwards 85% of their enrollments coming from field agents.

Angela: Plus, how about where you have to have your MA match your Medicaid plan? If they pick the wrong plan because they don't know that and then come January they don't coordinate. So it's just a nightmare, and the agent has become pivotal and they need to have a voice and they need to speak up.

My point about the Wellcare story is the agents will do the right thing.

Let them.

Let them get in front of their clients and let them help them. 

Bob: From the agency perspective, they're always doing what's in the best interest because if they're helping their individual, they're not just trying to make the sale. Right? Yeah. We talk about the field agent, that's not the traditional call center. Individual that's just trying to make a sale that's not an insurance company, where they're only promoting one carrier.

This is the total package when you're working with the individual insurance agent and we get the insurance agents calling here all the time, and we're doing tons of trainings on every product with the best possible outcome is for a client without having a conversation with the individual, how are you supposed to know what that is?

Right? 

Rob: Yeah, and with all the moving parts, there's a lot of stuff, I mean, in the office, I sit next to our support staff and you, you can only imagine some of the calls that they're getting from distraught agents, like, "Hey, what do I do?" I mean, I'm talking to a lady yesterday and she's like, (I'm not gonna name the carrier, but) "they're getting cut off of their plan. They don't qualify for Medicaid is what they're saying, but they do qualify and it, there's just all of these things and it's like, what can we do not just as brokers, but as agents to be able to help these people?

And I think the trenches are gonna be dug very deep this year and hopefully, like Jeff said, it's, it's not gonna be a trend. We're hearing what, 2027, things might start to settle down once some of these things have come into play, but... it is gonna be rough out there. 

Angela: You have to speak up. We talk about NAIFA, we talk about NABIP. Agents have to get involved. We have to speak up and have a voice. I don't want anyone to think the message is, "oh, you have to pay us," that's not what we're saying. The message is "if I'm a professional and I have a job and I'm equitably compensated, I'm sitting at that table. I'm doing what's in the best interest of my client."

And I think that to your point, we're not talking about telesales shops, we're talking about the people that have historically sold across the table. And whether across the table today means they call their client and they do a Zoom meeting, we're still talking about the person that knows their customer. 

Bob: Yeah, exactly.

Angela: If you don't live in the community, you might not know that this hospital is a terrible hospital and you have a seven hour wait in the ER, so a plan might look okay, but they're the little nuances the local agent's gonna know and inform the client. "Well, yeah, you picked that plan. You'll have to go to that hospital, but I know you frequent the ER for this or that." \

So really, that's why the agent is so critical. 

Bob: And we get on our soapbox here on these episodes a lot, but I think it's true, I mean, for the agent, they do a lot of work that they don't get paid for a lot of the times.

I even just look at the government shutdown, all the uproar ballot, government workers not being paid, right? What about their mortgage? What do you think is happening to the insurance agent? Their mortgages are still gonna come due, they have to also provide for their family. This is a business. They should be compensated. Fair market value, the rules are set up to do so.

There's no reason that it, that's not the case, for that to be. So it's still- it's in my crawl that agents not getting paid for the work they're doing. I think it's unconscionable. It's gotta be figured out and we can call this a reset this year, but it's hurting a lot of people and it's ultimately gonna hurt the beneficiary at the end of the day, which is what everybody clamors that they don't want happening, right?

Rob: All the rules that they put into place over the past couple years have been to protect people, right? The telesales shots gave us a bad name, yada, yada, but then with all of the plans being cut, PPOs, the commissions on top of it but then you also see these people that are helpless. Look at Connecticut, they have no plans. How is little Mrs. Smith gonna be taken care of when they have literally nothing available?

So they put all these rules in place, but now with all the suppressions and everything, it counterbalances those rules and at the end of the day even though insurance agents are definitely getting hurt. At the end of the day, the people I think get hurt the most, which is, it's sad. 

Angela: Connecticut has a couple plans, but there's spots in Connecticut that has no plans, but I believe it's New Hampshire that literally has no plans. 

Jeff: Yeah, it has nothing. 

Angela: Maryland has nothing. 

Jeff: Maryland, they just pulled commissions on everything the other day, and it's, it's right what Ang said, it's, it's not about the agents trying to figure out a way for themselves to get paid, it's just that if there is no ability to get paid people will have to do something different to be able to live and then you have less agents out there able to help people, and there's just more lost beneficiaries trying to figure out what to do and not having anyone to help. 

Angela: Jeff's, if I have to take care of my family, what am I gonna do? I'm gonna have to pivot. I'll find another career so who you gonna call? 1-800 Call Center. Then you're gonna have the mess that supposedly Final Rule's been trying to correct for years. 

Bob: Exactly, and let's jump a little bit into, because I think it's important, and we've been talking about it for several years: Ancillary, right?

So, not only are you having individuals that are losing their MA coverage and we gotta look at Medicare Supplements as an option, but just think about what's happening to the plans themselves. So you have plans that aren't as robust as they were before. So the copays and deductibles are higher, but also the supplemental benefits like dental, vision, hearing OTC, they're not where they were.

When you look at options for hospital indemnity, standalone dental, vision, and hearing, these are becoming more important I think, than they ever were because now you're having plans that don't cover as good as they did in previous years because of these cuts. So I know we're making a big push about it, but also our Connect4Insurance does have enrollment capability, which makes it easy for the agents, right?

Angela: That's exactly right. 

Jeff: Yeah. The last few years it had almost become a bidding war from the carriers in terms of the dental, what they were giving people to. Now it's lower than ever, or just back to being preventative and all of these people were used to having real comprehensive dental insurance then in many cases they don't or it's very limited and a lot of the plans you're going back to seeing them having a deductibles built in, which, obviously apply to the hospitalization, which has always traditionally been the biggest cost exposure for people and you gotta figure out a way to cover that for the clients. Thankfully those are things that you can do. Point of Sale with the same scope, right?

They're not outside of those appointment rules, but the agents need to, get comfortable with them, know how to sell them, know how to quote them in the Connect4Insurance.

So they can have that discussion when they're doing that same appointment with their people and not leave them exposed and figuring that out when we get into the start of the year and they start trying to use their plan.

Angela: The irony is if you're in a state like Vermont where there is nothing you don't need a scoop. You don't need a scope to talk about Ancillary products. You don't need a scope to talk about original Medicare.

So if you're there you could go in, you could talk about MedSupp, you could talk about Ancillary you do not even need a scope.

It's ironic that we're losing sight of the fact that you should be visiting your clients today. It's presale for Medicare Advantage.

It's not presale for Ancillary.

It is not presale for Medicare Supplement. 

Bob: We know the selling season for Ancillary Plans. Right?

Does everybody? Did we release that on this podcast already?

Rob: I think we did?

Bob: We did?

Rob: Something about 24 7 or something.

Bob: It's January 1st to December 31st every year is the selling season for ancillary plans. That's my understanding. Am I correct?

Angela: That's correct. 

Jeff: One of our big ancillary partners just announced an increase to their open enrollment, their guarantee issue window on their Hospital Indemnity plans so there's more and more of those opportunities, not less.

Bob: Yeah, and that's a great point with the selling process. 'cause really it comes down to, and Ang, I don't wanna steal your pitch here, but you get to the point of the sale where you talk about the hospital deductible and you, what do you say?

Angela: My pitch. "Hey, remember you signed on that scope that we were gonna talk about this? That's gonna uncover how we're gonna pay for that."

Bob: Exactly, you make it part of the sale. It's just seamless. You can use your Connect4Insurance, enroll right there just like you're enrolling for an MMA plan.

Jeff, great point- the guaranteed issues are pretty high at this point. I think we can go to, is it 79 the highest right now we have for Hospital Indemnity so it's pretty robust where you can actually get a guaranteed issue on a hospital indemnity plan. So everybody can get one of them fit it in your budget.

Nick: One other thing to note for the agents, too, is with the MAs, we're waiting to get paid January 1st. The hospital indemnity and the other ancillary products pay immediately.

Bob: i'd say. That's a great point. We're gonna, we're gonna toast that point.

Get paid now, not next year.

So AEP. It's here. If you don't have your Ancillary contracts set up I don't know what the heck you're waiting for, you better get 'em set up. If you're not sure how to use Connect4Insurance, you better call Rob 'cause he holds trainings on it six times a week.

And get on one of them. You know, everybody wants to know when you can have it. Pretty much every day we have these trainings that yeah, you can jump on and get yourself all trained up on it.

So AEP in most areas of the country, I think we can still say there's a lot of opportunity.

There are some pockets where we're gonna take a little bit of, a little bit of a hit. It's gonna be difficult in some of those pockets.

Rob: I don't think there's a way around it.

Bob: Yeah. I don't think there's any way around it this year, but I certainly think most, in most areas of the country, there's a lot of opportunity, a lot of disruption.

Agents are gonna be busy this year, so we should be prepping and getting everybody ready to go for sure. I wanna talk a little bit about too, because AEP is becoming bigger in another market: The D-SNP I market.

So, every time the final rule comes out, I feel like we just sort of like put our hands over our faces and, peek through about, what's gonna happen on it, but we know the 2025 final rule came out and everybody learned some new acronyms with HIDE and FIDE, right?

So, highly integrated and fully integrated. And we can go a little bit more into that. But the rules now are. In essence, if you don't have a HIDE or FIDE, your D-SNP clients don't have an SEP throughout the year so you're really looking at AEP as the time you can do a D-SNP sale. So do you guys wanna talk a little bit about the impact of that? Because I think it's worth stating how that works. 

Jeff: Some of the agents I've talked to have said, you know, it'll adjust or things go up and down in this world or Medicare, it's not the case with this. If anything, it's going more towards being integrated with the plans, for next AEP 2027: no new dual plans are even going to be allowed to get introduced if they're not integrated.

By 2030, any plans that are still hanging on that are not integrated actually will be removed. So we're on this track, right, and it's. Time to get in front of it and try and be more aware. And it really comes down to what state you're in, what part of the state you're in.

A lot of us have been familiar or not familiar with some of the Medicaid rules in the States, but you really gotta get as familiar with that as you can.

If you're in a coordinated only state like a Connecticut, or I wanna say, Missouri, off the top of my head, those plans do not have any external enrollment period outside of AEP or OEP. You have to do all of your dual sales during that timeframe or else you don't have that LIS enrollment period anymore. So, if you're in states where things are already fully integrated like a New Jersey, right? It's actually the opposite, right? It's a benefit to us as the agents and the clients. It's gone to a monthly SEP. So you don't have to figure out if they already switched or when you're gonna do it, you can put them in those plans all year long.

And then where it becomes confusing is the states and the areas where you got a mix of the fully integrated and the highly integrated and the coordinated only.

So the only real way to know what to do now, what to focus on is to do that research, attend the carrier meetings, call your sales director here.

Figure out what those plans are that are available in your state and which ones are not. But, if anything, we're going more towards being fully integrated and it's about being educated as the agent so that you can help your clients make the best decisions. 

Rob: I'd love to have been in that meeting where they're like, "all right, we're gonna come up with two more acronyms" and highly and fully to me sound very similar, , so why don't you do, you know, fully and kind of 'cause that's what I get, you know, kind of integrated would make more sense.

And I think that- just- the confusion is gonna be crazy until this is settled. 

Jeff: We haven't even talked SSBCI or anything.

Bob: Stop it. Just stop now. 

No more acronyms.

Rob: Q&B Plus. SLMB. Just throw it all on the wall.

Bob: And just to throw it out there for those that maybe aren't a hundred percent on the acronyms when we're talking about. Fully integrated or, the- somewhat in, highly integrated, we're talking about the same carriers for both the Medicare and Medicaid, right? So companies have to go and get state approved for Medicaid and so even in states where it's available it's still limited by what products actually have it, right?

It's not as though you've got 20 companies that have this even as an option in the states where it is an option.

Jeff: The idea essentially is that the carrier on the advantage side of things and on the Medicaid side are one and the same, and actually functionally working together. 'cause really it's saving costs. It's helping coordinate the care for the people better and just providing a general better overall experience for the member, and, it's something they were talking about for a while, and I don't think it was happening quick enough. So last year was let's rip the bandaid off. And now we're dealing with what that looks like in some cases. And actually from what we're hearing, some of the states are fighting this to the point where they may never allow an integrated plan or have that as an option. So it's definitely something to keep an eye on.

I know I said it a few times, but... we're not moving back away from this, we're moving towards it. So better to get the knowledge now and become the expert than become the person that's left behind. 

Bob: And I'm gonna throw the silver lining out there because I think there is some opportunity.

And it's growing and we're talking about the C-SNP, which is a D-SNP product.

We're saying C-SNP is the new D-SNP in that there's an SEP available if people can qualify for the C-SNP product and we're seeing a lot more of them come out from the carriers now and there's a reason for that.

First off, the carriers get reimbursed at a higher amount because those individuals need more care, in essence, right? They're a diabetic, for example, and they need more coordinated care, so I believe the last I heard was on average the carriers get $1,800 per member per month on a C-SNP, where they get, what is it, 1,012 hundred on a traditional MA plan per member, per month.

So they do get reimbursed at a higher level, but. It creates an SEP opportunity and we're seeing a lot more of them come down the pike. 

Jeff: Yeah. Well, and there's just inherently more coordination of care, of control of what's going on with that member. Cost can be saved, benefits are better. They're more tailored specifically towards what that member has the issue with. Where for years it was just diabetic C-SNPS that you saw.

Most of them have become very comprehensive at this point where. It's cardiovascular, it's a lot of stuff built into one plan, so it opens that up for more opportunities for people to enroll in them.

But, it's something that you need to have a little bit more knowledge on because there's a verification process along with it. And it varies by carrier, but you're doing yourself and your client a favor by looking at these and knowing that they're options because. More. More enrollment period opportunity better coverage for the clients, right? Higher benefits.

It's just better all around plan, but you gotta know what's available and how it works so that you can comfortably speak about it. 

Angela: The verification process is critical. We get lists from the carriers and it's the list of the people that wrote a chronic and didn't verify.

Jeff: RFIs? 

Angela: RFIs. So we literally have people assigned on the phone just calling the agents like, "Hey. You know this has to be done or this isn't gonna go through." So it's really critical.

If you're not comfortable, you don't know the process, call your sales director, call our support team. Whatever we can do to help you. The last thing you wanna do is spend the time, see the client, write the product, and then have it not be issued for one little step. 

Bob: Yeah. No, it's a great, it's a great point on the verification process. 'cause you have and have typically about 10 days in my understanding that the carrier wants to get that verification from the doctor kind of done. And if you listen to the last podcast, we talked a little bit about the verification process.

I stole the idea from our last guest, Bobby, but he came up with the idea, which I thought made a ton of sense. I'll throw it out to the group here: we already have products that carriers are already doing script checks on every application that comes in and will issue a final expense plan within four minutes of it being issued. If you're in a diabetic C-SNP and you can verify somebody's on a couple of diabetic meds, can't the verification just get done instantaneously in the same way? 

Jeff: I know on some of the additional benefits they're having to do that as part of the SSBCI this year and all of the carriers to this point that I've heard have a, internal way of doing the verification if the member been part of their plan because they have.

Claims the drug history. So I know it's there as an option. I don't know how we build it into the C-SNP process, but that would be, I would think a great idea for everybody. 

Angela: Yeah. Most of them are saying anywhere from 80 to 90% they can verify without requiring additional information for the SSPs.

Bob: Yeah. And then of course. Use our Connect4Insurance, we talk about training on this- we do a ton of training on the Connect4Insurance, which will show if there are C-SNP plans available in the areas that you are working. These plans will show up right there for you and if you need an SEP and somebody can qualify for it? It's a great plan for those individual clients, and it's a good opportunity to make that sale at that point. So I think everybody, again, get trained up, know the process. If there's a verification that's gotta get done, you gotta know what it is.

Call the sales director, and our team and we'd be happy to go through that.

It is a little bit different carrier to carrier, right? Everybody makes their own process a little bit on that. But... 

Angela: One thing an agent can do is they're. Every year we tell them, check to see if the doctors are the same check to see if the meds are the same. When they do those med lookups ahead of time in the sale, if they see, certain drugs are gonna be diabetes, certain drugs are gonna be cardiovascular certain, then they can say, oh, okay, you know what, let me see if there's a CSN in this area, because they're on the meds.

There's a tip off from their medications for them to be able to look for those plans. 

Rob: And also they started working that into the Connect4Insurance platform. So whichever one you're using, , connector, Sunfire, it actually tells you now those drugs, it'll actually list what they're typically for as well.

So that'll give you an idea. If you are doing that, you're plugging everybody in and you see they're on two diabetic meds. At this point, we know a lot of the main ones, but there is some crazy names for drugs out there, so you know, if you get familiar with it, you're able to also look that way.

Bob: Yeah, exactly. Exactly and I'm gonna go to my resident AI-expert here.

There is a way, Mr. Nick, to use our tools and platforms, to get drugs and to get all that stuff done, right? There's technology that should be getting utilized by the agents to make this as easy as possible 

Nick: if they're using copilot or any of those different tools out there today.

They're the boat big time. The amount of information you can get as quickly as you can from those platforms is incredible. It takes so much time and effort out of your day. It's not even funny. It really is. It's the cheapest, easiest tool for you to have in your tool belt. 

Angela: And we offer an option that gives them a little bit of extra access to that, 

Nick: right?

Yeah. That's one thing that we're probably the most excited about in one of our CRM is our AI automated inbound and outbound dialer. So what this does is, it's AI that will make outbound calls for you. Inbound calls for you. So for instance, you have a lot of clients that need to be moved this year.

This will make outbound calls to them clients and give them any message that you would like to be sent to them. It will schedule the appointments for you. It'll notify them that plan changes are happening this year. Availability and set an appointment directly on your, for you and start packing your calendar for you.

It'll also act as an AI assistant or a virtual assistant for inbound calls. It can basically answer anything that could be answered about Medicare, that you do not have to be a licensed agent to answer. So it won't go into plain details or specific benefits, but if you ask it, you know about Irma or Macro, for instance.

It'll explain everything in detail to the client. If it's something that it cannot explain, it'll schedule an appointment for them. So. We have these different tools available to the agents to make things easier for them and more efficient, um, texting capabilities, all different types of automation. So, uh, another reason to work with your marketers and learn how to use these tools to make your life that much easier.

Bob: Yeah, it working smarter, not harder these days. I mean, it's just true that utilizing the technology, taking advantage of everything that we are offering here. The training and, Connect4Insurance if you need one off trainings, we do them all the time as well. Our sales directors, I think they do screen shares.

Probably 20 times a day, each of them for agents and agencies to get help. You just gotta ask if you're not sure about something, whether it's the D-SNP rules, the C-SNP that's coming out, you know what ha, what do I do with my SAR clients?

There is a lot going on, but there's always a lot going on- maybe a little more this year, maybe a little more. Maybe. I'll give you that. We'll give you, we'll give you a little more this year, but, there's always a lot of moving parts. Lean on us. That's what we're here for. Give us a call, give, send us an email. Get on our webinars, whatever it may be, right, Rob?

Right? 

Rob: Yeah. I mean, look, the key words right, was disruption here. You're gonna hear that, but every time you hear that, you should also think opportunity, right? What's that? That old thing that people would do? Word association. When someone says that, you say that. You think that, and I think everyone just needs to think opportunity.

Don't think about the bad part of it. Think about how you can get around to helping your client. At the end of the day. 

Bob: Yep. No, that's a great point. 'cause that's what the agents are doing out there helping their clients and whatever you need as an agent from the Pinnacle team, lean on us. 

Angela: Can I add one quick thing?

Bob: You can add anything. There you go.

Angela: This year, when we did our event, we always get a huge turnout from our agents. I mean, that's, that's a given, right? But this year we had a huge turnout of agents that were not currently Pinnacle agents. And I got an opportunity, even though I was in a boot, 'cause I have a broken ankle, I had my little stroller there and I was walking out to people and asking them, you know, "why did you come?"

"Oh, I need information. I was hoping this would be the place I could go and learn things." And the agents just really wanna talk to somebody, they wanna do the best job they can do. So, you know, we wanna make sure that we are upfront at there. And one of the things that I think has always made Pinnacle kind of unique, we don't just talk to SGAs. We don't just talk to MGAs, we talk to agent-level agents.

I have this one agent, he calls me, texts me constantly, and he is, probably rates 25 apps a year. I don't care. He's still somebody that is in our hierarchy. So, you know, we wanna make sure the agents understand: we're here.

It doesn't matter what level you are, it doesn't matter where you fall in somebody's hierarchy. If you need something, we are a resource. Pick up the phone, find your sales director.

We'll do whatever we can. Whatever we can. And obviously the fact- I'm the COO, these guys are the sales guys now, right? But I'm telling you, this agent calls me all the time. I'm gonna take those calls.

Kevin takes those calls.

I was in his office the other day. I'm like, who the heck was that? And it was an agent that's been with us for like 18 years.

So, you know, we're gonna answer the phone. We have all the technology in the world, but we also are gonna answer the phone. We're not gonna become medicare.gov to our Agents. 

You're not gonna have to open a ticket. We will talk to you. 

Bob: Absolutely.

Rob: Love it.

Bob: Yeah. Great final words there. Ang, Jeff and Nick. Listen, a lot of moving parts as we're talking about. Glad you jumped on with us for a couple of minutes. I think as we're rolling into the AEP season, we're in presale right now I think it's more important than ever that we're all accessible and I think that's the message today is to reach out to us and we will help you have yet again, another great AEP.

So thank you.

Rob: Cheers everybody. Appreciate you guys.

Angela: Thank you!