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Navigating Disruption

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Quick Introduction

  • 21 Years in Insurance Industry
    • Medicare / Life & Final Expense / Health Insurance

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  • Branch Manager with United American & American Republic

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  • Joined Agent Pipeline in 2009
    • Work with Agencies to grow at scale

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  • VP of Sales Operations, Agent Pipeline

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Navigating Disruption

  • CAUSE:

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  • Cascading effect of Inflation Reduction Act
  • Medicare Inflation and Utilization increases
  • Post Covid Claims leading to late disease diagnosis, higher cost and worse outcomes for beneficiaries
  • Low Reimbursement rates to MAO from CMS have not kept up with the cost of claims
  • Regulatory environment has not always been industry friendly

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Navigating Disruption

  • EFFECT:

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  • SAR’s:
    • 2025 1.8 Million
    • 2026 2.8 Million
    • 2027 1.7 Million (expected to rise to 2026 levels)
  • Non Commissionable Plans
    • PDP / MAPD
  • Benefit Degradation
  • Fewer Plan Options
  • Carrier focus shifted to profitability over volume

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Navigating Disruption

  • Where to Focus:

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  • 3 Entities that must benefit from every change:
    • The Insurance Carrier
    • The Agent
    • The Consumer
  • If all parties don’t benefit, then none of them do:
    • Profitability
    • Stability
    • Sustainability

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Navigating Disruption

  • Opportunity:

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  • The only constant in this industry is change – embrace it!
  • The market is bigger, the products are better, the technology makes our roles significantly easier… but we complain more!
    • Make an excuse or make a way!
  • The Greatest Rewards Go To the Greatest Risk Takers!
  • Warren Buffett – ‘Be greedy when others are fearful!’
  • Panic is Expensive!

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Navigating Disruption

  • Opportunity:

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  • Imagine the future and then BUILD IT!
  • With Change Comes Opportunity!
  • Grow Fast or Die Slow!
  • Technology changes the WAY we do business, not WHO does business.
  • Today’s disruption is tomorrow’s defeat!
  • “At least 40% of all businesses will die in the next 10 years… if they don’t figure out how to change their entire company to accommodate new technologies.” Cisco Chairman, John Chambers

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Navigating Disruption

  • Medicare Market Growth:

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  • 2007: 8 Million Medicare Advantage Members
  • 2026 35 Million Medicare Advantage Members
    • 41% increase since 2005
    • 2026 51% MA penetration – up from 13% in 2007

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Navigating Disruption

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Navigating Disruption

  • Medicare Market Future Growth:

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  • Congressional Budget Office (CBO): projects 64% MA Penetration by 2034
  • 14,986,000 NEW Medicare Advantage Members in the next 8 years!
  • How many of those new members will work with YOU?!

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Navigating Disruption

  • Service Area Reductions (SAR’s): plans that will not be offered for Plan Year 2027 and members MUST be enrolled into a new plan
  • 1,705,082 nationally currently – more to be reported

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    • Termination letters received prior to 10/1/26
    • MAPD & PDP
    • SEP 12/8/26 to 2/28/27
      • Guaranteed Issue Option into Medicare Supplement
    • AEP Enrollment for 1/1/27 effective date
  • Serve More Members!

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Navigating Disruption

  • Plan Degradation: plans that will see reduced benefits Year over Year

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    • Higher MOOP, Copays, Deductibles
    • Higher Rx cost share, Deductibles and formulary changes
    • Reduced supplemental benefits
    • SSBCI qualification for benefits
    • Narrower networks

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  • Cross Sell: DVH, HIP, Cancer, HHC, STC

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Navigating Disruption

  • Medicare Supplement Disruption: significant rate increases and increased number of anniversary / birthday rule states

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    • Avg. increase nationally 2020 to 2025 – 5% to 8%
    • Avg. increase nationally in 2026– 12% to 26%
    • 16 State Birthday Rule
    • 7 states with additional GI year-round or AEP enrollment window

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Let’s connect!

800-962-4693 ext. 6463

Lester.conn@agentpipeline.com