Welcome to another edition of Agility – Word on the Street, our weekly newsletter designed specifically for you, our Key Partners. As the selling season progresses, we’ll continue to share vital insights and trends each week. In this edition, we’ll cover updates to ACA markets and earnings, upcoming training sessions, carrier updates, and, of course, “Riches in the Niches” with a look into the future.
Marketplace Open Enrollment Period Report Shows Changes This Year
On 11/22/24, CMS released its Open Enrollment Report, showing nearly 496K new consumers have signed up for 2025 ACA coverage. This is down from last year’s report of 920K new consumers. Total enrollment numbers so far are 2.5 million, compared to 4.5 million at this time last year.Oscar Adds Baptist Health in South Florida
Starting 1/1/2025, Baptist Health System will be in-network with Oscar. This adds to Oscar’s existing partnerships with providers like AdventHealth and UHealth.For more, visit thePlan Documents section of Oscar’s broker portal.
Georgia Access Introduces Agent Connect
Georgia’s state-based exchange has launched its version of Help On Demand, called Agent Connect! Agents can start receiving leads from the exchange after accepting the Terms of Use and the Georgia Access Acceptable Use Policy. Agents are already generating leads using this program.Contact Producer Support, your Sales Director, or Market Management for assistance.
North Carolina Bans NPN Override
To combat fraud, the North Carolina Department of Insurance has banned the use of NPN override. From now on, all enrollments in North Carolina must use the writing agent’s NPN.Earnings Updates: Aetna, Oscar, and Elevance
Aetna: Anticipates a 10%+ decline in MA enrollment and expects to cut 20–25% of ACA lives.
Oscar: Reports its MLR is trending toward the higher end of expectations. The company is focusing on ICHRA, chronic condition plans, tech-first HMOs, and Spanish-first plans.
Elevance: Reports 30% year-over-year ACA growth but notes challenges in Medicaid and plans to make certain MA products non-commissionable.
Upcoming Trainings
Learn where ACA plans are selling, why they’re thriving in certain markets, and hear directly from carrier reps!
Ambetter: 12/03/24 – 11 AM EST
Elevance (Anthem & Wellpoint): 12/05/24 – 10:30 AM EST
UHC: 12/05/24 – 12:30 PM EST
Oscar: 12/06/24 – 10 AM EST
Commission & Bonus Updates
UHC has increased bonus tiers, now offering up to $75 per member.
CMS Premiums & Deductibles
CMS has released 2025 premiums, deductibles, and coinsurance amounts for Medicare Part A, Part B, and income-related monthly adjustments for Part D.
BCBSTN Eligibility Check
For agents in Tennessee, BCBSTN now offers Medicare and Medicaid eligibility verification in its portal, with additional updates coming soon for Medicaid levels and LIS.
ICHRA Updates
CMS has released the Low-Cost Silver Plan Premium Lookup Table for 2025 to help employers determine the affordability of ICHRA offers.
As we approach a new year and administration, history is poised to rhyme. Here are opportunities to explore:
ACA Brokers Filling Navigator Gaps
During the Trump Administration, ACA Navigator funding dropped to below $10M. Last year, it was $100M. If this budget is cut again, brokers can fill the gap. Focus on areas where Navigators thrive: rural clinics, urban developments, housing authorities, and nonprofits. Establish yourself as the go-to broker!Short-Term and MEC Plans Resurgence
Rumors suggest a return to one-year short-term plans, creating new opportunities. Be ready by contracting with UHOne, Pivot, and Cigna Supplemental Benefits.Hospital Indemnity: Bridging Cost-Sharing Gaps
Premiums are rising for those above subsidy thresholds, likely pushing consumers from Silver/Gold to Bronze plans. Hospital Indemnity and Critical Illness plans can help cover increasing cost shares while offering agents additional revenue streams.
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Thank you for reading! We hope this information helps grow your business and strengthen your partnerships. Stay tuned for more updates in next week’s newsletter.
