The annual enrollment period for Medicare Advantage plans and Medicare Part D prescription drug plans for 2026 started today and is set to run until Dec. 7.
For employers and their benefits advisors, suspense over just how much chaos will, or won’t, occur could add to their overall level of stress.
Medicare basics: Employers use Medicare Advantage plans to provide health benefits for 5 million of their retirees, according to Urban Institute analysts.
Medicare Advantage plans of all kinds cover 35.4 million of the 69 million people eligible for Medicare, and stand-alone Medicare drug plans pay for prescriptions for 23 million Medicare enrollees.
Because Medicare plans make up such a big part of the U.S. health care finance system, any turmoil at Medicare could lead to turmoil for employer plans, by distracting health insurers, distracting policymakers in Washington and leading hospitals and other health care providers facing Medicare patient revenue cuts to try to increase the prices employer plan participants pay.
The history: A year ago, Medicare plan providers and brokers were coping with the effects of tough new reimbursement rules, Medicare prescription drug plan benefits rule changes, and an aborted effort to restructure agent compensation.
The enrollment period ended up being confusing and busy for consumers and their agents, but overall enrollment increased, and some brokers said consumers’ need for professional advice helped them attract customers.
This year: The Centers for Medicare and Medicaid Services, the agency that oversees the Medicare program, eased Medicare plan funding constraints slightly.
Some issuers, including Centene, seem to be keeping Medicare plan menus stable.
But some health insurers, including Aetna, Cigna and UnitedHealthcare have ended sales of Medicare plans in some communities or zeroed out the broker commissions because of worries about high enrollee claims.
Meanwhile, the federal government has shut down. CMS says it’s protecting Medicare enrollment operations against the effects of the shutdown, but some enrollment watchers fear there could be gaps in the protection.
The National Association of Benefits and Insurance Professionals, the National Association of Insurance and Financial Advisors and other advisor groups have joined to plead with CMS to stabilize plan issuer agent and broker commissions, to keep issuers from cutting sales by depriving consumers of professional help with coping with all of the expected upheaval.
If CMS has problems with supporting the Medicare enrollment period, that could be a sign that it will have trouble supporting the Affordable Care Act public exchange plan annual enrollment period, which will run from Nov. 1, 2025, through Jan. 15, 2026, in most states.
ACA exchange plan enrollment woes could hurt employers efforts to “give workers they can use to buy their coverage” through individual coverage health reimbursement arrangements and qualified small employer HRAs.
Surveys: About 75% of 1,500 Medicare enrollees polled by eHealth, a web broker, say shopping for Medicare plans is confusing, and 80% fear that choosing the wrong plan could hurt their financial wellbeing.
Medicare enrollees’ frustration could have hard-to-predict effects on elections and state and federal health policy: About 61% of 931 people ages 65 and older polled by SeniorLiving.org said they expect government policies to “somewhat harm” or “strongly harm” their personal health care.
Strategies EHealth, GoHealth and other web brokers are trying to help consumers cope with change by adding high-tech tools.
GoHealth, for example, has introduced PlanGPT, an AI-powered plan selection tool.
SelectQuote is emphasizing that it still has live agents who can talk on the telephone.