In 1997, President Bill Clinton signed the Medicare+Choice bill into law, which led the way to the creation of Medicare Advantage (MA) plans for Medicare beneficiaries. In 2004, only 13% of new Medicare enrollees selected MA plans. But the program has seen sustained growth over the years and is projected to reach 42% of new enrollees by 2028*. With 10,000 Americans turning 65 each day for the next decade, there are great opportunities for the Life & Health sales force to leverage MA plans as a means for agent success.

The MA Basics 📔
According to the Centers for Medicare and Medicaid Services (CMS), MA is an “all-in-one alternative to Original Medicare.” MA plans bundle Medicare Part A, Part B and usually Part D into a single plan. “Some of the plans may have lower out-of-pocket costs than Original Medicare,” says CMS, and “some plans offer extra benefits that Original Medicare doesn’t cover – like vision, hearing or dental.”

MA plans have become increasingly popular with Medicare beneficiaries, and for many reasons:

  • MA premium rates have been steadily declining. A multi-year trend shows MA premium rates have dropped each year since 2015**
  •  For many Medicare beneficiaries, MA plans offer a higher healthcare value. According to CMS Administrator Seema Verma, “… [MA] plans are competing on the basis of cost and quality, driving towards value and increasing choices for beneficiaries.”
  •  Seniors are already comfortable with MA-type products and services. Seniors have a long experience with the HMO and PPO plans hosted by their employers, and they’re internet savvy.
  • Increased number of MA plans being offered. In recent years, MA has added 600 new plans, and the trend is continuing.
  • More MA plans are adding non-traditional benefits. MA plans can now offer many non-traditional benefits, such as at-home grocery delivery, non-emergency medical transportation to doctors’ appointments, or home modifications (installation of air conditioning for beneficiaries with asthma; home renovations for fall-prone elderly)

Myths about MA Plans 🗿
Even with all the advantages of MA plans, myths still exist, which make some agents reluctant to add them to their product portfolio.

Myth #1: Network size and coverage
In the past, beneficiaries were concerned that their doctors and specialists would be excluded from their MA plans due to HMO networks that were limited in size and geographic area. Life & Health marketers can emphasize that in the past five years, MA plans have greatly expanded their networks and service areas.

Myth # 2: Referrals
Some beneficiaries were worried that they would need a referral from their PCP to see a specialist. PPO plans have never had this requirement, and many of today’s HMO plans are going to “open access” and dropping their referral requirements altogether.

Becoming an MA-Certified Agent 📢
Agents can also be reluctant to sell MA plans because they heard the certification process is burdensome. In reality, Life & Health marketers can reinforce that the path to becoming an MA-certified agent is rather straightforward. Here are the simple steps to follow:

Start your certification process now.

  • Agents can certify now to sell for the remainder of 2020 as well as 2021. The 2021 certification process for most carriers opened in July. Remember, agents can begin to sell MA plans on Oct. 15 for an effective date of Jan. 1, 2021.

Agents find carriers that are competitive in their markets.

  • Agents can work with their Marketers to determine what carriers are available in specific markets.

Agents can complete their carrier contracting with instructions on Agent Xcelerator®.

  • Remember, agents, can’t sell a carrier’s MA plan without a contract. Allow 7 – 10 business days for a contract to process before you can certify.

Prepare and train to become certified.

  • Most major carriers require agents to take Medicare 101 and FWA courses administered by America’s Health Insurance Plans (AHIP). But before agents begin the AHIP testing, they should spend time re-familiarizing themselves with Medicare overall, as well as with the specifics of MA plans. Agents can find the information on Medicare Basics on Agent Xcelerator.
  • This site will take agents through the ABCD’s of Medicare, the differences between Med Supp and MA, PDP features, and processes for appeals, grievances, and penalties; it has all the information agents need to obtain a basic understanding of Medicare.

Sign up for the AHIP test

  • This test has five modules on topics, including ethics, compliance, fraud and abuse. Each module ends with a quiz. After completing all five modules, agents need to take a 50-question test, which requires a score of 90% to pass. Agents have three attempts to pass the test and should budget 5-6 hours to complete the modules and the test.

Take carrier-specific training

  • Once agents have passed the AHIP tests, they can go to the individual carriers to take the plan-specific training, which includes content on plan information, carrier marketing rules, instructions on how to submit business, and how to market.

Compare plans and submit business

  • Now it’s real – agents have contracted with a carrier and passed their tests to become certified. It’s time to sell.
  • Agents contracted have access to a robust set of tools on Agent Xcelerator to help them with the MA enrollment process, including:

• Quoting tools – which allow agents to compare all the MA plans in their areas.
• Enrollment tools – which provide agents the ability to electronically enroll beneficiaries in an MA plan using a digital signature either in person or via email (a very useful way to practice social distancing).

Is MA Worth the Effort? 🎁
Absolutely! The trends all point to MA’s continued growth and popularity with HHS and CMS leadership advocating for regulatory changes, the steady demographics and the positive health outcomes for beneficiaries.

Beneficiaries are going to want to work with agents who provide complete Medicare solutions. Life & Health marketers can make sure their agents are well prepared and ready to start a successful AEP by guiding them through the certification process.


*A Dozen Facts About Medicare Advantage in 2019; Kaiser Family Foundation Gretchen Jacobson, Meredith Freed, Anthony Damico and Tricia Neuman; June 6, 2019

**Kaiser Family Foundation analysis of CMS Medicare Advantage Landscape and Enrollment Files, 2010-2019; “Medicare Advantage premiums continue to decline while plan choices and benefits increase in 2019,”; September 28, 2018