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What Has Changed & How It Affects You
Medicare has implemented new regulations that alter how Part D insurance companies interact with agents and brokers. Many of these changes were communicated only weeks before the 2024–2025 Annual Election Period, leaving little time for preparation. Despite our best efforts to adapt, these new rules make it impossible for agents to provide the standard of care that our agency is built to provide for Medicare Part D enrollments and ongoing support.
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Key Changes Affecting Part D Service
- Limited agent/broker access to enrollments: Medicare now allows insurance companies to decide whether to permit agents and brokers to enroll clients in their Part D plans. Approximately 80% of plans have chosen not to allow agent of record for new enrollments in 2026.
- Restricted support for appeals & service issues: Insurance companies may limit or deny agent assistance with appeals for medication coverage, prior authorizations, premium discrepancies, or even simple changes of address. About 80% of insurers have reduced or eliminated resources for agents to service these plans on clients’ behalf. In January, we attempted to coordinate with doctors to submit on your behalf; however, increased denials created an overwhelming burden on many providers, and many requests could not be completed promptly.
- Changes in broker compensation & transparency: Historically, even when compensation was restricted, we continued offering full-service support because our priority is our clients. With these new restrictions across the broader Part D market, we are now prevented from providing the hands-on assistance that ensures your plan works for you throughout the year.
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Highlight: New $2,100 Out-of-Pocket Maximum
Covered medication costs are now capped at $2,100 per year. After you reach this limit, you will pay $0 in copays for covered medications for the remainder of the year. While we support this improvement, it has coincided with reductions in other benefits, a significant increase in medication denials, and extensive limits on agent involvement.
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What This Means for Our Service on Part D
Our company was founded on three principles: (1) help people, (2) use quality, secure products, and (3) provide VIP customer service that clients want to tell others about.
Since the inception of Medicare Part D, we have guided clients through plan comparisons, enrollments, appeals, and prior authorizations with transparency. Our recommendations have always been based on your needs—not insurer contracts.
However, the new rules reduce transparency and prevent agents from providing the level of care and year-round support you deserve for Part D plans.
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