Agent Questions Going into the 2026 AEP & OEP & Our CEO's Answers!

Yes, in short, there are no changes when it comes to HSAs and Medicare.

Someone with a high-deductible employer health plan and HSA cannot contribute to it if they have Original Medicare. The employer also cannot contribute to it on the employee’s behalf.

In short, there are no changes when it comes to HSAs and Medicare.

The House-passed 2025 Federal Budget Reconciliation Bill, also known as the One Big Beautiful Bill, proposed lifting the HSA contribution restrictions for people entitled to Medicare Part A by age. However, this provision did not make it into the bill passed by the Senate in the summer.

When an insurance carrier terminates a Medicare Advantage (MA) plan, members get a Special Enrollment Period (SEP). During it, they can either join a new MA plan or return to Original Medicare and enroll in a prescription drug plan (PDP).

They may also qualify for a guaranteed issue (GI) right to enroll in a Medicare Supplement (Med Supp). This means they wouldn’t have to pass underwriting, which is what your question is getting at. That GI right means three things:

1. The company must sell you a GI Medicare Supplement plan.
2. It has to cover your pre-existing health conditions.
3. It can’t charge you more for the plan due to your health status.

The MAPD members getting termed could go to Med Supp Plans A, B, D, G, or even C or F if they qualify. Insurers can’t stop someone with a GI right from enrolling in a GI plan, so we could see related rate increases there.

Insurers can’t stop someone with a GI right from enrolling in a GI plan, so we could see related rate increases there.

As for a Plan Z… Med Supp plans are standardized across the United States. The federal government would need to create a new plan letter first. Then, carriers could then decide if they want to offer it or not.

Yes, the Departments of Labor, Health and Human Services, and Treasury issued a statement in August. They announced they’re rethinking the definition of “short-term, limited duration insurance.”

Basically, they said they wouldn’t penalize insurers for not meeting the current definition. It’s up to the states as to what insurers can offer right now.

Some states have relaxed their guidelines, allowing plans to return to 12-month or tri-term plans. Currently, Pennsylvania is mostly following the 3+1 month extension short-term medical (STM) model from last September. Pivot Health has some PA STM plans approved for a six-month and one-year duration.

Currently, Pennsylvania is continuing to follow the 3+1 month extension short-term medical model from last September.

Reading between the lines, I’d say the PA DOI’s stance is that STM plans are riskier. That they don’t provide the value and protections of the ACA.

Now starting in 2026, more individuals will qualify for a hardship exemption allowing them to purchase a catastrophic plan. This will be important in states with the shorter-duration STM plans.

Beneficiaries, even those 30 years old or older, who lose eligibility for cost-sharing reductions (CSRs) or the Advanced Premium Tax Credit (APTC) can join a catastrophic plan. These plans offer some first dollar preventative coverage and lower premiums than Bronze plans.

The pilot program, known as the WISeR program, will operate in New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. WISeR stands for Wasteful and Inappropriate Service Reduction.

It will run for the next five years, from January 1, 2026, through December 31, 2031. People with Original Medicare will see prior authorization apply to 17 services. These are services where the government has already found evidence of fraud, waste, and abuse.

CMS is hoping that AI will sort prior authorization requests more efficiently and cut down on fraud. They’ve stated licensed clinicians will still have the final say in decisions, protecting members.

I think there’s value in CMS eliminating fraud in traditional Medicare. It not only benefits the program itself, but also, the private Med Supp market. Med Supp carriers are seeing fraudulent claims, which contribute to the larger premium increases we’re seeing.

The main incentive I see CMS offering AI companies to cut Medicare costs is a government contract.

Apps done in the past or outside portals will show as unlinked policies in IntegrityCONNECT. However, applications submitted directly through IntegrityCONNECT should automatically link to the client record in the platform.

I encourage agents to submit applications through the Integrity platform for the best client and policy management. There are a lot of exciting developments occurring now and for 2026. I believe they’ll really solidify IntegrityCONNECT as the best CRM for insurance agents and agencies!