The Biden Administration has proposed reductions in spending for Medicare Advantage plans, intending to redirect funds towards other healthcare initiatives. These cuts could have significant implications for Medicare Advantage customers, the future of Medicare Advantage plans, and the entire Medicare Advantage market.

The Administration’s proposal would reduce spending for Medicare Advantage plans by 1.25% in 2022. This would translate to an estimated $8.3 billion in cuts for Medicare Advantage plans. The Administration hopes that these cuts will fund other healthcare initiatives, such as expanding home health services and expanding access to long-term care and hospice services.

The proposed cuts would primarily affect the Medicare Advantage market, which is already facing a period of uncertainty due to the pandemic. These cuts may lead to fewer plans being offered, higher premiums, and reduced benefits. This could create particular hardships for Medicare Advantage enrollees, especially those with lower incomes.

These cuts have also led to a decrease in Medicare Advantage plan enrollment. This could be due to the uncertainty surrounding the future of Medicare Advantage plans, as well as the potential for higher premiums and reduced benefits.

The Biden Administration has argued that the reductions are necessary to fund important healthcare initiatives. However, it might be difficult to assess the implications of the cuts without knowing the details of the Administration’s plans. Nevertheless, these cuts could have a significant impact on Medicare Advantage coverage and the future of Medicare Advantage plans.

It remains to be seen how the Biden Administration’s suggested cuts to Medicare Advantage plans will ultimately affect the Medicare Advantage market. In the meantime, it is important to keep a close eye on the situation and stay informed about any potential changes that may be on the horizon. As an agent, you need to understand the effects these cuts may have on your clients’ health insurance policies. You need to know what your Medicare Advantage customers should expect and adequately keep them informed.

Need to stay up-to-date with what’s happening in Medicare? Attend one of our live training sessions!

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The Centers for Medicare and Medicaid Services (CMS) recently announced new restrictions on marketing for Medicare Advantage Plans and other health care policies. With the new rules, it is more important than ever for Agility agents to understand the Medicare Advantage marketing guidelines and the policies associated with them. In this blog post, we’ll explore what the new rules mean for agents selling Medicare Advantage plans and the strategies available to stay compliant with these plans.

Under the new CMS guidelines, agents selling Medicare Advantage plans can no longer use promotional materials that could mislead, confuse, or exaggerate the benefits of their plans. This means that all marketing materials must be clear, and accurate, and not promote any plans inappropriately. Additionally, agents selling Medicare Advantage plans must provide consumers with detailed information about each plan, including out-of-pocket costs, services covered, and formulary information.

In addition to the new restrictions, CMS now requires that all Medicare Advantage plans to adhere to the same ethical standards as traditional Medicare plans. This restricts agents from offering any gifts, rewards, or other incentives to customers in order to encourage them to enroll in a particular plan. Agents selling Medicare Advantage plans are also prohibited from aggressive sales and marketing tactics, such as cold calling or door-to-door marketing.

It is important for Agility agents to note that they also must abide by all local and state laws regarding marketing and advertising for Medicare Advantage. For example, some states may have laws regulating the use of telemarketing or direct mail campaigns by Medicare Advantage plans.

The new restrictions from CMS are designed to protect consumers from deceptive marketing practices and ensure that they are fully informed about the benefits of Medicare Advantage plans. It is important for Agility agents’ consumers to understand the new rules and the policies associated with these plans in order to make the best decisions for their healthcare needs.

By following the Medicare Advantage marketing guidelines, Agility agents can be sure their customers are getting the most accurate and helpful information about the plans available. Moreover, agents should also take the time to thoroughly research each plan and understand all of the costs, benefits, and limitations associated with Medicare Advantage. With a little research and knowledge of the new rules, agents can help consumers make informed decisions and navigate the Medicare Advantage landscape with confidence and integrity.

Stay up to date with Medicare Marketing Guidelines by attending our Medicare Training Series live events!

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Medicare Advantage (MA) plans received more than 2 million prior authorization requests in 2021, of which about 6% were denied. This statistic, sourced from the Kaiser Family Foundation (KFF), illustrates the challenges MA users face in receiving the necessary treatments and medications.

Prior authorization is a practice used by health insurance companies to control costs by ensuring that procedures, treatments, and medications are medically necessary and prescribed for the right reasons. The process often requires the patient’s doctor to submit an authorization request beforehand, and the insurance company reviews it to decide whether or not to approve the procedure.
The KFF report found that the denial rate for prior authorization requests is much higher in MA plans than in traditional Medicare. The percentage of denied requests increased by 10% between 2020 and 2021. While the reasons for the increase are unclear, they may be related to new requirements that MA plans have implemented in response to the COVID-19 pandemic.
The report also found that certain specialties had higher denial rates than others, such as cardiology (17.5%), gastroenterology (13.2%), and radiation oncology (13.1%). This means that patients in these specialties may face even more difficulty in obtaining the treatments and medications prescribed by their doctors.

It is important to note that prior authorization is not only about controlling costs, but also ensuring that patients receive the treatments and medications that are most suitable for them. However, the high denial rate for prior authorization requests can add additional barriers for patients in need of medical care.

The KFF report highlights the need for MA plans to review their prior authorization requests and reduce the denial rate. Doing so would result in greater access to medically necessary treatments and medications for Medicare Advantage users.


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Health Care Service Corporation Launches Biggest Expansion of Medicare Advantage Plans in Company’s History

Medicare-Eligible Beneficiaries Have Greater Choice Of Medicare Products Through Expanded Footprint in Over 90 New Counties

CHICAGO — Health Care Service Corporation (HCSC), which operates health plans in Illinois, Montana, New Mexico, Oklahoma and Texas, announced the company is increasing its footprint in the Medicare Advantage market to serve more than 90 new counties, increasing access to new coverage options for more than 1.1M additional Medicare-eligible individuals. The expansion is the company’s largest service area and product expansion in its history, particularly in rural and underserved areas.

HCSC’s Medicare Advantage plans allow Medicare eligible individuals greater flexibility and choice in coverage, offering enhanced benefits and greater value. Premiums can vary by geography, including some $0 premium HMO and PPO plan offerings. Medicare Advantage plans may also provide additional benefits beyond traditional Medicare, including (or the option to purchase) dental, vision, and hearing coverage at a variety of price points in a simple and easy to understand plan design.

“We are delighted to be offering Medicare plans in more counties than at any point in our history; bringing greater access to care than ever before to more Medicare beneficiaries across our five states, with some gaining access to such plans for the very first time,” said Christine Kourouklis, president of Medicare, HCSC. “For more than 90 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care. This expansion continues our focus on that longstanding commitment by broadening our Medicare footprint.”

Through this expansion, HCSC is focusing beyond major metropolitan areas to provide needed access and choice to the rising population of those aging into Medicare– projected to increase to nearly 80 million people nationwide over the next decade, according the Centers for Medicare & Medicaid Services (CMS).

“We’ve chosen expansion markets very carefully to select areas where we are confident we can successfully leverage our strong reputation and the strength of our relationships with doctors and hospitals, as well as offering coverage for new potential customers,” said Nathan Linsley, senior vice president, Government Programs, HCSC. “Our Medicare Advantage plans will continue to provide greater choice, emphasize affordability, and are designed to help Medicare beneficiaries meet their health, lifestyle, and financial goals.”

To accommodate the expansion, HCSC significantly increased its broad network, adding 19,000 physicians and 2,800 hospitals and other medical facilities across its five states.

HCSC is in the process of seeking all necessary regulatory approvals in its targeted states for 2022. The Medicare Advantage and Prescription Drug Plan Annual Election Period (AEP) starts October 15, 2021 and ends December 7, 2021. For more information, visit

Press release by: Jori Fine, Health Care Service Corporation


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The Power of Partnership: Oscar + Holy Cross + Memorial

Oscar teamed up with Holy Cross and Memorial Health Systems to develop a new kind of Medicare Advantage option for Broward county. With deep knowledge of our patients and their unique needs, we’re able to offer members a best-in-class experience that costs less. 

To break through in Broward, we couldn’t settle for the status quo. We saw a community that was in need of a better approach to Medicare: one that offers a lot more value and treats people less like numbers on a spreadsheet and more like, you know, people.

  • $0 premiums for the care you need, including up to $2,600 in dental, vision and hearing benefits – even gym membership!
  • A complete approach to dental care – including plans with no maximum for preventative and comprehensive dental (even implants)
  • $0 medical and drug deductibles, so members know what they’ll pay from day one.
  • No referrals required to see a specialist, plus a Care Team to help Members navigate the system
  • Day-to-day savings, like $0 transport at ion and an “OTC Card” that covers up to $200 in over-the-counter expenses every three months
  • $0 copays on 85% of the most utilized prescriptions in the US (Tier 1 or Tier 2 drugs).


Oscar Contracting Available Now >


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