Individual Agent Update – Q1 2025
Medicare Supplement – Plan D
Due to the uncertainty of forthcoming bills addressing the Medigap birthday rule in the current state legislative session, we have decided to postpone the launch of Medicare Supplement Plan D. We apologize for the delay. We will revisit a potential launch next year after we’ve seen if/how the new birthday rule regulations will be implemented.
Medicare Advantage & Prescription Drug Plans
2025 Enrollment Forms
Per Executive Order 14168 (“Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government”) CMS will remove the voluntary Sexual Orientation and Gender Identification (SOGI) questions from the Model C/D enrollment forms. You can find our revised MA and PDP enrollment forms in the agent product library. Please print and use the revised forms with any remaining sales kit inventory you have on hand.
Telehealth
Recent legislation authorized an extension of many of the Medicare telehealth flexibilities that were in place during the COVID-19 public health emergency. The telehealth policies allowed Medicare patients to receive telehealth for non-behavioral/mental health care in their homes through March 31, 2025. Starting April 1, 2025, you must be in an office or medical facility located in a rural area (in the U.S.) for most telehealth services.
Compliance Reminders
TPMO Staff Disciplinary Actions and Violations – Per 42 CFR 422.2274(g) of the 2024 Final Rule, TPMOs are required to report on a monthly basis any staff disciplinary actions or violations of any requirements that apply current and prospective ABCBS enrollees.
SEPs for Dually Eligible and Other LIS-Eligible Individuals – Full-benefit dual eligible individuals, partial-benefit dual eligible individuals and other low-income subsidy (LIS) eligible individuals are eligible for a SEP to enroll once per month into a standalone prescription drug plan. This SEP can also be used once per month to switch between standalone prescription drug plans. This SEP does not permit enrollment into MA-PD plans or changes between MA-PD plans.
Declared Disaster or Other Emergency SEPs – Effective April 1, agents will not be able to submit an MA/PDP enrollment to carriers using the Declared Disaster or Other Emergency SEP. Individuals wishing to use this SEP must call 1-800-MEDICARE to make this election.
NOTE: On March 20, 2025, CMS reversed their guidance on the disaster/emergency SEPs. The planned changes set to take effect on April 1, will no longer be implemented.