69 million people are on Medicare and of those an estimated 52 to 54% are on some form of Medicare Advantage plan. That is almost 37 million people. Now there are major shifts in the Medicare Advantage space for 2026 that have already been announced with more coming. Some of them are unsettling and if you are not informed or you're unaware, I don't want you to miss out on what you're supposed to do and be left without any coverage. This is specifically for those of you who are on a Medicare advantage plan. If you are on a metag gap plan or a supplement plan or have VA coverage, try care for life, this does not apply to you. I'll start with what is happening. I'll move into why it's happening and then I'll end with what options you have. So what is happening is there are many insurance companies ranging from the very biggest to the smallest who are going to be eliminating certain advantage plans this next year. We're talking hundreds of advantage plans nationwide and estimates are at over 1 million individuals currently on Medicare Advantage plans who will lose their existing plan beginning January 1st of 2026. That is just under 3% of everyone on an advantage plan across the country who will need to look to alternatives for 2026. And as we get closer to the end of the year, that number is going to creep even higher. Of particular note, an announcement was made a couple of weeks ago by the largest insurance company in the country, United Health Group. In it, they stated that they will exit plans that currently serve over 600,000 members, primarily in less managed products such as PO offerings. They will take similar approaches for Medicare supplement, group MA, which is group Medicare Advantage for employer groups, and standalone part D pricing for next year. Now, PO stands for preferred provider organization. PO plans generally offer more flexibility for you to see more providers and facilities. PPOs generally have out of network coverage of some sort, meaning that if you did go to an out of network provider, you aren't left having to pay for all of the costs. And this is where that less managed products verbiage in the United Statement comes into play. PPOs have fewer cost containment structures in place than the other common advantage plan type, which is an HMO or health maintenance organization. HMOs generally do not have out of network benefits and are more restrictive. Therefore, costs are more contained for the insurance company. And it's not just PO plans that will be going away. HMO plans will as well, but United will have a focus on reducing more of their PO offerings. And again, it's not just United. This is happening all across the country with many different insurance companies heading into 2026. So, put yourself in the shoes of these insurance companies for just a minute. They are going to eliminate certain plans, but that does not mean that they want to lose out on federal dollars when covering people like yourself. If you currently have an advantage plan with this insurance company, you will need to proactively change to a new plan this year between October 15th and December 31st. And these dates may send some of your Spidey senses tingling if you're relatively familiar with Medicare dates and timelines because they're a little bit different than what you might be thinking. Keep watching. That wasn't a mistake. The insurance company eliminating your advantage plan will not do what is called a crosswalk to a new plan. What a crosswalk means is this automatic moving from one plan to another. Basically holding your hand across a crosswalk from an ending plan to a new plan with little to no action required on your end. This is not what is happening for those exiting advantage plans. The insurance companies, even though I'm sure they would love to be able to do this, will not automatically move you from the plan that is ending to the new plan. And this means that if you are on an advantage plan with drug coverage that is exiting the market and you do nothing, you will be stuck with original Medicare only, no advantage plan, no supplement plan, and now no part D prescription drug coverage either. So, if you are on one of these plans, you will get several notices from the insurance company informing you that the plan is ending. You may get calls from these insurance companies trying to get you to stay with them, just on a different plan that they have. Be aware of what is coming and please consider your options here. Know that insurance companies pay brokers a commission for helping you with these plans. And if the insurance company can bypass the broker, they now increase their profit margin. If you do not use an agent or broker and you do not want to, that is completely your decision and you can carry on with no change to your strategy or planning. If you do use an agent or broker, please reach out to them. Just to be clear, this is me advocating that you use my competitors if you have been using them already. Reach out to your broker once the annual enrollment period begins. And then I'll go over the important dates here in a minute. If you appreciate the idea of having your broker take care of all of this for you, help you compare plans, and have the ability to intervene on your behalf with the insurance companies. Again, reach out to him or her. If you do not have an agent, I'll have tips of what to do around that as well. Otherwise, if you decide to go straight to the insurance company itself, or you take that phone call from the national call centers buying up lists of phone numbers to spam you, or you call the number on your screen from a TV commercial, your existing relationship with your broker changes, you'd better bet that the massive companies also know about these plans ending and they spend insane amounts of money buying lists to call people and try to persuade them to switch. If you're responding to these telemarketing efforts, your existing agent can no longer help you with the new plan that you went on by calling the call center or the insurance company directly. That action changes what is called the agent of record or broker of record. This means that your agent can no longer intervene and help on your behalf. Most people unintentionally fall into this. Most seem to appreciate their broker relationship and did not know that the phone call that they made to the insurance company that they were on to switch or the call that they made to the TV commercial just kicked their broker out of being able to help them in some way. So again, work with your broker if you value that relationship. If you don't value that relationship, now you know how to end it. In addition to trying to bypass the agent relationship, insurance companies have some other levers that they can pull on their end to further contain their costs that are built into these plans. And you should watch for these things as you are choosing your plans this next year. For example, some plans may have a new requirement where you have to get a referral from a primary care provider before you're able to go see a specialist. This isn't a new idea, but there are many advantage plans that had no referral components, but maybe now are changing to referral required arrangements. Some insurance companies are forming partnerships with specific hospital groups. This means that some advantage plans will require that your primary care physician is part of one of these particular hospital systems. If you already are with this hospital system, there's no big deal. If you are not already with this hospital system, you would need to change away from your existing relationship over to a new provider. Another adjustment could be more encouragement from your insurance company to allow inhome health reviews. Others may add a medical deductible for some surgeries. Still others will have advantage plans that used to be $0 a month but now have new monthly premiums. Or if your advantage plan did have monthly premiums, you could see those increase. In my video about the astronomical US health care costs, I point out the fact that as health care costs tend to rise across the country, these costs ultimately get shifted to you and me. And these are subtle ways to manage or shift costs within the structure of the plans themselves. So, these are some of the things that insurance companies are doing if they are removing existing advantage plans and then they have other advantage plan offerings within their lineup to offer you. But there are also other insurance companies that are removing all of their advantage plans period. They are exiting the Medicare Advantage plan market altogether because they are losing too much money and they are not replacing those plans with new advantage plans. Which leads us to the why of all of this happening. Medicare Advantage plans replace original Medicare. That means that instead of having the government Medicare program being your hospital and medical insurance, the private insurance companies offering the advantage plans become that insurance. Advantage plans also throw in Part D prescription drug coverage, dental, vision, and hearing coverage in varying levels, gym memberships, transportation for doctor visits, and a combination of several other what we'll call perks into that plan. So, Advantage plans do cover more things than original Medicare, but not out of the goodness of their hearts and definitely not for free. The insurance companies offering these plans receive money from the federal government to take on this risk, which is why most people do not have monthly premiums to have advantage plans. And if you do have a premium, it's less than most alternative plan types. Now, the dollar amounts that insurance companies receive vary by state, by plan type, by rating, and several other factors. But for easy math, let's say that it's $1,000 per person on the advantage plan per month or $12,000 for the year. There is this really important metric called a medical loss ratio or MLR. It is the percentage of the insurance company's revenue that they get from premium payments. Think that thousands a month or $12,000 annually example. That must be spent on medical care and activities that improve the quality of care for their members. Advantage plans must spend at least 85% of their premium revenues on medical care and activities that improve the quality of care. Well, what counts as these activities? It would include their spending on clinical services, prescription drug coverage, quality improvement initiatives, those perks like dental, vision, hearing, and gym memberships, and even direct benefits for beneficiaries in the form of reduced PartB premiums or over-the-counter dollars to spend on over-the-counter health supplies. Using our $12,000 a year example, $10,200 must be spent on those various benefits and medical costs, leaving insurance companies $1,800 per year per person as a buffer against any aggressive or higher cost situations. Anything over that $1,800 results in a loss to the insurance company. And this is another area where many people go wrong. I read comments and I see videos of super smart people in this space who say that the insurance companies will never lose money on an individual. Meaning in our example, an insurance company would never use up all $12,000 in that year. This is so far from the truth. Insurance companies regularly pay more for individuals and regularly lose money on individuals, but the hope is that they will have more healthy, lowerc cost individuals that don't require any of that $1,800 buffer to be spent. That is insurance in its most basic form. Bank on more people in a population having lower costs in a given year to help pay for the smaller group of people in a population who have higher costs. Now, the reason the medical loss ratio is important to our conversation and to you is because it helps ensure that Medicare Advantage plans are providing value to you by spending the majority of their revenue on health care services and quality improvement activities rather than administrative costs and profits. The MLR promotes efficiency by creating incentives for those insurance companies to reduce administrative expenses and operate more effectively. And it promotes price transparency regarding insurance companies to report how they are spending the premium dollars. Well, over the past three years, three significant factors in the world have shifted more cost responsibility to the insurance companies. First is the overall higher than inflation cost increases to healthcare in general. The cost to get care in the United States is growing faster each year than inflation. Second, the frequency of care has increased. More people are seeking more care and now more expensive care more often. And third, the inflation reduction act had certain drug coverage components go into full effect in 2025 that shifted more of the prescription drug cost responsibility onto insurance companies. There are still other factors, but those are the big three. In my opinion, this has caused insurance companies offering advantage plans to lose money and a lot of money. The private insurance aspect of these plans means that the insurance companies are competing against each other in designing these plans in hopes of being more attractive to you than their competitors. But when an insurance company submits what is called their bid to offer an advantage plan, they don't get to see what the other companies are doing with their bids. This means that they try to make their plans as good as possible with very thin margins in most cases because if they submit a plan that isn't competitive, everyone flocks to their competitors plans. So imagine that you and I are competing companies that both make very similar, highly government regulated basketballs and we have to present our new basketballs and their costs to the consumer for the next year. But once we submit our basketball and the cost, we cannot change it for an entire year. If you price your ball at $80 and I price mine at 600, we'll all look pretty foolish and everybody will buy your ball instead of mine. However, if our basketballs cost us $200 to produce, now you look quite foolish because you lose $120 on every ball that you sell and you're selling a lot of them. This madeup scenario is kind of what it's like in real life for advantage plans. If an insurance company submits a bid and says, "We want in on this advantage plan. We agree to these plan costs. Once it is approved, that insurance company is responsible and liable for all of the costs that year from its members on that plan. Halfway through the year, they can't cancel the plan, even if they are hemorrhaging money because everyone flocked to that plan and has higher health care costs than what the plan receives from the government as payment. Well, for 2025 advantage plans whose bids were submitted, remember back in 2024 before the full force of the big three problems we outlined, especially the implementation of the inflation reduction act adjustments. Many of the insurance companies submitted very competitive plans with small margins for them because of the low max out of pockets maybe on their plan benefits or the other perks in the categories that we had talked about earlier. costs came rolling in in 2025 that are up quite significantly and that 15% margin that they had to work with or less disappeared and then the losses flooded in. But again, they can't just turn off the valve. They are legally required to cover these costs coming in even when profits may be gone. Their recourse is to turn off that plan for the next year, which is what United has openly acknowledged and what other companies will do as well. Now, this may be more information on this topic than you wanted. But it's important to understand the why behind the what of what is going on. And I am not saying boohoo for these insurance companies. They know full well what they are getting into and the risks associated with it. I am not saying insurance companies don't do things that drive me crazy. They do. A couple of which I've mentioned in this video. At the same time, insurance companies cannot and will not force themselves to lose absurd amounts of money without using the recourse that they have within the regulations they operate to make adjustments. And one of those adjustments is turning off their plan for the upcoming year. Now, if you are affected by these exiting plans, it is a pain in the neck, but it can also be a blessing for many. And I want you to know that you do have options. So, here are your options. The first option is to pick a new advantage plan. either with the same insurance company that you had or with a different insurance company. There are people who love the advantage plan concept over the supplement plan arrangement. And if this is you, you'd be looking for another advantage plan. There are people who cannot afford supplement plans and thus they are looking for another advantage plan in this situation. Work with your agent or broker to find suitable options. Your deadline is unique, though. If your plan were not exiting the market, you would have the annual enrollment period from October 15th through December 7th to make changes. And these changes would go into effect on January 1st. For any of you watching whose advantage plan was not eliminated, it could have been changed, but it's not eliminated, this is still your window, October 15th through December 7th. However, for anyone whose advantage plan was eliminated, you have until December 31st to elect a new Medicare Advantage plan to go into effect by January 1st. And I'm not advocating that you wait until December 31st. I think your agents would appreciate it though if you were willing to start either really early on in the process or tackle this between December 7th and December 31st to help those who are constrained to that December 7th deadline. Failure to change your plan before December 31st means that you will only have original Medicare and no coverage for the unlimited risk of original Medicare and no prescription drug coverage starting on January 1st. Getting on a plan after December 31st is possible, but you'll have a lapse in coverage, which is not a good thing. All right, option number two for those who are losing your plan. In most states, if you choose an advantage plan and you are outside specific special windows of time, you would need to go through medical underwriting to switch back to original Medicare and get a supplement plan or metagap plan. This means that you would need to answer questions about your health and you could be denied a supplement plan if you have health issues. This is where exiting advantage plans can be a blessing for you. Because if your advantage plan insurance company takes away your plan, you now have a new window of time called guaranteed issue rights to go back to original Medicare and pick up a supplement plan with no underwriting. You are guaranteed the right to be issued that plan without medical questions and at the same cost as somebody else your same age who is in an attained age or an issue age state. Now, there are a few very important details here. You have the right to purchase metagap plan letters A, B, C, D, F, or G that are offered by an insurance company in your state. Two things that are really important with this list of letters. First, plan N is not on this list. Plan N is underwritten only once you are outside your initial supplement plan open enrollment window when you first go on Medicare Part B. It is up to the discretion of these insurance companies offering plan N specifically on whether or not they want to allow people on during a guaranteed issue window outside of when you first go on Medicare. Remember, supplement plans are also offered by private insurance companies who also want to make a profit. And the insurance companies do not like guarantee issue rights because now they are forced to take on high-cost individuals onto their plans which lead to higher costs for the insurance companies which also leads to higher costs for everyone including you on that plan. Again, I have another video on what's coming for supplement plans. But the point is is that if you're excited for your guarantee issue right and your heart was set on plan N, it is highly unlikely that that route is open to you without going through medical underwriting. The second important part of that list of letters is plan F is only available to those who were eligible for Medicare before January 1st of 2020. If this is you or maybe you have a friend or a parent or a sibling that you're helping with this, most insurance companies require you to guarantee issue in this circumstance into plan F. Same goes if you are trying to guarantee issue after moving outside of your advantage plans coverage area. So, if you do qualify for plan F based on your age, you will also likely not have the option of getting any letter other than plan F in most states and with most insurance companies. We have people reach out all the time who are excited to get a certain supplement plan letter only to learn that they can't. Sometimes they get mad at us for delivering the news because they heard from a neighbor or a newer agent who didn't know or a YouTube video or a mailer that they could get whatever plan letter they wanted. They and you can't. If you live in a state that has something like year- round open enrollment or birthday rules or an anniversary rule, you could go on plan F initially and then switch down to a different letter around your birthday or the plan anniversary. Definitely something to discuss with your agent. And I've listed the special states in the description of this video that have things like birthday rules or an anniversary rule. As a general rule of thumb, plan F's total cost to you will be more than plan G. So, if you are able to switch down, it will save you some money. Now, you only have this right if you switch to original Medicare and not if you join another Medicare Advantage plan, which is why I caution against quickly making that phone call to your Advantage plan insurance company when you get the notice about your plan going away. Pause, connect with your agent, and go over your options. Your window to make this change begins 60 days before the date your Medicare Advantage plan coverage ends. With pullbacks of advantage plans like this, that means December 31st is the last day the advantage plan is active and January 1st is the first day that it is inactive. The window extends no more than 63 days after your Medicare Advantage plan coverage ends. Again, that December 31st is the last active day and January 1st is the first non-active day of your 63-day window starting moving forward. Finally, your new metagap coverage can't start until your Medicare Advantage plan coverage ends. So, your new metag gap plan would start January 1st if you want continual coverage without any gaps. Similar to earlier, if you want coverage with no gaps, you have until December 31st to make these changes, not December 7th. Just be aware of the extra time you have. And don't rush into a decision with all of the fear marketing that will come your way. Again, this is for those of you who have had your Advantage plans eliminated from the market. I need to be clear on that. with that December 31st timeline exception. Medicare Advantage plans are required to send out what is called an annual notice of change or ANOCH. These are usually sent out to you in September. So, please do not ignore this. It tells you if your plan is changing. It will also tell you if your plan is being eliminated. And if your plan is being eliminated, you will also get additional letters mailed to you from your insurance company to let you know that your plan is going away. If you use an agent, you will want to connect with him or her during the October to December window. And this is where the importance of that timing comes into play that I mentioned earlier. Agents and brokers are not allowed to discuss upcoming plan details until October 1st. And you can't actually make any changes of any form with any insurance companies until October 15th. So reaching out to us or to your agent before those dates really won't do you any good. We have a lot of planners out there who like to get things done early. I love that. We appreciate that more than those who wait until the last hour of the last day. But you have to hold your horses until October 1st at the earliest to get information about upcoming plans and then October 15th to actually do anything about it. This is only applicable for those of you already on Medicare and on an advantage plan in this example. This does not apply for those of you who may be starting Medicare for the first time because you're turning 65 in this timeline or you're losing employer coverage in this timeline. You can absolutely reach out before October and get those things going. the annual enrollment period from October 15th through December 7th and in this case that 31st for those exiting advantage plans. That is only for those who are already on Medicare, not those who are new to Medicare. Okay, here's another sensitive topic when it comes to these guarantee issue rights. My job here is to show you what's really going on out there in as transparent a way as possible. When you have this opportunity, it can be wonderful for many people who maybe felt stuck in their advantage plan. In 34 of the 50 states plus Washington DC, the insurance companies who offer supplement plans are not required to pay the agent for helping you get that supplement plan during this particular guarantee issue window. In 17 states, there are either insurance companies that will pay agents or there are laws in place to force insurance companies to do this. Here's a list of states that do and a list of states that do not. and even in the list of states that do the insurance companies that participate and the amounts could be very different as low as a onetime $20 or $25 payment or it could be a percentage of your premium amount for a certain amount of time. Why do I bring this up? Because agents, agencies, and brokers will all approach this differently. I definitely do not speak for all, but most cannot take on first the workload during the annual enrollment period because it is the busiest time of year and adding new people for no compensation is not sustainable. Second, most cannot and should not take on the liability that does come from being an agent of record with no compensation. And third, most cannot effectively handle the ongoing service requirements and the cost to provide that service. all for no compensation. Those are the realities of this situation. If you live in one of those states where insurance companies do not compensate agents for their help here, do not be surprised if it is difficult to find an agent who is willing to go through all of the steps and help you. Or watch out if there is an agent who is overly aggressive in pushing advantage plans only because that way they would get compensated and a metagap plan they would not. This is a delicate balancing act because I wouldn't immediately distrust an agent who brings up an advantage plan, especially since the context of this video is that you were already on an advantage plan. For some people with lower incomes, it is illegal to offer supplement plans. For others, an advantage plan is better. But if you have the means to be able to afford a supplement plan and you know that this is what you want and an agent is unwilling to talk about them and only pushes advantage, I'd be wary of that agent. I am biased and I feel my partners are as good as it gets when it comes to Medicare help. What that means is that they are busy. We are not just twiddling our thumbs during the annual enrollment period and bringing on people who are not current clients for no compensation would hurt our abilities to help existing clients and this is not something that I can push on and force my partners to do. Existing clients of course will get all of the help that they need, but new clients in those states that do not compensate for this guarantee issue, right, is a tough conversation to have and one that we recommend that you have with your existing agent. And this is frankly an unpleasant situation for those of you going through it because there are a lot of confusing deadlines as we talked about with the 7th or the 31st or 60 days or 63 days. Plus, there's paperwork that comes into play here, which is why I've built a checklist for you, because I want to still be able to help as many of you as I can with this situation, even if you're not able to be clients with us. So, if you are in one of those states that does not compensate agents, in the description of this video is a link to a checklist for you around what you would need to do if your advantage plan is terminating and you want to use your guarantee issue right to go to a supplement plan, but you don't have an agent who may be willing to help. It will show you where to compare plans and costs. the documentation that you'll need to show your future supplement plan insurance company and the order of when you need to do specific things around all of this. Remember, you'll also want to get a standalone Part D prescription drug plan if your advantage plan had drug coverage because by switching to a Medicare supplement plan, you would no longer have part D coverage. So, I have instructions on how to find the lowest cost Part D plan as well. This may be even more important for you to share with your loved ones who may not be as actively involved in watching videos like this. So, if you have friends or family on Advantage plans who may not be in a position to get updates, please share this video with them. Now, I like to leave secret code words at the end of my videos to help me with comment management. This one especially because it is all about advantage plans, which are a hot topic for some people. This is in no way me advocating for or against advantage plans. It is not a video about the pros and cons of advantage plans. It is solely to help those of you already on advantage plans who are going through your plan terminating know what is going on, why it's happening, and what options you have. So, if you can include the words what, why, and how in order in your comment, I'll know that you've made it at least to this point, and I can take those comments a little bit more seriously. Now, I wish this was the end of the disappointing news around Medicare and costs and that all of this was contained just within the advantage plans. However, it is not. And I have a video here on what is happening in the Medicare supplement or metag gap market that you'll want to watch. I will see you over there.