Industry experts gathered last week at the Medicare Marketing & Sales Summit in Puerto Rico to provide insight, discuss trends and strategies to remain competitive, grow Medicare Advantage plans, and retain membership. Here are our top takeaways from the conference:
Ghost networks and Star ratings may be in the new administration’s crosshairs
Provider directories display the full names of doctors, hospitals, and suppliers, but in many cases the providers don’t have the capacity or the ability to see members. The Senate has expressed concern with ghost networks and during a preconference workshop at the summit, Melissa Smith, founder, senior advisor of the Newton Smith Group, said she suspects that the Trump administration will also try to crack down on them.
Rather than more bureaucratic red tape, the administration may present new proposals for ghost networks as a way to improve beneficiary awareness, transparency, and beneficiary protection.
“It’ll mean we are going to have to sell with more accurate provider directories that are skinnier, much more reflective of the actual doctors that are going to be willing and able to see our patients, which is going to be a harder sales hurdle to climb,” Smith said.
The test period for putting together the provider directories would be this summer because they would have to be tested and ready by the time AEP begins in the fall, co-speaker Ana Handshuh, principal, CAT 5 Strategies said. If the administration was to crackdown on provider directories, Handshuh predicts it will happen in the next 60 to 90 days. “Your network team is going to probably have to do an abundance of clean up and then you will have to sell and market differently,” she said.
Star ratings may also be a focus area, according to Smith. The administration may eliminate quality bonus payments and the associated funds that plans receive when they earn four Stars. These bonus payments allow plans to offer better benefits, which makes it possible for plans to successfully market and sell products.
More seniors are becoming disillusioned with Medicare Advantage
During his presentation on Medicare consumer shopping and switching, George Dippel, president, Deft Research, said the industry has had a tough two years and must begin to build back Medicare Advantage. “We have to communicate more with our customers. We have to bring them back into the fold because right now the shine is off the MA apple,” he said.
“If this year was an earthquake, we have an aftershock coming next year,” he said. “The bond between consumers and carriers is a little bit fractured and the job that we all have in this industry is to build it back and do so quickly….The work that we do to build back that trust and that relationship and help these consumers understand the benefits and get all the value that they can out of the Medicare product gives you the best chance of holding onto these consumers.”
Don’t underestimate the power of the agent-consumer relationship
The agent-consumer relationship is more important than the carrier-consumer relationship. Indeed, during a session that focused on marketing lessons learned from the 2025 AEP, panelists said that agents picked up more influence this year because so much disruption happened between the carrier and consumer
Consumers value their relationship with the broker or agent because they want to work with a human being when something is wrong. They don’t really have a relationship with the carrier, Dippel said, “It was their agent that they saw as the hero of the game,” he said.
Reasons for the disillusionment include lawsuits over Star ratings and AI denying claims for post-acute care, carriers leaving the market and beneficiaries were terminated from plans, and weaker benefits. These factors helped contribute to the most disruptive and highest switching rate during the AEP, he said, and will lead to another high switching rate in 2026.
Look to the health plans of Puerto Rico for inspiration
Three of the biggest Medicare Advantage plan competitors in Puerto Rico spoke about the challenges they face and how they do more with less. Among the challenges: Puerto Rico has experienced a major migration of residents to the mainland, resulting in an older population. And by 2030, 25 percent of their specialist providers are expected to retire.
Sixty thousand Puerto Ricans have moved in recent years due to hurricanes, earthquakes, and COVID-19. “We now have a large population of people 65 and older, including doctors,” said Ixel A. Rivera, chief operations officer, Triple-S Salud (Triple-S).
Despite these limitations, the plans said that to provide high-quality plans for members, they:
- Create programs that are member-centered and fully tailored to the needs of their population, with a particular focus on social determinants of health
- Have developed strong relationships with their providers
- Identify gaps in care to better meet the needs of patients, such as an over-the counter medication delivery service for members
For more on the plans, see the coverage about the Medicare Marketing & Sales Summit panel from newspapers in Puerto Rico:
The flight of doctors ‘is an economic problem,’ warn voices of Medicare Advantage plans in Puerto Rico
More optimistic about possible increase in funds in Medicare Advantage
Insurers reiterate their claim for Medicare funding equity for Puerto Rico