Starting in 2025, CMS is rolling out a new requirement for Medicare Advantage plans: a Mid-Year Enrollee Notification of Unused Supplemental Benefits.
So many beneficiaries don't use their supplemental benefits; this letter is meant to encourage them to do so.
For insurance agents, this feels like a golden opportunity to connect with clients, help them get the most out of their plans, and reinforce your role as a trusted advisor.
Let’s dive into what this mid-year statement entails and how you can leverage it to better serve your clients.
CMS is requiring Medicare Advantage plans to send a personalized mid-year statement to each enrollee, detailing any supplemental benefits they haven’t used in the first half of the year. These statements must be sent out between June 30 and July 31 annually.
The goal? Ensure that enrollees understand and utilize the benefits available to them, especially given the significant federal investment in these plans.
Medicare Advantage plans are funded by billions of taxpayer dollars ($462 billion in 2023, to be exact), much of which is allocated for supplemental benefits ($67 billion in 2024, to be exact).
However, CMS found that many enrollees don't even use these benefits because they either don't know about them, or they can't figure out how to use them.
Until now, we’ve had little data on how Medicare Advantage beneficiaries use their supplemental benefits. While they have access to many perks, we didn’t know if they were actually using them.
Starting in 2023, MA plans were required to report their supplemental benefit expenses to CMS (Justice In Aging). And starting in 2024, CMS started requiring utilization data for supplemental benefits.
Plans must provide utilization data for supplemental benefits like OTC items, fitness benefits, dental services, vision services, hearing services, pest control, and so much more.
The Contract Year 2025 Medicare Advantage and Part D Final Rule says:
"To ensure the large federal investment of taxpayer dollars in supplemental benefits is actually making its way to enrollees and is not primarily used to market benefits that individuals rarely use, the final rule requires Medicare Advantage plans to engage in outreach efforts so that enrollees are aware of the supplemental benefits available to them."
Starting in 2025, sending mid-year notifications to beneficiaries is a logical step to ensure taxpayer dollars benefit the people, not insurance companies.
Each mid-year notification will include:
This detailed breakdown ensures that enrollees have all the information they need to take advantage of their benefits for the rest of the plan year.
Despite their value, many supplemental benefits remain unused.
Here are a few common reasons:
By helping your clients maximize their plan’s benefits, you position yourself as a knowledgeable and trusted resource.
Satisfied clients are not only more likely to stick with you but also to recommend your services to friends and family, growing your network and strengthening your business.
The mid-year notification is more than just a compliance requirement—it’s an opportunity for you to demonstrate value and build stronger client relationships.
If you want an excuse to connect with your clients in the summertime, this is the perfect opportunity.
Steve Spinner, Director of Medicare Advantage Sales, says that as he talks about this letter with his clients, they're excited:
"They are looking forward to seeing the balance sheet halfway through the year. They'll probably learn about some of the products that they either forgot about or were never told about."
That said, Spinner is slightly concerned about the unintended consequences. If more benefits are used, could it lead to increasing costs in the future?
"I’m for it, and I think its good, but it might have some unintended consequences for 2026 and beyond," he adds.
Still, Spinner sees this as a step in the right direction:
"Improving beneficiaries' understanding of their available benefits is always a good thing. It's a work in progress, but we applaud efforts like these to enhance clarity and empower clients to make more informed decisions."
The Mid-Year Enrollee Notification of Unused Supplemental Benefits is more than just a regulatory requirement—it’s an opportunity for you to connect with clients, provide value, and help enrollees make the most of their Medicare Advantage plans.
By proactively engaging with these notifications, you not only ensure clients receive the benefits they deserve but also strengthen your role as a trusted advisor in their healthcare journey.
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