THE MIDDLE MARK
Open Enrollment Starts with a Better Review
Clear news. Better renewal calls. Ready agents.
A new ACA permission step is here. Medicare plan choices are changing. New quality scores and rate updates give agents more to check. This week, focus on the people behind each renewal: their doctors, their drugs, their budget, and their next step.
01 / ACA workflow change · October 12 rollout
ACA Agents: Clear the Permission Step Before the Rush
For agents using approved platforms connected to the federal Marketplace
A renewal call can stall before you even reach the plan choices. A new step asks the client to confirm which agent may work on the application.
CMS set October 12 as the deadline for Enhanced Direct Enrollment, or EDE, platforms to add these checks. EDE tools let agents apply and enroll through an approved site connected to HealthCare.gov. This is the rollout of earlier federal guidance, not a law passed this week.
All applications through the EDE agent pathway need client authorization. Some also need an identity check first. Examples include new applications, a change of agent, and certain active plans that cost $30 or less per month after tax credits.
Keep three steps separate: documented permission to help the client, authorization for the agent to access the application, and the client's documented review of the application. Completing one does not complete the others. Get consent before searching for or accessing the client's information.
HealthSherpa says agents can collect 2027 authorizations now. Some existing clients have automatic access for 2026, but that does not carry into 2027. Its authorization also does not, by itself, change the agent of record or the commission relationship.
Review your platform's process with the team. Explain the request before it arrives. Make sure the client can use their own phone or email. Never put the agency's contact details in place of the client's. Track requests that are still waiting so those clients do not get lost in the rush.
“You may receive a request to confirm that I can help with your application. I will explain what to expect, and you will complete your own confirmation.”
Sources: CMS identity and authorization FAQ — released August 3; October 12 deadline; HealthSherpa agent authorization guide — checked October 15.
02 / New research · October 9
A Familiar Carrier Name Does Not Mean the Same Plan Is Staying
For Medicare agents preparing Annual Election Period reviews
Start with the client's county and exact plan. A carrier may stay in one area and leave another.
KFF's new study found that 193 counties will have no Medicare Advantage plan with drug coverage open for general enrollment in 2027. That is up from 123 in 2026. About 1% of Medicare beneficiaries live in those counties. It does not mean they lose Medicare or all drug coverage options.
Florida watch: KFF identifies Health Care Service Corporation's exit from these general-enrollment plans in Miami-Dade County for 2027. That finding does not apply to every carrier or every Florida county.
Put clients with a plan ending at the front of your call list. Read their notice. Check the exact plan ID, doctors, drugs, pharmacy, and yearly costs. Explain the next coverage step before discussing extra benefits.
“Let's check whether your exact plan is staying and what changes for next year. The company name alone does not tell us that.”
Sources: KFF: Medicare Advantage plan availability by county — October 9.
03 / CMS release · October 8
Use the New Star Ratings, Then Check the Fit
For Medicare Advantage and Part D plan reviews
CMS released its 2027 Medicare Star Ratings on October 8. These scores help people compare plan quality and service during fall enrollment.
About 37% of rated Medicare Advantage drug-plan contracts earned at least four stars. About 71% of current members are in contracts with those ratings. One number counts contracts. The other counts people.
A strong rating is useful, but it does not tell the whole story. It does not prove that a client's doctor is in the network, a drug is covered, or the plan will cost less over the year.
Show the rating beside the client's care needs. Check each drug and dose, the chosen pharmacy, specialist access, and costs when care is needed. Explain any tradeoff in plain words.
“This score helps us compare quality. Now let's see how the plan works for your doctors, medicines, and budget.”
Sources: CMS: 2027 Medicare Advantage and Part D Star Ratings — October 8.
04 / New research · October 13
Before Leaving Medicare Advantage, Check the Medigap Path
For agents discussing a move to Original Medicare
A client may want to leave Medicare Advantage and use Original Medicare. Before making that move, check how the client plans to pay the costs Medicare leaves behind.
Medigap is extra insurance that helps pay some of those costs. Fall Medicare enrollment does not give everyone a new right to buy it without health questions.
A KFF study released October 13 found that 74% of full-year Medicare Advantage members in its 2023 data had a health condition that could lead to a Medigap denial when health screening is allowed. The Florida figure was 82%. These are possible risks, not actual denial rates.
Some people have protected rights to buy a policy. These may come from their first Medigap enrollment period, a trial right, a plan leaving their area, or state law. The right depends on the person's case.
Check the client's rights, deadlines, and insurer rules first. When health screening applies, get the insurer's decision and line up start dates before ending current coverage. Also plan for prescription drug coverage. Save the notices that support any special rights.
“We can review that option. First, let's confirm what extra coverage you can get, what it costs, and when each plan would start.”
Sources: KFF: Health conditions and potential Medigap denials — October 13; Medicare.gov: Buying a Medigap policy; Medicare Medigap guide: protected buying rights, printed page 22.
05 / State Marketplace news · October 8–14
A Rate Headline Is Not the Client's Final Bill
For ACA agents; each update below applies only to the named state
Clients may hear that premiums are rising and assume there is no good choice. Use the news to start a review, then turn to the client's own numbers.
Colorado: plan previews opened October 8
Connect for Health Colorado opened its 2027 shopping preview. Its release cites an average 10% increase in individual-market premiums. Yet it estimates that about 60% of customers who receive financial help could find a plan costing $10 or less a month if they shop.
That is not a price promise for every person. A low premium can still come with costs or coverage limits that do not fit the client.
Illinois: 2027 rates released October 14
Illinois reported a statewide weighted average rate increase of 14.1% for individual plans. Five insurers will offer Marketplace plans. Shopping previews open October 19.
The average rate change is not each client's increase. The chosen plan and help with costs affect what the client actually pays.
Minnesota: flag changes that affect two years
MNsure warned on October 8 that changes to a 2026 application after that date do not flow into 2027 eligibility. If the change also applies next year, it must be reported again on or after November 1 using the 2027 application tab.
Build a short comparison: the renewal, another suitable lower-premium choice, and an option with lower costs when care is needed. Check doctors, medicines, household details, and expected income for the coverage year. For Minnesota cases, track which year was updated and set the follow-up.
“The headline gives us a market average. Let's check your price after any help with costs, then compare what you would pay when you use care.”
Sources: Connect for Health Colorado: 2027 preview — October 8; Illinois Department of Insurance: 2027 rates — October 14; MNsure: changes to the renewal process — October 8.
06 / Social Security announcement · October 14
A Bigger Social Security Check Still Needs a Budget Review
For agents helping Medicare clients plan for 2027
Social Security announced a 3.6% cost-of-living increase for 2027. It begins with January Social Security benefits. The average retirement benefit will rise by about $75 a month, though each person's amount will differ.
Do not promise that the full increase will reach the client's bank account. Medicare premiums and other deductions can affect the payment.
SSA's October 14 release says Medicare premium details will appear in notices starting in late November. This issue does not treat a projected 2027 Part B premium as a final rate.
Ask clients to bring their benefit and plan notices. Compare next year's premiums, drug costs, and likely care costs with their own budget. Keep estimates clearly marked until official amounts are available.
“Your benefit is going up. Let's check your own notice and health costs so we can see what that means for your monthly budget.”
Sources: Social Security: 3.6% benefit increase — October 14; Social Security: 2027 cost-of-living fact sheet.
07 / Enrollment date desk · Checked October 15
Two Enrollment Seasons. Two Clear Calendars.
Current deadlines for 2027 coverage; these are reference dates, not new laws this week
Medicare fall enrollment — AEP
October 15–December 7, 2026The Annual Election Period begins the day after this issue's reporting window. Plan changes generally start January 1, 2027. This is different from the Medicare Advantage Open Enrollment Period early next year.
HealthCare.gov — ACA Open Enrollment
November 1, 2026–January 15, 2027Enroll by December 15 for January 1 coverage. Enroll December 16 through January 15 for February 1 coverage. The client must pay the first premium for coverage to start. Check state-run Marketplace dates separately.
Name the program, the coverage year, the deadline, and the expected start date. Give the client one clear next step, such as booking a review or finding the plan notice.
Sources: Medicare.gov: fall Open Enrollment; HealthCare.gov: 2027 dates and deadlines.
08 / Put the news to work
Your Open Enrollment Team Huddle
Start with the cases that could leave a client without the coverage they expect. Then clear the small steps that slow down an appointment.
Check the boxes as you work, or print this page. Checks are not saved when you leave or reload.
A simple way to open the review
“What has changed since we last spoke: your doctors, medicines, income, or budget? Let's check next year's plan against what you need now.”
En español“¿Qué ha cambiado desde la última vez que hablamos: sus médicos, medicinas, ingresos o presupuesto? Revisemos si el plan del próximo año se ajusta a lo que necesita ahora.”
One useful question before the call ends
“Can you tell me what happens next and when your coverage should start?” If the answer is unclear, explain it again. A clear next step is part of a good review.
Sources: This NHPU checklist draws on the CMS and platform guidance, plan availability research, Medigap guidance, and official enrollment dates cited above. The checklist and scripts are NHPU editorial tools.
09 / Keep learning with NHPU
Make Room for Learning During Enrollment
Busy season can fill your calendar fast. Set aside time to check your continuing education (CE) due date. Look for courses that fit your license and state. Read the course's credit details before you enroll.
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NHPU sources: official email signup, training calendar, and course listings. Course availability and CE credit depend on the specific course and state.
Reporting window: Wednesday, October 7–Wednesday, October 14, 2026. Prepared October 15. This issue covers selected U.S. open enrollment developments. Earlier rules with a change this week and ongoing reference guidance are labeled separately.
Action steps and client scripts are NHPU editorial suggestions, not quotes from sources. Check the client's state, plan documents, and current official guidance before taking action.
