BIP Spring 2025

SPRING 2025

Chelsea and Donovan Ryckis of Ethos Benefits are realigning incentives and leveraging data to put people first

Official magazine of NABIP

DESIGNED TO DO BETTER

+ HOW AI

+ BROKER VOICES:

AND BETTER NUTRITION ARE TRANSFORMING THE FUTURE OF HEALTHCARE

AMANDA BREWTON DRIVES MEDICARE CHANGE BY

SUPPORTING AGENTS AND PROTECTING BENEFICIARIES

SPRING 2025

Official magazine of NABIP

NABIP Shaping the future of healthcare

Volume 72 No.1

EDITOR-IN-CHIEF Elizabeth Galentine elizabeth.galentine@contentovation.com

ADVERTISING SALES MCI USA (410) 584-1901 katy.lewis@wearemci.com

focus 24 24 Where benefits

PRINTER Walsworth (573) 442 8714 www.walsworth.com

REPRINTS MCI USA (410) 584-1901 katy.lewis@wearemci.com MAILING ADDRESS 999 E Street NW, Suite 400 Washington, D.C. 20004

strategy meets humanity Chelsea and Donovan Ryckis of Ethos Benefits aim to show that doing what’s right can lead to the most impactful benefit solutions. 30 Broker Voices: Amanda Brewton The founder of Medicare Answers Now is on a mission to empower brokers, educate beneficiaries and advocate for industry change. 32 The next era of healthcare champions intelligent tech and real food From digital innovations to clean eating initiatives, healthcare’s future is focused on prevention.

EDITORIAL & DESIGN ContentOvation with Therium Studio

www.ContentOvation.com jamie.green@contentovation.com

www.theriumstudio.com melissa@theriumstudio.com

The opinions expressed in this magazine are not necessarily endorsed by NABIP nor does the magazine assume responsibility for statements made in advertisements or published articles. Send editorial submissions to: bip Editor, 999 E Street NW, Suite 400, Washington, D.C. 20004. bip (ISSN 2475-5826, publication no. 238660), 2025, volume 72, number 1 Published 4 times per year (Spring, Summer, Fall, Winter) by the National Association of Benefits and Insurance Professionals, 999 E Street NW, Suite 400, Washington, D.C., 20004. $25 annual subscription price is included in NABIP member dues. Periodical postage paid at Washington, D.C., and additional mailing offices.

On the cover: photography by Douglas Scaletta

inspiration

02 LETTER FROM THE CEO Jessica Brooks

Woods looks to the future of healthcare.

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04 LETTER FROM THE PRESIDENT Alycia Riedl on the vaue of connections. 06 NABIP IN ACTION Delta Force drives

16 PROFESSIONAL DEVELOPMENT Best practices for agency management

key reforms; NABIP tracks state legislation;

software; NABIP’s Young Members Initiative creates pathways for future industry leaders. Help young clients maximize HSAs; Why coachability is key; Value-based healthcare is reshaping benefits.

Experts weigh in on healthcare advocacy in a new Trump era.

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12 INDUSTRY

20 VOICES

INNOVATION Help clients evaluate prescription discounts; Strategic Medicare planning for employees.

action 38 HEALTHCARE IS LOCAL

44 ONGOING

EDUCATION Earning the REBC enhances NABIP member’s benefits expertise.

Louisiana revives its Red River chapter; NABIP Oklahoma expands industry outreach; San Diego boosts engagement.

46 ENGAGEMENT Two members share how NABIP supports their careers. 52 THE MIDDLE MAN Colleen Blum helps

an entrepreneur choose between COBRA and individual coverage.

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Letter from the CEO

Guiding the future of healthcare

The healthcare landscape is shifting — bringing care closer to the individual through precision medicine, AI-driven diagnostics and the growing recognition of food as medicine. As NABIP members, you are navigators of this transformation, ensuring individu als and employers have the knowledge and support they need to make decisions in a complex system. Rather than reacting to illness, today’s healthcare is about prevention, personalization and empower ment. New plan designs integrate wearable health trackers for real-time insights, AI tools analyze patient data for tailored interventions and food-based health initiatives offer alternatives to traditional pharmaceuticals. But access to these innovations alone isn’t enough — your role is to bridge the gap between innovation and real-life impact. You are more than benefits professionals; you are trusted guides helping individuals make sense of

their healthcare options. Transparency in costs and coverage remains essential, but your role now extends beyond that — connecting clients to the right solutions, at the right time, in a way that makes sense for them. Health literacy is one of the most potent tools for consumer empow erment. When individuals understand their coverage options and treat ment choices, they gain the confidence to take control of their health care. Programs focused on closing the gap between policy and patient experience show that knowledge can be as transformative as medical advancements. The most significant changes happen when people feel heard, informed and equipped to advocate for their care. The innovations reshaping healthcare are not futuristic concepts. They are happening now, and you are at the center of it. Your work drives change, ensuring individuals and businesses are prepared. I also invite you to consider the Leading Producers Roundtable (LPRT). If you have successfully navigated the challenges of our indus try, you deserve to be recognized and connected with fellow high achiev ers. LPRT is more than a designation. It’s a network where top profes sionals exchange insights and shape the future of our field. If you’ve reached a milestone in your career, now is the time to step forward and claim your place among industry leaders. Applications are due May 31. Healthcare is evolving, and your leadership matters now more than ever. By staying ahead of these advancements, you empower individu als, strengthen businesses and build a healthcare system that truly works for people. Together, we are creating a future where healthcare meets individuals where they are, giving them the tools and confidence to take control of their well-being.

“

Visit nabip.org/ membership resources/ lprt-leading producers round-table for more information

Healthcare is evolving, and your leadership matters now more than ever.

on how to join LPRT.

”

Jessica Brooks-Woods CEO, NABIP

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Letter from the President

Brokers at the center: Driving change in healthcare

Over my tenure as NABIP President, one of the most potent themes that has emerged is the strength of connection. Connection with our members, connection with industry leaders and connection with policymakers. This year has been a banner year for strengthening those relationships and the theme of our upcoming annual conference, Future Forward: Connect, Innovate, Lead, captures this idea perfectly. When we collaborate and align our efforts, we create greater opportunities for our members and improve the healthcare experience for consumers. One way NABIP’s seen the power of collective action is through our Medicare surveys. We received over 10,000 responses, including feedback from Medicare beneficiaries. This data is invaluable in helping NABIP advocate for brokers and agents. Through initiatives like

Brokers Making a Difference, NABIP is ensuring these voices are heard in conversations that shape policy and industry standards. A significant part of our role as professionals is advocating for change and elevating the perception of brokers and agents as indispensable to the healthcare experience. Too often, the negative actors in our industry — primarily large call centers that prioritize volume over service — cast a shadow over the essential work of local brokers and advisors. But we are changing that narrative. Our work is personal. We help clients choose the right plans, ensure their medications are covered, find the right doctors and navigate complex healthcare decisions. This hands-on guidance differentiates us and makes our role irreplaceable. As we look ahead to NABIP’s Annual Convention, I’m excited about what’s in store. We are reimagining key experiences, like bringing a more engaging, celebratory approach to the Gordon Award dinner, introducing wellness and mindfulness activities and creating more dynamic opportunities to connect. The energy we felt at Capitol Conference will only build as we head into the Annual Convention, and I encourage you all to be a part of it. Healthcare is evolving, and so is our role within it. Consumers are becoming more empowered, demanding greater transparency and better outcomes. This shift is pushing the industry forward, and NABIP brokers and agents are at the center of it.

Join us in Miami! Visit nabip.org/ events/annual convention to register for the Annual Convention.

“

A significant part of our role as professionals is advocating for change and elevating the perception of brokers and agents.

”

Alycia Riedl President, NABIP

photo by Cary Rothschild

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NABIP in Action

Healthcare advocacy in a new Trump era NABIP’s Michael Andel and Jen Berman highlight key priorities in protecting employee benefits, supporting Medicare agents and ensuring affordable coverage options.

W With the Trump administration now well into its first months back in office, NABIP is closely monitoring how early policy decisions will impact employer sponsored benefits, healthcare cost transparency and Medicare market stability. While healthcare

deductible health plans, enacting PBM reforms and advancing site neutral payment policies. Telehealth provisions, which had allowed people to access remote healthcare services without triggering out-of-pocket expenses, expired recently. NABIP wants to see these benefits reinstated. Similarly, PBM reforms and site-neutral payment policies, which ensure fair pricing regardless of where services are received, had bipartisan support but failed to cross the finish line. “These are all bipartisan issues that cleared committees last year, and we were surprised they didn’t make it through,” Andel adds. Tax policy and employee benefits A key concern for NABIP is protecting tax benefits tied to employer-sponsored health insurance. As the Trump administration and Congress prepare for a major tax bill — with many provisions from Trump’s first term expiring in 2025 — NABIP is advocating for preserving these benefits. “We want to say, ‘Don’t touch employer-sponsored benefits,’” Andel says, noting

that while these benefits seem secure, lawmakers are considering tax shifts that could put them in jeopardy. NABIP also supports maintaining the expanded Affordable Care Act tax credits introduced during COVID-19, which have made ACA marketplace plans more affordable for middle-income individuals. With over 24 million Americans signing up for ACA coverage this year, NABIP is highlighting the role of brokers and agents in helping consumers navigate these plans. “Agents are involved in the majority of enrollments,” Andel says. Ensuring continued affordability remains a priority. NABIP also supports preserving pass-through tax deductions for small businesses, which benefit many of our members who run independent agencies. Medicare market stability NABIP is closely monitoring Medicare policy, particularly concerning agent compensation. During the last enrollment period, when some health plans abruptly cut or reduced commissions, it disrupted

has not been a headline issue in the administration’s initial agenda, NABIP is actively engaging with policymakers to ensure that critical reforms remain a legislative priority. As the administration gets to work, NABIP is pushing to protect key tax benefits, finalize stalled healthcare legislation and advocate for agent compensation reforms that impact millions of Americans. Incomplete healthcare reforms One of NABIP’s main legislative goals is pushing Congress to complete several healthcare related bills that stalled at the end of the previous session. “We want Congress to finish the drill,” says Michael Andel, vice president of congressional affairs at NABIP. These include extending telehealth provisions for individuals with high-

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Staying the course While Trump’s immediate policy focus is on tax reform, immigration and reducing government regulations, NABIP is prepared for potential shifts in healthcare policy. “There is an overarching reality of uncertainty and us not being able to know for sure where things are going,” says Jen Berman, NABIP Legislative Council chair.

independent agents and potentially limited access to unbiased advice. “It’s not just about getting paid,” Andel says. “If you take away agent compensation, the only source for advice on enrollment will be the health plans themselves, and they’ll just put people in the most expensive plans.” Beyond compensation, NABIP is advocating for more flexibility in Medicare Part D. Currently, beneficiaries can make a one-time change to their Medicare Advantage plan but lack the same option for Part D prescription drug plans. NABIP wants to change that, citing frequent formulary changes that surprise seniors at the pharmacy counter. Another Medicare concern is how COBRA coverage is treated when transitioning to Medicare. Currently, individuals who delay Medicare enrollment due to COBRA face lifelong penalties. NABIP is pushing for reforms to recognize COBRA as credible coverage to

Despite the unknowns, NABIP remains committed to its agenda. “Stay the course,” Berman adds. “Continue to focus on our legislative priorities, educate lawmakers on the role of brokers and agents, and advocate for stability in the healthcare market.” While healthcare policy may not be at the forefront of Trump’s immediate agenda, NABIP is actively working to ensure that key reforms remain a priority. NABIP is committed to

“ ”

If you take away agent compensation, the only source for advice on enrollment will be the health plans themselves,

and they’ll just put people in the most expensive plans.

engaging with policymakers and keeping healthcare accessibility and affordability front and center. As new agency leaders settle into office and legislative discussions unfold, NABIP will continue pushing for stability in an uncertain political environment. “We look forward to meeting the new leaders in the agencies,” Andel says. “We’ll be engaged the whole time.”

prevent unnecessary financial penalties.

georgeclerk / iStock

Spring 2025 bip magazine 7

NABIP in Action

STATE AFFAIRS QUARTERLY REPORT: NABIP tracks priority bills State legislatures are ramping up legislative activity, and the Government Affairs team is monitoring key legislation — all while celebrating a major win in Virginia. By Max Karlin

As 2025 kicks into gear, so do state legislatures across the country. Nearly all states have convened, with each introducing bills at a rapid pace. The NABIP Government Affairs team is working diligently to track these bills and collaborate with NABIP State Chapters to develop strategies for addressing priority legislation. Here’s what we’ve observed so far: • 5 birthday rule bills • 7 copay accumulator bills • 8 single payer/public option bills

In addition to these priority bills, we are monitoring dozens of proposals related to pharmacy benefit managers, along with other legislation that could significantly impact state insurance regulations. Virginia model legislation We are thrilled that a section of NABIP’s model drug pricing legislation has been introduced

in Virginia! HB 2375 is based on a portion of NABIP’s model legislation addressing pharmacy services administrative organizations (PSAOs), which act as intermediaries between independent pharmacies and PBMs. We believe HB 2375 will help reduce pharmacy costs for Virginians by increasing transparency among

NABIP UNITE Program provides relief for members in crisis

The NABIP UNITE Program exists to help NABIP members facing unexpected disasters. It provides immediate assistance while members await federal aid, insurance payouts or other further support. The program works by 1. Identifying those in need.

2. Coordinating support. 3. Collecting donations. 4. Providing direct assistance.

Gift cards are a practical way to help, allowing members to purchase food, clothing, temporary housing and other necessities. Many disaster survivors lose everything, including debit cards, checks and identification — making immediate access to funds essential.

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If you purchased, paid, and/or provided reimbursement for some or all of the purchase price of Seroquel XR or quetiapine fumarate ER 50 mg, 150 mg, 200 mg, and/or 300 mg tablets, you could get money from a settlement. There are proposed Settlements in a class action lawsuit filed against AstraZeneca Pharmaceuticals LP and AstraZeneca UK Limited (collectively, “AstraZeneca”) and Handa Pharmaceuticals, LLC (“Handa”) (together with AstraZeneca, “Defendants”). The lawsuit alleges that AstraZeneca and Handa unlawfully kept 50 mg, 150 mg, 200 mg, and 300 mg strengths of generic quetiapine fumarate ER (i.e., generic versions of Seroquel XR) off the market so third-party payors paid more for brand Seroquel XR and/or generic quetiapine fumarate ER than they should have. AstraZeneca and Handa deny they did anything wrong. There have been separate settlements with AstraZeneca and Handa. No one is claiming that Seroquel XR or quetiapine fumarate ER is unsafe. Who is included in the Settlements? You may be included in the Settlements if you purchased, paid, and/or provided reimbursement for brand Seroquel XR or generic quetiapine fumarate ER and fall within the following definition: All entities that, for consumption by their members, employees, insureds, participants, or beneficiaries, purchased, paid, and/or provided reimbursement for some or all of the purchase price of Seroquel XR or quetiapine fumarate ER 50 mg, 150 mg, 200 mg, and/or 300 mg tablets, other than for resale, in Arizona, Arkansas, California, the District of Columbia, Florida, Hawaii, Illinois, Iowa, Kansas, Maine, Maryland, Michigan, Minnesota, Mississippi, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Oregon, Rhode Island, South Dakota, Tennessee, Vermont, West Virginia, or Wisconsin, at any time from September 5, 2015, through and until December 9, 2024. Excluded from the Class are (i) Defendants and their subsidiaries and affiliates and (ii) federal and state governmental entities. A more detailed notice, including the full Settlement Class definition and who is not included, is available at www.SeroquelXRAntitrustSettlement.com. What do the Settlements provide? AstraZeneca and Handa will pay $5 million and $475,000, respectively, into a Settlement Fund that will pay (1) money to eligible Class Members that submit a timely and valid Claim Form; (2) notice and administration costs; (3) service awards to the class representatives who brought the lawsuit; and (4) attorneys’ fees, costs, and expenses. The full text of the proposed Settlement Agreements are available at www.SeroquelXRAntitrustSettlement.com. How can you get a payment? If you believe you are a Class Member and want to obtain a share of the Settlement Fund, you will need to complete and return a Claim Form. The amount of your payment will depend on the amount you purchased of Seroquel XR and/or generic quetiapine fumarate ER in 50 mg, 100 mg, 200 mg, and 300 mg strengths and the number of timely and valid Claim Forms that are filed. The Claim Form and information on how to submit one are available on the settlement website at www.SeroquelXRAntitrustSettlement.com. A Claim Form must be postmarked (if mailed) or received (if submitted online) on or before June 9, 2025 . What are your rights and options? Do nothing: By doing nothing, you are bound by the Settlements with AstraZeneca and Handa, and you give up any rights to sue Defendants separately about the same legal claims in this lawsuit. Ask to be excluded: You have the right to exclude yourself (i.e., to opt out) from the AstraZeneca and/or Handa Settlement(s) no later than February 24, 2025 . If you ask to be excluded, you will not share in these Settlements, but you would keep any rights to sue Defendants separately about the same legal claims in this lawsuit. Requirements for requesting exclusion are found in Question 10 of the Long Form Notice, which is available at www.SeroquelXRAntitrustSettlement.com, including the requirement that you provide data reflecting your purchases, payments, and/or reimbursements for 50 mg, 150 mg, 200 mg, and 300 mg strengths of Seroquel XR and generic quetiapine fumarate ER. Object to the Settlement(s): If you do not exclude yourself from a Settlement, you have the right to object to that Settlement but must do so no later than February 24, 2025 . The Long-Form Notice on the settlement website has instructions on how to opt out or object. The Court will hold a hearing on April 23, 2025 , to decide whether to approve the Settlements, the plan for allocating the Settlement Fund to Class Members, a request for payment of attorneys’ fees of up to 331/3% of the Settlement Fund, plus costs and expenses, and service awards to the class representatives. You or your own lawyer may appear and speak at the hearing at your own expense. The Court may amend the deadlines in this Notice or the hearing date (and time). Check the website below for updates. Want more information? Visit www.SeroquelXRAntitrustSettlement.com, call 1-888-884-8072, email info@SeroquelXRAntitrustSettlement.com, or write to the Claims Administrator at P.O. Box 5017, Portland, OR 97208 5017. The deadlines contained in this Notice may be amended by court order, so check the settlement website for any updates. Please do not call the Court or the Clerk of Court for information about the Settlements. YOUR LEGAL RIGHTS MAY BE AFFECTED

various stakeholders in the pharmaceutical supply chain that were previously not subject to transparency requirements. HB 2375 aligns with NABIP’s Healthcare Bill of Rights by promoting affordable medication access. On January 21, HB 2375 was unanimously reported out of the House Health and Human Services Committee.

Check your inbox for NABIP’s latest Washington Update and State Update emails.

ChrisBoswell / iStock

By supporting the NABIP UNITE Program, you help members recover faster.

Wildfire relief: How to help Most recently, wildfires

in Southern California have left NABIP members displaced, with at least two confirmed cases of total home loss. NABIP is collecting gift card donations to assist these members. “The response in support is extraordinary,” says CAHIP President Elect Dawn McFarland. To contribute, send gift cards to: NABIP UNITE Program Attn: Dawn McFarland M & M Benefit Solutions Insurance Services 19528 Ventura Blvd #173 Tarzana, CA 91356

Akarawut Lohacharoenvanich / iStock

NABIP in Action

Delta Force ensures NABIP’s Healthcare Bill of Rights priorities come to life In 2024, the standing committee focused on PBM transparency, mental health and healthcare literacy.

The Delta Force, originally formed to create NABIP’s foundational Healthcare Bill of Rights, is now a permanent standing committee within the association, reporting to the Board of Trustees. Each year, the committee intends to focus on at least three key elements of NABIP’s Healthcare Bill of Rights. In 2024, its areas of concentration were: • Pharmacy benefit management • Mental health • Healthcare literacy

1 Right to Affordable Medication (Article VII) — PBM transparency Leveraging the expertise of members with deep knowledge of PBMs, the Delta Force promoted a comprehensive position paper that breaks down how PBMs operate, exposing misaligned incentives and advocating for employer transparency in understanding PBM revenues. It outlines 10 actionable steps employers can take to ensure PBM transparency and accountability. The effort gained recognition from a range of thought leaders, including Mark Cuban, further underscoring its impact. “Employers often have no idea how PBMs or consultants are compensated,” says Gaunya. “This work not

Delta Force Chair Mark Gaunya, principal at Borislow Insurance, highlights the significant progress made in these areas over the past year, crediting NABIP’s Healthcare

Bill of Rights’ accompanying scorecard as a key tool. This 10 feature, 12-point scale evaluates

legislation and proposals against all of the Bill of Rights’ principles, with a score of 75 or higher deemed acceptable. “It enables discussions grounded in principles instead of politics and gives us a tool to advocate for improvements in the healthcare ecosystem,” Gaunya says. Here’s how the Delta Force advanced its 2024 priorities:

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3 Right to Quality Care (Article II) —mental health initiatives

only highlights the importance of transparency but also sets a standard for how PBMs should operate to serve their clients’ best interests.” 2 Right to Healthcare Education (Article VI) — healthcare literacy Many studies show the majority of Americans struggle with healthcare literacy — and NABIP members are not exempt. “NABIP members can be better stewards of teaching the language of healthcare so that they can educate their clients and help them become more fluent in all aspects of healthcare,” says Gaunya. To further this pursuit, the Delta Force partnered with the late Marshall Allen, an advocate for healthcare consumer education, on a series of 16 educational videos he developed to empower individuals with the knowledge needed to navigate the healthcare system effectively. These resources are now in the hands of NABIP’s Education Foundation, with plans to expand the reach to consumers nationwide. “We believe that by starting with our members and expanding outward, we can create a ripple effect that ultimately leads to more informed healthcare consumers who get the highest quality at the lowest possible price,” Gaunya says.

A standout accomplishment in 2024 was the Delta Force’s advocacy for integrated behavioral health (IBH) initiatives. When the federal government introduced its IBH model plan for Medicare and Medicaid, the Delta Force played a pivotal role in evaluating and supporting the effort. “We wanted to ensure that this strategy addressed immediate needs and served as a blueprint for the private market,” Gaunya says. The Delta Force’s support for IBH reflects its commitment to improving mental and behavioral health access and integration across the healthcare ecosystem. By advocating for scalable solutions, the Delta Force intends to create a lasting impact on both public and private healthcare consumers. Next steps Looking ahead, the Delta Force is exploring ways to expand access to primary care, including direct primary care (DPC), by addressing its classification as an insurance product under IRS regulations. This product classification prevents DPC from being considered an eligible

medical expense for tax-preferred accounts like FSAs and HSAs. There are more than 60 million people with more than $60 billion in savings in these types of accounts — funds that could be invested in primary care like DPC. To tackle this, the Delta Force is working with leaders in both houses of Congress. The Delta Force is monitoring relevant legislation with the potential to ease the burden by broadening eligibility, eliminating restrictions tied to high-deductible plans, doubling contribution limits and recognizing DPC as a qualified medical expense that improves access to primary care. “The system we’re living

in now has a crumbling foundation. It serves the policymakers, not the consumer. Our goal is to

change that,” says Gaunya. “Our job is to look at the existing infrastructure and say, ‘How do we build a smart healthcare house?’ Because the one we’re living in now doesn’t serve the people.”

Vladimir Ivankin / iStock

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Industry Innovation

Balancing prescription discounts and insurance How brokers can help clients weigh immediate savings against long term insurance benefits when using prescription discount programs.

Additionally, Medicare Part D plans change annually, impacting coverage and costs. Harriett stresses the importance of reviewing plans each year to avoid unexpected price increases. “Your prescription drug plan can change significantly, even if the name stays the same,” he says. “A $5 plan this year could jump to $40 next year, and clients need to know that.” Annual reviews help ensure that individuals remain on the most cost-effective plan. Beyond individual savings, legislative efforts are underway to increase transparency in drug pricing. Vanderwolk notes initiatives like New Jersey’s PBM law, which requires entities involved in the pharmaceutical supply chain to disclose pricing data. The belief is that greater transparency could lead to market-driven corrections that ultimately benefit consumers. “Our goal with the bill was transparency — show your work,” he says. Practical strategies for managing ensure adequate coverage, both consumers and brokers can take proactive steps: • Verify coverage: Harriett advises checking whether medications are included in a plan’s formulary to avoid unexpected expenses. “If the insurance company isn’t covering it, it won’t count toward your cap,” he says. • Consider generic prescription costs To maximize savings and

Rising prescription drug costs remain a financial challenge for many Americans. To help mitigate expenses, prescription discount programs have gained popularity as a way for consumers to access lower drug prices. While these programs can offer cost savings, it is important to understand their implications, especially for Medicare beneficiaries. How Rx discount programs work Prescription discount programs negotiate lower medication prices, allowing consumers to purchase prescriptions at reduced rates. These discounts can sometimes result in significantly lower prices compared to insurance-covered costs. Christopher Vanderwolk, chair of NABIP’s Working Group to Lower Prescription Drug Costs, points to increased transparency in pricing as a key advantage. Greater visibility into drug pricing can help consumers make more informed financial decisions. “Mark Cuban’s Cost Plus Drugs is publishing drug price lists as a way to keep

everybody accountable,” he says. For individuals paying out-of-pocket, the savings can be considerable. Vanderwolk highlights cases where the cash price of a medication can be drastically lower than the price under an insurance plan. “There are real examples of drugs that are $11 cash but $2,000 on the plan,” he says. In such cases, paying cash may be a more cost-effective option. Considerations for Medicare beneficiaries While these discount programs can lower immediate costs, they do not count toward Medicare out-of-pocket limits or deductibles. Elie Harriett, an independent Medicare broker, emphasizes the significance of Medicare’s new $2,000 annual cap on out-of-pocket drug costs. “If you use those discount cards, you don’t get to count it toward the $2,000 cap on prescription drug costs,” Harriett says. This is an important factor for Medicare beneficiaries when considering how to manage their prescription expenses over the long term.

Remind clients to regularly

review their prescription drug plan’s formulary, even if they keep the same plan from year to year.

alternatives: Asking a doctor about lower-cost

Petmal / iStock

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A $5 plan this year could jump to $40 next year, and clients need to know that. — Elie Harriett, independent Medicare broker “ ” alternatives can result in significant savings. “A simple question like, ‘Is there a generic I can try first?’ is usually enough to lower people’s prescription drug bills,” Harriett adds. • Conduct annual plan reviews: Staying informed about plan changes can prevent overpaying for prescriptions. Even a brief consultation with a broker can help identify the most cost effective options. Prescription discount programs can offer meaningful savings, but they are not without trade-offs. Understanding their impact on insurance coverage, particularly for Medicare beneficiaries, is essential for making informed decisions. As Vanderwolk says, “We need to change the mentality of just accepting what’s given. Use the information available to ask questions and find the best solutions for your needs.”

xxxx photo credit here

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Industry Innovation

A smarter approach to retirement and Medicare Help employees make informed decisions to avoid costly mistakes and optimize their benefits.

Many employees remain unaware of how their earnings trajectory can substantially influence their Medicare costs. With this knowledge gap in mind, group benefit advisors are pivotal in positioning employees for a seamless transition to Medicare. Danielle Roberts, co-founder of Boomer Benefits, underscores the need for strategic foresight. “Decisions made at ages 63 and 64 have direct consequences on what individuals will pay for Medicare at 65 and 66,” she says. “Many pre-retirees fail to anticipate that Medicare carries significant costs and that their income levels dictate pricing. We frequently encounter professionals who, upon realizing their projected expenses, delay retirement to recalibrate their financial plans.” A key consideration is the income-related monthly adjustment amount (IRMAA), which leverages a two-year look-back period to determine Medicare premiums. For instance, if an individual liquidates assets, withdraws from an IRA, or accepts a severance package at 63, their adjusted gross income could artificially inflate their Medicare Part B and D costs at 65. “Today, individuals aging into Medicare in 2024 who had a high income in 2022 might see their Part B premium surge to $628, in contrast to the baseline $185,” Roberts says. Policy shifts and advocacy Beyond financial strategy, ongoing regulatory challenges continue to shape the Medicare landscape. With the Trump administration bringing new leadership to the Department of Health and Human Services and CMS, industry advocates see an opportunity to revisit policies. “New appointees mean new conversations,” Roberts says. “One of our primary objectives is to challenge inefficiencies, such as the 48 hour waiting period for Medicare Advantage enrollments, which seniors overwhelmingly find

frustrating. These measures fail to deter unscrupulous actors yet create unnecessary roadblocks for honest brokers and clients.” Strategic guidance Sandra Ochoa of Vemax Insurance highlights the critical role that pre-retirement decisions play in long-term financial outcomes. “Timing is everything,” she says. “Delaying Part B enrollment, for example, can lead to lifelong penalties. Some individuals prematurely exit employer-sponsored plans without fully assessing whether Medicare is their best option.” While Medicare Advantage plans offer strong benefits in regions like Miami, where competition has driven down

provider networks, hospital affiliations and prescription drug coverage. “High-deductible employer plans may appear costly on the surface, but depending on an individual’s healthcare utilization, they could still provide superior coverage compared to Medicare alternatives,” she says. Given these complexities, Roberts and Ochoa advocate for a collaborative approach among advisors. “Group benefit brokers who lack direct Medicare expertise can create value by forging partnerships with NABIP members who specialize in the space,” Roberts says. “Hosting educational sessions for employees over 55 not only equips them with crucial information but also enhances the broker-client relationship.”

costs, Ochoa stresses the importance of evaluating

LaylaBird / iStock

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Professional Development

After graduation, 2020 participant Colin Johnson worked for a local insurance company as an underwriter before becoming a financial

systems analyst at the University of Alabama.

NABIP’s Young Members Initiative in Alabama is

creating new opportunities for students by introducing them to the insurance industry and connecting them with industry professionals. As NABIP expands its efforts with the Workforce Leadership Institute and an improved mentorship program, initiatives like Alabama’s serve as a model for cultivating the next generation of leaders. Investing in students early Paige Phillips, a longtime NABIP leader in Alabama, has been at the forefront of the Young Members Initiative, which brings students from the University of Alabama to NABIP’s Capitol Conference. "We have one endowed scholarship on behalf of one of our past state presidents at the University of Alabama, and we’re working on a second," Phillips says. Through this relationship, students are selected to attend the conference, fully funded. More than a trip, it provides mentorship and industry connections. “The university pays for some of it, we pay for some of it, but the student never has to pay anything,” she says. Phillips recalls a standout participant: "One of them got a head marketing job at one of the largest agencies in New Jersey. He was from New Jersey, and

NABIP’s Young Members Initiative is opening doors for future industry leaders With new mentorship opportunities and university partnerships, the program will evolve to ensure young professionals find their place and thrive in the field.

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Dave Mordo and some of our other members knew people up there and got him an interview — and he got the job." Another participant later pursued a political career after attending the conference and is now an Alabama State Representative. To keep students engaged, NABIP Alabama offers honorary memberships. “They get a little plaque and make a speech about their experience,” Phillips says. “We’ve seen this exposure change lives, opening doors students didn’t even know existed.” Phillips emphasizes the importance of keeping in touch with participants long after the conference. “Many of them stay on my radar through Facebook. I see when they get married, start new jobs, or even run for office,” she says. “It’s all about maintaining those relationships.” Expanding on a national scale NABIP is working to build on initiatives like Alabama’s with

the newly envisioned Workforce Leadership Institute. “We’re expanding it beyond CEs to be more applicable to anyone in the industry — especially younger professionals and students,” says Brooke Willson, SVP of Strategy & Innovation at NABIP. A key focus of this effort is strengthening university partnerships. “We’ve got great connections with Temple, Alabama and Florida, and we’re using what we’ve learned from Pennsylvania’s leadership program to develop something more national,” Willson says. Another critical piece is NABIP’s evolving mentorship program. “It’s becoming more of a self-driven program,” Willson adds. “People will be able to self select their mentors, see pictures and profiles, and choose based on their preferences — whether they want a local mentor, someone in their specialty or someone with a broader perspective.” The new system will make it easier for mentors and mentees to connect. “Previously, the

Now an Alabama State Representative, Brock Colvin, 2017 participant, poses with former Rep. Martha Roby, R-Ala. Colvin is a financial advisor with Ameriprise Financial

Services in Albertville, Alabama.

process took a while. Now, people can find a match much more quickly, making the program more responsive and engaging,” Willson says. Opportunities for local chapters Both Phillips and Willson see tremendous potential for NABIP chapters nationwide to adopt similar initiatives. “If someone reads this and thinks, ‘My local university could be a good fit,’ I’d love for them to reach out to me,” Phillips says. To identify and engage new professionals, NABIP Alabama has also begun purchasing insurance license lists from the Department of Insurance. “It shows when someone was first licensed, so we can reach out to newer professionals and invite them to events,” Phillips says. Willson sees these efforts as essential for the future of the industry. “You have to look to the young to help you move forward,” she says. “Even members whose kids don’t want to take over their businesses need to think about recruiting the next generation.”

Joe Pronti, 2018 participant, poses with Rep. Mike Rogers, R-Ala. Pronti worked for NABIP member GIS Benefits shortly after college graduation.

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Professional Development

6 AMS best practices every broker should know Position your brokerage for growth with these expert-recommended strategies for agency management software adoption and use.

The insurance industry is driven by efficiency and scalability, mak ing agency management software a key strategy for brokers who must stay competitive. Whether you’re just starting out or part of a larger firm preparing for growth, the right AMS can transform how you manage clients, track commis sions and streamline daily opera tions. Longtime NABIP members Tim Kanter, founder of Get Benefits, and Rosamaria Marrujo, president of Trusted American Insurance Agency, offer actionable advice for brokers navigating the complexities of AMS adoption and optimization. 1 Start with a plan and define your needs Brokers should assess their core objectives — whether it’s policy management, commission track ing or client communication — and map them to their AMS requirements. “Defining your business needs is the first step,” says Marrujo. Kanter advises brokers to “be forward-thinking.” When evaluat ing AMS options, consider not only current requirements but also potential future needs, such as the ability to manage multiple agents, integrate commission tracking or provide robust reporting capabili ties. “A lot of people don’t even

think about scalability, but It’s es sential to choose a system that can grow alongside your business,” adds Marrujo. 2 Leverage existing resources Marrujo suggests taking advan tage of free software or tools pro vided by existing partnerships or hierarchies for brokers just starting out. “Test these resources first before making significant invest ments,” she says. Kanter recommends commit ting to a system once revenue hits a sustainable threshold. Starting small and scaling up ensures that

brokers aren’t overwhelmed by features they don’t yet need. “It’s a necessary expense,” he says, but “wait until you’ve reached $30,000 to $50,000 in revenue.” 3 Prioritize user experience and staff involvement Involving your team in the AMS selection and implementation pro cess is crucial. Marrujo points out that successful businesses engage employees early on to gather feed back. From agents to office staff, ensuring everyone is comfortable with the platform fosters smoother adoption and higher efficiency.

TIP: Avoid

future data nightmares by planning ahead for data migration and hiring outside help if needed.

ipek yalaz / iStock

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“Businesses that actively involve employees from the start are more likely to thrive,” she says. Consistent and accurate data entry is vital, whether handled by staff, outsourced or managed by temporary help hired to transition data from a simple spreadsheet into an AMS. Kanter adds, “An AMS is only as good as the information you provide it.” 4 Evaluate scalability and integration Both industry veterans stress the importance of scalability. “You don’t want a one-trick pony,” says Marrujo. “Ensure the platform can grow with you or customize as your needs evolve.” Whether it’s integrating with e-signature platforms, email tools or commission-tracking software, compatibility is key. Kanter advises brokers to “avoid decision paralysis” by narrow ing down options to three or four platforms. “Ask your peers who they use, then schedule demos, free trials, and compare features like cloud stor age, document handling and reporting,” he says. 5 Invest in training and support Training and support can make or break the AMS experience. Look for systems with acces sible and timely customer service and training resources to empower your team. “There are great platforms out there, but if your team isn’t tech savvy and can’t access support when needed, it’s a problem,” Marrujo says. 6 Think long-term Kanter emphasizes the importance of select ing an AMS with future goals in mind. “If you ever plan to sell your agency, a well-implemented AMS is critical,” he says. “It provides potential buyers with organized data and makes the transi tion seamless.” Marrujo agrees, underscoring the importance of avoiding data migration headaches later. “Importing everything into a new platform down the line can be a nightmare. Plan ahead to save yourself time and stress.” By defining the agency’s needs, involving staff and focusing on scalability, brokers can set them selves up for long-term AMS success. “Your time is valuable,” says Marrujo. “Invest in tools that make your life easier and allow you to focus on what you do best.”

Voices

Maximize young clients’ HSA potential Brokers must show millennials and Gen Z how to use these accounts for maximum financial impact. By Brian Hutchin

Historically, we have significantly underestimated the costs of living in retirement, particularly healthcare. This trend is begin ning to change, however, with younger generations exploring a range of retirement savings, in cluding health savings accounts. By the end of 2023, people in their 30s accounted for about 30% of HSAs, according to research from Devenir & the HSA Council. Additionally, the Employee Benefit Research Institute found that millennials and Gen Z represent 60% of all HSA investment accounts. Given these trends, brokers need to help members of these generations understand how HSAs work. How HSAs work Thoroughly explaining HSA account options will allow your clients to maximize use. Here are some quick facts to share: • An HSA is individually owned and tax-advantaged. • The money in HSAs can be used for qualified medical expenses at any time, including retirement. • The 2025 maximum contribu tion amount for individuals is $4,300, and $8,550 for families. • HSAs have a triple tax advan tage: tax-free deposits, earnings and withdrawals.

open one with an HSA provider. Their HSA is tied to them, so their account will stick with them throughout life, with unused funds rolling over each year.

Maximizing an HSA An HSA is one piece of an

overall financial portfolio. Saving early and investing intentionally with an HSA is a great asset for young account holders. Regular review of all active accounts, such as 401(k)s, student loans or other financial obligations, will help to ensure balance and diversity. In addition to maximizing contributions, be sure your clients understand what is considered a qualified medical expense for HSA dollars. If they use their HSA for a non-qualified expense, they’ll have to pay income tax and a penalty fee of 20% on the withdrawal. Some HSA-eligible expenses:

To open and contribute to an HSA, your client must: • Be enrolled in a high-deductible health plan. • Not be enrolled in any part of Medicare. • Not be claimed as a dependent on another’s taxes. • Not have other non-permissible health coverage, such as a medi cal plan other than an HDHP or a flexible spending account. During open enrollment, if employers do not offer an HSA, HDHP plan participants can still Brian Hutchin is executive vice president and director of UMB Healthcare Services. With over 25 years in the financial industry, he is responsible for strategy and management of the healthcare team and on the executive team of the Institutional Banking division.

TIP: You can find a full list of HSA-eligible medical expenses in the IRS Publication 502.

• Dental treatments • Prescription drugs • Vision expenses • Chiropractic fees • Eye surgery

As your clients’ financial goals change, so will their HSA use. An HSA is a lifetime account, and if your clients start maximizing its benefits at a younger age, it has even more time to grow and help meet their ever-changing needs.

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The difference between success and missed opportunities A lack of coachability can turn a perfect setup into a costly mistake. Here’s why trusting the process matters. By Eric Silverman

taxes and then tells them how to do it. Nor does anyone micro manage a mechanic. There’s a method to the madness. Be coachable. People who are not coachable take advice, nod their heads and tell you what you want to hear. And then, sadly, do the exact opposite. That will never set up a success ful partnership.

A while back, I had an hour long call with a broker looking to increase voluntary revenue. We laid the groundwork for our collaboration, and both of us were enthusiastic. Then came the first test: a case with all the makings of a guaranteed success. The company was unhappy with its voluntary carrier and sought a change. We presented a dual carrier, best-in-class strategy with enhanced benefits at half the incumbent’s cost. By tran sitioning them to other well known, A-rated carriers, the solution seemed like a win. Our initial strategy setup is virtual. The adviser typically ar ranges a call with the employer, during which we present directly to the client via screenshare. While the broker agreed to this approach, he decided at the last moment to go it alone. We reminded him of our initial discussion, revisiting what works and what doesn’t. From experience, we’ve found that 99.9% of the time, ask ing a traditional health broker to master the intricacies of enhanced benefits is a challenge. Without specialized knowledge, they often struggle with common sales objections that arise when presenting a tailored enhanced

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benefits strategy. You can guess what happened. The broker went ahead on his own but couldn’t handle the employer’s questions or objec tions. The employer ultimately stuck with its carrier. We invested time, but the real loss was the broker’s. He missed a golden opportunity to help his client, its employees, himself and us. Instead, he prevented us from doing what we specialize in — the very reason he hired us. Being coachable No one hires a CPA to do their Eric Silverman owns Voluntary Disruption, a non-medical employee benefits technology, communications and engagement firm with in-house distribution and enrollment capabilities that serve advisors, brokers and consultants.

Asking a traditional health broker to master the intricacies of enhanced benefits is a challenge.

I’ve learned to say no to busi ness that won’t work as a part nership. Brokers who are stuck in their ways of doing things and block us from any contact with a group end up being a point of stress that ultimately blocks groups from getting the best benefits strategy. So, I po litely say we wouldn’t be a good fit for each other and move on. There’s no such thing as being 99% coachable. You’re either all in, or you’re not. That 1% resistance where you disagree with the subject-matter expert is often the difference between a sure thing and a slammed door.

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