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What to say to Clients on the other plans

Humana Value Choice (PPO) – 2026 Changes

Here’s a quick look at what’s changing with your plan for 2026. This is a simplified summary — you should have already received the official notice in the mail.

Summary ( Overall Good News)

Humana’s new Value Choice PPO keeps the same $0 premium and solid nationwide network, but now offers a small Part B giveback, slightly higher drug deductible, and a larger dental benefit ($2,500 per year).
Most everyday services like primary care, labs, and telehealth stay the same or slightly improve, while hospitalization and prescription costs remain stable.

Costs

  • Monthly Premium: $0 (no change)
  • Part B Giveback: Now includes a $1 premium reduction (new for 2026)
  • Maximum Out-of-Pocket (In-Network): $6,400 (no change)
  • Maximum Out-of-Pocket (Combined): $10,100 (no change)
  • Medical Deductible: $0 (no change)
  • Drug Deductible: $250 → $420 (applies to Tiers 3–5)

Medical Services

  • Primary Care Visits: $0 (no change)
  • Specialist Visits: $35 → $30
  • Inpatient Hospital: $310/day (days 1–6) (no change)
  • Skilled Nursing Facility (SNF): $10/day (days 1–20) → $0/day (days 1–20)
    • $214/day (days 21–100) → $218/day (days 21–100)
  • Emergency Care: $125 → $130
  • Urgent Care: $55 → $50
  • Outpatient Surgery (ASC): $350 → $275
  • Outpatient Surgery (Hospital): $450 → $350
  • Diagnostic Tests (Basic): $35 → $30
  • X-Rays: $50 → $30
  • Advanced Imaging (MRI, CT, PET): $200 → $200–$300 range depending on location

Dental

  • Preventive & Diagnostic: $0 (still included)
  • Comprehensive Dental: Coverage increased
    • Annual benefit $2,000 → $2,500 per year
    • $0 copay for cleanings, fillings, root canals, crowns, and extractions (network providers)
    • 2 cleanings and 1 exam per year
    • Includes deep cleanings, x-rays, and periodontal maintenance

Vision

  • Allowance for Glasses/Contacts: $200 → $200 ($300 with PLUS provider)
  • Eye Exams: $0 (no change)

Hearing

  • Hearing Exams: $0 (no change)
  • Hearing Aids: $299–$899 → $199–$499 per ear (through TruHearing)
    • Includes 3-year warranty and 60-day trial period

Over-the-Counter (OTC) & Extras

  • OTC/Healthy Food Allowance: $50/month (no change noted)
  • Gym/Fitness: SilverSneakers included
  • Telehealth: $0 copay for routine visits

Humana Essentials Plus Giveback (PPO) – 2026 Changes

Here’s a quick look at what’s changing with your plan for 2026. This is a simplified summary — you should have already received the official notice in the mail.

Summary (Overall Very Similar)

Humana’s Essentials Plus Giveback PPO keeps a $0 premium, adds a $90 Part B rebate, and strengthens preventive care and dental benefits. Hospital and office copays remain stable, while prescriptions maintain low costs. Overall, this plan rewards members with dependable nationwide coverage and consistent benefits year-over-year.

Would you like me to now create the same simplified version for the Humana USAA Honor Giveback with Rx (PPO) plan (the second file you uploaded)?

Costs

  • Monthly Premium: $0 (no change)
  • Part B Giveback: Up to $90 per month (new for 2026)
  • Medical Deductible: $425 combined (new deductible)
  • Maximum Out-of-Pocket (In-Network): $8,300
  • Maximum Out-of-Pocket (Combined): $13,900
  • Drug Deductible: $0 for Tiers 1–2; $350 for Tiers 3–5

Medical Services

  • Primary Care Visits: $0 (no change)
  • Specialist Visits: $40 (no change)
  • Inpatient Hospital: $310/day (days 1–7) → $0 after day 7
  • Outpatient Surgery (ASC): $275 (no change)
  • Outpatient Surgery (Hospital): $350 (no change)
  • Emergency Care: $115 (no change)
  • Urgent Care: $40 (no change)
  • X-Rays: $50 (no change)
  • Lab Services: $0 (no change)
  • Advanced Imaging (MRI, CT, PET): $200–$300 depending on location
  • Skilled Nursing Facility (SNF): $0/day (days 1–20); $218/day (days 21–100)

Dental

  • Preventive & Diagnostic: $0 (still included)
  • Comprehensive Dental: $0 copay for fillings, root canals, crowns, cleanings, and x-rays
  • Annual Maximum: $1,500 combined for preventive and comprehensive care

Vision

  • Allowance for Glasses/Contacts: $75 standard or $150 with PLUS provider per year
  • Eye Exams: $0

Hearing

  • Routine Hearing Exam: $0 (1 per year)
  • Hearing Aids: $699 (Advanced) / $999 (Premium) per ear (through TruHearing)

Over-the-Counter (OTC) & Extras

  • OTC Allowance: $50/month (no change)
  • Gym/Fitness: SilverSneakers included
  • Telehealth: $0 for routine visits

WellCare Clients

  • Simple & Giveback Plans Agent hint line:
    “It looks like these plans might take a slight step down next year.
    Nothing major, but whether it matters depends on your doctors, your meds, and how you use the plan.
    We’ll want to double-check everything once October 1st hits.”
  • Assist Plan Agent hint line:
    “It looks like this plan might be going away completely, but it’s not official yet.
    Once we know for sure, we’ll reach out and help you find the best replacement.”
  • Dual Plans Agent hint line:
    “They’re adding a bunch of new dual plans, and honestly, we don’t know yet if they’ll be better or worse.
    For now, I just want to know: How are you liking your plan this year?
    Your feedback helps us figure out what to keep an eye on.”

Aetna Clients

Aetna has seen better days, and a lot of their plans aren’t stacking up as well this time around.

  • Regular Aetna Plans Agent hint line:
    “Prices are creeping up a bit, so keep an eye on your premium and copays when you get your Annual Notice of Change letter.
    If it feels too high, don’t just suck it up — we can talk options after October 1st.”
  • Aetna Dual Plans Agent hint line:
    “Benefits are dropping a lot for next year.
    If you’re on one of these, you’ll most likely be better off switching.
    We’ll talk details when we’re allowed to, but just know: big changes are coming, and they aren’t in your favor.”

“Other Plans” and “PDP Only”

For clients with plans labeled as “Others” or “PDP Only”:

  • These aren’t showing major changes yet.
  • Just focus on building rapport and getting a read on how they feel about their current coverage.

Hint Line:
“Just wanted to check in and see how you’ve been feeling about your plan so far.
We’ll give you a call again soon after October 1st to go over exact details once we have the green light.”

Medicare Supplements (Med Supps)

Med Supps in Texas are seeing unusual price increases this year, but don’t bring this up unless the client mentions it first.

Most important thing is to get the meds as they should also be on a PDP with us bc those change a lot year to year, and we want to make sure we shop those for them

If at any moment you are not sure what to say to a client

Simply tell them we can’t tell them anything until next month and just check up and see if they are Red/Yellow/Green

UnitedHealthcare (UHC) – Ally, HMO-POS, and Plan 1

UHC is still one of the strongest, most stable carriers out there.
But here’s the deal for next year:

  • Copays are going up a little bit.
  • If you’ve been happy with your UHC plan and the small bump in copays doesn’t bother you, then nothing else is changing — UHC will keep being the reliable, steady option it’s always been.

There are other carriers offering lower copays, but keep in mind:

  • Smaller copays usually mean smaller doctor networks.
  • Those plans can also be less reliable than UHC in the long run.

Bottom line:

  • 👍 If you’ve liked UHC and the small price hike is fine with you → stick with it, it’s still solid.
  • 👎 If the increases feel like too much or if you’ve had problems with your UHC plan → we’re happy to shop around and compare options for you after October 1st.