Navigating the Future of Medicare with John Greene

In this episode of the Insurtech Building Blocs Podcast, host Cory Schmidt speaks with John Greene from Tri-Branch Resolution about his career in the insurance industry, insights from AgencyBloc's BlocBuilder 2025 conference, and the implications of the Inflation Reduction Act on Medicare. They discuss the challenges faced by agents in the Medicare market, the need for legislative changes, and the importance of political engagement for agents. John emphasizes the need for a more streamlined process for agents and beneficiaries alike, and shares his vision for the future of the Medicare landscape.

Chapters
00:00 Introduction and Conference Highlights
03:13 John Greene's Career Journey and Entrepreneurial Insights
06:01 State of the Industry: Key Takeaways from BlocBuilder 2025
09:07 Inflation Reduction Act: Impacts on Medicare and Drug Costs
12:06 Challenges in the Medicare Market and Carrier Dynamics
15:12 Legislative Changes and Their Implications for Agents
18:16 Navigating the Medicare Advantage Landscape
21:05 Engagement Strategies for Agents and Brokers
24:09 Future Legislation and Market Trends
26:57 Closing Thoughts and Future Directions

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💻 Learn more about AgencyBloc: https://www.agencybloc.com
🎟️ Learn more about Tri-Branch Resolution: https://www.tri-branch-resolution-llc.com/

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Transcript

Cory Schmidt (00:02)
Hey everyone. Welcome to another episode of the Insurtech Building Blocs Podcast. My name is Cory Schmidt and I'm your host today. I'm excited to be coming off of a ⁓ high from our BlocBuilder conference and spending time with customers and partners. ⁓ What a tremendous week and we'll actually talk a little bit about that as well during the podcast, but I'm fortunate to be joined by someone who actually participated at BlocBuilder and was part of our

State of the Industry panel, John Greene from Tri-Branch Resolution. Welcome to the podcast, John.

John Greene (00:39)
Well, thank you. It's great to be here. ⁓ you know, going to Arizona was just wonderful.

Cory Schmidt (00:46)
Yes. Yes. A good change of pace for those of us that are in a little bit more moderate climates this time of year and can't decide whether it's spring or winter still. So I enjoyed it. And you said you're back on East Coast time.

John Greene (00:59)
That I am.

Cory Schmidt (01:00)
Okay. All right. Good. I'm still struggling. I'm not going to lie. So I think I spent a little, little bit too much time on that, that side of the country. And so I'm still trying to get back to central, but, well, I'm glad you're here, John. know that, ⁓ you've got a lot of, experience in the industry, obviously spend some time, ⁓ at NABIP and now with Tri-Branch Resolution. So I think it'd be great if we could spend a little bit of time on your background. ⁓ you know, what, what you've done over your career and

and the changes that you've made in the last bit.

John Greene (01:35)
Sure. So, you I love working with agents and brokers. It was never boring, which is why I stayed 24 years. I worked in all market segments, but I was the Medicare specialist. I worked on the MMA ⁓ when the ⁓ Obama administration tried to cut overrides through a rule late in their administration. It was tagged as the 120.4.4.

⁓ I fortunately had friends in the new administration coming in and was able to get that removed from the regulation. I got the OEP restored in 2016 as part of the Cures Act. So I've always been very active in the Medicare space. also worked in long-term care, getting the long-term care partnerships ⁓ rolled out nationally. ⁓

We of course dispensed with the taxes in the ACA in 2019, the Cadillac tax and premium tax and the device tax, which was an interesting journey. So in October, I started Tri-Branch Resolution. I thought about the three branches of government and that's where I came up with that name.

And it's been very interesting transition doing it all on my own. But I do have a client and working on some others prospects. So it's slow, but it's interesting and it's good to be back downtown again.

Cory Schmidt (03:20)
Awesome. Have you been an entrepreneur before John, or is this your first foray?

John Greene (03:25)
That's my first foray. ⁓ that was something that I got out of AgencyBloc personally was tips about how to run your business, how to prospect and ⁓ the sort of ⁓ follow-ups that you should do and how you should do that, manage them. That's something that, you know, it's not in my wheelhouse. So I found that those sessions very ⁓ good for me personally. thanks to AgencyBloc.

Cory Schmidt (03:55)
Yeah, that's great. And in fact, thanks to Mari Tautimes and the Outgrow session that she did for us during the BlocBuilder. Like just, she's just a phenomenal speaker. And then that framework I think was really interesting. And her commentary about, "You gotta, you gotta get the next no to get to the next yes." Like just the whole mindset of it was really fascinating. I really enjoyed that session and, and Mari's always been a fantastic partner.

of AgencyBloc I fully suspect we'll see her again.

John Greene (04:28)
That's great. ⁓ I actually did it during the session and it, you know, it actually paid off. I got responses. So ⁓ a testimonial that it actually works.

Cory Schmidt (04:35)
that's amazing.

⁓ that's awesome. Well,

well, hopefully Mari's listening to this podcast and if not, we'll make sure that she actually, ⁓ actually tunes in so she can hear the good news about her impact, reaching, you know, reaching out. So, ⁓ so yeah, BlocBuilder, obviously, you know, we just had BlocBuilder about a week ago. We spent, ⁓ three days in, ⁓ in Phoenix, Arizona, ⁓ with our customers and partners, just a really, ⁓ tremendous, event like

John Greene (04:50)
great.

Cory Schmidt (05:09)
just my favorite ⁓ really event of the year, just because how supportive and invested our customers in and everything that we're doing. ⁓ really, you know, makes me really proud about our team and how we've built this company and the work that we're doing to help impact our customers. ⁓ John, you personally participated, I know on the State of the Industry panel and in some other ways at the conference. I'm curious, ⁓ you know, from your perspective, how it went.

Maybe did you learn anything? Obviously you learned some things from ⁓ Mari, but beyond that, I know you probably had a lot of conversations with brokers and just kind of curious if you had any key takeaways.

John Greene (05:50)
So I hear a lot of concern about the Inflation Reduction Act and the $2,000 deductible cap. ⁓ And I did a round table on the Inflation Reduction Act. And ⁓ I think the big takeaway was really around the difference between small molecule and large molecule, which is really the ability to take medications by mouth, which is the small molecule.

Where the promise of that technology for people with cancers to be able to do it from home. And so that really got a conversation started about, you know, ⁓ just other impacts that were probably unintended in the Inflation Reduction Act. And we can go into more of that. But that's what I was hearing. And I thought Bill Hepscher's you know, session was highly attended for that reason as well.

Cory Schmidt (06:49)
Yeah, I certainly learned a lot about the, you know, the, the drug market and some of the things that, folks are trying to do to get creative, to try to control those costs. I think I've seen a cake, Kaiser, ⁓ survey that, ⁓ you know, most employers, the biggest concern that they have is around prescription drug costs. Like that's really what's kind of the key driving force. I'm curious on the, ⁓ what did you call it? large, ⁓ large.

molecule.

John Greene (07:19)
well,

large molecule versus small molecule. it's just basically, you know, biologics are the large where you have to go to a doctor's office to have it administered versus a small molecule, which is like taking an aspirin.

Cory Schmidt (07:22)
Yes.

Okay.

Interesting. So is there a concerted push to try to make more drugs available in small molecule format? Is that what we're seeing? what's the Inflation Reduction Act? How does that play into that?

John Greene (07:48)
Well, it's actually flipping research and development to large molecule because of a patent ⁓ extension that's longer than small molecule. So investments are flipped and that's very concerning for the industry.

Cory Schmidt (07:59)
Interesting.

Yeah, so the manufacturers are trying to protect those drugs for a longer period of time by doing those in large molecule format.

John Greene (08:13)
Yes, and there's legislation pending in both ⁓ houses of Congress to equalize that patent ⁓ longevity ⁓ between the large and the small molecule, which ought to help ⁓ send a signal to the community that, you know, hey, it's safe to. I think that what they were thinking is that large molecule ⁓ breakthroughs take longer.

or more difficult. And so they were giving them a patent advantage for that extra work. But what it's done in the immediate term is flip it on its head. And we've seen some promising cancer medications come online that are in the small molecule. And so many people have difficulty with travel, know, making an appointment with a doctor, waiting two hours, getting the injection, getting back home again.

Cory Schmidt (08:55)
Mm-hmm.

John Greene (09:12)
You it's a whole day event, whereas small molecule, you wake up, pop it in your mouth, have a glass of water and you're done. So it's a convenience thing and it's an adherence drug adherence issue as well.

Cory Schmidt (09:22)
Yeah, interesting.

Okay. Yeah. You mentioned the Inflation Reduction Act. Obviously the, the big kind of headline that I saw just from, you know, more of an outsider perspective was around the $2,000 prescription drug cap. Um, I'm curious, like how, how has the Inflation Reduction Act played out in, the Medicare market and what do you expect for maybe additional impacts that we've yet to see?

John Greene (09:54)
So when the MMA rolled out, there were 47 carriers and today there are seven and half of them don't offer commissions. It feels like they're trying to run Part D carriers out of business. Their margins have always been very, very thin. This is just making it, the way that they calculated

TrOOP versus ⁓ MOOP people who are in the business, hopefully they know what that is, right? And what it did is it inadvertently transferred responsibility, financial responsibility to the carriers. So they priced for that. And so when the premiums came out, they were very, very large. And so being in an election year, the prior administration did a demonstration project

as a means to funnel money back to the carriers to backfill that. But in spite of that, carriers have withdrawn from service areas. We're really concerned about that in rural areas. And ⁓ they have discouraged enrollments in their plans. They want people to switch from ⁓ PDP to MAPD where it's more profitable.

And they've reduced or eliminated commissions as a way to also try to transfer. you know, agents have been accused of ⁓ shifting patients. There's a lot of concern about churn. Well, actually, the steering is occurring by through the carriers. And I think we're going to see more of that this coming AEP as well. It's not going to. I don't foresee it stopping.

Cory Schmidt (11:54)
Yeah. And it's, it's interesting. I was talking to a couple of our customers who do a lot of Part D work and they mentioned how that's actually more work than, some of the other products they sell. then simultaneously, you know, they're not getting paid for that work either. Like that seems like a, a really bad scenario. So, so your expectation is maybe that some of those beneficiaries would be, would be going to MAPD or maybe that's, that's what you're saying. That's what the carriers ultimately are pushing for.

John Greene (12:23)
Well, that's what they would

like, but I think that, you know, an agent does their due diligence and decides or helps them figure out, right? What's the best fit both in terms of financial as well as their medical needs. So ⁓ satisfaction is so high because agents place a business properly and ⁓ they often do the PDP work. If they've sold them a MedSupp as sort of a courtesy.

But now it's become, and with the new rules and the changes in the formularies has been dramatic. Even tier one generics are showing up on higher tiers. And there's going to be, there's so much manipulation of the formulary and there's no, we really need a Part D OEP. You know, when I mentioned that we got it restored, that was just for MA. But

they don't have the same consumer protection that MA ⁓ beneficiaries enjoy. And who needs this ⁓ even more now than ever, right? Because of what you talked about drug costs. If that's really the concern, then I think doing an OEP for them would be the right thing to do. It's a simple fix. I've talked to CMS. They could said, since it's already set up for MA,

It's literally flipping a light switch to make that happen. So it could occur in the fall. And we're, ⁓ you know, ⁓ trying to shop it to various congressional offices to do this. It's worked really well. AARP is fine with it. The Medicare Rights Center does has no objections. ⁓ But we do need to fix some of these things around the IRA.

It can't continue that way it is.

Cory Schmidt (14:25)
What specifically do you think should be changed John, as it relates to the IRA and how it's structured?

John Greene (14:31)
The first thing I'd do is make sure that that MOOP and ⁓ TrOOP issue is resolved. I think that might even be an administrative ⁓ thing that they could do without legislation. And then I think you really have to address the part, ⁓ the $2,000 deductible cap. When you look at the number of people who are affected by it, it is extremely small. I don't think that it's gonna have the impacts that they hoped.

that it would have for a population is, like I said, very, very narrow. And then this notion that you could go to the drug counter and not pay the full freight of the drug and be on a payment plan in the 11th or 12th month of the plan year create so much uncertainty for Part D carriers ⁓ because they could ⁓ just never pay.

who's gonna pay those costs, right? So this was the last major bill done during the COVID period when there was no stakeholder involvement, the hearings were closed and I think they were well intentioned, but they didn't get industry feedback on how this might work and it's not working.

Cory Schmidt (15:33)
you enforce it?

John Greene (15:59)
and we told them it wouldn't work.

And I think, you know, with the pressure of a midterm in the following year, a plan year is, it's critical that they address it by then.

Cory Schmidt (16:13)
Okay. Right. So you and I talked a little bit about that topic around the administration changes. ⁓ know, Dr. Oz is now I think confirmed in the seat. ⁓ He seems generally supportive of the Medicare Advantage market. ⁓ And I'm curious, like how do you think he'll approach things? Do you think he'll be a proponent of some of these changes? Yeah. How do you think things play out with the new administration in place?

John Greene (16:43)
So I attended the hearings for him and I think he's a very practical guy. He's very data driven and I think we can demonstrate ⁓ those facts. ⁓ yes, he has been historically favorable to MA plans, but I don't think he understands what changes are necessary. ⁓ They put out a rule for ACA market

that actually made some sense and was practical along the lines that you would expect from a more friendly administration. ⁓ Even the ⁓ rules on the payment ⁓ for Medicare got a far larger raise than anyone ever anticipated, over 5%. Another encouraging signal.

So I think what they want to do is kind of stabilize the marketplace, if not fix everything, at least bring it back to equilibrium. And then we can fix things and make the market work best. mean, given how many people are coming into the market, I think it's in everyone's best interest to do so.

Cory Schmidt (18:05)
Yeah, that makes sense. Yes. ⁓ similar on the political spectrum. I know there was a report issued by Senator Wyden's office around an investigation into kind of just the, don't know if it was, I think it was really around the distribution network, right? Or distribution model for the Medicare Advantage in particular. ⁓ you, you had mentioned that they, you know, made a ⁓

a clear distinction between lead generators and marketing organizations separate of like IMOs, FMOs. I'm kind of curious what you saw there and how you think that might change the perception of the different entities that are involved in the distribution of Medicare.

John Greene (18:49)
So remember that his investigation was really centered around the COVID period. When there was no distribution, people were in lockdown and carriers didn't know how they were gonna market and enroll their beneficiaries. So they went out of their way to create these call centers. Some of them were offshore, beyond the reach of regulatory authority. ⁓

it wasn't the best of times for anybody, right? ⁓ So his solutions seem to be focused on a problem that doesn't exist anymore. And I think that now we have some separation from that. think things are more at equilibrium in terms of the market. You don't see the level of complaints anymore. They're like at pre-COVID level. know, time has a way of

Cory Schmidt (19:23)
Right.

John Greene (19:49)
getting people to think a little differently when you don't see the same behavior anymore. And so I think it's a real possibility and there's a Senator who's already proposing legislation to remove ⁓ agents and FMOs from that definition of TPMO. When I was at NABIP, we gave them a ton of information about the differences between all those groups.

and how we were not them. But they ⁓ decided to lump us all together and we said, this will cause problems in the future if you keep us all tied on the same life raft. And I think this is demonstrating a loosening of that ⁓ mantra or belief. Because once you get smeared with middle man, you can't get that stink off.

Cory Schmidt (20:47)
Mm-hmm.

John Greene (20:47)
And

no one knows that better than the PBM community.

Cory Schmidt (20:54)
Yes. I thought it was interesting when the, think it was, you know, last year when the thousand plus page ruling came out and, I was trying to understand the, the, what they meant by TPMO and just, seemed like they threw everybody into that definition except for the actual like writing agent for a policy. ⁓ so, so your expectation would be that maybe they will.

adjust that definition over time and maybe have it be a little bit more purpose-built for these large lead generators and call centers.

John Greene (21:24)
And I think that the court case in Texas, which ⁓ stayed many of the most egregious ⁓ aspects of the marketing rules, also is an indicator that it isn't going to fly. You just can't sweep everyone into a rule. And this is typical of CMS in its general ⁓ rulemaking process. And it just happened to be agents and brokers this time.

Cory Schmidt (21:53)
Yeah. Okay. What's, you mentioned NABIP, obviously you've got a long, ⁓ history there, ⁓ and in terms of, know, getting some of these things to the forefront of CMS so they can consider, ⁓ you know, how, how they're, how their rulings affect the agents and how they're operating their businesses. Like what, what's the best way for, you know, agency owners and operators to get their perspective understood by the folks?

all the way up within CMS and even up to the CMS administration as they think about how to roll out changes and how to make those beneficial for the broader industry.

John Greene (22:33)
We have to stay engaged and ⁓ many agent groups have annual meetings here in Washington. I think people need to attend those, meet their legislators. tend, agents tend to be very ⁓ active politically because they're regulated both at the state and federal level. And so many of them know who their DOI is or know the phone number of their local Congressman.

So I think you have to keep working it and educating. There's a lot of turnover in Congress. I know it's tedious. Some of them are roofers and, you know, different professions outside of what you know. I think you need to trust their health aides. They know what they're talking about. They know what they're doing. They still need to be educated, but

Keep in mind that the legislator listens to them. And so if you can get through to the 24 year old across the table, ⁓ you know, you've done and it's follow-up. What did we talk about at the top of this podcast, right? It's about the follow-up and it's, so you guys come by this naturally, you know how to do this. And it's the same thing in politics.

Cory Schmidt (23:58)
Yeah, so we basically need all of our ⁓ constituents and agency operators to understand the Outgrow concept, right? So that they know how to send the right follow-up text messages and emails to get action.

John Greene (24:14)
100%.

Cory Schmidt (24:16)
That's awesome. ⁓ What, as you kind of think forward to the rest of 2025, John, and into 2026, what policies or specific legislation do you think brokers and employers should be watching for and paying attention to? Like, what do you think are the most impactful things that are potentially on the docket that could sway things either in a positive or negative direction?

John Greene (24:45)
Sure, well, we mentioned the TPMO definition, I think is important. I think there are other marketing issues that get in the way. I think scope of appointment ⁓ creates ⁓ no beneficiary ⁓ benefits. Imagine going to a car dealership and the car dealer had to say, "I'll see you in two days." Their heads would explode, right? They want you to walk off with the car.

Cory Schmidt (25:09)
48 hour rule

for buying a used car. love it.

John Greene (25:12)
Yeah,

it's ridiculous. These are captains of industry just because they turned 65 doesn't mean that they're idiots. ⁓ The disclosure requirements, again, a waste of time. When they found out that agents could be, ⁓ you know, ⁓ in all 50 states ⁓ certified to sell, they didn't know what to do about that. So they just made it even uglier. I don't know what the purpose of that is.

And keeping records for 10 years for a recording also serves no purpose. If there are no complaints within the plan year, you wipe the slate clean. It's cheaper, it's less vulnerable to breaches, and we know how many breaches there have been in the healthcare space. Seniors don't understand the cloud. It's kind of silly to tell them, you know, we're recording this and we're going to keep it for 10 years.

Again, they couldn't give me a rational reason for it, but keep in mind that HIPAA also has a number of requirements where they keep things for 10 years. So I think they just borrowed that. So it's arbitrary and capricious. And then ⁓ the 112th rule always annoyed me where you get the first year commission based on when the beneficiary was born. So if there are November or December,

You get 1 12th of the first year commission as opposed to the full first year commission. And why not just wait till January? Again, it doesn't serve any purpose for the beneficiary at all. And it's so much work to do even renewals. ⁓ Right? You have to comb through the medical or the drug piece as carefully each year than you did

the year before, if you get my gist, right? It's a lot of work, as you have said. So I think that would be ⁓ something to consider, but it's not on my critical list to do, but it's just, I think if we can make it easier for agents to do their job, they'd be more productive, right? And it's all about the numbers. Make it easy for them to do.

Cory Schmidt (27:19)
Mm-hmm.

Yeah.

Yeah. It seems like anytime there's,

⁓ yeah, sorry to cut you off there. seems like anytime there's additional, ⁓ you know, rules or, ⁓ structure coming out from CMS, just, adds complexity. adds, you know, difficulty and actually, you know, getting customers into the right plan at the right time that they can afford and also has the benefits that they need. I understand that there is a need for regulation and rules and things to protect consumers. to your point, like,

You know, my mother recently turned 65 and she doesn't need a special scope of appointment in order to engage with her agent to be able to make the decisions she needs to make for her healthcare. Do you think it's practical that the scope of appointment could be eliminated?

John Greene (28:26)
Actually, I do. think, and you you could even compromise to say that with existing clients, it's not necessary. I could accept it for brand new ones, but once they become a client and you're the AOR, not necessary anymore.

Cory Schmidt (28:47)
Mm-hmm. Yeah. Or maybe a scope of appointment that doesn't require the 48 hour window or something like that. So you still have to, still have to sign something. Right.

John Greene (28:54)
Right. Again, that was

set up to solve a problem following the rollout of the MMA when ⁓ carriers were desperate to get market share and they didn't know who their agents were. But once they started to appoint their agents, that all stopped.

Cory Schmidt (29:07)
Mm-hmm.

Yeah. Well now it just seems like there's more awareness of what the Medicare Advantage market is, the products that are available. mean, what is it? 50 % of beneficiaries are in a Medicare Advantage plan. that, is that stat?

John Greene (29:23)
Well,

it's actually creeped over 50%, which is not, that made me nervous when that happened because there's a large segment who believe that traditional Medicare with the MedSupp is ⁓ the American way. And MA is just the devil. It's the private market and a public program. hate it. ⁓ And so I figured someone might,

be looking at it. for instance, in the Wyden report, it talks about ⁓ the increase in commissions over a period of time, ⁓ maybe three times as much. Well, there's been three times as much business since they ⁓ did the math. I mean, right. There are ⁓ how many per day, 12,000 a day becoming eligible for Medicare.

365 days a year, including weekends, holidays. So the numbers, we can do math and it's just an increase in the numbers, that's all. But they make it look like ⁓ agents are doing nefarious things.

Cory Schmidt (30:43)
Interesting. Yeah. I saw that set actually the, think it went from like two and a half billion to almost $7 billion in terms of the commissions. But yeah, that, I mean, it makes complete sense. There's more, more beneficiaries, more consumers wanting to buy those products. So there's obviously more commission being generated in the market, which, makes a hundred percent sense. So again, it could probably make use statistics to make anything look true. ⁓ it's important to understand the context here, which I think is what you're highlighting. That's very, ⁓ yeah, very important.

John Greene (30:50)
Correct, yes.

Cory Schmidt (31:13)
⁓ So John, kind of bringing it back around, Tri-Branch Resolution, we didn't really talk about what you're gonna be doing, how you'll be working with your customers, ⁓ maybe as we close things out here, ⁓ what kind of things will you be helping your customers with and how can people get in touch with you?

John Greene (31:34)
Well, I have a website, ⁓ tribranchresolution.com and ⁓ you have my email and you can certainly share it in anyone in the AgencyBloc world. ⁓ And I'm on LinkedIn. I use social media a lot. I think it's a great tool. ⁓

Yeah, I'm working on Medicare, as you know, all things Medicare, as well as ACA. I think ⁓ that there are a lot of concerns about crossover effects in terms of treatment of agents and brokers. ⁓ There have been accusations of unauthorized switching.

some of which I believe is technology based. I don't think that a human can switch 7,000 customers in three seconds before midnight manually. I know this is, I mean, I wasn't intended to be a joke that really happened. And, but yet agents get smeared with this and those customers are harmed as well as that, you know,

Cory Schmidt (32:40)
Mm-hmm.

John Greene (32:51)
agency is also, I think the AOR means something. So anyway, the ACA really interests me. But, you like I said, I've worked in all market segments, group, middle group, small group and individual. So yeah.

Cory Schmidt (33:09)
Okay.

Great. Well, I know you and I just, you know, recently got introduced and you took time to, you know, visit BlocBuilder and share your perspective in the panel that I moderated. And ⁓ I will just say like, I've really appreciate, appreciated your practical approach. It seems like you really want the best for the, the beneficiaries and for the brokers. And you really want to make it a successful industry without unnecessary complexity, which

I think is really admirable. So ⁓ again, really appreciate you taking the time, John, to share your perspective here. And hopefully we'll get to see you ⁓ at BlocBuilder again next year in Fort Lauderdale.

John Greene (33:51)
That would be great. And I won't have a time zone change.

Cory Schmidt (33:54)
Yes, that's true.

And a little bit shorter flight as well. yeah, awesome. We'll really appreciate the time, John. We'll definitely stay in touch and look forward to connecting again.

John Greene (33:58)
Yeah, absolutely.

All right. Thank you, Cory. It was a pleasure.

Cory Schmidt (34:08)
All right,

thanks for tuning in everyone again for another episode of Insurtech Building Blocs ⁓ Look forward to seeing you next time.