Medicare Agent AEP Checklist: Networks, Formularies, ANOCs, and Compliance

Medicare Annual Enrollment Period runs from October 15 through December 7, 2026. Elections generally take effect January 1, 2027. Use the period to review existing coverage, compare available Medicare Advantage and Part D plans, and submit accurate enrollment requests.

A reliable Medicare AEP checklist must cover more than premiums and benefits. Verify provider networks, pharmacies, formularies, Annual Notices of Change, enrollment eligibility, required disclosures, documentation, and post-enrollment service.

Use the CMS CY 2026 Agent and Broker Training and Testing Guidelines, CY 2026 Enrollment and Disenrollment Guidance, and CMS model materials as primary references. Confirm carrier-specific instructions before using any plan materials.

Complete licensing and annual training first

Begin with licensing and certification. Confirm that every state license, appointment, carrier certification, and Medicare certification remains active for the jurisdictions and products you plan to sell.

CMS requires organizations and TPMOs to ensure that agents and brokers receive annual training and testing on Medicare rules, plan products, enrollment procedures, marketing requirements, beneficiary protections, and compensation standards. Carrier certifications may include additional product, compliance, and sales requirements.

Complete these steps before scheduling AEP appointments:

• Verify resident and nonresident insurance licenses.

• Confirm active carrier appointments.

• Complete the required Medicare agent training and testing.

• Complete each carrier’s 2026 certification.

• Review plan-specific benefits, formularies, provider directories, and service areas.

• Save certificates and completion records.

• Confirm your National Producer Number and required agent disclosures.

• Review updated carrier sales materials and submission procedures.

Use Advocate Financial’s Certification Station to organize available certification resources. Contact Advocate Financial if you need support confirming your preparation requirements.

Build the client review list in August and September

Do not wait until October to identify clients. Create a review list during August and prioritize clients with significant health, prescription, provider, or coverage changes.

Prioritize clients who:

• Use several prescriptions.

• See multiple specialists.

• Depend on a specific hospital or health system.

• Receive care from providers with changing affiliations.

• Have high-cost medications.

• Use dental, vision, hearing, transportation, or other supplemental benefits.

• Have Medicaid, Extra Help, employer coverage, or other insurance.

• Moved or may move before January.

• Received a plan termination or service-area reduction notice.

Request current client information before the appointment. Ask for the client’s current plan documents, medication list, providers, preferred pharmacy, preferred hospital, and coverage priorities. Explain that plan benefits, networks, formularies, and costs can change each calendar year.

Do not promise that a current doctor or medication will remain covered. Verify each item against the official 2027 plan materials when those materials become available.

Review every ANOC before comparing plans

The Annual Notice of Change, or ANOC, explains how a client’s current plan will change for the next contract year. Use it as the starting point for the Medicare plan comparison.

Review the client’s ANOC when it arrives in September. Identify changes to:

• Monthly plan premiums.

• Medical deductibles.

• Primary care and specialist cost sharing.

• Hospital and outpatient costs.

• Maximum out-of-pocket limits.

• Prescription drug tiers and restrictions.

• Provider and pharmacy networks.

• Dental, vision, hearing, transportation, and over-the-counter benefits.

• Prior authorization, referral, step therapy, and quantity limits.

• Plan service area and contract status.

Compare the ANOC with the Evidence of Coverage, Summary of Benefits, provider directory, pharmacy directory, and formulary. The ANOC identifies changes, but the Evidence of Coverage provides the complete rules and limitations.

Document the client’s response. Record whether the client wants to keep the current plan, compare alternatives, or review Original Medicare with a stand-alone Part D plan.

Verify providers, hospitals, and pharmacies

Network verification is one of the most important steps in how to sell Medicare insurance responsibly. A plan with a lower premium may not meet the client’s needs if it does not include the client’s providers or preferred facilities.

Create a provider list that includes the primary care physician, specialists, hospital, laboratory, durable medical equipment supplier, behavioral health providers, and other frequently used facilities.

Check each provider in the official directory for the specific plan and plan year. Confirm the network type, including HMO, PPO, PFFS, or SNP requirements. For PPO plans, explain the difference between in-network and out-of-network benefits. For HMO plans, explain referral and network rules when applicable.

Verify the preferred pharmacy using the plan’s pharmacy directory. Confirm whether the pharmacy is standard or preferred and explain how that distinction may affect prescription costs.

Encourage the client to contact providers directly before enrollment. Directory information can change, and a provider’s participation may depend on the specific plan, location, or contract.

Check every prescription against the formulary

Obtain a complete medication list. Include the drug name, strength, dosage, frequency, quantity, and pharmacy. Incomplete medication information can produce an inaccurate comparison.

Review every medication against the official Part D formulary. Record:

• Covered or non-covered status.

• Drug tier.

• Prior authorization.

• Step therapy.

• Quantity limits.

• Preferred pharmacy pricing.

• Mail-order availability.

• Estimated monthly and annual cost.

Compare total drug costs instead of focusing only on the premium. Include the deductible, copayments, coinsurance, coverage phases, and expected annual spending. Review insulin and vaccine costs when applicable. Confirm how current federal Part D changes affect the client’s projected costs under the specific plan.

Do not assume that a drug covered in 2026 will remain covered in 2027. Do not rely on an outdated formulary, a general carrier summary, or a third-party database without confirming the information in the official plan materials.

Compare plans using documented priorities

Use the client’s stated priorities to structure the comparison. Ask whether the client prefers a lower premium, broader provider access, predictable cost sharing, prescription savings, supplemental benefits, or a specific provider relationship.

Compare the current plan with realistic alternatives. Include Original Medicare with Part D when appropriate. Explain Medigap considerations separately when the client is evaluating a return to Original Medicare.

Use a consistent comparison record that includes:

• Plan name and contract information.

• Plan type and service area.

• Monthly premium.

• Medical deductible.

• Maximum out-of-pocket limit.

• Primary care and specialist costs.

• Hospital costs.

• Provider and hospital network results.

• Pharmacy network results.

• Prescription coverage and estimated annual drug cost.

• Supplemental benefit limitations.

• Client’s stated reason for selecting or retaining the plan.

The recommendation must reflect the client’s needs and preferences. Do not describe one plan as universally better than another.

Complete permission, scope, and compliance steps

Use a documented permission process for all outreach. Follow applicable CMS, carrier, state, and organizational requirements before discussing plan-specific products.

For scheduled personal marketing appointments, obtain and retain the required Scope of Appointment before the appointment when applicable. Limit the discussion to the products and product types agreed to by the beneficiary. Obtain a new scope when the discussion expands beyond the original scope.

Follow the current carrier and CMS rules for marketing events, educational events, unsolicited contact, referrals, gifts, meals, and health care settings. Do not conduct health screenings as part of a standard enrollment discussion. Do not request information that is not necessary for the enrollment process.

CMS training guidelines require TPMOs to record marketing, sales, and enrollment calls in their entirety. Confirm your carrier’s recording process before AEP begins. Store recordings, scopes, permissions, enrollment forms, comparison notes, and supporting documents according to applicable retention requirements.

Before enrollment, review the CMS standardized Pre-Enrollment Checklist. Discuss the client’s providers, pharmacy, prescriptions, costs, out-of-network rules, plan restrictions, benefits, and the Evidence of Coverage. Make sure the client understands that enrolling in a new plan can terminate existing Medicare Advantage or Part D coverage.

Follow the August–December AEP calendar

August 2026

Build the client review list. Verify licenses, appointments, Medicare agent training, carrier certifications, and product access. Review carrier readiness notices and prepare compliant outreach materials.

September 2026

Contact clients and request current information. Review ANOCs as they arrive. Update medication, provider, pharmacy, hospital, and coverage records. Identify clients affected by plan changes, non-renewals, network changes, or formulary changes.

October 1–14, 2026

Use this period for education, appointment scheduling, and plan preparation. Confirm that plan-year materials are final and available. Do not solicit or accept AEP enrollment requests before October 15. Obtain required scopes and permissions for scheduled appointments.

October 15–November 15, 2026

Begin AEP enrollment activity. Compare plans using official 2027 materials. Complete the Pre-Enrollment Checklist. Confirm the client’s election, effective date, signature or attestation, and required agent information.

November 16–December 7, 2026

Complete unresolved reviews and submit remaining applications before the deadline. Check incomplete applications immediately. Follow up on missing information, rejected submissions, and duplicate elections. Remind clients that December 7 is the final day of AEP.

December 8–31, 2026

Review carrier and CMS confirmations. Resolve application issues. Send clients plan-specific confirmation information and instructions for using coverage beginning January 1, 2027.

Submit, confirm, and service every enrollment

Submit the completed enrollment through an approved carrier or CMS mechanism. Record the application date, submission method, plan selected, election period, confirmation number, and submission status.

CMS guidance requires plans to process completed enrollment requests within established time frames. Agents should submit applications promptly and monitor carrier responses. Do not assume that a submitted application has been accepted.

Follow up on:

• Missing signatures or attestations.

• Incorrect Medicare numbers.

• Residence or service-area issues.

• Incomplete election-period information.

• Duplicate applications.

• Rejected transactions.

• Missing carrier confirmation.

• Effective-date discrepancies.

After acceptance, explain how the client will receive membership materials, access care, fill prescriptions, pay premiums, and contact the plan. Remind the client to verify the membership card, provider participation, pharmacy access, and prescription coverage before January 1.

CMS’s CY 2027 Medicare Advantage and Part D Final Rule includes updates affecting future plan operations, Part D requirements, supplemental benefits, Star Ratings, and enrollment processes. Continue monitoring CMS and carrier notices throughout AEP.

Use this Medicare AEP checklist for every client. Verify the facts. Document the recommendation. Submit on time. Follow through after enrollment.