The CMS Final Rule, shifting Star Ratings, and significant Medicare Advantage exits have placed enormous pressure on outdated systems. Plans that are modernizing their sales distribution operations will be able to respond effectively to the rapidly shifting healthcare landscape. Plans that have relied on spreadsheets, manual reconciliations, and siloed broker management, however, will struggle immensely to keep pace and will likely lose market share.
2025 has made one thing clear – health plans that are rebuilding distribution for resilience and growth will thrive. Here’s what 2025 made impossible to ignore.
The CMS Final Rule did more than raise expectations for oversight. It revealed the operational gaps inside many plans. Compliance teams are responsible for continuous visibility into call recordings, marketing activity, enrollment verification, disclaimers, and downstream partner behavior. Plans without connected systems are being forced into manual reviews and after-the-fact cleanup.
Plans that have been performing well are the ones that have already been operating from a unified data source, with contracting, hierarchies, commissions, and enrollment status living in one system. As a result, compliance work becomes faster, less risky, and far less expensive.
More importantly, these plans have become easier for agents to work with. Clean oversight and predictable processes improve trust, translating into higher productivity and more business.
Put simply, plans that treat compliance as a growth multiplier attract better agents and improve member experience.
Changes to Part C readmission weighting and Consumer Assessment of Healthcare Providers and Systems (CAHPS) experience scores created immediate consequences for many plans. For years, distribution and quality teams operated in parallel. In 2025, they became intertwined.
Agents influence expectations and navigation from the first conversation through renewal. Plans that support agents with more information and clearer workflows are better positioned to increase application volume and provide a stronger member experience.
Plans that continue to operate with fragmented systems are dealing with confusion, inconsistent guidance, and increased member friction. In a year where quality swings have had real financial impact, distribution strategy has become a lever for ratings performance.
The Medicare Advantage pullback altered the competitive landscape overnight. National carriers like Aetna, Humana, and Cigna have all reduced their footprints or have left counties where they could not maintain margin, creating new opportunities for regional plans. Thousands of agents needed products to sell and thousands of members needed new options.
Only the plans with fast onboarding, automated contracting, and immediate visibility into agent status have been able to capture this opportunity at scale. Plans without these capabilities simply haven’t been able to process paperwork fast enough, and are seeing their competitors move ahead. The gap between modernized plans and manual plans has been widening as a direct result.
As rules have been tightening and with large carriers leaving certain markets, many plans are discovering that their old, manual processes can’t keep up with the daily workload. Instead of focusing on members, teams have been wasting time inundated with spreadsheets, correcting errors, and answering status questions that should be visible in one place.
Digital distribution has become the practical solution. When onboarding, contracting, appointments, commissions, and compliance run through one connected system, execution happens faster with fewer mistakes. Agents get clearer answers, plans spend less time fixing problems, and new business flows more smoothly.
Plans that began this shift early have kept up with market changes. They’ve been ready to bring on agents quickly, avoid paperwork backlogs, and respond to compliance requirements without slowing down. In a year where speed has mattered, those advantages have added up.
Although open enrollment isn’t entirely over for all product categories yet, we can certainly say 2025 served as a stress test for every plan.
Plans with unified sales distribution solutions held up under the pressure and performed well during open enrollment. Their workflows were predictable and the data was clean. That foundation allowed them to scale without sacrificing accuracy. Overall, health plans learned that open enrollment is no longer a seasonal event, but a recurring stress test of distribution infrastructure.
The lesson from 2025 is straightforward. Growth is no longer solely driven by the number of agents or the size of a sales team. Rather, it’s determined by the quality of the systems that support contracting, onboarding, commissions, compliance, and agent experience. Plans that have invested in connected distribution operations gained speed, predictability, and share. Plans that didn’t invest spent the year reacting to preventable problems.
2026 will reward the plans that strengthen this foundation.
If 2025 showed anything, it’s that growth belongs to organizations that align contracting, onboarding, commissions, and compliance in one place. That is exactly why we built Abacus. It gives health plans the visibility and operational consistency they need to grow with confidence.
If you are ready to transform your distribution foundation and convert market disruption into sustainable momentum, Abacus is the next step.
Up next is Part 2 which shares our 2026 predictions and explains why distribution will shape the next decade of competitive advantage.