This review compares a client's current Medicare Advantage plan against alternatives for the coming plan year, using Medicare's own published plan data. Every figure names where it came from, and the review says when it doesn't know something yet rather than guessing.
The Annual Review lives on the Annual Review tab of the Individual Record, alongside the record's other tabs.
Requirements
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To open the Annual Review tab and run a review:
- You must be logged into AMS+ as an Agency User or Agent CRM User.
- You must be assigned to a Security Group with the Individual Visible and Policy Visible permissions. Without both, the tab does not appear at all.
- If you're an Agent CRM User, you need access to Individual Records and Policy Records assigned to your Accessible Agent, and optionally unassigned records.
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To mark a review as reviewed, or to un-mark it:
- You must be logged into AMS+ as an Agency User or Agent CRM User.
- You must be assigned to a Security Group with the Individual Edit permission.
- If you're an Agent CRM User, you need access to Individual Records assigned to your Accessible Agent, and optionally unassigned records.
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To configure your agency's Annual Review eligibility settings:
- You must be logged into AMS+ as an Agency User.
- You must be assigned to a Security Group with the Manage Data & Custom Fields permission. See Set up your agency for Annual Reviews below for what to configure.
In this article
What to expect
The review is built entirely from Medicare's published plan data, so there's no ANOC letter to collect and nothing for the client to fill out. The table below is the short version of what it does and doesn't do; the rest of this article covers each in more detail.
| What it does | What it doesn't do |
|---|---|
| Covers Medicare Advantage plans, compared against alternatives sold in the client's county. | Cover Medicare Supplement, standalone Part D, or ACA and small group coverage, even if the client holds one alongside an MA plan. |
| Ranks alternatives by how many of the client's medications each plan covers, then restrictions, then estimated cost. | Weigh what matters most to this specific client. The ranking is a reasonable default, not a verdict. |
| Names a recommended plan, calculated from that ranking. | Tell you whether the client should switch. That's a judgment call the numbers don't settle. |
| Sources every figure to Medicare's published plan data. | Verify the plan you selected, the client's doctor and pharmacy networks, or the Extra Help answer. All three depend on what you enter and confirm. |
| Shows star ratings for the conversation. | Use star ratings to rank alternatives or drive the recommendation. |
| Prepares talking points and a comparison for the appointment. | Complete enrollment or continue monitoring the client afterward. Enrollment happens in your quoting integration; nothing tracks the client once the appointment ends. |
Run the review during Annual Enrollment Period (AEP) for the full picture. Next year's pricing publishes in late September, but the drug data doesn't land until AEP opens in October. Run it before then and you'll get premiums, deductibles and out-of-pocket maximums, with drug costs marked as not yet available rather than shown as zero. Reopen the review once the drug data lands and you'll be offered an action to update it.
Set up your agency for Annual Reviews
Before the Annual Review tab can appear on any client's Individual Record, an Agency User with the Manage Data & Custom Fields permission needs to configure two settings. Neither is on by default, and this is a one-time setup.
- The Coverage Type Category must be set to Medicare Advantage on each coverage type the agency uses for Medicare Advantage policies.
- The policy statuses your agency treats as active must be marked In Force.
Until both are done, no client qualifies, so the tab won't appear on any record. If a client you'd expect to see this on doesn't have the tab, check these two agency-wide settings first — they have to be right before any single record can show the tab. If both are already correct, the tab may instead be missing because of that specific client's own record; see Running the review for what to check there.
Running the review
- Open the client's Individual Record.
- Select the Annual Review tab.
This assumes the client already qualifies. On a specific record, the tab only appears when that client holds an in-force policy categorized as Medicare Advantage and has a county or ZIP code on file — separate from the agency-wide settings above, which only control whether the tab can appear on any record. If your agency is configured correctly but the tab is missing on one client while showing on others, check those two record-level conditions on that client's own Individual Record.
The tab opens on Current plan. The other three cards show locked until you select a plan, answer Extra Help, and select Save changes. Most calls move through the cards in order, but nothing stops you jumping to whichever one the conversation needs.
Current plan
The Current plan card shows the client's county, read from their Individual Record's primary address, and where it came from. If the client has no county on file, or their ZIP spans more than one county, the review asks for a ZIP code and uses it to find the right one — selecting it automatically when the ZIP points to a single county, or offering a choice when it doesn't. Select Wrong county? Change it to correct it through the same ZIP-based flow at any time.
Below it, select the plan the client is on from the plans available in that county.
The plan is never matched automatically — select it yourself, or select Choose a different plan to pick a different one.
Beneath it, the review asks whether the client qualifies for Extra Help. This is the single largest source of wrong drug prices, so the review won't guess at it.
A Client qualifies for Extra Help checkbox sits unchecked by default. Checking it reveals a required list of categories, along with an I'm not sure option.
What you answer changes what the review can show:
- Left unchecked: the review is priced as no Extra Help and says so beside the figures. It still runs, so you're never blocked on an answer you don't have yet.
- Checked, no category chosen, or I'm not sure: no medication dollar figures appear anywhere on the review, and it names Extra Help as the missing fact.
- A category chosen: each medication is priced at the lesser of the plan's own cost share and that category's published ceiling, and the deductible is $0 whatever the plan's deductible is.
You can change the answer during the call and the review rebuilds on it. The answer is saved for that plan year, so next year's review starts from it and asks you to confirm it rather than applying it straight away.
The review also asks whether the client is enrolled in the Medicare Prescription Payment Plan. Nothing in AMS+ or in Medicare's data records who is enrolled, so this has to come from you. When you answer yes, the review describes costs as billed monthly by the plan rather than paid at the pharmacy counter. The yearly total is the same either way; only the timing changes.
Select Save changes to save the plan and Extra Help answer to the record and unlock the other three cards.
Year in Review
The Year in Review, What changes next year, and Options to present at the appointment cards are available once you've selected a plan and selected Save changes in Current plan.
The Year in Review card, titled "Year in Review for [Client]," offers a readable brief on what moved on the client's record this year and what to raise on the call.
Select Generate to have AgencyBloc Intelligence read the client's personal, policy, and medication history since the start of the plan year and write it up as talking points.
Every item names the record it was read from, so you can check it directly. Items worth a second look are flagged, including a medication list that hasn't been reverified this plan year or a client with no medication list at all.
Powered by AgencyBloc Intelligence. Review before relying on it. AI can make mistakes.
What changes next year
The What changes next year card, titled "What changes for [Client] next year if [Client] stays on the same plan," summarizes what moved on the plan. A summary line leads with the count, for example "5 changed, 3 working against the client," followed by a labeled tag for each changed plan detail — premium, deductible, medication coverage, benefits, and similar plan indicators — showing the change and whether it helps or costs the client.
A one-line medication summary names how many of the client's medications are affected and how: how many cost more, how many gained a restriction, and how many dropped off the plan's drug list. Medications that couldn't be matched are counted separately.
A boxed figure shows the estimated change in what the client pays over a year. Two things to know about it before you quote it:
- It counts copay-tier drug costs only. Drugs the plan prices as a percentage are excluded and named, so the figure can understate a client on those drugs.
- An allowance that went up, like a larger dental benefit, shows as a tag but isn't subtracted from the figure, because an allowance is only money if the client uses it. An allowance that went down is counted.
If the prescription check hasn't run for this plan, the total says why rather than treating the client as having nothing to check:
- A medication list that's never been requested reads "No medication list has been collected for this client."
- A client confirmed to be on no prescriptions reads "This client is on record as taking no prescriptions, so there is nothing to check."
- A pending or canceled Rx Collect request gets its own line. It's never shown as a client with nothing to check.
When a plan is changing or ending
Not every client's plan carries into next year unchanged. The card handles these cases:
- The carrier is merging the client into a single, clear next-year plan. The review names it and states that the move happens automatically.
- The plan splits into more than one next-year plan, and CMS names the destinations. You choose among the plans CMS names, even ones CMS has suppressed from the county's regular plan list, rather than from every plan sold where the client lives. Until next year's drug data publishes, these are listed alphabetically; once it's available, they're sorted by cost like the rest of the review.
- The plan is ending, or CMS doesn't name any successor at all. You choose a comparison plan yourself, starting from the ranked alternatives or any plan sold where the client lives.
- The plan renews but no longer covers the client's county. The client is treated as having lost it.
- The carrier has left the client's area entirely. The review says so directly, since it rules out staying with that carrier.
- The plan is carrying over unchanged. No difference is shown, since there isn't one to report.
A comparison plan you choose yourself is always labeled as a plan being considered, never as one the client is enrolled in or being moved to.
Plan breakdown
Select Plan breakdown to open every plan-level indicator, changed or not — premium, deductible, out-of-pocket maximum, dental, over-the-counter and hearing allowances, copays, and coinsurance — each with the itemized math behind the annual cost figure above.
The breakdown names what it leaves out and why: the out-of-pocket maximum isn't counted, since it's only paid if the client hits the ceiling, and per-visit copays aren't counted, since how often the client visits isn't known. If any medication couldn't be priced, the total says so and how many, rather than quietly summing only the ones it could.
Star ratings appear here too. They're the contract's rather than the plan's, so every plan under the same contract shows the same numbers. A standalone drug plan shows a Part D rating and no overall rating, which is how Medicare publishes it rather than a gap in the data.
Medication breakdown
Select Medication breakdown to open the full prescription check: how many of the client's medications carry a drug code that can be checked, and the day-supply basis behind each cost.
A price is never shown without saying what it accounts for. Medications without a drug code get a suggested match for you to confirm; nothing is applied automatically.
Options to present at the appointment
At the top of the Options to present at the appointment card, a banner shows the client's Scope of Appointment status — signed, with the date; not signed, with a Send a Scope of Appointment action to start one from here; or unavailable, if the status can't be read right now. None of the three holds up what's below: the comparison renders in full either way.
Below it, the card compares the renewing plan against the two best alternatives sold in the client's county, side by side on premium, deductible, medication coverage, benefits, out-of-pocket maximum, star rating, and estimated cost for the year. Where an alternative is better or worse on a given row, it's marked with the dollar difference.
A recommendation closes the card, naming which plan to lead with and what the runner-up would cost. It's a starting point for the conversation, calculated from the ranking below, not a directive.
The alternatives are ranked on how many of the client's medications each plan covers, then on how few restrictions those carry, then on the lowest estimated cost for the year. Star ratings play no part in it.
Select See all available plans to work from the wider list of eligible plans in the county rather than just the top two. Select the plans you want, then select Compare against this plan to bring them into the comparison.
Provider networks are not compared here. Each plan links to its own directory, and some plans don't publish one at all. Check with the carrier before presenting it.
Take action on the review
Start a quote
Selecting Start Quote opens your agency's configured quoting option for this client in a new tab, leaving the review open and unchanged behind it.
- If your agency has more than one active quoting integration, you'll see one option per integration, the same options you'd see starting a quote from the client's own record.
- If your agency has no active quoting integration connected, this option doesn't appear at all. Only your client carries into the quote; the plan and county don't yet.
Mark reviewed
Once the appointment is complete, select Mark reviewed. The client clears from the count on the Dashboard > Annual Reviews tab, and nothing is added to the client's Activity timeline. Who marked it and when is recorded, and the status belongs to that plan year, so it resets automatically when a new Annual Enrollment Period opens.
If you don't see the control, either you don't have the Individual Edit permission or no review has been run and saved for this client yet. If you do have the permission, it works the same on every client in the agency, not just the ones assigned to you.
To undo it, select Un-mark this review in the confirmation message. You can do this any time during the year, on the current plan year's review. A previous year's completed review stays visible as history and can't be un-marked.
If the review's underlying data changes after you've marked it, a banner tells you who reviewed it, when, and that it has changed since. The review stays marked, and you can un-mark it from the same message if the client needs another conversation.