Independent practices are preparing for the 2026 ACA and Medicare enrollment seasons. From contract negotiations to staff readiness, a lot is riding on how well practices prepare for a successful enrollment selling season.
Carriers can play a decisive role in this process as they can be partners that make it easier for practices to thrive. Here’s what independent practices need to have in place, and how carriers can help them do it.
Support with Carrier Contract Reviews
Enrollment season is when contract issues show up in real time, and practices often feel like they’re scrambling to catch up. Health insurance carriers can take proactive steps on contracts, like:
- Provide more precise, earlier contract terms that highlight adjustments for 2026.
- Share benchmarking data so practices see how their reimbursements compare regionally.
- Offer webinars or office hours to walk practices through contract updates and compliance expectations.
This level of transparency empowers practices to protect their margins and plan with confidence with a partner they trust more.
Help Practices ‘Know Their Numbers’
Many independent practices struggle to analyze which plans patients use for coverage and which carriers generate the most practice revenue. Carriers simplify this by:
- Providing practices with patient utilization data in an easy-to-read format.
- Sharing insights on enrollment trends for 2026 Medicare Advantage and ACA plans.
- Supplying quick-reference resources for staff to answer patient questions faster.
When practices understand their patient panel mix by carrier, they can better prioritize conversations with patients and align resources accordingly.
Strengthen Patient Communication Tools
Physicians are the second most used source for health insurance information, behind only the internet. Carriers should leverage this status to improve their member communication by using independent practices to inform carrier members of important information. Steps include:
- Supply customizable communication templates (emails, FAQs, portal posts) about plan options and enrollment timelines that are compliant with CMS requirements.
- Offer co-branded materials for patient education that practices can easily share.
- Make key dates and plan summaries accessible through practice-facing dashboards.
When patients receive accurate, timely information, confusion decreases, and satisfaction increases.
Provide Staff Training Resources
Front-line staff, such as receptionists, billing teams, and medical assistants, constantly get hit with insurance questions. Carriers make these conversations very productive for themselves and their members by:
- Creating compliant scripts for common patient questions.
- Offering training modules or staff lunch-and-learn sessions to train them on how to direct patients to enrollment help without overstepping CMS rules.
- Streamlining eligibility verification tools to help practices avoid time-consuming coverage verification.
A confident staff member means confident patient members on the panel, and a smoother enrollment for carriers, too.
Build Partnerships That Support Access
Independent practices can’t do it alone, so carriers strengthen independent practice partnerships by connecting practices with:
- Enrollment navigators or brokers who work with patients to select plans that fit their provider and coverage preferences.
- Care coordinators step in when patients transition between different types of coverage.
- Local community outreach partners for outreach in underserved areas.
These partnerships improve retention for practices and ensure continuity of care for patients.
Ensure Compliance and Documentation Readiness
Compliance changes every year, and practices often lack the resources to keep up. Carriers make a difference by:
- Sharing updated 2026 coding and documentation guidance well ahead of enrollment.
- Offering compliance checklists or “self-audit” tools for practices.
- Hosting Q&A sessions with compliance officers so practices can ask questions before mistakes happen.
Helping independent practices stay ahead of compliance reduces headaches for both practices and carriers.
Carriers Set Practices Up for 2026 Success
Independent practices want to focus on patient care, not on navigating the complexities of contracts, compliance, and enrollment chaos. Carriers that step in as true partners now build stronger provider relationships, reduce administrative friction, and ensure a smoother, more successful 2026 selling season.
It is clear that carriers helping independent practices creates mutual success for everyone. At PCH, we collaborate with carriers and independent practices to build bridges, facilitating mutually beneficial partnerships that will contribute to a successful 2026 enrollment season.
Our team has decades of experience successfully facilitating the activities above for an independent practice’s revenue and operational success. Partner with PCH today to ramp up your 2026 enrollment season success so you can focus on what matters most – your patients’ excellent care.
Phone: (866) 985-2010, Monday-Friday 9 a.m. – 5 p.m. CT
