CMS Final Rule for MA/part D overrides

[SeaSideJB]

So if I’m reading that correctly new commissions for 2025 aep are $710 for New to Medicare and $355 for someone who already has a plan . But renewals will not go up in 2025 to $355/12 =$29.58 until the yr 2026?

It looks like renewal is 305. Where are you getting the 355?

 

[goillini52]

Support? I haven’t called my FMO in years. I’d rather take $100 extra an app than have access to Medicare center.

Other than using CSG a couple of times and buying a few leads on LeadCenter, I haven't used MedicareCenter since I got Search and Save a couple of years ago.

 

[goillini52]

It is an enrollment software platform generically called Sunfire, but different names depending who your FMO upline. My upline refers to it as “Simply Enroll”, but it is still Sunfire. If HealthSherpa is free to ACA enrollment, I’m not sure why Sunfire couldn’t also be free for MA enrollments?

I'm pretty sure he was kidding.

 

[Special Agent]

Not so sure about that, actually. It's the govy way - It might not be final, but it's final for today.

No . Many others Brock included think money will still flow to Fmo’s not as overrides but as some other type of payment . Again everyone’s talking there book . Yes loa’s will work but still massive marketing money and the $250 per app override gone . Example you sell a non t-65 right now that’s $200 for 5-1 effective date . Means $450 of potential money plus hra fee is gone . You got to pay the agent min $150 an app . Sure the loa agency could say we’ll make the money on backend renewals of $29.50 a month . The way choas coming to mapd renewals aren’t safe as far as clients can jump around . This is a major major hit to all organizations that have lived off overrides . No amount if Brock sugar coating can change that

So will we get the new 29.50 FMV of renewals for previously written business starting 2025 or 2026.that will be huge for an agent with a big book of business.

 

[InsuranceGuy29]

It looks like renewal is 305. Where are you getting the 355?

Starting in January 2026, all existing policy/client renewals will massively jump to $355 from $306. In 2025, the only raise will be on any new policies written for anyone that's brand new to Medicare Advantage.

All those new-types of policies will jump $100.....from $611 to $711. Sounds great on the surface, but that part is really no huge deal.

Most agents aren't writing tons of folks that are brand new to Medicare Advantage, and most agents already get around $680 for those right now, as all the carriers offer an HRA (health risk assessment) bonus of about $70 or $80 per application.

So it's really not that big of a jump. I wish they would've done the renewals, first, and then the extra $100 for folks that are new to Medicare Advantage, second.

 

[GoPokes]

Call center P&L

Looks like a few of the big call centers already operate at a loss, even with significant increase in revenues.

 

[DonP]

Starting in January 2026, all existing policy/client renewals will massively jump to $355 from $306. In 2025, the only raise will be policies written for anyone that's brand new to Medicare Advantage.

All those new-types of policies will jump $100.....from $611 to $711. Sounds great on the surface, but that part is really no huge deal.

Most agents aren't writing tons of folks that are brand new to Medicare Advantage, and most agents already get around $680 for those right now, as all the carriers offer an HRA (health risk assessment) bonus of about $70 or $80 per application.

So it's really not that big of a jump. I wish they would've done the renewals, first, and then the extra $100 for folks that are new to Medicare Advantage, second.

Damm I forgot about that . I know the $355 renewals start in Jan 26 . But were not going to get $355 on ma to ma starting in aep ?

 

[InsuranceGuy29]

Damm I forgot about that . I know the $355 renewals start in Jan 26 . But were not going to get $355 on ma to ma starting in aep ?

I don't believe so, but I could be wrong. The way they wrote all of this is pretty confusing, but I'm about 95% positive that what I wrote is correct.

 

[CaptainPlanet]

"Additionally, the final rule generally prohibits contract terms between Medicare Advantage organizations/Part D sponsors and middleman Third Party Marketing Organizations (TPMOs), such as field marketing organizations, which may directly or indirectly create an incentive to inhibit an agent or broker’s ability to objectively assess and recommend the plan that is best suited to a potential enrollee’s needs."


The way I interpret this, FMO's as we know them today, are done for.

 

[InsuranceGuy29]

"Additionally, the final rule generally prohibits contract terms between Medicare Advantage organizations/Part D sponsors and middleman Third Party Marketing Organizations (TPMOs), such as field marketing organizations, which may directly or indirectly create an incentive to inhibit an agent or broker’s ability to objectively assess and recommend the plan that is best suited to a potential enrollee’s needs."


The way I interpret this, FMO's as we know them today, are done for.

I'm interpreting it as they just can't have agreements in place to compensate an agent for "special" things, via financial incentives, that may steer an agent to write one carrier over another.