Contract Year 2025 Policy and Technical Changes to the Medicare Advantage Plan Program, Medicare Pre

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[EXTERNAL LINK] - Contract Year 2025 Policy and Technical Changes to the Medicare Advantage Plan Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly, and Health Information Technology Standards | CMS

CMS is proposing to redefine “compensation” to set a clear, fixed amount that agents and brokers can be paid regardless of the plan the beneficiary enrolls in, addressing loopholes that result in commissions above this amount that create anti-competitive and anti-consumer steering incentives. The proposal ensures the payment of agent and broker compensation reflects only the legitimate activities required of agents and brokers by broadening the scope of the regulatory definition of “compensation” so that it is inclusive of all activities associated with the sales to/enrollment of a beneficiary into a Medicare Advantage plan or Part D plan. The proposed national agent/broker fixed compensation amount for Medicare Advantage is $632. This proposed fixed amount for Medicare Advantage compensation, compared to the existing national compensation cap of no more than $601, would eliminate the current variability in payments and improve the predictability of compensation for agents and brokers.
 
If you're in a tunnel and see a light coming towards you and hear a whistle it's time to run.....

New Guardrails for Plan Compensation to Agents and Brokers to Stop Anti-competitive Steering

Many beneficiaries rely on agents and brokers to help navigate complex Medicare choices as they comparison shop for coverage options. The Medicare statute requires that CMS’s marketing standards ensure that CMS develops guidelines to ensure that the use of compensation creates incentives for agents and brokers to enroll individuals in the Medicare Advantage plan that is intended to best meet their health care needs. However, financial incentives to agents and brokers, more readily paid by large plans, can result in beneficiaries being steered to some Medicare Advantage plans over others based on excessive broker and agent compensation and other bonus arrangements—rather than recommending plans based on the prospective enrollee’s best interests.

Specifically, CMS is proposing to redefine “compensation” to set a clear, fixed amount that agents and brokers can be paid regardless of the plan the beneficiary enrolls in, addressing loopholes that result in commissions above this amount that create anti-competitive and anti-consumer steering incentives. The proposal ensures the payment of agent and broker compensation reflects only the legitimate activities required of agents and brokers by broadening the scope of the regulatory definition of “compensation” so that it is inclusive of all activities associated with the sales to/enrollment of a beneficiary into a Medicare Advantage plan or Part D plan. The proposed national agent/broker fixed compensation amount for Medicare Advantage is $632. This proposed fixed amount for Medicare Advantage compensation, compared to the existing national compensation cap of no more than $601, would eliminate the current variability in payments and improve the predictability of compensation for agents and brokers.

Additionally, the proposed rule would generally prohibit contract terms between Medicare Advantage plan organizations and marketing middlemen, such as field marketing organizations, that result in things such as volume-based bonuses for enrollment into certain plans, which may interfere with the ability of agents or brokers to assist the enrollee in finding the plan that is best suited to their needs.

These proposed policies advance the goals of President Biden’s historic Competition Council and Executive Order signed in July 2021 by helping to ensure a robust and competitive Medicare Advantage marketplace.
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This is about stopping the extra money that FMOs are offering to agents. They are using loopholes , and I agree that it should be limited to keep agents from pushing the plan that is giving them extra money.

I welcome this.
 
I would be thrilled if the FMO's were cut out of this whole mess. I can still remember a time when direct contracting to a company was a common thing, and as long as you sold a few policies here and there (and had a low lapse ratio), everyone was happy. Of course, high production was alway preferred, but low production was basically acceptable by most companies. Anyway, as a guy who is, by most standards, a "low producer" in the Medicare space, I would welcome another $30 in compensation, and I would probably indirectly benefit from the prohibition "over and above" bonuses for the big producers, as they might not be flooding the market with so many advertisements. Their point about consumers being better off is also true, as a local agent in a small town is very unlikely to sell someone a product that doesn't fit that person; as reputation matters to that person. The slick sales folks on the other end of a telephone line only care about one thing -- closing the sale no matter what. I've always found it to be both hilarious and maddening when someone who KNOWS that I sell Medicare products will buy from a mass marketer, then contact me six months later complaining to me about how it isn't what the guy on the phone said it was.
And yes, $600 first-year and $300 renewal to sell a $0 premium plan is plenty as far as I'm concerned.
 
This is about the soft money floating around. Humana throwing out “non taxable” marketing money to their favorite shops. Why should an fmo make $250 on my fyc and $150 a yr on my renewals? That comp should be cut in 1/2 . I’d bet anything shit hit the fan with Humana pulling some funding to Ifg agencies . Tremors are hitting mapd . Started with Humana and United basically closing down their career Channels . United laying off many of there state regionals . It’s amazing . I’ve gotten almost zero emails from United this whole aep . Rumors of Cigna looking to exit mapd . All this is because of reduced mapd funding this yr and probably in the yrs to come . Same thing starting to hit aca. 100’s of thousands of agents have flowed into mapd and aca the last 5 yrs with dreams of getting rich .
 
I would be thrilled if the FMO's were cut out of this whole mess. I can still remember a time when direct contracting to a company was a common thing, and as long as you sold a few policies here and there (and had a low lapse ratio), everyone was happy. Of course, high production was alway preferred, but low production was basically acceptable by most companies. Anyway, as a guy who is, by most standards, a "low producer" in the Medicare space, I would welcome another $30 in compensation, and I would probably indirectly benefit from the prohibition "over and above" bonuses for the big producers, as they might not be flooding the market with so many advertisements. Their point about consumers being better off is also true, as a local agent in a small town is very unlikely to sell someone a product that doesn't fit that person; as reputation matters to that person. The slick sales folks on the other end of a telephone line only care about one thing -- closing the sale no matter what. I've always found it to be both hilarious and maddening when someone who KNOWS that I sell Medicare products will buy from a mass marketer, then contact me six months later complaining to me about how it isn't what the guy on the phone said it was.
And yes, $600 first-year and $300 renewal to sell a $0 premium plan is plenty as far as I'm concerned.


I keep hearing anyone can sell a zero premium product . Mapd could be $50 to $100 a month and the agents would still sell the same amount . Almost everyone has to buy it like car insurance .
 
Enjoy this aep because The mapd party is over and at its peak. Writing is on the wall and on legislative paper. The frenzy is similar to any other boom and bust cycles like the tech and real estate crashes. Maybe obesity or dental insurance is the next boom?
 
Enjoy this aep because The mapd party is over and at its peak. Writing is on the wall and on legislative paper. The frenzy is similar to any other boom and bust cycles like the tech and real estate crashes. Maybe obesity or dental insurance is the next boom?


Aca is coming next . I bet you 30% of people on aca are jobless for the last 2-3 yrs and brokers lieing saying they’re self employed .When trump gets back in you can sure as hell bet he cuts subsidies to the bone . I got people complaining about paying $55 a month . Unless you’re in the Middle income family mkt or 55 and over early retirement mkt aca is a shitshow of flipping . Young people coming and going . Poor people clicking ads being flipped monthly .Med sups won’t escape untouched . The gold rush cycle for agents to enter health insurance in general as been going on for 5 yrs.
 
Enjoy this aep because The mapd party is over and at its peak. Writing is on the wall and on legislative paper. The frenzy is similar to any other boom and bust cycles like the tech and real estate crashes. Maybe obesity or dental insurance is the next boom?
I say good riddance. Market is saturated. I have to uneducate then reeducate people every day because of the senseless and disingenuous advertising.

Btw, obesity insurance?
 
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