2025 CMS Final Rule published today

[Duaine]

§ 423.2274 Agent, broker, and other third party requirements.* * * * *(a) * * *Compensation. (i) Includes monetary or non-monetary remuneration of any kind relating to the sale, renewal, or services related to a plan or product offered by a Part D sponsor including,but not limited to the following:(A) Commissions.(B) Bonuses.(C) Gifts.(D) Prizes or Awards.(E) Beginning with contract year 2025,payment of fees to comply with state appointment laws, training,certification, and testing costs.(F) Beginning with contract year 2025,reimbursement for mileage to, and from,appointments with beneficiaries.(G) Beginning with contract year2025, reimbursement for actual costs associated with beneficiary sales appointments such as venue rent,snacks, and materials.(H) Beginning with contract year2025, any other payments made to an agent or broker that are tied toe nrollment, related to an enrollment in a Part D plan or product, or for services conducted as a part of the relationship associated with the enrollment into a Part D plan or product.* * * * *Fair market value (FMV) means, for purposes of evaluating agent or broker compensation under the requirements of this section only, the amount that CMS determines could reasonably be expected to be paid for an enrollment or continued enrollment into a Part D plan.Beginning January 1, 2021, the national FMV is 81. In contract year 2025, there will be a one-time increase of $100 to the FMV to account for administrative payments included under the compensation rate. For subsequent years, FMV is calculated by adding the current year FMV and the produce oft he current year FMV and Annual Percentage Increase for Part D, which is published for each year in the ratea nnouncement issued under § 422.31
(5) On an annual basis for plan years through 2024, by the last Friday in July,report to CMS whether the MA organization intends to use employed,captive, or independent agents or brokers in the upcoming plan year an t e specific rates or range of rates the plan will pay independent agents and brokers. Following the reporting deadline, MA organizations may not change their decisions related to agent or broker type, or their compensation rates and ranges, until the next plan year.* * * * *(13) Beginning with contract year2025, ensure that no provision of a contract with an agent, broker, or other TPMO has a direct or indirect effect of creating an incentive that would reasonably be expected to inhibit an agent or broker’s ability to objectively assess and recommend which plan best fits the health care needs of a beneficiary.* * * * *(d) * * *(1) * * *(ii) For contract years through contract year 2024, Part D sponsors may determine, through their contracts, the amount of compensation to be paid,provided it does not exceed limitations outlined in this section. Beginning with contract year 2025, Part D sponsors are limited to the compensation amounts outlined in this section.(2) Initial enrollment year compensation. For each enrollment in an initial enrollment year for contract years through contract year 2024, Part D sponsors may pay compensation at or below FMV.* * * * *(3) Renewal compensation. For each enrollment in a renewal year for contract years through contract year2024, Part D sponsors may pay compensation at a rate of up to 50 percent of FMV. For contract years beginning with contract year 2025, foreach enrollment in a renewal year, MA organizations may pay compensation at50 percent of FMV.* * * * *

 

[Duaine]

The document includes updated rules regarding agent and broker compensation in the Medicare Advantage (MA) and Prescription Drug Plans (PDPs). Here are the key points regarding agent commissions:

1. Compensation Limits: The rules ensure that the compensation agents and brokers receive for enrolling Medicare beneficiaries into MA and PDP plans aligns with CMS's statutory obligations to set limits. This is to ensure that the use of compensation creates incentives for agents and brokers to enroll prospective enrollees in plans that best fit their health care needs.
2. Prohibition on Separate Payments: The new rules generally prohibit contract terms between MA organizations and agents, brokers, or other third-party marketing organizations (TPMOs) that may interfere with the agent’s or broker’s ability to objectively assess and recommend the plan that best fits a beneficiary’s health care needs.
3. Standardized Compensation: A single, increased compensation rate for all plans is set, which will be updated annually. This change aims to simplify the compensation framework and ensure fairness across different plans.
4. Scope of Compensation: The scope of items and services included within agent and broker compensation is revised. The new rule eliminates the regulatory framework which currently allows for separate payment to agents and brokers for administrative services.
5. Impact on Marketing Practices: These changes align with broader efforts to ensure that beneficiary interactions with agents and brokers are based on providing clear and unbiased information, which supports beneficiaries in making informed choices among a robust set of health insurance options.

These revisions aim to streamline compensation practices, enhance the integrity of the enrollment process, and ensure that beneficiaries' interests are paramount in the marketing and sale of MA and PDP plans.

 

[DonP]

My understanding is words circulating at Medicare con that overrides gone . We’ll see what carriers say