Is the New 2025 CMS Rule for Agent compensation actually GREAT news for AGENTS and FMOs?

[yorkriver1]

The up front premium monthly cost for PDP's next year for the insureds is a concern with the approval of Wegovy and the $2000 maximum out of pocket Rx costs.

 

[GoPokes]

perhaps a better question, what do you dislike about the candidate you support, who you are going to vote for?

 

[somarco]

The up front premium monthly cost for PDP's next year for the insureds is a concern with the approval of Wegovy and the $2000 maximum out of pocket Rx costs.

Some were worried about premium increases for 2024 and they didn't really materialize as suspected. Of course no one expected a $0.50 premium plan.

And the 6% base premium cap is in play but some carriers will find a way to maneuver around it.

When I switched to Medicare in 2010 the lowest premium was $16 and a number of clients passed on it. They refused to pay for their $5 medication plus another $16 on top of that.

I expect to see a repeat next year if there are no plans under $10.

Also, Wegovy is not insulin so not subject to the $35 cap. . . and it may not be on the formulary for all plans.

A lot of moving parts in this projection

 

[Tscholar]

Yes lis/ partial Medicaid will have same seps as regular people . Oep/ aep etc . How I also read is unless a dsnp enrolls in a “ integrated “ dsnp which they can do monthly they also have the regular seps . But a fair warning what’s taking place . Cms wants all dsnps to eventually be “ integrated “ . This means the dsnp will have Medicaid / mapd with same carrier for total integration. It’s happening in Indiana next yr . What this means if you run into an Anthem dsnp they will have anthem Medicaid and mapd . It means unless you live there Medicaid first ti let’s say United you can’t move there dsnp . It affectively ends writing dsnps . But if you have a big dsnp book it’s good as retention will be much higher . Also a person who has Medicaid and gets Medicare will be auto enrolled in a “ integrated “ plan . So no more running into that given nugget were somebody just has Medicare /medicaid . Games getting tougher

I'm sorry, but I'm confused on what an integrated SNP is? Are you saying they will have Medicaid through a specific carrier?

 

[n3417511]

Saying companies shouldn't earn more than a certain amount misses how the free market naturally works. It's like forgetting that the chance to make more money pushes companies to come up with new ideas and value ads, that competing FMO’s helps keep margins fair, and that when companies do well. Basically, companies should be free to make as much as they can because their success means they're doing what people want and like.

Let's be clear: our deals with an FMO should be reflecting our actual value based on production levels, number of agents, and overall contribution. For instance, if I'm funneling 1000 applications a month their way, it's only reasonable they earn, say, $25 per app. But if I'm only managing to sell 4 apps a month, then sure, let them take $300 per app. Our earnings should mirror what the market dictates, not be tethered to some arbitrary figure an agent dreams up as their worth.

That would be true however it’s the government that pays the bills. No free market exists

 

[rmhaire]

That would be true however it’s the government that pays the bills. No free market exists

Sorry but @Packerland is correct. The gubment doesn't pay anything. Taxpayers do. But the gubment is damn good at running those bills up.

And everything is based on free markets. That's why socialism never works.

 

[GoPokes]

Sorry but @Packerland is correct. The gubment doesn't pay anything. Taxpayers do. But the gubment is damn good at running those bills up.

And everything is based on free markets. That's why socialism never works.

Ironically, Medicare and Social Security, are socialist programs

 

[rmhaire]

Ironically, Medicare and Social Security, are socialist programs

And both are going broke.

And after me and everyone else has paid hard earned money into both all of our working years.

Now that you mention it .....

 

[DonP]

You seem to be looking at the marketing money as something you earn or rightly deserve. It's not, it's a bonus. It was never something that was written in stone, so it's volatile. No one owes it to you.

No it’s not owed to me . And fmo overrides for doing jack crap aren’t owed either . Apparently cms agrees . I love watching all these fmo’s on facebook squirm

 

[DonP]

I'm sorry, but I'm confused on what an integrated SNP is? Are you saying they will have Medicaid through a specific carrier?

Yes that’s what cms is aiming for . I’m not in a state that does that . Apparently the carrier handles the integration of the Medicaid and carrier bills . The carrier handles the integration f care. Supposedly in Fla were the integration works that way you can still move an integrated plan and both the Medicaid and plan move together. I was told in some states you must move the Medicaid first. But the Fla model makes more sense so maybe that’s how it works