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

Integrity . But it’s not up to integrity wether they’re concerned with it . Carriers will get clarification from cms and what cms says all this means carriers must abide by it . It’s still cms’s call for what carriers can and can’t do .


Just seems like you are more worried about their money then they are
 
Just seems like you are more worried about their money then they are

I could care less if they all went under . Long long before your time in this business all agents were direct to carriers . It’s my job to know what people above me make so I can cut that as much as possible . What you’re saying is the guy at Lincoln Heritage making 60% should care that his upline makes 130-150% ? He should shut his mouth and be a good little soldier .
 
most agents probably are unaware of this

I dare say "most" agents are unaware of many things related to the products they sell. Not you, and this does not apply to several others, but the majority of postings I see from agents show blissful ignorance of even the basics of how Medicare works. Not just MA, but Medicare in general.

I'll try to reply to the other specific questions later.

Not necessary, unless you are hoping to enlighten the uninformed masses.

I have no argument with you personally, nor with your understanding of Medicare and the way your business model works. You are truly an exception to the crowd, and I sincerely mean that.

I have a lot of respect for you personally and professionally. Sometimes we may disagree on certain points, but the discussion is civil and does not resort to name calling.

There is always something to learn about our business and I do learn things from your post as well as some private conversations.
 
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I still don't have a dog in this fight, but my cursory reading of the topic SEEMS to be an attempt to limit actions by the (pick your acronym) IMO, FMO, TPMO, etc organizations and allow CMS to have more direct control over the actions of the "upline".

If a carrier or agent violates rules they can be sanctioned, fined, imprisoned, stoned on the town square . . . whatever.

But it SEEMS that some of the upline intermediaries are mostly able to operate with impunity. If the goal of CMS is to restrict or eliminate the intermediaries the new rules could well have an impact on those organizations including things like the Broadway Joe ads.

If the middleman is choked out the only players left may be the carrier and the agents . . . both of whom are subject to direct oversight by CMS.

My contracts are (almost all) direct with carriers, so my relationships won't be disrupted by new rules.

I wonder how @Newby and @Todd King feel and would like to see their input on this post.
 
I still don't have a dog in this fight, but my cursory reading of the topic SEEMS to be an attempt to limit actions by the (pick your acronym) IMO, FMO, TPMO, etc organizations and allow CMS to have more direct control over the actions of the "upline".

If a carrier or agent violates rules they can be sanctioned, fined, imprisoned, stoned on the town square . . . whatever.

But it SEEMS that some of the upline intermediaries are mostly able to operate with impunity. If the goal of CMS is to restrict or eliminate the intermediaries the new rules could well have an impact on those organizations including things like the Broadway Joe ads.

If the middleman is choked out the only players left may be the carrier and the agents . . . both of whom are subject to direct oversight by CMS.

My contracts are (almost all) direct with carriers, so my relationships won't be disrupted by new rules.

I wonder how @Newby and @Todd King feel and would like to see their input on this post.


I have no feelings about it at this point because (to me), it's all speculation right now.
 
This next song goes out to all the BFD's in the room . . .




But you do get paid for HRA's, right?

My understanding is that HRA's boost revenue for MA carriers. Is that correct?

If the HRA is never (or rarely) verified it certainly seems possible that carriers could collect additional taxpayer money for incorrect, falsified or embellished HRA's.

That certainly seems a logical conclusion. More HRA'a, more money for the carrier. What's not to love?

Feel free to jump in at any time with data.

I am willing to back off, just need some tangible evidence.



Perhaps you are right. Data? You don't seem like the type to BS their way through a discussion the way some of the agents do. When asked for supporting data they suddenly remember a tee time.



Aren't agents paid extra to complete an HRA? Seems like an incentive to me.

Risk assessment and risk adjustment are valuable tools
that are used for a variety of purposes in health care and
health insurance systems. They are used to adjust premium
payments to health insurance plans
so that plans are not
over- or under-paid relative to the health of their enrollees.

How many times does CMS challenge the HRA?

Is this just a rubber stamp operation? Seems like it.



Yes, the agent gets paid for the HRA. I think it used to be $50 and now it's $75 ??? I think some companies pay more, maybe for DSNP?? I can't remember exactly.

The HRA initially was pretty short and sweet, but it has grown a bit. The UHC one seemed like the shortest, and the others were longer. Now they are all longer, but the UHC still seems like the easiest, with mostly yes/no questions. The aetna HRA is pretty long.

I don't exactly see an incentive from the agent to falsify the answers to appear more unhealthy, on the contrary, an agent may quickly answer the questions... no, no, no ... to get it done quickly, which in turn makes the applicant appear healthier. If this were true, it would be working against the MA organization.

Personally, I have always done it truthfully, it's just a few questions, and an easy extra bonus payment. However, if the HRA is pretty long and tedious, I will just not do it.

The MA organization would get higher subsidies for the less healthy people, who are likely to have higher claims.

Ironically, there are agents always demanding higher commission levels, but when I tell them to just do the HRA and they will get paid the same as if they were at a higher level, they shrug and say no thanks.

There are agents who have abused the HRA, switching consumer plans just to get the HRA... possibly keeping within the same company. UHC to UHC, for example. UHC has now stopped paying HRA for internal plan changes.

I dont know exactly how call center agents are paid, but I could see where an agent in that setting, might have a higher temptation to take advantage of HRA's. Being paid hourly, with small bonus's for enrollment, would make an extra $50-$75 quite appealing.
 
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