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

[DonP]

Understand that but have you heard if all renewals that are currently being adjusted up to FMV( i have many that are not that are still paying 16.00-20.00 renewals which i don't expect to be adjusted up to 355) will be adjusted to 355 starting 1/26 or only business effective 1/1/25 and after.

I have been thinking about selling my book of business because i am tired of this crap but this would weigh heavily on my decision.

The reason your seeing the $16-$20 is because the adjusted up renewals only started in 2020 new plans and later .But that’s a very good question . $ 355 equals $29.58 a month . The carriers might not adjust the current $25.50 to $29.58 on all the old plans . They could keep that extra money . Few are talking about this . A nuke has hit the mapd/pdp mkt the last really 10 months . We got the double whammy of claims skying and funding to plans as inflation skys . The profitablity of mapd has tanked big . So the question is do carriers really even want more business ? I’m not so sure . So obviously they could give 2 shits about the agebt right now . We’ve had 7 years of booze and blow . Now we’re coming down off the high .

 

[somarco]

CMS issued its final 2025 Medicare Advantage and Part D rule April 4, setting new standards around marketing, broker payments, and prior authorization.

Here are 11 things to know about CMS' final rule:

#5, #7 - #9

CMS finalizes 2025 Medicare Advantage rule: 11 key updates

"Learn about CMS' final rule for 2025 Medicare Advantage and Part D, including changes to marketing, broker payments, and prior authorization. Read more here."

www.beckerspayer.com

 

[Russ]

Here's what I like.....

"CMS is increasing the final national agent/broker fixed compensation amount for initial enrollments into a Medicare Advantage or Part D plan by $100, which is an amount higher than what was proposed ($31). CMS believes this increase will provide agents and brokers with sufficient funds to serve individuals with Medicare. This increase will eliminate variability in payments and improve the predictability of compensation for agents and brokers. This increase will be added to agent and broker compensation payments for the Annual Election Period in Fall 2024 and applied to all enrollments effective in CY2025 and future contract years."

Thanks. Love them T65ers!!!

 

[Special Agent]

So we get 100 more or 711.00 max new to medicare and 355.50 for replacements starting 1/2025 which means on first renewal in 2026 we get renewals will be 29.63 per month for 2025 business and based on past history i don't see why we wouldn't start getting the 29.63 for current renewals that are paying the 25.50 FMV in 2024.


#9 This one is interesting because it seems like this may be the end of DSNP plans that allow or are designed for SLMB partials


The rule reduces the number of plans able to enroll beneficiaries dually eligible for Medicare and Medicaid outside of the open enrollment period. This will crack down on year-round aggressive marketing of D-SNP plans, CMS said.

 

[DonP]

So we get 100 more or 711.00 max new to medicare and 355.50 for replacements starting 1/2025 which means on first renewal in 2026 we get renewals will be 29.63 per month for 2025 business and based on past history i don't see why we wouldn't start getting the 29.63 for current renewals that are paying the 25.50 FMV in 2024.


#9 This one is interesting because it seems like this may be the end of DSNP plans that allow or are designed for SLMB partials


The rule reduces the number of plans able to enroll beneficiaries dually eligible for Medicare and Medicaid outside of the open enrollment period. This will crack down on year-round aggressive marketing of D-SNP plans, CMS said.

What that means is all lis , partial dsnp’s and even full dsnps ( unless you move to a fully integrated dsnp which you can do monthly can only love plans during aep and oep unless there’s a sep like dst or moving . The question becomes will carriers crack down on fraudulent seps like pap which call centers use all the time . I haven’t read about can csnp’s still move monthly ? What’s happening in a nutshell is cms is pushing to integrated dsnps ( same Medicaid and Medicare with 1 carrier ) . In Indiana in 2025 all dsnps getting forms now who they want there Medicaid with ( anthem, humana or United ) . Right now let’s say they have United dsnp and say they want there Medicaid with Anthem. Then there dsnp will move to anthem in 2025 . Again this is good if you already have a dsnp book . What this means for all new business is if you run into a person with United Medicare and Medicaid . You can’t move there dsnp unless you move there Medicaid first to another company . That’s going to be tough . There eventually going to knock agent out . There’s 12 million dual eligible and at least 6 million lis.18 mil total which is about 40% of all mapd . The future in 5-7 yrs looks bleak .I’ll ride it to the end . I advise all agents to save there money

 

[Special Agent]

In Florida duals on original medicare get assigned or have to choose a medicaid MMA plan that manages the medicaid side only (UHC,Humana,Sunshine,Wellcare are the big ones).If a dual CHOOSES to enroll in a DSNP the MMA plan they were assigned to goes away because the DSNP is now in responsible for managing both medicare and medicaid.So from what you are saying is for example if a dual on original medicare who assigned to Humana MMA wants to enroll in a DSNP plan it has to be Humana unless it is the AEP?

Just wondering how this will work in Florida since the enrollment period for people to choose their mediciaid MMA plan is different from the Medicare AEP

 

[newbie2001]

In Florida duals on original medicare get assigned or have to choose a medicaid MMA plan that manages the medicaid side only (UHC,Humana,Sunshine,Wellcare are the big ones).If a dual CHOOSES to enroll in a DSNP the MMA plan they were assigned to goes away because the DSNP is now in responsible for managing both medicare and medicaid.So from what you are saying is for example if a dual on original medicare who assigned to Humana MMA wants to enroll in a DSNP plan it has to be Humana unless it is the AEP?

Just wondering how this will work in Florida since the enrollment period for people to choose their mediciaid MMA plan is different from the Medicare AEP

Had a client move from CA to FL. Got FL Medicaid and was auto assigned to a Simply Health DNSP Plan. Was able to move plans using the quarterly SEP.

 

[DonP]

In Florida duals on original medicare get assigned or have to choose a medicaid MMA plan that manages the medicaid side only (UHC,Humana,Sunshine,Wellcare are the big ones).If a dual CHOOSES to enroll in a DSNP the MMA plan they were assigned to goes away because the DSNP is now in responsible for managing both medicare and medicaid.So from what you are saying is for example if a dual on original medicare who assigned to Humana MMA wants to enroll in a DSNP plan it has to be Humana unless it is the AEP?

Just wondering how this will work in Florida since the enrollment period for people to choose their mediciaid MMA plan is different from the Medicare AEP

Ok I don’t known that . So your saying right now a dual united has Medicaid with United and a plan with United ? So your saying if you flip him to Humana his Medicaid and Medicare dsnp plan both automatically flip to Humana so there integrated ? I’m sure since Medicaid is done by the state the rules different in different states . Yes in my example to flip a person period they must change there Medicaid first . But what your saying makes more sense that the Medicaid automatically flips when the plan changes to align both . It new in 2025 in Indiana so what I was told might not be correct

 

[myinsurebiz]

Y'all are giving me a Migraine. Just go sell it and it will be what it will be.

Why stress something you have NO control over?

 

[myinsurebiz]

If the Upline/FMO can still receive $$ from the carriers, then an agent can be a “hybrid” of both a W-2 ***AND a 1099? He could still work his own leads and get paid as 1099, but use the Upline’s marketing tools (Payment of E/O, leads, health fair fees) and get paid as a w/2 or LOA. It could be an option, though not every agent would be interested.

You can only be appointed by most Carriers as either Indy [ direct to Carrier ] or as LOA [ paid to Agency ] - can't be both.