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

[Special Agent]

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.

They don't get auto assigned to DSNP in Florida they will however get auto assigned to a MMA medicaid plan if they do not choose one or enroll in a DSNP plan.Now how the new rules in 2025 effect this am not sure yet.

 

[Russ]

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?

Exactly

 

[sshafran]

Part D plans will pay $200? Seriously?

How cool would it be if our current books of PDPs go up to the $100 renewal rate...

Suddenly talking to Hilda about Metformin might have been worth it...

 

[sshafran]

Vic, it's not that the funding is being cut; rather, the increase in compensation for agents isn't a windfall for agents that some think. The additional $100 for new to Medicare clients and a $50 raise for renewals now replaces reimbursements for things like completing an HRA AHIP testing, marketing expenses, free CRM's, free SunFire and Connecture, enrollment tools, direct mail reimbursement, event booths Etc.

The $100 raise is meant to cover these costs without relying on subsidies from higher-level distributors.

One-time HRA vs extra $100/50 with the $50 being part of lifetime comp....

Oh, and oops you moved from Humana to Humana, no HRA $ for you.

I'll take the extra comp, screw the HRA.

AHIP is CHEAP. No big deal there.

Some of the other things were nice but let's be real - a lot of agents didn't get them.

I can use Carrier eapps (though I do prefer Sunfire) and I can also use Search and Save for comparison just like I have been for years

For me - from my perspective - this is ALL GOOD.

$ direct to agent and fewer middle men.

 

[Special Agent]

How cool would it be if our current books of PDPs go up to the $100 renewal rate...

Suddenly talking to Hilda about Metformin might have been worth it...

i don't think they will do that because they haven't raised FMV for part D renewals before but getting 200 for a part D enrollment is not bad.i sure agent won't be as willing to work for free helping people sign up with non commissionable part d plans or CMS may realize this and restrict carriers from having non commissionable value part D plans.

 

[Special Agent]

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

Yes

 

[axeman462]

Any idea how contracts that pay above street level will be affected?

 

[DonP]

Any idea how contracts that pay above street level will be affected?

History . No amount over fmv base . If anyone gets anything it will Fmo’s in some type of fixed arrangement. You can’t pay above street for any enrollments . If Fmo’s get cute they’ll be turned into cms . It’s a level playing field going forward . It’ll hurt me to the tune of $40 -$50 k . Fmo’s will be hungry to buy books of business since override business over . Books of business could sky in value

 

[thomasm]

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

So, the gig is up soon for final expense agents building up a big Dual MAPD book empire through cross-sells? At least in Indiana?

 

[axeman462]

History . No amount over fmv base . If anyone gets anything it will Fmo’s in some type of fixed arrangement. You can’t pay above street for any enrollments . If Fmo’s get cute they’ll be turned into cms . It’s a level playing field going forward . It’ll hurt me to the tune of $40 -$50 k . Fmo’s will be hungry to buy books of business since override business over . Books of business could sky in value

How are agencies with downlines supposed to exist then?
Everyone had to be an Indy?