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

[hockeyday]

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

So for aep 2025 are you still going to dump 1,000's of pieces of dm,? How are you going to play the flip game in the dsnp market, if your 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

After reading it again, I'm going to have to disagree with you.

Agencies/GA/SGA/MGA etc.. are still allowed. And therefore those contract levels are still allowed.

What's not allowed is the admin fees/marketing monies etc.. that pays above and beyond the FMV commission amounts. These extras that some FMOs were offering agents were being used to steer clients into certain plans.

This rule is more about steering and less about commissions and hierarchy structures.

GA/MGA etc.. contracts should be fine. However, carriers may use this as an excuse to crack down on agents that have those contracts and should not have them.

 

[NewEnglander]

Am I right in thinking that the quarterly DSNP/LIS SEP will now be gone, thereby limiting call centers ability to switch DSNPS on demand? If true that's a big blow to the call centers?

DSNPs will be able to change monthly instead of quarterly.

 

[rmhaire]

Agencies/GA/SGA/MGA etc.. are still allowed. And therefore those contract levels are still allowed.

Even CMS knows that there's a limit to what they can regulate or control.

And the business structure of the insurance industry is beyond that limit.

Maybe next time ...

 

[DonP]

After reading it again, I'm going to have to disagree with you.

Agencies/GA/SGA/MGA etc.. are still allowed. And therefore those contract levels are still allowed.

What's not allowed is the admin fees/marketing monies etc.. that pays above and beyond the FMV commission amounts. These extras that some FMOs were offering agents were being used to steer clients into certain plans.

This rule is more about steering and less about commissions and hierarchy structures.

GA/MGA etc.. contracts should be fine. However, carriers may use this as an excuse to crack down on agents that have those contracts and should not have them.

Bs I disagree . Show me were overrides allowed for enrollments? I’m on national Facebook groups with thousands of agents and what I said is consensus . You really think all cms did is screw the agent out of his marketing money and hra and left the scum who overrides alone ? Your wrong as heck and delusional. Fmo (Tpmo’s) allowed . It says zip about GA’s or mga’s .Those are magenta that provide zip as far as. Enrollment , back office etc . All they do is suck overrides . Any override situation with the fmo will be a contract not related to enrollments

 

[axeman462]

Bs I disagree . Show me were overrides allowed for enrollments? I’m on national Facebook groups with thousands of agents and what I said is consensus . You really think all cms did is screw the agent out of his marketing money and hra and left the scum who overrides alone ? Your wrong as heck and delusional

Groupthink is a viscous animal.

 

[DonP]

Groupthink is a viscous animal.

Time will tell how the carriers interpret it . Why would an agent allow you to overide them if you provide them with nothing ? No marketing , enrollment etc . If overrides are allowed you’ll have give 1/2 that to agents in an override fee min

 

[DonP]

So for aep 2025 are you still going to dump 1,000's of pieces of dm,? How are you going to play the flip game in the dsnp market, if your in Indiana

In 2025 i’m in the same boat as all other agents . I got 40-$50 k marketing money out the door . What will you do with no marketing money? Outside aep I’d do no dsnp direct mail . I’m not in Indiana a few friends are. I was stating that will be the norm at some pt nationwide .My last mailing would have been near $100 a mailer if i were paying it .I’ll probably work on some type of post card like you for T-65.Call and door knock my big book of business for life ins and referrals . Honestly i don’t want to grow anymore just maintain .

 

[DonP]

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?

Possibly if the info is correct. Although it seems in fla they’re integrated and you can move it . So many that info is wrong . Nobody really knows anything until aug or so

 

[vic120]

Bs I disagree . Show me were overrides allowed for enrollments? I’m on national Facebook groups with thousands of agents and what I said is consensus . You really think all cms did is screw the agent out of his marketing money and hra and left the scum who overrides alone ? Your wrong as heck and delusional. Fmo (Tpmo’s) allowed . It says zip about GA’s or mga’s .Those are magenta that provide zip as far as. Enrollment , back office etc . All they do is suck overrides . Any override situation with the fmo will be a contract not related to enrollments

I don't know there is a monopoly isn't there

Do they not usually allow the carriers be the ones to interpret and enforce?

not saying it is but certainly not out of the realm of possibilities not by a long shot