CMS Medicare Final Rule Shows Serving Consumers Matters Most

Written by Dan Mangus

The following article was written by Senior Marketing Specialists’ very own Vice President of Growth and Development, Dan Mangus, and was published in BIP magazine (the official magazine of NABIP) in the Summer of 2024 edition.

To access the full magazine and original article, click here. You can find this article on pages 20-21.

Four changes that are likely to affect industry stakeholders and consumers.

The intent of CMS’ contract year 2025 Medicare Advantage and Part D Final Rule is clear: serving consumers matters most. Our industry has the same goal; to protect Medicare beneficiaries from adverse selection and to enhance access to care.

Still, it’s crucial to understand how the rule could impact your business with changes to Part D, contract terms, compensation rates, star ratings, admin payments, ancillary benefits, and more.

“Technology, comparison platforms, and evaluation solutions matter even more to ensure that agents can provide the right recommendations.”

The following are four initial thoughts about changes and what they might mean for industry stakeholders and consumers:

Agent Support

The rule calls for a $100 increase in the fair market value (FMV) used for commissions to agents. Commissions do not come from the medical loss ratio (MLR) requirement of 85%. Instead, they come out of the 15% for carrier administrative purposes. This makes items either fully commissionable or non-commissionable — there is no middle ground.

Consumer Data Focus

To protect against the misuse of personal data, third-party marketing organizations (TPMOs) are prohibited from selling data to other TPMOs unless the beneficiary gives prior express written consent.

This will help consumers while ensuring that responsible organizations can compliantly serve beneficiaries.

Putting Consumers in the Right Plan

It’s apparent that CMS also wants to help ensure unbiased guidance. Due to the focus on ensuring consumers are in the right plan for them, the rule manages contract terms between MA organizations and agents, brokers, or other TPMOs that CMS believes may interfere with the ability to objectively recommend plans. This means technology, comparison platforms, and evaluation solutions matter even more to ensure that agents can provide the right recommendations.

Providing More with Ancillary Benefits

The rule addresses how the value and relevance of ancillary benefits are determined. It also requires plans to notify mid-year enrollees of available supplemental benefits. This is intended to help ensure that Medicare beneficiaries fully utilize their plan benefits.

By stipulating changes that put consumers at the center, the Medicare Advantage and Part D Final Rule is certain to impact core aspects of the marketplace.

Dan Mangus joined Senior Marketing Specialists in 2012 as our National Sales Director, serving over 10,000 agents nationwide. He teaches Medicare courses at universities and keynotes national insurance conferences. He also conducts Medicare certification courses for both the National Guardianship Association and the American Association of Daily Money Managers. Dan has published numerous books and articles for advisors in the Medicare market.