CMS Proposed Rules for 2025

On November 12, 2023, CMS released the 2025 proposed rules for Medicare Marketing & Compensation, among other things. The full documents is 486 pages, but hidden within are some proposed changes that if passed, will effect agents, agencies and FMO's.

Some of the proposed rules include:

• Prohibit any contract terms between MA plans and agents, brokers, or TPMOs that could “reasonably be expected to inhibit an agent or broker’s ability to objectively assess and recommend” which plan best meets a beneficiary’s healthcare needs. Examples of prohibited terms would be those that make bonuses or contract renewal contingent on meeting higher enrollment rates or quotas or that provide for bonuses that are otherwise understood to be based on enrollment volume.
• Set a single agent and broker compensation rate for all MA plans while revising the scope of what is considered “compensation” to include all payments to an agent or broker relating to the initial enrollment, renewal, or services related to enrollment in an MA plan product.
• Eliminate the regulatory framework that allows for separate payment to agents and brokers for administrative services (including, for example, payments for agent- or broker-conducted health risk assessments characterized as an administrative service).

You can read the full CMS Proposed Rules at https://public-inspection.federalregister.gov/2023-24118.pdf?fbclid=IwAR0L5L6_7lgtqxMxW0Lk4VMHSURk1TgeB5Z37lCpna9OQuqdxxLrfZ11a5Y

These proposed rules are open for public comment through January 5, 2024. We encourage agents to let their voices be heard on this issue by copying and pasting into your browser: https://www.regulations.gov/commenton/CMS-2023-0187-0001