The Centers for Medicare & Medicaid Services (CMS) annually releases a memorandum that sets the stage for the healthcare industry by establishing the maximum Fair Market Value (FMV) for Agent & Broker Rates, Referral/Finder’s Fees, submission, and Training and testing Requirements. In the latest proposed rule CMS-4205-P, CMS addresses concerns surrounding administrative fees and their potential impact on compensation levels for carriers.
Key Proposed Changes:
CMS is focusing on addressing rising concerns about the influence of administrative fees on compensation levels. Below are some key points from the proposed rule that highlight the potential impact on agents, set to take effect for the 2025 contracting year beginning September 30, 2024:
Elimination of Marketing Assistance:
The proposed rules could eliminate marketing assistance from all sources, including carriers, uplines, providers, or other entities. This encompasses various aspects such as licensing/appointment fees, CRM systems, quoting/enrollment tools, lead systems, call recording systems, meeting and room space, marketing design help, and more.
Impact on Agent Services:
Agents may find themselves without assistance in various areas, including back-office services, compliance assistance, oversight, and even support with policyholder needs and commission issues.
Concerns about High-Pressure Tactics:
CMS expresses concerns about the rise in Medicare Advantage (MA) marketing complaints, indicating potential high-pressure tactics influenced by the pursuit of “administrative payments” beyond compensation. This could lead to beneficiary confusion about their enrollment choices.
Bidding Wars and Anti-Competitive Results:
CMS is wary of bidding wars among plans to secure anti-competitive contract terms with Field Marketing Organizations (FMOs) and their affiliated agents. Smaller plans may face challenges in competing with larger national plans, risking the loss of enrollees.
Influence of Contracts on Beneficiary Enrollment:
The proposed rule highlights the concern that current contracts between FMOs and MA plans may influence agents to enroll beneficiaries into plans that provide additional compensation, regardless of the plan’s appropriateness for individual enrollees.
Challenges in Recouping Administrative Costs:
The approach suggested in the rule may leave agents and brokers unable to directly recoup administrative costs, such as overhead or lead purchasing, unless a certain volume of business is maintained. This could pose challenges, particularly for agents with smaller enrollments.
As the healthcare industry awaits the finalization of the 2025 CMS rule, it’s essential for agents and brokers to stay informed and engaged. The proposed changes signal a shift in the landscape, with potential consequences for compensation structures and industry practices. Our collective industry voice can play a crucial role in shaping policies that strike a balance between fair compensation and maintaining the highest standards of service for beneficiaries.
How you can get involved:
With the CMS-4205-P proposal open for public comment until January 5th, we urges you and the broader community to unite in advocating for the best interests of our clients and the sustained strength of our profession. We encourage everyone to contribute professional and constructive feedback, and comments can be conveniently submitted through Regulations.gov.