Agent Compensation Rules on Hold, FFM Enrollment Procedures Updated
The Medicare Advantage sector is experiencing significant changes that will impact both agent earnings and client enrollment processes. Here is a quick summary of the two important changes:
Agent Compensation Overhaul: Temporarily Derailed
In a legal maneuver many brokers and agents were watching closely, a Texas judge has put a temporary stop to the plans of the Centers for Medicare and Medicaid Services (CMS) to revamp agent compensation structures.
Back in April, CMS unveiled a sweeping reform of agent compensation guidelines. The proposed changes aimed to create a uniform payment structure for Medicare Advantage plans and eliminate broker administration fees. CMS regulators argued this would curb what they perceived as “excessive compensation” potentially influencing agents’ plan recommendations.
However, this initiative hit a roadblock when two agent coalitions took legal action against CMS. Their primary concerns? The timing of these changes could disrupt preparations for the upcoming Medicare Advantage enrollment window (Oct. 15 – Dec. 7) and potentially jeopardize their business models.
In a pivotal July ruling, a federal judge in Texas sided with the coalitions, issuing a stay on the implementation of these new rules. Consequently, CMS has acknowledged this decision, confirming that the proposed compensation changes won’t take effect during this fall’s enrollment period.
FFM Enrollment: Tightening the Reins
Meanwhile, CMS is taking decisive steps to address what they describe as a rise in unauthorized enrollment modifications by agents and brokers within the Federally Facilitated Marketplace (FFM).
Under new guidelines, agents and brokers will face restrictions when attempting to alter a consumer’s FFM enrollment. Changes will only be permitted if the agent is already linked to the consumer’s existing enrollment.
CMS frames this move as an extension of their ongoing efforts to safeguard FFM consumers, which have included suspending and terminating agents found engaging in unauthorized Marketplace activities. For agents not currently associated with a consumer’s enrollment, the process becomes more involved.
As per CMS: Unaffiliated or new agents and brokers must now either:
- Participate in a three-way call involving the consumer and the Marketplace Call Center, or
- Guide the consumer to submit changes independently via HealthCare.gov or an approved Classic Direct Enrollment or Enhanced Direct Enrollment partner website with a consumer pathway.
Navigating Change with Confidence
As the rules around Medicare Advantage and agents continue to change, Pandora Insurance is here to help you stay informed. We’re committed to equipping you with the latest information to serve your clients effectively.
Here are some of the benefits you get when contracting through us:
- FreePre-license courses for our contracted agents
- Industry leading carrier contracting
- Federal Marketplace Certification for Affordable Care Act (ACA)
- MEDICARE AHIP annual certification discount
- Knowledge-based and practical training
- Partnerships with proven sales professionals in the Medicare industry
- Medicare off-the-shelf marketing material, custom layouts
- Carriers include: ACA (Obamacare), Medicare, life and supplemental
- Commission and bonus reporting
- Bilingual support
Start today on your path to growing your Medicare business! Get contracted by filling out a simple form on our website. Or contact us at 305-231-9898.
*Note:* This information is intended for broker use only and should not be distributed to Medicare beneficiaries.
