The Centers for Medicare and Medicaid Services on Monday proposed big cuts in Medicare plan broker administrative support services payments for 2025, and an executive with the National Association of Benefits and Insurance Professionals says that, if the proposal is enacted as written, it would wipe out the current broker compliance support system.
Issuers of Medicare Advantage plans and Medicare Part D prescription drug plans would have to scramble to build their own broker support programs, and the cost of replacing the current broker compliance systems would lead to big increases in 2025 Medicare plan premiums, according to John Greene, senior vice president of government affairs at NABIP.
"That's not good for the beneficiaries," Greene said in an interview.
What it means: If you help clients with Medicare plans, your professional groups may be inviting you to Washington to explain what you do to federal policymakers.
If you work with Medicare plan users, but you do not provide Medicare plan-related services, you may still find that the intricacies of Medicare plan compensation arrangements are a hot topic of conversation.
The history: National Medicare plan telemarketers got consumers', and regulators', attention in recent years by running waves of television commercials advertising their call centers.
Consumers and consumer groups complained that high-pressure sales reps at some call centers pushed consumers to trade in appropriate Medicare plans for inappropriate plans or to make other unsuitable transactions.
The Alliance for Community Health Plans argued that some plan sellers were getting $1,300 per sale, through sales commissions and administrative services payments.
CMS, the agency that oversees sales of Medicare Advantage plans and Medicare drug plans — but not Medicare supplement insurance policies — began to take action starting with the 2023 plan year, by requiring agents and brokers to read standard disclaimers to consumers and record all sales calls.
For the 2024 plan year, CMS is prohibiting producers from combining educational seminars with sales appointments and setting other tight rules for appointment-setting.
2025 proposed regulations: In a 486-page packet of draft regulations, CMS called for Medicare plans to meet new behavioral provider network adequacy standards in 2025, to eliminate the problems that occur when clients who need psychiatrists discover that their plans have few, or that none of the psychiatrists in the provider directory has an opening for a new Medicare patient until sometime in the 2040s.
CMS has also proposed adding new rules for supplemental benefits, such as grocery discounts or small amounts of coverage for homemaker services. The agency wants plans to remind enrollees about any unused supplemental benefits in the middle of the year and to take extra precautions when marketing the benefits.
