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2025 CMS Regulations and the Inflation Reduction Act: What Insurance Agents Need To Know

May 17, 2024

New CMS Regulations Carry Implications for Medicare Agents

From agent compensation to the amounts clients pay for prescriptions, major changes are ahead in what's being called the biggest Medicare disruption in decades.

Two regulations — the Inflation Reduction Act and the Centers for Medicare and Medicaid Services (CMS) Final Rule for the 2025 Contract Year — will greatly impact agents and their clients.

Dwane McFerrin, Senior Vice President, Med Solutions, at Senior Market Sales® (SMS), explains in two videos the potential impact on agents and clients as well as the challenges and opportunities.

In this first video, learn how the CMS rule could affect agents, including the cost of doing business, and the timeline for what to expect next.

How the Inflation Reduction Act Reshapes the Landscape

The Inflation Reduction Act, signed into law on Aug. 16, 2022, caps out-of-pocket Medicare Part D costs at $2,000 starting in 2025. A total of 5 million Part D enrollees had out-of-pocket drug costs of $2,000 or more in at least one year during the the 10-year period between 2012 and 2021, and more than 6 million Part D enrollees have paid $2,000 or more out of pocket in at least one year since 2007, according to a KFF analysis.

Yet, while millions will benefit from the cap, millions more could see premiums increase, some possibly by 50% or more, as carriers absorb the impact of that legislation.

In this second video, learn more about the potential premium hikes, particularly in rural areas where Medicare Advantage (MA) options may be limited, and how extra benefits on MA plans may be watered down.

How Agents Can Prepare for 'The Busiest Year Ever'

The tools that CareValue offers to our contracted agents can help save invaluable time and help you work more proficiently.

  • Our online enrollment platform, MedCareValue, allows agents to have a personalized landing page that includes a self-service option, electronic SOAs, pharmacy lookup, Medicare.gov’s BlueButton2.0 integration, and so much more!
  • Another resource for agents with these upcoming Part D changes will be an in-house pharmacist agents have access to via our relationship with SMS. Agents can call with questions and a tool that searches by drug name to identify clients affected by drug formulary changes so agents can alert impacted clients.
  • Next, CareValue offers MV360. This is an agent-facing backend to manage your clients and/or leads all in one place! It will also help calculate annual plan costs for you - no calculators, spreadsheets, or formularies needed! Agents are also able to review annual drug costs and tiers based on plan data and pharmacy preferences.
  • Worried about your call recording? Don’t panic - let CareValue do the heavy lifting for you! Our call recording and storage solution is included in MV360. Our recording solution saves and stores your recordings for the required 10 years, is HIPAA compliant, and the best part? It will automatically play the required disclaimer in the beginning of your phone calls!
  • Coming SOON to MV360 is the Beneficiary Eligibility Query tool! Agents will soon be able to look up Medicare Advantage and Part D plan eligibility within MV360 immediately and in real-time!
  • Are you an agent selling in New York? Exclusive to CareValue is the ONLY digital NYS SPAP application.  You can now help your clients submit their New York State Pharmaceutical Assistance Program applications online. Your members will no longer need to fill out the paperwork and then mail or fax it in!

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Questions? Call us at 855-888-8326.

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