NABIP Responds to CMS 2025 Proposed Changes

Recently, CMS issued a proposed rule to redefine “compensation” to set a clear, fixed amount that agents and brokers can be paid regardless of the plan the beneficiary enrolls in. You can read more about the proposed rule here, but a high-level analysis of the proposed changes include: 

• CMS is proposing a cap on broker compensation at $632, regardless of the plan a beneficiary enrolls in. This new cap would encompass all payments that plans can pay brokers. This proposal would generally prohibit insurers from paying TPMOs volume based "bonuses." TPMOs or third-party marketing organizations are now defined to include any organization (FMOs) or individual, including independent agents and brokers.
• Under this proposed rule, plans would be required to issue mid-year notices to enrollees reminding them of supplemental benefits to help ensure benefits are actually used and not simply leveraged as marketing tactics.
• CMS is considering new restrictions on the marketing of supplement benefits for chronically ill enrollees - requiring disclosures that these benefits are only available to those with certain diagnoses, not all Medicare beneficiaries.
• The proposed rule would reduce the number of plans able to enroll beneficiaries dually eligible for Medicare and Medicaid outside of open enrollment period. This would eliminate year-round aggressive marketing of D-SNP plans

Following this announcement, NABIP (formally NAHU) issued a response on behalf of over 100,000 licensed health insurance agents, brokers, general agents, consultants and employee benefits specialists throughout the United States. You can read their response here.