BIP Summer 2024

Voices

CMS Medicare final rule shows serving consumers matters most Four changes that are likely to affect industry stakeholders and consumers. By Dan Mangus

The intent of CMS’s Contract Year 2025 Medicare Advantage and Part D Final Rule is clear: Serving consumers matters most. Our industry has the same goal: to protect Medicare beneficiaries from adverse selection and to enhance access to care. Still, it’s crucial to understand how the rule could impact your business with changes to Part D, contract terms, compensation rates, star ratings, admin payments, ancillary benefits, and more.

This will help protect consumers while ensuring that responsible organizations can compliantly serve beneficiaries. 3 Putting consumers in the right plan. It’s apparent that CMS also wants to help ensure unbiased guidance. Due to the focus on ensuring consumers are in the right plan for them, the rule manages contract terms between MA organiza tions and agents, brokers, or other TPMOs that CMS believes may interfere with the ability to objec tively recommend plans. This means technology, com parison platforms, and evaluation solutions matter even more to ensure that agents can provide the right recommendations. 4 Providing more with ancillary benefits. The rule addresses how the value and relevance of ancillary benefits are determined. It also requires plans to notify mid-year enrollees of available supplemental benefits. This is intended to help ensure that Medicare beneficiaries fully utilize their plan benefits. By stipulating changes that put consumers at the center, the Medicare Advantage and Part D Final Rule is certain to impact core aspects of the marketplace.

Dan Mangus is VP of growth and

development with Senior Marketing Specialists, an

“ ”

Integrity company. He helps build businesses and guides them through mergers and acquisitions. Mangus started his first insurance agency at 18. By age 21, he was president of his local Association of Life Underwriters and later served

Technology, comparison platforms, and evaluation solutions matter even more to ensure that agents

as area chairman of the Life Underwriter Training Council. He is now on the NABIP FMO Council.

can provide the right recommendations.

The following are four initial thoughts about changes and what they might mean for industry stakeholders and consumers: 1 Agent support. The rule calls for a $100 increase in the fair market value (FMV) used for com missions to agents. Commissions do not come from the medical loss ratio (MLR) requirement of 85%. Instead, they come out of the 15% for carrier administrative

purposes. This makes items either fully commissionable or non-commissionable — there is no middle ground. 2 Consumer data focus. To protect against the misuse of personal data, third-party market ing organizations (TPMOs) are prohibited from selling data to other TPMOs unless the beneficiary gives prior express written consent.

20 bip magazine Summer 2024