BIP Summer 2024

Scrutiny of agent commissions, accusations of steering business,

questions about the role of Field Management Organizations, and more punctuated the debate over the new Medicare rule, Contract Year 2025 Medicare Advantage and Part D Final Rule (CMS 4205-F), released this spring. But now that the dust is settling, how should agents calibrate the rule’s impact on their business and the Medicare market? John Greene, NABIP senior vice president of government affairs, breaks down the rule, its effect on agents and brokers, and the association’s advocacy strategy. What’s your biggest takeaway from NABIP’s role in the new rule? We showed members that, once again, we protect their business — protect their ability to serve beneficiaries and make a living doing it. What’s

the value of being a member? This is it. I’ve had group agents say to me we’re spending too much time on Medicare. And I tell them that if your compensation was under threat, we would do the same for you. We would spend night and day on it. How did NABIP’s advocacy work reinforce the importance of agents in Medicare sales? NABIP’s advocacy on behalf of FMOs and agents helped the Centers for Medicare and Medicaid Services (CMS) understand the critical role of the agent. CMS has a habit — not just with agents and brokers, but anything over which they oversee — to sweep the good in with the bad. And that’s what happened in this case. They don’t differentiate a call center from an independent agent, who is a servicing agent, versus a lead generator. They put us all in one definition and it’s created tremendous confusion when you’re talking to Hill staff or other stakeholders. We’re servicing agents. After customers are enrolled, we are there to help them with claims or service issues. If they get cancer, one of the first calls they’re going to make is to their agent. And the agent will help clear the treatment plans so they can focus on getting well. That’s what a servicing agent does. A SHIP counselor does not do that. CMS.gov. won’t do that. The lead generators don’t do that. They’re not licensed. They have nothing to do with our side of the business, but we’re defined under the same rubric. We’re working to change that.

KEY POINTS

▶ NABIP’s role: NABIP’s John Greene highlights how the association has been pivotal in protecting Medicare agents’ interests against the new rule, ensuring they can continue to earn and serve effectively. ▶ Rule’s challenges: The new Medicare rule that imposes limits, such as a $100 cap on administrative fees, could change how FMOs support agents. NABIP advocates for changes to better meet agents’ needs by seeking further data and consideration from CMS. ▶ Looking ahead: NABIP plans to continue its advocacy by coordinating with carriers to ensure that FMOs can still operate under the new rule. The concern is that restrictions on FMOs and agent commissions could extend into the private sector, potentially leading to increased carrier administrative costs and higher consumer premiums.

What is NABIP’s position on the $100 cap on agent administrative fees?

We have significant concerns over the $100 limit set for administrative fees such as transportation, education, and other related expenses. We’re working to get CMS to reissue this part of the rule as a request for information instead of a final

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