On April 2, the Centers for Medicare, and Medicaid Services (CMS) released its final rules for Affordable Care Act (ACA) marketplaces for 2025. The rules include the requirements applicable to advisors who work with participants in ACA marketplace insurance.
The 2025 “Benefit and Payment Parameters” (RIN 0938-AV22) sets the standards for agents, brokers, and others who help people choose marketplace health insurance. It redefines “compensation” for agents and brokers to set a “clear, fixed amount” that agents and brokers can be paid, regardless of the health insurance plan the individual chooses. This new rule will eliminate the possibility of compensation (for example, overrides and administrative fees paid at agency levels) above the CMS maximum for individual agents and brokers. It sets a user fee rate of 1.5 percent of monthly premiums for states that use the federal exchange and a rate of 1.2 percent for states that have their own marketplaces.
ACA marketplace insurance is growing rapidly. The amount of marketplace insurance put in place during 2024’s open enrollment period increased by 31 percent—an increase of 5.1 million people insured through a marketplace plan over 2023.
Prospects: CMS made changes to the final rule as compared to the proposed rule that makes the final rule “less bad, although still bad.” Lawsuits challenging this rule appear to be likely, but as with all litigation, it would take months before the issues are settled.
NAIFA Staff Contact: Michael Hedge – Senior Director – Government Relations, at mhedge@naifa.org.