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Advocacy in action blog

NAIFA strongly urges the Centers for Medicare & Medicaid Services (CMS) to reconsider a proposal that would change the compensation rules for professionals providing products and services related to Medicare Advantage and Medicare Part D programs.

NAIFA members help millions of individuals and employers administer and utilize Medicare plan options as well as other health plans. They are a vital part of the plan-selection process and serve as expert resources for consumers considering their Medicare plan options or looking for specific drugs and services to be covered. Agents and brokers educate clients on how Medicare works, research physician networks and prescription formularies for the plans to ensure a suitable health and drug plan is recommended, and review plan-comparison and enrollment changes annually.Brokers and agents who provide Medicare Advantage Plans have their compensation capped by existing regulations. This capped compensation currently does not include other payments for services “at or below the value of those services in the marketplace.” This makes perfect sense. Agents and brokers providing additional services need to be compensated for their work that goes above and beyond the effort of enrolling beneficiaries. However, the new CMS proposal would classify many of these payments as “compensation” and subject them to the mandatory cap.

These payments for services other than the enrollment of beneficiaries include things like training, customer service, agent recruitment, operational overhead, and assistance completing health risk assessments. If these are counted under the capped compensation, as the CMS proposal would require, NAIFA is concerned that agents and brokers would no longer be able to provide consumer-focused, value-added administrative services, potentially affecting over 6 million current individual MA beneficiaries.

Consumer education and access to Medicare expertise would suffer and beneficiaries would more often find themselves on their own when making crucial decisions about their health care. This would reduce market competition and consumer choices and could increase overall costs for consumers.

NAIFA President Tom Cothron has sent a comment letter urging CMS to reconsider the proposed rule in its entirety and to work with NAIFA and health plan providers to accurately assess the fair market value of the services agents and brokers provide.