CMS: Final rule on Medicare Advantage plans caps comp for brokers, agents

The Centers for Medicare & Medicaid Services has issued a final rule that caps broker compensation in Medicare Advantage plans. The 1,327-page rule aims to stop brokers from steering beneficiaries to certain plans in exchange for higher reimbursement from insurers, while giving them more predictable compensation.

Among the key provisions of the rule:

• Medicare’s definition of compensation is broadened to include all actions associated with the sales to/enrollment of a beneficiary in a Medicare Advantage plan. As a result, insurers no longer will be able to pay brokers additional fees that aren’t subject to the government’s compensation cap, beginning with this fall’s annual enrollment.
• Fixed compensation amounts for brokers who enroll beneficiaries in plans increases by $100, which is significantly higher than the $31 increase originally proposed in November.
• Contracts between Medicare Advantage plans and marketing middlemen that result in such things as volume-based bonuses for enrollment into certain plans are prohibited. Marketing organizations also no longer are allowed to share beneficiary information with each other unless they receive the beneficiary’s written consent.
• Other provisions are geared toward increasing the use of supplemental benefits, including requiring plans to send out midyear notices informing beneficiaries of the benefits available to them.

The rule is the latest action by CMS to curb Medicare Advantage marketing misconduct after regulators banned misleading TV ads last year. Beneficiary complaints of inappropriate Medicare Advantage marketing more than doubled from 2020 to 2021, according to an investigation by the Senate Finance Committee. The report found that beneficiaries sometimes were enrolled in plans without their consent or had their coverage switched to a plan that didn’t cover their doctors.

The overall objective of the new rule is to ensure that brokers act in the best interest of enrollees, not themselves.

“The Medicare Advantage market has become increasingly consolidated,” said Roger Moore, policy director for the National Association of Insurance and Financial Advisors. “Larger entities have more resources to use various kinds of incentives that are violating compensation limits by CMS.”

Related: CMS: New rule would cap commissions for Medicare Advantage brokers, agents

Industry reaction to the new rule is mixed. “We are thrilled CMS embraced our proposal to cap total broker payment,” said Ceci Connolly, president and CEO of the Alliance of Community Health Plans. “This commonsense policy change eliminates those perverse financial incentives and levels the playing field for healthy competition.”

However, UnitedHealth Group and Humana, the nation’s two largest Medicare Advantage plans nationwide, said in comments on the rule that they oppose a universal broker compensation amount.