Important Take-aways for Agents from CMS’s MA & Part D Final Rule

The 2025 Medicare Advantage and Part D Final Rule issued by the Centers for Medicare and Medicaid Services (CMS) in April outlined changes to improve access and to raise awareness of mid-year unused benefits.  It also updates requirements for agent and broker compensation and the requirements for how third party marketing organizations collect and use beneficiary data.

The Final Rule establishes “Guardrails for Agent and Broker Compensation” as follows:

• “prohibits contract terms between MA organizations and agents, brokers or other TPMOs that may interfere with the agent’s or broker’s ability to objectively assess and recommend the plan that best fits a beneficiary’s health care needs;
• sets a single, increased compensation rate for all plans to be updated annually;
• revises the scope of items and services included within agent and broker compensation;
• eliminates the regulatory framework which currently allows for separate payment to agents and brokers for administrative services;
• makes conforming edits to the Part D agent broker compensation rules at § 2274.”

The Final Rule states that “the impact of these changes will better align with statutory requirements to ensure that the use of compensation creates incentives for agents and brokers to enroll individuals in the plan that best fits a beneficiary’s health care needs.”

Additionally, the Final Rule also addresses “Distribution of Personal Beneficiary Data by Third Party Marketing Organizations (TMPOS)” as follows:

• prohibits personal beneficiary data collected by TPMOs for marketing or enrolling a beneficiary into an MA or Part D plan to be shared with other TPMOs, unless prior express written consent is given by the beneficiary.
• finalizes a one-to-one consent structure where TPMOs must obtain prior express written consent through a clear and conspicuous disclosure for each TPMO that will be receiving the beneficiary’s data.

The CMS notes, “This provision is designed to address complaints we have received from beneficiaries and their advocates and caregivers about receiving harassing and unwanted phone and email solicitations from individuals attempting to enroll them in MA and Part D plans. This final rule protects beneficiaries against unwanted calls, texts, email solicitations, and other contacts, while still ensuring that beneficiaries have control over their personal data and can connect with the TPMOs they would like to speak with, creating a more transparent and safer environment for beneficiaries to find the plan that best fits their health needs.