CMS CY2025 Final Rule Implications

The Centers for Medicare & Medicaid Services (CMS) released the final rule for the contract year 2025 (CY2025) Medicare Advantage and Part D programs on April 4, 2024. And it’s causing quite a stir for many folks! How will this affect payments? How will this affect how we sell? Here’s what we know: 

What’s the Focus?

The Final Rule aims to strengthen protections for enrollees, promote competition, and enhance coverage and benefits. Key provisions include changes to marketing rules, agent and broker compensation, access to behavioral health care providers, and special supplemental benefits for the chronically ill (SSBCI).

Competition & Compensation

Regarding marketing, CMS modified rules on sharing beneficiary data by third-party marketing organizations (TPMOs) and agent/broker compensation to prevent abusive practices. The Final Rule prohibits anti-competitive provisions in contracts and sets fixed compensation rates for agents and brokers. Additionally, it addresses concerns about payments to larger marketing organizations affecting competition.

CMS is targeting the third party marketing organizations and the ways they’re compensated as well as agents and brokers. As a result of these changes, many agents and agencies are starting to look at other ways of enrolling individuals in a cost effective and efficient way, such as contact senters and self-service sites. 

Sensentia has a host of self-service options to help agents and agencies maximize their enrollment! We’re excited about how easy this groundbreaking solution makes things for consumers and for agents!  If you’d like to learn more about how we’re doing just that, we’d love to show you what we’ve got cooking for the healthcare industry! 

The Final Rule has a lot of implications for the industry and especially how we sell. If your sales team is looking for a way to simplify the way you’re selling Medicare plans, Sensentia’s suite of tools offer game-changing ways to improve your sales metrics across the board.