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CMS’ 2025 Proposed Final Rule

CMS’ 2025 Proposed Final Rule

CMS’ 2025 Proposed Final Rule
Comments

The Centers for Medicare & Medicaid Services (CMS) has introduced a proposed rule, CMS-4205-P, aimed at amending current regulations for Medicare Advantage and Part D programs. This proposal, set to take effect for the 2025 contracting year beginning September 30, 2024, includes significant changes in Medicare marketing and communications policies, particularly concerning agent and broker compensation as outlined in Section 1851(j) of the Act. These changes are expected to have a substantial impact on the Medicare sales distribution landscape.

We recognize that this approach could have some drawbacks, particularly as this policy would, in effect, leave agents and brokers unable to directly recoup administrative costs.

– The Centers for Medicare & Medicaid Services

These changes impacting FMO/Agency support, training, technology, and other items will impact beneficiary choice by reducing the agents that are not only offering Medicare Advantage but offering a wide variety of plans. In essence, this rule will have the opposite effect of what is being put forth.

In addition, the notion that small regional plans are getting anti-selected just does not stand up to what we see in the market. The free market year over year has varying top carriers including what regional carriers increase market share. The best plans for individual Medicare beneficiaries are what will continue to drive what plans are sold, period.

Key Aspects of the Proposed Rule Involve…

Eliminating Administrative Fees/ Overrides

The proposed rule intends to abolish compensation above the CMS maximum for individual agents/brokers, including overrides/admin fees paid at agency levels and higher. This could significantly affect agencies, especially those at the FMO/NMO level impacting the support, technology, and services being provided to agents. Find additional details on the Pinnacle 2025 Proposed Rule page.

Restrictions on Services Provided to Medicare Agents

Agencies and uplines may no longer be able to offer services such as quoting, enrollment platforms, such as Connecture and Sunfire, CRM software, support services such as website creation, logo designs, compliance guidance, discounted E&O and CE’s, marketing plan guidance, and agent/agency contracting.

working on laptop

Impacts on Different Agency Types

While all agencies would be impacted, LOA agencies and those focusing on ancillary product sales or who offer Medicare as a secondary service might find it easier to adapt to these changes. Agencies that are heavily focused on Medicare Advantage will be greatly impacted.

Changes in Marketing Reimbursements & Health Risk Assessments (HRA) Fees

The proposed rule plans to prohibit reimbursement payments/marketing allowances to agents/brokers for expenses and eliminate payments for completing HRAs.

Modifications in Commission Structures

Commission rates would continue to be standardized. This would include a small administrative increase that would in no way compensate for all of what would now be needed by agents.

Operational Adjustments for Agents & Agencies

The absence of uplines could necessitate direct contracting with carriers by agents and agencies, potentially leading to delays. Additionally, questions usually addressed by uplines must be directed to the carriers. If, and how quickly would carriers staff up to meet the huge demand of contracting, certifications, product training and more.

Our Industry’s Voices Need to be Heard

The CMS-4205-P proposal is a comprehensive document addressing these and other areas, detailed over hundreds of pages. The proposal is open for public comment until January 5th. CMS encourages professional and constructive feedback, particularly focusing on the value provided to clients and the potential impact of these changes on service capabilities. Comments can also be submitted through Regulations.gov.

What about Pinnacle?

Our team at Pinnacle will continue to be there to support your business and have made available resources for you to navigate and understand the 2025 Proposed rule and how it will impact not only your business but your Medicare clients. For more information, go to our 2025 Proposed Final Rule page for more detailed information on the rule and how to comment.

Reach out to a Pinnacle team member today with any questions.

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Bob Brzyski

Bob Brzyski

Vice President, Marketing

x7742 | bbrzyski@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881
support@pfsinsurance.com

Contact Us

Contact a Pinnacle Financial Service representative today for assistance.

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Best Medicare FMO

Best Medicare FMO

Best Medicare FMO
Comments

The Medicare market has grown by leaps and bounds over the past several years. Independent insurance agents have plenty of options when searching for the Best Medicare FMO for Medicare agents to help them grow their Medicare business.

FMO PROMISES:

In the sea of Medicare agencies, agents will have plenty of options with claims such as “The Best Medicare FMO” or “Best IMO” you can find when doing their due diligence.

But what does it take to be considered “The Best FMO”?

Here at Pinnacle Financial Services, we strive every day to be just that, the best for our agent partners. And for us, service is job one.

In our company’s long history of working in the Medicare market, we know that as an independent agent, having a support structure in place is crucial to growing their business.

And we are not done there.

MEDICARE FMO VALUE PROPOSITION:

Pinnacle provides at no charge all the tools and technology you will ever need.

  • Medicare Quoting
  • Quoting App for Phone or Tablet
  • Access to Connect4Medicare(the top Medicare quoting, comparison, and enrollment tool)
  • Online Contracting
  • Free Lead Program Option
  • Top Medicare Commissions
  • Ongoing Training (both in-person and remote)
  • Free CE Credit Option
  • CRM System

Next Steps for Medicare Agents:

So, whether you are new to selling Medicare plans or have a long history, we want to help you grow your business. Our experienced support staff is ready to answer all your questions.

Call us today to find out more about how Pinnacle Financial Services can be the best Medicare FMO for you.

For more information, contact a Pinnacle Financial Services representative today

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Bob Brzyski

Bob Brzyski

Author Position

x7742 | bbrzyski@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881
support@pfsinsurance.com

Contact Us

Contact a Pinnacle Financial Service representative today for assistance.

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Connect4Medicare Transforms into Connect4Insurance

Connect4Medicare Transforms into Connect4Insurance

Connect4Medicare Transforms into Connect4Insurance
Comments

From October 1, 2023, the name that has become synonymous with simplicity, innovative, and efficient Medicare quote, compare and enrollment—Connect4Medicare—will be known as Connect4Insurance. This change is more than just a brand transformation—it’s a commitment to continue offering agents unrivaled insurance services while aligning with evolving regulatory frameworks set forth by CMS.

The Reason for the Change

The driving force behind this rebranding is the 2024 Final Rule for Medicare Advantage and Part D. This new directive has been instituted by the Centers for Medicare and Medicaid Services (CMS) to provide a standardized approach to Medicare services across the nation. A significant facet of this rule is that it prohibits the use of “Medicare” in any third-party market organization’s (TPMO) business name, logo, or URL. The initiative is designed to mitigate any potential confusion among consumers seeking CMS-endorsed Medicare services.

The Impact and Importance of the 2024 Final Rule

The introduction of the 2024 Final Rule necessitates that TPMOs undergo rebranding efforts to remain compliant. It’s a rule that carries substantial weight in the industry, underlining CMS’s commitment to safeguarding the integrity of Medicare Advantage and Part D services, while promoting transparency for beneficiaries.

By changing its name from Connect4Medicare to Connect4Insurance, our organization is not just adhering to this rule but also leading the way in embracing change. This proactive approach showcases our unwavering dedication to providing exceptional services while maintaining regulatory compliance.

What Connect4Insurance Represents

While the name Connect4Medicare served us well, we believe that Connect4Insurance better encapsulates our broad array of services and commitment to connecting consumers with the right insurance solutions.
We’re not just about Medicare—we’re about a holistic approach to insurance. We offer an extensive range of services encompassing Medicare, ancillary health such as dental and hospital indemnity, life insurance, and more. This name change allows us to extend our reach, ensuring we cater to a more diverse demographic, without compromising our core values and principles.

Conclusion

We at Pinnacle Financial Services will keep pushing for excellence and innovation. We remain steadfast in our commitment to serving our agent partners, and we are enthusiastic about the possibilities that this change offers. Be assured that nothing about our mission or service quality has changed as a result of our name change. Our main goal is still to give our agent and agency partners the newest technological solutions so they can link their customers with the insurance products that are most suited to their particular needs.

FAQ’s

Do I need to take any action now or on October 1?

No. Our IT team will complete this transition behind the scenes so it’s completely seamless for you.

Will my Consumer PURL site have different features after the change?

No. Connect4Insurance will provide the same functionality for agents as Connect4Medicare.

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Bob Brzyski

Bob Brzyski

Author Position

x7742 | bbrzyski@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881
support@pfsinsurance.com

Contact Us

Contact a Pinnacle Financial Service representative today for assistance.

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Aflac Medicare Supplement and Final Expense

Aflac Medicare Supplement and Final Expense

Aflac Medicare Supplement and Final Expense
Comments

Since 1955, Aflac, a well-known and reliable insurance provider, has offered supplemental coverage to millions of policyholders. Aflac has established a strong brand identity and a reputation for offering high-quality insurance policies and responsive customer care. Aflac Medicare Supplement and Final Expense Plans stand out among the many insurance options they provide as worthwhile options for seniors, ensuring they can enjoy their golden years worry-free.

Aflac Medicare Supplement Plans:

As individuals reach the age of 65, they become eligible for Medicare, the government-sponsored health insurance program. While Medicare covers a significant portion of healthcare costs, it may not cover everything. This is where Aflac Medicare Supplement Plans come in handy.

By covering deductibles, copayments, and coinsurance, these plans, sometimes referred to as Medigap policies, address the gaps in Original Medicare coverage (Part A and Part B). Aflac offers several Medicare Supplement Plans, each tailored to meet a different set of requirements and financial constraints. Seniors can rest easy knowing they’ll have complete health coverage and lower out-of-pocket expenses by choosing the proper plan.

Aflac Final Expense Plans:

While it’s essential to plan for healthcare expenses during one’s lifetime, it’s also crucial to prepare for end-of-life expenses. Aflac Final Expense Plans provide a whole life insurance policy designed to cover funeral costs, outstanding debts, and other expenses associated with the passing of a loved one.

Final Expense Plans offer a death benefit, which is a fixed amount of money paid to the designated beneficiary upon the policyholder’s death. This benefit can be used to cover funeral expenses, medical bills, or any other financial needs. Some advantages of Aflac Final Expense Plans include:

  1. Simplified underwriting: These policies often have a simplified application process, requiring minimal medical information and no medical exam.
  2. Fixed premiums: The premiums for Final Expense Plans are fixed, meaning they will not increase over time, making budgeting for the future more manageable.
  3. Tax-free benefits: The death benefit is generally tax-free, ensuring that the beneficiaries receive the full amount to help cover expenses.

The Aflac Brand:

Aflac’s brand awareness is bolstered by its commitment to customer satisfaction, innovative products, and strong financial stability. With the Aflac duck as their mascot, they have created a recognizable and memorable identity that resonates with consumers. This recognition, coupled with their dedication to providing valuable insurance products, has solidified Aflac’s position as a leading insurance provider for seniors and their families.

Aflac Medicare Supplement and Final Expense Plans offer seniors and their families peace of mind and financial protection during their golden years.  Pinnacle Financial Services makes the Aflac Medicare Supplement and final expense plans available to all agents where available.  Reach out to a Pinnacle team member today to get contracted.

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Bob Brzyski

Bob Brzyski

VICE PRESIDENT, MARKETING

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881
support@pfsinsurance.com

Contact Us

Contact a Pinnacle Financial Service representative today for assistance.

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Medicare Advantage & Part D Poised to See Significant Compliance Changes in 2024

Medicare Advantage & Part D Poised to See Significant Compliance Changes in 2024

Medicare Advantage & Part D Poised to See Significant Compliance Changes in 2024
Comments

The 2024 Proposed Rule from the Centers for Medicare & Medicaid Services suggests a return to more controlled Medicare communications and marketing standards.

Medicare sales call recording regulations and new third-party marketing organization criteria became required for agents selling Medicare Advantage and prescription drug plans in 2023. In an ongoing effort to tighten down on misleading sales tactics, CMS has proposed clarifying a few points connected to these requirements, bringing back a few outdated rules, and adding a few new ones for 2024.

NABIP, formerly NAHU, submitted a comment letter to CMS this week in response to a new Medicare marketing proposed rule. It’s the ultimate hope that the proposed rule will not go into effect as currently laid out.

The impending Medicare Advantage and Part D rule modifications that will likely be completed prior to this year’s Annual Enrollment Period are summarized below.

Remember TPMO from 2023.  The Centers for Medicare and Medicaid Services (CMS) published its 2023 Final Rule this past spring. The Final Rule announces changes that have been made to existing marketing and communication requirements for both Medicare Advantage and Part D plans.

These changes sought to strengthen the oversight of third-party marketing organizations (TPMO) and include new consumer protections.

TPMO Sharing of Beneficiary Information

TPMOs are defined by CMS as organizations and individuals who are compensated to perform lead generation, marketing, sales, and enrollment-related functions as part of the chain of enrollment. (The steps taken by a beneficiary from becoming aware of a Medicare plan or plans to make an enrollment decision). TPMO also includes independent agents/brokers.

The sharing of personal beneficiary information with other TPMOs would now become prohibited, and the TPMO disclaimer has been updated.

State Health Insurance Programs (SHIPs) will need to be listed in the updated disclaimer as a way for beneficiaries to get further assistance, in addition to an MA organization and Part D sponsor with which the TPMO has a contract in the beneficiary’s service region.

“We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area which are [insert list of MA organizations or Part D sponsors]. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.”

Updates to the 2023 Final Rule on Call Recording

Only sales, marketing, and enrollment calls between TPMOs and beneficiaries must be recorded according to CMS. This should do away with the requirement to record calls for scheduling appointments and check-ins following sales. Calls with current clients, however, must be recorded for client retention reasons.

Additionally, CMS is requiring that all virtual calls for enrollment, marketing, and sales that are conducted by video conferencing or other forms of virtual telepresence be recorded.

Scope of Appointment Rule Change

In order to prevent personal marketing appointments from happening before 48 hours have passed since a potential enrollee has finished a Scope of Appointment, SOA, CMS plans to reestablish the 48-hour SOA time restriction. If you are familiar with the prior 48-hour SOA requirement you should know that the phrase “when practicable” will not be included in the new rule. It will be necessary to obtain SOAs at least 48 hours beforehand.

An SOA is only valid for six months after the beneficiary signs it, according to CMS.

push pin in calendar

Holding an Education Event

Agents will not be permitted to make future selling appointments at educational events or gather SOAs or beneficiary contact information. Additionally, agents will not be allowed to have a sales event there within 12 hours of the educational event. (The entire building or nearby buildings are considered to be in the same place.)

How Pinnacle Can Help

We recognize that these changes will present significant challenges for you when assisting clients with their Medicare coverage. Please keep in mind that we are here to assist you as you work through them to conduct your business compliantly, continue growing your sales, and provide the best service to your clients.

Please reach out to the team at Pinnacle Financial Services for additional information on these or any other questions you have, by contacting our Compliance team by email at compliance@pfsinsurance.com.

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Bob Brzyski

Bob Brzyski

Vice President - Marketing

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881
support@pfsinsurance.com

Contact Us

Contact a Pinnacle Financial Service representative today for assistance.

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