CMS’ 2025 Proposed Final Rule: SAHU Advocates for Industry Response with Compensation & Marketing Changes On the Rise

In response to the Centers for Medicare & Medicaid Services’ (CMS) 2025 Proposed Final Rule, the Sacramento Association of Health Underwriters (SAHU) is taking a proactive stance to represent the interests of its members and the broader health insurance community.

CMS has introduced a comprehensive proposed final rule, CMS-4205-P, set to bring about substantial changes to Medicare Advantage and Part D programs, effective from the 2025 contracting year starting September 30, 2024. Notably, the proposed rule addresses critical aspects of Medicare marketing and communications policies, particularly impacting agent and broker compensation outlined in Section 1851(j) of the Act.

Key elements of the proposed final rule encompass the elimination of administrative fees and overrides, restrictions on services provided to Medicare agents, impacts on different agency types, changes in marketing reimbursements and Health Risk Assessments (HRA) fees, modifications in commission structures, and operational adjustments for agents and agencies.

SAHU and its board members believe that CMS-4205-P may have certain drawbacks, particularly as this policy would essentially leave agents and brokers unable to directly recover administrative costs. These adjustments impacting FMO/Agency support, training, technology, and related aspects will influence beneficiary options by diminishing the number of agents not only promoting Medicare Advantage but also providing a diverse range of plans. In essence, this regulation is poised to yield outcomes contrary to its intended objectives.

“Field Marketing Organizations (FMOs) are General Agents who provide training, and a multitude of compliance expertise to field agents. Agents struggled to comply with the recent CMS recording requirements, but FMOs were able to quickly provide a scalable solution. Without the general support of FMOs, insurance carriers would need to provide these services, raising their administrative costs and premiums to beneficiaries.” Says, NABIP CEO Jessica Brooks-Woods.

With the CMS-4205-P proposal open for public comment until January 5th, SAHU urges its members and the broader community to unite in advocating for the best interests of our clients and the sustained strength of our profession. We encourage everyone to contribute professional and constructive feedback, and comments can be conveniently submitted through Regulations.gov.

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For over 30 years, SAHU has worked to improve our members’ ability to meet the health, financial and retirement security needs of all Californians and Americans through education, advocacy, and professional development. For more information, please visit: sahu-ca.com. 

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SAHU PAC Event_April11

SAHU PAC EVENT

April 11 @ 5:30 pm 10:00 pm

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Join us and learn more on NABIP PAC & CAHIP PAC’s engagement, education, and support. PACs engages with lawmakers from both parties to make sure members’ voices are heard. PACs educates legislators about how to provide Americans with superior health care. PACs supports lawmakers who prioritize high-quality, low-cost health care.

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SAHU’s summary of the 2023 CAHIP Capitol Summit

SACRAMENTO, CA- May 8-10th 2023 – Members of SAHU (Sacramento Association of Health Underwriters) attended the annual Capitol Summit held by California Agents & Health Insurance Professionals (CAHIP), reporting back a warning against the implementation of a state-run health care system.  

SAHU strongly opposes – SB 770: a proposed legislation that would create a costly and untested state-run health care system.  SAHU emphasizes that implementing SB 770 would eliminate existing Medicare and Medi-Cal programs, leaving millions of Californians without essential health care coverage.   SAHU warns that SB 770 does not introduce new providers or facilities, potentially leading to longer wait times for procedures, reduced access to specialists, and a loss of doctors to other states. The association urges the Legislature to pursue constructive and viable solutions to enhance access to affordable health care.

SB 770 is the first step towards a single-payer health care system, which not only eliminates Medicare and Medi-Cal but also prohibits private health coverage, including employer-sponsored plans. The projected cost of over $500 billion per year would require significant tax increases on individuals, employers, and small businesses.

CAHIP states in its own talking points of this year’s Summit, that there has been “progress made in expanding access to affordable health coverage in California since the passage of the Affordable Care Act. Californians are satisfied with their health care and prefer to build upon this progress, preserving their ability to choose private coverage for their families.” 

To read more about CAHIP’s Capitol Summit talking points, visit their website- https://www.cahu.org/cahip-capitol-summit-talking-points.

SAHU Supports AB 716: Protecting Californians from Costly Surprise Billing for Ambulance Services.  SAHU stands behind AB 716, a vital legislative measure aimed at safeguarding injured Californians from burdensome balance bills and resolving billing disputes for emergency ground ambulance services beyond their control. 

By passing AB 716, Californians will be protected from excessive out-of-pocket expenses and relieved from the complexities of billing disputes between health plans and ground ambulance service providers. This legislation is crucial in addressing the common practice of surprise billing, or “balance billing,” which often leaves injured individuals in the midst of billing disputes for essential services.

ON WATCHSAHU is also closely monitoring AB 1690, a “spot bill” lacking substance and a funding source for a proposed government monopoly on health care.  SAHU advocates for market stabilization strategies and supports AB 716, which aims to protect Californians from expensive balance billing for emergency services.

Dave Fear Jr., SAHU Legislative chair says this, “Addressing our elected legislators, whether in DC or Sacramento, is such an important part of our governmental system. Being able to meet face to face and let them know who we are, what we do and how we work to make things better is a fundamental part of citizenship in this country!”  SAHU maintains a steadfast commitment to actively engage and participate in relevant legislative proceedings and keeping the public informed with accurate information. 

If you are interested in learning more about current health insurance industry news and legislative updates, please visit our website, https://sahu-ca.com.

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For over 30 years, SAHU has worked to improve our members’ ability to meet the health, financial and retirement security needs of all Californians and Americans through education, advocacy, and professional development. For more information, please visit: sahu-ca.com. 

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