Medicare Regulatory Compliance Updates
There are several upcoming changes to the Medicare regulatory landscape. To keep you informed, we have summarized a few of the more significant changes below:
Medicare Advantage Compensation $$$
CMS issued a CY2025 Proposed Rule on November 6, 2023, including policies that change Medicare Advantage compensation, potentially impacting distribution significantly.
These proposed changes include:
Adding a provision to prohibit contract terms that create incentives inhibiting an agent's or broker's objective assessment and individual plan, including terms contingent on enrollment quotas, bonuses tied to enrollment volume, and FMOs providing leads or incentives based on previous enrollments.
Revising compensation definition to include all payments related to initial enrollment, renewal, or plan-related services, removing separate regulatory authority for "administrative payments" and clarifying calculation independence.
Eliminating the current framework allowing separate payments to agents and brokers for administrative services.
Increasing the compensation rate $31 to account for administrative costs.
CMS is accepting comments until January 5, 2024.
Minnesota Medicare Supplement Amendment
Governor Tim Walz of Minnesota approved SF 2744, which amends Minnesota’s Medicare Supplement regulations that applies to policies offered, issued, or renewed on or after August 1, 2025.
SF 2744 amends Minnesota Statutes 2022, sections 62A.3099 through 62A.44, by:
Prohibiting pre-existing condition limitations:
- Repeals the requirement that policy must provide pre-existing condition coverage during the first six months of coverage if the insured was not diagnosed or treated for the condition for 90 days immediately preceding the effective date of coverage.
- Repeals the requirement that replacement coverage should waive any time periods applicable to pre-existing conditions, or waiting, elimination, or probationary periods to the extent the time was spent under the original policy.
Adding a Guarantee Issue situation for individuals:
- enrolled in a state public program and is losing coverage due to the unwinding of the Medicaid continuous enrollment conditions, as provided by Code of Federal Regulations, title 45, section 155.420(d)(9) and (d)(1), and Public Law 117-328, section 5131 (2022).
Adding an open enrollment period, as defined in Code of Federal Regulations, title 42, section 422.62, paragraph (a), clauses (2) to (4), for any eligible Medicare beneficiary in Minnesota, where medical underwriting cannot be used when issuing a Medicare Supplement plan.
Virginia Medicare Supplement Open Enrollment Period
Effective January 1, 2024, Virginia is changing its Medicare Supplement regulations to include an open enrollment period for individuals under 65 with end stage renal disease (ESRD) and a premium rate limitation for qualifying disabilities.
§ 38.2-3610 of the Code of Virginia was amended to include:
Open enrollment period is six months beginning the first month in which the under age 65 individual is enrolled in Medicare Parts A and B, and is eligible for Medicare by reason of disability, specifically end-stage renal disease.
Each insurer issuing Medicare supplement policies are required to offer at least one of its issued Medicare supplement policies:
- Plans A, and D or G for persons new to Medicare on or after January 1, 2020
- Plans A, and C or F for persons eligible prior to 2020
Prohibits insurers from charging individuals who are under age 65 and eligible for Medicare by reason of any qualifying disability premium rates for any Medicare supplement plan that exceed the premium rates charged for such plan to individuals who are 65.
For more regulatory compliance updates and reminders like these, check out the Compliance Chatter section in our weekly Medicare Market Insights newsletter.
Telos Actuarial’s team of experienced regulatory compliance professionals has over 40 combined years of experience and is ready to help YOU stay informed of regulatory changes, remain compliant, and improve the speed to market of your Accident & Health products, by providing the following services:
Policy form, rider, and application development
State filing preparation, submission, monitoring, and correspondence
Forms, advertisements, rate modifications, statutory modifications, and block closure
Impact assessment of laws, regulations, and bulletins to product forms
Regulatory intermediary between client and state departments of insurance
Advertising review
State data call and survey assistance
Competitive language and underwriting conditions assessment
Customized insurance regulatory compliance research
We’ve secured over 11,000 approved state filings since 2014!
Reach out to compliance@telosactuarial.com to learn more.
