The White House released a fact sheet on Tuesday detailing the launch of the “Strike Force on Unfair and Illegal Pricing,” co-chaired by the DOJ and FTC. In the fact sheet, the Biden administration outlines several actors that the Strike Force will focus on – including “insurance companies paying brokers to steer patients towards certain plans based on compensation.”

Regarding affordability and competition in healthcare, the Biden administration noted that “HHS rejected more than 1,000 Medicare Advantage TV marketing ads in one year that were misleading to consumers and proposed a rule that if finalized will prohibit insurance companies from paying brokers to steer patients towards certain plans based on compensation, rather than options that meet best patient health needs.”

NABIP has spent a significant portion of time educating legislators and regulators on how the Medicare Advantage program works. This includes differentiating between the TPMO call centers that sell seniors plans they do not need through misleading advertisements and the licensed, independent agents that personally service beneficiaries.

CMS recently acknowledged that independent agents “have become an integral part of the industry, helping millions of Medicare beneficiaries to learn about and enroll in Medicare, MA plans and PDPs by providing expert guidance on plan options in their local area, while assisting with everything from comparing costs and coverage to applying for financial assistance.” Despite this nuance, regulators are still operating under the assumption that MA agents are incentivized by large plans to steer beneficiaries to certain plans over others based on “excessive compensation” and other bonus arrangements rather than what is best for the beneficiary.

In our press release issued just hours after the White House published the fact sheet, NABIP clarified certain details, including the MA compensation structure. Medicare agents operate under a fixed compensation structure, established and regulated CMS. This means that Medicare agents do not stand to gain more by steering beneficiaries towards specific plans. CMS, however, believes that “administrative fees” (that go towards the operations of Field Marketing Organizations, or FMOs) are additional compensation that goes directly into the agent’s pocket. This could not be further from the truth. To read our full comment letter in response to recent alarming regulations, click here.

“Medicare agents are vital advocates for seniors navigating the complex world of healthcare coverage,” stated NABIP CEO Jessica Brooks-Woods. “Their dedication to transparency, regional inclusivity, personalized service, and client empowerment collectively contribute to the overall positive experience of Medicare beneficiaries. NABIP remains open to engaging in constructive conversations on MA with policymakers to address these concerns and work towards solutions that ensure a fair and effective Medicare marketplace.

Source: National Association of Benefits and Insurance Professionals