Broker comp rates are in for 2019. CMS recently released a memorandum on contract year 2019 agent and broker compensation rate adjustments, submissions and training and testing requirements. Here’s a breakdown of what you need to know.
Compensation Rates
The compensation rate cut-offs have been adjusted for the new contract year.
Compensation amounts paid to independent agents or brokers for enrollment have to be at or below the fair market value cut-off amounts. The initial year amount is the maximum that can be paid during compensation cycle-year one, and the renewal amount is the maximum that can be paid after that.
For contract year 2019, these are the cut-off amounts for Medicare Advantage and Section 1876 Cost Plans, rounded to the nearest dollar:
| National |
Connecticut, |
California and New Jersey |
Puerto Rico and U.S. Virgin Islands |
|
| Initial year | $482 | $542 | $601 | $331 |
| Renew year | $241 | $271 | $301 | $166 |
For contract year 2019, these are the cut-off amounts for prescription drug plans, rounded to the nearest dollar:
| Initial year | $74 |
| Renewal years | $37 |
These cut-offs are higher than they were for the previous contract year. The national initial year cut-off for Medicare Advantage and Section 1876 Cost Plans increased by $27, from $455 in contract year 2018 to $482 in contract year 2019. The national renewal year cut-off for Medicare Advantage and Section 1876 Cost Plans increased by $13, from $228 in contract year 2018 to $241 in contract year 2019.
The prescription drug plan cut-offs also increased, going from $72 in contract year 2018 to $74 in contract year 2019 for the initial year, and from $36 in contract year 2018 to $37 in contract year 2019 for renewal years.
Compensation Rate Submission
Organizations must notify CMS whether they are using employed, captive or independent agents. If an organization uses independent agents, the organization must submit the initial and renewal compensation amounts that will be paid, as well as any referral fees.
To submit this information, organizations should use the Health Plan Management System (HPMS) Marketing Module.
The information must be submitted between June 4, 2018, and July 27, 2018, 11:59 pm EST. The submission must include an attestation from the organization’s CEO, COO or CFO. Changes to the information cannot be made after July 27.
Failure to complete the submission on time will result in an organization being out of compliance with CMS requirements.
Training Requirements
Agents and brokers who sell Medicare products must be trained and tested every year.
- The training and testing covers Medicare Parts A, B, C and D, as well as plan specific information.
- Training and testing requirements apply to employees, subcontractors, downstream entities and/or delegated entities.
- Agents and brokers need to achieve an 85 percent passing rate.
You can download the training and testing requirements for contract year 2019 here.
