Medicare Managers May Ease Agent License Rules


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Officials at the Centers for Medicare and Medicaid Services may loosen the way CMS handles licensing enforcement requirements for the agents and brokers who sell Medicare Advantage plans and Medicare Part D plans.

CMS has included that idea in a 713-page draft of Medicare program changes proposed for the 2019 contract year. CMS is preparing to publish the draft Nov. 28. A preview copy of the draft is available here.


Federal laws and regulations require Medicare plan issuers to sell their plans through licensed agents and brokers. CMS wants to continue to enforce that requirement, but it wants to give state regulators and plan issuers more freedom to come up with their own ways to handle licensing rule violations, officials say in a description of the proposed rule changes. 

(Related: Meet the New Medicare Card)

Today, CMS officials say, issuers have only two choices.

If producers have already gotten their licenses reinstated, an issuer can terminate the producers and immediately rehire them.


Otherwise, the issuer must prohibit the producers who let licenses lapse from ever selling the issuer’s Medicare plans again.

That rigid approach conflicts with the goal of keeping agents and brokers involved in the Medicare program, officials say.

“We believe agents/brokers play a significant role in providing guidance to beneficiaries and are in a unique position to positively influence beneficiary choice,” officials say.

Officials say they intend to handle the problem by deleting the regulations that now limit issuers’ compliance choices


“Nonetheless, CMS may pursue compliance actions upon discovery of [Medicare Advantage] organizations and Part D sponsors who allow unlicensed agents/brokers to continue selling their products in violation” of the licensing laws, officials warn.

The proposed change would remove language that states that enrollees have a chance to choose new plans if they bought coverage through unlicensed producers, but another regulation continues to make a Medicare plan special enrollment period available to consumers who bought Medicare plans through unlicensed products, officials say.


The proposed change and other parts of the draft 2019 Medicare program rules will be going through a public comment period. Comments will be due 5 p.m. Jan. 16.

—Read Medicare Advantage Plan Count Rises 10% on ThinkAdvisor.

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The plans are profitable enough that insurers sincerely want to sell more of them.

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