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2025 CMS Regulations and the Inflation Reduction Act: What Insurance Agents Need To Know


New CMS Regulations Carry Implications for Medicare Agents

From agent compensation to the amounts clients pay for prescriptions, major changes are ahead  in what's being called the biggest Medicare disruption in decades. 

Two regulations — the Inflation Reduction Act and the Centers for Medicare and Medicaid Services (CMS) Final Rule for the 2025 Contract Year — will greatly impact agents and their clients.

Dwane McFerrin, Senior Vice President, Med Solutions, at Senior Market Sales® (SMS), explains in three videos the potential impact on agents and clients as well as the challenges and opportunities.

In this first video, learn how the CMS rule could affect agents, including the cost of doing business, and the timeline for what to expect next.

How the Inflation Reduction Act Reshapes the Landscape

The Inflation Reduction Act, signed into law on Aug. 16, 2022, caps out-of-pocket Medicare Part D costs at $2,000 starting in 2025. A total of 5 million Part D enrollees had out-of-pocket drug costs of $2,000 or more in at least one year during the the 10-year period between 2012 and 2021, and more than 6 million Part D enrollees have paid $2,000 or more out of pocket in at least one year since 2007, according to a KFF analysis.

Yet, while millions will benefit from the cap, millions more could see premiums increase, some possibly by 50% or more, as carriers absorb the impact of that legislation.

In this second video, learn more about the potential premium hikes, particularly in rural areas where Medicare Advantage (MA) options may be limited, and how extra benefits on MA plans may be watered down.


How Agents Can Prepare for 'The Busiest Year Ever'

Independent insurance agents will need tools to solve for their clients needs and work efficiently.

SMS offers technology such as Lead Advantage Pro®, a comprehensive tool equipped with features like self-service enrollment, pharmacy lookup, and multiple enrollment methods.

Of particular value for agents with these upcoming Part D changes will be an in-house pharmacist agents can call with questions and a tool that searches by drug name to identify clients affected by drug formulary changes so agents can alert impacted clients.

This video explains eight tools to help agents in the upcoming AEP, which McFerrin expects to be "the busiest year ever for agents."

Get in touch to learn more about the 2025 CMS regulations and the Inflation Reduction Act.

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