Today, the Centers for Medicare & Medicaid Services (CMS) posted Frequently Asked Questions (FAQs) regarding compensation paid by issuers to agents and brokers who assist consumers with enrollment during a Special Enrollment Period (SEP) or during Open Enrollment Periods (OEPs). The Biden-Harris Administration has made it a priority to provide those who are uninsured and underinsured with quality, affordable health care coverage and recognizes that agents and brokers play a vital role in helping consumers enroll in coverage that best fits their needs and budget.
CMS has become aware that some issuers in the individual market, who commonly use agents and brokers as part of their marketing and sales distribution channels, have reduced or eliminated commissions and other forms of compensation to agents and brokers for enrollments during an SEP. Today’s FAQs provide guidance that paying differential compensation to agents and brokers for coverage in the same benefit year based on whether the enrollment is completed during an SEP or during the OEP is prohibited under federal law. These practices violate the guaranteed availability protections afforded to these individuals under the Affordable Care Act.
To read the FAQs visit https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs#Health_Market_Reforms.
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Contact: CMS Media Relations
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