LowCostCaHealth.com

We have received several questions from clients regarding whether they can pay us a fee to review and enroll them in the now non-commissionable Medicare Advantage (MA) or Prescription Drug Plans (PDP).

We want to make this absolutely clear: federal regulations prohibit agents from directly charging any fee to beneficiaries for marketing, consulting, or enrollment services involving MA or PDP plans, even if the plan does not pay a commission.

Federal Regulation: 42 CFR § 423.2274(c)(8) requires Part D sponsors to “ensure beneficiaries are not charged marketing consulting fees when considering enrollment in Part D Plans.” The same prohibition applies under Medicare Advantage regulations. Federal law preempts state law in this area. Even if a state permits Certified Insurance Consultants or Registered Investment Advisors to charge fees for other products, they may not do so for MA or PDP plans.

All compensation must come directly from plan sponsors and must comply with CMS regulations. Charging beneficiaries directly for these services places the agent at risk of regulatory enforcement and plan contract termination.

This means that we no longer are compensated for assisting with Medicare Drug plan reviews. We are also not compensated for some of the Medicare Advantage Plans.

We are offering free of charge specific zoom events and two in person events at our office to show you how to find and enroll in the best drug plan for you this open enrollment.

Go to https://www.lowcostcahealth.com/2026-aep-events/ When there is a zoom time listed, click on the zoom link to join in. Be on your computer or the largest screen you have and have a comprehensive list of any medications you currently take for best results.

Your Prescription or Medicare Advantage Plans are changing for 2025

It’s important to review your Medicare Advantage or Part D plan every AEP because, as we’ve talked about, plans and coverages can change each year. This year, it’s especially important to conduct your review because potentially disruptive changes are coming in 2025, courtesy of the Inflation Reduction Act, that may significantly alter the makeup of your Part D prescription drug coverage.

Here are some key Inflation Reduction Act changes:
• Insulin available at $35 per covered prescription (took effect in 2024)
• Annual out-of-pocket maximum reduced to $2,000 from $8,000
• Expansion of low-income subsidy program to 150% of the federal poverty level
• Plus, several important changes to the structure within Part D, including elimination of the coverage gap

Many of these changes will have positive impacts for you as the consumer. However, experts are predicting we could see substantial adjustments to products released in 2025, which could affect pricing, formularies and benefits.

That’s why I’m urging all my clients to pay special attention to their carrier’s Annual Notice of Change (ANOC) letter when it arrives in the mail this September. Once you review your ANOC letter, please contact me to schedule a no-cost, no-obligation appointment to review your coverage. This is the best way to ensure you remain in a suitable plan going forward into 2025.

I look forward to helping you!

Pamela Fugitt-Hetrick