Health Care

PIA National supports the critical role that independent agents play in the sale and servicing of health insurance.

In March 2010, the Affordable Care Act (ACA) was signed into law, dramatically changing the health insurance landscape. Since the implementation of the ACA, PIA has focused on rolling back specific provisions that are harmful to independent insurance agents. PIA will continue to support legislation that would improve the independent agents’ ability to sell health insurance and demonstrate the value employer-sponsored health coverage to the health insurance industry.

Reversing Burdensome Medicare Rule

The Centers for Medicare and Medicaid Services (CMS) recently finalized its updated Medicare Program: Contract Year 2023 Policy and Technical Changes to the Medicare Advantage Program and Medicare Prescription Drug Benefit Program. The rule made significant changes to existing marketing requirements for both Medicare Advantage and Medicare Part D plans.

PIA, along with other agent groups, strongly opposed the final rule, which seeks to discourage dishonest marketing behaviors by requiring third-party marketing organizations (TPMOs) to record all enrollment conversations. However, traditional TPMOs are already required to record all enrollment conversations. The now-final rule dramatically broadens the definition of TPMO to impose an unnecessary burden on many entities that are acting responsibly, including individual agents and brokers, who will be subject to this new recording requirement.

The new requirement imposes an additional demand on licensed agents and brokers attempting to assist Medicare beneficiaries in choosing suitable health care and prescription drug plans and will discourage licensed agents from representing Medicare Advantage and Part D Plans until they can develop compliant processes and procedures. For the foreseeable future, this could leave millions of Medicare beneficiaries without access to the quality assistance with the enrollment process that can only be provided by licensed professionals. 

Additionally, because agents and brokers were excluded from stakeholder discussions during the rule’s development, it does not accurately reflect the routine business practices of independent agents and brokers, nor does it accurately reflect their relationships with their clients. 

In 2022, Senator Mike Rounds (R-SD) introduced legislation (not yet reintroduced in the 118th Congress)  that would have narrowed the TPMO recording requirement in the Medicare rule by removing agents from the definition of TPMO.

PIA strongly supports this legislation and will work to have it reintroduced in the 118th Congress this year.