A Guide For Agents: Staying Ahead Of Medicare Legislation

Every year in Medicare brings a new set of rules and challenges. It can be hard to keep up. In this guide, we’ll provide some resources to help you stay ahead of the changes each year as well as talking about the way that Fidelis Consultants supports its agents with legislative change information.

We’ll also touch on how to share this information with your clients in an organized and efficient way.

Stay Updated About Changes

A. Official Sources

• CMS.GOV:

  • Of course, the best place to start is with the Centers for Medicare & Medicaid Services (CMS), the federal agency responsible for Medicare, Medicaid, and more. Their website (cms.gov) provides regular updates for everything including fact sheets on health topics to the annual Final Rule legislation. The website cms.gov is a trove of information as well as a repository of historic information about legislation, changes in Medicare rules, and more.

• FEDERAL REGISTER:

  • Another government resource is the Federal Register (federalregister.gov), a daily publication of all documents created by the executive branch agencies. The website was developed, “to make it easier for citizens and communities to understand the regulatory process and to participate in Government decision-making.” [1]

  • The Federal Register publishes proposed Final Rules, allowing the public to leave comments about possible changes to Medicare and Medicaid programs. This is an excellent way to make your voice heard concerning changes in how these programs work. After CMS consideres public comments, the Final Rule is enacted and published.

• STATE DEPARTMENTS OF INSURANCE:
  • Each state (including the District of Columbia and Puerto Rico) has a dedicated Department of Insurance that develops detailed regulations that specify how insurance companies operate, ensure that they comply with the regulations, and provide data for legislators to help with making new laws. Links to state Departments of Insurance can be found on the NAIC.org website.
• 1. Description taken from the Federal Register About page.

B. Conferences & Organizations

• 2025 AEP ROLLOUT EVENTS:
  • Fidelis Consultants hosts MULTIPLE AEP EVENTS each year. Reach out to your Fidelis Team to learn more about the AEP resources in your area and the carrier and community connections to help you as you continue to grow this year.

• AHIP:

  • This national trade association (formerly known as America’s Health Insurance Plans) is for people who provide health care coverage and services to Americans.

  • AHIP is the testing body for the annual certification test that insurance agents take. In order to sell Medicare Advantage and Part D plans, agents must demonstrate that they understand current Medicare regulations and compliance. The online exam covers Medicare basics, plan types, enrollment rules, and fraud, waste, and abuse prevention, and a passing score is required by most insurance carriers.

• MEDICARIANS:

  • This conference, hosted annually in Las Vegas, focuses on Medicare and other senior “health and wealth distribution’ topics. It is attended by agents, agency owners and principals, FMOs/IMOs, carriers, investors, and regulators.

  • Agents can attend to learn about new trends in the industry from major carriers and regulators, meet with other agents and agency owners, learn from the top-performing leaders in the country, and network with over 4,000 industry professionals.

C. Industry Blogs

• NELSON MULLINS – MEDICAID & MEDICARE:
  • This blog from Nelson Mullins, an association of over 1,000 am law attorneys, focuses on insights on legislative changes, regulations, and litigation.
• HEALTH LAW SCAN:
  • This blog, from the law practice Morgan Lewis, covers a wide range of topics affecting Medicare and Medicare Advantage, including industry news and a wide perspective of issues facing the healthcare industry.
• INSIGHTS by MANATT:
  • Manatt, Phelps & Phillips hosts a large archive of articles about legislative developments, regulatory updates, and case law.
• FIDELIS CONSULTANTS:
  • The Fidelis blog is a great resource for agents, covering topics from the basics of Medicare to more detailed information about how to increase client referrals, understanding Star ratings, and more.

Keep Clients Informed

As an insurance agent, keeping your clients informed about potential changes to their health care options is an essential part of your role. Here are some tips on how best to approach this.

• CLEAR & CONCISE EXPLANATIONS: 
  • You are an expert at what you do, which is why your clients trust you. It’s important to remember that they may not have the level of understanding that you do about Medicare topics. Be sure to explain things in everyday language, giving examples of why this is relevant to your audience.
• SEND ONLY THE MOST RELEVANT INFORMATION:
  • Legislative changes happen frequently. Your clients don’t need to know every detail of what’s happening; they’re only interested in the most relevant parts. Take time to understand how the information you’re gathering impacts them and filter out what isn’t necessary.
• BE PROACTIVE:
  • If you ensure that communication with your clients is relevant and necessary, they will appreciate that you were proactive in communicating the information.

• If you need help speaking with your clients about difficult topics, we have an article with suggestions to make it go more smoothly. Click Here to Read

Become Proficient at Adapting to Change

In an industry as rapidly-changing as Medicare, it’s important to learn how to be flexible and adjust to ever-evolving regulations.

• ATTEND EDUCATIONAL EVENTS:
  • Conferences, like those mentioned above, are a great way to continue your education and keep information fresh. In addition, there are many online webinars on relevant topics that you can join. Fidelis Consultants hosts webinars monthly from January to September on topics ranging from compliance guidance (August 31, 2024) to featured speakers like the Bundle Queen (May 21, 2024).
• STAY ORGANIZED:
  • It’s hardest to stay organized during the busiest times, so it’s best to have a good system in place before things get hectic. This will allow you to more easily filter out the less important information when changes are happening.

• Do you need assistance figuring out a good time management plan? Check out our article with some helpful tips. Click Here to Read

Legislative changes are a challenging and inevitable part of being an insurance agent. Luckily, there is a host of tools available to help you stay on track. Fidelis Consultants is proud to support their agents in learning about changes in legislation and the ways it can impact their business.