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New CMS Medicare Advantage Final Rule: Beneficiary Data, Agent Compensation, Behavioral Healthcare Access, and More

Recording of a 90-minute CLE video webinar with Q&A

This program is included with the Strafford CLE Pass. Click for more information.
This program is included with the Strafford All-Access Pass. Click for more information.

Conducted on Thursday, July 11, 2024

Recorded event now available

or call 1-800-926-7926

This CLE webinar will guide healthcare practitioners through the Centers for Medicare & Medicaid Services' (CMS) CY 2025 Medicare Advantage and Part D final rule, effective Oct. 1, 2024, that significantly updates CMS policies to promote competition and equity in coverage, increase access to behavioral health services, protect individuals from inappropriate marketing, and improve supplemental benefits. The panel will offer best practices for navigating the final rule's requirements.


CMS recently released the CY 2025 Medicare Advantage and Part D final rule, effective Oct. 1, 2024, that makes significant changes to certain CMS policies including to promote competition, protect beneficiaries' data from being used inappropriately for marketing, increase access to behavioral health services, promote equity in coverage, and improve supplemental benefits.

One of the most notable changes in the final rule is related to agent/broker compensation to stop what CMS says is anticompetitive steering of enrollees toward some Medicare Advantage (MA) and Part D plans over others based on the agent/broker's financial interests rather than the enrollee's healthcare needs. The final rule caps agent/broker non-salary compensation, eliminates separate payments for administrative services, and intends for compensation to encompass all administrative fees and commissions paid to independent agents/brokers. The final rule also prohibits contractual terms that create incentives to enroll beneficiaries in plans other than in the best interests of the beneficiary and that provide bonuses for hitting volume-based sales targets for plan sales.

Other significant updates include requiring express written consent from beneficiaries before third-party marketing organizations (TPMOs) may share personal beneficiary data with other TPMOs for marketing or enrollment purposes; improving access to behavioral healthcare services by finalizing important updates to network adequacy standards; and requiring MA plans to issue mid-year notices to enrollees that include a list of supplemental benefits to which they are entitled but have not yet accessed.

Listen as our expert panel guides practitioners through the notable changes in the CMS CY 2025 Medicare Advantage and Part D final rule and offers best practices for compliance.



  1. Introduction
  2. Medicare Advantage Part C and Part D prescription drug plan marketing
    1. Agent and broker compensation
    2. Distribution of personal beneficiary data by TPMOs
  3. Improving access to behavioral healthcare providers
  4. Supplemental benefits
    1. Mid-year enrollee notification of available supplemental benefits
    2. New standards for special supplemental benefits for the chronically ill
  5. Annual health equity analysis of utilization management policies and procedures
  6. Other changes
  7. Practitioner takeaways


The panel will review these and other important considerations:

  • How does the final rule encourage competition?
  • What impact will the final rule's requirements related to administrative fees and capped compensation have on agents/brokers?
  • What is the status of the recent lawsuits filed to challenge these regulatory changes?
  • In what ways does the final rule promote equity and access to healthcare?
  • How will the final rule's requirements improve supplemental benefits available to enrollees?
  • What are best practices for navigating the final rule's requirements and ensuring compliance?


Bergeron, Christina
Christina Bergeron

Ropes & Gray

Ms. Bergeron provides strategic business and regulatory counsel to prominent health care and private equity...  |  Read More

Fingold, Helaine
Helaine I. Fingold

Epstein Becker & Green

Ms. Fingold’s practice focuses largely on the regulation of Medicare managed care (including Medicare Advantage,...  |  Read More

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