Whether SEP or OEP, CMS says commissions should be the same

What happened: On June 7, the Centers for Medicare and Medicaid Services (CMS) released a memo titled Frequently Asked Questions on Agent/Broker Compensation and Guaranteed Availability of Coverage.

Why it matters: The memo clarifies that carriers must compensate agent and brokers at the same rate for all enrollments that occur during a benefit year, regardless of whether the enrollment happened during the Open Enrollment Period (OEP) or a Special Enrollment Period (SEP).

CMS became aware that some carriers are compensating agents and brokers at lower rates for SEP enrollments than OEP enrollments. The agency finds this practice to be in violation of guaranteed issue protections that consumers are entitled to under the Affordable Care Act, as compensation structures may influence the marketing, enrollment and retention of individual market consumers. In short, more equitable commissions structures for agents and brokers contribute to more equitable access to coverage for consumers.

What agents and brokers should do: Read the full memo. If you have been working under a commissions structure that pays differently for OEP and SEP enrollments, contact the Michigan Department of Insurance and Financial Services or CMS at marketconduct@cms.hhs.gov. Be prepared to submit documentation of the commissions structure in question.