Medicare Sales Updates 2025: 5 Things Every Licensed Agent Should Know

Staying compliant while delivering value to beneficiaries has never been more challenging—or more rewarding. Below is a concise rundown of the biggest changes licensed insurance agents must master before the Annual Enrollment Period (AEP) 2025. Bookmark it, share it with your down‑line, and reach out to Informed + Choice for the tools that turn these updates into a competitive edge.

1. Part D Redesign Caps Out‑of‑Pocket at $2,000 (Starts Jan 1, 2025)

The Inflation Reduction Act finishes reshaping Part D next year. The catastrophic “donut hole” phase disappears, and members stop paying once their true out‑of‑pocket costs hit $2,000. A new smoothing option lets them spread those costs over the year—expect questions on how it works and which plans support it.

2. Agent & Broker Compensation Gets a $100 Boost—But Also a Hard Ceiling

CMS re‑defined compensation to include all financial incentives and raised the national initial‑year commission maximum by $100. The intent: eliminate plan‑by‑plan bonuses that steer clients for the wrong reasons. Verify your contracts now; anything that pays above the fixed amount is prohibited.

3. 48‑Hour Scope‑of‑Appointment Rule Is Here for Good

Unless it’s a valid walk‑in situation or the beneficiary is ≤ 4 days from a valid election period, you must obtain a signed SOA at least 48 hours before the appointment. Digital SOA tools make compliance painless—Informed + Choice integrates SOA capture right into your workflow.

4. Tighter Marketing Compliance for TPMOs & Digital Leads

• TPMO Data‑Sharing → One‑to‑one written consent now required before passing a lead to another marketer.
• Call Recording → All marketing and enrollment calls (inbound + outbound) must be recorded and stored 10 years.
• Standard Disclaimer → Continue using the 2024 language, but add the State Health Insurance Assistance Program (SHIP) reference.
• Superlatives & Benefit Ads → Any claim of “best,” “most,” or “lowest” must be objectively documented and filed.

5. Extra Help Expansion & Monthly Special Enrollment for Duals

The LIS (“Extra Help”) full subsidy now applies up to 150% FPL, and qualifying beneficiaries can switch plans monthly. Make sure your CRM flags extra‑help prospects so you stay on top of SEP opportunities.

Action Items for Agents

1. Update Sales Scripts to reflect the $2k cap and smoothing program.
2. Audit Contracts for compliance with the new all‑in compensation ceiling.
3. Implement 48‑hour SOA Tracking (digital or paper) across your team.
4. Refresh Marketing Materials with the correct TPMO disclaimer and eliminate prohibited language.
5. Segment LIS Clients for year‑round retention touchpoints.

Need help? Informed + Choice delivers real‑time drug lists and coverage data so you can answer tough questions in seconds—without handling PHI you don’t need. Book a quick demo today »