2026 Medicare Agent and Broker Compensation Rates & Guidelines
Relevant to: PDP, PACE, Part D
Each week, we scan the latest CMS memos to find the most important ones that apply for PACE programs. Below is a summary of what you need to know.
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Introduction
In anticipation of Contract Year 2026, CMS under the Department of Health & Human Services has released a critical memorandum detailing agent and broker compensation rates, referral fees, and vital training requirements for Medicare Advantage Organizations and other affiliated plans. This memorandum, issued by Kathryn A. Coleman, outlines compliance instructions and stays by the U.S. District Court in Texas affecting certain 2025 provisions. Understanding these updates is essential for all stakeholders to ensure compliance and uniformity within the Medicare Advantage and Prescription Drug programs.
Key Dates and Deadlines
- June 18, 2025: Memorandum date
- July 3, 2024: U.S. District Court’s orders issued
- June 2, 2025: Start of data submission period
- July 25, 2025, 11:59 pm EST: Deadline for data submission
- Open annually before CY 2026: CMS to make organization-submitted compensation information public
PACE Compliance
This memo is relevant to PACE programs because of the implications regarding the stay on certain provisions of the CY 2025 Final Rule by the U.S. District Court for the Northern District of Texas. The stay affects the regulatory language that impacts Programs of All-Inclusive Care for the Elderly (PACE) among other programs.
The PACE programs must recognize that for CY 2026, the regulatory provisions that were in effect prior to the CY 2025 Final Rule remain applicable due to the litigation stay. This means that any changes proposed in the CY 2025 Final Rule regarding 42 C.F.R. sections related to agent and broker compensations, referral fees, and training/testing requirements are also stayed, and programs must comply with prior provisions until further legal developments.
Organizations involved in PACE are required to understand these maintained provisions as they plan their agent and broker compensation structures and related compliance requirements for CY 2026.
Any adjustments made based on the CY 2025 Final Rule proposals should be reevaluated and adjusted to align with the status quo ante due to the court’s decision. PACE-related plans must continue to follow the guidance as laid out in the previously established regulatory framework.
Additionally, PACE programs should stay informed on any legal updates regarding the litigation as any changes can directly affect compliance responsibilities. Regular review of CMS updates and thorough documentation of compliance practices is recommended to ensure continued adherence to federal requirements.
Required Actions
1. Review and update your compensation schedules to align with the CMS-provided fair market value amounts for initial and renewal compensation rates, as well as referral fees for CY 2026. Ensure these are updated in accordance with 42 C.F.R. §§ 422.2274(d) and 423.2274(d).
2. Submit your agent and broker compensation data, including intended use of agents and specific rates, to the HPMS Marketing Module between June 2 and July 25, 2025, at 11:59 pm EST. This submission must include an attestation from your CEO, COO, or CFO to be considered complete.
3. Develop and implement training and testing programs for agents and brokers that comply with 42 C.F.R. §§422.2274(b)(2) and 423.2274(b)(2). Ensure programs include CMS’s annual guidelines and require agents and brokers to achieve an 85% or higher score on testing.
FAQs
- “What are the compensation rates for agents and brokers for CY 2026?”
- “When is the deadline for submitting agent and broker compensation data for CY 2026?”
- “What are the training and testing requirements for agents and brokers in CY 2026?”
- “Which regulatory provisions are affected by the court’s stay order?”
- “What are the guidelines for paying referral fees under CMS regulations for CY 2026?”
