How the 2027 Medicare Advantage & Part D Proposed Rule Could Impact Insurance Agents & Beneficiaries

The Centers for Medicare & Medicaid Services (CMS) released their Medicare Advantage (MA) & Part D Proposed Rule for Contract Year 2027 on November 25, 2025. And we have great news for agents selling Medicare!

There should be some major, positive changes for agents and Medicare beneficiaries in 2027.

Just a heads up, most of these changes aren’t mentioned in CMS’ press release or fact sheet. Industry professionals should read the whole 465-page rule, or this blog post summarizing it 😇, if you really want to know what’s going on!

So, what are the key changes in the Medicare rule for 2027 for insurance agents and their clients? Check out the highlights below!

Overall: Improvements Abound!

We’re excited to say that, if you’re selling Medicare products, you should be able to breathe a sigh of relief after reviewing the recent CMS Medicare news.

For one, the document itself is only 465 pages; last year’s proposed rule was 714 pages long! Two, CMS is streamlining agent and plan requirements — from Scopes of Appointment to marketing language.

CMS classifies this proposed rule as “deregulatory” — and it certainly is! Those familiar with the industry will note the repeal of some 2023 Final Rule policies and the return to 2021 policies.

Key Takeaway: In 2027, Medicare beneficiaries should find it easier to discuss and learn about their Medicare options with a licensed agent, as well as enroll in a plan that meets their unique needs. Agents should find it easier to educate and serve their clients.

In 2027, Medicare beneficiaries should find it easier to discuss and learn about their Medicare options with a licensed agent, as well as enroll in a plan that meets their unique needs.

2027 Medicare Proposed Changes Agents Need to Know

In their press release and fact sheet announcing the Proposed Rule, CMS states they’re streamlining and refocusing Star Ratings, codifying existing Special Enrollment Period (SEP) and Inflation Reduction Act (IRA) regulations, and requesting input on ways to modernize the MA Program.

Digging deeper into the PDF on the Federal Register, we can see there are several major changes that should positively directly impact agents and their clients in 2027!

Repeal of the 48-Hour Scope of Appointment Rule

Rejoice! Rejoice! CMS is, once again, proposing to eliminate the 48-hour Scope of Appointment (SOA) rule.

Reasoning: “CMS believes that the strict 48-hour SOA requirement may create an unnecessary barrier to accessing important MA and Part D information for impacted beneficiaries, and also barriers for plans and agents/brokers distributing this information, without offering a quantifiable protection to the beneficiary.”

Wondering why the back and forth on the rule? Different administrations with differing beliefs. The Trump Administration appealed the 48-hour SOA rule in 2021, and the Biden administration re-enacted it in 2023.

Allowing PTC & Multiple Contacts with One SOA

The new rule would allow permission to contact (PTC) to be on the SOA. Additionally, the signed SOA could be used for multiple contacts or appointments over the phone or in person.

Reasoning: “Because §§ 422.2264(c)(3)(iii) and 423.2264(c)(3)(iii) require that plans and agents/brokers holding personal marketing appointments may not market any health care related product during an appointment beyond the scope agreed upon by the beneficiary and documented in an SOA, the SOA must therefore include, at a minimum, the type of product(s) to be discussed … CMS encourages plans to also include other pertinent information in the SOA.”

CMS does not currently have a model document for SOAs. A new SOA must be signed for the same product for a different plan year.

Requiring SOAs for All “Personal Marketing Appointments”

CMS proposes to remove the word “scheduled” before personal appointment. An SOA would be required for plan/agent/broker-initiated outbound contact and beneficiary-initiated inbound contact.

Reasoning: “CMS believes these regulatory text changes are necessary to avoid ambiguity and prevent misinterpretation.”

Personal marketing appointments, according to CMS, are for one person or small group. CMS newly clarifies a “small group” as “a limited number of people, generally related or living in the same household” (e.g., married couple, parent or child).

An audio or audio-visual recording or an electronic record would suffice as an SOA record, but the SOA would have to be in writing for in-person personal marketing appointments. Instances in which SOAs could be accepted or collected include: (1) Plan activities in the health care setting; (2) marketing events; and (3) educational events.

Repeal of the 12-Hour Educational Event Delay

CMS is also proposing eliminating the 2023 rule barring marketing events from being hosted within 12 hours of an educational event in the same location.

Reasoning: “CMS is concerned that the requirements … impose an unnecessary burden on beneficiaries and plans and agents/brokers. Furthermore, CMS believes, based on stakeholder input, that the 12-hour delay requirement between an educational event and a marketing event may also create an unnecessary barrier to accessing important MA and Part D information for beneficiaries, especially those who live far from the events or those who lack access to transportation.”_

They propose that a marketing event can directly follow an educational event when:

Beneficiaries are notified of the switch (e.g., verbally or via written event)

There is a sufficient break between the two (e.g., snack or restroom break) when beneficiaries can leave the educational event prior to the marketing event

Allowing SOAs at Educational Events

Additionally, CMS plans to rescind the 2023 rule prohibiting agents and plans from providing and receiving SOAs at educational events.

Reasoning: “If plans and agents/brokers are allowed to collect SOAs at educational events, then it decreases the likelihood that beneficiaries might face undue burden and the potential challenge of reconnecting with a plan or agent/broker or traveling back to a venue to locate a plan or agent/broker at the conclusion of an educational event.”

Interestingly, CMS clarifies, “The collection of an SOA form is not a sales or marketing activity but is the making of an agreement regarding what type of product(s) will be discussed in advance of a personal marketing appointment between the beneficiary and the plan or agent/broker.”

Streamlining the TPMO Disclaimer

The TPMO disclaimer is a bulky, but required, disclaimer that agents, and other entities, must use when marketing Medicare services. Agents will be happy to know that, for 2027, CMS suggests eliminating the requirement to mention State Health Insurance Assistance Programs (SHIPs) in the third-party marketing organization (TPMO) disclaimer.

Reasoning: “CMS recognizes that, while SHIPs can be a source of unbiased information about plan choices, informing beneficiaries on every sales call about the SHIP may cause additional issues. SHIP volunteers may not always have the expertise to help beneficiaries navigate increasingly complex MA and Part D programs. CMS believes that beneficiaries enrolled in the MA and Part D programs may be more effectively served by information and entities for which CMS has direct oversight.”

They also propose removing the one-minute rule; allowing entities to read the disclaimer “prior to the discussion of any benefits” during the call.

Reasoning: “Notifying the beneficiary of the number of plans that a TPMO represents in the first minute does not always promote clear communication with the beneficiary or mitigate beneficiary confusion. By permitting TPMOs to read the disclaimer at an appropriate point during the call, provided it is read prior to the discussion of any benefits, the disclaimer will fit in better with the flow of the conversation.”

They clarify that simply mentioning something like “nearly all MA organizations offer routine dental care” does not constitute a “discussion of benefits.” In their own words, “CMS believes that discussing the specificity of a benefit with the intent to draw a beneficiary’s attention to an MA or Part D plan(s), or to influence a beneficiary’s decision making process when making an MA or Part D plan selection, or to influence a beneficiary’s decision to stay enrolled in a plan, could represent a discussion of benefits, as defined by the marketing definition.”

Reducing Retention of Call Recordings to Six Years

Medicare call recordings are here to stay, at least another year. On the bright side, you no longer have to keep all of them for a decade.

CMS proposed reducing the amount of time agents and plans must retain marketing and sales call recordings to six years.

Reasoning: “Audio call files are large, taking a substantial amount of data storage, especially when the record retention requirement is to store these calls for 10 years. In addition to the cost of maintaining these calls, CMS is highly unlikely to review calls past the 6-year mark.”

Note, this would only change the required retention time for the marketing and sales portions of calls; agents and plans must maintain enrollment documentation for 10 years.

Allowing Superlatives Without Citations

Generally speaking, CMS proposes allowing the use of superlatives in Medicare advertising without a supporting citation.

Reasoning: “MA organizations and Part D sponsors are already broadly prohibited from providing beneficiaries marketing and communications materials that are misleading, confusing, or materially inaccurate.”

They do clarify that MA organizations and Part D sponsors should be able to factually support such superlatives through data, surveys, studies, or other type of information when requested by CMS. Furthermore, CMS states organizations and sponsors should indicate the year when the statement is based on older data or convey that in other way.

Revising & Renaming SEP for Provider Network Changes

Whether a doctor is in network or not can make or break a beneficiary’s Medicare enrollment decision. CMS wants to expand the eligibility criteria for the current SEP for Significant Change in Provider Network and rename it to “SEP for Provider Terminations.”

The definition of “affected enrollee” would remain as “an enrollee who is assigned to, currently receiving care from, or has received care within the past 3 months from a provider or facility being terminated.”

Reasoning: “Although CMS evaluates cases of possible significant network change carefully and strives to reach a determination as expeditiously as possible, we continue to look for ways to reduce the time it takes to inform beneficiaries of their rights and their enrollment options. Specifically, we are looking to streamline the currently separate notification requirements for provider terminations and the SEP for Significant Change in Provider Network.”

The SEP would start the month the beneficiary is notified of their eligibility and continue for two additional calendar months. Beneficiaries would be notified of the SEP in the provider termination notice for affected enrollees.

Fewer Disclosures & LI NET Changes

Lastly, we also want to point out that CMS is proposing to:

Exempt account-based plans (such as health reimbursement arrangements (HRAs), flexible spending accounts (FSAs), and health savings accounts (HSAs)) from creditable coverage disclosure requirements

Rescind the requirement for MA plans to send mid-year notices about unused supplemental benefits

Waive the requirement for the Limited Income Newly Eligible Transition (LI NET) program to maintain toll-free customer call centers open from 8 a.m. to 8 p.m. in all regions

Reasoning: “To reduce burden and remove requirements that are duplicative or no longer necessary or applicable.”

CMS Requests Feedback on Modernizing Agent/Broker Medicare Regulation

While releasing the proposed rule, CMS put forth several “Requests for Information” (RFIs) out to the public.

Agents and brokers should note that CMS is interested in hearing ways to “modernize their approach to marketing oversight and agent/broker regulation in the Medicare program while ensuring beneficiaries continue to receive accurate information about plan choices.” Specifically, they are seeking input on:

• Modifying the current definition of third-party marketing organization (TPMO) under §§ 422.2260 and 423.2260 to delineate the roles of and requirements applicable to the different kinds of TPMOs.
• Modifying the 5 percent translation requirement found in §§ 422.2267 and 423.2267.
• Removing the requirement for our approval of plan use of the Medicare Card image found in §§ 422.2262(a)(1)(xix) and 423.2262(a)(1)(xviii).
• Eliminating the Outbound Enrollment Verification found in §§ 422.2272(b) and 423.2272(b).
• Modifying testimonial requirements found under §§ 422.2262(b) and 423.2262(b).
• Eliminating mailing statement requirements found under §§ 422.2267(e)(36) and 422.2267(e)(37).

It’s exciting to see that CMS intends to hold “bad actors” accountable instead of burdening TPMOs adhering to requirements!

CMS’ CY2027 Proposed Rule for MA & Part D was short and sweet — streamlining processes and reducing administrative burden on plans, agents, and beneficiaries alike! Now, we wait until the spring (the 2026 Final Rule was released in April 2025) to see what’s finalized.

We hope you found this summary valuable! Be sure to check out the full Medicare Proposed Rule on the Federal Register to see all the changes.

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