CMS has released its Contract Year 2027 Proposed Rule for Medicare Advantage (MA) and Part D, and while much of it is highly technical, there are several proposals that could meaningfully change how agents explain benefits, structure events, and handle compliance.

This post highlights 11 of the most important items for independent agents, agencies, and FMOs, especially those focused on Medicare Advantage and Part D.

Important: These are proposals, not final rules. CMS may modify or drop some of these items in the final rule.

Codifying the New Three-Phase Part D Benefit Design

The Inflation Reduction Act (IRA) dramatically redesigned Part D beginning in 2025; eliminating the donut hole, capping annual out-of-pocket drug costs, and restructuring how plans and manufacturers share costs. In this rule, CMS is formally codifying that redesign into regulation, locking in a three-phase structure: deductible > initial coverage > catastrophic, with the coverage gap removed and a firm annual out-of-pocket threshold after which the member pays $0 for covered Part D drugs.

What this means for agents

• The old four-stage “deductible / initial coverage / coverage gap / catastrophic” story is officially becoming history.
• Explaining Part D should get simpler: members will move from deductible > cost-sharing > $0 after hitting the annual cap.
• Expect plan designs and premium strategies to evolve as carriers fully adapt to the new structure

A New Simplified Determination Methodology for Creditable Coverage

For group plans and other coverage that want to be considered “creditable” compared to Part D, CMS is proposing an updated simplified determination methodology. Plan can either:

• run their own actuarial equivalence test, or
• use CMS’s simplified approach, which for 2027 requires at least a 73% actuarial value for drug coverage (up from 72% in 2026).

Why agents should care

• This primarily affects employer group coverage and retiree plans, but your clients may rely on those “creditable coverage” notices to avoid late enrollment penalties.
• The more clearly CMS defines the standard, the easier it is to help clients evaluate whether staying on employer coverage vs. enrolling in part D is the right move.

Clarifying SSBCI Rules Around Cannabis & Hemp Products

CMS is proposing to refine the prohibition on using Special Supplemental Benefits for the Chronically Ill (SSBCI) to cover cannabis products. The earlier rule banned “cannabis products” outright; the new language would clarify that federally legal hemp products (those meeting Farm Bill THC thresholds) are not swept into that ban, while marijuana and high-THC or synthetic cannabinoid products remain prohibited.

What this means in practice

• Plans still cannot use SSBCI to cover marijuana or higher-THC products that remain illegal under federal law.
• There’s a bit more clarity (and potential flexibility) around hemp-based products that meet federal standards, but plans will need to tread carefully and follow CMS guidance.

A Revised SEP for Provider Terminations

CMS is proposing to revamp the Special Enrollment Period (SEP) tied to provider terminations. The change would make it easier for members affected by losing an in-network provider (such as long-time PCP or specialist) would qualify for an SEP without CMS or the plan first determining that there’s a “significant” network change, and would require plans to clearly notify members about their SEP rights when providers leave the network.

Why this matters for agents

• When a key provider leaves a plan’s network, members may have a clearer path to change plans mid-year
• You’ll have more opportunities to help affected clients transition to a plan that maintains their provider relationships, if you’re monitoring those notices and educating your book of business.

Removing the Waiting Period Between Educational and Sales Events

Under current rules, there’s a required 12-hour delay between an educational event and a marketing/sales event being held in the same location. CMS now proposes to remove that time barrier, allowing plans and agents to conduct a marketing event right after an educational event at the same location, as long as beneficiaries are clearly informed and given a chance to leave before the sales portion begins.

What this could mean for your event

• You could host a “Learn the Basics” session followed by an optional “Plan Comparison & Enrollment Q&A” in one trip for attendees.
• Beneficiaries who are ready to engage more deeply won’t have to come back another day, making it easier to meet them where they are, while still honoring their choices to leave after an educational portion.

Eliminating the 48-Hour Waiting Period After a Scope of Appointment (SOA)

One of the biggest proposed changes for agents: CMS is proposing to eliminate the 48-hour waiting period between when a Scope of Appointment (SOA) is completed and when a personal marketing appointment can take place. Plans and agents/brokers would still need to obtain an SOA before discussing plan products, but no specific time gap would be required.

Impact on your day-to-day

• If finalized, you could meet with a beneficiary right after completing the SOA, rather than waiting two days.
• This reduces scheduling friction, especially for clients who have transportation challenges, limited availability, or who are already present at a community event or office visit

Allowing Agents to Collect SOAs at Educational Events

CMS also proposes to allow SOAs to be collected during educational events, reversing the more restrictive rule that had prohibited this. The educational event itself would still need to remain purely educational (no sales pitches), but beneficiaries who decide they want a follow-up appointment could complete the SOA right there.

Why this matters

• You can more seamlessly move interested attendees from “I’m learning” to “I’d like to talk about my options” without extra hoops.
• It respects the beneficiary’s initiative while still maintaining a clear separation between education and actual marketing discussions

Letting BRCs, Voicemails and Web Forms Count as SOAs

Another agent-friendly proposal – CMS would allow certain beneficiary-initiated contacts to serve as a valid Scope of Appointment, as long as the contact clearly indicates the type of product the beneficiary wants to discuss (for example, MA, MAPD, PDP). This could include Business Reply Cards (BRCs), voicemails, website forms, and other documented inbound leads.

Practical implications

• In many cases, you may no longer need a second step to obtain an SOA if your lead forms already capture the product type
• This reduces paperwork and re-contact friction, while still giving CMS and plans evidence that the beneficiary proactively requested information on specific products

Removing SHIP from the TPMO Disclaimer

Today’s TPMO disclaimer references State Health Insurance Assistance Programs (SHIPs) as an alternative counseling resource. CMS is proposing to remove SHIP references and instead point beneficiaries to Medicare.gov or 1-800-MEDICARE as the standardized, centrally monitored resource.

Why the change?

• CMS notes variability in SHIP operations and wants to direct beneficiaries to a consistently available, federally overseen resource.
• For TPMOs and brokers, this means updated disclaimer language on websites, call scripts, and marketing materials if the proposal is finalized.

New Timing Rules for the TPMO Disclaimer Calls

Currently, TPMOs must deliver the disclaimer within the first minute of a call. CMS is proposing to adjust that requirement so the disclaimer must be provided before any discussion of plan benefits, rather than being tied to the first 60 seconds.

Why agents will like this

• You’ll have a bit more flexibility to open the call naturally, verify identity, confirm why the person is calling, etc. before delivering the disclaimer.
• You still must provide the disclaimer before you start talking about benefits, but this change could reduce “gotcha” compliance issues tied to the timing of the first 60 seconds.

Revised Call Recording Retention Requirements

The proposed rule also includes a deregulatory change related to how long marketing and sales call recordings must be retained. CMS is proposing to revise and reduce the record retention requirements for these recordings to 6 years, which it estimates will save plans and TPMOs several million dollars in storage and compliance costs over time.

What this could mean for you

• If you’re a TPMO or agency that records calls, you may see shorter retention periods or clearer, more targeted requirements, depending on how the final rule is written.
• This doesn’t remove the need to record or retain calls, but it may lessen the operational and storage burden, especially for organizations handling large call volumes.

BONUS: CMS Wants Feedback on Who Really Counts as a TPMO

Finally, CMS is asking for industry feedback on one deceptively simply, but hugely important, question: who actually counts as a Third-Party Marketing Organization? In the Supplemental Request for Information, CMS floats the idea of modifying the current TPMO definition to better delineate the roles, size, scope, and requirements for different kinds of TPMOs.

CMS is clearly wrestling with how to hold “bad actors” accountable, including certain large lead aggregators and high-pressure marketing shops, without overburdening smaller, compliant agencies and partners. They specifically invite comments on segmenting TPMOs by role/size, aligning incentives for agents and brokers, and using data and technology (including AI) to monitor behavior and protect beneficiaries.

For agents and agencies, this is a signal that the TPMO conversation isn’t over. Even as some rules are being relaxed, CMS is actively exploring a more nuanced framework that would clarify responsibilities – and raise the stakes – for different plays in the marketing ecosystem.

Taken together, these proposals point to a few encouraging themes. Simpler Part D design and clearer coverage rules, more practical, real-world flexibility for marketing events and SOAs, refined compliance expectations for TPMOs, disclaimers, and call recording, and better protections and options for beneficiaries impacted by provider terminations.

As always, these changes are not final yet. CMS will review public comments before issuing a final rule, and carriers will then interpret and implement those requirements in their own policies and training. If and when these proposals are finalized, we’ll be ready to break down the final rules for agents, update training, checklists, and event strategies, and help you stay compliant while making more of the new flexibilities.

You can read all 465 pages and submit public comment on the Federal Register’s website. Comments are being accepted through 5 PM Eastern Time on January 26, 2026.