If a member disenrolls from one plan and enrolls in another, what does CMS determine?

The correct answer pertains to how CMS (Centers for Medicare & Medicaid Services) evaluates the compensation structure when a member transitions from one plan to another. When a member disenrolls from one plan and enrolls in a new one, it impacts how commissions and compensation are handled. CMS has specific regulations in place regarding the types of compensation that can be offered for new enrollments, especially to ensure compliance with federal guidelines.

This transition is a critical point where CMS assesses the new enrollment to ensure that it aligns with the federal standards for compensation. Factors like these are crucial for agents and brokers as they navigate all compliant practices during the enrollment process and understand how their compensation may vary depending on the plan and member actions.

In contrast, considerations like eligibility for bonuses, commission structures unrelated to new enrollments, or outright approval of plans typically fall outside the immediate scope of CMS evaluations when a member switches plans. These elements are governed by the internal policies of the plans and the structural agreements agents have with their respective carriers.