Around the PIA Western Alliance States - Week of November 10th, 2025

Idaho — DOI Issues Orders to Medicare Advantage Insurers:

BULLETIN NO. 25-06
DATE: October 15, 2025
TO: Health Insurance Companies operating in Idaho
FROM: Dean L. Cameron, Director

SUBJECT: Unfair Trade practices in marketing insurance products to Idahoans eligible for

Medicare

1. Purpose

The purpose of this bulletin is to clarify the Idaho Department of Insurance’s (the Department) perspective on unfair trade practices that lead to manipulation of the insurance market and withholding or denying access to products from Medicare-eligible consumers, and the applicability of Idaho Code § 41-1321 to such practices.

2. Applicability

This bulletin applies to all carriers and producers who offer any health insurance plans to Idahoans eligible for Medicare, including Medicare Advantage and Medicare Supplement plans. It has been brought to the Department’s attention that some insurance carriers, including those offering Medicare Advantage plans have attempted to restrict access by either removing the enrollment application from their website, encouraging producers to avoid selling their products, or changing or discontinuing producer compensation.

The Department views these practices as an unfair trade practice or method of competition under Idaho Code § 41-1321, which prohibits any method of competition or act in the business of insurance that is unfair or deceptive, even if not specifically enumerated in statute. It is an inappropriate and unfair practice, with the potential for great harm to Idaho insurance consumers, for carriers to restrict access or dissuade consumers from buying a product that was filed to market in Idaho and priced accordingly. To maintain fair competition in these markets, carriers must:

• make available and easily accessible their applications for enrollment in all forms, including printed, on-line on their website, and through their appointed agents;
• not engage in convincing or suggesting their products not be sold, marketed or discouraging enrollment;
• not change compensation or commissions mid-year.
• provide compensation or commissions if the product they filed had built compensation into its rate development.

3. Compensation or commissions is not a buffer against a bad market or a method to bolster profits. Discontinuing commissions on any insurance products disincentivizes producers from marketing these products to those who need them. This practice is especially concerning when the carrier has appointed independent agents, has historically paid commissions for the same products, the rate development for the products included commissions, or the carrier did not provide advanced notice that the plans would be “zero commission only.”
4. Conclusion

All carriers and producers operating in Idaho that offer insurance products to people eligible for Medicare are to act in good faith. All products filed and approved for sale must be made similarly accessible and marketed without artificial barriers or disincentives. If such products were filed or developed with an expectation to pay commissions, they should compensate producers accordingly. Only those carriers who expressly filed plans with a clear statement that the plan would provide zero commission are permitted to avoid compensating an appointed agent. Carriers are strongly cautioned against any other artificial manipulations of the Idaho insurance market which would harm Idahoans eligible for Medicare. All producers have an ethical and legal duty to put the best interest of the consumer first and are to assist the consumer in finding and acquiring the plan that best suits the consumer. Considerations of prescription drug coverage, provider access, overall cost, and affordability should be the priority.

The Department will closely monitor compliance and may take enforcement action under Idaho Code § 41-1321 against any carrier engaging in practices that manipulate the market or harm consumers.

This Bulletin is not new law but is an agency interpretation of existing law, except as authorized by law or as incorporated into a contract. Requests for additional information or other inquiries regarding this Bulletin can be directed to Market Oversight Bureau

Chief Shannon Hohl at 208-334-4315 or shannon.hohl@doi.idaho.gov.

Washington — OIC Releases Proposed Rule (CR-102) to Implement SSB 5579 (Provider Contract Terminations, R 2025-10): OIC is releasing a proposed rule (CR-102) to implement SSB 5579 (R 2025-10). Substitute Senate Bill 5579 (codified at RCW 48.43.732) is a new law that regulates public statements by health insurers and health care providers regarding potential contract terminations.

The comment period on the proposed rule (CR-102) opened on November 5, 2025 at 12 a.m. Pacific Time and closes on December 10, 2025 at 11:59 p.m. Pacific Time. Please submit comments to rulescoordinator@oic.wa.gov.

OIC has scheduled a public hearing regarding this rule:

When: December 9, 2025 at 10:30 a.m. Pacific Time

Where: Virtual Meeting on Zoom | Register in advance — https://wa-oic.zoom.us/meeting/register/692a5UhYQaOhOLAZneZq9g?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=#/

For more information, including text of the proposed rule (CR-102), please visit OIC’s website for this rulemaking.

Washington — Consolidated health care proposed rule posted: We have released the proposed rule language on R 2025-12. This rulemaking updates existing rules to align with changes in state and federal laws. It clarifies rights and obligations for affected entities and Essential Health Benefit plan coverage requirements. We also intend to clarify reporting responsibilities for locally set ground ambulance rates.

The rule updates include, but are not limited to, Chapter 284-43 WAC Subchapter D Prior Authorization and Utilization Review, Chapter 284-43 WAC Subchapter H Health Plan Benefits, Chapter 284-43 Subchapter L Reproductive Health Care and Contraception, WAC 284-43-7010, and WAC 284-43B-029.

We scheduled a public hearing on the rule:

When: Dec. 9, 2025, at 2:00 p.m.

Where: virtually via Zoom, please register in advance — https://wa-oic.zoom.us/meeting/register/sF68GipkSr2alOMzrAZm1w?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=#/registration

Comments on the proposed rule language are due Dec. 10, 2025 at 11:59 p.m. Please send them to rulescoordinator@oic.wa.gov

For more information, including the proposed rule language (CR-102), please visit the rule's webpage.

Washington — Registering and identifying umpires in auto appraisals proposed rule posted: We have released the proposed rule language on R 2025-04, registering and identifying umpires in auto appraisals. The Legislature passed Engrossed Senate Bill 5721 relating to consumer protections for automobile insurance coverage. The new law requires the insurance commissioner to register competent and disinterested umpires who will be identified to auto appraisers if they are unable to agree on an umpire to resolve their loss dispute.

We scheduled a public hearing on the rule:

When: Dec. 9, 2025 at 11:00 a.m. Pacific Time

Where: Virtual via Zoom, please register in advance — https://wa-oic.zoom.us/meeting/register/JuQazzmuQ_2CJM0p_XupkQ?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=#/registration

Comments on the proposed rule language are due by Dec.10, 2025, at 11:59 p.m. Please send them to rulescoordinator@oic.wa.gov.

For more information, including the proposed rule language (CR-102), please visit the rule's webpage.

Washington — OIC Releases Proposed Rule (CR-102) on Health Care Benefit Managers (R 2025-11): OIC is releasing a proposed rule (CR-102) regarding health care benefit managers. The proposed rule addresses health care benefit manager and pharmacy benefit manager regulations, including implementation of Engrossed Second Substitute Senate Bill (E2SSB) 5213 (Chapter 242, Laws of 2024).

The comment period on the proposed rule (CR-102) opens on November 4, 2025 at 12 a.m. Pacific Time and closes on December 11, 2025 at 11:59 pm Pacific Time. Please submit comments to rulescoordinator@oic.wa.gov.

OIC has scheduled a public hearing regarding this rule:

When: December 10, 2025 at 10:00 a.m. Pacific Time

Where: Virtual Meeting on Zoom | Register in advance — https://wa-oic.zoom.us/meeting/register/gffOTJSiQTO-O9P2axpH_g?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=#/registration

For more information, including text of the proposed rule (CR-102), please visit OIC’s website for this rulemaking.