California not paying 'MAPD commission' --- is this a national trend?

[sman]

I'm on several aca facebook groups . Aca looks cooked for agents and a certain degree consumers . The coming rules will make it difficult . If even commissions all drop to $10 a person a month I'd never write an aca plan . Everybody for 10 yrs are longer has been warned . When you deal with gov't subsidized products anything can happen . Nobody knows what happens but it definitely looks like big changes coming to plans and compensation.

You do realize there was a time when ACA carriers paid $10 per month on enrollments, right?

 

[sman]

When reimbursements get lowered from Fed carriers will lower comps to agents. They are first on chopping block not seniors.

Guaranteed. Already happening see OP

Party is over TBA

CMS recently announced a 5.06% increase in funding for MAPD/PDP for 2026.

 

[DonP]

CMS recently announced a 5.06% increase in funding for MAPD/PDP for 2026.

lol That 5.06% will be clawed back and more on 10's of billions cms will clawback on bogus upcoding from the last 8 plus yrs . In reality with inflation mapd carriers will be hurting again in 2026 .The real unknown is how many plans and areas does United term? The avg agent is by far the most exposed to united and this could shape aep for many brokers

 

[DonP]

You do realize there was a time when ACA carriers paid $10 per month on enrollments, right?

Yes back in 2014-2019. I only started selling aca in 2020 and the commissions have been mostly $20-$30 a person since then . Honestly i never solicit aca and only sell when referrals call me.I'll say this. The amount of customer calls i get from aca is 1/10th that of mapd . Clients are younger and don't use services as much . It almost feels like a stress free annuity I've made over the past 5 yrs .

 

[m87482]

CMS recently announced a 5.06% increase in funding for MAPD/PDP for 2026.

If DOGE looks under the Medicare Advantage hood this party is over

Agent commission would be on chopping block then the product not the reverse.

 

[Special Agent]

The loudest and most confident person in the room is usually the clown …

DJT be thy name

If DOGE looks under the Medicare Advantage hood this party is over

Agent commission would be on chopping block then the product not the reverse.

If DOGE was invited to one of trumps Crypto parties they would meet their quota the same day.... just kidding DOGE IS the fraud!

 

[renee15]

The codes go along with the members, but no one is as aggressive as United when it comes to coding.

Even if a T65 is healthy, they're 65 years old. They're one visit away from being diagnosed with something expensive, and it'll be a year until that risk score produces incremental revenue … assuming the provider codes it. They're also one trip away from a fall, etc.

Carriers might get $8,000 a year on a T65 - they have a fairly low default risk score. Add a chronic disease like heart disease or diabetes or depression and you're looking at more like $15,000.

Just because you think all the sick people chose Medigap doesn't mean it's true. The ones with high incomes might gravitate there, but more than half of all T65 choose MA. Plenty of them are sick … they just can't afford $200/month for a supplement and a drug plan and dental.

Lower income people, as a group, are always more medically complex than wealthier people. And tons of people with Medicare are low income but not "poor" enough for Medicaid or LIS.

Sick people are lucrative for MA carriers as long as the sickness is manageable and it can be coded well. But you can't code your way out of metastatic cancer.

anyone with health issues turning 65 should get a med sup

 

[wehotex]

The word is, Aetna, Anthem, Humana and United are not paying agents a commission for MAPD (in some CA counties).

• What's the reasoning behind this... are they getting to many customers to their pool?
• Makes no sense... won't agents just find another MAPD plan to sell?

Anyone know why they are doing this?

Thanks!

It is just eliminating the counties and products that are not profitable. This could be due to high utilization, expensive IPA/hospital contracts in those counties and lower Medicare capitation rates.

 

[jdeasy]

Companies have always controlled the business with commission adjustments. Or tried to.

I wrote MA plans when they were first available.

In this area then Pyramid Today's Options was the bomb.

But there were areas they didn't want to be in. So in some counties they cut commissions by 50% and 75% in others.

 

[renee15]

Everyone who keeps saying this obviously isn't aware that employees are more expensive than contractors, and carry more liability.

Paying an employee $100k salary is much more expensive than paying a broker a $100k in commission