United Healthcare is cutting commissions for 15% of all MAPD

[Special Agent]

I am puzzled. Why would an agent write s 0 comisdion plan?

because according to my disclaimer i am licensed and appointed to sell 20 plans in my area. lol

 

[Medicare bro]

I am confused did I miss something did anyone say they are going to write 0 comp?

I had someone brand new to Medicare 4 months ago, I went over several plans and she chose an Aetna giveback plan. Went into Medicare app and.......not commissionable. I must have done a pretty big sigh because she asked what was wrong. I told her, and she said, then I don't want to do this plan let's pick something else. I said don't worry about it, this is right for you and I feel good about this.

 

[goillini52]

I am puzzled. Why would an agent write s 0 comisdion plan?

Mostly on PDP's.

I'm no longer writing PDP's, but I'll tell them which plan to take and help them call in and enroll over the phone. I'm not doing certs if they aren't paying me.

I'll only do it for Med Supp customers, or if they have something else with me. I don't want to leave the door open for another agent to write then a PDP.

 

[sshafran]

Here is the thing though, If they are not termed, and they are highly popular plans and they are advertising them Direct

and the comp plans have far lesser networks and not great benies

this is going to be a huge Issue

Over hear Medical Mutual went non comp its the best plan here, UHC is the next best and they are off the table now
Aetna not that great but they are off in some areas

Medi gold is not great and Humana is not accepted by a lot here anymore, and people are upset with that WellCare is junk what's left

In NY same thing UHC was the go to Cigna and Aetna was the fall back they are all off the table now

Yes, I still have quite a few OH customers and the MMofOH thing is frustrating.

The plan was basically head and shoulders better than most others. They got inundated with enrollees.

Ohio is tough right now - as in there are plans that you might want to sell but simply can't sell and continue to be profitable

 

[MedicareWAA]

I'm saying it is a big deal . In a nutshell the carriers saying we're not taking your commission on your book away yet in the other hand they terminate the plans on Dec 31 . There's few carriers to move them too . Once those carriers get flooded with business they go to zero commission in days . Medicare is no longer the renewal train of old . Your going to have to flip your book like crazy to keep your clients

You are too confident in your predictions given your limited industry experience - as a broker but also inside a large carrier.

You are also assuming these are permanent compensation changes. If history is any indication, these are not permanent. Carriers don't want membership in these plans at this time.

They will almost certainly make changes to the benefits for 2026 and they'll want more members. But they can't make benefit changes mid year. The only way to slow things down is to discourage people from marketing the plans to people, hence the MID YEAR comp changes (which are in no way unprecedented).

The same thing is happening with these carriers' captive agents. None of these carriers are actively trying to find new members to put into these plans - either externally or internally - because more members just pressures the P&L more.

Yes, carriers can term plans for 2026, but the reality is that CMS and market realities make it pretty hard to term plans with lots of members. I won't get into all of the details but it's just not a realistic option for most carriers, absent extenuating circumstances or another plan that'sdecently attractive.

Yes, carriers can always non-renew a contract, but that comes with two consequences. First, you can't get a new contract in that service area for three years and, second, playing these games too often will make it harder to get new contracts in other service areas. Plus, the comp is not the best in the first two years of a new contract because it doesn't have a star rating, and new contracts are risky. You don't know if or when you'll have a deep enough risk pool.

For what it's worth, here are my predictions in a hard to read market based on 30 years in this industry, half being as a health plan exec:

1. Benefits will again be reduced - especially ancillary stuff. CMS won't let a plan reduce core benefits by more than X in any given year. But the cap does not apply to many ancillary benefits like OTC cards and dental. Frankly, benefits got too generous and a return to rationality is probably good for this industry.

2. Carriers will dump their most problematic plans, with a focus on PPOs and ones with relatively few members. PPOs are especially tough because providers usually aren't sharing the downside risk with the plan, or they aren't sharing as much as with HMOs.

Also, large call centers love PPOs, and they tend to write shit business that churns and complains and is resistant to care management. Walking away from those big brokers isn't realistic, but you can trim the portfolio they sell.

3. Some markets will continue to be relatively stable. There are lots of places where medical groups are pretty good at managing risk, and they're on full risk contracts. The plan is basically just the TPA.

4. Brokers aren't going anywhere, and despite what you might think, there is NO national carrier with a DTC machine sophisticated enough to let them completely walk away from third party distributors. Humana? No. United? No. Aetna and WellCare and Anthem? Hell no.

They might cut commissions but, if money were to be cut, I'd expect it to come out of overrides and especially soft money. You don't need to crush street agent comp to save a ton of money. There are plenty of places to cut, and overrrides in particular have gotten out of hand over the last five years. They've peaked and it would be good to see them reset back to normal.

5. The standalone Part D market will continue to be a mess. If you don't have an enormous Part D book of business, there are not many good reasons to stay in that market. Part D was designed to limit upside and downside risk, meaning plans never get rich from Part D and it's hard to completely lose your shirt, too. (No, the IRA didn't blow up the drug plan market. It was a headwind that everyone expected … but carriers weren't sure exactly how other carriers would act. See comment about risk corridors, which help but aren't perfect. You'll still lose enough money to matter if you see extreme anti-selection, but you're not going bankrupt because of it.

I think we will see fewer Part D plans, and more plans will have a standard benefit design. Formularies will be adjusted. If commissions are cut, carriers will do it to drug plans. They're still limited in how much they can degrade benefits. So if they want to stay in that market, and assuming they're struggling with profit, they'll cut admin expenses in this category (because there's a lot less money in play). Even more than before, having a Part D presence is mostly for strategic reasons, including to support their supplement line. The more their supplement line is pressured, the more you need Part D to spin out a profit, assuming you're in both markets.

Wildcard: MAPD provider networks. If a market sees massive disruption, the disruption is probably coming from changes to provider choices.

Agents would be well served to quit freaking out about carriers dis-intermediating them. Spend your time preparing for having to waste an AEP and OEP moving clients or defending your book, with all those moves bringing you no incremental profit. That's the real risk to your business, and it's hard to manage unless you prepared for it.

 

[MedicareWAA]

because according to my disclaimer i am licensed and appointed to sell 20 plans in my area. lol

Because sometimes a sale is a loss leader. You need to protect a supplement, you need an opening to market a high commission ancillary product, you want to keep another client satisfied (maybe they sent the person to you), you want to preempt a competitor or a carrier from creating a 1:1 relationship with your client, etc.

We don't have to make money on everything we do. Play the long game and focus on how all of this comes together in the end.

 

[DonP]

You are too confident in your predictions given your limited industry experience - as a broker but also inside a large carrier.

You are also assuming these are permanent compensation changes. If history is any indication, these are not permanent. Carriers don't want membership in these plans at this time.

They will almost certainly make changes to the benefits for 2026 and they'll want more members. But they can't make benefit changes mid year. The only way to slow things down is to discourage people from marketing the plans to people, hence the MID YEAR comp changes (which are in no way unprecedented).

The same thing is happening with these carriers' captive agents. None of these carriers are actively trying to find new members to put into these plans - either externally or internally - because more members just pressures the P&L more.

Yes, carriers can term plans for 2026, but the reality is that CMS and market realities make it pretty hard to term plans with lots of members. I won't get into all of the details but it's just not a realistic option for most carriers, absent extenuating circumstances or another plan that'sdecently attractive.

Yes, carriers can always non-renew a contract, but that comes with two consequences. First, you can't get a new contract in that service area for three years and, second, playing these games too often will make it harder to get new contracts in other service areas. Plus, the comp is not the best in the first two years of a new contract because it doesn't have a star rating, and new contracts are risky. You don't know if or when you'll have a deep enough risk pool.

For what it's worth, here are my predictions in a hard to read market based on 30 years in this industry, half being as a health plan exec:

1. Benefits will again be reduced - especially ancillary stuff. CMS won't let a plan reduce core benefits by more than X in any given year. But the cap does not apply to many ancillary benefits like OTC cards and dental. Frankly, benefits got too generous and a return to rationality is probably good for this industry.

2. Carriers will dump their most problematic plans, with a focus on PPOs and ones with relatively few members. PPOs are especially tough because providers usually aren't sharing the downside risk with the plan, or they aren't sharing as much as with HMOs.

Also, large call centers love PPOs, and they tend to write shit business that churns and complains and is resistant to care management. Walking away from those big brokers isn't realistic, but you can trim the portfolio they sell.

3. Some markets will continue to be relatively stable. There are lots of places where medical groups are pretty good at managing risk, and they're on full risk contracts. The plan is basically just the TPA.

4. Brokers aren't going anywhere, and despite what you might think, there is NO national carrier with a DTC machine sophisticated enough to let them completely walk away from third party distributors. Humana? No. United? No. Aetna and WellCare and Anthem? Hell no.

They might cut commissions but, if money were to be cut, I'd expect it to come out of overrides and especially soft money. You don't need to crush street agent comp to save a ton of money. There are plenty of places to cut, and overrrides in particular have gotten out of hand over the last five years. They've peaked and it would be good to see them reset back to normal.

5. The standalone Part D market will continue to be a mess. If you don't have an enormous Part D book of business, there are not many good reasons to stay in that market. Part D was designed to limit upside and downside risk, meaning plans never get rich from Part D and it's hard to completely lose your shirt, too. (No, the IRA didn't blow up the drug plan market. It was a headwind that everyone expected … but carriers weren't sure exactly how other carriers would act. See comment about risk corridors, which help but aren't perfect. You'll still lose enough money to matter if you see extreme anti-selection, but you're not going bankrupt because of it.

I think we will see fewer Part D plans, and more plans will have a standard benefit design. Formularies will be adjusted. If commissions are cut, carriers will do it to drug plans. They're still limited in how much they can degrade benefits. So if they want to stay in that market, and assuming they're struggling with profit, they'll cut admin expenses in this category (because there's a lot less money in play). Even more than before, having a Part D presence is mostly for strategic reasons, including to support their supplement line. The more their supplement line is pressured, the more you need Part D to spin out a profit, assuming you're in both markets.

Wildcard: MAPD provider networks. If a market sees massive disruption, the disruption is probably coming from changes to provider choices.

Agents would be well served to quit freaking out about carriers dis-intermediating them. Spend your time preparing for having to waste an AEP and OEP moving clients or defending your book, with all those moves bringing you no incremental profit. That's the real risk to your business, and it's hard to manage unless you prepared for it.

So are you saying that all these United plans going non commissionable 7/1 many will not be termed 12/31?Your saying most of these plans will be available in 2026 but have reduced benefits ?

 

[Newby]

I am puzzled. Why would an agent write s 0 comisdion plan?

Have you never read this forum? Hundreds of agents have said through the years they only want to help people and don't care about the money.

Now they can show everyone that they weren't just full of BS. They really meant it.

 

[axeman462]

So are you saying that all these United plans going non commissionable 7/1 many will not be termed 12/31?Your saying most of these plans will be available in 2026 but have reduced benefits ?

@MedicareWAA is being too nice. Let me translate for him: You're an id!ot.

 

[MedicareWAA]

So are you saying that all these United plans going non commissionable 7/1 many will not be termed 12/31?Your saying most of these plans will be available in 2026 but have reduced benefits ?

Some will be termed. Some will not. Don't confuse making a plan non-commissionable for six months with a plan being terminally ill. Sometimes that's true, many times it'll stick around but look different in the new year. And sometimes the carrier is just waiting for the market to rebalance so the anti-selection improves.

I don't know enough details about every one of these plans and the markets where they operate.

What I DO know is that the sky is not falling, insurance agents aren't going away, MA will remain lucrative for carriers (which is true today, also), and everything is gonna be alright with time. Breathe.