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This year has been very confusing to say the least; as far as Medicare commisions 2025 go. As a result of recent lawsuits regarding the 2025 Medicare Final Rule, CMS issued updates to 2025 Medicare Advantage and Part D broker commissions on July 18, 2024. The newest amounts supersede those originally reported by CMS for CY 2025.

What you need to know

Please note; additional amounts previously stated have been removed. The one-time administrative increases of $100 to initial enrollments and $50 to renewals no longer apply.

This means, the additional money will not be added into the commission amounts anytime in the near future. If the judge approves CMS Final rule at some point in 2025, the commission rates will increase by $100 for initial enrollments and $50 for renewals.

Even without the increases listed above, CMS has increased commissions for both MA and PDP plans. This is due to an increase in the Fair Market Value (FMV). The maximum broker compensation below reflects the increase.

Maximum commissions 2025

It is important to note: commission rates vary by state.

In both CA and NJ, initial commission rates have increased from $762 per member for 2025 to $780 per member for the year.  The renewal commissions for CA and NJ have gone up from $381 per member for the year to $390 per member for the year. 

The states of CT, DC and PA have had an increase in initial MA commissions from $689 per member for the first year to $705 per member for the first year.  Renewal commissions for CT, DC and PA have increased from $345 per member per year to $353 per member per year.

Both Puerto Rico and the U.S. Virgin Islands initial MA commissions have gone up from $418 per member for the year to $428 per member for the year.  The renewal commissions have increased from $209 a member for the year to $214 per member for the year.

In all states not listed above, the initial MA commission amounts have increased from $611 per member per year to $626 per member per year. Renewal commissions have increased from $306 per member for the year to $313 per member for the year.

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Maximum commissions for PDP plans 2024:

The commission rates for PDP plans are the same in all states.

Initial commission rates for PDP plans have risen from $100 per member per year to $109 per member per year.  Commissions for PDP plan renewals have also increased from $50 per member each year to $55 per member each year.

Medicare Advantage Commissions 2025

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When it comes to Medicare, most people have an understanding of the traditional options like Original Medicare and Medicare Advantage plans. However, individuals with certain chronic conditions, may want a specialized Medicare Advantage plan called a what is a Chronic Secial needs plan, or C-SNP. In this post, we answer the questions; what are Medicare C-SNP plans, who is eligible to enroll in them, and what they provide.an medicare

What Are Medicare C-SNP Plans

Medicare C-SNPs are a type of Medicare Advantage plan that serves individuals with specific chronic health conditions. Unlike typical Medicare Advantage plans, C-SNPs provide tailored coverage and care coordination to address the unique needs of individuals with specific health conditions. Just like regular Medicare Advantage plans, these plans are offered by private insurance companies and include all the benefits of Original Medicare. In addition, they cover the necessary services to managing chronic conditions.

Who Qualifies for a C-SNP

To enroll in a Medicare C-SNP, you must meet specific eligibility criteria:

Chronic Condition Diagnosis

You must have one or more chronic conditions that the C-SNP is designed to manage. Common conditions that C-SNPs cover include diabetes, chronic heart failure, cardiovascular disorders, chronic lung disorders (like COPD), and end-stage renal disease (ESRD).

Medicare Eligibility

You must be eligible for Medicare Part A and enrolled in Part B.

Living in the Service Area

Enrollees must reside in the service area of the C-SNP plan in order to join. Not all plans are available in every location.

Key Features of Medicare C-SNP Plans

Targeted Care Coordination

One of the primary benefits of C-SNPs is the focused care coordination tailored to the chronic condition. These plans offer a network of healthcare providers who specialize in managing specific illnesses. Additionally, C-SNPs may offer case managers who help navigate healthcare needs, ensure enrollees follow treatment plans, and connect with resources and support.

Customized Benefits

C-SNPs may offer additional benefits beyond what is covered by Original Medicare. These could include: specialized treatment plans, rides to appointments, a care coordinato, nutrition plans and much more.

Specialized drug formularies

C-SNPs often include a list of covered prescription drugs specifically tailored to manage your chronic condition.

Access to specialists

Enrollees have access to specialists and healthcare providers who have expertise in treating a specific condition.

Wellness programs

In some cases, these plans offer services designed to help manage the condition, such as nutrition counseling, exercise programs, or disease management education.

Lower Out-of-Pocket Costs

Because C-SNPs manage chronic conditions more effectively, they may offer lower out-of-pocket costs for common services and medications associated with treatments. This can be a significant financial benefit for those managing costly, ongoing medical care.

Why choose a Medicare C-SNP Plan

Personalized Care: The primary advantage of a C-SNP is the personalized care that aligns with your specific health needs. This targeted approach ensures that treatment is optimized for your condition and can lead to better health outcomes.

Comprehensive Coverage: C-SNPs provide all the benefits of Original Medicare and often include Part D prescription drug coverage, along with additional services tailored to your condition.

C-SNPs emphasize care coordination. This ensurs that all aspects of your healthcare are managed effectively. This can reduce the likelihood of hospitalizations and improve your overall quality of life.

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what to consider before choosing a C-SNP

While C-SNPs offer significant advantages for those with chronic conditions, there are some considerations to keep in mind:

Network Restrictions: Like other Medicare Advantage plans, C-SNPs typically require you to use a network of providers. Ensure that your preferred doctors and specialists are within the plan’s network.

Plan Availability: Not all C-SNPs are available in every area, and the specific chronic conditions covered can vary by plan. Be sure to check if a C-SNP that fits your needs is available in your region.

Eligibility Requirements: You must have a qualifying chronic condition to enroll in a C-SNP. If your health needs change, you may need to switch plans, which could affect coverage.

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How to Enroll in a Medicare C-SNP Plan

If you think a C-SNP might be the right choice for you, follow these steps:

1. Find a licensed Medicare agent to help show you plan options and explain differences in coverage. This will help you make a well-informed decision.
2. See what’s available in our area. Consider the specific chronic conditions covered, the provider network, and the additional benefits offered.
3. Look at the costs including; premiums, deductibles, and out-of-pocket costs associated with each plan.
4. Ensure you meet the eligibility criteria for the C-SNP, including the diagnosis of a qualifying chronic condition.
5. You can enroll in a C-SNP during your Initial Enrollment Period, the Annual Election Period (October 15 to December 7), or a Special Enrollment Period if you qualify.

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Medicare C-SNP plans offer a valuable option for individuals with chronic health conditions who need specialized care. By providing tailored coverage, enhanced care coordination, and access to specialized providers, C-SNPs help better manage some chronic conditions and improve overall quality of life.

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SEPs are important for both agents and beneficiaries to understand. Missing an SEP can cause a beneficiary to pay more for their medical care then necessary. We will discuss the disaster/emergency SEP requirements to make sure your plan is approved without delays.

It is important to note; disasters or emergency SEPs that are declared by a government entity are only applicable to beneficiaries who were unable to complete an enrollment during a valid election period that took place during the emergency or disaster. CMS has clear guidelines when beneficiaries can use this SEP.

How to qualify for this SEP

The beneficiary has to have missed a valid election period when the declared disaster or emergency occurred. They have to have been unable to make the desired plan change during the specified time period. SEPs for disasters or emergencies are only applicable to those who live in the affected area during the emergency.

CMS also states; beneficiaries who rely on the help of individuals who reside in an area where the disaster or emergency occurs for health care decisions, may also be eligible for the SEP

Some reasons for not using this SEP

This SEP is not valid in cases when the beneficiary has already used another valid election period during the time the SEP begins. This is the case when the disaster SEP occurs during another valid election period. For instance, if the disaster SEP begins at some point during the AEP and the beneficiary uses the AEP election period, they are not eligible to use the SEP. This is because they have already used an election period. Thye are now ineligible to switch plans again.

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How long does the SEP last 

SEPs last for either at least 2 months after the end of the emergency or disaster or when the end of the incident is stated, the rules follow whatever date is later.

Here’s an example:

On August 8th through August 15th there is a wildfire that causes FEMA to declare a disaster/emergency in two counties. FEMA declares the SEP on August 20th; this means the start of the SEP is August 8th. This SEP would end two full months after the SEP is announced on August 20th. In other words, the end of the SEP would be October 20th because this is the later date.

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Managing healthcare online is not only easy but in some cases, a necessity. In this post we answer the question: why create an online Medicare account. We discuss some of the ways this makes accessing information easier.

The online Medicare account is tailored to each individual and provides personal information about benefits and coverage. This ensures beneficiaries receive updates and reminders in a timely manner.

Create an Online Medicare Account

It is not difficult to set up an online Medicare account.

1. Go to the Medicare website; Medicare.gov
2. Scroll down until you see the linbk to log in or create an account.
3. Once you are in there, follow the prompts and enter your personal information. such as (Medicare number & birthdate).
4. Once the account is set up, you can access all the tools and inforamtion you need.

Why create an online Medicare account:

Save current prescriptions and pharmacies to help keep track of your medications as well as easily compare health and drug plans in your service area.

Click here to watch a YouTube video on the new prescription payment program

1. Enroll in digital information. This provides a quick and easy way to access materials without waiting for the mail to arrive.
2. The site uses encryption and other security measures to ensure the safety of personal data. This proivides peace of mind to Medicare beneficiaries.
3. In the event you can’t find your Medicare card, you can use this site to print out a copy of your card.
4. Access all your Medicare information in minutes.

Fast and Easy

An online Medicare account provides easy access to important information. It also allows Medicare beneficiaries a way to manage health information from home anytime they like. They can check coverage, review claims, or update personal information with just a few clicks. There is no need to waste time on hold or fill out paperwork. All the Medicare information is accessible whenever it’s needed.

Medicare Coverage

The online account provides an up-to-date look at Medicare benefits. Beneficiaries can find out what their plan covers and keep track of deductible payments. It is easy to check on recent cliams without waiting for mail to arrive.

Claims and Payments

Online Medicare accounts are an easy way to track claims and payments. In addition, this can help beneficiaries spot discrepancies or billing errors. Finding mistakes early is a great way to correct them quickly and avoid delays in payments and aggrevation.

Replace a lost Medicare card

Losing your Medicare card can be stressful, but with an online account, requesting a replacement is simple and straightforward. You can order a new card online and have it sent to you without the hassle of phone calls or office visits.

Tools and Resources

Medicare’s online portal provides many tools and resources to help beneficiaries make informed decisions about healthcare. By entering an updated list of medications, beneficiaries can compare drug prices. They can view Medicare plan information or estimate out-of-pocket costs for specific services. These tools help beneficiaries understand what’s available and lets them look at plans that best suit their needs.

Please note: It is always a good idea to enlist the help of a licensed insurance agent to discuss coverage need and sort out all the options.

Paperless

When an individual sets up an online Medicare account, they can choose to recieve paperless communications. In other words, they can avoid some of the paper mail cluttering their counter tops. This provides a way to view important documents in a timely manor and eliminates the need to file them and search for them later.

Additionally; an online Medicare account is useful for Medicare beneficiaries. It is an easy and secure way to access important health coverage information.

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CMS will begin their Medicare drug price negotiations 2026 with 10 popular high cost prescription medications. CMS has announced the first 10 drugs that will be subject to price negotiations.  The negotiations are part of the Inflation Reduction Act.  Until recently, Medicare was able to negotiate prices for the medical care beneficiaries receive; this did not include the costs of medications.  As of January 1, 2026, this will change and the negotiated drug prices begin to go into effect.

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Medicare will negotiate the cost for some of the more expensive prescrption medications with drugmakers. Please note; the negotiations do no tapply to drugs that have a generic equivalent.

The first 10 medications CMS will negotiate are:

1. Eliquis (a blood thinner)
2. Enbrel (for rheumatoid arthritis)
3. Entresto (for heart failure)
4. Farxiga (for diabetes, heart failure & chronic kidney disease)
5. Fiasp & Novalog (for diabetes)
6. Imbruvica (for blood cancers)
7. Januvia (for diabetes)
8. Jardiance (for diabetes)
9. Stelara (for psoriasis & Chron’s disease)
10. Xarelto (a blood thinner)

As per CMS, the 10 drugs listed above make up about 20% of the Medicare Part D spending from June 2022 through the end of May 2023.  Medicare Part D covers prescriptions beneficiaries take at home.  Part D does not cover medications administered by medical providers in medical facilities. When this is the case, Medicare Part B covers the necesary drugs. This applies to treatment of cancer or other health conditions. 

Take a look at the drug price negotiation fact sheet 

Medicare beneficiaries spend billions on prescription drugs

Due to the incredibly high cost of some essential medications, some beneficiaries have to either forgo basic needs or the drugs that maintain their quality of life. 

CMS has also put a prescrption payment program in pace to help spread out the cost of prescriptions for beneficiaries.

Learn about the Medicare prescription payment program.

The first 10 drugs are just the start

This list of 10 drugs is only the beginning of the price negotiations.  In 2027, Medicare plans to add 15 more drugs and more in the following years.  As long as the rug manufacturers continue to be unsuccessful in their attempts to stop price negtiations, the list will continue to expand each year.

Drug manufacturers

If the drug companies do not agree to the negotiations, they face possible tax penalties.  Drug manufacturers can avoid the tax penalty if they remove their drug from the Medicare market.  However, if they do that, they will take lifesaving drugs from Medicare beneficiaries as well as lose a large part of their market share.

Some large drug companies are seeking legal counsel to stop the drug price negotiations.  They argue that the loss in income will affect their ability to fund necessary research and development and that in turn will reduce their ability to produce new medical treatments.

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