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Medicare commissions are not as straight forward as we want them to be. Many agents are confused when they receive their commission deposits. That is why reading Medicare Commission Payments Explained may help unravel the mystery. It is important to note: commission payments require a certain amount of attention to detail.  

CMS and commissions

Each year the maximum allowable commissions for Medicare Advantage and PDP sales is set by CMS. The amounts vary by state and can usually be found online once they are available. Unfortunately, there are many different situations that determine how much of that commission an agent receives for each sale.

For the last several years, CMS has consistently raised the commission rates. The renewal amount differs from the amount agents receive for an initial enrollment. Renewal commission amounts also change annually and add up to half the amount of the initial enrollment commission rate. The rates are decided by state and each state is put into a group. The state groupings are (CA and NJ), (CT, PA and DC), (Puerto Rico and US Virgin Islands) and all the other states are in the “National” bucket.  The highest pay goes to CA and NJ, followed by CT,PA and DC, then the national bracket.  Puerto Rico and Virgin Islands pay the lowest amounts.

Watch a recorded webinar to learn more about commission payments CLICK HERE TO VIEW.

Initial payment, true up and pro-rata

In 2025, the max commission for an MAPD sale in CT is $705 with renewals at $353 for the year.  That sounds easy enough, but it is not that simple.  The amount of commission an agent receives depends on the situation.  We provide a breakdown below:

Medicare Advantage commission payments – new to Medicare 

If your client is new to Medicare, the carrier pays the full commission in two payments:  the intial payment, then the true up payment.  The two will total up to the full amount.  The renewal commission rate will be half of the full amount and pays over the course of 12 months starting in January. (Regardless of the effective date of the original sale).

New to Medicare Advantage but not new to Medicare 

If the client enrolls in a Medicare advantage plan for the first time, the commission is the same as a new to Medicare enrollment. The difference is how the carrier pays it out.  The commission is pro-rated.  In other words, the payment amount is based on the month the plan is effective.  So if someone is enrolled for a June 1 effective date, the agent receives 50% of the full commission. (They will be in the plan for 6 out of the 12 months.)  If the person is enrolled for a March 1 effective date, the agent receives 75% of the commission and so on. The renewal starts in January and the agent receives the full renewal amount.

Click here to find out what the 2025 commission rates are

Changing from one Medicare Advantage to another 

When your client changes from one MA/MAPD plan to another, the agent receives the same amount when they renew an MA/MAPD plan (half the new enrollment commission).  If you enrolled a PA client in an MAPD plan with a Jan 1 start date, the commission is $353. However, plan changes are also pro-rated and if you enroll a PA client in a plan with a March start date, you receive 75% of the $353. In other words, $264.75.

See what to do about non-commissionable PDP plans

Commission payments for AEP

The commission rules do not change during AEP although when agents receive their payment does.  Any clients agents enroll during AEP will not pay out until January. Insurance carriers are not permitted to pay them before then enrollment goes into effect. Therefore, most carriers pay out sometime during January.

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Because navigating Medicare enrollment period options can feel overwhelming, we will explain one specific enrollment opportunity. For beneficiaries seeking flexibility in healthcare coverage, Medicare supplements provide a good option. Because of this, the Medicare Supplement birthday rule is an important policy to understand. This rule, available in certain states, offers a window of opportunity to change Medicare Supplement (Medigap) plans without medical underwriting.

What Is the Medicare Supplement Birthday Rule

The Medicare Supplement birthday rule allows beneficiaries to switch Medigap plans annually around their birthday without undergoing medical underwriting. This means insurers cannot deny coverage or charge higher premiums based on health status during the designated timeframe.

Medicare supplement plans help cover out-of-pocket costs not paid by Original Medicare, such as copays, coinsurance, and deductibles. However, outside of the initial enrollment period, switching plans typically requires medical underwriting, which can be a barrier for those with pre-existing conditions. The birthday rule removes this obstacle during its specific enrollment window.

States That Have the Birthday Rule

As of now, the Medicare Supplement birthday rule is not a federal policy; it is enacted at the state level. Currently, 8 states including California, Idaho, Illinois, Kentucky, Louisiana, Maryland, Nevada and Oregon have implemented variations of this rule. Each state’s version differs slightly in terms of timing and eligible plans:

California

Beneficiaries have 60 days from the first day of their birth month to switch Medicare supplement plans to enroll in one with the same or a less benefits. They also have the option to switch insurance carriers during this period.

Idaho

Those who reside in ID have 63 days from their birthday to switch Medicare supplement plans with the either the same or less benefits. They can also switch to another insurance carrier if they like.

Illinois

Beneficiaries in IL have 45 days from their birthday to change Medicare supplement plans with either the same or less benefits. This rule only applies to plans with the existing insurance carrier or an affiliate of the current carrier. The affiliate carrier was added in 2024. In order to To qualify for the birthday rule in IL, beneficiaries must be between 65 and 75.

Kentucky

As of 1-1-24, KY allows Medicare supplement enrollees to switch to another supplement carrier that offers a plan with the same benefits as their current plan. They must switch within 60 days of their birthday.

Louisiana

In the state of LA, beneficiaries are given 63 days from their birthday to switch to another Medicare supplement plan with equal or lesser benefits. Enrollees are only permitted to enroll in a plan offered by either their current carrier or an affiliate of their current insurer.

Maryland 

As of July 1. 2023, beneficiaries have 30 days from their birthday to change Medicare supplement plans with either equal or less benefits than their current plan.

Nevada

In the sate of NV, the birthday rule allows beneficiaries 60 days form the first day of their birthday month to change supplement plans to one with the same or less benefits. It is also permitted to switch insurance carriers.

Oregon

Beneficiaries have 30 days from the first day of their birth month to switch Medicare supplement plans to another with the same or fewer benefits. They can also change insurance carriers.

Please note; beneficiaries and their agents must verify the state specific rules and timelines.

Watch a quick YouTube video on Medicare enrollment periods

How the Birthday Rule works

Each year plan enrollees should evaluate their current supplement coverage and decide if it still meets their needs. A licensed Medicare agent can help compare available plan options to find one that best suits the needs of the enrollee. They will also be able to advise of the applicable enrollment window using the appropriate birthday rule for each eligible state.

Beneficiaries must submit all applications before the enrollment period ends. Insurers cannot deny applications submitted during the birthday rule period. They are also prohibited from increasing premiums based on health conditions.

Benefits of the Birthday Rule

The birthday rule provides several advantages for beneficiaries. This includes the ability to adjust their coverage to better align with their healthcare needs and budget. It also allows enrollees an opportunity to change plans without fear of rejection.

Considerations for Beneficiaries

Although the birthday rule provides some significant benefits, there are a few important considerations:

State-Specific Rules: The availability and details of the birthday rule depend on where each beneficiary resides. It is not available in every state.

Plan Restrictions: In general, the rule applies only to plans that offer equal or lesser benefits, so beneficiaries cannot use it to upgrade coverage.

Timing: Those who miss the enrollment window must wait until next year’s birthday period to change plans.

Learn about Medigap guarantee issue rules; click here

The Medicare Supplement birthday rule is valuable for eligible beneficiaries. It provides an annual opportunity to change coverage without medical underwriting.

Why use a Medicare agent

If anyone asks why people use Medicare insurance agents, we have a few good reasons below.

To start; Medicare agents complete hours of training on both compliance regulations.  They also complete hours of study and testing on the Medicare products available in their area.  They must be well versed on the plans and provide detailed information to clients. A good agent can provide comparisons of several plans and help find the Medicare plan to best fit their needs.

learn the difference between Medicare Advantage and Medicare Supplements,

Compare plan choices

Because health insurance coverage is such an important decision, it is important for clients to understand all their choices. Choosing the wrong plan can be a very costly mistake.  For this as well as many other reasons, the help of a licensed Medicare agent is essential. A Medicare agent can go over the client’s list of wants/needs for coverage and find plan options that are right for them. Agents help clients weigh the benefit of each plan. Medicare plan benefits, rules, and exceptions may be overwhelming to sort out without a trained professional.

To find out about our quoting tools, Connecture and Sunfire, click here

Consider the client’s current coverage

It is important to consider the client’s current Medicare coverage and find out what about the plan works or does not work for them.  With this information in mind, it is easier to find help them decide whether they should stay in their current plan or if there are better options available to them.

Agents do not charge for their service

As a Medicare agent, you cannot take money from the client for the advice you provide.  This means clients receive expert advice at no cost.  This service is provided for free.  That is one deal you cannot beat!

Medicare agents receive payment through a couple different ways depending on the type of agent they are.  Agents who are employed by and insurance company receive payment based on their agreement with their employer.  Many other agents who are not captive with a carrier, receive payments through the commissions they earn.  They may receive this payment directly from the carrier or if they are LOA, they receive payment from their up-line.  Either way, the amount they make is based on their total number of sales made.

Please note: commission amounts vary based on the plan type and carrier as well as the level each individual agent is contracted at.

Find out about commission levels for 2025

How clients choose a Medicare agent

Here are some things clients may consider when they choose a Medicare agent.

1.  The first way clients choose an agent is usually word of mouth.  If you have done a great job helping their friends, relatives or co-workers, believe me they will hear about it.  People love to tell their friends about an agent who really did a good job for them.  That is why all your clients need to know that you are there to answer any questions or concerns they have.
2. Clients feel better knowing they are working with an experienced agent someone who understands the plan benefits and how they work.  Be sure you are up to date on all the plans in the areas you sell in as well as what the rules for enrollment are.
3. Offer many different carries and plan types for each area you sell in.  Clients want to work with an agent who has access to all the best plans in their area.  Each client is an individual and one plan type may not be the best choice for every client. Do not offer only Medicare Advantage plans as some clients are better off with a Supplement and PDP plan.

Click here for a scope of appointment

A knowledgeable and caring Medicare agent is a very valuable resource for the community. If you make sure you are well informed and truly enjoy helping those who need advice on Medicare coverage, you can become a successful agent with the right amount of time, effort & training.

The 3 primary out-of-pocket costs to consider when you compare Medicare plans are; copays. coinsurance & deductibles. Medicare copays, coinsurance and deductibles all contribute to annual coverage costs for plan enrollees each year. These terms all describe the money beneficiaries pay towards health care services and prescription drugs when they have health insurance. 

Copays

A copay is a fixed amount of money beneficiaries pay for a specific service. They generally apply to: primary care provider visits, specialist visits, prescription drug refills (depending on the tier of the drug), and hospital services. Copays let the beneficiary know what they pay for each provider’s visit up front. Copays apply to most prescription drug plans, Medicare Advantage plans and some Medicare Supplement plans. Please keep in mind, sometimes there are other costs associated with a visit to a provider’s office.

Coinsurance

When a beneficiary and their health plan share the cost of approved medical services, that is coinsurance. Coinsurance payment amounts are based on a percentage of the cost. Beneficiaries enrolled in Original Medicare, will have to pay 20% of the cost for most services after they meet the annual deductible. After the enrollee meets the deductible, Original Medicare covers 80% of all approved costs.

Usually members of Medicare Advantage plans pay co-pays for medical visits instead of coinsurance. Although in many cases, MA/MAPD plan enrollees pay 20% coinsurance for Part B drugs (in-network).

Up until 2025, stand alone PDP plan enrollees could end up paying 25% coinsurance for drugs if they fell into the donut hole (coverage gap). The coverage gap was removed for 2025, therefore stand alone PDP enrollees do not pay coinsurance.

Click here to learn about the Part D prescription payment program

Deductibles

Deductibles are the amount plan enrollees pay out of pocket for most health care services before their plan starts to cover medical costs. The deductible does not apply to preventative services. Medicare plans cover preventative services at not cost to enrollees.

Once the deductible is met, enrollees are still required to pay copays and/or coinsurance costs.

There are 2 different deductibles for Original Medicare Part A & Part B, however many Medicare supplement plans cover the Part A deductible. There only 2 plans that cover the Part B deductible (Plan F & Plan C) neither plan is available to anyone who turns 65 after 1/1/2020.

Most MA/MAPD plans have separate deductibles; one for medical costs and one prescriptions. That means enrollees must meet their medical deductible before the plan pays for specific covered services. It also means enrollees must pay the deductible for prescriptions before the plan covers the cost of the medication. MA/MAPD enrollees still pay copays and coinsurance after they meet the deductible. Please note; each plan is different and deductible amounts are specified in a plan’s summary if benefits.

Watch a quick YouTube video on the $2,000 drug cap

Copays, coinsurance, and deductibles

Copays, coinsurance & deductibles are all factors to consider when discussing Medicare options. All these things contribute to the total cost of each plan a beneficiary chooses.

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Medicare’s one to one consent rules have become increasingly more complex in recent years. Both the Centers for Medicare & Medicaid Services (CMS) and the Federal Communications Commission (FCC) have imposed rules to safeguard consumers.

One-to-One Consent

One-to-one consent refers to requirements that each individual must provide consent for specific interactions, particularly with regard to healthcare and telecommunication interactions.

At its core, “one-to-one consent” means each individual interaction requires separate and specific consent. This applies to businesses that gather, use, or share personal information, which includes sensitive data related to healthcare or communication preferences. For organizations subject to CMS and FCC rules, failure to obtain the correct form of consent can lead to penalties, litigation, or loss of trust with clients and consumers.

For CMS, consent standards often pertain to healthcare communications. CMS oversees programs like Medicare and Medicaid, its regulations ensure that beneficiaries’ personal health information is protected and that there is explicit consent before using or sharing it.

The FCC and consent

In general, the FCC regulations focus on telecommunications and includes phone calls, texts and email communications. The FCC requires individuals to give permission before a company can contact them for marketing purposes.

The FCC’s regulation on consent comes from the Telephone Consumer Protection Act (TCPA), is in place to prevent unsolicited robocalls, telemarketing, and other unwanted communications. The TCPA mandates that individuals must provide prior express consent before businesses or organizations contact them via certain channels, including:

Telemarketing calls require written consent if they’re automated or involve a pre-recorded message. For non-telemarketing calls, prior express consent is sufficient, but it must be clear and documented.

Text Messaging follows the same standards as calls; organizations need explicit consent to send promotional or transactional messages.

Learn how to manage your book of business

The TCPA incorporates the Do-Not-Call registry requirements and allows individuals to opt-out of telemarketing calls.

The TCPA allows consumers to revoke consent at any time. It must be easy for the consumer to opt out and honored immediately by the organization. Non-compliance can result in fines or lawsuits. The increased use of automated dialing systems makes it more important for businesses to ensure they follow the regulations closely.

The CMS and consent

Due to concerns about patient privacy and data security, CMS consent requirements are even more strict. In particular, the Health Insurance Portability and Accountability Act (HIPAA) plays a significant role in setting the privacy standards enforced by CMS. HIPAA requires protected health information (PHI) be treated with a high level of confidentiality, and patients give specific consent for each use or disclosure of their PHI.

Any provider, organization or individual under CMS jurisdiction must have documented consent for communications to share personal information with third parties, except under certain treatment or operational exceptions.

Anyone using digital communication (emails, texts, or calls) must obtain explicit consent to do so.

Individuals must have the right to withdraw (opt out) their consent to communications. CMS requires those who contact potential clients to clearly explain how to revoke consent, usually through a simple opt-out option or written request.

Additionally, CMS enforces the need for clear explanations regarding what individuals are consenting to. This ensures no information is hidden in fine print or hard-to-understand language.

How FCC and CMS regulations differ

FCC Regulations primarily focus on consumer privacy in communication channels for marketing or solicitation purposes. The purpose is to avoid unwelcome communications and provide consumers control over who can contact them. The new FCC rules go into effect as of January 27, 2025.

CMS Regulations focus more on healthcare privacy, ensuring that information remains private and that individuals are fully aware of and agree to any sharing of their data.

Impact on Businesses and Consumers

One-to-one consent regulations are essential for both protecting consumers and clarifying business obligations. This empowers Individuals to make informed decisions about their private data. For telecommunication, consumers benefit from reduced unsolicited marketing and better control over their contact preferences.

For businesses, these regulations require meticulous record-keeping, clear communication protocols, and potentially, investment in new technology to capture, document, and manage consent. Companies that fail to comply face financial penalties and potential legal action, but more importantly, they risk damaging their relationship with consumers.

How this effects agents

After October 1, 2024, agents who make outbound calls can only contact leads that need provide a CMS-compliant One-to-One consent.

Lead companies that supply inbound warm transfers must have written consent from the consumer. They can also get a real-time one-time verbal consent to transfer the call to another TPMO. Please note: the verbal consent must be recorded clearly state the TPMO’s name. A generic permission to transfer is not acceptable.

Learn how to choose the right type of lead

The CMS rule restricts sharing consumer information with affiliates or other entities without prior written consent from the consumer.

What about inbound calls

This rule does not apply to direct inbound calls.

Agents who use Medicare leads

Agents using Medicare leads must be sure their lead company has recorded written consent specifically in your name for the warm transfer.

Click here to watch a YouTube video for strategies to handle the 2025 AEP

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Many Medicare enrollees are wondering what the costs for Medicare Part B 2025 will be. Medicare Part B is a critical part of healthcare coverage for Medicare beneficiaries. It covers outpatient services, preventive care, doctor visits, and durable medical equipment. Knowing the expected premiums and deductible amounts can help beneficiaries plan their healthcare budgets effectively.

Medicare Part B Premiums in 2025

The Medicare Part B premium is the monthly amount that beneficiaries pay for medical coverage. In recent years, premium costs have steadily increased due to rising healthcare expenses, which include the cost of outpatient services and medical advancements.

For 2025, the CMS (Centers for Medicare and Medicaid Services) has projected an increase in the standard monthly premium for Medicare Part B to $185. This is up from $174.70 in 2024.

Please note; individuals who have an income over the specified threshold will pay an IRMAA and therefore the cost of their Part B coverage will be higher. For 2024, the high-income threshold was 103,000 for an individual and $206,000 for a couple. For 2025, it increases to $106,000 for an individual and $212,000 for couples.

Individuals who enroll in Part B coverage late may pay a penalty and therefore their monthly premiums are also higher.

Medicare Part B Deductible in 2025

In addition to the monthly premium, Medicare Part B enrollees must meet an annual deductible before Medicare starts covering most of the costs. For 2024, the Part B deductible was $240. For 2025 the deductible is predicted to be about $257.

Once the deductible is met, Medicare generally covers 80% of the Medicare approved costs leaving the beneficiary responsible for the remaining 20%. Factoring in the deductible as well as anticipated co-payments help with healthcare budgets.

Planning for Higher Costs

With the cost increases in 2025, there are a few ways beneficiaries can prepare:

Beneficiaries with a low income and limited assets may be able to apply for MSP. MSP may pay for Medicare Part B for those who qualify.

Those who are near the income threshold for IRMAA adjustments, consider strategies to manage your taxable income to potentially reduce your premium amount.

Consider a Medicare Advantage (Part C). These plans bundle Parts A and B and often Part D. They may also include additional benefits, like vision, dental, hearing and more. They sometimes offer lower out-of-pocket costs compared to traditional Medicare.

Look into a Medigap plan (Medicare Supplement). Medigap/supplemental policies help cover costs not paid by Medicare, such as co-pays and deductibles, which can help offset increases in Part B costs.

Navigating Medicare Costs

Medicare costs can be complicated, and even a small increase can have a significant impact on a fixed income. Resources like licensed Medicare agents and the State Health Insurance Assistance Program (SHIP) offer free advice for Medicare beneficiaries. This helps them understand their options and make the best possible choices.

Are you a licensed Medicare agent; join our team at Crowe – click here for online contract

Agents – Click here to watch a YouTube video of updates to Connecture and Sunfire for 2025

Knowing what to expect in terms of Medicare Part B costs helps enrollees make informed decisions about healthcare coverage.

Just like the other Medicare coverage options, there are specific rules for Medicare supplement changes. In general, beneficiaries enroll in a Medicare Supplement plan during their Medigap Open Enrollment Period.

Those who wish to apply for or change Medicare Supplement plans outside the Medigap OEP, may have to go through medical underwriting. However, there are some instances when beneficiaries qualify for a guaranteed issue right. This depends on which sate a beneficiary lives in.

Medigap open enrollment

The suggested time to enroll in a Medicare Supplement is during the Medigap OEP. This is a 6-month period that starts when the beneficiary enrolls in Medicare Part B and is at least 65 years of age. Those who enroll during this time do not have to go through medical underwriting. Underwriting is when an insurance carrier can deny coverage due to an underlying medical condition.

Keep in mind, the Medicare Supplement Open Enrollment is entirely different than the Medicare Open Enrollment that takes place annually from October 15th through December 7th.

During the Medicare AEP, beneficiaries can change or drop their Medicare Advantage (Part C) or PDP (Part D) plan. Be sure not to confuse this with the fall Medicare open enrollment period. This period runs from October 15 to December 7 every year. During fall open enrollment, you can enroll in, change, or drop your Medicare Part D prescription drug plan or your Medicare Advantage (Part C) plan. In many states, enrollees do not use this enrollment period to change Medicare Supplement plans.

Guaranteed issue rights

Those who miss their Medicare Supplement OEP may still qualify for guaranteed issue to enroll in or change their Medicare Supplement without underwriting. There are specific circumstances that offer enrollees guarantee issue rights. Review some circumstances that allow for GI rights below:

1. Enrollees who live in one of the four GI issue states (CT, NY, NH or MA).
2. Individuals who have Medicare A and B as well as employer coverage and are losing their employer plan.
3. Beneficiaries who enroll in a MA/MAPD or PACE program when they are first eligible and change their mind within the first year of coverage.
4. Those who have a MA/MAPD plan and are moving out of their plan’s service area.
5. The MA/MAPD plan the beneficiary enrolls in leaves the service area.
6. The Medicare Supplement provider ends coverage through no fault of the enrollee.
7. Enrollees who left a Medicare Supplement plan to try an MA/MAPD plan for the first time can re-enroll in a Medicare Supplement within the first year of trying a MA/MAPD plan.

Click here to learn more about GI rights for Medicare Supplement enrollment

What if you don’t qualify for a GI right

Those who do not qualify for a guaranteed issue right but still wish to change their Medicare Supplement plan may need to go through underwriting. If the beneficiary is healthy, most likely they will pass medical underwriting and receive approval for a new plan.

Beneficiaries with pre-existing conditions may be approved for a new plan although they may pay higher premiums. In some instances, the carrier may deny the beneficiary coverage.

Free look period

A free look period is a 30-day window that some Medicare Supplement enrollees can use to decide if they are happy with their new plan choice. This free look is available if a beneficiary changes from one Medicare Supplement to another.

What to remember when switching Supplements

When considering making a change in Medicare coverage, it is a good idea to get advice from a licensed Medicare agent. A licensed agent understands all your coverage options as well as your needs. They can sort out area plans and help guide you to making an informed decision.

Those who enroll in a new plan should not cancel their old plan until their new enrollment is confirmed. Beneficiaries may also want to pay for both plans for the first month in the event they decide not to keep the new plan.

Once the beneficiary is accepted into the new plan, they must cancel their current Medicare Supplement plan. If they do not, they will be charged for both plans. Those who are unsure about keeping the new plan can wait a month and pay for both to make sure they are happy with the new coverage.

Beneficiaries can request cancellations over the phone or in writing. Those who request the disenrollment over the phone should record a reference number for the call. It is also a good idea to make sure payment for the old plan does not continue.

Learn more about Medicare enrollment periods

More Rules for Medicare Supplement changes:

If a beneficiary moves to another state, they can remain in their current Medicare Supplement plan even if it is not offered in the new state. Although the new state may have its own Medicare Supplements that offer a better price point. A licensed Medicare agent can help find plan options in the new area.

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This year many agents are wondering what to do about lost PDP commissions. We are offering a few solutions to help supplement the loss of commissions. Please note there are still many opportunities to earn income in the field of Medicare sales.

The first thing you need to remember is that clients rely on your assistance to find the best plan options each year. Stay with us for a few suggestions to help raise your income.

Look at your client’s current PDP plan

Although your client’s current PDP plan may not be commissionable, it may still be the best option for them. Remember they have other plans with you, and you must make sure they know they can rely on your guidance. When clients see that you are willing to help them without a commission, it may lead to increased trust and a boost to your reputation. This can even lead to more client referrals in the long run.

Although we understand this will not pay your bills, if you do not want to provide assistance, someone else might. A smart agent knows, there are plenty of opportunities to assist clients with other commissionable products.

Watch a quick video on the prescription payment program

It is also important to know; some carriers are still paying commissions on PDP sales. Be sure you are contracted with a variety of carriers and plans in your service area. The best choice for the client may be a commissionable plan and, in that case, it’s a win for you both.

Click here to add carriers to your current Crowe contract or start a new contract request

Look at making a Medicare Supplement plan change

As you know, clients who are enrolled in a standalone PDP plan are usually enrolled in a Medicare Supplement plan. Many clients do not think about changing their Medicare Supplement coverage. The plan just renews each year and goes unnoticed.

In some instances, the Medicare Supplement plan carrier may have raised the plan cost over the year, and clients may not realize it. This provides an opportunity to find them a savings opportunity with the same coverage at a better rate from a competitive carrier. Keep in mind, some states may require underwriting to make a Medicare Supplement change. If you are lucky enough to be selling in a GI state, changing plans is as easy as writing an app.

A MAPD plan could be an option

Clients may want to give a Medicare Advantage plan a try. For some enrollees, this a great way to save money and still receive the protection of comprehensive medical coverage. MAPD plans are a very popular choice and can add to your bottom line. MAPD plans pay a generous commission rate for both new and renewal business.

Click here to learn about 2025 Medicare commissions

If you offer PDP plans, you already need to complete your AHIP, so there’s no reason not to add MAPD plans to your business.

Having a variety of product offerings help protect your income stream and gives clients a greater choice of coverage options.

Offer other needs-based products

Before you meet with each client, you should conduct a thorough needs-based assessment. This often leads to cross-selling opportunities. Clients may want to purchase insurance that fills a specific coverage gap. If you plan to discuss these coverage options, be sure your SOA includes ancillary products. In some cases, you may need to collect an additional SOA and make a subsequent appointment.

Ancillary products such as dental, vision, hospital indemnity, critical illness, cancer, heart attack and stroke or even long- and short-term care or life insurance are a few options. These products can provide necessary coverage for your clients and a supplement to your income as well. These products can more than make up for lost PDP commissions.

Learn more about why you should add ancillary products

For many agents, this year has been a bit frustrating and that is putting it mildly. The 2025 Medicare commissions have been the topic of many conversations. The commission amounts were up in the air for several months before the lawsuits that caused a federal judge to put a stay on a portion of the Medicare Final Rule that directly affects agent commission. As a result of the lawsuits, CMS issued some updates to 2025 Medicare Advantage and Part D broker commissions on July 18, 2024. The new amounts supersede those originally reported by CMS for 2025.

Medicare commission final update – YouTube Video

Important:

The additional administrative fee amounts of $100 for initial enrollments and $50 for renewals of both PDP and MA/MAPD Plans is no longer applicable. In other words, the additional money will not be added to commissions for 2025.

If the judge approves CMS Final rule at some point, the commission rates may increase by $100 for initial enrollments and $50 for renewals. This will be used as a one-time administrative fee to offset the loss of carrier marketing funds.

Although the increase we talked about in the previous paragraph will not be put in place, CMS has approved commission increases for both MA and PDP plan sales. This is due to a FMV (Fair Market Value) increase.

2025 Medicare Advantage commissions

Please keep in mind; the commission rates are not all the same and vary state to state.

In the states of CA and NJ, there will be an increase for initial commissions from $762 per member to $780 per member for 2025.  Renewal commissions for CA and NJ are going from $381 per member to $390 per member for 2025. 

For CT, DC and PA initial commissions will go from $689 per member for the first year to $705 per member.  Renewal commissions for CT, DC and PA will increase from $345 per member annually to $353 per member in 2025.

Puerto Rico as well as the U.S. Virgin Islands initial MA commissions will go from $418 per member annually to $428 per member for 2025.  The renewal commissions have increased from $209 a member for the year to $214 per member for the year.

For any state not listed above, initial MA commission amounts have increased from $611 per member annually to $626 per member for 2025. The commission rates for renewals have increased from $306 per member annually to $313 per member for 2025.

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PDP commissions for 2025:

In the case of PDP commissions, commission rates 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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There are a few different terms people use for supplemental Medicare insurance such as; Medigap, Medicare Supplement or Med Supp. Private insurance companies offer these health insurance policies to individuals who are eligible for Medicare coverage. In general, Medicare covers about 80 % of approved medical charges. Medicare supplement plans are designed to cover the 20% of approved medical charges not covered by Original Medicare. Essentially, Medicare supplement policies help reduce out-of-pocket costs. This ensures healthcare costs are predictable and manageable.

Why choose a Medicare Supplement

Although Original Medicare provides substantial coverage, it doesn’t cover everything. Here are some reasons to consider a Medicare Supplement:

Out-of-Pocket Costs: Original Medicare requires beneficiaries to pay for a percentage of their approved medical expenses. Because these can add up quickly, especially if you have frequent medical needs, a Medicare supplement pays these costs and saves enrollees money.

Find out more about Medicare costs

Foreign Travel: In general, Original Medicare doesn’t cover healthcare services outside the U.S.. Although some Medicare supplement plans provide coverage for emergency medical care during foreign travel.

Predictable Expenses: With a Medicare supplement plan, enrollees have predictable medical expenses, making it easier to manage their healthcare budget.

No Network Restrictions: Medicare supplement plans do not have network restrictions, this allows individuals to see any doctor or specialist that accepts Medicare.

Supplemental Medicare insurance plans

There are ten standard Medicare supplement plans, labeled A through N. Each plan provides a different level of coverage. The plan benefits of each plan letter are standardized, meaning Plan A from one insurance carrier offers the same benefits as Plan A from any other insurance carrier. These benefits are universal and don’t change by location. Although, plan availability varies by location. Insurance carriers do not offer all plans in every state.

Here is a basic over view of plan benefits:

• Plan A: This plan provides basic benefits, covers coinsurance and hospital costs (up to 365 additional days after Medicare benefit is used).
• Plan B: Benefits Include all the Plan A benefits plus it covers the Medicare Part A deductible.
• Plan C: Covers all of Plan B as well as skilled nursing facility care coinsurance and foreign travel emergency and also covers the Part B deductible.
• Plan D: This plan is similar to Plan C , although it does not cover the Part B deductible.
• Plan F: Provides comprehensive coverage, including the Part B deductible. Please note; this plan is no longer available to anyone who is eligible for Medicare after January 1, 2020.
• Plan G: These plans provide coverage very similar to Plan F although, they do not cover the Part B deductible.
• Plan K and L: Both these plans offer lower premiums but higher out-of-pocket costs, with coverage limits.
• Plan M and N: Plans provide a good cost-sharing option for specific benefits and lower plan premiums.

Click here to view a comparison chart of Medigap plans

Choosing the Right Plan

Selecting the right Medicare supplement plan requires careful consideration of both health needs and finances. Things to consider when choosing a plan. Please consider using the services of a licensed Medicare agent when making important health coverage decisions. This will ensure you have all the information you need to make an informed choice.

Assess Your Health Needs: Consider your current health status and any anticipated medical needs. If you require frequent medical services, a plan with more comprehensive coverage might be beneficial.

Budget Considerations: Evaluate your budget for monthly premiums versus out-of-pocket costs. Higher premiums generally mean lower out-of-pocket expenses.

Compare Plans: It is a good idea to use the services of a licensed Medicare agent when making important health coverage decisions. In most cases, they can access tools that can provide a comparison of the plans available in your area. This ensures you have all the information you need to make an informed choice.

Watch a YouTube video comparison of our quoting tools Sunfire vs Connecture

Check for Special Benefits: Some plans offer additional benefits, such as foreign travel emergency coverage or even a fitness benefit.

If you want to learn some of the differences between a Medicare Supplement and an Advantage plan, click here.

Enrollment Periods

The best time to buy a Medicare supplement policy is during your Open Enrollment Period, which starts the first month you have Medicare Part B and are 65 or older. During this period, you have a guaranteed issue right, meaning insurers cannot deny you coverage or charge higher premiums due to pre-existing conditions.

Always remember to meet with your agent each year to review your options and adjust your plan as your healthcare needs change.

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