What Is The Commission Rate for Medicare Advantage?
What is the commission rate for Medicare Advantage. And why does it matter to you? If you are a senior considering Medicare Advantage coverage you want someone recommending the best plan for you (not themselves). If you are an agent marketing MA plans, you want to earn as much money for your hard work. That’s why.
And here’s an important fact to know: Agents earn higher commissions for enrolling beneficiaries in Medicare Advantage plans. That’s compared to traditional Medicare with Medigap (Medicare Supplement).
For Seniors: When you decide to buy or sign up for a Medicare Advantage plan, someone is going to get paid. It could be an independent agent or broker. Or it could be someone picking up the phone in a call center. The payment comes from an insurance company or health plan. How much they get paid depends on several factors.
- Firstly, the maximum limits imposed by CMS.
- Secondly, what state you live in.
- Thirdly, are you new to the Medicare Advantage plan (new enrollee).
- Or, are you renewing your plan coverage.
- Finally, is some entity sharing in the compensation.
For Agents: We share the CMS permitted commission numbers. Commissions are important but only part of the support provided. But it’s a good place to start from.
Why Do Payments Come From Insurance Companies (Not Medicare)?
Medicare Advantage (MA), also known as Part C, is a type of health insurance plan. MA provides an alternative way for individuals to receive their Medicare benefits.
These plans are offered by private insurance companies. They are approved by Medicare (Centers for Medicare & Medicaid Services). Thus the insurers must adhere to specific regulations set forth by the federal government. Coverage is NOT Medicare provided.
The Centers for Medicare & Medicaid Services (CMS) pays private insurance companies. They get a fixed monthly amount for each beneficiary enrolled in their MA plan. This payment is intended to cover the expected costs of providing Medicare Parts A and B benefits. It also cover costs including commissions paid to agents or call centers.
The monthly payment amount is adjusted based on the health status of enrollees. The process is called risk adjustment. Beneficiaries with higher expected healthcare costs (e.g., those with chronic conditions) lead to higher payments to insurers.
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The 2025 Commission Rate for Medicare Advantage
Medicare Advantage commissions are broken out by state or region. They are higher for the first year you enroll in a plan (initial year). Commissions are lower when you renew participation in a Medicare Advantage plan.
- For All States EXCEPT Those Listed Below
Initial year Medicare Advantage commissions are $626/member/year (2025).
This is a 2.5% increase from $611/member/year (2024).
Renewal year(s) commissions are $313/member/year (2025).
An increase from $306/member/year (2024). - Connecticut, District of Columbia and Pennsylvania
Initial year Medicare Advantage commissions are $705/member/year (2025).
This is a 2.3% increase from $689/member/year (2024).
Renewal year(s) commissions are $353/member/year (2025).
An increase from $345/member/year (2024). - For California and New Jersey
Initial year Medicare Advantage commissions are $780/member/year (2025).
This is a 2.4% increase from $762/member/year (2024).
Renewal year(s) commissions are $390/member/year (2025).
An increase from $381/member/year (2024). - For Puerto Rico and the U.S. Virgin Islands
Initial year Medicare Advantage commissions are $428/member/year (2025).
This is a 2.4% increase from $418/member/year (2024).
Renewal year(s) commissions are $214/member/year (2025)..
An increase from $209/member/year (2024).
Why Does the Commission Rate for Medicare Advantage Matter To Seniors?
Commission rates directly affect the incentives of insurance agents who help seniors choose their Medicare coverage.
Agents earn higher commissions for enrolling beneficiaries in Medicare Advantage (MA) plans compared to traditional Medicare with Medigap or standalone Part D plans.
This financial incentive may lead agents to recommend MA plans. Yes, even when they may not be the best fit for a senior’s specific health needs. As a result, seniors might end up in plans that do not provide optimal care or access to necessary services.
What Are Medicare Advantage Call Centers?
The Medicare Advantage market has seen significant growth. Today some 30 million Americans are enrolled in MA plans according to the American Association for Medicare Supplement Insurance (2024). This growth has attracted numerous companies, including large insurance carriers and specialized brokers. Many use call centers to field calls from seniors.
Types of Medicare Advantage Call Centers: There are primarily two types of call centers involved in selling Medicare Advantage:
Captive Call Centers: These are typically affiliated with specific insurance companies and focus on selling their own products. They may employ agents who are trained specifically on those products.
Independent Call Centers: These centers often represent multiple carriers and provide a broader range of options to consumers. They may operate nationally or regionally. But they will usually have favorite MA plans. They may even get paid incentives to focus on select plans.
While there is no definitive count available, estimates suggest that hundreds of call centers across the United States engage in selling Medicare Advantage plans. This includes both large national firms and smaller regional operations.
What Are 4 Tips To Get The Best Medicare Advantage
Understand Your Healthcare Needs
Before selecting a Medicare Advantage plan, assess your healthcare needs. Consider factors such as your current health status, frequency of doctor visits, and any ongoing treatments or medications. This will help you identify what coverage options are most important for you.
Compare Plan Options
Use the Medicare Plan Finder tool to compare different Medicare Advantage plans available in your area. Look at the benefits offered, including additional services like dental, vision, and hearing care. Likewise make sure to check if the plans include prescription drug coverage (Part D).
Check Provider Networks
Ensure that your preferred doctors and hospitals are included in the plan’s network. Why? Because most Medicare Advantage plans have specific networks of providers, and going out-of-network can result in higher costs or no coverage at all.
Review Costs Thoroughly
Examine all potential costs associated with each plan, including monthly premiums, deductibles, copayments, and out-of-pocket maximums. Because some plans may have low premiums but high out-of-pocket costs when you need care.
Look for Medicare Star Ratings
The Centers for Medicare & Medicaid Services (CMS) assigns star ratings to Medicare Advantage plans based on quality and performance metrics. As a result, higher-rated plans generally indicate better member satisfaction and quality of care.
How About 4 More Tips To Get The Best Medicare Advantage
Consider Additional Benefits
Many Medicare Advantage plans offer extra benefits beyond what Original Medicare covers. These may include fitness programs and transportation services. Plus meal delivery after hospital stays, or wellness programs. Thus evaluate which additional benefits are valuable to you.
Investigate Prescription Drug Coverage
If you take medications regularly, ensure that the plan covers your prescriptions at an affordable cost. Besides checking the formulary (list of covered drugs) to see how much you’ll pay for your medications see if your local pharmacy is included.
Stay Informed About Enrollment Periods
Likewise, be aware of enrollment periods for Medicare Advantage plans—initial enrollment when you first become eligible and annual open enrollment from October 15 to December 7 each year when you can switch plans or make changes.
Seek Assistance if Needed
Finally if you’re feeling overwhelmed by choices or unsure about which plan is best for you, consider reaching out to a licensed insurance agent who specializes in Medicare.
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Commission Rate for Medicare Advantage – A Message To Agents
Selling Medicare Advantage plans can be a lucrative opportunity for agents. Especially given the growing number of seniors entering the Medicare system.
Working with an FMO (field marketing organization) can provide agents with access to multiple MA carriers and products. Plus valuable training and support. An FMO helps agents get contracted with various insurance companies, which is essential for selling different Medicare Advantage plans.
There are lots of them out there. Here are some questions to ask when selecting an FMO.
- What type of insurances do you specialize in?
- Do you offer any training?
- How do you communicate with agents?
- What is the initial commission structure?
- When I’m successful can my commission levels increase?
- Do you have a quote engine for Medicare plans? Is there a cost to use?
- Is there a Medicare lead program? Are there costs?
- What is your policy on releases?
- What is the background on the FMO and the FMO owners?
- What makes you different and better than other FMOs out there?
Medicare Insurance Information Statistics Resources
Firstly, access relevant Medicare insurance statistics and information using these links.
Secondly find the 2024 Medicare Supplement Price Index – PLAN G. See the lowest and highest premium rates for top-10 U.S. markets.
Thirdly we post PLAN N Price Index rates. Lowest and highest rates for top-10 U.S. cities.
Also available Medicare Supplement insurance statistics – what plans people turning age 65 choose.
Finally find best long-term care insurance costs – free insurance quotes.