September 2025 – Medicare Business Update

A couple years ago, some of the zero premium Prescription Drug Plans went $0 commission. PDP’s don’t pay much commission so this wasn’t a big deal. Some did start paying renewals the following year, and that was nice.

Last year, a small number of overly populated plans went $0 commission. This was to discourage enrollment in plans that were already “full” for lack of a better word. How a plan becomes “full” is beyond my scope as an agent.

For AEP 2025 – Plan Year 2026, unfortunately, there are a number of plans from a number of insurance carriers that are going $0 commission or paying very reduced commissions. We have not been told the reasons this time. It is possible that this is simply a cost saving measure.

However, if agents keep enrolling people without getting paid, carriers will simply drop commissions even further. Legally, we cannot charge clients for our services, so commissions are the only way we can get paid.

As an agent, I cannot afford to work for free. I have my own bills to pay.

As an agent, I cannot reward carriers, who refuse to pay their agents, with free business, because this will give them an unfair advantage over the companies that do pay full commissions to their agents. More importantly, I am a bill for them, the same way they have to pay the electrical bill for their office and the bill for their internet services. If they cannot afford to pay the electric company, the electric company will not service them with power. Likewise, if they cannot afford to pay me, they won’t receive my sales services.

However, there are a number of carriers with plans that are still paying full commissions. These plans I will continue to offer.

For any plans that I feel may be a very good fit for a client, but non-commissionable, I will direct them to call the insurance carrier customer service desk for more information. This is the same policy I’ve had since I started back in 2016, for the insurance carriers that don’t use outside agents for sales. This keeps me from working for free, but ensures my clients have access to all the available plans that may fit them well. To this day, nearly ten years later, I can count the number of clients who have used this policy on one hand. It has not been a significant factor in my business, as I usually have a good competitive plan to offer in the place of the non-paying plan.

Washington Healthplanfinder (the Exchange) Note

The only exception to the “no free work” clause are my Medicaid Apple Health members on the Healthplanfinder (Exchange). Apple Health plans do not pay commissions to anyone, period. However these clients also need to ensure their providers/hospitals are in-network for their managed care plan, and if they don’t pick an insurance carrier they are automatically enrolled in one. Frequently, this auto-enrollment plan doesn’t meet their needs. Given that the vast majority of these clients are in poverty, and some of them may be disabled, it is infuriating to me that they are left to either find a navigator (a free service, but with limited availability) or be forced to do the in-network research themselves.

So, as a community service, I do accept a certain ratio of Apple Health clients to my ACA clients, because I believe that these clients deserve professional help to find insurance carriers that meet their provider network needs as much as the other commissionable Individual and Family clients on the Exchange.

I realize I’m putting starfish back into the ocean one at a time, but it’s what I’m able to do.

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