NAIFA to Lobby Against Medicare Plan Commission Cuts

The backdrop: The maximum commission for new Medicare drug plan sales will be $109 for plans with coverage starting Jan. 1, 2025, up from $100 this year.

But many health insurers have talked about taking a “disciplined approach” to managing their Medicare plan market footprint in 2025 because of concerns about federal benefits design changes and other changes.

One major cause is a provision in the Inflation Reduction Act that will limit Medicare drug plan enrollees’ out-of-pocket costs for covered drugs to $2,000 per year.

The Inflation Reduction Act provision will hold down bills for enrollees taking expensive medications during the plan year, but issuers are responding by trying to maintain underwriting profit margins by narrowing the lists of covered drugs, finding other ways to limit plan spending or increase enrollees’ premiums and pulling plans that would look much less attractive out of the market.

Executives from CVS Health’s Aetna unit have said that it will let its Medicare Advantage plan enrollment fall about 10%, and executives from Elevance Health said the company will focus on “efforts to recover margin” rather than efforts to build share.

Centene’s WellCare unit recently focused agent and brokers’ attention on the impact of the footprint cuts by announcing it will eliminate sales and renewal commissions for its Medicare drug plans.

Kevin Mayeux. Credit: NAIFA