Open enrollment: Commission payments, CMS suspensions plague health agents

Open enrollment season for Medicare as well as Affordable Care Act health plans is in full swing and many agents are finding it difficult – if not impossible – to enroll people in coverage.

Medicare open enrollment for 2025 began Oct. 15 and runs through Dec. 7. Meanwhile, ACA open enrollment for the coming year began Nov. 1 and will run through Dec. 15 in most states.

Agents who work in the Medicare and ACA markets are experiencing two particular challenges this open enrollment season: 1. Carriers announcing they will not pay agent commissions on certain Medicare Advantage plans and Part D prescription drug plans; 2. ACA agents finding the Centers for Medicare and Medicaid Services has suspended from enrolling clients because an algorithm has flagged them.

Carriers who announced they will not pay agent commissions on certain plans include:

• Aetna, on 24 of its Medicare Advantage plans.
• UnitedHealthcare, on 106 of its Medicare Advantage plans.
• Cigna, on its prescription drug plans
• Wellcare, on its prescription drug plans
• Humana, on 54 of its Medicare Advantage plans.
• Wellpoint/Elevance/Anthem, on new sales of some of its plans submitted after Nov. 1.

Companies 'decide it's not profitable'

“My opinion is that you filed the rate with CMS so you intended to sell the product. Now, after you already contracted with the agents to sell the product, you decide it’s not profitable so you won’t pay commissions. You should have determined that it’s not profitable before you filed the rates that included the commissions,” Ronnell Nolan, president of Health Agents for America, told InsuranceNewsNet.

Aetna told InsuranceNewsNet the company “routinely reviews and updates our distribution strategy, including the commissionable status of our plan offerings and the channels through which we distribute them.”

“The elimination of commissions and the lack of a CMS solution to the problem hurts the millions of American seniors who need agents to help them manage costs, explore plan options, and ensure they get proper coverage,” the National Association of Insurance and Financial Advisors said in a statement. “Without professional agent assistance, consumers will be confused and left to contact call centers unfamiliar with their unique situations.”

The National Association of Benefit and Insurance Professionals first sounded the alarm on the commission issue Nov. 1, issuing a statement condemning Aetna’s and Elevance’s decisions to stop paying commissions for new enrollments in select Medicare plans. Some agents and brokers were notified with less than 24 hours’ notice, in the middle of Medicare’s open enrollment period, creating significant disruption, NABIP said.

“By eliminating agent commissions in certain Medicare plans, Aetna and Anthem have created a substantial barrier for seniors who rely on agents to understand their plan options, manage costs, and access the care they need. This disruption hits particularly hard at a time when seniors are already grappling with higher prescription costs and shrinking benefits in their Medicare Advantage plans,” NABIP CEO Jessica Brooks-Woods said.

Open enrollment woes

Elie Harriett is co-owner of Classic Insurance and Financial Services in Mansfield, Ohio, where he specializes in Medicare-related insurance. He told InsuranceNewsNet he has been impacted more by the decision not to pay commissions on Part D plans than on Medicare Advantage plans.

“Aetna has done some strange things with their prescription drug plans,” he said. “They’re no longer paying commissions on their prescription drugs plans but they’ve also significantly reduced the number of options available and their plans are markedly worse.”

Harriett said he is telling clients who want to buy a particular drug plan that doesn’t pay him commission that he will sell them the plan but won’t be able to service it.

“It really sucks when you have to tell a client, look, this is the best thing for you, but I can't do it because they won't pay me. What other industry is there in the world where you would have to make that kind of declaration?”

HAFA is hearing from many of its members who are trying to enroll clients in the ACA marketplace, only to find out they have been kicked out of the CMS online enrollment system and suspended from selling coverage.

“CMS is using algorithms, and they will not explain what those algorithms are,” Nolan said. “These algorithms are targeting agents – maybe they wrote too many policies on the same day for people who have the same income or they’re writing too many policies on people of a certain occupation. Agents are then getting a letter from CMS telling them CMS canceled their certification – they can’t write business, they can’t be paid income.

“We have members who have thousands of ACA clients. They can’t update or renew their clients. So those consumers have lost access to their professional agent, which is simply unfair.”

CMS did not respond to InsuranceNewsNet’s request for comment on this issue.

‘They're killing us’

Holly Perry is cofounder of The Appointment Firm in Piney Flats, Tenn., where she and her business partner operate several call centers using licensed agents to enroll consumers in ACA coverage. She told InsuranceNewsNet at least five of her company’s agents were suspended by CMS.

“CMS is picking five people at random that you enroll through the Health Sherpa platform and because CMS apparently doesn’t like the answers, the agent is suspended even though the agent obtained the client’s consent and did everything by the book,” Perry said.

“It's just like some kind of algorithm is flagging people. CMS isn’t giving a reason for it.”

Perry said that ACA enrollment is all her company does and that the CMS actions “are killing us.”

“It's almost like they're trying to weed out the agent brokers, the ones who are boots on the ground, who know the communities and that want to serve the clients. They want to squash the little people.”

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Susan Rupe is editor in chief, magazine, for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected].