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Eldercare Review | Wednesday, March 16, 2022
Medicare beneficiaries need to weigh the pros and cons of each option before choosing a health care plan.
There are several trade-offs when choosing between private Medicare Advantage plans and traditional Medicare with supplemental coverage. It needs to be clarified to beneficiaries how brokers and agents narrow plan options and what financial incentives might influence their advice. In light of the widespread use of brokers and agents and the potential impact their guidance can have on beneficiaries' coverage choices, the Commonwealth Fund partnered with researchers to gain their perspective on the state of coverage options, the challenges they face in choosing an option, and how their financial incentives differ from beneficiaries' interests.
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Most brokers and agents in the focus groups recalled receiving higher commissions — sometimes much higher — for enrolling people in Medicare Advantage plans compared to Medigap supplemental plans for traditional Medicare, with some variation by geographic region and new enrollments versus renewals.
Alignment: Beneficiaries' interests should align with financial incentives. It is uncommon for the industry to commission brokers and agents in complex ways for their services. The commissions they earn are typically derived from the enrollment of beneficiaries in Medicare Advantage, Medigap, or Part D plans they sell, which they sell through multiple insurance carriers. In addition to not being required to contract with all plans available in an area, brokers and agents only need to offer beneficiaries some plans. A broker or agent who does not offer all plans in an area must disclose that fact to clients beginning in 2022 but is not required to disclose what percentage of plans they sell or how their compensation differs. Aside from commissions, plans often offer additional compensation for completing enrollment benchmarks or engaging in other activities, such as assessing beneficiary health risk.
Commission structure: Medigap commission structures encourage the sale of expensive plans. Most Medigap beneficiaries choose high-premium plans that provide comprehensive coverage, such as Plan G or F because they value having almost all the cost-sharing of traditional Medicare covered. Those on a tight budget may benefit from Medigap plans like plan K or L, which offer high cost-sharing but low premiums and no out-of-pocket expenses. Medigap plans with lower premiums typically have low broker and agent fees, as commissions are usually a percentage of the plan's premium. Since some beneficiaries may be paying more than they need to due to the commission structure, some research has concluded that this comprehensive Medigap coverage can also result in higher Medicare spending.
Part D plans: According to reports, commissions for stand-alone Part D plans need to be higher, making them unprofitable. The industry sets a minimum for Part D commissions, so some brokers believe they need to receive a fair commission. Currently, many insurers do not pay according to prescription drug plans. Although a Part D plan's coverage can change each year, low commissions do not incentivize brokers and agents to help people in traditional Medicare reevaluate their plans each year. Several brokers described clients who came to them without Part D or other drug coverage, even though they had been on Medicare for years. Due to their failure to enroll in Part D plans, these enrollees must pay a monthly late-enrollment penalty for the remainder of their Medicare years. They must wait until the next open enrollment period to enroll in Part D plans.
Insurance brokers and agents disagreed on how brokers' and agents' individualized processes for winnowing plans affect their clients' choices. Many brokers and agents viewed the Medicare coverage selection process as flawed and needing improvement. The higher commissions they earn for enrolling in Medicare Advantage also encourage them to increase enrollment despite most preferring traditional Medicare with supplemental coverage.
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