When the Market Contracts: Channel Economics After the Subsidy Cliff
Most of what we publish focuses on how health plans grow. But in 2026, growth is only half the story. When the individual market contracts, health plans and carriers face a different challenge: protecting revenue, retaining members, and doing more with less room for operational error. The enhanced premium tax credits expired on December 31, […]
CMS Compensation Reporting: What Health Plans Need to Be Able to Prove
For the CY2027 reporting cycle, Medicare Advantage and Part D organizations tell CMS whether they use employed, captive, or independent agents and brokers. Organizations using independent agents also report the initial and renewal compensation amounts or ranges they actually pay, and plans that pay referral fees disclose those amounts. Read as a reporting task, that […]
Why Integrated Care Growth Demands Stronger Agent Operations
Integrated care continues to be one of the most important areas of growth in Medicare Advantage. Dual Eligible Special Needs Plan (D-SNP) enrollment grew from 2.2 million in 2018 to 5.8 million in 2024, according to KFF. By early 2025, roughly 44% of all dual-eligible beneficiaries were enrolled in a D-SNP. The number of D-SNP […]
AEP Operational Readiness: A Distribution Checklist for Health Plans
Annual Enrollment Period (AEP) is the highest stakes sales period of the year for Medicare Advantage plans. From October 15 through December 7, health plans have only eight weeks to activate their distribution networks, support thousands of agents, process enrollments, and ensure commissions are accurate and timely. This places extraordinary pressure on the systems, teams, […]
What the CY2027 Final Rule Changes for Health Plan Agent Oversight
Most of the coverage of the CY2027 Medicare Advantage Final Rule has focused on what changes for agents and brokers. But health plans have a different question to answer: What do these changes mean for the systems and processes responsible for managing the distribution channel? The short version is that CMS is reducing some of […]
Why PACE Programs Require Stronger Enrollment and Agent Operations
PACE programs serve some of the most complex populations in health care. The Program of All-Inclusive Care for the Elderly helps eligible older adults receive coordinated medical and social services while continuing to live in the community when possible. CMS notes that most PACE participants are dually eligible for both Medicare and Medicaid, making the […]
Why Commission Operations Are a Growth Issue for Medicare Advantage Plans
Commission operations are often treated as an administrative function. For Medicare Advantage plans, that is a mistake. Commissions shape agent confidence, partner trust, internal efficiency, compliance risk and exposure, and the plan’s ability to grow through the broker channel. When commission processes are clear and accurate, agents can focus on helping members. Partners can trust […]
What Every Medicaid Health Plan Needs to Know About Working with Agents and Brokers
As Medicaid managed care organizations expand into Medicare Advantage and Dual Eligible Special Needs Plans (D-SNPs), success depends on more than benefit design. Building a scalable, compliant agent and broker operation is becoming a critical competitive advantage. Medicaid and Medicare Are Becoming Increasingly Connected For decades, Medicaid managed care organizations and Medicare Advantage plans operated […]
How Health Plans Can Better Support FMOs and Agencies
Field marketing organizations (FMOs) and agencies play a major role in how health plans grow. They help plans reach new markets, activate agent networks, support enrollment, and build stronger relationships with brokers and members. For Medicare Advantage, Medicaid, D-SNP, individual market plans, and other health insurance products, these partner relationships can be a significant growth […]
Why Regional Health Insurance Markets Require More Than a Bigger Sales Push
Regional and rural markets remain some of the most important growth opportunities for health plans and carriers These communities are often underserved and rely heavily on trusted local relationships. For many plans, they represent a meaningful path to stronger market presence, deeper member reach, and more durable growth. But growth in these markets is […]