Sorry, but the World is Not coming to an End

[Special Agent]

Updated commissions on MA and Section 1876 Cost Plans
National....Conn.,Pennsylvania, DC....California,NJ......PR, US Virgin Islands..
Initial Year $626 $705 $780 $428
Renewal Years $313 $353 $390 $214


PDPs
Compensation
Type National
Initial Year $109
Renewal Years $55


Referral Fees
MA Plans $100
PDP Plans $25

$726 would have been more better.Boycott the FMOs that screwed the agents.My understanding is their overrides were not going to be effected either way only the GA level was going to be cut off from overrides in 2025.

 

[Midlevel]

Updated commissions on MA and Section 1876 Cost Plans
National....Conn.,Pennsylvania, DC....California,NJ......PR, US Virgin Islands..
Initial Year $626 $705 $780 $428
Renewal Years $313 $353 $390 $214


PDPs
Compensation
Type National
Initial Year $109
Renewal Years $55


Referral Fees
MA Plans $100
PDP Plans $25

I will lose $40000.00 due to lower renewals but at least I will still have access to the quoting software I never use along with countless, worthless emails. Win, win.

 

[DonP]

Here's the bottom line . You continue selling what you sell until it's no longer profitable . It's that simple .

$726 would have been more better.Boycott the FMOs that screwed the agents.My understanding is their overrides were not going to be effected either way only the GA level was going to be cut off from overrides in 2025.

They thru the agent under the bus. But here's the kicker . What will carriers do ? Will they take this and slash the overrides now to cut this fat . I wouldn't be surprised if Gorilla united says we want to cut back on agents we don't need them

 

[Chazm]

UHC isn't cutting out agents. That's the dumbest thing I've heard.

 

[just-a-client]

That's exactly correct. You sound like an expert for sure. And here I thought I was talking to my senior.

Ha, unless I'm having senior moments and am only sounding like I know what I'm talking about. I mean, as a non-professional it's difficult to actually find clear explanations of the details. I've seen the bar charts showing how the share of the players (beneficiary, plan, manufacturer, Medicare) has changed comparing 2023, 2024, and 2025. Like in articles at kffhealthnews. But these come without detailed explanations. I've tried my best to figure out how it works. I'll know the premiums when I get the ANOC (unless someone posts prices here first!), but the whole picture won't be really complete till we see how the formularies and utilization rules change. I'll be on the Plan Finder October 1.

BTW do people find that the analysis they do at q1medicare.com, where they list the number of drugs on each formulary, and how many are in each tier, is correct? Or the number of enrollees in the states and nationwide?

 

[T Sparks]

They thru the agent under the bus. But here's the kicker . What will carriers do ? Will they take this and slash the overrides now to cut this fat . I wouldn't be surprised if Gorilla united says we want to cut back on agents we don't need them

What is they "thru" the agent under the bus?

That's some backwoods shit right there for sure.

 

[T Sparks]

I could give 2 shits to be honest . I know irregardless of what comes out I'm selling 250 plus plans aep and getting a check nicely north of $100k in Jan .My renewals will be stout stout 5 figs a month in 25

Who gives a F

 

[Medicare bro]

I'm not an agent. Finally registered after reading this forum since early days leading up to ACA, and then ACA early days. But I've been on Medicare now for 7 years, reading this Senior forum. I'm inspired to chime in now.

Wellcare Value Script had that $11 tier for 2023 and 2024 for very expensive diabetes drugs. I thought about how the cost-sharing for those drugs would actually work out those years. After deductible, you'd pay $11 - but just for a few months. The total drug costs were so high that you'd then enter the coverage gap pretty quickly - and pay 25% till you reached the catastrophic phase and owed, as of 2024, nothing. But that meant spending around $3500 before reaching the catastrophic phase. (And in 2023, it meant paying 5% after that, forever.)

I realized pretty quickly that Wellcare would have to change this for 2025, because there is no way they could possibly allow an $11 co-pay for these expensive drugs for the entire year. And no one here would imagine that could be sustainable. So I figured those drugs would likely move into Tier 3 or Tier 4.

Wellcare, for California, is lowering Tier 4 from 50% to 35% (preferred pharmacy, but 36% at standard pharmacy). Tiers 3 and 5 remain 25%. If these Tier 6 drugs get put into Tier 3, it does mean they would cost 25% immediately rather than only after hitting the gap. But then, costs are capped at $2000 max oop, so I think it's probably a net gain. Probably a net gain even if the drugs are in Tier 4 too - you'd just hit $2000 max oop sooner in the year.

If I may, I have more to say about why I personally don't think the sky is falling - details about what Medicare reinsurance actually means, why I think CMS has changed it, and what I think it really means that their reinsurance contribution will be dropping. (I think it is less of an issue than people have been worried about.)

I'll post my thoughts about that eventually and look forward to feedback!

Thanks for letting a non-professional like me post.

Do you need a plan? I can help.

 

[Yagents]

Do you need a plan? I can help.

You never want a client that does more research then most agents do or know

 

[Yagents]

Ha, unless I'm having senior moments and am only sounding like I know what I'm talking about. I mean, as a non-professional it's difficult to actually find clear explanations of the details. I've seen the bar charts showing how the share of the players (beneficiary, plan, manufacturer, Medicare) has changed comparing 2023, 2024, and 2025. Like in articles at kffhealthnews. But these come without detailed explanations. I've tried my best to figure out how it works. I'll know the premiums when I get the ANOC (unless someone posts prices here first!), but the whole picture won't be really complete till we see how the formularies and utilization rules change. I'll be on the Plan Finder October 1.

BTW do people find that the analysis they do at q1medicare.com, where they list the number of drugs on each formulary, and how many are in each tier, is correct? Or the number of enrollees in the states and nationwide?

You're wasting your time. KFF doesn't provide details, because nobody knows the answers until the last minute. The govt way.

You have to wait for the initial rule, then comments period, then final govt rule, then interpretations of that rule, and then the interpretations of that interpretation, and then reaction from carriers which is released just in time before open enrollment.

To find out Oct 1st that the website is wrong, RX formularies are wrong, doctor networks incorrect. On and on. I'd recommend not checking formularies until late October if on expensive meds to ensure accuracy.

Yes Q1 is a good resource along with this forum. But going back to wasting your time, I am "Y"agents, there is a reason we exist....so we can spend countless hours learning this chit each day and year so you don't have to.