Initial Enrollment Compensation: Everything You Need to Know

The Medicare Marketing Guidelines (Sections 110.6.1 and 110.6.5) detail the scenarios in which brokers can receive full or prorated initial enrollment compensation. Here’s what brokers need to know about initial enrollment compensation.

How Much Can Brokers Get Paid for Initial Medicare Enrollment in 2019?

Brokers can make at, or below, the fair market value for the products they sell. In 2019, the fair market values for initial enrollment for the following products are as follows.

Product National Connecticut, Pennsylvania, DC California, New Jersey Puerto Rico, US Virgin Islands
Medicare Advantage $482 $542 $601 $331
Prescription Drug Plans $74 $74 $74 $74
Section 1876 Cost Plans $482 $542 $601 $331

When Can Brokers Get Paid for Initial Enrollment?

You can earn full or prorated initial enrollment compensation if one of the following scenarios is true:

Scenario 1: This is your enrollee’s first year of enrollment in any plan.

Scenario 2: Your enrollee moves from an employer group plan to a nonemployer group plan.

  • You will be compensated whether the parent organization for the plan is the same or not.

You must be paid prorated initial compensation, if one of the following scenarios is true:

Scenario 3: Your enrollee changes plans during his or her initial enrollment year.

Scenario 4: Your enrollee changes his or her coverage to a plan that is not similar his or her previous plan.

When Will Brokers Receive Full or Prorated Compensation?

In scenarios 1 and 2, brokers can receive full or prorated compensation. Centers for Medicare & Medicaid Services describes the compensation year as January 1-December 31. Regardless of when your client enrolls, the compensation year begins and ends within those dates. So, the initial compensation amount will depend on when a client first enrolls in Medicare coverage and the carrier you represent.

In scenarios 3 and 4, brokers can receive prorated compensation. Specific to scenario 4, the enrollee must choose a plan type that is unlike his or her previous coverage during his or her renewal year. The prorated amount brokers earn will also depend on when their clients changed their coverage and the carrier they represent.

What Else Can You Find With Excelsior?

With our online resource center, you can find more explainers on the Medicare Marketing Guidelines. With our regional sales directors, you can find out how to double or triple your revenue. To learn more about the Excelsior team and how we can help you, contact us.

Note: For the most current information, see the CMS Medicare Marketing Guidelines.


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