In 333 of 592 MA contracts, agent pay topped quality spend
Medicare Advantage insurers paid $7.7 billion to agents and brokers in 2023 and spent $8.07 billion on quality improvement. In 333 of 592 contracts, the agents got more.
333 of 592 Medicare Advantage contracts paid agents and brokers more in 2023 than they spent on quality improvement. The figures come from the insurers’ own 2023 medical loss ratio reports, which CMS publishes in a public use file. CMS last updated the file on Mar. 25, 2026.
Across all 592 contracts, agent and broker fees and commissions came to $7,696,726,430 in 2023. That is $20.63 for each member each month.
Quality improvement spending across the same contracts came to $8,072,299,686. Commissions equaled 95.3% of it.
A contract is the agreement under which an insurer sells one or more Medicare Advantage plans. CMS reports loss ratios by contract, not by plan.
What counts as quality improvement
Insurers report quality spending in set categories. The categories in CMS’s file include these.
- Improving health outcomes
- Preventing hospital readmissions
- Patient safety and fewer medical errors
- Wellness and health promotion
- Health IT tied to quality
- Medication therapy management
- Fraud reduction
The category is spending an insurer classifies as quality work under federal loss ratio rules. It is not a quality score or a star rating.
Why the split matters
Federal rules set a floor for each contract. If its medical loss ratio falls below 85%, the insurer pays CMS the difference, under 42 CFR 422.2410.
Quality improvement spending counts toward that ratio, along with claims, under 42 CFR 422.2420. Agent and broker commissions do not. CMS’s file lists them with other non claims costs.
How we got these numbers
We added the commissions and the quality improvement spending each Medicare Advantage contract reported in CMS’s 2023 file. Then we compared the two for each contract. The monthly figure divides total commissions by total member months, 373,164,968.
Limits.
- 2023 is the latest year in CMS’s public file.
- Insurers report the figures themselves.
- The totals include employer group members.
- The file is at contract level only, so it shows no plan or county results.
- CMS leaves very small contracts and single plan contracts out of the file. Results for small contracts swing more from year to year.
What it means for you
If an agent or broker helps you choose a Medicare Advantage plan, the insurer pays that agent. You can compare every plan sold in your county in Medicare Plan Finder.
This story is general information from public sources. It is not insurance or enrollment advice, and we don’t recommend any plan or insurer.
commonwealthfund.org
KFF
