In January, we wrote about the challenges insurance carriers would face in 2025 and how these challenges would impact agents. Today, we revisit this article with a mid-year update about the challenges and how the tips we mentioned back in the winter still apply.
Medical Loss Ratios (MLRs) Rising
This article from Fierce Healthcare offers an excellent overview of the financial health of major carriers in 2024. How do things look so far in 2025?
- Centene, UnitedHealthcare, Oscar, Molina, and Elevance changed their financial guidance for 2025 to reflect lower revenue and higher costs.
- Gold Kidney ends non-SNP commissions.
- UnitedHealthcare ends commissions for some of its Medicare products.
- Elevance only accepts paper applications for all Elevance-branded PPO plans, excluding Chronic and Dual Special Needs Plans.
- NY Essential plans end commissions 1/1/26.
Carriers Reduce Benefits
We have seen one-way carriers address MLR increases with the 2025 Medicare Annual Enrollment Service Area Reductions of Humana, Centene, and Aetna. Where do things stand now?
- Anthem is leaving the Kentucky Managed Care plan.
- Cigna leaves Medicare, with HCSC buying it.
- Aetna leaves the ACA Marketplace.
- Allstate and Manhattan Life leave the Medicare Supplement market.
- Devoted, Blue Shield Trio, Health Net Salud y Mas, and Kaiser Permanente are expanding.
Some regional carriers are making growth actions while other larger entities are ending business lines entirely.
PBM Ownership and Regulation
The new administration continues to investigate Pharmacy Benefit Managers (PBMs), while six states have passed more laws regulating PBMs. Few in Washington, D.C., don’t expect the federal government to take action on PBMs shortly.
Physicians and Hospital Updates
Many insurance agents have great partnerships with hospitals and doctors, so how are they doing right now?
- CenterWell and Conviva are ending their agent access program.
- Doctors accepting Medicare will receive a 2.5% payment increase in 2026, thanks to the ‘Big Beautiful Bill’ that goes away in 2027, back to 2025 levels.
- So far in 2025, up to 18 hospitals around the nation have closed, approximately 2 hospitals per month.
- There have been between 15,000 and 20,000 healthcare layoffs year-to-date in 2025.
How to Thrive During the Changes
So, what do health insurance agents do about all of this?
- Information is power, so stay informed on what’s happening with your health insurance carrier partners, especially their MLRs.
- If you haven’t done so already, fill your product toolkit with supplemental products to address the benefit gaps of your ACA or Medicare clients.
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- Hospital indemnity insurance.
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- Critical illness products for cancer, stroke, or heart attacks.
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- Dental, vision, and hearing.
- If you haven’t done so already, fill your toolkit with supplemental products to diversify your business revenue.
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- Short-term health plans
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- Accident
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- Life and annuity.
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- ICHRA for employer group clients.
Agility Here to Help
Agility’s excellent team of local market managers and ACA/ICHRA, Medicare, and Life and Supplement product specialists is here to answer all your questions on successfully navigating these changes. They’re happy to refer you to our Supplement and Life and Annuities contracting pages as well, for additional revenue opportunities.
You can also contact our Producer Support team with any insurance questions now at 866-590-9771 or email support@enrollinsurance.com for assistance. All of the resources can add you to our email list to receive the latest updates on all insurance matters delivered to your Inbox!
