New York state will bar insurers from compensating brokers for enrolling members in the state’s essential plan, beginning in 2026.
The essential plan is available to low-income adults in New York who do not qualify for Medicaid.
Andrew Biernant, vice president of New York-based insurance agency Gilroy Kernane & Gilroy and board member of the National Association of Benefits and Insurance Professionals, told Becker’s some insurers provided compensation for the essential plan, while others did not.
Most brokers would enroll members in the best plan for them, Mr. Biernant said, regardless of whether the insurer paid compensation. Without any compensation from plans, brokers may not be able to provide the same level of assistance, he said.
The change comes as a major upheaval approaches for many individual market beneficiaries, Mr. Biernant said. Enhanced subsidies, which significantly cut the cost of individual coverage for most enrollees, are expected to expire at the end of 2025.
“I don’t know if the state is going to be able to handle all the potential questions and concerns that individuals may have,” he said. “It’s going to create more confusion. The administrative burden to the state will increase.”
In the Medicare Advantage market, many major insurers have stopped paying brokers compensation for enrolling new members in certain plans. Groups representing brokers have decried the changes, saying they undermine Medicare beneficiaries’ access to professionals who can help them navigate MA enrollment.
Mr. Biernant said the changes are likely a result of the financial pressure insurers are facing.
“Insurance carriers are struggling with decreasing margins, just as providers are struggling with decreasing margins,” he said. “Each has worked hard to try to improve efficiency, but at the same time, there are some unintended consequences that are happening.”
