Reconciliation by agency type

Commission reconciliation for medicare agencies

Medicare commissions run on rules no other line has: CMS sets the maximum, carriers pay an initial-year rate and a renewal rate at exactly half, and a member who disenrolls inside the first 90 days triggers a full chargeback. That structure makes a Medicare book uniquely easy to underpay — and uniquely hard to audit by hand.

Where Medicare agencies get paid from

A Medicare agency's commissions arrive from a fragmented set of carriers and back-office feeds, each on its own schedule:

  • Medicare Advantage (MA) carriers — Humana, UnitedHealthcare, Aetna, Wellcare, and regional plans
  • Standalone Part D (PDP) prescription drug plan payments
  • Med Supp / Medigap carriers paying on their own schedules
  • FMO/IMO commission statements when you write business through an upline
  • CMS-driven true-ups, renewals, and retroactive adjustments

Where the money leaks

The discrepancies that hit a Medicare book hardest are specific to how CMS and the carriers pay:

Missing initial payments
A newly effective MA or PDP enrollment that never generated a commission — the enrollment took, but the payment didn't follow. Easy to miss across thousands of members.
Renewal-year underpayment
CMS pays a renewal at half the initial rate. A carrier that keeps paying (or stops paying) the wrong rate at the year boundary quietly under- or over-pays — reconciling initial vs. renewal is where the money is.
Unprocessed chargebacks
A rapid disenrollment inside 90 days should claw back the payment; a member who moves plans mid-year shifts commissions between carriers. When these don't reconcile, your ledger and the carrier's diverge.
Sub-CMS-max payments
CMS publishes the annual maximum per plan type and region. A payment below the cap without a valid reason is a flag worth chasing.
Split / upline discrepancies
When an FMO takes an override, the net paid to you must match your contracted split. Override math is a common quiet leak.
During AEP you write 400 new MA enrollments. Come January, the carrier statement shows commissions on 388 of them — twelve members enrolled, active, and paying premium, but never commissioned. At roughly $600 per initial-year MA enrollment, that's over $7,000 that never shows up unless someone reconciles the enrollment file against the commission statement member by member.

Common mistakes to avoid

  • Treating a renewal-year payment as correct because a payment arrived — without checking it against the halved renewal rate.
  • Never reconciling the enrollment/effectuation file against the commission statement, so silently uncommissioned members go unnoticed.
  • Assuming the FMO's override math is right and taking the net deposit at face value.

Automate it with CommissionGuard

No one can eyeball thousands of member-level payments against CMS rates and prior-year renewals. CommissionGuard reads every carrier and PDP statement into a clean ledger, matches each member against the initial-vs-renewal rate they were owed, and flags the missing payments, wrong-rate renewals, and unprocessed chargebacks automatically.

For the fundamentals, read the complete commission reconciliation guide or the step-by-step guide to auditing carrier commission statements. You can also estimate your own exposure with the free leakage calculator.

Reconciliation built for Medicare agencies.

CommissionGuard reads every carrier statement with AI, reconciles it against what you were owed, and flags what's missing or underpaid. Start your 7-day free trial — no card required.

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Prefer to run the numbers first? Try the free leakage calculator →