Kevin Knauss: Health, History, Travel, Insurance
Posts and commentary related to health insurance agents generally in California, commissions, carriers, service, Covered California.
However, there can be no mistake that AI is becoming more sophisticated in providing financial analysis for health insurance. There is a large population of people for which the AI analysis is good enough to base a health insurance decision upon. This makes health insurance agents obsolete in many situations.
Whereas I was optimistic about 2025, I am pessimistic about 2026. Because the enhanced subsidies were not passed by Congress, I’m seeing people drop health insurance. I anticipate more people will drop health insurance during the year because they just will not be able to afford the high health insurance premiums.
Commissions from the various health, dental, and vision plans I represent totaled approximately $87,000 in 2023. Insurance commissions equaled 92 percent of my total revenue. Google and YouTube advertising revenue accounted for 2 percent of income and a few crumbs from book sales.
There was no specific cause for the Molina action against me. The letter stated, “Molina has the right to terminate an appointment or revoke a Participating Producer’s authority to Solicit the Molina Marketplace products at any time.” Gosh, what had I ever done to Molina other than represent their products fairly when presenting their Covered California health plans to consumers?
Health insurance agents are not paid by Covered California. We are paid by the health plans, either PMPM or a percentage commission. There are 13 different health insurance carriers and 13 different agent commission structures.
For the first time, I attempted to segregate my insurance revenue into the different categories of individual and family, vision and dental, Medicare, and small group. Individual and family enrollment commissions made up 85 percent of the revenue. Enrollments in vision and dental plans comprised 4 percent of my income. Medicare Supplements, Medicare Advantage, and Part D prescription drug plan enrollments total 8 percent of my income. Small group commissions came in at 3 percent.
If you consider certified agents are an extension of the Covered California customer service staff, the different agent compensation models are like paying a different hourly wage based on the health plan enrollment. The varying compensation amounts introduces a certain level of bias. If you are paid $15 an hour for enrollments in health plan X and only $8 per hour for enrollments in health plan Y, which health plan would you favor?
Covered California does not pay agents to assist consumers with enrollments into individual and family plans. The insurance plan or carrier compensates the agent. Agents are not paid anything for answering questions about Covered California. They are only paid a commission if the person enrolls into a health plan the agent represents and is appointed with.
Occasionally, I am asked whether I am an insurance agent or a broker. The underlying premise of the question is that the person does not want their insurance options limited to only those insurance companies the agent represents. The assumption is that a broker will not steer the client into an insurance policy that he or she receives the highest commission for. For the purposes of this discussion involving health insurance, there are no brokers, we are all agents. But not all agents are equal when it comes to the health plans they represent.
The family continued to wait, not paying any of the invoices they received because they figured that Covered California was working to resolve the issue. The health insurance plan was terminated by the health plan for lack of payment. If the consumer does not pay the all the premiums after 90 days, the consumer loses the right to make all the back-premium payments and reinstate the health plan. This is what happened to the family.
