Agent education
Chargebacks explained
A chargeback is a commission the carrier takes back. Under CMS rules it happens when a client leaves the plan within the first three months, and it shows as a negative line on a later statement.
01
The rule
CMS requires carriers to recover the compensation paid on an enrollment when the beneficiary disenrolls within the first three months (a rapid disenrollment). There are exceptions for certain special enrollment situations, such as a move out of the service area or a change in Medicaid or Extra Help status, and the carrier decides when they apply.
Source: 42 CFR 422.2274.
02
What it looks like
- ◆A negative entry on a statement one to three months after the original payment, tied to the policy number.
- ◆The full initial commission for a rapid disenrollment, or a pro-rated amount where the carrier pays monthly.
- ◆Sometimes a chargeback is a timing error: a plan change within the same carrier, or a mis-keyed effective date.
03
Reducing them
- ◆Confirm the client’s doctors and drugs are covered before the application, not after.
- ◆Set expectations about the first bill, the ID card and the plan’s network in the appointment.
- ◆Follow up in the first 30 days; most rapid disenrollments start with a surprise.
- ◆Document the Scope of Appointment and the needs assessment; they also protect you in a complaint.
04
Disputing a chargeback
If a chargeback looks wrong, use the Support Hub: one inquiry form per carrier with the policy number, client name and effective date. Topflight reviews, verifies and forwards the inquiry to the carrier, and most are completed within 1 to 7 business days.
Frequently asked
Questions agents ask about Chargebacks explained
What causes a Medicare commission chargeback?
A client disenrolling from a Medicare Advantage or Part D plan within the first three months. CMS requires the carrier to recover the commission paid.
Are there exceptions to the rapid-disenrollment rule?
Yes, for certain special enrollment situations such as a move out of the service area or a change in Medicaid or Extra Help status. The carrier applies them.
How do I dispute a chargeback through Topflight?
Submit the carrier’s commission inquiry form from the Support Hub with the policy details. Most inquiries complete within 1 to 7 business days.
Last reviewed: · Reviewed by Joanna Wyckoff, Founder. Published by the Topflight Data Desk.