If a Medicare Advantage member disenrolls in the eleventh month of their plan year, here is exactly how much of your $694 commission the carrier takes back for 2026, why month 11 lands where it does under the CMS recovery rule, and how agents keep month-11 clawbacks from happening in the first place.
Quick answer: A member who disenrolls in month 11 is past the 3-month rapid-disenrollment window, so the carrier recovers a prorated share — $694 × 1 unenrolled months ÷ 12 = $58 clawed back (8%). You keep $636 for the 11 months the member was enrolled. Track which policies are still inside this window and you can save them before they lapse.
Month 11 is past the 3-month rapid-disenrollment window, so the 2026 chargeback is prorated, not all-or-nothing. The carrier keeps you paid for the 11 months the member was actually enrolled and recovers the remaining 1 months: $694 × 1 ÷ 12 = $58 clawed back, leaving you $636 earned. The later in the plan year a member leaves, the more you keep — which is precisely why the whole retention game is about getting members past their early months and holding them to renewal.
CMS sets the recovery rule in 42 CFR 423.2274. The 2026 Medicare Advantage initial-year commission national maximum is $694 per member. For a month-11 disenrollment the math is: month 11 is beyond the 3-month rapid-disenrollment window, so the carrier recovers a prorated amount equal to the months the member was not enrolled — $694 × (12−11) ÷ 12 = $58, leaving $636 earned for the 11 enrolled months. Carriers pay Medicare Advantage at or below the CMS maximum and some IMO/FMO contracts extend the full-recovery window past 3 months, so treat $58 as the CMS-baseline figure and confirm your specific carrier's earn-through schedule.
One month-11 chargeback is annoying; a cluster is what actually breaks a month. If 10 of your members happened to disenroll in month 11 — a realistic spike after a plan's benefits change or a competitor's marketing push — that's $578 (10 × $58) reversed out of income you already spent on the calendar. Because carriers net chargebacks against future commission deposits rather than billing you directly, a bad wave can show up as a mysteriously small statement two months later. The agents who never get blindsided are the ones who reconcile every deposit against the policies that earned it and watch the early-month window like a hawk. (Example figure — your real exposure depends on your book and carrier mix.)
Enter your advance, the advance term, and how many months the policy stayed active to see exactly what you owe back on any policy — Medicare Advantage or final expense.
Open the free Chargeback Calculator →You can't undo a month-11 disenrollment once it posts, but you can stop most of them upstream. Three levers do the heavy lifting: (1) right fit at the point of sale — the wrong-network or wrong-formulary enrollment is the one that bounces in the first 3 months; (2) draft-date and card-on-file alignment so a missed premium doesn't quietly lapse the policy; and (3) proactive contact during the chargeback window — a welcome call, a benefits-usage check, a heads-up before a plan change. The one thing all three require is knowing which policies are still inside the window right now, which is a tracking problem, not a talent problem. That's what the retention and persistency trackers below are for.
You owe back $58 — 8% of the $694 commission. Month 11 is past the 3-month rapid-disenrollment window, so the carrier recovers a prorated share for the 1 months the member wasn't enrolled ($694 × 1 ÷ 12 = $58) and you keep $636 for the 11 enrolled months. Your carrier or IMO/FMO contract can be stricter — verify your earn-through schedule.
Rapid disenrollment is when a member leaves the plan within the first 3 months of the enrollment. Under CMS rules the plan must recover the entire commission — not a prorated share — because the enrollment is treated as never having taken hold. Carriers may define an even longer full-recovery window in their agent contracts, so always confirm your specific agreement.
It depends on when the member leaves. Inside the first 3 months it's all-or-nothing — the full $694 comes back. From month 4 through the end of the plan year it's prorated: the carrier keeps you paid for the months the member was enrolled and recovers the rest ($694 × unenrolled-months ÷ 12).
No — once a member disenrolls inside the window the recovery is contractual. What you can control is preventing it: good plan fit at the point of sale, draft-date and card-on-file alignment, and proactive contact during the first several months while the policy is still inside its chargeback window. Knowing which of your policies are still inside that window is the practical key.
A month-11 disenrollment costs you $58 you already counted as income — and a handful in the same month can wipe out a payday. The Commission & Chargeback Tracker ($19, Excel + Google Sheets) reconciles every statement and flags clawbacks; the Final Expense Persistency Radar ($25) and Client Retention Hub ($25) surface every policy still inside its chargeback window so you can save it before it lapses. Own them once, no monthly fee.
See the retention toolkits on Etsy →The 2026 commission figure and recovery rule are verified against U.S. government primary sources: