Service-First Needed In CA's Medicare Advantage Marketplace

By Sachin Jain President and CEO of SCAN Group

Sachin Jain, MD, MBA, President and CEO of SCAN Group and Health Plan, shared the focus his organization has to shape the future of Medicare Advantage with a theme of “Championing service and integrity over profit”. This stance is unique and stands out in California’s volatile and highly competitive health insurance landscape. This is a summary of Jain’s speach at a recent CAHIP LA conference on Medicare. Due to the consistent changes in the marketplace as carriers exit markets, suppress enrollments, and recalibrate benefits under complex CMS guidance, Jain’s candor and operational transparency offer actionable lessons for brokers, agency owners, and Medicare benefits consultants navigating today’s regulatory and business terrain.

Leadership Beyond Denial

In a landscape where many organizations optimize operations to reach target profit margins often before member welfare, Jain is unapologetically honest: “Denial is not a strategy… All of us have participated in gaslighting ourselves and the American people,” he told attendees at the CAHIP-Los Angeles Medicare Summit. This self-examination is not just philosophical; it underpins SCAN’s daily operations and its ethos. Jain asserts, “We fight to want to be the company we say we are, that we’ve always said we are. And that’s what I’m really proud of”.

For brokers, this transparency has tangible impact. Every SCAN member receives Jain’s personal email and, every week, he reviews direct complaints. “We pause and we ask the question, what’s the bigger issue at play?” he explained, sharing how broker advocacy recently turned a near-disenrollment into a strong client endorsement through hands-on engagement with SCAN’s pharmacy team. The message to health insurance professionals is let’s work together to provide the best outcome for SCAN members and your clients. Authenticity, proactive service, and relentless honesty are words that define sustainable client relationships in a hypercompetitive market.

Regulatory Shifts and Broker Strategy

California brokers are preparing for and actively shaping client first strategies do deal with several crucial regulatory changes. CMS in 2025 enacted stricter rules for broker compensation, product standardization, and marketing. Agent commissions in California have increased modestly (from $762 to $780 for initial MA enrollments per member per year), yet the maximum is standardized across plan sponsors and excludes some administrative fees after recent litigation.

CMS’ final rule aims to curb anti-competitive steering, limit cash incentives tied to enrollments, and reinforce the statutory intent of MA as a safety-net program rather than a profit engine. Notably, new requirements mandate mid-year notices for unused supplemental benefits and extend panel reviews to include health equity experts. Once again health insurance professional working within the Medicare market must master compliance scripts, record calls, and follow enhanced disclosure rules—while still providing the client advocacy that Jain describes as the broker’s real value-add.

Jain’s advice is actionable: “If your core values are being crossed, whether it’s a client who’s not treating you the way you should be treated as a broker, or a carrier… know your core values and just know where that line lies. And if it’s being crossed, it’s okay to say no. And for sure, to speak up”. For California brokers, this means judicious plan selection, informed refusals, and honest communication with clients and carriers—a stance increasingly supported by CMS oversight.

Product Strategy and Market Expansion

SCAN isn’t standing still. By Fall 2025, the group is launching joint MA products through a partnership with Sutter Health, extending its reach in Northern California and focusing on chronic disease management, digital health, and preventive care. In addition, SCAN has plans which address specialized products categories such as women’s health, LGBTQ seniors, and culturally competent care all of which are a direct response to real member feedback.

“Integrated payer-provider plans seek to foster a shared mission of improving outcomes and patient experience while finding efficiency, rather than push costs on the other’s plate,” Jain noted. When health insurance professionals align with this strategy and emphasize high-touch service, member advocacy, and outcome-driven product recommendations over transactional sales, they will sperate themselves from the entities and individuals who are once and done enrollment only focused. This client first approach is how the local independent health insurance professionals can rise above and lead our industry.

Move past the transactional and reclaim a primary role as patient advocates and industry truth-tellers.

Utilization Management and the Prior Authorization Challenge

Jain’s critique of “denial as a margin tool” rings especially true in California’s highly delegated care environment. “What has happened is we have bought something from someone, and they are not delivering it to us,” Jain explained, referencing delays in specialty access and excessive prior authorization hurdles for procedures— even ST-elevation myocardial infarction admissions. For brokers, verifying network adequacy, advocating for expedited care, and escalating access issues to SCAN leadership can differentiate their value proposition in the post-CMS rule era.

The Broker as Community Health Worker

One of Jain’s most radical proposals is for brokers to move beyond enrollment and function as community health workers: “At the end of the day, the broker is the person who’s helping to navigate the complex healthcare system for the beneficiary… getting people scheduled with a primary care appointment, getting their medications refilled, helping them navigate supplemental benefits. That’s the added value that this industry can really provide.” Legislative momentum may make these expanded roles—and commission structures—standard in the coming years. This bodes well for the local independent health insurance professionals.

Navigating Uncertainty, Building Integrity

In a market roiled by exits, suppressions, and plan volatility, Jain insists, “Incentives matter. And if your incentives are around service and stability, you’re going to behave differently than if your incentives are around profitable growth.” California’s brokers, already well-versed in compliance and changing markets, should lean into this ethos, prioritize member outcomes, and lobby for regulatory clarity as Washington shapes the next wave of broker guidelines.

Conclusion

Sachin Jain’s presentation poses a challenge to move past the transactional and reclaim a primary role as patient advocates and industry truth-tellers. “Leadership is not silent… we have to keep fighting to get back to that kind of good place where we’re doing things for the right reasons.”

This message is vitally important as through the work NABIP performs which includes educating state and national decision makers and the elected representatives, the goal is to consistently focus on this message. Consider this as part of your work with clients and help your colleagues do the same. We need to collectively work together to future-proof the work of health insurance professionals in this business as we consistently redefine the value brokers deliver to beneficiaries and the broader health system.

Sachin Jain is President and CEO of SCAN Group and SCAN Health Plan, where he has led a transformative period of growth and performance. Under his leadership, SCAN has grown its membership, expanded into new markets, and achieved record revenue—while maintaining industry-leading member satisfaction and quality ratings. Since joining SCAN, Dr. Jain has diversified the organization’s portfolio beyond traditional Medicare Advantage, launching new ventures in care delivery, home-based services, and complex care management. These initiatives have not only opened new revenue streams but have also positioned SCAN as a national innovator in senior care.