- In the market, health insurance leads cost roughly $50 to $125 to turn into one closed ACA customer, $75 to $350 for a Medicare customer, and $250 to $500 for an off-exchange private under-65 customer.
- Those are cost-per-acquisition figures: what you spend to land one paying customer, not the price of a single lead.
- The segments split by product and subsidy, not by age. ACA and private under-65 are both under 65 and behave nothing alike.
- ACA is the cheapest lane because it is subsidized, high-volume and commoditized. Private under-65 is the priciest because it is none of those things.
- To go from a segment CPA to what you can pay per lead, multiply the CPA by your own close rate.
Quick answers:
- What is the cost per acquisition for health insurance leads?
- Why is ACA cheaper than private under-65 health leads?
- Is that a per-lead price or a per-customer price?
- How do I turn a CPA into what I can pay per lead?
- How is under-65 health insurance commission paid?
What each health insurance segment costs to acquire
Search for a cost per acquisition on health insurance leads and you get a definition, a vendor price list, and one worked example that belongs to a Medicare call center. What you rarely get is the number by segment.
In the market today, buying and closing health insurance customers runs about:
- ACA on-exchange, subsidized: $50 to $125 per acquired customer.
- Medicare, age 65 and up: $75 to $350 per acquired customer.
- Off-exchange private, under 65: $250 to $500 per acquired customer.
They reflect market and operator knowledge, not a rate card and not our own results. The split that matters is product and subsidy, not age. Two of these three segments sit under 65, and they cost four to five times apart.
| Segment (by product and subsidy) | Market CPA, per closed customer | What puts it there |
|---|---|---|
| ACA on-exchange, subsidized | $50 to $125 | Premiums are subsidized, the pool is large, plans are standardized, intent runs lower |
| Medicare, 65 and up | $75 to $350 | Strong intent, but demand and lead prices spike inside the annual enrollment window |
| Off-exchange private, under 65 | $250 to $500 | No subsidy, a smaller pool, a harder close, and no enrollment season to concentrate demand |
Market CPA ranges reflect operator and market knowledge (Elevarus, 2026). They are not an Elevarus rate card or a client result. The drivers in the right column are explained and sourced in the sections below.
Why ACA is cheaper and private under-65 the most expensive
A few things make ACA cheap to acquire and private under-65 expensive.
Subsidy does most of the work. An ACA shopper who qualifies for a premium subsidy is buying something the government helps pay for, so the yes comes easier and the close rate climbs. A private under-65 buyer pays full freight and closes slower.
Volume does the rest. The ACA market is enormous. About 19 million people were enrolled in ACA Exchange plans in early 2026, per the federal government’s own estimate. Enrollment averaged about 22 million across 2025 and is projected to settle toward 17 million in 2026, according to KFF. A market that size is commoditized: many shoppers, many sellers, thin prices. The off-exchange private market has no equivalent scale, so nothing pushes acquisition cost down.
Medicare sits in the middle for a different reason: intent is high, but demand concentrates in the annual enrollment window, and lead prices climb hard inside it. Buy in season and your acquisition cost rises with everyone else’s.
Commission is what you earn, CPA is what you spend
Two numbers in this market look almost identical and mean opposite things. Keep them apart.
CPA is spend. It is what one customer costs you to acquire. Commission is revenue. It is what the policy pays you back after you land it.
On the revenue side, Medicare and the two under-65 lanes are built differently, and the difference is structural rather than a matter of degree:
- Medicare Advantage commission is a flat amount per enrollment, and the government sets the ceiling nationally. CMS set the contract year 2026 national caps at $694 for an initial enrollment and $347 for a renewal, in its June 2025 compensation memo to plans. The renewal cap is exactly half the initial cap, under the rule published in the Federal Register, which is why Medicare commission tables show the same two-to-one shape.
- Under-65 commission is a flat dollar amount, usually per member per month, and each carrier sets its own rate state by state. There is no federal dollar ceiling on it the way there is for Medicare Advantage, but the carriers cap it themselves: nine of the schedules stop counting after five members on one policy.
The distinction matters, because a share of premium and a flat monthly amount behave nothing alike. One 2026 compilation of 29 carrier schedules, published by the FMO Agent Resource Center, shows 24 paying a flat dollar amount, three paying a percentage of premium, and two doing both depending on the state or the age of the plan. According to that same compilation, most of the flat rates fall between $15 and $30 per member per month.
Read your own contract before you use any of that, because the exceptions are where the money moves. Most of those schedules pay per member, so a household pays more than a single enrollee, but a few pay per contract, which means household size changes nothing. Genuinely non-ACA products are different again: Priority Health pays short-term business as a percentage. What does not change the rate is the exchange, since Ambetter, Antidote Health, CareSource, Cigna and Blue Cross Blue Shield of North Carolina all publish the same commission on and off exchange for 2026.
| Commission, side by side | Medicare Advantage | Under-65 individual and family |
|---|---|---|
| How it is paid | A flat amount per enrollment | A flat amount per member, every month |
| Who sets the level | CMS, one national cap | Each carrier, and it varies by state |
| 2026 level | $694 initial, $347 renewal, national (CMS, 2026) | Mostly $15 to $30 per member per month (FMO Agent Resource Center, 2026) |
| What renewal pays | Half the initial year | Usually the same rate as year one |
| Effect of household size | One enrollee, one payment | Every covered member counts, commonly up to five |
Medicare figures are the CY2026 national caps published by CMS. Under-65 figures are compiled from the 2026 carrier schedules republished by the FMO Agent Resource Center, which notes carriers may update them at any time.
Then there is the trap. A lead vendor’s 2026 guide puts under-65 commission at about $200 to $500 a year, per Aged Lead Store, and for a single member that range sits right on top of the under-65 acquisition cost of $250 to $500. They are not the same number twice. One is what a customer costs you to win once. The other is what that customer pays you every year you keep them. Netting the two in your head is how the math goes wrong.
Turn a segment CPA into what you can pay per lead
A CPA is a per-customer number; a lead price is a per-lead number, and your close rate bridges them.
How household size changes what a sale is worth
That formula holds. What changes is the number you feed it. Where a carrier pays per member per month, the size of the household moves your revenue without moving your close rate. According to its 2026 schedule, Blue Cross Blue Shield of Texas pays $25 per member per month on its Blue Advantage Plus plans and counts a maximum of five members per policy, so one member returns $300 over twelve months and a four-member household returns $1,200. Same policy, same close rate, four times the revenue. That only holds where your carrier counts members and the household sits inside its cap; on a per-contract schedule the household changes nothing.
So the ceiling is not one number per segment. It moves with the average household you write, which is why the target CPA in that formula has to come from your own revenue per sale: the per-member rate in your carrier contract, the members you average per sale, and the months you expect to hold the policy.
Run it once per segment, write the ceilings on a card, and shop leads against them. Measure your close rate on a real batch first; a rate you assumed instead of counted is the fastest way to overpay.
Key numbers – ACA on-exchange customers cost about $50 to $125 to acquire; Medicare about $75 to $350; private under-65 about $250 to $500 (market and operator ranges, Elevarus, 2026). – About 19 million people were enrolled in ACA Exchange plans in early 2026 (ASPE, 2026). – ACA enrollment averaged about 22 million in 2025 and is projected to settle toward 17 million in 2026 (KFF, 2026). – Medicare Advantage commission is capped at $694 initial and $347 renewal nationally for contract year 2026 (CMS, 2026 compensation memo). – Under-65 individual commission is a flat dollar amount, usually per member per month, on 24 of 29 carrier schedules compiled for 2026, most rates between $15 and $30 (FMO Agent Resource Center, 2026). – Under-65 individual commission runs about $200 to $500 a year (Aged Lead Store, 2026 pricing guide).
Frequently Asked Questions
What is the cost per acquisition for health insurance leads?
It depends on the segment, and the segment is set by product and subsidy, not age. In the market, an ACA on-exchange customer costs about $50 to $125 to acquire, a Medicare customer about $75 to $350, and an off-exchange private under-65 customer about $250 to $500. Those are per-acquired-customer figures, not per-lead prices, and they are market ranges rather than a rate card.
Why is ACA cheaper than private under-65 health leads?
ACA coverage is subsidized, so it closes more easily, and the market is large and standardized, so prices stay thin. About 19 million people held ACA Exchange plans in early 2026. Private under-65 coverage is unsubsidized, sold into a smaller pool, and harder to close, so the cost to acquire one customer runs four to five times higher.
Is that a per-lead price or a per-customer price?
A per-customer price. Cost per acquisition is total spend divided by customers closed, not the price of a single lead. A single lead costs far less, because only a fraction of leads become customers. To move from one to the other, use your close rate.
How do I turn a CPA into what I can pay per lead?
Multiply the target CPA by your close rate. A $100 acquisition cost at a 20 percent close rate means up to $20 a lead; a $400 cost at 10 percent means up to $40. Anything below that ceiling is margin, so measure your real close rate first.
How is under-65 health insurance commission paid?
On ACA-qualified individual and family plans, almost always as a flat dollar amount per member per month, set by each carrier and varying by state, rather than as a share of premium. One 2026 compilation of 29 carrier schedules shows 24 paying a flat dollar amount, three paying a percentage of premium, and two doing both. According to that same 2026 set, most flat rates fall between $15 and $30 per member per month, and nine of those carriers stop counting after five members on one policy.
Cite this data
Cost Per Acquisition for Health Insurance Leads by Segment. Elevarus, 2026. The segment cost-per-acquisition ranges are market and operator knowledge, presented as market ranges, not an Elevarus rate card or client result. ACA enrollment figures are from HHS ASPE and KFF. Medicare Advantage commission caps are quoted from CMS rulemaking in the Federal Register and from CMS’s contract year 2026 compensation memo. Under-65 commission structure is compiled from the 2026 ACA-qualified carrier schedules republished by the FMO Agent Resource Center. The under-65 annual commission range is vendor-published by Aged Lead Store and identified as such.
Sources:
- HHS ASPE, ACA Exchange Enrollment in 2026
- KFF, What We Know So Far About 2026 ACA Marketplace Enrollment
- Federal Register, CMS Medicare Advantage and Prescription Drug Benefit final rule
- Aged Lead Store, Health Insurance Leads Cost 2026 Pricing Guide
- FMO Agent Resource Center, 2026 carrier commission schedules
- CMS, Contract Year 2026 Agent and Broker Compensation Rates
Where to take this next
Set your three ceilings, then shop against them. For the price side, our breakdown of what health insurance leads cost for agents compiles the published ranges by lead type. If the line between the two under-65 lanes is still fuzzy, start with under-65 versus ACA health insurance leads, because they do not share a buyer, a season or a close rate.
If you would rather buy answered calls than sort leads, talk to us about what we run.
