Medicare Relaxes Rules for Agents, Brokers Before Open Enrollment This Fall

New rules pause trend of tighter regulation

Just a few years ago, CMS was tightening marketing rules amid concerns that agents and brokers were steering people into unsuitable coverage because of improper financial incentives from insurers. A barrage of ads that consumers considered misleading and confusing further complicated open enrollment season.

Last year, the Justice Department sued three Medicare Advantage insurers and three broker organizations, claiming the carriers paid the brokers hundreds of millions of dollars in illegal kickbacks over five years to funnel people into their plans, whether it met their needs or not, a department press release said. The case is ongoing, and defendants have denied the accusations.

After years of increasing regulatory scrutiny, some Medicare marketers are pleased with the new rules.

“CMS repeatedly echoed NABIP’s recommendations throughout the final rule, demonstrating that the voices of agents and brokers and the beneficiaries they serve were heard,” says Michael Andel, senior vice president of government affairs at the trade group.

Many of the new CMS policies reflect a January 2025 executive order that directs federal agencies to identify at least 10 regulations to repeal for each new one proposed.

That deregulation is apparent throughout the new rules. One reduces the time that agents and brokers must retain recorded Medicare marketing calls from 10 years to six years, citing regulatory burden.

Another loosens restrictions on the use of superlatives, such as “best” and “highest-rated,” in Medicare Advantage and Part D marketing materials. Plans are already prohibited from providing misleading, confusing or inaccurate materials to beneficiaries, CMS says.

While streamlining the process is important, “you certainly don’t want to do so at the cost of creating confusion or providing less information to Medicare beneficiaries,” Jacobson says.

Agents, brokers and other marketing organizations that don’t sell all available plans must continue to say that they provide information only on the plans they offer.

“Overall, it’s deregulatory, at least as far as guardrails for brokers are concerned,” says Andrew Twinamatsiko, a director of the Center for Health Policy and the Law at Georgetown University in Washington.

Do your homework, then talk to agents

Before contacting any agent or broker, identify all your coverage options through the Medicare Plan Finder.

Then check out the advice of your local SHIP. The staff and volunteers put your interests first, provide free personalized information and don’t receive bonuses or commissions from insurers.

The nation’s 54 SHIPs provide free, unbiased information on all Part D, Medigap and Medicare Advantage plans available in your area. Their counselors can help you understand Medicare more broadly, avoid potential penalties and find out about financial assistance programs.

They’re the only federally financed programs that provide individual counseling for people on Medicare, their families and caregivers.

“[SHIP programs] must follow strict conflict-of-interest rules and have no financial affiliation with any private insurance company,” AARP’s O’Reilly says.

A 2022 Commonwealth Fund survey found that about 5 percent of people who signed up for original Medicare and 4 percent who chose Medicare Advantage used a SHIP counselor to help find coverage, compared with 5 percent in original Medicare and 9 percent in Medicare Advantage who used Medicare.gov or 1-800-MEDICARE. Removing the SHIP reference from millions of Medicare sales calls will reduce awareness of the program among plan shoppers, Jacobson says.

“Beneficiaries should continue to be made aware of other important information sources, including SHIPs, before discussing plan options” with agents, brokers and other third-party marketing groups, says the Medicare Payment Advisory Commission (MedPAC), which advises Congress about the program. The agency is against removing SHIP mentions from the disclaimer.

New rules could hurt the SHIP network

CMS, which originally provided the grants to states to create the SHIP advisory service, says enrollees are better served by 1-800-MEDICARE, which has representatives available 24/7 and standardized customer service training. References to Medicare.gov and Medicare’s toll-free number will remain in the disclaimer. Only the SHIPs will be removed.

SHIP volunteers “may not always have the expertise to help beneficiaries navigate increasingly complex MA [Medicare Advantage] and Part D programs,” CMS says. And because each SHIP provides different training for counselors, beneficiaries could receive “different information based on the SHIP and SHIP counselor that is ultimately reached.”

MedPAC says otherwise:

“SHIPs cover counseling topics in greater depth and offer more personalized assistance in comparison to 1-800-MEDICARE. For this reason, SHIPs often take referrals from 1-800-MEDICARE and other federal aging and disability resources to address more complex beneficiary concerns,” Michael E. Chernew, a Harvard health policy professor and MedPAC chair, wrote to CMS.

But resources for SHIPs have been limited for years, and “SHIP funding is currently less than $1 per Medicare beneficiary,” MedPAC says.

Allowing the disclaimer to be read anytime during sales calls, as long as it’s before any benefits discussion, will “fit in better with the flow of the conversation,” CMS says.

The brokers’ trade group agrees, saying the change better reflects the way calls proceed.

“There is no indication that delaying the reading of the disclaimer would improve an enrollment decision,” AARP’s O’Reilly says. Keeping the disclaimer in the first minute of a call maintains transparency.

Medicare rescinds midyear benefit notice

Medicare Advantage enrollees were to begin receiving midyear updates on their remaining supplemental benefits this year. These benefits, available only in Medicare Advantage plans, often include some dental, hearing and vision coverage.

CMS reviewed the regulation requiring the midyear benefit notifications after the president’s executive order and found them unnecessary and a “significant burden on MA [Medicare Advantage] organizations that outweighs the intended benefit.”

The government should make sure a plan’s enrollees know if they have unused supplemental benefits and should further require agents and brokers to tell prospective customers if benefits advertised on TV or elsewhere aren’t available to a caller, O’Reilly says. Insurers often offer multiple plans in an area, some with lower prices than others.

AARP also opposes removing Medicare Advantage enrollees’ assessments of customer service and care from the factors that determine a plan’s star rating.

“Those measures of how well MA plans work for their enrollees are essential elements of the current star rating system … that can inform beneficiary plan selection,” O’Reilly says. The two measures are among 11 that CMS will no longer use to determine star ratings, citing little variation in scores across plans.

A Medicare Advantage plan’s rating of one to five stars is intended to help people make choices on Medicare coverage. Part D plans are rated similarly.

Five stars is considered excellent. Medicare allows you to switch to a five-star plan anytime, except Dec. 1 to 7 each year, if one is available in your area.

But these plans are rare and often relatively small: Fewer than 5 percent of Medicare Advantage contracts, 18 total that can include more than one plan, have five stars for 2026. Two Part D contracts, 5 percent of the total, have five stars, CMS says.

A plan with fewer than three stars is considered poor quality, according to the National Council on Aging.

AARP supports the addition of a new rating on whether Medicare Advantage enrollees receive depression screening and follow-up mental health care and agrees “there is room for streamlining and simplifying the star ratings program to eliminate” unhelpful and redundant measures.