Your Money
WHAT TO KNOW ABOUT NEW MEDICARE RULES
You have reasons to be more careful when choosing a plan
During open Medicare enrollment season, the average beneficiary has about 50 different plans to choose from. That’s a lot. Because the decision can be so complicated, many people seek expert assistance in choosing a plan. According to Jeannie Fuglesten Biniek, deputy director for the Program on Medicare Policy at KFF, insurance brokers and agents “serve an important role and are useful in helping people sort through what is out there and how to make sense of it.”
That said, those shopping for a Medicare Advantage or Part D prescription drug plan during open enrollment season this year should be aware of some new rules that could affect their ability to compare all their policy options.
The new guidelines, adopted by the Centers for Medicare & Medicaid Services (CMS) in April, reflect a January 2025 executive order that directs federal agencies to reduce red tape and regulations.
But some changes “could make things more confusing for people making decisions about their coverage,” says Gretchen Jacobson, a vice president at the Commonwealth Fund, a foundation focused on health care research.
The new sales rules, effective before the Oct. 15 open enrollment launch, apply to Medicare Advantage—the private alternative to original Medicare—and to Part D drug plans. The rules cover agents and brokers, who enroll people in plans themselves or connect consumers directly to insurers to enroll.
WHAT’S DIFFERENT THIS YEAR
The changes roll back rules, finalized in 2023, intended to help ensure that agents and brokers act in customers’ best interests when recommending Medicare plans. Starting with this open enrollment season:
▶︎ In the first minute of a Medicare sales call, agents and brokers no longer have to disclose that they don’t offer all options available in your area and that they don’t provide information on plans they don’t offer. The disclosure, still required, can come later in the call.
▶︎When making that disclosure, agents and brokers no longer have to mention that you can contact your State Health Insurance Assistance Program (SHIP) for information about all coverage. The nation’s 54 SHIPs provide free, unbiased information on all Part D, Medigap and Medicare Advantage plans available in their areas.
WHY IT MATTERS
Allowing agent and broker disclaimers later in sales calls and removing their references to SHIP “could erode the protections gained in recent years meant to enable better enrollment decisions,” Megan O’Reilly, an AARP vice president of government affairs, said in a comment letter to CMS Administrator Mehmet Oz.
Just a few years ago, CMS tightened marketing rules amid concerns that agents and brokers were steering people into unsuitable coverage because of improper financial incentives from insurers. A barrage of misleading and confusing TV ads further complicated open enrollment season.
CMS is also loosening restrictions on the use of superlatives, such as “best” and “highest-rated,” in Medicare Advantage and Part D marketing materials.
“These changes remove some of the guardrails that protected consumers from unscrupulous brokers,” says Andrew Twinamatsiko, a director of the Center for Health Policy and the Law at Georgetown University.
All the more reason to rely on trusted sources of information like those listed below. Making an informed choice among plans during open enrollment can make it easier to stay healthy the rest of the year.
Tony Pugh is an award-winning writer and editor who covers Medicare for AARP.
TIPS FOR SMARTER MEDICARE SHOPPING
Before contacting an agent or broker, visit the government’s medicare.gov website and identify your coverage options through the Medicare Plan Finder tool. There you can compare Medicare Advantage (MA) and Part D prescription drug plans available where you live.
Take note of plans’ ratings on Medicare’s five-star scale; five stars is the highest, and any plan with less than three stars is considered poor quality, according to the nonprofit National Council on Aging. For MA plans, the stars are based on factors including customer service, treatment of chronic conditions and provision of preventative care. Part D plans are also based on measures such as accuracy of their pricing and how easily enrollees can obtain their needed medicines.
Seek advice from your local State Health Insurance Assistance Program (SHIP) counselors, whom you can reach at shiphelp.org. You can find free, unbiased information on questions including how to enroll, how to change coverage and how to seek assistance with out-of-pocket Medicare costs.
Make sure that agents or brokers you’re dealing with are reputable. Check for their license through your state insurance department (visit naic.org and click on Insurance Departments). Also check the directory of the National Association of Benefits and Insurance Professionals (visit nabip.org and click on Find an Agent).
Get help from us. For quick answers to your questions, visit aarp.org/medicare. And AARP is working with Chapter, a service that provides personalized Medicare plan guidance. Licensed advisers can help you compare plans at no cost. Go to aarp.org/medicare/chapter.