Photo: Maskot/Getty Images
Brokers who sell Medicare Advantage plans may not be telling consumers about all of the plans available, according to a new Urban Institute report.
Brokers, who are paid by insurers, may be withholding information because they are not being given commissions to sell those plans, according to Laura Skopec, senior research associate at the Urban Institute and one of the authors of the report.
“Some plans are not being talked about because commissions are not being paid,” Skopec said. “We heard about it last year too.”
Brokers don’t sell every plan that is available. But all plans may be found online at the Medicare plan finder. Open enrollment began on Oct. 15 and ends on Dec. 7.
WHY THIS MATTERS
For the 2026 plan year, insurers have exited markets where plans are unprofitable and have also made cuts to benefits.
In Vermont, only an estimated third of residents who qualify for Medicare have access to an MA plan after UnitedHealthcare and Vermont Blue Advantage left the market. Humana, the remaining insurer, offers three plans. Last year, eight plans were available in the state.
“What we heard from agents and brokers is that in addition to exiting markets, plans are offering zero commissions so that agents and brokers won’t sell them,” Skopec said.
This is pushing people to enroll in more profitable plans.
One independent licensed broker, who did not wish to be named, said many insurers are not paying them to sell PPO plans, but are being given commissions for HMO plans. Brokers are also not being given commissions to sell some Part D drug plans, she said.
PPO, for Preferred Provider Organization, is a type of plan that offers a network of providers but gives the option to see physicians outside of the network. Health Maintenance Organization, or HMO, plans have narrower networks that require members to see a primary care doctor before going to a specialist, according to the broker.
“It’s becoming more challenging for the population to have a choice,” she said.
Skopec said all brokers, whether they be independent agents, those who work in local communities or those who work for a healthcare plan, are paid by health plans.
The big picture of the Urban Institute report is that this is all public money, Skopec said. The money comes from taxpayers to the federal government to the health insurers. The funding covers the marketing expenses. The government shutdown hasn’t affected this system, though the Centers for Medicare and Medicaid Services recently called back an estimated 3,000 furloughed employees for temporary help during open enrollment.
The Urban Institute report found that agents and brokers, especially local and independent brokers, play an important role in educating beneficiaries about their options for Medicare.
Insurers pay brokers more for enrolling consumers in an MA plan, as opposed to a Medicare gap or supplemental plan that’s needed under original Medicare, according to Skopec. Brokers don’t get paid anything to enroll individuals in a Medicare plan except for a small commission for Part D plans, she said.
But brokers are incentivized to provide a good health plan match for their clients.
“What we’ve heard from agents and brokers, they really need referrals to keep their business alive,” she said. "They need good business.”
THE LARGER TREND
During open enrollment, Medicare beneficiaries can enroll in original Medicare, Medigap plans that support needed supplement coverage for original Medicare, Medicare Advantage and Prescription Drug Plans.
Beneficiaries struggle to make a decision when faced with so many choices on cost and coverage and often seek assistance from health insurance agents and brokers, according to the Urban Institute’s “Challenges of Choice in Medicare, The Role of Agents and Brokers in a Public Program.”
MA enrollment has grown rapidly over the past decade, from 31% of Medicare enrollment in 2014 to 54% in 2024. This growth, said the Urban Institute, was fueled by MA overpayment that often led to heavy investment in marketing.
While CMS sets maximum commissions in the MA market, the agency does not have the authority to regulate other administrative fees that may be paid to agents, brokers and other sales organizations, limiting its ability to create a level playing field among MA plans or between MA and original Medicare, the report said
Brokers and others interviewed for the Urban Institute report said they were concerned that organizations that generate sales leads for agents and brokers may engage in misleading marketing and overwhelm beneficiaries with many phone calls.
Starting in 2024, MA margins tightened, leading some insurers to stop offering commissions altogether for some plans or to exit unprofitable markets.
The Urban Institute recommends that payment and benefit policy include simplifying and strengthening Medicare, tying agent and broker commission increases to inflation and benchmarking them to other insurance markets. It also recommends reining in MA overpayment, increasing funding for neutral enrollment assistance and improving transparency, oversight and enforcement.
Email the writer: SMorse@himss.org