Selecting the right 2025 Medicare Part D prescription drug plan or private insurer’s Medicare Advantage plan during Open Enrollment, ending December 7, is no picnic. In fact, 88% of beneficiaries in an eHealth survey said shopping for a plan is confusing and overwhelming.
That’s why roughly one in three people in Medicare hire an agent or broker. (Independent agents represent multiple insurers and are paid by the companies; brokers, also generally paid by insurers, let people choose policies and send them to agents for purchases.) But there’s a big problem using a Medicare agent right now.
Although 96% of Medicare Advantage and Part D plans contract with agents, Aetna, Centene (which sells Wellcare policies), Cigna, Elevance (which sells Anthem policies), Humana and United Healthcare have stopped paying agents commissions on some Medicare Advantage plans in certain markets.
Which insurers aren’t paying some agents
Centene, the largest Part D insurer, has stopped paying commissions on all its standalone Part D plans. Aetna and Cigna aren’t paying commissions for some new Part D plans and Aetna, Cigna, Elevance, Humana and United Healthcare have halted commissions for some of their Medicare Advantage plans.
“This is not a decision that we took lightly, but it was the right thing to do, Elevance chief financial officer Mark Kaye said at the UBS Healthcare conference, according to Modern Healthcare.
The Association of Health Insurance Programs (AHIP), did not respond to Fortune’s request for a comment about some agents and brokers not getting paid to sell Medicare policies.
In many cases, the insurers’ Medicare Advantage businesses have grown so fast in 2024, companies are curbing commissions to limit sales.
“They say, ‘Oh my gosh, we need to tighten things up so we don’t get outsized growth in a product that was already barely hanging on,’” says Vijay Kotte, CEO of the health insurance marketplace GoHealth.
The insurers sometimes aren’t paying agents for policy renewals either.
“Renewal commissions have historically [been] seen by the industry as a way to earn a commission as long as the member stays in the plan—an untouchable,” says Sam Melamed, founder of the Insurance Forums online community for agents. The maximum commission for Part D and Medicare Advantage renewals, set by the Centers for Medicare and Medicaid Services, is 50% of the amount for initial purchases.
What it means for Medicare shoppers
Because some agents aren’t getting paid to sell certain Part D or Medicare Advantage policies, they may not recommend those plans even when they’re the best choices for beneficiaries.
Brokers and agents who don’t offer all plans in an area must disclose that to clients, but they’re not required to say the proportion of plans they sell or how their compensation varies across plans, according to the Commonwealth Fund, a health research nonprofit.
“Unfortunately, brokers’ and agents’ financial incentives are not transparent to beneficiaries,” says Gretchen Jacobson, vice president of the Medicare program at the Commonwealth Fund.
She believes that when insurers aren’t paying agents and brokers, “it’s reasonable to expect that brokers will enroll their clients in plans that pay them commissions, which may not always align with the needs of beneficiaries.” That’s called steering.
Mark Squires, a Kansas City Medicare agent who dubs himself The Medicare Whisperer says, “Agents are going to be tempted to not mention the plans where they’re not going to get paid.”
A year when Medicare shoppers could use help
If there was ever a year when Medicare shoppers might want to hire an agent, this is it. Insurers have been changing plans dramatically due to Part D rules taking effect in 2025 and the financial squeeze on some Medicare Advantage plans.
“Now more than ever, people need trained professionals to guide them through their Medicare decisions,” says NerdWallet’s Elizabeth Ayoola. “While companies may be improving their bottom lines by cutting these agents’ commissions, seniors end up with the short end of the stick, unfortunately.”
Medicare beneficiaries can also run into trouble if they buy plans from agents who aren’t getting paid: the agents can’t help them handle pre-authorization rejections or appeals for denied claims.
If an agent has no contract with an insurer not paying commissions, “we have no access to any information about the client’s specific policy,” says Squires.
A tricky situation
“There is no other profession I know in the United States, and maybe in the world, that is asked to work for free,” says Ronnell Nolan, president and CEO of Health Agents for America (HAFA). “So why in the hell does an insurance company think that insurance agents should do that?”
Melamed says insurers not paying Medicare salespeople “is one of the biggest explosions of discussion I’ve seen since we started Insurance Forums.”
Occasionally, in the past, a health insurer would offer one or two non-commissionable Medicare Advantage or Part D plans, says Danielle Roberts, chair of the Medicare Advisory Group of the National Association of Benefits and Insurance Professionals. “But this year has been off the charts,” she notes.
Medicare beneficiaries may not know that their agent isn’t suggesting a Part D or Medicare Advantage plan because they can’t get paid to sell it.
But some agents are still selling Part D and Medicare Advantage policies from insurers that aren’t paying them. “Our policy has always been that if a plan where we don’t get paid is what’s right for our client, that’s what we’re going to recommend,” says Squires.
Others, Melamed tells Fortune, “are saying: ‘I just refuse to write business with a plan that’s not paying commissions.”
The moves to restore commissions
Insurance agent trade groups have been trying to persuade insurers to pay all commissions.
Roughly 2,000 members of Health Care Agents of America signed a Change.org petition so Wellcare would resume paying Part D commissions. “HAFA argues that fair compensation is not just a matter of equity for agents—it’s a necessity for protecting the seniors who depend on them,” the petition said.
The National Association of Benefits and Insurance Professionals has been calling insurers directly.
So far, both efforts have been unsuccessful.
How to buy a policy without an agent
If you want a Part D or Medicare Advantage plan for 2025 and want to compare every possible, go to the Medicare.gov Plan Finder tool. It lets you see all choices for your area and compare your out-of-pocket cost and coverage with each policy.
Some agents who aren’t getting paid to sell policies are directing customers to the Medicare.gov site to buy them.
“If I have a client who doesn’t take any medications, I’m telling them the options: ‘Here’s a plan that’s $12 a month that I could put you on, but there’s also this Wellcare plan [not paying agents] that’s $0. I feel you need to know about it. If that’s best for you, here’s how you enroll on Medicare.gov,” says Roberts. “We’re actually participating in losing money.”
After using Plan Finder, if you want to buy a Part D or Medicare Advantage plan on your own, you can call the insurer to do so. Just remember that you won’t have an agent to help if something goes wrong.
When agent fees might return
Some Medicare agents believe the compensation cloud may disappear in 2025 or 2026, offering more choices to people shopping for policies.
“I believe with all my heart that in a year or two, the insurance companies will be back with their hat in their hand asking us to come back,” says Squires.
Roberts thinks President Trump and Republicans controlling Congress might end the agent payment problem for Medicare Advantage plans.
“Republicans tend to be more favorable toward Medicare Advantage than Democrats, so we may see changes that would make Medicare Advantage plans more profitable again, which might reinstate payment for us for Plan Year 2026,” she says. “I’m less confident about Part D.”
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