MW Medicare Advantage buyers beware: The rules for selling plans are changing - and could harm seniors

By Jessica Hall

'This absolutely puts profits ahead of people'

Medicare Advantage represents 51% of the total Medicare market of roughly 69.6 million subscribers.

When it comes to choosing a Medicare Advantage plan, now more than ever, buyers must beware.

The marketing rules behind Medicare Advantage are about to get looser, benefitting brokers and agents that sell the private-insurance alternative to traditional Medicare.

While the rule changes individually may not be radical, taken together, they mark an erosion of protections for beneficiaries choosing their medical plans, analysts said.

Under the new rules, which are effective June 1, the Centers for Medicare & Medicaid Services $(CMS)$ agreed to relax restrictions on the use of superlative language in marketing materials - such as "best," "most" and "cheapest" - and remove strict rules that separated the lines between educational and marketing events.

Other changes include removing requirements for brokers and agents to inform beneficiaries about State Health Insurance Assistance Programs (SHIPs), which are free, independent counseling services for Medicare beneficiaries. Another change removes the requirement that agents have to disclose which plans they represent in the first 60 seconds of a call or meeting - allowing them to disclose it later in the discussion.

"This absolutely puts profits ahead of people," said Mary Johnson, an independent Medicare and Social Security analyst. "These changes simply lock in insurer profits, and the profits of members of Congress and the [Trump] administration who happen to own shares in these companies."

The new rules come as Medicare Advantage's subscriber gains have cooled, as the private insurers behind the program exit certain unprofitable markets or discontinue plans due to higher-than-expected medical expenses among subscribers, as well as changes in government payments that have squeezed margins.

The Medicare open-enrollment season runs from Oct. 15 to Dec. 7 each year, allowing beneficiaries to change their health and drug plans. A separate Medicare Advantage open-enrollment period runs from Jan. 1 to March 31 annually, letting existing Medicare Advantage users switch plans or return to traditional Medicare.

Open-enrollment season typically involves heavy marketing, with older adults bombarded with media ads and mail fliers, making it difficult to know where to get trusted information.

Medicare Advantage plans had 35.5 million enrollees as of February 2026, up 3.2% from 34.4 million enrollees as of February 2025, according to data from CMS. That's down from growth that ranged from 7% to 10% a year between 2017 and 2024. Medicare Advantage represents 51% of the total Medicare market of roughly 69.6 million subscribers.

The stakes are high, as the overall customer base for Medicare will continue to rise as about 11,000 Americans turn 65 every day and become eligible to choose either traditional Medicare or Medicare Advantage.

Read: Medicare Advantage's 'secretive maze' of costly marketing and incentives needs an overhaul, Senate report says

'There's the possibility of confusion'

Part of the rollback of marketing rules was driven by feedback from brokers and agents, who saw the protocols as too restrictive or too duplicative. The rollback is also driven by the January 2025 executive order "Unleashing Prosperity Through Deregulation," under which the government has worked to eliminate what is seen as unnecessary or burdensome regulations, said Alex Cottrill, senior policy analyst specializing in Medicare at KFF.

"It's not a free-for-all. There are still rules in place. The extra guardrails have gotten a little looser," Cottrill said. "Every time you take a guard rail away, there's the possibility of confusion."

Although CMS still prohibits misleading claims, it will allow superlatives to be used in marketing such as a plan being the "best" or having the "most" providers without evidence to support it, under the new rules.

"Superlatives can be emotional - they can be very strong statements. While the statements may be accurate in a certain context, beneficiaries might not be understanding that it's only a limited context," Cottrill said.

Read: Overwhelmed by Medicare Advantage ads? You're not alone, but change may be coming.

Other changes may be more nuanced, such as allowing agents to disclose later in a conversation which plans they represent instead of in the first 60 seconds.

"Agents and brokers complained about having to disclose the information in the first minute, saying it disrupted the flow of natural conversation. Now they will have more time to disclose it in the conversation," Cottrill said.

Brokers and agents get paid commissions for each new Medicare Advantage subscriber they sign up, and a lesser amount for renewals. They receive no commission if the subscriber signs up for traditional Medicare.

SHIPs and free services

Another new rule eliminates the requirement that brokers have to inform beneficiaries that they could get free and independent information from SHIPs. Instead, CMS viewed 1-800-Medicare and Medicare.gov as being more centralized and standardized and having 24/7 access, Cotrill said,

"SHIPs are a really unique resource. Beneficiaries know less about them. They operate at the local level and might have knowledge on a local network at a level of specificity that you couldn't get at Medicare.gov, for example," Cottrill said. "SHIPs counselors are trained to spend a long time with clients and spend time one-on-one.""It remains to be seen what the impact of the changes will be. Awareness of SHIPs is not high to begin with," Cottrill said.

Read: Medicare open enrollment: if you're confused, this program can help

Johnson said education about SHIPs should be given to consumers as they approach age 65 and are close to enrolling in Medicare.

"The public in general is not getting the type of guidance needed for making the difficult financial decisions as it now stands. What we are stuck with feels more like a shakedown," Johnson said.

Others disagreed, saying SHIPs can provide inconsistent information.

Cobi Blumenfeld-Gantz, chief executive of Chapter, a company that helps subscribers choose Medicare and Medicare Advantage plans, pointed to a 2025 study published in JAMA Network Open in which researchers mystery shopped more than 130 SHIP locations. They found that guidance was often inaccurate and incomplete, according to the study.

For example, when the mystery shopper asked whether a specific physician was in network with a specific health plan being considered, the SHIP counselor provided an accurate and complete answer only 26% of the time, the study found. Meanwhile, when the mystery shoppers asked about the enrollment windows they could use to enroll in Medicare or change coverage, more than one-third of counselors provided incomplete information.

"There are many problems with the guidance that brokers provide but referring folks to SHIPs isn't the solution," Blumenfeld-Gantz said.

"Today, brokers are not required to look at a minimum number of plans, nor are they required to recommend Medicare Supplements on an equal basis to Medicare Advantage plans. The result is that consumers often receive results biased by the subset of plans that brokers choose to sell - or those that pay more in commissions," Blumenfeld-Gantz said. "Buyers still have to beware."

-Jessica Hall

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April 24, 2026 14:11 ET (18:11 GMT)

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