State Health Insurance Assistance Programs (SHIPs) are federally funded programs in every state and several territories that provide free, unbiased counseling to Medicare beneficiaries about navigating the Medicare program. Sometimes going by different names in different states (e.g., CHOICES in Connecticut, HICAP in California and New York, SHINE in Florida, etc.), this critical program serves an important role for people with Medicare, free from financial incentives dependent upon coverage choices.
Last year, the Trump Administration entertained eliminating all non-mandated funding for the SHIP program. As reported in a MedPage Today article titled “Leaked HHS Budget Draft Deletes Federal Spending for SHIP Counseling Programs” by Cheryl Clark (April 18, 2025), a leaked, “pre-decisional” budget for the Department of Health & Human Services for the 2026 fiscal year proposed to eliminate all discretionary funding for SHIPs (approximately 80% of the program’s overall funding). This proposal was not finalized, and Congress subsequently funded the SHIP programs for the duration of the fiscal year.
In the proposed Part C & D rule for CY2027, the Centers for Medicare & Medicaid Services (CMS) proposed to rescind a requirement that certain entities selling Medicare products have to disclose the existence of SHIPs to their customers (see our CMA Alert concerning the Center for Medicare Advocacy’s comments to this rule, available here.
In our comments in opposition to this proposal, reproduced below, we explain the importance of the SHIP program, particularly in light of extensive marketing misconduct surrounding the sale of Medicare Advantage plans, financial incentives that drive agents and brokers to steer people towards certain products that might not be in the best interest of individual beneficiaries, and the short-comings of 1-800-MEDICARE as an alternative.
- Updating Third-Party Marketing Organizations (TPMO) Disclaimer Requirements (§§ 422.2267 and 423.2267)
CMS proposes that Third-Party Marketing Organizations (TPMOs) no longer need to reference State Health Insurance Assistance Programs (SHIPs) as a source of information on all plan options. We strongly object to this proposal and view it as an effort by CMS to sideline SHIPs while both promoting agents and brokers and limiting their oversight. For the reasons outlined below, we urge CMS to rescind this proposal.
We remind CMS of its own justification for instituting these disclaimers as outlined in the proposed 2023 rule (CMS-4192-P), as discussed in our comments to that rule.[1] In the preamble to the proposed 2023 rule, CMS noted that it “has seen an increase in beneficiary complaints associated with and has received feedback from beneficiary advocates and stakeholders concerned about the marketing practices of third-party marketing organizations (TPMOs) who sell multiple MA and Part D products. In 2020, we received a total of 15,497 complaints related to marketing. In 2021, excluding December, the total was 39,617” (CMS-4192-P, pp. 1844-5).
During reviews of sales and enrollment call recordings between TPMO staff and beneficiaries, CMS reported that “[m]any of these calls demonstrate that beneficiaries are confused by these TPMOs, including confusion regarding who they are speaking to, what plans the TPMOs represent, and that the beneficiary may be unaware that they are enrolling into a new plan during these phone conversations” (CMS-4192-P, pp. 1900-01).
As we noted at the time, CMS’ findings were (and continue to be) consistent with the CMA’s experience, along with that of SHIP and Senior Medicare Patrol (SMP) programs with whom we communicate. Similarly, in comments to the 2023 propose rule, the National Association of Insurance Commissioners (NAIC) reported[2] that it and state regulators had heard many stories in which beneficiaries have enrolled in or been enrolled in plans with narrow networks that didn’t include their current providers, had pharmacy benefits with higher costs, imposed higher copayments than expected, didn’t have the benefits they had seen advertised, or that were completely inappropriate for their particular needs and not what they thought they were buying. These sales often involved agents/brokerages or TPMOs that represent only some of the options available to Medicare beneficiaries.
In our comments to the proposed 2023 rule, we asserted that the rules should be even stronger, including a reference to SHIPs; as we noted, “CMS funds these programs and they are the obvious Medicare experts in each state, and are a trusted resource for beneficiaries to get personalized assistance and verify the information they are receiving from third party marketers, brokers or agents.”
In addressing the revised disclaimer adding SHIPs as a source of information required by the April 2023 Final Rule, CMS notes in the current proposed rule that in comments to the prior proposed rule, “some stakeholders pointed out that budget constraints and limited training would hinder a SHIP’s ability to effectively assist beneficiaries with plan choices” (p. 54950). CMS now seems to adopt this stance of commenters, undoubtedly largely made up of agents and brokers who view SHIPs as competition. At the same time, CMS makes no reference to comments submitted by consumer advocates and others who strongly supported this change.
CMS notes that “[b]ased on CMS’s review and industry feedback, CMS determined that additional changes to the TPMO disclaimer may be appropriate” including reading the disclaimer “prior to the discussion of any benefits” instead of within the first minute and “remove SHIPs as a source of information from the disclaimer” (p. 54950).
CMS articulates its rationale for removing referral to SHIPs:
CMS is also proposing to remove SHIPs as a source of information from the disclaimer. CMS recognizes that, while SHIPs can be a source of unbiased information about plan choices, informing beneficiaries on every sales call about the SHIP may cause additional issues. SHIP volunteers may not always have the expertise to help beneficiaries navigate increasingly complex MA and Part D programs. CMS believes that beneficiaries enrolled in the MA and Part D programs may be more effectively served by information and entities for which CMS has direct oversight. Moreover, a recent article in the Journal of the American Medical Association Network [citation omitted] details a study conducted to determine if SHIP counselors provided accurate and complete information to Medicare beneficiaries about their coverage options. In this study, mystery shoppers posed as individuals newly eligible for Medicare. While over 94 percent of the responses differentiating Original Medicare from MA were accurate, fewer than half of counselors mentioned Dual-Eligible Special Needs Plans (D–SNPs) as an option for mystery shoppers posing as dually eligible beneficiaries. The results suggested that SHIPs may not always be able to address the needs of Medicare beneficiaries seeking unbiased information on coverage options.
CMS also recognizes that each SHIP works differently and provides different training to its counselors, which can vary further at the local level. This can result in Medicare beneficiaries receiving different information based on the SHIP and SHIP counselor that is ultimately reached. CMS believes that, for the TPMO disclaimer, 1–800–MEDICARE is a better option to assist beneficiaries with health care choices. 1–800–MEDICARE has representatives available 24/7 to assist beneficiaries, provides standardized training to its customer service representatives, is centrally monitored and controlled by CMS, which facilitates efficient and consistent information sharing, and is a one-stop shop for all beneficiaries, regardless of the state in which they live. (p. 54951)
CMS’ articulated rationale completely ignores a number of relevant issues, including, as discussed further below: 1) ongoing marketing misconduct and financial incentives of agents and brokers, including the fact that TPMOs don’t have to sell all available plans in a given area; and 2) the value of SHIPs and their unbiased counseling compared to both agents/brokers and the shortcomings of 1-800-MEDICARE.
Misconduct surrounding the sale of MA and Part D plans continues apace. As we outlined in a 2025 issue brief:[3]
As a result of aggressive marketing campaigns, as well as the overwhelming number of plan options available, in 2022 about one in three beneficiaries used insurance agents or brokers to help them choose a plan. Agents contract with insurers to enroll beneficiaries into those companies’ plans. Agent compensation and bonuses (such as trips, parties and cash) has historically been tied to enrolling large numbers of beneficiaries into specific plans. This incentive model creates a situation where an agent’s own financial interest might be at odds with the health care needs of the beneficiary he or she is advising. Insurers also make payments to companies known as field marketing organizations (FMOs) that provide administrative and operational support to agents and brokers, such as marketing and technology infrastructure [citations omitted].
In our brief, we cited to a November 2022 Senate Finance Committee report[4] which found:
that some TPMOs, brokers, and agents are cold calling seniors, enrolling seniors and people living with disabilities in plans without their consent, and enrolling seniors in plans that don’t meet their needs. Most troubling, it appears that vulnerable individuals with cognitive impairments and dual eligibility are being targeted.
More recently in March 2025, Senator Ron Wyden, Ranking Member of the Senate Finance Committee, released a report titled “Pushing Medicare Advantage on Seniors: Unraveling the Complex Network of Marketing Middlemen”[5] which found rapid growth in spending on marketing, and, as noted in the sub-heading to the corresponding press release, “Third-Party Marketing Organizations Resort to Increasingly Predatory Tactics to Enroll Seniors in Preferred Private Medicare Plans that Don’t Meet Their Needs”.[6] As summarized in the press release, key findings of the report include:
- Spending on “agents and brokers fees and commissions” by insurance companies investigated by the committee increased $2.4 billion to $6.9 billion from 2018 to 2023, nearly tripling.
- State and federal regulators have limited oversight of marketing practices, especially with the increased use of TPMOs and other subcontractors.
- The Medicare Advantage marketing boom has encouraged insurance companies and brokers to aggressively enroll seniors into plans that may not cover their preferred doctor or cover key health benefits.
Recognizing challenges that beneficiaries face in the Medicare marketplace, the Senate report concludes:
Medicare enrollees face a confusing and overly complex landscape of health plan options. While Traditional Medicare does not meaningfully market its services, MA plans flood the zone with mailers, online advertisements, and phone calls. These marketing services are conducted by a vast array of plan marketing affiliates, all for the purpose of directing eligible beneficiaries toward a private plan. They are sometimes deceptive and sometimes unclear. By the time a beneficiary speaks with an insurance agent, they may have been steered on the basis of minimal information about their health needs and are dramatically more likely to make an enrollment decision on the basis of their conversation with a broker. A resulting plan enrollment may not meet their health needs, may constrain choice of health care provider, and might impose the added burden of prior authorization and referral requirements.
Agents and brokers, along with TPMOs, do not have to contract with or sell all available plans in a given service area. This alone negatively impacts fully informed decision-making on the part of Medicare beneficiaries. Further, higher commissions are generally paid for Medicare Advantage (MA) plans compared to stand-alone Part D plans and Medigaps. Even within the MA market, insurers try to drive – or suppress – enrollment based on differing commissions between plan offerings.
For instance, in the most recent open enrollment period in the Fall of 2025, MA plans seeking to limit enrollment in certain less profitable plans cut back on commissions to brokers and other third-party marketers, while increasing commissions for more profitable plans. As noted in a recent STAT article:[7]
The most recent actions from Medicare insurers are catching the ire of state insurance officials, who are worried Medicare beneficiaries are having their choices artificially suppressed. […] Cutting or eliminating commissions paid to brokers is a sign that insurance companies don’t want any more enrollment — usually because they are enrolling too many people and are worried medical costs will rise. Although brokers may have a responsibility to enroll people in the best coverage for them, they have no incentive to enroll people in plans that don’t pay.
As noted in a recent Think Advisor article,[8] insurers have deliberately tried to influence enrollment choices in different plans by manipulating commissions:
Once the issuers saw more 2025 claims, and they decided that they had put underpriced products on the shelves for 2026, they took steps such as eliminating sales commissions and pulling plans off of electronic sales systems to keep hordes of potentially costly enrollees from surging onto their customer lists.
Further, many insurers pay no commission for Part D enrollments – severely disincentivizing agents and brokers from discussing stand alone Part D plans, and in turn, the option of traditional Medicare, instead favoring higher commissions for select MA plans. As stated in the same STAT article referenced above:
Brokers told STAT that the marketplace for Medicare prescription drug plans, known as Part D, has become particularly untenable. Almost none of the insurers selling Part D plans are paying commissions — meaning brokers are working for free if they help someone sign up for a Part D plan.
By proposing to eliminate reference to SHIPs in the TPMO disclaimer, CMS undermines the value of SHIPs and their unbiased counseling. In order to justify this proposal, CMS makes reference to a JAMA article[9], and while conceding that “over 94 percent of the responses differentiating Original Medicare from MA were accurate” points to the finding that “fewer than half of counselors mentioned Dual-Eligible Special Needs Plans (D–SNPs) as an option for mystery shoppers posing as dually eligible beneficiaries” and therefore concludes that “[t]he results suggested that SHIPs may not always be able to address the needs of Medicare beneficiaries seeking unbiased information on coverage options.” As discussed above, SHIPs are the only source of unbiased information compared to agents and brokers heavily influenced by disparate commissions driving enrollment that might not be the best options for individuals. As noted in the same JAMA article, “Insurance brokers can provide helpful information but may have financial incentives to steer enrollees to suboptimal choices.” Further, CMS ignored one of the JAMA article’s conclusions: “Given recent growth in MA and federal efforts to counter deceptive marketing practices from agents or brokers—in part by directing beneficiaries to SHIPs—policymakers should consider providing SHIP with additional resources for training and capacity improvements.”
Had CMS chosen to highlight the importance of SHIPs, rather than diminish their role in the Medicare marketplace, the agency could have consulted and cited to other sources, including with respect to the value the program offers in comparison to TPMOs, agents and brokers. Instead, CMS asserts that “for the TPMO disclaimer, 1–800–MEDICARE is a better option to assist beneficiaries with health care choices.”
Both 1-800-MEDICARE and private actors selling Medicare coverage fall short of the level and type of assistance to beneficiaries provided by SHIPs. As noted in a KFF report, the Medicare landscape facing consumers is daunting:[10]
Recent years have also seen a steep rise in advertising for private Medicare plans, as well as aggressive marketing tactics by insurance brokers and other third-party marketing groups, which may make it increasingly difficult for beneficiaries to seek clear guidance and select the coverage that best meets their needs.
The KFF report compares assistance provided by SHIPs compared to agents and brokers, and reiterates the justification for including reference to SHIPs in TPMO disclaimers:
Nonetheless, while many beneficiaries find brokers to be a helpful resource, they generally do not offer the same level of unbiased counseling as financially disinterested resources such as SHIPs or 1-800-MEDICARE, as they may not represent all coverage options available in a given county or region, and often have a financial incentive to steer beneficiaries towards Medicare Advantage over other forms of coverage. Following a rise in beneficiary complaints about misleading marketing practices by brokers and other third-party marketing groups, the Centers for Medicare & Medicaid Services (CMS) began requiring third-party marketing materials to mention SHIPs as an additional resource in 2024, highlighting the unique service that SHIPs provide in Medicare’s increasingly complex coverage environment.
Comparing the level of assistance SHIPs vs. 1-800-MEDICARE can provide, the report notes:
In comparison to 1-800-MEDICARE, the federal helpline for information and assistance with Medicare health coverage issues, SHIPs cover counseling topics in greater depth and offer more personalized assistance. For this reason, SHIPs often take referrals from 1-800-MEDICARE and other federal aging and disability resources to address more complex beneficiary concerns.
Noting that SHIP counselors spent on average three times the number of minutes spent on each counseling session compared to 1-800-MEDICARE contacts, the report notes that “[g]iven the more extensive one-on-one support provided by SHIP counselors, CMS often coordinates with local SHIP offices to refer beneficiaries whose cases are too complex to be addressed during calls to 1-800-MEDICARE alone.”
Among the resources KFF cites to is a 2024 document issued by the Department of Health & Human Services’ own Administration for Community Living (ACL),[11] which describes the critical role that SHIPs play:
Accessing affordable health insurance can be difficult even for those with Medicare. The SHIP program is the only resource that provides this level of unbiased, in-depth counseling and one-on-one assistance to older adults and people with disabilities who struggle to navigate the complexities of their financial and medical needs. Many beneficiaries utilize SHIP every year because of the complexity of their situations, including prescription needs and identifying plan network. SHIP counseling can help Medicare beneficiaries save thousands of dollars per year.
Helping illustrate the complexity of the assistance provided to SHIP beneficiaries, the average time spent on one-on-one counseling continues to increase annually, reflecting the ongoing need for and complexities of the questions and help that Medicare beneficiaries request. The average length of time spent assisting beneficiaries increased from 28 minutes in 2014 to 33 minutes in 2020. This is more than three times the 9.5-minute call average to the 1-800 Medicare call center reflecting the greater complexity of issues handled by SHIPs in comparison to 1-800 Medicare.
As summarized in a 2025 post by Georgetown University’s Medicare Policy Initiative:[12]
The value of SHIP is especially obvious when individuals eligible for Medicare are trying to decide among traditional Medicare, Medigap plans, MA plans, and Medicare Part D drug plans. SHIP counselors are vital resources, especially in an environment saturated with aggressive insurance company marketing and insurance brokers who may be giving advice in line with their personal financial motivations rather than a beneficiary’s best interests.
The Center for Medicare Advocacy strongly supports the current TPMO disclaimer informing beneficiaries, when applicable, that the TPMO does not contract with every available plan in a given service area. We also strongly support the current requirement that beneficiaries interacting with the TPMO be advised of the availability of SHIP services, where Medicare beneficiaries can get unbiased information about all available options in a given area, including all MA plans, all Part D plans and all Medigap plans, along with information about Medicare Savings Programs (MSPs), the Part D Low-Income Subsidy (LIS) and other federal, state and local programs that might be able to provide assistance to an individual. These two disclaimers – that the TPMO does not sell all plans that are available, along with reference to SHIPs, an unbiased source of information that can counsel on all plans available – are critically linked. A referral to 1-800-MEDICARE alone is wholly inadequate.
Rather than removing reference to SHIPs in TPMO disclaimers, CMS should be actively promoting SHIPs, including as a check on agent and broker misconduct instead of sidelining the SHIP program. Should CMS proceed with this proposal, it would signal a clear capitulation to the insurance industry and a regrettable rollback of an important consumer protection.
January 28, 2026 – D. Lipschutz
[1] CMA comments to proposed CY2023 rule, available here: https://medicareadvocacy.org/cma-comments-on-2023-part-c-and-part-d-payment-policies/.
[2] National Association of Insurance Commissioners (NAIC) letter to CMS (March 4, 2022), available at Senior Issues (B) Task Force (SITF) webpage under the Documents tab at:https://content.naic.org/cmte_b_senior_issues.htm.
[3] Center for Medicare Advocacy, Issue Brief: “Marketing Medicare Advantage and Part D Plans: Regulation and Recent Legal Challenges” (March 27, 2025), available at: https://medicareadvocacy.org/wp-content/uploads/2025/03/2025-CMA-Issue-Brief-Marketing-MA-and-Part-D-Plans.pdf.
[4] U.S. Senate Committee on Finance, Majority Staff, “Deceptive Marketing Practices Flourish in Medicare Advantage” (Nov. 2022) available at: https://www.finance.senate.gov/imo/media/doc/Deceptive%20Marketing%20Practices%20Flourish%20in%20Medicare%20Advantage.pdf.
[5] Senate Finance Committee Ranking Member Ron Wyden, “Pushing Medicare Advantage on Seniors: Unraveling the Complex Network of Marketing Middlemen” (March 2025), available at: https://www.finance.senate.gov/download/pushing-medicare-advantage-on-seniors-unraveling-the-complex-network-of-marketing-middlemen_-32425docx.
[6] Sen. Wyden press release titled “Wyden Investigation Finds Rapid Growth in Spending on Marketing Middlemen Among Medicare Advantage Plans” (March 25, 2025), available at: https://www.finance.senate.gov/ranking-members-news/wyden-investigation-finds-rapid-growth-in-spending-on-marketing-middlemen-among-medicare-advantage-plans.
[7]STAT News “Major health insurers like Humana, UnitedHealth are cutting broker commissions to avoid costly Medicare enrollees” by Bob Herman (Nov. 25, 2025), available at: https://www.statnews.com/2025/11/25/health-insurers-avoid-costly-new-medicare-enrollees-regulators-say/.
[8] Think Advisor, “Many Insurers Hid From 2026 Medicare Advantage Plan Sales” by Allison Bell (Dec. 8, 2025), available at: https://www.thinkadvisor.com/2025/12/08/many-insurers-hid-from-2026-medicare-advantage-plan-sales/.
[9] JAMA, “Accuracy of Medicare Information Provided by State Health Insurance Assistance Programs” by Kacey Dugan, Ilse Peterson, Allison Dorneo and Melissa Garrido (April 1, 2025), available at: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2832052#google_vignette.
[10] KFF, “The Role of SHIPs in Helping People with Medicare Navigate Their Coverage” (Sept 2025), available at: https://www.kff.org/medicare/the-role-of-ships-in-helping-people-with-medicare-navigate-their-coverage/.
[11] “DHHS FY 2025 Administration for Community Living, Justification of Estimates for Appropriations Committees” (2024) available at: https://acl.gov/sites/default/files/about-acl/2024-03/FY2025ACL-CJ-508.docx.
[12] Medicare Policy Initiative, “SHIPs Provide a Critical Service for Medicare Beneficiaries” By Jack Hoadley, Beth Fuchs, and Rachel Schmidt (May 14, 2025), available at: https://medicare.chir.georgetown.edu/ships-provide-a-critical-service-for-medicare-beneficiaries-may-14-2025/.