The Journal of American Medical Association (JAMA) Internal Medicine recently published a research letter written by Brown University School of Public Health researchers that “found that payments to Medicare Advantage brokers more than doubled between 2014 and 2022, rising from about $3.9 billion to roughly $10 billion a year.”
The key findings of the study by David J. Meyers, Jay Shroff, Jeffrey Marr, Em Balkan, Andrew M. Ryan, and Amal N. Trivedi were:
- Broker involvement in new enrollments increased from 35.8% (2014) to 43.7% (2022)
- Renewal broker enrollments increased from 50.1% (2014) to 69.4% (2022)
- Broker-related spending more than doubled, rising from $3.9B (2014) to $10.1B (2022)
- In 2022, 73.6% of broker spending was tied to renewal enrollments, not new enrollees
- Overall, 25.9 million MA beneficiaries generated a broker fee in 2022
As stated in the Brown Press Release, “‘At the end of the day, this is money that is coming from the U.S. taxpayer,” said Meyers, an associate professor of health services, policy and practice at Brown. “While insurance companies are spending a ton of money on brokers, we don’t know if it’s actually in the beneficiary’s best interest, since brokers are beholden to the companies […]’”
The Press Release notes: “One of the most surprising findings, according to Meyers, is that renewals rather than new enrollments were the primary driver of broker spending. Brokers receive an initial commission upon enrollment and additional annual payments for as long as a beneficiary remains in the plan. By 2022, 70% of Medicare Advantage beneficiaries generated a renewal, accounting for 74% of all broker commissions.”
2027 Compensation Rates
On June 1, 2026, after the Brown report was published, CMS issued broker compensation and other rates for 2027 in a memo to health plans. These amounts reproduced below are the maximum allowable amounts that plans can pay for both initial and renewal fees for MA and Part D plans, respectively. As discussed in a previous CMA Alert (Sept. 5, 2024), MA commissions are much higher than stand-alone Part D commissions. Plan sponsors have discretion to pay less than these amounts in order to drive business towards, or away from, certain plans. For instance, a growing number of Part D plan sponsors have stopped paying commissions altogether, which further incentivizes agents and brokers to push MA products.
Excerpt from CMS Memo:
MA and Section 1876 Cost Plans
| Compensation Type | National | Connecticut, Pennsylvania, District of Columbia | California New Jersey | Puerto Rico, U.S. Virgin Islands |
| Initial Year | $725 | $816 | $902 | $495 |
| Renewal Years | $363 | $408 | $451 | $248 |
PDPs
| Initial Year | $130 |
| Renewal Years | $65 |
Compare Spending on Agents/Brokers to SHIP Funding
The authors of the Brown study raise the issue of “whether spending on brokers could alternatively be directed to State Health Insurance Assistance Programs which are underfunded and provide a potential alternative source of information for beneficiaries.” As we outlined in a CMA Alert earlier this year (Jan. 29, 2026) 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. Our CMA Alert outlines how 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 also outlined in our CMA Alert, there have been recent efforts to undermine SHIPs, including proposals to eliminate federal funding for SHIPs (which was not finalized) and a Medicare rule removing the requirement that third-party marketing organizations (TPMOs) reference SHIPS as a source of information on all plan options (which was finalized).
In an analysis of the SHIP program by KFF titled “The Role of SHIPs in Helping People with Medicare Navigate Their Coverage” by Alex Cottrill, Juliette Cubanski, Meredith Freed, and Tricia Neuman (Sept. 24, 2025), it is noted that federal funding for SHIP programs across the country was $70 million in 2025 ($68 million in 2022, the year analyzed in the Brown study) – roughly $1 per Medicare beneficiary.
Conclusion
At the same time that it is widely established that Medicare Advantage plans are overpaid compared to what traditional Medicare spends on a given beneficiary (see, e.g., MedPAC, 2026), spending by MA plans on agent and broker commissions aimed at trying to convince people to enroll in their own products (which, as noted by the Brown study is taxpayer funded) is wildly imbalanced compared to what the Medicare program spends on unbiased counseling provided by SHIPs. This glaring discrepancy does not serve Medicare beneficiaries well and must be addressed by policymakers.
June 4, 2026 – D. Lipschutz