JAMA Intern Med/Ann Intern Med
ACP urges reform as Medicare Advantage broker payments at $10 billion
Clinical Takeaway: Patients increasingly choose Medicare Advantage plans with help from brokers paid by insurers, a dynamic that may steer enrollment toward higher-commission plans rather than the best clinical fit. Clinicians can ask older patients how they selected their plan and whether their preferred specialists and medications are covered.
Medicare Advantage now enrolls more than half of all Medicare beneficiaries, and brokers have become central to how seniors pick among the dozens of plans available in most counties. Two new reports, a research letter in JAMA Internal Medicine and a position paper from the American College of Physicians (ACP), together raise concerns about the financial incentives shaping that choice and the broader integrity of the program.
The analysis in JAMA Internal Medicine found that payments to Medicare Advantage brokers rose from about $3.9 billion in 2014 to roughly $10 billion in 2022. Broker involvement also grew: 36% of first-time enrollees used a broker in 2014, climbing to 44% by 2022. The most striking finding was that renewals accounted for 74% of broker commissions by 2022, with 70% of beneficiaries generating a renewal payment that year.
Brokers receive an initial commission when a beneficiary enrolls and additional annual payments for each year that beneficiary stays in the plan. That structure rewards retention more than active plan selection, and it raises the possibility that brokers may favor plans with higher commissions or bonus payments tied to enrollment targets.
The ACP position paper frames broker compensation as one of several structural issues threatening the program's integrity. It calls for stronger oversight of marketing practices, penalties for deceptive advertising, standardized benefit designs and cost disclosures, streamlined prior authorization with faster response times, and risk adjustment mechanisms that reflect patient complexity without rewarding excessive diagnostic coding.
Together, the two analyses point to a market in which billions of taxpayer dollars flow through intermediaries with limited evidence that enrollees end up in plans matched to their health needs. The Centers for Medicare & Medicaid Services attempted to cap broker compensation, but the rule was struck down in federal court in 2024.
"At the end of the day, this is money that is coming from the U.S. taxpayer," said David Meyers, PhD, associate professor of health services, policy and practice at the Brown University School of Public Health. "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."
Sources: Meyers DJ. JAMA Intern Med. 2026 May 18. Trends in Broker Enrollment and Spending in Medicare Advantage
Hallowell AL. Ann Intern Med. 2026 May 19. Protecting the Integrity and Quality of the Medicare Advantage Program: A Position Paper From the American College of Physicians