Across the country, state insurance departments are sounding the alarm. As Medicare Advantage (MA) carriers rethink their strategies for 2025—shrinking plan footprints, adjusting commission structures, and tightening budgets—regulators in several states are stepping in to warn insurers not to restrict beneficiaries’ access to Medicare plans.
For insurance agents, this emerging trend highlights one of the biggest industry storylines of the year: states are closely watching how carriers are treating agents, compensation, plan access, and consumer choice. And the actions being taken now could shape the level of oversight we see in the MA market for years to come.
Below is a breakdown of what’s happening, why it matters, and what agents should expect moving forward.
The combination of rising operational costs, stricter CMS rules, and financial pressure on Medicare Advantage margins has led carriers to make big adjustments this year. In many cases, those adjustments have included:
States are now stepping in to make one thing clear: carriers cannot limit access to approved Medicare plans, manipulate compensation, or undermine consumer choice.
Over just a few weeks, regulators in Idaho, Delaware, New Hampshire, and North Dakota issued emergency orders or bulletins reminding insurers that:
This is one of the strongest multi-state responses we’ve seen in recent memory.
Idaho’s Department of Insurance issued an emergency order targeting practices such as:
Discouraging brokers from offering specific plans
Removing certain MA applications during open enrollment
Altering compensation in a way that could influence sales behavior
The message was direct: companies must stop any activity that restricts consumer choice or interferes with brokers’ ability to serve beneficiaries.
Delaware regulators clarified that:
Pulling applications offline
Changing producer compensation
Steering beneficiaries toward or away from certain plans
…all potentially violate state law and federal Medicare protections.
They also warned that such actions could result in enforcement measures.
New Hampshire focused on mid-year changes, stating that:
Adjusting broker compensation after the year has begun
Limiting access to approved MA or Med Supp plans
…may harm seniors and violate laws governing fair marketplace competition.
North Dakota’s bulletin emphasized the importance of:
Transparent compensation
Equal access to all approved Medicare products
Preventing insurers from manipulating the marketplace to their advantage
These warnings are more than compliance reminders—they reflect deeper shifts in the Medicare Advantage market that directly affect agents.
Agents have already seen carriers rework compensation strategies this year. State regulators stepping in suggests increased scrutiny on how—and when—compensation changes can occur.
Agents should expect:
Less mid-year commission volatility
Clearer guardrails on compliant compensation
Stronger protections for brokers who follow the rules
If you’ve felt pressure this year to steer toward certain products, these bulletins send a strong counter-signal: agents must remain free to recommend what is best for the beneficiary.
This reinforces your role as an advocate and protects your independence.
Historically, CMS has handled most MA oversight, with states taking a limited role. This new trend suggests states are no longer willing to stay on the sidelines when consumer access—or agent compensation—is affected by carrier decisions.
Agents should anticipate:
More state-level audits
New compliance bulletins during AEP/OEP
Clearer rules around broker conduct and plan availability
States are united in a single message: beneficiaries cannot be disadvantaged by behind-the-scenes carrier strategies.
For agents, this means:
Plan comparison tools must remain available
Approved plans must remain sellable
Your ability to present all compliant options is protected
This coordinated action from states signals a broader shift across the Medicare ecosystem:
Carriers are reducing benefits, cutting service areas, and making tough financial decisions. But regulators are drawing a line when those decisions impact transparency, access, and fairness.
Commission caps, supplemental compensation rules, and overrides have all been under scrutiny. These state warnings add momentum to the national conversation.
Despite predictions that digital enrollment tools would replace agents, regulators clearly recognize the value brokers deliver in ensuring seniors make informed decisions.
As compliance complexity increases, agents need training, support, and clarity on fast-moving regulatory changes. FMOs who provide guidance—not just contracting—will become even more essential.
The Medicare Advantage market is in a period of dramatic transformation. Costs are rising, benefits are tightening, and regulatory pressure is mounting. But the flurry of state-level warnings makes one thing clear:
Consumer access, agent compensation integrity, and fair competition are non-negotiable.
For agents, this is both reassuring and instructive. Your role remains central. Your independence is protected. And your ability to serve clients fairly is being defended at the state level.
As this story continues to evolve, staying informed—and aligned with a partner who helps you navigate the shifting landscape—will be key.