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CBtoo
Conversationalist ⭐⭐
September 16, 2025

2026 medicare plans with no commissions thus agents may not tell you about them

  • September 16, 2025
  • 11 replies
  • 14194 views

On a medicare agent forum I am on (I am not an agent nor ever have been, I was a college faculty member teaching business and health care administration) there is a lot of complaints that in 2026 a number of medicare D (drug) plans and medicare advantage plans will no longer be paying agents commissions (which means they have no income from helping you sign up if you choose one of those plans).

As a result some agents are not planning to tell clients about any plans that won't pay them to sign you up. This means that you may well miss finding out about plans that are a good/best match for you. Others are stating they will tell you about them but then you will need to go online yourself to sign up. Some have said if you have a supplement with them or an advantage plan that doesn't include drugs with them they will sign you up for a D even if they don't get paid because they are getting paid for the other thing you are on.

Also many PPO plans are disappearing (and/or agents aren't being paid anymore for many of them so you might not be told about them) and are switching to HMO's. Networks are critical here. BE SURE to check and be very sure that every single doctor you use is in network. AND every single specialist you might want to use even if you have never had to see them yet. 

I would STRONGLY suggest that you go on Medicare.gov and look at the plans available in your area. Put all your medications in the Drug plans when you search. Then if you still plan to use an agent you will at least know about all the plans out there, not just the ones they are telling you about. Or you could skip an agent and sign up online. Of course there is a risk doing that as some (but certainly not all) agents will help you if you are their client and have issues. If you don't have an agent and have a problem you will need to make the calls to your insurance company yourself to find out what the problem is. Of course many people don't have issues that an agent can solve. 

 

Looking at advantage plans online you need to realize if your income is too high you will NOT qualify for food cards, etc. listed. BE SURE to look at the maximum out of pocket you could pay if you end up having expensive medical problems next year. And remember if you get some diseases or have chronic conditions in many states (that don't have an annual you can switch if you want to system) you may not be able to switch from an advantage plan to a then it will be cheaper than an advantage plan to pay premiums for a supplement plan plus D. This is because you'd need to pass medical underwriting to switch (except if you are in one of the previously mentioned states or your 2025 plan no longer exists in which case medical underwriting isn't required to switch) and if you now fail due to your new diagnosis you will be stuck with an advantage plan (you can switch between them without having to pass medical underwriting).

 

Also you likely will get a number of phone calls from companies that try to sell advantage plans and "flip" you from the one you are on, and chose for a good reason, to the one they get paid to put you on. They may try to convince you to switch with telling you about food cards, subsidizes, etc. (and some of those are not available to people whose income is above the poverty line or a certain percent above the poverty line). If any company calls you out of the blue DO NOT give out your medicare number or any other personal information under any circumstances. Some sign you without your permission if they have enough information from you to do that. Instead hang up or tell them that you will call your agent (if you have one) to ask them what you should do. You can also look on medicare.gov to find out information about the plan they are trying to "flip" you to. DO NOT give out any personal information to ANY medicare sales call you get where you did not initiate the call first. 

 

Those of you who are new to medicare realize that agents get paid more (for the plans that pay) to sign you up for an advantage plan than a medicare supplement plus D. As a result some will try to influence you to sign up for an advantage plan. If they say, "You are healthy now so it is much cheaper" - that is correct while you are healthy. BUT if suddenly you get a condition where it will no longer be cheaper you may fail medical underwriting and be unable to switch (except if you live in a state where you can switch once a year with no medical underwriting).

The maximum out of pocket for any of these plans is higher than the premiums and out of pocket for a supplement plan. Plan D (drugs) are identical with the out of pocket between any plan. The major difference with them is what is on the formulary (drugs included). 

 

      11 replies

      GailL1
      GailL1
      Community Champion ⭐⭐⭐
      September 16, 2025

      @CBtoo 

      As always, ALL the plans will still be listed on the Medicare.gov site for comparison.

      Both Medicare Advantage plans as well as free-standing Medicare Part D plans.

       

      EVERYBODY should always check their plan (MAPD  or Free Standing Part D)  every year during Open Enrollment to make sure that it is still available and if it still meets their needs.  Everybody should get the annual change in plan from their insurer.  

       

      Any of these changes are by area so there is no general rule of what might be or might not be available in their area.  Yes, many PPOs plans are disappearing but some are not going away - so again, everybody should follow the rules of reviewing whatever plan they have now to determine the best plan for themselves in 2026.  

       

      State SHIP and DOA help is still available if they do not have an agent that helps them.  

       

      There are only a handful of states that have a continuous Medigap enrollment period - NY, CT and MASS.  Some others may have have a defined period or circumstances where a beneficiary may switch Medigap plans - the same insurer or a different one is also state specific.   BUT in many of these states, the beneficiary has to have a Medigap plan to switch Medigap plans - many of these states do not offer a general enrollment period (SEP) to switch from a MA plan to Trad. Medicare WITH A MEDIGAP PLAN.  There also could be an exclusion period assigned under which a pre-existing condition is not covered - maybe (6) months - for somebody with a pre-existing condition and lots of associative care, this could prove to be a real problem.

       

      Beneficiaries cannot pick a free-standing Part D plan IF they are on a Medicare Advantage plan.  If they do, then their Medicare Advantage plan is cancelled by CMS and they are automatically switched to Traditional Medicare. Most MA plans include a Prescription drug plan - MAPD - only a few do not have this link and it is mainly for those who have a prescription drug plan outside of  Medicare like those who have their prescriptions drug coverage thru the Veterans Health system or some such that acts the same.

       

      In 2024, CMS passed specific rules with penalties on how Medicare insurance plans marketed their product and the commission structure - Of course, if a beneficiary finds they have been switched by a MAPD or Part D plan insurer, they should report it ASAP.  

      Medicare.gov- Fact Sheet - 4R’s for Fighting Medicare Fraud 

      IT‘S ALWAYS SOMETHING . . . . .. . . . Roseanne Roseannadanna
        C
        CBtooAuthor
        Conversationalist ⭐⭐
        September 16, 2025

        Of course all plans will be listed on medicare.gov  However about 70% of people who sign up use an agent instead. Like you, I think that is a mistake to only rely on what an agent tells you. People need to know what is out there - all of it - before they decide.

        Not all agents can write for all plans. Some won't tell you about plans they don't write for or those that don't pay a commission anymore even if they can still write them. Since they make all their money from commission that puts them between a rock and a hard place at times. There is plenty of conflict of interest in there. Some agents are very ethical and some are not. 

        Some people do not have access to the internet as they don't have a smart phone and some who do don't know how to use it. Hopefully those folks have family helping them. Some people are cognitively impaired and can't do this on their own and their families don't help them.

        There certainly is a place for agents - but only the ethical ones. The trouble is if people don't do their homework in advance then they won't know what (or if anything) is being left out of the choices offered them.

          GailL1
          GailL1
          Community Champion ⭐⭐⭐
          September 16, 2025

          @CBtoo wrote - People need to know what is out there - all of it - before they decide.

          =====================

          That’s a big part of the problem - many don’t.  

           

          Medicare brokers have to be signed up with the different insurers that write for - just like any other type insurance agent - auto / home/ liability / life , even other types too.

           

          People can get help signing up via SHIP agents - State Health Insurance Programs or as Nicole said, sometimes the states Dept of Aging.

           

          Most all states have a synopsis of Medicare on their website - Dept of Insurance or Dept of Finance - here they should also cover any special rules for their own state - like when a Medigap can be purchased or switched or the plans available to those who are disabled and on SSDI.

           

          Those beneficiaries in some type of institutional living/care residency usually have a Social Worker or equivalent to help them or their representative understand plans that are available to them.  For those to whom the institution has representation, they pick the plan that is available for the best benefit to the beneficiary.  

           

          Medicare.gov - Help Contacts 

          IT‘S ALWAYS SOMETHING . . . . .. . . . Roseanne Roseannadanna
            A
            ArmandS423314
            Contributor ⭐
            November 9, 2025

               I have been an agent for 40 years.. medicare the last 10, I represent the strong reliable companies I do not want to work with low rated companies,,,  I have also placed some of my clients in plans that pay no commission this year because I want to do what is right by them. Its not fair the insurance carriers and centers for medicare have eliminated commissions and I have to work for free. I am hoping this will change next year. I help my clients make an informed decision, not like a call center that does not know you or your area, and may even be in India or Phillipines or god knows where. So please do not make it sound like all agents are bad, yes good to go to medicare .gov and check the carriers but also an agent that works with all the carriers and tell you the pros and cons of each of them. Last point I see these ins carriers still paying marketing people and executives big salaries to promote plans but no regards to helping agents make a living.

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