Eliminating Medicare Advantage Waste: Independent Enrollment Verification
The Challenge: Broker-Driven Inefficiencies Cost Taxpayers and Seniors Billions
Medicare Advantage (MA) enrollment has increasingly become driven by commission-based brokers whose incentives often prioritize insurer profitability over beneficiary needs and fiscal responsibility. In 2024, broker-driven enrollments accounted for nearly 70% of Medicare Advantage sign-ups, significantly contributing to rising costs and inappropriate plan selections. CMS acknowledges that broker commissions create "questionable financial incentives," inflating federal expenditures.
Documented issues include:
Encouraging unnecessary switching between plans, disrupting beneficiaries’ continuity of care.
Promoting "zero-premium" plans that conceal substantial out-of-pocket expenses, misleading seniors.
Inflating Medicare costs through aggressive marketing strategies that result in plan choices poorly aligned with seniors’ actual needs.
The financial consequences are considerable:
Broker-driven inefficiencies potentially cost federal taxpayers between $80 billion to $250 billion over the next 10 years.
Seniors could collectively lose hundreds of billions, tied to inappropriate, high-cost plans that offer minimal practical benefit.
Unfolding News: DOJ Takes Action on Medicare Advantage Broker Practices (May 1, 2025)
On May 1, 2025, the U.S. Department of Justice filed a significant False Claims Act complaint against major Medicare Advantage insurers—Aetna (CVS Health), Elevance Health (formerly Anthem), and Humana—and brokers eHealth, GoHealth, and SelectQuote. The DOJ alleges these insurers illegally paid hundreds of millions in kickbacks to brokers between 2016 and 2021, steering Medicare beneficiaries toward unsuitable plans. Additionally, Aetna and Humana reportedly pressured brokers to limit enrollment of less profitable, disabled beneficiaries, further highlighting systemic ethical concerns in broker-driven enrollment practices.
This development reinforces the urgency for reforms such as Independent Medicare Enrollment Assisters (IMEAs) to eliminate conflicts of interest and ensure enrollment practices prioritize beneficiary needs.
Proven Solution: Independent Medicare Enrollment Assisters (IMEAs)
Replacing commission-based brokers with salaried Independent Medicare Enrollment Assisters (IMEAs)—professionals focused exclusively on matching beneficiaries to the most appropriate, cost-effective plans—would eliminate conflicts of interest and deliver immediate benefits:
Federal Savings: Potential savings of $8–25 billion annually, totaling up to $250 billion over a decade.
Beneficiary Protection: Seniors directly benefit through unbiased enrollment guidance, saving significantly on out-of-pocket and hidden costs.
Fraud Prevention: Immediate reduction in deceptive practices documented by Congress and CMS.
Immediate Steps for Executive Action
Executive Directive: CMS should swiftly phase out broker commissions and transition Medicare Advantage enrollments to independent assisters.
Regulatory Clarity: Close loopholes permitting indirect broker incentives, restoring transparency and accountability in enrollment practices.
Conclusion: Ethical Enrollment, Immediate Savings
Implementing IMEAs is fiscally responsible and ethically compelling. It ensures Medicare Advantage remains an efficient, sustainable option, directly benefiting seniors and taxpayers by eliminating unnecessary spending and ensuring enrollment integrity.