SHIP and the Medicare Agents America Cannot Afford to Lose
Guest post by Andrew Saul.
If we truly care about Medicare beneficiaries, why are we making it increasingly difficult for the very professionals who have dedicated their careers to serving them?
Here's a thought that might challenge the status quo: What if SHIP (State Health Insurance Assistance Programs), including CA/TX HICAP (California's Health Insurance Counseling and Advocacy Program and Texas's Health Information, Counseling and Advocacy Program), developed formal partnerships with independent Medicare agents to assume more responsibility for PDP (Prescription Drug Plan) enrollments, particularly those that no longer compensate agents?
The goal wouldn't be to replace agents or even to compete with them. Rather to build a Medicare system where publicly funded resources and licensed professionals work together instead of expecting one side to carry an increasingly unsustainable burden.
The Uncompensated Enrollment Problem
Medicare agents maintain licenses, certifications, E&O (Errors & Omissions), compliance standards, CE (Continuing Education), technology, marketing expenses and year round client relationships. They invest their own money to build businesses around helping beneficiaries navigate one of America's most complicated healthcare programs, and increasingly, carriers are eliminating commissions on the very products our beneficiaries need.
A noncommissionable enrollment is not a zero work enrollment. Prescriptions still need reviewing. Formularies, pharmacies, deductibles, premiums and annual drug costs still need comparing. And somehow, the expectation remains that agents should absorb these costs indefinitely. I, and the majority of agents I know, disagree.
SHIP and HICAP Could Be Part of the Solution
SHIP and HICAP already receive public funding to provide free Medicare counseling. So why aren't we discussing formal partnerships? Imagine an agent helping a beneficiary evaluate OM (Original Medicare), MA (Medicare Advantage), Medigap, and their overall healthcare strategy. When that beneficiary needs assistance enrolling in a PDP, the agent could facilitate a warm referral to a SHIP or HICAP counselor. The beneficiary receives professional assistance. The agent maintains the client relationship and can dedicate more time to comprehensive planning, advocacy and services that sustain their business.
Everybody wins in this example but especially the beneficiary. This doesn't have to be some revolutionary concept. In MedPAC's June 2026 report to Congress, people involved with SHIP programs described longstanding productive relationships with local insurance agents, including more agent referrals when agents cannot earn a commission on the plan. But several also reported that their local SHIP reached appointment capacity before Thanksgiving during the 2025 AEP. Clearly, expanding these relationships requires expanding resources. Transferring an overwhelming workload from uncompensated agents to overwhelmed counselors isn't a solution, but building a funded partnership is.
And Why Stop at SHIP and HICAP?
We already have AAA (Area Agencies on Aging), ADRC (Aging and Disability Resource Centers), NCOA (National Council on Aging), Medicare Rights Center and even CMS's own 1-800-MEDICARE enrollment infrastructure. These organizations have different responsibilities, and not all currently handle PDP enrollments. But collectively, they represent an extensive network of government supported and nonprofit resources already dedicated to helping Medicare beneficiaries.
So why aren't we discussing how to coordinate these existing resources with independent agents instead of repeatedly expecting agents to absorb uncompensated responsibilities? Let's develop dedicated PDP enrollment teams, referral systems, additional counseling capacity and coordinated educational resources.
Let's identify which organizations can expand their enrollment assistance and give them the funding and infrastructure necessary to accomplish it. Before we build another government program, perhaps we should figure out how to better utilize the programs and professionals we already have.
And to anyone who opposes that collaboration, I'd be happy to challenge you. Is your objection genuinely about protecting beneficiaries, or about refusing to recognize the economic and professional value Medicare agents bring to the table? Because protecting beneficiaries and supporting agents should never be mutually exclusive goals.
Congress: You're Overlooking One of Medicare's Greatest Assets
Before Congress spends another dollar attempting to solve Medicare's enrollment and education challenges, perhaps it should examine the professional workforce already serving beneficiaries across America. Medicare agents have built something government programs cannot simply manufacture through additional appropriations.
Think of all the relationships and years of institutional knowledge that on the ground Medicare agents have. They invest their own capital, create jobs, support local economies, pay taxes and remain personally accessible to the families they serve. When a beneficiary receives a confusing notice, experiences a coverage disruption, or needs help understanding a complicated Medicare decision, who do many of them call?
Their agent. Why?
Because someone earned their trust.
Every experienced agent who leaves this industry because the economics no longer work represents a potential loss of personalized assistance. Congress should be asking how to leverage these professionals, not how to make their continued existence more difficult. Supporting independent agents isn't only supporting an insurance distribution channel, but it's supporting an important part of America's healthcare infrastructure.
Insurance Carriers Have Some Explaining to Do
If Medicare agents are valuable enough to educate beneficiaries, generate enrollments, explain benefits and maintain customer relationships, why are some carriers unwilling to compensate them? And when compensation disappears, who exactly absorbs the cost of distribution? Is it the agent? The beneficiary? The taxpayer?
Eliminating agent compensation doesn't eliminate the cost of professional assistance. Let's be careful to recognize that publicly funded counseling programs don't become the financial solution to a compensation problem created by private insurance companies. We should not automatically assume taxpayer funded enrollment assistance is more efficient than appropriately compensating the private professionals already performing those services. SHIP partnerships should complement sustainable agent compensation, not give carriers another excuse to eliminate it.
If carriers want the benefits of professional distribution, they should be willing to discuss the cost of maintaining it.
To Those Who Question the Value of Agents
I frequently hear the argument that because independent agents receive commissions, their recommendations are somehow less trustworthy. Physicians are compensated. Attorneys are compensated. Financial professionals are compensated. Being paid for professional expertise doesn't automatically make someone unethical, and providing a service for free doesn't automatically make someone more knowledgeable.
We should judge professionals by their competence, transparency, conduct and the quality of their recommendations.
Does our industry have bad actors? Every profession does. But the misconduct of individuals shouldn't diminish an entire workforce of professionals serving Medicare beneficiaries. A responsible agent should always recommend appropriate coverage, even when that recommendation pays absolutely nothing. This is why a reliable SHIP and HICAP referral partnership makes sense.
And to Anyone Who Opposes This Partnership, I Have One Question.
What exactly is your alternative? If you believe SHIP, HICAP and other publicly supported programs shouldn't collaborate with independent agents, explain how separating these resources makes beneficiaries better off. If you believe agents should continue handling uncompensatable enrollments indefinitely, then explain how small business owners are supposed to sustain that model. If you believe government counseling programs can assume the entire responsibility, demonstrate the staffing, funding and infrastructure necessary to accomplish it. If you believe Medicare agents are unnecessary, explain why beneficiaries continue voluntarily seeking their assistance.
Nobody is suggesting SHIP or HICAP sacrifice their independence, endorse carriers or steer beneficiaries toward commissionable products. Don't tell us why agents shouldn't be part of the solution. Show us how your solution works better without them. Show us the enrollment capacity. Show us the financial sustainability. Show us how removing a trusted local professional improves the beneficiary experience. If you cannot demonstrate those outcomes, perhaps it's time to reconsider your position.
It's Time to Challenge the Status Quo
I'd like to see Congress, CMS, SHIP and HICAP leadership, AAA, other Medicare assistance organizations, insurance carriers and independent agent representatives sit down together. Our ultimate goal should be to figure out how we can serve more beneficiaries, compensate professional services appropriately and use public resources more efficiently. We can establish voluntary referral partnerships with appropriate safeguards, expand dedicated PDP enrollment centers and preserve independent counseling. Then we can measure beneficiary satisfaction in this model, enrollment completion and the actual costs of delivering these services.
Maybe then Congress will start recognizing the economic consequences of making Medicare distribution increasingly uncompensated. A professional cannot build a sustainable business on goodwill alone, and a beneficiary shouldn't lose access to professional assistance simply because the industry has decided the person providing it no longer deserves compensation.
My Final Thought
The Medicare agent is not a liability to the Medicare system. The Medicare agent is one of its most valuable assets. These professionals deserve more than occasional appreciation during enrollment season. They deserve meaningful participation in policy discussions, an economically sustainable environment and government funded partners who recognize their value.
SHIP, HICAP and our nation's other Medicare assistance programs have an important mission. Medicare agents have an important mission. Imagine what could happen if we stopped treating those missions as competing interests and started treating them as complementary responsibilities.
To Congress, CMS, publicly funded Medicare assistance programs and the insurance industry: Stop asking how much more a Medicare agent can do for free and start asking how much stronger Medicare could become if we gave these professionals the partnerships, resources and respect they've earned. America's Medicare beneficiaries can't afford to lose the local Medicare agent.
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Related reading:
Margin Over Membership: How to Sell MA When Carriers Are Pulling Back
Navigating the Challenges Facing Medicare-Focused Insurance Agents
Frequently Asked Questions
Can I refer a Medicare client to SHIP for help with a Part D plan?
Yes. SHIPs give free, one-on-one Medicare counseling and aren't connected to any insurance company or health plan, and some SHIP grantees also help beneficiaries enroll in plans. Your client can find their local SHIP at shiphelp.org. MedPAC's June 2026 report notes that SHIP staff have seen more agent referrals when agents can't earn a commission on a plan.
What if the local SHIP is full during AEP?
It happens. In MedPAC's June 2026 report, several SHIP interviewees said their local SHIP stopped taking new appointments before Thanksgiving during the 2025 AEP (October 15 to December 7). When a SHIP is at capacity, it tells 1-800-MEDICARE and directs the public there instead.
Can a client enroll in a Part D plan without an agent?
Yes. Medicare.gov lists three ways to join a plan: select Enroll for the plan at Medicare.gov/plan-compare, contact the plan directly, or call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048), which is open 24 hours a day, 7 days a week except some federal holidays.
What is HICAP?
HICAP is what California and Texas call their SHIP. In California it's the Health Insurance Counseling and Advocacy Program, and in Texas it's the Health Information, Counseling and Advocacy Program. Both offer free, unbiased Medicare counseling.
