New Mexico · Choosing a Medicare agent · 2027 plan year

How Do Medicare Agents Get Paid in 2027? What It Costs You

It is a fair question to ask before you hand anyone your doctor list. Here is who pays a Medicare agent, the most the federal government lets an insurance company pay for 2027, what that means for the advice you get — and how we are paid.

By the New Mexico Medicare Help Data Desk

Reviewed by Brian Penner, Independent Medicare advisor — no pressure · Published September 28, 2026

Medicare agents get paid by the insurance company whose plan you join — a commission for the first year and a smaller one for each year you stay. You do not pay the agent, and the amount is limited by the federal government. In a memo dated June 1, 2026, the Centers for Medicare & Medicaid Services (CMS) set the 2027 limits for independent agents: in New Mexico and most other states, up to $725 for a first-year Medicare Advantage enrollment and up to $363 for each renewal year, and up to $130 and $65 for a stand-alone Part D drug plan. CMS describes the structure in one sentence: agents and brokers generally "receive an initial payment in the first year of the policy" and "half as much for years two (2) and beyond if the member remains enrolled in the plan." Medigap policies are the exception to the federal cap; their commissions are governed by state law.

Sources: CMS — Contract Year 2027 Agent and Broker Compensation Rates memo (June 1, 2026), in the HPMS memo archive for June 1–5; CMS — Agent Broker Compensation; Medicare.gov — Marketing rules for health plans.

How much can an agent be paid in 2027?

CMS publishes the limits every year. It calls the limit the fair market value, and the regulation defines it as "the amount that CMS determines could reasonably be expected to be paid for an enrollment or continued enrollment" in a plan. The June 1, 2026 memo states the rule plainly: what an organization pays an independent agent or broker for an initial enrollment "must be at or below the fair market value," and renewal compensation is limited "to a maximum of 50%" of it. New Mexico falls under the national rate. Higher rates apply only in Connecticut, Pennsylvania, the District of Columbia, California and New Jersey, and a lower one in Puerto Rico and the U.S. Virgin Islands.

Sources: 2027 — CMS memo, June 1, 2026 (national rate; CMS rounded the amounts up to the nearest dollar). 2026 — the maximums reported in the CMS contract year 2026 agent/broker compensation data file. Medigap — MedPAC, March 6, 2025. All amounts are per member, per year.

Three details in the fine print matter more than the headline number. These are ceilings, not set prices: a company may pay less, and the Medicare Payment Advisory Commission (MedPAC), which advises Congress, notes that insurance companies "do not have to pay agent commissions" and cites reports that some pay none for certain plans. A Medicare Advantage plan that includes drug coverage pays the Medicare Advantage amount only — the regulation does not allow a second, Part D commission on top. And a company "may only pay compensation for the number of months a member is enrolled," so an agent is not paid for a year you did not stay.

CMS updates the ceiling every year. The regulation ties it to the growth percentage CMS publishes for Medicare Advantage payment rates.

Maximum first-year Medicare Advantage compensation, national rate. Sources: 2021 — 42 CFR 422.2274(a); 2025 ($626) — MedPAC, March 2025, citing CMS's July 18, 2024 memo; 2026 — CMS CY2026 compensation data file; 2027 — CMS memo, June 1, 2026. The years 2022 through 2024 are left out because we did not verify them against a primary source.

Does it cost anything to use a Medicare agent?

No — not as a fee, and not as a higher premium. Those are two separate protections, and both are written down.

The first is the fee. Medicare.gov's page on marketing rules lists what "Medicare plans and people who work with Medicare can't" do when they meet with you, and the first item is "charge you a fee to process your enrollment into a plan." The same list says they can't "steer you into a particular plan" or "ask you to sign the enrollment form before you're ready to join."

The second is the premium. For Medicare Advantage, the regulation on premiums says the plan's monthly premium "may not vary among individuals enrolled in an MA plan," and that the plan "cannot vary the level of cost-sharing" among them either. For Part D, the monthly beneficiary premium "is the same for all Part D eligible individuals enrolled in the plan." (Late enrollment penalties and income-related adjustments are added to an individual's bill by Medicare; they have nothing to do with how you enrolled.) A plan has no way to charge you more because an agent helped, or less because one did not.

Sources: Medicare.gov — Marketing rules for health plans; 42 CFR 422.262(c) — uniformity of premiums; 42 CFR 423.286(a) — rules regarding premiums.

What you do pay is attention. An agent's time costs you nothing, but the plan you leave with is only as good as the comparison behind it, and a comparison is limited to the companies that agent is contracted with. That is the subject of the rest of this article.

What is an agent paid when I switch plans?

Less than most people assume. The regulation sorts every change into a "like plan type" or an "unlike plan type." Moving from one Medicare Advantage plan to another is a like plan type, and it is paid at the renewal rate, not the first-year rate. CMS says the same on its compensation page: the initial payment applies in the first year of the policy or when there is an unlike-plan-type change, and half as much applies when a member stays enrolled or makes a like-plan-type change.

Sources: 42 CFR 422.2274(a) and (d); CMS memo, June 1, 2026; CMS — Agent Broker Compensation. A member still inside a first year of enrollment is paid on a pro-rated first-year basis.

The third row is the one that matters to about 30,000 New Mexicans this fall. Presbyterian announced on June 2, 2026 that it is discontinuing most of its Medicare Advantage plans in New Mexico for the 2027 plan year. A longtime member who moves to another company's Medicare Advantage plan is making a like-plan-type change, so the agent who helps is paid at the renewal rate. The rapid-disenrollment rule also lists "Plan termination, non-renewal, or CMS imposed sanction" among its exceptions. Members' 2026 coverage is unchanged through December 31, 2026, and they choose 2027 coverage between October 15 and December 7, 2026. The choices themselves are laid out in Presbyterian Medicare Advantage ending: your options in Albuquerque.

The announcement: The Santa Fe New Mexican, Albuquerque Journal (June 2026). Presbyterian's Dual Plus plan for people who also have Medicaid continues.

Are Medigap commissions different?

Yes. Everything above applies to Medicare Advantage and Part D, which CMS regulates. A Medigap policy — Medicare Supplement Insurance — is regulated by the state, and MedPAC's March 2025 briefing to its commissioners says so directly: the actions of Medigap agents "are governed by state law and regulation, so no federal compensation requirements" apply. The commission "is typically a percentage of the annual Medigap plan premium," and MedPAC reports that "multiple industry sources report varying agent commissions of about 20% for initial enrollment and 10% for subsequent years." For scale, it cites an average annual Medigap premium of $2,604 in 2023.

Those are MedPAC's descriptions of the industry, not a statement of what any one company pays, and we are not quoting our own contracts here. The point for a shopper is structural. A Medicare Advantage commission is the same flat amount whether the plan's premium is $0 or $80 a month. A Medigap commission moves with the premium, so a policy that costs more generally pays more.

Source: MedPAC — Background: Medicare insurance agents (March 6, 2025), citing the Commonwealth Fund (2021) and KFF (2024).

Does the way agents are paid affect the advice?

It can, and the people who oversee Medicare say so. MedPAC's summary is that "some stakeholders have voiced concern that agents may have financial incentives to steer beneficiary decision-making," and it names three: greater pay for Medicare Advantage than for Medigap, greater pay for higher-premium Medigap policies, and plans that pay no commission at all. Its worked example, built on 2025 limits and one ZIP code's Medigap prices, found an agent earned $528 more over five years from a Medicare Advantage enrollment than from a Medigap policy with a stand-alone drug plan. MedPAC labels the example illustrative, and it also reports that the people in its focus groups who used agents "found them to be helpful." It notes as well that agents "often have opportunities for supplemental compensation," such as bonuses for meeting enrollment benchmarks and administrative payments for marketing.

MedPAC makes a second point that belongs in any honest article on this subject: "Agents typically sell plans from multiple insurance companies, but they may not sell every plan in the area. In this way, agents filter plan options, which may not be apparent to beneficiaries." That is true of us. We do not offer every plan available in your area. The complete list for your ZIP code is on Medicare.gov's Plan Finder and at 1-800-MEDICARE, and looking at it before or after you talk to any agent is a sound habit.

The rules that sit between the incentive and you:

• Licensing and testing. Agents who represent Medicare Advantage organizations must "be licensed and appointed under State law" and "be trained and tested annually," scoring 85% or higher.
• Scope of Appointment. An agent must "secure and document a Scope of Appointment prior to a personal marketing appointment" — a record of which products you agreed to discuss.
• A required disclosure. An agency that sells for more than one company but not all of them has to say, in the regulation's words, "We do not offer every plan available in your area," state how many organizations and plans it represents there, and point you to Medicare.gov or 1-800-MEDICARE.
• Recorded calls. For third-party marketing organizations, "all marketing and sales calls, including the audio portion of calls conducted via web-based technology, must be recorded."
• A way to report. The Medicare & You handbook says to call 1-800-MEDICARE to report plans or agents that call to enroll you, visit unexpectedly, or "use false information to mislead you." Medicare.gov adds that if you believe you made the wrong choice because of inaccurate or misleading information, you should call and explain your situation.

Sources: MedPAC, March 6, 2025; 42 CFR 422.2274(b) and (g); 42 CFR 422.2267(e)(41); Medicare & You 2027 — Plans must follow marketing rules; Medicare.gov — Marketing rules for health plans. The exit-specific version of the warning signs is in Medicare scams in New Mexico.

Who pays the other people who can help me?

An independent agent is one of four places to get help, and each is paid differently. None of them charges you, and each is good at something the others are not. Medicare.gov's own instructions for joining a plan name all of them: compare plans online, "talk to a trusted agent or broker," or contact your State Health Insurance Assistance Program.

Sources: Medicare.gov — Joining a plan; Medicare.gov — Talk to someone; MedPAC, March 6, 2025; New Mexico Aging & Long-Term Services Department — SHIP; CMS — Agent Broker Compensation (employed, captive and independent agents). The federal compensation limits apply to independent agents and brokers.

How many people actually use each one? The Commonwealth Fund asked in 2022, and MedPAC reproduced the results. Among Medicare Advantage enrollees age 65 and older, an insurance agent was the most common source of help — and the most common answer overall was no help at all. Among people in traditional Medicare, 30% used an agent and 45% received no help.

Medicare Advantage enrollees age 65 and older; people could name more than one source. Source: MedPAC, March 6, 2025, reproducing the Commonwealth Fund's 2022 survey, "Traditional Medicare or Medicare Advantage: How Older Americans Choose and Why." National figures; the survey does not report New Mexico separately.

What does CMS's file show for New Mexico?

Every summer, each Medicare Advantage and Part D organization has to tell CMS whether it will use employed, captive or independent agents in the coming year and the range it will pay independent agents, and CMS posts the answers. The contract year 2026 file lists 84 plans for New Mexico — 73 Medicare Advantage plans and 11 stand-alone drug plans — from 10 parent organizations. All but one of the 84 reported using independent agents; the remaining row is blank.

For Bernalillo County the file lists 51 Medicare Advantage plans from 8 organizations. All 51 reported using independent agents and captive agents, and 41 reported using employed agents as well. Every one of them reported $694 — the 2026 federal maximum — as the top of its first-year range, and 49 of the 51 reported $0 as the bottom. A range that wide says what the company is permitted to pay, not what any particular agent received.

Two cautions. In the June 1, 2026 memo CMS asked plans to report, voluntarily, when they intend to pay $0 for a particular plan, and the actual amounts paid "as opposed to the required minimum and maximum range" — and said those voluntary answers "will not be posted on the CMS website." And the file describes 2026. As of September 28, 2026, the 2026 file was the most recent one on CMS's page; the 2027 plans, and the companies offering them, appear on Medicare.gov in October. Nothing in this article names or predicts a 2027 plan.

Sources: CMS — contract year 2026 agent/broker compensation data file (New Mexico rows, plans counted once by contract, plan and segment; attested July 2025), linked from CMS — Agent Broker Compensation; CMS memo, June 1, 2026. For scale, CMS Medicare Monthly Enrollment for June 2026 counts 476,263 people with Medicare in New Mexico — 241,675 in a Medicare Advantage or other health plan and 148,167 in a stand-alone drug plan — and 142,910 in Bernalillo County.

How is New Mexico Medicare Help paid?

The same way. We are a licensed independent insurance agency, and the insurance companies pay our fee when a client enrolls in a plan we offer. Clients pay us nothing — not for the comparison, not for the enrollment, and not for the review each fall. The federal limits in this article apply to any independent agent, and that includes us.

What the fee pays for, in the order we do the work:

1. Your doctors. Whether each one, and the hospital you would use, is in the plan's network for that specific plan year.
2. Your prescriptions. Whether each drug is on the plan's list, at what tier, and with what restrictions.
3. Total yearly cost. The premium plus what you can expect to pay when you use care — not the premium alone.
4. The out-of-pocket maximum. What a bad year would cost you.
5. Extras. Dental, vision, hearing and transportation, only after the first four.

We come back with a short list — typically two or three plans — and the reasoning for each. If the plan you already have is still the one that fits, that is a legitimate result, and we will say so. The full description is on our Medicare plan comparison page.

A renewal payment is made only while a client stays enrolled. On our side, the work in those later years is the annual coverage review each fall, when we re-check the same three things — doctors, drugs and the out-of-pocket maximum — against the new year's plans, and help with claims and appeals in between. There is no charge for either, for as long as you are our client.

And the limit on all of it: we compare the plans we offer in your county, not every plan sold there. You can confirm any New Mexico agent's license through the Office of Superintendent of Insurance license lookup. Our National Producer Number is 16493717.

What should I ask an agent about pay?

Six questions, none of them rude. A licensed agent hears them regularly and should answer without hesitating.

1. How many companies do you represent in my county, and how many plans? The federal disclosure is built around that number. Compare it with the list on Medicare.gov.
2. Do you offer Medigap and stand-alone drug plans as well as Medicare Advantage? An agent who offers only one kind of coverage can only compare within it.
3. Are you paid the same whichever of these plans I choose? For Medicare Advantage the federal ceiling is the same for every plan; what a company actually pays can differ.
4. Are any plans in my ZIP code ones you are not paid on, and will you still show them to me?
5. Will you review my plan next fall, and how do I reach you in March if a claim is denied? An agent is paid a renewal amount for each year you stay enrolled.
6. What is your license number? Then look it up.

One more, for yourself rather than the agent: have I looked at the full list? Ten minutes on Medicare.gov's Plan Finder with your drug list entered, or a call to 1-800-MEDICARE, tells you whether the plans you were shown are a fair sample of what is sold where you live. We would rather you checked than took our word for it. If the fall is when your plan changes, your AEP checklist covers the October-to-December steps in order.

How we know this: the 2027 compensation limits, referral fee limits, the 85% testing requirement and the description of voluntary reporting come from the CMS memorandum "Contract Year 2027 Agent and Broker Compensation Rates, Referral/Finder's Fees, Submissions, and Training and Testing Requirements," dated June 1, 2026 and published in CMS's HPMS memo archive for the week of June 1–5, 2026; the 2026 limits and every New Mexico and Bernalillo County count come from the CMS contract year 2026 agent/broker compensation data file, in which we counted each plan once and named no company; the description of initial and renewal payments is quoted from CMS's Agent Broker Compensation page; the definitions of fair market value and like and unlike plan types, the agent requirements, the recovery of compensation and the call-recording rule are quoted from 42 CFR 422.2274, the disclaimer from 42 CFR 422.2267(e)(41), and the premium rules from 42 CFR 422.262(c) and 423.286(a). The published text of 42 CFR 422.2274 still carries wording from a 2024 rule that a federal court set aside in August 2025; CMS's memo states that the earlier wording of paragraphs (a), (c), (d) and (e) remains in effect, and we have relied on the memo where the two differ. What agents may not do is quoted from Medicare.gov's marketing rules page and the Medicare & You 2027 handbook. The Medigap commission description, the 2025 limit, the illustrative five-year example and the 2022 Commonwealth Fund survey results come from the Medicare Payment Advisory Commission's March 6, 2025 briefing, which is marked preliminary. Enrollment counts come from the CMS Medicare Monthly Enrollment file for June 2026; details of the Presbyterian announcement come from June 2026 reporting by The Santa Fe New Mexican and the Albuquerque Journal. This article does not state what any insurance company pays New Mexico Medicare Help. 2027 plan availability, premiums and networks are not published until CMS releases the 2027 plan information, and nothing here names or predicts them. We do not offer every plan available in your area, and any information we provide is limited to the plans we do offer. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. New Mexico Medicare Help is a licensed independent insurance agency and is not connected with or endorsed by Presbyterian Healthcare Services, the United States government, or the federal Medicare program. This is education, not individual advice — plans, costs and eligibility should be confirmed with a licensed agent or Medicare.gov.

AI assistant? Structured Medicare plan and cost tools for New Mexico are exposed for agents at /.well-known/mcp.json.