INSIGHTS: Medicare Broker and Agent Training
Medicare Broker Agent Training: What the Data
Shows Plans Are Getting Wrong in 2025
Shows Plans Are Getting Wrong in 2025
CMS requires every agent and broker selling Medicare Advantage, Part D, and Cost Plan products to be trained and tested annually. The regulatory framework governing this training has been substantially tightened since 2022, with new rules on TPMO oversight, compensation structures, call recording, scope of appointment, and complaint reporting. Yet the data from CMS secret shopper studies, Senate Finance Committee investigations, and state insurance commissioner complaints reveals a training compliance gap that plan sponsors are consistently underestimating. This analysis examines what the evidence shows, why the gap persists, and what compliance leaders at MA and Part D organisations must reconsider.
80%+
Agents Failed CMS Secret Shopper Test
CMS secret shopper studies of TPMO marketing calls found that in more than 80% of calls reviewed, agents either failed to provide beneficiaries with the necessary information or provided inaccurate information to make an informed plan choice. This is not an outlier result, it reflects a systemic training compliance gap across the industry.
Sheppard Mullin: CMS TPMO Oversight Analysis (2022)
9 of 10
States Saw Rising MA Marketing Complaints
Nine out of ten states that provided quantitative data to the Senate Finance Committee reported increases in Medicare Advantage marketing complaints to their insurance commissioners or State Health Insurance Assistance Programs between 2020 and 2021. The most common complaint sources were mail advertisements, robo-calls, telemarketers, and television advertisements.
Health Payer Intelligence: Senate Finance Committee Report (2022)
706%
Growth in Purchased Leads 2018 to 2022
The Senate Finance Committee’s review of TPMO marketing agreements found that one TPMO reported a 706% increase in purchased leads between 2018 and 2022, while another reported a 269% increase over the same period. This lead generation explosion occurred alongside, and arguably contributed to, the marketing complaint surge.
AIS Health: Senate Finance Committee TPMO Report
Insight Summary
- CMS secret shopper studies found more than 80% of TPMO agent calls failed to provide adequate or accurate information to beneficiaries, a figure that predates the 2024 regulatory overhaul and indicates the training gap pre-existed the new requirements.
- The CY2025 agent and broker training and testing guidelines require annual training on Medicare rules, specific plan benefits, enrollment and disenrollment procedures, marketing regulations, and fraud, waste, and abuse, with no grandfather exception for previously trained agents.
- The April 2024 final rule capped non-salary broker compensation, prohibited volume-based bonus structures, and required express written consent before sharing beneficiary data, all obligations that feed directly into training content for CY2025 and beyond.
- Plans are legally required under 42 CFR 422.2272(e) and 423.2272(e) to have a mechanism for monitoring all agents, brokers, and TPMOs, and to report moderate to severe violations to CMS at least monthly. Compliance with the reporting mechanism itself is audited.
- Five states reported to the Senate Finance Committee that brokers were specifically targeting beneficiaries with cognitive impairments, and six states reported cases where beneficiaries were unaware they had been enrolled in a Medicare Advantage plan, failures that go directly to the quality of pre-enrollment conversation training.
- The compliance implication for plan sponsors is operational, not just regulatory: the training obligation extends to all employed, subcontracted, downstream, and delegated entities, including TPMOs the plan does not directly manage day to day.
Key Insight
The 80% agent failure rate in CMS secret shopper calls is not primarily a problem of bad agents. It is a problem of inadequate plan sponsor training infrastructure applied to a sales channel that grew faster than the compliance systems designed to govern it.
Plans that treat annual CMS training as a pass-fail checkbox, rather than as the minimum floor of a continuous oversight programme, will continue to generate the 80% failure rate the data already shows. The regulatory trajectory from 2022 through 2025 makes clear that CMS intends to keep raising the compliance floor. The question for compliance leaders is not whether the training requirement is real, but whether the infrastructure to execute it at scale across all TPMO relationships actually exists.
What the Data Shows
DATA
CMS conducted secret shopper studies by calling telephone numbers associated with TV advertisements, mailings, newspaper advertisements, and internet searches targeting Medicare beneficiaries. In more than 80% of the calls reviewed, agents either failed to provide beneficiaries with the information required under CMS marketing regulations or provided inaccurate information. CMS published these findings in an October 2022 memo and FAQ on TPMO best practices. Source: Sheppard Mullin: CMS TPMO Oversight Analysis (2022)
INTERPRETATION
An 80% failure rate does not describe a fringe compliance problem. It describes a default operational state, where the majority of broker-to-beneficiary conversations are not meeting the informational standards CMS requires. This is the baseline against which the CY2024 and CY2025 training requirements must be understood: they are not responding to isolated incidents but to a systemic pattern already documented at scale.
WHY IT MATTERS
For plan sponsors, the secret shopper data is a direct signal of litigation and enforcement exposure. When beneficiaries enroll in plans based on inaccurate information provided by the plan’s agents or brokers, the plan bears regulatory responsibility for those conversations under 42 CFR 422.2272 and 423.2272. The training that agents received before those calls, or did not receive, is the compliance question that CMS programme auditors will ask.
DATA
The Senate Finance Committee investigation of Medicare Advantage marketing practices, led by Senator Ron Wyden, found that nine of ten states providing quantitative data reported increases in marketing complaints to state insurance commissioners or SHIPs between 2020 and 2021. Five states specifically reported complaints about agents targeting beneficiaries with cognitive impairments. Six states reported cases where beneficiaries were unaware they had been enrolled in a Medicare Advantage plan at all. Source: Health Payer Intelligence: Senate Finance Committee Report (2022)
INTERPRETATION
The finding that six states reported beneficiaries unaware of their own enrollment is the most operationally serious data point in the complaint record. It means the enrollment conversation, which agents are trained to conduct, either did not happen or was conducted in a way that failed to establish the beneficiary’s understanding and consent. This is not a marketing aesthetics problem. It is a consent and disclosure failure that has direct legal implications for the plan under CMS enrollment processing requirements.
WHY IT MATTERS
The CY2025 training guidelines specifically require agents to be trained on the requirement to capture the beneficiary’s acknowledgment and consent to required key elements before completing an enrollment request, and on the Pre-Enrollment Checklist (PECL) review requirement. These are not new procedural additions, they are the regulatory response to exactly the consent failures the state data documented. Plans whose training content does not make the PECL review a non-negotiable step are producing agents who can reproduce the same consent gaps the Senate investigation found.
DATA
The Senate Finance Committee’s review of TPMO-insurer marketing agreements found that the volume of purchased leads at major TPMOs grew by between 269% and 706% from 2018 to 2022. The committee’s analysis connected this lead generation growth directly to the surge in marketing complaints, recommending that Congress grant CMS authority to directly regulate lead generators and approve TPMOs before plans can contract with them. Source: AIS Health: Senate Finance Committee TPMO Report
INTERPRETATION
A 706% increase in purchased leads over four years means that the agent channel scaled massively faster than the training and oversight infrastructure designed to govern it. Training compliance is fundamentally a scale problem: the same training system that adequately governed 1,000 agent relationships may be structurally inadequate for 7,000. Plans that inherited this channel growth without proportionally scaling their training oversight capability are now operating at structural compliance risk.
WHY IT MATTERS
The April 2024 final rule’s compensation overhaul, capping non-salary broker compensation and eliminating volume-based bonuses, was directly aimed at reducing the financial incentives that drove lead generation growth. For plan sponsors, the implication is that the regulatory constraint on the sales channel now requires a parallel investment in the compliance infrastructure that monitors it. A smaller, better-governed agent network is the regulatory direction of travel. Training systems designed for volume at the expense of verification are misaligned with where CMS is taking the programme.
What Is Driving the Trend: Why Training Compliance Fails at Scale
The TPMO structure separates training responsibility from training delivery
Under 42 CFR 422.2272 and 423.2272, the plan sponsor bears regulatory responsibility for ensuring that all agents, brokers, and TPMOs who sell on its behalf are trained and tested annually. But in practice, training is often delivered by the TPMO, a separate organisation whose training quality the plan cannot directly observe. A plan that accepts a TPMO’s completion certificate as evidence of adequate training has discharged its administrative obligation but has not verified that the training content met CMS standards or that the agents who completed it can execute it in a beneficiary conversation. Source: CMS CY2025 Agent and Broker Training and Testing Guidelines
Annual training is designed as a floor, not a programme
CMS requires annual training and testing. It does not define minimum training hours, nor does it prescribe a particular format or delivery mechanism beyond the content areas in the training guidelines. This regulatory flexibility allows plans and TPMOs to design training that is technically compliant but operationally thin, a single online module that can be completed in 45 minutes and that a distracted agent passes at the minimum acceptable score. That design produces agents who have technically satisfied the annual training requirement but who cannot reliably execute the enrollment conversation the training was supposed to prepare them for.
Compensation structures historically rewarded volume over accuracy
The April 2024 final rule explicitly acknowledged that agent and broker compensation structures had created incentives to enrol beneficiaries in plans that maximised commissions rather than plans that matched beneficiary needs. Volume-based bonuses and administrative payments on top of commissions amplified the speed-over-accuracy dynamic that produces the information failures the CMS secret shopper data captured. The final rule’s compensation overhaul is designed to reset this incentive structure, but it does not automatically retrain agents whose default approach was shaped by the old incentives. Source: Sidley Austin: CMS Broker Compensation Final Rule (April 2024)
Monthly non-compliance reporting obligations are frequently under-resourced
Under 42 CFR 422.2272(e) and 423.2272(e), plans must report moderate to severe agent and broker violations to their CMS account manager at least monthly. This requires an active monitoring mechanism, not a passive complaint intake process. Plans that are receiving and logging agent complaints without systematically categorising them for CMS reportability are non-compliant with the oversight mechanism requirement, regardless of whether the underlying violations are serious. The monitoring infrastructure required to execute this obligation is distinct from the training infrastructure, and compliance with both is audited. Source: CMS CY2024 Agent and Broker Compensation Memorandum
What This Means for Compliance Leaders
Training completion rates are not training effectiveness rates
A plan that can demonstrate 100% agent training completion has met the administrative threshold of the CMS requirement. It has not demonstrated that its agents can conduct a compliant enrollment conversation. CMS secret shopper studies evaluated the output of trained agents, not their completion records. The compliance question for 2025 is not “did all our agents complete training?” but “can all our agents execute what they were trained on?” The monitoring obligation under 42 CFR 422.2272(e) exists precisely because completion rates have never been a reliable proxy for field compliance.
The April 2024 compensation rule changes training content obligations
The final rule prohibiting volume-based bonuses, capping non-salary compensation, and requiring express written consent before sharing beneficiary data with third parties created new content requirements for CY2025 training. Agents must understand the new compensation structure they operate under and the new consent requirements before they make a single lead contact. Plans whose CY2025 training content was developed before the April 2024 rule was finalised, or that did not update their TPMO training modules to reflect it, are producing agents with a knowledge gap in the most recently changed and most actively enforced area of the regulation.
Downstream TPMO training oversight is the compliance gap most likely to generate a programme audit finding
The CY2025 training guidelines require that all employed, subcontracted, downstream, and delegated entities selling Medicare products on behalf of the plan are trained and tested annually. For a plan with a large TPMO network, this obligation cascades several layers deep into organisations the plan may not have a direct contractual relationship with. The compliance assumption that a TPMO’s own training programme satisfies the plan’s obligation under 422.2272 has never been supported by the regulatory text, and CMS programme auditors examine TPMO training documentation directly during audits.
Scope of appointment records are a concurrent audit risk alongside training compliance
CMS requires agents to secure a scope of appointment at least 48 hours before any formal Medicare Advantage sales presentation. This requirement, which CMS has emphasised consistently since 2022, is a training content obligation and an operational records obligation simultaneously. The plan must ensure agents are trained on the 48-hour rule, and must have a mechanism to verify and retain scope of appointment records. A plan whose agents are trained on the rule but whose operational system does not enforce and capture the 48-hour window has a compliance gap that does not appear in training completion data but does appear in CMS field monitoring and complaint data. Source: Insurance News Net: Medicare Advantage Marketing Rules (2023)
Practical Implications: Medicare Broker Agent Training CY2025 Requirements
The CMS CY2025 agent and broker training and testing guidelines specify the content areas that organisations must cover in annual training. These are not optional curriculum suggestions, they define the floor of what every agent selling Medicare products on behalf of a plan must be trained on before selling. The content areas most commonly undertrained, based on the compliance data above, include the following.
| Training Area | Regulatory Basis | Key Content Requirement | Evidence of Gap |
|---|---|---|---|
| Enrollment and disenrollment procedures | CY2025 Guidelines; 42 CFR 422.60-422.68 | Pre-Enrollment Checklist (PECL) review; enrollment period eligibility; non-discrimination requirements; approved enrollment mechanisms only | 6 states: beneficiaries unaware of own enrollment |
| Marketing and communications requirements | 42 CFR 422.2268; 423.2268; CY2025 Guidelines | Scope of appointment (48 hours in advance); call recording requirements; TPMO disclaimer language; prohibition on unsolicited contact | 80%+ CMS secret shopper failure rate |
| New compensation rules (effective Oct 2024) | April 2024 Final Rule; 42 CFR 422.2274; 423.2274 | Non-salary compensation caps; prohibition on volume-based bonuses; elimination of separate administrative payments; express written consent before data sharing | New effective Oct 2024, training content gap risk for any plan that did not update CY2025 modules |
| Fraud, waste, and abuse | CY2025 Guidelines; 42 CFR 422.2272; 423.2272 | Recognition of deceptive practices; reporting obligations; cherry-picking prohibition; targeting of vulnerable populations prohibition | 5 states: agents targeting beneficiaries with cognitive impairments |
| Plan-specific benefits and coverage | CY2025 Guidelines; required for each plan sold | Specific benefits of each plan the agent sells; formulary basics; cost-sharing; network restrictions; supplemental benefits | 80%+ failure to provide adequate plan information in CMS secret shopper calls |
Executive Takeaway
For Compliance Leaders
- Audit training content for CY2025 to confirm it reflects the April 2024 compensation rule changes, the express written consent requirement for beneficiary data, and the updated guidance effective January 1, 2025.
- Establish a monitoring mechanism that actively identifies and categorises moderate to severe agent and broker violations for monthly CMS reporting, passive complaint intake is not sufficient under 42 CFR 422.2272(e).
- Verify that TPMO-delivered training meets the CMS content standards, not just that completion certificates have been received. Request training content for review against the CY2025 guidelines.
- Assess scope of appointment recordkeeping at the operational level: is the 48-hour rule being enforced in the system, or trained in a module and ignored in the field?
- Treat the CMS 80% secret shopper failure rate as a benchmark, not a historical footnote. If compliance infrastructure has not materially changed since the calls were reviewed, the failure rate has not materially changed either.
Key Takeaways
Annual CMS training is a regulatory floor, not a compliance programme
CMS annual training requirements define the minimum content all agents must receive. They do not define the minimum programme a plan must operate to ensure its agents and brokers are actually compliant in the field. The 80% secret shopper failure rate reflects what happens when the floor is treated as the ceiling. A compliance programme adds monitoring, verification, ongoing oversight, and a non-compliance reporting mechanism on top of the training baseline, not instead of it.
The regulatory trajectory from 2022 through 2025 shows no sign of pulling back
CMS has tightened TPMO oversight requirements in every contract year since 2022. The April 2024 compensation overhaul was the most significant single intervention, but it follows a consistent pattern: complaint data drives regulatory response, regulatory response creates new training and oversight obligations, and plans whose infrastructure cannot absorb the new obligations generate the audit findings that drive the next round of enforcement. The pattern is not slowing down.
The compliance gap is not primarily a training content problem, it is a training infrastructure and verification problem
CMS has published clear training content guidelines every year. The 80% secret shopper failure rate does not mean agents are receiving the wrong content, it means the training delivery, verification, and ongoing oversight system is not producing agents who can execute the content in a live beneficiary conversation. The content is not the gap. The infrastructure that should verify the content was absorbed and is being applied is the gap. Compliance leaders who respond to poor field performance by revising training content without examining the monitoring and verification system underneath it are solving for the wrong problem.
Frequently Asked Questions
What does CMS require for Medicare broker agent training in 2025?
CMS requires that all agents and brokers selling Medicare Advantage, Part D, and Cost Plan products on behalf of an organisation are trained and tested annually on Medicare rules and regulations and on the specific benefits of the plan or plans they sell. The CY2025 training guidelines specify content areas including original Medicare, MA plan structures, Part D rules, enrollment and disenrollment procedures, marketing and communications requirements, appeals and grievances, and fraud, waste, and abuse. This training obligation extends to all employed, subcontracted, downstream, and delegated entities, including TPMOs. Source: CMS CY2025 Agent and Broker Training and Testing Guidelines
What is a TPMO and how does it affect plan training obligations?
A Third-Party Marketing Organisation (TPMO) is any organisation or individual compensated to perform lead generation, marketing, sales, or enrollment-related functions as part of the chain of enrollment for a Medicare Advantage or Part D plan. This includes independent agents and brokers, field marketing organisations, and lead generation companies. Under 42 CFR 422.2272 and 423.2272, plans bear regulatory responsibility for ensuring that all TPMOs operating on their behalf are trained, that their activities are monitored, and that moderate to severe violations are reported to CMS at least monthly. The plan cannot transfer this responsibility to the TPMO by contract alone. Source: Sidley Austin: CMS Marketing Requirements (2023)
What did the April 2024 CMS final rule change about broker compensation?
The April 2024 final rule, effective October 1, 2024, made three major changes to broker compensation: it capped non-salary compensation to prevent commission structures that created incentives to steer beneficiaries toward plans that maximise broker income rather than beneficiary needs; it eliminated separate administrative service payments on top of commission caps; and it prohibited contractual terms creating volume-based bonus structures for plan sales. The rule also requires express written consent from beneficiaries before their data can be shared with third parties. These changes are CY2025 training content obligations, agents must understand the compensation structure they operate under before selling. Source: Sidley Austin: CMS Broker Compensation Final Rule (April 2024)
What is the Pre-Enrollment Checklist (PECL) and why does it matter for training?
The Pre-Enrollment Checklist (PECL) is a tool agents must review with beneficiaries before completing an enrollment request. It ensures the beneficiary understands key elements of their enrollment decision, including the plan they are enrolling in, the implications for their current coverage, and their rights. The CY2025 training guidelines specifically require that agents are trained on the requirement to review the PECL with the beneficiary before completing the enrollment request. The Senate Finance Committee data showing that beneficiaries were unaware of their own enrollment is a direct indicator of PECL review failures in the field, the most consequential operational consequence of inadequate enrollment training. Source: CMS CY2025 Agent and Broker Training Guidelines, Enrollment Procedures
What is the scope of appointment requirement for Medicare Advantage sales?
CMS requires agents to secure a scope of appointment from the beneficiary at least 48 hours before conducting a formal Medicare Advantage sales presentation. The scope of appointment documents that the beneficiary agreed to discuss specific plan types before the meeting. This requirement applies to in-person sales meetings and certain other sales interactions. Training must cover when the scope of appointment is required, how to obtain it, and how to retain documentation. Plans must also have an operational system for capturing and storing scope of appointment records, the training obligation and the records obligation are concurrent compliance requirements. Source: Insurance News Net: Scope of Appointment Requirements (2023)
What violations must plans report to CMS under the agent oversight requirements?
Under 42 CFR 422.2272(e) and 423.2272(e), plans must report moderate to severe violations by agents, brokers, and TPMOs to their CMS account manager at least monthly. Reportable violations include credentialing issues (licensing, appointment, testing, termination for cause), failure to comply with CMS marketing requirements (misleading information, cherry-picking, unsolicited contact), and other violations of CMS requirements. This obligation requires an active monitoring mechanism, plans must have a system that captures complaints, categorises them by severity, and produces monthly reports to CMS. Passive complaint logging without systematic severity categorisation and reporting does not satisfy this obligation. Source: CMS CY2024 Agent and Broker Compensation Memorandum
How do enrollment periods affect what agents must be trained on?
CMS CY2025 training guidelines require agents to be trained on the full range of Part C and Part D enrollment periods and the eligibility rules for each: the Initial Coverage Election Period (ICEP), the Annual Election Period (AEP), the Medicare Advantage Open Enrollment Period (MA OEP), the Initial Enrollment Period for Part D, the Open Enrollment Period for Institutionalized Individuals (OEPI), and Special Enrollment Periods (SEPs). Training must include what actions MA organisations may and may not take during each period, including the prohibition on knowingly targeting or sending unsolicited marketing materials during the MA OEP. Agents who do not understand enrollment period rules can generate invalid enrollments and expose plans to disenrollment and audit risk. Source: CMS CY2025 Agent and Broker Training Guidelines, Part C and D Enrollment Periods
Sources
Government and Regulatory Sources
- CMS: CY2025 Agent and Broker Training and Testing Guidelines: the authoritative annual training content document. Source for the mandatory content areas (enrollment procedures including PECL review, marketing requirements, enrollment periods, fraud waste and abuse) and the scope of the training obligation (all employed, subcontracted, downstream, and delegated entities).
- CMS: CY2024 Agent and Broker Compensation, Training, and Testing Memorandum (June 2023): source for the monthly CMS non-compliance reporting obligation under 42 CFR 422.2272(e) and 423.2272(e), including the definition of moderate to severe violations and the examples of reportable non-compliance (credentialing issues, marketing violations, cherry-picking, unsolicited contact).
Research and Policy Sources
- Health Payer Intelligence: Report Urges CMS to Increase Oversight of Medicare Advantage Marketing (2022): source for the Senate Finance Committee finding that 9 of 10 states reported increased MA marketing complaints between 2020 and 2021; five states reported targeting of beneficiaries with cognitive impairments; six states reported beneficiaries unaware of their own enrollment.
- AIS Health: Senate Finance Committee TPMO Report, Lead Generation Growth Data: source for the 269% to 706% growth in TPMO purchased leads between 2018 and 2022, and the committee’s recommendation to grant CMS authority to directly regulate lead generators and approve TPMOs before plans can contract with them.
- Sheppard Mullin: CMS Heightens Oversight of TPMO Marketing Programs (2022): source for the CMS secret shopper study finding that in more than 80% of TPMO agent calls reviewed, agents failed to provide the necessary information or provided inaccurate information to beneficiaries.
- Sidley Austin: CMS Finalizes Proposal to Overhaul Medicare Advantage Broker Payments (April 2024): source for the April 2024 final rule provisions: non-salary compensation caps, prohibition on volume-based bonuses, elimination of administrative payments, and express written consent requirements for beneficiary data sharing, effective October 1, 2024.
- Insurance News Net: Clarifying Medicare Advantage Marketing Rules (2023): source for the scope of appointment 48-hour advance requirement and CMS’s emphasis on this requirement during the 2023 and 2024 plan years.
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