Last reviewed: 15 September 2026

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Medicare Advantage vs. Medigap: two different rulebooks for the agent selling you one

Both are sold by licensed insurance agents to people turning 65 or already on Medicare, and both are frequent sources of consumer complaints about pressure tactics. But "Medicare Advantage agent" and "Medigap agent" are operating under genuinely different rulebooks — one federal and direct, the other built on the same state licensing framework the rest of this site covers.

Medicare Advantage and Part D: regulated directly by CMS

The Centers for Medicare & Medicaid Services (CMS) writes and enforces its own marketing rules for agents and brokers selling Medicare Advantage (Part C) and Part D prescription drug plans, published through its Medicare Communications and Marketing Guidelines and codified rulemaking — not left to each state to adopt or not. Specific, checkable requirements include a signed "Scope of Appointment" form before an agent can discuss specific plan options with you, required recording or monitoring of enrollment-related calls, a prohibition on unsolicited door-to-door marketing, and a requirement that marketing materials be filed with and not disapproved by CMS before use.

The 2024 compensation rule, and the litigation around it

In April 2024, CMS finalized a rule (effective for the 2025 plan year) setting a single, national, fixed compensation amount that agents and brokers can be paid per initial Medicare Advantage or Part D enrollment — a flat figure that can't vary based on which specific plan the enrollee is steered toward, with renewal-year payments set at a defined percentage of that same amount. The same rule also tried to cap separate "administrative" payments insurers make to field marketing organizations and third-party marketing organizations (TPMOs) at $100 per enrollment, and restrict certain contract terms between insurers and TPMOs that CMS said could still incentivize volume-based steering.

That second piece didn't survive intact: in 2024, a federal court in the Northern District of Texas (in litigation brought by Americans for Beneficiary Choice and the Council for Medicare Choice) first stayed and then vacated the $100 administrative-payment cap and the related TPMO contract-term restrictions, ruling CMS had exceeded its statutory authority. A separate beneficiary-consent requirement — requiring your consent before one TPMO shares your contact information with another — was allowed to take effect regardless. Because this area is still moving through litigation and rulemaking, verify the current status directly with CMS rather than relying on any specific dollar figure as fixed and final.

Medigap: the same state framework the rest of this site covers

Medigap (Medicare Supplement) policies are a different animal. Federal law (Section 1882 of the Social Security Act) sets minimum standards Medigap policies have to meet, but CMS satisfies that requirement by recognizing a state's own adopted version of the NAIC's Medicare Supplement Insurance Minimum Standards Model Act and Model Regulation — meaning the day-to-day rules governing how a Medigap policy is actually marketed and sold to you are primarily state insurance law, checked through the exact same license, appointment, and anti-rebating framework described in our standard, not a separate federal marketing rulebook the way Medicare Advantage is.

What this means when you're being sold one

If someone contacts you about Medicare Advantage or Part D, a Scope of Appointment form and the CMS-level rules above apply, and CMS itself (not just your state) is a place a marketing complaint can go. If it's a Medigap policy, the relevant checks are the same ones the rest of our standard already covers for any producer: verify their state license and appointment (see our licensing guide) and, if something goes wrong, your state Department of Insurance (see our complaint-filing guide) is the right first stop either way.