Managed Care—Who Calls the Shots? State and Federal Roles in Medicare Marketing and the Inevitable Power Struggle in Governing AI

• May 01, 2026

• Devon Minnick , Epstein Becker Green
• Helaine Fingold , Epstein Becker Green

Since the beginning of the Medicare Advantage (MA) and Part D programs, regulators and advocates have emphasized the need to protect beneficiaries from misleading and abusive marketing and enrollment practices. Under the predecessor to the MA program, Medicare+Choice, state and federal regulators worked together to address marketing concerns. Congress, however, adopted broad federal preemption provisions for the MA and Part D programs, which, among other things, limited state regulators’ ability to address Medicare marketing misconduct at a time of increased beneficiary reliance on marketing communications to understand program developments. How to balance federal and state responsibilities over Medicare marketing concerns has again come to the fore in response to increasing program pressures. This article reviews the history and development of Medicare marketing regulations and the current tensions between federal and state regulators around marketing. It also explores another area relevant to marketing that is ripe for future federal/state conflict—the use of Artificial Intelligence (AI) in Medicare marketing efforts.

ARTICLE TAGS

• Payers, Plans, and Managed Care Practice Group
• Government Reimbursement
• Health Insurance