Do You Need a Medicare Insurance Agent?

Updated on: August 27th, 2020

Reviewed by Elaine Wong Eakin

We aim to help you make informed healthcare decisions. While this post may contain links to lead generation forms, this won’t influence our writing. We follow strict editorial standards to give you the most accurate and unbiased information.

Navigating Original Medicare, Medicare Supplement Insurance plans, or Medicare Advantage plans can be overwhelming. When you’re first learning about Medicare options, the internet is a great place to start. You may want to ask family members and friends who have Medicare if they like their Medicare plans. Additionally, there are community resources to help you understand your options. If you find that you would like personal guidance to choose what’s best for your needs, an insurance agent may be helpful.

What Is an Agent? 

An agent is a licensed professional who helps you select and enroll in a health plan. 

There are two types of agents.

Independent

An independent agent can partner with and sell policies for different insurance companies. The agent can choose the specific policies they want to sell from a multitude of providers.

Captive

This type of agent can only sell policies from one insurance company.

What Is a Broker?

A Medicare insurance broker is just like an independent agent. Brokers sell plans from different insurance companies.

How Does an Agent or Broker Help You With Medicare Choices?

A Medicare agent or broker can help you narrow down your options and pick the best one. To do this, they’ll learn about your health goals and budget. They’ll present you with options to meet your goals within your budget. They can help you enroll in the plan you choose. 

You can also contact an agent or broker to help you change plans if the one you’re enrolled in changes coverage or doesn’t meet your needs. 

Using a Medicare broker or agent is free — you don’t pay for their service directly.

Agents or brokers are either employed by healthcare companies or have a contract with the companies to sell their plans. They’re typically paid by commission. When an agent or broker enrolls you in a health plan, they get a fee for that first year. For every year you stay in the plan, they get half the initial payment.1 

However, the commissions agents and brokers receive for different plans vary by company and arrangement. For instance, the commission can be a flat fee or a percentage of the premium. Regardless, you don’t pay for the agent’s or broker’s service directly.

How Do You Find an Agent or Broker Near You?

You can find a Medicare insurance agent or broker near you by using the Centers for Medicare & Medicaid Services (CMS) healthcare.gov’s Find Local Help search tool.2 You can also find licensed agents and brokers through your state insurance department. Many websites of state insurance departments allow you to check the license status of someone who claims to be a licensed insurance agent or broker. 

Why Work with an Agent or Broker? 

Although there is no requirement to work with an agent or broker, you may choose to do so for the following reasons:

Navigating Medicare

Medicare can be complex. There are numerous plans, plan combinations, benefits, rules, and exceptions — all of which can be confusing. Buying health insurance is a huge investment, so you want to find a plan that meets your needs. An ethical and knowledgeable agent or broker can help you get the best value for your money. Agents or brokers who sell health insurance products related to Medicare have to pass a test on their knowledge of Medicare every year.3

Searching Multiple Companies

To find the best health plan for your individual needs, you might have to check with multiple insurance companies. One of the benefits of working with an independent Medicare broker or agent is that they represent many health insurance companies. They can present you with plan options from different carriers, increasing your chances of finding the right fit.

Medical Underwriting

If you want to buy a Medicare Supplement Insurance policy (also called Medigap) after your open enrollment period, insurance companies may use medical underwriting and set the premium based on your current health condition. They may also refuse to sell you the policy based on any health issues you have. A Medicare agent or broker can help you figure out if you’ll meet the underwriting requirements for the plan you want.

What Type of Agent or Broker Should You Choose? 

Independent

Working with an independent Medicare insurance agent means you get to choose policy options from different companies. Independent agents and brokers are more likely to give unbiased plan recommendations and advice. But they may not have in-depth knowledge of these plans.

Captive

Agents who represent a particular health insurer can only sell you plans from that insurer. These captive agents are typically experts on all the options their company offers. But you won’t learn about plans from other Medicare insurance companies.

What Should You Consider When Choosing an Agent or Broker?

Licensure

Before choosing a Medicare agent or broker, make sure they’re licensed by checking with your state insurance department. Their business card should include their license number. The websites of many state insurance departments allow you to check an agent’s or broker’s license status. The Centers for Medicare & Medicaid Services requires them to be licensed in the state they operate in.4

Experience

You should pick a broker or agent with solid experience selling Medicare plans in your state. Ask your family members and friends for referrals. When interviewing an agent or broker, ask about the types of plans they handle and the kind of customer they usually work with. 

Customer service

Pick an agent or broker with excellent customer service by asking for references from previous clients. Ensure that you make time to call the references.

Conclusion

It’s up to you whether you want to work with a Medicare agent or broker. Using a knowledgeable and ethical agent or broker can make your search for a health plan significantly easier and faster. Since their services are free, you have nothing to lose by trying an agent or broker near you. 

Share this article
  1. Centers for Medicare & Medicaid Services. “Agent Broker Compensation.” cms.gov (accessed May 19, 2020).

  2. U.S. Government Website for the Federal Health Insurance Marketplace. “Find Local Help.” healthcare.gov (accessed May 19, 2020).

  3. Agent Broker Compensation.”

  4. Agent Broker Compensation.”