What to know about using a Medicare broker to find the best coverage for you (2024)

Shopping for the right Medicare plan, or plans, isn’t easy.

First, you have to choose between Traditional Medicare (for Medicare Parts A and B) and a private insurer’s Medicare Advantage or Part C plan. Then, if you’ll take Traditional Medicare, you’ll likely also want a Medigap supplemental insurance plan and a Part D prescription drug plan.

So, you may want to get help from a Medicare broker or agent (a broker works for someone who wants a Medicare plan; an agent represents one or more insurers). Almost one in three people aged 65 and older use one, according to Gretchen Jacobson, vice president of Medicare at The Commonwealth Fund, a health care research foundation.

“The Medicare population is growing, so more organizations are seeing that as an opportunity to sell Medicare policies,” says Josh Hodges, the National Council on Aging’s chief customer officer. “It puts even more pressure on consumers to make sure they’re getting the guidance and advice they need.”

Before hiring a Medicare broker, though, it’s important to understand how they work, how they get paid, and how to separate the best from the rest.

“Navigating Medicare is an incredibly complex process, and a broker is a good way to navigate that,” Hodges notes. “But you’ve just got to make sure you’re vetting the insurance broker like you vet any other professional.”

Scathing reports on Medicare brokers

Medicare Advantage plan brokers are more regulated than Medigap and Plan D brokers. But two recent Senate reports revealed seamy sales practices of some Medigap and Medicare Advantage plan brokers.

Sen. Elizabeth Warren’s (D-Mass.) recent investigative report, described the “pervasive, secret” sales incentives Medigap brokers working for major insurers receive.

In the 2022 Medicare open enrollment period, Warren’s researchers found, at least 32 companies provided cash bonuses and lavish vacations to places like Maui and St. Thomas as incentives to brokers for selling certain Medigap policies.

“The widespread use of secret perks raise questions about whether agents and brokers are recommending certain Medigap policies because they are the right fit for seniors, or because they yield credit toward the fanciest vacations or most generous bonuses,” the report concluded.

Last fall, Sen. Ron Wyden (D-Ore.) and the Democratic staff of the U.S. Senate Committee on Finance released a scathing report about the way Medicare Advantage plans are often sold.

It looked at Medicare Advantage marketing complaints from 14 states and found, among other things:

  • Insurance agents telling prospects that their doctors were covered by their plans when the physicians were actually out-of-network, meaning the policyholders would need to pay out of pocket for them
  • A Medicare Advantage insurance agent calling people 20 times a day, trying to get them to switch their Medicare coverage
  • Medicare beneficiaries being disenrolled from their plans due to misleading and aggressive marketing practices of agents and brokers

Low-quality vs. high-quality medicare brokers

Selling Medicare policies can be highly lucrative. One insurance agency is advertising an upcoming “Six-Figure Medicare Agent Summit” in Salt Lake City, charging $200 to $5,000 to “help Medicare Agents grow and scale their business!”

Darwin Hale, CEO of Advocate Health Advisors, a marketing organization whose agents sell Medicare policies, says: “I’ve heard horrible stories of short-term, transactional” brokers who “basically wanted to make the sale and go away as soon as possible, never to be heard from again.”

High-quality brokers, Hale notes, “invest a lot of time and energy in the beginning of the relationship and the focal point is the client.”

How Medicare brokers get paid

You don’t pay to use a Medicare broker or agent. But how, and how much, Medicare brokers and agents earn by selling policies varies enormously.

Independent agents represent multiple insurers and work on commissions paid by the companies; captive agents work for just one insurer and receive a salary from the company as well as a commission with a lower rate than an independent agent’s.

By contrast, a broker lets you choose among different Medicare Advantage, Medigap or Part D prescription policies and then sends you to an agent once you’ve decided which to buy. Brokers are paid commissions from the insurers and the rates are set by state insurance regulators.

The umbrella agency for Medicare, the Centers for Medicare and Medicaid Services (CMS), sets maximum commissions for Medicare Advantage plans and standalone Part D plans, but doesn’t set minimum commissions, says Jacobson.

The Biden administration has issued a proposed rule cracking down on the marketing of Medicare plans by insurers and salespeople, “but it doesn’t touch agent commissions,” says David Lipschutz, associate director of the Center for Medicare Advocacy, at the recent American Society on Aging’s OnAging 2023 annual conference.

Typically, commissions are twice as much for signing someone up for a Medicare Advantage, Medicare or Part D plan than for subsequent years if someone stays in the plan, according to CMS.

For example, the national maximum initial commission for a Medicare Advantage Part D plan is $601; it’s $301 for a renewal on that type of plan, according to the Tidewater Management Group, a marketing firm for Medicare agents.

Brokers and agents also tend to earn higher commissions selling Medicare Advantage plans than Medigap plans or Part D prescription drug plans.

What Medicare brokers and agents say

Last fall, when the public opinion research firm Perry Undem held focus groups with over two dozen Medicare brokers and agents, they heard that these salespeople generally recalled getting higher commissions for enrolling people in Medicare Advantage plans than Medigap plans.

“Medigap plans and Medicare Advantage plans often have incentives for enrollment targets,” says Jacobson. “So, for example, if you enroll 20 people in a company’s plan over a one-week or two-week period, they’ll provide a bonus for every person you enrolled.”

The commission structure of Medigap plans also incentivizes the sale of plans charging higher premiums, the brokers and agents says. And, they noted, commissions for standalone Part D plans were viewed as too law and not worth their time.

“According to the brokers and agents, insurers now are oftentimes not even paying a commission for standalone Part D plans or paying a really low commission for those plans,” says Jacobson.

Most of the brokers and agents says they’d personally choose Traditional Medicare with Medigap over Medicare Advantage plans. The reason? Better coverage and choices, especially as people get older.

“Beneficiaries lack information, however, about how brokers and agents winnow down plan options and what role financial incentives might play in the advice they give,” a February 2023 Commonwealth Fund article about the focus groups says.

How to find a good Medicare broker or agent

A good Medicare broker “knows which doctors are keeping people happy and which [insurer’s] front office is behaving,” says Hale. “A good broker builds trust and rapport.”

If you want to hire a Medicare broker or agent, Hale advised, get referrals from your doctors as well as from friends and family members on Medicare. Then, “interview a broker the same you would a Realtor to get a few quotes on your house,” he adds.

You may also want to look at the National Council on Aging’s (NCOA) Medicare Standards of Excellence list to find agents and brokers working in your best interest. Currently, four organizations have completed NCOA’s review and training process to meet its Standards of Excellence.

The standards include ensuring: you won’t be inappropriately steered to buy insurance products; agents won’t be paid differently based on the company or plan they recommend; you can choose from a broad range of the best coverage options; you’ll get comprehensive information about those options and plan choices; you’ll get excellent and prompt service and the insurance brokerage and its agents comply with Medicare and state insurance regulations.

The four companies now on the list are: Alight Retiree Health Solutions (for Medicare Advantage and Part D plans); Ask Chapter; Fidelity Medicare Services (for residents in 17 states) and Medicare Choice Group.

When choosing a Medicare broker or agent on your own:

Ask how long they’ve been selling the plans and how they’re trained

“At least three years of experience, in my opinion,” says Hale. “If it’s a new salesperson with a manager who’s guiding and training them, that’s okay.”

Ask how many health insurers they represent, and which ones

“I would encourage older adults look for brokers who have a wide variety of plans,” says Hodges.

The Commonwealth Fund’s focus groups found that brokers don’t sell all plans in their geographic area; they chose which to sell based on how fast insurers answered their questions, client feedback and sometimes plan benefits. By contrast, Affordable Care Act Marketplace [salespeople] “are required to sell all the plans,” Jacobson says.

Ask how, and when, you can reach them

“They should have open communication,” says Hale. “They should give you their cell number and make you feel comfortable to call them anytime.”

Later this year, the National Association of Insurance Commissioners expects to release a customized online search tool to let you see if someone is licensed to sell Medicare policies. Medicare agents and brokers need to be licensed.

Other sources of medicare information

NCOA’s Hodges and The Commonwealth Fund’s Jacobson says that to make smart Medicare decisions you could also contact your State Health Insurance Assistance Program (SHIP) for free, unbiased, expert information — but not recommendations of particular plans.

The U.S. government’s Medicare.gov site has detailed information about how Medicare and the various types of Medicare plans work, as well as a Medicare Plan finder tool and a guide to shopping for Medigap policies. There’s very little information about Medicare brokers or compensation on the site, though.

The American Association for Medicare Supplement Insurance site has a search tool to find local Medigap agents, too.

“I very much encourage people to buy Medicare the way they buy their house: thoughtfully,” says Hodges.

What to know about using a Medicare broker to find the best coverage for you (2024)


What to look for when choosing an insurance broker? ›

A good broker will be patient, understanding, not “pushy,” as quick to listen as to talk, and willing to walk you through each insurance type step by step so you can understand how to choose the policy you'll be most satisfied with. These are some of the qualities to look for in a quality insurance broker.

How do I know which Medicare Advantage plan is best? ›

Factors to consider when choosing a Medicare Advantage plan
  1. costs that fit your budget and needs.
  2. a list of in-network providers that includes any doctor(s) that you would like to keep.
  3. coverage for services and medications that you know you'll need.
  4. Centers for Medicare & Medicaid Services (CMS) star rating.

What Medicare plan has the most coverage? ›

Medicare Supplement Plan G is the best overall plan that provides the most coverage for seniors and Medicare enrollees. Plan G will cover almost everything except the Medicare Part B deductible, which is only $226 for 2023.

How do commissions work with Medicare Advantage? ›

Medicare Advantage Commissions

2023 commissions for most U.S. states are $601 for persons new to Medicare and $301 for renewals. Commissions are even higher in some U.S. states like California. Commissions are paid in advance. Renewal commissions stay level for the life of the policy.

What are the 5 qualities of an insurance broker? ›

5 Traits of a Good Insurance Broker Partner
  • Fast Turnarounds. If you don't get back to a client with a quote quickly, there's a chance they could go to another agent. ...
  • They Are Knowledgeable of the Industry and Their Specialties. ...
  • They Have Good Carrier Relationships. ...
  • They're Stable and Reliable. ...
  • They're Responsive.

What questions should I ask an insurance broker? ›

Start a conversation: 8 questions to ask your insurance agent.
  • What is my deductible? ...
  • What is my premium? ...
  • What happens if I get in a car accident? ...
  • Does my homeowners insurance policy offer enough protection? ...
  • Is it time for me to consider life insurance? ...
  • Do I have enough liability coverage? ...
  • Do I need an umbrella policy?
Jan 6, 2021

What are the top 3 Medicare Advantage plans? ›

Local plans can be high-quality and reasonably priced. Blue Cross Blue Shield, Humana and United Healthcare earn the highest rankings among the national carriers in many states.

What percent of seniors choose Medicare Advantage? ›

Forty-five percent of Medicare beneficiaries are enrolled in Medicare Advantage plans in 2022, a share that is projected to rise to more than 50 percent by 2025.

Do I still pay Medicare premiums with an Advantage plan? ›

A premium is an amount you pay monthly to have the plan, regardless if you use covered services or not. For example, if you pay $55 a month for a Medicare Advantage plan, you will pay $660 yearly to be covered by that plan, even if you don't see one doctor that year.

Can I drop my Medicare Advantage plan and go back to original Medicare? ›

If you joined a Medicare Advantage Plan during your Initial Enrollment Period, you can change to another Medicare Advantage Plan (with or without drug coverage) or go back to Original Medicare (with or without a drug plan) within the first 3 months you have Medicare Part A & Part B.

Why do agents push Medicare Advantage plans? ›

Advantage plans are heavily advertised because of how they are funded. These plans' premiums are low or nonexistent because Medicare pays the carrier whenever someone enrolls. It benefits insurance companies to encourage enrollment in Advantage plans because of the money they receive from Medicare.

What percentage of people take Medicare Advantage? ›

As of January 2023, 48 percent of all Medicare beneficiaries are enrolled in Medicare Advantage, translating to 30.7 million people. Medicare Advantage enrollment growth continued at a rapid pace, adding 2.7 million beneficiaries in 2023.

Who pays claims with a Medicare Advantage plan? ›

CMS Pays Medicare Advantage Plans

Medicare Advantage companies have a contract with the federal government. Medicare pays these private companies to take on the risk of its policyholders. So, instead of Medicare paying for your claims, they pay the insurance company to manage them.

What makes a good broker? ›

Enthusiastic, diplomatic and outgoing, a good broker is a skilled communicator. They know how to talk to potential buyers and meet their expectations during a property visit. They are able to ease tensions, provide a framework for discussions, and find the right words during negotiations and explanations.

What is the primary responsibility of an insurance broker? ›

Insurance Broker Responsibilities:

Meeting with potential clients to discuss their insurance needs. Researching all the available policy options for the client. Negotiating with underwriters to get the best policy at the best price. Presenting policy details to the client and signing the policy agreement.

What is the point of an insurance broker? ›

An insurance broker represents consumers in their search for coverage and can sell policies from several different insurance companies for a commission. Unlike captive and independent agents, who represent one or more insurance companies, a broker's primary duty is to the client.

What is the most common conflict of interest that an insurance broker? ›

Contingent Commissions. The commissions most likely to cause a conflict of interest are contingent commissions. This is where an insurance broker can earn an additional commission if he brings clients to a certain insurer.

What should you ask your agent when choosing an insurance plan? ›

Related questions to ask:
  • How big is the plan's coverage network? What kind of network is it?
  • Is my current doctor covered by this plan (are they in-network)?
  • How much will I pay if I see a doctor who isn't covered by this plan (out-of-network)?
  • Do I plan to get out-of-network care?

How do I interview an insurance agent? ›

5 Insurance Agent Interview Questions & Answers
  1. What qualities do you have that make you a great insurance agent?
  2. How would you differentiate yourself from your competitors?
  3. Are you able to handle rejection? ...
  4. What was your most successful sale?
  5. What kind of strategy would you devise to gain clients' attention?

Which is the cheapest health insurance for senior citizens? ›

Medicare is the best health insurance option for seniors and retirees. For those age 65 and older or who have a qualifying disability, the Medicare program will be the cheapest health insurance with the best benefits. When you were working, you paid into the Medicare program via a Medicare tax on income.

What states have 5 star Medicare Advantage plans? ›

States where 5-star Medicare Advantage plans are available:
  • Alabama.
  • Arkansas.
  • California.
  • Colorado.
  • Florida.
  • Georgia.
  • Hawaii.
  • Idaho.
May 2, 2023

Who is the best person to talk to about Medicare? ›

Call 1-800-MEDICARE (1-800-633-4227) to talk with a customer support representative about your Medicare questions and concerns—or visit the Medicare.gov website to start a live chat. TTY users should call 1-877-486-2048. The Medicare Support Hotline is available 24/7, except for some federal holidays.

Who is the largest Medicare Advantage provider? ›

UnitedHealthcare is the largest provider of Medicare Advantage plans and offers plans in nearly nine out of every 10 U.S. counties. UnitedHealthcare also partners with AARP, insuring the Medicare products that carry the AARP name.

What changes are coming to Medicare in 2023? ›

Everyone pays a Part B monthly premium, even people with Medicare Advantage plans. In 2023, the Part B standard premium is $164.90 per month, down from $170.10 per month in 2022. If you have a higher income, you may pay more. The Part B deductible dropped to $226 in 2023, down from $233 in 2022.

Does Medicare Advantage pay 100 percent? ›

Medicare Advantage Plan (Part C):

Deductibles, coinsurance, and copayments vary based on which plan you join. Plans also have a yearly limit on what you pay out-of-pocket. Once you pay the plan's limit, the plan pays 100% for covered health services for the rest of the year.

What are two disadvantages of Medicare? ›

  • Members are responsible for copayments and deductibles.
  • May require referrals to see a specialist.
  • The provider network limits the choice of doctors/hospitals and doctors may not accept certain Medicare Advantage plans.
  • Members are required to pay full price for services outside the provider network.

Is Medicare Advantage more expensive than Medicare? ›

Medicare Advantage can cost less than Original Medicare. That's because Medicare Advantage plans must have a maximum out-of-pocket limit.

What is the difference between a Medicare cost plan and a Medicare Advantage plan? ›

Like Medicare Advantage plans, Medicare cost plans are offered by private companies and may also include extra coverage. However, unlike Medicare Advantage plans, a Medicare cost plan doesn't replace your original Medicare coverage. Instead, it offers other benefits in addition to those of original Medicare.

What are the 6 things Medicare doesn't cover? ›

Some of the items and services Medicare doesn't cover include:
  • Long-Term Care. ...
  • Most dental care.
  • Eye exams (for prescription glasses)
  • Dentures.
  • Cosmetic surgery.
  • Massage therapy.
  • Routine physical exams.
  • Hearing aids and exams for fitting them.

How do you qualify to get $144 back from Medicare? ›

To qualify for the giveback, you must:
  1. Be enrolled in Medicare Parts A and B.
  2. Pay your own premiums (if a state or local program is covering your premiums, you're not eligible).
  3. Live in a service area of a plan that offers a Part B giveback.

Will Medicare Part B premiums increase in 2023? ›

The Part B basic premium in calendar year 2023 is scheduled to be $164.90 per month, or about 25 percent of expected Part B costs per enrollee age 65 or older. Premiums can be higher or lower than the basic premium for enrollees who receive Part B benefits through the Medicare Advantage program.

What are the pros and cons of a Medicare Advantage Plan? ›

Medicare Advantage plans can be full of extra benefits like prescription drug coverage, dental, hearing, and vision coverage. Another advantage of a Medicare Advantage plan is a mandatory out-of-pocket maximum. A possible disadvantage of a Medicare Advantage plan is you can't have a Medicare Supplement plan with it.

Is Medicare Advantage taken out of Social Security? ›

Medicare part B, Medicare part D, and Medicare Advantage premiums can all be deducted from your Social Security checks.

What is the out-of-pocket limit for Medicare in 2023? ›

Medicare Advantage (Part C): In 2023, the out-of-pocket maximum for Part C plans is $8,300 for approved services, but individual plans can set lower limits if they wish.

How many times can you switch from Medicare Advantage to Medicare? ›

No, you can't switch Medicare Advantage plans whenever you want. But you do have options if you're unhappy with your plan. You can jump to another plan or drop your Medicare Advantage plan and change to original Medicare during certain times each year.

Can a Medicare Advantage plan cancel me? ›

Medicare Advantage plans may discontinue your Medicare Advantage coverage if you don't pay your premium within the grace period allowed by the Medicare Advantage plan. If you can't make your premium payment, you should contact your Medicare Advantage plan's customer service.

Can you change Medicare Advantage plans every year? ›

Yes, you can elect to switch to traditional Medicare from your Medicare Advantage plan during the Medicare Open Enrollment period, which runs from October 15 to December 7 each year.

Why are people leaving Advantage plans? ›

While some plans provide excellent dental, vision, and hearing coverage, many only cover preventative services. This is one once of the leading causes of individuals leaving Medicare Advantage plans.

Why do people leave Advantage plans? ›

Beneficiaries may choose to leave their plan if they are dissatisfied with providers covered, if their medical needs change, or if out-of-pocket costs are too high.

Do most people use Medicare Advantage? ›

Of Medicare's 64.5 million beneficiaries — the majority of whom are age 65 or older — about 29.1 million are enrolled in Advantage Plans, which deliver Parts A and B and usually Part D prescription drug coverage, along with extras such as basic dental and vision.

What is the fastest growing Medicare Advantage plan? ›

Devoted Health is the fastest growing Medicare Advantage startup plan, according to an analysis from Chartis. Startup MA plans grew by 21.7 percent from 2022 to 2023, according to Chartis' report published March 23.

Is Medicare Advantage a good policy? ›

For many seniors, Medicare Advantage plans can work well. A 2021 study in the Journal of the American Medical Association found that Advantage enrollees often receive more preventive care than those in traditional Medicare. But if you have chronic conditions or significant health needs, you may want to think twice.

Why do some people not like Medicare Advantage? ›

One of the primary reasons why Medicare Advantage plans are bad for some is because of their high costs. While these plans may offer lower premiums than traditional Medicare, they often come with additional costs that can quickly add up.

What qualities should you consider in selecting an insurance agent? ›

Top Ten Traits of Successful Insurance Agents
  • Problem-solver. Do you enjoy coming up with creative solutions to problems? ...
  • Self-motivated.
  • Honest. This might seem obvious, but unethical insurance agents rarely stay in business very long. ...
  • Sense of urgency. ...
  • Reslience. ...
  • Passionate. ...
  • Communication Skills. ...
  • Good Listener.
Mar 7, 2019

What characteristics should you look for in an insurance agent? ›

Characteristics to Look for When Hiring Insurance Agents
  • Problem-solving ability. As an agent, you have to help people find the best insurance policy for their needs, so a necessary skill is being able to find solutions to problems such as these.
  • Motivation. ...
  • Integrity. ...
  • Resilience. ...
  • Communication skills. ...
  • Love of learning.
Jul 28, 2022

What is the difference between insurance agent and insurance broker? ›

Insurance agents and insurance brokers can both help you buy an insurance policy. But insurance agents represent the insurance provider that employs them and help sell policies from that single provider. Insurance brokers represent the consumers who use them and can help them shop for policies from multiple providers.

What three things are most important to you when choosing an insurance company? ›

Here are the main points to keep in mind when selecting an insurance company:
  • Licensing. Not every company is licensed to operate in each state. ...
  • Price. Many companies sell insurance policies and prices vary greatly from one to another, so it really pays to shop around. ...
  • Financial Solidity. ...
  • Service. ...
  • Comfort.

What are 4 things you should look at when choosing an insurance plan? ›

What to look for in a health insurance plan
  • Premium. This is the amount of money you pay each month for insurance.
  • Deductible. This is the amount of money you have to spend before the plan starts paying for your health care. ...
  • Co-payment (also called co-pay). ...
  • Maximum out-of-pocket cost or expense.

Which of the following questions are important to consider when choosing insurance agent? ›

Which of the following questions are important to consider when choosing an insurance agent? -Is your agent happy to answer questions? -Does your agent keep up with changes in the insurance field? -Does your agent advise you to have a financial plan?

What do you think is the most important characteristic that an agent should have? ›

Emotional intelligence is the key to all relationship management. The agent must always recognize emotions running through the conversation. Also, he has to reply with empathy and cleverness.

What are the major responsibilities of insurance agent? ›

Insurance Agent duties and responsibilities

Network with potential customers. Educate customers on each type of insurance coverage and make recommendations based on their needs. Evaluate current insurance policies and recommend additional coverage when needed. Maintain all insurance documents in a confidential way.

What questions should you ask when considering an HMO or PPO? ›

  • Is it an HMO or a PPO? ...
  • Is there a waiting period? ...
  • Will I pay a monthly premium? ...
  • What are the copays, coinsurance, and deductibles? ...
  • Are dental and vision coverage included? ...
  • What are the healthcare providers and networks I can use? ...
  • Where will I be covered? ...
  • Will it cover pre-existing conditions?
Jul 1, 2019

What is the difference between a PPO and a HMO? ›

HMO plans typically have lower monthly premiums. You can also expect to pay less out of pocket. PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral. Out-of-pocket medical costs can also run higher with a PPO plan.

What are the disadvantages of using an insurance broker? ›

Disadvantages of Choosing an Insurance Broker
  • Reliance on Insurance Agents. Since insurance brokers represent their clients and not the insurance company, they cannot bind the coverage themselves and must turn the process over to an insurance agent to complete.
  • Lack of Training and Experience. ...
  • Sales-driven.
May 30, 2023

What is the benefit of using a broker? ›

They consider multiple plan options and negotiate on your behalf to find the best value for your coverage. Their expertise and existing relationships with various companies give them a broader understanding of the offerings available. Customization. Brokers ask a lot of questions to understand your needs fully.

What is the difference between a broker and an agent? ›

Agents work for insurance companies, while brokers work for consumers. Because brokers represent their clients, they have a duty to provide impartial advice and act in the buyers' best interest. Agents, on the other hand, are motivated to sell the products that the insurers they represent offer.


Top Articles
Latest Posts
Article information

Author: Amb. Frankie Simonis

Last Updated:

Views: 6147

Rating: 4.6 / 5 (76 voted)

Reviews: 91% of readers found this page helpful

Author information

Name: Amb. Frankie Simonis

Birthday: 1998-02-19

Address: 64841 Delmar Isle, North Wiley, OR 74073

Phone: +17844167847676

Job: Forward IT Agent

Hobby: LARPing, Kitesurfing, Sewing, Digital arts, Sand art, Gardening, Dance

Introduction: My name is Amb. Frankie Simonis, I am a hilarious, enchanting, energetic, cooperative, innocent, cute, joyous person who loves writing and wants to share my knowledge and understanding with you.