What is a Medicare Insurance Agent?

Learn about Medicare insurance agents, how they make their money if you use them, and what they can do for you.
By Mike Parker
Updated Aug 29, 2022
A man that is happy with his Medicare insurance agent.
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Enrolling for Medicare

If you're thinking of joining the federal Medicare program, you should first check whether you are eligible to do so. To be eligible for Medicare, you must be a U.S. citizen or a legal resident of the U.S.

Who is eligible to join Medicare. 

To qualify for Medicare you must be:

  • 65 or older (or turning 65 in the next three months).

  • Disabled.

  • Suffering from ESRD (End-Stage Renal Disease).

The next step is to decide whether you want to get Original Medicare or Medicare Advantage coverage.

This can be a difficult decision to make. Original Medicare’s structure and coverage conditions can make it tricky to know how much you will pay for medical items, services, and procedures.

Medicare Advantage is no less complicated. There are many plans to choose from, and each state has providers with different benefits and coverage options.

A Medicare beneficiary looking at his different coverage options before calling his insurance agent.

(Source: Pexels

What Do Medicare Insurance Agents Do?

Most people don’t know where to begin when choosing a Medicare Advantage or Medicare Supplement Insurance plan.

Some insightful resources, like PolicyScout's Medicare Hub, are great for learning about Medicare and health insurance.

Sometimes a friend, doctor, or family member can point you in the right direction of a quality Medicare Advantage plan.

At other times you’ll need a professional, like a Medicare insurance agent, to guide you through your options.

Medicare insurance agents primarily sell insurance plans on behalf of private health care insurance companies.

They act as the first point of contact between insurance companies and potential clients by offering essential information about policies and enrollments.

Medicare insurance agents also research different policies, companies, and health plans to provide clients with on-hand knowledge and assist them with Medicare health coverage choices.

An older couple greeting their Medicare insurance agent.

(Source: Pexels)

The Different Types of Medicare Insurance Agents

There are two types of Medicare insurance agents—independent agents and captive agents.

Both kinds must be licensed in their state of operation to sell Medicare Advantage, health care insurance, or Medigap products.

Both provide the same services to their clients in different ways. Knowing the difference can help you find a Medicare insurance agent that's right for you.

Independent Medicare Agent/Medicare Insurance Broker

An independent Medicare agent, also known as a Medicare insurance broker, is a sales representative that works for multiple insurance companies in their state.

Because they work for multiple companies, independent Medicare agents are knowledgeable about different policy types and plans.

They can also advise Medicare beneficiaries on issues around enrollment, medical underwriting, premiums, and plan structures.

Independent Medicare agents and Medicare insurance brokers are great for people new to Medicare, or those who don't have a specific company they would like to join. 

What Is Medical Underwriting?

Medical underwriting is a risk assessment done by insurance companies to determine whether they will cover you and how much they will charge.

Licensed Medicare insurance agents will be able to guide you through the underwriting process, answer your questions, and help you get covered.

Captive Medicare Agent

While the name may sound strange, a captive Medicare agent is just the term for a sales representative who works for one insurance company.

Like independent Medicare agents, they are knowledgeable about Medicare enrollment, plan structures, and premiums. However, they are employed by one insurance company and can only sell that company’s plans.

Captive Medicare agents are ideal for people interested in joining a particular Medicare insurance company. They can also provide in-depth knowledge about switching policies if you want to keep your current insurance provider.

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Why Do People Use Medicare Insurance Agents?

There are various reasons why people use or would like to use a Medicare insurance agent to assist them with their health care.

Medicare brokers and agents make a living by knowing the ins and outs of policies and Medicare coverage options. 

Using an agent can be an invaluable resource to someone who doesn’t know anything about Medicare and health coverage.

Because of their expertise, they can make the process of finding a good plan or service provider quicker. They can also advise you on your health care options if you're thinking about changing plans or switching to another insurance company.

You’ll be able to ask them questions about your health care and use their knowledge to lower your health care costs. They are required by law to provide you with accurate, unbiased information about health care plans.

Agents can save you a significant amount of time by finding a plan and enrolling in one. Their professional experience and connections within the industry will make signing up for a plan stress-free and straightforward. 

Requirements for Enrolling in a Medicare Advantage Plan

If you want to sign up for a Medicare Advantage plan, you need to be:

  • Turning 65 in the next three months (or over 65)

  • A U.S. citizen or lawfully present in the U.S.

  • Enrolled in Original Medicare (Parts A and B)

Should I Use a Medicare Insurance Agent?

If you are uncertain about your Medicare health coverage options and would like to speak to someone, a reputable Medicare broker or agent will be able to help you and answer your questions.

If you’re looking for general help with your Medicare questions, you can also reach out to the team at PolicyScout by email or telephone.

We provide up-to-date and accurate information about Medicare, Medicare Advantage, and Medicare Supplemental Insurance.

We also can connect you with some of the best Medicare insurance agents in your area if you’re ready to look into different Medicare Advantage plans. 

Want to learn more about Medicare and Medicare Agents?

Send your questions to Help@PolicyScout.com or call us on 1-888-912-2132 to get assistance from one of our skilled Medicare consultants.

Medicare insurance agent showing his client the different Medicare Plans.

(Source: Pexels)

How Do Medicare Insurance Agents Make Money?

Medicare insurance agents earn money in different ways. Most of the time, they will receive a commission for each sale they make and another commission payment for each year their clients stay on the plan.

The amount they earn is based on many factors, including the insurance company's commission rates, total annual sales, and level of experience.

But a general rule is that a Medicare broker or agent will earn half of their initial sales commission rate for every year that their clients remain on a policy.

For example, if a Medicare insurance agent makes $600.00 when they sign you up for a Medicare Advantage plan, they will earn $300.00 each subsequent year you stay on the plan.

You’d be forgiven for thinking that Medicare insurance agents are all about making sales and signing up Medicare beneficiaries to policies.

But there is a strong financial incentive for them to keep clients happy and make sure they will stay on their plan for a long time.

While you may get some unethical Medicare insurance agents, the large majority are hardworking and worthy of their fees.

What Makes a Good Medicare Insurance Agent?

A Medicare insurance agent can often mean the difference between finding your ideal Medicare plan and being stuck with one that doesn’t meet your needs.

Follow these steps to make sure you get the best service:

1) Find out if your Medicare insurance agent is licensed to practice in your state. Having a Medicare Insurance Agent license will mean that your broker is qualified, skilled, and able to assist you in finding a great Medicare or Medigap plan.

2) Look at how long your agent has been selling Medicare and Medigap policies in your state. Experienced agents will be able to advise on a range of topics around health cover. They will ultimately save you time and money when you choose a health care plan.

3) Check if your Medicare insurance agent is knowledgeable about their policies and Medicare regulations. Ask them questions, get their advice, and check online to see if what they are saying is correct.

If they can answer any question you throw their way or explain a complicated subject in a way that makes sense to you, then you've got a winner.

4) See if your Medicare insurance agent has a track record of happy, satisfied clients. Ask for references and be wary if they are unwilling to give them.

You can speak to friends or other people who have used their services or even look online to see if people have left good or bad reviews about them.

A Good Medicare Insurance Agent Is:

  • Licensed

  • Experienced

  • Knowledgeable

  • Client-focused

Finding a good health care agent will ensure that you get the best policy available. It will also mean you can rest assured knowing your health care concerns are in good hands.

If you'd like to learn more about Medicare insurance agents or Medicare Advantage plans in your area, reach out to one of our consultants.

Rules of Conduct for Medicare Insurance Agents

Because Medicare beneficiaries are often older, disabled, or suffering from a terminal illness, independent and captive agents are limited in how they can interact with clients.

A professional, licensed Medicare agent will always act in a way that is legal and ethical. They are governed by federal rules and regulations, which set out what they can and can't do. 

We’ve outlined some of the practices and regulations that Medicare insurance agents must follow below.

What are Medicare Insurance Agents not allowed to do?

By law, a licensed Medicare agent, broker, or insurance company representative cannot:

  • Offer cash or other material incentives to join their plan.

  • Come to your home uninvited to sell you a plan.

  • Call you if you are not a member of their plan.

  • Ask you for payment of any kind over the phone or online.

  • Sell non-health-insurance products during a Medicare health or drug plan sales pitch.

  • Talk to you about their plans in areas where you receive health care.

  • Make an appointment with you to discuss their plan unless you agree to it.

  • Market their plans or enroll you during an educational event.

An elderly couple impressed with the Medicare plan provided by their insurance agent.

(Source: Pexels)

Meeting with Medicare Insurance Agents

If you're planning on meeting with a Medicare insurance broker or agent to discuss Medicare health care options, take note of what they can and can't do.

Medicare Insurance Agent Meeting Rules
They cannotThey can
Steer you towards a specific plan.Give you materials about their plan.
Tell you incorrect information about Medicare insurance plans.Tell you about their plan options and how you can learn more about them.
Describe Medicare plans as “the best” or “number one”.Provide you with an enrollment form.
Tell you about other plan options unless you’ve asked them to.Collect your completed enrollment form.
Pressure you into joining a Medicare Advantage or Medigap insurance plan.If you agree, they can leave business cards for other people.
Ask for names, addresses, and contact details of your friends and family to sell plans to them.
Charge money to process an enrollment application.

Where Can I Learn More about Medicare Insurance Agents?

If you want to know more about Medicare insurance agents and Medicare, visit our Medicare Hub. We provide up-to-date information and resources to help you learn about health care.

Some additional resources to look at include the Medicare.gov and CMS websites.

If you have a particular question about Medicare insurance agents or would like to find a health care agent in your area, send us an email or give us a call.