What is a Medicare broker?
Getting close to Medicare age can feel like a big milestone. Suddenly, you’re faced with a bunch of new terms and choices regarding your health. Many people turn to brokers for help figuring it all out.
But who are these brokers, and can you trust them with your coverage needs? It’s helpful to understand their role as you approach enrolling. We’ll discuss what Medicare brokers do, how they get paid, and what you need to know before working with one.
What is a Medicare broker?
Medicare brokers are licensed professionals who represent multiple insurance companies to help seniors compare different coverage options, including Advantage (Part C or MA programs), Supplement coverage (Medigap), and Prescription Drug Programs (Part D).
Think of a broker as an independent guide for your journey. This isn’t someone tied to just one company’s products. Because they work with several insurers, they should be able to show you a wider range of possibilities for your benefits package.
A broker needs to hold a state license and often get special certifications to sell programs. This licensing confirms they meet certain standards set by state regulators and the Centers for Medicare & Medicaid Services (CMS). They are distinct from a captive agent who typically represents only one agency.
What does a Medicare broker do?
Medicare brokers compare care coverage details, cost factors like premiums and deductibles, and provider networks to find benefits packages that seem like a good match for your specific situation, whether it’s an Advantage plan, supplement coverage, or Part D drug program.
A broker’s job starts with understanding you and your specific needs. A broker will ask about your health status, doctors you want to keep seeing, and any prescription drug coverage you require. They also consider your budget and how you live when discussing coverage options. Using this information, they look through the various policies they’re certified to sell from different companies.
Brokers spend time explaining how different coverages work, which is crucial since benefits packages vary significantly. They can break down the differences between original Medicare and Medicare Advantage, or explain the various Medigap supplement programs. They also help you understand enrollment periods, like open enrollment, and application processes, aiming to make enroll procedures clearer for you.
Which insurance companies do Medicare brokers represent?
Here are some examples of insurance carriers that Medicare brokers commonly represent:
- UnitedHealthcare
- Aetna
- Humana
- Cigna
- Anthem Blue Cross Blue Shield
- Kaiser Permanente
- WellCare
- Molina Healthcare
- Blue Cross Blue Shield Association (regional affiliates)
- Mutual of Omaha
- Centene Corporation
- Highmark
Brokers often represent a mix of national and regional carriers. National providers offer policies across many states and tend to have broad name recognition. Regional carriers—such as local Blue Cross Blue Shield affiliates or community-based programs—may serve more specific geographic areas and can offer competitive benefits tailored to local needs. This combination allows brokers to match clients with programs that fit both their healthcare preferences and their location
Should I Use a Medicare broker?
Deciding whether to use a licensed broker depends on your comfort level with the information. If you find Medicare confusing and want personalized help comparing policies, a broker could be very useful. They can save you time researching multiple companies and various benefits packages on your own.
They have access to information about many products, potentially more than you’d easily find yourself. This can be helpful if you have specific needs or doctors you must keep who accept Medicare. A good broker can simplify the choices related to your coverage and answer your specific questions about benefits access.
But, if you enjoy doing your own research and feel comfortable comparing options online using tools like the official Medicare Plan Finder, you might not need a broker. Some people prefer to handle the process themselves directly with companies or through government resources. Exploring options independently is always a valid approach to finding the right coverage.
Are Medicare brokers legit?
Yes, licensed brokers are legitimate professionals operating within the health industry. They operate under state laws and federal Medicare regulations. These rules require them to act ethically and provide accurate information about coverage options.
Brokers must complete training and pass exams to get their licenses from their state’s Department of Insurance. They also need to renew their licenses regularly and often complete continuing education courses. This helps them stay up-to-date on changing rules and program options, including the latest advantage coverages and drug programs.
You can usually verify a broker’s license through your state’s Department of Insurance website. This is a good step to take for peace of mind before engaging with any sales agent. Legitimate brokers should be willing to show you their license information and discuss their privacy policy regarding your data privacy.
Are Medicare brokers unbiased?
This is a common and important question regarding brokers. Ideally, brokers present options fairly, giving you a clear view of your choices. But, it’s good to know how they get compensated based on the policies they sell.
Brokers earn commissions from companies when they enroll someone in a program. Because commission amounts can differ between types (like Advantage vs. Medigap) or companies, there’s a potential for bias. A broker might consciously or unconsciously favor benefits packages that pay them more.
However, regulations aim to lessen this bias. For example, CMS sets maximum commission amounts that companies can pay for Advantage and Part D enrollments. Brokers are also required to disclose that they are paid commissions, though they might not always state the exact amounts unless asked directly about their compensation.
Why do Medicare brokers recommend Advantage plans?
You might notice brokers often discuss Medicare Advantage programs (MA programs). There are a few reasons for this common occurrence in sales. Commissions for selling Advantage coverages are generally higher than for Medigap policies or supplement coverage.
Advantage programs also often have lower monthly premiums (sometimes $0) and frequently include extra benefits like dental, vision, or hearing care, which original Medicare doesn’t cover. These features can be very appealing to beneficiaries, making them an easier ‘sell’ for a sales agent. Brokers know these programs look attractive upfront compared to the basic coverage.
It’s also true that the Advantage market is large and growing, with many options available. Brokers might simply have more of these types of policies in their portfolio to offer. But it’s always wise to ask about all your coverage options, including original Medicare with a supplement, to get a full picture before deciding on a program.
Are Medicare brokers free?
Using a broker generally doesn’t cost you anything directly; there is no extra fee for their service. Their assistance is typically free to you, the beneficiary. You don’t pay them a fee for their help comparing coverages or enrolling you.
This might sound strange, but their payment comes from the companies offering the policies. When a broker successfully enrolls you in a program, the company that offers that program pays the broker a commission. This system allows you to get help without an upfront cost.
So, while the service is free to you, remember the broker is getting paid by the companies whose products they are selling. This indirect payment structure is why understanding potential bias is important when considering their recommendations for your prescription drug coverage or main content of the program.
How much does a Medicare broker cost?
A Medicare broker should not cost you anything out-of-pocket for their guidance. If someone claiming to be a broker asks you for a fee for their consultation or enrollment help, that’s a major red flag. Their compensation comes entirely from company commissions.
The cost of the coverage itself – premiums, deductibles, copays – is separate and determined by the specific benefits package you choose. Those costs are set by the company and paid by you as part of your care coverage. The broker’s service in helping you choose and enroll is covered by the insurer’s commission payments, not an extra fee from you.
Insurance With Malachi offers you a medicare insurance broker at no cost to you who represents multiple insurance providers.
Are Medicare brokers worth it?
Whether a broker is ‘worth it’ really depends on your individual needs and preferences when seeking coverage. For many people, especially those new to Medicare or overwhelmed by choices among advantage programs and supplement coverages, a broker offers real value. They simplify complex information and personalize recommendations.
A good broker can save you hours of research time that you might spend trying to compare different drug programs or options alone. They can help you avoid common mistakes, like choosing a program where your preferred doctor isn’t in-network or understanding if the program accepts assignments properly. Their knowledge can lead you to a program that fits your health needs and budget well, ensuring good benefits access.
But, the value depends on the quality of the broker. An ethical, knowledgeable licensed agent is a great resource. However, if a broker seems pushy, doesn’t clearly explain the privacy policy, or only promotes certain policies, you might be better off doing your own research or finding a different assistance resource like SHIP.
How do Medicare brokers get paid?
Medicare brokers get paid through commissions from the insurance agencies they sell for based on the plans they sell. When you sign up for an Advantage or Part D prescription drug program through a broker, the company pays them. This happens for the initial enrollment and often continues in later years if you stay on the program (these are called renewal commissions).
Commissions for Medigap coverages (also known as supplement policies) work differently. They are often paid as a percentage of the premium. This means the commission can vary based on the specific Medigap policy and the premium amount for that coverage.
Because of this system, where brokers are compensated based on sales, they are motivated to make sales. While regulations exist to protect consumers, it’s still smart to be an informed consumer when discussing your care. Ask questions and make sure you understand why a particular program is being recommended for you, especially regarding prescription drug coverage.
Medicare broker commissions in 2025
CMS sets the maximum amounts brokers can receive for new enrollments in Advantage and Part D programs each year. These amounts vary slightly by state or region. Renewal commissions, paid for members who stay enrolled in programs offered, are typically half of the initial commission amount.
For 2025, the national maximum commission for a new Advantage enrollment is $637. For Part D drug programs, it’s $105. Some states have slightly different maximums based on CMS guidelines for sales agent compensation.
Here’s a simplified look at typical 2025 maximums:
| Plan Type | Initial Year Commission (Max) | Renewal Year Commission (Max) |
|---|---|---|
| Advantage Plan | ~$637 (National) | ~$319 |
| Prescription Drug Plan (Part D) | ~$105 (National) | ~$53 |
| Supplement (Medigap) | Varies (Often % of premium) | Varies (Often % of premium) |
Remember, these are maximums for MA and Part D programs. Actual amounts might vary, and Medigap commissions follow different rules, often percentage-based. This information helps you understand the broker’s potential financial incentives when they present different options.
Can I change my Medicare broker?
Yes, you absolutely can change who helps you with your Medicare choices. You are not permanently tied to a specific broker or agent. If you worked with a broker one year, you are free to consult a different licensed broker the next year or handle things yourself during the next open enrollment period.
Your relationship is primarily with the program you choose, not the broker who enrolled you. If you switch programs during an enrollment period (like the Annual Election Period), you can use a different broker or sales agent to help with that change. Your coverage itself isn’t dependent on sticking with the same broker; you maintain control over your decisions.
If you feel pressured or uncomfortable with a broker, don’t hesitate to seek help elsewhere. You can always contact Medicare directly at 1-800-MEDICARE. Alternatively, use your State Health Insurance Assistance Program (SHIP), a valuable assistance program offering free, unbiased counseling from trained volunteers; many organizations offer expert guidance through SHIP.
What’s the difference between a Medicare broker and an agent?
The difference between an Medicare agent and a broker is that an agent works for one insurance company while a broker represents multiple providers.
The terms ‘broker’ and ‘agent’ are often used interchangeably in conversation, but they are not exactly the same. A broker is typically independent. They represent multiple companies and can show you various programs from different carriers, providing a broader view of coverage options.
An agent, especially a ‘captive’ agent, usually works for just one specific company or agency. They can only sell you program options offered by that single company. While they might know those specific coverages very well, they can’t offer comparisons with other insurers’ products like a licensed broker can.
Using a broker generally gives you a broader view of the market, including different advantage programs and supplement coverages. But, make sure the broker you choose works with a good number of companies active in your area. Both brokers and captive agents must be licensed and follow rules regarding sales and client interactions.
Finding the right help for your Medicare needs
Whether you work with brokers, a captive agent, or utilize resources like SHIP, the goal is finding the right coverage. Understanding the nuances between original Medicare, Advantage, Supplement programs, and prescription drug programs is vital.
Take time during enrollment periods, especially open enrollment, to review your current program. Your care needs can change, and new coverages become available each year. Consider factors like network restrictions, total out-of-pocket costs (not just premiums), and prescription drug coverage formularies.
Don’t hesitate to ask potential brokers or agents about the number of carriers they represent and how they are compensated. A trustworthy professional will be transparent. Also, inquire about their data privacy practices and review their privacy policy to understand how your personal information is handled.
Remember that Original Medicare doesn’t cover everything, which is why supplemental options like Medigap or comprehensive Advantage coverages exist. Evaluate which approach best suits your health status and financial situation. Resources like the official Medicare website and SHIP can offer unbiased information to supplement any advice you receive from brokers or agents offering assistance.
Final thoughts
As you can see, a Medicare insurance broker can be a valuable resource when you’re trying to make sense of your options and the various policies available. Your care is personal, so evaluating different benefits packages carefully matters. Being informed about your options and the enrollment process empowers you to make confident decisions about your senior healthcare journey.