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 insurance. Many people turn to Medicare insurance brokers for help figuring it all out.

But who are these brokers, and can you trust them with your medicare coverage needs? It’s helpful to understand their role as you approach enrolling in Medicare. We’ll discuss what they do, how they get paid, and what you need to know before working with one.

What is a Medicare broker?

Think of a Medicare insurance broker as an independent guide for your medicare insurance journey. They are licensed insurance professionals, often referred to as a licensed insurance agent, who represent multiple insurance companies. This isn’t someone tied to just one company’s medicare products.

Instead, their role is to help you compare different medicare plan options. These can include Medicare Advantage (Part C or MA plans), Medicare Supplement insurance (Medigap), and Prescription Drug Plans (Part D Medicare). Because they work with several insurers, they should be able to show you a wider range of possibilities for your health plan.

A Medicare broker needs to hold a state insurance license and often get special certifications to sell Medicare plans. 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 insurance agent who typically represents only one insurance agency.

What do Medicare insurance brokers do?

A Medicare broker compares 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 you need an Part C, gap, or drug prescriptions.

A Medicare broker’s job starts with understanding you and your specific needs. They’ll likely 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 insurance plans they’re certified to sell from different insurance companies. They compare care coverage details, medicare cost factors like premiums and deductibles, and provider networks. The idea is to find plans that seem like a good match for your specific situation, whether it’s an Advantage plan, supplement plan, or Part D Medicare drug plan.

Brokers spend time explaining how different plans work, which is crucial since plans vary significantly. They can break down the differences between original Medicare and Medicare Advantage, or explain the various Medigap supplement insurance plans. They also help you understand enrollment periods, like open enrollment, and application processes, aiming to make medicare 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
• Florida Blue
• Mutual of Omaha
• Centene Corporation
• Highmark

Medicare brokers often represent a mix of national and regional insurance carriers. National providers offer plans across many states and tend to have broad name recognition. Regional carriers—such as local Blue Cross Blue Shield affiliates or community-based plans—may serve more specific geographic areas and can offer competitive benefits tailored to local needs. This combination allows brokers to match clients with plans that fit both their healthcare preferences and their location.

Should I Use a Medicare broker?

Deciding whether to use a licensed medicare broker depends on your comfort level with the information. If you find Medicare confusing and want personalized help comparing plans, a broker could be very useful. They can save you time researching multiple companies and various health plans on your own.

They have access to information about many medicare products, potentially more than you’d easily find yourself. This can be helpful if you have specific health needs or doctors you must keep who accept medicare. A good medicare insurance broker can simplify the choices related to your medicare plan and answer your specific questions about benefits access.

But, if you enjoy doing your own research and feel comfortable comparing plans 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 insurance companies or through government resources. Exploring options independently is always a valid approach to finding the right health insurance.

Are Medicare brokers legit?

Yes, licensed Medicare brokers are legitimate professionals operating within the health insurance industry. They operate under state insurance laws and federal Medicare regulations. These rules require them to act ethically and provide accurate information about medicare insurance plans.

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 Medicare rules and medicare plan options, including the latest advantage plans and drug plans.

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 medicare 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 medicare 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 plans they sell.

Brokers earn commissions from insurance companies when they enroll someone in a medicare plan. Because commission amounts can differ between plan types (like Medicare Advantage vs. Medigap) or companies, there’s a potential for bias. A broker might consciously or unconsciously favor plans that pay them more.

However, regulations aim to lessen this bias. For example, CMS sets maximum commission amounts that companies can pay for Medicare Advantage and Part D Medicare 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 plans (MA plans). There are a few reasons for this common occurrence in medicare sales. Commissions for selling Medicare Advantage plans are generally higher than for Medigap plans or supplement insurance.

Medicare Advantage plans 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 advantage plans look attractive upfront compared to the basic medicare coverage.

It’s also true that the Medicare Advantage market is large and growing, with many options available. Brokers might simply have more of these types of insurance plans in their portfolio to offer. But it’s always wise to ask about all your coverage options, including original Medicare with a medicare supplement, to get a full picture before deciding on a health plan.

Are Medicare brokers free?

Using a Medicare broker generally doesn’t cost you anything directly; there is no extra fee for their service. Their assistance is typically free to you, the Medicare beneficiary. You don’t pay them a fee for their help comparing medicare plans or enrolling you.

This might sound strange, but their payment comes from the insurance companies offering the medicare insurance. When a broker successfully enrolls you in a plan, the company that offers that plan pays the broker a commission. This system allows you to get help without an upfront medicare cost.

So, while the service is free to you, remember the broker is getting paid by the companies whose medicare 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 plan.

How much does a Medicare broker cost?

To put it simply, a licensed medicare broker should not cost you anything out-of-pocket for their guidance. If someone claiming to be a Medicare broker asks you for a fee for their consultation or enrollment help, that’s a major red flag. Their compensation comes entirely from insurance company commissions.

The cost of the Medicare plan itself – premiums, deductibles, copays – is separate and determined by the specific health plan you choose. Those costs are set by the insurance 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 health insurance. For many people, especially those new to Medicare or overwhelmed by choices among medicare advantage plans and supplement plans, 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 plans or coverage options alone. They can help you avoid common mistakes, like choosing a plan where your preferred doctor isn’t in-network or understanding if the plan accepts medicare assignments properly. Their knowledge can lead you to a medicare plan 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 insurance agent is a great resource. However, if a broker seems pushy, doesn’t clearly explain the privacy policy, or only promotes certain plans, you might be better off doing your own research or finding a different insurance assistance resource like SHIP.

How do Medicare brokers get paid?

As mentioned, Medicare insurance brokers get paid through commissions from the insurance agency whose plans they sell. When you sign up for a Medicare Advantage or Part D Medicare prescription drug plan through a broker, the insurance company pays them. This happens for the initial enrollment and often continues in later years if you stay on the plan (these are called renewal commissions).

Commissions for Medigap plans (also known as medicare supplement insurance) work differently. They are often paid as a percentage of the plan’s premium. This means the commission can vary based on the specific Medigap plan and the premium amount for that supplement insurance plan.

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 health care. Ask questions and make sure you understand why a particular medicare plan 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 Medicare Advantage and Part D plans each year. These amounts vary slightly by state or region. Renewal commissions, paid for members who stay enrolled in plans medicare offers, are typically half of the initial commission amount.

For 2025, the national maximum commission for a new Medicare 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 Medicare Advantage and Part D Medicare plans. 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 insurance plans.

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 medicare broker or insurance agent. If you worked with a broker one year, you are free to consult a different licensed medicare broker the next year or handle things yourself during the next open enrollment period.

Your relationship is primarily with the insurance plan you choose, not the broker who enrolled you. If you switch plans during an enrollment period (like the Annual Election Period), you can use a different broker or sales agent to help with that change. Your medicare coverage itself isn’t dependent on sticking with the same broker; you maintain control over your health insurance 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 health insurance 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 terms ‘medicare broker’ and ‘insurance agent’ are often used interchangeably in conversation, but there’s a key difference in how they represent insurance plans. A Medicare broker is typically independent. They represent multiple insurance companies and can show you various medicare plans from different carriers, providing a broader view of coverage options. A Medicare agent, especially a ‘captive’ agent, usually works for just one specific insurance company or insurance agency. They can only sell you medicare plan options offered by that single company. While they might know those specific plans very well, they can’t offer comparisons with other insurers’ medicare products like a licensed medicare insurance broker can. Using a broker generally gives you a broader view of the market, including different advantage plans and supplement insurance plans. But, make sure the medicare insurance broker you choose works with a good number of companies active in your area. Both brokers and captive agents must be licensed and follow Medicare rules regarding medicare sales and client interactions.

Finding the right help for your Medicare needs

Choosing how to get help with Medicare is a personal decision. Whether you work with an insurance agent or broker, or utilize resources like SHIP, the goal is finding the right medicare coverage. Understanding the nuances between original Medicare, Medicare Advantage, Medicare Supplement insurance, and prescription drug plans is vital.

Take time during enrollment periods, especially open enrollment, to review your current health plan. Your health care needs can change, and new medicare plans 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 Medicare Advantage plans 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 insurance assistance.

Final thoughts

Medicare insurance brokers can be a valuable resource when you’re trying to make sense of your Medicare options and the various insurance plans available. They offer personalized help, compare plans from different companies, and guide you through enrollment, usually at no direct cost or extra fee to you. Knowing how licensed medicare brokers work, how they are compensated based on sales, and the difference between independent brokers and captive agents helps you use their services effectively.

Understanding the details of medicare coverage, including options like medicare supplement insurance, prescription drug plans, and Medicare Advantage plans, is important. Your health care is personal, so evaluating different health plans carefully matters. Asking questions about everything from medicare cost to provider networks ensures the final choice feels right for your health and budget needs.

Ultimately, whether you use a medicare insurance broker, an insurance agent, or research on your own, the objective is to secure the health insurance that best serves you. Being informed about your coverage options and the enrollment process empowers you to make confident decisions about your Medicare journey. Remember that resources like SHIP provide free, unbiased insurance assistance program support if you need it.