A Medicare broker and agent can sift through myriad health insurance plans to help you find the best one for your needs.
Read on to learn more about what Medicare brokers and agents do, if you should use one and when to be cautious about scams and fraud.
[READ: How Do I Know When I’m Eligible for Medicare?]
What Is a Medicare Broker and How Do They Help?
In general, a broker arranges buying or selling assets on someone’s behalf. Just like there are stockbrokers and real estate brokers, there are also Medicare brokers.
A Medicare broker is a professional whose role is to synthesize Medicare options — Medicare Advantage and Medigap, for instance — and present the best plan for you, given your preferences and budget.
Specifically, Medicare agents and brokers can help with:
— Medical underwriting, which you will need to apply for a Medigap plan
— Reviewing and comparing plans
— Assessing your financial situation against potential plan deductibles, premiums and out-of-pocket maximums
— Deciphering which plans offer benefits most useful to you, such as where your prescription medications will be most affordable
[Read: 5 Steps for Picking a Medicare Plan.]
What’s the difference between a Medicare broker and an agent?
Medicare brokers represent the consumer’s best interests and have knowledge of a variety of health plans. Agents, on the other hand, usually offer one or a select few insurance company plans.
What is most critical to understand, however, is the difference between “independent” and “captive” agents.
Independent agents:
— May present you with options for multiple health plans
— May have less specialized knowledge about each plan
— Usually work as independent contractors or business owners
Captive agents:
— Represent one specific health plan
— Have specialized knowledge of the plan they represent
— Usually work for the insurance company
In addition, State Health Insurance Assistance Program counselors can help you understand your Medicare coverage. SHIP is a free, local resource available to Medicare beneficiaries and those eligible for Medicare.
| Factors | Independent Broker or Agent | Captive Agent | SHIP Counselor |
| Variety of plans | Multiple companies | One specific company | All available plans |
| Cost to you | $0 (commission-based) | $0 (salary and commission) | $0 (volunteer-based) |
| Can they enroll you in a plan? | Yes | Yes | No |
| Best for: | Comparing multiple options | Comparing plans from one company | Unbiased and neutral advice |
[READ: How Do You Apply for Medicare?]
Navigating Trust: Are Medicare Brokers and Agents Reputable?
Many seniors may be concerned about the trustworthiness of Medicare brokers and agents. After all, insurance brokers and agents are incentivized to sell plans to make a commission.
The Centers for Medicare & Medicaid Services (CMS) has guidelines for how these professionals must conduct themselves. Medicare brokers and agents cannot:
— Claim they are representatives of federal Medicare plans or use words or symbols to mislead consumers about their affiliations
— Market door-to-door
— Make unsolicited phone calls, texts or voicemails to beneficiaries
The United States Senate Committee on Finance also scrutinizes deceptive marketing practices by Medicare brokers and agents. Over the years, the committee has found many instances of Medicare agents and brokers misleading consumers.
Cited issues include:
— Violating the above advertising rules, such as making unsolicited robocalls
— Intentionally marketing their plans to beneficiaries with dementia
— Switching beneficiaries to new plans where the network did not cover their established health care provider
— Enrolling beneficiaries in new plans without consent
CMS institutes enforcement actions when the standards are violated. To submit a complaint, call 1-800-MEDICARE.
[READ: Medicare Mistakes to Avoid.]
Step-by-Step: How to Find a Trustworthy Medicare Broker
Finding a trustworthy Medicare broker is easier when you take it one step at a time.
Tyler Dalton, Medicare advisor at Dalton Insurance Agency in Dadeville, Alabama, advises that you start with these three steps:
— Step 1: Tap your network. Ask family members or friends if they have used a trusted Medicare broker they would recommend.
— Step 2: Check a Medicare directory site. A good directory compiles Medicare brokers and agents near you who can support you long-term, not just during the enrollment period.
— Step 3: Check a search engine by asking for “Medicare broker near me” or “Medicare advisor near me.” Make sure to filter through paid ads for big call centers, and find a local broker with an up-to-date Google business page with high reviews. Once you find a reputable business, get in contact with them and continue the vetting process.
The best advisor is a local one, Dalton says, “someone who knows your doctors, hospital systems and the plans that work best in your area.”
Is my Medicare broker the right fit?
Once you are in contact with a reputable broker or two, schedule a consultation to finalize whether it is the right fit.
A good Medicare agent or broker, according to Roger Milliner, chief growth officer at MetroPlusHealth, will:
— Come highly recommended by community members
— Have empathy and strive to understand your finances, goals and preferences
— Tailor their recommendations to your needs. For example, if you speak Spanish, a good Medicare broker will find a plan with a network with many Spanish-speaking doctors
— Be licensed in your state or region
Dalton says one of the biggest green flags in a Medicare broker is one who gets to know your wants and needs. Asking “What is important to you? Are you looking to change and keep your current doctors, pharmacy or dentist, or are you interested in changing any of those?” is a good sign they are dedicated to helping you.
Questions to consider asking your Medicare agent or broker to make sure they are right for you include:
— What part of the enrollment process are you able to help me with?
— Are you licensed in my state?
— Which plans do you work with and why?
— What type of beneficiary would not be a good fit for the plan(s) you offer?
— Would traditional Medicare (parts A and B) be enough coverage for me?
— If I change my mind and want to switch plans, what is that process like?
— Are you available to speak with me if I have questions or concerns later on?
Medicare Broker Red Flags
When you’re choosing a Medicare broker or agent, make sure you know the red flags of fraud and scams.
Dalton warns that some top red flags include:
— Asking for personal information too early
— Making a plan recommendation prior to knowing your doctors, health conditions or medications. The wrong decision could leave you with an out-of-network doctor and surprise bills.
— Not working with a variety of Medicare options, including Medicare Advantage and supplement plans
Using a Medicare broker involves providing sensitive information, such as your Social Security number, address, phone number and more. To avoid a scam, make sure you verify that your Medicare broker is legitimate. Confirm their license with your state’s department of insurance and check that they have a reputable digital footprint through a professional website and customer reviews.
If a Medicare broker is pressuring you to move fast, act now for a “big discount” or calling or texting you unsolicited, be on high alert that it could be a scam.
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Medicare Agents and Brokers: How They Help and How to Find a Good One originally appeared on usnews.com
Update 01/22/26: This story was published at an earlier date and has been updated with new information.
