What Is a Medicare Advisor?
Medicare advisors can be independent insurance agents who represent multiple Medicare plan providers (insurance companies). Insurance brokers acting on behalf of a Medicare beneficiary can also help you make informed Medicare decisions. The best person to talk to about Medicare is a specialist with a license to practice in your state.
What Are Medicare Advisors?
Medicare advisors are insurance agents, Medicare brokers and Medicare underwriters. They work for private companies that are under contract with Medicare to sell certain Medicare plans — Medicare Advantage plans and Medicare Part D prescription drug plans.
Many insurance agents may sell insurance plans besides Medicare. Other advisors may specialize in Medicare plans.
You should look for a Medicare advisor who offers a variety of plans from different providers. Medicare advisors should be unbiased and weigh the pros and cons of various Medicare plans as they apply to your personal situation.
You should shop around and compare Medicare advisors to find one who is well versed in the intricacies of Medicare coverage and who can give you a clear understanding of how each plan he or she sells addresses your specific needs.
What Are the Differences Between Medicare Brokers and Agents?
Medicare brokers and agents can be very similar as both can help you identify and enroll in a Medicare plan.
The main difference is that a broker typically does not have a relationship with one firm and can help you compare plans from different providers. This isn’t always the case with an agent.
If your agent is captive, then that means they work exclusively for certain insurance companies and typically must direct you to their specific plans. But there are also independent agents who can help you identify and enroll in any plan, regardless of provider.
What are Medicare Underwriters?
Medicare underwriters essentially work to assess the risk that an insurance company is taking on by accepting you as a beneficiary. The underwriter may do research and ask you questions to get an idea of your current health situation.
If you are already dealing with serious health problems or are very likely to be in the near future, the underwriting process may determine that you are not a fit candidate to be a beneficiary and you may not be accepted onto the plan.
|Type of Advisor||What They Do|
|Medicare Agent||Helps you find and enroll in a Medicare plan. Can be independent but may be tied to a specific firm or plan.|
|Medicare Broker||Helps you identify a Medicare plan to enroll in. Typically independent.|
|Medicare Underwriter||Assesses the risk the insurance company will take on by adding you as a beneficiary.|
How Are Medicare Advisors Paid?
You often don’t pay Medicare advisors anything for their services. Your only costs will be actually enrolling in the plan after your agent or broker helps you find and select it.
Medicare Advisors are typically paid by commission, meaning they earn money from the insurer once you have signed on to become a beneficiary.
It’s important to understand how your Medicare advisor is paid since it could play a role in the options presented to you. For example, if you have a captive agent as your advisor, they may not receive a commission if you select a plan that is not from the firm or firms they are connected to.
How to Find a Medicare Advisor
Before looking for a Medicare advisor, you should first compare plans. You can use Medicare’s plan finder tool do this.
You can then contact companies or Medicare advisors that sell these Medicare plans. To find them, you can search the internet for “Medicare advisors near me.” Or you can go through professional agent associations in your state.
Once you have a list of plans and potential Medicare advisors, you can begin narrowing your options.
You may want to consider an agent or broker who specializes in Medicare plans. A specialist may have more expertise and skill in helping you find the best plan for you.
You should also remember to consider whether the advisor is a captive agent or an independent agent. This can make a difference in getting the best plan for you.
- Captive Agent
- A captive agent is a broker or agent who represents a single company or group of companies. Captive agents are required to sell plans from those companies only or give that company the first right of refusal before offering you other plans.
- Independent Agent
- You should also make sure your Medicare advisor is licensed in your state and has passed an annual American Health Insurance Plans (AHIP) exam. AHIP is a trade association of health insurance professionals. Medicare advisors should be AHIP certified and hold other certifications for the particular types of Medicare plans they sell.
You should also make sure your Medicare advisor is licensed in your state and has passed an annual American Health Insurance Plans (AHIP) exam.
AHIP is a trade association of health insurance professionals. Medicare advisors should be AHIP certified and hold other certifications for the particular types of Medicare plans they sell.
What to Expect When You Meet with a Medicare Advisor
A Medicare advisor must get your permission to meet in person and cannot come to your home without an appointment.
If you make an appointment at your home or in the advisor’s office, the Medicare advisor must document the plan options you wish to discuss.
- Give you business cards to pass on to your friends and family
- Provide you with an enrollment form
- Provide you with plan materials
- Talk to you about plan options you agreed to discuss
You have certain rights when meeting with a Medicare advisor. There are certain things an advisor is not allowed to do during your appointment.
- Tell you about other plan options you’ve not agreed to discuss — unless you specifically ask about them
- Ask for names, addresses or phone numbers of friends or relatives
- Ask for your credit card or bank account information
- Ask you to sign an enrollment form before you are ready to enroll in a plan
- Offer you cash, rebates or other inducements to purchase a particular plan
- Pressure you to join a plan
- Sell you any other products that are not health care related, such as life insurance or auto insurance
If your Medicare Advisor fails to follow these rules you should immediately notify Medicare by calling 1-800-633-4227 (TTY users can call 1-877-486-2048).
Where to Find Free Medicare Counseling
You can find free Medicare counseling and assistance through your local State Health Insurance Assistance Programs (SHIP).
SHIP provides unbiased, one-on-one counseling for anyone who is eligible for Medicare as well as their families and caregivers.
SHIP counselors can explain complex issues involving your Medicare coverage including coverage changes, Medicare costs, enrollment questions, what your Medicare covers and how to appeal claims.
6 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2021, December 1). Agent Broker Compensation. Retrieved from https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/AgentBroker
- O’Brien, S. (2020, October 23). Here Are Tips From Financial Advisors for Getting Your Medicare Coverage Right. Retrieved from https://www.cnbc.com/2020/10/23/here-are-tips-from-advisors-for-getting-your-medicare-coverage-right.html
- Powell, R. (2015, November 29). How Do I Pick an Unbiased, Helpful Medicare Adviser? Retrieved from https://www.usatoday.com/story/money/columnist/powell/2015/11/29/how-do-pick-unbiased-helpful-medicare-adviser/76451114/
- State Health Insurance Assistance Programs. (n.d.). Local Medicare Help. Retrieved from https://www.shiphelp.org
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Meeting With Agents One-on-One. Retrieved from https://www.medicare.gov/Pubs/pdf/MeetngAgntsOneonOne_fctsht_ENGLISH_link.pdf
- American Health Insurance Plans. (n.d.). AHIP Designations. Retrieved from https://www.ahip.org/designations/