What Is a Medicare Advisor?

Choosing the best Medicare plan for your situation is not always easy, especially when there are so many options available to seniors.

Luckily, Medicare beneficiaries are not left to wander in the dark. They can use the services of Medicare advisors who can help them make the right choice and enroll them in the plans that are best for them.

Medicare advisors are professionals that work with Medicare beneficiaries to evaluate and select the right plans that will meet their needs and fit their preferences.

In most cases, Medicare beneficiaries are only aware of a limited number of plans. Even amongst those, it is difficult to know which is the best to select.

Medicare advisors make that process easier by helping beneficiaries understand the various features and the pros and cons of each option, and then assisting them in enrolling for their preferred plans.

For these reasons, many Medicare beneficiaries have found advisors to be helpful. Consequently, there are now many associations of Medicare advisors and websites that help connect beneficiaries and advisors.

Beneficiaries themselves rarely pay Medicare advisors anything for their services. Your only costs will be 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, an advisor might not receive a commission unless you select a plan from the firm or firms they are connected to.

Though all Medicare advisors help Medicare beneficiaries select Medicare plans well-suited to their situation, not all of them operate in the same way. There are three types of Medicare advisors that beneficiaries may encounter.

Advisors who are Medicare brokers are typically independent professionals with no ties to any single insurance provider. They identify and evaluate plans provided by various insurance companies and help the Medicare beneficiary select the right one.

The Medicare broker acts more like a representative of the Medicare beneficiary than of the insurer.

As such, they are not directly involved in enrollment. Once a broker helps a beneficiary select a plan, they will connect them to an agent of the insurance company to complete enrollment.

Medicare brokers typically offer other types of insurance — auto, life, etc. — which means they can work with the beneficiary at other times in their life as well.

Medicare brokers are best for beneficiaries who are unfamiliar with the companies operating in the health insurance space and are trying to appraise a wide pool of Medicare plans.

Medicare agents‌ are representatives of insurance providers. They offer beneficiaries plans from the insurance companies they represent.

Medicare agents may be best for beneficiaries who are already familiar with health insurance providers and don’t necessarily need the broad list of options that brokers will provide.

Agents can immediately enroll beneficiaries in their selected plan. This is helpful for beneficiaries who prefer to work with one person throughout the entire process.

Underwriters are also representatives of insurance companies. However, instead of helping beneficiaries select the right plans, they assess the risk that the insurance company is taking on by accepting a beneficiary into the plan.

The insurance company can decide whether to take the beneficiary based on the underwriter’s assessment. And, if they choose to enroll the beneficiary, the assessment will determine the premium that they will charge.

Brokers and agents often work with underwriters to understand the underwriting requirements of various plans so they can factor them into the selection process. It is in this sense that Medicare underwriters are considered a type of Medicare advisor.

Before looking for a Medicare advisor, first compare plan options. You can use Medicare’s plan finder tool to do this.

You can then contact companies or Medicare advisors that sell these Medicare plans. To find them, you might search the internet for “Medicare advisors near me.” You can also go through professional agent associations in your state to find advisors in your area.

Once you have a list of plans and potential Medicare advisors, you can begin narrowing your options.

It’s wise to look for 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.

Also consider whether the advisor is a captive agent or an independent agent, as this can make a difference in getting the best plan for your situation.

Make sure your chosen 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 additional certifications for the particular Medicare plans they sell.

Medicare advisors are not created equal; therefore, you must carefully choose the one you want to work with.

You have certain rights when meeting 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.

There are also certain things an advisor is not allowed to do during your appointment.

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).

In addition to working with an agent or broker, you can also receive free, one-on-one Medicare counseling from your local State Health Insurance Assistance Programs (SHIP) office.

SHIP counselors seek to provide unbiased advice that will help you make better decisions in view of your current situation and future.

Editor Sierra Campbell contributed to this article.