What Is a Medicare Advisor?
Medicare advisors are professionals who work with Medicare beneficiaries to select and enroll in the most appropriate Medicare plans for their situations. Consider working with a Medicare advisor to make the best choices for your health care needs.
- Written by Marguerita M. Cheng, CFP®, CRPC®, RICP®
Marguerita M. Cheng, CFP®, CRPC®, RICP®
Marguerita M. Cheng, CFP®, CRPC®, RICP®, is the founder and chief executive officer at Blue Ocean Global Wealth. She is a past spokesperson for the AARP Financial Freedom campaign and has extensive expertise in the fields of financial planning, personal finance, retirement and investing.Read More
- Edited BySavannah Hanson
Senior Financial Editor
Savannah Hanson is a professional writer and content editor with over 16 years of professional experience across multiple industries. She has ghostwritten for entrepreneurs and industry leaders and been published in mediums such as The Huffington Post, Southern Living and Interior Appeal Magazine.Read More
- Reviewed ByChristian Worstell
Christian Worstell is a licensed health insurance agent and an established writer in the sector, with articles featured in Forbes, MarketWatch, WebMD and more. His work has positively impacted beneficiaries nationwide and empowers them to make strong health care decisions.Read More
- Published: January 19, 2021
- Updated: March 13, 2023
- 16 min read time
- This page features 6 Cited Research Articles
- Edited By
- Medicare advisors help Medicare beneficiaries select the Medicare plans that are best for them in a time-efficient and cost-effective way.
- Medicare advisors can be insurance agents, Medicare brokers and Medicare underwriters.
- Before choosing an advisor, ensure that they are licensed, reputable and equipped to provide the range of services required.
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.
What Are Medicare Advisors?
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.
- Time Saving
- Instead of spending time researching and evaluating various Medicare plans, beneficiaries can talk with people whose entire job is to do such research and evaluation. For example, instead of spending five hours combing the internet (among other sources), Medicare beneficiaries can learn the same thing in a half-hour meeting with a professional Medicare advisor.
- Cost Saving
- By using the wider pool of options that Medicare advisors provide, a beneficiary can more easily find a less expensive option. And since the beneficiary is not the one who pays the Medicare advisor — in most cases — this is a cost-effective option.
- Medicare advisors can also help Medicare beneficiaries select the plan that is best suited to meet their current and future health needs. The broader set of options they provide and the years of experience helping a variety of people make it easier for them to point beneficiaries in the right direction.
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.
Medicare can be confusing and it’s easy to feel overwhelmed by the many different plan options available. A Medicare advisor can be a valuable resource for beneficiaries in search of the best coverage for their needs. An advisor can help you save time, money and stress while delivering a plan that is more suited to you as an individual.
How Medicare Advisors Get Paid
Beneficiaries themselves rarely 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, an advisor might not receive a commission unless you select a plan from the firm or firms they are connected to.
Types of Medicare Advisors
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.
- Captive Agents
- 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 Agents
- An independent agent is a broker or agent who works as a contractor representing different insurance companies. Independent agents search the marketplace looking for the best possible plan based on your needs.
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.
How To Find a 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.
Things To Look For
Medicare advisors are not created equal; therefore, you must carefully choose the one you want to work with.
- Valid Licenses
- Before anything else, the beneficiary must ensure that the chosen advisor is licensed by the state insurance department, as per the requirements of the Centers for Medicare & Medicaid Services. The advisor should also be a member of the AHIP.
- An advisor should have a track record of performance. Therefore, it is prudent to speak to family and friends who can recommend trustworthy and quality advisors they have used in the past. Also, check the reviews that previous clients have left for the advisor.
- Scope of Services
- Consider the services an advisor can provide. A beneficiary with little knowledge about the top companies providing Medicare plans might be better off with the services of Medicare broker rather than an agent, while a beneficiary who wants to work directly with only one intermediary might prefer a Medicare agent.
- Support Offered
- Will the Medicare advisor provide the necessary support if you have questions or run into problems after you have purchased the plan? Having that extra after-sale service can be helpful down the line.
What To Expect When You Meet With a Medicare Advisor
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.
- Provide you with an enrollment form when you are ready to enroll.
- Talk to you about plan options you agree to discuss.
- Provide you with plan materials.
- Offer their business cards to pass on to your friends and family.
There are also 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.
- 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
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.
FAQs About Medicare Advisors
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6 Cited Research Articles
- State Health Insurance Assistance Programs. (2023). Local Medicare Help. Retrieved from https://www.shiphelp.org
- U.S. Centers for Medicare & Medicaid Services. (2022, September 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/
- American Health Insurance Plans. (n.d.). AHIP Designations. Retrieved from https://www.ahip.org/designations/
- 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
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