A good Medicare agent can save you time and help you find the right plan. But not all agents have your best interests at heart. Here's how to tell the difference — and protect yourself.
You have complex medical needs, many medications, or multiple doctors. You prefer personalized guidance and someone to walk you through the process.
You can enroll directly at Medicare.gov for free. Our DIY Enrollment Guide walks you through every step.
Understanding the difference helps you know what to expect — and what questions to ask.
Works for a single insurance company and can only sell that company's plans.
Advantages
Limitations
Licensed to sell plans from multiple insurance companies. Can compare options across carriers.
Advantages
Limitations
Our recommendation: If you use an agent, seek out an independent broker contracted with multiple carriers. Ask upfront how many companies they represent — a good answer is 5 or more.
Understanding agent compensation helps you recognize potential conflicts of interest — and ask the right questions.
When you enroll in a Medicare Advantage plan through an agent, the insurance company pays the agent a commission. You pay nothing extra. Federal law prohibits agents from charging you a fee for Medicare plan enrollment.
CMS sets maximum commission rates that agents can receive for Medicare Advantage enrollments. In 2024, the maximum initial enrollment commission is $611 per year, and $306 for renewals. These caps apply nationwide.
CMS requires that agents receive the same commission regardless of which Medicare Advantage plan you choose. This rule is designed to prevent agents from steering you toward higher-commission plans. A good agent should recommend the plan that best fits your needs.
While per-enrollment commissions are capped and equalized, some carriers offer agents bonuses for hitting enrollment volume targets. This is a potential conflict of interest — ask your agent directly whether they receive any volume bonuses.
A trustworthy agent will welcome these questions. Evasive or dismissive answers are a warning sign.
If you encounter any of these behaviors, slow down, ask questions, or walk away.
A trustworthy agent will give you time to review your options. High-pressure tactics — "this offer expires today" or "you'll lose this benefit if you don't sign now" — are a serious warning sign.
Medicare marketing rules prohibit agents from making unsolicited in-person visits or cold calls to Medicare beneficiaries. If an agent shows up at your door or calls you out of the blue, that's a violation of federal rules.
Claims like "this plan covers everything" or "you'll never pay a copay" are misleading. Every plan has limitations. Be skeptical of any agent who glosses over costs and restrictions.
A good agent should be willing to show you multiple plan options and explain why they're recommending one over another. If an agent only shows you one plan and won't discuss alternatives, ask why.
It is illegal for agents to charge you a fee for enrolling in a Medicare plan. If an agent asks for payment, walk away and report them.
Any agent who recommends a plan without first checking that your doctors are in-network and your medications are on the formulary is not doing their job. This is the most basic due diligence.
Some agents earn commissions by switching clients to new plans annually — even when the current plan is still a good fit. Ask for a clear explanation of why a switch is being recommended.
A trustworthy agent should be able to clearly explain how they are compensated. Evasiveness about commissions or bonuses is a red flag.
Federal law protects you throughout the Medicare enrollment process. Know your rights.
You have the right to take time to review any plan before enrolling — no agent can force you to decide immediately.
You have the right to receive a copy of any plan documents before signing.
You have the right to cancel enrollment within the first 30 days of coverage (trial right).
You have the right to file a complaint against an agent with your State Insurance Commissioner.
You have the right to report Medicare fraud or agent misconduct to 1-800-MEDICARE.
You have the right to free, unbiased counseling from your State Health Insurance Assistance Program (SHIP).
To report fraud or file a complaint: Call 1-800-MEDICARE (1-800-633-4227) or contact your State Insurance Commissioner. You can also report Medicare fraud at oig.hhs.gov.
Every state has a State Health Insurance Assistance Program (SHIP) — a federally funded program that provides free, one-on-one Medicare counseling. SHIP counselors are trained volunteers with no financial stake in your decision. They don't sell plans and don't earn commissions.
Disclaimer: Medicare Made Clear, Made Simple with AI is an independent educational website not affiliated with the U.S. government, Medicare, or any insurance company or agent. Commission figures cited are for 2024 and may change. Always verify agent credentials at your State Insurance Commissioner's website and plan details at Medicare.gov.