Should I Use a Medicare Insurance Agent?

Medicare Insurance Agents

Choose your agent wisely - ask how many plans they represent, whether they are an independent agent or a captive employee of the insurance company

A licensed Medicare health insurance agent can help you select the best insurance product that fits your budget and healthcare needs  They are licensed by the state and they are paid commissions for a sale by the insurance companies. Their commissions have no direct impact on your benefits or plan premiums – they’re the same if you buy your policy directly from the company or from an agent.  Their job is to help you understand benefits and how they differ between plans and ultimately – enroll you in a plan.  Check out a very comprehensive post and “insider’s view” we did around insurance agent commissions by clicking here.

Most good health insurance agents continue to advocate for you after you enroll, helping you to understand things about your claims and how they process them. The downside may be that they’ll only present you with options from companies they are licensed and certified to sell.  In other words, it may not be all that’s available in your area.

Medicare Insurance Agent Rules

The rules for Medicare health plans state that health insurance agents or members of the insurance plan cannot contact you by coming to your home, call you unless you are already a member or you contacted them, make an appointment to talk to you about their products unless you contacted them first and agreed to such an appointment, or market their plans or enroll you in any educational event. So, as you can see it’s hard for them to get in touch with you to offer you their services.

So, if you do decide to go to an agent and are worried that you might get pressured into a plan or pressured into signing up before you are ready to consider your options, you shouldn’t worry. Medicare has also made rules for what can and cannot happen during your meeting with an agent.

When meeting with an agent, they can give you plan materials and tell you how to get more plan information, tell you about plan options that you agree to discuss, give you enrollment forms, collect your completed enrollment form, and leave you with business cards for your family or friends.

What they CANNOT do is pressure you—whether it’s into a plan or ask for your friends and family’s information. They cannot charge you to enroll you into a plan, steer you towards a plan, give you incorrect or misleading information, pressure you by telling you that you won’t have coverage, or ask you to sign an enrollment form before you are ready. They also cannot tell you about other plan options you haven’t agreed to discuss. This requires a separate appointment form.

Ready to Enroll in a Medicare Plan?

Make sure that you only sign an enrollment form when you feel confident in your choice of the health insurance plan that best meets your needs. Also understanding what you are financially responsible for as a premium per month and if you have any deductibles that must be met before having coverage.

After the meeting, the plan will contact you to make sure you want to join and make sure you understand how the plan works. The agent may contact you to discuss other health plan options.

Some insurance companies have pop-up centers that offer you information on their plans specifically just before and during open enrollment. Sometimes they’re staffed by “captive” agents which are fully licensed and certified, but they only sell that company’s products.  You can go to these offices to find out the difference between the plans that they offer, find out about their network of doctors and pharmacies, check their formularies for your medications, and ask any questions you may have about their plans.  In a market where there is little competition for most of the Medicare Advantage clients, these centers can help the undecided make decisions without an insurance agent.

The Takeaway

So, do you need a health insurance agent? Around 75% of all Medicare Advantage enrollments happen through an agent – which means that 25% of the time people sign up on their own.  It’s a personal question only you can answer for yourself. If you are in a market with many different options, cannot seem to narrow down plans, or don’t understand the features (like whether a plan with a deductible is best for you, or you are better served with a higher premium) or you have any other questions that you cannot seem to find the answers to you may benefit from a health insurance agent.

Question the agent about which plans they represent to make sure that you are getting a full view of all your options. If they do not represent a certain sector of the options, they will not tell you about them, and you may lose the chance to hear about those options.

You are never obligated to sign an enrollment form with a health insurance agent.
If you decide you want to go it alone or do your own research, you can check Medicare and Medicare Advantage plans and which options are available to you in your area by using Medicare’s plan finder by clicking here.