How Agents Influence Medicare Beneficiaries Plan Choices

For instance, the commission can be a flat fee or a percentage of the premium. Regardless, you don’t pay for the agent’s or broker’s service directly. A Medicare agent or broker can help you narrow down your options and pick the best one. To do this, they’ll learn about your health goals and budget. They’ll present you with options to meet your goals within your budget. A Medicare insurance broker is just like an independent agent.

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Not connected with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance, and your response may generate communication from a licensed producer/agent. Download your free PDF and get help with understanding enrollment periods, penalties and Medicare's "alphabet soup" of coverage. When selecting a Medicare agent or broker, make sure they look at whether or not your current coverage — based on both coverage terms and price — is the best option for you. You don’t pay for the services of a Medicare broker or agent.

Increasing transparency and reporting on carriers’ actual compensation payments — as opposed to the CMS-defined maximums — across MA, Part D, and Medigap could help address this. Policymakers also should consider additional regulatory clarity around the administrative payments, bonuses, and other forms of compensation. For Medigap plans, the agent’s commission is typically a percentage of the annual plan premium; the percentage is set and the commission paid by the insurer. Unlike MA and Part D, the rates are not set by CMS or individual states. A recent report indicates that first-year commissions for enrollments in Medigap are approximately 20 percent of annual premiums, but they can vary based on the state or plan type. The commission for subsequent years (i.e., the renewal commission) is set at 10 percent of the premium.

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Because of the complexity of the plan selection process, many beneficiaries rely on independent insurance agents to help them identify the coverage and benefits options that may best meet their needs. Enrolling in a Medicare Advantage, Medigap or Medicare Part D prescription drug plan does not increase your premium or other costs for coverage. Since agents and brokers receive commissions from the insurers, their service is effectively free of charge to you.

The current model for plan selection favors beneficiaries who have the means and resources available to get the information and/or assistance they need to make a decision. Over time, Medicare has evolved to provide more customer choice around plans. For savvy beneficiaries as well as those with uncomplicated medical needs, this may be ideal. However, it may leave others behind, particularly those with fewer resources, less education, and complex medical needs, likely having a negative impact on health equity.

In this system, beneficiaries would have the ability to search and evaluate agents based on their qualifications and beneficiary ratings. Beneficiaries may medicare agent not understand their postenrollment rights. Ideally beneficiaries will use the coverage to which they are entitled, but this is not always straightforward.

There are two potential requirements you’ll need to meet to get your health insurance license to sell Medicare. Medicare has neither reviewed nor endorsed this information. In some states, all Medicare Supplement plans are offered to qualified individuals under the age of 65. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or call MEDICARE to get information on all of your options. By calling the number above, you will be directed to a licensed insurance agent.