What is a Medicare advisor?
Navigating Medicare can be confusing. However, Medicare advisors can help you understand the different parts, costs, and coverage.
It is important to check their licensing before choosing which one to use.
Types of Medicare advisors
There are different types of Medicare advisors — the two main types are brokers and agents.
Medicare brokers
A Medicare broker is a licensed individual who represents multiple insurance companies. They can help you evaluate plan options.
As Medicare brokers are not tied to a particular insurance company, they can help walk you through various plans from different companies to find the best one for your coverage needs and budget. Once they help you choose a plan, they will then connect you with an agent from the insurance company to help you with the enrollment process.
A Medicare broker may be the best option if you are unfamiliar with the insurance companies that offer Medicare Advantage (Part C), Part D, or Medigap plans and want to compare a variety of plans.
Medicare agents
Medicare agents are licensed individuals who help enroll people in various insurance products, such as Medicare Advantage, Part D, and Medigap.
There are two types of Medicare agents:
Independent: An independent agent is a contractor who represents different insurance companies. They search for the best plans based on each client's individual needs.
Captive: A captive agent is an individual who represents an individual insurance company and is required to sell only plans from that company.
Federal requirements for Medicare agents
hold a license in the states where they do business
use approved marketing materials
test and train annually on their knowledge of Medicare health and prescription drug plans
agree to the scope of appointment via document or phone call before meeting with potential enrollees
SHIP volunteers
The State Health Insurance Assistance Program (SHIP) is a federally funded state-based organization that provides Medicare counseling and information to beneficiaries and their caregivers.
SHIP counselors are all volunteers. They offer unbiased one-to-one counseling and assistance. SHIP also screens, trains, and certifies all its volunteers as Medicare experts.
To contact SHIP, you can call 877-839-2675 or find your local SHIP office.
Contacting Medicare
You can contact Medicare directly with any questions you may have. The Medicare line is open 24/7, except for certain federal holidays.
How do Medicare advisors get paid?
It is rare for a beneficiary to pay a Medicare advisor anything out of pocket. Generally, Medicare advisors are paid via commission for enrollment and retention in Medicare Advantage, Part D, and Medigap plans.
They may also be offered further compensation for:
administrative payments for marketing
bonuses for meeting enrollment benchmarks
selling other health-related insurance products, such as hospital indemnity insurance
other activities for plans, such as beneficiary health risk assessments
The Centers for Medicare & Medicaid Services (CMS) requires that agent compensation for Medicare Advantage and Medicare Part D plans be at or below fair market value. The following table gives examples of compensation for 2025.
Compensation type National maximum
Medicare Advantage initial year $626
Medicare Advantage renewal year $313
Medicare Part D initial year $109
Medicare Part D renewal year $55
For each Medicare Advantage or Plan D plan renewal or switch to a new similar plan, the Medicare advisor is paid up to 50% of the fair market value. For Medigap plans, agents are given about 20% initial enrollment and 10% for each subsequent year.
What to look for when choosing a Medicare advisor
When choosing a Medicare advisor, there are certain criteria you may want to consider:
Licenses: Be sure to check that your chosen advisor is licensed by your state insurance department, as required by CMS. Also, check to be sure they are a member of the AHIP, the national trade association for the health insurance industry.
Scope of services: Consider the services an advisor offers. If you are unfamiliar with the top companies that provide Medicare plans, a Medicare broker may be a better option. If you would rather work with only one intermediary, an agent may be more suitable.
Support offered: Consider whether the Medicare advisor will provide support if you have questions or run into problems after you purchase a plan.
Summary
Medicare advisors are licensed individuals who can help you choose and enroll in a Medicare plan. There are two main types of Medicare Advisors — brokers and agents. Each one of these can help you in different ways.
You can also contact the State Health Insurance Assistance Program (SHIP) and get unbiased one-to-one counseling on Medicare issues and questions. Medicare also has a helpline that you can call or chat online with 24/7.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
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