Independent Medicare Agent: What They Do and How to Choose One

An independent Medicare agent is a licensed agent or broker who may offer plans from more than one insurance company. Some agents are "captive," which means they sell for a single company. Independent agents generally are not limited that way, though which carriers they work with can vary.

Independent agents often help with Medigap (Medicare Supplement) plans, Medicare Advantage plans and Part D drug plans. Medigap plans are standardized by letter. Only Plans A, B, D, G, K, L, M and N (and high-deductible Plan G) are sold to people newly eligible for Medicare. Plans C and F (and high-deductible F) are available only to people who became eligible before January 1, 2020. Plans E, H, I and J were discontinued and are not sold today, even though people still search for Plan H.

Massachusetts, Minnesota and Wisconsin standardize Medigap differently, so plans there may not follow the same letter system. An independent agent in your state may be able to explain how your state works. Official information is always available at Medicare.gov.

Many people have traditionally learned about Medicare in a few ways. Some read the official Medicare handbook and compare plans on their own. Others call a carrier directly, attend a community seminar, or ask a friend or family member who has been through it.

Some people choose to work with a captive agent or call a single company directly. This can be a simple path if you already know the company you want. Others prefer to speak with someone who can discuss several companies in one conversation.

Many people also turn to their State Health Insurance Assistance Program (SHIP), which offers free counseling in most states. Each approach has its place, and many people use more than one. There is no single right way to start.

The right independent Medicare agent may help you sort through choices at your own pace. They may explain how Medigap and Medicare Advantage differ, and what each can offer. Medigap generally lets you see any provider nationwide that accepts Medicare, with no network or referrals, and cost-sharing that tends to be predictable. Its trade-offs can include generally higher monthly premiums, possible medical underwriting outside open enrollment or guaranteed issue, a separate Part D plan for drugs, and no routine dental, vision or hearing.

Medicare Advantage has its own strengths, such as often lower premiums, an annual out-of-pocket maximum, extra benefits and drug coverage in many plans. Its trade-offs can include networks, prior authorization and copays. A good agent may walk you through both sides fairly, so you can decide what fits your doctors, your health and your budget.

A conversation with an agent is usually relaxed and focused on your situation. You might ask: Which companies do you work with? Are you licensed in my state? How are you paid? Will my doctors and prescriptions be considered? What rules apply to my enrollment timing? Rules on open enrollment, guaranteed issue and birthday or anniversary windows vary by state and change over time, so confirm current rules with Medicare.gov, your SHIP, or a licensed agent. Call 1-800-MEDIGAP for more information.