What to Look for in a Medicare Agent or Broker

“It’s important for people to first know all of their plan options so they have an idea of which choices” their broker or agent “is not discussing with them or is not licensed to sell,” she says.

Also, prepare a list of key items and questions for anyone you talk to so they can give you answers about plan features important to you, such as:

• Coverage for medications you take or expect to
• Whether pharmacies you want to use are in-network
• What supplemental benefits that Medicare Advantage plans offer are most meaningful
• Which providers you want to see and in what locations.

“All of those things can help determine what the best plan is,” says Jeannie Fuglesten Biniek, an associate director for the Program on Medicare Policy at KFF, a San Francisco–based health policy nonprofit with an office in Washington, D.C.

Check your annual notice of plan changes

Even if you don’t plan to change your Medicare Advantage or Part D coverage next year, use the open enrollment period to review your annual notice of change, says Eric Krupa, a supervising attorney at the Center for Medicare Advocacy. The nonprofit, public interest law firm is based in Washington, D.C.

“You may be going into this enrollment period feeling relatively satisfied with your current Medicare setup. But know that it’s not guaranteed to stay that way,” Krupa said during his organization’s recent open enrollment webinar. Medicare Advantage and Part D plans “may change for the upcoming 2026 year. How will you know this? The annual notice of change.”

The document, typically sent to Medicare Advantage and Part D enrollees in September, details next year’s changes to your plan’s premium, deductible and co-payments; lists covered drugs and their cost; and mentions whether any doctors, hospitals and specialists are leaving your plan’s in-network list.

Generally, beneficiaries who make no coverage changes during open enrollment will automatically roll over into that same plan if it is offered next year.

Not all agents and brokers are created equal

Commissions that agents and brokers receive from Medicare Advantage insurers are tied to enrollment and plan retention. These advisers can also earn extra bonuses for meeting other goals insurers set.

Federal guidelines say agent and broker compensation must incentivize enrollment “in the Medicare Advantage plan that is intended to best meet [enrollees’] health care needs.” But conflicting financial incentives could affect the advice they provide.

In May, the Justice Department sued three large Medicare Advantage insurers and three broker organizations, alleging the insurers paid the brokers “hundreds of millions of dollars in illegal kickbacks” over five years to steer people into their plans, “regardless of the suitability of the MA [Medicare Advantage] plans for the beneficiaries,” a department press release said.

The plans and brokers named in the lawsuit have denied accusations that they violated the federal False Claims Act, which makes it illegal to knowingly submit fraudulent claims or cause them to be submitted to the federal government. Whistleblower allegations initially sparked the civil suit, which is ongoing. But the case has resurrected long-standing concerns about whether agents and brokers act in the best interests of Medicare beneficiaries and new enrollees.

As older adults look for help during open enrollment to secure the best Medicare coverage for their needs, they should feel free to ask agents and brokers about the government’s case and its troubling allegations, says Jessica Brooks-Woods, CEO of the National Association of Benefits and Insurance Professionals in Washington, D.C., which represents health insurance agents and brokers.

“Don’t be shy to bring this up,” Brooks-Woods tells AARP. “Most agents will welcome that conversation because they’re impacted by this as well. They’ve been harmed by this. A narrative has been painted and a broad brush has been stroked across the profession, and it’s creating vulnerabilities and risks to those who rely on the agent” and “who now have to add another layer of concern in a very complex industry.”

Insurance pros help navigate a confusing Medicare system

Because choosing a Medicare plan among so many options is complicated, “brokers and agents do serve an important role and are useful in helping people sort through what is out there and how to make sense of it,” says KFF’s Biniek.

The Commonwealth Fund’s Jacobson agrees.

“Agents and brokers can be valuable to Medicare beneficiaries because they can provide the one-on-one counseling and advice that many beneficiaries have said they want,” she says.

Biniek says she wouldn’t dissuade people from using a broker or agent because of the lawsuit. Instead, she says, beneficiaries should “trust but verify” the information they receive from these insurance professionals.

That starts by visiting plans’ websites, the Medicare Plan Finder and talking with SHIP counselors. While many agents and brokers are “absolutely trying to do the best for their clients,” Biniek says, consumers should understand they are paid by insurers and may not provide complete information about all available plans.

So-called captive agents and brokers sell only plans from a specific insurer. But even independent agents and brokers, who offer coverage from multiple companies, don’t have to offer all available plans in a geographic area.

Beginning in 2022, brokers and agents who didn’t offer all plans in an area were required to notify their clients, according to a 2023 Commonwealth Fund report. But they were “not required to disclose what proportion of plans in the area they sell or how their compensation differs across plans.”​​​​​​“Bring this up.… Have the open dialogue around the changes that we need to see in our industry.”

Don’t be afraid to ask tough questions

In focus groups, agents and brokers said they were generally paid more to enroll people in Medicare Advantage plans, received higher fees from higher-premium Medigap plans, and said that commissions for stand-alone Part D plans were “viewed as too low and not worth the time,” the Commonwealth study says.

“So it’s important for people to realize that the brokers’ and agents’ compensation may really differ depending upon what choices” the beneficiary makes, Jacobson says. “And it’s usually not at all transparent to beneficiaries how brokers’ and agents’ compensation works, much less what they’re getting paid more to do versus not getting paid at all for some coverage choices.”

The question about commissions and bonuses is one you should ask an agent or broker outright, especially because several insurers are cutting commissions on some Medicare Advantage and Part D plans or removing the policies entirely from their advisers’ sales lists. So don’t hesitate to talk about money:

• Which plans are you paid to sell me?
• Which ones pay higher commissions?
• Do you get a bonus if you meet certain goals for a plan’s enrollment?
• What plans or insurers are you not offering and why?

Medicare agents and brokers should not “be exempt from having to prove and regain” any consumer trust that may have eroded in recent years, says Brooks-Woods of the National Association of Benefits and Insurance Professionals.

“Beneficiaries deserve people who are going to serve them at the highest level,” she says. The organization has no tolerance for bad actors.

After years of working with agents or brokers, Brooks-Woods says, beneficiaries have built relationships that allow them to discuss any concerns about the lawsuit.

“Take those conversations to the next level,” she says. “Bring this up. Tell them that you’re aware of this and have the open dialogue around the changes that we need to see in our industry.”