Key takeaways
- Medicare agents represent specific insurance companies, assisting with plan selection and providing customer service post-enrollment.
- Medicare brokers represent the customer and offer a broader range of plan choices across multiple companies, but may not provide in-depth, ongoing customer support.
- While agents and brokers can be helpful for Medicare Advantage, Part D, or Medigap plans, it’s important to remember they are paid by insurers, which may influence their recommendations.
Both insurance brokers and agents can be helpful when it comes to choosing a private health insurance plan.
You do not need an agent or a broker for Original Medicare (parts A and B), as this government plan is standardized nationwide. However, you may seek help when selecting a Medicare Advantage (Part C), Medicare Part D, or a Medigap plan as an addition to Original Medicare.
Read on to learn about the difference between a broker and an agent in Medicare, and which one to choose depending on your needs.
Broadly speaking, a Medicare agent helps you choose and enroll in a private Medicare plan, offering free guidance for plans from one or numerous insurers they represent.
After you select a plan, they may, in many cases, be available for additional questions and customer service support for your plan.
On the other hand, a Medicare broker represents your interests. They also have access to numerous plans and insurers, allowing them to recommend the best plan from multiple companies. However, once they connect you with your new insurer, you’ll be interacting with that insurer directly for any questions or ongoing support.
The terms “agent” vs. “broker”
Sometimes agents and brokers may be referred to collectively as “agents” or “advisors.” For clarity, this article references “agents” and “brokers” as distinct types of professionals who can help you select a Medicare plan.
That said, it’s important to understand that there are actually two types of agents: Captive agents, who work for one insurance company and only sell that company’s plans, and independent agents, who work for several insurers and can compare plans from different companies.
Independent agents may seem similar to brokers. The difference is that brokers represent you, while independent agents represent the companies whose plans they sell.
In general, here’s what to keep in mind when deciding whether to use an agent or a broker, and which type of professional to choose:
| Captive agent | Independent agent | Broker | |
|---|---|---|---|
| Who they represent | one insurer | multiple insurers | you |
| What they do | evaluate plans from one insurer to find the best option for you, and provide plan-specific customer service after enrollment | evaluate plans from multiple insurers to find the best option for you, and provide plan-specific customer service after enrollment | evaluate plans from multiple insurers to find the best options for you and provide broad, additional guidance after enrollment, but without plan-specific customer service |
| What they offer | in-depth knowledge of their company’s insurance plans and policy updates | broad knowledge of plan options from several insurers but potentially less knowledge of policy updates | broad knowledge of plan options, but potentially even less knowledge of policy updates |
It’s also important to understand what both agents and brokers are allowed to do regarding interactions with you, according to rules established by the Centers for Medicare & Medicaid Services (CMS).
What they can do:
- Call you only with written permission and about the specific plan you agreed to discuss.
- Contact you if you’re enrolled to review or discuss plan options within the same company.
- Call for feedback if you disenroll or qualify for Extra Help.
- Follow up after a marketing event with documented permission.
- Confirm appointments and update your scope of appointment if needed.
- Market in approved public areas of healthcare facilities (like waiting rooms or cafeterias).
- Get a signed scope of appointment before meetings when possible.
- Offer light snacks at marketing or sales events.
What they can’t do
- Claim to represent or be endorsed by Medicare.
- Solicit you at home, in person, or with flyers.
- Send unsolicited texts or voicemails.
- Approach you in public spaces like hallways or parking lots.
- Market in restricted healthcare areas such as exam rooms or hospital rooms.
- Make deceptive sales calls about other products that switch to Medicare plans.
- Serve full meals at events (only snacks allowed).
- Promote or hand out sales materials at educational events.
In Medicare, typically neither an agent nor a broker charges you for their services. Instead, they typically get paid as follows:
- Captive agents: earn a salary from one insurance company plus smaller commissions.
- Independent agents: work on commission from whichever insurer whose plan you enroll in
- Brokers: also paid commissions by the insurance company after enrolling you in its plan, but compensation rates may vary from those of brokers, depending on the state
That said, CMS limits agent and broker compensation for Medicare Advantage and Part D plans to fair market value as follows:
2025 maximums:
- Medicare Advantage: $626 (new) and $313 (renewal)
- Medicare Part D: $109 (new) and $55 (renewal)
2026 maximums:
- Medicare Advantage: $694 (new) and $347 (renewal)
- Medicare Part D: $114 (new) and $57 (renewal)
That said, the states of Connecticut, Pennsylvania, California, and New Jersey, as well as the District of Columbia,
Puerto Rico and the U.S. Virgin Islands generally have higher limits.
You don’t need an agent or broker to find the right Medicare coverage for you. You can simply visit Medicare.gov, enter your ZIP code, and go through the private Medicare plans available in your area.
But expertise from an agent or broker can be helpful in some cases. For example, they can help you review your current plan, compare it with other options, and save money without sacrificing important benefits.
If you’re applying for a Medigap plan outside of open enrollment, they can also explain medical underwriting requirements and help you find policies with fair premiums.
They can also identify Medicare Advantage plans that include your preferred doctors and hospitals, as well as prescription drug plans that cover your medications at your chosen pharmacy.
That said, because both agents and brokers are paid by insurers, they may not recommend all the options that might be a good fit and may focus on the ones that may earn them revenue.
Focus group findings
A 2023 focus group study involving 29 brokers and agents conducted by PerryUndem showed, for example, that many agents earn more money when they sign you up for a Medicare Advantage plan.
This may, in some cases, lead them to recommend these plans instead of a Medigap addition to Original Medicare, even if the latter might be a better fit.
In addition, the study found that focus group participants tended to recommend Medicare Advantage plans to people with lower incomes, while recommending Medigap plans with Original Medicare to people who earn more.
Generally, if you’re interested in using a Medicare agent, you’ll first need to go to the Medicare.gov website and select an insurer that offers Medicare plans in your area. From there, you can go to the insurer’s website and look into how to connect with an agent.
Medicare brokers, on the other hand, typically work for independent agencies. Some examples are SelectQuote and Hello Medicare.
You can also find an agent or broker on HealthCare.gov via the American Association for Medicare Supplement Insurance (AAMSI), or the State Health Insurance Assistance Program (SHIP) in your state.
All Medicare agents and brokers must be licensed to operate in your state. Before selecting a professional, verify their licensure through your state insurance department.
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Both insurance agents and brokers can help you compare and choose private Medicare plans. Their help can be useful when selecting Medicare Advantage (Part C), Medicare Part D, or a Medigap plan to add to your Original Medicare coverage.
Agents work for specific insurance companies, help you with enrollment, and provide customer service afterward. Brokers work for you, offering a wider range of plan options, but they usually don’t provide ongoing support.
While expert help can make the process easier, keep in mind that both agents and brokers are paid by insurance companies, so their recommendations may not include every plan that fits your needs.