Question 1

What is a Medicare broker vs a Medicare agent?

Accepted Answer

The terms 'Medicare broker' and 'Medicare agent' are often used interchangeably, but there can be subtle differences. Both are licensed insurance professionals who can help you enroll in Medicare plans. A broker typically works independently and represents multiple insurance companies, giving you access to a wide range of plan options. An agent may work for a specific insurance company (captive agent) or independently. The key is to work with an independent professional who represents multiple carriers so you can compare all available options in your area.

Question 2

Do I pay for using a Medicare broker?

Accepted Answer

No, you do not pay anything to use a Medicare broker. Medicare brokers are compensated by the insurance companies whose plans they sell, not by consumers. Their services are completely free to you, including plan comparisons, enrollment assistance, and ongoing support throughout the year. The commission they earn from insurance companies does not increase your premium costs—you pay the same premium whether you enroll directly or through a broker. Be wary of anyone asking for upfront fees or charging for Medicare information.

Question 3

How do I verify a broker's license?

Accepted Answer

You can verify a Medicare broker's license through your state's Department of Insurance website. Each state maintains a database of licensed insurance professionals. Ask the broker for their license number and state, then visit your state insurance department's website to search their license database. You can also verify their credentials through the National Insurance Producer Registry (NIPR) at www.nipr.com. A legitimate broker will readily provide this information and welcome your verification.

Question 4

What's the difference between an independent Medicare broker and other types of agents?

Accepted Answer

Independent Medicare brokers work with multiple insurance companies and can offer you plans from various carriers, giving you more options to find the best fit for your needs and budget. They're licensed professionals who must act in your best interest. In contrast, captive agents work for only one insurance company and can only sell that company's plans, limiting your choices. Call centers often employ unlicensed representatives who may not have the expertise to properly assess your individual needs and typically use high-pressure sales tactics. Independent brokers provide personalized service, local expertise, and ongoing support throughout the year.

Question 5

Why should I avoid foreign call centers for Medicare advice?

Accepted Answer

Foreign call centers often employ representatives who lack proper Medicare licensing, local market knowledge, and understanding of U.S. healthcare systems. They typically use high-pressure sales tactics, may not understand your specific state's regulations, and cannot provide the ongoing personal service you need. These operations prioritize sales volume over customer service, and you'll likely never speak to the same person twice, making it difficult to build a trusted relationship. Additionally, they may have limited knowledge of local doctors, hospitals, and healthcare networks in your area.

Question 6

What's wrong with captive agents for Medicare?

Accepted Answer

Captive agents work exclusively for one insurance company, which means they can only show you plans from that single carrier—even if another company has a better plan for your specific needs. They're incentivized to sell their company's products regardless of whether it's the best fit for you. This limited approach means you're not getting a true comparison of all available options in your area, potentially missing out on better coverage, lower costs, or plans that better match your preferred doctors and medications.

Question 7

How do I know if I'm talking to a licensed Medicare professional?

Accepted Answer

Licensed Medicare professionals should readily provide their license number and state licensing information upon request. They should be able to discuss multiple insurance carriers and plan options, not just push one company's products. Legitimate brokers will take time to understand your needs, medications, and preferred doctors before making recommendations. They should never ask for payment or banking information upfront. Be wary of high-pressure tactics, unsolicited calls, or anyone who won't provide their licensing credentials. You can verify their license through your state's Department of Insurance website.

Question 8

What are the benefits of working with a local independent Medicare broker?

Accepted Answer

Local independent Medicare brokers offer personalized service with face-to-face meetings, deep knowledge of your area's healthcare providers and networks, and ongoing support throughout the year—not just during enrollment. They work with multiple insurance companies to find the best plan for your specific needs and can help you navigate claims issues or plan changes. Most importantly, they're accountable to your local community and build long-term relationships, so you'll have a trusted advisor you can reach when you need help. They understand local doctors, hospitals, and healthcare systems in your area.

Question 9

Do Medicare brokers cost me anything?

Accepted Answer

No, legitimate Medicare brokers and agents are paid by the insurance companies, not by you. Their services should be completely free, including plan comparisons, enrollment assistance, and ongoing support. Be suspicious of anyone asking for upfront fees or charging for Medicare plan information. Reputable brokers earn their compensation from insurance companies when you enroll in a plan, but this doesn't increase your premium costs—you pay the same whether you enroll through a broker or directly with the insurance company.

Question 10

How can I tell if a Medicare agent is legitimate?

Accepted Answer

Legitimate Medicare agents will have proper state licensing (ask for their license number), represent multiple insurance companies (if independent), never ask for payment upfront, and won't use high-pressure sales tactics. They should schedule appointments at your convenience, provide detailed plan comparisons, and give you time to make decisions. Red flags include unsolicited door-to-door visits, requests for banking information over the phone, claims of being 'from Medicare' (Medicare doesn't sell plans directly), or anyone pressuring you to make immediate decisions without time to review your options.

Question 11

What questions should I ask a Medicare broker before working with them?

Accepted Answer

Ask for their state license number and verify it with your state's insurance department. Find out how many insurance companies they represent—more is generally better for getting comprehensive comparisons. Ask about their experience specifically with Medicare (not just general insurance), whether they provide year-round service or just during enrollment periods, and if they can meet with you in person or virtually. Ask if they specialize in any particular type of Medicare plan and how they're compensated. A good broker will welcome these questions and provide clear, detailed answers.

Question 12

Do I need a Medicare broker or agent?

Accepted Answer

While not required, Medicare brokers and agents can provide valuable assistance in understanding your options, comparing plans, and enrolling in coverage. Medicare can be complex with many plan choices, and brokers can help you navigate this complexity to ensure you choose the plan that best fits your needs and budget. They can explain how different plans work with your specific medications and doctors, help you understand costs beyond just premiums, and provide ongoing support. Best of all, their services are typically free to you, making them a valuable resource for most Medicare beneficiaries.

Question 13

What is Medicare and who is eligible?

Accepted Answer

Medicare is a federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). You're eligible for Medicare at age 65 if you or your spouse worked and paid Medicare taxes for at least 10 years. People under 65 may qualify if they have received Social Security Disability Insurance (SSDI) for 24 months or have ALS (Lou Gehrig's disease) or ESRD.

Question 14

What's the difference between Medicare Advantage and Original Medicare?

Accepted Answer

Original Medicare (Parts A and B) is a fee-for-service program run by the federal government that lets you see any doctor or hospital that accepts Medicare nationwide. Medicare Advantage (Part C) is an alternative way to receive Medicare benefits through private insurance companies approved by Medicare. Medicare Advantage plans often include prescription drug coverage and may offer additional benefits like dental, vision, hearing aids, or wellness programs. However, they typically use networks of doctors and hospitals, requiring you to see in-network providers except in emergencies. Original Medicare gives you more freedom to choose providers, while Medicare Advantage often offers lower out-of-pocket costs and extra benefits.

Question 15

What's the difference between Medicare Advantage and Medigap?

Accepted Answer

Medicare Advantage (Part C) and Medigap (Medicare Supplement Insurance) are two different ways to get Medicare coverage. Medicare Advantage is an alternative to Original Medicare offered by private insurance companies that includes Part A, Part B, and usually Part D prescription drug coverage, often with additional benefits like dental and vision. You can only have Medicare Advantage OR Original Medicare. Medigap works alongside Original Medicare to help cover out-of-pocket costs like copayments, coinsurance, and deductibles. Medigap policies are standardized and labeled with letters (Plan G, Plan N, etc.). You cannot have both Medicare Advantage and Medigap at the same time.

Question 16

When should I enroll in Medicare?

Accepted Answer

Your Initial Enrollment Period (IEP) begins 3 months before you turn 65, includes the month you turn 65, and continues for 3 months after you turn 65, giving you a 7-month window. If you miss this window and don't have creditable coverage from an employer, you may face late enrollment penalties and have to wait until the next General Enrollment Period (January 1 - March 31) with coverage starting July 1. You can also enroll during the Annual Open Enrollment Period (October 15 - December 7 each year) to make changes to your existing coverage. Some people qualify for Special Enrollment Periods due to life events like moving or losing other coverage.

Question 17

Can a broker help me compare all plan options?

Accepted Answer

Yes, an independent Medicare broker can help you compare all Medicare plan options available in your area from the multiple insurance companies they represent. This includes Medicare Advantage plans, Medicare Supplement (Medigap) policies, and Part D prescription drug plans. They can show you plan details side-by-side, explain differences in coverage, costs, and networks, and help you determine which option best fits your healthcare needs, preferred doctors, medications, and budget. Unlike captive agents who only sell one company's plans, independent brokers give you access to the full marketplace.

Question 18

What does Medicare Part A cover?

Accepted Answer

Medicare Part A (Hospital Insurance) covers inpatient hospital stays, care in a skilled nursing facility (not custodial or long-term care), hospice care, and some home health care services. It covers semi-private rooms, meals, general nursing, and other hospital services and supplies. Most people don't pay a monthly premium for Part A if they or their spouse paid Medicare taxes while working for at least 10 years. However, Part A does have deductibles and coinsurance for certain services.

Question 19

What does Medicare Part B cover?

Accepted Answer

Medicare Part B (Medical Insurance) covers medically necessary doctors' services, outpatient care, medical supplies, preventive services, and some home health care. This includes doctor visits, lab tests, X-rays, outpatient surgery, durable medical equipment like wheelchairs and walkers, mental health services, and many preventive services like flu shots and cancer screenings. Part B requires a monthly premium that varies based on your income (higher earners pay more through IRMAA - Income-Related Monthly Adjustment Amount). There's also an annual deductible and you typically pay 20% coinsurance for most Part B services.

Question 20

What is Medicare Part D?

Accepted Answer

Medicare Part D provides prescription drug coverage offered by private insurance companies approved by Medicare. You can get Part D coverage through a standalone prescription drug plan (PDP) if you have Original Medicare, or through a Medicare Advantage plan that includes drug coverage (MA-PD). Part D plans have varying premiums, deductibles, copayments, and formularies (lists of covered drugs). Plans are organized into tiers, with different costs for different types of medications. It's important to review the plan's formulary to ensure your medications are covered and understand your out-of-pocket costs.

Question 21

What is Medigap insurance?

Accepted Answer

Medigap (Medicare Supplement Insurance) is private insurance that helps pay some of the health care costs that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles. Medigap policies are standardized and labeled with letters (Plan A, Plan B, Plan C, Plan D, Plan F, Plan G, Plan K, Plan L, Plan M, and Plan N). Each lettered plan offers a different set of benefits, though Plan F and Plan C are no longer available to people newly eligible for Medicare after January 1, 2020. Medigap only works with Original Medicare, not Medicare Advantage. You pay a monthly premium to the private insurance company for your Medigap policy in addition to your Part B premium.

Question 22

Can I change my Medicare plan?

Accepted Answer

Yes, you can change your Medicare plan during certain times of the year. The main opportunities are during the Annual Open Enrollment Period (AEP) from October 15 - December 7, when you can switch from Original Medicare to Medicare Advantage, change Medicare Advantage plans, add or drop Part D coverage, or switch Part D plans, with changes taking effect January 1. There's also the Medicare Advantage Open Enrollment Period (MA OEP) from January 1 - March 31 for those already in Medicare Advantage to switch to another MA plan or return to Original Medicare. Some people may qualify for Special Enrollment Periods (SEPs) due to certain life changes like moving to a new area, losing other coverage, or qualifying for Extra Help.

Question 23

How much does Medicare cost?

Accepted Answer

Medicare costs vary depending on which parts you have and your income. Part A is usually premium-free if you or your spouse paid Medicare taxes for at least 10 years. Part B has a standard monthly premium (2024: $174.70) with higher earners paying more through IRMAA. Part D premiums vary by plan, typically ranging from $0 to $100+ per month. Medicare Advantage plan premiums vary widely, from $0 to over $200 per month depending on coverage and location. Medigap plan costs depend on the plan letter, your age, location, and insurance company. All plans also have deductibles, copayments, or coinsurance that affect your total out-of-pocket costs.

Question 24

What happens if I'm still working at 65?

Accepted Answer

If you're still working at 65 and have employer health insurance from a company with 20 or more employees, you may be able to delay Medicare Part B enrollment without penalty, though you should still enroll in Part A (it's free for most people). If your employer has fewer than 20 employees, Medicare becomes primary and you should enroll in both Part A and B at 65. The rules are complex and making the wrong decision can result in penalties and coverage gaps. It's important to understand how your employer coverage works with Medicare and speak with your HR department and a Medicare expert before making enrollment decisions.

Question 25

Can I have Medicare and employer insurance at the same time?

Accepted Answer

Yes, in some cases you can have both Medicare and employer insurance, known as dual coverage. The coordination of benefits depends on several factors, including the size of your employer (20+ employees or fewer than 20) and whether you're actively working or have retiree coverage. Understanding which insurance pays first (primary) and which pays second (secondary) is important for managing your costs and avoiding surprise bills. For employers with 20+ employees, employer coverage is typically primary while you're actively working. For smaller employers and retiree coverage, Medicare is usually primary. A Medicare broker can help you understand your specific situation.

Question 26

What are the penalties for late Medicare enrollment?

Accepted Answer

If you don't enroll in Medicare when you're first eligible and don't have creditable coverage from an employer or other source, you may have to pay late enrollment penalties. The Part B penalty is 10% of the standard premium for each full 12-month period you were eligible but didn't enroll, and you pay this penalty for as long as you have Part B. The Part D penalty is calculated based on how long you went without creditable prescription drug coverage and is added to your Part D premium permanently. These penalties can add up to significant costs over time, so it's important to enroll during your Initial Enrollment Period unless you have creditable coverage.

Question 27

How do I find the right Medicare plan for me?

Accepted Answer

Finding the right Medicare plan involves evaluating several factors: your health needs, prescription medications, preferred doctors and hospitals, budget, and whether you travel frequently. Start by listing your current medications and preferred doctors, then check which plans cover them. Consider factors like monthly premiums, deductibles, copayments, out-of-pocket maximums, and whether your current doctors accept the plan. Think about whether you prefer the flexibility of Original Medicare with a Medigap plan or the potentially lower costs and extra benefits of Medicare Advantage. A licensed independent Medicare broker can help you compare all options and find the best fit for your specific situation at no cost to you.

Question 28

What should I do if I receive unsolicited Medicare calls or visits?

Accepted Answer

Be very cautious of unsolicited Medicare calls or door-to-door visits. Legitimate Medicare brokers typically work by referral or appointment, not through cold calls or surprise visits. Never give personal information like Social Security numbers, bank account details, or Medicare numbers to unsolicited callers. If someone claims to be 'from Medicare,' know that Medicare doesn't make sales calls or visit homes unannounced. Don't feel pressured to make immediate decisions. Hang up on suspicious calls and don't answer the door for unexpected visitors. Report suspicious activity to the Senior Medicare Patrol (SMP) at 1-877-808-2468, your State Health Insurance Assistance Program (SHIP), or Medicare directly at 1-800-MEDICARE.

Question 29

How is working with an independent broker different from using Medicare.gov?

Accepted Answer

Medicare.gov is an excellent resource for researching plans and enrolling, but it can't provide personalized guidance or answer specific questions about your situation. The website shows you plan information but doesn't explain complex differences in simple terms or help you understand how plans work with your specific doctors, medications, and healthcare needs. Independent brokers offer personalized service, can compare plans side-by-side while explaining what the numbers mean for you specifically, help you understand trade-offs between different options, and provide ongoing support after enrollment. They can also help you navigate issues that arise during the year, file claims, or switch plans if your needs change, whereas Medicare.gov is primarily a self-service research and enrollment tool.

Question 30

What is the Medicare Advantage Open Enrollment Period?

Accepted Answer

The Medicare Advantage Open Enrollment Period (MA OEP) runs from January 1 to March 31 each year. During this time, people who are already enrolled in a Medicare Advantage plan can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and return to Original Medicare and add a Part D prescription drug plan. You can only make one change during MA OEP. This is different from the Annual Enrollment Period (AEP) which runs October 15 - December 7 and is open to all Medicare beneficiaries to make broader changes to their coverage.

Question 31

Can I enroll in Medicare if I have a pre-existing condition?

Accepted Answer

Yes, Medicare does not deny coverage based on pre-existing conditions. When you're first eligible for Medicare (typically at 65), you have guaranteed issue rights for both Medicare Advantage and Medigap plans during your Initial Enrollment Period. For Medicare Advantage, you can enroll regardless of health conditions during any enrollment period. For Medigap, you have a one-time 6-month Medigap Open Enrollment Period starting when you're 65 or older and enrolled in Medicare Part B, during which insurance companies cannot deny you coverage, charge you more, or make you wait for coverage to start due to pre-existing conditions. After this period, in most states, Medigap insurers can use medical underwriting and may deny coverage or charge higher premiums based on your health.

Medicare FAQ.

Medicare Brokers & Agents

Medicare Basics

Plans & Coverage

Working Past 65 & Coordination of Benefits

Finding the Right Plan & Staying Safe

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