There’s one experience that most Americans have before they turn 65: Choosing a Medicare plan. It doesn’t end there, though. Every autumn after that, during the Medicare Open Enrollment period, there’s an intense flurry of Medicare advertising, and the amount of information can feel overwhelming.

With some dedicated time, you can sift through the information, identify Medicare coverage that suits your health and financial needs, and sign up independently. But not everyone has the luxury of time, and it’s certainly not an easy process. That's why many prefer to have help from an expert—specifically, a licensed insurance broker with deep knowledge of Medicare plans and coverage.

How a licensed Medicare broker can help

Brokers sell Medicare plans offered by private health insurance companies. While offerings may include Medicare Advantage (Part C), Medicare Supplement (Medigap), and stand-alone prescription drug (Part D) plans, a broker may not offer all types of plans. Private Medicare plans provide coverage beyond Original Medicare, which includes Part A (hospital insurance) and Part B (medical insurance). (Brokers don’t sell Original Medicare, which is facilitated through the Social Security Administration.)

Well-educated brokers specializing in Medicare can walk you through multiple plan options and help you focus on the plan, or set of plans, that would fit your health and financial needs. They can also help you determine when to enroll in Medicare to avoid missing important deadlines and possibly incurring late-enrollment penalties. You shouldn’t feel pressured to purchase a plan or be charged for the consultation.

What should I ask a Medicare broker?

Here are some questions to consider asking a broker you may want to work with:

• What types of plans are you licensed to sell in my state?
  
  Why you should ask: It’s important to know which types of plans the broker actually offers. Some will offer only Medicare Supplement plans, for example, because they aren’t contracted or certified to sell other types of plans.
• How do you select the health insurance companies you work with?
  
  Why you should ask: Offering a range of plans may be a sign that the broker has interest in having options for clients with different circumstances, rather than in selling one particular type of plan regardless of whether it fits your needs.
• How are you paid? Do you receive salary, commission, or other incentives for enrolling me?
  
  Why you should ask: It’s important to understand how your broker or agent is compensated. Usually, a broker collects a commission for selling an insurance company’s plan. A broker who employs sales agents may pay those agents with commission, salary, or a combination of the two. An agent paid only by commission may have incentive to sell you a plan even if it isn’t ideal for you.
  
  Remember, you should not be charged for consulting a broker. And you have no obligation to buy a plan from a broker you meet with. It remains your choice.
• Do you help only with initial enrollment in a plan? Do you offer ongoing support and guidance?
  
  Why you should ask: Many brokers focus on helping someone enroll for the first time, rather than advising people who are already enrolled in Medicare. You’ll want to know whether you can expect help from the broker if you run into problems with your coverage. Some offer follow-up and support services. Some don’t. One style isn’t necessarily better than the other, but you should know whether support is offered.
• Do you offer all the plans available in my area?
  
  Why you should ask: A broker may have contracts with only a few of the health plans that cover your location. If you’re interested in a different health plan in your area, you may need to find a different broker or go directly to the insurance company. Some have their own internal sales teams and don’t allow their plans to be sold by a broker or broker’s agent.

How to prepare for your meeting with a Medicare broker

When you’re ready to set up a consultation, keep in mind that your broker will have questions for you, too. Answering them openly and honestly will help the broker identify plans that that offer benefits and services that meet your health and financial needs, as well as your preferences. Your answers also help the broker make a recommendation for the date of your enrollment. For example, in some situations, it makes sense to delay enrollment, even though you’re eligible at age 65.

Expect to provide information, such as:

• Your date of birth.
• Your planned or actual retirement date. Are you retiring early? Will you continue working past age 65?
• The health insurance you have now. If you’re already enrolled in Medicare, have your card information on hand.
• Other insurance coverage that may be available to you in retirement—such as retiree coverage from a former employer (yours or your spouse’s), your working spouse’s insurance coverage, or U.S. military retiree coverage.
• Names and addresses of your current medical providers, along with the hospitals and other medical facilities you use. Think about whether you want continued access to them, even if it means paying more for a plan that includes them in its network. (The broker shouldn’t ask you about any medical conditions or illnesses, unless the information is required on the application for the Medicare plan you choose.)
• A list of the prescription medications you take, the name and location of your pharmacy, and whether you prefer store pick-up or mail-order services. The broker can determine whether your pharmacy is in-network and how much your medications would cost with different plans.
• How often you plan to travel when you’re retired. If you have a vacation home, you may be asked the location and how much time you spend there annually. You could need a plan with a more expansive service network if you spend significant time away.
• A general estimate of your annual Modified Adjusted Gross Income. (This is your adjusted gross income—total taxable income before deductions, exemptions, or credits—after you re-add certain deductions. AGI is on your IRS Form 1040)
  • If you have a high income, the broker may advise you when and if Medicare IRMAA (income-related monthly adjustment amount) surcharges apply to you. (Read about how to reduce the IRMAA premium surcharge.)
  • If your income is low and you qualify for Medicaid, they may suggest a combined Medicare–Medicaid plan. If your broker doesn’t sell those, contact your local State Health Insurance Assistance Program (SHIP) for information. (Read about how to save on Medicare costs if your income goes down during retirement.)

Rules for brokers selling Medicare plans and what to watch out for

Brokers and their agents can share educational information on plan options you agreed to discuss, provide an enrollment form, and send your enrollment form to the health insurer. However, they must follow rules from the Centers for Medicare & Medicaid Services (CMS):

• Topics should only include the types of Medicare plans you give advance permission to discuss. If you change your mind during the meeting, you can request that the agent or broker update the permission on file.
• They’re not allowed to sell you insurance products unrelated to health care, such as annuities or life insurance, during a conversation about Medicare plans.
• There should be no offers of cash or gifts to incentivize you to work with them or enroll in a plan.
• You shouldn’t be pressured to purchase a plan or to sign an enrollment form.
• They can’t ask you for names or contact information of your friends or family who might be interested in Medicare plans.
• They can’t come to your home unless you invite them.

Your interaction with a broker should be informative and helpful and should result in you fully understanding your Medicare timeline and plan options. If you are feeling pressured or uncomfortable, you can walk away without signing up for coverage. A broker who is a good match for you will wait for you to make a choice when you are ready to do so.

Here are some ideas for finding straightforward, trustworthy Medicare guidance:

• Talk directly to a licensed Medicare broker from an organization that meets NCOA's Medicare Standards of Excellence (SOE). These organizations have gone through NCOA's intensive SOE training and certification process, enabling them to provide in-depth Medicare education and practical decision-making support. Talking to them costs you nothing.
• Contact your local SHIP, available nationwide and in Puerto Rico, Guam, and the U.S. Virgin Islands. SHIPs offer free, impartial, and personalized insurance counseling and assistance to Medicare-eligible individuals, as well as their families and caregivers. They don’t sell insurance products of any kind.
• Visit NCOA's Medicare Enrollment Assistance resource and the Fidelity Medicare Services Learning Center for more information.  

Fidelity Medicare Services, an official NCOA partner, meets NCOA Standards of Excellence for Medicare Consumer Education and Brokerage Services. Fidelity Medicare Services provides complimentary Medicare guidance—from your initial enrollment to coverage review to year-over-year support.