Should a Senior Use a Medicare Broker?

What is a Medicare broker, and how can a broker help a person to navigate the multiple options within Medicare? How does this kind of broker differ from a State Health Insurance Assistance Program (SHIP) counselor? What other resources exist to help seniors learn how best to use Medicare?

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Medicare Brokers

Also called Medicare agents or advisors, Medicare brokers are licensed professionals who help evaluate, select, and enroll clients in Medicare plans. They have detailed knowledge of Medicare benefits, restrictions and plan options and stay current with Medicare changes through annual training and certifications. Brokers work to answer any and all questions that their clients have about Medicare, which can be a valuable service to seniors in doubt.

While agents typically work for one insurance company, Medicare brokers usually work with multiple insurance companies to offer a range of plan choices to accompany Medicare, and they are paid by insurance companies through commissions, at no cost to the client.

Most brokers provide unbiased recommendations based on your individual needs and budget and should advise you of your best option even if they don’t represent that particular plan. They can ensure your doctors and medications are covered in the plan, and some provide additional client service support for issues such as claims denials or drug exceptions, as well as helping you find financial assistance programs if needed

Brokers can be particularly helpful for those feeling overwhelmed by Medicare decisions, as they provide personalized guidance based on an individual’s needs and budget. Commissions are actuarially factored into premiums, and you pay the same rate to the insurance company whether you enroll directly without a broker, or have a broker enroll you.

It should be noted that brokers receive higher commissions for enrolling seniors in Medicare Advantage than for Medigap and Part D, so this financial incentive does exist. With Medicare Advantage plans, staying within your policy’s network is key to paying the lowest possible costs for health services. Going out of your network could mean high fees or no coverage, and this program has been falling into disfavor within the healthcare field in recent years.

Comparison with SHIP Counselors

State Health Insurance Assistance Program (SHIP) counselors differ from Medicare brokers in that they are funded by government and receive no commissions from insurance companies. While they cannot actively enroll individuals in Medicare plans (since they don’t work for them), their goal is to provide free, objective counseling funded by the federal government. Like brokers, SHIP counselors can also help find financial assistance programs, and point you to other sources of help to engage with Medicare in the most beneficial way.

Medicare Resources for Seniors

To learn how to best use Medicare, seniors can often attend local Medicare workshops or seminars offered by community organizations, as well as contacting their state’s local SHIP office, or finding a recommended Medicare broker such as those partnered with the National Council on Aging (NCOA).

Online tools are available also, and the official Medicare Plan Finder on Medicare.gov is one of the most comprehensive and user-friendly tools. This will allow you to make the crucial comparison for yourself between Medicare Advantage, Part D, and Medigap plans.

The site provides personalized results based on your location and medications, shows estimated costs, coverage details, and star ratings for plans, and allows side-by-side comparisons of up to three plans at a time. To use this tool effectively, you’ll need to enter your ZIP code, medications, and preferred pharmacies.

Several other organizations offer Medicare plan comparison tools. NCOA provides a tool to compare plans and connect with Medicare experts, while websites such as NerdWallet provide guides on how to compare Medicare Advantage plans effectively. Some insurance companies, such as Aetna, offer worksheets to help compare Medicare Advantage plans.

When using these tools, focus on comparing monthly premiums, deductibles and out-of-pocket maximums. Review all network restrictions (in-network vs. out-of-network coverage), prescription drug coverage, and any additional benefits (dental, vision, hearing, etc.), as well as star ratings from users.