The Value of Working with an Insurance Agent

Whether the Annual Enrollment Period is right around the corner or you’re entering a special
enrollment period, there’s a large chunk of the calendar where you can shop for Medicare
insurance plans. In many of these cases, millions of individuals around the United States
choose to entrust their Medicare insurance plan search to a licensed insurance agent. But
why do they do that?

Sometimes you may need assistance knowing what options are out there, and there’s no shame
in asking for help. In fact, working with an agent may help you understand your coverage more
or find you a better plan, and the agent’s assistance won’t cost you a dime!

Professional Knowledge of the Medicare Program

Perhaps the biggest reason people seek out the assistance of a licensed insurance agent is
because of their knowledge of the Medicare program. When you’re looking at your plan options,
it’s easy to quickly feel overwhelmed. The search for a fitting plan can get downright confusing
with all the options you may have. So, that’s where a licensed insurance agent who specializes in
Medicare insurance plans can come in handy.

Any licensed insurance agent that works with Medicare insurance plans should know a great deal
about the different enrollment windows of the Medicare program calendar and what’s permitted
during each. Specifically, they should be aware of compliance and enrollment rules with the
Medicare program.

This also means that they’ll be in the know about any upcoming changes to
requirements or rulings within the Medicare program, so you won’t be caught off guard. This is
true for both changes from the Centers for Medicare & Medicaid Services (CMS) and individual
insurance companies offering Medicare Advantage, Part D, and Medicare Supplement plans,
among others.

If that sounds like a lot of work, teaming up with a licensed insurance agent may
be for you, as they’ll handle the research for you!

Understand You and Your Area

A key trait of any agent is that they know the area they work within. Since different areas offer
different plans, it’s essential that any licensed insurance agent you work with knows what’s
offered in your area, because you may not. It’s not always easy to see the spread of plans near
you.

Additionally, licensed insurance agents should be well-versed in the plans and products
that they offer, being intimately aware with the specifics like which doctors and health care
groups are in network under a specific Medicare insurance plan (or know how to find out).

This
can protect you from enrolling in a plan only to find out that your doctor isn’t in its network.
Working with the same agent has an added bonus — they get to know you and your needs.

When looking for a Medicare insurance plan that fits you, the more knowledge they have
about you, the easier it’ll be for them to find you the right plan. This includes finding plans that
have features you didn’t know were available that align with your interests or health needs.
This is only one example of the benefits that agents can give you by becoming familiar with
your needs. If the right agent knows what you need and what plans are in your area, your
chances of finding a suitable Medicare insurance plan rise substantially.

Medicare Consultations Are No Cost

The best part about working with an agent is that using them is no cost to you. However,
you can still trust insurance agents to help you find the right plan since they get paid by the
insurance company, whether you go to a new plan or stick with your old one.

Effectively, an
agent is paid a specific commission for enrolling you in a new Medicare Advantage plan or
Part D plan. At the same time, if you stick with the same plan you had the previous year, the
agent gets paid a renewal commission by the insurance company. This helps to incentivize
agents to find you a good plan the first time.

Does this mean that if you work with a licensed insurance agent, you should just stop doing
all research and trust them blindly? No, we’d never suggest that. Even though you should trust
your agent, it’s always a good idea to stay informed so that you can be an active participant in
finding your coverage. After all, you should have a say in the coverage you purchase.

If you’re finding a Medicare insurance plan for the first time or just want help finding a suitable
plan for your needs, a licensed insurance agent can be a stellar ally in your search. Think
of them as a guide toward your goal — purchasing a Medicare insurance plan that fits your
individual and financial needs. You could get there by yourself, but you’ll likely get there quicker
and with less stress if you get help from somebody who’s walked the path many times.

Not affiliated or endorsed by Medicare or any government agency.

Captive agent, independent agent or broker: what’s the difference?

Before working with an insurance agent, it helps to know which kind you’re talking to. Not every agent can show you the same choices. The NAIC (the group of state insurance regulators) sorts them into three types.

• Captive agent. Sells for only one insurance company. You see that company’s policies and no one else’s.
• Independent agent. Can sell policies from many different companies. That lets the agent compare carriers side by side.
• Broker. Works for you and searches the market on your behalf. Because a broker represents you, the NAIC says brokers generally charge a fee for their services.

Octans is an independent agency, so our agents quote more than one carrier. That doesn’t make one type right for everyone. If you already like a certain company, a captive agent may be fine. If you want to compare prices and health rules across carriers, an independent agent covers more ground in one conversation.

How are insurance agents paid?

The NAIC says both independent and captive agents receive a commission from the insurance company when you buy one of its policies. You don’t write a separate check to the agent. The commission is built into what the carrier charges.

At Octans, we explain this on our How We Get Paid page. In short, the carrier pays us when a policy is issued. We don’t charge you fees for quotes, comparisons or help with an application.

Commissions can differ by carrier and product. That is a real conflict of interest, and you should ask about it. A fair question is: “Would you earn more if I picked this policy instead of that one?” A good agent will answer plainly and show you the lower-cost options too.

How do you check an insurance agent’s license?

Every licensed agent has a National Producer Number, or NPN. NIPR describes the NPN as a unique NAIC identifier assigned during the licensing process. It follows the agent from state to state.

Here’s how to check:

1. Ask the agent for their full name and NPN.
2. Go to your state insurance department’s website. The NAIC notes that state departments keep lists of the agents and companies licensed to do business in your state.
3. Search by NPN or name. Confirm the license is active and that it covers the kind of insurance you’re buying, such as life or health.
4. Check the company too. The NAIC says you should confirm that both the agent and the insurer are licensed in your state.

If an agent won’t share an NPN, or the license doesn’t show up, stop there. Don’t sign anything until it’s sorted out. A quick license check is one of the simplest ways to protect yourself when working with an insurance agent you just met.

What should you bring when working with an insurance agent?

A little prep makes your first meeting shorter and your quote more accurate. Have these ready:

• A list of your medications, with doses. Health questions on most applications ask about them.
• Your doctors’ names and recent diagnoses. Approximate dates help.
• Any current policies: life, annuity or Medicare plan documents. This is how the agent spots replacement issues.
• Your Medicare card, if you’re shopping for Medicare coverage.
• Debts and goals: mortgage balance, kids’ ages, and what you want the money to cover.
• A budget you can keep paying for years, not just this month.
• Beneficiary details: full names and how each person is related to you.

Take notes during the call. Ask the agent to email a summary of what you discussed and which carriers they quoted. Those notes help if questions come up later.

What a good agent should ask you. A good agent asks more questions than they answer at first. They can’t match you to the right policy without knowing your situation. Expect questions like these:

• Who depends on your income, and for how long?
• What debts, like a mortgage, would need to be paid off?
• What is your health history, and what medications do you take?
• Do you use tobacco or nicotine?
• What monthly premium fits your budget?
• Do you already have life insurance or an annuity?

That last question isn’t optional. Under the NAIC replacement model regulation, an agent who takes an application must submit a statement, signed by you and the agent, saying whether you have existing policies. An agent who skips it is cutting a corner that most states require.

Red flags: replacement rules and “twisting”

Sometimes replacing an old policy makes sense. Often it doesn’t. The NAIC warns that replacing a policy may be costly. It also says not to cancel your old policy until you have the new one.

“Twisting” is the problem regulators watch for. A Texas legislative analysis describes it as an incomplete comparison of policies used to persuade you to cancel one and buy another.

Most states base their rules on the NAIC model. If you do have coverage, the model says:

• The agent must read a “notice regarding replacement” to you, no later than when the application is taken. You and the agent both sign it.
• The agent must leave you a copy of all the sales material used.
• The new insurer must tell you that you can return the replacement policy within 30 days of delivery for a full refund of premiums paid.

Watch for these red flags:

• Pressure to cancel a policy before the new one is approved.
• No replacement notice, even though you mentioned existing coverage.
• A comparison that leaves out surrender charges, new waiting periods or a new contestability period.
• An agent who won’t give you an NPN or put the details in writing.

What are the rules for Medicare agents?

Medicare Advantage and Part D sales follow federal marketing rules. Medicare.gov says people representing Medicare plans can’t:

• Come to your home uninvited to sell or endorse anything.
• Call you unless you’re already a member or you’ve given permission to be contacted.
• Make an appointment to tell you about their plan unless you agree.
• Offer cash, or gifts worth more than $15, to get you to join.
• Charge you a fee to process your enrollment.
• Pressure you to join, or ask you to sign before you’re ready.
• Sell you a non-health product, like life insurance or an annuity, during a Medicare health or drug plan sales pitch.

Scope of appointment. Before a one-on-one sales meeting, the agent must collect a Scope of Appointment (SOA) form. It records which types of plans you agreed to discuss. Under the old rule, the meeting had to wait 48 hours after the SOA. CMS removed that waiting period in its final rule for 2027 plans. The CMS summary says the changes apply to 2027 marketing beginning October 1, 2026.

Some protections remain. CMS’s 2027 agent training guidelines say an SOA is still required, it must be in writing for in-person meetings, and sales and enrollment calls must be recorded. Agents must also give a disclaimer stating how many organizations and products they represent.

What happens after you buy?

Working with an insurance agent shouldn’t end when the policy arrives. A good agent stays your point of contact for changes, questions and claims. Here is when to check back in:

• Big life changes. Marriage, divorce, a new baby, a new mortgage or a death in the family can all change how much coverage you need and who should be your beneficiary.
• Beneficiary updates. Your policy pays the people named on the beneficiary form, so keep it current. Your agent can help you request the right form from the carrier.
• Medicare’s yearly window. Medicare.gov says Open Enrollment runs October 15 to December 7, with new coverage starting January 1. That’s a good time to have your agent review your plan against your current doctors and drugs.
• Before you cancel anything. Call your agent first. Older policies may have features or pricing you can’t get again at your current age and health.

If an agent is hard to reach after the sale, that tells you something. Ask up front who handles service calls and how quickly they reply.

How do you file a complaint about an insurance agent?

Most problems are fixed with a phone call to the agent or the carrier. If that doesn’t work, your state insurance department handles complaints, and it’s free. The NAIC defines a complaint as a statement about how an insurance company or agent handled a situation. It suggests these steps:

1. Gather your policy number, bills and records.
2. Keep a log of every call, email and letter, with dates and times.
3. Fill out your state’s complaint form. Most states take complaints online, by mail or by phone.
4. Stick to facts and timelines. Use language from your policy when you can.
5. Say what outcome you want.

In Massachusetts, start at the Division of Insurance’s filing an insurance complaint page. For Medicare plan problems, Medicare.gov says to call 1-800-MEDICARE and explain your situation if you think misleading information led you to the wrong plan.

Working with an insurance agent should feel clear, not rushed. If anything feels off, you can always pause, check the license, and ask for it in writing.