A Medicare broker is a licensed insurance agent who helps you compare and enroll in Medicare Advantage, Part D drug plans, or Medigap (Medicare Supplement) policies. You do not pay the broker. The insurance company pays a commission when you enroll, and your monthly premium is the same whether you sign up through a broker, through the insurer, or on Medicare.gov yourself. Medicare's own rules say an agent can't charge you an enrollment fee. The real question is not cost. It is whether the broker can show you every plan that fits you, or only the ones that pay them. This guide explains how brokers are paid for 2027 coverage, the difference between captive and independent agents, and seven questions to ask before you let anyone enroll you.
Annual Enrollment runs October 15 to December 7, 2026, and changes take effect January 1, 2027. If you are comparing plans right now, the timing matters. See our Medicare AEP dates guide for what you can change in this window.
What a Medicare Broker Does
A broker's job is to narrow dozens of plans down to a few that fit your doctors, your prescriptions, and your budget, then handle the enrollment paperwork. A good one will:
- Check whether your doctors and hospitals are in each plan's network
- Run your prescription list through each plan's formulary and estimate your yearly drug costs
- Explain the trade-off between Medicare Advantage and Original Medicare with a Medigap policy
- Submit the enrollment and follow up if something goes wrong
- Review your plan again next fall, when benefits and networks change
A broker cannot enroll you in Original Medicare Parts A and B. That happens through Social Security. Brokers work with the private plans layered on top: Medicare Advantage (Part C), standalone Part D drug plans, and Medigap.
Medicare Agent vs Broker: Captive and Independent
People use "agent" and "broker" interchangeably, and in Medicare that is mostly fine. Both must hold a state insurance license and be appointed by each insurer they sell for. The difference that actually matters is how many companies the person represents.
| Type | Who they work for | How many insurers they show you | What to watch for |
|---|
| Captive agent | One insurance company (employee or exclusive contract) | One | You only see that company's plans, even if a competitor fits you better |
| Independent agent or broker | Themselves or an agency, appointed with several insurers | Several, sometimes many | "Independent" does not mean "every plan." Ask how many |
| Call center (third-party marketing organization) | A marketing company working with several insurers | Varies | Often a different person each call; must disclose how many organizations they represent |
| SHIP counselor | Your state's free counseling program | All plans, sells nothing | Not a salesperson, so no enrollment pitch, but appointments can book up during AEP |
CMS, the federal agency that runs Medicare, requires every Medicare Advantage and Part D insurer to report each year whether it uses "employed, captive, or independent agents or brokers." That distinction exists in federal rules because it changes what you get shown.
Do Medicare Brokers Charge a Fee?
No. Medicare.gov's marketing rules list "Charge you an enrollment fee" among the things agents and brokers can't do during a meeting. Brokers earn money from the insurer after you enroll.
Your premium does not go up because a broker was involved. A Medicare Advantage or Part D plan charges every member the same premium for the same plan in the same area. Medigap insurers charge the rates they file with your state insurance department, generally the same whether you buy through an agent or directly.
If someone asks you to pay them to enroll you in a Medicare Advantage or Part D plan, stop and call 1-800-MEDICARE (1-800-633-4227).
How Medicare Brokers Get Paid in 2027
For Medicare Advantage and Part D, CMS sets a ceiling on what insurers may pay independent agents. The figures below come from CMS's memo of June 1, 2026, "Contract Year 2027 Agent and Broker Compensation Rates." They apply to enrollments for 2027 coverage, including the plans being sold during this fall's enrollment period.
Maximum commission per enrollment, 2027 (Medicare Advantage and Section 1876 cost plans)
| Area | First year | Each renewal year |
|---|
| Most of the U.S. (national rate) | $725 | $363 |
| Connecticut, Pennsylvania, District of Columbia | $816 | $408 |
| California, New Jersey | $902 | $451 |
| Puerto Rico, U.S. Virgin Islands | $495 | $248 |
Standalone Part D drug plans, 2027: up to $130 for the first year and $65 for each renewal year.
Referral fees, 2027: up to $100 for a Medicare Advantage referral and $25 for a Part D referral.
Three things follow from these numbers.
These are maximums, not guarantees. An insurer can pay less, including nothing. In its 2027 memo, CMS asked insurers to voluntarily report when they plan to pay $0 to independent agents for a particular plan, citing concerns states raised during the 2026 enrollment period. A plan that pays an agent nothing may never come up in a sales conversation, even when it would suit you.
The first year pays about twice as much as a renewal. Federal rules cap renewal pay at 50% of the first-year amount. That gives an agent a reason to move a new client into a plan, and less reason to move an existing client from one plan to another unless it truly helps.
Medigap works differently. CMS's caps cover Medicare Advantage and Part D only. Medigap commissions are typically a percentage of your premium, paid each year you keep the policy, under state insurance rules. Higher premiums mean higher commissions, so it is fair to ask why a broker recommends one Medigap company over another that sells the same lettered plan for less. Plan G from one insurer covers the same benefits as Plan G from another. Only the price and the company's service differ.
Broker vs Shopping Yourself
You can compare every plan in your area for free at Medicare.gov's Plan Finder (medicare.gov/plan-compare) and enroll there yourself. Here is how the options stack up.
| Independent broker | Shopping yourself on Medicare.gov | Free SHIP counselor |
|---|
| Cost to you | $0 | $0 | $0 |
| Plan premium | Same | Same | Same |
| Plans shown | Only insurers the broker is appointed with | Every Medicare Advantage and Part D plan in your ZIP code | Every plan |
| Medigap quotes | Yes, from the companies they carry | Medicare.gov lists Medigap policies sold in your area, but you call insurers for exact prices | Can explain options and rules; does not sell |
| Help with enrollment | Yes, start to finish | You do it | Explains steps; you or the plan complete enrollment |
| Ongoing help | Often, especially at renewal | None | Yes, including appeals and billing problems |
| Conflict of interest | Paid by insurers, more for some plans than others | None | None |
If you are comfortable entering your drug list and doctors online, shopping yourself gives you the widest view. If you want someone to do the legwork and stick around for problems, a broker can be worth it, as long as you vet them. If you want a second opinion from someone with nothing to sell, a State Health Insurance Assistance Program (SHIP) counselor is free in every state. Our guide to Medicare advocates and SHIP counselors covers what they do. Find yours at shiphelp.org or 877-839-2675.
Many people use both: a broker for the shortlist, then Medicare.gov's Plan Finder to confirm nothing better was left out.
The 7 Questions to Ask a Medicare Broker First
1. How many insurance companies do you represent in my area?
Under federal rules, a third-party agent or marketing company must tell you how many organizations it represents before it discusses plan benefits on a call. Starting with 2027 marketing materials, CMS requires that disclaimer to be said out loud before benefits come up, not just within the first minute. If you hear "we do not offer every plan available in your area," that is the disclaimer. Ask for the actual number and the company names. One company means you are talking to a captive agent.
2. Are there plans in my ZIP code you can't sell me?
A good broker will say yes and tell you which. If a plan you have heard about is missing from their list, ask whether it is because it does not fit you or because they are not appointed with that insurer, or are not paid to sell it.
3. Will you check my doctors and every prescription I take?
Bring a full list: drug names, doses, and how often you take them, plus your doctors, specialists, hospital, and pharmacy. The broker should check each one against the network and the formulary of every plan they suggest. A doctor who is out of network can cost you far more than any premium difference, and several insurers are leaving counties for 2027. See Medicare Advantage plans leaving counties in 2027.
4. What is my total yearly cost, not just the premium?
A $0 premium plan can cost more than one with a premium once you add copays, drug costs, and the out-of-pocket maximum. For 2027, CMS lets Medicare Advantage plans set in-network out-of-pocket limits as high as $9,850, and the Part D out-of-pocket cap rises to $2,400. Ask the broker to estimate your worst-case year for each plan, not only your average year.
5. Should I be looking at Medigap instead of Medicare Advantage, and what happens if I switch later?
This is the biggest decision in Medicare, and it is hard to undo. In most states, if you leave Medigap for Medicare Advantage and later want Medigap back, the insurer can review your health and may deny you or charge more. Federal "trial rights" protect some people who try Medicare Advantage for the first time and leave within 12 months, but not everyone. A broker who only sells Medicare Advantage, or only Medigap, may not raise this. Ask directly. Our Medicare Advantage vs Medigap guide lays out the trade-offs.
6. Do I qualify for Extra Help or a Medicare Savings Program?
These programs can cut or cover your Part B premium and drug costs, and they come with Special Enrollment Periods that let you change plans outside the fall window. Brokers are not paid to enroll you in them, so some never mention them. If your income is limited, check Extra Help and Medicare Savings Programs before you choose a plan.
7. Will you still help me after I enroll, and how do I reach you?
Ask whether they will handle a billing problem, a denied claim, or a pharmacy issue in March, and whether they will review your plan next fall. Get a direct phone number. Then confirm the license with your state insurance department's online lookup before you sign anything.
Red Flags When Working With a Medicare Broker
Medicare.gov lists what plans and their agents are not allowed to do. Walk away, or report it, if someone:
- Charges you an enrollment fee
- Shows up at your home uninvited to sell you a plan
- Calls or texts you about a plan you are not a member of, when you never asked to be contacted
- Asks for your bank account or credit card number when giving a quote, or asks you to pay over the phone or online
- Pressures you to join or to sign an enrollment form before you are ready
- Offers cash, gifts worth more than $15, or free meals to get you to join
- Tries to sell you an annuity or life insurance during a Medicare plan pitch
- Says they are calling "from Medicare." Medicare does not call to sell you plans.
An agent should also ask you to complete a Scope of Appointment form before a sales meeting, listing which types of plans you agreed to discuss. CMS dropped the old 48-hour wait for 2027 marketing, so the form can be completed right before the appointment. The agent should stick to the products you checked.
If you think an agent misled you or enrolled you in a plan you did not agree to, call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048). If the change took effect recently, you may be able to switch back.
How to Find a Medicare Broker Near You
- Make your list first. Write down your doctors, hospital, pharmacy, and every prescription with its dose.
- Run your own search. Enter that list in Medicare.gov's Plan Finder so you know what is available in your ZIP code before anyone pitches you.
- Get names from people you trust. Friends, your doctor's office, or a local senior center often know agents who answer the phone after the sale.
- Check the license. Look the agent up on your state insurance department's website.
- Ask the seven questions above. Note how many insurers they represent and whether any plans you found are missing.
- Compare the recommendation to your own search. If the broker's pick costs more in a typical year than one you found, ask why.
- Enroll by December 7, 2026, for coverage starting January 1, 2027. If you are already in Medicare Advantage, you get one more chance to switch plans or return to Original Medicare from January 1 to March 31, 2027.
Frequently Asked Questions
Do Medicare brokers charge a fee?
No. Medicare.gov's rules say agents and brokers can't charge you an enrollment fee. The insurer pays the broker a commission, and your premium is the same whether you use a broker or not.
Is it cheaper to buy a Medicare plan directly instead of through a broker?
No. Medicare Advantage and Part D plans charge every member the same premium for the same plan in the same area, regardless of how they enrolled. Medigap insurers generally charge the same filed rate whether you buy directly or through an agent.
How much does a Medicare broker make per client?
For 2027 Medicare Advantage enrollments, CMS caps first-year pay at $725 in most of the country, up to $902 in California and New Jersey, and caps renewals at $363 nationally. Part D is capped at $130 for the first year and $65 for renewals. Insurers can pay less, including nothing. Medigap commissions are set separately, usually as a percentage of the premium.
What is the difference between a Medicare agent and a Medicare broker?
In everyday use they mean the same thing: a licensed person who sells Medicare plans. The difference that matters is captive versus independent. A captive agent sells for one company. An independent agent or broker works with several insurers, but rarely all of them.
Can a broker help me with Original Medicare Parts A and B?
A broker can explain them, but you sign up for Parts A and B through Social Security, at ssa.gov or by phone. Brokers enroll you in the private plans: Medicare Advantage, Part D, and Medigap.
Is there free, unbiased Medicare help?
Yes. Your state's SHIP program offers free one-on-one counseling from people who do not sell insurance. Find your local office at shiphelp.org or 877-839-2675. You can also call 1-800-MEDICARE any time.
Can I change my plan if a broker put me in the wrong one?
During Annual Enrollment, October 15 to December 7, 2026, you can change plans as often as you like, and the last choice you make takes effect January 1, 2027. If you are in Medicare Advantage, you can make one change between January 1 and March 31, 2027. If you were misled or enrolled without consent, call 1-800-MEDICARE, which may be able to grant a special enrollment period.
