Medicare Advantage Brokers: Top Choice
Why Medicare Advantage Brokers Matter for Your Enrollment
Medicare Advantage brokers are licensed insurance professionals who help you compare and enroll in Medicare Advantage (Part C) plans at no cost to you. Here’s what you need to know upfront:
- Free to use – brokers are paid by insurance companies, not by you
- Independent brokers work with multiple carriers to find your best fit
- They handle the complexity – plan comparisons, network checks, drug formularies, and enrollment paperwork
- Ongoing support – a good broker stays in your corner after enrollment for billing issues, claims, and annual plan reviews
Medicare is confusing. Between Original Medicare, Medicare Advantage, Medigap, and Part D drug plans, most people feel overwhelmed before they even start comparing costs. And the TV ads don’t help – during the 2022 open enrollment period alone, there were over 643,000 Medicare-related ad airings, many featuring celebrity endorsements and promises of benefits that may not even be available in your area. Finding someone you can actually trust to cut through the noise makes a real difference.
That’s exactly where a qualified broker earns their value.
I’m Scott Lunsford, founder of The Lunsford Agency in Chillicothe, Ohio, with over 35 years of experience in insurance and financial services helping retirees and pre-retirees navigate their coverage options – including working with medicare advantage brokers to match clients with plans that fit their health needs and budgets. In the sections below, I’ll walk you through everything you need to know to find the right broker and ask the right questions.
What Are Medicare Advantage Brokers and How Do They Work?
When you start looking for Medicare help, you’ll run into two main types of professionals: agents and brokers. While people often use the terms interchangeably, there is a big difference in how they serve you.
An insurance agent (specifically a “captive” agent) works for one single insurance company. If you call a big-name carrier directly, you’re talking to an agent who can only sell you that company’s plans. They might be experts on those specific plans, but they can’t tell you if the company across the street has a better deal or a larger doctor network.
In contrast, medicare advantage brokers are independent. We partner with multiple insurance companies—sometimes dozens of them. This allows us to act as a middleman between you and the carriers. Instead of trying to fit you into one specific plan, we look at the whole market in Ohio to find the one that fits your lifestyle.
Think of it like shopping for a car. A captive agent is the salesperson at the Ford dealership; they’re going to tell you why a Ford is great. A broker is more like a personal shopper who can look at Fords, Chevys, and Toyotas to see which one actually fits your garage and your budget.
The Role of Medicare Advantage Brokers in Plan Selection
Selecting a plan is about more than just the monthly premium. In fact, many Medicare Advantage plans have a $0 premium, but that doesn’t mean they are “free” or all the same. Our job is to dig into the fine print that most people miss.
- Network Verification: We check if your specific doctors, specialists, and hospitals in Chillicothe or Columbus are “in-network.” If you pick a plan and your cardiologist isn’t on the list, you could be stuck with massive bills.
- Formulary Checks: Every plan has a “formulary,” which is just a fancy word for a list of covered drugs. We run your current prescriptions through the systems of various carriers to see which plan offers the lowest co-pays for your specific medications.
- Out-of-Pocket Maximums: While Original Medicare has no limit on what you might pay in a year, Medicare Advantage plans do. We compare these limits to ensure you have a “safety net” if a major health event occurs.
By providing these Medicare Services, we take the guesswork out of the process.
Professional Standards and CMS Oversight
You might wonder, “Can just anyone call themselves a Medicare broker?” Absolutely not. This is one of the most heavily regulated sectors in the insurance industry.
To help you, medicare advantage brokers must be licensed by the Ohio Department of Insurance. But the requirements don’t stop there. Every single year, we must complete rigorous training and pass the AHIP (America’s Health Insurance Plans) certification exam. This ensures we are up to date on the latest New regulations from CMS and understand the nuances of the plans we represent.
| Feature | Independent Broker | Captive Agent |
|---|---|---|
| Carrier Options | Multiple (often 10-30+) | Single Company |
| Bias | Focused on client-plan match | Focused on company sales goals |
| Cost to Consumer | $0 | $0 |
| Service Area | Licensed States (e.g., Ohio) | National or Regional |
| Post-Enrollment Help | Personalized advocacy | General customer service line |
Using a Broker for Medicare: What to Know
Understanding Broker Compensation and Consumer Costs
One of the most common questions we get at The Lunsford Agency is, “How much is this going to cost me?” The answer is simple: Zero.
Medicare brokers provide their consultation and enrollment services at no cost to the consumer. We are paid a commission by the insurance companies after a client successfully enrolls in a plan. You pay the exact same premium whether you sign up through a broker, through the carrier’s website, or via Medicare.gov. The commission is already “baked into” the price of the plan, so you might as well have a professional in your corner.
Commission Structures and CMS Maximums
The federal government (CMS) actually sets the maximum amount a broker can be paid to prevent “bidding wars” between insurance companies. For 2025, the maximum commission for an initial Medicare Advantage enrollment is $626 in most states. For renewals (when you stay in your plan for another year), the commission is typically 50% of the initial amount, or $313.
This structure is designed to encourage brokers to help you find a plan you’ll be happy with for the long term. If you’re unhappy and switch plans every year, it creates more work for everyone. However, it’s important to be aware of how these payments compare to other products. For example, a standalone Part D (prescription drug) plan only pays an initial commission of about $109. This is why some “big box” call centers might push Medicare Advantage—the payouts are significantly higher.
Are Medicare Advantage Brokers Unbiased?
This is the “elephant in the room.” Because Medicare Advantage plans pay higher commissions than Medigap (Medicare Supplement) or Part D plans, some critics argue that brokers are biased toward Advantage plans.
According to a survey of brokers, some participants admitted that low Part D commissions make it hard to spend hours researching drug plans for a client. At The Lunsford Agency, we believe the best way to remain unbiased is to look at the “Total Annual Cost.” If a Medigap plan plus a Part D plan is better for your health needs than a Medicare Advantage plan, that is what we will recommend.
A trustworthy broker should be able to explain the pros and cons of both. For instance, while Medicare Advantage often has $0 premiums and “extra” benefits like dental, Medigap offers more freedom to see any doctor in the U.S. that accepts Medicare. We want you to choose based on health, not based on a broker’s paycheck.
How Health Insurers and Brokers Are Marketing Medicare
Beyond Enrollment: Ongoing Support Services
A broker’s job doesn’t end when you get your insurance card in the mail. In many ways, that’s just the beginning.
Have you ever tried calling a giant insurance company to ask why a $50 bill turned into a $500 bill? It’s not fun. When you work with a local broker, you call us instead. We can help with:
- Claims Assistance: If a claim is denied, we can help you understand why and assist with the appeal process.
- Billing Issues: We can act as a liaison between you and the carrier to resolve payment discrepancies.
- Annual Plan Reviews: Every year in September, you’ll receive an “Annual Notice of Change” (ANOC). We help you review those changes to see if your plan is still the best deal for the coming year.
If you have more questions about how this works, check out our Frequently Asked Questions page.
Navigating Regulations and Avoiding Misleading Marketing
If you’ve turned on a TV during the day in the last few years, you’ve seen them: flashy ads featuring Joe Namath or William Shatner promising “money back in your Social Security check” and “free” everything.
While some of these benefits are real, they are often highly restricted. For example, the “Part B Premium Giveback” is only offered by about 17% of plans, and usually only in specific zip codes. Many of these ads are run by “Third-Party Marketing Organizations” (TPMOs) rather than local brokers. These organizations are essentially “lead generation” machines—their goal is to get you to call a 1-800 number so they can sell your information.
CMS has recently released a report showing a massive spike in complaints regarding these misleading practices. Complaints jumped from about 16,000 in 2020 to nearly 40,000 in just the first 11 months of 2021.
New Marketing Rules to Protect You
Because of this “Wild West” atmosphere, CMS implemented strict new rules in June 2023. Here are a few things medicare advantage brokers and marketers can no longer do:
- Misleading Imagery: They cannot use the official Medicare name, logo, or an image of the Medicare card in a way that implies they are the government.
- Unsolicited Contact: They generally cannot “cold call” you or show up at your house without an appointment.
- The $15 Rule: Brokers cannot give you gifts or cash worth more than $15. So, if someone offers you a $50 gas card just to sit through a presentation, they are breaking the law.
- “Medicare” Hotlines: Many ads feature a “Medicare Hotline” that isn’t the actual 1-800-MEDICARE. New rules require them to disclose that they are a private entity.
How to Find a Trustworthy Broker for Your Enrollment
Finding a broker is easy; finding a good one takes a little more effort. Since you’re trusting this person with your healthcare and financial security, you should vet them just like you would a doctor or a financial planner.
Start by looking for local expertise. A broker in a call center in another state might not know that a specific hospital system in Southern Ohio just went out-of-network with a certain carrier. At The Lunsford Agency, we live and work in the same communities as our clients, so we have our ears to the ground.
Verification and Transparency
Before you share any personal information, verify the broker’s credentials:
- Check the BBB: Look for the Better Business Bureau (BBB) rating for the agency.
- Read Reviews: Sites like TrustPilot can give you a sense of how the broker treats their clients after the sale.
- The Scope of Appointment (SOA): This is a document that federal law requires you to sign before a broker can talk to you about specific plans. It protects you by documenting exactly what you agreed to discuss. If a broker tries to sell you life insurance during a Medicare meeting without your prior consent, that’s a red flag.
You can find more helpful Resources on our website to help you prepare for your first meeting.
Questions to Ask Your Medicare Advantage Brokers
When you sit down with a broker, don’t be afraid to put them in the “hot seat.” A professional will welcome the opportunity to show their expertise. Ask these questions:
- “How many carriers are you appointed with?” If they only work with two or three, they aren’t giving you a full view of the market.
- “Will you check my specific medications?” Don’t settle for a “general” answer. They should use a tool to input your exact dosages.
- “What happens if my doctor leaves the network mid-year?” They should explain your rights and how they can help.
- “How are you paid?” They should be transparent about commissions.
To learn more about our philosophy and how we handle these questions, read more About The Lunsford Agency.
Frequently Asked Questions about Medicare Brokers
Does it cost more to use a broker than enrolling through Medicare.gov?
No, it does not cost a penny more. The premiums for Medicare Advantage plans are filed with the government and must be the same regardless of how you enroll. Whether you use a broker’s expert guidance or the Part C plan comparison tool on the official website, your monthly cost will be identical. The advantage of the broker is the personalized “human” element—we can catch mistakes that an algorithm might miss.
Can a broker help me if my doctors leave the plan network?
Yes. While brokers can’t force a doctor to stay in a network, we can monitor “Network Adequacy” and help you understand your options. If a doctor leaves, you might be eligible for a Special Enrollment Period (SEP) in certain circumstances, or we can help you find a new provider who offers the same quality of care within your current plan. We also help you analyze your “Annual Notice of Change” every fall to see if any network shifts are coming for the next year.
What is the difference between a broker and a 1-800 Medicare hotline?
The 1-800-MEDICARE hotline is staffed by government employees who can give you factual information about the program, but they generally cannot give you advice or tell you which private plan is “better.”
Private 1-800 “helplines” you see on TV have seen an increase in airings, but these are often high-pressure environments where the person on the other end may never talk to you again. A local broker provides long-term advocacy. We know the local Chillicothe pharmacies, we know which local doctors are easy to work with, and we are here year after year to support you.
Conclusion
Navigating Medicare doesn’t have to be a solo mission. At Lunsford Insurance, we specialize in taking the stress out of the “Golden Years.” Whether you are just turning 65 or you’ve been on Medicare for years and are tired of the rising costs, we are here to help.
Our deep connections with major carriers allow us to provide affordable, personalized healthcare strategies that go beyond just a simple insurance policy. We look at your whole financial picture, from Ohio retirement planning to supplemental retirement plans, ensuring that your healthcare costs don’t derail your hard-earned savings.
If you’re ready to have a professional in your corner, Contact Us today. Let’s make sure your Medicare coverage is working as hard as you did to earn it.