Medicare guide
The Role of Independent Medicare Insurance Agents
Independent Medicare insurance agents are licensed to sell plans from more than one insurance company. Their job is to help you compare Medicare Advantage, Medigap, and Part D options in your area, check them against your doctors and prescriptions, and help you enroll. Here is what they do, how they are paid, and the rules they follow.
Blake Insurance Group is an independent agency serving clients by phone, email, and online in states where we are licensed; coverage depends on the insurer, the policy, and underwriting.
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What an independent agent does
An independent agent appointed with several insurers can compare Medicare Advantage, Medigap, and Part D options available in your area, check your doctors and prescriptions against plan networks and drug lists, and help again each fall during Open Enrollment. Agents are paid by the insurers, so you don’t pay a fee for their help. Medicare.gov, 1-800-MEDICARE, and your State Health Insurance Assistance Program (SHIP) also give free, unbiased help; the national SHIP line is 877-839-2675.
- Explain the difference between Original Medicare with Medigap and Medicare Advantage.
- Check your doctors against plan networks.
- Check your prescriptions against plan drug lists.
- Compare premiums, copays, and out-of-pocket limits.
- Help you enroll and review your coverage each fall.
Rules agents follow
Federal rules shape how agents work. Third-party marketing organizations that represent more than one Medicare Advantage organization must give a disclaimer explaining that they don’t offer every plan in your area. Agents must agree with you on a Scope of Appointment, the products you want to discuss, before a sales appointment; a CMS rule effective June 1, 2026 removed the old 48-hour waiting period. And under a 2024 CMS rule, your personal information can be shared with another marketing organization only with your prior express written consent for each recipient.
When to talk with an agent
| Period | When | What you can do |
|---|---|---|
| Initial Enrollment Period | 7 months around your 65th birthday month | Sign up for Parts A and B, and join a plan |
| Annual Open Enrollment | October 15 – December 7 | Join, switch, or drop Medicare Advantage or drug plans; coverage starts January 1 |
| Medicare Advantage Open Enrollment | January 1 – March 31 | One change: switch MA plans or return to Original Medicare (and add a drug plan) |
| General Enrollment Period | January 1 – March 31 | Sign up for Parts A and B if you missed your IEP; penalties may apply |
| Special Enrollment Periods | After qualifying events | For example, moving or losing employer coverage |
| Medigap Open Enrollment | 6 months from the first month you have Part B and are 65+ | Buy any Medigap policy sold in your state without health questions |
Source: Medicare.gov, October 2026.
Costs an agent will review
| Item | 2026 amount |
|---|---|
| Part A hospital deductible | $1,736 per benefit period |
| Part A coinsurance, days 61–90 | $434 per day |
| Skilled nursing facility, days 21–100 | $217 per day |
| Part B standard premium | $202.90 per month |
| Part B deductible | $283 per year |
| Part D deductible (maximum) | $615 |
| Part D out-of-pocket cap | $2,100 |
| Insulin | No more than $35 for a month’s supply |
Sources: CMS (Nov. 2025, Apr. 2025) and Medicare.gov. 2027 Part A and B amounts had not been announced as of Oct. 22, 2026; CMS usually publishes them in mid-November. Higher-income beneficiaries pay more for Parts B and D.
Medicare Advantage or Medigap?
The biggest choice is between Medicare Advantage, which bundles coverage through a private plan with a network and an out-of-pocket cap, and Original Medicare with a Medigap policy and a drug plan, which lets you see any provider that accepts Medicare.
Medicare Advantage plans must cap in-network out-of-pocket costs for Part A and B services. For 2026, KFF reports the federal limit is $9,250 in network and $13,900 combined for in- and out-of-network services in PPOs, and that the average plan’s in-network limit is about $5,421. Original Medicare has no out-of-pocket cap, which is one reason people pair it with Medigap.
Your best time to buy is the six-month Medigap Open Enrollment Period, which starts the first month you have Part B and are 65 or older. During it, insurers can’t refuse to sell you any policy they offer or charge more for health problems. Outside it, insurers in most states can use medical underwriting unless you have a guaranteed issue right, such as when your Medicare Advantage plan leaves your area, employer coverage that pays after Medicare ends, or you leave a Medicare Advantage plan within your first year. You generally must apply within 63 days after the other coverage ends.
What’s changing for 2027
KFF counts 35.2 million Medicare Advantage enrollees in 2026, about 55% of eligible beneficiaries. For 2027, KFF’s analysis of CMS data found the average beneficiary can choose from 28 Medicare Advantage plans with drug coverage, but several large insurers are leaving some counties: UnitedHealth is exiting 228 counties, Humana 62, and Centene, Wellcare’s parent, 359 while entering 15. If your plan is leaving, you have a Special Enrollment Period and may have Medigap guaranteed issue rights.
For 2027, CMS set the Part D national base beneficiary premium at $41.33, up from $38.99 in 2026, and said it will end the Part D premium stabilization demonstration for standalone drug plans after 2026. The 2027 final rule keeps the Inflation Reduction Act’s redesign in place: there is no coverage gap, and there is no cost sharing once you reach the annual out-of-pocket threshold.
Telling a real agent from a scam
Medicare.gov says Medicare will never call you to sell you anything or visit you at your home, and that it calls for personal information only in limited cases, such as returning your call. Don’t join a plan over the phone unless you called and asked for help, and don’t give your Medicare or Social Security number to anyone who contacts you unexpectedly. The FTC adds that Medicare sends new cards automatically and for free.
Report suspected fraud to 1-800-MEDICARE (1-800-633-4227) or the HHS Office of Inspector General at 1-800-HHS-TIPS (1-800-447-8477). Medicare Advantage and Part D members can also call the I-MEDIC at 1-877-772-3379.
Checking a plan and insurer
- Networks. Confirm your doctors and hospitals are in the plan’s network.
- Drugs. Check each prescription on the plan’s formulary and its tier.
- Costs. Compare premiums, deductibles, copays, and the out-of-pocket maximum.
- Agent license. Confirm the agent is licensed in your state through your state insurance department.
- Star Ratings. Review the plan’s rating on Medicare.gov’s Plan Finder.
What an independent agency does
An independent insurance agency is licensed to sell policies from several insurance companies. Instead of quoting one company's products, an independent agent can compare options from the insurers the agency represents, explain the differences in coverage, and help you re-shop at renewal. The insurance company, not the agent, makes underwriting and claim decisions.
Blake Insurance Group is an independent agency. We work with clients by phone, email, and online in states where we are licensed, and we will tell you which insurers we can quote for your situation.
How we work
Blake Insurance Group serves clients by phone, email, and online in states where we are licensed. The insurers and plans we can offer depend on our appointments and your location; a company named on this page may not be available through us.
How to verify an insurer or agency
Before buying through any website or app, confirm who is selling you the policy and who will issue it:
- Find the licensed agency or insurer named in the site's footer, terms, or license page.
- Look up the agency or producer on your state insurance department's license search, or through the National Insurance Producer Registry (NIPR).
- Look up the insurer on your state insurance department's company search to confirm it is authorized in your state.
- Save the insurer's name and policy number once issued, since that is who handles claims.
A legitimate service will make this information easy to find. Be cautious if you cannot identify the licensed entity.
Sources
We checked the facts on this page against the sources below in October 2026. Plans, prices, and rules change, so confirm current terms before you buy.
- 42 CFR 422.2267: Required materials and content (TPMO disclaimer)
- 42 CFR 423.2264: Beneficiary contact and Scope of Appointment
- 42 CFR 423.2274: Agent and broker requirements (data-sharing consent)
- CMS: Contract Year 2027 Medicare Advantage and Part D final rule (Apr. 2026)
- ACL: State Health Insurance Assistance Program (Mar. 2026)
- Medicare.gov: When does Medicare coverage start?
- Medicare.gov: Joining a health or drug plan
- CMS: 2026 Medicare Parts A & B premiums and deductibles (Nov. 2025)
- CMS: Final CY 2026 Part D redesign program instructions
- KFF: Medicare Advantage out-of-pocket limits
- Medicare.gov: Ready to buy a Medigap policy
- KFF: Medicare Advantage plan availability for 2027 (Oct. 2026)
- CMS: Part D 2027 national average monthly bid information (July 2026)
- Medicare.gov: Medicare fraud
- FTC: Avoid scams during Medicare open enrollment (Nov. 2024)
What to have ready for a Medicare review
These details help an agent quote accurately.
- Medicare card. Your Medicare number and Part A and B start dates.
- Doctors. Names of doctors and hospitals you want to keep.
- Prescriptions. Drug names, doses, and pharmacies.
- Current coverage. Any plan, employer, or Medicaid coverage you have.
- ZIP code. Plans differ by county.
Independent Medicare agents FAQs
Do independent Medicare agents charge a fee?
No. Agents are paid by the insurance companies whose plans they sell.
Can an independent agent sell every plan?
Not necessarily. Agents can offer only plans from insurers they are appointed with, which is why they must give a disclaimer.
What is a Scope of Appointment?
An agreement on which products you’ll discuss, recorded before a sales appointment. The 48-hour waiting period was removed effective June 1, 2026.
Where can I get unbiased Medicare help?
Medicare.gov, 1-800-MEDICARE, and your State Health Insurance Assistance Program.
Related guides
Partner quote options
Sponsored
Blake Insurance Group works with the partners below. Each link opens the partner's own website, where its terms, eligibility rules, and privacy policy apply. Blake Insurance Group may be compensated if you buy through these links.
- Wellcare Medicare plans (online enrollment): View Wellcare Medicare Advantage and prescription drug plans available in your ZIP code and enroll online with Blake Insurance Group as your agent.
Important information
Compensation. Links in the partner section of this page are sponsored, and Blake Insurance Group may be paid if you make a purchase. Sponsored placement does not affect the other information on this page.
Independent agency. Blake Insurance Group LLC is an independent insurance agency. Licensed insurance producer NPN 16117464. Licensed states: AZ, AL, TX, CA, NY, OH, FL, NC, VA, GA, OK, NM, IA, KS, MI, NE, SC, SD, WV, IL, NJ, PA, TN, and WA. Which insurance companies we can quote depends on our current appointments, the product, and your state. Mentioning a company on this page does not mean we represent it.
Medicare disclaimer. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE (TTY users 1-877-486-2048), or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options.
Medicare figures. Costs, limits, and rules on this page were checked against CMS, Medicare.gov, and the other listed sources in October 2026. 2027 Part A and B amounts had not been announced. Confirm current figures at Medicare.gov.
Coverage terms. Descriptions are general. The policy contract controls what is covered.
Availability. Coverage, prices, and eligibility vary by company, state, and applicant, and are subject to underwriting. The issued policy controls.
Your next step
Request a quote, and a licensed agent will compare options available to us for your situation.
