10 Things to Know Before Becoming a Medicare Agent

Written by Matthew King, time it takes to read this article is  minute(s).

With roughly 15% of Americans enrolled in the Medicare program, there’s plenty of opportunity for becoming a successful Medicare agent.

Are you a people person? Do you enjoy helping others secure their financial future?

These characteristics, along with a few others, will make you an excellent candidate for Medicare training.

But before you sign up for a training program, you need to keep reading for our Medicare training 101 crash course.

Here we’ll cover 10 things every aspiring Medicare agent should know before diving into the profession.

What Does a Medicare Agent Do?

Here’s the first question you need to ask yourself before signing up for Medicare agent training online: What exactly does a Medicare agent do?

As a Medicare agent (as an independent insurance agent), you’ll represent several insurance carriers to help clients choose the best Medicare plan option. You’re tasked with offering an unbiased, honest opinion.

You’re not trying to upsell any specific plan but instead offer information and pricing based on the client’s specific needs and budget.

The ability to help people find affordable healthcare is one reason becoming a Medicare agent is so rewarding.

Medicare Training 101

Becoming an Independent Medicare agent is different than other insurance agents since you’re not representing a specific carrier. Your job description, training, and best practices are unique to the Medicare program.

Here are a few things to consider before signing up for Medicare training.

1. Know Your Audience

Not everyone is eligible for Medicare. Your target customer base will consist of three groups:

  • Individuals who are above the age of 67+, and could save money by looking at newer plans.
  • Individuals who recently turned (or are turning) 65 and are now eligible for Medicare benefits
  • Individuals under the age of 65 who are disabled and eligible for Medicare benefits

Many Medicare agents report building lasting, meaningful relationships with their clients.

Getting to know your clients on a personal level gives you a better handle on their individual needs. Now, you can recommend the best, most affordable Medicare plan in good faith.

2. Get the Proper License

Before you can become a Medicare agent, you need to obtain a health insurance license in the state where you currently live. Each state’s laws and requirements differ, so be sure to check with yours before moving forward.

You’ll receive your resident state health insurance producer license after passing the required exam. Once you have your license, you can legally apply to represent insurance companies within your state.

Keep in mind that this licensing exam is separate from the Medicare online certification training you’ll need to represent Medicare Advantage and PDP insurance companies. The good news is, this exam will lay the groundwork for what’s to come.

You’ll undergo fundamental training that teaches you the basics of health insurance plans and how they work. Some of the most important topics covered include:

  • Deductibles
  • Claims
  • Networks (HMO, PPO, etc.)
  • Co-insurance
  • Compliance and ethics
  • Healthcare laws

This information will serve you well as you continue your Medicare agent training online.

3. Choose Between In-Person and Online Training

Depending on your state, you’ll need to attend classroom training to obtain your health insurance license or study independently.

Many aspiring agents choose to study online or using textbooks since it’s more flexible and allows you to work at your own pace. Check your state’s laws since some require classroom training with a seasoned professional.

This is a beneficial option since it gives you access to a knowledgeable broker who can answer your questions quickly.

Both options require an exam to obtain your license. Many programs offer you the opportunity to get your life insurance license at the same time.

While you don’t need a life license to sell Medicare, it’s advantageous to offer life insurance advice to clients in the future.

4. Pass the AHIP Medicare Training

Getting your health insurance license is step one in the process of becoming a Medicare agent.

Next, you’ll need to take the Medicare training and certification offered by America’s Health Insurance Plans (AHIP). Not only do you need to undergo training and take the exam, but you need to pass with a 90% or better. This test will allow you to sell Medicare Advantage and Prescription Drug Programs. It is not needed to sell Medicare Supplements alone. 

Not just anyone can sell Medicare-related products. The Center for Medicare and Medicare Services (CMS) requires agents to obtain special certifications.

CMS oversees all insurance companies, agents, and agencies that sell their products. It’s important to note that AHIP training is offered annually (usually in June or July) for the following Medicare plan year, so be sure to plan ahead.

5. Medicare Agent Training Isn’t Mandatory but Strongly Encouraged

Chances are, you want to be the best Medicare agent possible. Not only for yourself but for your clients.

To do so, it’s strongly recommended that you complete Medicare Agent training. One of the main reasons is that these training programs don’t just teach you the ins and outs of the Medicare program.

You’ll also gain valuable information and training on how to talk to and approach clients.

Getting your health insurance license doesn’t automatically make you a good sales representative.

You need to reach people on a personal level and express genuine concern for their future and well-being.

6. You Need to Choose a Field Marketing Organization

A Field Marketing Organization (FMO) is an approved company that distributes health insurance plans on behalf of other insurance companies so insurance agents like you can sell them.

You need to enroll with an FMO to sell Medicare Advantage, prescription drug plans, and Medicare supplements with multiple insurance companies. You need to be officially appointed with different insurance carriers to sell and market their products and receive a commission legally.

When considering an FMO, find out what carriers they’re associated with, how you’ll receive your commissions, and how involved they are in the marketing process. As a Medicare agent just starting, you may need help generating leads and marketing to prospects.

7. Protect Yourself

Not every client you encounter will turn into a lifelong friend. Some clients might provide false information, putting you at risk of a fraudulent lawsuit.

To protect yourself (and your license), you need your own insurance. Errors & Omissions Insurance (E&O) is designed to do exactly that.

You’ll need to obtain some form of protection since most insurance agencies require it. Calculate this expense, which costs between $300 and $500 per year, into your budget and income projection. 

8. Set Realistic Sales Goals

Speaking of budgeting and income, before you become a Medicare agent, it’s important to calculate your income and expenses.

There are no guarantees with commission jobs — insurance agent included. You’ll need a flexible budget with room for dips in your income.

But that doesn’t mean you can’t estimate your income and expenses to set reasonable sales goals and objectives.

As of this writing, Medicare agents receive an average of $250 renewal fee per member per year. In addition, you receive anywhere from $300 – $500 for signing up a new client, depending on the state you live in.

It’s also important to note that commissions vary based on the products and plans you sell and the carrier. Working with multiple carriers means more opportunities and access to potential clients.

It’s best to have a financial nest egg to fall back on when first starting out.

9. Complete Contracts and Start Selling Medicare

You’re almost at the finish line!

Now that you know what certifications and protections you need to become a successful Medicare agent, you need to get contracted and start making sales.

You must complete and sign a contract with each individual insurance company to be appointed to sell. Your upline can help with this.

As you approach and contract with multiple agencies, you’ll need a few things, including:

  • A copy of your current health insurance license
  • A copy of your E&O coverage
  • Approved background check
  • A completed legal questionnaire (provided by your upline)

You’ll also need to pass the carrier’s annual certification exam. (If applicable) 

It takes time and patience to get approved to sell Medicare through multiple agencies. Medicare, specifically, regulates this process closely.

Each carrier will require agents to go through different processes before approving them to sell Medicare. 

10. Never Stop Learning

Even after you complete the initial Medicare agent training and certification exams, you’ll need to stay on top of policy changes, regulations, and laws.

Continued education is an important part of becoming a Medicare agent and one that many agents often overlook. 

These requirements vary from state to state, so be sure to check with your resident state to ensure your license stays active. Without a legitimate license, you can’t continue to sell Medicare or receive commissions.

The minimum requirements for continued education include dedicated hours in your area of concentration and ethics and anti-money laundering.

Start Your Journey as a Medicare Agent Today

Becoming a Medicare agent is a lucrative and rewarding experience. You’re not just providing people with medical insurance and peace of mind but also trusted advice and guidance.

Your prospects rely on you to give them detailed information and your professional opinion. As you become more invested in their future and well-being, you may even form lasting relationships.

Are you ready to take the first step toward becoming a Medicare agent? We’re here to help!

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