How to Get Started as a Medicare Agent
As a new health insurance agent, developing a strong understanding of Medicare can accelerate your growth and help you serve clients with confidence. Medicare is a continually expanding market, and many people rely on knowledgeable guidance to make informed decisions. This is where agents play a pivotal role. With more than 10,000 people turning 65 every day, the need for Medicare agents and plan guidance continues to rise. Many individuals approaching Medicare feel uncertain about their options, which creates a meaningful opportunity for you to serve as a knowledgeable and dependable resource.
In this blog, you’ll learn what Medicare is, how to get started selling Medicare, the tools you need to succeed, and how to confidently support clients throughout their coverage decisions.
What is Medicare?
Medicare is a federal health insurance program for people age 65 or older. It also serves certain younger individuals who qualify through a disability. Original Medicare forms the core of this coverage — it includes Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).
Original Medicare also covers:
- Inpatient hospital care
- Nursing facility care
- Doctor visits
- Outpatient services
- Preventive care
- Some home health services.
Coverage decisions are guided by federal and state laws, national Medicare policies, and local rules set by Medicare Administrative Contractors.
Original Medicare does not cover every cost or service. Beneficiaries will still have to pay:
- Deductibles, copayments, and coinsurance
- Most outpatient prescription drug costs
- Routine dental, vision, and hearing care
- Long-term custodial care
Because of these gaps, many beneficiaries turn to private Medicare options. These plans can help manage out-of-pocket expenses and offer benefits that Original Medicare does not provide.
As an agent working in the senior insurance market, your role is to help your clients:
- Understand the differences between Medicare plan types (Original Medicare, Medicare Advantage, Part D, Medigap)
- Compare coverage options based on their unique healthcare needs and budget
- Help clients choose the right coverage plan for their current and upcoming needs
When you simplify the process and provide clear guidance, clients can make confident, informed decisions about their health care needs. This support builds trust with your clients and reinforces your role as a knowledgeable, dependable resource.
Another key part is to understand the value of Medicare coverage. Medicare plays an important role in protecting clients’ health and financial well-being as they age. It offers access to critical medical services, helps manage out-of-pocket costs, and provides coverage options individuals can tailor to their needs. Your expertise gives clients the clarity and support they rely on throughout the decision-making process.
Understanding the Types of Medicare Plans
Medicare can feel overwhelming for many people, especially when they’re trying to understand unfamiliar terms and coverage options. As an advisor, knowing how Medicare works helps you confidently point your clients in the right direction. Use the table below for a breakdown of the different parts of Medicare.
| Medicare Part |
What It Covers |
| Medicare Part A |
Medicare Part A covers inpatient hospital care and skilled nursing facility care after a qualifying hospital stay. Part A includes hospice care and some home health services. It helps pay for room, meals, nursing care, and other hospital-related services. |
| Medicare Part B |
Medicare Part B covers outpatient medical care. It pays for doctor visits, preventive services, lab work, and diagnostic tests. Part B also covers outpatient procedures, mental health care, durable medical equipment, and some home health services. |
| Medicare Part C (Medicare Advantage) |
Medicare Part C, often called Medicare Advantage, is an alternative to Original Medicare offered by Medicare-approved private insurance companies. It replaces and combines Part A (hospital) and Part B (medical) coverage into one plan. Most Medicare Advantage plans also include prescription drug coverage (Part D) and may offer extra benefits such as dental, vision, hearing, and wellness services, but these extras vary by plan. |
| Medicare Part D |
Medicare Part D helps pay for prescription drugs to help protect against high medication expenses. It covers many common medications, including brand name and generic drugs. Coverage, drug lists, and costs vary by plan. |
| Medicare Supplements (Medicare Supplement Insurance) |
Medicare Supplements, also called Medigap, help pay costs that Original Medicare does not cover. These costs can include deductibles, coinsurance, and copayments. They are offered by private insurance companies and only work with Medicare Parts A and B. |
Looking for more definitions? Check out our Medicare Terminology 101 blog.
Who is Eligible for Medicare?
Most people qualify for Medicare when they turn 65, but several groups may be eligible earlier. Here’s a simple breakdown you can share with your clients:
- Age 65+: Must be a U.S. citizen or a lawful permanent resident who has lived in the U.S. for at least 5 years.
- Under 65 with a disability: Eligible after receiving Social Security Disability Insurance (SSDI) for 24 months. Note: People with ALS qualify immediately.
- End-Stage Renal Disease (ESRD): Eligible at any age if they need dialysis or a kidney transplant and meet specific work-related requirements.
- Eligible through a spouse: May qualify for premium-free Part A through a spouse’s, ex-spouse’s, or deceased spouse’s work record.
Understanding who qualifies for Medicare is the first step in helping clients feel confident about their decision. When you provide straightforward guidance, you lay the foundation for a smoother, more informed enrollment experience.
7 Steps to Start Selling Medicare Insurance Plans
Before jumping into the tactical steps, it’s important to know what your first few years as a Medicare insurance agent might look like.
Building a Medicare book of business is a gradual process. Your early years are often focused on learning the industry, establishing your reputation, and growing your book of business.
Success in this industry requires patience and consistency. Whether you’re just starting out or looking to add another line of coverage, offering Medicare is a strategic way to grow your agency and support clients as their needs change. Below are the core steps to help you get started with selling Medicare.
1. Get Licensed to Sell Medicare Plans
Before you can sell Medicare products, you must:
- Complete your pre-licensing education: Many states require you to finish an approved pre-licensing course before you are allowed to schedule or take the licensing exam.
- Pass your state exam: Once you complete your pre-licensing education (if required), you then must pass your state’s insurance exam in order to get a license.
- Complete required Medicare Advantage/Part D training and testing: Consider taking the AHIP (America's Health Insurance Plans) certification or carrier-specific equivalent.
- Obtain E&O coverage: E&O, or Errors & Omissions, insurance protects businesses and professionals from financial loss due to client claims.
- Complete continuing education (CE): In most states, your license is good for two years. In order to keep it active, you will need to complete continuing education. There are many ways to get CE credits, like attending trade shows, association classes, and AEP kickoffs with different IMO/FMOs
- Comply with CMS’s marketing and sales regulations: Stay aligned with critical regulations, such as the Medicare Communications and Marketing Guidelines (MCMG).
Following these steps ensures you are fully authorized and compliant to help clients choose Medicare plans.
2. Get Appointed & Contracted with Your Medicare Carriers
Once you have the proper licensing in place, your next step is to get appointed and contracted with the Medicare carriers you plan to represent.
Some carriers only contract through an upline wholesale organization. If you encounter this, partnering with an experienced upline can simplify onboarding and set you up for early success.
How to Choose the Right Upline (IMO, FMO, or GA)
Medicare can be complex, especially when you’re just getting started. A strong upline helps you navigate that complexity by giving you access to carriers, tools, and ongoing support. Ensure the upline you choose offers the tools, resources, and training you need to find success with Medicare.
Typically, there are three different acronyms you will see for uplines:
Each will offer different packages and commission opportunities, so be sure to interview the ones in your area and ask other agencies which upline they’d recommend and why.
Some things to consider looking for in an upline:
- Access to Medicare quoting and enrollment tools
- Online contracting tools
- Lead program options
- Commission payout options
- Ongoing agent training (both in-person and remote) — great opportunity for CEs!
- Access to an independent insurance CRM, such as AgencyBloc, to manage your business
3. Understanding Your Commission Structure
As you build your client base, renewal commissions begin to stack up. By year three or four, many agents see their income grow significantly as those renewals compound. Commission structures vary, but you can generally expect to earn between 10% and 25% of a policy's annual premium. Your exact rate depends on factors like:
- Your production history
- Carrier agreements
- Years in the business
- Your upline partnership
- The product you’re selling
4. Build Your Medicare Knowledge & Training
Medicare rules and carrier plan offerings change every year, making ongoing education essential. Level up your knowledge by focusing on:
The more confident you are in your Medicare expertise, the better you can support your clients.
5. Understand Plan Options & Carrier Differences
Each carrier offers its own Medicare Advantage, Part D, and Medigap plans. To find the right option for your beneficiary, review:
- Coverage differences
- Provider networks
- Formularies — a list of covered prescription drugs (Each Medicare Advantage or Part D plan has its own list. Drugs are grouped into tiers that affect the cost. Formularies can change each year, so reviewing them annually is important.)
- Premiums and out-of-pocket costs
- Extra benefits and add-ons
Reviewing this information helps you provide accurate, unbiased comparisons that guide clients toward the right fit.
6. Support Clients Through the Entire Medicare Process
Regular communication helps clients feel supported beyond AEP. Here are ways your agency can stay connected with clients throughout the year:
- Send welcome and onboarding emails after enrollment to help clients understand what to expect from their plan.
- Check in on prescription needs a few months into the year to identify medication changes that may affect future coverage decisions.
- Share educational reminders about key Medicare dates, important documents, and common topics, such as Explanation of Benefits (EOBs), provider networks, and cost changes.
- Send ANOC reminders in early fall so clients know what changes to watch for in their current plan.
- Communicate proactively during AEP with a series of emails and text messages that include appointment links, coverage review prompts, and enrollment deadlines.
Consistent communication throughout the year builds trust, increases retention, and helps clients make informed decisions with confidence.
7. Cross-Selling Opportunities With Medicare Clients
Once clients trust you, they often turn to you for help filling other gaps in their coverage. Cross-selling becomes a natural part of the conversation and gives clients added protection where they need it most. Here are a few common cross-selling options you can offer:
- Final expense life insurance: Helps cover end-of-life costs and provides peace of mind for families.
- Dental and vision plans: Popular add-ons since Original Medicare does not include routine dental or vision care.
- Hospital indemnity coverage: Provides cash benefits to help manage costs associated with hospital stays.
- Cancer and critical illness plans: Help offset expenses not fully covered by Medicare or other insurance.
- Long-term care plans: Support clients who want protection from the high costs of extended care needs.
- Life insurance: Provides essential coverage that helps families manage expenses, replace lost income, and maintain financial stability after the death of a loved one.
Offering these additional plans gives your clients a stronger, more comprehensive coverage strategy that supports their long-term needs. Remember: you must be properly licensed and contracted to sell different types of plans. Connect with your upline to ensure you’re set up properly before you start the conversation.
The Best Tools for Medicare Agents
Often, Medicare agents ask “what is the best insurance CRM for my agency?” Having the right tools in place from day one helps your agency stay organized, remain compliant, and deliver a better client experience. These tools also reduce administrative tasks so you can focus on conversations that matter.
Medicare Quoting & Comparison Tools
You will need a fast, accurate way to compare Medicare Advantage, Part D, and Medicare Supplement plans against Original Medicare. The best quoting tools will allow your agency to:
- Compare multiple carriers side-by-side
- View premiums, drug costs, out-of-pocket maximums, and provider networks
- Generate client-friendly proposal PDFs
- Track plan changes year over year
An Industry-Focused Agency Management System (AMS)
Managing multiple clients, communications, carriers, compliance documents, call recordings, and enrollment windows requires organization. It’s crucial to use a tool that is built for your industry so you can get up and running faster, without spending all of your time building, customizing, and preparing.
An insurance platform like AgencyBloc gives you a single place to:
- Organize clients, policies, and all interaction history
- Track renewals, follow-ups, and coverage changes
- Automate reminders for AEP, birthday rules, or policy anniversaries
- Maintain compliance with built-in Scope of Appointment (SOA) documents, automatic call recording, and audit-ready activity logs
- Streamline data collection with the industry-leading Medicare intake tool, Rx Collect, which helps you efficiently gather prescriptions, providers, pharmacies, and more, so you only have to make annual updates
- Connect the dots with your quoting and enrollment tools with pre-built integrations that reduce manual work and help you work more efficiently during AEP
- Stay connected with digital marketing tools, like social media posting, email marketing, and texting
- Commissions processing tools that help you process your commissions efficiently and uncover any inaccuracies (because carriers do make mistakes and you shouldn’t pay that price!)