The Agent Who Puts You in Advantage Earns $694 the First Year and $347 Every Year You Stay. He Earns $0 the Year You Leave

Medicare open enrollment opens tomorrow, so an agent may be on the other end of your next phone call. Here is what that call is worth to him. If he signs you up for a private Medicare replacement, he earns $694 the first year and $347 for every year you stay. If he moves you to Original Medicare, he earns $0. A member who stays five years pays that agent $2,082.

None of this makes agents villains. Most do careful work, and a good one can save you hours of plan comparison. This fall the pay structure matters more than usual. The New York Times reported this month that millions are losing private Medicare plans and facing rising costs. You may soon need an agent’s advice. If your plan is leaving your county or you turn 65 soon and expect to lean on an agent, that advice will come from someone whose income depends on which answer you pick.

How Medicare Agent Pay Actually Works

You never pay the commission directly. The insurance company pays it, and CMS publishes the amounts plans pay independent agents and brokers for enrollments. Your premium stays the same whether you use an agent or enroll yourself.

The split between first-year and renewal pay influences behavior. The larger first-year payment rewards new enrollments. The renewal payment rewards keeping you put. Over a career, renewals build a book of recurring income, and every client who leaves Advantage for Original Medicare takes a payment from it.

Original Medicare is a government program with no carrier behind it, so it pays nothing. A Medigap supplement can pay the agent. But insurance company set that pay under separate state-regulated arrangements, and many agents who sell Advantage plans do not sell Medigap at all.

What This Pay Structure Does to Your Advice

Which plans you see first. The $0-premium Advantage plan with dental and gym extras leads most sales calls. It is easy to sell, and it pays. You still owe the 2026 Part B premium of $202.90 a month either way.

Which questions nobody asks. Are your specialists in network? Do you spend winters in another state? What will your drugs cost? An Advantage plan’s in-network out-of-pocket maximum excludes Part D drug spending and any care outside the plan’s network, so your worst year can cost more than the advertised cap. In a sick year, prior authorization and narrow networks hurt more than the premium does. These are the kind of surcharges and coverage gaps we cataloged in a free Medicare guide here, since the listed premium is rarely the number that ends up mattering.

Why Original Medicare plus Medigap rarely comes up. Moving into Advantage is easy. Moving back usually means applying for Medigap with medical underwriting once your one-time six-month guaranteed-issue window has closed. In most states, an insurance company can then deny you or charge you more. Some states, including New York and Connecticut, offer broader guaranteed-issue rights, so check yours. Under Original Medicare with Plan G, you pay the 2026 Part B deductible of $283 and then little or nothing for most covered services. A salesperson paid on retention has no reason to mention that the Advantage decision is close to irreversible.

How to Use an Agent Well Anyway

Learn what kind of agent you have. A captive agent represents one insurance company and can show only that company’s plans, while an independent broker can show plans from several carriers, but only the ones he holds contracts with. Neither can show you what he does not sell.

Ask these before you discuss any specific plan:

• “How many carriers do you represent in my county, and which ones can you not sell?”
• “Do you sell Medigap Plans G and N? If I chose one, what would you earn?”
• “If I want to switch back to traditional Medicare in three years, could I get a Medigap policy in my state without health questions?”
• “Are my doctors and my hospital in this plan’s network for next year?”

If an agent dodges the Medigap question, assume you have heard half the options.

For a second opinion that carries no commission, call your State Health Insurance Assistance Program. SHIP counselors provide one-on-one assistance, counseling, and education to beneficiaries and their families. State programs describe the service as free, unbiased, and confidential. Counselors earn nothing from the plan you choose. They will lay out Original Medicare plus Medigap next to Advantage without a interest in either.

One Question Worth Asking Before You Sign Anything

Before you accept any enrollment recommendation, ask the agent: “What would you recommend if you earned the same amount no matter what I chose?”

A good agent will answer it directly. He might still say Advantage, and for a healthy 66-year-old whose doctors are all in network, that may be the right call. But the answer should name your doctors, your prescriptions and your state’s Medigap rules. If he cannot give that answer, book a SHIP appointment before the enrollment window closes and compare the two recommendations side by side.

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