Help Selecting a Medicare Plan: Your Guide to Getting Expert Guidance

With over 60 Medicare Advantage plans and dozens of Medigap options in most areas, trying to select a Medicare plan on your own can feel impossible. You're not imagining the complexity. Medicare has more moving parts than almost any other insurance decision you'll ever make.

The good news? You don't have to figure it out alone. Multiple types of help exist, from completely free government programs to paid professional advisors. The challenge is knowing which type of help is right for your situation and how to evaluate the advice you receive.

This guide covers every option available for getting help selecting a Medicare plan, what each type of helper can and can't do for you, and how to make sure the guidance you receive is truly in your best interest.

Why Getting Help With Medicare Selection Matters

Before diving into where to find help, let's acknowledge why Medicare plan selection is so overwhelming and why professional guidance can be valuable.

The Complexity Problem

Selecting a Medicare plan involves understanding:

• Multiple coverage types: Original Medicare, Medicare Advantage, Medigap, Part D, and how they interact
• Dozens of plan options: The average county has 40+ Medicare Advantage plans and 10+ Medigap carriers
• Variable costs: Premiums, deductibles, copays, coinsurance, and out-of-pocket maximums
• Network restrictions: Which doctors, hospitals, and pharmacies each plan covers
• Drug formularies: Whether your medications are covered and at what tier
• Enrollment timing: Missing deadlines can result in permanent penalties

One wrong choice can cost you thousands of dollars or leave you without coverage when you need it most. That's why getting help selecting a Medicare plan isn't a sign of weakness. It's smart planning.

Free Medicare Help Resources

Several free resources exist to help you select a Medicare plan. Each has strengths and limitations.

SHIP (State Health Insurance Assistance Program)

SHIP is a federally funded program that provides free, unbiased Medicare counseling in every state. SHIP counselors are trained volunteers who don't sell insurance and have no financial stake in which plan you choose.

What SHIP counselors can do:

• Explain Medicare Parts A, B, C, and D
• Help you understand your coverage options
• Review your current coverage for problems
• Assist with enrollment paperwork
• Help with Medicare appeals and billing issues
• Explain Medicare Savings Programs and Extra Help

Limitations:

• Availability varies by location (some areas have long wait times)
• Counselor experience levels vary
• May not provide specific plan recommendations
• Limited appointment availability during busy enrollment periods

To find your local SHIP program, call 1-800-MEDICARE (1-800-633-4227) or visit shiphelp.org.

Medicare.gov and the Plan Finder Tool

The official Medicare website offers a Plan Finder tool that lets you compare Medicare Advantage and Part D plans based on your medications, doctors, and pharmacy preferences.

What Medicare.gov offers:

• Side-by-side plan comparisons
• Drug cost estimates based on your specific prescriptions
• Star ratings for plan quality
• Provider network lookup
• Online enrollment capability

Limitations:

• Requires computer literacy and patience
• Doesn't include Medigap plans in comparisons
• Can't account for nuances in your health situation
• Drug cost estimates may not reflect actual costs

1-800-MEDICARE

Medicare's toll-free hotline (1-800-633-4227) is staffed 24/7 and can answer questions about Medicare coverage, enrollment, and benefits.

Best for: Factual questions about Medicare rules, enrollment periods, and eligibility. Less helpful for personalized plan selection guidance.

Insurance Agents and Brokers

Most people who get help selecting a Medicare plan work with insurance agents or brokers. Understanding how they operate is essential to evaluating their advice.

How Agent Compensation Works

Insurance agents and brokers are typically paid by insurance companies, not by you. Here's how the compensation model works:

• Medicare Advantage: Agents earn $600-$700 for each new enrollment (2025 rates), with renewal commissions of $300-$350 per year
• Part D: Lower commissions, typically $80-$100 per enrollment
• Medigap: Commission rates vary by carrier but are often a percentage of the first-year premium

What Agents Can Do

• Explain plan options in your area
• Help you compare plans based on your needs
• Assist with enrollment paperwork
• Provide ongoing service after enrollment
• Answer questions year-round

What Agents Can't (or Won't) Do

• Recommend plans they don't sell: Captive agents work for one company; even independent agents may not represent all carriers
• Always recommend what's best for you: Some prioritize plans with higher commissions
• Help with Medicare billing issues: Their job ends after enrollment
• Provide objective analysis: They have a financial interest in your decision

Questions to Ask Any Insurance Agent

Before working with an agent, ask:

1. "How are you compensated for this advice?"
2. "Which insurance companies do you represent?"
3. "Why are you recommending this specific plan over others?"
4. "What are the downsides of this plan?"
5. "Did you consider Original Medicare + Medigap for my situation?"

For more on evaluating Medicare advisors, see our article on getting unbiased Medicare advice.

Fee-Only Medicare Advisors

Fee-only Medicare advisors represent a different model: you pay them directly for advice, and they don't sell insurance or earn commissions.

How Fee-Only Advice Works

Instead of being compensated by insurance companies, fee-only advisors charge you directly, usually:

• Flat fee: A set price for a comprehensive Medicare review ($400-$600 is typical)
• Hourly rate: Payment for time spent on your case ($150-$300/hour)
• No commissions: The advisor doesn't sell insurance or receive payments from insurance companies

What Fee-Only Advisors Provide

• Objective analysis of all options, including Original Medicare + Medigap vs. Medicare Advantage
• No financial incentive to recommend one plan over another
• Personalized recommendations based on your specific health situation
• Drug cost analysis using your actual prescriptions
• Provider network verification
• Documentation of reasoning behind recommendations

When Fee-Only Advice Is Worth It

Paying for Medicare advice makes sense if you:

• Have complex health conditions requiring expensive treatments
• Take multiple specialty medications
• Are uncertain whether Medicare Advantage or Medigap is better for you
• Want to switch from Medicare Advantage to Medigap and need help navigating underwriting
• Split time between states and need coverage that works everywhere
• Want confidence that advice is truly unbiased

Comparing Your Help Options

Here's how the different types of Medicare help compare:

Online Tools and Plan Finders

Beyond Medicare.gov, several online tools can help with Medicare plan selection:

Third-Party Plan Comparison Sites

Websites like eHealth, Medicare.com, and others offer plan comparison tools. Be aware:

• Most are lead generation sites that earn commissions on enrollments
• Results may be influenced by business relationships with insurers
• Useful for seeing what's available but not for unbiased recommendations

Insurance Company Websites

Individual insurance companies (UnitedHealthcare, Humana, Aetna, etc.) have tools to explore their own plans. These are helpful for understanding specific plan details but obviously don't compare competitors objectively.

Red Flags When Getting Medicare Help

Not all Medicare help is good help. Watch for these warning signs:

High-Pressure Sales Tactics

• "You need to decide today" (you almost never do)
• Refusing to explain other options
• Calling or visiting repeatedly after you've said no
• Using scare tactics about penalties or coverage loss

Limited Options

• Only presenting one plan or one company's plans
• Dismissing Medigap without explaining why
• Not asking about your doctors or medications
• Generic advice that doesn't account for your situation

Lack of Transparency

• Won't explain how they're compensated
• Can't explain why this plan is better than alternatives
• Won't put recommendations in writing
• Glosses over plan limitations or costs

Medicare Fraud Warning Signs

• Asking for your Medicare number without your consent
• Offering gifts or cash for enrolling
• Claiming to be from Medicare itself
• Showing up at your door uninvited

If something feels wrong, trust your instincts. Report suspected Medicare fraud to 1-800-MEDICARE.

Preparing for a Medicare Consultation

Whether you're meeting with a SHIP counselor, insurance agent, or fee-only advisor, preparation helps you get better guidance.

Documents to Gather

• Medicare card: Your Medicare number and Part A/B effective dates
• Current insurance cards: If you have existing coverage
• List of medications: Name, dosage, frequency, and pharmacy
• List of doctors: Names, specialties, and addresses
• Recent medical bills: To understand your current healthcare usage
• Annual Notice of Change: If you have an existing Medicare plan

Questions to Prepare

• What's most important to me: low premiums, low out-of-pocket costs, or specific doctor access?
• Do I travel frequently or live in multiple states?
• Am I comfortable with network restrictions?
• What's my budget for monthly premiums?
• Do I have any major health procedures planned?

Questions to Ask the Advisor

• "Why do you recommend this plan for my situation?"
• "What are the downsides of this plan?"
• "Are all my doctors in-network?"
• "What will my medications cost under this plan?"
• "What happens if I need expensive care?"
• "How does this compare to [alternative option]?"

Why Selecting a Plan Is Just Step One

Here's what many people miss: selecting a Medicare plan isn't a one-time decision. It's an annual responsibility.

Plans Change Every Year

Medicare Advantage and Part D plans can change significantly from year to year:

• Premiums can increase
• Drug formularies can drop or tier-up your medications
• Provider networks can shrink
• Benefits can be reduced
• Star ratings can decline

Your Needs Change Too

Even if your plan stays the same, your situation evolves:

• New diagnoses requiring new treatments
• Changes in medications
• Doctors retiring or leaving networks
• Moving to a new area
• Changes in your budget

Taking the Next Step

Getting help selecting a Medicare plan doesn't have to be complicated. Here's a simple path forward:

1. Start with free resources: Call your local SHIP or use Medicare.gov's Plan Finder to understand your options
2. Gather your information: Compile your medications, doctors, and current coverage details
3. Consider your complexity level: Simple situations may only need free help; complex cases benefit from professional guidance
4. Evaluate any advisor carefully: Ask how they're compensated and why they recommend specific plans
5. Don't rush: Take time to compare options and understand trade-offs
6. Plan for annual reviews: Mark your calendar to reassess coverage each fall