Every insurance agency has a shelf, and every shelf has edges. Most agencies do not talk about theirs. This page is ours.
What we can see
The plans offered by the carriers we are appointed with. An appointment is a contract between an agency and an insurer that permits us to sell and service their products. We hold appointments with a number of carriers across Medicare, Marketplace and ancillary lines.
For those plans we can quote accurately, compare side by side, check networks and formularies against your specific doctors and prescriptions, submit an enrollment, and stay with the case afterwards when something goes wrong.
What we cannot see
Plans from carriers we are not appointed with. They do not appear in our quoting tools at all. We are not withholding them; we genuinely cannot see them.
This is true of every agent and every agency. Anyone who tells you they show “every plan available” is either using the phrase loosely or is not being straight with you.
Whether a plan will suit you clinically. We can tell you what a plan covers. We cannot tell you what care you will need. That is a conversation with your doctor, not with us.
Anything about your medical history you have not told us. We do not have access to your records and do not want them. What you tell us is what we work from, which is why an inaccurate answer produces an inaccurate recommendation.
What we are paid, and by whom
The carrier pays us a commission when you enroll. You pay us nothing, and your premium is identical whether you come through us, through another agent, or directly from the carrier. Premiums are filed with regulators; there is no agent mark-up and nothing to negotiate.
The honest implication: an incentive exists. We would rather you knew that than guessed at it. It is why the section above about the edges of our shelf is on the site at all, and why the free alternatives are named on seven pages rather than buried in a footer.
Where to look for what we cannot show you
- Medicare Plan Finder — every Medicare Advantage and Part D plan available where you live. Free.
- 1-800-MEDICARE — 24 hours a day, TTY 1-877-486-2048.
- Your SHIP counselor — free one-to-one Medicare counselling from people who sell nothing at all.
- HealthCare.gov — every Marketplace plan and the subsidy calculation, plus free local Navigators.
If your situation is straightforward, those may be all you need, and we will say so on the call rather than after it.
What you are entitled to ask us
- The name and license number of the agent handling your case.
- Which carriers we are appointed with, and therefore which we cannot quote.
- Whether a plan we are recommending pays us more than an alternative we are also showing you.
- What we did not show you, and why.
Those are all fair questions. An agent who is uncomfortable with any of them is telling you something useful.
The test we try to hold ourselves to
If the best answer for you is a plan we cannot sell, or no plan at all, we should say so on the first call — before we have invested time in you and while it is still easy to walk away.
What we can see
Being specific about this is more useful than reassurance.
We can see the plans offered by carriers we hold appointments with, in the counties where we are licensed. We can see published benefit summaries, formularies and provider directories — the same documents available to you, though we spend more time in them. We can run a comparison using the prescriptions and doctors you give us. And we can see the status of an application we submitted for you.
That is close to the whole list, and it is smaller than most people imagine.
What we cannot see
We cannot see your medical records. We have no access to your chart, your diagnoses, or your history, and nothing about being a licensed agent grants any.
We cannot see your prescriptions unless you tell us. There is no lookup. If you leave a drug off the list, it is simply absent from the comparison — which is the single most common reason a plan chosen with an agent turns out to fit badly.
We cannot see your claims history, your credit, or your tax return. We cannot see plans from carriers we are not appointed with, which is the honest limit on any agent’s advice. We cannot see whether a provider directory is accurate; we are reading the same list you are, and those lists are frequently wrong.
And we cannot see the future — which sounds glib, but matters. Formularies and networks are refiled annually, and a plan that suits you in January can change the following January.
Why this makes your list the whole job
Because the information asymmetry runs the other way from what people expect. You hold the facts that decide the outcome; we hold the catalog.
That is why a first call is mostly questions, and why the answers need to be complete rather than tidy. The drug you take occasionally still counts. The specialist you see once a year still counts. The plan to spend three months in another state absolutely counts.
Bring the actual bottles or the pharmacy printout rather than working from memory, with doses. A dose changes which tier a drug sits on, and tier changes cost.
What we are paid, and what that does to the advice
We are paid a commission by the carrier when you enroll, out of the carrier’s budget rather than added to your premium. Your price is identical through us, through another agent, or direct.
Two honest consequences follow. We are paid nothing if you enroll directly, or through a free counselor, or if the best answer for you is Medicaid — and we will still tell you when one of those is the better route, because the alternative is worth less than our reputation. And commission amounts are not identical across every product, which is exactly why you should feel free to ask why a particular plan is being recommended, and expect an answer about your doctors and your drugs rather than about the plan.
Questions you are entitled to ask any agent
- Which carriers are you appointed with in my county, and which are you not?
- Is my exact prescription list on this plan’s formulary, at what tier, and with what restrictions?
- What is your license number, and in which states do you hold one?
- Have you completed this plan year’s certification?
- Why this plan rather than the next one down — in terms of my doctors and my drugs?
- Will you be the person answering if I telephone in March with a denied claim?
The last one is not a technical question and it is the most predictive. Anyone can sell you a policy in October. The value is in who picks up in March.
That is the whole argument for using an agent rather than a comparison screen: someone who has to put their name and license number on the advice, and who will still be there in March when a claim is denied.
Where to check this independently
Nothing on this page is advice about your situation, and none of it replaces the free sources. The Medicare Plan Finder, 1-800-MEDICARE, your SHIP counselor and HealthCare.gov are free, independent, and show plans we cannot sell.
Healthbase is a licensed insurance agency, not a government agency and not connected with Medicare or any federal or state program.
