Medicare’s best-kept secret: The licensed agent

We’ve all heard of Peak 65 — more than 11,000 Americans will celebrate their 65th birthday each day this year. That reality isn’t only a demographic headline; it’s transforming the client base. As clients a ge, Medicare becomes a key factor in their pre- and post-retirement financial security picture. And here’s the truth: Sound financial planning is incomplete without integrating health care.

The catch? The Affordable Care Act and Medicare are complex, fast-changing and highly regulated. Financial professionals can’t (and shouldn’t) go it alone. That’s why partnering with or encouraging your clients to engage with a trained, licensed Medicare agent is so powerful. These agents bring specialized knowledge and compliance expertise, ensuring clients make informed choices.

Open enrollment = a planning checkpoint

Every fall, Medicare’s Annual Enrollment Period — Oct. 15 through Dec. 7 — opens a window for retirees to elect, review, adjust or switch their coverage. For clients, it’s a decision-making crossroads. For industry and financial professionals, it’s a chance to reinforce the value of holistic planning — but only if health care, lifestyle and retirement strategies are aligned.

One challenge is that many retirees assume Medicare is “set it and forget it.” In reality, plan benefits, premiums, formularies, provider networks and even rules from the Centers for Medicare & Medicaid Services change every year. Without guidance, clients risk higher costs, surprise gaps and plans that don’t match their health or financial needs.

“There are two crucial aspects to keep in mind for the 2026 Medicare Annual Enrollment Period,” said Bryan Keeven, president, wholesale health affiliate partners at Amerilife. “The first is the ongoing evolution of Medicare Advantage, Prescription Drug Plans and Medigap plans. You should anticipate changes in plan availability, premiums, value-added benefits and copays or coinsurance. 

The second is to remember that the role and the services agents provide are more valuable than ever. The Medicare system is complex, and many consumers rely on an agent’s expertise to navigate it in their best interest. An agent’s integrity and dedication are invaluable, and your clients count on them to help them make informed decisions.”

Why advisors and consumers need agents

Here’s where licensed Medicare agents make a difference:

» Spotting changes in costs: Agents know that premiums, deductibles and provider networks reset annually, and they can flag when last year’s “best fit” becomes this year’s budget-buster.

» Navigating drug formularies:  “Part D prescription coverage is the glue that holds Medicare coverage together because it protects consumers from the high and often unpredictable cost of medications,” said Dwane McFerrin, senior vice president, Medicare solutions at Senior Market Sales. “With Original Medicare and a Medigap plan, you need a separate Part D plan to cover prescriptions, while Medicare Advantage Prescription Drug plans bundle medical and drug benefits into one. In either case, having the right Part D coverage ensures access to necessary medications without facing overwhelming out-of-pocket expenses.”

Part D is an essential part of Medicare coverage, yet agents are no longer compensated for guiding clients through these choices. This creates a real dilemma, because consumers still need expert help to compare formularies, premiums and coverage rules that change every year. Without a licensed agent advisor’s guidance, consumers risk higher drug costs or gaps in coverage.

» Managing tax interactions (IRMAA): Agents can work together with financial planners, ensuring tax decisions (like Roth conversions) don’t unintentionally push clients into higher premium brackets.

Preparing for 2026

Craig Ritter, CEO of Ritter Insurance Marketing and managing partner at Integrity, warned of rough waters ahead. “Due to inadequate funding in 2024 and 2025 and higher-than-expected claims intensity, the upcoming Medicare annual enrollment period will be challenging for both Medicare beneficiaries and the insurance professionals who serve them,” he said. 

“Agents will need to educate their clients on the reasons for the changes in their plans and benefits coming in 2026 as well as employ the most cutting-edge technology to assist them in finding the right plan for their clients and to enroll them efficiently. The need for well-trained and technically equipped insurance professionals has never been greater than now.” 

Medicare open enrollment is not only about health coverage — it’s also a financial planning checkpoint. Licensed agents and financial professionals serve clients best when they collaborate, because health care and financial security are inseparable.

For financial professionals, the question isn’t whether Medicare belongs in your practice, it’s how you’ll incorporate it. Partnering with a licensed agent allows you to deliver holistic, compliant and client-centered strategies. For your clients, that partnership means confidence. For you, it means stronger relationships and a more resilient practice.

Carroll Golden, CLU, ChFC, LTCP, CASL, FLMI, CLTC, LACP, is executive director of NAIFA’s Limited and Extended Care Planning Center. She is the author of How Not to Tear Your Family Apart: A Practical Guide to Caregiving and Financial Stability. She may be contacted at [email protected].