The Most Undervalued Person in Medicare: The Moral Agent

Guest post by Andrew Saul.

To every Medicare agent who has spent countless hours on the phone, fought for a beneficiary, explained a confusing rule they didn't create or spent hours helping someone without earning a dime, this one's for you.

You are more than a commission. More than a policy count. More than a line item on a carrier's financial statement. You are the human side of a trillion dollar healthcare system and it's time this industry recognized your worth.

The Value of a Moral Agent

Every year, billions of dollars move through the Medicare system. Congress writes legislation, CMS establishes regulations, insurance carriers design products, actuaries price risk and healthcare providers deliver medical services. But somewhere between Washington and the kitchen table of an American senior sits a professional whose contribution is rarely measured, frequently misunderstood and far too often underestimated.

The Medicare insurance agent.

Agents spend enormous amounts of time discussing the financial health of insurance companies, the solvency of Medicare, provider reimbursement, medical loss ratios, risk adjustment and federal expenditures. But how much time do we spend examining the economic and social value of the individual responsible for helping beneficiaries navigate all of it?

I would argue that the professional Medicare agent is one of the most underappreciated participants in the entire healthcare financing system, and their value extends far beyond the beneficiary sitting across from them.

1. To the Beneficiary: The Agent Translates Complexity Into Confidence.

Medicare is not a simple insurance program. It is a complex intersection of federal entitlements, private insurance contracts, eligibility requirements, enrollment periods, provider networks, prescription drug formularies, underwriting rules and financial exposure. This year on its own, KFF reports that the average Medicare beneficiary has access to 28 MAPDs (Medicare Advantage Prescription Drug Plans). Add PDPs (Prescription Drug Plans), Medigap options and the distinction between OM (Original Medicare) and MA (Medicare Advantage). Now imagine navigating those decisions at 65, potentially while retiring, losing employer coverage, managing chronic illnesses or living on a fixed income. The wrong decision can have consequences extending far beyond an insurance premium.

A beneficiary might inadvertently lose access to a physician. A medication might become significantly more expensive. An enrollment mistake could result in a penalty. A decision to leave Medigap could create future underwriting consequences that are not easily reversed. These are financial and healthcare decisions that can affect someone's quality of life for decades.

An experienced Medicare agent understands the human circumstances surrounding the decision. AI at its best can't comprehend this. Imagine the widow concerned about affordability, the cancer patient concerned about continuity of care, the retiree who wants to travel, the couple who cannot afford an unexpected medical bill, or the individual who wants to understand not only what their insurance covers today, but what their options might look like five or ten years from now.

A professional agent takes extraordinarily complicated information and translates it into something a beneficiary can understand and act upon. That professional relationship typically continues long after enrollment. When a hospital leaves a network, a prescription changes tiers or a policyholder receives a confusing notice, who often receives the telephone call?

The agent.

Not because the agent is legally responsible for every problem, but because a relationship of trust has been established. In an increasingly automated healthcare environment, that relationship is an incredibly valuable commodity.

2. To Insurance Carriers: Agents Are More Than a Distribution Expense.

Insurance companies understandably evaluate distribution through financial metrics. Customer acquisition costs, commission expenditures, persistency, retention, lifetime member value and administrative expenses all matter. But reducing an insurance agent's contribution to a commission expense misses a much larger economic picture.

An experienced agent is helping a carrier acquire a customer, understand the customer's expectations, communicate the product's limitations and maintain an ongoing relationship. These activities have potential implications for enrollment quality, consumer satisfaction and long term retention. Consider the economics of acquiring a policyholder.

A carrier incurs expenses before collecting sufficient revenue to recover its acquisition investment. Depending on the insurance product, profitability may depend on persistency, claims experience, administrative efficiency and the duration of the policy. A policyholder who misunderstands coverage, experiences unexpected provider restrictions or discovers that a product does not meet their needs may be more likely to become dissatisfied or seek another option. A knowledgeable agent who accurately explains those limitations before enrollment can help reduce the mismatch between expectations and reality. That has economic value, even if every dollar of that value is difficult to isolate on a financial statement.

Agents also provide something that actuarial models and corporate dashboards may struggle to capture in real time.

Local market intelligence.

They hear which hospitals are refusing contracts, which medical groups are expressing dissatisfaction, which benefits beneficiaries actually value and which products are creating confusion. They can recognize emerging market changes before those changes fully appear in enrollment reports or financial results. A carrier's actuarial department can explain why a product is profitable. An experienced local agent may be able to explain why that product is not selling. Both of these perspectives matter, and as insurance companies increasingly examine their distribution expenditures, they should distinguish between the cost of acquiring a customer and the value of acquiring the right customer for the right product. Those are not necessarily the same thing.

3. To Congress and Policymakers: Agents Represent the Human Reality Behind the Numbers.

Congressional offices, federal agencies and healthcare policymakers have access to extensive research, budget projections, actuarial analyses and industry testimony. These resources are essential to understanding Medicare, but they don't always reveal how a policy works in someone's living room. That is where the Medicare agent provides a different kind of insight.

A federal policy can appear straightforward in legislation and become extraordinarily complicated during implementation. A change to an enrollment period might seem administratively minor until a beneficiary misunderstands the deadline. A change in plan availability might appear as a line on a county level spreadsheet until hundreds of seniors are forced to reconsider their coverage. An adjustment to provider networks might improve a carrier's financial position while fundamentally changing how an individual accesses medical care. The agent encounters these consequences firsthand.

Medicare agents are uniquely positioned to identify the distance between policy as written and policy as experienced. That perspective can help inform congressional constituent services, regulatory feedback, public education and discussions about Medicare's future. This is particularly important because Medicare decisions are not made exclusively through calculations of federal spending. They involve questions of access, affordability, competition, consumer protection and the practical administration of a national healthcare program. There are no substitutes for sound actuarial analysis or rigorous public policy research.

But neither should policymakers dismiss the practical observations of professionals who work directly with beneficiaries every day. The agent is often among the first to recognize when a technically compliant policy produces an unexpected outcome for the person it was designed to serve.

4. To the American Economy: Medicare Agents Are Small Businesses With an Outsized Reach.

When we discuss the economic contribution of Medicare, we often focus on hospitals, pharmaceutical manufacturers, insurance carriers and government expenditures. But there is another economy operating underneath those institutions. The independent insurance agency.

There are hundreds of thousands of insurance sales agents across the nation. That figure includes multiple insurance lines, not just Medicare, but it illustrates the substantial employment footprint of insurance distribution. Many agents operate independently or work in small businesses. They employ administrative staff, purchase technology, rent office space, hire marketing professionals, contract with service providers and support other businesses in their communities.

Their income circulates through local economies. They pay taxes, purchase homes, support families and contribute to the economic activity of communities that may otherwise have limited access to specialized insurance expertise. But their economic contribution goes beyond the money they earn. Consider what happens when a retiree makes an informed insurance decision.

They may better understand their expected annual healthcare expenditures. They may be better prepared for deductibles, premiums, coinsurance and prescription expenses. That understanding can help families make more informed retirement and household budgeting decisions. For retirees living on fixed incomes, financial predictability can be nearly as important as the actual cost of coverage.

I am not suggesting that every agent enrollment produces measurable savings for the federal government or the healthcare system. That would require careful research and evidence. I am preaching that informed insurance decisions have economic consequences, and the professionals helping people make those decisions deserve recognition in that equation.

An insurance agent's economic contribution should not be measured exclusively by the premium generated or the commission received. It should also be understood through the professional services, consumer education and local economic activity associated with that relationship.

5. To Healthcare Providers: Agents Help Bridge the Gap Between Coverage and Care.

Physicians and hospitals are primarily concerned with diagnosing and treating patients. Insurance carriers are responsible for administering coverage according to their contracts and applicable regulations. Those responsibilities do not always align neatly.

Beneficiaries can find themselves caught between medical recommendations and insurance requirements. A professional Medicare agent cannot replace a physician, adjudicate a claim or independently overturn a coverage determination. But an agent can help beneficiaries understand their coverage, identify relevant plan resources, recognize potential network conflicts and navigate appropriate channels when questions arise. The value of this role becomes particularly visible when insurance markets change.

As hospitals and carriers renegotiate contracts and insurance companies adjust geographic footprints, patients may be confronted with increasingly complicated coverage decisions. The agent can help translate those market changes into practical information. For healthcare providers, this can mean dealing with patients who better understand their coverage arrangements. For beneficiaries, it can mean having someone familiar to contact when the financial and administrative side of healthcare becomes overwhelming.

6. The Agent Is Also a Form of Consumer Protection.

Insurance products are not inherently interchangeable. Two MAPDs with identical monthly premiums may offer substantially different provider networks, formularies, cost sharing structures and MOOP (Maximum Out of Pocket) exposures. Two Medigap carriers offering the same plan letter may have different premiums, underwriting practices, rating methodologies and long term rate histories. The distinction between purchasing insurance and understanding insurance is enormous.

A well trained agent can help identify those differences before a beneficiary makes a consequential decision. Importantly, this does not mean every agent provides objective advice or represents every available product. Compensation arrangements, carrier appointments and business relationships can create conflicts of interest. Those realities should be disclosed and managed, not ignored. But we should also recognize that professional agents are subject to licensing requirements, carrier oversight and, for MA and Part D sales, annual training and testing requirements.

The highest value of a professional Medicare agent is the ability to recognize when enrollment would be inappropriate. Sometimes the correct recommendation is to keep the coverage a beneficiary already has. Sometimes it is to select a lower cost option. Sometimes it is to choose OM with Medigap coverage rather than MA. Sometimes it is to explain that a desired transition could jeopardize future insurance options, and sometimes the most valuable service an agent provides produces no new commission whatsoever.

That is the difference between selling an insurance policy and practicing insurance professionalism.

7. Technology May Change the Agent's Job. But it Will Not Eliminate the Need for Judgment.

Artificial intelligence, automated enrollment systems, online plan comparisons and sophisticated consumer tools are transforming insurance distribution, and many of those developments are beneficial. Technology can make information more accessible, improve operational efficiency and reduce the time required to compare complex products. But information and judgment are not synonymous.

A computer can calculate projected annual prescription drug costs. It cannot automatically know how much a beneficiary values a particular physician relationship unless that information is accurately provided and incorporated. An algorithm can compare monthly premiums. It may not fully capture someone's tolerance for financial uncertainty or the consequences of losing the ability to obtain a Medigap policy later.

Digital tools can improve the quality of a recommendation. But the ultimate responsibility for understanding a beneficiary's priorities, explaining tradeoffs and making an appropriate recommendation still requires careful professional judgment.

The future of the Medicare agent should be defined by how effectively professionals use technology to serve beneficiaries.

8. The Industry Must Stop Confusing Compensation With Value.

As MA carriers face increasing financial pressure, it is understandable that every expense receives additional scrutiny. But the value of an experienced agent is more difficult to capture in a single financial metric.

What is the economic value of a beneficiary understanding their coverage before an expensive medical event?

What is the value of preventing an enrollment mistake?

What is the value of preserving continuity of care through an informed plan selection?

What is the value of an agent spending hours helping a senior resolve an issue after the enrollment commission has already been earned?

Some of these outcomes can potentially be measured. Others represent service quality, consumer confidence and professional responsibility that are harder to quantify. But an expense being easy to measure does not mean its corresponding value is insignificant. And a service being difficult to measure does not mean that service lacks value. The industry should be careful not to evaluate the Medicare agent solely as a customer acquisition expense while overlooking the broader contributions of professional distribution.

I have spent many years in Medicare distribution, working alongside agents, carriers and industry leaders. The longer I work in this industry, the more convinced I am that the professional Medicare agent represents something much greater than an enrollment channel.

To the beneficiary, the agent can be an educator, an advocate and a trusted relationship.

To the carrier, the agent can be a distribution partner, a source of market intelligence and an important contributor to customer retention.

To policymakers, the agent can provide real world insight into how federal policy affects individuals.

To healthcare providers, the agent can help patients better understand the insurance arrangements surrounding their medical care.

To the American economy, the agent represents entrepreneurship, employment, consumer education and locally generated economic activity.

And the agent brings something into Medicare that cannot be written into an insurance contract or fully captured by an actuarial model: human accountability. There is a person who answers the phone. A person who remembers your spouse's name. A person who understands why keeping your cardiologist matters more than receiving another supplemental benefit. A person who is willing to explain the same confusing Medicare rule three different ways until you finally understand it.

The Medicare system needs effective regulation. It needs responsible carriers. It needs financially sustainable products, competent healthcare providers and sound actuarial management. It also needs people who can connect those institutions to the individuals they exist to serve.

That is why I believe the professional Medicare agent remains one of the most valuable, and most undervalued, participants in American healthcare. At the end of the day, Medicare is not simply about managing insurance risk but rather it's about taking care of people. Behind millions of those people is an agent who has dedicated their career to doing exactly that.

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Frequently Asked Questions

What is a "moral agent" in Medicare?

It is Andrew Saul's term for the professional Medicare agent who puts the beneficiary's needs first: translating complex coverage into clear choices, staying with clients after enrollment, and sometimes recommending no change at all, even when that earns no commission.

How many Medicare Advantage plans can the average beneficiary choose from?

According to KFF, the average Medicare beneficiary can choose from 28 Medicare Advantage prescription drug (MAPD) plans in 2027, down from 32 in 2026, and 35 Medicare Advantage plans in total when plans without drug coverage are included.

How many insurance sales agents are there in the U.S.?

The U.S. Bureau of Labor Statistics reports about 572,600 insurance sales agent jobs in 2025. That count covers all insurance lines, including property and casualty, life and health, not just Medicare.

Will AI replace Medicare agents?

Technology can speed up plan comparisons and make information easier to find, but it cannot replace professional judgment about a beneficiary's priorities, such as keeping a trusted doctor or protecting future Medigap options.