What Certifications & Training Does a Medicare Sales Agent Need?

If you’re working with a licensed insurance sales agent this Annual Enrollment Period, something we’ve suggested in the past, it’s important to trust the one you’re working with. In most cases, certifications and trainings are required of agents in order to help sign you up for certain plans. In others, certifications may simply serve as proof that the agent has gone above and beyond to expand their expertise. Understanding what’s required of agents who can help you find Medicare insurance may help you trust them to recommend the right plans.

Carrier Certifications

Before an agent is allowed to sell a Medicare plan, they have to be certified by that plan’s carrier. The carrier is the company that offers that specific plan. To be certified by a carrier to sell their plans, an agent often has to undergo a few tests. First, they have to prove they have a firm understanding of Medicare and insurance compliance laws. We’ll cover this in greater depth in a bit. The other requirement is carrier-specific training and/or testing.

Each test differs depending on the carrier, meaning agents need to be certified by each carrier they plan to work with.

Undergoing these tests can be arduous and time-consuming, but they’re essential to show that an agent knows a great deal about the plans they’ll be discussing with consumers. Each test differs depending on the carrier, and this means agents need to be certified by each carrier they plan to work with. It’s also worth noting that many carriers operate with three-strikes-you’re-out policy, meaning if an agent fails the test three times, they can’t market those plans that year. So, you should be able to trust that an agent who’s certified by a carrier knows what they’re talking about when it comes to those plans.

Compliance Trainings

In order to be certified with a carrier, an agent will almost always be required to take a Medicare and fraud, waste, and abuse (FWA) compliance certification. The two most popular forms of these certifications are the Gorman Health Group and America’s Health Insurance Plans (AHIP) certifications. The AHIP certification is by far the more common of the two. Many carriers require AHIP certification as part of their own certification process.

The bulk of the training refers to ways that agents can spot Medicare Fraud, Waste, and Abuse.

AHIP training teaches agents the basics of Medicare and different types of Medicare Part C and D plans and compliance with Medicare marketing guidelines, as well as proper enrollment procedures. These are all important for a good agent to have mastered. The bulk of the training, of course, refers to ways that agents can spot Medicare FWA. Medicare FWA costs the centers for Medicare & Medicaid Services (CMS) billions every year, so being vigilant protects the long-term viability of the program.

Similarly to carrier certifications, agents usually have three chances to pass the AHIP exam. In order to pass, they need to score a 90 or higher on a 50-question test. Once this is completed, agents can then complete their carrier certifications and prepare to start offering Medicare plans to consumers.

Additional Certifications

In many cases, compliance and product certifications and trainings are all that an agent needs to help you find a Medicare plan. However, some agents look to expand their repertoire with extra certifications.

If you’re ever curious about a designation, a quick Google search should give you a full idea.

If you ever see letters behind an agent’s name, that generally refers to specialized designations. If you’re ever curious about what they mean, a quick Google search should give you a full idea. Two popular designations many agents get are the Certified Insurance Counselor (CIC) and Certified Financial Planner (CFP) designations. Both have crossover with Medicare products and give agents a well-rounded level of expertise that can help Medicare beneficiaries.

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Trusting your agent to point you in the right direction is key to having a successful relationship with them. Whether that trust comes from knowing how agents get paid or that their knowledge of plans is solid, it should help to make you more confident in the advice you’re receiving and the choice you’ll eventually make.