Why These Questions Matter
The most important questions to ask a health insurance broker: Are you independent or captive? Which specific carriers are you contracted with? Will you verify my doctors by NPI number before recommending anything? Will you run my prescriptions against each plan’s formulary? Will you model my total annual cost — not just the premium? And what happens after I enroll if I have a billing problem or my doctor leaves the network?
A broker who can answer all six clearly, without hesitation, is doing the job correctly. A broker who deflects on any of them is one of the three failure modes described below. Call (828) 761-3326 to speak with an independent NC broker. NC License #10447418.
The 3 Broker Failure Modes These Questions Are Designed to Catch
Most bad broker experiences trace back to one of three failure modes. Every question category below is specifically designed to identify which failure mode, if any, you’re dealing with before you enroll.
Failure Mode 1: The Captive Agent
Only contracted with one carrier. Shows you 4–8 plans when your county may have 40+. Cannot compare Medigap pricing across 8+ NC carriers. Recommends what they can sell, not what’s best for your doctors and prescriptions. Most common in call centers and single-brand websites.
Failure Mode 2: The Enrollment-Only Agent
Available during enrollment season, unreachable after. No post-enrollment support for billing disputes, claim denials, network changes, or annual plan reviews at AEP. You have a carrier’s 1-800 number instead of your broker’s direct line. The plan may be fine; the relationship isn’t.
Failure Mode 3: The Premium-First Agent
Quotes the monthly premium without verifying your doctors, running your prescriptions, or modeling total annual cost. A $0-premium Bronze plan can cost $9,200 more than a subsidized Silver plan in a year with routine care. Recommending by premium alone is the most common and most expensive mistake.
25 Questions — 6 Categories
Each question includes what a good answer looks like (green) and what a red flag sounds like (red). Print this list and use it before you enroll in any Medicare or ACA plan.
“I’m independent and contracted with multiple carriers. I can compare every plan available in your county.”
Vague answer, or “I work with several companies” without being able to name them. A captive agent who says “several” may mean only 2–3 within one parent company.
A clear list of carriers: Humana, UHC, Aetna, Cigna, Wellcare, Blue Cross NC, etc. For Medigap: Mutual of Omaha, Aetna, Cigna, Transamerica, and others. Can list them immediately.
Cannot name the carriers, says “all the major ones,” or only names one or two. In NC, a well-contracted independent broker has 8+ Medigap carriers alone.
“No. Medicare broker commissions are CMS-regulated and are the same across all MA and PDP plans. I have no financial incentive to recommend one plan over another.”
Evasion, deflection, or an inability to clearly answer this question. Any broker who seems uncomfortable discussing compensation transparency is worth scrutinizing further.
“Both. For mixed households or ACA-to-Medicare transitions, I handle the full sequence without handing you off to another broker.”
Medicare-only or ACA-only. For early retirees (55–64) transitioning from ACA to Medicare at 65, or mixed households, a broker who only does one system creates a handoff gap at the most critical moment.
“Yes. Give me a list of your doctors and I’ll check each one by NPI number against the plan’s live provider directory before I recommend anything.”
“Most doctors accept this plan” or “you can check that on the carrier’s website.” This is not a verification. It is passing the work back to you without doing the job.
A direct, specific answer by name: “Duke University Hospital is in-network on plans X and Y but not Z. WakeMed is in-network on all three.” For NC-specific situations: awareness of the UHC/WakeMed network dispute of November 2025.
A general assurance without checking, or confusion about which plans cover which NC hospital systems. Network contracts change annually at AEP.
“You’re entitled to continuity of care provisions for ongoing treatment. You may be able to switch plans at AEP. I’ll notify you if I become aware of any network changes affecting your providers.”
“You’d need to call the carrier” or uncertainty about what happens. A broker who can’t explain your options for mid-year network changes is unlikely to be available to help you navigate them.
“Yes. At systems like Duke and UNC, the physicians may bill under separate entities from the hospital. I check both the facility and the physician group NPI numbers.”
Unaware that academic hospital physicians and the hospital facility may have different network participation, or dismisses the distinction. This is a common source of surprise out-of-network bills.
“Yes. Give me your complete medication list including dosages and I’ll check the tier placement on each plan we’re comparing before making any recommendation.”
Skips this step, says “most common generics are covered,” or suggests you check the formulary yourself. Drug tiers vary significantly between plans and represent hundreds of dollars per year per medication.
A specific tier number and estimated monthly cost for each plan. “That medication is tier 2 at $12/month on Plan A and tier 3 at $47/month on Plan B.”
Vague answer, “it’s covered,” or not knowing the difference between tiers. “Covered” at tier 5 ($95/month) is not the same as covered at tier 1 ($5/month). The tier is the number that matters.
“Let me check. Preferred pharmacies have lower cost-sharing for Part D drugs. If your pharmacy isn’t preferred, I can show you what the difference is and whether it’s worth switching.”
Doesn’t ask which pharmacy you use or doesn’t know the preferred pharmacy network for each plan. Preferred pharmacy status can represent $10–$30/month per medication in cost-sharing difference.
“Yes. Tell me roughly how often you use care — how many specialist visits, any expected procedures, your prescription usage — and I’ll model the total annual cost for each plan we’re comparing.”
Only quotes the monthly premium. Premium alone is the wrong comparison metric and it leads people into high-deductible plans that cost dramatically more in years they actually use care.
“Because Silver plans below 250% FPL are eligible for Cost Sharing Reductions. At your income, Silver CSR can reduce your deductible from $6,000–$9,200 on Bronze to $300–$1,500, with lower copays from day one. At many income levels, the subsidized Silver premium is the same as or lower than the unsubsidized Bronze premium. Let me model both.”
Cannot explain the CSR benefit, says “Bronze is cheaper,” or recommends a plan without modeling both with your specific income. This is the most common and most expensive ACA mistake.
A specific answer: the daily copay after the deductible, how many days are covered, and what the out-of-pocket maximum is. Can compare this to Medigap as an alternative. Volunteers that a $0-premium MA plan with a $350/day hospital copay can cost $3,500 for a 10-day stay.
Only emphasizes the $0 premium without walking through the inpatient cost structure. A $0-premium plan with no out-of-pocket maximum and high daily hospital copays is not “free coverage.”
“Yes. NC has 8+ carriers offering Plan G. For a 65-year-old, pricing ranges from roughly $116 to $198/month for the same standardized coverage. I compare them all before making a recommendation.”
Only quotes one carrier’s Plan G price, or seems unaware that Plan G benefits are identical across all NC carriers regardless of price. The price difference alone can represent $984/year for zero difference in coverage.
“Your IEP is the 7-month window centered on your 65th birthday month — 3 months before, your birthday month, and 3 months after. Missing Part B without creditable employer coverage triggers a 10% lifetime penalty per 12 months of delay, added permanently to your Part B premium. There is also a General Enrollment Period January–March with July coverage start, but that requires the full year before enrollment and the penalty still applies.”
Fuzzy on the IEP window, unaware of the permanent penalty, or says “you can enroll anytime.” Missing Medicare enrollment windows has permanent consequences and any Medicare broker must understand them precisely.
“Your Medigap OEP is the 6-month window beginning when Part B is effective. During this window, NC carriers must issue any Medigap plan without medical underwriting. After it closes, NC carriers can deny coverage or charge higher rates based on health conditions. In some cases, a chronic condition can permanently disqualify you from Plan G. I make sure to enroll Medigap within this window.”
Unaware of the OEP window, says you can switch to Medigap anytime, or doesn’t proactively bring up the underwriting risk. This is one of the most consequential enrollment windows in all of health insurance and every Medicare broker must know it precisely.
“You need to cancel your ACA Marketplace plan when Medicare Part B starts — otherwise you’re paying for both and your ACA subsidy may generate excess advance credit at tax time. The sequence is: apply for Part B during IEP, enroll Medigap within OEP, enroll Part D simultaneously, and disenroll from the Marketplace. I manage this timing for clients.”
Handles Medicare only and tells you to “call HealthCare.gov for the ACA side.” This handoff is exactly where the transition gap happens. The whole sequence must be managed by one broker who knows both systems.
“Yes. You’ll have my direct number. If you get a bill that looks wrong or a claim is denied, call me and I can help you navigate the appeals process or contact the carrier on your behalf.”
“You’d need to call the insurance company directly” or vague non-commitment. If the broker is unreachable after enrollment, you have a carrier’s 800 number and no advocate. This is the enrollment-only failure mode.
“Yes. I contact my clients before every AEP. Plan benefits, networks, and drug formularies change every year. What was the best plan this year may not be next year and I review it proactively.”
No structured review process, or “you can call me if you have questions.” AEP runs October 15–December 7 for Medicare and November 1–January 15 for ACA. Missing these windows means staying in a plan that may no longer be optimal.
A direct phone number, not a call center. A license number provided immediately without hesitation. “You can verify NC License #_____ at NCDOI.gov in under 30 seconds.” Robert Simm: (828) 761-3326, NC License #10447418.
Cannot provide a direct number (only an 800 number or web form), hesitates to provide license number, or says “you can find it online somewhere.” Any licensed NC broker can provide their license number immediately and should welcome verification.
Red Flag vs. Green Flag Answer Summary
A quick reference for evaluating any broker’s answers across the six categories.
| Situation | ✓ Green Flag | ✗ Red Flag |
|---|---|---|
| Carrier panel | Names 8+ carriers immediately; says “independent” and means it | Says “all the major ones” without being able to name them |
| Commission transparency | Explains CMS-regulated Medicare commissions are equal across plans | Deflects, gets uncomfortable, or can’t explain how they’re paid |
| Doctor verification | Checks by NPI number before recommending; names specific NC hospital system knowledge | Says “most doctors accept it” without verifying your specific providers |
| Drug formulary | Quotes specific tier number and cost per medication per plan | Says “it’s covered” without specifying tier or cost |
| Cost modeling | Models total annual cost: premium + copays + drugs + deductible | Only quotes monthly premium and calls it a comparison |
| Silver/CSR knowledge | Explains CSR eligibility, models subsidized Silver vs. Bronze at your income | Recommends Bronze because the premium looks lower without modeling CSR |
| Medigap OEP | Proactively explains the 6-month OEP window and underwriting risk after it closes | Says you can switch to Medigap anytime or doesn’t mention underwriting |
| Post-enrollment | Gives direct phone number; proactively reviews plan at every AEP | Refers you to the carrier’s 800 number; no structured annual review |
| License verification | Provides license number immediately; welcomes NCDOI.gov verification | Hesitates, can’t provide a number, or says “you can look it up somewhere” |
What to Bring When You First Talk to a Broker
These questions work best when you come prepared. A thorough broker will ask for all of this information before making any recommendation. If they don’t ask, ask them why not.
I tell every person I talk to: ask me every one of these questions. I want you to vet me. If I can’t answer them clearly and specifically, you shouldn’t work with me. The questions that most often surface a problem: Which specific carriers are you contracted with? and Will you model my total annual cost, not just the premium? Those two alone will tell you most of what you need to know. Call (828) 761-3326. NC License #10447418 — verify at NCDOI.gov.
Talk to Rob — Answer Every Question Above Before You Enroll
Independent · All NC carriers · NPI verification · Drug formulary check · Total cost modeled · Same agent every call · NC License #10447418
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Rob answers every question on this page with specifics, not deflections. Independent. All NC carriers. Doctor and drug verification. Total cost modeled. Same agent every call. $0 cost.
📞 Call (828) 761-3326Mon–Fri 9am–7pm · Sat 12pm–4pm 💬 Text Us Your Questions 📅 Book a Free CallIndependent — All NC Carriers
Rob is contracted with multiple carriers and compares every plan available in your county. Not captive to any single company. NC License #10447418 — verify at NCDOI.gov.
NPI Verification Before Any Recommendation
Rob checks every doctor by NPI number against the plan’s live provider directory before recommending anything. “Most doctors accept it” is not how he works.
Same Agent After Enrollment
(828) 761-3326. For billing disputes, claim questions, network changes, and annual AEP reviews. Direct number, not a queue. Same person every call.
What is the most important question to ask a health insurance broker?
The single most important: “Are you independent, and which specific carriers are you contracted with?” An independent broker compares all plans available in your county. A captive broker can only show you one company’s options. In Wake County alone, that’s the difference between seeing 4–8 plans and seeing 40+. Call (828) 761-3326. NC License #10447418.
Does using a health insurance broker cost anything?
No. Brokers are paid by the insurance carrier when you enroll. Your premium is identical whether you enroll through a broker, a call center, or directly on Medicare.gov or HealthCare.gov. Medicare broker commissions are CMS-regulated and are equal across all MA and PDP plans. Call (828) 761-3326.
What are the red flags that a broker isn’t working in my interest?
Six red flags: (1) Captive to one carrier. (2) Recommends a plan without asking for your doctors and medications. (3) Quotes only the monthly premium. (4) Cannot explain the CSR benefit for ACA plans. (5) Disappears after enrollment — no direct phone number. (6) Rushes you to enroll without comparing options. Call (828) 761-3326. NC License #10447418.
What is an independent broker and why does it matter?
An independent broker is contracted with multiple carriers and can compare plans across the full market. A captive agent represents only one carrier. In NC, Wake County has 40+ Medicare Advantage plans. A captive agent may show you 4–8. NC has 8+ Medigap carriers offering Plan G with pricing ranging from $116–$198/month for identical coverage. An independent broker compares them all. Call (828) 761-3326.
Should I ask about the Medigap Open Enrollment Period?
Yes — and if your broker doesn’t bring it up, that itself is a red flag. The Medigap OEP is the 6-month window beginning when Part B is effective. During it, NC carriers cannot use underwriting to deny or charge more. After it closes, a pre-existing condition can permanently disqualify you from Plan G. Any Medicare broker must know this window and sequence it correctly. Call (828) 761-3326.
What should I bring when I first talk to a health insurance broker?
Every doctor and specialist you see, your preferred hospital, every prescription medication with dosage, your preferred pharmacy, your estimated annual income, your Medicare card and enrollment dates if applicable, and the broker’s NC license number to verify at NCDOI.gov. A broker who doesn’t ask for most of this before recommending a plan is not doing a thorough comparison. Call (828) 761-3326.
How do I verify a health insurance broker’s license in NC?
Go to NCDOI.gov, click “Verify a License,” and enter the broker’s name or license number. Takes 30 seconds. Robert Simm of GenerationHealth holds NC License #10447418, NPN #10447418, AHIP Certified 2026. Any broker who hesitates to provide their license number should not be trusted with your enrollment. Call (828) 761-3326.