How to Sell Health Insurance in 2025

First and foremost, I feel compelled to say this out loud. Selling health insurance comes with a great responsibility as it impacts the number one area of financial concern to individuals, families and retirees. There is a reason you’re required to get an insurance license with the department of insurance in the state you live in and any additional states you plan on selling in.

This is more than just a transaction, it’s about building trust and delivering tailored solutions that address your clients’ needs and giving them confidence. Whether you’re helping clients with Medicare Advantage Plans, Medicare Supplements, ACA health insurance plans, or a small business seeking group health benefits, your ability to guide and provide them the information needed to make informative healthcare decisions is what sets you apart.

I’d like to not only discuss the nuances of selling health insurance, but the incredible importance of doing so in a holistic manner, positioning yourself as an expert in the insurance industry.

By mastering how to deliver both Medicare solutions and Affordable Care Act (ACA) educational presentations, you will help clients learn to navigate their health coverage needs with confidence while at the same time earning a competitive compensation that sits firmly on the foundation of providing deep, lasting value to your customers.

Here is what I’ll cover in this 5 minute read.

1. Why Selling Health Insurance is Unique
2. Developing a Problem Solving Mindset
3. Understanding the Core Products
4. Bringing Your Products Together
5. Starting the Process and Deploying Scalable Approach Language

Why Selling Health Insurance is Unique

Let’s start with the basics.

In general, health insurance is a complicated and often overwhelming topic for most people, so you always need to remember that the majority of people can’t speak fluent “insurance” language like you do. This is such an easy mistake to make.

Health insurance is at the top of the list for your prospects financial stability, and sometimes even life-or-death situations. Treating it with care will nurture your relationships and maintain your role as their subject matter expert.

Here’s why it can be challenging:

1. Abundance of Plan Options: Consumers are confused.  There are so many insurance policies available, from Medicare Advantage to ACA health insurance plans, all with varying levels of insurance coverage and benefits to choose from. This is the driving reason why a commitment to continuing education is so important.
2. Long-Term Commitment: Health insurance isn’t a one-time purchase, it’s a monthly investment that comes along with the potential of working through claims as they arise. Clients want to feel confident they’re making the right choice. They want to know that when they call an insurance company and don’t get the answer they are looking for, that you are there to support them, day or night and holidays and weekends. You must be accessible.
3. Evolving Regulatory Environment: Changes from the federal government are very real, such as updates to healthcare.gov and medicare.gov impacting both ACA plans and Medicare policies.  Selling each type of plan has their own certification process which is AHIP for Medicare and FFM certification for ACA. Staying informed is key to staying relevant and compliant.  Plus, it’s necessary if you want to get paid for the work you are doing.

While the information can be complex, your role as a licensed agent is simple. Educate your prospects and customers by simplifying the complexity, educating on the changes to ensure they understand how it works, and provide personalized recommendations based on their needs.

Developing a Problem Solving Mindset

This is the first thing you need to remember. You get paid to solve problems which can be both easy and complex, but requiring a standardized mindset and process.

Here’s a way I’ve always explained this to agent’s I have trained.

Visualize your last doctor’s visit. They asked you good questions about your symptoms which you then validated and expanded on until the point your doctor had enough information to properly recap your symptoms (giving your confidence they understand your concerts), educate on the potential causes and prescribe a solution to help reduce the pain or issue (giving you the confidence to follow their directive so you can feel better). This is usually followed by a follow up visit and various check ins through out the year (nurturing your relationship and keeping you confident your doctor is there for you).

Your job as a health insurance agent follows an eerily similar process when helping someone choose or change their health plan each year.

Understanding of Your Core Products

There are two primary categories of products you will work with, and an easy way to think about it is Medicare and Not Medicare.

1. Medicare Plans
2. Not Medicare Plans (also known as under 65, or ACA plans)

Understanding Medicare:

Medicare is federal health insurance offered to those who meet the requirements through out their working years and offers critical coverage for individuals aged 65 and older or those with certain disabilities. As a health-insurance-agent, understanding Medicare’s layers is essential to your success:

Key Medicare Info:

• Original Medicare: This consists of Part A and Part B which are the fundamental requirements someone must have to meet eligibility requirements for bother Medicare Advantage and Medicare Supplements (the two types of products you’ll sell in the Medicare category). You can read the full Medicare and You 2025 Handbook, and I suggest reading it cover-to-cover.
• Medicare Advantage Plans (Part C): These plans are offered by private insurance companies and often bundle additional benefits like hearing aids, fitness memberships, and transportation for medical visits. These available to those in good health as well as those with chronic conditions or meet income requirements for state Medicaid.
• Medicare Supplements (Medigap): Designed to cover out-of-pocket costs like deductibles and copays, Medigap plans are ideal for clients who want predictable expenses.
• Part D: These plans cover prescription drugs and are most commonly sold in conjunction with Medicare Supplements.

Medicare Sales Tip:

When you meet with a prospect and identify they are eligible for Medicare, or are already on a Medicare plan, you’ll know that you’re either going to help them in one of the following ways:

1. Medicare Advantage plan
2. Medicare Supplement paired with a part D drug plan.

This is where you will use clear visuals and comparisons to help clients understand the trade-offs between the two solutions and highlight the health benefits and costs associated with each option to build trust and confidence.

From there, you’ll identify the pain points and the conversation will guide you to the right solution based on the needs of your prospect.

ACA Marketplace Insurance

These plans are for the majority of your under 65 prospects.

While Medicare serves a specific population most commonly associated with individuals over the age or 65, the Affordable Care Act (ACA) opened the door for millions of Americans under 65 to access affordable health coverage. As a health insurance agent, understanding ACA plans is a requirement providing holistic solutions.

Key Features of ACA Plans:

1. Income-Based Subsidies: One of the biggest changes that came with the inception of the affordable care act was the eligibility changes for subsidies which is based on the federal poverty limits. You will find that many clients qualify for financial assistance, making coverage more affordable, even when they are working and earning a competitive wage. This can be calculated through healthcare.gov or HealthSherpa.
2. Essential Health Benefits: ACA plans cover services like preventive care, mental health, maternity care, and prescriptions which are considered minimum essential benefits. If your prospect has a private plan that is not listed in the marketplace, it must meet the minimum essential coverage requirements in order to avoid potential penalties.
3. Metal Tiers: Plans are categorized in four ways, Bronze, Silver, Gold, and Platinum to allow clients enough choices based on their healthcare needs and budget.

ACA Sales Tip:

At this point of your sales meeting, you have likely identified your prospect is not on Medicare or an employer health plan, and therefor eligible for an ACA plan.

You’ll use your HealthSherpa account or other enrollment platform to identify the available plans in their area as well as access to the tiered benefits from each company in the following scenarios.

1. Comparing benefits for the upcoming year to their current ACA plan.
2. Explaining how ACA can serve as a bridge if your prospect is nearing Medicare eligibility or retirement.

Based on your findings, you’ll follow the same process education and proposed solutions for enrollment.

The Importance of a Standardized, Holistic Process

If you don’t start off on the right foot with your process and consistency, you run a much higher chance of failing.

Your ability to offer both Medicare and ACA options makes you a health insurance advisor rather than just an insurance broker. People value a professional who can consider their unique circumstances and provide comprehensive solutions, this is a fact!

For example:

• A small business might need group health insurance for employees while also helping their employees aging into Medicare transition to off the group plan. You may be able to sell all, or advise on a great group benefits partner while establishing yourself as the Medicare transition expert.
• An individual client might need an ACA plan for themselves while their spouse continues to work for the next couple of years.
• You might meet with a husband and wife where one isn’t Medicare eligible, but retired early and the other is Medicare eligible.

When you can bridge the gap between these scenarios, you create a seamless customer experience that is memorable and will result in strong retention and a higher referral rate.

Health Insurance Education, Sales Process and Approach Language

This part should be incredibly simple if you open every single appointment with the following language.

“Mr. or Mrs. Prospect, I approach solving health insurance problems in a very specific way with my customers.  There are 3 main areas of financial concern that most people face which are their overall monthly health insurance costs, unexpected diagnosis of a chronic or critical illness, hospitalization, and drug costs.  Today I’m going to ask you a number of questions that help me understand your unique situation and needs so we can help propose a solution that works specifically for you, does that sound fair?”

Notice we didn’t talk about Medicare, group benefits or under 65 health plans.  You are setting the expectation at the onset of the meeting that you are their to help them do this correctly and think through the contingencies to ensure they have the right information to make a decision.

From this point, you can begin fact finding to determine which product path you are going down (Medicare or Not Medicare) and you won’t be confused on which platform you need to use, or the types of plans.  You’ll know exactly what direction to go, how to assess their needs and ultimately recommended solutions and process an enrollment.

Tips for Health Insurance Sales Success

Whether you’re an independent agent or working for an insurance agency, the following are tips I wouldn’t suggest ignoring.

1. Focus on Education

Your prospects more than likely don’t understand how these plans work, so you must take the time to explain terms like “deductible,” “out-of-pocket maximum,” and “network” among others. The more they understand how the product works, the closer you get to a closed sale as their emotions allow them to visualize the future benefit of having their new plan.

2. Leverage Technology

This is a no brainer, but you would be surprised how many agents still aren’t leveraging tech.

Tools like quoting platforms and CRMs can help you streamline your sales process. Use resources like healthcare.gov to quickly calculate subsidies or compare plans for ACA, and Sunfire Matrix for your Medicare solutions.

3. Build Trust Through Transparency

Show clients the math behind your recommendations.

For example, compare the total cost of a Bronze ACA plan versus a Gold plan over a year using real life examples identified in your fact finding process. Clients will appreciate your honesty, attention to detail and instinctively begin to realize you do in fact have their best interest in mind.

4. Stay Up-to-Date on Health Insurance

The insurance industry is always changing.

Whether it’s new benefits or updates to ACA policies from the federal government, staying informed builds confidence and your clients will feel more secure knowing they’re working with a knowledgeable insurance professional.

FAQs

Why is selling health insurance so challenging?

The biggest challenge is the time it takes to understand the best path to navigating the complexity of options and regulations. Clients will never know where to start, which is why having a trusted health-insurance-agent is necessary. It’s a lot of information that changes often, creating a constant moving target that you have to be aware of.

What’s the best way to build trust with clients?

Hands down it’s your focus on education and transparency.

Clients want to feel supported and confident they’re making informed decisions, so take the TIME to explain their options clearly.

How can I grow my book of business?

The best way to scale a health insurance book of business is through a holistic approach that allows you to maximize your enrollment chances in every appointment.

By mastering both Medicare and ACA plans, you can address a broader range of client needs and generate more referrals. Medicare sales are often 1 sale per meeting, but the average ACA plan is 3. At an average of $20 per month per client on an ACA plan, does it make sense to not capture an additional $720 per year to help an average family of 3 that will ultimately generate more referrals?

Holistic approach to health insurance solutions is the best way to scale a health insurance book of business.

Next Steps

As a health insurance agent, your role is more than just selling insurance policies, it’s about empowering clients with the knowledge and confidence to make the best decisions.

Recap of the Steps:

1. Partner with an FMO like Senior Market Advisors.  Get contracted with SMA today.
2. Follow a holistic education approach in every sales opportunity to identify which of the two paths your presentation will go, Medicare or Not Medicare.
3. Fact find your prospects to identify their pain points and leverage that information through out your presentation by telling hypothetical stories to help them better understand how their potential new plan will work.
4. Take the TIME to listen and solidify your position as the subject matter expert.
5. Enroll them in the plan they have chosen based on their specific needs.
6. Nurture the relationship through out the year to maintain your position as their go to, trusted resource.

To truly stand out, stay educated, leverage the latest tools, and focus on building long-term relationships. Industry evolution isn’t stopping any time soon, but with the right approach, you can thrive in this rewarding career.

Ready to take the next step?

Let’s connect and become growth partners.