Overview
Establishing an agency is essential to ensure you receive proper credit for the agents you recruit. Below is the step-by-step process for establishing a Medicare insurance agency through the National Insurance Producer Registry (NIPR).
📢 Disclaimer: The following is not legal advice, but rather a general guideline intended for informational purposes only. You are strongly encouraged to consult a qualified attorney before proceeding.
Starting a Medicare Insurance Agency via NIPR
Step 1: Form a Legal Business Entity
Before using NIPR, you must have a legally recognized agency. To do this:
Choose a Business Structure (LLC, Corporation, etc.).
Register the Business Name with your Secretary of State.
❗Note: Do not use "Medicare" in your business name. Some states prohibit it, and CMS prohibits the use of “Medicare” in your business name, logo, or website URL if used in a misleading way — one that would cause potential enrollees or beneficiaries confusion over whether you're affiliated with Medicare.
Obtain an EIN (Employer Identification Number) from the IRS.
Set up a business bank account.
Step 2: Obtain a Business/Agency Insurance License
You’ll use NIPR to apply for your agency's insurance license in your resident state:
Create an NIPR Account (optional, but helpful):
While an account isn’t strictly required to use NIPR services, it makes tracking and re-filing easier.
To create an account, go to: https://nipr.com
Apply for an Agency License:
Use the NIPR Licensing Center
Select Apply for a New Insurance License
Choose Business Entity / Agency
Select your resident state
Submit the required documents:
Business registration (LLC/Corp)
FEIN (Federal Employer Identification Number)
Business Address
Step 3: Appoint an Agency Principal
After submitting your agency application, you must appoint an agency principal:
The Agency Principal must be:
Already licensed in the same lines of authority (e.g., Medicare = Life/Health).
Licensed in the same resident state.
To appoint the Agency Principal:
During the agency license application, NIPR will prompt you to designate a principal.
You may need to submit a Form 500 or state-specific equivalent, or complete it online via NIPR.
The Agency Principal’s license must remain active and in good standing at all times.
Step 4: Obtain Non-Resident Licenses (if applicable)
If your agency will operate in multiple states:
Use NIPR’s Non-Resident Licensing tool.
Make sure the Agency Principal also holds matching non-resident licenses.
Step 5: Appoint the Agency with Carriers
Once licensed:
Contract with Medicare Advantage and PDP carriers (e.g., Aetna, Humana, UnitedHealthcare).
Each carrier may require:
W-9
E&O insurance
Background check
Appointment forms
Carriers will often appoint the agency, the Agency Principal, and possibly any sub-agents.
Step 6: Compliance & Setup
Purchase Errors & Omissions (E&O) insurance.
Register for Medicare certification platforms (e.g., AHIP).
Comply with CMS marketing rules.
Set up commissions and contracting for downline agents (if applicable).