What your Medicare agent should do for you

Given that Medicare can seem like a confusing web of options, it’s no wonder that many consumers rely on licensed professionals for help.

If you’re among those who turn to an agent or broker, it’s worthwhile making sure the person has evaluated all of your options during Medicare’s open enrollment period, which starts each year on Oct. 15 and ends Dec. 7. With plans changing from year to year and new ones available in many areas, there could be a better choice out there for you both in terms of cost and coverage.

Before Medicare’s annual fall window closes, you can:·

Switch to an Advantage Plan (Part C) from original Medicare (Part A hospital coverage and Part B outpatient coverage);·

Switch to original Medicare from an Advantage Plan;

Move from one Advantage Plan to another;

Move from one prescription drug plan (Part D) to another or purchase one if you did not when first eligible (although you could face a penalty for late enrollment).

Of course, you aren’t required to do anything — if you take no action, you’ll automatically remain enrolled in your current plan, assuming it’s still available.

If you work with an agent, it’s important to keep in mind that the broker might not have a relationship with all insurance companies that offer plans in your area. This means the broker might not automatically take a look at every coverage choice.

“Brokers should speak to clients about all options, not just the plans they represent,” said James Parsley owner and general manager of NorthWest Medicare Solutions, founder and independent broker for Medicare plans in Oregon and Washington. “If the client is going to save, say $1,000 a year, the broker should recommend the plan even if they can’t help them directly.”

Also, some Medicare agents focus on selling only supplemental insurance, or Medigap. Those policies help you with copays, deductibles, and other out-of-pocket expenses, and can only be paired with original Medicare. You could be paying more in the long run since these types of policies have varying monthly premiums.

While original Medicare with or without Medigap might be the best option instead of an Advantage Plan — which includes Parts A & B, typically Part D and often extras such as dental and vision — you won’t know if you or your agent doesn’t check.

For many of the roughly 59 million Medicare beneficiaries in 2019, more plans are available.   The average recipient can choose from 39 plans in the Portland area, although people in rural areas have fewer to pick from, according to the Kaiser Family Foundation. In fact, 115 counties around the country have none available for 2019, down from 149 counties without one in 2018.

advantage plans 2019 kkf chart obrien

There are federal and state laws governing agents or brokers who sell Medicare plans, which include things such as barring them from showing up uninvited at your house to pitch a plan or trying to lure you with a cash offer. They also cannot legally charge you a fee to process your enrollment. If you do schedule an appointment, make sure you are provided with a document called “Scope of Appointment”  If the agent doesn’t provide, that’s a violation of the guidelines per CMS (Center Medicare Services)  that needs to be followed by all agents.

Agents generally are compensated through commissions from the insurance carriers they are licensed to sell plans for. And ideally, Parsley said, the person not only will be well-versed in Medicare matters but also will work in your best interest.

Be aware that if you call a number on an ad you see on TV or elsewhere, the agent on the other end of the phone might sell plans only for one insurer. This means you won’t hear about options that might be better suited for your individual situation.

Make sure your agent checks whether your doctor, hospital, preferred pharmacy, and other providers are considered in network.

Also, your agent should be familiar with programs that could help pay your prescription drug expenses if you’re struggling with their costs.

“They don’t need to be experts in their state’s programs, but at least know enough to help get the client a little extra help if they need it,” Parsley said.

kff medicare v nonmedicare households obrien
Of course, you also can comparison shop on your own to see what your options are. At the Medicare Plan Finder, you can plug in your information (including your medications) and your options will appear.

New for 2019 and beyond: If you pick an Advantage Plan during fall enrollment and realize afterward that it’s not a good fit, you can switch to another one or to original Medicare and a stand-alone Part D prescription plan between Jan. 1 and March 31.

However, in that early year window, you cannot go from one stand-alone drug plan to another or go from original Medicare to an Advantage Plan. Also, you can only do one switch during that window. In the current open enrollment period, you can change your mind multiple times before it ends on Dec. 7.

Key Points:

  • Your broker should take a look at whether your current coverage remains the best option for you, both in terms of coverage and cost.
  • Deal with a broker that has access to the majority of plans available in your area. You want to make sure you have the right coverage for your health needs.
  • Ideally, the Broker will review all plans available to you even if the broker doesn’t represent all insurers in your area.
  • The average Medicare beneficiary nationwide has around 24 Advantage Plans to choose from, although rural areas generally have far fewer.

Need more information? Just visit our web site: NorthWest Medicare Solutions

Medicare Information Disclosure

This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE or consult www.medicare.gov (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
NorthWest Benefits Solutions or NorthWest Medicare Solutions is not affiliated with Medicare.gov or CMS.gov. Medicare.gov and CMS.gov have the .gov domain because they are official web sites of the Federal government. Medicare has not endorsed this information provided on this web site by NorthWest Benefits Solutions.

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