Why does Medicare have to be so confusing? Its multi-part structure with varying eligibility criteria, enrollment periods, cost-sharing requirements, and coverage gaps makes it all very complex. Additional factors like Medicare Advantage plans, Medigap options, changing regulations, and network considerations contribute to its intricacy. Navigating Medicare requires thorough research along with guidance from a knowledgeable and experienced independent Medicare agent to make informed healthcare coverage decisions.
Don’t Drink the Kool-Aid
My favorite quote from Marilyn Duckworth, an independent Medicare agent with 21 years of experience is,
“Don’t drink the Kool-Aid…If it sounds too good to be true, it probably is.”
It seems like it should be simple to sign up for Medicare, but unfortunately, enrollment is anything but simple. There is no one-size-fits-all solution and it’s important to find the plan that provides the specific type of coverage you need at the best price. It doesn’t help that we are assaulted with conflicting Medicare-related information by phone, online, and in commercials before, during, and after the open enrollment period. How do you know what’s true or who to believe?
What About Those Great Medicare Commercials With Beloved Older Celebrities?
Have you seen Joe Namath, William Shatner, or Jimmie Walker on commercials talking about Medicare? I love all three of these guys and remember them well. These trusted older celebrities list a handful of health care benefits on cable TV, from no co-pays to bundled benefits like dental, vision, and hearing to home-delivered meals at no additional cost. They also say beneficiaries can receive extra money in their Social Security check every month. Sounds great, right? Unfortunately, the wise-sounding words from these beloved old-timers are misleading. These features are not standard for every plan; you must do your research before purchasing a plan. In truth, the purpose of these commercials, is simply to entice people to call a Medicare hotline so they can be sold something else. On a side note, keep in mind these commercials are not from the government or from Medicare.
“Research shows that aside from the financial risks, choosing the wrong plan can literally knock years off your life.“
How Do You Weed Through All the Information?
For many, perhaps most, navigating the Medicare system is complicated. The decision-making process is daunting. How do you weed through all the information to find the most cost-effective plan that will work best for you?
As per Duckworth, there is much to consider. For example, how much are the premiums, deductibles, and other costs? What do you pay for services such as hospital stays or doctor visits? Does the plan have a limit for what you might pay out-of-pocket for medical services on an annual basis? Can I see my usual doctors? Will my prescriptions be covered and what’s the cost under each plan? What services does Medicare not cover? Should you get traditional Medicare or a Medicare Advantage plan? What are Medicare supplement plans? What happens if you miss open enrollment? It’s absolutely essential to understand the details to make the right choices.
In fact, research shows that aside from the financial risks, choosing the wrong plan can literally knock years off your life. Your best bet is to work with a trusted professional who can educate you about the pros and cons of the different plans and make a recommendation based on your specific needs. The best part? They do not charge you a fee. If you work with a licensed agent, you pay exactly the same for the plan as if you purchased it on your own.
How to Choose a Licensed Medicare Agent and Why
We recommend you work with a licensed professional who works independently and is not beholden to a specific company or plan. These agents are very knowledgeable about Medicare plans and must complete training and pass a test every year about the health and prescription drug plans. If possible, get a referral for an agent from someone you know and trust. You want someone who is a straight shooter; someone who is in this profession because they are truly passionate about helping older adults and not just in it to make money.
Duckworth explains, “Agents carefully assess your situation, including your medications, and present you with the best options from among the health insurance companies with whom they work to meet your needs. Having all the information and your questions answered helps you make an educated decision.”
In addition, go with an independent Medicare agent with experience selling plans in your state since availability, benefit rules, and exceptions differ depending on location. You can check with your state insurance department to verify that the agent is licensed in your state using their license number from their business card.
Ways an Independent Medicare Agent Can Assist You
Review health plans
Streamline your options after gaining a solid understanding of your finances and health needs. Once you make a decision, the agent can enroll you in the plan.
Evaluate your current coverage
If you are already on Medicare, an agent can review your current coverage to determine if it still meets your needs. If not, they can help you change plans to one that better suits your current situation
Save you time and effort
Trying to navigate the Medicare system on your own is an extremely time-consuming option. A bonus is that an agent can help you stay on top of the important dates so you are not penalized!
Assist with medical underwriting
The insurance company doesn’t have to offer you the same premium offered during open enrollment if you try to purchase a Medigap plan outside this window. That means they can instead go through the medical underwriting process and have the right to decide not to enroll you in the plan at all due to underlying health conditions if you have any. A skilled Medicare agent can help determine if you’ll meet the underwriting requirements for the plans you’re considering.
Beware of Scammers During Open Enrollment
Open enrollment, which runs from October 15th through December 7th every year is open season for scammers. There are a lot of fraudsters out there looking for a payday who find the vulnerable senior population trying to understand Medicare to be easy targets. As per Duckworth, Medicare’s 60+ million beneficiaries are a huge target for bad actors looking to defraud Medicare or steal personal information. These scams open them up to medical identity theft and/or false claims.
Common Medicare Scams
Duckworth provided some great tips to help protect yourself and your loved ones from these common Medicare scams.
Scam operators, many with foreign accents, call beneficiaries claiming they represent Medicare. They may claim they sell Medicare policies, can improve your benefits, ask you to “verify” your new Medicare card number to confirm you received your card, ask you to send in your old one, or even threaten to cancel your benefits unless you provide updated information. Sometimes they sell phony products like supplemental or prescription drug Medicare plans. These people sound legit and say whatever it takes to try to gain your trust. Often, they do their homework in advance to make accurate statements that make them sound credible to get you to respond. Be careful! Some of the scammers can make the caller ID number appear as if it comes from an official place. The purpose of these calls is to get your Medicare card number, social security number, or banking information. Do not give out this information on the phone; assume it’s a scam if a caller asks for any personal information. Medicare does not call to sell you anything and cannot enroll over the phone unless you call first.
Counterfeit sales materials, offers for discounted prescription drug plans or supplemental Medicare covering, or bills from a healthcare provider show up quite often these days in our mailbox. Scammers know people often pay the bills without checking the dates and/or services. Do yourself a favor and keep records of the dates you receive services and save receipts or statements to compare against the invoices to make sure the charges are valid.
Guess what? Medicare doesn’t make house calls. If someone knocks on your door claiming to represent Medicare and trying to sell you prescription drug coverage, medical equipment, supplements, or medicine, don’t talk to them! Just shut – and lock – the door.
Free or discounted genetic testing
Medicare does not pay for random genetic testing…beware of people offering you a free or discounted DNA test whether by phone, mail, or even at a health fair. Scammers offer cheek swabs to scan for cancer or predispositions for other illnesses, claiming Medicare covers the costs. What they are really after is your Medicare information for identity theft or fraudulent billing purposes.
The Bottom Line
Many find Medicare confusing and somewhat overwhelming. Most Americans know the basics, that Medicare is a federal health insurance system that kicks in at age 65, but not much more. We don’t spend a lot of time thinking about it until we have to, figuring we will simply enroll when the time comes.
To ensure you get the best coverage at the most affordable price that meets your needs, use the services of a trustworthy and knowledgeable agent or broker. They can help you sort through the details in far less time than you could educate yourself.
Finally, take steps to protect yourself from Medicare fraud. Visit CMS.gov for more information and tips or call 1-800-MEDICARE.
About Marilyn Duckworth
Marilyn Duckworth, owner of Health Insure Plus, is an independent Medicare agent who works tirelessly to meet the specific needs of every customer. Through superior customer service and being mindful of budgetary constraints, she delivers no-hassle quotes for the best insurance options available. Thanks to her 21 years in the insurance industry, clients can be assured of a stress-free shopping experience for coverage. Many say she delivers the insurance industry’s best customer service in Texas!
Marilyn is a member of the Texas Association of Health Underwriters and the National Association of Health Underwriters. She has also received the Small Group Specialist designation and AHIP certification.
Just a few of the companies she currently quotes with include Aetna, Blue Cross, Cigna, Humana, UnitedHealthcare, and UnitedHealthOne.
FAQs About Medicare
What is Medicare?
Medicare is a federal health insurance program in the United States primarily for individuals aged 65 and older. It also covers certain younger individuals with disabilities and those with end-stage renal disease.
How do I become eligible for Medicare?
Most people become eligible for Medicare when they turn 65. Younger individuals with certain disabilities or those with end-stage renal disease may also qualify.
When can I enroll in Medicare?
Initial enrollment typically occurs around your 65th birthday, and there are specific enrollment periods for each part of Medicare. These include the Initial Enrollment Period, Special Enrollment Periods, and the Annual Enrollment Period.
Are there penalties for late enrollment?
Yes, late enrollment in certain parts of Medicare, like Part B and Part D, can result in lifelong penalties in the form of higher premiums. It’s crucial to enroll during the appropriate periods to avoid these penalties.
What does Medicare cover?
Medicare Part A generally covers hospital services, while Part B covers medical services and outpatient care. Part D covers prescription drugs, and Medicare Advantage plans (Part C) offer an alternative way to receive Medicare benefits. However, coverage specifics can vary.
What is Medigap, and do I need it?
Medigap, or Medicare Supplement Insurance, is a type of policy that helps cover the gaps in traditional Medicare coverage, such as copayments and deductibles. Whether you need it depends on your healthcare needs and preferences.
How can I find healthcare providers who accept Medicare?
You can use the Medicare website’s “Physician Compare” tool or contact Medicare directly to find healthcare providers in your area who accept Medicare patients.
What is Medicare Open Enrollment?
Medicare Open Enrollment, also known as the Annual Enrollment Period (AEP), is the time each year when Medicare beneficiaries can make changes to their Medicare plans. It typically occurs from October 15th to December 7th.
What happens if I miss the Medicare Open Enrollment period?
Missing the Open Enrollment period may limit your ability to make changes to your Medicare coverage, except in certain circumstances like qualifying for a Special Enrollment Period (SEP).
Can I change my Medicare Advantage plan at other times of the year?
In addition to Open Enrollment, there are specific circumstances, such as moving to a new area or qualifying for a Special Enrollment Period, that may allow you to change your Medicare Advantage plan outside of the typical enrollment period.