Question from Kristen: Prior to reading your column last week, I had no idea that when I chose an Advantage Plan at age 65, I might not ever be able to get a Supplement in the future. Why wasn’t I warned about that? 

Answer: Had you come to The Health Insurance Store, you would have been warned. However, agents and Advantage Plan company representatives ARE NOT required or simply choose not to disclose that the only time Supplement companies must accept everyone into their plans is the three months prior to getting Medicare Part B for the first time, the month it becomes effective, and the six months after. Once that Initial Enrollment Period (IEP), as that seven months is called, expires, Supplement companies can discriminate on who they accept in their plans based on an applicant’s current or prior health issues. 

If you call an insurance company directly, most don’t offer both types of plans, just Advantage. So of course, they're not going to mention Supplements or the IEP enrollment window. 

If you worked with an agent, there are only two reasons he or she didn’t even mention a Supplement as an option, or disclose that the IEP is the only time where you can enroll without health being a factor: 1) They aren’t trained well enough to know or, 2) They only want to sell Advantage Plans because the commissions are as much as 500% higher on HMOs and PPOs than Supplements. 

I estimate that around 90% of Medicare agents are derelict in their duties by not fully understanding all the rules, regulations, and intricacies of Original Medicare, Supplements, Advantage Plans and Part D prescription coverage, or they don’t have a client’s best interests in mind. Their own paycheck is the number one priority. 

That’s not how we conduct business here at The Health Insurance Store. What we do is focus on educating every potential client first. We have an easy to follow 3-page presentation that goes over the foundation of Original Medicare Parts A and B, what’s covered, and what isn’t. Then we explain Supplements and Advantage Plans in detail, comparing and contrasting them; the pros and cons, risks and rewards of both types of plans. 

As brokers, we’re appointed to provide plans from every competitive Supplement and Advantage Plan in the market, ensuring unbiased advice. We ask lots of questions, listen to the concerns, wants, and needs of the people who seek out our advice to help them decide if a Supplement or Advantage Plan is the best fit. Once that’s been determined, we make sure they enroll in the plan that offers the best value. This includes advising people when they’re better off keeping their current plan or enrolling in one provided by a company they retired from or are still working for.  We never make a recommendation based on if we get a commission or not. I estimate that 25% of our appointments result in us giving advice where we don’t get a dime of commission. 

Enrolling someone in a plan is only the beginning of our job. Once someone becomes a client, we provide support when issues or concerns arise. Every day we investigate bills that are questionable or erroneous. We help people work through prescription cost or coverage issues. We make calls to insurance companies, medical providers, billing departments, Medicare, and Social Security with our clients or on their behalf.  We do whatever it takes until we get an acceptable resolution.  

We also keep clients updated on current developments or changes in their plans from year to year. We send out email updates when necessary and each Fall every client gets our recommendation letter prior to the Annual Enrollment Period (AEP) letting them know if it’s best to remain on their plan the following year or if they should consider another. Never has it been more important to work with an experienced and caring agency because Medicare, Advantage Plans, Part D, and Supplements are becoming more confusing and expensive. We’re going to see some very significant changes to Advantage Plan HMOs and PPOs in the coming years. You must stay informed so you can save money where possible without giving up important coverage and benefits. That’s exactly what The Health Insurance Store does for our clients.  If you didn’t originally get your plan though The Health Insurance Store, you can actually become a client without changing plans! If you’re interested in that, have questions regarding this column or any other Medicare topic, or would like to make an appointment for a no cost consultation during the Annual Enrollment Period that runs October 15^th through December 7th, give us a call, 724-603-3403, or email me personally at Aaron@GetYourBestPlan.com.