Even if you have decided what form of Medicare coverage you want, you still have many decisions to make. And if you choose Original Medicare (Parts A and B) instead of Medicare Advantage (Part C), you may also have decisions to make about your Medicare-approved prescription drug plan (Part D) and a Medicare supplement insurance (Medigap) plan.
You can comparison shop online to check out all your options, starting with Find a Medicare plan. But that means you’ll be making important decisions on your own – decisions that can have long-term consequences.
One solution is to get a referral for a reliable insurance agent or broker specializing in Medicare insurance. That person or company will have far more experience in the Medicare field and can help you get the best policy – or combination of policies – for your unique situation.
But you will want to decide between using an agent or a broker.
The insurer compensates both, so their services are free to you. But, in general, the difference is this: an agent typically represents one insurer (or a few), often contractually. And a broker proposes a broad range of insurers, acting independently. So a handy phrase is, “An agent sells for the insurer, and a broker buys for the customer.”
Takeaway action step: To help with all the decisions surrounding your Medicare health care coverage, invest the time to find a broker with extensive Medicare experience. Go beyond just online searches for a broker. Ask friends and family for referrals, and question their experience with that broker regarding cost savings, knowledge, personal support and empathy. It’s that important.
Let’s look at five things you could ask your broker to save money on your Medicare costs.
Can you help me decide between Original Medicare and a Medicare Advantage plan?
Most people begin their research into their Medicare coverage options on the internet. There are no secrets about Medicare. In fact, if anything, there is too much information, leading to more confusion than clarity.
It may also be tempting to ask a friend or relative about their choice. However, because everyone’s health care needs are so individual, what works for one person may not work for another.
Medicare Advantage is typically considered the least expensive alternative with the broadest coverage. However, depending on your usage, that is not necessarily the case. Besides, the best coverage is not just about the lowest premiums or costs. It also includes how easy it is to access care, where it can be accessed and who can provide it.
A good broker can offer a streamlined education about how Medicare works. And by asking you a series of questions to determine what is most relevant and essential to you, a broker can help you identify which of the two systems – Original Medicare and Medicare Advantage – would provide you with the best coverage at the best cost.
They also have their finger on the pulse of each insurer’s customer service reputation; that is, how customers are treated after the contract is signed and the policy is put into use.
Can you help me avoid penalties for missing enrollment deadlines?
Medicare comes with all kinds of initial enrollment requirements and periods. And if you miss one, it could cost you long-lasting penalties in what you pay as monthly premiums.
To start, unless a qualified employer’s plan covers you, you have to enroll in Medicare during the 7-month period around your 65th birthday. If you don’t, the late enrollment penalties could last as long as you have coverage.
Even with a qualified plan, you have some hoops to jump through regarding Medicare enrollment timing. (Your Human Resources administrator should be able to help you meet them.)
If you opt for Original Medicare, you will need a prescription drug plan with its own enrollment timing requirements and possible penalties. And if you add a Medigap plan, your greatest choice (and lowest cost) is limited to the 7-month period around your 65th birthday.
If you opt for Medicare Advantage coverage, it also has its designated enrollment schedule.
By working with a broker starting before your 65th birthday, you can get orientation on the enrollment deadlines that apply to your choice of Medicare coverage and avoid costly life-long penalties.
Can you help me choose the right drug plan?
If you opt for Original Medicare, you will need a private prescription drug plan to have those costs covered. The plan you choose can significantly impact your health care costs, depending on how many medications you need to take. And those needs will likely increase over time.
Your goal is to cover as many of your medications as possible at the least possible cost. But there is no one “best plan,” and the drug plan with the lowest premium may not cost you the least.
Prescription drug plans group medications into “tiers” that determine how much you’ll pay for each one. Each insurer selects the drugs it will cover, includes them on its “formulary” list, and chooses what tier to list them under.
Besides the cost of drugs, drug plans also include deductibles and varying reimbursement levels the higher your usage goes during the year.
If you opt for Medicare Advantage, it will likely include your prescription drug coverage. Still, you will want to examine that coverage following the same questioning applied to prescription drug plans.
You can go to Find a Medicare plan, enter your current medications and explore the possible plans. Or you can work with a broker and identify the absolute best plan for you, considering your individual needs.
Can you help me change plans or programs if my health circumstances change? Can you help me change my Medicare Advantage plan if I don’t like the one I have?
If you decide you are unhappy with the type of Medicare coverage you chose – maybe because of surprise costs – you can change it during specific enrollment windows during the year. For example, if you chose Original Medicare and prefer a Medicare Advantage plan, or vice versa, you should have no difficulty transitioning as long as you follow the proper steps.
But not all changes are possible. For example, say you want to add a private Medigap plan to your Original Medicare or change the Medigap plan you have. You may no longer have access to all plans as you did during your initial enrollment period around your 65th birthday. And now, you may have to undergo the insurance company’s underwriting process where you can be turned down, face restrictions on pre-existing conditions or have a higher premium.
You can go to Find a Medicare plan to compare Medicare Advantage, Medigap and prescription drug plans. But because brokers have expertise and experience with so many insurers, they will know what companies offer the most significant opportunities for change. This assistance could save you a lot of time, legwork – and money.
Can you help me manage my account after I’ve purchased it, or am I on my own?
You will inevitably have questions or issues with your Medicare coverage once you use your policy. And if you purchase your Medicare coverage directly from an insurer, you take your chances with the customer service employee you land on when you call.
But by working with a good broker, you can get experienced help with billing errors, Medicare appeals, pharmacy exceptions and countless other complications that affect your costs. You also have access to a valuable explanation of communications you receive from Medicare or your insurer.
Also, each fall, Medicare Advantage and prescription drug plans will issue their changes for the following year. As a result, you may see changes in copayments, deductibles, premiums, networks or drug formularies that are problematic. A broker can help keep you updated and inform you of those changes, but they can also help you decide during the open enrollment period what replacement plan is most cost-effective, based on your needs and your budget.