This month’s column will be about the value of using an agent to decide which plan is your best fit.

The website medicare.gov has a lot of powerful information inside it. The catch is that there are many configurations possible and they yield changing information. So if you have the wrong things entered, you don’t get the answer you are looking for.

For instance, each company has preferred pharmacies with lower costs. If you have the wrong pharmacy chosen, you won’t see the best available pricing. On the other hand, medicare.gov is the only database I know that can figure out when you might hit the donut hole, and what it will cost you.

It’s still not that simple. I have seen drugs that cost $47 a month on a plan, but you can get them for $15 cash with a coupon. Of course I have also seen drugs that cost $500 cash and $47 a month on a plan.

I take the time to dig into each person’s drug list and doctor list, as do other agents I know. Most often those lists determine the best fit. But not always.

I might be talking with a client and they will say, I need a hearing aid. I am aware that several plans have a hearing aid benefit and these are not available on traditional Medicare.

Each plan has a preferred provider with a discount for each device. The average person would not likely have a clue these benefits are on some plans and not others.

I’ve seen a client choose one plan over another simply because her plan offered the type of device she wanted, at a price she could afford.

Hearing aid costs range from a few hundred each to $5,000 each, the bottom line being that there are many MAPD (Medicare Advantage plan that offers prescription drug coverage) with benefits not available on traditional Medicare, and often not listed in the simplest summaries.

Agents know these details and can help you find the best.

On the supplement side, all the lettered plans are exactly the same for each letter. Costs are different from each company. Here is the catch: Once you choose during a guaranteed issue period, changing plans subjects you to medical underwriting and increased costs.

So, many companies start out low, then in a few years, jack their rates way up. Rates can change each year. Other companies cost more at the start, but utilize moderate yearly price hikes.

In general, stick with a company you have heard of, or rely on your agent to know which companies are the most stable.

Another factor is that all the companies compensate agents about the same. So, A, you don’t pay a nickel extra for an agent’s help. And B, agents are trained to help you choose what is best for you, not what is best for them.

Every year, every agent must pass a battery of tests. The first one costs $175 and to move forward, you must pass with a score of 90 percent or above. You get three tries for your first payment, then you have to pay again to keep trying. If you can’t pass in six tries, you can’t write Medicare Advantage or Prescription Drug Plans. Then each company has a battery of tests you must pass to get appointed and credentialed to be ready to sell.

Scores required on these tests are between 100 percent and 85 percent, and each company has several you must pass. The questions on these tests are not common sense sorts of questions. They are about details you actually must learn. So one thing you can count on with getting an agent’s help. They can’t be a dimwit.

The alternative is calling up a company and saying, “I want to sign up.”  The person on the phone must be a licensed agent themself, but they are not going to tell you how their company’s plan compares to others. They will just take down your info and sign you up. Your choice.

Bert Weiss is a life and health insurance agent licensed in New Hampshire and Maine, focusing on Medicare Advantage. He writes about the basic components to help the public understand how to manage Medicare insurance choices. Contact him at (603) 694-3058.

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(1) comment

Ramo R.

Mr. Weiss, thank you for this great article! Medicare's rules can be very convoluted and confusing at times. If you do not have an unbiased, licensed agent to help you navigate the Medicare waters, you will either drown in debt or with the wrong plan!







As someone who works closely with our elder loved ones, explaining and assisting can sometimes be difficult. The website I found and suggest they look into is called MedicarePlanFinder.com because it has in-depth information about everything Medicare. This article on preparing to meet with an Insurance Agent will help some of your readers:







https://www.medicareplanfinder.com/blog/medicare-insurance-agent/







Thank you again and have a great day!


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