Turning 65 can be strenuous, because you must make choices you are not familiar with. The health insurance provided by employers, while it may look the same, plays by different rules. If you don’t know the new rules, it’s easy to make the wrong choice or be misled. But it doesn’t end after your Initial Enrollment Period (IED). Each year things change, and you must stay on top of those changes to make sure:
- You have the coverage you need for your specific needs, and…
- That you can afford the copays and coinsurances, if any.
So, here are four (4) tips to help you make solid choices that will serve you well.
1: Find a Fiduciary Agent
You don’t have to do this on your own. Many people try to by calling Medicare and Social Security. However, keep in mind that CMS (Centers for Medicare and Medicaid Serves) and SSA (the Social Security Administration) are behemoth organizations. While they strive to provide the best service possible, they are not designed to provide one-on-one consultative services. That’s why Medicare Insurance Specialists exist.
You want to find your own agent. I believe many people think that an agent costs money, like a realtor, for example, which is why they try to do it themselves. Agents charge you nothing. Their job is to provide you with the information, so you can make the best choice. They do not choose for you; they only guide you. Then when you choose, they help you enroll – period.
When choosing an agent, there are two kinds of agents: captured agents and contracted agents.
- A captured agent represents the insurance company that hired him or her.
- A contracted agent is not captured by any carrier, but contracts with multiple to have a well-balanced portfolio from which to dip into, to better serve your needs.
While both agents will do their absolute best to help you, a captured agent can only offer you what his or her carrier has. While the contracted agent, being a fiduciary, is bound by law to look only after your best interest, and no one else’s. By having a portfolio of companies to chose from, they find the right fit for your needs.
2: If You’re Turning 65, Do an Assessment. If already on Medicare, Do an Annual Assessment.
Before choosing any plan, you need to look at everything:
- Family health history – are there any conditions you feel you may inherit from your parents or grandparents that you want to make sure you have coverage for?
- Your current health condition – do you have any conditions like diabetes, prior bouts with cancer, autoimmune conditions like lupus, sarcoidosis or other illness that would require specialized ongoing treatment?
- Your finances – how much do you earn annually and how large is your household? You may qualify for special programs that will help pay for many services, saving you thousands of dollars annually.
- Lifestyle – do you travel a lot or are you a snowbird (live up north during the summer and down south in the winter)? You may need coverage you can take with you anywhere.
The answers to these questions determine which plan is best for you. Should you go with an HMO, PPO, a D-SNP, C-SNP or MediGap plan. While all those acronyms may not mean much to you now, your agent will make sure you understand each so you can choose the most beneficial one.
Just because you did an assessment the first year you were eligible, doesn’t mean you are done. You want to an annual assessment. Your circumstances may not have changed, but plan benefits may have changed.
You will want to find out if next year’s plans have removed any benefits, raised copays, added benefits you would like to have, etc. If nothing has changed, great! If things have changed, your agent can help find the right fit, again, and help you make the switch.
3: If Your Circumstances Change During the Year, Do Another Assessment with Your Agent
Life happens. We make the best plans then circumstances make you have to change them. You might get diagnosed with a new condition (diabetes, heart disease, an autoimmune condition). Maybe you moved to be closer to family so they can help you or you help them. Your spouse passes away and your income drops. You are now in an assistant living facility. Whatever the reason, your needs have shifted.
The first thing you want to do is call your agent. Keep in mind that since your agent helps many people, he or she may not only know what plans and programs can help, but might also have knowledge of other resources he or she can share.
For example, being a veteran, I am currently helping a beneficiary facing a crisis by not just guiding him on plan options, but also providing some guidance on how the Veterans Administration, VFW and DAV, and local veteran’s organizations can help as well. Remember, your agent is a person who cares, has family, has probably had challenges in the past and understands what you are going through. We are not robots; often, we try to help beyond just insurance.
4: Once You’ve Found a Good Agent, Stay with Him or Her
When you found your agent, you went through a process of explaining everything to him or her. Being a fiduciary, you have agent/client confidentiality and nothing you say can be disclosed to any other party with the exception of your insurance company or Medicare. During the process, he or she has come to know you and your unique circumstances. When life happens, your agent will consider all the moving parts in your life to find the best solution. If you change agents, you will need to go through that entire process all over again.
Sometimes you have no choice. You moved out of state and your agent is not licensed in that state. Your agent is no longer available, due to illness or death. But unless there is a good reason for changing agents, you want to avoid doing so.
Medicare is a wonderful benefit you’ve earned through many years of hard work. You want to make sure you understand it well, so you can maximize your benefits while lowering your cost. The best way to do so is by finding an experienced Medicare agent who can explain it well and will help you through the bureaucracy that accompanies all government programs. If you do so, you will reap the rewards, save money, and have peace of mind – not to forget, often find a new friend.
If you live in Florida or South Carolina (and soon to be Texas), and you’re looking for an agent. Give us a try. Contact us. We would be honored to be your agent.
