Highlights from this week’s conversation include:
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Michael Hughes 00:07
Hello, and welcome to this episode of Ask a NaviGuide, which is part of the Abundant Aging Podcast Series. I’m Mike, your host, and on the show, we help families and really everybody tackles subjects in aging and family caregiving, which can be stressful to work through. And we do this with the tips and advice from the United Church Homes NaviGuide team. Our NaviGuides have decades of experience helping families work through these issues, and we want to help everyone everywhere, age with abundance. So we’re lucky to have Robin with us today. And today we are going to talk about Medicare brokers, Medicare Advantage brokers. On an earlier podcast, we talked about the basics of Medicare medical care Supplement insurance and Medicare Advantage plans. And as I understand it, when you are looking at a Medicare Advantage plan in particular, very often it’s helpful to work through your choices with the help of a Medicare Advantage Plan broker. So Robin, I guess the first question is, can you just tell us a little bit more about what a Medicare Advantage Plan broker is? Or does it?
Robin Peconge 01:10
Yes, so that is my background. Although being a navigator is certainly my favorite job that I’ve ever had, I was an insurance agent for senior health care from 1999. Until about two years ago, I still carried a license even though I didn’t sell insurance anymore. And so I always was a broker because that was important to me, I never felt that being with one company only would allow me to provide the needs that everybody has. So a broker simply means that you’re contracted with more than one company so that you can offer a broader range of services. One misconception with Medicare Advantage plans that people think is because oftentimes, there’s no premium or very little premium. So I think the client might believe that the agent really doesn’t get paid very much either or something along those lines. But in fact, they do make a lot of money off Medicare Advantage plans. So again, you don’t want someone that is just with one company or has a preference for one company because although ethnic, ethically they’re not supposed to, they could be motivated by what their reimbursement is.
Michael Hughes 02:18
So on one side, like I imagine that if you know, let’s say I turned 65. And now I have the opportunity to be part of a Medicare Advantage plan, Medicare Advantage plan. Basically a Medicare if I’m an employer plan, you know, I pay premiums through my paycheck to my employer to or the premiums for a Medicare Advantage plan. Typically lower than what I would be paying with an employer plan.
Robin Peconge 02:45
Oh, my goodness, yes. Oftentimes, there are not a premium is not a premium, especially with the HMOs
Michael Hughes 02:50
Oh, wow, I didn’t know that. Okay, so okay, so now, it’s actually a good thing. I’m going to have more, you know, maybe more disposable income, depending on my situation. But you can have Medicare Advantage plans, but there’s, how many Medicare Advantage plans are there out there?
Robin Peconge 03:04
I would say 10, that is the most common that we see. I mean, you know, all over the country, there might be smaller companies that develop their own plans, they typically don’t last very long, or they get bought out by a bigger plan, but I would say 10 That you would see for the most part. And some of those larger plans, again, might have different plans within themselves. So they could have a PPO and HMO. And then within those, you know, sometimes they have a certain plan, but then they might tag on gold because it has extra benefits. So that type of thing.
Michael Hughes 03:37
Okay, so Okay, so I’m imagining myself going to the computer and signing up for a Medicare Advantage plan. And then I’m seeing that the 10 these are all names that we know we probably had covered like the United Humana Cigna plans, you know, things like that. So yeah, and he’s the third in the same business, providing a Medicare Advantage plan. And so I go to the computer, and I type in my county I search, I basically see what the you know, what the plans are available in my area, and I’m gonna have probably, maybe two or three big carriers, let’s say, and then maybe some other plans that are new to me. And each of them I’m going to have PPO, HMO, gold, silver, platinum plan, whatever, it might be so valuable. Yeah, okay. So, this is where a Medicare Advantage Plan broker could help. Right? And how would I find a Medicare Advantage Plan broker? Or do they find me?
Robin Peconge 04:31
You can find almost every one if you go, let’s see if I can find it here. Yeah. So the ship is the State Health Insurance Assistance Program. There is a link that maybe we can list that people can go to to find their local ship office. They are trained professionals in these they can also educate them on maybe what is the best plan for them and then also help find them an agent that can help them so that’s certainly what I recommend because those people are non biased. They’re trained and they can really give good advice.
Michael Hughes 05:03
Okay, so just say that again. So the place to start would be to find yourself a Medicare Advantage Plan broker similar to the ship State Health Insurance Plan website. And oh, and I’ve got a website here, www.shiphelp.org. Okay, okay, great. And okay, so now I found myself a Medicare Advantage Plan broker, and how would he or she, he asked me, if you would just sort of set me up and say, Okay, here’s, here’s my short list of recommendations for you. Okay?
Robin Peconge 05:34
Well, if they’re a broker, hopefully, they’re also going to present Medicare supplement plans, because that’s always the option. It’s not always just going straight to a Medicare Advantage plan. Okay. So when they sit down with someone, really, they do want to ask some personal questions, and they want to see you know, what their income is, what type of savings they have. They have accessible disposable income available. So those are the types of things that you want to ask as well, you want to see what they’re looking for? What do they want out of that plan? Would they rather just pay a premium and not worry about it and not have to worry about having any out of pocket? Or would they rather have more disposable, no premium each month and have the possibility of some out of pocket? Should health issues arise? So really, those are the things you want to look at? And then once you have those answers, you can narrow it down,
Michael Hughes 06:20
always seems to be the trade off, right? I mean, lower premiums more out of pocket if something happens or higher premiums. Yeah. And you said something earlier about qualification? So if they’re looking at income, right, would a Medicare Advantage Plan broker also say, Well, look, you know, you might, because of your income and your situation, you might be able to get Medicaid that or or you might be able to be what they call, like I said, both Medicare and Medicaid with a with a good broker, a good broker would would would would kind of give you that option as well. Right?
Robin Peconge 06:47
Certainly. And because you can get a richer Medicare Advantage benefit if you’re considered what’s called dual eligible, which is what that is,
Michael Hughes 06:55
or Medicare Advantage plan brokers, are they Professionally licensed, should you look for any sort of a certification or things the broker might have
Robin Peconge 07:02
just might have a senior advisor certification, but in general, they have to go through a lot of training every single year to be certified to represent companies to sell Medicare Advantage plans. So they and even if you’re a broker, you have to do that with every single company that you’re licensed with. So that usually starts in the summer, because open enrollment, we’ll start in October, so they have to go through a lot of training.
Michael Hughes 07:28
Interesting, right? Because there is that enrollment period, right? So you’re because I always see the commercials, I always see the commercials in like September and October, and they’re talking about, you know, these kinds of new benefits and Medicare Advantage can provide like home care and exercise and things like that. And, and then you’ll call and that’s another way people kind of, because they get sold to right? I mean, they get your letter in the mail, you’re gonna get all this stuff, which is fine. They’re allowed to advertise that’s, that’s okay. But when you’re looking at choosing a broker, what sort of things should you be factoring in to say, maybe this could help me out more than this one, or this person might have more of my best interests at heart? I think they all get into this business, because you do have people’s best interests at heart. But, but just to give people more put in so with, with the person that might be working with,
Robin Peconge 08:16
I think you could just get a feel if they just seem to be so stuck on one particular plan from the get go. That would be a red flag. If they’re not even really asking you questions that I had mentioned, as far as your income, what it is that you’re looking for, what do you want out of your plan? How often do you see the doctor if they’re really not even asking those questions? That would be a red flag that they came there, you want to give me the one plan? And that’s it.
Michael Hughes 08:41
Okay, so I guess so. A Medicare Advantage plan broker should be interested in you as a person. Yes, they should be interested in you and your best interest because my, I guess what, you know, do Medicare Advantage plan brokers get paid more if you stay on the Medicare Advantage plan that they helped you choose for for longer? You choose? Because I know you can change every single year. Right. So but if you stay on a plan for longer than that, that fits the Medicare Advantage plan broker, right?
Robin Peconge 09:12
Well, I guess that’s a tough question. Because it’s less of a headache. Because if they just are getting a straight premium from this person, but then they switch it up every year, bookkeeping wise, you know, if they’re self employed, or even working with a company, because most workers are self employed, you know, it can be a hassle. So it certainly would be easier if they stayed on the same plan for a long period of time. But even then, the person should be reaching out yearly. A lot of people in this are where the person needs to advocate for themselves. They really should look at that plan every year. Oftentimes, I hear all the time. Well, it was great for me this year. So why would I change? Every year those plans change, you really need to plug in those same factors. You need to plug in what your medicines are, what your network is, you need to look at all of that to make sure that the plan that you’re in is still the best one for you. And if you’re not Feeling new every year doing that, then that’s not good either.
Michael Hughes 10:03
Okay, so a good broker will keep in touch with you, sir. I’m going to say as a broker is going to ask you about you and be interested in you, they’re not going to just push a single plan, they’re not going to be too salesy. This is a relationship that they’re trying to build, right. And they want to build this relationship for the long term, because whether you stay on your current plan, or choose to, to go to another one, I mean, that’s, that’s, that’s their job. That’s the response. I mean, so I guess, another sort of thing you should consider is like, if you’re happy with your Medicare Advantage plan, and your broker contacts you yearly, and then they seem to be putting a hard sell in for a new type of plan, is that a red flag?
Robin Peconge 10:43
It might be you, you’d want to know why. Because sometimes it might be that they have better transportation, better said grocery benefit over the counter benefit. But although those are nice, and I know that people need that, you want to make sure that your medical needs are going to be covered to the best for you.
Michael Hughes 11:01
So okay, so that’s interesting. So they’re going to contact you, it’s a relationship that they’ll contact you at, you know, through the life of your experience, as long as you wish with the Medicare Medicare Advantage program. They know that it’s in your best interest to switch from one plan to the other. And I guess what are the questions? So if they are recommending a certain type of plan, we’ve talked about doctors being a network covering medical needs, that sort of thing. What are the other questions you should ask your Medicare Advantage plan broker when they’re saying this might be a good plan for you?
Robin Peconge 11:38
Okay, travel, if that person plans on traveling in their retirement age, that’s a biggie. They want to know what type of coverage is available. If they travel, and you know, PPO, that’s where you might look at the differences between PPO versus HMO because if you do travel, most of them even HMOs have emergency benefits. But again, it’s usually for an emergency room or urgent care facility. It’s not for any length of stay in a hospital. But if you have a BPO, you’re going to know, you’re gonna have coverage. Regardless if it’s in an in network or out of network. Got it?
Michael Hughes 12:13
Got it, got it. Got it. And let’s say it’s open enrollment period, and you’ve chosen a plan. And then oops, you know what, I liked that other plan, or you’ve already signed the paperwork and all the rest of it. I mean, is it okay to go back to your Medicare Advantage plan broker and say, You know what, I think if something just came to me, I shouldn’t feel bad about doing that. Right. I only have a certain amount of time to do that.
Robin Peconge 12:36
Right? Okay. Well, you have it in between October and December, the first of December, but then after the first of the year, and you have the first three months to make one change.
Michael Hughes 12:45
Okay, that’s great to know. So, right, this is because you’ll be on the plane, and you’ll experience it right. And you’ll have a chance to say oops, I didn’t know this. I didn’t figure that. So the open enrollment period is from October through December. And then January, February, March, is a period we can say, Nope, I want to change to something else.
Robin Peconge 13:02
Yes. Also, if you have state assistance, you actually can change once a quarter, right, and I state assistance where they’re actually called Special Needs Plans. So if you have a chronic illness, or if you have state assistance, there’s lots of reasons why you might have what’s called a Special Needs Plan. But usually, if you have those, you can switch more often, if needed. I certainly don’t recommend doing that once a quarter. But if you receive a notice in the mail that says your insurance company because they must notify you at least 30 days ahead of time if they’re not going to cover medication anymore. That would give you time to get with your broker, find a new plan and then it would become effective. The first step is the following month.
Michael Hughes 13:38
Okay, that’s great to know. So this is for the Special Needs Plans you’re talking about. Right? So because that’s a scary scenario, right? You’re on medication, suddenly it’s not covered anymore, but there are rules around that. Yes, they can’t just they can’t just drop coverage, not tell you not give you time to change, click
Robin Peconge 13:56
or if you move, that’s another special situation from a county that could just be within the same state but to a different county, you’ll have to switch to a different plan.
Michael Hughes 14:04
Well, this has been terrific Robin, I really appreciate you sharing this knowledge with us. It’s terrific stuff. We could talk for a long time about this, but it’s time to wrap up this episode of Ask a NaviGuide. And thank you to our listener for listening to this episode of ask a NaviGuide which is a part of the Abundant aging podcast series brought to you by United Church Homes. If you liked this week’s show, please share and subscribe, I will always say that. And for more information about ACH and the NaviGuide program, please visit www.uch.org. And for more information about United Church homes, please visit www.unitedchurchhomes.org. We’ll see you all next time!