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Medicare Plans for the Life and Annuity Specialist

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What You Need to Know

  • If you already sell Medicare plans, you know all of this.
  • If you don't sell Medicare plans, you still need to be able to talk about them.
  • One thing you could tell clients: Try a private health care marketplace.

If you’re in the business of helping seniors make sound financial decisions, and you’re not a health insurance agent, you know that health care can be a big pain point.

It also can be a big opportunity.

At its most basic level, Medicare provides a lifeboat for people who are retiring, offering affordable health insurance to people entering a stage in life when health care is most needed.

Medicare, however, is anything but basic. It’s a complicated system, but, with a little effort, you can help your clients sail into retirement with peace of mind that comes with affordable and efficient health coverage.

Whether your clients are asking you questions about Medicare or you’re researching on their behalf, here are some things worth discussing.

“Which Medicare Program Is Right for Me?”

The federal program known as Original Medicare provides a pretty amazing value for U.S. citizens: If your clients pay Medicare taxes for at least 10 years through employment, then, when they turn 65 years old, they get hospital insurance (Medicare Part A) without paying a monthly premium. And regardless of your clients’ work history, clients also can enroll in insurance for their outpatient medical needs (Medicare Part B) for a reasonable monthly premium.

While it’s worth noting that Part B premiums are rising at historic rates in 2022, the standard monthly premiums for Part A ($0) and Part B ($170.10) still provide a wealth of coverage for the price point. Collectively known as Original Medicare, Parts A and B allow your clients to see any doctor or go to any medical facility that accepts Medicare. And most providers across the nation do accept Medicare.

Medicare Advantage, the private-insurance alternative to Original Medicare, offers the same coverage as Parts A and B but also additional benefits like dental, hearing and vision coverage, and allowances for over-the-counter supplies — sometimes with no additional premium.

How is that possible?

Medicare Advantage plans generally require that policyholders see doctors or visit hospitals that are within a defined local network – and that’s at the heart of why Medicare Advantage plans can add more value without adding costs. Policyholders, in exchange for addressing their health care needs within a managed network of providers, can get more bang for their buck.

That being said, when it comes to Medicare Advantage, there’s no such thing as a one-size-fits-all plan. Every plan and every person looking for a plan is different, so visiting a private health care marketplace that offers a wide range of plans can be a great place for your clients to start.

“What’s My True Bottom Line?”

Monthly premiums are the most eye-catching costs for people new to Medicare, but they’re not the only costs to consider. And, often, premiums aren’t even the most important costs to consider.

While other Medicare costs aren’t truly hidden — they’re spelled out beyond the fine print — they sometimes aren’t given proper consideration before it’s too late.

The cost structure for Original Medicare is universal. Your clients pay the same premium as every other American in their financial position, and they’re responsible for the same percentage of out-of-pocket costs when they use their coverage.

With most Part B claims, for example, after a client pays the standard annual deductible ($233 in 2022), Medicare pays for 80% of covered services and the client pays 20% out of pocket.

However, your client doesn’t have the protection of an out-of-pocket maximum. The sky’s the limit when it comes to how much the client will pay in a given year — a sobering scenario if the sky falls in terms of the client’s health.

By contrast, while there’s very little that’s universal about Medicare Advantage plan costs, all Medicare Advantage plans do feature the protection of an annual out-of-pocket maximum. If your clients choose Medicare Advantage for their health care needs, they can plan for the absolute maximum they’ll have to pay for their covered services in a given plan year.

Does that mean Medicare Advantage is always the way to go? It does not. Every Medicare Advantage plan has its own unique cost structure, and perhaps a particular client of yours would benefit instead from adding a Medicare supplement plan to help cover some costs not covered by Original Medicare.

Helping your clients dissect those details — based on your knowledge or on advice from an expert in the field — is crucial to providing them with peace of mind.

“How Do I Get the Most for My Money?”

Some things related to Medicare are best left to the experts, but some things that impact dollars and cents are simply common sense — if clients have the good sense to look into them.

You would be surprised how many people on Medicare miss out on maximizing their benefits simply because they lose track of their coverage.

For example, clients may have felt excited to learn during the process of switching from Original Medicare to a Medicare Advantage plan that their new benefits include $800 a year to spend on over-the-counter medicines and health care supplies. But in the process of switching, clients also learn about a dozen other things, and, three months later, they’ve completely forgotten about the over-the-counter benefit.

That’s why marketplaces can be useful guides through Medicare. Once someone purchases a Medicare Advantage plan from GoHealth, for example, our TeleCare team becomes their concierge of sorts, steering them through the onboarding process and then checking in with them while they’re on the plan to make sure they’re getting the most out of it. We help members schedule their first doctor’s appointment, for example. And while we’re at it, we’ll remind them if their policy offers them a complimentary ride to and from the doctor if they need it.

A private marketplace may be able to work with an agent, broker or financial planner to support the client’s efforts to get and use Medicare coverage.

Every once in a while, offer to take a look at each client’s Medicare policy, or at least have a conversation about it. A healthy dialogue can lead to a wealth of discoveries.


Simmons-Kelderman (Photo: GoHealth)Lamaretta Simmons-Kelderman, is vice president of telecare at GoHealth, a company that runs a private Medicare plan marketplace.