Should You Get a Medicare Broker?
Many people don’t realize that working with a broker can help demystify the application process and match them with the best plan for their needs — and it doesn’t cost a dime
By Dawn Papandrea
Once you reach a certain age, you start paying attention to those Medicare conversations that always seem to come up at family gatherings or social get-togethers. Inevitably, you will hear some familiar comments.
“It’s so confusing. You need an advanced degree just to understand all the terminology.”
“It’s getting more and more expensive.”
“How do they expect non-techie types to navigate all this stuff?”
“I’m turning 65 soon and I don’t even know where to begin!”
If all that has you beginning to dread your own Medicare rite of passage, take heart. Medicare brokers can help you not only navigate your initial Medicare enrollment, but continue to hold your hand through the process and any follow-up needs you may have — and the service is completely free.
But wait. How can this free service be out there, but hardly anyone you know uses it?
Dispelling the Big Myth
First things first. You do not have to — nor should you — pay for a Medicare broker’s services. Medicare brokers earn commissions from insurance carriers and plan providers and are not allowed to charge beneficiaries for their services. What’s more, the brokers work on your behalf and in your best interest. “Nobody pays me any more or any less to send a client to them — we’re carrier agnostic,” says Tracy Brown, a Medicare broker and founder of MedWiseTrust in San Diego.
Knowing that, you may wonder why everyone doesn’t automatically use a broker. Besides the misperception about cost, people often assume they will have no problem selecting Medicare plans by themselves. After all, they’ve successfully sorted through employer-based health care plans for years. But as many people come to learn, Medicare can be more complex than that.
“During your whole working life, the employer does the heavy lifting to find suitable insurance for you,” says Danielle Kunkle Roberts, founding partner at Boomer Benefits, which is based in Fort Worth, Texas, and specializes in Medicare-related insurance.
When signing up for employer-provided health insurance, you might have had to choose a plan level, or a PPO versus an HMO. Medicare has many more options, from whether to get a comprehensive, privately run Medicare Advantage plan or go with original Medicare with a drug plan and a supplement to help you pay deductible amounts and co-payments.
Who Should Get a Medicare Broker?
On top of that, people are bombarded with marketing materials, from postcards to commercials. “You don’t ever want to enroll in a plan because you saw a TV commercial where they promised everything will be free,” warns Roberts, who is also author of “10 Costly Medicare Mistakes You Can’t Afford to Make.”
Pretty much anyone can benefit from using a Medicare broker. “People make expensive Medicare mistakes because they don’t know who to trust for help,” says Sylvia Gordon, who wrote “Medicare Mama’s Guide to Medicare and Social Security Retirement” and helps run her family’s insurance broker business, The Medicare Family.
A common mistake cited by one in 10 respondents to a Commonwealth Fund survey is enrolling in a plan thinking that their doctor was covered, only later to learn that there were limitations on seeing that doctor or the doctor was not in the plan’s network.
A broker can save you hours of research and help you avoid such mistakes, potentially saving you hundreds or even thousands of dollars.
“Brokers who are not captive to one insurance carrier, ask and care about your needs, and provide on-going support can make a huge difference in your experience with Medicare,” says Dan Hardle, chief executive of Medicare Advocates, an insurance marketing organization.
This is especially true if any of the following applies to you:
• You have a complicated life situation. Let’s say you work past age 65, you’re coming off your group insurance while you’re in your home state, but then you’re moving to another state a few months later. “A broker can shop the quotes to say, ‘Here’s what’s going to be best for you in Texas, but here’s what you have to do when you go to Florida,’” says Roberts.
• You have a lot of providers and medications. “It can be really easy for you to make a mistake using the tools on the Medicare website on your own, “ says Roberts. When using Medicare’s online tool for choosing the best Part D insurance for prescription drugs, for example, you might type in the brand name of a medication instead of the generic version or ask for tablets instead of capsules. This could result in you getting an incorrect quote. “If you have more complex medical issues, or are spending more with medications, that’s not something you want to get wrong,” says Roberts.
• You might be dual eligible. That is, if you qualify for both Medicare and Medicaid, there are special products available, and brokers should be familiar with how to set yourself up in the best possible way.
• You’re not tech savvy or don’t have the time to do research. Can you compare plans on Medicare.gov, call 10 insurance companies, and read through plan documents? Sure. “But a broker can do it all in less time, explain complicated terms in plain language, and catch things you might overlook, like hidden costs and coverage restrictions,” says Gordon.
State Health Insurance Programs (SHIPs) are another resource that Medicare beneficiaries can turn to for free, personalized health insurance advice. SHIPs help individuals compare coverage options and plan costs and are not connected to any insurance company or health plan.
Contacting your SHIP can be an excellent starting point, says Roberts, but you won’t get ongoing support as you would with a broker. What they do well is help you sort through the options available to you, in a non-biased way, she adds.
What a Broker Can Do for You
If you decide to move forward with a Medicare broker, you may be pleasantly surprised at the breadth and depth of services they can offer you.
• Get you up to speed on the basics. If you don’t know your Part B from your Part D, for example, or the order of events to get signed up for Medicare the first time, your broker will start there. “They should explain the difference between Medicare and Medigap, and Medicare Advantage and how they differ, what it covers, and what it costs,” says Roberts.
• Help you choose a plan. The first big decision is whether you want to go with Original Medicare plus a Medigap supplement plan and Part D prescription plan. Or, if you want to choose more of an all-inclusive Medicare Advantage program. If you go with the latter, then you’ll have to choose from a variety of network plans, which change yearly.
When it comes to comparing plans, a broker can also help you look beyond just cost. “People think they have to buy the most expensive plan because they think $160 a month is way better than the one for $20 a month,” says Brown. “But buying the most expensive one could also be the fastest way to waste your money.”
A broker can also help perform due diligence like calling your doctors’ offices to confirm that they do in fact accept a particular plan, since online directories are not always up to date or accurate, says Roberts.
“Brokers also know which plans have better customer service and which ones deny the most claims — something you won’t find on Medicare’s website,” says Gordon. And while the government rates Medicare Advantage plans, it does not rate Medicare Supplement plans. “We’ve worked with these plans for 30 years,” she adds, “so we can speak about each of them from experience.”
Problems that May Arise
Helping you pick a policy is just the first part of a broker’s job, says Roberts. They also can help you navigate questions and issues that come up. Some examples:
• You might get a bill in the mail and don’t know if you should call the insurance company, Medicare, the lab or the doctor’s office.
• You get a late penalty from Part D and you want to file an appeal to get that penalty waived.
• You have a Medicare Advantage plan but aren’t sure how to find a dentist or file a claim.
“We don’t run from problems,” says Brown. “We’re here when people have questions, and we teach them to solve some of the easy ones themselves.”
Signing up for Medicare is not a one-and-done process. Plans can change each year, and so might your health status, including the medications you take. Moving to a new state can also affect your Medicare Advantage plan options. That’s why maintaining an ongoing relationship with your broker is key. “They will update you each year of upcoming changes and help ensure you stay in the best available coverage,” says Hardle.
How to Find a Medicare Broker
Like any other service provider, choosing the best broker for your needs requires some upfront research on your part.
• Start with referrals. Talk to friends or family, or your trusted financial professionals or health care providers.
• Go online and search for independent brokers. You can use an online directory like the one from the American Association for Medicare Supplement Insurance or see if your state has a search tool (for example, there is one from New York State).
• Read reviews. “A good broker who really knows what they’re doing should have thousands of five-star reviews. Take a look at what their customers are saying about them,” says Roberts.
As for when to start looking for a broker, start researching Medicare about a year before you plan to enroll and read broker reviews, says Gordon. If you are already on Medicare but think you could benefit from a broker’s help, remember that you can change plans every year in the open enrollment period from October 15 to December 7. Try to book your appointment a few weeks ahead of time.
Questions to Ask a Potential Broker
• How long have you been doing this and how many clients do you have? Ideally, you’ll want to choose an experienced broker who has a long track record of satisfied customers.
• How many plans do you represent? Look for brokers who have a dozen or so plans in every state that they work in, says Roberts. If they represent just one plan, then they are health care agents, not brokers.
• Are you available for assistance after I choose a policy? “If they tell you to call your insurance carrier, that should be the end of the line,” says Roberts.
Follow Your Gut
Finding a broker with whom you have a good rapport is important, so don’t hesitate to look elsewhere if you don’t click. Also, watch for red flags, such as feeling you’re being pushed in one direction or a broker isn’t being responsive to your questions.
Most important, do not work with agents who attempt to charge you extra for a consultation or meeting, says Hardle. “Agents get paid by insurance providers in the form of commission, if they enroll you,” he adds. “They should not be getting a dime of your money.”
This article was previously published in www.nextavenue.org, a nonprofit, digital journalism publication produced by Twin Cities PBS (TPT).