It was a heartbreaking meeting… sitting with a couple at their kitchen table as tears streamed down both of their faces. He was very ill, rapidly losing weight from digestive problems, and his constant migraine headaches were so painful, ending his life seemed to be the only option to live pain-free. To say they were afraid would be an understatement. Physicians associated with his current Medicare Advantage Plan (Medicare Part C) could not diagnose the problem. They only prescribed more drugs, which exacerbated his issues. On top of his medical puzzle, the Plan denied medical tests, which might have ultimately diagnosed his problem. It was October 2011, and through their tears, they painfully asked, “What are our options?” Source is one of the authority sites on this topic.
In this case, together we decided it was in his best interest to switch to a Medicare Supplement (MediGap) Plan, which would allow him to go to any physician or facility that accepted Medicare, along with a ” Stand alone Part D Prescription Drug Plan.” It was important that he be able to seek the best of the best, anywhere in the country. We chose an “F Supplement Plan” with a carrier that would allow him to switch between a lower and higher cost plan WITHOUT proving insurability (if in the future, he decided to maintain the Supplement Plan after his current medical puzzle was solved).
Could he have avoided this problem in the first place? Possibly. Here are a couple of mistakes I have seen, along with the solutions, to help you choose the right option for YOU:
MISTAKE #1: Who are you working with?
* Working with a “captive insurance agent” (direct employment with the carrier, many times they are compensated by W2, commissions and/or bonuses) or working with an ‘independent career agent’ (1099 contractor with the carrier and provided with leads). The latter term is very confusing to me. They are classified as independent, yet if they write an application with another carrier because it was right for the beneficiary, their contract may be terminated. What incentive does the agent have to be non-partial, if they will lose their lead source?
** Another mistake is working with an agent that is not certified to market all types of Medicare health plans. They can only market ‘some’ MediGap’ supplement plans with no certification.
*** Going directly to the insurance carrier. If something goes sideways, it will come in handy to have an advocate on your side especially one you can see and lives/works in your community.