America's Benefit Specialist November 2022

MEDICARE MATTERS

Editor’s note: This article is from the October Medicare News emailed to all NAHU members.

MEDICARE ADVANTAGE VS. A MEDICARE SUPPLEMENT PLAN: HELPING NEW BENEFICIARIES DECIDE

by Margaret Stedt, LPRT, CSA

The first step is to explain about Part A and B of Medicare by reviewing the different parts of Medicare. Note that there is no maximum out-of-pocket for the copay ments, deductible and coinsurance amounts of Medicare. Agents should review the monthly cost for Part B and IRMAA and that it is typically adjusted each year. The Income-Related Monthly Adjusted Amount for Part B and D may be found on www. medicare.gov. The next step to is review the two main ways to get Medicare coverage: (1) by re maining on Original Medicare and enrolling in a Medicare Supplement (Medigap) Plan, or (2) enrolling in a Medicare Advantage Plan (also known as a Part C of Medicare). Again, I use the chart provided on page 7 of Choosing a Medigap Policy to review the

Many times, beneficiaries insist that they want a PPO plan like their current coverage. This needs to be addressed carefully as you explain the difference between a Medicare Supplement Plan and the various types of Medicare Advantage Plans. In the senior products arena, a PPO is a type of Medicare Advantage Plan, never a Medicare Supple ment Plan. Agents need to able to explain the difference between the Medicare Supple ment Plans (Med Supps) and the Medicare Advantage (MAPD) Plans. I begin by using Section 1 of the CMS booklet Choosing a Medigap Policy (CMS Product No. 02110) that is typically provided with the Medicare Supplement Sales Kit. I find the chart on page 7 helpful for the beneficiary to take notes on.

Agents play a key role in assisting new Medi care beneficiaries in understanding what types of coverage and plans may best fits their needs. Medicare beneficiaries have an initial learning curve with new terminology and coverage options that can be confusing. When meeting with Medicare beneficia ries for the first time, start by asking what type of coverage they are on now and how it is working for them. Who are their doctors and do they have relationships with spe cialists in several medical groups? Are they comfortable with the idea of a referral pro cess? Do they travel both inside and out of the country? Is prescription drug coverage important to them and have there been any challenges? These questions will help you in explaining the options and to determine which plans to consider.

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