Ask the Medicare Specialist

There is no question today because I want to introduce my next column series, “New to Medicare,” which will be written with the goal of helping those who will be going on Medicare for the first time. According to AARP, every day in the U.S., 10,000 people turn 65. Thousands more enroll in Medicare after their 65th birthday, while others are awarded Medicare before turning 65 due to being granted Social Security/Disability. Although everyone currently on Medicare can gain knowledge during the next several weeks, the series is specifically designed to educate anyone who will be going on Medicare Part A, B, or both, in the near future. I will go through the process from the very beginning stages which begin several months prior to enrollment in Original Medicare itself, what needs to be learned and considered before making one’s initial choice of either a Medicare Advantage or Supplement plan, actions that need to be taken annually after making that decision, and everything in between.

I will be providing a tentative schedule of questions and topics that will be addressed during the course of the series, which will start next week.

First, I want to get into the history of The Health Insurance Store, an overview of what we do, services we provide, our business model, and mission.

13 years ago, I decided to make a career change and was recruited to sell individual health and Medicare insurance for a company named MEGA Life and Health. At the time there were approximately 40 million Americans who had no health insurance as well as over 30 million active Medicare beneficiaries with hundreds of thousands more enrolling each year. I saw a great opportunity after hearing those figures and dove headfirst into my new career.

After spending a few months getting my license, training, and driving all over Pennsylvania on house calls, I discovered that MEGA, the only company I was able to offer to prospective clients as a “captive” agent, wasn’t competitive. They also didn’t have a good reputation for disclosing the fine print in their policies or paying claims in a consistent and timely fashion. After 25 years in sales and consulting, one thing I know for certain, if you don’t believe 100% in the product or service you represent, success and happiness at the job can never be achieved.

In addition, I found it uncomfortable selling policies at kitchen and dining room tables, which at the time was almost 100% the norm in the industry and still is extremely common. It never felt right getting a signature, packing up all my materials, and leaving someone’s house with the client’s last view of me being the back of my head and taillights.

Although my tenure with MEGA didn’t last long, I quickly realized the public had a huge need for agents with expertise, information, and guidance regarding health insurance, especially Medicare, as Advantage Plans were in their infancy. I also asked myself why is there an agency selling homeowner and auto insurance on practically every corner in every town, but literally not one brick-and-mortar health and Medicare office anywhere in Western PA? I decided there should be and The Health Insurance Store doors officially opened on April 1st, 2008.

Just having an office wasn’t my only goal. I wanted to be a onestop shop where people could compare Medicare Supplements, Advantage Plans, and Part D as well as individual and employer health insurance from every competitive company on the market, ensuring unbiased advice from local agents. We get to know our clients, ask questions, listen to the answers, and then find solutions, matching them with the best plan and company based on an individual’s health, concerns, needs, and budget. Our mission is to advise clients based on what’s best for them 100% of the time, regardless of commission. It’s extremely common for us to let people know they’re best to stay with the plan they already have or choose one provided by a company they work for or retired from rather than a plan we get paid to provide. We’ve advised thousands of people for free and have never once charged for a consultation.

Lastly, and most importantly, I wanted to provide outstanding customer service and support to every client that purchased a policy at The Health Insurance Store. It’s not enough to help people choose a plan when they initially go on Medicare or come see us for the first time. So, as we grow, I continue to hire dedicated staff who advocate for our clients whenever they have premium issues, medical or prescription claims denied, receive erroneous bills, or have any other problem or questions. We don’t expect our clients to fight with insurance companies or providers. That’s our job and we’re extremely good at it. We make calls with, or for, our clients to the insurance companies, billing departments, medical providers, Social Security, and Medicare. I continue to look for ways our clients can be better served and recently created the position of Prescription Drug Caseworker and hired a good friend, Tony DiRoma, one of the hardest working and detail-oriented people I know to help our clients find financial relief when they’re paying high prices for medications in the Doughnut Hole or taking extremely expensive life sustaining medications. As with consultations, we do not charge for these services.

The following is a tentative schedule of topics for the next nine weeks.

Part 1) When do I need to start thinking about Medicare and my plan options? What steps need to be taken to enroll? When does Medicare Part A and B go into effect?

Part 2) Do I have to enroll in Medicare when I turn 65 if I’m still working? Are there penalties for not doing so? Who should and shouldn’t enroll in Medicare?

Part 3) What does Medicare Parts A and B cover? What are my choices in Medicare Plans? Do they differ as far as coverage, access to doctors and hospitals, and how claims are approved and paid?

Part 4) What the pros and cons of both Medicare Supplements and Advantage Plans?

Part 5) Who is best to choose an Advantage Plan and who is best on a Supplement?

Part 6) What are the most important considerations when choosing an Advantage Plan? Which plans and companies are the best?

Part 7) What are the most important considerations when choosing a Supplement and what and plans and companies are the best?

Part 8) How are prescriptions covered for those on Medicare? What is the Doughnut Hole? Why are drugs more expensive for those on Medicare?

Part 9) After I pick my plan for the first time, is there anything I need to do? Do plans change year after year?

You will be able to find copies of the columns shortly after they appear on our website and Facebook page. You also can listen or watch my podcast and webcast versions of the columns which can also be accessed via the website. Please feel free to reach out to myself or one of our offices with questions or to schedule an appointment. We are employing all safety precautions in our offices including taking temperatures, wearing masks, and have installed plexiglass at desks and are meeting face to face with those comfortable doing so. We also offer phone and Zoom appointments as well for those who wish to take more caution.