Steve Wilson, Medicare Insurance Broker

Navigating Annual Enrollment Period Successfully

July 19, 2024

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What are the reasons why I should work with a Medicare agent?

Answer: A Medicare broker brings knowledge and experience to work with a prospective client. When I meet a client, the first things I let them know are (1) that there is no cost to work with me, and that (2) I work with all of the carriers in the market and my job is to help them identify a plan or an option that will serve their needs.

I bring nearly 30 years of experience to the table when I am getting to know someone and am extremely familiar with the transition from employer group plans to Medicare. The transition can feel overwhelming and my goal is to always help the consumer feel at ease to make the transition smooth - AND dare I say enjoyable.

Lastly, my hope is to build a lifetime relationship with everyone I work with. I treat each of my clients like they are a my parents, or a close relative and want to build and earn their trust.

Are Medicare Advantage plans really "free," or is that just clever marketing?

Answer: I think Medicare Advantage plans can be a great option for many consumers but labeling them as "free" is definitely clever marketing.

If the Medicare Advantage plan has a $0 premium, I describe it as such and then walk through all of the benefits with the consumer so that they understand ho the plan might have cost shares they would be responsible for.

Unlike Medicare Supplement plans, most Medicare Advantage plans offer benefits that are not covered by Medicare. Namely, dental, vision, hearing, and over the counter allowances. I always ensure that when going through the benefits, we discuss all of them and the word "free" is something I do not use. In fact, Medicare prohibits a broker from using the word free.

I keep hearing about free preventive services with Medicare. What exactly is free and what will I still pay for?

Answer: Medicare covers preventive services that per the Medicare.gov website are identified as exams, shots, lab tests, and screenings. They key benefit that Medicare does not specifically cover are Routine Physical Exams. The majority of Medicare Advantage plans do cover a routine annual exam and typically they are a $0 copay.

It is really important when setting up a routine physical exam with your doctor or provider that you have a good understanding of what services will be provided. For example, lets say your Medicare Advantage plan covers the routine physical exam which would include all of the $0 copay screenings, shots, and lab tests covered by Medicare. Those items would be a $0 copay. I never use the word free and Medicare does not allow a broker to ever use the word free.

It is common though that a good provider will ask you if there are other things you would like to discuss during your visit. Those items could be outside of the routine exam and you might have a copay for that portion of your visit. Lets say for example that you wish to discuss shoulder or knee pain you have been having. Those discussions are generally beyond your preventive $0 copay services and could trigger a copay for you.

In conclusion, its important to know that Medicare encourages all consumers to stay healthy and obtain the preventive services that have a $0 copay. It would only be services beyond or outside of the routine physical exam, tests, labs, screening that you might see additional costs.