Medicare Questions & Answers: Agent Interview
Agent Interview Q&A
Showing 40 questions
What do you like most about being a Medicare agent?
I really enjoy helping seniors navigate Medicare, as it can be quite confusing. Not only do I help my clients with applying for Medicare, but I also take pride in getting them into the plan that best suits their needs, regardless whether it is an Medicare Advantage or Medicare Supplement plan.Knowing my clients enables me to determine if they qualify for any additional benefits through the state. I am also proficient at helping my clients solve issues that may arise, as I have access to solutions outside of their plan.
My clients are part of my extended family!
What do you enjoy most about working with Medicare clients?
I truly enjoy working with Medicare clients because it gives me the opportunity to make a meaningful difference in their lives. Medicare can be a complex and overwhelming monster, and I take great satisfaction in helping my clients navigate their options with clarity and confidence. I thoroughly enjoy clarifying Medicare for my clients, ensuring they fully understand their choices, and guiding them toward the best coverage for their specific situation. There's nothing more rewarding than seeing the relief and peace of mind that comes when seniors feel secure in their healthcare decisions. My goal is always to provide personalized, thoughtful service so that each client gets coverage that truly meets their needs.
How do you educate clients who are completely new to Medicare?
I give them a little history of Medicare and explain the two different ways one can take their Medicare coverage - either Original Medicare with a Supplement and a drug plan for the least restrictions, or a Medicare Advantage plan that also includes other benefits, like transportation, an over-the-counter (OTC) catalog, dental, vision, and more depending on their plans in their area.
What is one of the the most common misconceptions people have about Medicare?
One of the most common misconceptions about Medicare is that it covers all healthcare costs for seniors. Turns out, Medicare doesn't cover every single healthcare expense. Additionally, many assume it includes long-term care (like nursing homes) or dental, vision, and hearing services, but these items are not covered under original Medicare. People often learn this the hard way when they realize they need supplemental insurance like Medigap, Medicare Advantage, and other tertiary coverage options to fill those gaps. It’s a rude awakening for those who think Medicare = free healthcare, hence the need to fully understand your options to make the best decision for yourself.
Can you describe a time when you helped a client navigate a complex Medicare issue?
I recently met with a new client that thought he was covered for everything. Upon asking several questions, it was discovered that he had lost his medicaid, extra help, his medicare advantage plan, and his drug coverage! In other words all he had was orgianl medicare parts A and B.With lots of due diligence I was able to enroll him into a proper medicare advantage plan with drug coverage. We also did a new application for "Extra Help". I communicated with his son the urgency of obtaining specific documents so that we could reapply for his medicaid.
It is expected that in the next 6-8 weeks we will have him receiving his extra help benefits and his medicaid!
What's the most frustrating misconception you have to clear up with clients about Medicare every year?
First, It’s essential to clearly understand the differences between Traditional Medicare with a Medigap plan vs Medicare Advantage.Second item is the mistakenly think that starting with a low-cost plan is the best option; however, this isn’t always the case with insurance companies under the Medigap program. After the first four to five years, premiums can increase significantly, making it difficult for those with health issues to switch to a more affordable plan. Often, individuals are left at point in life with no choice but to transition to an Advantage plan a more affordable monthly rate and giving up their freedom of choice. Being informed about these options can lead to better long-term decisions regarding healthcare coverage.
What role do you think technology will play in the future of Medicare?
Advancements in technology are poised to transform Medicare in the coming years. Telemedicine, which saw explosive growth during the COVID-19 pandemic, is likely to become a permanent fixture in Medicare’s coverage. Other technological innovations, such as artificial intelligence (AI) and wearable devices, have the potential to improve care delivery and outcomes. However, integrating these technologies into Medicare will require addressing challenges such as data privacy, reimbursement policies, and ensuring equitable access for all beneficiaries.
What's an underrated benefit of Original Medicare that many people overlook?
The most underrated benefit of Original Medicare is freedom of choice. With Original Medicare you can see any provider as long as they take Medicare. no referrals are needed and it travels well. The coverage is Nation wide.If you had to pick just one, what's the worst Medicare-related decision someone can make?
People fail to analyze their options at the beginning of their Medicare journey, making hasty decisions or following their friends' or families' decisions. These first decisions could affect their Medicare coverage throughout their retirement years, especially their pocketbooks. You should know all the facts or have an agent that you can trust to guide you through the Medicare process when signing up for Medicare.
What's the difference between a Medicare broker and a Medicare agent?
The main difference between a Medicare broker and a Medicare agent is that brokers represent multiple insurance companies and can present a broader range of Medicare plans, while agents typically represent one insurance company and offer a more limited selection of plans.
What are the red flags I should look for when interviewing agents? I want to make sure I'm not just getting sold to but genuinely advised.
Experience matters. Ask your agent how long they've been in business? What percent of their business is Medicare (important!). Have your agent provide you with the names of the states where they're licensed and list the Medicare plans they are licensed / appointed to sell in your resident zip code.
I tried calling Medicare and got transferred five times. Is there any way to get straight answers from them?
It's much better using a chat on Medicare.gov! Get on the site and set up an account and then get on the Chat feature! I use it regularly and there is almost Immediate help and answers for all your questions!
What's your go-to strategy for helping someone decide between Medicare Advantage and Medigap?
I have a seven question algorythm that is 99% accurate. Seven questions and the appropriate strategy is evident.
Why do some clients ignore your advice and end up in bad Medicare plans-what makes them resistant?
Some clients hesitate to follow my advice because of a common misconception that Medicare advisors like me drive up their premiums or costs due to commissions, when in reality, our guidance doesn’t change what you pay—plans and pricing are set by insurers and Medicare, not us. There’s also a false narrative that we can push you into specific plans for higher payouts, but the truth is, we earn the same regardless of the provider or product, so my focus is purely on what fits your needs best. Ignoring tailored advice can lead to picking the wrong plan, missing out on key benefits, and facing unexpected costs that hit both your health and wallet hard.
What shift has been observed in Medicare spending, particularly regarding Medicare Advantage plans?
Some plans which were in place in 2023 and 2024 have had their Maximum Out Of Pocket (MOOP) increase in 2025.
Can you help me understand Maximum Out-of-Pocket (MOOP) limits in Medicare plans, from your experience as an agent?
There are two maximums out of pocket limits to consider.The first one is on prescription drugs.
In 2024, Medicare changed the way prescription drug plans work. Out with the old and in with the new $2,000 maximum amount you will pay for your covered prescription drugs. Our prescription drug plan insurance company keeps track of how much you've paid for your prescriptions and when you have reached your maximum, your covered prescriptions will drop to zero amount for the rest of the year.
The second maximum out of pocket to know about is with the Medicare Advantage plans.
If you have a Medicare Advantage Plan, commonly known as a Part C, the insurance company keeps track of how much you pay for co-pays and co-insurance through the year. Once you reach the plans maximum out of pocket amount, then the insurance company pays the remaining co-pays and co-insurance for the rest of the year. Each plan has a different Maximum out of pocket amount, so knowing what that amount is important.
Make note that if you only have original Medicare, there is no maximum out of pocket amount for your 20% co-insurance.
Can you explain Special Needs Plans in Medicare?
There are people who have special circumstances that CMS has determined qualify for extra help and benefits.There are several different categories.
Dual Special Needs - Medicare / Medicaid eligible.
Chronic Special Needs - Those with listed health conditions
SNP - facility plasn - Those who are confined to a facility.
each case is different it is best to talk with a professional
I got a call from a "Medicare agent" promising me free groceries and I almost fell for it. Why is this kind of marketing allowed?
It’s unfortunate but there are a few loopholes in Medicare marketing guidelines that allow agents to discuss benefits associated with “DSNP’s” (Dual Special needs plans) on cold calls. These types of plans require that you have both Medicare and Medicaid, if you have both of these then there may be a DSNP plan available in your area that includes a”healthy food and produce” benefit that gives you a monthly allowance towards OTC items and groceries. Unfortunately I think a commonly used tactic is the “bait and switch”. Agents/brokers have to be a little more transparent if you were to physically meet them and go over your plan options. Be a good practice To ask these individuals “how are these benefits available to me” or simply just hang up. This sure isn’t a way to conduct good business but some brokers do engage in this.What is the biggest disadvantage of the Medicare Advantage plans?
The biggest disadvantage of the Medicare Advantage plans is the negative publicity surrounding the insurance, the negative sentiment and fake news making Medicare Advantage seem like a bad idea. As an independent Medicare agent for the past 18 years and a Medicare Advantage member for the past 5 years, I have no regrets and if I could do it all over again, would stick with Medicare Advantage. OK, there are plusses and minuses with Medicare Advantage but the program is overseen by the Federal Government. That's CMS, the Centers for Medicare Services. By law, Medicare Advantage must be "at least as good as" original Medicare. Medicare Advantage members are protected by an out of pocket maximum so that's probably the best thing about the program. On the flip side, many doctors don't like Medicare Advantage because it's more work for them. Some procedures require prior authorizations so the additional paperwork is not popular among the medical profession. But, I have yet to hear of a medically necessary procedure that has been denied by any Medicare Advantage plan.
How do you stay up to date with changes in Medicare policies and plan options each year?
I listen to a weekly podcast that does a deep dive on the news and notes of the industry. I just got back from an insurance conference in Las Vegas to keep me up to date and make connections. Because of the way the industry is constantly changing you have to keep up to date of you will be left behind.
What's a common trick in Medicare marketing that hides restrictions on doctor choices?
Unscrupulous agents will not check networks providers and tell members their doctor takes the plan. This is why it is so important to meet with an agent in person.
How might artificial intelligence change how Medicare approves claims in the future?
AI will definitely be a part of claims decisions in the future, but it will not be the end all as you will always have the ability to appeal to a real person.What are some lesser-known benefits or services that my Medicare plan might cover that I could be missing out on?
This is a perfect question, and a great one especially in today’s time, as Medicare Advantage plans are introducing more creative and innovative benefits to differentiate themselves. You might find lesser-known Medicare Advantage perks like quarterly allowances for rent, utilities, groceries, over-the-counter items like pain relievers, or even transportation to medical appointments and gym memberships for wellness programs. Meanwhile, Medicare Supplement plans, such as G or N, often include a valuable international travel benefit for emergency care abroad, which can be crucial if you’re overseas and need treatment unexpectedly.Is Medicare becoming more expensive over time, and will it ever be unsustainable?
As the cost of medical care increases with inflation, so will the cost of medical insurance premiums, deductibles, coinsurance, and co-pays. Whether it will ever become unsustainable is a question that only time can honestly answer. What is the future of America's healthcare costs?Why does Medicare have so many coverage gaps, and is it designed that way on purpose?
In 1965, the government set up Medicare to help primary care for those over 65 with healthcare costs. President Johnson set it up to share healthcare costs between the government and beneficiaries. This was called the cost-sharing approach, with the intent to help control Medicare abuse and overcharge by discouraging unnecessary use of the services.Today, with healthcare costs rising, the original design has revealed six major gaps in its coverage. Therefore, yes, I think it was designed this way in the beginning, which makes it very confusing today. You need to make sure you have the right coverage and can’t afford the coverage of these gaps.
What's a common Medicare myth that even some agents still believe?
I'd say that some agents still think they have to take additional tests in order to get a non-resident license.
What's the biggest frustration Medicare agents have when helping clients enroll?
Medicare and Social Security do not do a good enough job helping clients understand that Social Security and Medicare are two different things. Many people are waiting past the age of 65 to retire because full Social Security benefits comes much later at age 67. If you are not yet collecting your SS, then you are not automatically enrolled. Clients need to enroll early and allow 4-6 weeks sometimes to show up in the system. Waiting for clients to finally get in system, even when they already had Part A and are waiting to get Part B, can be frustrating for clients, and I am frustrated for them.
What are the most overhyped benefits of Medicare Advantage plans that seniors should be wary of?
Benefits that are advertised nationally that only a super small percentage of the population (usually poverty level) qualify for. It's misleading for our senior population and creates confusion when there doesn't need to be any.
How is Medicare Advantage expected to evolve in the future?
Medicare Advantage is expected to soon be the more popular form of Medicare coverage. Enrollment for Medicare Advantage plans is growing and expected to continue to grow.
Aren't those Medicare seminars just sales pitches in disguise?
Mostly, yes they are. They benefit you as you can meet the agent, ask questions and gather information. They are not supposed to have a sales pitch attached, or even any obligation for follow up contact. However, as polite human beings, many feel obligated to follow through and set up a meeting. To be fair, most presenters are salespeople, and we can't help but sell.As an agent with 30 years behind me, I always have preferred one on one meetings. I have always felt they are far more personal and efficient for the customer. Skip the seminar and go see an agent.
