Medicare Questions & Answers: Agent Interview
Agent Interview Q&A
Showing 61 questions
What are the reasons why I should work with a Medicare agent?
The only reason you should work with a medicare agent is because of the quality of understanding you get from quality agent. A true agents purpose is to do right by the consumer. A true agent should be able to communicate the medicare Information clearly, communicate why its important and how it affects you annually. They should be able to not only be responsive but cater to finding a plan where you dont have to change your Dr's or hospitals to use the plan. They will provide you with an annual review to make sure you are always in the best place medically. A quality agent is strong enough to put commission aside to help there consumer.
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!
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 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.
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!
Is it ok to meet with multiple Medicare Brokers and Agents as I start looking for help?
I would suggest talking with a couple different Insurance Agents or Brokers as you start looking for Medicare help. Some Agents or Brokers only work with one carrier for supplemental plans. Some are too pushy, some may have the knowledge but can't communicate that well to transfer that knowledge to the people they are helping. Many different reasons to talk to a couple different people.
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.
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.
If you had to pick just one, what's the worst Medicare-related decision someone can make?
In my professional opinion, the worst Medicare-related decision is choosing a plan without assessing one’s individual circumstances and relying instead on unsolicited advice from others. I frequently encounter clients who select coverage based on someone else’s experience, only to discover it doesn’t align with their specific healthcare or financial needs. This misstep often leads to unnecessary complications or expenses that a tailored evaluation could prevent.
What's your go-to strategy for helping someone decide between Medicare Advantage and Medigap?
To help someone choose between Medicare Advantage and Medigap, I ask:Health Usage: Frequent doctor visits or chronic conditions? → Medigap.
Budget: Want low monthly premiums? → Medicare Advantage. Prefer predictable costs? → Medigap.
Doctor Choice & Travel: Want nationwide coverage and keep any doctor? → Medigap. Okay with networks? → Medicare Advantage.
Drug Coverage: Want it included? → Medicare Advantage. Don’t mind a separate plan? → Medigap.
Simplicity: Want one bundled plan? → Medicare Advantage. Don’t mind piecing it together? → Medigap.
It's important to have a conversation going over all of this and find out what fits best for each individual. There are lots of plans out there with different benefits. Not all may fit your needs.
Aren't those Medicare seminars just sales pitches in disguise?
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 is the biggest disadvantage of the Medicare Advantage plans?
Medicare Advantage plans have netwrork restrictions and can cost more out of pocket for deductibles and copays. Your doctor who is in network now may not be next year and the plans change annually.If you are on a Medicare Advantage plan and exceed your first 12 months and have health problems you may never be able to apply for a Medicare Supplement in the future.
What's the most frustrating misconception you have to clear up with clients about Medicare every year?
One of the most frustrating misconceptions I often have to clear up is the belief that Medicare is completely free and covers everything. Many clients are surprised to learn that Medicare has premiums, deductibles, copays, and that it doesn’t cover everything like dental, vision, hearing, or long-term care. Medicare plans are not a one size fits all and when i meet with my clients, i do a Client Needs Assessment to find the right plan for YOU.Should there be stricter regulations on Medicare Advantage marketing and sales practices?
Short answer - yes and long answer it's complicated. Deceptive marketing is a problem with some marketers using confusing and misleading messages. Not to forget the people turning 65 that get a overwhelming amount of marketing calls, emails, and letters. To the point that a person feels as if they are underseige. While most agents are ethical who actually care about clients, there are definitely bad actors out there who game the system and chase commissions. People then get put into a plan that does not meet their needs.The intent of stricter regulations is good but it could also hinder the good agents but adding more red tape to do the right thing. Not every agent is going to be deceptive. Most agents have good intentions and want to do right by the client.
Why do some clients ignore your advice and end up in bad Medicare plans-what makes them resistant?
Great question.. It happens occasionally.. I represent all the major plans and focus on their doctors and prescriptions not the shiny objects that some plans offer. So I don't run into it very often.. When I do it usually has to do with an added benefit.. Example: I recommend a plan that fully covers all their docs and prescriptions. Say it has a $1500 dental benifits.. They see a plan with a $3000 benifits and they decide to go with that.. However that plan doesn't have the same coverage for doctors rxs. It's not that they got bad plan, they just end up making a decision based on that shiny object that reduced the real important coverages.
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.
I would find out how long they have been selling Med supps and Medicare Advantages and why they like this market. I would also have them explain the difference between the two. Can they do it in a way that you understand stand it. I would also like to know how many companies they represent. If just one then that's all you will get told about. They should also be asking you questions about your doctor's, like their names. Plus the drugs you are taking and what your specific health situation is. They should be asking questions to find out what your enrollment situation is. The health situation will tell them what you may or may not qualify for. By getting these questions asked hopefully it will give you a better feel of the agent and if they can assist you or not.Cleo Martin
Can you explain Special Needs Plans in Medicare?
Sure. If you are already qualified for Medicaid and are about to enroll with Medicare, you're going to qualify for a "SNP" or Special Needs Plan. This means that you are not going to pay for ANYTHING at all since your status (financially speaking) has been approved. Not every insurance firm offers a SNP plan. You will have to do a little searching but it should be fairly easy to do. By the way, if you've been granted Medicaid status by either a State or Federal agency and two years have elapsed, no matter what your age, you can enroll with Medicare! There are clients who are in their 50's who were approved for Medicaid and then 24 months later, they were able to only enroll into an Advantage plan with drug coverage. But, when you are Medicare-eligible at age 65, you can transition to a Medicare Supplement and a Part D(rug) plan, each with a monthly premium, if that is your preference.
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'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.
How to know if a Medicare agent is legitimate?
Your first step should always be verifying their insurance license information on the state’s Department of Insurance (DOI) website. Beware of door-to-door sales; Medicare agents cannot solicit business at your home without an appointment and Medicare will never send an agent to your home to enroll you into a plan. A legitimate Medicare agent will take the time needed to understand your specific needs and recommend products to meet those needs. Look for an agent that represents multiple private insurance companies. They should lay out all your coverage options (Medicare Supplement plans, Medicare Pharmacy (Part D) plans, and Medicare Advantage plans) and provide unbiased guidance. You can also search the internet (Google) to see if they have any reviews or ask for client references.
I tried calling Medicare and got transferred five times. Is there any way to get straight answers from them?
I would first say make sure you called the right number for Medicare. When you call that number make sure to say representative until they actually get someone on the phone.
How can I tell the difference between an experienced Medicare Broker and an inexperienced Medicare Broker?
Regarding the experience of Brokers. Your wisdom and intuition will lead you to the right Broker. Experience isn't measured by years when it comes to brokers, however it is certainly a contribution factor. Word of mouth is still one of the best ways to find professional help, however I do encourage you to look at recommendations from your friends and family at a higher consideration, than recommendations from other professionals, as sometimes recommendations from other professionals, such as your financial advisor could be clouded with other motives. Brokers with experience have a diverse portfolio of insurance products, and the broker you are working with should be able to offer you plans from many different insurance carriers.
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.
In your experience, what are the best Medicare Supplement insurance companies and why?
The best Medicare Supplement companies varies from region to region, even the large ones are not everywhere, so it makes no sense to compare and contrast by name , rather the best choice is the one that strikes a balance between cost, coverage and added values.
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.
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.
Are there disadvantages to working with a Medicare broker/agent?
There are some disadvantages. Since covid there have been several brokers that come into the Medicare space that are not doing what is in the best interest of the senior population. These individuals are flipping insurance plans just to make commissions, which is giving a negative representation to all the other honerable agents in the field. There are also captive agents that are employed by a specific insurance company and are paid a salary to represent that one particular company, which is biased and not giving the senior the entire picture. Therefore, when selecting a local broker to work with; request to know if they represent the plans in your area (not just one), ask them how long they have been in business and how they operate their business. I am proudly servicing my members year after year and work primarily on referrals- my goal is to make and keep them happy (which I am sure I am doing). I love having the ability to offer them all their options (and will enroll them in a plan even if I do not get commissions paid) because I will always do what is in their best interest!
Is Medicare becoming more expensive over time, and will it ever be unsustainable?
Medicare is the 2nd or 3rd largest budget in the United States. It’s a very important part of our sustainability as a country, so I don’t believe it’s going anywhere anytime soon - the efforts, time and money dedicated to it.With that said, the government is trying to crack down on fraud and waste, as they should, so this should extend the budget and help it go further. Over time, there might be more costs passed off to the Medicare beneficiaries, but the entire purpose of Medicare was to off-set high medical costs for the 65 and older population, so I’m sure there will always be a push to sustain its purpose.
Should Medicare cover dental, vision, and hearing, or would that just make it more expensive for everyone?
If Medicare covered dental, vision and hearing it would increase the cost to tax payers no doubt. These services are provided by independent practices so it is most cost effective for them to be offered through private companies such as Humana, Aetna, Manhattan life etc….If you could change one thing about the Medicare system, what would it be and why?
Medicare is very complex. The cost of prescription drugs are high and it's difficult for some clients to fill their prescriptions due to the cost. It would be great if pricing was adjusted for Medicare clients
How do you get paid, and does it affect the plan you recommend?
So Medicare has already thought this through, and it actually makes a lot of sense. Great question! The way that we get paid is from the insurance company that we enroll you into. But Medicare has flat fees, and they basically level the playing field. All the fees are the same, typically for the carriers. So it doesn't matter if you're getting enrolled into a Blue Cross plan, Humana, or United; they all pay the same fees to brokers when you're enrolled.
And the same goes for the renewal. So that's just how it works. It makes it pretty easy because there are some agents out there that might steer you to a plan depending on what the compensation is.
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.
Why does Medicare have so many coverage gaps, and is it designed that way on purpose?
What's one tip for balancing affordability and personalization when finding the best Medicare options?
Figure out what is most important to YOU when it comes to your health plan. There are a lot of factors to consider when looking at your options but the most important thing at the end of the day is you.
Is it ok to work with a younger Medicare Advisor?
To answer the question of working with a young licensed Medicare agent. As long as the agent is licensed and you feel comfortable working with the agent. Then you have a choice.How will advancements in wearable health tech (like smartwatches) integrate with Medicare?
Advancements in wearable health technology are poised to significantly enhance patient care and facilitate faster diagnoses. By continuously monitoring vital metrics such as heart rate, blood pressure, glucose levels, oxygen saturation, and sleep patterns, these devices provide valuable data that can be shared with healthcare providers. This allows for more efficient coordination of care and timely follow-up.
What's a common trick in Medicare marketing that hides restrictions on doctor choices?
You must check if your doctor accepts either a PPO or HMO with a specific plan. All plans do not have to accept all doctors.
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.
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 a Medicare rule or regulation that's outdated or unfair to seniors?
Medicare raises costs for seniors who miss their Part B or Part D signup deadline, even if they didn’t know about it.
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.
How could a shrinking workforce affect Medicare funding in the next 20 years?
Medicare is funded through the workforce for future generations which is why it is very important that every person working is contributing to this program. We have many workers in the US who are either self-employed or undocumented who are not contributing, that gap needs to be fixed by having a legal path to citizenship for those workers who will also benefit from Medicare when they retire.
Do Medicare advisors work with people that have dementia?
Advisors may work with someone diagnosed with Dementia, however they may not make any changes if the person appears to not understand what is being discussed. This is one of the reasons it is important for our seniors to have a family member or friend whom they trust to help them as they get older and better still have a power of attorney set up in case they are unable to make their own decisions.
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.
Does the SOA need to be completed by a licensed agent, or can administrative staff complete it on the agent’s behalf before the agent contacts the client? This question specifically refers to clients in the USVI.
An administrative assistant could fill out the scope of appointment, but both the licensed agent and the client need to sign it. It is a short form and the licensed agent should be able to complete it without assistance from an administrator.
How has telemedicine enhanced personalized healthcare?
Telemedicine has been a great tool for people in remote areas or those who do not have a mean of transportation. These video conferencing sessions offer convenience and fast resolution to a health problem from the comfort of your own home. It enhances personalized service because it's still face to face (even though it's through videoconference) with your doctor.
Tell me about a time you had to fight through the appeals process to secure coverage for a client—what was on the line and how did it resolve?
A client on a MAPD plan was denied coverage for a critical cancer drug her oncologist prescribed, labeled “not medically necessary.” We filed a Level 1 appeal with medical records—it was denied. We escalated to a Level 2 appeal, adding clinical studies, a peer physician letter, and a personal statement from the client. The Independent Review Entity reversed the denial, approving the drug with retroactive coverage. She began treatment within 10 days and saw improvement. This case underscored the power of persistence and strong documentation in the appeals process.
What's the projected impact of an aging population on Medicare Part A hospital funds?
I just searched online and the second article listed was written in 2008 and stated that Medicare Part A will have insufficient funds by 2019. Be careful of the information you read online. It's good to be informed but don't get caught in the weeds or buy into fear-based articles. If you called Medicare I would guess they would not be able to answer that question, other than Part A funds must be increased every year.How much is spent on healthcare per year the U.S., and what does this amount represent per person?
The 2023 CMS Healthcare Expenditure Report revealed an eye-opening total of $4.9 trillion spent on healthcare, averaging about $14,570 per person.Have you ever encountered a situation where a healthcare power of attorney made a significant difference? What guidance would you offer to someone thinking about setting one up?
Yes I have, and in ALL of my experiences it was a good thing. If someone is in a position where they are able to have a loved one be power of attorney over them it usually is because they are unable to see the full picture of how to manage their healthcare. I don’t say this lightly but some of my clients can be “stubborn” when deciding what plan to get on and may see a small benefit or allowance as a good reason to select a plan while displacing the fact that there may be a deductible, lack of providers, excessive co-insurance for needed services etc.. Seeing the big picture is crucial and the person most invested in the overall health of an individual is usually most qualified to make an enrollment decision between a bad/good plan.
Do I have to pay extra to use a local Medicare Licensed Insurance agent?
No all agents are compemsated by the carriers it is illegal for an agent to charge a fee gir his services
What was your most successful strategy for building rapport with a beneficiary during a remote meeting? How does this approach differ from your in-person communication techniques?
Remote meetings can be wither held as Zoom calls or similar. That is what I prefer. This way you can see the client and they, you. PH calls are a secondary option. Disclose your contact information to build trust. If necessary, share your License# as well...
How could a universal healthcare debate shift Medicare's structure in the next decade?
Despite the stories hard in the US, Universal Healthcare has not been an effective solution in any of the countries that use it.The continuously skyrocketing rise in costs are not stopped by that method. Politicians keep thinking they can mandate a solution that may sound good but is actually impractical.
An example is the Inflation Act & the Infrustructure Act that mandated healthcare changes, as did the Affordable Care Act that solved some problems, but priced to finding to do what was required.
That is why the countries with so-called Universal Healthcare have extreme waiting periods for serious procedures like hip replacement, and heart by-pass operations, etc; causing those that can afford to go to countries like the USA, India, etc; where they can pay to have the procedures done.
How has the push for healthcare price transparency affected your work as a Medicare Agent? What's one unexpected outcome you've observed?
I really have not found this has affected my work as a Medicare Agent. I do believe the Medicare Advantage plans have adjusted and set copays for procedures and tests based on hospitals charging more than stand alone facilities and physician group facilities.How do Medicare brokers get paid, and does it affect the plan they recommend?
Brokers are paid by the insurance companies.You want a broker to show you all plans not just the ones he recommended and let you choose the plan that meets your needs
What do you think will have the biggest impact on how healthcare engages digitally with patients over the next couple of years?
Talking about myself at 70 years old a having sold Medicare programs for 30+ years. When I started I could talk direct to a Dr. Today everything go through a portal. AI is growing everyday.
Do Medicare brokers charge seniors a fee, or is their help free?
Medicare brokers or agents should not be charging anyone a fee. They are paid by the Medicare carrier. Monetarily speaking, it isn't a large amount of money and every carrier pays the same amount so there should be no reason for a broker or agent to push one policy over another. This should be your choice based on your needs.Is home healthcare becoming the preferred option for Indian seniors? Why?
Due to reservation statusMost Native Americans prefer to be treat in their home and the reservations provide home care
Why is it important to find an agent with great reviews from long time existing clients.
Agents who have been in the field for at least 5 years or more are the ones to look for.Experience, trends and knowing what to do for everyone as everyone is different and experience is needed in the medicare field more than ever
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