• Tom

How to Find the Right Senior Health & Prescription Drug Plan

One of two main areas I have focused on for 15 years in my insurance practice is helping seniors enroll in the Medicare Advantage or Medicare Supplement Plan that is right for them. It’s no surprise that this can be a difficult, confusing process for many individuals, and that’s why I take the process so seriously. This is the first in a ‘short series’ of five articles on the subject, and in this article #1 I discuss five points to get you off to a good start to the process to find a plan. Article #2 will describe the three main types of plans: Medicare Advantage Plans, Medicare Supplement Plans and Stand-Alone Prescription Drug Plans. Article #3 will cover the different enrollment periods to enroll in a plan. Article #4 covers what you must have in place before you enroll in a plan. Article #5 will cover the most common questions when enrolling in a plan along with answers to those questions. In addition to the articles, I publish a monthly newsletter covering different insurance topics, along with other fun and interesting material. If you’re interested in receiving it please send a message with your email address. I hope the information in article #1 is helpful!



Article #1: How to Get Off to a Good Start to the Process to Find a Plan


1. If you have no idea how to start looking for a plan, begin by finding a licensed agent to talk with. I recommend that you talk with senior friends, relatives and others you know who are already enrolled in a plan and ask for referrals. You’re looking for individuals you know you can trust to help you. If you are retiring, your Human Resources Department often can help. Other sources for referrals include your church and different clubs and organizations you belong to. Never select an agent by answering a telephone call, an email message or a door-to-door solicitation for your business.


2. Make an appointment to meet with an agent IN-PERSON. And when you meet with an agent, don’t be afraid to begin with some friendly conversation just to get to know each other a little bit. Again, you’re trying to find someone you are comfortable with, and whom you feel you can trust. Ideally, you also want to feel comfortable that you can build a relationship with an agent over time. If the person you are meeting with for the first time tries to hurry through this initial conversation and get right into his/her presentation, consider looking for another agent.


3. When you do find an agent and meet in person, when he/she goes through the product presentation(s), he/she should give you copies of the same material being covered so you can follow along and answer questions. (Note: The term ‘enrollment kit’ does NOT mean you will be enrolling in the plan being presented in that first appointment. It is simply the title most commonly given to the booklets agents use to present plan benefit information). Your agent is required to go through every section of the enrollment kit, in order, by page number. If the agent goes through the information randomly and just gives a general plan description of the plan, find to another agent. Why the 'hard line' you might ask? Because as agents for senior health & prescription drug plans, it is one of many required practices in the annual certification training we must complete! You cannot possibly choose the plan that is right for you, knowing only some of the information about that plan. Also, be sure and ask all of your questions and make sure the agent answers all of them in the appointment. Also it is not uncommon to schedule a second appointment at a later date to insure that all of your questions are answered before you choose a plan. I often meet with seniors two to three times before they decide it they want to enroll or not.


4. When you and your agent have reviewed different senior health & prescription drug plan enrollment kits and you are trying to decide which specific plan you want to enroll in make sure your agent explains the following:

a. If you are considering a Medicare Advantage Plan, or a ‘Stand-Alone’ Prescription Drug Plan, it must be available in your specific state AND county. You will also want your agent to tell you which specific providers: hospitals, doctors, etc., will honor your plan IN-NETWORK. You have to make sure there are enough providers in your county that you can go to for care. If you are using a specific family doctor, have your agent also verify that your specific doctor will honor the plan IN-NETWORK. (More in upcoming articles on ways to do this).

b. If you are considering a Medicare Supplement Plan, unless it is a ‘Select Plan’ (which I will cover in a separate article), there are no provider networks. You can go to any provider, anywhere if they accept Medicare’s standard schedule of benefits and they will honor the specific Medicare Supplement plan you have chosen.

c. If you are taking specific prescription medications make sure your agent locates each of them in the specific ‘Drug Formulary’ for the plan(s) you are considering. The ‘Drug Formulary’ is a list of every specific prescription drug the plan covers. (More on this in future articles in the series).


5. Questions, questions and more questions. Again, it is imperative that all of your questions are answered because the goal is to put you in a position where you are totally confident to decide on the specific plan that is right for you!




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