Let the (Medicare) games begin

By Dan Hoelscher - Contributing columnist

The Medicare games are about to begin! I am talking about the Medicare annual enrollment period (AEP) and the unethical and sometimes illegal sales activities or “games” played by some insurance agents. Please don’t get me wrong: there are many agents and advisers who are doing things right, but there are also those who push the legal and ethical envelope, who are more interested in making the sale rather than doing what is right for you. And just because a particular action is legal doesn’t mean it is necessarily the right thing to do. As Potter Stewart, former U.S. Supreme Court justice once stated, “Ethics is knowing the difference between what you have a right to do and what is right to do.”

The Medicare AEP runs from Oct. 15 through Dec. 7 and is the one time during the year when you can make changes to your Part D prescription drug plans or Medicare Advantage plans, although companies and agents may begin marketing to you beginning Oct. 1. So let’s get you suited up, so that you can protect yourself during the games!

Helmet — Know your coverage

It is extremely important to understand your current coverage, because if you don’t, you won’t be able to protect your head (mind) from an unethical agent who makes claims/statements that just aren’t true. You should know whether you have a Medicare Supplement or Medicare Advantage plan, what your premiums are, the amount of your deductible and out of pocket maximums. It’s important to understand that a Medicare Supplement plan may have a higher premium, but it will offer much better coverage, while a Medicare Advantage plan may have lower premiums, but could leave you with $4,000 to $6,000 out of your pocket in the case of a major medical claim. The more you know about your coverage, the better protected you will be against agents who are making false statements.

Shoulder pads — Know what agents can and cannot legally do

Knowing what agents are/are not allowed to do will allow you to block unwanted/illegal activities during the game and throw the penalty flag. For example, if you understand that agents are not allowed to call you without your permission, you will be able to end an unwanted call very quickly by letting that person know you did not give him permission to call and he is doing so illegally. The only uninvited contact an agent is allowed to make with you is via direct mail unless you have an existing policy with that particular agent. Other prohibited activities include high-pressure sales tactics, sending uninvited emails, soliciting door-to-door, claiming someone works for Medicare. There are many, many more. If you would like a copy of “Protecting Yourself from Predatory Sales Practices” from the Ohio Department of Insurance, email us at [email protected] and we would be happy to email it to you.

Cleats — Work with a trusted adviser

Run as fast as you can to a trusted adviser. The trick here is how you can know ahead of time whether you can trust a particular agent/adviser. The bad news is you can’t, at least not until you have had some experience with him or her. So here are a few questions to ask, which will help. How long has he been in the business? Is he a jack of all trades or does he focus on Medicare health insurance? Does he have a local office? Does he have a website to help you research your options? Does he work with someone you know who can vouch for him? Is he available during working hours to help you, or do you just get a voicemail? Does he have any education, certifications or associations that indicate he has taken extra steps to know his industry well? Is he a one-man show, or does he have a staff that can answer questions when the adviser is not available? Don’t assume that just because an adviser is nice that he/she is trustworthy and never ever buy or make changes to your coverage if you are feeling pressured to do so. If an agent won’t give you time to think things over, use those cleats and run for the hills.

So, now that you are all suited up, go out there and win the game!


By Dan Hoelscher

Contributing columnist

The writer is the founder of Seniormark LLC. Reach him at [email protected]

The writer is the founder of Seniormark LLC. Reach him at [email protected]