#1. A Good Medicare Insurance Agent Should Ask “What Kind of Prescription Medications You Are Taking?”

After almost a decade of being a Medicare insurance agent, I still get nervous when prospective clients push their list of medications across the conference table. When I look at the list, I either tense up or breathe a sigh of relief.

Medication Costs Can Be Devastating

As a licensed Medicare agent in Omaha, Nebraska for more than 10 years, I see examples of this every day. Yesterday I was completing an application for a relative of mine in Texas. He is a great guy. Jim is older than me. I remember playing together when we were kids. He was like a big brother. Being the firstborn in my family, I didn’t have an older brother, so I idolized Jim.

Jim is retiring in a few days. He is bone tired and is looking forward to getting out of the rat race. For the past year, his doctor gave him samples of Entresto for his heart. The manufacturer offered coupons for the medication too, but those stop once you are on Medicare. He was mainly paying nothing for it. When I told him the medication was around $600 a month, you could feel the ice-cold silence through the phone.

The Reality of A Fixed Income

On the Medicare Part D plan, the deductible would be $445 upfront, and the monthly dose would be $47 per month. After his icy pause, the response that we Medicare Insurance Agents hear too often came, “I can’t pay that.”

Like many people going on Medicare and retiring, his Social Security is really all he has. Even a part-time job isn’t a viable option when his body and nerves are shot. So I took a big swallow.

Jim thought I had it wrong or made a mistake. I explained the reality to him about Medicare Part D and prescription costs if you are on high-dollar medications. I don’t think he believed me even after that.     

His response was he would quit the medication, which is what many of my Medicare insurance clients say. And a few do that. Others listen to their doctor, a pleading spouse and children, or their body that sometimes tells them they need the medication.

A Medicare Insurance Agent Should Find Out The Medication Costs At the Beginning

It is painful to watch people go through this. Consequently, I have learned early on as a Medicare insurance agent to find out what medications people are on right away. The various software, including the Medicare.gov website, are helpful–though not infallible. I explain to clients the reality that sometimes Medicare and the Medicare insurance companies make mistakes in listing their medications. They may take medications off the formulary or raise the tier level. Consequently, even if we do everything right, there may be some surprises down the road on their medications.

As a longtime Medicare insurance agent, an old trick I’ve seen insurance companies pull is to put a medium-cost medication in tier 3, so you get hit with the deductible versus keeping it in tier 2, where it has been for a long time.

Fortunately, most of these problems are infrequent, but expensive medications, like Entresto, insulin, or other anti-diabetic medications, can be bank-breaking.

If you are on no medications, very few medications, or inexpensive medications, God bless you. Of course, circumstances can always change, but you should still understand that a good Medicare insurance agent will very carefully ask about your medications and conscientiously show you the plans that best address those medication needs. “What are your medications?” is a very important question, and it should be one of the first.

#2.  A Good Medicare Insurance Agent Should Ask “How Do You Handle Risk?”

When you go to the casino, which slot machines do you play? The nickel slots? The quarter slots? Or the dollar slots? Or don’t you play at all?

Everyone handles risk differently. When I was in the investment side of financial services, before becoming a Medicare agent, we would put clients through a risk assessment. We walked them through several scenarios of their investments going up and down based upon the level of risk they were willing to take.

Of course, everyone was happy when the investments went up, and no one was happy when the investments went down. They understood, however, unless they were going to put their money in a can and bury it in the dirt, they would have to assume some level of risk.

What Is Your Tolerance For Risk?

People’s risk tolerance was all over the board. Some were conservative. Others moderate. A small group was high-risk takers. In the end, they would sign and date the risk assessment form, and it was put in their file. Then, the investment advisor would invest their money based upon how much risk they were willing to take.  What does this have to do with Medicare insurance?  I’ll explain.  

I remember when clients came back during downtimes in the market. All of them were angry that their assets went down. The advisor showed them the history of the different asset classes and how they go up and down depending on markets and the type of assets. Clients were not impressed.

In the end, the clients complained their money went down too far. So then the advisor pulled out the risk assessment the clients all had completed months or years earlier. Right there in black and white was their signature next to the level of risk they were willing to assume, and their assets went down precisely what was predicted.

When the asset went up, they never called. A Medicare insurance agent should be testing your ability to handle risk.

No One Knows The Future: That’s Why You Buy Insurance

Over the years, in my role as a Medicare insurance agent, I have talked with clients months and years after choosing their Medicare Advantage plan or Medigap policy. I go through the same presentation with everyone. Thousands of clients have heard the exact same words over the years. I could do it in a coma.

People still come back and say I didn’t think the copays on my Advantage plan would end up being this much. I didn’t think my supplement premium would go up this high.

Whether you purchase a Medicare supplement or a Medicare Advantage plan, there are costs. Over time and as you age, those costs will go up. Unavoidable. The reality of those costs hit us differently than the idea of those costs when we are considering our options. It is crucial when considering your options to look at how you have handled risk in the past.

Did you pick the car insurance or the homeowners insurance with the high deductible? Were you ok when s__t happened?

Or did you pay the much more expensive premium, so you didn’t have a hefty deductible? Or did you switch after a while? That will tell you more about the type of Medicare insurance you should choose. How do you handle risk?

#3.  A Good Medicare Insurance Agent Should Ask “Which Way? Pay As You Go Or Pay Upfront?”

Would you prefer to pay upfront and not worry, or would you rather pay when you actually use the service?

I love to travel. Over the years, I have been all over the United States and the world for pleasure and business. No style of travel is more appealing. I have gone on tours. Put some stuff in a knapsack and just gone out the door with no place in mind.

Depending on what I’m doing and how much money I have for the project, I make my strategic travel plans.
When I have gone on the cheap, I pay for the bare minimum. It saves money. I don’t mind sleeping on overnight trains and park benches–at least when I was younger. I paid for things when I wanted them or really needed them.

Other times, usually when I had more money, I did the all-inclusive thing. I didn’t have to worry about the nickel-and-dime stuff. I was comfortable with everything being taken care of and paying a lot for it.

Two different styles. Two different experiences. Two different outcomes. What type of experience do you want?  As a Medicare insurance agent, that’s a question I need to ask.  

What Kind of Experience Do You Want with Medicare?

Medicare Advantage is pay as you go. You don’t pay any copays unless you see a doctor, get a test, have surgery. The nice thing is you save money at that moment. But when something serious happens, like cancer treatment, you may be paying thousands of dollars–with a limit–for that year.

On the supplement side, you pay your monthly premium. Remember, this premium will keep going up each year. So when you are probably your healthiest on Medicare in those initial years, you may not use Medicare and your supplement much, but you are paying.

As you get older, the premium will go up. It may double at some point from what you initially paid when you turned 65. At that point, you are older. You are starting to have medical needs, but nothing serious yet. Do you change to an Advantage plan because supplement premiums are going up? But now the likelihood of something costly happening during the twilight years of life significantly increases. You have already forked out a considerable sum on Medigap premium. Do you keep trudging along and pay increasing premiums, or do you cut your losses? Do you risk potentially high copays or pay certain higher premiums? What if I can’t afford Medicare premiums anymore?

Which scenario is less damning? What do the questions cause you to think and feel?

A good Medicare insurance agent asks these hard questions, but only you can answer them.