Ask The Medicare Specialist

According to an article in Yahoo Finance, "More than 11,200 Americans will turn 65 every day from 2024 through 2027" and become eligible for Medicare. Thousands more will enroll in Medicare after their 65th, while others will have it awarded before turning 65 due to being granted Social Security/Disability.

There is no question today. With the column being new to Daily Courier I want to begin publishing a series titled "New to Medicare," It is written with the goal of helping those going on Medicare for the first time. By far, the questions we get asked most are related to the process of signing up for Medicare, who needs and doesn't need to enroll, and the repercussions of getting any part of the process wrong.

We will be going over that in detail as well as the importance of understanding the differences between the two choices in a Medicare plan; Supplement and Advantage, as well as how Part D prescription coverage works.

As an introduction to the series, today I want to get into the history of The Health Insurance Store, an overview of what we do, services we provide, our business model, and mission.

Almost 20 years ago and upon moving to Connellsville from Albuquerque, New Mexico, I decided to make a career change and was recruited to sell individual health and Medicare insurance for a company called MEGA Life and Health. At the time there were approximately 40 million Americans who had no health insurance as well as over 30 million active Medicare beneficiaries with hundreds of thousands more enrolling each year. I saw a terrific opportunity after hearing those figures and dove headfirst into my new career.

After spending a few months getting my license, training, and driving all over Pennsylvania on house calls, I discovered that MEGA, the only company's plans I was able to offer to prospective clients as a "captive" agent, wasn't competitive. They also didn't have a good reputation for disclosing the fine print in their policies or paying claims in a consistent and timely fashion. After 25 years in sales and consulting, one thing I know for certain, if you don't believe 100% in the product or service you represent, success and happiness at the job can never be achieved.

In addition, I found it uncomfortable selling policies at kitchen and dining room tables, which at the time was almost 100% the norm in the industry and is still extremely common. It never felt right getting a signature, packing up all my materials, and leaving someone's house with the client's last view of me being the back of my head and taillights.

Although my tenure with MEGA didn't last long, I realized there was a huge need for agents with expertise, information, and guidance regarding health insurance, especially Medicare, as Advantage Plans were in their infancy. I also asked myself why is there an agency selling homeowner and auto insurance on practically every corner in every town, but literally not one brick-and-mortar health and Medicare office anywhere in Western PA? I decided there should be, and The Heatlh Insurance Store officially opened on April 1st, 2008, right here in my adopted hometown of Connellsville. We've been in the same office at 121 N. Pittsburgh Street since!

Just having an office wasn't my only goal. I wanted to be a one-stop shop where people could compare Medicare Supplements, Advantage Plans, and Part D as well as individual and employer health insurance from every competitive company on the market, ensuring unbiased advice from local agents, not someone on the other end of a phone in another state. We get to know our clients, ask questions, listen to the answers, and then find solutions, matching them with the best plan and company based on an individual's health, concerns, needs, and budget. Our mission is to advise clients based on what's best for them 100% of the time, regardless of commission. It's extremely common for us to let people know it's best to stay with the plan they already have or choose one provided by a company they work for or retired from rather than those we get paid to provide. We've advised thousands of people for free and have never once charged for a consultation.

Lastly, and most importantly, I wanted to provide outstanding customer service and support to every client who allows myself or one of the other agents to help enroll them in a policy. Our business model is understanding that the job is so much more than just selling someone a plan when they initially go on Medicare or come see us for the first time. So, as we grow, additional staff are hired who advocate for our clients whenever they have premium issues, claims denied, receive erroneous bills, are dealing with expensive prescription costs, or have any other problems or questions. We don't expect our clients to fight with insurance companies or providers. That's our job and we're extremely good at it. We make calls with or for our clients to the insurance companies, billing departments, medical providers, Social Security, and Medicare.

Today, The Health Insurance Store has more than 15,000 active clients!

The following is a tentative schedule of topics for the next ten weeks.

When do I need to start thinking about Medicare and my plan options? What steps need to be taken to enroll? When will Medicare Part A and B go into effect?

Do I have to enroll in Medicare when I turn 65 if I'm still working? Are there penalties for not doing so? Who should and shouldn't enroll in Medicare?

What do Medicare Parts A and B cost? What does it cover? What are my choices in Medicare Plans? Do they differ as far as coverage, access to doctors and hospitals, and how claims are approved and paid?

What are the pros and cons of both Medicare Supplements and Advantage Plans?

Who is best to choose an Advantage Plan and who is best on a Supplement?

What are the most important considerations when choosing an Advantage Plan? Which plans and companies are the best?

What are the most important considerations when choosing a Supplement and what plans and companies are the best?

How are prescriptions covered for those on Medicare? What is the Donut Hole? Why are drugs more expensive for those on Medicare?

After I pick my plan for the first time, is there anything I need to do? Do plans change year after year?

What will Medicare look like in the next five to ten years?

Please, please, please, do not use this series or my columns as a substitute for meeting with us in person and going over options based on your individual health care needs. They're for general information and education only. Give us a call at 724-603-3403 or email me personally, aaron@getyourbestplan, to set up an appointment or if you have any other questions.