How to Assist a Client Already Enrolled in Medicare

We often receive the question, "How can I help my client who is already on Medicare but wants to potentially switch their coverage?"

Unfortunately, making changes in the type of coverage a person has after 6 to 12 months on Medicare can be very difficult - if not impossible. (A person enrolled in a Medicare Advantage plan or Part D drug plan can always change from one specific plan to another each year during Open Enrollment, Oct. 15-Dec. 7.)

Here is how we suggest using i65 to assist clients reviewing their TYPE of Medicare coverage after the age of 65.

PROVIDE YOUR CLIENT WITH A ROADMAP:

  1. Create an i65 account for this client. Uncheck the boxes to send an invitation email to the client AND the box to send a Roadmap via email to the client.
  2. To the best of your ability, answer the i65 questions as if you were your client.
  3. In the final question, be sure to choose the type of coverage your client currently has.
  4. Remove the Step-by-step directions pages from the report.
  5. Provide your clients with the report that basically summarizes the current coverage they have. This can be very helpful to a client who does not have any such information about their current Medicare situation.

FOR THE CLIENT ENROLLED IN A MEDICARE ADVANTAGE PLAN:

The most important thing to know about switching from a Medicare Advantage plan to Original Medicare is that your client may no longer have a Guaranteed Issue Right to get a Medicare Supplement policy. Without this, your client will most likely be asked to prove their insurability in order to receive this type of coverage. If they are not healthy, it is critically important that they do not disenroll from any coverage before knowing that they have a new type of coverage to move in to.

  1. Ensure that your client is trying to learn more about switching from Medicare Advantage to Original Medicare with a Supplement (Medigap) and Part D drug plan.
  2. From the tools available on your client's i65 home page, find the "Choosing a Medigap Plan" guide for your client's specific state. (Please note: Guides for the states of CT, MA and NY are not available.)
  3. Have your clients follow the instructions in these specific guides taking care to note that they most likely do NOT have a guaranteed issue right any longer. This means that your clients can still go through the process of trying to get a Medigap plan, but they may not be able this coverage.
  4. If your client is granted this coverage, follow the steps to provide your client with a Roadmap listed earlier in this post. Be sure to choose the Original Medicare option this time and, once again, remove the section related to enrolling in Medicare.

FOR THE CLIENT ENROLLED IN ORIGINAL MEDICARE WITH A SUPPLEMENT (MEDIGAP) POLICY:

The most important thing to know about switching from Original Medicare with a Supplement to Medicare Advantage is that your client is potentially giving up their Supplement policy for life. If your clients decide later on to switch back to Original Medicare, they may no longer be able to prove insurability. As a result, they may never be able to get this type of coverage again.

  1. Ensure that your client is trying to learn more about switching from Original Medicare with a Supplement (Medigap) and Part D drug plan to a Medicare Advantage plan.
  2. From the tools available on your client's i65 home page, find the information about Open Enrollment and click on the "Open Enrollment Q&A Whitepaper." Your client can switch to an Advantage plan during the annual Open Enrollment period between Oct. 15th and Dec. 7th of any year.
  3. To choose a Medicare Advantage plan, head to the "Choosing a Medicare Advantage Plan" video guide with handouts on the client's i65 home page. This guide will show your clients how to use the Medicare.gov Plan Finder tool to select the Medicare Advantage plan that is best for their unique needs.