How to Assist Clients Already Enrolled in Medicare

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UPDATED 4/17/18

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

Unfortunately, making changes in the type of coverage a person has after being on Medicare for more than 6 to 12 months can be very difficult - if not impossible. This is particularly true for those people with poorer health.

Please note: A person enrolled in a Medicare Advantage plan or Part D drug plan can always change from one specific plan to another of the same type (Ex: Medicare Advantange to Medicare Advantage) each year during Open Enrollment (Oct. 15-Dec. 7).

That said, you can still assist your clients already enrolled in Medicare to better understand what type of coverage they have and what it means for them moving forward.

Here is how we recommend using i65 to assist clients 65 years of age and older who are already enrolled in of Medicare:

PROVIDE YOUR CLIENT WITH A ROADMAP:

  1. Create an i65 account for this client. When asked who will complete the RoadMap for this client, choose the "Me" option.
  2. Choose Option 4 if your client has retiree coverage. If not, choose Option 1.
  3. Answer the i65 questions to best of your ability as if you were your client.
  4. In the final question, be sure to choose the type of coverage your client currently has.
  5. Remove the Step-by-step directions and Initial Enrollment Period sections from the report.
  6. The remainder of the RoadMap will provide your client with a basic understanding of the current coverage they have and what it means moving forward. This information be very appreciated by a client who has little to no information about current Medicare coverage.

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 insurability before securing this type of coverage. If your client is not in good health, it is critically important that he/she does NOT disenroll from any current coverage before having secured new coverage.

  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.
  3. Have your client follow the instructions in the state-specific guide. Be sure to note whether or not your client has a Guaranteed Issue Right. Without Guaranteed Issue, your client can still go through the process of trying to get a Medigap plan but may not be able to get this type of coverage.
  4. If your client is granted this coverage, follow the steps earlier in this post to provide your client with an Original Medicare RoadMap.

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.

FOR THE CLIENT ENROLLED IN A RETIREE PLAN:

The most important thing to know about switching from a retiree plan 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 your client is not in good health, it is critically important that he/she does not disenroll from any current coverage before having secured new coverage.

  1. Ensure that your client is trying to learn more about switching from retiree coverage (any coverage not related to ACTIVE employment) to another type of Medicare coverage.
  2. If your client is interested in obtaining supplemental coverage, locate the "Choosing a Medigap Plan" guide for your client's specific state from the tools available on your client's i65 home page.
  3. Have your client follow the instructions in the state-specific guide. Be sure to note whether or not your client has a Guaranteed Issue Right. Without Guaranteed Issue, your client can still go through the process of trying to get a Medigap plan but may not be able to get this type of coverage.
  4. If your client is granted this coverage, follow the steps earlier in this post to provide your client with an Original Medicare RoadMap.