Explanation

Why is Medicare so Complicated? Not sure I can answer that question but let’s look at some of the complexities.

1. Medicare recipients can change their Medicare Advantage plan during AEP and OEP. Seniors with a standalone prescription drug plan can only change their plan during AEP. There is no logic in this because the MAPD plan includes drug coverage. ALLOW SENIORS TO CHANGE THEIR STANDALONE DRUG PLAN DURING OEP.

2. Those of us with Medicare Supplements can only change their supplement using the Nevada birthday rule meaning you can change your plan the month of and the month after your birthday. Meaning you could potentially change your plan annually if desired. WHEN YOU CHANGE YOUR SUPPLEMENT ALLOW US TO CHANGE OUT DRUG PLAN IF NEEDED.

3. Medicare supplement clients need to have a standalone drug plan so while you can change your supplement plan at one time during the year you would have to wait until the AEP to change your drug coverage. What if your medication needs change significantly. You are only allowed to change plans during AEP so if your birthday were in March you would have to wait until October to change your drug plan and it would start January 1st of the following year. SEE ITEM 2

4. Why do we have an AEP (Annual Election Period) and a separate OEP (Open Enrollment Period) where you can only change twice during the year. Incidentally, those underage for Medicare can only change their insurance plans during the open enrollment period from November 1st through January 15th, unless they have a special election period due to significant change in their personnel status, like marriage, divorce, birth of a child, moving into a new county, or state. ALLOW MORE FLEXIBILITY IN CHANGING PLANS.

5. All Medicare brokers and agents selling Medicare are required to record all phone calls to prospects or clients. Consider that recording a call where you se talking about someone’s health is a violation of the HIPAA act but since CMS make this rule, no one is challenging it. THERE SHOULD NOT BE A REQUIREMENT TO RECORD CALLS BECAUSE IT IS A HIPAA VIOLATION OF PRIVACY.

6. We are also not allowed to call a senior unless they request us to call. This significantly impacts our business because we are not allowed to cold call. Yet daily we get between 10 and 15 calls about Medicare even though it is illegal to make cold calls. CMS is not doing anything about it yet each year they come up with more ways to restrict our

business. There are some very large Third-Party companies that do nothing but violate the rules daily and CMS does nothing about it.

I’ve even sent the phone numbers of these cold callers to CMS and nothing gets done. Their ads (The Joe Namath ads) have finally been taken off TV but that doesn’t stop them. Yet independent brokers and agents are forbidden to make these same cold calls. EITHER STOP THESE LARGE COMPANIES FROM CALLING SENIORS OR ALLOW BROKERS AND AGENTS TO COLD CALL SENIORS.

7. Many seniors are working longer beyond their 65th birthday and there are some complicated rules regarding Medicare Parts A & B. If your company has over 20 employees you only need Part A, but if your employer has less than 20 employees you need both parts A & B. The reasoning is if you work for a larger company their group health plans pay first so you only need Part A. The reverse is true for company for a with less than 20 employees as Medicare pays first so you need both Parts A & B. Why is this so complicated? I think it just

the government being the government, but things do need to change. CHANGE THE RULES TO REQUIRE PART A ONLY REGARDLESS OF COMPANY SIZE SO SENIORS WHO MAKE THESE MISTAKES AREN’T PENALIZED FINANCIALLY FOR LIFE.

As you can see there are rules about changing coverage which when you analyze it makes no sense. Why can’t you change plans anytime you want or need to because of a change in health status, etc.? The answer is Congress set it up this way with input from the insurance carriers, who didn’t want to make changes every month because it took too much effort and manpower. Rather inconvenience the client but not the insurance company. Congress has their own coverage with more liberal rules and regulations. Congress is not on Medicare or social security. Why not?

I have been a broker for 22 years and I’ve seen so many situations that on the surface don’t make any sense yet that is what we must handle regularly.

I do understand that most people do not want health insurance and only want it when they have a medical situation and understand how this affects the insurance company, but the rules keep getting more complicated. Surely, we can design a better model so Medicare and under-age clients can get the coverage they need when they need it. I would consider a surcharge on the monthly premium for those who did not sign up and now need to due to health issues. Design a formula where the surcharge is based on how many months they did not have coverage and should have.

As you can see, there are many things that should be changed to improve both individual health insurance and Medicare coverage, but it is not being addressed. Perhaps it should!

I hope this information is useful and if anyone has questions, please contact me via phone or email and I will respond quickly.

Also, take a look at Medicare 2025 Information.

The Barend Agency Inc.

Len Barend, Broker

Cell:702-250-2200
Email: len@insurance4unevada.com