Avoid Medicare fraud with an independent agent

Are you a captive agent or independent?

Yearly, insurance agents that want to represent Medicare Advantage (MA) or Part D Prescription drug plans (PDP) must complete a Medicare approved program course and test. Essentially this program goes over what the different MA and PDP plans are and the “do’s” and “don’ts” of marketing the plans. I always get a chuckle when I come to the section that says,

  • Marketing representatives must NOT:
    • Assert that their plan is the “best” plan.
    • Make explicit comparisons between their plan benefits and those of another plan, unless they are presenting comparative information that was created or approved by CMS or they have written concurrence from all plan sponsors being compared.

Go Team Go!

The Centers for Medicare and Medicaid (CMS) includes this language because many agents are captive to one company. In other words, they only represent one insurance company’s MA or PDP plans. I’ve sat through a company presentations on why their plans are the best. You combine the insurance company’s cheerleading session with an agent that has to sell only that plan and you get lop-sided sales presentations to the beneficiary.

All of the CMS training, regulations and rules are meant to shield the perspective member from undue sales pressure to sign on the dotted line, tonight! How can anyone make an informed decision when they are only presented with options from one insurance company?

Coming to a store near you

Retail store kiosks show up in stores during Annual Enrollment Period.

You may have seen the super market or pharmacy retail stands or kiosks each fall with a happy insurance agent touting the benefits of a specific company’s Medicare plans. Be aware that in most instances the agent standing behind the kiosk had to pay a fee for the privilege of standing next to the insurance company’s plan material. I know because I’ve done it. With that sort of investment there can be pressure to sell only those plans sponsored by that company even if the agent represents other insurance company’s MA and PDP plans.

Let’s be honest

Routinely, folks would approach me in the store while I was standing at my kiosk and ask, “Is this the best plan?” The honest answer is, “It depends on your individual circumstances, and there might be other plans that are best suited for your needs.” There are many agents, captive or independent, which will give this answer.

A little research goes a long ways

My admonition for folks either during the Annual Enrollment Period this fall or initially enrolling in Medicare, sit down with an independent agent that represents several insurance companies and review all of your options from Original Medicare, Medicare Advantage, Part D Prescription, and Medicare Supplement plans.

One more disclaimer please

My recommendation to the CMS is that they require captive agents to specifically inform any Medicare beneficiary that they only represent the plan(s) for one company and there may be other plans, if available, that they should research. The best scenario would be to have CMS prohibit captive agents all together. All agents should be independent and represent all plans available in the particular geographic region they are working in. In addition, compensation to the agent should be the same whether they sell company A, B or C.

When we put the emphasis on education and comparison of plans, the Medicare beneficiary is the winner and not the insurance company.