Question: I have gotten numerous phone calls from individuals saying they are calling from Medicare. Are they really from Medicare?

Answer: This is my most commonly asked question this year. I can confidently say no, that caller is not from Medicare. These types of calls are probably from an insurance company that contracts with Medicare to provide insurance coverage to individuals with Medicare (many are representing a Medicare Advantage Plan). Medicare Advantage Plans and Medicare Supplement Plans pay commissions to brokers who enroll people into the plans. Commissions are how these brokers get paid from a one-time enrollment commission or how long you stay in the plan and the type of plan you enroll in.

The Centers for Medicare & Medicaid Services (CMS) will only call you because you called to report a problem, file a grievance or something similar. CMS staff will not call an individual unsolicited. CMS will mail you information, like your Medicare Card, the Medicare & You handbook and Medicare Summary Notices (MSN). You get a quarterly bill from CMS for your Medicare Part B premium if you are not collecting Social Security Benefits.

Individuals report getting many calls from insurance companies, sometimes repeatedly from the same company this time of year. These brokers often say they “are calling regarding your Medicare coverage”, or “calling on behalf of Medicare”. The individual calling is probably not someone from our local area and may not be asking you enough questions to make an informed decision and definitely is NOT from Medicare.

Commercials on TV bombard people with exaggerated benefits over and over again.

Individuals also report that during the year they hear from their current insurance company via the phone to talk about “additional benefits” they may be eligible for. This usually is a situation in which the current insurance company also owns other type of insurance products. Take for instance you have Medicare with a Medicare Supplement Plan and a separate Prescription Drug Plan. Each of those products are through an insurance company, who may have other products it would like to peddle you. This alternative coverage is usually a Medicare Advantage Plan which bundles all of those products into one card. The premium usually costs much less, but the co-pays tend to be much higher when you access care. Medicare Advantage Plans usually include additional benefits, like a health club membership, dental benefits, over the counter products, or payment towards eyewear. Some Medicare Advantage Plans even give you part of your Part B premium back.

It is very important to understand that this type of insurance switch has many factors to consider, most importantly; “Are your doctors, labs, and hospitals in the network of providers with this alternative company?” and “Are your medications covered at the pharmacy you use?”

I often use the analogy of automobiles when talking about insurance. Not every car is right for every individual, but every car is ideal for someone. There are over 76 different Medicare products available to those in Chautauqua County, and more than 80 in Cattaraugus County. We don’t all drive the same vehicle, we don’t all need or want the same insurance products.

When you get that phone call about your Medicare coverage, or someone saying they are calling on behalf of Medicare, my advice is to hang up. If you speak to them at all, ask them to send you material in writing. Review it carefully, meet with someone in person or locally to review all the issues important to you, like doctor network, pharmacy you prefer, medications you take, and where/when you travel.

If you get a new insurance card in the mail, or a cancellation notice from your current plan and you don’t feel that is correct, call them and ask questions. If you need help, reach out to Senior Life Matters, The Office For the Aging, or the insurance broker you have used in the past. It is important to act quickly if you don’t want this new coverage.

Senior Life Matters is a community based program sponsored by Lutheran Jamestown. For questions and concerns or to reach Janell Sluga, GCMC, call 716-720-9797 or email SLM@lutheran-jamestown.org.