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

Answer: This is my most commonly asked question I hear from individuals I meet with. 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 (almost always a Medicare Advantage Plan). Medicare Advantage Plans, Medicare Prescription Drug Plans and Medicare Supplement Plans almost always pay commissions to brokers who enroll people into the plans and commissions are how the brokers get paid. The commission could be a one-time enrollment commission or may last for a longer period of time (months) depending on how long you stay in the plan.

The Centers for Medicare and Medicaid Services (CMS) rarely call individuals directly. If they do call you directly, is it 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 may get a quarterly bill from CMS for your Medicare Part B premium if you are not collecting Social Security Benefits.

Often individuals who are turning 65 or those who are enrolled in Medicare report getting many calls from insurance companies, sometimes repeatedly from the same company. These brokers often say they “are calling regarding your Medicare coverage”, or “calling on behalf of Medicare”.

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. 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 you to know about and potentially enroll into. 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 also usually include additional benefits, like a health club membership, or payment towards eyewear, dental or over the counter benefits. Some Medicare Advantage Plans even give you part of your Part B premium back.

It is very important to understand that this type of 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 70 different Medicare products available to those in Chautauqua and Cattaraugus County. We don’t all drive the same vehicle, and 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 used, medications, and where/when you travel.

That individual calling is probably not someone from our local area and may not be asking you enough questions to make an informed decision.

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 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.

Janell Sluga is a Geriatric Care Manager helping seniors in our community access services and insurance. To reach her, please email editorial@post-journal.com.