Insurance Agent Forum

[midwestbroker]

Why agents are so important to Medicare Beneficiaries:


I called Medicare to ask about the coverage gap / donut hole in Part D of Medicare.


Here is the conversation with Javon at 1-800-MEDICARE:


Me – I am calling on behalf of my father-in-law who is getting Medicare soon. He asked me about the coverage gap or donut hole that is in the drug coverage. What is it?


Javon – Which one are you talking about? The coverage gap and donut hole are 2 different things


Me – I thought they were the same thing?


Javon – No. The coverage gap is when you spend too much and you can get coverage to cover the gaps of Medicare. The donut hole is when you have to pay full price for your drugs for a couple of months.


Me – So at what point will I have to pay full price?


Javon – Each plan is different.


Me – Ok, thank you for your time. (I had to go, had another call).


Here is what was wrong:

1. The donut hole and coverage gap are one in the same.
2. The time that one may be in the coverage gap may not be a few months.
3. Each plan has the same start and end point in the gap ($2700 total drug cost to enter the gap and $4350 in total out of pocket to get out of the gap)

So, CMS is making it harder to talk to seniors, and now we have to clean up Medicare's mess.


Thanks CMS!


I am going to ask someone else to call and do the same thing and post the results. I am going to call again tomorrow and have a more detailed conversation.

[policy doctor]

All this research takes so much time and resources which avg agent does not have.

However, I would love an independent consumer study group to do exactly what you have done....screen CMS svc. reps and critique the job that they do for their beneficiaries.

Show how uninformed and ignorant they are of their own procedures, and the misinformation they give how it harms seniors. We need heavy numbers to sway public opinion.

[Insuranceman]

I agree, on most of the occations when I called a goverment agency for information it turned out to be incorrect.

[midwestbroker]

The only study that I found that was aimed at this is this:

U.S. GAO - Medicare: Accuracy of Responses from the 1-800-MEDICARE Help Line Should Be Improved

Basically, 61% accurate, 29% inaccurate, and 10% of the calls were routed incorrectly or disconnected.

[The Rabbi]

Typical gov't SNAFU.

[mking]

I heard that the people on the 800-Medicare line do NOT work for Medicare,,,,,,,,but rather and outside company.....

Can someone confirm that?.........It this is the case we should really hold their feet to the fire!..........

[midwestbroker]

I have heard that as well, but I am not sure.

[honestagent]

I have called many times and each time I'm routed to a different caller, different state. I always ask to speak to an experience benefit specialist(log name and date/time) who can help with ____ and _____. (once transfered) Hi, My name is.... and I'm on the phone with .... and we need help with ..... and we're wondering if you...... or do I need to talk to your superivsor?

When I take this route, it usually cuts through much of the red tape and I get to a person who actually knows what the hay I'm talking about and we speak the same jargon.. donut hole, aep, sep.. etc. etc. client in the meantime is doing this.... I'm sure.... and then.... it's more timely, but it gets the job done! hope this helps you!

Of course there were a few occasions where I got an idiot, yes an idiot, that I screamed at.. and where the idiot hung up on us. The client and I laugh and then call and rewind the process again once I have settled down and then, the job gets done.