I admit it: I’m human. Far from perfect. But I do pride myself on being a good person to the extent it’s part of my professional identity as Mr. Nice Guy Medicare Advisor. At this point in my career I’ve met with thousands of Medicare beneficiaries. My experiences have run the gamut from meeting some of the best, most genuine people around to having people rudely chase me off after having driven many miles to see them.

Throughout the years I’ve had a few interactions that really got me angry. Very few times did I ever show that to the person I was trying to help. But one time, in particular, I really screwed up and boiled over. The good news is I learned from doing that to not let it bother me where it messes up my day and it gives any potential client a negative experience with me.

The story begins at a Panera Bread. One of my favorite clients, Arlene*, had referred her brother Sean* and her sister in law, Pam*, to me. I met Sean and Pam at the restaurant and we sat down for our meeting. We talked like old friends for about half-an-hour and got to know each other. However, Sean, hadn’t activated his Medicare Part B yet, so I volunteered to do that there since I knew how to do it and save him the time and aggravation of having to deal with Social Security directly (which I could do back then). Since I had my tablet, we went online and I walked through signing him up and it took about 45 minutes to do that.

Having accomplished that painful, time-consuming task we got to talking about Medicare options and what they were. Pam had several health problems already and was looking at some upcoming surgeries potentially, so I recommended a Medigap plan, which they both signed up for (Sean wanted the same thing as his wife). All told we were at Panera for 2 ½ hours on a Friday night but we got it all handled and, in my view, had a pretty decent time doing so. We had a good rapport and never a lull in the conversation. I’ve had at least a dozen appointments like this where a couple and me just had a grand time and it didn’t feel like customer-salesperson. It felt like doing business with a friend and this was just how this had gone. It was about as pleasant as dealing with health insurance could be.

Fast forward about two weeks later and I get a call from Sean saying he had decided to go with a different Medicare Supplement company and to cancel out the applications we had submitted for he and Pam. I was so stunned I was dumbfounded and immediately outraged. What?! The competing Medicare Supplement company had lower rates by a dollar or two, but being a veteran of the industry, I knew they were infamous for coming out with what agents call ‘teaser, low-ball’ rates and then within two or 3 years having the rates double in some cases. I’d been burned by this company as an agent numerous times and avoided using them like the plague.

Telling Sean why I hadn’t presented this company to him, he didn’t seem affected by my reasoning. I told him what he needed to do was call this other agent back and tell him what he told me, he didn’t want that insurance! And if he really wanted it, despite their reputation, I could sell it to him if he really was hung up on saving a few bucks for the short term. He proceeded to say “but I promised him we’d take it already”. This sent me over-the-edge as I blurted “You promised me too! And I actually did you a huge service, helping you sign up for Part B of Medicare! This guy doesn’t care anything about you! If he did, he wouldn’t have sold you that terrible company!” I must’ve short-circuited poor Sean who thought I’d be an easier guy to say no to who abruptly got off the phone after I’d given him a piece-of-my-mind.

And usually I’d handle a situation like this with far more grace, but I felt taken advantage of and felt like our good time together was all for naught. At this point this had never happened to me where someone I had a great appointment with ended up not using my services.

Now, instead of being a pleasant memory and potentially years of being a good relationship, it was a source of pain. I’d gone out-of-my-way to see them late on a Friday night and taken time away from me and my family to help them. For what? To have some two-bit, hustler of an agent undo it to save a few bucks?! And why even talk to anybody else after we’d met? Didn’t this guy get I was trying to do my absolute best for him and his wife, and make his sister, Arlene, feel good about referring them to me? Still, despite that, I was way wrong in going off like I did.

First of all, it doesn’t align with my values of trying to help each and every person like they’re family and friends. Second, if I’d have handled it better Arlene would’ve probably told him what an idiot he was for not taking my advice and making her look bad even. Now I was just some jerk who cried like a baby when I didn’t get his way. I helped justify his decision to not use me as an agent with my misbehavior and closed the door on him coming back later and saying he should’ve used me all along (which has happened a number of times) because the other agent didn’t do right by them.

Secondly, I knew what my intentions were and I could’ve explained them calmly and maybe gotten him to see that too. By involving my ego and sense-of-righteousness to angrily defend myself, I put him in a position of feeling berated and insulted. I knew better than to let something so petty disrupt my mindset. What’s the big deal? If he doesn’t become my client is it going to affect my bottom line? Not really.

The truth is my ego was wounded and I handled it poorly. It felt personal and I made it personal in a negative way. Even if I was technically or morally in-the-right given what had previously transpired, I was better than that. Nobody deserves to be gone-off-on in such a manner and I learned that lesson.

The moral of the story is in-the-long-run I resolved to be a kinder, gentler agent who wanted to help people for the right reasons from then on. We all make mistakes. It’s our job to learn the lessons from them and use it going forward. After all, why deal with a jerk, when you can deal with a Nice Guy?!

*-names changed to protect their true identity

That’s all we do here! My name is Randy W. Hall and professionally I’m known as “Mr. Nice Guy Medicare Advisor”. First off, let me share with you I hate traditional sales methods and tactics. I’ve learned I hate cold-calling folks like you and like it even less when someone cold-calls me. And if someone tries to pressure me into buying? I want to walk away out of spite when a salesperson tries that on me!  That’s why I’m writing you today. I want to invite you to seek out the information that could help you Maximize Your Medicare! All with the promise of helping you first and never pressuring you to buy something.

I’m a licensed broker in Tennessee and am authorized-to-offer most major carriers in the Medicare industry that operate in our state. Why do business with a broker? First off it means I’ll help you figure out which plan or programs are best-suited for you individually. You’d be surprised how many people assume that just because a plan is great for their family member or friend, that it’s the best one for them. While it very well may be a great plan for them, there’s an even better chance something else out there would suit them more. And since I’m a representative for most everyone I’m not limited to showing you just whomever I happen to work for (such as if you called a carrier directly). You can get a 360-degree look at what is available to you and the different costs and benefit packages there are out there.

Best of all, my sole mission is explaining things to you in a way that’s easy-to-follow and not confusing. Too often things like “Medicare & You” are written in way that are hard-to-follow or filled with confusing terms that assume a level of understanding the average person doesn’t have. Also, we don’t believe in high-pressure sales. We call ourselves ‘Advisors’ because we see ourselves as here to give information and guidance. In my ten years of being an independent agent I’ve helped thousands of folks navigate the Medicare Maze and keep up with my clients on an annual basis when plans change as well. Many of clients have become like friends to me over the years.

Right now, you may be overwhelmed and don’t know where to start with all the mail and information you’ve been sent. Be it Medicare supplements or Advantage plans or Part D questions I specialize in all of it. We don’t charge for any of our time. In fact, the way we get compensated is by enrolling you in a plan and the companies themselves pay us. Conveniently they all pay me the same so I’m not biased by which company pays me what, simply which plan works best for you! And you pay the same price for your insurance whether you have my help or not. The difference is if you decide to use me as your agent, I can be your advocate and help you with any situation that may arise once you’re on your plan!

When people are weighing their Medicare options the most fundamental thing we discuss is the difference between Original Medicare Supplement with a Medicare Supplement (aka ‘Medigap’) and Medicare Advantage plans. I’d be willing to lay down a bet of five dollars that the majority of folks who have a Medicare Advantage plan believe they have a Supplement to Medicare. A Medicare Advantage plan is not the same as buying a Medicare Supplement to fill-in the gaps of Original Medicare. The reason, I think, is because Medicare themselves have complicated the issue by having the word ‘Medicare’ be used in describing their insurance plan. If they called it something without the word ‘Medicare’ it would probably help when I explain the difference between the two as well. But we live in the real world so we’ll deal with the reality of the situation.

The way I get most to understand the difference is by focusing on who the ‘Primary’ insurance is through. Most of us, by having had insurance the majority of our working lives, are familiar with the concept of having a primary provider. When I worked for an advertising company my ‘primary’ insurance was through Blue Cross Blue Shield of MI. I usually had to meet a deductible for the year, and then BCBS of MI would pick up 80% and I had to pay 20%. So, in this instance, BCBS of MI was primary and I was secondary once the deductible was met. Most of us who work or got our insurance through a spouse or parent are familiar with this set-up.

So back to Medicare. In the case of Original Medicare being primary, you have the chance to buy what’s called a Medicare Supplement (aka ‘Medigap’) to fill in the gaps of Medicare. So, if you have a Med Supp, your provider, a doctor or hospital, will bill Medicare first and then send the remainder to your supplement provider. And here’s something that’s important, it makes virtually no difference which company you have, all that matters is that Original Medicare is accepted by the provider. If the provider accepts Original Medicare, and they pay the claim, then whomever you have your Med Supp through, will pay their share automatically. This is because the claims payment system is electronic and all Supplement carriers use it.  This also means you don’t have to concern yourself with whether your provider accepts your Medicare Supplement company. By law, each company pays according to which letter plan you have. There are no networks. This means a plan F or G or N (the most popular type of Med Supp plans) is exactly the same in what benefits it covers. The only difference is the premium you pay can vary wildly from company-to-company. That’s why we offer so many different Medicare Supplement carriers. Since all Medigap rates go-up over time we stay contracted with the companies that are the most competitive.

One thing to keep in mind is that if you have Original Medicare with a Med Supp, you will have to buy what’s called a stand-alone Part D plan, which has an additional premium, if you want prescription drug coverage. We also offer a variety of different stand-alone Part D options to go with your Med Supp. However, as a courtesy to our Med Supp clients, we will do a Drug Plan search annually for free if you’d like. If the Part D plan that’s best for you happens to be one we sell we will enroll you personally. If it’s not one we are authorized-to-offer we can tell you the company which is best and you can contact them directly, or we’ll sign you up with the understanding we aren’t the agent-of-record and can’t work with them on your behalf if there’s any issues that arise.

In the case of Medicare Advantage (aka Medicare Part C), what happens is Original Medicare is no longer your primary insurance. Instead you’ve selected a private company to administer all of your Medicare benefits for certain co-pays, and unlike Original Medicare, they’re able to add additional benefits that Medicare can’t. Some examples include:

-Dental

-Vision

-Hearing

-Over-the-counter items such as vitamins, medical items that we spend our own money on, medical equipment

– Post-hospitalization meals

– Emergency response systems

– Prescription drug coverage

-Gym memberships or at-home fitness packages

So what, in effect, happens is you pick a company (Blue Cross, Blue Shield, Aetna, Cigna, et al) and Medicare pays them so much per month to cover all of this for you. Often at a zero premium or low-monthly premium over-and-above what you pay Medicare for Part B coverage ($135.50 monthly for most people).

The thing to keep in mind is these are very similar to insurance most of us have had prior to being eligible for Medicare. They are HMO’s and PPO’s, which are network-based. This means, prior to enrolling, you need to be careful to make sure your doctors accept the plan you choose if that’s something that’s important to you. One thing we do at Mr. Nice Guy Medicare Advisors is confirm your doctors are in-network before we enroll you into a Medicare Advantage (aka Part C) plan.

They also have co-pays (or cost-sharing) that are equal to or, in most cases, superior to having Original Medicare without a Med Supp. For example, you’d pay a co-pay of $10 to see your primary-care doctor and $40 to see a Specialist. Depending on the Medicare Advantage plan you pay a co-pay for every Medicare-service covered.

The other thing we do is look up your prescription drugs (if you take any) to see how they’re covered by each company. The majority of Advantage plans include Part D prescription drug coverage included in the plan itself for no additional premium.

On Medicare Advantage in an emergency or urgent care situation you’re covered the same way you would be if you were in-network. However, if you go to a provider that’s out-of-network and it doesn’t fall under an emergency or urgent situation, there’s a great chance you’d pay for the entirety of the cost in an HMO. In the case of a PPO you’d likely pay a higher cost-share (co-pay) than seeing someone in-network.

One key feature to keep in mind is all Medicare Advantage plans have out-of-pocket maximums ($6700 or less per year) so if you had a rough year health-wise there’s a limit to what you’d spend out-of-pocket. Also the plans can improve or weaken their benefits every year, which is why we call our clients every October to update them on their particular plan.

To help compare the 2 here are some at-a-glance pros & cons of each

Original Medicare with a Med Supp (aka ‘Medigap’)

Pros                                                                                                       Cons

• No networks – Rates increase over-time
• Cost-certainty (you pay premium and go on) – Have to buy stand-alone Part D
• Low-risk – No additional benefits beyond Medicare
• Good across the U.S. – Pay premiums whether you use it or not

Medicare Advantage (aka ‘Part C’)

Pros                                                                                                       Cons

• Often have zero or low premiums – Network-based (HMO or PPO’s)
• Coordinate care better than Original Medicare – Costs vary by health (higher risk)
• Prescription drug plan included w. no premium – Plan has to approve certain procedures
• Can save significant money – Plans vary by county
• Usually include additional benefits (see above)
• No deductible to meet on most plans