As a business owner or homeowner, when one asks you if you are happy with your insurance agent, you may usually gauge the relationship you have with your property and casualty insurance agent by the level of service you require and are provided.  If you are unhappy or if you feel the costs are too high, it is common place to cancel your insurance and place it with another agent or insurer at any time you see fit. If you are being provided health insurance at Age 65 and over, there is not the same ability to cancel your existing benefits and make changes whenever you may wish.  There are certain enrollment periods which must be adhered to.

Whereas business owners usually compare the coverage and loss control services which are received in conjunction with the premiums or audits involved, very few homeowners consider such a comparison, until it is too late and they have suffered a loss.

The difference between business and personal insurance is that many are so confident their needs may be met by pricing alone, that an insurance agent is not even consulted. Instead one may respond to the advertisements of how your costs may be lowered in auto and in homeowners insurance, not understanding that possibly you may be provided lower limits or that you are not being covered in the manner which best serves the protection of your assets. 

For instance, has your agent or the advertisement which you have responded to, even stated that there are certain properties which have limitations to theft insurance.  So what happens if your guns, your jewelry, furs or silverware and precious metals are stolen?  Does it matter that you if your precious heirlooms disappear?

And does it matter to you that when offering a friend who does not drive the opportunity to travel with you to another State that your no-fault coverage may not pick up medical expenses for that person if the accident did not occur in the state from which you purchased coverage?  Unless you have had a good insurance agent to start with, who has given you credible information so that you feel proficient about your choices and have read the ever changing laws, including those pertaining to benefits offered (i.e. up to $5,000 in matching funds offered by the State of Florida to provide hurricane mitigation), then it is suggested you seek assistance through an agent who makes inquiries and answers your questions.  However, remember, those insurance agents who may be proficient with your business and personal property and casualty insurance, may not be proficient with your senior benefits programs.  You again may have to choose an agent who you may respect and confide in.

As a senior facing retirement, on an income which is limited, it surprises me that most prefer to make their own decisions relating to health care and related retirement benefits. You may have read some of the advertisements pertaining to certain products which may be available to you and may have not investigated the many other advantages which may be available to you, based upon your current health situation.  

You may feel that being able to handle your finances while in the working field is similar to handling your assets while during your retirement period.  But is the method similar?  Consider the fact that you are no longer in an earning capacity and the assets which you have accumulated may have to last you for another thirty to fourty or more years. 

You may have secured investment opportunities throughout your lifetime and may have a large pension, life insurance and a health care program which is paid over and above your original Medicare options. You may be fortunate indeed if the incidents in your life do not change and you have secured such additional benefits as long term care.  

And, perhaps in the event of your untimely death, your loved one may be provided the same benefits as you currently enjoy, less any social security or pension trust which may have been available to you alone or while you are alive.  Perhaps you have a life insurance policy, which will assist your beneficiary during that period to pay estate taxes or provide additional funds to survive in the same manner as when you were alive.  But will the life insurance proceeds last or will your loved one require additional income?

However, for the average American who is in the upper or lower middle class, it may not be as easy for them.  Any change in their health or financial stability could make them lose the very assets they have worked so hard to obtain. Even a celebrity such as Ed McMann recently has had his share of health difficulties and may be facing bankruptcy and losing his assets as a result.  Do you have friends or family who may be able to bail you out? And would you wish your financial difficulties imposed upon your friends and families? Will you be able to live with other family members?

It is always said, “if you have your health, you have everything!”  So let’s start with your health care options when you turn 65.   You already may know that if you do not enroll in Medicare Part B when you are first eligible (or during an annual enrollment period such as after you drop or lose your employer coverage), you may have to pay a late-enrollment penalty, paying higher monthly premiums for Medicare Part B and Part D for as long as you have Medicare Part B and D. But what happens after that?  

Has your current agent discussed your current health insurance options?  Has your agent advised the financial implications or costs which may be associated with calendar changes made by Medicare each year, and the penalties which may be imposed if coverage is not elected in the initial enrollment period?  Have you been made aware of the percentage of health care for which you may be responsible for? 

If one purchases a Medicare Advantage plans which provides drug coverage, have you been told that in the event of cancer or other diseases, you may still be required to pay 20% under Medicare Part B and 33% under the Prescription Drug Portion of Part D? 

Perhaps, you may require a Medicare supplement through a private insurer because even  its costs, will be far below a 20% coinsurance requirement you will have to pay under a Medicare Advantage. 

Has an insurance representative provided you with the differences in Medigap costs based upon a premium based upon your issue age rather than community rated or an attained age rate?  

Has anyone discussed the ramifications of being in the Donut hole relative to part D?   Have they apprised you of the donut hole where you are required to pay 100% of your prescription drug coverage after a specific retail value of your drugs have been reached?   Some Medicare Advantage plans have donut hole coverage for generic drugs, but that may change in 2009, dependent upon the Medicare changes required.    

Perhaps you cannot afford a Medicare supplement or Medigap policy or perhaps you can afford one but are healthy and you do not wish to choose a Medigap policy to cover your Medicare Part A and B deductibles or the now 20% coinsurance?   The excess costs for Part D Prescription Drug coverage may no longer be provided under the Medigap or Medicare Supplemental standardization as of January, 2006.

Have you been provided information relating to the HMO, PFFS, SNPs, MSAs and PPO’s which may be available in your area?  Do you have a preference in certain doctors who may be included within a plan; the preferred and specialized copayments for certain prescription drugs and the plan which includes these prescription drugs at the lowest cost to you.  Does the plan offered include additional perks such as some dental or optical coverage or perhaps even membership to an athletic club?  Do you require special services because of chronic conditions?  Is your health excellent at this time, so that you could build a savings account by Medicare returning a portion of your Part B premium until such time as you may be required to pay your health care costs?

If you do not have an agent who is willing to listen to your health care concerns and needs, why would you consider leaving your other retirement options in the hands of one who just wishes to sell you life or burial insurance, long term care or annuities?  After all, you are the only person who understands your health care needs based upon your overall health history and those of your family.  And, dependent upon those needs, should your health conditions change by accident or illness, only you may determine how those conditions will change your financial needs for the future.  You may have already determined you may be able to utilize your life insurance to pay health care costs, or purchasing an annuity to protect not only your assets but your loved ones. 

There are many types of life insurance policies available, at varying costs, dependent upon your needs as are their annuities.  Dependent upon your circumstances and the determination of the payments to be received, some annuities may provide a guaranteed income, an equity income or one in which your income may vary based upon the portfolio which may be chosen by you. 

if you have a strong relationship with the individual who is assisting you with your health care needs, who answers your inquiries and assists you to be provided the best benefits which may be available to you, then the individual seated before you may also be able to assist you with planning your future so that both you and your loved ones may be protected in the event of a death or disability. This individual most probably will not sell you something you do not need.

It should be noted that 50% of all individuals may end up in a skilled nursing home or in assisted living at one time in their life.  Yes, perhaps your children will assist you through that time, but one must also consider the burdens which may be imposed upon such loved ones as well as your own desire for independence.  If you end up in long term care without the appropriate insurance, you could lose all of the assets and equity you have built throughout the years. 

If you may not be able to afford the premiums for such long term care, perhaps your children may be able to provide you with a gift of a long term care policy.  In fact, most states offer long term care policies through their insurers to assist those even less fortunate to retain some of their assets.

So how do you find that one individual who you may trust will do the right thing for you?  It is not easy. And, it is much like choosing an insurance agent for your business, home or auto, but at a more critical time when your earnings are not the same as during your retirement period. 

As of the Annual enrollment period beginning 11/15/2008, Medicare has changed the rules and it has become a more difficult task.  

Although the formal rules are not out yet, the HR6631 MIPA stipulates that no unsolicited contacts may be made if it relates to Medicare advantage plans. The law has been changed based upon complaints of 1% of the senior population.  No longer will you be contacted with respect to your medicare advantage plans. 

There may be no door to door contacts if such relates to Medicare Advantage Plans.   

There may be no telemarketing of clients relative to Medicare Advantage Plans, no free meals, nor may information be provided with non-health care addition. 

There will no longer be educational events.  By law your agent is no longer able to contact you regarding Medicare Advantage Plans.  

Even though President Bush did veto the bill, it was passed by Congress and now, it will be difficult to determine how to choose an agent who meets your needs relative to the formularies and doctors under the various Medicare Advantage plans.  To be assured you have the best plan for you for 2009, you need to contact your agent for the annual enrollment period starting November 15.

If after making an appointment for specific information, if the individual in front of you does not navigate you into the various options available based upon your actual needs, beware of your future ramifications. Remember your choices are important and they may impact your future.

Most importantly, do unto others as you would wish others to do unto you.  If you have to change appointments or have changed your mind about meeting with the individual, contact them and be honest about your reasons.  Consider how you would feel if you made an appointment with someone and after driving several miles, you were left on the porch, with no one answering the door, especially with the price of gas in 2008.

I understand why, however, when I noted some of the tactics used by others and realized that it is like any other relationship in life.  Some are interested in assisting others based upon that individuals unique needs as well as making a living in the sale of insurance products, where some are interested only in the latter.

Just remember as of November 15, 2008, no one may utilize tactics to sell you Medicare Advantage Plans.  In accordance with the Center for Medicare and Medicaid Services, an insurance agent may no longer contact you.  You either must be responsible for your own decisions relating to the Medicare Advantage plan you are in or have chosen or you must contact one or more insurance agents who you feel may fulfill your needs and choose the one who you are most comfortable with.

You shall now have to choose an agent whose very principles are to provide the products which meet your  needs, without high leveled sales tactics and imputed obligation. If your needs may not be met by a specific plan, they should apprise you why a change should not be made  

Kathryn Weiss