The Importance of the Agent’s Role for Medicare and Medicare Plan Enrollment

Medicare focused agents have a special responsibility when assisting a client to transition into Medicare enrollment and helping them to select the plans that best fit their individual needs. Agents need to understand the client’s requirements and address their concerns as well as effectively communicate the timing, requirements and potential penalties regarding Medicare enrollment. And, agents should set realistic expectations for the completion and timing of each step.










Tips to make a difference

First, when meeting with the prospect either in person, on the phone or via an online meeting such as ZOOM, make sure that you have scheduled enough time to discuss and review both Medicare and the plan information. I usually schedule the initial appointment for an hour and half.

Always ask if the prospect needs to have any additional folks at the meeting such as a spouse, significant other, son or daughter or another key person. If you will be discussing Medicare Advantage (MAPD) or Stand-Alone Prescription Drug plans and benefits, be sure to obtain a signed and dated Scope of Appointment from the client. I start the meeting off asking what questions and concerns they have so that I can make sure to address them.

You need to help the client determine if they indeed should enroll in enrollment could be delayed and may be subject to penalties (A, B and D). Also discuss dependent coverage concerns as well.

  • If they are on a small group plan (less than 20 employees) then they should also enroll into Medicare Parts A and B. They may continue on their group plan if the small group plan continues to offer coverage to those age 65 and above, or they may leave the plan and enroll in a MAPD or Medicare Supplement Plan and a Stand-Alone Part D Again, you need to address any coverage issues for a dependent spouse or children.

Next steps to easy enrollment

Once the client determines that they do indeed want to enroll into Medicare, you should discuss the next steps. It is important to note that enrolling in Medicare has become to access the right area on the www. socialsecurity website.

The Medicare enrollee should have their Social Security card handy when they enroll so they know how they are identified in the system.

Warn the prospect that if the Medicare online enrollment process doesn’t allow the individual to complete enrollment, they will need to contact Social Security at (800) 772- 1213 to continue. They are happy to assist.

Once they have completed their enrollment (and printed off a copy!) they will typically receive a letter 3 weeks after enrollment.

They may wish to call either Social Security (800-772-1213) or Medicare (800-633-4227) after 7–10 days to confirm their enrollment and to obtain their Medicare number. Note that the Social Security line Medicare or delay to a later date. Ask what type of coverage they are currently on. Their options depend on their current coverage and their situation at age 65.

  • If they are working for a company with 20 or more employees and intend to continue working, they are allowed to continue to be covered under the group plan and waive their Initial Open Enrollment Period. If they wish to leave the group and go onto Medicare coverage and plans, you need to address coverage issues for a dependent spouse or children.
  • If they are on individual coverage (on or off exchange) or on COBRA coverage they should enroll into These plans are not creditable and later Medicare more challenging during the pandemic. Many Social Security offices have been overwhelmed. Processing applications is taking longer than expected, especially for those who are enrolling under special enrollment when they are past their initial enrollment period.

For those aging into Medicare at age 65, the best way to enroll is to use Social Security’s on-line enrollment tool and have the client establish a “mysocialsecurity” account.

One of the easiest ways to access this is through the website. On the homepage go to “Resources” then click on “Apply for Medicare.”

This connects to a page where they can scroll down and find the light blue box “Apply for Medicare Only”

(800) 772-1213 is open for calls from 7a.m. to 7p.m. Monday through Friday and the Medicare line is open 7 days a week, 24 hours a day.

agents CANNOT be online or call Social Security on the client’s behalf.

If the applicant is applying in the 3 months prior to their birthday month, their Medicare Plan A and B coverage should be the first of the month of their birthday (unless they are born on the 1st) then it is the first of the month prior. If they apply during their birthday month or in the 3 months following, their effective date will be the two months following.

If the applicant is applying under Special Enrollment such as loss of employer coverage, they will need to submit the Request for Employment

Information form (L564) also with the CMS 40 form to Social Security.

Note that due to COVID-19’s impact, some applications are taking longer to process! These forms may be mailed, faxed, or walked into the local Social Security office. Individuals are able to locate their local Social Security office online through along with instructions for submission of the forms. Remind your prospect to always keep a copy of the forms!

Once the prospect is enrolled in Medicare, it is time to review their coverage options and drill down to what plans will best fit their needs.

The completion of a Needs Analysis Worksheet is especially helpful as it provides a step-by-step information gathering tool and it also documents the process for your review.

  • Ask about their physicians, including primary and
  • Most will request that you assist them with their prescription drug coverage needs.
  • If you are willing to do so, make sure to document their prescriptions by name, dosage, frequency and their preferred pharmacy(ies).
  • Ask if they have any concerns about upcoming or scheduled

BE AWARE that you cannot ask about health history. If available in their county, you should mention that there are special needs plans for conditions such as COPD or diabetes.

Remember, it is always the prospect’s final decision on what type of coverage and plan they want to enroll in. Your job is to make sure that they understand the options and coverages clearly.

Review the plans thoroughly. Note the star ratings for Medicare Advantage prescription drug (MAPD) and stand- alone drug plans and their prescription coverages under the plans, including the initial coverage gap and the catastrophic coverage stages.

Review how to access information to find their physicians and networks and how the referral process works if enrolling into a MAPD plan. If it is a PPO plan, make sure they understand how to use the plan.

Again, I find having a check list is helpful to make sure I have covered all the important information. Provide the required materials such as an outline of benefits, and if a Medicare Supplement Plan, include the CMS “Guide to Choosing a Medigap Policy” booklet.

There is an important piece of information many agents forget to mention. When an individual has left an employer plan after their initial enrollment period and enrolled in a MAPD or Stand-Alone Part D Plan, they will receive a letter from their plan requesting proof of prior coverage. To avoid late enrollment penalties, make sure these clients know they need to respond within 3 weeks by phone or letter to confirm the prior coverage.

One of the biggest delays for coverage is the submission of incomplete applications.

Make sure to review that the submission is as complete as possible. This is where the online submissions really are an asset, because you can make sure that the application is fully complete and it is handled on an expedited basis. Once you start using online submissions, you will be hard pressed to go back to paper and faxing submissions!

Lastly, send a thank-you letter to your new client. Make sure to include plans they have applied for, the effective date applied for and the plan’s Member Services contact numbers. If prescription drug coverage is included, I remind clients of the coverages in the different stages. For MAPD and Stand-Alone Drug plans I remind them that they need to pay their premiums by the method they selected and that they must maintain their Medicare Part A and B coverage. Also let them know that you will be reviewing the plans with them during Annual Open Enrollment.

If they are on a Medicare Supplement Plan you will contact them around their birthday.

Today’s marketplace is becoming more and more competitive. Agents will see their practice continue to grow and thrive when they strive to meet their client’s needs and address their concerns, help them enroll in the plan that best fits their needs and continue to provide ongoing service and up-to-date information.

Through a commitment to providing excellent service and lending your expertise, you make a big difference!

MAGGIE STEDT is an independent agent that has specialized in the Medicare market for the past 21 years. She is the immediate past president of California Association Health Underwriters

(CAHU) and past president of her local Orange County Health Underwriters Association (OCAHU) chapter. Reach her at