By Mark Brownstein, CSA — Director of Medicare, Emerald Medicare
If you’re a Medicare agent, you’re probably hearing this more often: “My Medigap premium went up again. What should I do?”
For years, annual Medigap increases were relatively manageable. Today, we’re seeing much larger increases across carriers and markets, and clients who have been happy with their coverage for years are suddenly asking whether they should switch.
My advice to agents: don’t immediately start shopping for the cheapest carrier.
The Cheapest Carrier Isn’t Always the Answer
A carrier that’s cheaper today may have substantial increases later. We’ve all seen attractive introductory pricing followed by significant increases in future years.
If a client has Plan G or Plan N with a strong carrier, likes the coverage and can afford the increase, changing may not be the best answer.
And in many states, changing plans or carriers requires medical underwriting. I remind clients:
Never have a client cancel existing Medigap coverage until replacement coverage has been approved and the effective date is confirmed.
Plan N — and High-Deductible Plan G — Deserve a Bigger Conversation
For clients who really need premium relief, Plan N can be a reasonable middle ground. Rather than focusing only on copays, show clients the potential annual premium savings and let them evaluate the tradeoff.
But there’s another option I’m discussing more frequently: High-Deductible Plan G.
As traditional Plan G premiums continue to increase, High-Deductible G can dramatically reduce the monthly premium while allowing the client to remain with Original Medicare and retain the basic flexibility that makes Medigap attractive.
The Key Is Explaining It Simply
Before the annual deductible is reached, if there’s a $1,000 Medicare-approved outpatient charge, Medicare generally pays $800 and the client is responsible for $200. On a $500 charge, Medicare generally pays $400 and the client is responsible for $100.
The client continues paying their share of Medicare-approved expenses until reaching the plan’s annual deductible. After that, the High-Deductible Plan G provides the Plan G benefits for the remainder of the year.
For a client who can potentially save $150 or $200 a month in premiums, taking on that additional exposure may be a very reasonable financial decision.
Don’t Spend Someone Else’s Money
One thing I’ve learned over many years in this business: I don’t spend someone else’s money.
A $60 monthly increase might be insignificant to one client and a serious financial burden to another.
Our role isn’t to decide what’s expensive. It’s to explain the choices, savings and risks so the client can make an informed decision.
Sometimes “Do Nothing” Is Good Advice
Agents are trained to find solutions. But a client calling about a rate increase doesn’t necessarily need a new policy.
Sometimes they just need their agent.
If the coverage is excellent, the carrier is strong, the client can afford the premium and changing introduces underwriting or other uncertainty, my recommendation may simply be: stay where you are.
That’s not a missed sales opportunity. It’s good advice—and good retention.
With thousands of Medicare clients at Emerald Medicare, we’ve learned that these difficult conversations are often the moments when clients recognize the real value of having an experienced agent.
Our value isn’t simply finding today’s cheapest premium. It’s helping clients understand when a change makes sense, what alternatives they actually have—and when staying exactly where they are may still be the best answer.
Mark Brownstein, CSA, is Director of Medicare at Emerald Medicare and has worked in healthcare since 1986. His education-focused Medicare practice serves thousands of beneficiaries and provides Medicare education through individual consultations, seminars and webinars.
