When you need help with Medicare, do you need a Medicare insurance agent—or a Certified Medicare Insurance Planner™? There is a difference, and after more than two decades of helping people with Medicare, I believe it matters.
I am an independent Medicare broker and a Certified Medicare Insurance Planner™ (CMIP®). At Bayside Health Benefits, we help Medicare beneficiaries in Homosassa and throughout Florida’s Nature Coast, with agents focusing on Citrus, Hernando, Pasco, Pinellas and Polk counties.
I chose to become a Certified Medicare Insurance Planner™ because Medicare decisions are not just about comparing Medicare plans from different insurance companies. People come to me with doctors they don’t want to lose, expensive prescriptions, chronic medical conditions, VA benefits, retiree health insurance, Social Security questions, and sometimes a Medicare mess that needs to be untangled.
What Is a Certified Medicare Insurance Planner™?
The Certified Medicare Insurance Planner™ (CMIP®) credential is awarded by the Society of Medicare Planners®. The credential recognizes Medicare knowledge and experience along with a commitment to professional and ethical standards. You do not have to be a CMIP® to sell Medicare insurance, and many excellent Medicare agents take great care of their clients. For me, earning the credential was about taking a broader approach to the Medicare process. Before I recommend coverage, I want to know your doctors, prescriptions, health concerns, and budget. I also want to understand any coverage you already have, including employer or retiree health insurance or VA. Then we can look at your Medicare coverage options, including Original Medicare, Medicare Advantage plans, Medicare Supplement plans, and Medicare Part D prescription drug plans. Sometimes, after doing all that work, my recommendation is: stay exactly where you are. That’s actually Medicare planning too.
Medicare Agent vs. Certified Medicare Insurance Planner™: What’s the Difference?
A licensed Medicare insurance agent can represent insurance companies and help beneficiaries compare and enroll in the Medicare plans the agent is authorized to offer, but you really do not know how much experience or ethics they have to represent you, the beneficiary. An agent with a Certified Medicare Insurance Planner™ designation must have 10 years of experience in the field and is held to high ethical standards. The conversation shouldn’t begin with, “Which plan do you want?” It should begin with, “Tell me about your healthcare.”
One of my clients learned why that distinction matters the hard way. She survived a terrible automobile accident that left her with a significant brain injury. When I first met her, I worked with her and her mother to find Medicare Advantage plans based on their individual healthcare needs. We checked their doctors and made sure the networks worked for the care they were receiving. Then an insurance agent showed up at my client’s home unsolicited. She wasn’t shopping for another plan, but she was convinced to change her coverage to an HMO. Later, she called me. “Oops. I did it again.” Unfortunately, it wasn’t the first time. She had been told her doctors were in the new plan’s network. They weren’t. And with an HMO, she generally couldn’t simply use out-of-network benefits for the specialist care she needed.
One time, she called me during the Medicare Advantage Open Enrollment Period, and we had an opportunity to change her coverage.
Another time, there wasn’t a standard enrollment period available, and she needed to see one of her specialists. I encouraged her to contact the Medicare Agency, explain what had happened, and ask whether her circumstances qualified for a Special Enrollment Period. She didn’t need someone to find her another plan. She needed someone to understand why the coverage she already had mattered.
Why Ethics Matter in Medicare Planning
One reason the CMIP® credential appealed to me is the emphasis the Society of Medicare Planners® places on professionalism and ethical conduct. Medicare beneficiaries trust us with information about their health, finances, prescriptions, and doctors. Then they rely on our recommendations to make important healthcare decisions. I take that responsibility seriously.
And yes, this is where I need to talk about door knocking. The Centers for Medicare & Medicaid Services (CMS) has rules restricting certain unsolicited marketing of Medicare Advantage and Medicare Part D plans, including unsolicited door-to-door solicitation. Those rules are there to protect Medicare beneficiaries. I have seen agents use what appears to be a friendly gesture—dropping off a gift at someone’s home as an opportunity to make contact. If you didn’t invite an insurance agent to your home, you shouldn’t unexpectedly find yourself having a Medicare sales conversation at your front door. A gift doesn’t change that.
Before changing coverage, has your agent returned your contact request and taken the time to understand your health and financial needs? Have they reviewed your doctors and prescriptions? Have they explained what you have now, what the new plan changes are, and what you could lose by leaving your current coverage? Because the wrong Medicare plan can have real consequences. You may discover that a specialist you have seen for years is out of network, or a hospital you depend on isn’t included. You may face higher out-of-pocket costs or restrictions on where you can receive care. And you may not be able to change your mind the next day. Medicare has specific enrollment periods that determine when coverage can be changed. Depending on the circumstances and timing, you may have to live with that decision until another enrollment opportunity becomes available. That’s the part of the doorstep sales pitch people don’t always hear about.
Sometimes Medicare Planning Starts With Medicare Eligibility
A husband and wife found me through Google after another agent had come to their home and, according to them, said she would enroll them in Medicare Part A and Medicare Part B. They weren’t asked to log into their Social Security accounts or sign anything. They were told their Medicare enrollment was taken care of, and their cards would arrive in three or four weeks. Nine weeks later, they had no cards. They tried reaching the agent and told me their calls weren’t returned. That’s when they contacted me.
Before discussing Medicare Supplement Insurance, Medigap plans, or Medicare Advantage, I needed to know whether they were actually enrolled in Medicare Part A and Part B. We discovered the wife’s Medicare eligibility was more complicated. She did not have enough work history on her own record to qualify for premium-free Medicare Part A. There was also an important timing issue involving when she could potentially qualify for premium-free Part A based on her husband’s work record. Then we ran into another problem. Social Security had an old telephone number associated with her information, preventing us from completing the identity verification online. So we continued the process with Social Security by phone.
As I learned more about her, I discovered she had a serious chronic medical condition and needed access to a particular hospital about an hour from her home. She told me she hadn’t been walked through the choice between Original Medicare with the option of Medicare Supplement Insurance and Medicare Part D, and receiving her Medicare benefits through Medicare Advantage. For her, that decision mattered. So we discussed both since I write Medicare Advantage and Medicare Supplement Insurance. Her situation wasn’t simple. We had Medicare eligibility and timing issues, Social Security complications, a serious chronic condition, and access to specialized care all affecting the decision. This is where ethics matter. When someone’s healthcare needs are this complicated, the goal shouldn’t be to get them enrolled in a plan. The goal should be to make sure they understand their choices and the consequences of each before making a decision.
Medicare Advantage, Medigap and Part D: Understanding Your Coverage Options
This is where I believe a Certified Medicare Insurance Planner™ earns their seat at the table. Medicare coverage isn’t one-size-fits-all. Original Medicare, Medicare Advantage, Medigap policies, and Part D drug plans work differently. Medicare Advantage plans can have provider networks and plan-specific rules. Medigap policies work alongside Original Medicare, while prescription drug coverage may require a separate Medicare Part D plan.
Costs matter. So do doctors, hospitals, and prescriptions. Someone approaching their Initial Enrollment Period may need a very different conversation from an existing beneficiary reviewing coverage during the Annual Enrollment Period. The goal shouldn’t be to steer everyone toward one type of coverage. It should be to help each person understand the choices and tradeoffs before making a decision.
Medicare Planning for Veterans and People With Other Health Benefits
A Certified Medicare Insurance Planner™ should also understand when Medicare isn’t the only piece of someone’s healthcare. One of my clients is a veteran and a double amputee who receives much of his healthcare and prescriptions through the VA. He called me after suffering a heart attack. The ambulance crew determined there wasn’t enough time to transport him to the VA hospital he normally used, so they took him to a nearby hospital. At the time, he had Original Medicare but no additional Medicare coverage.
After reviewing his situation, I helped him enroll in a Medicare Advantage plan that fit his needs and included a Medicare Part B premium reduction, commonly called a giveback benefit. He could continue using the VA healthcare and prescription benefits he valued while having his private plan for Medicare-covered services. More importantly, we talked about how those benefits worked. The same principle applies when someone has retiree coverage, employer health insurance, or other benefits. Before changing anything, understand what you already have.
What Should You Expect From a Certified Medicare Insurance Planner™?
A credential doesn’t replace good service. The value should show up in how your Medicare professional works with you. I believe Medicare planning should include understanding your healthcare needs, reviewing your doctors and prescriptions, comparing appropriate coverage options, and explaining both benefits and tradeoffs. And the relationship shouldn’t end with Medicare enrollment. My clients call when a claim doesn’t make sense, a doctor leaves a network, a prescription changes, their plan changes for the next year, or they receive something from Medicare or Social Security they don’t understand.
I had a client call me in July, well outside any enrollment period, because her plan had quietly changed her preferred pharmacy to a non-preferred tier. We got on the phone with the plan together, confirmed the change, and I walked her through her options so she wasn’t paying more than she needed to for the rest of the year.
Sometimes we need the insurance company, Medicare, or Social Security involved. Our team works to answer these questions all year long. We are one of your best resources as you navigate your health journey.
Finding a Certified Medicare Insurance Planner™ Near You
If you’re searching for a Certified Medicare Insurance Planner™ near you, the value is in finding someone who brings together knowledge, experience and an ethical responsibility to help point you in the right direction. A CMIP® should help you understand the moving parts, explain the differences between Medicare Advantage, Original Medicare and Medicare Supplement Insurance, and help you weigh the tradeoffs so you can make an informed decision with confidence.
At Bayside Health Benefits, our agency is based in Homosassa and helps Medicare beneficiaries throughout Florida. We have agents focusing on Citrus County, along with Hernando, Pasco, Pinellas and Polk counties. The Medicare plans available to you can vary by ZIP code, insurance company and county. Your healthcare needs are even more individual. That’s why I became a Certified Medicare Insurance Planner™. The goal is not to enroll you in a Medicare plan, but to be a trusted, dependable Medicare advisor for the years ahead. That’s how we conduct our practice—with knowledge, experience, ethical responsibility, and planning that begins with our client.
Before the plan comes the person. That’s Medicare planning.
Follow our blog page at www.baysidemedicare.com for the next article in this series where I’ll discuss the most overlooked costs in Medicare Plans.
About Dayna Schafer
Dayna Schafer is a Certified Medicare Insurance Planner™ and founding member of Bayside Health Benefits in Homosassa, FL. With over 25 years of experience, Dayna has guided thousands of Medicare beneficiaries across Florida in choosing coverage with clarity and confidence. A member of the RISE Community and contracted with 11 insurers, she is known for her integrity, personal guidance, and dedication to finding the right fit for each client’s healthcare needs. Learn more at www.baysidemedicare.com.
FAQ
Who is the best person to talk to about Medicare plans?
The best person to talk to about Medicare plans is someone who takes the time to understand your healthcare before recommending coverage. A Certified Medicare Insurance Planner™ should and typically goes beyond comparing plans and starts by reviewing your doctors, prescriptions, existing coverage, and health concerns. a CMIP® is held to high ethical standards. At Bayside Health Benefits, that’s exactly how we approach every Medicare conversation. Contact us through baysidemedicare.com to get started.
At what age should I start planning for Medicare?
Medicare planning ideally begins six months before you turn 65. The decisions you make at that point, including whether to choose Original Medicare with a Medigap policy or Medicare Advantage, can affect your coverage options for years. If you have employer coverage, retiree benefits, or VA benefits, those factors need to be understood before you make any Medicare enrollment decisions.
Are Medicare advisors worth it?
A good Medicare advisor can help you avoid costly mistakes that are difficult or impossible to undo. Medigap has specific underwriting in some situations. The wrong plan can have financial consequences or may cause you to lose access to a specialist, face unexpected out-of-pocket costs, or be locked into coverage that doesn’t fit your needs until the next enrollment window opens. Working with a Certified Medicare Insurance Planner™ means someone held to high ethical standards is reviewing your full picture, not just finding you a plan to enroll in.
What are the biggest mistakes people make with Medicare?
One of the most common mistakes is changing Medicare coverage without fully understanding what you’re giving up. Switching to an HMO plan without verifying that your current doctors are in-network, or enrolling in a plan without confirming your Medicare Part A and Part B are actually active, can create serious problems. Another mistake is making coverage decisions based on a doorstep sales conversation rather than a thorough review of your health needs, prescriptions, and existing benefits. CMS has rules restricting certain unsolicited marketing of Medicare Advantage and Medicare Part D plans, including unsolicited door-to-door solicitation. Those rules are there to protect Medicare beneficiaries.