introductory post

For a little more than a year now I have been breaking into a new career as an agent of life, accident, and health insurances in NYS (New York State). The specialty area I have entered pertains primarily to Medicare related health insurances, most particularly: Advantage Plans, Prescription Drug Plans, and Supplement Plans.

In the short time I have engaged in this new career I have already experienced many ups and downs, as the career change in itself is quite dramatic and at times even traumatic due to the responsibilities of operating an independent business. Freedom is neither free nor easy nor devoid of regulation, ethics, and accountability. In my middle age I have transistioned from the predictable but less than subsistence income and mentality of being an hourly laborer, faced with one glass ceiling after another, to being CEO, CFO, CIO, VP-Marketing, VP-Sales, VP-PR, VP-IT, Outside Sales Representative, Customer Service Clerk, Bookkeeper, and whatever other duties and the indefinite, unguaranteed income that go along with being owner of one's own business. In other words I have transitioned from being Gopher to Boss, from Step'n-Fetch-It to Bone Thrower, from Slave to Master -- only now, as a one-man business, I am all of those roles and everything in between.

Eventually one may be more than a one-man business. In the meantime there is quite a learning curve. One is constantly educating oneself, licensing, re-licensing, certifying for this, certifying for that, recertifying -- and somehow time must be found for actually doing business! No certification, no right to sell; no sales, no income.... Such daily matters as personal illness, holidays, personal time, weekends, seasonalilty of marketing, commissions, commission lag time, operating expenses including insurances, equipment, transportation -- all of these take on new and deeper meaning. For better and for worse one knows largely that one is the measure of one's own success or failure -- however one defines success and failure.

Some define success strictly by sales volume. Others define success by personal freedom. Still others define success by helping as many clients as possible. For me all three are equal ingredients. One can be too "free" and do nothing; once can "sell" quickly and carelessly to too many too soon and risk one's integrity by doing harm rather than good for clients and for the firms one represents; one can "help" so disproportionately to one's level of responsibility that one can involve oneself to an inappropriate degree in the life of a client and one can deprive oneself of time for education, sales, and personal time. The challenge is learning to achieve a proper balance and to manage one's time efficiently and in good health.

Most clients are initially complete strangers, although in some cases friends or family may sooner or later choose to become clients. It is often easier to be objective with the complete stranger than with a familiar individual. In either case one must be professional. Sooner or later, some strangers become familiar; it is also true that sooner or later, familiars may become strangers. It is all about relationships and boundaries.

The joys are that one can do a great deal to help one's clients, if one "does one's homework, dots all the i's, crosses all the t's, etc." One of my greater joys was enrolling a client into a particular Medicare Advantage Plan such that he was able to save $500 monthly in healthcare expenses and afford to move from a dangerous living environment to a safer one. Another joy was in helping a client understand his medical billing better than he did and by so doing helping him to avoid a possible billing nightmare. Still another joy has been to educate certain low income clients as to additional benefits specifically created by law in order to help them keep their financial heads above water in these tough times. My most moving experience so far is the time that, in enrolling an elderly man into an Advantage Plan, it came out that a bureaucratic matter had left him unable to pay for his necessary prescription medications for heart disease and diabetes, including two forms of insulin, needles, and syringes; my positive intervention solved this problem for him within 48 hours and may have saved his life.

A word about Medicare Advantage Plans (Medicare Part C), Medicare Prescription Drug Plans (Medicare Part D), Medicare Supplement Insurance Plans, and "Medicare" (Medicare Part A with Parts B and D optional [customarily referred to as "Medicare", "Original Medicare", or "Traditional Medicare"]:

MEDICARE has gone through several major changes subsequent to it's initial creation. In it's origin there was only "Medicare Part A", providing hospitalization coverage at the cost of pre-paid premium to the government taken out as a tax during one's working years. Some decades later, voluntary "Part B" was added on retirement (or after 24-months in the event of eligibility by disability) at the cost of a monthly premium (today the Part B Premium amount in 2008 is $96.40/monthly for most beneficiaries). Medicare Parts A & B have deductibles, and/or co-payments and co-insurance obligations to the Beneficiary; but, no OOP Maximum (that is, there is no Out Of Pocket Maximum or "ceiling" limiting the possible medical liability a Beneficiary may accrue in a high usage or even medically catastrophic year).

Retiree Benefit Plans and Medicare Supplement Insurance Plans (commonly referred to as "MediGap Plans") were created by the insurance industry, and those, who could afford the respective premiums for the policies, could "supplement" their Medicare coverage and simultaneously protect their bank accounts and homes (OOP coverage) to a far greater degree than previously possible.

Today as a result of the Medicare Modernization Act of 2003, most Medicare Beneficiaries enrolled in Medicare Parts A & B can enroll in a Medicare Part C Plan (Advantage Plan) which by law has OOP protection built into the the policy of his or her choice, and in many cases there is a "zero-dollar" premium (Premium = $0.00 monthly)! Many Medicare Advantage Plans also include the Medicare Part-D Prescription Drug Coverage at no monthly premium as well. Then there are "stand-alone" (PFFS) Medicare Advantage Plans and "stand-alone" Prescription Drug Plans so that there is greater flexibility in choosing (for example) a PFFS Plan from one company and an RX Plan from the same or a different company.

Company Benefit Plans and Medicare Supplement Plans still flourish. There is no "one size fits all" plan in existence; there are many plans, enabling the independent insurance agent great flexibility in assisting the Medicare Beneficiary into the optimal policy for his or her needs and budget. As a result of the Medicare Modernization Act of 2003, more Medicare Beneficiaries have better coverage at costs more easily able to afford and budget.

This is not to say that medical costs or drug costs are universally inexpensive, nor to suggest that there are not improvements to be made in our healthcare system and how it is paid for. But it would be hugely wrong to fail to appreciate the good that has come to the Medicare Beneficiary in the latter half of this decade, and one hopes that the recent Congressional setback to the Medicare Advantage Plan system earlier this July month -- an Act of Congress done in the guise of affording to prevent a ten-percent Medicare paycut to physicians -- will not cripple the Medicare Advantage Plan system. One hopes the Act will not frighten Medicare Beneficiaries from choosing these Plans, will not harm the present enrollees, and will not undermine the positive cooperation between government and private industry that has shown the way for healthcare in America to evolve in a way that can be modelled after this type of cooperation and benefit all Americans.

In contemprorary America, health insurance is highly controversial and highly political. Congress is divided, whether or not to move towards greater privatization, towards universal healthcare, or to an "hybrid" system. This is especially true with respect to Medicare and Medicaid. The 2008 Presidential, Senatorial, and Congressional Elections may determine the direction of future healthcare for this country.