Consumer Guide:
Medicare Supplement & Medicare Advantage Insurance

NAOSA Gold Standards of Professional Practice™

Medicare Supplement and Medicare Advantage Insurance

The NAOSA Gold Standards of Professional Practice for Medicare Supplement (Medigap) and Medicare Advantage agents/brokers requires that all members perform a thorough needs analysis prior to recommending a policy to a client. NAOSA requires that the client be educated in all aspects of coverage and at no time will the client be steered to one policy over another.

The Centers for Medicare & Medicaid Services (CMS) has strict rules regarding the sales and marketing of Medicare Supplement and Medicare Advantage plans. Individual states also have insurance regulations in place. The following NAOSA Gold Standards of Professional Practice™ are requirements of NAOSA members and are not intended to replace or interfere with existing CMS or individual state rules and regulations already in place. Be sure to visit the official US Government website for Medicare at www.medicare.gov and your state’s insurance commissioner for a complete listing of current rules and regulations.

Z

NAOSA Members Must Be an Unbiased Advisor

In accordance with CMS regulations, members must remain unbiased and may not steer the client to a specific policy or insurance company.

Z

NAOSA Members Must Present Coverage from More Than One Company

NAOSA Members are required to show plans from multiple insurance companies to ensure a complete comparison of benefits and premiums. In addition to CMS and state regulations where applicable, comparisons must include, at a minimum, policy benefits, premiums, out-of-pocket costs (including, but not limited to: deductibles, maximum out-of-pocket risk, co-payment, and co-insurance), prescriptions, and provider network.

Z

NAOSA Members Must Present Medicare Supplement Insurance

NAOSA Members may not only present Medicare Advantage Plans (with the exception of individuals on medical assistance). As stated previously, members must remain unbiased advisors. Medicare Advantage Plans generally have lower premiums than a Medicare Supplement Policy, however, the lower premiums usually come with higher out-of-pocket costs if one becomes ill. This may be especially important if you choose to switch plans at a future date due to cost. Switching insurance plans may require additional underwriting and you may be ineligible to change plans due to medical history.

Z

NAOSA Members Must Thoroughly Compare Physicians and Other Medical Facilities Offered in The Policy Network Prior to Recommending A Policy

A Medicare Advantage Plan physician and provider network may be limited and may not include your doctor, hospital, or other providers. Before choosing any policy, NAOSA members must perform a thorough review of a client’s current medical providers to verify participation and discuss alternatives if applicable. Note: Medicare Supplement ‘Select Plans”, available in a few states, have limited networks as well. Be sure to check if you choose this option.

Z

NAOSA Members Must Offer to Review Prescriptions

Prescriptions must be reviewed to ensure the client’s current medications are listed on the suggested plan’s formulary. This is especially important when comparing Medicare Supplement vs. Medicare Advantage Plans. It is recommended that every individual review prescriptions and costs yearly.

Z

NAOSA Members Must Be a Resource for Prescription Drug Financial Assistance If Applicable

NAOSA members will be a resource for those who need guidance on finding resources to pay for prescriptions.

Z

NAOSA Members Must Provide Full Disclosure of Potential Out of Pocket Costs of a Medicare Advantage Plan

If choosing Medicare Advantage Plan, clients should be comfortable with the potential of paying the deductible if applicable, and the maximum out-of-pocket costs of the Medicare Advantage Plan. A clear examination of potential future costs must be evaluated, especially if an individual is currently undergoing treatment for an illness, has a history of extended hospital stays, and/or is being treated for other major chronic conditions that would require ongoing treatments. Even though Medicare Advantage Plans may be cheaper initially, serious consideration should be given to potentially higher costs due to illness.

Are you a professional in the Medicare insurance field?
We welcome your constructive input to assist in the protection of all consumers. Please contact us.

NAOSA Gold Standards of Professional Practice™

Medicare Supplement and Medicare Advantage Insurance

The NAOSA Gold Standards of Professional Practice for Medicare Supplement (Medigap) and Medicare Advantage agents/brokers requires that all members perform a thorough needs analysis prior to recommending a policy to a client. NAOSA requires that the client be educated in all aspects of coverage and at no time will the client be steered to one policy over another.

The Centers for Medicare & Medicaid Services (CMS) has strict rules regarding the sales and marketing of Medicare Supplement and Medicare Advantage plans. Individual states also have insurance regulations in place. The following NAOSA Gold Standards of Professional Practice™ are requirements of NAOSA members and are not intended to replace or interfere with existing CMS or individual state rules and regulations already in place. Be sure to visit the official US Government website for Medicare at www.medicare.gov and your state’s insurance commissioner for a complete listing of current rules and regulations.

Z

NAOSA Members Must Be an Unbiased Advisor

In accordance with CMS regulations, members must remain unbiased and may not steer the client to a specific policy or insurance company.

Z

NAOSA Members Must Present Coverage from More Than One Company

NAOSA Members are required to show plans from multiple insurance companies to ensure a complete comparison of benefits and premiums. In addition to CMS and state regulations where applicable, comparisons must include, at a minimum, policy benefits, premiums, out-of-pocket costs (including, but not limited to: deductibles, maximum out-of-pocket risk, co-payment, and co-insurance), prescriptions, and provider network.

Z

NAOSA Members Must Present Medicare Supplement Insurance

NAOSA Members may not only present Medicare Advantage Plans (with the exception of individuals on medical assistance). As stated previously, members must remain unbiased advisors. Medicare Advantage Plans generally have lower premiums than a Medicare Supplement Policy, however, the lower premiums usually come with higher out-of-pocket costs if one becomes ill. This may be especially important if you choose to switch plans at a future date due to cost. Switching insurance plans may require additional underwriting and you may be ineligible to change plans due to medical history.

Z

NAOSA Members Must Thoroughly Compare Physicians and Other Medical Facilities Offered in The Policy Network Prior to Recommending A Policy

A Medicare Advantage Plan physician and provider network may be limited and may not include your doctor, hospital, or other providers. Before choosing any policy, NAOSA members must perform a thorough review of a client’s current medical providers to verify participation and discuss alternatives if applicable. Note: Medicare Supplement ‘Select Plans”, available in a few states, have limited networks as well. Be sure to check if you choose this option.

Z

NAOSA Members Must Offer to Review Prescriptions

Prescriptions must be reviewed to ensure the client’s current medications are listed on the suggested plan’s formulary. This is especially important when comparing Medicare Supplement vs. Medicare Advantage Plans. It is recommended that every individual review prescriptions and costs yearly.

Z

NAOSA Members Must Be a Resource for Prescription Drug Financial Assistance If Applicable

NAOSA members will be a resource for those who need guidance on finding resources to pay for prescriptions.

Z

NAOSA Members Must Provide Full Disclosure of Potential Out of Pocket Costs of a Medicare Advantage Plan

If choosing Medicare Advantage Plan, clients should be comfortable with the potential of paying the deductible if applicable, and the maximum out-of-pocket costs of the Medicare Advantage Plan. A clear examination of potential future costs must be evaluated, especially if an individual is currently undergoing treatment for an illness, has a history of extended hospital stays, and/or is being treated for other major chronic conditions that would require ongoing treatments. Even though Medicare Advantage Plans may be cheaper initially, serious consideration should be given to potentially higher costs due to illness.

Are you a professional in the Medicare insurance field?
We welcome your constructive input to assist in the protection of all consumers. Please contact us.

CONSUMER GUIDES

Be Sure to Review All the NAOSA Gold Standards of Professional Practice™ Before Making a Buying Decision

Simply click on the industry to access the Consumer Guide

Auto and Home Insurance Owners

Home Care & Assistance

Insurance & Investments

Legal
Professionals

Long-Term Care Insurance

Medicare Supplement & Medicare

Real
Estate

Reverse
Mortgage

Advantage
Insurance

Senior Living Communities

Home Improvement / Home Repair

Senior Living Brokers/Consultants

CONSUMER GUIDES

Be Sure to Review All the NAOSA Gold Standards of Professional Practice™ Before Making a Buying Decision

Simply click on the industry to access the Consumer Guide

Auto and Home Insurance Owners

Home Care & Assistance

Insurance & Investments

Legal
Professionals

Long-Term Care Insurance

Medicare Supplement & Medicare

Real
Estate

Reverse
Mortgage

Advantage
Insurance

Senior Living Communities

Home Improvement / Home Repair

Senior Living Brokers/Consultants

NAOSA Guarantee

NAOSA requires members to act in utmost good faith when working with clients. Members must agree to work under “the fiduciary standard” and act in a way that the member reasonably believes to be in the best interest of the client. In addition to compliance with all federal and state regulations, each professional member of the National Association of Senior Advocates must follow and act in accordance with a standard of guidelines called the NAOSA Gold Standards of Professional Practice™.

The NAOSA Gold Standards have been created by professionals in their specific fields. The NAOSA Gold Standards strive to eliminate any gray areas that may exist in various business practices. Although these gray areas may be legal in many cases, NAOSA experts agree that they generally do not serve the best interest of the consumer.

The NAOSA Gold Standards of Professional Practice™ also strive to offer transparency in various professions, and aim to educate consumers on the various business models of these professions. Consumers must have information to make an educated decision when considering a specific product or service.

Members who are found not in compliance with these standards will be censured, with membership subject to revocation.

NAOSA Guarantee

NAOSA requires members to act in utmost good faith when working with clients. Members must agree to work under “the fiduciary standard” and act in a way that the member reasonably believes to be in the best interest of the client. In addition to compliance with all federal and state regulations, each professional member of the National Association of Senior Advocates must follow and act in accordance with a standard of guidelines called the NAOSA Gold Standards of Professional Practice™.

The NAOSA Gold Standards have been created by professionals in their specific fields. The NAOSA Gold Standards strive to eliminate any gray areas that may exist in various business practices. Although these gray areas may be legal in many cases, NAOSA experts agree that they generally do not serve the best interest of the consumer.

The NAOSA Gold Standards of Professional Practice™ also strive to offer transparency in various professions, and aim to educate consumers on the various business models of these professions. Consumers must have information to make an educated decision when considering a specific product or service.

Members who are found not in compliance with these standards will be censured, with membership subject to revocation.

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What Our Members Say

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The NAOSA consumer guides are great. Clear explanations, without all the complex language, is extremely important in helping me make the right decision.

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Potomac, Maryland

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NAOSA Member

Austin, Texas

In a world filled with mistrust and spin, honesty and integrity offer a tremendous opportunity for professionals and businesses who do business the right way.

Anthony L. Cinotti, Founder

National Association of Senior Advocates

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