Bill Pellegrini on the benefits of independent Medicare insurance agents, Medicare Advantage PPO plans, Medicare Supplements, checking Medicare Advantage provider networks, and more.

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Bill Pellegrini

“You have to shop your (Medicare) plans every single year.  There are too many moving parts, not to. And there's too many dollars on the table that you could be losing by not shopping.”

— Bill Pellegrini

Bill Pellegrini runs a large Medicare insurance agency in Phoenix, Arizona that works with over 300 Medicare insurance agents across twenty states.  That gives him a pretty unique perspective on what kind of Medicare insurance people are buying across a large section of the country and why they’re buying it.

This episode will give you a bit of an insider’s view into how why Bill thinks local independent Medicare insurance agents are an extremely important part of finding people personalize and individualize their Medicare insurance coverage, plus a whole lot more.  You can call Bill at 602-368-4422 and find Bill on Twitter or at PellegriniandAssociates.com. and on LinkedIn here or email him at bill@pellegriniandassociates.com.  Enjoy!

Bill Pellegrini on the benefits of independent Medicare insurance agents, Medicare Advantage PPO plans, Medicare Supplements, checking Medicare Advantage provider networks, and more.

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“Shop (your Medicare insurance) every year.  Don’t be lured in by some of the promises on television.”

— Bill Pellegrini

“It just comes down to experience. It's time in the field and it's really knowing your products and knowing your plans.”
— Bill Pellegrini

“You have to shop your (Medicare) plans every single year.  There are too many moving parts, not to. And there's too many dollars on the table that you could be losing by not shopping.”
— Bill Pellegrini

“There's a lot of (Medicare) mail that's being sent during that (end-of-year) timeframe, whether it's an advertisement, but you're also getting it from your carrier. Read through that information, particularly your Annual Notification Of Change (ANOC) document that the consumer receives late September or first part of October. Read that because that identifies everything that's going on with your plan, not from a network standpoint but at least from a benefit standpoint, to give you a clear picture of where you're headed the following year.”
— Bill Pellegrini


Bill Pellegrini on the benefits of independent Medicare insurance agents, Medicare Advantage PPO plans, Medicare Supplements, checking Medicare Advantage provider networks, and more.

Selected Link from the Episode:

Show Notes:

  • On how Bill approaches fact-finding with new Medicare beneficiaries [2:20]
  • Medicare Premium comparisons to commercial group deductibles [6:45]
  • 60/40 split selling Medicare Advantage vs. Medicare Supplement  [7:40]
  • Benefits of local, field-based Medicare insurance agents [8:24]
  • Independent Medicare insurance agent/broker vs. Captive Agents  [10:53]
  • Things great Medicare insurance agents do for their customers prior to the AEP [15:01]
  • Medicare Senior Savings Program – Insulin [16:39]
  • Largest year-over-year Medicare Supplement premium increase Bill has ever seen [18:51]
  • “Shop every year.  Don’t be lured in by some of the promises on television.” [20:47]

Full Show Transcript:

00:00 / 22:48


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Matt Feret (00:15):

Hello everyone. This is Matt Feret and welcome to another episode of The Matt Feret Show.  My guest today is my longtime friend, Bill Pellegrini.  Bill runs a large Medicare insurance agency that works with over 300 Medicare insurance agents across 20 states. That gives him a pretty unique perspective on what kind of Medicare insurance people are buying across a large section of the country and why/ one of the things I do in my book, Prepare for Medicare: The Insider's Guide to Buying Medicare Insurance, is show people the three ways to consume their Medicare benefits. There are also two ways to go about buying Medicare insurance. There are of course DIY options.  That's one.  Or two, you can essentially outsource it by finding an expert Medicare insurance agent to help you. This episode will give you a bit of an insider's view into how the latter works and why Bill thinks local independent Medicare insurance agents are such an important part of finding people that are personalized and individualized Medicare insurance coverage, plus a whole lot more. You can find Bill at www.pellegriniandassociates.com. Enjoy!

Matt Feret (01:24):

Bill, welcome to the show.

Bill Pellegrini (01:26):

Thank you, Matt. Thank you for having me on. I really appreciate it.

Matt Feret (01:29):

All right, so let's just jump right in. What do you do and how do you help people?

Bill Pellegrini (01:33):

Well, we specialize in Medicare. So, we help people navigate the maze of Medicare. As we know, it can be confusing. It can be overwhelming.  There's lots of information out there. There are a lot of planned choices. And so, we work with about 300 agents and multiple markets.  We're in 20 different states and we help people get through the maze.

Matt Feret (01:53):

Talk about the maze, what specifically? We all know... Well, I don't know if we all know but certainly, there's the A, B, C and D's of Medicare. There are different letters for Medicare supplements. There's Medicare Advantage.  There's a whole jumble of this. Tell me where you start or where your agents start with the whole process. So, when somebody's turning 65, how does this whole thing begin?

Bill Pellegrini (02:20):

Well, we start with a needs analysis. So, we want to learn a little bit more about that person, what they're looking for, what they want to get out of the plan and what their budget is so we can align them appropriately. We're looking at their providers. Want to make sure those docs are in the network. We're looking at their prescription drugs. As I mentioned, we're looking at what's affordable to them. And then once we complete that research, we narrow down some choices. In a lot of these markets, Matt, there might be 50 to 60 different plans to choose from. And so, we do all the heavy lifting and the legwork for those consumers to narrow it down to a few options and then help them make an informed decision.

Matt Feret (03:02):

So, you mentioned a couple of things. You've mentioned network and the doctors they use. What does that process look like? Is that over the phone? Is that in person? How does that process begin? It sounds like you're narrowing down based upon the customer's or the potential customer's needs, the needs analysis, hence your phrase, "Needs analysis." What's that conversation look like?

Bill Pellegrini (03:30):

A lot of times we do that right over the phone. I think it's easier to really do the fact finding over the phone. Once we get that information, then can narrow down some options and that's typically when we'll do that face-to-face meeting. We'll do a Zoom meeting. We'll meet them where they are. And I think that's important, particularly in today's environment. Some folks want to meet face to face and some folks don't. So, really, we just meet them where they are and what they're comfortable with.

Matt Feret (03:56):

So, we're talking about Medicare insurance. Three types or three options for Medicare insurance. Right? One is, what I call, Bear with Medicare, which is using original Medicare Part A and then adding a Part D drug plan on top of it. And then there's Medicare Part D Plus a Medicare Supplement option two. And then option three is Medicare Advantage. How do you know which ones best for you or is that what you help people figure out?

Bill Pellegrini (04:19):

That's exactly right. And we work through a series of questions. And so, based on those questions, we kind of narrow it down. So, we'll ask questions like, "How do you feel about referrals? How do you feel about an HMO? How do you feel about a PPO?" And I think that most people retiring today have probably come off of a PPO plan through their employer group. Not all, but I would say a large percentage. We'll ask them, "Are there any particular providers that they want to see?" So, there are some hospital networks out there that will not take Medicare Advantage. And so, if they identify one of those, that also helps us narrow it down because we know then Medicare Advantage would be out. And so, then we're pointed more towards a Medicare Supplement, such as fee for service with a Medicare Supplement. The other thing we look at is, do they travel? Are they sun birds? Are they snowbirds? Of course here in Phoenix, we have sun birds. They're getting out of here because of the heat and probably in your neck of the woods, you have snowbirds that come here to Phoenix.

Matt Feret (05:24):

Sure. And so, you're going travel, income and then network. Usually, what's the calculation you use or your agents use around that when it leans in towards the Medicare Advantage or it leans in towards a Medicare Supplement?

Bill Pellegrini (05:41):

Yeah. So, a few things. We're looking at IRMAA, which we have not talked about yet but that's the Income Related Monthly Adjustment Amount. So, we have to factor that into the equation. Where are the folks at with that? Then we look at maybe a Medicare Supplement Plan G. We're probably looking at $120 a month, round figures. And then we add a Part D to that, which is somewhere around $20 to $40 a month.

Bill Pellegrini (06:12):

So, we are looking at what's comfortable for them in terms of a budget. We're looking at utilization. It's hard to see around the corner, right? None of us have a crystal ball but we also look at utilization and then determine based on utilization, based on network, based on budget. That's how we start the process. And I would say today, if you're looking at $120 a month, what is that? $1440 a year on an annual.  That's not a lot of out of pocket, plus the Part D deductible, for most people. What are you looking at? $1,600-ish. Most people coming off of a group plan probably have $2000 to $5,000 or more in a deductible. So, they're looking at premium and deductible combined is lower than their total exposure right off their work plan.

Matt Feret (07:08):

What's the mix normally of, not only you but also all the agents across your 20 states? What does that look like in terms of a mix?  When people say, "Well, what do you recommend?" What do most people do or is it a mix?

Bill Pellegrini (07:20):

For us, I think it's probably 60/40. We're watching with the development of PPO plans now, becoming more commonplace in the market. I find we're writing more Medicare Advantage than Medicare Supplement (Medigap) but it's probably a 60/40 split. And that's only because of the flexibility within those PPO plans. I think previously, here in Arizona, this was more of an HMO environment. And that being said, I think our mix was a little bit different than what we're seeing today, just because of the flexibility inside the PPO.

Matt Feret (07:55):

Gotcha. And you mentioned earlier on, in our chat together, the millions of... Well, it's not millions but there are a lot of options out there. How should people think about those options in terms of... Well, you said there are 40 or 50 different choices just in Medicare Advantage in some particular areas. How do you shop for that? How do you narrow down your choices or is that what an independent agent or what your firm does?

Bill Pellegrini (08:24):

Well, that's exactly what we do and I think that's why it's so important for folks to work with a local agent. Someone that shops where they shop and knows the community that they reside in. They know what networks work in, what part of The Valley. For us, Phoenix is a large metro area. Number five in the United States. So, it's big. Not every plan works in every part of The Valley. So, you have to know what works, where, and that's what we do. So, folks that live in the far West Valley here, like a retirement center, retirement area, not every plan works out there because it's dominated primarily by one hospital network. And so, it's knowing those nuances within the plans. That's how we identify and narrow down those choices.

Matt Feret (09:13):

And how does an agent or how do you get to know those nuances? They say healthcare is local and locally consumed. And I think that's kind of what you're saying here too, is that even when it comes to your insurance coverage, it can be geographically specific within a geographic area. It's not just state or county. You're saying it even gets down to zip code. How do you know that? How do the agents figure that out?

Bill Pellegrini (09:37):

Well, we have tools that we use where we can plug in providers but really, at the end of the day, Matt, it just comes down to experience. It's time in the field and it's really knowing your products and knowing your plans. And that's why as we develop new agents, we don't put them with every single plan we have on our shelf because it's really too much to grasp, much like it is for a consumer. So, you have to narrow that down and give them a handful of products but not 17 or 18 different plants. And so, it just takes time to digest that information, process it and then working with leadership advisors like ourselves, where they have good resources to go back to.

Matt Feret (10:26):

So, good resources.  Let's pivot for a quick second here. How do you know if you've got a good agent?

Bill Pellegrini (10:33):

That's a great question.

Matt Feret (10:36):

What are the hallmarks of a good Medicare insurance agent?

Bill Pellegrini (10:40):

Well, I think one thing right off the bat is, if you're working with a captive agent that has one product to offer you-

Matt Feret (10:51):

What's a captive agent?

Bill Pellegrini (10:53):

A captive agent would maybe be an agent that works for a plan for insurance company. They only have one product. So, certainly if they have one product in their mind, that has to be the best product because nothing else will fit for them. Their job is to sell plans. So, I think when you work with a broker, they've got a whole list of plans to choose from and they understand that it's really on a case-by-case basis. And so, you can dig deep and you can truly find the plan that makes sense for them. And so, that's where I would start. I would work with an agent that has several plans to offer you. Not just one.  I would also look at, how long has that agent been in the business?  If it's a new agent trying to find their way, they may not know all the ins and outs.

Matt Feret (11:48):

It goes back to that experience piece.

Bill Pellegrini (11:50):


Matt Feret (11:51):

How do you know? You can't just know by just looking at them.

Bill Pellegrini (11:54):

No, but you're going to ask questions. "How long have you been in the business? How many products do you represent? Roughly, how many clients do you serve?" That helps you get a lay of the land of the experience level of this agent. If they say, "Well, I've got 20 clients, 40 clients." They're probably pretty new. If they have 200 to 500 clients or a thousand clients, then you could feel comfortable that you have a seasoned agent. But also too, not one that has a thousand clients that just works for one particular carrier. And we see that a lot. They're captive and they get leads from the carrier. And so, they write a lot of business but that doesn't always mean that it's the right fit for that consumer because there may be other plans that offer extra benefits, dental, vision and hearing that may be appealing to that consumer but they're not aware of.

Matt Feret (12:50):

What are the hallmarks of a really good insurance agent?

Bill Pellegrini (12:53):

Well, you want one that's going to be proactive and that's going to be reaching out to you. That's going to be checking, "Hey, you've got a rate increase. Maybe you're on a Medicare Supplement (Medigap)." That's going to make that outbound call and say, "Hey Betty, we just saw your rates went up 12%. Maybe we should shop and see if there's something else out there for you where we can save you some money." Also too, you want that agent that's going to hit you periodically throughout the year, just to check in, whether it's an email, a newsletter or a birthday card. But at least that you know that you're on that agent's radar. And then also too, as we move into the annual enrollment period, that's also important. You want your agent reaching out to you to say, "Hey, there may maybe some new options that we should take a look at this year. Maybe your needs have changed. We should look at your drugs. Maybe you've added a drug. Drop the drug." Whatever the case is, where they can shop again for you on an annual basis.

Bill Pellegrini (13:47):

So, it's really someone that's going to be engaged with you and touching you a few times a year and just staying in contact. I live by the model that, "Once a client, always a client," and I can tell you that we've lost clients. Maybe they've gone to a seminar or something and they've enrolled with that person. And then we end up getting them back because we never take them off of our emails or take them off of our newsletters and that other agent, maybe didn't do that. And they come back to us. So, I think that's important that you have an agent that stays in contact.

Matt Feret (14:23):

If I have a great agent, what should I expect that agent to do when, and what if my rates did go up 12% and I have a Medicare Supplement plan? Then what? What if my agent tells me that hospital system I was using or that I preferred or my primary care physician is no longer in the network. What does that kind of communication look like? It's a tight window to operate in. And obviously, nobody wants to make any mistakes during the AEP in their insurance coverage.

Bill Pellegrini (14:57):

Sure. Those are great questions. I can tell you the way that we handle it. In our newsletter, we put out some things that they need to look for. Kind of the landmines out there in the field. "Have your needs changed? Did you get any notification from your provider that you've had network changes?" And then we ask them to call us, set an appointment and then we review the options to find a program where their providers in it, right? Similar benefits, same thing with their medications. And then the other thing that we do, we'll shop their Medicare Supplement. Of course, Medicare Supplements, we can shop those year round. So, if they get a rate increase in July, we can always change provided we can qualify medically. And I think that's the one key thing with Medicare Supplement (Medigap) is we have to qualify medically.

Bill Pellegrini (15:46):

And so, we'll usually have a conversation. We'll ask them what their health looks like. Are they going through any treatment? Do they have anything pending or any surgeries coming up, even if it's something relatively simple like cataracts. We see a lot of that in our population. We'll ask those questions and maybe it's time for us to make a move. Maybe it isn't but it's all going to be relative to, at least from a Medicare Supplement (Medigap) standpoint, their health and what they're going through. And if everything is fine, then we'll start shopping rates and then we will apply. We'll wait till we get feedback from the carrier, whether they're approved or they're rated up and then we'll discontinue their prior plan.

Matt Feret (16:27):

Sounds like you are kind of recommending every fall to take a peak or a good agent should help you take a peek into your coverage and the pricing and your health.

Bill Pellegrini (16:39):

There's no question about it. You have to shop your plans every single year. There's too many moving parts, not to. And there's too many dollars on the table that you could be losing by not shopping. There are so many folks out there this last year. The Senior Savings Program was introduced for insulins but a lot of folks didn't shop that. What does that mean to them? Well, it's $35 all the time and those folks that are taking insulins that know the cost of that, and we haven't touched on this, but the coverage gap and donut hole, they're finding out what that means. And maybe they're paying $40 or $47 and all of a sudden, they're paying $125. With these senior savings programs, it's $35 all the time. And so, there are things like that out there that people need to be exploring to save them money.

Bill Pellegrini (17:30):

And then again, their needs may have changed. Maybe they weren't too taking Eliquis last year or Intresto, but now they are. And you throw a couple name brands in the mix, it's really going to be important to make sure that you have the right coverage. And I would say that when we're talking about even just Part D standalone plans, you're probably looking at 25 to 30 different plans in any given market out there. There are a lot of choices. Maybe the deductibles moved, maybe the formulary, which is a list of approved medications that the plan supplies, maybe that has changed. So, maybe you were on a tier two that's now tier three or tier four. There are so many moving parts and you're right, it is a lot of work but you have to keep a pulse on it. It's not a crock pot, Matt. Don't set it and forget it. You have to be out there checking with your agent, vice versa, your agent checking with you, to make sure you're on the right plan on an annual basis.

Matt Feret (18:28):

What's the worst movement a plan you've ever seen. For example, one year it was one benefit or in the next year it was another one completely different. What's the most shocking thing that you see out there that, if you're not paying attention, it might just fly by people.

Bill Pellegrini (18:46):

Well, I would say that it's deductibles and copays. There's no question about it, and then formulary. So, it's hard to say that there's just any one thing. From a Medicare Supplement standpoint, I would say folks have been hit with 30% rate increases. Folks that have that on an automatic bank draft, a lot of times that slips by them for a while. "I didn't realize I was paying 30% more." So, we've seen that happen and then we've also seen plans in the marketplace just really make tremendous adjustments in their copays but also, maybe dropping a provider network.

Bill Pellegrini (19:28):

And I think dropping a provider network is where folks get a little bit blindsided because that's not something they're using all the time. Unlike their prescriptions, it's a monthly basis. And so, that usually shows itself pretty quickly. But losing that cardiologist that saved your life three years ago and you don't go to see them until July and you don't know that. That's a big deal. And so, when you lose large provider networks and we've seen that happen where it's not just one doctor, it may be a group of doctors. It slides right by people. And thankfully, we have the open enrollment period that does give folks on Advantage plans, that extra three months if they discover that, the ability to change.

Matt Feret (20:14):

Yeah but if they lose the provider group in July or August-

Bill Pellegrini (20:18):

Doesn't help.

Matt Feret (20:19):

Doesn't help.

Bill Pellegrini (20:20):


Matt Feret (20:21):

Final thoughts, Bill. Thanks for your time today. What are some final thoughts around this? We talked about insurance agents and what it's like to have an expert insurance agent on the team and what they should be doing for you. And I think you drove home the point of, you got to shop every fall. I know it's a pain. Nobody really likes to go shopping but you should because things change all the time. It's not like car insurance. It's very different.

Bill Pellegrini (20:47):

I think final thoughts, you're right. Shop every year. Maybe don't be lured in by some of the promises on television. We see a lot of that right now. A lot of things being pitched. Small percentage of the people out there may qualify for those benefits but they get lured in. So, I'd be careful with that. Read your mail. It sounds so simple but you know this, Matt. There's a lot of mail that's being sent during that timeframe, whether it's an advertisement but you're also getting it from your carrier. Read through that information, particularly your annual notification of change document that the consumer receives late September or first part of October. Read that because that identifies everything that's going on with your plan, not from a network standpoint but at least from a benefit standpoint, to give you a clear picture of where you're headed the following year.

Matt Feret (21:44):

Yeah. Nobody's going to call you from the insurance company and say, "Hey, guess what? Your plan's changing." It's just going to come in one document and if you're not paying attention, you're going to miss it.

Bill Pellegrini (21:54):

That's exactly right. And it happens time and time again.

Matt Feret (21:59):

Bill, thanks so much for your time today. How can my audience find out more about you or get in touch with you on the internet?

Bill Pellegrini (22:07):

Several ways.  www.pellegriniandassociates.com.

Bill Pellegrini (22:19):

Or you can call us at (866) 731-6112.

Matt Feret (22:26):

Thanks, Bill.

Bill Pellegrini (22:28):

Thank you, Matt. Appreciate it. Good to see you as always.

Matt Feret (22:30):


Matt Feret (22:32):

Be sure to connect with Bill on LinkedIn or find him at www.pellegriniandassociates.com.  Please also subscribe to The Matt Feret Show YouTube channel and on iTunes or your podcast provider of choice.  Check out the show notes and links at www.mattferet.com.

Matt Feret (22:48):

Until next time, to your wealth, wisdom and wellness. I'm Matt Feret and thanks for tuning in.

Matt Feret is the host of The Matt Feret Show, which focuses on the health, wealth and wellness of retirees, people over fifty-five and caregivers helping loved ones. He’s also the author of the book series, Prepare for Medicare – The Insider’s Guide to Buying Medicare Insurance and Prepare for Social Security – The Insider’s Guide to Maximizing Your Retirement Benefits.

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