News about Medicare insurers facing cost pressures is everywhere right now, and the winds of change are blowing through the Medicare market. With more PPO plans projected to be endangered in 2026, many clients will seek clarity when choosing between Medicare Advantage and Medicare Supplement (Medigap) coverage.
That’s where you come in. Clients need an agent who can guide them with confidence and empathy when the ground feels like it’s shifting.
Here’s how to guide clients through the Medicare Advantage vs. Medigap decision to build trust and clarify the choice.
Start with Listening, Not Pitching
The best way to serve clients is to slow down and revisit their priorities with a thorough needs assessment. Ask open-ended questions like:
- Did they hear something that made them anxious?
- Did a doctor leave their carrier’s network?
- Did a neighbor scare them off with a horror story?
- What’s most important right now: keeping a doctor, saving money, or maximizing benefits?
- Are they healthy and only see a doctor once a year?
- Or are they juggling five prescriptions and multiple specialists?
Sometimes, just letting them vent helps uncover what really matters. Medicare Advantage often appeals to “benefit seekers” who value perks like dental, vision, or fitness memberships.
Medigap is a better fit for those who want provider freedom or travel flexibility. Use scenarios they can relate to, like, “Let’s say you’re in Florida for the winter and need to see a doctor. Here’s how that would play out on Advantage vs. Medigap.”
Don’t Assume They Know Their Current Plan
Many Medicare Advantage members don’t fully understand the benefits they already have, especially since those benefits change each year. For example:
- Their cardiologist may no longer be in-network.
- Their drug formulary may have changed, affecting prescription coverage.
- The $0 premium remains, but co-pays may have increased.
Review their current plan and highlight the benefits that matter most to them. When the Annual Notice of Change (ANOC) is released, conduct a side-by-side comparison of this year’s coverage versus next year’s so they can clearly see the differences.
Talk Plainly About the Budget
Many clients assume Medigap is “too expensive.” That’s your chance to walk them through real-world cost scenarios.
- Hospital stays and ongoing specialist visits are covered under Advantage.
- The peace of mind that comes with Medigap’s predictable premiums.
A simple way to frame it is, “Medigap is like paying more upfront for peace of mind. Advantage is paying as you go—you save when you don’t use it, but you may get hit with co-pays later.”
Lay it out, then let them decide which model best fits their life.
Timing Matters, so Explain It Clearly
This is where agents either shine or lose trust. If they want to switch from Advantage to Medigap, explain the medical underwriting process.
- Unless they’re in their Medigap Open Enrollment Period or in a special situation such as plan termination, acceptance isn’t guaranteed.
- Be upfront – “Here’s when you can switch freely. After that, it gets trickier, and you may not qualify.”
On the flip side, moving from Medigap to Advantage is straightforward during AEP. But clients need to understand they may not be able to re-enter Medigap later without health questions.
Give Them Breathing Room
The worst mistake during uncertain times is pressuring people. Don’t push for a decision on the first call.
Instead, say something like, “I know that was a lot. Let’s give it a couple of days, and I’ll check back in. If questions come up in the meantime, just text me.”
That builds trust and shows you’re in it for the relationship, not just the sale.
Be Their Rock in a Sea of Change
When the Medicare market gets noisy, your role is to bring clarity and confidence, not panic. Keep listening, educating, and guiding, and you’ll position yourself as the advisor they can rely on.
If you need additional support, Scott Meeks, Agility’s Medicare Product Specialist, is here to help you strategize and connect with the right communication tools. You can reach Scott through the Agility Producer Support Team at (866) 590-9771 or support@enrollinsurance.com to schedule a meeting or call with him or to get answers to any insurance questions.
And don’t forget, you can join our free weekly email list for timely tips and updates to help you maximize this Medicare AEP.
