What Are the Medicare Standards of Excellence—and How Do They Help Older Adults?

What’s the best way to find a Medicare plan? If you’re turning 65 soon, this question may be at the top of your mind. Since health care expenses tend to increase as we age, choosing the right Medicare plan is a key part of protecting your physical and financial well-being.

As important as it is, however, the process of enrolling in Medicare can be daunting. There’s a seemingly endless array of coverage options to choose from within the Medicare universe. The out-of-pocket costs for these plans may differ by thousands of dollars each year.

Confusion about their Medicare options can lead many older adults to make costly enrollment mistakes. These errors—whether it’s choosing the wrong plan or not enrolling at the right time—can add up to a large amount of money over the years and take a serious financial toll.

The good news? NCOA has the tools and resources to help you make an educated choice about your Medicare coverage. Through NCOA’s Standards of Excellence (SOE), NCOA has identified Medicare brokers you can trust, as our partners meet rigorous standards to ensure you can feel good about your plan options.

What are NCOA's Medicare Standards of Excellence?

NCOA only partners with Medicare brokers that meet our Standards of Excellence (SOE). The SOE are requirements our Medicare partners must meet when providing consumer education and health insurance brokerage services. You can feel confident about your Medicare choices when working with a professional who has gone through our rigorous SOE training and certification process.

The SOE fall into the seven key areas below:

1. Agent Compensation and Anti-Steering

These standards make sure an agent (broker) will not “steer” you into buying specific insurance products. Unlike many agencies, brokers who work for agencies that meet the SOE do not get paid more by recommending a certain company or insurance plan.

Why should you care about this? You won’t feel pressured by one of our Medicare partners into buying a specific plan. Their priority is helping you find a plan that fits your unique health care and financial needs.

2. Agent Training and Quality Assurance

This set of standards requires our partner brokers to be highly trained in every part of the Medicare program. In addition, their interactions with consumers are routinely reviewed to make sure they’re always delivering accurate, up-to-date, and impartial advice about Medicare.

Why should you care about this? You can have confidence that the broker you speak with is knowledgeable about Medicare and held to the highest customer service expectations.

3. Carrier Representation

Under these standards, a broker must provide you with a broad, unbiased range of Medicare coverage options that meet your needs—even if that means suggesting plans not represented by their brokerage service.  

Why should you care about this? You can trust you’ll have all the information necessary to make smart decisions about your Medicare coverage. You won’t be discouraged from pursuing products from an insurance carrier not represented by the broker you’re speaking to.

4. Consumer Advocacy

Our Consumer Advocacy standards were created to make sure you get additional help—free of charge—if you have problems with your Medicare coverage. Potential problems include claims denials, authorization and referral issues, or trouble accessing health care services and/or prescriptions.

Why should you care about this? You can rest assured that if you run into any difficulties with your Medicare plan, help is right at your fingertips. Support from one of our broker partners can help you resolve complex problems faster than traditional support channels.

5. Consumer Education and Decision Support

These standards are designed to make sure you receive Medicare-related advice that is:

• Clear
• Practical
• Impartial
• Focused on your needs

Why should you care about this? You know you’ll receive Medicare information that is straightforward and easy to understand. It will also be tailored to your personal needs, preferences, and finances—not the broker’s.

6. Customer Service and Support

Our Customer Service and Support standards ensure that services provided by our Medicare partners are responsive and high-quality. They must also be available in multiple languages and accessible to people who are hearing impaired.

Why should you care about this? You can be confident you’ll receive prompt, excellent Medicare guidance no matter what language you speak or if you’re hearing impaired.

7. Regulatory Compliance

These standards require our broker partners to comply with all relevant Centers for Medicare & Medicaid Services (CMS) and state insurance regulations and notification rules.

Why should you care about this? When communicating with you about your Medicare coverage options, our broker partners follow all state and federal laws. These laws are intended to protect the rights and interests of you, the consumer.

If I'm a senior who needs help choosing a Medicare plan, what’s the next step?

NCOA offers no-cost, personalized Medicare guidance to help you find the plan that best meets your health care needs and lifestyle. Visit our easy-to-use Age Well Planner resource to read more about:

• Medicare coverage and costs
• Different Medicare plan options available
• When to enroll in Medicare

You can also get a free, 100% confidential Medicare cost estimate and connect with advisors who meet the SOE outlined above.

“Selecting a Medicare plan is a big decision,” said Josh Hodges, NCOA’s Chief Customer Officer.

The choices you make could affect your health for years to come and save—or cost—you hundreds of dollars in out-of-pocket expenses," Hodges said.

"Working with a licensed Medicare broker that meets NCOA’s Standards of Excellence can give you the peace of mind that you’re making the best choice for your health care coverage,” Hodges continued.