Founder of The Modern Medicare Agency, Paul Barrett, shares his experience and insights on what it takes to establish a business. Formed in 2007, The Modern Medicare Agency helps clients understand the workings of Medicare, focusing on personalized, one-on-one guidance. Paul also advocates for senior education on Medicare, especially in light of changes from the Inflation Reduction Act, and encourages employers to support their older employees’ transition to Medicare.
To begin, could you introduce yourself and what led you to found The Modern Medicare Agency?
I first became involved in Medicare back in 2007 because, as a health insurance agent, I realized just how confusing it was—not only for clients but even for other agents. Most health insurance agents don’t fully understand Medicare, and I saw firsthand how challenging it could be for people to navigate.
When I worked for some of the larger firms, I noticed a lot of pressure to push specific products, even when they weren’t the best fit for the client. That really didn’t sit well with me because I’ve always believed in doing what’s right for the person sitting across from me.
That’s why I decided to start my own agency, one that focuses exclusively on Medicare. I wanted to build something that wasn’t about one-size-fits-all solutions but instead about taking the time to find the right plan for each individual. For me, it’s not just about insurance—it’s about making a complicated process easier and giving people peace of mind.
With the Inflation Reduction Act now in effect, what are the most important changes seniors need to understand about how it impacts Medicare?
The Inflation Reduction Act has brought some significant changes to Medicare, particularly with Part D, and these are really important for seniors to understand. One of the biggest changes is the new $2,000 spending cap on Part D prescription drugs, which provides some much-needed financial relief for those with high medication costs. There’s also the Insulin Savings Program, which caps the monthly cost of insulin at $35—a huge help for seniors managing diabetes.
Another notable change is the introduction of balanced billing for Part D plans. This allows consumers with high-deductible plans to average their deductible and monthly drug costs so they can spread out their expenses more evenly throughout the year. It’s designed to make budgeting a little easier for those who need it.
That said, there are some less favorable changes to be mindful of. Part D plans are updating their formularies—the lists of drugs they cover. Some drugs have been removed entirely, while others have been moved to higher-cost tiers, which can increase out-of-pocket expenses. Many plans have also shifted from charging flat copays for brand-name drugs to coinsurance, which is a percentage of the drug’s cost. Unfortunately, that often means seniors are paying more, especially for expensive medications.
On top of that, a lot of Part D plans have stopped paying agents to help clients choose the right coverage. This creates a potential problem because it could lead some agents to recommend plans that pay commissions rather than the best plan for the client’s needs. It’s more important than ever for seniors to work with someone who truly puts their needs first.
At the end of the day, the Inflation Reduction Act has brought some great improvements, but it’s also made Part D more complex. Seniors should take the time to review their plans annually to make sure their coverage still works for them, especially with all these changes.
The Act aims to reduce prescription drug costs—a significant concern for Medicare beneficiaries. How will these provisions work in practice, and what should consumers be prepared for in the coming years?
The Inflation Reduction Act introduces several important provisions to reduce prescription drug costs. It also changes the way costs are shared, which will impact all Medicare beneficiaries.
One of the most significant changes is the new $2,000 annual cap on out-of-pocket spending for Part D drugs, set to take effect in 2025. This is great news for the roughly 10% of Medicare beneficiaries who spend more than $2,000 a year on their medications. These individuals will see substantial savings because they’ll no longer face unlimited out-of-pocket costs.
However, it’s important to understand the ripple effects. While the 10% of consumers with high drug costs will benefit, the insurance carriers will now be covering a much greater share of these expenses. This shift is likely to result in higher premiums, deductibles, and cost-sharing for the remaining 90% of beneficiaries who don’t reach that $2,000 threshold. Essentially, the costs of these changes will be redistributed across the Medicare population.
In addition, there are other changes to be mindful of, like updates to Part D formularies. Many plans are removing certain drugs or moving them to higher-cost tiers, and a shift from flat copays to coinsurance for brand-name drugs is becoming more common. These adjustments can lead to higher out-of-pocket costs for some consumers, even as the Act targets overall savings.
Consumers should be prepared for these changes and take a proactive approach by reviewing their plans annually. This is especially critical during open enrollment, as premiums, deductibles, and drug coverage can change from year to year. It’s also a good idea to work with a knowledgeable agent or advisor who can help navigate these complexities and ensure they’re still in the plan that best meets their needs
As someone who advocates for senior protection, do you think the IRA sufficiently addresses the issues Medicare beneficiaries face, or are there areas that require further action?
I believe that the Inflation Reduction Act was a good idea in theory. However, the politicians who put this in play did not realize the impact it would have on the large majority of consumers who it really was not designed for. I believe there should be more focus on preventative health and fixing the root cause of many medical conditions rather than just trying to pay for medication. More efforts should be put towards functional health & nutrition education to help reduce the need for all these costly medications.
Consumer education on Medicare can be challenging due to complex terminology and frequent policy updates. What practical resources or tips do you recommend to help seniors stay informed?
I personally host many Medicare seminars and webinars throughout the year to help educate consumers. During these presentations, we are strictly focused on education and helping the consumer learn how to choose the right coverage for themselves as opposed to trying to sell coverage. Educated consumers tend to have a lot less complaints and issues with coverage.
Looking to the future, what further reforms or educational initiatives would you like to see implemented to support seniors in making well-informed healthcare decisions?
I believe there should be more opportunities to get educated on Medicare and how it will relate to you as the consumer. Employers should have guest speakers come in to do lunch and learn for their older employees, and HR directors should also be more educated and concerned with helping Medicare-eligible employees transition to Medicare.
