Questions to Ask Your Medicare Agent


When coordinating your health care coverage, it’s best to prepare a list of questions to ask your Medicare agent ahead of time. Also, having certain information handy will make the process smoother.

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Specific details can help your Medicare agent determine the proper coverage for you. The better prepared you are for your call with your agent, the better they’ll be able to guide you. Whether you are seeking Medigap, Advantage, or Part D coverage, we’ll let you know which questions you should ask in each scenario.

Questions to Ask Your Medicare Agent

When shopping for a Medigap, Medicare Advantage, or Part D prescription drug policy, beneficiaries should have a list of things to ask their agent. Often, when researching and reviewing plan options on your own, you’ll think of some questions.

It’s wise to write these questions down because an agent will likely have the answers. In addition to what you come up with, we’ve compiled lists of queries that will help you and your agent determine the best coverage for your needs.

Questions to Ask Your Medicare Agent About Medicare Supplement Plans

For most people, Medicare eligibility begins at age 65. After signing up, you may wish to enroll in a Medigap plan. The Medigap Open Enrollment Period is a six-month window during which insurance carriers will not use medical underwriting to determine application acceptance.

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What are the most popular Medigap plans in my area?

The state you reside in will determine which Medigap plans are available to you. Asking your Medicare agent about the most popular plans in your area is a good place to start when seeking supplemental coverage.

The same Medigap plans are available in most states. Further, these plans are standardized by the federal government, meaning the same plans consist of the same benefits regardless of carrier. Yet, prices can vary across carriers. Thus, the most popular plan is likely one that provides value through a lower monthly premium and reputable carrier.

When will my Medigap coverage begin?

When your coverage begins depends on when you purchase your policy. Your Medicare agent will know when your coverage will begin based on when you enroll, so don’t forget to ask them.

Is there a waiting period before a policy covers my pre-existing conditions?

Let’s say you were diagnosed with a certain medical condition six months before you buy a Medigap plan. In this case, you may need to wait up to six months before your supplemental coverage begins.

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However, enrolling during the OEP gives beneficiaries guaranteed issue rights. Carriers can’t enforce the waiting period during this time. When speaking to your agent, ask if there is a waiting period before a policy covers your pre-existing condition.

Are there similar plans for lower premiums?

Even if you think you’ve found the perfect coverage, you might be able to get the same plan for a lower premium. Additionally, some plans have extra benefits you might not need. Consequently, you could end up paying more for benefits you don’t use. Thus, it can be beneficial to ask your agent if a less expensive plan is available to you.

Keep in mind, though, that everyone’s Medigap premiums are unique. Several personal factors determine these rates, including your gender, age, location, tobacco use, and more.

Questions to Ask Your Medicare Agent About Advantage Plans

Many people enroll in Advantage plans to try to save money. Therefore, it’s important to understand what you will need to pay for if you choose this coverage.

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What are the out-of-pocket costs?

Medicare Advantage plans come with out-of-pocket costs for which you will be responsible.  Therefore, you should ask your agent about these costs.

You’ll want to know what you need to pay each month in premiums, what coinsurance or copays you’ll be responsible for, the annual deductibles you must meet, and the maximum out-of-pocket for your plan. Many Advantage plans include prescription drug coverage, for which there may be an additional deductible.

Does the plan network include my preferred practitioners?

Advantage plans are most often HMOs or PPOs, so they involve networks. You’ll want to make sure the network for the plan includes your preferred health care providers so your care receives coverage. Also, out-of-network care sometimes doesn’t apply to the plan’s deductible, so costs will be even higher if you see doctors outside your plan’s network.

In contrast, Medigap plans don’t involve networks. Instead, they pay for doctors who accept Medicare assignments, which includes most doctors.

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Will I need a referral to visit a specialist?

When enrolling in an HMO Advantage plan, you’ll most likely need a referral letter from your doctor to see a specialist. This is also true for Special Needs Plans (SNPs). Annual services such as mammograms are exceptions to this rule.

Generally, if the Advantage plan in which you’re enrolling is a PPO, you don’t need a referral to see a specialist. Private Fee for Service (PFFS) plans also don’t require them. However, the best way to know whether the plan in which you’re considering enrollment requires referrals is to ask your agent.

Questions to Ask Your Medicare Agent About Part D Plans

If you choose to enroll in a Medigap plan or remain on Original Medicare (Part A and Part B), it’s wise to enroll in a Part D prescription drug plan. It’s best to enroll sooner than later, so as to avoid the penalty you’ll need to pay if you lack creditable coverage for prescription drugs.

Does the formulary include my medications?

Each prescription drug plan comes with a formulary, which is a list of medications receiving coverage under the plan. Before enrolling in a Part D plan, you’ll want to make sure all of the medications you take on a regular basis receive coverage. Ask your Medicare agent specifically about the prescriptions you take.

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Can I use my pharmacy of choice?

Part D plans from many carriers require the use of preferred pharmacies for lower-cost drugs. This most often means the provider partners with a chain pharmacy.

A good question to ask your Medicare agent when selecting a Part D plan is what the preferred pharmacy is for the plan you’re considering. If the pharmacy with which the carrier partners is not convenient for you, you may want to rethink your plan choice.

Do I have the option of mail-order prescriptions?

Some Part D providers offer the option of mail-order prescriptions. If you prefer this method of receiving your prescriptions, ask your Medicare agent which plans offer the option.

FAQs

How will my Medicare coverage work with my health care benefits through my employer?
Whether Medicare is primary or secondary to your employer coverage depends on the size of your employer. If you plan on working beyond Medicare enrollment, describe your employment status to your Medicare agent, with details about your employer size.
Does my Medicare coverage coordinate with my retiree insurance?
If you’ve retired early or are expecting to receive retiree insurance through your former employer, tell your Medicare agent. You’ll want to ask your agent if your Medicare coverage coordinates with your retiree insurance. Make sure you’re prepared with information about the type of retiree insurance you have.
What should I have during my call with my Medicare agent?
You should have the following available during your call: your Medicare card, preferred provider list, list of prescriptions you take regularly, and current health care information.

How to Find a Medicare Agent

Once you've prepared your questions and personal information, give us a call at the number above or fill out our online rate form. Our agents are licensed in every state and are happy to help, at no cost to you.

Medicare can be complicated but we're here to simplify the process. Our ultimate goal is to assist you in making the best decisions for your health and budget needs.

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Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

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