Questions to ask before you enroll in a medicare plan...

COSTS 

How much are the plan's premiums, co-pays, coinsurance, and deductibles? How much will you pay for doctor visits and hospital stays? What is the plan's maximum out-of-pocket? What is the plan's minimum out-of-pocket?  

BASIC COVERAGE 

Will the plan cover the services you think you will need? "Original Medicare" (parts A & B) covers about 80% of your medical services in hospitals, doctor offices, and some other healthcare facilities. Medicare Supplements help cover the "gaps" that Original Medicare doesn't cover, like some co-pays, coinsurance, and deductibles. Most Medicare Advantage plans and some Medicare Supplements offer additional benefits like fitness benefits, over-the-counter allowances, and some dental, vision, & hearing benefits. Check the plan's EOC (Evidence of Coverage) for details.  

OTHER COVERAGE 

How will Original Medicare (A&B) work with other medical or prescription drug coverage you may have?  (e.g. if you are a Federal employee) Which coverage with be primary and which will be secondary?  Will you have an option to keep your work coverage after you retire?  Understand your options in retirement for enrolling in a Medicare Supplement or Medicare Advantage plan. Remember you can't have both a Medicare Supplement and a Medicare Advantage plan. 

PRESCRIPTION DRUGS 

Are all your prescriptions included in the plan's formulary? When will you need to enroll in a part D plan to avoid a penalty? Do you have "creditable" coverage at work and do you plan to retire at 65 or continue working? What are the premiums, deductibles, and coinsurance? Medicare Advantage plans include part D for no additional premium. Medicare Supplement plans do not include part D, so you will need to enroll in a separate part D plan. 

NETWORKS 

Does the plan have a network?  Medicare Advantage plans are network plans (like HMOs and PPOs) so you need to be aware of your plan's network. Medicare Supplements are not network plans so you can go to any doctor who accepts Medicare. Some doctors (about 1.1% nationwide) "opt out" of Medicare and may charge more for their services.  

ADDITIONAL BENEFITS  

What "extras" will the plan have? Many Medicare plans include "extras" such as fitness center memberships, home meal delivery after hospital stays, 24/7 nurse lines, some dental, vision, & hearing benefits, and Over-The-Counter allowances for non-prescription pharmacy items to be delivered to your home. 

COMPANY QUALITY 

What is the Star Rating of the Advantage plan or the AM Best Rating of the Supplement plan?  Medicare gives every Advantage plan (part C) a "Star Rating" from 1 to 5 stars every year as a measure of the quality of services provided by the plan. These annual ratings are based on over 50 healthcare categories like ease of scheduling, wait times, coding accuracy, effectiveness of care, timeliness of care, customer co etc. Medicare Supplement plans are not given star ratings by Medicare since they are not a part of Medicare, however they do receive AM Best ratings. 

FOREIGN TRAVEL 

Will the plan cover me during foreign travel?  Most Medicare Supplements and Medicare Advantage plans provide only for emergency coverage during foreign travel. But some supplement plans cover 80% of your cost after a $250 deductible up to a lifetime maximum of $50,000. 

USA TRAVEL 

Does the plan include coverage throughout the USA?  Coverage while traveling within the United States is provided by most Medicare Supplement plans and is provided by most Medicare Advantage plans as out-of-network coverage. 

ENROLLING YOURSELF  

Can I enroll myself in a Medicare plan? Visit the MedicareCENTER where you can learn more about Medicare and where you can even enroll yourself in a Medicare plan if you want! 

ADVISOR COMPENSATION

How is your advisor compensated? Does your advisor get paid more for enrollments in certain plans?  Our compensation comes from the companies that our clients enroll in like Aetna, Cigna, Mutual of Omaha, Physicians Mutual, UnitedHealthcare, Wellmark BCBS, etc.  Our compensation amounts are standardized by Medicare so there is no financial incentive for us to recommend certain companies over others.  We explain your options, you choose the plan you want, and we get you enrolled with the effective date you need.  

ADVISOR QUALIFICATIONS  

Is your advisor certified by Medicare?  Medicare has a national certification program called AHIP (America's Health Insurance Programs). Advisors who are not AHIP certified are not allowed by Medicare to advise clients about all aspects of Medicare.  Be sure you are talking with an AHIP certified advisor.  

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SOME CAUTIONS... 

BEWARE OF SCAM CALLS!  Medicare will never call you - unless they are calling you back. 

Protect your Medicare card like a credit card and don't give anyone your Medicare number. 

Don't let anyone rush you into making a Medicare decision - take your time and consider all your options. 

If you suspect fraud or abuse of any kind, you can report it to Medicare at 1-800-MEDICARE (1-800-633-4227).