Questions to ask before you enroll in medicare...

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?  

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.  

COORDINATION OF COVERAGE 

How will Original Medicare (parts A & B) work with other medical or prescription drug coverage you may have?  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? Most 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 1-2% nationwide) "opt out" of Medicare.  

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 RATINGS 

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, timeliness of care, customer complaints, etc. Medicare Supplement plans are not given star ratings by Medicare since they are not a part of Medicare, however they all do have an AM Best rating. 

USA TRAVEL 

How does the plan cover travel throughout the USA?  Coverage while traveling within the United States is provided by most Medicare Supplement plans.  Medicare Advantage plans cover travel within the United States as out-of-network coverage. 

FOREIGN TRAVEL 

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

ENROLLING YOURSELF  

Can you enroll yourself 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 (after you have your Medicare card with parts A & B). 

ADVISOR COMPENSATION

How is your advisor compensated?  Our compensation comes from the companies that our clients enroll in, like Aetna, Cigna, Mutual of Omaha, Physicians Mutual, UnitedHealthcare, and Wellmark BCBS.  Medicare compensation amounts are standardized by Medicare so there is no financial incentive for advisors to recommend one company over another.  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 an annual certification program called AHIP (America's Health Insurance Programs).  Advisors who do not achieve Medicare's AHIP certification every year are not qualified to enroll clients in or advise clients about Medicare Advantage plans.  So don't limit your options!   Be sure you are talking with an "AHIP Certified" Medicare Advisor - like US - so you can get the Medicare plan you want!  

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SOME CAUTIONS... 

BEWARE OF SCAM CALLS OR TEXTS!  Medicare will never call or text you - unless they are calling or texting you back. 

Treat 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).