Before You Talk to a Medicare Salesperson, Do This First

If you are getting ready to choose a Medicare plan, there is something you should do before you talk to an insurance agent, attend a Medicare seminar, respond to an advertisement, or call one of those numbers flashing across your television screen.

Figure out what you need first.

That may sound obvious, but it is where many people get Medicare backwards.

They begin with the insurance plan.

They hear about a $0 premium, dental benefits, hearing aids, vision coverage, gym memberships, over-the-counter allowances and other extras.

Then they try to figure out whether the plan fits them.

A better approach is the opposite:

Start with yourself. Then find the plan that fits.

Medicare itself recommends checking whether a plan covers your prescriptions, includes the benefits you need, includes your doctors and pharmacies, and fits your costs before enrolling. Medicare also recommends considering whether coverage will work if you live in another state for part of the year.

Whether you eventually enroll through an agent or decide to compare and self-enroll in Medicare, doing a little preparation first can completely change the quality of the conversation.

Start With Your Doctors

Before anyone shows you a Medicare Advantage plan, make a written list of your healthcare providers.

Include your:

• Primary care doctor
• Cardiologist
• Orthopedist
• Neurologist
• Oncologist
• Eye doctor
• Any other specialist you see regularly

Then add the hospitals and medical systems that matter to you.

This is especially important when considering Medicare Advantage because many plans use provider networks. Depending on the type of plan, going outside that network may cost more or may not be covered except in certain situations.

Medicare explains that HMOs and PPOs operate differently. PPO plans generally allow members to receive covered care outside the network, although they may pay more, while HMOs generally have tighter network requirements.

Do not simply ask a salesperson:

“Does this plan have a big network?”

Ask:

“Are my doctors and hospitals in this specific plan?”

The word specific matters.

A physician may participate with one Medicare Advantage plan from an insurance company but not another.

If keeping your doctors is important, verify them before enrolling.

Our article Can I Use My Current Doctor With Medicare Advantage? goes into this issue in more detail.

Make a Complete Prescription List

Next, write down every prescription medication you take.

Do not write “blood pressure pill.”

Write the actual drug name.

Include:

• Medication name
• Dosage
• How often you take it
• Preferred pharmacy
• Whether you use mail order

Prescription drugs are one of the areas where seemingly similar Medicare plans can produce very different costs.

A drug can be covered by two plans but placed on different tiers.

One plan may require prior authorization.

Another may impose quantity limits.

And the pharmacy you use can affect your costs.

Medicare’s own Plan Compare system allows beneficiaries to enter their medications and estimate monthly and annual drug costs under different plans.

You can also read our guide to what Medicare Part D drug plans cover before comparing plans.

The important lesson is simple:

Do not ask only:

“Is my drug covered?”

Ask:

“What will my drug cost under this plan?”

Those are very different questions.

Decide Whether You Prefer Predictability or Lower Monthly Premiums

Before talking to anyone about Medicare Advantage or Medigap, think about how you want to handle healthcare expenses.

Some people prefer paying more every month in exchange for greater predictability.

Others prefer keeping monthly premiums lower and accepting more copayments and coinsurance when they use medical care.

That is one of the major differences between Medicare Advantage and Original Medicare combined with Medigap.

Original Medicare and Medicare Advantage are the two primary ways to receive Medicare coverage. With Original Medicare, beneficiaries can add a separate Part D plan and may purchase Medigap coverage. Medicare Advantage is offered by private companies approved by Medicare and often bundles hospital, medical and prescription drug coverage.

Neither approach is automatically better.

It is a matter of fit.

Our detailed comparison, Medicare Advantage vs. Medigap: What Seniors Need to Know Before Choosing, explains these tradeoffs.

Think of it this way:

With one approach, you may be paying more now for greater predictability.

With another, you may be paying less now but accepting more expenses when you use healthcare.

That is not merely an insurance decision.

It is a financial decision.

Ask What a Bad Healthcare Year Could Cost

Many people compare Medicare plans by looking almost entirely at the monthly premium.

That can be a serious mistake.

A $0-premium Medicare Advantage plan can still have deductibles, copayments, coinsurance and other expenses when you receive medical care.

You should ask:

• What does a specialist visit cost?
• What does outpatient surgery cost?
• What does an MRI cost?
• What does a hospital stay cost?
• What will physical therapy cost?
• What is the maximum out-of-pocket limit?

One of the most useful questions you can ask before choosing coverage is:

“What could this plan cost me during a really bad healthcare year?”

That forces you to think beyond the monthly premium.

Our article What Are the 3 Most Important Questions to Ask About Medicare? focuses on doctors, prescriptions and total healthcare cost rather than simply premium.

Insurance exists partly to protect you when things do not go according to plan.

So compare your Medicare coverage for the year when you are healthy — but also for the year when you may not be.

Think About Where You Live and Travel

Do you spend winters in Florida?

Do you visit children in another state for months at a time?

Do you travel frequently?

Do you own two homes?

These are not lifestyle details that should be discussed after you choose a Medicare plan.

They should be discussed before.

Medicare specifically advises people who live in another state for part of the year to determine whether the plan will cover them there.

Network flexibility may be far more important to a frequent traveler than to someone who receives nearly all their healthcare within one community.

Again, there is no universal “best plan.”

There is only the plan that best fits your circumstances.

Do Not Let Extra Benefits Distract You

Dental benefits matter.

Hearing benefits matter.

Vision benefits matter.

Over-the-counter allowances can be useful.

But they should not be the first things you compare.

Your medical coverage should come first.

Imagine choosing a car primarily because you liked the cup holders.

That would be ridiculous.

Yet people sometimes choose Medicare plans based heavily on extra benefits while barely examining hospital costs, physician networks or prescription coverage.

Compare the extras after you have answered the more important questions.

Your order should generally be:

Healthcare first.

Doctors second.

Prescriptions third.

Financial exposure fourth.

Extras after that.

Ask the Salesperson What Companies They Represent

Insurance agents can provide valuable help.

A knowledgeable independent Medicare agent may be able to explain complicated options, help compare benefits and identify issues you might otherwise overlook.

But you should understand something before the conversation begins:

An insurance agent may not represent every Medicare plan available in your market.

So ask:

“Which insurance companies and plans are you able to offer me?”

You do not need to make the question confrontational.

You are simply trying to understand the universe of choices being presented.

Medicare encourages beneficiaries to compare plans themselves and also recognizes trusted agents and brokers as one source of help. It additionally points consumers toward State Health Insurance Assistance Programs, or SHIPs, which provide free counseling and are not connected to an insurance company or health plan.

The point is not that agents are bad.

The point is that you should know who is showing you what.

Look at Medicare.gov Before the Appointment

Even if you have absolutely no intention of enrolling online by yourself, visit Medicare.gov before talking to a salesperson.

You do not need to become a Medicare expert.

Spend enough time to understand what is available in your area.

Medicare’s official comparison tools allow you to review Medicare Advantage plans, Part D plans and Medigap options, including costs and prescription estimates.

That gives you a reference point.

Then when someone presents a plan to you, you are not hearing about Medicare for the first time.

There is an enormous difference between saying:

“What should I buy?”

and saying:

“I have already done some research. Here are my doctors, medications and priorities. Now show me the options that fit.”

The second person is much harder to sell.

And much easier to educate.

Write Down Your Questions

Do this before the appointment.

Otherwise, you may forget half of them.

Ask:

• Are my doctors in this exact plan?
• Is my preferred hospital in network?
• Are my prescriptions covered?
• What will my prescriptions cost?
• What is the maximum out-of-pocket limit?
• What are the hospital copayments?
• What does outpatient surgery cost?
• Do I need referrals?
• What happens if I receive non-emergency care outside the network?
• What prior authorization requirements should I know about?
• What companies and plans do you represent?

You can even print the questions and bring them with you.

That turns the sales appointment into an interview.

And remember who is doing the interviewing.

You are.

Do Not Be Afraid to Say, “I Want to Think About It”

You are not required to enroll simply because somebody spent an hour explaining a plan.

You can say:

“I want to compare this before making a decision.”

You can check Medicare.gov.

You can talk with your family.

You can verify your doctors.

You can check your prescriptions.

You can get another opinion.

CMS regulates Medicare Advantage and Part D marketing and maintains specific rules governing how plans, agents and brokers market to beneficiaries.

But regulations do not replace your own judgment.

If somebody makes you uncomfortable or rushes you, slow the process down.

A genuine Medicare enrollment deadline may be important.

Sales pressure is something entirely different.

The Best Medicare Conversation Starts Before the Salesperson Arrives

The best way to protect yourself is not to avoid every Medicare salesperson.

It is to become an educated consumer before you meet one.

Have five things ready:

Your doctors.

Your medications.

Your hospitals.

Your budget.

Your priorities.

Then you can say:

“These are the things that matter to me. Show me the plans that fit them.”

Now the conversation is about your healthcare instead of a product brochure.

That is exactly the philosophy behind MedicareSelfEnroll.com.

Before you compare Medicare plans, plan for your healthcare.

Education first.

Enrollment second.

We don’t sell you plans.

We help you find the right choice.

You may ultimately decide to enroll yourself online.

You may decide to work with an insurance professional.

Either approach can work.

But whichever path you choose, understand the decision before you make it.

Because the person who should be in control of your Medicare decision is not the salesperson.

It is you.