What to Ask Your Medicare Insurance Broker- and When

You don’t have to know all the Medicare terminology to have a helpful conversation about your coverage. Start with what matters to you: your doctors, prescriptions, budget, and ability to get care. The right questions can help you feel more comfortable with your choices.

Each fall: “Does my coverage still fit my needs?”

Even if you’re happy with your plan, schedule an annual review. Medicare Advantage and prescription drug plans send an Annual Notice of Change in September outlining changes for the coming year. Medicare’s Annual Enrollment Period runs October 15–December 7, with changes generally taking effect January 1.

Ask your broker:

• “Will my doctors, specialists, and preferred hospital be in-network next year?” Ask about your exact plan, and confirm participation with your providers, too.
• “Are all my prescriptions covered, and what will they cost at my pharmacy?” Make sure to tell your broker or agent your medication names, dosages, and how often you take them so they can run a cost comparison for you. Ask whether another pharmacy could lower your costs.
• “What could I spend beyond the monthly premium?” Review deductibles, copays, hospital costs, and applicable out-of-pocket limits.
• “If I keep my current plan, what changes should I prepare for?” A review doesn’t have to lead to a switch. 

Before changing coverage: “What would I gain… and what would I give up?”

An appealing extra benefit is only one part of the picture. Ask whether a different plan changes access to your doctors, requires specialist referrals, or needs advance approval for certain services. These rules vary by plan and year.

Also ask: “Which insurance companies and plans do you represent?” This helps you understand the scope of your broker’s comparison.

If you’re considering changing or dropping Medicare Supplement Insurance (Medigap), ask about eligibility and any health questions before taking action. Fall enrollment does not automatically guarantee the right to buy or switch Medigap coverage!

When life changes: “Should we review my coverage now?”

Contact your broker before a move or loss of employer coverage, or promptly if you receive notice that your plan is ending. Certain circumstances may qualify you for a Special Enrollment Period; deadlines and available changes depend on your situation.

Whenever something is confusing: “Can you help me understand my next step?”

An unexpected bill, prescription problem, or coverage denial is a reason to ask for help right away. Your broker can help you identify whom to contact, though your plan handles coverage decisions and appeals. Keep the notice handy and pay attention to any response deadline.

Before your appointment, gather your insurance cards, medication list, provider names, and plan notices. Write down your top three concerns- and bring a trusted family member if you’d like.

You deserve clear answers and time to understand them. No question is too small when it affects your care.