Questions to ask when choosing a Medicare plan

Medicare Plan Questions You Should Ask Your Insurance Agency Before You Choose

We may not like to admit it, but getting older often means coping with an increasing number of health concerns. So choosing the right Medicare plan—a plan that ensures access to affordable and high quality health care—is especially important.

Yet understanding the complicated world of Medicare insurance can be pretty tricky. After all, there are so many different options available on the market today: the government’s Medicare plan versus private Medicare insurance; difference coverages under Parts A, B, C, and D; the benefits of a Medicare Advantage plan as compared to a Medigap plan, and so on. Each plan offers different levels of coverage and an often-confusing mix of premiums, co-pays, deductibles, and out-of-pocket maximums. Indeed, comparing plans can be overwhelming.

On the plus side, there is a lot of readily-available information designed to help make the process of selecting a Medicare plan more comprehensible. As you approach your 65^th birthday and Initial Enrollment Period—the 7 months around your 65^th birthday in which you are eligible to enroll in Medicare—you will begin receiving mailings from Social Security and private insurance companies. Several basic Internet searches can also wield a wealth of important and easy-to-digest information.

However, probably the best way to get the information you need—to ensure that you are comparing apples to apples—is to talk directly to information representatives. When researching Original Medicare (the plans offered by the government), the Social Security Administration has representatives who can walk you through the various alternatives. You can also speak with an independent insurance agent and/or representatives of insurance companies offering authorized Medicare Advantage and Medigap plans.

To help guide these conversations, we have prepared a list of useful questions; we encourage you to take this checklist to each meeting to ensure that you get the answers you need to make an informed choice about your health care!

Questions about medical plans

• What is the monthly premium?
• What are the co-pays/coinsurance payments for doctor visits/ tests/ procedures/ hospitalizations?
• What is the annual deductible?
• What is the annual out-of-pocket maximum, if any?
• Does the plan include coverage for medications/prescription drugs?
• Does the plan include coverage for additional services such as dental, vision, hearing?
• Does the plan include travel coverage?
• Can I keep my current doctor(s) (are they “in network”)?
• Are “out-of-network” providers covered under the plan?
• Can I get year-round coverage if I live in two different regions of the country (summer v. winter)?
• Do I need referrals for specialists?
• What is the plan’s quality rating?
• Who will assist me if I have questions about coverage or medical bills?

Questions about prescription drug plans

• What is the monthly premium?
• What is the annual deductible?
• What are the co-pays for medications, if any?
• Are my current prescriptions covered under the plan? (Be sure to come prepared with a list of your current medications.)
• How will I know if new medications will be covered?
• Can I get my medications at my local pharmacy?
• Can I/Must I get my medications through a mail order service?