10 questions to ask your broker or agent about Medicare coverage

There are a lot of options out there when choosing Medicare coverage. And of course, plans change each year, and new plans become available that could be a better option for you in terms of cost and coverage. We know that’s why many of you ask for help from a licensed agent or broker. Since we’re all about making Medicare easier to understand, the ApexHealth team decided to put together 10 questions to ask your broker or agent about Medicare coverage.

Original Medicare does not cover routine dental, vision and hearing coverage. Most Medicare Advantage plans offer these benefits along with new non-medical benefits and extras that give you more “bang for your buck” including gym memberships, OTC allowance and more! These offerings vary by plan.   

1. Is my plan changing?

Each year, plans change. If you’re enrolled in a Medicare plan, your plan will send you an Annual Notice of Change (ANOC) in September, and it will include any changes in costs, coverage, or service area effective January 1 of the next year. Look over your ANOC to make sure your plan will continue to meet your needs, and if you have any questions, your agent can go over them with you.

2. Are new benefits available in my area?

Original Medicare does not cover routine dental, vision and hearing coverage. Most Medicare Advantage plans offer these benefits along with new non-medical benefits and extras that give you more “bang for your buck” including gym memberships, OTC allowance and more! These offerings vary by plan.  

3. Is prescription drug coverage included?

Original Medicare (Parts A and B) does not include coverage for prescription drugs. Neither do Medicare Supplement plans. Most Medicare Advantage plans do (MAPD plans). If you enroll in a plan that does not include prescription drug coverage, you’ll need to enroll in a separate Part D plan. However, you are not allowed to add a separate Part D plan unless the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan or a Medicare Medical Savings Account (MSA) plan.

4. Are my prescriptions covered?

It’s a good idea to make sure the plan you’re interested in – whether it’s an MAPD plan or a standalone Part D plan – covers your prescriptions. A plan’s formulary (drug list) is a great place to start. If you need help, talk to your agent!

5. Can I see my regular doctor?

When enrolled in Original Medicare, you can see any doctor in the U.S. that accepts Medicare. Medicare Advantage plans will require you to use a network of hospitals and providers. When working with an agent, go over your plan’s provider network to see which doctors, hospitals and specialists are included. 

6. Does the plan offer programs to help navigate my health care?

We think Medicare is great – but it can be confusing! How does the plan you’re interested in help you navigate an often-confusing health care system? ApexHealth members receive one-on-one support from an ApexAssistant, a personal Medicare expert who knows you, your plan, your preferences and your needs. Your ApexAssistant will be your advocate who’s on your side, to help and guide you.

7. What is the plan’s annual out-of-pocket maximum?

Original Medicare does not have an out-of-pocket maximum meaning that medical care can be expensive, especially in the case of an emergency. Medicare Supplement plans can help offset these costs, or you can enroll in a Medicare Advantage plan. The Centers for Medicare and Medicaid Services (CMS) sets the Medicare Advantage out-of-pocket limit each year, but some plans may set lower limits. When talking with your agent, have them help you figure out your out-of-pocket costs and limits.

8. What will my total costs be each year?

In addition to your monthly premium, it’s important to look at your expected out-of-pocket costs, like copays and deductibles. Factor in your income and regular expenses to help determine what you can afford each month or in case of an emergency.

9. What if I don’t like my current plan?

If you’re unhappy with your current plan, you can switch your coverage during the Medicare’s fall open enrollment period, known as the Annual Election Period (AEP). It starts on October 15 and runs through December 7. If you’re enrolled in a Medicare Advantage plan and change your mind, you can use the Medicare Advantage Open Enrollment Period (OEP) to switch plans or switch back to Original Medicare between January 1 and March 31, or else you’ll need to wait until the next open enrollment to change coverage.

10. When can I enroll in a Medicare Advantage plan?

You can enroll in a Medicare Advantage plan each year during AEP. During this time, you can switch to a new Medicare Advantage plan, change from Original Medicare to a Medicare Advantage plan or change your Part D coverage. If you’re happy with your current coverage, you can always stay put, too! There are also other enrollment periods known as the Initial Enrollment Period (IEP) when you first become Medicare eligible or a special enrollment period (SEP).

If you have any questions for ApexHealth, give us a call at (844) 279-0508 (TTY: 711). Our hours of operation are Monday through Friday 8 a.m. – 8 p.m. (local time) from Apr. 1 through Sept. 30 and seven days a week 8 a.m. – 8 p.m. (local time) from Oct. 1 through Mar. 31.

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