20 Questions to Ask Your Medicare Agent

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20 Questions to Ask Your Medicare Agent

By Daniel Petkevich

Mar 17, 2023

You have questions. We have answers.

Before you read any further, have you spoken with one of our

Fair Square Medicare experts yet

? This blog post is chock full of information about Medicare, but there is no substitute for our agents tailoring a recommendation for you based on your exact lifestyle and healthcare needs.

Have more questions about Medicare?

If you're not sure where to start with that first phone call with your Medicare advisor for life, let's play 20 questions.

1. Do I need to sign up for Medicare?

That depends on whether or not you (or

your spouse

) have creditable coverage.

Creditable coverage

from your employer means that your insurance is at least as good as what Medicare provides. If you are over 65 and without creditable coverage, then you need to sign up for Medicare.

2. When do I sign up for Medicare?

The best time to sign up for Medicare is during your

Initial Enrollment Period (IEP)

. Your IEP is a 7-month window unique to your birthday. It begins three months before you turn 65 and ends three months after your birthday. The date your Medicare plan begins depends on when you sign up, but as a rule of thumb, the earlier, the better.

3. What if I missed my window to sign up?

If you already missed your Initial Enrollment Period, then you might have to wait for the General Enrollment Period. This lasts from January 1 to March 31 each year, and your coverage starts the month after you sign up. Be wary, for each month that you are without coverage after you become eligible for Medicare, you might have to pay a Late Enrollment Penalty. If you have a Special Enrollment Period due to your circumstances, you can enroll without facing the LEP. Here’s a list of

Special Enrollment Period qualifying events.

4. Which parts do I need to sign up for?

Odds are you are already enrolled in Social Security, which means you are automatically enrolled in Medicare Part A and Part B, aka Original Medicare. If you want to avoid a Late Enrollment Penalty for your prescription drug coverage, you need to sign up for Part D as well. You might have heard of Part C, but that’s just another name for Medicare Advantage, which can act as a bundle for Parts A, B, and D.

5. What do I have to pay for the different parts?

Part A is also known as Hospital Insurance, you will likely not have to pay any premium for Part A, so you only have to pay the Part A deductible of $1,600 per benefit period if you are admitted into the hospital.
Part B is also known as Medical Insurance, you will have different ways to pay:
- A yearly deductible of $226
- Monthly premium of $164.90 (depending on your income)
- Coinsurance of 20% of medical costs (which can add up)
Part D Prescription Drug has premiums, deductibles and copayments depending on your choice of plan. Check out our blog post for
estimating prescription drug costs
.

6. Is Original Medicare enough, or do I need more?

For most people, it’s not enough. We like to use the analogy that only having Original Medicare is like trying to make it through

winter with only a hat and scarf

. Medicare Supplement or Medicare Advantage plans act as your coat, offering the proper amount of coverage. There are numerous plans to choose from between Medicare Supplement and Medicare Advantage. Our licensed Medicare advisors at Fair Square can help you narrow down your options.

7. What is the difference between Medicare Supplement and Medicare Advantage?

One easy way to illustrate this difference is that

one is fee-based, and the other is value-based

. Medicare Supplement and Original Medicare, are value-based. Meaning, providers (such as doctors and hospitals) are reimbursed by Medicare for each service they perform. Medicare actually has a list of how much they'll reimburse for each medical procedure that could possibly be administered to you.

Medicare Advantage (MA) plans are value-based. The government gives MA carriers a fixed amount of money per person they insure. This is called a capitation fee, after the word "capita," referring to "per head." The plans can spend this money however they want as long as their members have quality health outcomes. One way MA plans do this is by taking more control of what services you can use and when. For example, unlike Medigap plans or Original Medicare, MA plans require you to see in-network doctors rather than any doctor you like. Many also require your primary physician to refer you to a specialist. You can't go straight to one. This control allows some of their plans to be $0 premium.

8. How do
prescription drug prices
work on Medicare?

Your price for prescription drugs will depend on which tier your prescription drug plan (PDP) has designated for that specific drug. Generally, plans have up to 5 tiers, with prices increasing with each successive tier. Your price will also depend on which coverage phase you are in. The coverage phases, initial coverage,

donut hole

, and catastrophic coverage, go into effect after you pay your deductible.

9. What do I need to consider when picking my Medicare plan?

Short answer:

chat with one of our Medicare agents

for a free consultation about what you value and how a Medicare plan fits into your life. Give us a call at 888-376-2028.

Longer answer: there are many considerations, but first, you should ask if your current doctors and prescriptions are covered. Once you’ve narrowed down to plans that work with your medical providers, you should consider your healthcare needs and how they square with your budget. This is where the decision between Medicare Supplement and Medicare Advantage comes into focus.

We often recommend Medicare Supplement plans to our clients because they offer the most comprehensive coverage. Your healthcare costs generally increase as you age, and it’s much more difficult to switch from a Medicare Advantage plan to a Medigap plan than vice versa.

Medicare Advantage plans are often called the “Pay-As-You-Go” option. That’s why it might be risky to opt for short-term savings on your monthly premium against long-term spending on your healthcare. With that being said,

Medicare Advantage plans are not inherently bad

, they are frequently misunderstood, though. One reason to consider a Medicare Advantage plan is if your vision or dental costs are significant, so you might be able to save more on a plan that offers these extra benefits not included in Medicare Supplement plans.

10. Is that premium for Part B separate from the additional premiums?

Yes, the Part B premium of $164.90 is paid in addition to the Plan premium of your Medicare Advantage or Medicare Supplement plan.

11. So, what do I have to pay each year?

You have to pay your monthly premiums. Otherwise, you are at risk of losing coverage. Before your coverage kicks in, you need to pay your deductibles. Then once you hit your deductibles, then your costs will be your copays and/or coinsurances, depending on your plan. Before you know it,

the costs of Medicare can pile up.

If you are on a Medicare Advantage plan, you have an out-of-pocket maximum per year which puts a cap on your spending. One of the reasons we love Medicare Supplement Plan G is that your out-of-pocket costs are limited to the annual Part B deductible of $226 (for 2023).

12. How do I choose between Medigap plan letters?

This is another answer that might seem complicated but is quite simple. Plan G is the most popular option. In some states, Plan N might also be popular. If you were Medicare eligible before 2020, you might be eligible for Plan F. Our blog post

here

goes into great detail about the different plan letters.

13. Do Medigap plans cover dental and vision?

They do not. These extra benefits are only included in some Medicare Advantage plans. If you choose a Medigap plan, you might need separate plans for dental, vision, and/or hearing benefits.

14. Can Medicare pay for my groceries?

If you are asking this question, you are likely referring to

Flex Cards

sometimes offered by Medicare Advantage plans. Technically, the answer is yes, but you should approach these plans with a degree of caution. These flashy perks probably come at the expense of actual medical coverage. Saving a couple of hundred bucks on groceries is less appealing when you’re spending thousands of dollars more because of your choice of Medicare plan.

15. Can I deduct Medicare expenses from my taxes?

Yes, you can! Your monthly premiums can be deducted from your taxes in addition to costs associated with certain procedures. Check out our

handy guide here

for more information.

16.
What if my doctor doesn’t accept Medicare?

Over 90% of doctors nationwide accept Medicare, so this isn’t too common of an issue. However, if your doctor is one of the select few who has chosen not to accept Medicare, here are some strategies:

Ask for a referral
Use the
Medicare physician directory
Find a new doctor in your plan's network
Ask for a discount from your doctor

As we discussed earlier, some Medicare Advantage plans have limitations on which doctors you can visit based on your network. If your physician or procedure is not approved by your Medicare Advantage plan’s network, consider switching to Medicare Supplement.

17.
Do I need to renew my Medicare plan?

No, you don’t need to renew your plan as long as you’re up to date with paying your premiums. However, a best practice is to review your plan details every year, as these might change depending on your plan.

18. What if I don’t like my plan anymore?

Call us

. A licensed Medicare advisor at Fair Square to discuss your options. You can change your plan during the

Annual Enrollment Period (AEP)

or during a Special Enrollment Period. The AEP lasts from October 15th to December 7th each year. There are some restrictions to which plans you might be eligible to switch.

19. Where can I check if my procedure is covered by Medicare?

We have a section of

our blog

dedicated to answering if Medicare covers certain procedures. However, different Medicare plans have different rules for what they might cover, so it’s a good practice to check with your plan and your healthcare provider to ensure you’re coverage.

You can also consult the AI-powered

Virgil

20. How can I stay updated on the latest in Medicare?

here

For any questions here that were left unanswered, our Medicare experts are ready to help. Call us today at 888-376-2028 and take your next step on your Medicare journey.

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20 Questions to Ask Your Medicare Agent