Healthcare Educators


10 Questions to Ask Your Medicare Agent During Fall Open Enrollment

by | Sep 12, 2023

October 15 through December 7 is Medicare’s Annual Enrollment Period (AEP), also known as fall open enrollment. This is the period when Medicare beneficiaries can make changes to their coverage for the coming year.

Understanding the different Medicare plan options can feel overwhelming, but a local, licensed Medicare agent can help. An agent will look at your current coverage to see if it is still the best fit for you. If you need to make a change, your agent will help you review and evaluate other Medicare plans in your area. Ask your agent the following questions.

1. What insurance carriers do you represent?

Local Medicare agents represent a number of different insurance carriers in your area. They can educate you on a variety of plans and give you recommendations for the best coverage.

2. What is changing with my current plan?

In September, insurance carriers will send out their Annual Notice of Change Letter to Medicare beneficiaries. This letter tells you about changes to your plan for the upcoming year. A Medicare agent can review these changes with you to show you what impact they will have and help you decide if you should change plans.

3. What type of plan best suits my needs?

When you choose a Medicare Advantage plan, you have the option of an HMO or PPO plan. With an HMO plan, you must see healthcare providers within the plan’s network, whereas a PPO plan provides some out-of-network coverage at higher out-of-pocket costs. If you have health concerns or travel plans and don’t want to be constrained by a plan’s network, ask your agent about switching to Original Medicare with a Medigap plan. Bear in mind that not everyone qualifies for a Medigap plan. Your agent will help you decide what type of plan is best, based on your individual needs.

4. Are there new plans or benefits available in my area?

There could be new benefits or plans in your area. Even if you are happy with your current plan, it is worth talking to an agent to find out what’s new.

5. What will my out-of-pocket costs be?

It’s important to understand your out-of-pocket costs for medical services and prescription drugs. Even if you keep the same plan, your out-of-pocket costs may change in the coming year. Costs could include premiums, deductibles, copays, and coinsurance. If you cannot afford these out-of-pocket costs, there are programs to help. Your Medicare agent can help you find out if you qualify.

6. Does the plan cover all my doctors, treatments, and prescription drugs?

Ask your Medicare agent to verify that the plan you want covers all your preferred doctors, hospitals, pharmacies, and prescription medications. If you have chronic health conditions, find out how the plan will cover your treatments. Ask about any special requirements, such as referrals and prior authorizations. If you are keeping your current coverage, check if there are any changes to the provider network or drug formulary for the coming year.

7. Do Medicare Star Ratings matter?

Medicare rates all Medicare Advantage and Part D plans according to their quality and performance using a five-star rating system. The higher the star rating, the better the plan. Nonetheless, a high rating is just one factor to consider when choosing a plan. Your Medicare agent can help you weigh the importance of star ratings with other considerations.

8. Am I locked into my decision for all of 2024?

You should make every effort to pick a plan that will provide the best coverage for the upcoming year. However, Medicare does allow beneficiaries to change plans in certain special circumstances. Your Medicare agent can let you know if you qualify for a Special Enrollment Period.

9. Am I using all the benefits my current plan offers?

If you decide to keep your current coverage, it’s worth reviewing the benefits to make sure you are taking advantage of everything your plan offers. Medicare covers many preventive services in full. Most Medicare Advantage plans offer supplemental benefits that may include vision, dental, hearing, and more.

10. What other services do you offer?

Medicare agents can go beyond helping you with AEP enrollment – they offer ongoing customer service and support throughout the year. Some agents sell additional products, such as retirement planning and life insurance.

Healthcare Educators Is Here to Help

The licensed agents at Healthcare Educators will be available in local H-E-B locations to meet with you during the Annual Enrollment Period. Stop by to ask all your Medicare questions!  Contact us today.