5 Tips for Meeting with your Medicare Broker

Updated on: April 27, 2020

Originally posted on: August 3, 2018
The Roadmap for Medicare staff specialize in all topics related to Medicare Part D, choosing a Medicare plan, and making smart health decisions in retirement.

Medicare Part A, Part B, Medigap, Medicare Advantage Plans, Medicare Part D…it can be a bit mind- boggling when researching the choices you have and trying to understand the type of Medicare coverage that makes the most sense for your healthcare needs.

Some people turn to Medicare insurance brokers to help sort through the fine print and choose the right Medicare plan. These professionals are experts at navigating through Medicare plan details and can narrow down options that suit your particular health and financial circumstances. They can also help you through the enrollment process. You will need to do some initial leg work to find the right broker and ensure you get the most out of the broker’s services, which are all free of charge.

If you choose to meet with a broker, here are five tips to help you find the right one and prepare for the meeting.

  1. Look for a specialist: Make sure you meet with a licensed broker who specializes in Medicare and has an American Health Insurance Plans (AHIP) certification. The broker should be licensed in the state where you have residency since Medicare plan options vary by state.
  2. The more information you share the better: Gather the following information that will help the broker direct you toward the best Medicare coverage for your health and financial needs.
    • Medical status and history: Your current and past health conditions.
    • Medications: Those you currently take as well as drugs you might need to take in the coming year. It’s best to have a discussion with your physician to assess what drugs you may need in the near future.
    • Finances: Be prepared to have a frank conversation about your finances so the broker can determine which plans are within your budget. It’s important to share information about your yearly income, if you’re on a fixed income, your living expenses, and the amount of money you currently spend on healthcare.
  3. The lowdown on prescription drug coverage: Each Part D plan has its own formulary, or list of covered drugs, so the broker will need to know your current prescriptions to make certain that not only the medications but the dosages you take are covered. You should ask the broker to check if the Part D plan has a preferred network of pharmacies that offers lower drug costs and if your own pharmacy or those in your area are included on that list.
  4. Know the lingo: Medicare has a lot of terminology, policies and processes that can be difficult to navigate and understand. The Medicare plan types are:
    • Original Medicare: The government-run benefit that includes Medicare Parts A and B
    • Medicare Part A: Covers inpatient care in hospitals, skilled nursing facilities, hospice care and some home healthcare. For most beneficiaries, there is no charge for Part A.
    • Medicare Part B: Covers physician services, outpatient services, laboratory tests, mental health services and other medical services not covered under Part A. Those enrolled in Part B will pay a monthly premium.
    • Medicare Part C also known as Medicare Advantage Plans: These are plans offered by private insurers as alternatives to Parts A and B. They usually provide additional benefits and may also include prescription drug coverage. The benefits and costs of these plans can vary widely.
    • Medicare Part D also known as a Prescription Drug Plan (PDP): These plans are offered by private insurers and provide prescription drug coverage which in most cases is not covered under Parts A or B. The formularies (drugs covered under the plan), clinical services and costs can vary widely.
    • Medicare supplemental insurance also known as Medigap plans: These plans are sold by private insurers and provide supplemental coverage to Original Medicare coverage. Unlike Medicare Advantage Plans, they are not meant to replace Parts A and B coverage but to provide additional benefits.

    A full glossary of Medicare terminology is available at https://www.medicare.gov/glossary/a.html

  5. Make it habit to review yearly: Since your health status may change over time and plan benefits and costs often change from year to year, it’s important to review your Medicare coverage during the appropriate annual enrollment periods to ensure you have the right plan that will meet your health and budgetary needs in the coming year.

Healthcare coverage decisions can have serious consequences on your health and financial well-being, and a licensed insurance broker may be the resource that helps you find the Medicare insurance plan that is right for you at the price you can afford.