Some of the questions/information you should be asking and understanding the answers to, are:
- Review the plan’s Summary Of Benefits.
(Ask questions about anything you don’t understand.)
Take notes on how much the copays/coinsurance are for each service.
For in-patient hospital stays, ask how much copays are for each day and also how many hospital days you will be responsible to pay copays for each stay. - What is the monthly premium?
- What is the Annual Maximum Out-Of-Pocket Cost?
In a worst case scenario, this is the most you will have to pay each year for Medical.
Note: The Annual Maximum Out-Of-Pocket Cost doesn’t include prescription drug costs. Also please keep in mind that PPO plans have different Out-Of-Pocket Amounts for
In-Network vs Out-Of-Network. So be sure to find out both those amounts. - Is there a deductible for Medical?
(A deductible is the amount you have to pay out of pocket before coverage starts.) - Ask if all your doctors are in-network!
(If your providers are not in the plan’s network, depending on what type Medicare Advantage plan you have, they may not be covered at all!
Generally HMO Plans do NOT cover out of network providers unless it is a true emergency, so you would be responsible for the entire cost of the visit, etc.
However with a PPO plan, the out of network provider may be covered, but it will cost you more, if you go out of network.) - What type of Medicare Advantage Plan is this?
HMO or PPO or something else? - Do I need referrals for a specialist?
- Will the in-network doctors I want to see take new patients, if I can’t find my existing doctors within the in-network provider list?
- Which local hospitals are in-network?
- Are all my prescriptions in the plan’s formulary?
(A formulary is a list of all the drugs covered in a specific plan.)
If your drug is not in the plan formulary, it won’t be covered. (With some very limited exceptions.) - How much will each of my prescription drugs cost me each month?
What about total annual costs with the donut hole? (Also known as the Coverage Gap) - How much is the prescription drug deductible?
- What is the service area for the plan?
- Does the plan cover dental?
- Does the plan cover vision?
- Does the plan cover hearing and hearing aids?
- Does the plan include a fitness membership?
- Does the plan include an Over The Counter (OTC) allowance each quarter?
- Will my plan work when I travel and it is not an emergency?
Don’t be shy! Ask anything else you want to know about.
If you don’t understand, ask again until you do understand!
Note: Medicare Insurance information can be overwhelming and confusing to many people. As an independent licensed agent I can explain things to you in simple terms so you feel comfortable making a decision. Then I can help you choose and enroll in a plan that you feel fits your needs.
By the way, it doesn’t cost you any more if you enroll in a Medicare Insurance plan through me as an independent agent versus directly with an insurance company either over the phone or via the Internet, since I get paid by the insurance companies for your enrollment. Plus you will have personalized service by a local agent. If you would like my assistance, please call me at 941-404-5334.
By calling this number, I understand I will be directed to a licensed insurance sales agent.