Before we sit down
A good review starts with a little prep. If you can have these handy, the conversation goes faster:
- Your current plan card (Medicare Advantage, Part D or Supplement)
- A list of your prescriptions, with doses
- Your doctors, specialists and the hospital you'd want to use
- Your pharmacy
- The Annual Notice of Change, if your plan sent one
Please don't email or text me your Social Security number or Medicare number. If we need anything like that for an application, we'll handle it the right way, together.
Doctors and hospitals
This is usually the first thing I check, because it matters most to people. If you're on a Medicare Advantage plan, I confirm that each of your doctors, specialists and preferred hospital is in the plan's network for next year. Networks can change, and a doctor being in-network this year doesn't guarantee it next year.
Around here, that check matters even more. Plenty of people live on one side of the river and see doctors on the other. A plan that works well for someone in Southern Indiana needs to work with the Louisville providers they actually use, and the other way around.
If you're on a Medicare Supplement plan, most Supplement plans let you see any doctor who accepts Medicare, so the network question is simpler. I still confirm that's how your specific plan works.
Prescriptions
I go through your medications one at a time against the plan's drug list, called a formulary. For each one I'm looking at:
- Whether it's covered at all next year
- What tier it's on, which drives the copay
- Whether it needs prior authorization, has quantity limits, or requires trying another drug first
- What it's likely to cost over the whole year, not just one fill
Formularies change from year to year. One medication moving tiers can change what you pay more than a premium change would.
Your pharmacy
Many Part D and Medicare Advantage plans have preferred pharmacies, and the same prescription can cost different amounts depending on where you fill it. I check that your pharmacy is in network and whether it's a preferred one. Sometimes the simplest fix is a pharmacy change, not a plan change. Mail order can be worth a look for maintenance medications, depending on the plan.
The full cost picture
The premium is the number everyone notices, but it's only part of what you'll pay. I look at:
- Monthly premium
- Medical and drug deductibles
- Copays for the doctor visits, tests and hospital stays you're most likely to have
- The plan's maximum out-of-pocket limit for in-network care, if it's a Medicare Advantage plan
A $0 premium plan can be a great fit for one person and an expensive one for someone else. It depends on how you actually use your coverage. My guide to Medicare costs goes deeper on how these pieces fit together.
Extras that matter to you
Some plans include things like dental, vision or hearing benefits. These can be useful, but they vary a lot from plan to plan. I look at the ones that matter to you, and I don't let a nice extra outweigh the basics. A good dental benefit doesn't help much if your cardiologist isn't in network.
Where you spend your time
If you travel, spend part of the year somewhere else, or are thinking about moving closer to family, that affects which plan fits. Some plans have limited coverage outside their service area except for emergencies. It's an easy question to forget and an important one to ask.
Gaps and add-ons
Some clients want extra protection for a hospital stay. I may talk about hospital indemnity coverage if it fits your situation and budget. It isn't right for everyone, and I'll tell you when I don't think you need it.
After the review
If your plan still fits, we're done, and you'll know why you're staying. If a change makes sense, I'll explain the options I represent, what's different, and help with the enrollment. Either way, you keep my direct number. If something comes up in March or July, call me.