Licensed Medicare Insurance Agents

You may find that you have more than one option when it comes to your Medicare coverage.

For instance, many people choose to enroll in a Medicare Advantage plan (also called Medicare Part C), a Medicare Supplement Insurance plan (Medigap) or a Medicare Part D prescription drug plan, all of which are sold by private insurance companies.

A licensed Medicare insurance agent can help you learn more about each type of coverage. They can also guide you as you compare a number of Medicare plan options that may be available where you live.

To get started with a licensed insurance agent, you can call TTY Users: 711 24 hours a day, 7 days a week.

Licensed insurance agent

An agent can help you compare Medicare plans from different providers

When you speak with an agent, you can compare plans from a number of different insurance providers. Some of the Medicare plan options that may be available to you can include:

Not all plans are offered in all locations, and some carriers may not provide a Medicare plan where you live. A licensed agent can help you review the availability, costs and benefits of Medicare plans in your area.

Here are some questions you can ask a Medicare agent that may help you find a Medicare plan that works for you.

How to prepare for your call with a licensed insurance agent

When you call an insurance agent about Medicare, he or she may ask you several questions to get a better idea of your insurance needs and the Medicare plans near you.

1. Your birth date

Your birth date helps an insurance agent know when you may be eligible to enroll in Medicare. Most people are eligible for Medicare three months before their 65th birthday.

2. Your zip code

If you’re interested in exploring your Medicare plan options, providing an agent with your zip code can help them find Medicare Advantage plans in your area.

3. Doctors and health care facilities you frequent

Not all doctors accept Medicare as insurance, and some that do may charge more for their services.

Providers who accept Medicare but do not accept Medicare’s reimbursement (known as “assignment”) as payment in full are called “non-participating providers.” This is a little confusing. They still accept Medicare as a form of health insurance, but they do not have to accept Medicare’s approved amount for health care services as full payment, which means they can charge you more for healthcare services. This can increase how much you pay out of pocket for your care.

Some Medicare Advantage plans have networks of contracted providers, and you may be required to choose providers within your plan network when you seek medical care.

Providing a Medicare agent with a list of your doctors can help them determine which of your doctors/providers participate in Medicare and whether they are in any Medicare Advantage plan networks near you.

4. Any additional questions you’d like answered

Medicare agents are happy to answer any questions you have about Medicare, including how plans differ, how to enroll, and what to expect in out-of-pocket costs. To help you get started, we’ve included a list of questions below that can help guide you on your call with a Medicare agent.

Questions to ask a licensed insurance agent

It helps to understand all of your Medicare plan options so that you can enroll in a plan that will allow you to get the most from your benefits.

Here are 5 frequently asked questions about Medicare that you may want to ask an insurance agent.

1. Who is eligible for Medicare?

If you’ve been a United States citizen or permanent legal resident for at least five consecutive years, you may be eligible for Medicare Part A and Part B (also called Original Medicare) if you meet one or more of the following criteria:

  • You are 65 years or older and are eligible for retirement benefits through Social Security or the Railroad Retirement Board
  • You have a disability and have been receiving disability benefits for at least 24 months
  • You have amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease)
  • You have End-Stage Renal Disease (ESRD) and require dialysis treatment or a kidney transplant

There may be other circumstances that make you eligible for Medicare that are not listed here.

Most people who are enrolled in Original Medicare are eligible for Medicare Advantage plans, with the exception of people who have end-stage-renal disease, in most cases. You may also be eligible for Medicare Supplement Insurance or a Medicare Part D prescription drug plan.

2. What does Medicare cover?

Original Medicare is made up of two parts: Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).

Some examples of the types of services covered by Medicare Part A include:

  • Inpatient hospital care
  • Inpatient care in a skilled nursing facility
  • Hospice care

Some examples of the types of services covered by Medicare Part B include:

  • Medically necessary doctor services
  • Durable medical equipment
  • Outpatient care
  • Some mental health services
  • Preventive services and some other medical services

Original Medicare does not typically cover prescription drugs or routine dental, vision or hearing care.

Medicare Advantage plans provide the same hospital and medical benefits as Original Medicare. Unlike Original Medicare, many Medicare Advantage plans also cover prescription drugs and may cover routine dental, vision and hearing care, among other additional benefits.

Medicare Supplement Insurance plans can help cover some of the out-of-pocket costs that Original Medicare doesn’t cover, such as Medicare copayments, coinsurance and deductibles. Some Medigap plan types may also cover additional costs, such as emergency medical care received outside of the U.S.

Medicare Part D prescription drug plans can help cover some of the costs of certain prescription drugs. Some plans may offer lower out-of-pocket drug costs if you use in-network or preferred pharmacies.

Initial Enrollment Period

3. When can I enroll in Medicare?

The best time to enroll in Medicare is during your Medicare Initial Enrollment Period. For most people, this seven month period begins three months before your 65th birthday, includes your birthday month, and ends three months after your 65th birthday.

If you are younger than 65 and qualify for Medicare because of a disability, your Medicare coverage typically begins 24 months after your disability benefits are approved.

If you have ALS, your Medicare benefits typically begin the first month you receive Social Security Disability Benefits.

If you have ESRD and are on dialysis, your Medicare benefits typically start on the first day of the fourth month of your dialysis treatment.

You must be enrolled in Original Medicare before you can enroll in Medicare Advantage. There are specific times when you can sign up for Medicare Advantage and/or a Medicare Part D prescription drug plan. The first time is during your Medicare Initial Enrollment Period.

Open Enrollment Period

You also have the opportunity to enroll in a Medicare Advantage plan and/or a Medicare Part D plan during the Annual Election Period (also called Medicare Open Enrollment), which runs from October 15 to December 7 each year.

You may enroll in Medicare Advantage outside of these enrollment periods if you qualify for a Medicare Special Enrollment Period.

The first time that you can enroll in a Medicare Supplement Insurance plan is during your six-month Medigap open enrollment period, which starts as soon as you are both 65 years old and enrolled in Medicare Part B. If you enroll outside of this period, you may be subject to medical underwriting by insurance providers, which can affect your plan eligibility and premium charges.

4. Will Medicare cover my spouse?

Neither Original Medicare, Medicare Supplement Insurance, Medicare Advantage or Medicare Part D provide family coverage, so you and your spouse must enroll separately once you’re each eligible for a Medicare plan.

5. How much does Medicare cost?

The answer to this question varies from person to person, depending on the plan you’re enrolled in and your specific medical needs.

These out-of-pocket costs can help give you an idea of the types of charges you could face in 2019.

Premiums

Premiums are what you pay each month for your Medicare benefits. Most people do not pay a premium for Medicare Part A, as long as they paid sufficient Medicare taxes while working. The standard Medicare Part B premium is $135.50 per month in 2019.

If you enroll in a Medicare Advantage plan, you still pay your Medicare Part B premium. Some Medicare Advantage plans require that you pay a Medicare Advantage premium in addition to your Part B premium, and some Medicare Advantage plans offer $0 premiums.1

Medicare Supplement plan costs and Medicare Part D plan costs will also vary based on your plan, your insurance provider and when you bought your plan.

Deductibles

Your Medicare Part A deductible is the amount you must pay out-of-pocket costs before Medicare will pay its share for covered services. In 2019, the Part A deductible is $1,364 for each benefit period.

Your Medicare Part B deductible is the amount you must pay in medical costs before Medicare will pay its share for covered services. In 2019, the Medicare Part B deductible is $185 per year.

Some Medicare Supplement Insurance plans may cover the Part A and/or Part B deductible.

Medicare Advantage plan deductibles and Medicare Part D plan deductibles are determined by the insurer, so deductible amounts will vary by plan. Some Medicare Advantage plans and some Medicare Part D plans may offer $0 deductibles.

When you speak with a licensed insurance agent, he or she can provide more detailed information about deductible amounts for the Medicare plans in your area.

Coinsurance or copayments

Coinsurance or copayments refer to the healthcare charges that you pay after your deductible is met.

2019 Medicare Part A coinsurance amounts are as follows:

  • $0 coinsurance for days 0-60 that you spend in the hospital
  • $341 coinsurance for days 61-90
  • $682 coinsurance for days 91 and beyond, for up to 60 lifetime reserve days

The Medicare Part B coinsurance is typically 20 percent of the Medicare-approved amount for covered services. This means that you pay 20 percent, and Medicare pays 80 percent.

Medigap plans cover the Part A deductible in full, and they cover the Part B deductible either in part or in full.

Medicare Advantage and Medicare Part D coinsurance amounts are determined by the insurer, so coinsurance amounts will vary by plan.

When you speak with a licensed Medicare agent, he or she can provide more detailed information about coinsurance amounts for the Medicare plans in your area.

Don’t delay, speak with an agent

We want you to have the most successful conversation with a Medicare agent that you can have, and we hope you found this article helpful.

To learn more about your Medicare options, reach out to a licensed insurance agent now by calling TTY Users: 711 24 hours a day, 7 days a week.

Copyright © 2018 TZ Insurance Solutions LLC. All rights reserved.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.