Medicare Basics
What is Medicare?
This is the federal health insurance program for people 65 and older.
What is an SEP for loss of coverage?
SEP - LEC
What is $185?
This is the standard monthly premium for Medicare Part B in 2025
What is: "I completely understand! Just to clarify, is it the plan itself, the timing, or something else that concerns you? Let’s go over it together to make sure you don’t miss out on benefits."
"I want to think about it."
What is a great open-ended question to understand what’s working for them before making a recommendation?
"What do you like about your current plan?"
What are Parts A, B, C, and D?
Medicare is divided into four parts, including hospital insurance, medical insurance, and prescription drug coverage.
What is an SEP for loss of caid?
SEP-MCD
What is Extra Help (Low-Income Subsidy)?
This program helps lower-income beneficiaries pay for Part D prescription drug costs
What is: "That makes total sense! Are they available to come on the line or can you call them in? That way we can make sure you have all the details and review the benefits together and can make an informed decision"
"I need to talk to my spouse/kids first."
What is a question that helps uncover pain points and opportunities for better coverage?
"In a perfect world, what would you like to see improved or added to your plan?"
What is Medicare Part A?
This part of Medicare helps cover hospital stays, skilled nursing facilities, and hospice care
What is an SEP for lis?
SEP-NLS
What is the Medicare Savings Program?
This financial assistance program helps cover Medicare premiums, deductibles, and coinsurance for low-income individuals.
What is: "That’s great! Let’s just do a quick comparison to make sure you aren’t missing out on any new benefits for this year. Wouldn't you want to be in the best plan possible?"
"I’m happy with my current plan."
What is a question that helps assess their healthcare needs and potential costs?
"How often do you visit the doctor or specialist, and are there any upcoming procedures or treatments?"
What is Medicare Advantage (Part C)?
This Medicare program allows private insurers to offer coverage that includes hospital, medical, and often prescription drug benefits.
What is an SEP for non-renewal of Medicare contract(at the end of the year)?
SEP- EOC
What is the Part B late enrollment penalty?
This penalty applies if you do not enroll in Medicare Part B when first eligible and don’t have other coverage
What is: "That’s important! Let’s check and see if your doctor is in the network. If they are, great! If not, we can explore options that work best for you."
"I don’t want to change doctors."
What is a way to determine if they could benefit from better drug coverage?
"Do you take any prescriptions regularly, and have you noticed any changes in price?"
What is age 65?
You automatically qualify for Medicare at this age if you have worked and paid Medicare taxes for at least 10 years.
What is Trial right?
What is a Medigap (Medicare Supplement) plan?
This type of plan helps cover out-of-pocket costs such as deductibles and coinsurance for Original Medicare beneficiaries.
What is: "I understand, and that’s why I’m here—to find you a plan that could actually save you money. Let’s check if there’s a plan with lower out-of-pocket costs or additional benefits that can help."
"I can’t afford a new plan."
What is a way to prioritize their needs and tailor a plan recommendation?
"What’s most important to you when it comes to your healthcare—cost, coverage, or provider choice?"