What Questions Should I Ask My Insurance Agent about Medicare Advantage Insurance?

What Questions Should I Ask My Insurance Agent about Medicare Advantage Insurance? What to Know Before Committing to a Plan

If you are shopping for a Medicare Advantage plan, the best thing you can do is walk into your agent meeting with a list of good questions. I have seen too many people pick a plan because the TV ad looked nice or because a friend liked it. Then, a few months later, they find out their doctor is not in the network or their pills cost way more than they thought.

I don’t want that to happen to you. So in this guide, I am going to share the exact questions I would ask an insurance agent about Medicare Advantage. I will also explain why each question matters, in plain words.

Timing matters too. Medicare’s Annual Enrollment Period runs from October 15 to December 7, 2026. Any change you make in that window starts on January 1, 2027. If you already have a Medicare Advantage plan and don’t like it, you get one more chance to switch from January 1 to March 31, 2027.

That means right now is the perfect time to get your questions ready. Grab a pen, print this page, or save it on your phone. Let’s dig in.

Quick Answer: The Top 10 Questions to Ask

If you are short on time, here are the 10 questions I think matter most:

1. Are you an independent agent, or do you work for one company?
2. Are my doctors and hospitals in this plan’s network?
3. Are all of my prescriptions covered, and what will they cost?
4. What is the monthly premium?
5. What is the maximum out-of-pocket limit?
6. What are the copays for doctor visits, specialists, and hospital stays?
7. Which services need prior authorization?
8. Is this an HMO or a PPO, and do I need referrals?
9. What extra benefits are included, like dental, vision, or hearing?
10. What is this plan’s star rating?

Keep reading, and I will break down each of these, plus many more.

What Is Medicare Advantage? (A Quick Refresher)

Before we get to the questions, let me make sure we are on the same page.

The government runs Original Medicare. It has Part A (hospital care) and Part B (doctor visits and outpatient care). Many people add a separate Part D plan for drugs and a Medigap plan to help pay what Medicare doesn’t.

Medicare Advantage, also called Part C, is a different path. Private insurance companies approved by Medicare sell it. One Medicare Advantage plan bundles your Part A and Part B coverage together. Most plans also include drug coverage, and many add extras like dental and vision.

Here is the catch: every plan is different. Two plans from the same company can have very different doctors, drug lists, and costs. That is exactly why asking the right questions matters.

Q: Do I still pay my Part B premium with Medicare Advantage?

A: Yes, in most cases. Even if your Medicare Advantage plan has a $0 premium, you usually still pay your Part B premium to Medicare. A few plans give you some of that money back. I will cover that in the cost section below.

Questions to Ask About the Agent First

I always start by asking about the agent, not the plan. Why? Because the answers tell you how much you can trust the advice you are about to get.

1. Are you an independent agent or a captive agent? An independent agent (sometimes called a broker) can show you plans from many companies. A captive agent works for one company and can only sell that company’s plans. Neither is bad, but you want to know if you are seeing the whole picture.
2. Which insurance companies can you sell in my area? If they only work with two companies and there are ten in your county, you might miss a better fit.
3. Are you licensed in my state? Every agent should have a state insurance license. You can look them up on your state’s Department of Insurance website.
4. How do you get paid? Most agents are paid by the insurance company, not by you. You should never pay an agent a fee to enroll in a Medicare Advantage plan. Asking this question also shows the agent that you are paying attention.
5. Will you help me after I enroll? A good agent will help you with claim problems, billing mix-ups, and your yearly plan review. Some disappear after the sale.
6. Will you review my plan every year? Plans change every single year. A good agent will check your plan each fall and tell you if something better comes along.

Q: Is it free to use an insurance agent for Medicare?

A: Yes. You should not pay anything to work with a licensed Medicare agent. The plan price is the same whether you buy it through an agent, on the phone with the company, or on Medicare.gov.

Questions to Ask About Costs

A $0 premium sounds great. But the premium is only one piece of what you will pay. I like to think of Medicare Advantage costs as a puzzle with several pieces. You need to see all of them to know the real price.

1. What is the monthly premium? This is what you pay every month to have the plan. Many plans are $0, but some charge more for richer benefits.
2. Is there a Part B giveback? Some plans pay back part of your Part B premium. That money shows up as a bigger Social Security check. Ask how much it is and when it starts.
3. Is there a deductible? A deductible is what you pay before the plan starts paying its share. Ask if there is one for medical care and a separate one for drugs.
4. What are the copays and coinsurance? A copay is a flat fee, like $20 for a doctor visit. Coinsurance is a percent, like 20% of the bill. Ask about each of these:
   • Primary care doctor visits
   • Specialist visits
   • Urgent care and emergency room visits
   • Hospital stays (often charged per day)
   • Lab work, X-rays, and MRIs
   • Outpatient surgery
   • Skilled nursing facility stays
5. What is the maximum out-of-pocket (MOOP) limit? This is one of the most important numbers in the whole plan. It is the most you will pay for covered medical care in one year. After you hit it, the plan pays 100% of covered care. For 2026, Medicare set the highest allowed in-network limit at $9,250, and many plans set theirs much lower. Ask your agent for the exact 2027 number for each plan you compare.
6. Is there a separate out-of-network limit? PPO plans often have a higher out-of-network limit. Ask for both numbers.
7. What would a bad year cost me? I love this question. Ask the agent to walk you through what you would pay if you had a hospital stay, surgery, and lots of follow-up visits. It turns confusing numbers into a real dollar amount.

Q: Is a $0 premium plan always the cheapest?

A: No. A $0 premium plan might have higher copays or a higher out-of-pocket limit. If you see the doctor a lot or have a chronic illness, a plan with a small premium can save you money over the year.

Questions to Ask About Doctors, Hospitals, and Networks

For most people I talk to, keeping their doctors is the top concern. Medicare Advantage plans use networks. A network is a group of doctors and hospitals that agree to work with the plan. If you go outside the network, you may pay more or even pay the whole bill.

1. Is this an HMO or a PPO? An HMO usually only covers in-network care, except in emergencies. A PPO lets you see out-of-network doctors, but you pay more. Ask which type each plan is.
2. Are my doctors in the network? Give the agent the full name of every doctor you see, including specialists. Don’t just say “Dr. Smith.” Give their first name, last name, and office address.
3. Are my hospitals in the network? Think about the hospital closest to your home and any hospital where your doctors work.
4. Do I need a referral to see a specialist? Many HMO plans require a referral from your primary doctor first. That can mean an extra visit before you see a heart doctor or skin doctor.
5. Do I have to pick a primary care doctor? Some plans require it. Ask whether you can keep your current doctor.
6. What happens if my doctor leaves the network during the year? Doctors can leave a plan mid-year. Ask how the plan will let you know and help you find a new one.

My Tip: Double-Check With Your Doctor’s Office

Network lists are not always up to date. After your agent says a doctor is in the network, I suggest calling the doctor’s office yourself. Ask them, “Do you take the [exact plan name] Medicare Advantage plan for 2027?” Use the exact plan name, not just the company name. A doctor might take one plan from a company and not another.

Questions to Ask About Prescription Drugs

Drug costs can make or break a plan. Bring a list of every medicine you take, with the name, dose, and how often you take it. Better yet, bring the bottles.

1. Does this plan include Part D drug coverage? Most Medicare Advantage plans do. These are called MAPD plans. If a plan does not include drug coverage, ask why, and make sure that is what you want.
2. Are all of my drugs on the formulary? The formulary is the plan’s list of covered drugs. If one of your drugs is missing, you may have to pay full price.
3. What tier is each of my drugs on? Drugs are sorted into tiers. Lower tiers, like generics, cost less. Higher tiers, like specialty drugs, cost more.
4. Is there a drug deductible? For 2027, the most any plan can charge for a Part D deductible is $700. Many plans charge less, and some have no drug deductible.
5. What will I pay for drugs over the whole year? Ask the agent to add up your yearly drug cost for each plan. Medicare.gov’s Plan Finder tool can do this too.
6. Do any of my drugs need prior authorization or step therapy? Prior authorization means the plan must approve the drug first. Step therapy means you must try a cheaper drug before the plan will pay for the one your doctor picked.
7. Which pharmacies are preferred? Using a preferred pharmacy can lower your copays. Ask if your usual pharmacy is preferred and whether mail order saves money.

Q: Is there a cap on what I pay for drugs in 2027?

A: Yes. In 2027, the most you will pay out of pocket for covered Part D drugs is $2,400 for the year. That is up from $2,100 in 2026. Once you reach it, you pay $0 for covered drugs for the rest of the year. This cap also applies to Medicare Advantage plans that include drug coverage.

Q: Can I spread my drug costs out over the year?

A: Yes. The Medicare Prescription Payment Plan lets you pay your drug costs in monthly amounts instead of all at once at the pharmacy. Ask your agent how to sign up if you take expensive medicines.

Questions to Ask About Extra Benefits

Extra benefits are a big reason people choose Medicare Advantage. But “includes dental” can mean a free cleaning or it can mean $3,000 toward crowns. Details matter.

1. What dental coverage is included? Ask if it covers just cleanings and X-rays, or also fillings, crowns, root canals, and dentures. Ask about the yearly dollar limit.
2. What vision coverage is included? Ask about eye exams and how much the plan pays toward glasses or contacts.
3. What hearing coverage is included? Hearing aids are expensive. Ask how much the plan pays and if you must use a certain company.
4. Does it include a gym or fitness benefit? Many plans include a free gym membership. Ask which gyms take it.
5. Does it include an over-the-counter (OTC) allowance? Some plans give you money to buy things like vitamins and bandages. Ask how much, how often, and whether unused money rolls over.
6. Are there other perks? Some plans cover rides to doctor visits, meals after a hospital stay, or in-home help. Ask whether you qualify, since some perks apply only to people with certain health conditions.

Questions to Ask About Prior Authorization

Prior authorization is when the plan has to say “yes” before it pays for a service. It is one of the biggest complaints people have about Medicare Advantage, so I always ask about it.

1. Which services need prior authorization? Common ones include MRIs, surgeries, skilled nursing stays, and some drugs.
2. How long do approvals usually take? Ask about both normal and urgent requests.
3. What happens if a request is denied? You have the right to appeal. Ask the agent to explain how the appeal process works.

Questions to Ask About Travel

If you travel, have a second home, or spend winters somewhere warm, ask these questions.

1. Am I covered if I get sick in another state? Most plans cover emergencies and urgent care anywhere in the U.S. But routine care may not be covered outside your area.
2. Am I covered outside the country? Original Medicare usually does not cover care abroad. Some Medicare Advantage plans include a small amount of foreign emergency coverage. Ask how much.
3. Does the plan have a travel or visitor program? Some PPO plans let you use network doctors in other states.
4. Does the plan offer telehealth? Video visits can help you see your doctor while you are away.

Questions to Ask About Plan Quality and Switching

1. What is this plan’s star rating? Medicare rates plans from 1 to 5 stars each year. Higher is better. Ask for the newest rating.
2. Is anything changing in this plan for 2027? Every plan sends an Annual Notice of Change (ANOC) each fall. Ask the agent to walk you through it if you are staying in your current plan.
3. Can I switch later if I don’t like it? You can change plans during Annual Enrollment each fall. You also get one switch from January 1 to March 31 if you are already in a Medicare Advantage plan.
4. If I leave Medicare Advantage, can I get a Medigap plan? This one is big. In many states, after your first Medigap window ends, an insurer can turn you down or charge you more because of your health. Ask what the rules are in your state before you decide.

Red Flags to Watch For

Most agents are honest and helpful. But I want you to know the warning signs. Walk away if an agent:

• Pushes you to sign up the same day
• Won’t tell you which companies they represent
• Says a plan is “free” without explaining copays and the out-of-pocket limit
• Asks for a fee to enroll you
• Calls you out of the blue and won’t give their license number
• Promises your doctor is in network but won’t check

What to Bring to Your Agent Meeting

Being ready saves time and gets you better answers. Here is my checklist:

• Your red, white, and blue Medicare card
• A list of all your doctors, with full names and addresses
• A list of your drugs, with doses and how often you take them
• The name of your favorite pharmacy
• Your current plan’s Annual Notice of Change, if you have one
• A notebook to write down answers
• A family member or friend, if you’d like a second set of ears

Frequently Asked Questions

Q: How many plans should I compare?

A: I suggest comparing at least two or three. That helps you see what a fair price looks like in your area.

Q: Should I get the agent’s answers in writing?

A: Yes. Ask for the plan’s Summary of Benefits and Evidence of Coverage. These documents show what the plan really covers.

Q: Can I get free, unbiased help?

A: Yes. Every state has a SHIP (State Health Insurance Assistance Program). SHIP counselors give free Medicare advice and don’t sell anything.

Final Thoughts

Picking a Medicare Advantage plan is a big decision, but it doesn’t have to be scary. The secret is asking good questions and not rushing. Start with the agent, then dig into costs, doctors, drugs, extra benefits, and the fine print.

I hope this list helps you feel more confident when you sit down with your agent. Remember, the Annual Enrollment Period ends on December 7, 2026. Don’t wait until the last week. Make your list, set up your meeting, and take your time. Your health and your wallet will thank you.

Why choose Steve Turner Insurance Specialist?

Because I’m an “Insurance Specialist.” An “insurance specialist” is a broad term that includes insurance agents and insurance brokers, but the key difference is who the agent represents versus who the broker represents.

An “insurance agent” works directly for an insurance company and sells its specific policies to clients.

An “insurance broker” acts as an independent intermediary, comparing policies from multiple companies to find the best fit for their client’s needs, essentially representing the client rather than the insurance company.

I am both a licensed Insurance Agent and a licensed Insurance Broker.

My number one goal in life is to help people and ensure, without a shadow of a doubt, that you and your family are secure and protected. I will always be by your side, helping you mitigate risk by providing the industry’s best and most affordable insurance solutions.

I will find insurance plans for the entire family to help cover whatever life throws at you. I can help you save on severe medical emergencies, find a health insurance plan with low- or no-cost doctor visits and affordable prescription medications, and protect your family in the event of an unexpected accident or illness.

Best of all, it doesn’t cost you anything extra to use an experienced Insurance Agent and Broker like me to help you find the Insurance Plans that fit your individual, family, or business needs.

The companies that sell the insurance plans “you choose“ pay me – you don’t pay me. Calling any big insurance company directly won’t get you a lower price, as they will forward your call to the next available insurance agent on their list. You won’t have had any opportunity to learn about the insurance agent you’re speaking with in advance, understand their qualifications or experience level, or make an informed choice about who you want to work with.

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