Latest / Smart Coverage. Real Advice.: Medicare / What to Bring to Your Medicare Plan Review: Cards, Medications, Doctors, and Pharmacies
Transcript
- Tanya: Every year I get this big envelope about my Medicare plan, but I never know what to bring to my annual review. What do I actually need to have with me so I’m not missing something important? Tanya: Welcome to Smart Coverage. Real Advice., the insurance podcast from The Jordan Insurance Agency. I'm Tanya, your host, and I'm here with Billy Jordan, a licensed insurance agent and the president of The Jordan Insurance Agency. Billy: Glad to be here, Tanya. A quick disclaimer: we're not affiliated with or endorsed by Medicare or any government agency, and this is general education, not advice for your situation. Now, let's get into it. Tanya: So Billy, let’s start with the basics. What exactly should someone bring to their Medicare plan review appointment? Billy: Great question. To get a complete review, you’ll want to bring your Medicare card, your current plan card, the Annual Notice of Change—that’s your ANOC—an exact list of your prescription medications, the names and locations of your doctors, and your preferred pharmacies. Having these on hand lets your advisor check if your medications are covered, your doctors are in-network, and what your real costs might look like. If you just guess or bring partial info, the comparison can miss some big details. Tanya: That sounds like a lot! Why is it so important to have the exact medication details and not just the names? Billy: The specifics really matter. You need the exact medication name, the dosage, the form—like tablet or capsule—and how often you take it. Different strengths or forms can land in different coverage tiers or even not be covered at all. For example, if you take a brand-name drug in a forty-milligram tablet, but the plan only covers the twenty-milligram capsule, your cost could be much higher or the drug might not be covered. A common mistake is bringing a list that just says “blood pressure pill” or “atorvastatin,” but not specifying the dose or form. That can throw off the whole cost estimate. Tanya: Got it. And what about pharmacies? Does it really make a difference which one you use? Billy: Absolutely. Your choice of pharmacy can change your drug costs quite a bit. Some plans have preferred pharmacies with lower copays, and others just have standard in-network options. You want to check your actual medication prices at the pharmacies you use—not just assume one is always cheapest. For example, a local pharmacy might be convenient but not offer preferred pricing, while mail order could be cheaper for a ninety-day supply. A common mistake is assuming your usual pharmacy is always in-network, or that “preferred” means lowest cost for every prescription, which isn’t always true. Tanya: Okay, so you’ve got your list of medications and your pharmacy picked out. What about doctors? How do you make sure your providers are still covered? Billy: That’s a key part of the review. Bring the full legal names of your doctors, their clinic locations, and any hospitals or facilities you use. Networks can change every year, so you want to check both the provider and the specific location. For example, your primary care doctor might still be in-network, but the hospital where they practice could be out-of-network on your plan for next year. A common mistake is just checking the doctor’s name and not verifying the facility, which can lead to surprise bills if you need tests or procedures. Tanya: So even if my doctor is in, the hospital might not be? Billy: Exactly. It’s important to check both separately, and for the right plan year. And if you see specialists or use physical therapy, labs, or outpatient centers, include those too. Make sure you ask about referrals or authorizations if you’re on an HMO plan, since those rules can change from year to year. Tanya: And what’s the Annual Notice of Change? I see it in the mail, but I’m never sure what to do with it. Billy: The Annual Notice of Change, or ANOC, is the letter your plan sends each fall to outline what’s changing for the next year—things like coverage, costs, and service area. You’ll want to read it alongside the provider directory, the formulary for drugs, and the Evidence of Coverage. Highlight anything that affects your doctors, prescriptions, or budget, and bring it to your appointment with your questions. One mistake people make is skipping this review because they assume their plan will stay the same, but even familiar plan names can change their network, formulary, or prices. Tanya: What about out-of-pocket costs? How do you know what you might really pay in the new year? Billy: You need to look at more than just the monthly premium. Compare the premium, the deductible, your expected copays for office visits and prescriptions, and the annual out-of-pocket limits. For twenty twenty-six, the Part D covered drug out-of-pocket limit is two thousand one hundred dollars. But that doesn’t include premiums or drugs you buy outside of coverage. It’s also important to keep your medical and drug spending limits separate. A common mistake is thinking a plan with no monthly premium means all care is free, when really there can still be costs for services and medications. Tanya: That’s a lot to keep track of. Is there an easy way to organize all this before a review? Billy: The best way is to put everything in one folder: your Medicare cards, your ANOC, your exact medication list, your doctors and locations, your preferred pharmacies, and a page for your questions. If someone helps manage your care, consider having them join the review too. And always keep your Medicare details private—share them only through the agency's agreed secure process. Tanya: Three things to remember. One: Bring your Medicare cards, exact medication list, your doctors’ names and locations, preferred pharmacies, and your Annual Notice of Change to your review. Two: Check the details—medication strength, pharmacy network, and both doctor and facility participation—for the right plan and year. Three: Compare premiums, copays, and separate medical and drug out-of-pocket limits, and don’t assume your plan or network stays the same from year to year. Tanya: For a personalized look at your situation, book a free thirty-minute chat with Billy and his team at thejordaninsuranceagency.com/podcast. Billy: I'm Billy Jordan with The Jordan Insurance Agency. Until next time, take care. Tanya: Thanks for listening to Smart Coverage. Real Advice. from The Jordan Insurance Agency.