Key Takeaways

• Medicare clients ask a recurring set of questions. If you’re prepared to answer clearly and compliantly, you build more trust and close more sales.

• The most common questions relate to costs, provider networks, prescription coverage, enrollment periods, and plan changes. Learn how to address each with confidence.

The Real Value of Answering Questions Well

Every Medicare appointment is an opportunity to build long-term trust. But trust doesn’t come from having all the answers. It comes from having the right answers, stated clearly, without sounding like you’re reading from a brochure.

Clients expect you to be the expert. That means your job is not only to explain the rules, but to make them feel manageable. Especially with Medicare Advantage and Part D, where benefits vary widely, clients want honest, plain-spoken information. When you answer their biggest concerns with clarity and compliance, you set yourself apart.

The Questions You Should Always Expect

Whether you’re meeting a new lead or following up with a returning client, there’s a core set of questions that come up almost every time. Be ready for these:

1. “What will I have to pay?”

This is often the first question you hear. Clients want a sense of their financial responsibility. While you can’t promise exact figures, you should be able to explain the basics:

• Monthly premiums for Medicare Advantage and Part D vary, but everyone pays the standard Part B premium ($185 in 2025).

• Plans may have deductibles. In 2025, the maximum deductible for Part D is $590.

• Copayments and coinsurance can apply for services like office visits, ER, or prescriptions.

• Out-of-pocket maximums vary, but in-network limits for Medicare Advantage cannot exceed $9,350 in 2025.

• Part D now includes a $2,000 annual out-of-pocket cap.

Avoid suggesting that plans are “free”. Even zero-premium plans involve costs through copays or out-of-pocket expenses. Be honest, and help them compare realistic annual costs.

2. “Will I be able to see my doctors?”

This is a critical concern, especially for those with ongoing health needs.

• Explain the importance of checking the plan’s provider directory.

• Confirm whether their preferred physicians, clinics, or hospitals are in-network.

• Emphasize that some plans offer out-of-network coverage but at higher costs.

Reassure them that you will help verify provider participation, but remind them that networks can change each year. Encourage clients to review their plan’s Annual Notice of Change every fall.

3. “What if my prescriptions aren’t covered?”

Prescription drug coverage is a top priority for most clients. Clarify how Part D works in 2025:

• Each Part D plan has its own formulary (list of covered drugs).

• Tier placement affects cost: generics are usually lower, specialty drugs higher.

• Clients may face quantity limits, prior authorizations, or step therapy.

• The deductible phase, initial coverage, and catastrophic phase still apply, but the out-of-pocket cap ends the cycle at $2,000.

Use tools to help clients look up their medications during the appointment. That transparency goes a long way.

4. “When can I enroll or switch?”

Enrollment windows can be confusing. Here’s how to keep it clear:

• Initial Enrollment Period (IEP): Starts 3 months before the 65th birthday and lasts for 7 months.

• Annual Enrollment Period (AEP): From October 15 to December 7 each year, allowing changes for the following year.

• Medicare Advantage Open Enrollment: January 1 to March 31; allows one plan switch or return to Original Medicare.

• Special Enrollment Periods (SEP): Triggered by events like moving, losing coverage, or qualifying for Medicaid.

Make sure your clients understand when they can act and what actions are allowed in each window.

5. “Can I lose my coverage?”

This is a fear many clients don’t articulate directly but often feel. Reassure them with facts:

• Medicare Advantage and Part D plans renew annually if premiums are paid.

• Clients can be disenrolled for nonpayment or moving out of the plan’s service area.

• Noncompliance with certain plan rules (like prior authorizations or referrals) could result in denied services, not loss of coverage.

Remind them to update their address and income info with Social Security or the plan when needed.

6. “What happens if my plan changes next year?”

Plans change every year. You should explain:

• Clients will receive an Annual Notice of Change (ANOC) every fall.

• This outlines changes in costs, coverage, and provider networks for the upcoming year.

• Encourage reviewing it carefully and calling you with questions during AEP.

Use this opportunity to position yourself as their annual resource—not just a once-a-year salesperson.

7. “Can I have both Medicare and Medicaid?”

Clients who are dual-eligible often don’t understand what that means.

• Explain that Medicaid helps cover costs Medicare doesn’t, like premiums and cost-sharing.

• Let them know about Special Needs Plans (SNPs) that coordinate Medicare and Medicaid benefits.

• Stress that eligibility must be maintained through their state’s Medicaid office.

If they’re unsure of their status, guide them on how to verify eligibility.

8. “Do I have to keep both Medicare and my employer coverage?”

Some clients delay retirement or have spousal coverage. Clarify:

• Medicare eligibility begins at age 65, but they may be able to delay Part B if they have credible coverage.

• Delaying Part D without credible coverage can lead to penalties.

• Once employer coverage ends, they’ll have an 8-month SEP to enroll in Part B without penalty.

Make sure they understand the coordination rules and long-term cost implications.

9. “What’s the difference between Medicare Advantage and Original Medicare?”

This is a good moment to clarify their options:

• Original Medicare includes Part A and B, with optional Part D and Medigap for coverage gaps.

• Medicare Advantage bundles A and B (often D), adds extra benefits, and has an out-of-pocket cap.

• MA plans use provider networks and may require referrals.

Help clients align their choice with their care preferences, budget, and travel needs.

10. “What’s the penalty if I sign up late?”

Late enrollment penalties cause lasting confusion. Break it down:

• Part B Penalty: 10% for every 12-month period delayed without creditable coverage.

• Part D Penalty: 1% of the national base premium times the number of months delayed.

These penalties are permanent unless the client qualifies for an SEP. Help them avoid these with proactive planning.

How to Make These Answers Work for You

Memorizing facts isn’t enough. You need to:

• Use simple, respectful language.

• Avoid sounding salesy or rehearsed.

• Bring visual aids or worksheets if needed.

• Use the client’s own concerns to guide which points matter most.

If you’re honest, helpful, and efficient with your explanations, clients are more likely to refer you and come back year after year.

Why Your Responses Set the Tone for Referrals and Retention

Your ability to answer questions clearly is part of your value proposition. Anyone can quote a plan. Fewer agents can offer peace of mind.

When clients understand what they’re enrolling in, they’re less likely to disenroll, switch agents, or complain about unexpected costs. That means:

• Higher retention

• Fewer servicing headaches

• More referrals

And if you’re tracking questions in a CRM or notes system, you can improve your follow-up conversations each year.

Help Clients Get Clarity and Confidence

The questions you hear most often are the best opportunities to deepen trust. When you learn how to answer confidently and compliantly, you don’t just sell plans—you build a long-term book of business.

At BedrockMD, we help agents like you prepare for these exact conversations. From training to quoting tools to compliance updates, we equip you with everything you need to support your clients, keep your book, and grow your income. Sign up today and let’s make this your best sales year yet.