Key Takeaways

• Clients often believe they fully understand Medicare, but many misinterpret how coverage, costs, and plan types work. Your job is to recognize where those misunderstandings begin and redirect with clarity.

• Simplifying comparisons and correcting assumptions—especially around Part A, Part B, Part C, and Part D—is more important than presenting every detail. Precision in explanation builds trust.

Start With What They Think They Know

Many Medicare annuitants come into conversations with you convinced they already understand their coverage. Often, they rely on past experiences, hearsay, or outdated materials. This creates a mental framework that seems complete—but it rarely is.

You may hear:

• “I already have Medicare. I’m all set.”

• “I don’t need anything else—my plan covers everything.”

• “I’m not paying anything, so I must be on the best plan.”

These statements are red flags, not signs of comprehension. When clients speak this way, they’re signaling confidence without confirmation.

Identify Where the Confusion Starts

To guide your clients, start by locating the foundational gaps in their understanding. These often stem from:

• Misinterpreting what “Original Medicare” includes. Many assume it covers everything, including prescriptions and long-term care, when in fact it doesn’t.

• Equating cost with value. Some believe a plan that appears low-cost must be superior.

• Thinking they don’t qualify for certain benefits. They may be unaware of Medicare Savings Programs, Extra Help, or Special Enrollment Periods.

Instead of correcting clients right away, ask questions that expose these assumptions, like:

• “When was the last time you looked at your Annual Notice of Change?”

• “Do you know what your current plan’s out-of-pocket maximum is?”

• “Are your prescriptions covered the same way they were last year?”

Break Down the Four Medicare Parts—Clearly

Even if clients can name Part A, B, C, and D, they rarely grasp how these parts interact—or what’s missing.

Medicare Part A

• Covers inpatient hospital stays, skilled nursing facilities, hospice, and some home health care.

• In 2025, the deductible per benefit period is $1,676.

• Most people don’t pay a monthly premium if they worked 40 quarters.

Medicare Part B

• Covers outpatient care, doctor visits, durable medical equipment, and preventive services.

• In 2025, the standard monthly premium is $185, with an annual deductible of $257.

Medicare Part C (Medicare Advantage)

• Offered by private insurers, combining Parts A and B and usually Part D.

• Can include extra benefits not covered by Original Medicare (e.g., dental, vision, hearing).

• Often misunderstood as “replacing” Medicare—it doesn’t. Clients are still in the Medicare program.

Medicare Part D

• Covers prescription drugs.

• In 2025, the deductible is capped at $590.

• Now includes a $2,000 annual out-of-pocket spending cap thanks to the elimination of the coverage gap.

Explain each part separately, but also describe how they function together—or don’t. This is often the first time clients truly understand where their risks and gaps lie.

Explain the Real Meaning of Out-of-Pocket Costs

Medicare costs are layered, and many clients don’t realize what they’re responsible for until a bill arrives. Use plain language to describe:

• Deductibles: What they pay before coverage kicks in.

• Copayments: Fixed amounts for services like doctor visits.

• Coinsurance: Percentage-based costs that can add up.

• Out-of-pocket maximums: These don’t exist under Original Medicare unless paired with supplemental insurance or a Part C plan.

In 2025, the average Medicare Advantage in-network out-of-pocket maximum is around $9,350, though many plans differ.

Ask your clients:

• “Do you know what your total financial exposure would be this year if you had a major medical event?”

• “Are you covered if you travel out of state or require care from a specialist who doesn’t accept your plan?”

Address Drug Coverage Confusion Early

Prescription coverage is one of the most confusing aspects of Medicare. Clients often assume their drugs are covered—until they’re not.

Clarify these key points:

• Part D is not automatic. If they only have Original Medicare and didn’t enroll in a Part D plan, they’re likely paying full retail prices.

• Not all drugs are covered. Formularies vary, and clients must check annually.

• Late enrollment can lead to penalties. These penalties are permanent and grow the longer they delay.

• 2025 changes matter. The new $2,000 cap can be helpful, but only applies to those enrolled in a Part D plan.

You should always ask:

• “What medications do you take regularly?”

• “Have you checked if those are still covered in your current plan?”

Communicate What Supplemental Plans Do—and Don’t Do

Many clients are either unaware of supplemental coverage or misinformed about what it includes.

You should clarify:

• Medigap plans only pair with Original Medicare. They do not work with Part C plans.

• They don’t cover prescription drugs. A separate Part D plan is needed.

• You must be enrolled in both Part A and Part B to be eligible.

Also emphasize:

• Medigap plans can significantly reduce out-of-pocket costs, but they come with premiums and often underwriting requirements if clients don’t enroll during their initial eligibility window.

Use Annual Enrollment to Reframe the Conversation

From October 15 to December 7 each year, clients can review and switch plans. But many let this window pass without making changes.

To prevent that, frame the Annual Enrollment Period (AEP) as:

• A health and financial checkup opportunity.

• A way to realign with changing health needs.

• A chance to catch what they missed last year.

Lead with this question: “When did you last compare your coverage to your actual care needs and costs?”

Don’t push change for its own sake—but do push understanding.

Revisit Special Enrollment Period Scenarios

Many annuitants don’t realize that qualifying life events may open the door to make plan changes throughout the year. This is especially useful when clients:

• Retire and lose employer coverage

• Move to a new service area

• Gain or lose Medicaid eligibility

• Enter or exit a care facility

Explain that these windows are time-sensitive and often last 60 days from the event. Missing that can mean waiting until the next AEP.

Ask clients during each interaction if any of the following have changed:

• Address or ZIP code

• Medicaid or Extra Help status

• Employment or retirement status

Clear Up the Myth That “No Premium” Means No Cost

Too often, clients confuse premium cost with total cost. A plan with a low or no monthly premium can still result in thousands in out-of-pocket spending. And in 2025, that could include:

• Deductibles as high as $590 for prescription drugs

• Copays up to $75 for urgent care visits

• Coinsurance rates of 20%-30% for specialists or procedures

Remind clients:

• Premiums are just one part of the cost structure.

• The absence of a premium doesn’t mean a plan is free.

• Comprehensive protection comes from understanding total cost exposure, not monthly pricing alone.

Strengthen Your Client Relationships by Simplifying the Complex

At the heart of all these discussions is your ability to take complicated structures and make them understandable. The better your client understands their Medicare plan, the more likely they are to stay with you, trust your advice, and refer others.

What matters most:

• Don’t assume they know the basics.

• Use visual aids when needed, but lead with questions.

• Reassure them that confusion is normal—and that clarity is part of your value.

Help Clients Understand Medicare the Right Way—With Your Help

Clients don’t need more information. They need better information—presented with context and care. When you correct their assumptions, explain the moving parts, and offer time-sensitive guidance, you become more than an agent. You become a trusted partner.

At BedrockMD, we support independent professionals like you with tools, automation, and real-time Medicare insights to simplify client education and increase retention. From plan comparison support to client communication templates, we help make Medicare conversations easier, more accurate, and more effective.

Join us and see how we help you deliver smarter service.