Your Phone Script for Speaking with a Medicare Agent: We Wrote It For You

Susie Valentine
Oct 6, 2021

Reclaim your health with us!  This article gives you a script to follow when speaking to a Medicare agent and covers:

  • What questions to ask a Medicare agent
  • What factors matter when choosing a Medicare plan
  • How a Medicare agent makes money
  • How much commission Medicare agents earn based on the plan you choose

If you’re approaching age 65, chances are you won’t need to call a Medicare agent or “broker” yourself; they’ll already be calling you!  On your 65th birthday, you automatically qualify for Medicare, and the U.S. government will send you most of the information you need about enrolling in the mail without you having to do anything.  But choosing which Medicare plan or set of plans is right for you can be really overwhelming.  This is where a licensed agent or broker can actually be quite helpful. 

We understand if you’re skeptical about talking with one of these agents, but have no fear: it’s at no cost to you, and they do not stand to make more money depending on which plan they recommend.  Their job is to be unbiased and not approach it in a “sales-y” way.  In fact, while they do earn commissions on any Medicare plan sales they make, their commission is the same no matter what plan you choose due to regulations by CMS (The Center for Medicare & Medicaid Services).  In short, there’s little to no risk of being scammed by a Medicare agent.  They’re here to help you choose a Medicare plan that is right for you based on your health needs and your financial situation.

There are so many questions to consider when talking to an agent, so we’ve come up with a handy script for you to follow when you finally make that call.  *Before you call, review the script below and gather any information it recommends having on hand ahead of time.

Hi, there!  I’m eligible for Medicare, but I don’t know where to start.  Can you help me?

The agent will probably ask where you live. This is important because different plans are available in different cities across the country.

I live in this zip code.

(Note that you must tell them your specific zip code, as different plans can be offered in different parts of a single county.)

At this point, the agent may give you a rundown of which Medicare plans are available in your area. 

How can I figure out which plan is best for me?  Here’s a little more information about my situation:

(Tell the agent your age, any chronic conditions, upcoming surgeries, family history, and other personal health variables to consider. We recommend reviewing the last 2 years of your medical history before the phone call and jotting down some notes about the following areas:

  1. How many times have you seen your primary care physician each year? 
  2. Have you seen any specialists in the last 2 years? How many specialists have you seen?
  3. Do you have a chronic medical condition such as diabetes, asthma, or high blood pressure?
  4. Did you have any elective surgeries in the last 2 years, such as a hip surgery?
  5. Do you believe you will need an elective surgery in the upcoming year?
  6. Do you take more than 5 prescriptions? )

The agent will probably make some recommendations based on your current health and history.  

This is my total monthly budget for medical costs.  That includes any premiums, copays, out-of-pocket costs, prescriptions, everything.  Which of the plans available in my area fit my budget?

At this point, the agent may ask some questions about how frequently you see your PCP or specialists, how many prescriptions you have, and other medical costs you typically see in any given month, so have this information on hand, perhaps in the form of a monthly bank statement.  Then, the agent will probably be able to make a plan recommendation:

I recommend “Plan X” for you and your budget. 

Are my regular providers covered under “Plan X”?  (Be prepared with a list of providers you’re not willing to give up due to a coverage change. This doesn’t mean that you will no longer see an expert healthcare provider in this area. It means that you are willing to see a different provider who will be covered by the Medicare plans you are considering.)

Are my regular prescriptions in my formulary under “Plan X”?

(As a reminder, a drug formulary is a list of generic and brand name prescription drugs covered by a health plan. If your agent is unable to answer this question, you can call Express Scripts or the appropriate drug company to see if any of your prescriptions are covered under certain plans. You may also be asked to pay a percentage of a brand-name drug listed on the formulary, making your out-of-pocket cost much higher.)

Beyond these concerns, we recommend taking stock of what’s important to you and asking additional questions based on that.  Do you belong to a gym?  If so, ask if the plan being recommended to you has a fitness discount.  Do you have a chronic but manageable condition, such as Type 2 Diabetes?  Ask if the plan provides free or discounted medical equipment such as home blood sugar monitoring kits.  

Most important of all, finish the call by asking the following questions:

How do I enroll?  How long do I have to enroll?  And if I decide this plan doesn’t work for me, can I switch plans, or do I have to wait for open enrollment?

If you find you’re in the middle of a call with your Medicare agent and you don’t have a certain piece of information ready, don’t worry: you can always put them on hold or ask to call them back.