10 Questions Agents Should Ask During Every Medicare Annual Review

“Do you want to keep the same plan?” shouldn’t be the starting point for a Medicare annual review.

A client’s doctors, prescriptions, budget and health care needs may have changed. Their plan’s coverage and costs may have changed, too—even when the plan name stays the same.

Specific questions help agents uncover those differences and give clients a clearer picture of their options for the coming year.

Use these 10 questions to guide your next review.

For help organizing your outreach and appointments, explore PSM’s AEP Preparation Guide.

1. Are all of your doctors still the same?

Start with the client’s primary care physician. Confirm the provider’s name, practice location and whether the client wants to continue seeing them.

For Medicare Advantage clients, verify participation in the specific plan being considered for the upcoming year. Don’t assume last year’s network status still applies.

Original Medicare and Medicare Advantage have different provider-access rules, so tailor the conversation to the client’s coverage.

Agent action: Update the provider list and record the source and date of network verification.

2. Have you started or stopped taking any medications?

Last year’s prescription list is a starting point. Ask the client to confirm:

• Drug names and dosages
• How often each medication is taken
• New or discontinued prescriptions
• Brand-name or generic versions
• Specialty medications

Use the updated list to review the coming year’s formulary, tiers, restrictions and estimated costs.

Prescription expenses can involve premiums, deductibles, copays and coinsurance. Comparing only the plan premium leaves out much of the cost picture.

For additional context, read PSM’s 2027 Medicare Drug Prices: What Agents Should Know.

Agent action: Run a fresh drug comparison using the client’s current medication list.

3. Which pharmacy do you use now?

Confirm the pharmacy’s exact location, whether the client uses mail order and whether convenience limits their choices.

For each plan being considered, check the pharmacy’s network status and whether preferred cost sharing applies. Compare estimated prescription costs at the locations the client would realistically use.

Agent action: Record the preferred pharmacy and any acceptable alternatives.

4. Have you added any specialists or other health care providers?

A client may remember their primary care physician but forget a cardiologist, physical therapist or specialist they started seeing recently.

Ask about the entire care team, including providers involved in ongoing treatment.

For Medicare Advantage options, review specialist network participation and applicable referral requirements. Some plans require referrals to see specialists.

Agent action: Identify essential providers before narrowing the plan comparison.

5. Which hospital or health system would you want to use?

Ask about preferred hospitals, outpatient facilities and treatment centers—especially when the client already receives care within a particular health system.

A physician’s network participation does not replace the need to check the facilities where the client expects to receive care.

Agent action: Verify relevant facilities separately for the specific Medicare Advantage plan and plan year.

6. Do you travel or spend part of the year somewhere else?

Ask about extended trips, second homes, seasonal residences and regular medical care outside the client’s local area.

Then explain how the coverage handles routine care away from home, emergency care and out-of-network services. Medicare Advantage plans may require network providers for non-emergency care; some offer out-of-network coverage at additional cost. International coverage also requires a separate review.

Agent action: Match the coverage discussion to the client’s actual travel habits.

7. Which benefits did you actually use this year?

A benefit matters most when the client can use it.

Ask which dental, vision, hearing or other supplemental benefits helped them—and which were difficult to access.

Follow up with practical questions:

• Could you use the provider you wanted?
• Were the allowances or coverage limits clear?
• Did you encounter unexpected expenses?
• Which benefits would you miss if they changed?

Agent action: Compare benefit details, participating providers, limits and eligibility requirements rather than relying on a summary headline.

8. Have premiums or other health care costs become a concern?

Give clients room to explain where their coverage is stretching their budget.

Review premiums alongside deductibles, specialist copays, hospital cost sharing, prescription expenses and other expected costs.

For Medicare Advantage, explain the maximum out-of-pocket limit for covered Part A and Part B services. That limit is separate from Part D drug spending. Original Medicare by itself does not have an annual out-of-pocket limit.

A $0 plan premium does not mean $0 health care costs.

Agent action: Compare likely annual expenses and financial exposure, not just the monthly premium.

9. Has anything changed with your health or expected care?

Ask whether the client anticipates surgery, ongoing therapy, additional specialist visits or a new course of treatment.

The goal is to understand expected use of care so the comparison reflects the client’s needs.

Review the applicable coverage, cost sharing, referral rules and prior authorization requirements for services they expect to use.

Agent action: Document anticipated care and flag anything requiring additional verification.

10. If you could change one thing about your current coverage, what would it be?

This open-ended question often reveals what a checklist misses.

Clients may say:

“My specialist visits cost too much.”

“I couldn’t use the dentist I wanted.”

“My prescriptions were more expensive than I expected.”

“I want more flexibility when I travel.”

Ask a follow-up question to understand the problem before suggesting an alternative.

Agent action: Record the client’s top priority and explain the tradeoffs among available options.

Turn the Answers Into a Clear Review Process

These questions work best alongside the client’s Annual Notice of Change. The ANOC outlines changes to plan coverage, costs and other details taking effect in January. Review it with the client to identify what deserves closer attention.

After the conversation:

1. Update the client’s providers, prescriptions, pharmacy and priorities.
2. Verify the relevant details for the upcoming plan year.
3. Compare options against the needs the client identified.
4. Explain important costs, limitations and tradeoffs.
5. Document the discussion and any outstanding follow-up.

Store those notes in your CRM so the next conversation begins with accurate information. Explore PSM’s CRM Solutions for tools to support client organization and follow-up.

The review may confirm that the client’s existing coverage remains a good fit. It may uncover a reason to consider another option. Either outcome should follow a careful comparison.

Download the Medicare Annual Review Worksheet

Keep these 10 questions handy during client appointments with our printable, 8.5 × 11-inch worksheet. It includes space for answers, changing priorities and agent follow-up notes.

Download the Medicare Annual Review Worksheet

Build Stronger Client Relationships Throughout the Year

An annual review gives agents a chance to listen, resolve confusion and help clients understand their coverage.

Make the process repeatable, keep clear notes and follow through on unresolved questions. Those habits reinforce the value of having an independent agent long after enrollment.

Prepare your workflow with PSM’s AEP Preparation Guide, and explore the PSM Marketing Hub for customized materials to support your client outreach.