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“Hi Maria, this is Mike from HealthFirst Insurance. I'm following up on our conversation about Medicare Advantage plans. Is now still a good time?”
• Plan G vs Plan N comparison
• Her current medications — check formulary
• PCP: Dr. Ramirez — confirm network
• Premium budget: $150-200/mo
“I understand the concern about switching plans. The good news is that during the Open Enrollment Period, you can change plans with no penalty and guaranteed acceptance.”
Medicare marketing rules require a Scope of Appointment (SOA) before discussing specific plan details. Confirm SOA is on file before proceeding.
Covers all Part A & B copays, coinsurance, and excess charges. Only out-of-pocket: Part B deductible ($257/yr).
Avg premium: $165/mo (Palm Beach County)
Similar to Plan G but with small copays ($20 office, $50 ER). Does NOT cover Part B excess charges.
Avg premium: $128/mo (Palm Beach County)
Given Maria's budget of $150-200/mo, both plans fit. Plan G = max predictability. Plan N saves ~$37/mo but adds small copays.
Based on Maria's medication list (Lisinopril, Metformin, Atorvastatin), all are covered under both Plan G and Plan N formularies with no prior auth required.
Dr. Ramirez is in-network for both Humana and Aetna Medicare Advantage plans in Palm Beach County.