Prompt Tools

Curated Medicare Prompts

Each prompt is written to force a structured, source-cited answer. Fill in the bracketed details with your own situation before you send it.

Showing 14 of 14 prompts
Enrollment

Build My Initial Enrollment Period timeline

Turns your birthday and work status into a month-by-month checklist of Medicare enrollment windows.

I am turning 65 on [MONTH/YEAR]. I currently [have / do not have] employer group health coverage through [my job / my spouse's job] at an employer with [number] employees.

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Build My Initial Enrollment Period timeline

Turns your birthday and work status into a month-by-month checklist of Medicare enrollment windows.

I am turning 65 on [MONTH/YEAR]. I currently [have / do not have] employer group health coverage through [my job / my spouse's job] at an employer with [number] employees.

Explain my Medicare Initial Enrollment Period as a month-by-month timeline. For each month, state what I can do, what happens if I skip it, and which government website handles the action. Identify any late enrollment penalties that could apply to Part B and Part D, and how they are calculated. List the questions I still need to answer before deciding. Cite the official Medicare.gov or SSA.gov pages that support each point, and clearly flag anything that varies by state.

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Enrollment

Should I Delay Part B While Still Working?

Structures the employer-coverage decision, including HSA rules and Special Enrollment Periods.

I am [age] and still working with employer coverage from an employer with [number] employees. My plan is [HDHP with an HSA / a standard PPO / other]. I contribute [$amount] per year to an HSA.

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Should I Delay Part B While Still Working?

Structures the employer-coverage decision, including HSA rules and Special Enrollment Periods.

I am [age] and still working with employer coverage from an employer with [number] employees. My plan is [HDHP with an HSA / a standard PPO / other]. I contribute [$amount] per year to an HSA.

Walk through the trade-offs of enrolling in Medicare Part A and/or Part B now versus delaying. Cover: how employer size changes who pays first, how Medicare enrollment affects HSA contributions, what documentation I need for a Special Enrollment Period later, and the deadlines that trigger penalties. Present the answer as a short decision table, then list the three most common mistakes people make in my situation.

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Enrollment

Check My Medigap Guaranteed Issue Rights

Clarifies when you can switch supplements without medical underwriting.

I am considering moving from [current coverage] to a Medigap policy. My situation: [turning 65 on date / losing employer coverage / my plan is leaving my area / I moved / I want to switch plans voluntarily]. I live in [state] and my

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Check My Medigap Guaranteed Issue Rights

Clarifies when you can switch supplements without medical underwriting.

I am considering moving from [current coverage] to a Medigap policy. My situation: [turning 65 on date / losing employer coverage / my plan is leaving my area / I moved / I want to switch plans voluntarily]. I live in [state] and my health history includes [summary].

Explain my Medigap open enrollment and guaranteed issue rights: when they apply, how long each window lasts, and what happens if I miss them. Explain medical underwriting in plain language. Highlight any state-specific rules for my state, such as birthday rules or continuous open enrollment, and tell me how to verify them with my state insurance department.

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Coverage Rules

Is This Service Covered by Part a or Part B?

Clarifies which part of Medicare pays for a specific service and what conditions apply.

I need to understand coverage for this service: [describe the service, test, equipment, or procedure]. It would be provided at [hospital inpatient / hospital outpatient / doctor's office / home / skilled nursing facility].

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Is This Service Covered by Part a or Part B?

Clarifies which part of Medicare pays for a specific service and what conditions apply.

I need to understand coverage for this service: [describe the service, test, equipment, or procedure]. It would be provided at [hospital inpatient / hospital outpatient / doctor's office / home / skilled nursing facility].

Explain whether Original Medicare Part A or Part B typically covers it, the coverage conditions that must be met, what documentation my provider must supply, and my expected cost sharing. Explain the difference between inpatient admission and observation status if it is relevant. Note where a Medicare Advantage plan might apply different rules such as prior authorization or network limits. List the exact wording I should use when calling 1-800-MEDICARE to confirm.

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Coverage Rules

Explain Skilled Nursing and Rehab Coverage Limits

Breaks down the 3-day rule, benefit periods, and day-by-day cost sharing.

A family member was recently [hospitalized / discharged] and may need skilled nursing or rehabilitation care.

Explain how Medicare covers skilled nursing

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Explain Skilled Nursing and Rehab Coverage Limits

Breaks down the 3-day rule, benefit periods, and day-by-day cost sharing.

A family member was recently [hospitalized / discharged] and may need skilled nursing or rehabilitation care.

Explain how Medicare covers skilled nursing facility care: the qualifying hospital stay requirement, how observation status affects eligibility, how a benefit period works, and the day-by-day cost sharing for days 1-20, 21-100, and beyond. Explain what "improvement standard" myths exist and what the actual coverage rule is. Describe how to appeal a discharge notice and the deadlines involved. Keep the answer plain-language and cite Medicare.gov pages.

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Coverage Rules

Draft a Medicare Claim Denial Appeal

Turns a denial notice into a structured appeal with the correct level and deadline.

My claim or service was denied. Here is the denial language from the notice: [paste it]. The service was [describe]. My coverage is [Original Medicare / Medicare Advantage plan name].

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Draft a Medicare Claim Denial Appeal

Turns a denial notice into a structured appeal with the correct level and deadline.

My claim or service was denied. Here is the denial language from the notice: [paste it]. The service was [describe]. My coverage is [Original Medicare / Medicare Advantage plan name].

Identify which appeal process applies and which level I am at, the filing deadline, and the exact form or method required. Draft a clear, factual appeal letter that references the coverage criteria at issue and lists the supporting documentation I should request from my provider. Add a short section on how to request an expedited decision if care is urgent, and where to get free help from my State Health Insurance Assistance Program.

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Cost Analysis

Project My Total Annual Medicare Costs

Builds a full-year cost model including premiums, deductibles, and worst-case exposure.

Assume: Part B premium [$amount or standard], IRMAA status [yes/no, income $amount from 2 years ago], plan type [Advantage plan with $X premium / Medigap Plan [letter] at $X plus a Part D plan at $X], and expected annual

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Project My Total Annual Medicare Costs

Builds a full-year cost model including premiums, deductibles, and worst-case exposure.

Assume: Part B premium [$amount or standard], IRMAA status [yes/no, income $amount from 2 years ago], plan type [Advantage plan with $X premium / Medigap Plan [letter] at $X plus a Part D plan at $X], and expected annual use: [doctor visits, specialists, imaging, procedures, prescriptions].

Build a total annual cost projection with three scenarios: a healthy year, a typical year, and a high-utilization year that hits the out-of-pocket maximum. Show premiums, deductibles, copays, coinsurance, and drug costs as a line-item table. State every assumption you made and which numbers I must verify against the current year's official figures.

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Cost Analysis

Understand and Appeal an Irmaa Determination

Explains income-related premium surcharges and the life-changing event appeal process.

I received a notice that I will pay an income-related monthly adjustment amount. My income two years ago was [$amount] because of [reason: retirement, one-time capital gain, business sale, spouse's death, etc.].

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Understand and Appeal an Irmaa Determination

Explains income-related premium surcharges and the life-changing event appeal process.

I received a notice that I will pay an income-related monthly adjustment amount. My income two years ago was [$amount] because of [reason: retirement, one-time capital gain, business sale, spouse's death, etc.]. My current income is approximately [$amount].

Explain how IRMAA is calculated for Part B and Part D, which tax year is used, and which life-changing events qualify for a reconsideration. Walk me through filing Form SSA-44 step by step, the documentation to attach, expected timelines, and what to do if the request is denied. Note what is not an eligible life-changing event.

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Drug Plans

Audit My Drug List Against a Part D Formulary

Turns your medication list into concrete formulary questions to verify.

Here are my medications with dosage and monthly quantity: [list]. I live in [ZIP code] and use [pharmacy name].

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Audit My Drug List Against a Part D Formulary

Turns your medication list into concrete formulary questions to verify.

Here are my medications with dosage and monthly quantity: [list]. I live in [ZIP code] and use [pharmacy name].

Explain how Part D formularies work: tiers, prior authorization, step therapy, and quantity limits. For each of my drugs, tell me what to look for in a formulary and what a lower-cost alternative conversation with my prescriber might sound like. Explain the current annual out-of-pocket cap and the Medicare Prescription Payment Plan. Then give me a checklist for verifying each drug in the Medicare.gov Plan Finder, since only the official tool has real-time plan data.

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Plan Comparison

Advantage vs. Medigap: Build My Comparison Framework

Produces an objective, criteria-based comparison instead of a sales pitch.

I live in [county, state]. I travel [rarely / several months a year], see these specialists: [list], and use these facilities: [list]. My monthly budget for premiums is roughly [$amount], and my tolerance for unexpected out-of-pocket costs

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Advantage vs. Medigap: Build My Comparison Framework

Produces an objective, criteria-based comparison instead of a sales pitch.

I live in [county, state]. I travel [rarely / several months a year], see these specialists: [list], and use these facilities: [list]. My monthly budget for premiums is roughly [$amount], and my tolerance for unexpected out-of-pocket costs is [low / medium / high].

Compare Medicare Advantage against Original Medicare plus a Medigap supplement for someone in my situation. Be objective and do not recommend a specific insurance company. Cover networks and referrals, out-of-pocket maximums, prior authorization, travel and out-of-area care, drug coverage, and future switching rights including medical underwriting rules. End with the specific questions I should verify on Medicare.gov's Plan Finder for my ZIP code.

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Plan Comparison

Run My Annual Plan Review Before the Deadline

Uses your Annual Notice of Change to build a structured yearly review.

My current plan is [plan name and type]. Here is what my Annual Notice of Change says is changing next year: [paste the changes]. My health and medications over the past year: [summary].

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Run My Annual Plan Review Before the Deadline

Uses your Annual Notice of Change to build a structured yearly review.

My current plan is [plan name and type]. Here is what my Annual Notice of Change says is changing next year: [paste the changes]. My health and medications over the past year: [summary].

Help me review whether to keep or change plans. Explain the difference between the Annual Enrollment Period and the Medicare Advantage Open Enrollment Period, including what each one allows. Turn the ANOC changes into a plain-language impact summary for my situation. Give me a prioritized checklist of what to verify in the official Plan Finder, and the date deadlines I cannot miss.

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For Agents

Explain a Medicare Concept at a Client's Reading Level

Helps agents produce clear, compliant, plain-language client explanations.

Explain [Medicare concept] to a client who is [age] and has [no prior insurance experience / a technical background / limited English proficiency].

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Explain a Medicare Concept at a Client's Reading Level

Helps agents produce clear, compliant, plain-language client explanations.

Explain [Medicare concept] to a client who is [age] and has [no prior insurance experience / a technical background / limited English proficiency].

Write at a sixth-grade reading level in under 250 words. Use one everyday analogy. Avoid insurance jargon; when a technical term is unavoidable, define it in a parenthetical. Do not name or recommend any specific carrier or plan, and do not make any statement that could be read as a sales inducement. End with three questions the client should ask themselves and a pointer to the official Medicare.gov page on the topic.

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For Agents

Pressure-Test My Client Materials for Compliance

Reviews educational materials for marketing language and required disclosures.

Here is a draft of client-facing material I plan to use: [paste text].

Review it as a compliance-minded editor. Flag any language that could be read as marketing

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Pressure-test My Client Materials for Compliance

Reviews educational materials for marketing language and required disclosures.

Here is a draft of client-facing material I plan to use: [paste text].

Review it as a compliance-minded editor. Flag any language that could be read as marketing rather than education, any implied plan recommendation, any unsubstantiated superlative, and any missing disclaimer. Rewrite the flagged sentences in neutral, educational language. Then list the general categories of disclosures that materials like this typically require, and note that I must confirm current requirements against official CMS guidance and my carrier's own review process, since rules change annually.

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For Agents

Refine a Vague Medicare Question Into a Strong Prompt

A meta-prompt that upgrades your rough question before you ask the real one.

I want to ask an AI assistant about this Medicare situation, but my question is vague: [write your rough question].

Do not answer it yet. Instead, rewrite it as a high-quality

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Refine a Vague Medicare Question Into a Strong Prompt

A meta-prompt that upgrades your rough question before you ask the real one.

I want to ask an AI assistant about this Medicare situation, but my question is vague: [write your rough question].

Do not answer it yet. Instead, rewrite it as a high-quality prompt. Add the context slots I should fill in, such as age, state, coverage type, income year, medications, and providers. Specify the output format I should request, the level of detail, and an instruction to cite official sources and flag state-specific variation. Then show me the finished prompt in a copyable block and list the three follow-up questions I should ask after I get the first answer.

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