Medicare Made Easier to Understand
Medicare doesn't have to feel overwhelming. We help you understand your coverage options, including Medicare Advantage, Medicare Supplement (Medigap), and Part D prescription drug plans, so you can make an informed decision based on your individual needs.
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Medicare Advantage
Medicare Advantage plans combine your Medicare Part A and Part B benefits through a private insurance company. Many plans may also include prescription drug coverage and additional benefits. We’ll help you compare available options based on your individual needs.
How Medicare Advantage Works
With a Medicare Advantage plan, you still have Medicare, but your Part A and Part B benefits are provided through the Medicare Advantage plan. You generally receive your covered medical services through the plan's network and follow the plan's rules for receiving care.
Plans May Include
Depending on the plan, benefits may include prescription drug coverage, dental, vision, hearing, fitness programs, and other supplemental benefits. Benefits, provider networks, costs, and availability vary by plan and service area.
Things to Consider
When comparing Medicare Advantage plans, it’s important to consider your doctors, hospitals, prescription medications, expected healthcare needs, and out-of-pocket costs. Plan availability and benefits can vary by county and may change from year to year.
Medicare Supplement (Medigap)
Medicare Supplement Insurance, also called Medigap, helps pay some of the out-of-pocket costs that Original Medicare doesn't cover. These plans work alongside Original Medicare and are offered by private insurance companies.
How Medigap Works
With a Medicare Supplement plan, Original Medicare pays its share of approved healthcare costs first, and your Medigap policy may then help pay certain remaining costs. You can generally see any doctor or hospital in the United States that accepts Medicare.
What Medigap May Cover
Depending on the plan, Medigap may help with costs such as deductibles, copayments, and coinsurance that Original Medicare does not fully pay. Coverage varies by the standardized Medigap plan you choose.
Things to Consider
Medicare Supplement plans generally have a monthly premium in addition to your Medicare Part B premium. Premiums can vary by insurance company and other factors. Medigap plans do not include prescription drug coverage, so you may need a separate Part D plan for your medications.
Part D Prescription Drug Coverage
Medicare Part D helps cover the cost of prescription medications. Part D plans are offered by private insurance companies approved by Medicare, and each plan has its own list of covered drugs, costs, and participating pharmacies.
How Part D Works
You can get Part D coverage through a stand-alone prescription drug plan that works with Original Medicare, or through a Medicare Advantage plan that includes prescription drug coverage. You generally pay a monthly premium and may have deductibles, copayments, or coinsurance depending on the plan.
Drug Coverage Varies by Plan
Each Part D plan has a formulary, or list of covered medications. Drugs may be placed into different cost-sharing tiers, and the pharmacies in a plan's network can also affect what you pay. It's important to review your medications and preferred pharmacies when comparing plans.
Things to Consider
When comparing Part D plans, consider the medications you take, each plan's formulary, pharmacy network, premiums, deductibles, and other out-of-pocket costs. Plans can change their costs and coverage from year to year, so reviewing your drug coverage annually is important.
When Can I Enroll or Make Changes?
Medicare has specific times when you can first enroll or make changes to your coverage. The enrollment period that applies to you depends on your individual circumstances.
Initial Enrollment Period
Your Initial Enrollment Period generally begins three months before the month you turn 65, includes your birthday month, and continues for three months afterward. If you qualify for Medicare before age 65, different timing may apply.
Annual Enrollment Period
The Medicare Annual Enrollment Period runs from October 15 through December 7 each year. During this time, you can review your current coverage and make certain changes to your Medicare Advantage or prescription drug coverage for the following year.
Special Enrollment Periods
You may qualify for a Special Enrollment Period when certain life events or changes occur, such as losing employer coverage or moving outside your plan's service area. The timing and changes you can make depend on your specific situation.
Medicare Learning Center
Medicare can be confusing, and you’re not alone if you have questions. Here are answers to some of the questions we hear most often from our clients.
Do I have to pay for Medicare Part B, or can I choose not to have it?
Most people pay a monthly premium for Medicare Part B. You can choose to delay or decline Part B, but doing so may result in a late enrollment penalty or a gap in coverage unless you qualify for a Special Enrollment Period, such as having coverage through current employment. Before declining or delaying Part B, it’s important to understand how your current coverage works with Medicare.
Can I collect Social Security and still work?
Yes. You can receive Social Security retirement benefits and continue working. However, if you are under your full retirement age, your earnings may temporarily reduce the amount of Social Security benefits you receive if you earn over certain limits. Once you reach full retirement age, there is no reduction in your Social Security retirement benefit because of how much you earn.
Why can’t I be on the same Medicare plan as my neighbor?
Medicare coverage is not one-size-fits-all. A plan that works well for your neighbor may not be the best choice for you. Your doctors, prescription medications, preferred pharmacies, healthcare needs, budget, and the plans available where you live can all affect which option may be appropriate. That’s why we review your individual needs when helping you compare available plans.
I keep hearing commercials saying I can get $1,200 a year on a food card. Is this something you can get for me?
Some Medicare Advantage plans may offer allowances or benefits that can be used for certain groceries or other eligible items. These benefits are not available with every plan or to every person, and the amount can vary. Eligibility may depend on the plan, where you live, and in some cases whether you meet certain health or financial requirements. We can review the plans available to you and explain which benefits you may actually qualify for.
I don’t understand the different parts of Medicare. Why do I need more than one part?
Medicare is divided into different parts because each part covers different types of healthcare services. Part A generally helps cover inpatient hospital care, while Part B generally helps cover doctor visits and other outpatient medical services. Part D helps cover prescription medications. Medicare Advantage plans, also called Part C, are another way to receive your Medicare Part A and Part B benefits through a private insurance company approved by Medicare and often include additional benefits. Which coverage you need depends on how you choose to receive your Medicare benefits and your individual needs.
I receive Social Security disability benefits now. What happens when I reach full retirement age?
If you receive Social Security Disability Insurance (SSDI), your disability benefits generally convert automatically to Social Security retirement benefits when you reach your full retirement age. You do not receive both an SSDI benefit and a retirement benefit based on the same earnings record at the same time. If you receive Supplemental Security Income (SSI), different rules apply because SSI is a separate needs-based program. Social Security can explain how your individual benefits may be affected.
When should I review my Medicare coverage?
It’s a good idea to review your Medicare coverage every year. Plans can change their premiums, costs, provider networks, prescription drug coverage, and other benefits from one year to the next. Your own healthcare needs and medications can change too. An annual review can help you determine whether your current coverage continues to meet your needs for the coming year.
Ready to Review Your Medicare Options?
Medicare choices are personal. We’ll take the time to understand your needs, answer your questions, and help you compare the Medicare options available to you.
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