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Which Medicare insurance plan is the right one for me? Is it a Medicare Supplement or Medicare Advantage Plan? Our advisors will take the time to do the research to find a plan that meets your needs.

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What are the differences between Original Medicare and Medicare Advantage (Part C)?

Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance). With Original Medicare, you get broad provider access – you can see any doctor or hospital that accepts Medicare across the country. You’ll pay deductibles and coinsurance, but you have the freedom to choose your healthcare providers. If you want prescription drug coverage, you’ll need to enroll in a separate Part D plan. Many of our clients also add a Medicare Supplement (Medigap) plan to help cover those out-of-pocket costs that Original Medicare doesn’t pay.

Medicare Advantage (Part C) is a completely different approach. These are private insurance plans that are approved by Medicare to provide all your Part A and Part B benefits. Most Medicare Advantage plans also include Part D prescription drug coverage built right in. They often bundle additional benefits that Original Medicare doesn’t cover – things like vision, dental, hearing aids, and wellness programs.

But here’s the trade-off: Medicare Advantage plans typically have more limited networks of doctors and hospitals. You might need prior authorizations for certain services or referrals to see specialists. The cost structure is different too – you might have lower monthly premiums but higher copays when you actually use services.

The key difference our clients need to understand: Medicare Advantage plans have out-of-pocket maximums that cap your yearly spending, while Original Medicare has no such limit (unless you add a Medigap plan).
We help our clients understand which option makes the most sense based on their health needs, budget, and preferred doctors.

What does “Medicare Supplement Insurance (Medigap)” do, and when can I buy it?

Medigap policies are designed to fill the “gaps” in Original Medicare – things like deductibles, coinsurance, and copayments that you’d otherwise pay out of your own pocket. These plans are sold by private insurance companies, but they’re standardized by the government, so a Plan G from one company covers exactly the same things as a Plan G from another company.

Here’s what’s important: You must have Original Medicare (Parts A & B) to buy a Medigap policy. You cannot use Medigap if you have a Medicare Advantage plan – it’s one or the other.

Timing is everything with Medigap: There’s a special 6-month period called your Medigap Open Enrollment Period that starts when you first enroll in Medicare Part B (usually when you turn 65). During this time, insurance companies cannot deny you coverage or charge you more because of health issues. This is your best chance to get the coverage you want at the best price.

Miss this window, and things get complicated. Outside of this period, insurance companies can require you to answer health questions and may deny you coverage if you have certain medical conditions.

Our experienced advisors help clients navigate this timing to ensure they don’t miss their opportunity for guaranteed coverage.

What are the different types of Medicare Advantage plans (HMO, PPO, SNP, etc.), and how do they vary?

HMO (Health Maintenance Organization) plans are the most restrictive but often the least expensive. You’ll typically need to choose a primary care doctor and get referrals to see specialists. You must use doctors and hospitals in the plan’s network, except for emergencies.

PPO (Preferred Provider Organization) plans give you more flexibility. You can see out-of-network providers, though you’ll pay more. You usually don’t need referrals to see specialists, making them popular with our clients who want more freedom in their healthcare choices.

Special Needs Plans (SNPs) are designed for people with specific chronic conditions (like diabetes or heart disease) or those who qualify for both Medicare and Medicaid. These plans tailor their benefits, provider networks, and drug formularies to meet the specific needs of their members.

Private Fee-for-Service plans allow you to see any Medicare-approved provider who accepts the plan’s payment terms, but these are less common.

Each plan type has different rules for cost-sharing, provider networks, and accessing care. The key is matching the plan type to your health needs and preferences. Our advisors help you evaluate which type makes the most sense for your situation.

What are “out-of-pocket maximums” with Medicare Advantage, and why are they important?

Every Medicare Advantage plan must have an annual limit on how much you’ll spend out-of-pocket for Part A and Part B services. Once you reach that limit, the plan pays 100% of covered services for the rest of the year.

Why this matters: Without this protection, a serious illness or injury could result in thousands of dollars in medical bills. Original Medicare by itself has no such limit – your costs could theoretically continue to climb all year.

But here’s what to watch for: These maximums can be quite high – sometimes $8,000 or more per year. Also, some plans only apply the maximum to in-network services, so out-of-network care might not count toward your limit.

Different plans have very different maximums. We’ve seen plans with limits as low as $3,000 and others as high as $8,850 (the maximum allowed by law). This is one of the key factors our advisors help clients compare when choosing between plans.

Remember: prescription drugs often have their own separate out-of-pocket maximum, so your total potential costs could be higher than just the medical maximum.

How does Medicare work with other coverage I already have (employer, union, retiree benefits, Medicaid)?

If you have employer or retiree coverage: The coordination depends on several factors, including the size of your employer. Sometimes your employer plan pays first, sometimes Medicare does. Enrolling in Medicare might affect your existing coverage, so it’s crucial to understand the rules before making changes.

If you qualify for both Medicare and Medicaid (dual eligible): You have special options, including Medicare-Medicaid Plans and Special Needs Plans designed specifically for people in your situation. These plans often provide additional benefits and lower costs.

Medicare Savings Programs: These state-run programs help people with limited income pay for Medicare premiums, deductibles, and coinsurance. Many people don’t realize they qualify for this help.

Important warning: Don’t assume you can just add Medicare to your existing coverage without consequences. Sometimes enrolling in Medicare can affect your spouse’s coverage or your access to Health Savings Accounts.

Our experienced advisors work with clients to understand how Medicare will coordinate with their existing coverage and help them make informed decisions that protect all their benefits.

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TestimonialsWhat Our Customers Say About Us

Ted Putnam
Mike Barnes is a talented professional with excellent communication skills. He listens and then brings his marketplace knowledge to bear to get the best possible deal for his clients. In this day and age of too much information, it's nice to have a seasoned professional to sort through all the noise. Have been a client for many years - Highly Recommend
Patti Johnson
Love this place and it’s such a great thing they are doing to assist us seniors in making important and sometimes confusing insurance decisions. I highly recommend Karen S. This is the second year she has helped me with my Medicare coverages. She knows her stuff and is very efficient and a pleasure to deal with. Thank you.
Diane Kapinos
Sharon Sass was highly recommended from my sister & brother-in-law who both rely on Sharon’s expertise. Sharon is knowledgable of current senior laws, medical information, drug plans and all to do with Medicare. The process is overwhelming and challenging moving from company benefits to Medicare A &B, Supplemental and drug coverage. Sharon was extremely patient, helpful and kind. We discussed many plans, pricing, current medications and best options for me. My Medicare A & B, part G, and Part D are all in place and I could not be happier!! If you are about to go on Medicare and would like to speak to a professional that is unbelievably knowledgeable please reach out to Sharon Sass. Totally amazing experience!!
H Spradlin
Great group of people. Shawn is extremely helpful in choosing the correct plan for my personal needs. She is genuinely concerned about my situation concerning Medicare.
Mark Day
Sharon brings a wealth of knowledge to understanding social security benefits, so that her clients can make well informed decisions and maximize their benefits. Her knowledge and patience make her a pleasure to work with. I highly recommend Sharon to guide retirees through what can be complicated decisions.

Get Affordable Medicare Plans.

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We Do FREE Quote Comparisons of up to 25 Companies

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