How to Get a Jump Start on Changes to Your 2026 Medicare Plan During Medicare Annual Enrollment

Top 10 Red Flags to Watch Out for When Choosing a Medicare Insurance Agent Navigating Medicare can be overwhelming, especially with all the plans, rules, and changes that happen year after year. A trustworthy Medicare insurance agent can make the process smoother, clearer, and tailored to your needs. But not all agents have your best interests at heart. Whether you’re new to Medicare or reviewing your current plan, it’s essential to recognize the warning signs that you might not be dealing with the right agent. Here are the top 10 red flags to look out for when choosing a Medicare insurance agent: 1. They Push One Insurance Company Only A reliable Medicare agent should offer multiple carriers and plan options, not just one. If they constantly promote only one company without explaining why it suits you best, you may be dealing with a captive agent or someone more focused on commission than your needs. 2. They Promise Too Much Be cautious if an agent guarantees extra benefits, huge savings, or "secret" perks. Medicare is standardized and regulated—no one can promise you a miracle plan that no one else can access. If it sounds too good to be true, it probably is. 3. They Skip the Needs Assessment A good agent will ask about your doctors, medications, preferred pharmacies, travel habits, and budget before recommending a plan. If an agent jumps straight into selling you something without understanding your situation, that’s a red flag. 4. They Rush You to Enroll If you’re being pressured to sign up on the spot, take a step back. A trustworthy agent will give you time to compare plans, ask questions, and even consult family or advisors. 5. They Don’t Explain the Fine Print Medicare Advantage and Part D plans come with rules, networks, co-pays, and coverage phases. If an agent glosses over these details, it could cost you later. You need to understand what you're signing up for. 6. They Avoid Putting Things in Writing Every conversation and recommendation should be documented. If an agent hesitates to give you a summary in writing, or won't email you details, that’s suspicious. Transparency is non-negotiable. 7. They’re Not Licensed or Certified Agents must be licensed in your state and certified annually to sell Medicare Advantage and Part D plans. Always verify their credentials. You can check with your state’s Department of Insurance. 8. They Ignore Your Doctors and Medications Your preferred providers and prescriptions should be central to plan selection. If an agent doesn’t check formulary coverage or provider networks, you might end up in a plan that doesn’t meet your needs. 9. They Don’t Disclose Their Compensation Agents are usually paid by insurance companies, not by you. But ethical agents will explain this clearly and won’t steer you toward plans based solely on commissions. If an agent seems evasive about this, be cautious. 10. They Disappear After You Enroll Support shouldn't end after enrollment. A good Medicare agent will offer ongoing help—answering questions, helping with appeals, and checking in during the Annual Enrollment Period. If they vanish after you sign, that's a major red flag. Final Thoughts Choosing a Medicare plan is a big decision. The right agent should act as your advocate—someone who listens, explains, and genuinely wants to help. If you spot any of these red flags, trust your instincts and seek help elsewhere. Your health and financial well-being are too important to leave in the hands of someone who isn’t looking out for you.  Senior Insurance Advisors is your trustworthy partner to help you with Medicare We’ll begin with a brief conversation to understand your specific needs—like your medications, preferred doctors, and what you want from your coverage. Then we’ll compare plans from several top companies and explain the differences in clear, simple terms. There’s no pressure at all—you’ll have all the time you need to make a confident, informed decision. Get in touch today to book your no-cost consultation.

Medicare is a vital part of retirement planning, providing essential health coverage for millions of Americans aged 65 and older. But simply enrolling in Medicare isn’t enough. To get the most value from your benefits, it’s important to understand how the system works, what options are available, and how to tailor your plan to your needs. At Senior Insurance Advisors , we specialize in helping retirees navigate the complexities of Medicare. Our team is here to ensure that you not only get the coverage you need but also maximize your benefits and savings for a healthy, secure retirement. Understand the Basics of Medicare To make the most of your benefits, start with a clear understanding of the different parts of Medicare: Medicare Part A covers hospital stays, skilled nursing facility care, and hospice. Medicare Part B includes outpatient care, doctor visits, and preventive services. Medicare Part C, or Medicare Advantage is an all-in-one alternative to Original Medicare, often including extra benefits like dental, vision, and prescription coverage. Medicare Part D provides standalone prescription drug coverage. Knowing what each part covers, and what it doesn’t, is the first step in choosing the right plan for your lifestyle and budget. Enroll at the Right Time Timing is everything when it comes to Medicare. Missing your Initial Enrollment Period (IEP) can lead to late enrollment penalties and gaps in coverage. Your IEP begins three months before your 65th birthday, includes the month you turn 65, and ends three months after. If you’re still working and covered by employer insurance, you may qualify for a Special Enrollment Period (SEP) later. Our licensed advisors at Senior Insurance Advisors can help you navigate Medicare enrollment to avoid unnecessary costs and ensure continuous coverage. Consider a Medicare Advantage Plan Medicare Advantage plans (Part C) often provide greater value by bundling multiple benefits into a single plan. These plans are offered by private insurers approved by Medicare and can include: Dental and vision coverage Hearing aids Gym memberships and wellness programs Prescription drug coverage Some plans even offer transportation services and telehealth options—important perks for retirees. To see if Medicare Advantage is right for you, visit our Medicare Advantage page. Don’t Overlook Prescription Drug Coverage Prescription drugs can be a significant expense in retirement. Whether you choose Original Medicare with a Part D plan or a Medicare Advantage plan that includes drug coverage, it’s important to review your medications each year to ensure your plan still meets your needs. Our team at Senior Insurance Advisors can conduct a free Medicare plan review to help you compare your options. Learn more about how we can help on our Medicare Part D page . Take Advantage of Preventive Services Medicare offers a wide range of preventive services at no cost, including: Annual wellness visits Cancer screenings Flu shots Cardiovascular screenings Diabetes prevention programs Staying proactive with your health can help you catch conditions early—and avoid costly treatments down the road. Review and Adjust Your Plan Annually Your health needs and budget can change from year to year, which is why it’s important to review your Medicare coverage annually during Open Enrollment (October 15 – December 7). During this time, you can: Switch from Original Medicare to Medicare Advantage or vice versa Change your Medicare Advantage plan Enroll in or switch Part D plans At Senior Insurance Advisors, we offer free annual Medicare reviews to help you stay informed and covered. Work with a Licensed Medicare Advisor Choosing the right Medicare plan can be overwhelming—but you don’t have to do it alone. A licensed advisor can help you: Understand plan benefits and costs Avoid coverage gaps and penalties Tailor your plan to your specific health needs and lifestyle Save money on premiums and prescriptions Our advisors provide personalized Medicare guidance. We’re here to simplify the process and help you make confident, informed decisions. Get the Most Out of Your Medicare in Retirement Maximizing your Medicare benefits isn’t just about saving money, it’s about ensuring peace of mind as you enjoy retirement. With the right plan and expert guidance, you can get better coverage, avoid surprises, and stay healthy for the years ahead. Ready to get started? Schedule your free Medicare review today with one of our licensed advisors at Senior Insurance Advisors, your trusted partner in Medicare and retirement planning.

Medicare provides essential health coverage for millions of Americans, but many people are surprised to learn that it doesn’t cover everything. Gaps in Medicare coverage can leave beneficiaries responsible for significant out-of-pocket costs. Understanding what Medicare doesn’t cover—and how to protect yourself financially—can help you make informed decisions about your healthcare. What Medicare Doesn't Cover While Medicare Parts A and B (Original Medicare) cover hospital stays, doctor visits, and certain medical services, they do not include several important healthcare expenses: 1. Dental, Vision, and Hearing Care Medicare does not cover routine dental exams, cleanings, fillings, dentures, eyeglasses, or hearing aids. These services are essential for maintaining overall health, yet they can be costly without supplemental insurance. 2. Long-Term Care If you need help with daily activities such as bathing, dressing, or eating, Medicare won’t cover extended stays in a nursing home or assisted living facility. Medicaid may help those who qualify financially, but most individuals will need other planning strategies. 3. Prescription Drugs Original Medicare does not cover most prescription medications. Beneficiaries must enroll in a Medicare Part D plan or choose a Medicare Advantage plan that includes drug coverage to help with these costs. 4. Overseas Medical Care If you travel outside the U.S., Medicare typically won’t cover your healthcare expenses. Without supplemental insurance, you could face high medical bills if you need care while abroad. 5. Alternative and Cosmetic Treatments Medicare does not cover acupuncture (except for certain cases of chronic pain), chiropractic care beyond spinal adjustments, or elective cosmetic procedures. How to Fill the Gaps in Medicare Coverage Fortunately, there are several ways to protect yourself from the costs Medicare doesn’t cover: 1. Medicare Supplement Plans (Medigap) Medigap policies help pay for expenses such as copayments, deductibles, and coinsurance. These plans, offered by private insurers, can reduce your out-of-pocket costs and provide peace of mind. L earn more about Medicare Supplement Plans → 2. Medicare Advantage Plans Many Medicare Advantage (Part C) plans include additional benefits such as dental, vision, hearing, and even wellness programs. These plans are a great alternative to Original Medicare, offering broader coverage under a single policy. Medicare Part D provides prescription drug coverage and is sold by private insurance companies. Most Medicare enrollees purchase prescription drug coverage as an addition to their Medicare coverage. Learn more about Medicare Advantage (Part C) → 3. Standalone Dental, Vision, and Hearing Insurance Since Medicare doesn’t cover routine dental, vision, or hearing care, separate insurance policies can help cover these essential services. 4. Long-Term Care Insurance Long-term care insurance can help cover the costs of assisted living, nursing homes, and in-home care, reducing the financial burden on families. 5. Travel Insurance with Medical Coverage If you travel frequently, investing in a travel insurance plan that includes emergency medical coverage can provide peace of mind. Get Expert Guidance on Medicare Coverage Navigating Medicare’s complexities can be overwhelming, but you don’t have to do it alone. At Senior Insurance Advisors, we help individuals understand their Medicare options and find the best supplemental coverage to meet their needs. Contact us today to ensure you have the protection and benefits you need for a secure and healthy future!

How does Tricare and VA work with Medicare? Service members who leave active duty may qualify for health care coverage through either the Department of Veterans Affairs (VA) or TRICARE, depending on how they separated from the military. But what happens to your VA or TRICARE benefits when you turn 65, which is the age most people become eligible for Medicare ? Do veterans and military retirees have to take Medicare Part A and Medicare Part B , or do the VA and TRICARE provide enough coverage? It’s all about what works for you. Medicare can add another layer of coverage, protection, cost savings, and convenience if you already have VA benefits or TRICARE. Here’s how. VA benefits and Medicare enrollment You can be enrolled in benefits through Veterans Affairs (VA) and Medicare at the same time. Having both gives you more options for care, as well as the flexibility and freedom to choose providers within the VA or with a non-VA provider in your Medicare network. Plus, Medicare Advantage plans can come with extra benefits that most veterans don’t receive through the VA, such as dental, vision, gym memberships, over-the-counter allowances and transportation benefits. How Medicare and VA benefits work together Although you can have benefits through Veterans Affairs (VA) and Medicare, you’ll need to choose which benefits you want to use when receiving care: To use your VA benefits, you must visit a VA doctor or VA medical facility. The VA may also cover care at a non-VA facility if it’s preauthorized. To use your Medicare benefits, you must receive care at a Medicare-authorized facility. In some cases, Medicare may also be able to pay for services the VA has not authorized. What Medicare does and doesn’t cover will depend on your plan, where you’re receiving care, and which benefits you plan to use — if you can use both. TRICARE and Medicare enrollment As a veteran, your coverage under TRICARE ends once you become eligible for Medicare. That means you’ll need to enroll in Medicare Parts A and B during your Initial Enrollment Period to avoid any lapse in TRICARE coverage. When you enroll in Medicare Parts A and B, TRICARE will automatically switch to TRICARE For Life (TFL). TFL acts as supplemental coverage for your Medicare plan. That means Medicare is your primary payer, while TFL reduces or eliminates out-of-pocket costs for deductibles, coinsurance, and copayments. How Medicare and TRICARE work together When you have Medicare and TRICARE For Life, you can visit any authorized provider. Here’s how the two work together to pay your health care costs: The provider will file the claim(s) with Medicare. Medicare will then pay the portion it’s responsible for and send the claim to the TRICARE For Life. TRICARE For Life will pay its portion directly to the provider for the services TRICARE covers. There are so many factors to consider when choosing the Medicare coverage that is right for you, and it can be an overwhelming process. We would love for you to schedule a free consultation to go over your unique needs. We want to empower you to choose the coverage that is the best for you.  Ready to enroll now? Click here to enroll and enter your zip code to get started!

What is the importance of Hospital Indemnity policy? A hospital stay can be upsetting to your health, your wallet and your family. Even if you have other medical insurance, some costs may not be covered. That’s when a Hospital Indemnity insurance can provide a peace of mind in your time of need. Hospital Indemnity insurance complements your existing health insurance by giving you cash to help with the cost your plan doesn’t cover. Unlike standard health insurance, Hospital Indemnity insurance pays you directly. You are paid a set benefit amount, depending on your plan and the length of your stay. And you can use the payment in any way you want. There’s no deductible, and you receive payment even if you have other insurance. How do Hospital Indemnity insurance plans work? The age at which you can apply for Hospital Indemnity insurance varies by provider, but is typically between 18 and 85 years old. A cash benefit is paid for each day your billed for a hospital stay. You simply choose the days of coverage and daily cash benefit. · The number of days you can choose from (3, 6, 7, 8, 9, 10, 21, or 31) · The cash benefit amount per day (from $100 to $600 in increments of $25) · Premiums are age and gender related and they do not increase as you age. If you remain at the hospital for 60 continuous days, your policy benefit period resets, along with most of the additional riders listed below. The other additional riders that can be added are: emergency room services, observation unit monitoring, inpatient mental health services, travel to the hospital or medical facility, ambulance or urgent care center services, cancer diagnosis, outpatient surgery, outpatient therapy and chiropractic, and skilled nursing. How do you get paid? When you need to use your Hospital Indemnity coverage, you can access your benefits by following a few steps. 1) Complete a claim form. 2) Submit the claim form along with any other required information for any covered items. 3) Receive a check in the mail. Hospital Indemnity insurance is a separate insurance product with a distinct purpose and benefits that are paid for specifically covered events. However, the benefit may help lessen the financial impact of your hospital stay, and perhaps it will help you maintain your retirement savings or avoid hardship withdrawals, as you encounter out-of-pocket costs . Choosing A Hospital Indemnity Plan Whether you’re just learning about supplemental health plans, like Hospital Indemnity insurance or actively planning to enroll in them, make sure they have the appropriate coverage to compliment your Medicare coverage. Senior Insurance Advisors will work with you so you’re able to make informed insurance decisions for today and tomorrow. We encourage you to reach out so we can show you how Hospital Indemnity insurance and health insurance together can help you plan for the unplanned.

As we age, managing healthcare costs becomes increasingly important. Many seniors are looking for ways to save on medical expenses and ensure they have sufficient funds for future healthcare needs. One option that has gained popularity in recent years is the use of a Health Savings Account (HSA). While HSAs offer several benefits, they may not be the right fit for everyone. In this blog, we’ll explore the pros and cons of senior health savings accounts (HSAs). What is a Health Savings Account (HSA)? An HSA is a tax-advantaged account that allows individuals to save money for qualified medical expenses. The main advantage of an HSA is its triple tax benefit: Contributions are tax-deductible, Growth (interest or investment earnings) is tax-free, Withdrawals for qualified medical expenses are also tax-free. HSAs are available to individuals who are enrolled in a High Deductible Health Plan (HDHP) , which typically offers lower monthly premiums but higher deductibles. While HSAs are often used by people under 65, they can also be a useful tool for seniors, especially those with Medicare. Pros of Health Savings Accounts (HSAs) for Seniors Tax Benefits: The triple tax advantage is the most compelling reason to open an HSA. Contributions to your HSA are tax-deductible, reducing your taxable income for the year. The funds you contribute also grow tax-free, and any withdrawals for medical expenses are not taxed. This can significantly reduce your overall tax burden. Savings for Future Healthcare Costs: As you approach retirement, healthcare costs can become a major concern. An HSA allows you to save for current and future medical expenses. Unlike Flexible Spending Accounts (FSAs), which have a "use-it-or-lose-it" policy, funds in an HSA roll over year after year, so you don’t have to worry about losing any remaining balance at the end of the year. No "Use-It-or-Lose-It" Rule: Unlike FSAs, which often require you to use the funds within the calendar year or risk forfeiting them, HSAs allow your contributions to carry over indefinitely. This makes them an excellent option for seniors who want to save for larger medical expenses later in life. Can Be Used for Medicare Expenses: Although seniors over 65 are no longer eligible to contribute to an HSA if they are enrolled in Medicare , they can still use the funds in their HSA to pay for a variety of medical expenses, including Medicare premiums, copayments, and even long-term care services. This can help reduce the strain on your retirement savings and keep you financially secure. Flexibility and Control: With an HSA, you have full control over your healthcare spending. You can use the funds for a wide range of medical expenses, from doctor visits and prescriptions to dental and vision care. If you don’t need to use the funds immediately, you can invest the money to grow it for future healthcare needs. Cons of Health Savings Accounts (HSAs) for Seniors Eligibility Requirements: To open and contribute to an HSA, you must be enrolled in a High Deductible Health Plan (HDHP). Many seniors, especially those who are enrolled in Medicare, may no longer meet this requirement. While you can still use existing HSA funds once you are on Medicare, you cannot make new contributions. Contribution Limits: For 2025, the annual contribution limit for HSAs is $3,850 for individuals and $7,750 for families. Seniors aged 55 and older can make additional "catch-up" contributions of up to $1,000. While these limits are generous, they may not be enough for seniors with significant healthcare needs or for those who wish to fully fund their future medical expenses. If you're wondering how to best use your retirement savings, our team can assist with strategies to maximize your funds. Visit Senior Insurance Advisors to learn more. High Deductible Health Plans May Have High Out-of-Pocket Costs: While HDHPs offer lower premiums, the higher deductibles can be a burden if you experience significant medical costs. For seniors, who may face increased healthcare needs as they age, a high deductible can mean that you must pay a substantial amount out of pocket before your insurance begins covering costs. This may make it difficult to manage healthcare expenses in the short term, even if you have an HSA. Limited Use of Funds Before Age 65: If you're not yet 65, using your HSA for non-medical expenses will incur a 20% penalty (in addition to taxes). This can make it difficult to access your HSA funds if you need them for reasons other than healthcare, particularly if you’re under 65 and facing unexpected financial hardship. Is an HSA in Lincoln, Nebraska Right for You? An HSA can be a powerful tool for saving and paying for healthcare costs, especially for seniors who are looking for tax advantages and long-term savings. However, they are not suitable for everyone. If you're on Medicare, you won't be able to make new contributions, but you can still use your existing HSA funds for qualified medical expenses. Additionally, the eligibility requirements and high deductible plans may not align with your current healthcare situation. If you’re considering opening an HSA or want more information about how it fits into your retirement strategy, reach out to our team at Senior Insurance Advisors. We can help you navigate the various options available to ensure that your healthcare and financial needs are met.

Reviewing your Medicare plan might not be at the top of your mind, but it’s something that could make a significant difference in your healthcare costs and coverage. Medicare offers a variety of plans, and they’re not “set it and forget it.” Each year, changes can occur, whether it's in your health needs, available plan options, or even costs. That’s why it’s important to regularly review your Medicare plan. Are you asking yourself, “Do I need to review my Medicare plan?” If so, the answer is yes. Why Should You Review Your Medicare Plan? Medicare plans are not static. They can change yearly in terms of costs, coverage, and the network of providers. Even if you’ve been satisfied with your plan in the past, it’s important to review it annually to ensure it still meets your needs. Here are some reasons why you should consider reviewing your Medicare plan: Your Health Needs May Have Changed As you age, your health may change, and with that, your Medicare needs. For example, you may require more medical care or need new prescriptions. Your current plan might not cover these services or prescriptions, or there might be a better plan available that offers the coverage you need at a lower cost. Reviewing your plan annually ensures that you're covered for any new or ongoing health concerns. Costs Could Increase or Decrease Every year, Medicare plans can adjust premiums, co-pays, deductibles, and out-of-pocket costs. These changes can vary from one plan to another. Even if the changes seem small, they can add up over time. Reviewing your plan will make you certain that you're not paying more than necessary or will help you find a plan that offers similar coverage at a more affordable price. New Plan Options May Be Available Medicare plans can change from year to year, and new plans may become available that better suit your needs. These new plans could offer better coverage or a more affordable option for the services you use most. By reviewing your plan, you have the opportunity to explore new options and make sure you're getting the best deal. Your Current Plan’s Network May Change If your doctor or healthcare provider is no longer in your plan’s network, you could have higher out-of-pocket costs or even have to switch providers. It’s important to review your Medicare plan to ensure your preferred healthcare providers are still in-network , and that you can continue to receive the care you need without unexpected costs. Prescription Drug Coverage May Change Prescription drug coverage ( Part D ) can change annually. If the medications you take are added to or removed from the plan’s formulary, your out-of-pocket costs may go up or down. A review of your Medicare Part D plan can help you avoid paying more for medications than necessary. It’s also important to check if your pharmacy is still in your plan’s network. Check our recent blog about Everything you Need to Know about Medicare Part D Changes in 202 5 . When Should You Review Your Medicare Plan? The best time to review your Medicare plan is during the Annual Enrollment Period (AEP), which runs from October 15 to December 7 each year. During this period, you can switch from one Medicare Advantage (Part C) or Medicare Prescription Drug (Part D) plan to another. You can also enroll in a plan for the first time or drop coverage altogether if it no longer meets your needs. However, it’s important to start reviewing your plan well before AEP. Give yourself time to compare your current plan with other available options, so you can make an informed decision without rushing. How Can Senior Insurance Advisors Help? At Senior Insurance Advisors, we understand how overwhelming Medicare can be, especially with all the changes and options available. Our team is here to simplify the process for you. We can help you review your current Medicare coverage and identify areas where you might be able to save money or improve your coverage. We compare plans to find the right one for your needs, whether it's Original Medicare, a Medicare Advantage plan, or a Part D prescription drug plan. We will answer your questions about coverage, benefits, and any changes that may occur in the upcoming year. We’ll help you understand your options, explain the fine print, and ensure that you’re making the best choice for your health and budget. Ready to Review Your Medicare Plan? Don’t wait for changes to catch you by surprise. Take the time now to review your Medicare plan and make sure you’re getting the coverage you need. Contact Senior Insurance Advisors today for help reviewing your current plan or comparing options for the upcoming year. Our expert team is ready to help you find the best Medicare plan for you.

As we approach 2025, significant changes are on the horizon for Medicare Part D that will impact how prescription drug coverage is managed for seniors. In this blog, we'll breakdown the upcoming changes mandated by the Centers for Medicare & Medicaid Services (CMS) and what they mean for you or your loved ones. Here is everything you need to know about Medicare Part D Changes in 2025. How is Medicare Part D Changing in 2025 1. Prescription Payment Plan Beginning January 1, 2025, the Inflation Reduction Act mandates all Medicare Part D plans, including standalone Medicare prescription drug plans and Medicare Advantage plans with prescription drug coverage, to offer a Prescription Payment Plan. This plan allows enrollees to pay out-of-pocket prescription drug costs through capped monthly installment payments instead of all at once at the pharmacy. This option is particularly beneficial for those facing high cost sharing early in the plan year, as it spreads out expenses over time. 2. Removal of Coverage Gap/Donut Hole Thanks to the Inflation Reduction Act, starting in 2025, annual out-of-pocket costs for Medicare Part D enrollees will be capped at $2,000. The coverage gap (commonly known as the "donut hole") will now be eliminated. This means you will no longer experience a gap in coverage where you are responsible for higher out-of-pocket costs for prescription drugs. 3. Impact on Prescription Drug Costs Seniors enrolled in Medicare Part D can expect potential savings on their prescription drug expenses due to these changes. The redesigned benefit structure aims to address the rising costs of medications and ensure that beneficiaries have access to necessary treatments without facing excessive out-of-pocket expenses. What You Need to Do As these changes take effect, it's important for Medicare beneficiaries to stay informed and proactive. Here are steps you can take to stay ahead of the curve: Review your current Medicare Part D plan to understand how it may be affected. October 1st start consulting with a trusted insurance advisor to explore new plan options that align with your healthcare needs and budget. Stay updated on communications from CMS and your healthcare providers. Look out for your Annual Notice of Change letter from your carrier in September, which will detail any coverage and cost changes effective January 1st. Senior Insurance Advisors is Here to Help At Senior Insurance Advisors, we specialize in navigating Medicare and are dedicated to helping you understand and benefit from these new Medicare Part D changes. Our team can provide personalized guidance, evaluate your coverage options, and ensure you have the right plan in place for 2025 and beyond. The upcoming changes to Medicare Part D in 2025 represent a huge step forward in enhancing prescription drug affordability and access for seniors. By staying informed, you can navigate these changes confidently and ensure that your healthcare needs are met effectively. To schedule a free consultation and learn more about how these changes may impact you, contact Senior Insurance Advisors today. We're here to support you in making informed decisions about your Medicare Part D coverage.

Why is there so misconception about Medicare Advantage Plans Medicare Advantage also known as Part C of Medicare can be a polarizing topic. Some people will say they love their Medicare Advantage Plan and others will warn you to stay away. They have a bit of misconception. If you’ve been checking with some of your doctors about what plans they take, chances are, you have heard some of your providers tell you why Medicare Advantage plans are bad. Over the years, we’ve heard from many providers that do not like Medicare Advantage plans because their payments come slower than they do for Original Medicare or there is so much more paperwork involved to receive approvals. So, are Medicare Advantage plans bad? Not really - they are just misunderstood. All too often, Medicare beneficiaries try to enroll in coverage on their own without free help from a Medicare insurance broker like Senior Insurance Advisors. They often miss some really important details when they do this. Then they are later unhappy with the plan, but it’s not the fault of the plan. It’s simply that they didn’t know the rules before they enrolled. So, let’s dive in on some of the reasons why Medicare Advantage plans are bad for certain individuals. We’ll go over some of the most common things that Medicare beneficiaries have reported to us that they don’t like about these plans. Then you can decide for yourself if you wish to enroll in one or not. Constantly Paying Out of Pocket for Services Medicare Advantage plans usually have copays and coinsurance. When you enroll in a traditional Medicare Supplement like Plan G, you pay a higher premium upfront, but very little out-of-pocket on the back end. No copays for doctor visits, lab work or daily hospital copays. You are only responsible for the Part B deductible. When you enroll in a Medicare Advantage plan, you pay a much lower premium and now, you will pay copays and coinsurance for services as you go along. For example, you might pay $20 for a primary care doctor or $40 to see a specialist. Then that doctor may order an MRI, and you must pay a $200 copay for this service. When you pay a copay at the time of service, the copay gets deducted from the annual out of pocket maximum. Each Medicare Advantage Plan has a Summary of Benefits. This Summary lists all the costs in detail. Your agent will review this information with you. If you carefully review the summary up front, then there should be no surprise to you. Unfortunately, people fail to read the fine print, and then they end up thinking that their Medicare Advantage plan is bad. This is not the fault of the plan but rather a failure by the enrollee to do his due diligence upfront. They Mistakenly Think They Don’t Have to Pay for Their Medicare Part B Premium Medicare Advantage plans are paid by Medicare. When you enroll in a plan, Medicare pays the insurance company to take on your health risk. Many Medicare Advantage plans will set very low premiums or a $0 premium for the plan itself. However, the $0 premium is confusing to beneficiaries. Many of them think that a $0 premium means they don’t have to pay for Part B. This is false. You will still pay for Part B the entire time that you are enrolled in a Medicare Advantage plan. Smaller Networks and Referrals Most Medicare Advantage plans have local, or nationwide networks, so the plan’s entire network might only have a few thousand providers. However, if you stay with Original Medicare and enroll in a Supplement plan, you would have access to nearly a million providers nationwide. Many people enroll in a Medicare Advantage plan without realizing this. They fail to check with their favorite doctors and hospitals to confirm they participate in the plan’s network. Then they go to use their coverage, and their doctor turns them away because they don’t accept that coverage. This one is really easy to avoid by checking the plan’s provider directory online before you enroll in the plan. Be sure that you confirm the doctor’s participation in the EXACT plan name of the plan that you are thinking about. Some insurance companies operate multiple networks. For example, United Healthcare may have an HMO plan and a PPO plan in your area. Your doctor may participate in one but not the other. If you check the wrong directory, you could come up with a false result. If you travel often, a Medicare Advantage plan may not be right for you. However, most plans do have nationwide networks. Which means, if you see a doctor and they accept your plan it will be consider in network even though you’re outside the service plan area. Getting a referral If you enroll in a Medicare Advantage plan with an HMO network, then you will usually have to choose a primary care provider. Most plans do not require a referral to see a specialist. High Out-of-Pocket Maximums Medicare Advantage plans all have an Out-of-Pocket Maximum (OOPM) limit to protect you from high out of pocket costs. This is a good thing! It protects you from spending beyond a certain dollar amount each year on Part A and B services. The downside is that plans can set that OOPM as high as $8,850 in 2024. For people on fixed incomes, coming up with $8,850 in a calendar year is a lot. Prior Authorizations Insurance companies are always looking to make sure something is reasonable and necessary. These plans typically involve a greater requirement for your provider to get pre-authorizations before approving services. Sometimes that authorization request might get denied. We see this a lot on medications. The drug is listed in the plan’s formulary, but in the fine print, it requires prior authorization or a quantity limit. The Expertise of a Local, Licensed Agent Senior Insurance Advisors offers a valuable opportunity for beneficiaries to get ready and plan for Medicare . By understanding the basics of Medicare, evaluating your current coverage, exploring your options, reviewing your medications, and seeking professional guidance, you can make informed choices that ensure you have the right coverage for your healthcare needs. Meet with our advisor so you can secure the peace of mind and financial security that proper healthcare coverage offers. With careful consideration and proactive planning, you can confidently navigate your Medicare Enrollment, knowing that you've optimized your healthcare coverage. Call us to schedule a consultation and secure your medical future today!