Our Adept New Jersey Financial Advisors Help Clients Nationwide Make Sense of Their Medicare Coverage Options
Are you nearing retirement age and gearing up for Medicare enrollment? With specific sign-up periods based on age and circumstances and a plethora of additional coverage choices, navigating the transition to Medicare can be surprisingly complex. Leonard Financial Solutions' caring and capable financial advisors guide clients through enrollment, providing expert guidance and insight that empower you to achieve your retirement objectives. We can help you explore your Original Medicare, Medigap, and Medicare Advantage options, weighing the pros and cons of each plan to find your ideal coverage. Contact us to discover how we could aid your search.
Medicare is a federal insurance program that helps seniors age 65 and older and younger individuals with certain disabilities manage their health care costs. While Original Medicare (Parts A and B) helps pay for wide-ranging medically necessary hospitalization, outpatient, and preventive services, it doesn’t cover everything you may need. Medicare Advantage (Part C) and Medicare Supplemental Insurance (Medigap) plans can include vision, hearing, dental, and other services not covered by Original Medicare.
At Leonard Financial Solutions, our experts get to know your needs and goals, allowing us to offer targeted advice about obtaining security, stability, and comprehensive health coverage in retirement. Read on to learn more about Medicare, your coverage options, and how our trusted financial advisors can assist you.
Understanding What Each Part of Medicare Covers
Medicare contains many parts, each addressing a different aspect of health care. Here’s a brief overview of each part, what it covers, and whether you can expect to pay a premium.
- Medicare Part A. A form of hospital insurance, Medicare Part A helps cover hospitalizations, skilled nursing facility care, hospice care, and home health care. Most people with Part A coverage aren't required to pay a monthly premium because they worked long enough in jobs that contributed to Medicare via payroll taxes. However, you can purchase Part A hospital insurance if you don't qualify for premium-free coverage.
- Medicare Part B. This medical insurance helps cover services from doctors and other health care providers, outpatient care, home health care, and durable medical equipment such as walkers, wheelchairs, hospital beds, and other assistive equipment or devices. It also includes coverage for medical screenings, vaccines, annual checkups, and other preventive services. Everyone pays a monthly premium for Part B, with your modified adjusted gross income determining whether you pay the standard or premium amount.
- Medicare Part C. Also known as Medicare Advantage, Part C Medicare-approved private insurance plans “bundle” Part A, Part B, and usually Part D (prescription drug) coverage with additional benefits like fitness programs, vision, hearing, or dental benefits, or medical transportation services. Though you pay a monthly premium, in some cases, Medicare Advantage plans may have lower out-of-pocket costs than Original Medicare.
- Medicare Part D. Medicare’s prescription drug coverage helps cover the cost of prescription drugs and vaccines. Select a standalone Part D plan or Medicare Advantage plan with Part D benefits and pay a monthly premium to obtain this additional coverage.
- Medicare Supplemental Insurance. Also known as Medigap, these are supplemental insurance policies you can purchase from private companies to help pay for costs associated with Original Medicare.
Examining Medicare Advantage’s Many Benefits
By combining Original Medicare’s Part A hospital insurance, Part B medical insurance, and Part D prescription drug coverage with additional features aimed at improving your overall health and wellness, Medicare Advantage offers an array of enticing benefits. These plans:
- Must cover the same medically necessary services Original Medicare covers
- May also offer additional benefits, like vision, hearing, dental, and medical transportation services, over-the-counter drug coverage, gym memberships or discounts, and other programs promoting health and wellness
- Typically include Medicare Part D prescription drug coverage
- Can offer benefit packages customized to meet the needs of enrollees with certain chronic illnesses
- Have an annual limit on out-of-pocket costs paid for services covered by Medicare Parts A and B, which may result in lower overall out-of-pocket costs than Original Medicare
Types of Medicare Advantage Plans
Medicare Advantage offers different plans catering to wide-ranging individual health care needs and preferences. Some of the most common types of Medicare Advantage plans include the following:
- Health Maintenance Organizations (HMOs). These plans offer comprehensive coverage within a specific network of providers, with a primary care physician coordinating your care. These plans place emphasis on promoting preventive care to help manage overall health and health care costs.
- Preferred Provider Organizations (PPOs). Medicare limits your choice of providers, but PPO plans offer greater flexibility by allowing beneficiaries to seek care from both in-network and out-of-network providers, albeit usually at a higher cost.
- Special Needs Plans (SNPs). These plans are tailored to meet the specific health care needs of people with certain chronic illnesses, disabilities, or other health conditions requiring special care, providing targeted treatment and additional support services.
- Medicare Medical Savings Accounts (MSAs). MSAs pair high-deductible health plans with medical savings accounts, allowing you to control your healthcare spending while still accessing Medicare benefits.
- Private Fee-for-Service Plans (PFFs). Another option for people desiring enhanced choice and flexibility, PFFs let you see any Medicare-approved provider for a specified fee, avoiding referral requirements and network restrictions.
What to Consider Before Buying a Medicare Advantage Plan
Though Medicare Advantage can offer attractive benefits, weighing them against its drawbacks is vital before purchasing a plan. Here are a few things to consider when determining whether a Medicare Advantage plan is right for you:
- Doctor and hospital choice. While Medicare Advantage plans limit your choices to doctors, health care providers, and facilities in that plan’s specific network and coverage area (for non-emergent care), in most cases, Original Medicare lets you go to any doctor or hospital in the United States that accepts Medicare.
- Specialist referrals. Medicare Advantage plans may require you to get a referral from your primary care provider (PCP) if you want to see a specialist; meanwhile, Original Medicare allows you to make appointments with specialists without referrals in most cases.
- Clinical trials and hospice coverage. Though Medicare Advantage plans don’t provide coverage for clinical trials or hospice care, Original Medicare can step in to help you cover some of these costs.
- Preauthorization. Medicare Advantage often requires you to get prior approval from your plan before covering some health care supplies and services, which typically isn’t necessary with Original Medicare.
- Separate Part D prescription coverage. Most Medicare Advantage plans include Medicare Part D prescription drug coverage; however, these policies usually don't allow you to join a separate Medicare drug plan.
- Medigap availability. Unlike Original Medicare, Medicare Advantage doesn’t allow you to purchase Medigap (also known as Medicare Supplemental Insurance) to help cover your out-of-pocket health care expenses.
- Employer and/or union coverage. Sometimes, buying a Medicare Advantage plan could cause you and your family to lose your employer or union insurance coverage; talk with the benefits administrator for your employer or union to ensure you understand how joining a Medicare Advantage plan might affect any other benefits you receive.
Despite their many benefits, Medicare Advantage plans don’t offer much freedom, which is why our seasoned New Jersey financial advisors generally don’t recommend them.
Original Medicare With Medigap Can Offer Comprehensive Coverage With Fewer Rules and Restrictions
Medicare Advantage typically limits your choice of health care providers and has very specific rules that force you to jump through bureaucratic hoops to obtain covered care—and without a Medigap plan, your out-of-pocket costs can quickly mount. If you're searching for comprehensive Medicare coverage that offers greater flexibility and choice and could help defray out-of-pocket costs, we typically favor combining Original Medicare with a supplemental Medigap plan over Medicare Advantage.
Are you ready to explore your options for Medicare coverage? We’re here to help! Our skilled financial advisors patiently explain the available plans to help you find the health coverage that best aligns with your needs.
