Leonard Financial Solutions' experienced, patient, and approachable financial advisor in Moorestown, NJ, helps seniors nationwide navigate the ins and outs of Medicare, explore the enrollment process and coverage options, and choose the best plan for their needs

But, before we dive into what options seniors have available for Medicare health insurance, we need to understand what Medicare is to begin with.

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Table of Contents:

couple discussing options for Medicare in MoorestownWhat is Medicare?

Medicare is a complex and nuanced federally funded health insurance program primarily serving individuals aged 65 and older. Whether you're swiftly approaching retirement or simply preparing for the future, understanding how to navigate Medicare enrollment is a crucial aspect of financial planning and paramount to securing access to vital health care services.

Important Facts About Medicare

Unless you have helped a parent or friend navigate Medicare, you might not know any more about it than what you occasionally hear on the news. In fact, many seniors who have had excellent health insurance their whole working lives are totally unprepared to make the transition. That's why we're here!

First, the basics. When you turn 65, you become eligible for Medicare, a federal health insurance program primarily available to individuals aged 65 and older. Medicare provides coverage for various health care services and helps reduce out-of-pocket expenses. Here is an overview of Medicare options available to you when you turn 65:

  • Part A (Hospital Insurance). Medicare Part A covers inpatient hospital stays, skilled nursing facility care for a limited amount of time, hospice care, and some home health services. Most people do not pay a premium for Part A if they or their spouse paid Medicare taxes while working.
  • Part B (Medical Insurance). Medicare Part B covers outpatient medical services, such as doctor visits, preventive care, lab tests, and durable medical equipment. Part B requires a monthly premium, and the amount is income-dependent. It is optional, but most individuals choose to enroll in Part B to have comprehensive coverage.
  • Part C (Medicare Advantage). Medicare Advantage plans, also known as Part C, are offered by private insurance companies approved by Medicare. These plans combine the benefits of Part A and Part B and often include prescription drug coverage (Part D). Medicare Advantage plans may offer additional benefits like dental, vision, and hearing coverage. Premiums, deductibles, and co-pays vary depending on the specific plan (see below).
  • Part D (Prescription Drug Coverage). Medicare Part D is prescription drug coverage. It helps cover the cost of prescription medications and is available through private insurance companies approved by Medicare. Part D plans have different formularies and cost-sharing structures. Premiums and out-of-pocket costs depend on the specific plan and the medications covered.
  • Medigap (Medicare Supplement Insurance). Medigap policies, also known as Medicare Supplement Insurance, are offered by private insurers to help cover the "gaps" in Original Medicare (Parts A and B). Medigap plans pay for some or all of the out-of-pocket costs, such as deductibles, coinsurance, and co-payments. There are different standardized Medigap plans, each offering different levels of coverage. Medigap policies require an additional monthly premium on top of the Part B premium.

You first become eligible to sign up for Medicare three months before you turn 65. Enrolling late can incur penalties and increase your premiums, so it's important to understand your obligations.

What Are Medicare Advantage Plans?

Medicare Part C, or Medicare Advantage Plans, can be cost-effective for many people, providing more coverage for less money than traditional Medicare. You have probably seen the ads on TV—they run constantly during the open enrollment period from October through December each year. They might sound too good to be true, but we can walk you through your options and explain the advantages.

These plans offer:

  • Comprehensive coverage. Medicare Advantage plans provide comprehensive coverage that combines the benefits of Original Medicare (Parts A and B) in a single plan. This means you have one plan that covers hospital stays, doctor visits, preventive care, and other medical services, often including prescription drug coverage (Part D).
  • Additional benefits. These plans may offer additional benefits not covered by Original Medicare, such as dental care, vision care, hearing aids, fitness programs, transportation services, and wellness programs. These extra benefits can contribute to improved overall health and well-being.
  • Cost savings. Advantage plans often provide cost-saving opportunities compared to Original Medicare. They typically have annual out-of-pocket maximum limits, beyond which you won't have to pay for covered services for the remainder of the year. Some plans also have lower premiums than Original Medicare coupled with additional benefits.
  • Care coordination. Advantage plans often include care coordination services. These services can help manage and coordinate your health care needs, ensuring you receive the appropriate care, minimizing duplicate services, and potentially improving health outcomes.
  • Convenient coverage. Advantage plans can simplify health care administration as they often streamline coverage and claims processes into a single plan. This can be beneficial in terms of managing paperwork, understanding coverage details, and tracking health care expenses.
  • Annual enrollment options. Advantage plans have an annual enrollment period during which you can review and switch plans if necessary. This allows you to reassess your health care needs, compare plan options, and make changes to your coverage as required.

Medicare Advantage plans often have provider networks, meaning you might be limited in the doctors and health care facilities you can go to. That's why it's important to work with a knowledgeable advisor who is not tied to any plan or insurance company.

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How Original Medicare and Medicare Advantage Differ

One of the fundamental decisions seniors face when enrolling for Medicare in Moorestown, NJ, (or anywhere in the country) is the choice between Original Medicare (Parts A and B) and Medicare Advantage (Part C). Here are some of the key ways these health insurance programs differ. 

  • Doctor and hospital choice. Original Medicare offers flexibility in choosing health care providers and doesn't restrict individuals to specific networks. If you have Parts A and B, you can go to any doctor or hospital in the United States that accepts Medicare, and, in most cases, you don't need a referral to see a specialist. On the other hand, Medicare Advantage plans often operate within networks, meaning you can only use providers in your designated network and service area for non-emergency care and might need a referral from your primary care provider to see a specialist.  
  • Coverage. Medicare Parts A and B cover most medically necessary services (and supplies) in doctors' offices, hospitals, and other health care facilities, but Original Medicare doesn't cover all routine exams, eye exams, or most dental care. Though Part B only covers limited outpatient prescriptions, you can purchase a Part D plan to get Medicare drug coverage. Meanwhile, Medicare Advantage must cover the same medically necessary services as Original Medicare but may also offer vision, hearing, and dental services. Additionally, most Medicare Advantage plans include Part D prescription drug coverage.
  • Cost. While Original Medicare typically involves separate premiums, deductibles, and coinsurance, Medicare Advantage combines these elements into a single plan with potential cost savings. However, though Medicare Advantage plans tend to have lower premiums, out-of-pocket costs can vary.  

Do you have questions about your Medicare insurance options? Our seasoned financial planning experts can help you compare plans to ensure they meet your specific health care and financial needs.

Why it’s Important to Hire an Experienced Financial Advisor for Medicare Enrollment?

Medicare enrollment is a pivotal task that can profoundly impact your health and financial well-being. Making informed choices can pave the way for greater security and peace of mind in retirement. Fortunately, navigating the enrollment maze doesn't have to be difficult. Our Moorestown financial advisor can guide you through the various facets of the enrollment process, shedding light on eligibility criteria, and providing essential insights to empower your decisions.

Unraveling Medicare Enrollment Period Rules 

Unfortunately, the rules for Medicare in Moorestown can be challenging to decipher, especially regarding enrollment periods. Understanding when—and how—to enroll in Medicare is crucial to avoiding costly penalties and potential gaps in health insurance coverage. Not all Medicare enrollment periods are for signing up for coverage. Some Medicare enrollment periods allow you to make changes to an existing plan. Read on for an enrollment period overview.

Initial Enrollment Period (IEP)

Medicare eligibility typically begins when you turn 65. The Initial Enrollment Period spans seven months, beginning three months before your 65th birthday and including your birth month and the three months following it.

Special Enrollment Periods (SEPs)

Certain life events trigger Special Enrollment Periods that allow you to enroll outside the standard enrollment periods. During a SEP, you can change your Medicare Advantage or Part D plan without paying penalties. Examples of special circumstances that could potentially qualify you for a two-month SEP include:

  • Retiring
  • Losing employer health coverage
  • Moving outside the area your current plan serves
  • Entering or leaving a nursing home
  • Losing service because Medicare discontinues, sanctions, or terminates your plan
  • Receiving financial assistance with Medicare through Part D Extra Help, Medicaid, or the Medicare Savings Programs (MSPs)
  • Enrolling in or being dropped from a State Pharmacy Assistance Program

General Enrollment Period (GEP)

If you missed your Initial Enrollment Period but don't qualify for a Special Enrollment Period, the General Enrollment Period, which runs from January 1st to March 31st each year, provides another opportunity to enroll in Medicare in Moorestown (and around the country).

Annual Enrollment Period

During the Annual Enrollment Period from October 15th to December 7th, you can review and change your existing Medicare Advantage and Part D plan, ensuring that it aligns with your evolving health care needs and preferences.

Medicare Enrollment Penalties

Failing to enroll in Medicare during your Initial Enrollment Period may result in lifelong penalties that impact your premiums for Part A and B. These penalties can accrue for each year of delayed enrollment, leaving you with higher health care costs. However, with Leonard Financial Solutions by your side, our expert advisors can guide you through enrollment, helping you avoid penalties and ensuring a seamless transition into the Medicare system.

Moorestown financial advisor discussing medicare optionsCommon Medicare Enrollment Mistakes

Medicare is a complex program. Enrollment is complicated, confusing, and intimidating for many. Fortunately, a thorough understanding of the enrollment process and working with a trusted financial advisor with Medicare insurance experience can help you avoid common pitfalls. Frequent Medicare enrollment mistakes include: 

  • Missing crucial deadlines
  • Failing to sign up for Part D prescription drug coverage
  • Underestimating the need for supplemental coverage 

Medicare enrollment errors can cost you a lot of money. Therefore, it pays to take advantage of our financial advice. Leonard Financial Solutions' capable and conscientious financial advisors can help you explore your options, meet enrollment deadlines, and confidently navigate Medicare's complexities, providing personalized guidance tailored to your specific health care needs and financial goals. Schedule your free Medicare insurance consultation with a member of our team.

Need Help Navigating Options for Medicare in Moorestown (or Across the USA)?

The system can be overwhelming, but the licensed Medicare insurance financial advisors at Leonard Financial Solutions in Moorestown, NJ, can help. From navigating the enrollment process to assessing the right plans for your needs, we provide thorough information and guidance so you can make truly informed decisions about your financial future.

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When you work with us, you can rest assured the options you choose align perfectly with your overall goals for financial security. Contact us today for a free consultation by clicking the button above or calling 856-444-5433 now. Although we're located in Moorestown, New Jersey, we serve clients from all over the United States.