An Essential Guide for Medicare Advantage Plans

by | Feb 5, 2025 | Medicare Advantage, Rules & Enrollment

As your trusted Medicare experts, Emerald Medicare is committed to helping you navigate your healthcare options with ease. Medicare Advantage (Part C) plans are a popular choice among beneficiaries, offering comprehensive coverage with additional benefits not included in Original Medicare. If you’re considering Medicare Advantage, this guide will walk you through how these plans work, their benefits, and how to choose the best plan for your needs.

What is Medicare Advantage?

Medicare Advantage (Part C) is an alternative to Original Medicare (Parts A & B) offered by private insurance companies approved by Medicare. These plans bundle hospital (Part A), medical (Part B), and prescription drug coverage (Part D) into one all-inclusive plan. Many also offer extra benefits like dental, vision, hearing, and even wellness programs—making them an attractive option for those seeking added value beyond traditional Medicare.

With Medicare Advantage, all healthcare services are managed through your plan’s network of doctors, hospitals, and pharmacies. While this structure helps control costs, it’s important to understand how provider networks function before enrolling, and how this may limit your options for medical care.

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What Do Medicare Advantage Plans Cover?

Unlike Original Medicare, which requires separate coverage for prescriptions (Part D) and supplemental benefits (Medigap), Medicare Advantage plans integrate multiple types of coverage into a single, bundled plan. Here’s what’s typically included:

Hospital Coverage (Part A) – Inpatient stays, skilled nursing facility care, and some home healthcare services.
Medical Coverage (Part B) – Doctor visits, outpatient services, diagnostic tests, preventive care, and durable medical equipment.
Prescription Drug Coverage (Part D) – Most Medicare Advantage plans include built-in drug coverage, covering a range of prescription medications.

 

Additional Benefits – Many Medicare Advantage plans also offer:

  • Dental Coverage (routine cleanings, fillings, dentures, etc.)
  • Vision Coverage (eye exams, glasses, and contacts)
  • Hearing Coverage (hearing exams and hearing aids)
  • Fitness Benefits (gym memberships, virtual exercise programs)
  • Transportation (rides to medical appointments)
  • Over-the-Counter (OTC) Allowances (stipends for medical supplies and everyday wellness products)

Because benefits vary by plan, it’s essential to compare options carefully or consult a Medicare expert to find the best fit for your healthcare needs.

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Why Should I Choose a Medicare Advantage Plan?

Medicare Advantage plans combine coverage, convenience, and cost savings into a single plan, making them a great option for many beneficiaries. Here’s why they appeal to millions of Medicare enrollees:

1. Comprehensive Coverage

Unlike Original Medicare, which requires additional plans for prescriptions and supplemental coverage, Medicare Advantage offers all-in-one protection with extra benefits.

2. Lower Out-of-Pocket Costs

Many Medicare Advantage plans have low or $0 monthly premiums, and they cap out-of-pocket expenses, protecting beneficiaries from excessive costs. In contrast, Original Medicare has no limit on annual medical expenses unless paired with a Medigap policy.

3. Extra Benefits Beyond Original Medicare

With dental, vision, hearing, and wellness perks, Medicare Advantage covers services not included in traditional Medicare, making healthcare more affordable and accessible.

4. Preventive Care & Care Coordination

Many Medicare Advantage plans focus on preventive care and managed healthcare, offering case management services, wellness incentives, and telehealth options for added convenience.

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Medicare Advantage vs. Medigap: Key Differences

Understanding the distinction between Medicare Advantage and Medigap (Medicare Supplement Insurance) is crucial when choosing a plan.

Feature Medicare Advantage (Part C) Medigap (Supplement)
Coverage Type Combines hospital, medical, and drug coverage Supplements Original Medicare, filling cost gaps
Network Limited to plan’s provider network (HMO/PPO) No network restrictions—see any provider nationwide who accepts Medicare
Premium Costs Often lower premiums, but may have higher copays/coinsurance Higher premiums but lower out-of-pocket costs
Out-of-Pocket Maximum Yes (protects against high medical bills) No limit on costs under Original Medicare
Extra Benefits Includes dental, vision, hearing, fitness, etc. No additional benefits beyond medical cost coverage
Prescription Drug Coverage Usually included (Part D) Requires separate Part D enrollment
Travel Coverage Limited outside your service area Nationwide and some foreign travel coverage

Medicare Advantage is best for those who prefer bundled coverage and lower upfront costs, while Medigap is ideal for those who want broad provider access and more predictable expenses.

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How to Choose the Right Medicare Advantage Plan

When selecting a Medicare Advantage plan, consider the following:

🔹 Provider Network: Does your preferred doctor, hospital, or pharmacy accept the plan? HMOs require referrals and network providers, while PPOs offer more flexibility.
🔹 Prescription Drug Coverage: Check the plan’s formulary (covered drug list) to ensure your medications are included.
🔹 Extra Benefits: Need dental or vision care? Want access to telehealth or home fitness programs? Compare added perks to find a plan that suits your lifestyle.
🔹 Out-of-Pocket Costs: Compare premiums, deductibles, copays, and maximum out-of-pocket (MOOP) limits to determine your total expected expenses for the year.
🔹 Star Ratings: Medicare.gov rates plans on a 5-star scale based on customer satisfaction and quality of care. A higher-rated plan often means better coverage and service review from real beneficiaries.

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How to Enroll in a Medicare Advantage Plan

You can enroll in a Medicare Advantage plan during specific enrollment periods:

📌 Initial Enrollment Period (IEP) 
Starts 3 months before you turn 65 and continues 3 months after your birthday month.
📌 Annual Enrollment Period (AEP) 
October 15th – December 7th each year. You can switch, join, or drop a Medicare Advantage plan.
📌 Medicare Advantage Open Enrollment Period
January 1st – March 31st each year. If you’re already enrolled in a Medicare Advantage plan, you can switch to a different plan or return to Original Medicare during this time.

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Explore Medicare Advantage with Emerald Medicare

Choosing a Medicare Advantage plan is an important decision that requires careful consideration of your healthcare needs, provider preferences, and financial situation. At Emerald Medicare, we’re dedicated to helping you find the best-fit plan with zero-cost expert guidance.

If you’re considering a Medicare Advantage plan or need help comparing options, we’re here for you! Click below to schedule an appointment with one of our expert brokers through Calendly or contact us directly:

Contact Us:
Phone: (888) 683-6372 or (845) 358-1220
Email: office@emeraldmedicare.com

 

Click below to schedule an appointment with one of our Medicare Experts.

Mark Brownstein, CSA® | Calendly

An Essential Guide for Medicare Supplement Plans

by | Jan 30, 2025 | Medicare Supplement, Rules & Enrollment

As your dedicated team at Emerald Medicare, we understand that navigating the Medicare enrollment process can be overwhelming. That’s why we’re here to provide clarity on one of the most valuable options available to Medicare beneficiaries: Medicare Supplement Insurance, also known as Medigap. This comprehensive guide will walk you through what Medigap plans are, how they work, and how they can benefit you by filling the gaps left by Original Medicare.

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What are Medicare Supplement (Medigap) Plans?
A Comprehensive Guide

A Medigap plan (Plan G, Plan N, etc.) is private health insurance designed to work alongside Original Medicare (Parts A & B).

While Original Medicare provides broad coverage, it doesn’t cover everything. For example, beneficiaries are still responsible for certain deductibles, co-pays, coinsurance, and out-of-pocket costs. Medigap plans help cover these “gaps” in Medicare, providing financial protection and peace of mind.

Here’s how it works:

  • Original Medicare pays for its share of covered healthcare services (typically 80% of approved costs).
  • Medigap plans help pay for the remaining out-of-pocket costs, like the 20% co-insurance on doctor visits or hospital stays.

What Do Medigap Plans Cover?

Medigap plans can help pay for various out-of-pocket expenses that Original Medicare doesn’t cover. Depending on the Medigap plan you choose, it may cover:

  • Medicare Part A coinsurance and hospital costs
  • Medicare Part B coinsurance or copayments
  • The first three pints of blood used in a medical procedure
  • Part A hospice care coinsurance or copayments
  • Skilled nursing facility care coinsurance
  • Part A deductible
  • Part B deductible (for some older plans)
  • Part B excess charges
  • Foreign travel emergency coverage (up to plan limits)

Each Medigap plan is standardized, meaning that the benefits for each plan type are the same no matter which insurance company offers the plan. For example, Medigap Plan G from one insurance company will offer the same benefits as Medigap Plan G from another. However, premiums can vary based on things like your home state, income, and more, so it’s essential to compare offerings or work with a Medicare broker, like our team at Emerald Medicare, to find the best plan for your needs and budget.

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Why Should I Choose a Medigap Plan?

Medigap plans, as opposed to Medicare Advantage (Part C) plans, are particularly beneficial for individuals who:

  • Want predictable healthcare costs: If you want to avoid unexpected out-of-pocket expenses, a Medigap plan can provide peace of mind by covering those costs.
  • Travel frequently: Some Medigap plans offer coverage for medical care when traveling outside the U.S. (a benefit not offered by Original Medicare).
  • Need frequent medical care: If you visit doctors or specialists regularly or require frequent hospital stays, Medigap plans can help reduce the financial burden of these services.
  • Prefer flexibility in healthcare providers: Unlike Medicare Advantage plans, Medigap plans don’t have network restrictions. You can see any doctor or specialist nationwide who accepts Medicare.

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Medigap vs. Medicare Advantage: What’s the Difference?

It’s essential to understand that Medigap and Medicare Advantage plans are different, and you cannot have both – only one or the other.

  • Medigap works with Original Medicare (Parts A and B) to cover out-of-pocket medical costs, like co-insurance and/or certain deductibles. However, as prescription medications are not covered by Medigap plans, you are also required to enroll in a Part D plan (Prescription Drug Plan) when enrolling in a Supplemental plan. In tandem, A Medigap plan + a Prescription Drug Plan is a highly comprehensive option for a higher monthly premium – with less restrictions than Medicare Advantage. Any doctor’s office in America will accept your Medigap insurance as long as their office accepts Medicare.
  • Medicare Advantage (Part C) is an alternative to Medicare Supplement + Part D coverage that combines hospital, medical, and drug coverage into one all-encompassing plan, often including additional benefits like dental or vision. However, Medicare Advantage plans all have their own unique network of ‘preferred’ medical providers that beneficiaries are limited to, meaning the patient will be 100% financially responsible for services received from Out-Of-Network doctors. Furthermore, some Medicare Advantage plans provide less comprehensive drug coverage when compared to dedicated Prescription Drug Plans (Part D) and their formularies.

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How to Enroll in a Medigap Plan

You can enroll in a Medigap plan during your Initial Enrollment Period [IEP] – which begins as you approach age 65 – after enrolling in Original Medicare (Parts A & B). This six-month IEP window is critical because during this time, you have guaranteed issue rights, meaning insurance companies can’t deny you coverage or charge higher premiums based on your health status. After this period, you may still be able to apply for a Medigap plan, but insurers can use medical underwriting to determine your eligibility and rates.

How to Choose the Right Medigap Plan

Choosing the right Medigap plan depends on your specific healthcare needs, budget, and lifestyle. Here are a few tips to help you decide:

  1. Assess your current health needs: If you frequently visit doctors or specialists, a Medigap plan that covers Part B copayments and coinsurance can be very beneficial.
  2. Consider your travel habits: If you travel frequently, especially outside the U.S., look for a Medigap plan that includes foreign travel emergency coverage.
  3. Plan for the long term: While some Medigap plans may have higher premiums, they can save you money in the long run by limiting out-of-pocket expenses.
  4. Consult with a Medicare broker: A licensed Medicare broker, like the experts at Emerald Medicare, can help you compare different Medigap options, review costs, and find the plan that best suits your needs.

For advice on choosing a Prescription Drug Plan, read our Blog Post to learn more:  

Blog: How to Choose a Part D Plan

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Explore Medigap Options with Emerald Medicare

At Emerald Medicare, we’re here to help you make informed decisions about your healthcare. Medigap plans can be a great way to secure financial peace of mind while ensuring that you get the care you need. Our team of licensed Medicare experts will guide you through the process, helping you understand your options and choosing a plan that fits your unique needs.

If you’re interested in learning more about Medigap plans or need help finding the right one for you, we’re here to help. Click below to schedule an appointment with one of our expert brokers through Calendly, or contact us directly:

Contact Us:
Phone: (888) 683-6372 or (845) 358-1220
Email: office@emeraldmedicare.com

Click below to schedule an appointment with one of our Medicare Experts.

Mark Brownstein, CSA® | Calendly

Medicare Eligibility & Enrollment

by | Sep 13, 2024 | Original Medicare, Rules & Enrollment

As your trusted Medicare resource with Licensed Medicare experts, we know that understanding Medicare eligibility and the enrollment process can often overwhelming or confusing. Whether you’re approaching age of 65 or considering retirement, or navigating Medicare eligibility for yourself or a loved one, this guide will help clarify who qualifies for Medicare and how to navigate the enrollment process.

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Who Qualifies for Medicare?

1. Age-Based Eligibility

The most common way to qualify for Medicare is by reaching the age of 65. If you or your spouse have worked and paid Medicare taxes for at least 10 years (40 quarters), you’re eligible for premium-free Medicare Part A (hospital insurance). Medicare Part B (medical insurance) is available for a monthly premium based on your adjusted gross income from your tax return income from 2 years prior.

2. Disability-Based Eligibility

If you’re under 65 but have been receiving Social Security Disability Insurance (SSDI) for at least 24 months, you automatically qualify for Medicare. You’ll receive Medicare Parts A and B, just like someone who qualifies based on age. Based on the health insurance you have access to currently you may or may not accept Part B at that time.

3. End-Stage Renal Disease (ESRD)

Individuals of any age with End-Stage Renal Disease (ESRD), requiring regular dialysis or a kidney transplant, qualify for Medicare. Coverage usually starts the first month of dialysis if you apply promptly.

4. Amyotrophic Lateral Sclerosis (ALS)

If you have ALS, you automatically qualify for Medicare the first month you start receiving SSDI benefits, with no 24-month waiting period.

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How to Apply for Medicare

1. Automatic Enrollment

Already Receiving Social Security: If you’re already receiving Social Security benefits, you’ll be automatically enrolled in Medicare Parts A and B when you turn 65. Your Medicare card will arrive in the mail about three months before your 65th birthday. Based on your specific situation if you are working or covered through your spouse you may keep your company coverage or consider Medicare options at this time. If you choose to keep the company coverage you would need to reject your Part B so that the premium for Part B does NOT come out of your social security check. This decision is an important one and our suggestion is to consult with an experienced Medicare advisor to guide you properly to your best course of action at this stage.

2. Manual Enrollment

If you’re not receiving Social Security benefits, you will need to be proactive in signing up for Medicare on your own when the time is right. You can do this through the Social Security Administration (SSA) website, by phone by scheduling an appointment, or in person at your local SSA office. Consult a medicare expert to ensure you avoid timing and/or penalty issues. 

3. Initial Enrollment Period (IEP)

The Initial Enrollment Period is a seven-month window that includes the three months before your 65th birthday, the month of your birthday, and the three months after. This is your first opportunity to sign up for Medicare Parts A and B. This ONLY applies to individuals who are self-employed, unemployed or working for a company of less than 20 employees. This is often a very often misunderstood aspect of Medicare.

4. Special Enrollment Period (SEP)

If you’re still employed (for a company greater than 20 employees) and covered by an employer’s health plan, you can delay enrolling in Part B without penalty. Once your employment ends, you’ll have an eight-month Special Enrollment Period to sign up for Part B before you would incur a penalty. Each person’s situation is different based on the cost of Cobra for you and your family and the quality and details of coverage your company provides.

5. General Enrollment Period (GEP)

Missed Initial Enrollment: If you miss your Initial Enrollment Period and don’t qualify for a Special Enrollment Period, you can enroll in Medicare during the General Enrollment Period, which runs from January 1 to March 31 each year. However, a late enrollment penalty may apply.

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Understanding Medicare Parts A and B

Medicare Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.

Medicare Part B (Medical Insurance): Covers doctor visits, outpatient care, preventive services, and medical supplies.

Understanding these components is crucial for selecting the right coverage and avoiding potential penalties. To learn more, click below to read our blog post on Medicare Parts A and B. 

An Essential Guide for Medicare Parts A & B

Take Charge of Your Medicare Journey with Emerald Medicare

Navigating Medicare eligibility and enrollment can be overwhelming, but you don’t have to do it alone. Our team of Licensed Medicare experts is here to guide you through every step of the process, ensuring you make informed decisions about your healthcare coverage. Click below to schedule an appointment with one of our expert brokers through Calendly, or contact us via the provided phone number or email.

Contact Us:
Phone: (888) 683-6372 or (845) 358-1220
Email: office@emeraldmedicare.com

Click below to schedule an appointment with one of our Medicare Experts.

Mark Brownstein, CSA® | Calendly

An Essential Guide for Medicare Parts A & B

by | Aug 27, 2024 | Original Medicare, Rules & Enrollment

At Emerald Medicare, we know how important it is for you to have a clear understanding of your healthcare options. In this post, we’ll break down Medicare Parts A and B — often referred to as “Original Medicare” — to help you make informed decisions about your health coverage.

What is Medicare Part A?

Part A (Hospital Coverage) covers essential services such as inpatient hospital stays, home health care, and skilled nursing facility care. Together with Medicare Part B, these services form the core of Original Medicare.

Q: “Is Medicare Part A free?”

A: Most people don’t pay for Part A if they have paid Medicare taxes (FICA) while working. However, if you don’t qualify for premium-free Part A, it can be purchased for a monthly premium. The exact amount may vary based on how long you or your spouse worked and paid Medicare taxes.

What is Medicare Part B?

Part B (Medical Coverage) is designed to cover doctor visits, outpatient services, X-rays, lab tests, and preventive screenings. It’s a key component of your healthcare, granting you access to a wide array of medical services.

Q: “Do you need Medicare Part B?”

A: Yes and No; If you have health insurance through a current job or your spouse’s employer plan, you can delay your Medicare Part B enrollment without penalty*. Once the employer coverage ends, you have an eight-month window to sign up for Part B. Further, you MUST be enrolled in Medicare Part B if you want to sign up for a Medicare Advantage and/or MediGap plan. Reviewing the costs associated with your employer coverage is essential when making this decision.

*company providing coverage must be greater than 20 employees.

How Do Parts A and B Work Together?

Together, Medicare Parts A and B provide coverage for both hospital and medical care at 80% coverage. While Part A focuses on inpatient care, Part B covers all outpatient services, making them complementary in providing comprehensive healthcare coverage throughout retirement & beyond the age of 65.

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Key Points to Consider

Enrollment

When you’re eligible, you can enroll in both Medicare Parts A and B through the Social Security Administration (SSA). Enrollment for original Medicare is automatic if you’re already receiving Social Security benefits. However, if you are not collecting Social Security, you’ll need to be proactive and sign up either by going online to SSA.gov, In-Person to your local Social Security office, or by calling Social Security for a phone appointment.

Coverage

Original Medicare covers the essentials, but there are services it doesn’t include, such as prescription drugs (covered via Part D), routine dental or vision care, and/or hearing aids. Understanding these gaps is crucial as you consider additional coverage options like Medigap or Medicare Advantage plans.

Costs

While Part A is typically premium-free, Part B comes with a standard monthly premium which can increase based on your income. When you apply for Part B, your income level is calculated using your tax return from 2 years prior. Additionally, depending on your supplemental coverage, you should expect some out-of-pocket costs, such as deductibles, co-pays and coinsurance. The amount will vary depending on the plan you choose.

Emerald Medicare is your Trusted Medicare Resource.

Making the right decisions about your Medicare coverage can be confusing, timely, and/or stressful. If you have questions about Medicare Parts A and B, or need help navigating your options, our team of Licensed Medicare experts is here to assist throughout retirement & beyond.

Contact Us:
Phone: (888) 683-6372 or (845) 358-1220
Email: office@emeraldmedicare.com

Click below to schedule an appointment with one of our Medicare Experts.

Mark Brownstein, CSA® | Calendly

Understanding Underwriting in Medicare Supplement

by | Aug 22, 2024 | Medicare Supplement, Rules & Enrollment

While Medicare Advantage (Part C) plans never require medical underwriting, understanding underwriting and guaranteed issue rights is key for anyone considering a Medicare Supplement Insurance plan (MediGap). By learning how these processes work and how underwriting requirements differ across states, individuals can make more informed decisions about their healthcare coverage options.

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What is Underwriting?

Underwriting is a process used by insurance companies to evaluate an individual’s health status, medical history, and other risk factors before issuing a MediGap policy. If a beneficiary is being underwritten, it helps insurance companies assess the likelihood of future claims, and thereby determine if the individual would be accepted into the plan or if any premiums adjustments would need to be made to offer coverage.

It’s important to note that there is NO underwriting for your initial enrollment into Medicare; this is when you turn 65, or leave your employer-provided credible coverage after the age of 65.

Why Do I Have to Go Through Underwriting to Get a Medicare Supplement Insurance Plan?
Underwriting is necessary for Medicare Supplement Insurance plans to ensure that individuals are eligible for coverage and to determine the cost of their policies. By assessing an applicant’s health status and medical history, insurers can better manage risk and maintain financial stability. Underwriting also helps prevent adverse selection, where individuals with higher healthcare needs are more likely to purchase coverage, leading to higher costs for everyone.

What is Guaranteed Issue?

Medigap guaranteed issue is a consumer protection where you can’t be turned down for a policy or be charged more than others in your age group. Guaranteed issue rights virtually allow individuals to enroll in a Medicare Supplement Insurance plan without undergoing underwriting during certain situations, such as when they are first eligible for Medicare or when they experience a qualifying event.

Which states have NO underwriting for Medicare Supplement Insurance plans?

Connecticut, Massachusetts, Maine, and New York are the 4 states that have no underwriting requirements for Medicare Supplement Insurance plans. In these states, individuals have guaranteed issue rights all year long, which means they will never undergo medical underwriting if they are able to apply for Medicare Supplement coverage. This ensures they cannot be denied coverage or charged higher premiums based on their health status upon enrolling in a new Medigap plan.

What if I live outside of Connecticut, Massachusetts, Maine, or New York?

In some other states, including California, Louisiana, Idaho, Illinois, Nevada, Oregon, and Maryland, specific rules grant Medicare-Supplement beneficiaries guaranteed issue rights during the month of their birthday. This means that enrollees are allowed to select any Medigap plan available in their area WITHOUT going through medical underwriting during a 30-day window following their birthday each year. It’s important to check in with your Medicare broker or a reliable Medicare-expert to confirm the terms & conditions for underwriting in your home state.

Contact Us:
Phone: (888) 683-6372 or 845-358-1220
Email: office@emeraldmedicare.com

Click below to schedule an appointment with one of our Medicare Experts.

Mark Brownstein, CSA® - Calendly
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