Medicare Advantage
Insurance Plans
What Is Medicare Advantage?
Medicare Advantage (also called “Part C,” or “MA Plans”) is a way to get your Medicare benefits through a private insurance company, instead of directly through the government.
Here are the key facts:
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It bundles your Part A (Hospital Insurance) and Part B (Medical Insurance) into one plan.
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Most plans also include Part D (prescription drug coverage).
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Many plans offer extra benefits that Original Medicare does not cover, like vision, hearing, dental, or wellness programs. ​
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Who Can Join a Medicare Advantage Plan
You are eligible to join a Medicare Advantage plan if:
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You have both Medicare Part A and Part B.
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You live in the plan’s service area.
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You are a U.S. citizen or lawfully present.
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Why Some Beneficiaries Choose Medicare Advantage Plans
Here are reasons people might prefer a Medicare Advantage plan.
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All‑in‑one plan: Since MA often includes Part A, B, and D, it can be simpler. One plan, one card.
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Extra benefits: Vision, hearing, dental, wellness programs, sometimes fitness memberships or transportation to doctor’s visits. These extras are often not part of Original Medicare.
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Annual out‑of‑pocket max: Helps protect against very high medical costs for Part A & B bills.
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Potential lower costs: Depending on the plan, network, and your health needs, you may pay less in total than you would with Original Medicare + supplemental insurance.
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Possible Disadvantages
It’s also important to know what might not be ideal, so you can compare and choose wisely.
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Network rules: If your doctors are not part of the plan’s network, you may pay more or even need to change doctors.
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Prior authorization: Some plans require approval before covering certain services, specialists, or procedures.
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Plan changes: Benefits, provider networks, premiums, and rules can change every year. You get a notice from your plan (Annual Notice of Change) that tells you what’s changing.
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Travel / out‑of‑area care: If you travel a lot or spend seasons in different states, access may be limited outside the plan’s service area.
How to Choose & What to Ask
If you’re deciding whether Medicare Advantage is right for you, here are good questions and steps:
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What is my budget?
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How much is the monthly premium?
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What are the copayments, coinsurance, and deductibles?
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What is the plan’s maximum out‑of‑pocket cost for the year?
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Which doctors and hospitals are in the network?
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Do my current doctors accept the plan?
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How far will I have to travel for care?
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What extras does the plan offer?
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Vision, hearing, dental, wellness, fitness, etc.
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Are there benefits like transportation or telehealth?
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What are the plan rules?
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Do I need referrals to see specialists?
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Is there prior authorization required for services?
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What will my drug coverage look like?
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If the plan includes Part D, check the formulary (list of covered drugs).
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What are the copays or coinsurance for my medicines?
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Check yearly changes
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Always review the plan’s Annual Notice of Change before the end of the year. What was good last year might change next year.
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Bottom Line
As your insurance agent, here’s what I tell clients in simple terms:
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Medicare Advantage can be a great option if you want everything under one plan, with added benefits, and protection against very high costs.
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It might be less ideal if you want the freedom to see any provider, if you travel a lot.
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The right choice depends on your health needs, budget.
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Medicare Supplement Plans
What Is a Medicare Supplement (Medigap)?
Medicare Supplement Insurance—also called Medigap—is private insurance you can buy to help cover costs that Original Medicare (Parts A & B) doesn’t pay.
Original Medicare helps a lot, but it doesn’t cover everything. For example, you might owe deductibles, copayments, or coinsurance. Medigap helps fill those “gaps.”
How Medigap Works
Here are the key points:
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You must have Original Medicare (Part A and Part B) to buy a Medigap policy.
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You pay the normal Medicare Part B premium (and Part A, if applicable), plus a monthly premium for your Medigap policy.
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When you get care that Original Medicare covers, Medicare pays its share. Then your Medigap policy pays its share of the costs that Medicare doesn’t cover (depending on what plan letter you have).
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Medigap polices are standardized. That means in most states, each letter plan (for example Plan G, Plan N, Plan K, etc.) must offer the same basic benefits no matter which insurance company sells it. The difference between companies is usually the price (premium), customer service, etc.
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Medigap policies are guaranteed renewable, meaning as long as you pay the premiums, the insurance company cannot cancel your policy just because of your health.
When Can You Buy a Medigap Policy
Timing matters if you want to get the best terms. Here are the rules:
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You’ll get a six‑month Medigap Open Enrollment Period that starts on the first day of the month in which you are both aged 65 or older and enrolled in Part B. During this period, you can buy any Medigap policy sold in your state, including ones that have more benefits. The insurance company cannot deny you coverage or charge more because of health problems.
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If you miss that window, you may still be able to buy a Medigap policy, but the insurance company can:
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Deny you coverage based on pre-existing health conditions.
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Charge higher premiums.
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There are also certain guaranteed issue rights under Federal or state law. In specific situations (for example, losing certain Medicare Advantage coverage or moving out of an area), you might have a right to buy certain Medigap policies without being denied or charged more for health history.
What Medigap Does Not Cover
It’s important to know the limits of Medigap so you’re not surprised. Here are things it generally doesn’t cover:
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Prescription drugs (you’ll need a separate Part D Prescription Drug Plan if needed).
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Long‑term care (like many stays in a nursing home when custodial care is needed)
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Dental care, vision care, hearing aids (unless the policy includes some minor extra benefits; many don’t)
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Private duty nursing, or care not covered by Medicare.
Why Some Medicare Beneficiaries Get Medigap
As an insurance agent, here’s how I explain the benefits of Medigap to people deciding if they should buy one:
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Reduce Unexpected Costs
Without Medigap, you can be responsible for things like:-
The Part A deductible for a hospital stay.
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Coinsurance or copays for doctor visits, lab tests, etc.
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Part B deductible (for those plans that cover it).
A Medigap policy can help you avoid large bills, especially if you have frequent medical needs.
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Budget Predictability & Peace of Mind
With a supplement policy, you generally know better what your monthly and annual medical costs may be. When big expenses come (hospital stays, surgeries, tests), you may have much lower out‑of‑pocket cost than with Original Medicare alone. -
Access to Any Doctor that Accepts Medicare
Medigap works with Original Medicare, so you have the flexibility to go to any doctor or hospital that accepts Medicare. You are not limited to a network (unlike some Medicare Advantage Plans). This can be especially important if you travel, have specialists you trust, or want more freedom of provider choice. -
Guaranteed Renewable
Once you have a policy, as long as you pay the premium, your coverage can’t be cancelled just because your health changes. -
Standardization of Benefits
Because each plan letter has the same basic benefits across all insurance companies (in most states), you can compare costs (premium) more easily and choose what works best for your budget.
What Is Long-Term Care Insurance (LTC)
Long-Term Care (LTC) refers to care services that help with everyday living tasks (like bathing, dressing, eating, managing medications, getting around) over a long period of time—because of chronic illness, disability, or aging.
Long-Term Care Insurance is a private insurance policy you can purchase that helps pay for those types of services, either at home, in assisted living, or in a nursing home, depending on the policy.
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Why Long-Term Care Insurance Matters
Planning ahead for long-term care can make a big difference. Here is why:
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Protect your savings and assets. Without LTC insurance, many people end up paying large amounts out-of-pocket for care, sometimes draining retirement savings.
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Maintain quality of life and choice. With LTC insurance, you may have more options in choosing where and how you receive care (at home, facility, etc.) rather than being limited by what you (or family) can afford.
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Peace of mind. Knowing you have a plan in place reduces worry—for you and your family—if illness or disability arises later.
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Flexibility. Many LTC policies offer benefits like home care, adult day care, respite care, assisted living, or nursing home care. Some offer inflation protection or benefit riders so coverage keeps up over time.
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What Medicare and Medicare Advantage Cover (and What They Don’t)
It’s very important to understand what Medicare and Medicare Advantage do not cover when it comes to long-term care, so you can see where LTC insurance fills in.
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Original Medicare (Parts A & B):
Medicare does not cover most long-term care (often called custodial care). That means help with daily living tasks (bathing, dressing, etc.) is generally not covered.
Medicare will cover medically necessary skilled nursing care or rehabilitation, but only for a limited time, under specific conditions (for example after being in hospital). -
Medicare Advantage Plans:
Medicare Advantage plans follow similar rules: they cover what Medicare covers, but they do not generally cover long-term custodial care either. If care is non-medical or helps with daily living without medical necessity, LTC insurance or another source is needed.
So LTC insurance helps cover the “gap” for long-term help that Medicare/Advantage don’t provide.
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When It Makes Sense to Buy LTC Insurance
From my experience helping clients, LTC insurance tends to be a good idea if:
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You expect that you may need help with daily living tasks in the future—especially if there’s family history of chronic illness or disability.
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You want to protect your savings and avoid exhausting retirement or other assets to pay care costs.
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You prefer having choices—care at home vs facility, higher quality, more comfort, etc.
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You’re relatively healthy now (so premiums are lower) and can purchase while younger. Buying earlier often helps cost less.
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You want to leave more for heirs, or avoid burdening family members with caregiving or costs.
Things to Watch Out For
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Exclusions & waiting periods. Some policies have “elimination periods” (you pay first X days on your own), or won’t cover certain pre-existing conditions right away.
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Inflation protection. If policy benefits don’t increase over time, cost of care inflation can erode what your policy can buy decades in the future.
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Policy caps / maximum benefits. Some policies limit how much they pay (maximum dollars, or maximum time).
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Premium changes. Private insurers can adjust premiums, so make sure the policy has rules you understand.
Bottom Line
If I were advising you: LTC insurance is one of those “insurance you hope you don’t have to use, but very glad it's there” protections. Because long-term care can be enormously expensive, and Medicare / Medicare Advantage do notgenerally cover custodial or daily-living help.