3 Step Process to Make Medicare Enrollment Easy For You!

Help you understand Medicare A & B in simple terms. Then if you’re not yet enrolled, we can show you how.
Help understand differences between Traditional Medicare and Medicare Advantage so you know all your options and can determine which plan is right for you.
Based on your selection in step 2, we’ll show you how to get the most out of Medicare to include finding you most affordable Drug Coverage. We can also help with Dental, Vision, Long Term Care and Final Expense Plans.

There is Absolutley No Cost or Obligation for Our Services and You are Free to Choose the Plan that’s Right For You!

To talk with one of our Licensed Texas Medicare Insurance Specialists, give us a call or complete the contact form below and we will get right back to you.

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When do I need to enroll?

In most cases you have to enroll in Medicare A&B and have a Medicare drug plan in place within 3 months of your 65th birthday or you may be subject to a penalty. This is would apply unless you are currently enrolled in an employer group plan or some other credible coverage and plan to keep that coverage past your 65th birthday.

A licensed agent is available to answer all your questions and advise you based upon your personal situation.

What is the difference between Medicare Advantage and Traditional Medicare?

Medicare Advantage was designed to save Medicare money and cut their costs. When you enroll in Medicare Advantage (MA), you disenroll from Medicare and the MA plan you choose becomes 100% responsible for all costs of your medical care. Most MA plans incorporate a provider network and may not pay for services out of network or may charge a higher price for services out of network. Some have broader choices, but in almost all cases you must have a Primary Care Provider to navigate you through all provider services to include specialists, hospitals, and other services and you must receive a referral before you can visit these specialists. In addition, because the MA plan is 100% responsible for your cost of care, many procedures and care require preauthorization prior to services being rendered.

In addition, most Medicare Advantage plans require co-payments for doctor visits, specialists, hospital stays, ER, etc. and all have a maximum annual dollar amount you must pay each year for out of pocket expenses and in the event you incur a lot of services in a given year and this ranges from $2500 to $7500 in network, and sometimes as high as $10,000 or more out of network depending upon the plan you choose. In some cases no services will be covered Out of Network except in life threatening emergencies where care is rendered and stabilized but then transferred back in network when it is medically feasible.

Original Medicare is the original program established by the Social Security Administration for the medical care of seniors (those above the age of 65, the qualified disabled, and those with end stage renal disease). Original Medicare allows you to go to ANY DOCTOR, or HOSPITAL in the Continental United States that takes Medicare and allows you to choose your own provider. When on Original Medicare, there are No Co-Payments for services and if you receive a diagnosis and want a second opinion, you can get one without asking permission and Medicare will pay the care as long as the provider accepts Medicare, and the service rendered are a for Medicare approved service.

When choosing Original Medicare there are no copay’s unless you choose a gap policy that requires them! You can go to any doctor or hospital that accepts Medicare. When on Original Medicare we always advise purchasing a Medigap policy in order to cover costs not covered by Medicare. When this is done your maximum out of pocket exposure can be as low as $233 to $0 per year when you choose from the most popular plans which are Plan G or Plan F. Plan N does require co-payments but we typically recommend plan G as we have have found in most situations to be the most cost effective solution for our clients.

What about Drug Coverage? How does that work with Medicare?

Drug Coverage. When enrolling in Medicare we advise you include Drug Coverage when you first enroll even if you are not taking any prescriptions unless you have credible coverage from another source. The reason is if you do not have credible drug coverage in place when you first enroll and later decide to add a drug plan, you could be penalized and have to pay a higher premiums for drug coverage when you do enroll.

If you have decided to stay with Original Medicare, we advise a stand alone Part D prescription drug plan be added to go along with a Medigap policy. One of our licensed professionals can show you how to find the most cost effective drug plan from the large selection of plans (typically 25-30 in each area) based upon the exact list of prescriptions you are currently taking.

If you decided a Medicare Advantage plan is right for you, be sure to include one with drug coverage unless you have other credible drug coverage through another source. Again it is advisable that you include your list of prescriptions in your evaluation of the MA plan because costs of drugs can vary greatly depending upon your list of prescriptions and plan you choose.

One of our advisors can review these details with you and show which plan gives you the most cost effective coverage based upon your specific need and your current list of prescriptions.

Keep in mind that in most cases, you have to keep your drug plan in place for the entire calendar year unless you qualify for a special enrollment period. The annual enrollment period to shop or change your prescription drug Part D Coverage is October 15 through December 7th each year and the effective date for new coverage if you change plans is the first of January the following year.

Mike's Take

Founder & CEO

My experience has shown that staying on Original Medicare and not Medicare Advantage is almost always the better solution for clients. The reason is Original Medicare with a good Medicare Supplement policy allows the client to go to any doctor hospital or provider with little to no out of pocket expense for all Medicare approved charges. In addition, care and treatments is more readily rendered because the provider does not have to get preauthorization for services if they are Medicare approved services. The provider is paid when services are rendered and so the provider is able to bill Medicare and the Medicare Supplement policy for Medicare approved services for medically necessary services as rendered. On a Medicare Advantage plan however the dynamic changes dramatically. Enrolling in Medicare Advantage actually disenrolls you from Original Medicare and Medicare will no longer be paying your provider directly. This is because the Medicare Advantage plan received compensation from Medicare directly when you enroll in their plan and not when services are rendered and for this compensation the plan assumes full responsibility to cover all costs for your care. In addition, the Medicare Advantage plan cannot increase compensation from Medicare unless your health dramatically changes. As a result, services rendered are a direct cost to the Medicare Advantage plan and because it is the plans responsibility to cover these costs, care is often scrutinized and preauthorization is required for many services and in some cases care for certain procedures can even be denied. In our experience, while the up front cost (or monthly premium) to stay on Original Medicare with a good Medicare Supplement policy may exceed the monthly cost of many Medicare Advantage plans, the overall client benefits, assurance of care, and security of client selection and control, make staying on Original Medicare well worth the cost. In addition staying on Original Medicare with a Medicare Supplement greatly limit the exposure client has to future out of pocket costs during the year to as low as $233 per year with a Plan G Supplement vs up to $7,500 to over $10,000 on a Medicare Advantage plan.