Medicare Plans
Take the stress out of choosing the right Medicare plan!
Medicare Plans
Going onto Medicare can feel like an overwhelming task - after all, most people have had employer sponsored insurance the majority of their lives! Choosing your Medicare plan is an extremely important decision and must be done on the correct timeline in order to avoid penalties, but you don’t have to do it alone.
Our team helps hundreds of Medicare beneficiaries every year choose and manage a plan that works best for their particular needs and budget. We are contracted with all the major A rated companies and have decades of experience with the entire process from start to finish = our clients are aligned with the right plan at the right time.
First, let’s get to know each other. We want to understand your goals, health needs, and budget.
Next we will determine your correct timeline to complete the Medicare process so that you don’t miss any important deadlines and avoid late enrollment penalties. For some, we may recommend postponing Medicare if you qualify for employer-sponsored creditable health insurance (https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/working-past-65).
Now we’re ready to discuss the differences between Original Medicare, Medigap (Medicare Supplement), and Medicare Advantage (Part C) programs. We use the official Medicare & You government handbook so that the guidance we provide is straight from the source and not colored by any particular insurance companies.
Once you have a good understanding of how Medicare functions, then we will review plan options based on your personal needs (doctors, medications, etc.) and budget.
We do all these steps before scheduling a time to complete any necessary enrollment paperwork to ensure that you are confident in your plan choices.
Once we’ve helped you enroll in your chosen plans, our team is available year-round for support and we perform complimentary annual plan reviews.
Request a free PDF of our Medicare Readiness Checklist
-
Original Medicare is broken down into two parts: Part A (Hospital) and Part B (Medical).
Typically, Part A is $0/month if you meet eligibility requirements. Medicare Part A helps with costs for inpatient hospital stays, hospice care, skilled nursing facility (AKA short-term rehab), and more. https://www.medicare.gov/providers-services/original-medicare/part-a
Medicare Part B helps pays for other medical services like doctor visits, preventive care, ambulance, durable medical equipment, and more. In 2026, the baseline price for Medicare Part B is $202.90/month, although some beneficiaries pay a higher price due to late enrollment penalites or IRMAA (high income surcharge).
https://www.medicare.gov/providers-services/original-medicare/part-b
-
Enrolling into Medicare Parts A & B is the 1st step in getting your coverage set up and you must have a valid election period to do so. Your Smart Insurance Solutions® agent will give you direction otherwise you may also call Social Security Administration.
Generally, if you are already receiving Social Security benefits prior to becoming eligible for Medicare, you will be automatically enrolled and should receive your Medicare card by postal mail about 100 days prior to your start date.
If you are not drawing Social Security benefits yet, then you will not be enrolled automatically and you must apply for your Medicare benefits. You may apply securely online: https://www.ssa.gov/medicare/sign-up or may contact Social Security Administration to apply over the phone.
-
Medicare Part D (PDP = Prescription Drug Plan) helps cover the cost of prescription medications. Since Original Medicare does not pay for most prescription medications, it is necessary to obtain a drug plan (Part D) either as an add-on to Original Medicare or as part of a Medicare Advantage program. Medicare drug plans (Part D) are administrated by private companies.
Note: Technically, Medicare Part D is “optional” but you will be assessed a late enrollment penalty (certain exceptions apply) if you do not enroll when you’re first eligible and later choose to enroll during a valid election period like the Annual Enrollment Period (AEP).
Part D plans are allowed to have different drug formularies (list of covered drugs), so it is extremely important to review the details as opposed to purchasing based on monthly price (premium) alone.
Every year during the Annual Enrollment Period (Oct 15 - Dec 7), beneficiaries are allowed to review and make plan change requests.
-
Medicare Supplement, also called Medigap, is a coverage option that pays secondary to Original Medicare. Since Medicare Parts A & B (Original Medicare) do not pay 100%, a Medigap plan can help pay leftover amounts like deductibles and/or coinsurance. The available Medigap plan options are standardized by the government but sold by private insurance companies. You will pay a premium to the private insurance company for this additional coverage.
Medigap plans are designed to work with Original Medicare and cannot be combined with a Medicare Advantage program. You may have to pass medical underwriting in order to purchase a Medicare Supplement plan if you do not do so when you first become eligible for Medicare Part B or turn age 65.https://www.medicare.gov/health-drug-plans/medigap/ready-to-buy
-
Medicare Advantage, also known as Medicare Part C, is a way to obtain your Medicare A & B benefits through a private insurance company. Part C plans are offered by private insurance companies but are funded and regulated by the Federal government.
When you enroll in a Part C plan, the insurance company becomes your Medicare “administrator” and you carry their ID card, use their network of providers, they pay your claims, and you utilize their customer service centers instead of 1-800-Medicare. Part C plans include Medicare A & B benefits and often include extra benefits like Part D, dental, vision, hearing, and a gym membership. Medicare Advantage Plans are not the same as a Medicare Supplement.https://www.hhs.gov/answers/medicare-and-medicaid/what-is-medicare-part-c/index.html
-
Medicare Advantage without Prescription Drug coverage (MA-Only) manages a beneficiary’s Medicare A and B benefits but does not include Part D coverage; for this reason, beneficiaries who have access to creditable drug coverage outside of Medicare, for example through the VA or TriCare for Life, might benefit from this type of a plan.
Your Smart Insurance Solutions® advisor can help you determine whether an MA-Only plan could be right for you.
-
IRMAA (Income-Related Monthly Adjustment Amount) is a Part B and D surcharge for “high-income” individuals. Social Security Administration makes this determination and uses a 2 year lookback rule.
The IRMAA surcharges are added onto your Part B and D premiums.
If you’ve had a life changing event, like retirement, and therefore expect your income to be much lower, then you should consider submitting an IRMAA appeal.
https://www.ssa.gov/forms/ssa-44.pdf
The agents at Smart Insurance Solutions® provide new beneficiaries with the IRMAA charts as part of the initial education process.
-
The Federal government offers a prescription cost assistance program called Extra Help/Low Income Subsidy (LIS) for eligible individuals.
Medicare beneficiaries that qualify for LIS receive assistance with Part D premiums and drug costs.