1. Medicare Plan Options & Decision-Making Process

Medicare offers three main coverage choices:
Part B Only – Covers outpatient care but leaves significant coverage gaps.
Part B + Supplemental Plan (Medigap) – Fills most coverage gaps, reducing out-of-pocket costs.
Medicare Advantage (Part C) – An all-in-one plan managed by private insurers with lower premiums but network restrictions.

With 10 Medigap plans and 45+ Medicare Advantage plans, choosing the right one requires evaluating costs, networks, and coverage details.

2. Discovery Phase: Finding the Right Medicare Plan for You

Before selecting a plan, consider:
Employment Status: Are you or your spouse still working and covered by an employer plan?
Employer Options: Will your employer’s insurance work alongside Medicare?
Family Considerations: Will your Medicare transition affect a younger spouse or dependents?

Who must enroll in Medicare at 65?
Individuals without employer coverage
Those on COBRA insurance (not considered credible coverage)
TRICARE beneficiaries
Employees at small companies (fewer than 20 employees)
ACA plan holders (Affordable Care Act marketplace insurance)

If any of these apply to you, you must enroll in Medicare Part B when you turn 65 to avoid penalties.

3. Enrolling in Medicare Part B

Initial Enrollment Period (IEP): 7-month window around your 65th birthday (3 months before, the month of, and 3 months after).
Special Enrollment Period (SEP): Available if you delayed Part B due to employer coverage.
Automatic Enrollment: If you’re on Social Security, you’ll be enrolled automatically. Otherwise, you must manually apply.

Tip: If delaying Part B, ensure you qualify for an SEP to avoid lifelong penalties!

4. Comparing Medicare Coverage Options

Medicare Part B Only
Lowest upfront cost but highest out-of-pocket expenses
No coverage for hospital deductibles, coinsurance, or skilled nursing care
Risky without additional coverage

Medicare Supplement Plans (Medigap)
Covers gaps left by Medicare Part A & B
Plans G & N are the most popular
No networks – visit any doctor who accepts Medicare
No referrals or pre-authorizations required
Lifetime coverage with stable, predictable costs

Medicare Advantage (Part C)
Managed by private insurers (e.g., Humana, Aetna, UnitedHealthcare)
Lower monthly premiums but higher out-of-pocket costs
Requires staying within a provider network
May include extra benefits like dental, vision, hearing, and gym memberships
Requires pre-authorizations for some treatments

Key Difference: Medicare Supplement plans offer flexibility and lower medical costs but require a separate drug plan (Part D), while Medicare Advantage plans bundle coverage but come with network restrictions and potential out-of-pocket costs.

5. Choosing the Right Medicare Insurance Provider

Top Medicare Supplement (Medigap) Companies (based on 50,000 clients):
UnitedHealthcare: 57% of clients
Aetna: 15% of clients
ACE/Chubb: 10% of clients

Top Medicare Advantage Companies (for those choosing Part C):
Humana: 32% of clients
UnitedHealthcare: 30% of clients
Aetna: 25% of clients

Tip: The best provider depends on your location, network coverage, and premium stability.

6. Finalizing Your Medicare Decision

Step 1: Compare Costs & Coverage
Monthly premiums, deductibles, and max out-of-pocket costs matter.
Medicare Advantage plans may cost less upfront but can cost more over time if you require frequent care.

Step 2: Consider Doctor & Hospital Access
Do you need a specific doctor or specialist?
Will you be traveling often and need nationwide coverage?
Do you want a referral-free plan?

Step 3: Choose the Right Insurance Carrier
Look for financial stability, network flexibility, and customer reviews.
Consider the long-term rate increases for Medigap plans.

Step 4: Apply for Medicare & Your Chosen Plan
If new to Medicare, sign up for Part B through SSA.gov.
Then, enroll in a Medigap or Medicare Advantage plan through an insurance provider.

Final Thoughts: Get the Right Medicare Plan for Your Needs

Choosing between Medigap and Medicare Advantage is one of the most important financial decisions you’ll make in retirement. Understanding costs, coverage, and enrollment timing ensures you avoid mistakes and maximize your benefits.

Need Help Deciding? Consult a Medicare expert or visit Medicare.gov to compare plans.

Have questions about Medicare? Drop them in the comments! Let’s find the best coverage for you.

The post Choosing the Best Medicare Plan appeared first on ROI TV.

1. What Is the Medigap Open Enrollment Period?

The Medigap Open Enrollment Period begins the first month your Medicare Part B coverage starts and lasts for six months.

Why This Matters

• During this window, insurance companies cannot deny you coverage or charge you higher premiums based on health conditions.
• After this period, you must medically qualify to enroll in a Medigap plan, which means answering health questions and risk being denied.

Once this window closes, your options become more limited—so timing is everything.

2. Benefits of Choosing a Medigap Policy

Medigap policies help cover out-of-pocket costs that Medicare doesn’t pay, such as deductibles and co-pays. Here’s why they’re a preferred option:

Low out-of-pocket costs – The only out-of-pocket cost with a Plan G Medigap policy is the $257 Part B deductible (2025).

No provider networks – Medigap works with any doctor nationwide who accepts Medicare, offering flexibility and portability.

No referrals needed – Unlike Medicare Advantage plans, you don’t need a primary care doctor’s approval to see a specialist.

No pre-authorizations – You and your doctor decide on treatments, not the insurance company.

Lifetime coverage – As long as you keep paying your premium, your policy won’t be canceled.

3. When Should You Enroll in Medicare Part B?

Your Medigap Open Enrollment Period depends on when you sign up for Medicare Part B. Here are the key enrollment periods:

Initial Enrollment Period (IEP)

• Begins three months before your 65th birthday and lasts until three months after.
• Your Part B coverage starts on the first day of your birth month (unless you delay enrollment).

Special Enrollment Period (SEP)

• For those covered by active employer health insurance, delaying Part B is penalty-free.
• Once employer coverage ends, you have 8 months to enroll in Part B and 6 months to enroll in Medigap without medical questions.

General Enrollment Period (GEP)

• Runs January 1 – March 31 each year.
• Coverage begins the following month, but late enrollment penalties may apply.

4. What Happens If You Miss the Medigap Open Enrollment Period?

After the six-month window, insurance companies can deny your application or charge higher premiums based on your health. Here’s what to expect:

Medical Underwriting – You must answer 30+ health questions and disclose current medications.

Risk of Denial – Carriers can reject your application based on pre-existing conditions.

Higher Premiums – If accepted, you may face higher monthly costs due to medical history.

If you don’t qualify for Medigap after missing your open enrollment period, your only alternative may be a Medicare Advantage (Part C) plan—which comes with network restrictions, pre-authorizations, and higher out-of-pocket costs.

5. How to Avoid Medigap Enrollment Mistakes

Don’t Delay Signing Up for Part B – Your Medigap Open Enrollment Period depends on when your Part B coverage begins.

Work With an Independent Medicare Broker – Some agents may push Medicare Advantage plans for higher commissions. A trusted, independent broker will explain all options.

Verify Medigap Plan Options – Compare Plan G, Plan N, and high-deductible options to find the best fit for your health needs and budget.

Plan Ahead – If you’re delaying Medicare due to employer coverage, mark your calendar to enroll in Medigap as soon as you retire.

Final Thoughts: Secure Your Medigap Coverage While You Can

Missing your Medigap Open Enrollment Period could cost you thousands in out-of-pocket expenses or even leave you without coverage. If you’re approaching Medicare eligibility or leaving employer coverage, act fast to lock in affordable, comprehensive Medigap benefits without medical underwriting.

Have questions about your Medigap options? Comment below! I’d love to hear about your experience and help you navigate your Medicare choices.

The post Medigap Open Enrollment: Avoid These Costly Mistakes When Signing Up appeared first on ROI TV.

1. How Employer Coverage & Medicare Work Together

If you’re still working at 65 or older, your employer health plan is usually the first payer, meaning it covers medical expenses before Medicare pays anything. However, Medicare enrollment timing matters, and delaying Part B could impact your ability to enroll in Medicare Advantage or Medigap later. If your employer has fewer than 20 employees, Medicare becomes the primary payer, making it crucial to enroll in Part A and Part B to avoid gaps in coverage.

2. Comparing Costs: Medicare vs. Employer Coverage

Example: If your employer plan costs $300/month with a $4,000 deductible, it might be cheaper to switch to Medicare with a Medigap or Advantage Plan. If your employer covers dependents, keeping employer coverage might be better for family coverage.

3. Should You Keep Employer Benefits Like Dental & Vision?

If your employer offers separate vision and dental coverage, you may keep those benefits while switching to Medicare for medical coverage. Medicare doesn’t cover routine dental or vision unless medically necessary. You can purchase standalone dental & vision plans if you leave employer coverage. If your employer lets you keep only dental/vision benefits, you can still switch to Medicare for better medical coverage while maintaining other perks.

4. When Does It Make Sense to Switch to Medicare?

Switching to Medicare is usually a smart financial decision if your employer coverage is expensive and Medicare offers similar or better benefits, you don’t need family coverage through your employer, you want broader provider access (Medigap allows you to see any Medicare doctor), or you’re worried about rising employer plan costs in retirement.

When to Keep Employer Coverage: If you need coverage for your spouse or dependents, if your employer offers premium discounts that make it more affordable than Medicare, or if you plan to retire after 65 but before 70, and your employer offers bridge coverage.

5. Avoid Medicare Enrollment Mistakes

If you delay Medicare enrollment past 65 without employer coverage, you may face late enrollment penalties for Part B and Part D.

Key Enrollment Rules: If your employer has 20+ employees, you can delay Part B without penalties. If your employer has fewer than 20 employees, Medicare becomes primary, and you must enroll in Part B. When you leave your job, you have 8 months to enroll in Medicare without penalties.

6. Next Steps: How to Choose the Best Option

Compare your employer’s costs (premiums, deductibles, out-of-pocket max) to Medicare + Medigap/Advantage costs. Ask your employer’s HR department if your health plan will continue past 65 and if dependents can stay covered. Enroll in Part B & Medigap/Advantage on time to avoid penalties and delays in coverage.

Need help picking a Medicare plan? Visit MedicareSchool.com to explore your options!

Final Thoughts: Should You Switch to Medicare?

Deciding whether to keep employer health insurance or switch to Medicare depends on cost, coverage needs, and family considerations. For many people, Medicare is more cost-effective and offers better network flexibility, but if you have family members on your employer plan, you might want to keep it a bit longer.

Have you switched from employer coverage to Medicare? Let me know your experience in the comments!

The post Medicare vs. Employer Coverage: Which One is More Cost-Effective? appeared first on ROI TV.