What Medicare Advisors Recommend for Medicare Coverage

What do a NASA rocket scientist, a plumber and a kindergarten teacher have in common? Medicare would confuse the snot out of all of them!

So, can’t we just tell you what coverage to pick and let you move on with your life? Well, as with everything around Medicare, it’s more complicated than that. We’d love to hand down a perfect answer from on high, but the plan you should go with really comes down to your situation.

And there are over 20,000 different plans out there.

Ari Parker—lead advisor for Chapter, a Medicare guidance company—says when a Medicare advisor recommends coverage, they’re looking at both a person’s needs and wants.

“Based on someone's particular health care providers, prescriptions and preferences, there is almost always one coverage that stands out as the right fit for that person,” he said.

That’s why everyone should talk to a Medicare advisor. They know how each plan relates to each nuance of your situation so they can recommend coverage that’s the ideal fit for you.

 

Understanding Medicare Coverage Options

To understand Medicare recommendations, you have to understand the coverage. Let’s take a look at the basics.

Medicare comes in four parts:

• Part A: hospital insurance

• Part B: medical insurance

• Part C: Medicare Advantage (a bundling plan run by private insurers that can include extra coverage)

• Part D: prescription drug coverage

Parts A and B together are called Original Medicare. People who opt for Original Medicare often buy extra coverage called Medigap that helps cover their share of Medicare costs.

Part C (aka Medicare Advantage) is parts A, B and usually D bundled together with (sometimes) a few other coverages like vision and dental. Medicare Advantage plans have networks (specific providers you have to use), while Original Medicare lets people go pretty much wherever they want for care.

Now let’s look at each part more closely.

Medicare Part A (Hospital Insurance)

Part A is your hospital insurance. It covers inpatient hospital stays, skilled nursing facility care, hospice and some home health care.

For about 99% of people, Part A premiums are free.¹ To qualify, you must have worked 10 or more years and paid into Social Security for that time.

The inpatient hospital deductible is $1,632 for 2024. After 60 days, you’ll also have coinsurance to pay.²

Medicare Part B (Medical Insurance)

Part B covers your medical expenses like doctor visits, outpatient care, preventive services, durable medical equipment, certain services not covered by Part A, and also some home health care.

Everyone has to pay premiums for Part B. In 2024, the standard monthly premium is $174.70. The yearly deductible is $240.³ You also have to cover coinsurance with Part B.

Medicare Part C (Medicare Advantage)

So far, it’s been fairly straightforward. Well, get ready to board the crazy train.

Connect With Our Recommended Medicare Advisors Now for Annual Enrollment

Part C is not actually a third part of Medicare coverage that helps pay for a third set of health-related expenses. Instead, it’s the name of a private Medicare plan that bundles parts A and B with some random extra coverages. These are decided by the insurer but can include dental, hearing and vision, along with prescription drug coverage (most of the time). You’ll only carry one card with this plan—which is the only simple thing about it.

Premiums, deductibles, copayments and out-of-pocket maximums all vary by insurance company.

Medicare Part D (Prescription Drug Coverage)

Part D is the only part that feels like it kind of makes sense because it covers prescription drugs. (D for drugs. Get it?) Part D is also through private insurance companies—not directly through the government.

Also similar to Part C, the costs for Part D vary based on the company you go with and the plan you choose. Some plans have no premium at all, while others do. In 2024, the average Part D premium was projected to be $55.50.⁴ You’ll have a yearly deductible and a cost-share amount to cover with each drug.

 

Medicare Advisor Recommendations

With all these choices and confusing plans, it sure would be nice to have a guide like Gandalf to make sure you get the most out of your Medicare journey! While Medicare advisors don’t wear a pointy grey hat, they do stay with you every step of the way, helping you know when to enroll, what to pick, and how to get the best value out of Medicare and keep it working it for you.  

Comprehensive Coverage Strategy

Every good advisor will tell you that your main concern is to make sure you’re fully covered. The difficulty is, there are lots of different ways you can achieve this with Medicare—and then there’s the fact that everyone’s situation is different.

Parker says Original Medicare by itself will have some serious gaps.

“What we’ll recommend is coverage that will cover those gaps,” he said.

Here’s what an advisor will consider when they evaluate plans and recommend one for you:

• Chronic conditions: Does the plan provide coverage for ongoing treatments and medications you may need?

• Location: What facilities and plans are available based on your address?

• Specialist needs: Does the plan let you use specific specialists and facilities?

• Premiums and out-of-pocket costs: What are the budget considerations for monthly premiums, deductibles and copayments?

• Provider preferences: Does the plan let you use the doctors and hospitals you like?

• Prescription needs: Are your regular medications covered and affordable under the plan?

• Out-of-state coverage: Does the plan cover out-of-state services in case you travel or live in multiple states?

Once an advisor understands your needs, Parker says they’ll find plans that meet those needs. Then they’ll use your preferences to narrow down the plans to find the right fit for you.

In the end, a good advisor will recommend the plan that gives you the coverage you need at a price that works with your budget.

 

Parts A and B Together (Original Medicare)

Everyone getting Medicare needs parts A and B. Period. But that’s almost never enough by itself because Original Medicare still requires you to pay quite a lot out of pocket with no annual maximum. That leaves you pretty vulnerable financially.

You’ve got two options for combatting that: buying Medigap or buying Medicare Advantage.

 

Supplemental Coverage (Medigap)

Medigap doesn’t cover more services—it offers extra coverage for what Medicare already covers. When you receive a Medicare-covered service, Medigap helps cover your share of the costs (deductibles, coinsurance and copays). 

For folks new to Medicare, Parker recommends starting with a Medigap plan because you usually can’t get one later if you change your mind. You’re only guaranteed Medigap coverage during your initial opportunity to sign up for Medicare. If you don’t sign up for Medigap then, you have to go through underwriting (where the insurance company decides if you’re too risky to insure) and usually can’t get it at an affordable price.

“Our perspective is that far more people should be choosing Medigap than are doing so today,” he said. “That’s because they can never take it away from you as long as you pay your premiums.”

The biggest drawback to Medigap is the extra premium. But Parker says you should get Medigap if your goal is flexibility and peace of mind.

Advisors recommend Medigap if you like to have more control over who you see for care. For instance, if you’ve been seeing a doctor for years and don’t want to change, Medigap will let you keep them. This is also the recommended plan if you have health problems that require a lot of specialist referrals.

 

Medicare Advantage Plans

For most people, Medicare Advantage isn’t the best choice. But occasionally, it’s the closest fit with their situation.

Advantage plans only really have a few financial “advantages.” These are:

• $0 premiums (sometimes)

• Dental, vision and hearing coverage (sometimes)

• Defined annual out-of-pocket limit

Yeah, we had to use the word sometimes twice up there. That’s because Advantage plans are offered through private insurance companies contracting with the federal government, so each one is different. Even the plans with $0 premiums are offered only because they often charge more for deductibles and copays.

Parker says there are three situations when he would recommend an Advantage plan to someone:

• They can’t afford the premiums for Medigap.

• They’ve missed their window to enroll in Medigap without underwriting, and it’s unavailable to them because of their health status.

• Their state gives them universal rights to Medigap (meaning they can sign up whenever), so they can try an Advantage plan first to see if they like it—with no consequences.

The $0 premium plans can work well for people who are healthy and don’t use the medical system much. However, you’d still need to weigh that with the downsides of Advantage plans, like being limited to in-network providers. And as you get older, you’ll likely use health care services more—but at that point, switching to Medigap won’t be an option for you.

An advisor might also recommend an Advantage plan for patients who expect to have a lot of medical expenses. But this would be for particular health problems that use the plan’s network of providers and specialists and only when patients anticipate expenses being super high every year. The plan would likely have premiums and an annual out-of-pocket maximum set lower than legally required.

Most Advantage plans make it hard to see specialists and use certain facilities or simply don’t cover them. You have to be very careful when selecting these plans.

 

Choosing the Right Part D Plan

You can either get a Part D plan on its own or through a Medicare Advantage plan. If you go with Original Medicare, you’ll need to pick out a part D plan to complete your coverage. If you go for an Advantage plan, you’ll get the Part D plan that comes with whichever Advantage plan you choose. In other words, you don’t get to pick that out on its own. If you go this route, consider each Advantage plan’s drug coverage as you evaluate the plans overall.

Some things advisors consider when recommending a Part D plan are:

• What’s the plan’s formulary?

• How much are the plan’s premiums?

• What’s the plan’s pharmacy network?

A formulary is the list of drugs a plan covers. These are often broken down further into tiers to help regulate costs (least expensive drugs in the lowest tiers, most expensive drugs in the highest). Each plan has a different formulary, so an advisor will look at what medications you take and compare that to the plan’s formulary to know whether it’s a good fit. 

Premiums on Part D plans can vary—a few even have no premiums. An advisor will do a cost-benefit analysis looking at three factors:

• Does the formulary match your medications?
• How much does the plan cost?
• Does the plan use your preferred pharmacies?

The advisor will then recommend the plan that most closely matches your needs for as little money as possible.

 

Regular Reviews and Updates

Remember, your coverage needs can change. So what an advisor recommends today could be different in one, two or 10 years.

You and your advisor will check in before the Medicare Open Enrollment Period every year to make sure your coverage is still working for you and then make changes if something different would serve you better.

You’ll also want to keep your advisor informed of any big life changes. These could include loss of your spouse’s coverage, changes in your health, or a drastic shift in your finances, like a windfall inheritance or a lot of losing bingo nights. (Oh, wait—it’s the Zoomers playing bingo now. Pinochle then?)

 

Find an Advisor

Don’t settle for just reading about what an advisor might recommend. Talk to one personally and see what plan they recommend for you and your life.

We know—not every advisor on the other end of a phone number is solid. So how do you find a good one? Most advisors make more money selling specific plans, which means they’ll recommend those plans whether they’re good for you or not. Avoid them! Instead, look for an advisor who isn’t tied to any insurance company or plan and can compare lots of plans—not just a couple.

We’ve partnered with a group of Medicare advisors who meet all the standards. The advisors with Chapter make money when you get covered—no matter what plan you pick. They compare 24,000 plans to make sure you’ve got the perfect fit.

And it doesn’t end there. Chapter’s advisors help you get the most out of your plan by scheduling doctor appointments, checking in on how your plan is working, helping you use your benefits, and more. They keep up with Medicare’s ever-changing rules so you don’t have to. If the rules or your situation changes, they’ll help you find a new plan so you can keep living out your retirement the way you want.