Choosing a Provider

NJ Life and Health Insurance Group is an Insurance Brokerage. This means we work on behalf of the client, not the insurance companies. Our brokers contract with all insurance providers to find the option that is best for the client, free of charge. By organizing our business in this fashion, we are able to lack bias and form life-long client relationship. Our team has a specialized understanding of the current and ever-changing Medicare program, and make choosing insurance plans simple again. Below you will find more specifics about Medicare Supplement and Medicare Advantage Plans. If you need more information you can either check our FAQ’s page for more information, or stop by, call, or visit our website to make an in office or in-home appointment with a Medicare Specialist.

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What is a Medicare Supplement?

Medicare Supplement or “Medigap” Insurance was created to supplement the benefits of Original Medicare (Part A and B). A beneficiary must be enrolled in both parts A and B to apply for a Medicare Supplement. According to the Center for Medicare Services (CMS), Medigap policies must follow federal and state laws, and must be identified as “Medicare Supplement Insurance”. Insurance companies can only offer a standardized policy identified in most states by the letters A though D, F, G, and K through N. All policies offer the same basic benefits.

Basically, a Medicare Supplement is a supplementary insurance plan that can pay for what Original Medicare doesn’t. For example, the standard Plan G covers all Medicare part A and part B copays, the full 20% of remaining part B services, and the Part A deductible ($1,408 for 2021). Medicare with a Supplement allows you to see any Medicare provider in the country with no referrals needed. There is no cap to how much a Medicare Supplement will pay out to cover your health costs. This approach would be paired with a stand-alone Prescription Drug Plan and is known as Option 1 when choosing how to supplement your Medicare. For more information either click here, or please stop by our office or give us a call to make an appointment!

Why should I choose a Medicare Supplement Plan?

Simply put, Medicare Supplements are standardized to be the same between companies. This means that a plan G is a plan G, no matter where you purchase it. It is almost akin to buying a brand-name product at a grocery store; it does not matter which grocery store you go to, you still will be purchasing the same brand name product. The only difference is that you will pay a different price dependent on where it was purchased!

Medicare Supplements can be of a benefit to clients who are looking to pay a reasonable monthly premium for comprehensive coverage. Cost beneficial and comprehensive Medicare Supplement plans usually require the beneficiaries to pay a monthly premium and a small deductible ($203 once a year for part B), which results in full freedom within the Medicare network, no copays, and no coinsurance. This gives most clients piece of mind; knowing that you are covered for virtually anything, anywhere in the United States, and the payments are controlled.

What is an MAPD, Advantage Plan, or Part C?

In its most basic form, an MAPD (also known as Medicare Advantage or Part C) allows you to trade in your rights under Original Medicare to have a private insurance company effectively meet those same benefits. While many of these plans are offered at low to zero-dollar premiums and accompanied by a drug plan, the trade-off is a much smaller network of doctors you can see, similar service costs as if you had stayed on original Medicare, as well as a potential out-of-pocket maximum of $6,700 for the year. This is known as Option 2 when choosing how to supplement your Medicare. For more information, please stop by our office or give us a call to make an appointment!

Why should I choose a Medicare Advantage, MAPD or Part C Plan?

A Medicare Advantage or Part C plan may be beneficial depending on each clients needs and financial situation. Unlike Medicare Supplements, each MAPD is different based on the provider that offers it. Medicare Advantage plans vary in primary care, specialty care, and all other service co-pays. Some companies may offer extra benefits like gym memberships, transportation, and meal services. They also may have coverage for vision and dental, but these are usually reimbursements towards services. Many of these plans are offered at low to zero-dollar premiums and accompanied by a drug plan, which can be of benefit for those clients on a tighter monthly income.  

When enrolling into a Medicare Advantage plan, be sure to coordinate your medical care with the company you are joining. Check that your doctors and hospitals are in the network, and make sure that the company you choose covers your drugs specifically. Lastly, make sure you have a rainy-day fund. There is a potential out-of-pocket maximum of up to $6,700 for covered services in some plans, which resets every year. Simply put, the reasoning behind choosing an MAPD usually lies in the potentially low monthly premium, original Medicare benefits, and extra supplemental benefits; but this is at the cost of network freedom, as well as comprehensive protection.

What is Part D?

Part D of Medicare is your prescription drug coverage. This can be obtained by purchasing a stand-alone Prescription Drug Plan (PDP) alongside a Medicare Supplement Plan or by enrolling in an MAPD. When purchased alongside a Medicare Supplement, this combination is the most comprehensive way to cover your Medicare costs. Please note that if you do not enroll in Part D when first eligible, you may need to wait up to a year to enroll, and you may be charged a premium penalty for the rest of your life. You can find more information on part D here. For a more personalized evaluation, please stop by our office or give us a call to make an appointment!