How Advocates Help You Find Your Best Healthcare Plan

Introduction

Choosing a health plan is about more than premiums. It is about access to the right doctors, predictable costs, drug coverage that actually matches your prescriptions, and benefits that support your daily life. A skilled advocate researches the plans in your area, translates the fine print, and organizes your choices so you can make a confident decision.

This guide explains how an advocate works with you, what choices you will compare, and how to prepare for a plan review. It also weaves in the key points from the video script on this page so you can follow along while you watch.

To connect with our team at any point, visit https://understoodcare.com/healthcare-info/how-our-care-team-assists-you

What your advocate does for you

Our approach mirrors the plain language from the video

• If you have Original Medicare and nothing else, you usually pay a Part B coinsurance of about twenty percent for covered services after the annual deductible.
• Your advocate presents options. If you are interested in a secondary plan or a Medicare Supplement policy, your advocate compiles the plans available where you live and compares costs and coverage.
• If you want to explore Medicare Advantage, your advocate reviews the local plans and explains benefits, networks, authorizations, copays, coinsurance, and the annual out of pocket limit.
• We do not make changes for you. We prepare and present research, answer your questions, and follow up to see whether you want to act.
• If you choose a Medicare Supplement, that policy can help cover your share of Part A and Part B costs in Original Medicare. If you choose Medicare Advantage, copays may be zero for some services and higher for others. Your advocate shows the exact details so your decision is informed.

Throughout the process, your advocate gathers plan documents and checks provider directories and drug formularies. You get a clear side by side summary instead of a stack of confusing brochures.

For help with related needs like transportation or lowering drug costs, see
https://understoodcare.com/care-types/transportation-help and https://understoodcare.com/care-types/lower-costs-of-medication

Understanding your main choices

Original Medicare by itself

Original Medicare includes Part A hospital insurance and Part B medical insurance. You can see any clinician who accepts Medicare. There is no yearly cap on your out of pocket costs, which is why many people add other coverage.

Original Medicare with a Medigap supplement

A Medigap policy from a private insurer helps pay your share of costs for services covered by Original Medicare. Depending on the specific plan, Medigap may cover part or all of your Part B coinsurance and other approved amounts. You still use Original Medicare and you keep the freedom to see any Medicare participating provider. Medigap policies do not include Part D drug coverage, so you would usually add a separate Part D plan.

Medicare Advantage

Medicare Advantage is another way to receive your Part A and Part B benefits through a Medicare approved private plan. Most Medicare Advantage plans include Part D drug coverage and set an annual limit on what you pay out of pocket for Part A and Part B covered services. Costs vary by plan and service. Many plans use in network providers and may require prior authorization for some services. Extra benefits such as limited dental, vision, hearing, fitness, and transportation may be included.

Part D prescription drug plans

Drug coverage can be included in a Medicare Advantage plan or purchased as a stand alone Part D plan with Original Medicare. Each plan has a list of covered drugs, preferred pharmacies, and specific rules such as prior authorization or quantity limits. Your advocate verifies how your current medications are covered and estimates your yearly costs.

Secondary and other coverage

Some people also have Medicaid, retiree coverage, or coverage from a current employer. These can change how costs are paid and which plans you can join. Your advocate checks coordination rules so you are not surprised by bills.

How an advocate compares plans

Cost

• Monthly premiums for Medigap, Part D, or Medicare Advantage
• Deductibles, copays, and coinsurance for the services you use most
• The plan’s yearly out of pocket limit if you consider Medicare Advantage
• Help programs such as Medicare Savings Programs and Extra Help for drug costs

Coverage

• Your specific medications and dosages on the plan’s formulary
• Coverage rules for injectables, infusions, supplies, and equipment
• Extra benefits that matter to you, such as dental cleanings, hearing aid allowances, fitness, or over the counter credits

Access

• Your doctors and hospitals in network for Medicare Advantage
• Whether your clinicians accept assignment if you keep Original Medicare
• Prior authorization and referral rules and how they affect your care

Support

• Plan star ratings and service history
• Member materials such as Evidence of Coverage and Annual Notice of Change
• Appeals, grievances, and how to get help if problems arise

When the research is complete, your advocate presents an organized summary with plain language notes. You can talk through tradeoffs live or by phone. If you decide to switch, the advocate can prepare a checklist for you to complete enrollment directly with Medicare or with the plan.

To see more ways advocates can reduce daily hurdles, visit https://understoodcare.com/healthcare-info/what-is-a-patient-navigator

What to bring to a plan review

• Your Medicare card and any cards for other health coverage
• A list of your clinicians and facilities, plus any care locations you prefer
• A complete medication list including strength and dose
• Recent Explanation of Benefits and any plan notices you received
• Your care priorities such as keeping a specific specialist, lowering drug costs, reducing paperwork, or adding dental or vision benefits

Timing and key dates

Every year there are windows when you can enroll, compare, or make changes.

• October 15 to December 7 is the national Open Enrollment Period for the next calendar year
• January 1 to March 31 is the Medicare Advantage Open Enrollment Period for people who are already in a Medicare Advantage plan
• Special Enrollment Periods are available for certain life events such as a move, a loss of other coverage, or qualification for Medicaid or Extra Help

As these dates approach, your advocate can review next year’s premiums, changes to your plan’s network or drug coverage, and new options in your county. For a personalized review with our team, start here https://understoodcare.com/

Practical examples based on the video script

• You have Original Medicare only and worry about coinsurance for frequent visits. Your advocate explores Medigap plans available in your state, compares monthly premiums with the potential savings on coinsurance, and clarifies how Medigap works with any future hospital stay or outpatient therapy.
• You want an annual spending cap and combined drug coverage. Your advocate compares local Medicare Advantage plans, confirms your doctors in network, checks whether the plan requires referrals, verifies each medication on the formulary, and lists the plan’s out of pocket limit.
• You are considering a change but do not want anyone to switch your coverage without your say so. We never enroll you. We present research, answer questions, and follow up only if you wish to move forward.

How advocates support the rest of your care

The right plan is a foundation, but daily life still brings tasks. Advocates can arrange rides, coordinate refills, and set up follow up care so your plan benefits are actually usable.

• Transportation help https://understoodcare.com/care-types/transportation-help
• Lower medication costs https://understoodcare.com/care-types/lower-costs-of-medication
• Care coordination and appointments https://understoodcare.com/care-types/appointments and https://understoodcare.com/care-types/care-coordination
• Financial help overview https://understoodcare.com/healthcare-info/financial-help‍

When to call for immediate help

Call if you receive a plan notice you do not understand, a bill that seems wrong, or a letter about prior authorization or network changes. Early action prevents gaps in care. You can reach our team at https://understoodcare.com/‍

Choosing a Health Plan With Confidence: Frequently Asked Questions

• What does an advocate actually do when helping me choose a health plan?
  Your advocate researches the plans available where you live, gathers official documents, checks provider networks and drug formularies, and then translates all of that into clear, plain language. They prepare side by side comparisons of Original Medicare, Medigap, Medicare Advantage, and Part D plans based on your doctors, prescriptions, and priorities. They answer your questions and follow up with you, but you are the one who decides whether to make any changes and you complete enrollment directly with Medicare or the plan.
• How is Original Medicare different from having no other coverage at all?
  With Original Medicare alone, Part A helps with hospital care and Part B helps with outpatient and doctor services. You can see any clinician who accepts Medicare, but you typically pay about 20 percent coinsurance for covered Part B services after your deductible, and there is no yearly cap on your out of pocket costs. That is why many people add a Medigap policy, a Part D drug plan, or choose a Medicare Advantage plan.
• What does a Medigap supplement do for me?
  A Medigap policy is sold by private insurers to fill in some of the gaps in Original Medicare. Depending on the specific Medigap plan you choose, it can cover part or all of your Part B coinsurance and other approved amounts. You still use Original Medicare and can see any clinician who accepts Medicare. Medigap plans do not include prescription drug coverage, so you usually pair them with a separate Part D drug plan.
• How is Medicare Advantage different from Original Medicare with Medigap?
  Medicare Advantage is another way to receive your Part A and Part B benefits through a private Medicare approved plan. Most Medicare Advantage plans include drug coverage, set an annual out of pocket limit for Part A and Part B covered services, and may offer extra benefits like dental, vision, hearing, or fitness. In return, they usually use provider networks and may require prior authorizations or referrals. With Medigap you stay in Original Medicare and pay extra for a supplement that helps with your share of costs, but you do not have a network in the same way. You cannot have Medigap and Medicare Advantage at the same time.
• Do I still pay my Part B premium if I choose a Medicare Advantage plan?
  Yes. You keep paying your Part B premium whether you stay in Original Medicare, add a Medigap plan, or enroll in Medicare Advantage. Some Medicare Advantage plans may offer a partial giveback that lowers what you pay each month, but you still remain responsible for Part B. Your advocate can show how any giveback compares with copays and other costs in real life.
• How does an advocate check if my doctors and hospitals are covered?
  Your advocate starts with your list of clinicians, clinics, and hospitals. For each plan you are considering, they check the plan’s provider directory to see whether your clinicians are in network for Medicare Advantage or accept Medicare assignment if you remain in Original Medicare. They also look at referral rules and prior authorization requirements that might affect how easily you can see specialists. They bring these results into the side by side comparison so you can see how access would change under each option.
• How does an advocate review my medications against plan options?
  You share a complete medication list including drug names, strengths, and how often you take each one. Your advocate checks each plan’s formulary to see if your drugs are covered, whether they are preferred or non preferred, and whether there are special rules like prior authorization, step therapy, or quantity limits. They estimate yearly costs at your preferred pharmacies and highlight any drugs that might become more expensive or need an exception.
• What costs do we compare besides the monthly premium?
  In addition to monthly premiums, your advocate looks at deductibles, copays, and coinsurance for the services you use most, such as primary care visits, specialists, hospital stays, imaging, and physical therapy. For Medicare Advantage plans, they identify the annual out of pocket limit so you know the maximum you could pay for Part A and Part B covered services in a year. They also review help programs such as Medicare Savings Programs and Extra Help if you may qualify.
• What information should I bring to a plan review session?
  It helps to bring your Medicare card and any other insurance cards, a list of your doctors and preferred hospitals, a complete medication list with doses, and any recent Explanation of Benefits or plan notices you have received. You should also be ready to share your priorities, such as keeping a certain specialist, lowering drug costs, adding dental or vision benefits, or having a predictable yearly maximum.
• When can I change my Medicare coverage?
  Most people review and change coverage during specific windows. The main Open Enrollment Period runs from October 15 to December 7 for changes that take effect the next calendar year. If you are already in a Medicare Advantage plan, there is another window from January 1 to March 31 when you can switch to a different Medicare Advantage plan or return to Original Medicare. Special Enrollment Periods may be available after certain life events such as moving, losing other coverage, or qualifying for Medicaid or Extra Help.
• Will my advocate enroll me in a plan or change my coverage without permission?
  No. Your advocate does not enroll you in plans or make changes on your behalf. Their role is to research options, explain the differences in plain language, organize comparisons, and answer your questions. If you decide to change plans, they can help you prepare a checklist and show you how to enroll directly with Medicare or the plan so that the final decision and action stay in your hands.
• Are there free resources besides advocacy that can help me compare plans?
  Yes. Every state and territory has a State Health Insurance Assistance Program that offers free, unbiased counseling about Medicare. These programs are not connected to insurance companies and can help you understand your options. Your advocate can also point you toward official Medicare tools that allow you to compare plans, view star ratings, and review the details of coverage.
• How else can an advocate support my care after I choose a plan?
  Once you are in a plan that fits your needs, there are still practical tasks to manage. Advocates can help arrange transportation to appointments, coordinate refills and prior authorizations, and schedule follow up visits so your benefits are actually used. They can help lower medication costs, track bills, and connect you with community and financial help programs so your coverage supports your daily life, not just your paperwork.
• When should I contact an advocate or my plan right away?
  You should reach out promptly if you receive a notice about changes in coverage you do not understand, a bill that seems higher than expected, or a letter about prior authorization, denials, or network changes that could disrupt your care. Early clarification can prevent gaps in treatment and help you act within important deadlines.

References

• Medicare. Compare Original Medicare and Medicare Advantage. https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/your-coverage-options/compare-original-medicare-medicare-advantage
• Medicare. What does Medicare cost. https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/what-does-medicare-cost
• Medicare. Understanding Medicare Advantage Plans. https://www.medicare.gov/publications/12026-understanding-medicare-advantage-plans.pdf
• Medicare. Compare Medigap plan benefits. https://www.medicare.gov/health-drug-plans/medigap/basics/compare-plan-benefits
• Medicare. What is Medigap. https://www.medicare.gov/health-drug-plans/medigap
• Medicare. Joining a plan and enrollment periods. https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan
• Medicare. How much does Medicare drug coverage cost. https://www.medicare.gov/health-drug-plans/part-d/basics/costs
• Medicare. Get help with costs including Medicare Savings Programs. https://www.medicare.gov/basics/costs/help
• Medicare. Extra Help for drug costs. https://www.medicare.gov/basics/costs/help/drug-costs
• State Health Insurance Assistance Program. Find local Medicare help. https://www.shiphelp.org/ and https://www.shiphelp.org/local-medicare-help

This content is educational and is not a substitute for medical advice. Always consult your healthcare provider for personalized care.