How Advocates Help You Find Your Best Health 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.

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.

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

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/‍

Frequently asked questions

What is the difference between Medigap and Medicare Advantage

Medigap works with Original Medicare to help pay your share of approved costs such as coinsurance and copays. You keep access to any clinician who accepts Medicare. Medicare Advantage is an alternative way to get Part A and Part B through a private plan that often includes drug coverage, has an annual out of pocket limit, and usually uses a network. You cannot have both at the same time.

Do I still pay the Part B premium if I choose Medicare Advantage

Yes. You continue paying the Part B premium. Some plans offer a partial giveback, but you should look at the full picture of costs and benefits.

Do Medicare Advantage plans always have zero copays

No. Some services may have zero copays and others may have copays or coinsurance. Your advocate checks the specific costs for the services you use.

Can a Medigap policy cover my twenty percent coinsurance

Many Medigap plans cover Part B coinsurance either fully or at a set percentage, depending on the plan you buy. Your advocate reviews the plan chart for your state and explains what each option covers.

How do I know if my medications are covered

Your advocate looks up your drugs on each plan’s formulary, notes any coverage rules, and estimates yearly costs with your preferred pharmacies.

What is an out of pocket maximum

Medicare Advantage plans include a yearly cap on what you pay for Part A and Part B covered services. After you reach that limit, the plan pays for covered services for the rest of the year. Original Medicare does not have a yearly cap unless you add supplemental coverage.

Can I change plans if I make a mistake

Yes. If you enroll in a Medicare Advantage plan and change your mind, the Medicare Advantage Open Enrollment Period from January 1 to March 31 lets you switch to another Medicare Advantage plan or go back to Original Medicare. Special Enrollment Periods may also apply after certain life events.

Who can help me for free besides my advocate

State Health Insurance Assistance Programs provide unbiased counseling in every state and territory. They are not connected to insurance companies and can help you compare options.

Will my advocate enroll me in a plan

No. Your advocate prepares research and walks through your choices so you can enroll directly with Medicare or the plan you choose. This keeps the decision in your hands.

How soon should I start reviewing plans for next year

Start in early October when most changes are available to review. This gives time to compare options before the December deadline.

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.