Medicare Solutions

Medicare is health coverage run by the federal government. It serves people 65 and older, plus some younger adults with disabilities. The program comes in parts, and each part has one job. Learn what those parts do, and the rest of Medicare gets much simpler.

Part A and Part B together are called Original Medicare. That is the government side of the program. Parts C and D and Medigap are all sold by private insurance companies. Those companies must follow rules that Medicare sets.

Neither path is better for everyone. Each one trades something away. Original Medicare with a supplement gives you wide doctor access and steady, predictable bills. Medicare Advantage gives you a lower monthly premium and extra benefits, in exchange for using a network.

Medicare runs on set enrollment windows. Miss one, and you may wait months for coverage to begin. You may also pay a penalty for life. These are the windows that matter most.

Still working at 65? Your next step depends on the size of your employer. Small employer coverage usually pays after Medicare, so delaying Part B can be costly. If you put money in a health savings account, stopping those deposits on time also matters. Our turning 65 guide walks through the full timeline.

There is no single price tag. Your cost depends on the path you pick, your income, and your health. Most people pay nothing for Part A. Nearly everyone pays a monthly premium for Part B, and that amount is reset each year.

Here is how that plays out. Two neighbors in Orange each take three medicines and see a cardiologist. One picks Original Medicare with a Plan G supplement. She pays more each month, then pays almost nothing when she gets care. The other picks an Advantage plan with no extra premium. He pays less each month, then pays a copay at every visit and test. After a busy year, their totals can land close together.

Drug coverage is where most people overpay. Every Part D plan has a formulary, which is the plan's list of covered drugs. Two plans can cover the same drug at very different prices. The plan with the lowest premium is often not the cheapest for your list.

What Makes One Drug Plan Cheaper Than Another?

• The formulary, meaning which drugs the plan covers at all.
• The tier your drug sits on, which sets your share of the cost.
• The pharmacies in the plan's preferred network, which change every year.
• Rules such as prior approval, or trying a cheaper drug first.
• Whether mail order lowers the price on a long term medicine.

Part D now has a yearly limit on what you pay out of pocket for covered drugs. Once you reach that limit, your covered drugs cost you nothing more that year. Medicare sets the limit and adjusts it over time. Ask us for the current figure, or look it up on Medicare.gov.

Plan quality is local. A carrier can be excellent in one county and thin in the next. In Orange County, the real question is which hospitals and medical groups a plan includes. That detail is worth checking before you sign anything.

• Which hospital systems a plan includes, such as Hoag, UCI Health, Providence, or MemorialCare.
• Which medical group an HMO plan assigns you to, since that group controls referrals.
• Whether your specialists sit in the same group as your primary doctor.
• Whether the plan covers routine care when you spend months out of state.
• Whether the plan offers care in your language, including Spanish, Korean, Vietnamese, or Mandarin.
• How Medicare rates the plan, using the star rating system.

California also gives Medigap members a second chance every year. Under the state birthday rule, you may move to a plan with equal or lesser benefits. No health questions are asked. The window opens on your birthday and closes quickly, so put it on the calendar.

Trial rights matter too. Join a Medicare Advantage plan for the first time, then change your mind, and you get a protected window. During it, you may return to Original Medicare and buy a Medigap policy without health questions. That safety net works once, so use it with care.

The best plan on paper is rarely the best plan for a real person. Your doctors and your prescriptions decide the answer.

We are an independent agency, so no single carrier owns our advice. We sit on your side of the table and compare plans across many companies. Our job is to shrink a confusing market down to two or three real options. Then we explain the trade-offs in plain words and let you choose.

Our California license number.

0718082Our California license number.

Languages we can serve you in.

5Languages we can serve you in.

Ways to meet: office, video, or phone.

3Ways to meet: office, video, or phone.

Our help costs you nothing. Carriers pay agents, and plan prices stay the same whether you enroll with us, online, or by phone. What changes is the guidance you get along the way. Meet us at our office at 2135 N Pami Circle in Orange, or by video or phone. Call (714) 922-0043 when you are ready.

We give you advice. The government gives you the rules. Both are worth using, and they answer different questions. Use the official sites for enrollment dates, premiums, and the figures for the current year.

• Confirm your Part A and Part B start dates through Social Security.
• Look up the current standard Part B premium before you set a budget.
• Search plans and drug prices in your own ZIP code.
• Check whether a specific test or service is covered.
• Call us for the judgment calls, since a rule book cannot weigh your life.