Find an all-in-one plan that fits your life. We provide honest, independent advice to help you find a plan that covers your doctors, hospitals, and prescriptions.
Original Medicare pays for your hospital and doctor visits, but many people prefer an “all-in-one” package. This coverage works very similar to health insurance you’ve had most of your life.
Medicare Advantage (also called Part C) plans are offered by private insurance companies. These plans give you all the medical benefits of Original Medicare, plus a “safety cap” that limits your out-of-pocket costs for the year. Most of these plans also include prescription drug coverage, and they often throw in extra perks like dental care, vision, hearing aids, and free gym memberships.
Medicare Advantage plans have local networks of doctors and hospitals. At Senior Benefits NW, we make sure that the plan actually covers your doctors, specialists, and hospitals before you sign up.
HMO (Health Maintenance Organization) HMO plans usually offer the lowest monthly bills—many even cost $0 a month. In exchange, you must use their specific list of local doctors. You also usually have to pick a primary care doctor and get their permission (a “referral”) before you are allowed to see a specialist. If you like staying within one local health system and want to save money, an HMO is a great option.
PPO (Preferred Provider Organization) A PPO gives you much more freedom. You do not need a referral to see a specialist. You are also allowed to see doctors outside of the plan’s network, though you will pay a higher copay if you do. If you travel often or want the flexibility to see any doctor who accepts Medicare, a PPO is the better choice.
You have probably seen the commercials promising free dental care, hearing aids, and money for groceries. While many Medicare Advantage plans do include great extra perks, the insurance companies are starting to change how these work.
They use special “flex cards” with strict spending limits. Some benefits are only available if you have certain chronic health conditions.
Senior Benefits NW helps you look past the flashy ads to see exactly what these extra benefits cover, so you find a plan that actually gives you real, lasting value without any hidden surprises.
We make finding and setting up your Medicare Advantage plan easy and stress-free.
“Blair did a great job explaining our options in choosing between Medicare Supplement and Medicare Advantage plans. His detailed but easy to understand information helped us tremendously in making choices we felt confident in. Highly recommend Blair to anyone embarking on navigating their way through the various choices.”
“Makes it easy. Offers meetings via telephone, video chat or in person. Highly recommend”
This is a built-in safety net that Original Medicare does not have. Every Medicare Advantage plan has a yearly limit on how much you have to pay for covered medical care. If your copays reach that limit during the year, the insurance company pays 100% of your covered medical bills for the rest of the year.
Doctor networks can change. If your doctor leaves your plan’s network mid-year, you usually have to pick a new doctor who is still in the network to keep your costs low. Because this can be frustrating, we try to recommend insurance companies that have a stable history with our local doctors and hospitals.
No. It is against the law to hold both at the same time. They do not work together. Medigap plans only work with Original Medicare, and they cannot be used to pay the copays on a Medicare Advantage plan.
Most Medicare Advantage plans have prescription drug coverage (Part D) built right in. This means you only have to carry one ID card for the doctor, hospital, and pharmacy. We use special software to check your prescriptions and ensure your medications are covered at the lowest possible price.
Some Medicare Advantage plans offer a special benefit where the insurance company pays a portion of your monthly Medicare Part B premium, putting that money back into your Social Security check. It sounds great, but we always check the fine print to make sure they aren’t charging you higher doctor copays to make up for the free money.
Yes. If you have conditions like diabetes or heart issues, there are “Special Needs Plans” built just for you. They offer customized doctor networks, lower copays for the specific drugs you need, and extra benefits to help manage your condition.
Plans are required by law to cover mental health and substance abuse treatments just as fairly as they cover physical medical care. You will not face unfair or inflated copays for mental health support.
You can change your plan every Fall during the Annual Enrollment Period (Oct 15 – Dec 7). If you already have a Medicare Advantage plan, you get one more chance to switch to a different one or go back to Original Medicare between January 1 and March 31.
Your income doesn’t change what plans you are allowed to buy, though people with higher incomes do have to pay a bit more for their baseline Medicare Part B and Part D. Your choice really depends on whether you prefer paying a lower monthly bill (Advantage plans) or paying more upfront so you never see a surprise doctor’s bill (Medigap plans).
The best time to reach out is at least 3 months or earlier before your 65th birthday, or 3 months before you transition off an employer’s health insurance plan. This gives us plenty of time to check your doctors, compare plans, and get your paperwork filed so your coverage starts exactly when you need it, with no late fees.
