What You Need to Know Before Making Your Choices
*IMPORTANT VIDEO WITH PERTINENT QUESTIONS SECTION IS AT THE END OF THE BLOG
In my experience over the past 30+ years of providing financial guidance and portfolio management, few things give clients greater concern than possible changes in their healthcare coverage.
Each year, from October 15 to December 7, Medicare’s Open Enrollment period gives you the chance to review and update your coverage. Whether you’re enrolling for the first time or considering changes to your current plan, this season is about ensuring your health coverage meets your needs-and avoiding unwelcome surprises down the road.
At Gates Pass Advisors, we know how overwhelming Medicare decisions can feel, especially with the wide range of options available. Here are some key considerations to help guide your choices.
Medicare Advantage vs. Medicare Supplement: What’s the Difference?
One of the most significant decisions retirees face is whether to opt for a Medicare Advantage (Part C) plan or a Medicare Supplement (Medigap) policy.
Medicare Advantage Plans
- Bundled coverage (includes Parts A and B, often prescription drugs, and sometimes extras like dental or vision).
- While typically premiums are lower, provider networks are more limited.
- Out-of-pocket costs can be higher, depending on usage and the plan’s rules.
- Great for those who want simplicity and are comfortable with in-network restrictions.
Medicare Supplement (Medigap) Plans
Most of our clients opt for Original Medicare plus a Medicare Supplement.
- The supplement with Original Medicare to cover costs like deductibles, copays, and coinsurance.
- Monthly premiums are higher, but out-of-pocket expenses are more predictable.
- No provider networks: choose any doctor or hospital that accepts Medicare nationwide.
- A good fit if you value flexibility and/or travel frequently.
The right choice depends on your budget, lifestyle, and health needs.
Potential Surprises for New Enrollees
Even with preparation, new Medicare enrollees often encounter unexpected twists:
Prescription Drug Costs
- Not all plans cover medications equally or consistently year over year. It’s common for people to discover their prescriptions fall into higher cost tiers or aren’t covered at all. Checking and verifying formularies is essential.
Provider Networks
- With Medicare Advantage, your favorite doctor or hospital may not be in-network. Confirming access before you enroll can prevent headaches later.
Dental, Vision, and Hearing Gaps
- Original Medicare has limited coverage for most dental, vision, or hearing services. You’ll need supplemental coverage or a Medicare Advantage plan that includes these benefits.
Timing Penalties
- Missing initial enrollment deadlines can mean lifelong penalties, particularly for Part B or Part D. Planning early helps you avoid costly mistakes.
Regional Differences
- Where you live can dramatically shape your options. In California, specific Advantage plans may be more robust in urban areas than in rural communities.
Making Confident Medicare Decisions
Medicare choices aren’t just about the lowest premium or the most popular plan. They’re about ensuring you have the coverage that fits your personal health needs, financial situation, and lifestyle goals.
At Gates Pass Advisors, we integrate your Medicare decisions into your broader retirement and financial plan. We help clients look beyond the surface, considering how healthcare costs will impact cash flow, taxes, and long-term security.
Next Step: If you’re approaching enrollment or considering a switch during this year’s open enrollment window, let’s talk through your options together. Please go to gatespassadvisors.com to schedule a conversation with Esther or Erik. Schedule your no-obligation consultation today
Questions asked in the Medicare Enrollment Video link below :
- How simple or complex is it to select the right Medicare Program? (01:23)
- What is the difference between Medicare D and Medicare Advantage? (05:07)
- If I liked my 2025 plan, can I pick the same plan for 2026? (06:40)
- What is the difference between Medicare Advantage and Medicare Supplement? (08:17)
- Do you help people select the right supplement plan? (12:34)
- How do you, Susan, get paid for your assistance? (13:14)
- Do you anticipate any significant changes in Medicare coverage in 2026? (15:08)
- Can you help people outside of California? (16:25)
- How to reach Susan Lucas (17:56)
LINK TO MEDICARE ENROLLMENT VIDEO
Blog Citations:
California Plan Variations – “Choosing a Medicare Advantage Plan.” California Health Advocates. Link. The best time to plan is before the cost becomes real.
Medicare Open Enrollment Period – “Medicare Open Enrollment Period.” Humana. Link
What You Can Do During Open Enrollment – “What You Should Know About Medicare.” Mercer Advisors. Link
Medigap Basics & Rules – “How Medigap Works.” Medicare.gov. Link
Extra Benefits in Medicare Advantage – “Medicare Advantage vs. Medicare: A Decision Guide.” USC Schaeffer Center for Health Policy. Link
Provider Network Limitations – USC Schaeffer Center for Health Policy. Link
Prescription Drug Coverage & Formularies – “How Medigap Works.” Medicare.gov. Link
Enrollment Deadlines & Penalties – “Avoid Late Enrollment Penalties.” Medicare.gov. Link
Initial Enrollment Period Basics – “Medicare Enrollment.” Anthem Blue Cross California. Link
General Enrollment Period – “Medicare Enrollment Periods: What to Know.” Aetna. Link