Medicare Advantage, Medigap, And New Marketing Rules What Beneficiaries Should Watch For

Medicare beneficiaries today have more choices than ever, especially when it comes to Medicare Advantage, Part C, and Medigap, also called supplement, policies. With all these choices, there is also more advertising and marketing, and regulators have responded with stricter rules to protect consumers.

If you are eligible for Medicare in Texas, it is critical to understand the types of plans available and what to watch for when comparing options.

Medicare Advantage vs Medigap A Quick Overview

Original Medicare, Part A and Part B

• Run by the federal government
• Generally allows you to see any provider that accepts Medicare
• Does not have a strict out of pocket maximum
• Often paired with a Part D drug plan and sometimes a Medigap policy

Medicare Advantage, Part C

• Offered by private insurance companies
• Wraps Part A, Part B, and often Part D drug coverage into one plan
• May include extra benefits such as dental, vision, hearing, and fitness
• Usually uses networks and managed care such as HMO or PPO
• Has an annual maximum out of pocket limit

Medigap, Medicare Supplement

• Sold by private insurers but works with Original Medicare
• Helps pay deductibles, coinsurance, and other gaps
• Has no networks in most cases, so you can see any provider that accepts Medicare
• Typically paired with a standalone Part D drug plan

Why Medicare Marketing Rules Have Tightened

Because Medicare Advantage and Part D plans are sold by private insurers and agents, there has been a lot of marketing activity, sometimes confusing or misleading.

In response, regulators have:

• Tightened rules around TV ads, mailers, and call centers
• Increased requirements for disclaimers and disclosures
• Emphasized that agents must present information in a clear, unbiased way

The goal is to help beneficiaries understand:

• What plans do and do not cover
• Whether their doctors and medications are included
• The trade offs between premiums, networks, and out of pocket costs

What You Should Watch For When Comparing Medicare Plans

1. Are your doctors and hospitals in network

For Medicare Advantage plans, always confirm:

• Your primary care provider
• Any specialists you see frequently
• Your preferred hospital or health system

1. Are your medications covered and at what cost

Check:

• Whether your prescriptions are on the plan’s formulary
• Which tier they fall into
• Any prior authorization or step therapy rules

1. How much could you pay in a bad year

Do not just look at the premium. Compare:

• Maximum out of pocket in Medicare Advantage
• Medigap premiums versus lower cost sharing under Original Medicare
• Potential costs for hospitalizations, surgeries, or ongoing therapy

1. Extra benefits are nice to have, but not everything

Dental, vision, hearing, and fitness benefits can be great, but they should not overshadow the core medical and drug coverage you rely on most.

Why Working With A Licensed Agent Matters

A licensed agent who understands Medicare:

• Can compare multiple Medicare Advantage and Medigap options
• Help you understand trade offs between plans
• Make sure you are aware of important enrollment periods
• Present information in a way that respects CMS rules and guidance

How Insurance Solutions USA Supports Medicare Beneficiaries

Insurance Solutions USA can help Texas Medicare beneficiaries:

• Compare Medicare Advantage and Medigap options side by side
• Review Part D prescription drug coverage choices
• Look at your unique mix of doctors, medications, and budget
• Avoid common pitfalls that lead to higher costs or disruption in care

We strive to provide clear, unbiased education so you can choose what is right for you.

Need help reviewing your Medicare options
Call us at 817 756 1442 or email [email protected].

Medicare Disclaimer
Insurance Solutions USA is not connected with or endorsed by the U S government or the federal Medicare program. We may not offer every plan available in your area. Any information we provide is limited to the plans we do offer in your area. Please contact Medicare.gov or 1 800 MEDICARE for information on all of your options.