Medicare Insurance
Navigating Medicare coverage can feel intricate and overwhelming, but you don’t have to do it alone. At LJ Adams Insurance Services, we specialize in providing personalized Medicare insurance solutions for Arlington residents. With extensive experience in health insurance and senior-focused planning, our agency is a trusted pillar of the community—here to guide you with clarity and care.
How to Get Started with Medicare
If you’re new to Medicare, you are not alone. Many first-time enrollees find the process confusing, especially when comparing coverage options, premiums, and benefits. Each year, thousands of Medicare beneficiaries struggle after reading the handbook or researching plans online. Our team helps simplify the process, offering clear guidance so you can choose a plan that meets your needs, preferences, and budget.
Medicare Advantage
Medicare Advantage—also known as Medicare Part C—combines coverage for hospital stays, doctor visits, and other essential medical services. Many plans also include prescription drug coverage and additional benefits such as routine vision, hearing, dental, and wellness services. For individuals seeking more complete all-risk insurance coverage within a medical plan, Medicare Advantage often delivers more extensive protection than Parts A and B alone.
Enrollment begins three months before the month of your 65th birthday and ends three months afterward.
Some Medicare beneficiaries choose Original Medicare for their health insurance, while others prefer getting their benefits through a private Medicare Advantage Plan. These plans contract with the federal government and are paid a fixed amount per person to provide Medicare benefits.
The Most Common Medicare
Advantage Plans
- Health Maintenance Organizations (HMOs)
- Preferred Provider Organizations (PPOs)
- Private Fee-For-Service Plans (PFFS)
You may also encounter:
- Special Needs Plans (SNPs)
- Provider Sponsored Organizations (PSOs)
- Medical Savings Accounts (MSAs)
Regardless of the plan, you remain enrolled in Medicare. You may still pay a monthly premium for Part B (and Part A if applicable). Each plan has different rules, coverage limits, and cost-sharing structures, so it’s important to evaluate options carefully.
Many MA plans include prescription drug coverage (Part D). If yours does not, or if you have Original Medicare, you may choose to enroll in a stand-alone Part D plan.
How are MA Plans different?
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Networks of providers
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Coverage rules
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Premiums (in addition to the Part B premium)
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Cost-sharing for covered services
Even plans of the same type offered by different companies may have different rules, so you should always check with a plan directly to find out how its coverage works.
Many Medicare Advantage Plans also offer prescription drug coverage (Part D). If you join an MSA plan or a PFFS plan without drug coverage, you can enroll in a stand-alone Part D plan. Remember that people with Original Medicare who want Part D coverage also enroll in a stand-alone Part D plan.
If you have health coverage from your union or employer (current or former) when you become eligible for Medicare, you may automatically be enrolled in an MA Plan that they sponsor. You have the choice to stay with this plan, switch to Original Medicare, or enroll in a different MA Plan. Be aware that if you switch to Original Medicare or enroll in a different MA Plan, your employer or union could terminate or reduce your health benefits, the health benefits of your dependents, and any other benefits you get from your company. Talk to your employer/union and your plan before making changes to find out how your health benefits and other benefits may be affected.
Medicare Supplement Basics
Once you reach age 65, you are eligible for Medicare—our federal health insurance program. But Medicare alone may not cover every cost, which is why many beneficiaries consider purchasing supplemental insurance to reduce out-of-pocket expenses.
Medicare Supplement Insurance (Medigap) fills in the gaps left by Original Medicare, helping pay for copayments, coinsurance, and deductibles. It also gives you freedom to choose your providers—no referrals, no network limitations, and no prior authorization requirements. As long as a doctor or hospital accepts Medicare, your Medigap plan can be used nationwide.
These policies offer the same basic benefits across carriers, with some offering additional options, allowing you to choose the plan that best supports your long-term retirement insurance strategy.
Prescription Drug Plan
Medicare Part D provides prescription drug coverage through Medicare-approved private insurance companies. Part D is optional but recommended if you want comprehensive disease insurance protection for long-term medication needs.
Part D plans vary in:
- Deductibles
- Coverage limits
- Formulary lists
- Co-pay tiers
- Out-of-pocket phases (Initial Coverage, Donut Hole, Catastrophic Coverage)
Each plan has its own formulary—its list of covered medications—which may change annually. If your medication is not listed, you may be responsible for the full retail cost, making it essential to choose a plan aligned with your prescriptions.
Schedule Your Complimentary Evaluation
Experience the LJ Adams Insurance Services difference with a Complimentary Evaluation—tailored specifically for your Medicare coverage, supplemental options, and long-term retirement insurance needs. We take the time to understand your goals so you can choose the protection that aligns with your health, lifestyle, and financial future.
Why Opt for a Complimentary Evaluation?
Personalized Guidance: Our experts assess your individual needs and provide customized recommendations.
Optimal Protection: Explore insurance solutions that offer well-rounded protection for your home, auto, business, Medicare, and senior life planning.
Transparent Insights: We clarify every option, term, and benefit—empowering you to make informed decisions.