What is the difference between Medicare Advantage (Part C) and Medicare Supplement (Medigap)?

Medicare Advantage replaces Original Medicare through a private insurer's network — typically an HMO or PPO — and often bundles dental, vision, and hearing benefits. Medicare Supplement (Medigap) works alongside Original Medicare to cover cost-sharing gaps like copayments, coinsurance, and deductibles, while preserving access to any Medicare-accepting provider nationwide. The right choice depends on your health usage, preferred providers, travel habits, and budget.

Can I have both Medicare Advantage and a Medicare Supplement (Medigap) plan at the same time?

No. Federal law prohibits insurance companies from selling a Medigap policy to someone enrolled in Medicare Advantage. Medigap is designed to supplement Original Medicare (Parts A and B) — not a Medicare Advantage plan. If you want Medigap coverage, you must first disenroll from Medicare Advantage and return to Original Medicare during a valid enrollment period.

Do I need a separate Part D prescription drug plan if I already have Medicare Advantage?

It depends on your plan. Many Medicare Advantage plans bundle Part D drug coverage (called MAPD plans), but not all do. If your plan excludes drug coverage and you skip a separate Part D plan when first eligible, you may face a permanent late enrollment penalty. Always check your plan's Summary of Benefits for drug coverage details and review your medications against the plan's formulary.

What happens if I miss my Initial Enrollment Period for Medicare?

Missing your Initial Enrollment Period — the 7-month window around your 65th birthday — generally means waiting for the General Enrollment Period (January 1–March 31), with coverage starting July 1. Late enrollment in Part B also triggers a permanent 10% premium penalty for each full 12-month period you were eligible but not enrolled. If you have creditable employer coverage, a Special Enrollment Period applies when that coverage ends, protecting you from the penalty.

Why doesn't Wisconsin offer the standard federal Medigap plans like Plan G or Plan N?

Wisconsin opted out of the federal standardized Medigap framework (Plans A–N) and operates under a state-mandated structure regulated by the Wisconsin Office of the Commissioner of Insurance (WI OCI). Wisconsin residents receive a Basic Plan with optional stackable riders — Plans G and N are not available to Wisconsin residents. A licensed Wisconsin agent is essential for understanding your specific rider options and how they compare to federal plan equivalents.

What is a Scope of Appointment (SOA) and why is it required before discussing specific plans?

A Scope of Appointment is a federally required CMS document that records your permission for a licensed agent to discuss specific Medicare product types with you. Under the CMS Contract Year 2027 Final Rule (effective June 2026), the prior 48-hour waiting period has been eliminated — plan discussions can now begin immediately after your electronic SOA is captured. Your SOA is maintained for the required 6-year CMS compliance lookback period.

How do Medicare Advantage network restrictions work — can I see any doctor I choose?

Medicare Advantage HMO plans restrict care to the plan's provider network and typically require referrals to see specialists — out-of-network care is rarely covered except in emergencies. PPO plans offer more flexibility with higher out-of-network cost-sharing. By contrast, Original Medicare plus a Medigap plan allows you to see any doctor or specialist nationwide who accepts Medicare — no referrals, no network limits.

How often can I change my Medicare plan, and what triggers a Special Enrollment Period?

Outside of the Annual Enrollment Period (October 15–December 7) and the Medicare Advantage Open Enrollment Period (January 1–March 31), plan changes are only permitted through Special Enrollment Periods triggered by qualifying life events — moving to a new service area, losing employer coverage, entering or leaving a care facility, or your current plan leaving your area. Changes outside valid enrollment windows are generally not permitted.

Medicare Plans & Guidance | Merit Protection Group

Required Medicare Disclosure: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

Senior couple meeting with a licensed Medicare advisor — plan guidance from Merit Protection Group

Back to Home

Medicare Services

Navigate Medicare with clarity and confidence. We evaluate available plan options to help you find the plan that fits your health needs and budget.

Licensed in WI · AZ · CO·NPN: 20055600·AZ DIFI · CO DOI

Complete Medicare Forms

No Open Enrollment Active

No major enrollment period is currently open. You may still qualify through a Special Enrollment Period if you have a qualifying life event.

Special Enrollment Periods are available year-round for qualifying events such as moving, losing other coverage, or becoming newly eligible.

Find Medicare Plans in Your State

Select your state for a dedicated plan comparison page with your local regulator and verified license credentials. Plan availability varies by ZIP code.

WIWisconsinWI OCINPN 20055600

Compare Plans

AZArizonaAZ DIFINPN 20055600

Compare Plans

COColoradoCO DOILic #952410

Compare Plans

Medicare is federal health coverage for adults 65 and older, or those with qualifying disabilities or medical conditions — it is not the same as Medicaid. If you are looking for Medicaid (income-based state assistance), please visit medicaid.gov or contact your state Medicaid office, as those programs are administered separately from Medicare.

Medicare Eligibility Requirements

Most Americans qualify for Medicare at age 65. Some may qualify earlier based on disability or specific medical conditions.

Age 65 or Older

U.S. citizens or permanent legal residents who have lived in the U.S. for at least 5 continuous years are eligible for Medicare at age 65.

Under 65 with Disability

If you have received Social Security Disability Insurance (SSDI) benefits for 24 months, you automatically qualify for Medicare regardless of age.

End-Stage Renal Disease (ESRD)

People of any age with permanent kidney failure requiring dialysis or a kidney transplant may qualify for Medicare.

ALS (Lou Gehrig's Disease)

If you are approved for SSDI benefits due to ALS, Medicare coverage begins immediately the month your disability benefits start — no 24-month wait.

Part A is premium-free for most people who worked at least 10 years (40 quarters) and paid Medicare taxes. Part B requires a monthly premium for all enrollees.

Medicare Enrollment Periods

Understanding when you can enroll or make changes is critical to maximizing your Medicare coverage.

Initial Enrollment Period (IEP)

7 months around your 65th birthday

Begins 3 months before the month you turn 65, includes your birthday month, and ends 3 months after. This is your first opportunity to enroll in Medicare Parts A and B.

Annual Enrollment Period (AEP)

October 15 – December 7 (every year)

The primary window to join, switch, or drop Medicare Advantage and Part D plans. Any changes take effect January 1 of the following year.

Medicare Advantage Open Enrollment (OEP)

January 1 – March 31 (every year)

If you are already enrolled in a Medicare Advantage plan, you may switch to a different MA plan or return to Original Medicare. Changes take effect the first day of the month after you request them.

Special Enrollment Periods (SEP)

Year-round — qualifying events required

Triggered by qualifying life events: moving to a new area, losing employer coverage, moving into or out of a care facility, or becoming newly eligible for Medicaid.

General Enrollment Period (GEP)

January 1 – March 31 (for late enrollees)

If you missed your Initial Enrollment Period, you can sign up for Part A and/or Part B during this window. Coverage begins July 1. Late enrollment penalties may apply.

Medicare Plan Options

We represent multiple organizations offering Medicare plans in WI, AZ, and CO. Our licensed agents guide you through available plan options.

Medicare Advantage (Part C)

An all-in-one alternative to Original Medicare that combines Parts A and B, often with additional benefits such as dental, vision, and hearing coverage.

Part D — Prescription Drug

Stand-alone prescription drug coverage that significantly reduces your out-of-pocket costs for medications.

Medicare Supplement (Medigap)

Covers the gaps left by Original Medicare — including copayments, coinsurance, and deductibles — for greater financial predictability.

How the Process Works

Complete our secure online intake form with your health and coverage preferences.

A licensed agent reviews available plans in your area.

You receive personalized plan options by email — no phone calls.

Select the plan that fits your needs and we handle the rest.

CMS CY2027 Compliance Preview — Marketing Implementation: October 1, 2026

The CMS Contract Year 2027 Final Rule eliminates the prior 48-hour Scope of Appointment waiting period for the upcoming enrollment cycle. For all current mid-year enrollments conducted prior to October 1, 2026, the standard 48-hour regulatory waiting period between SOA capture and benefit presentation remains strictly observed. Prior Express Written Consent must be freely and explicitly given — pre-checked boxes do not satisfy this requirement. The TPMO disclosure must be provided prior to any plan benefit discussion.

Request Your Medicare Plan Options

Complete this consent form and a licensed agent will reach out to you with personalized plan options.

Full Name *

Email Address *

Zip Code *

State *

Required CMS Disclosure: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Not connected with or endorsed by the U.S. government or the federal Medicare program.

Wisconsin Medicare Notice

Wisconsin does not use the standard federal Medicare Supplement letter plan framework (Plans A–N). Wisconsin residents are covered under the state-mandated Basic Plan with optional stackable riders governed by the Wisconsin Office of the Commissioner of Insurance (OCI). If you are a Wisconsin resident, a licensed agent will explain your specific plan options after you submit this form.

What is a Scope of Appointment?

Under current CMS guidelines, a mandatory 48-hour waiting period applies between your signed Scope of Appointment form and any plan benefit or cost-sharing presentation. Note: Beginning October 1, 2026, under the newly finalized CMS CY2027 standards, this 48-hour delay will be officially removed for the upcoming plan year, allowing for same-day plan consultations. By submitting your information today, a licensed agent will reach out to securely schedule your compliant enrollment window.

Yes, I agree. By checking this box, I provide my Prior Express Written Consent — unchecked and freely given — authorizing Merit Protection Group to contact me via email regarding Medicare Advantage (Part C), Part D Prescription Drug Plans, and Medicare Supplement (Medigap) plans available in my area. I understand that (1) a valid Scope of Appointment (SOA) is required before any benefits presentation under CMS CY2027 rules, (2) I am not required to provide this consent as a condition of purchasing any product or service, and (3) I may revoke this consent at any time by emailing support@meritprotectiongroup.io with the subject line REMOVE.

By submitting, you consent to be contacted by a licensed Medicare agent via email regarding Medicare Advantage (Part C), Part D Prescription Drug Plans, and Medicare Supplement (Medigap) plans available in your area. Your information will not be sold or shared with third parties for marketing purposes. Consent is not a condition of purchase.

Your information is protected under SSL encryption and is never sold or shared with third-party lead aggregators. See our Privacy Policy.

Frequently Asked Questions

Common Medicare Questions Answered

The coverage decisions you need to understand before you enroll — explained clearly.

Find Your Medicare Plan

Complete our secure form and a licensed agent will email you personalized plan options. No phone calls. 100% online.

Complete Medicare Forms

Reviewed by Tammy Finley, State-Licensed Insurance Agent | NPN: 20055600 | Active Licenses: WI OCI · AZ DIFI · CO DOI | Updated July 2026

Financial & Tax Disclaimer: Merit Protection Group does not provide financial, investment, legal, or tax advice. Consult a qualified tax professional or financial adviser before making insurance or financial decisions. Tax implications of insurance products vary by individual circumstance and applicable law.

Cookie Notice

We use cookies to enhance your browsing experience and analyze site traffic in accordance with our Privacy Policy. By continuing, you consent to our use of cookies. Privacy Policy