ACA Insurance 101: What It Is & Why It Matters

Taking the Confusion Out of Health Insurance

Health insurance doesn’t have to be complicated. If you’re under age 65 and not covered by an employer or government program like Medicare, the Affordable Care Act (ACA) may offer you the coverage—and savings—you need.

At F.S.B.G. we’re here to make sense of it all so you can get the health care you deserve, without the stress.

✅ What Is the ACA?

The Affordable Care Act, also known as “Obamacare,” was created to ensure that every American has access to affordable, comprehensive health insurance. Through the Health Insurance Marketplace, individuals and families can shop for private plans—often with financial help available based on income.

💡 What Does ACA Insurance Cover?

Every ACA plan must cover a list of 10 essential health benefits, including:

• Doctor visits

• Hospitalization

• Prescription drugs

• Mental health services

• Preventive care (like vaccines and screenings)

• Maternity and newborn care

• Emergency services

• Pediatric care

Even better? You can’t be denied coverage for pre-existing conditions.

💲 Can You Afford It? (Yes!)

Many people qualify for premium tax credits that reduce their monthly costs. In fact, 4 out of 5 people find plans for $10/month or less after subsidies!

You may also qualify for cost-sharing reductions that lower deductibles and copays.

🔍 Who Is ACA Insurance For?

ACA coverage may be right for you if:

• You’re under age 65

• You don’t have access to employer-sponsored insurance

• You’re self-employed, a freelancer, or recently unemployed

• You want peace of mind with comprehensive coverage

🗓️ When Can You Enroll?

• Open Enrollment: Starts November 1

• Special Enrollment: If you’ve had a life change like losing job coverage, getting married, or moving to a new state, you may qualify now

👩‍⚕️ Why Work With F.S.B.G.?

We’re not just here to sell a plan—we’re here to help you understand your options and choose what’s best for your health and your budget.

When you work with us, you’ll get:

• Free, friendly guidance from licensed experts

• Help checking your subsidy eligibility

• Personalized plan recommendations

• Support during and after enrollment

📞 Let’s Talk—No Pressure, Just Help

Health insurance is personal—and we’re here to make it simple.

👉 Schedule your free consultation and get the answers you need to move forward with confidence.

Understanding Medicare Advantage vs. Medigap

Understanding Medicare Advantage vs. Medigap Choosing the Right Plan for Your Health and Budget

When it comes to Medicare, one of the most important decisions you'll make is how to supplement your Original Medicare (Part A & B). Two common options are Medicare Advantage (Part C) and Medigap (Medicare Supplement Insurance) — but how do you know which is right for you?At F.S.B.G. (Friendly Senior Benefits Group), we're here to break it down so you can feel confident in your choice.

✅ What Is Medicare Advantage?

Medicare Advantage plans are all-in-one alternatives to Original Medicare. Offered by private insurance companies approved by Medicare, these plans often include:Hospital & medical coverage (Parts A & B)Prescription drug coverage (Part D)Extra benefits like dental, vision, hearing, gym memberships, and morePros:May have low or $0 monthly premiumsIncludes extra benefits beyond Original MedicareCoordinated care with provider networks (HMO or PPO)Cons:Must use network doctors (except for emergencies)Costs like copays and coinsurance can add upMay require referrals or prior authorizations

💡 What Is Medigap?

Medigap is supplemental insurance that helps pay for out-of-pocket costs not covered by Original Medicare—such as deductibles, copays, and coinsurance. These plans don’t include drug coverage, so you’ll need to pair it with a separate Part D prescription plan.Pros:Freedom to see any doctor that accepts MedicarePredictable costs with fewer surprise billsNo network restrictions, ideal for frequent travelersCons:Monthly premiums can be higherNo extra benefits like dental or visionMust purchase a separate Part D plan

🔍 Key Differences at a Glance

 Feature                                          Medicare Advantage                                                                 Medigap

Doctor Network:                              Limited (HMO/PPO)                                             Any provider accepting Medicare 

Prescription Drugs:                            Often included                                                                     Not included

Monthly Premium:                  Low or \$0 (plus Part B premium)                            Varies, higher than Advantage 

Out-of-Pocket Costs:                      Pay as you go (copays, etc.)                                    Most costs covered after premium 

Extra Benefits:                               Yes (dental, vision, etc.)                                                     No extra benefits

Travel Coverage:                              Limited to plan area                                     Nationwide (some include foreign travel)

👩‍⚕️ Which One Is Right for You?

The best plan depends on your health needs, lifestyle, and budget. If you want convenience and extra perks, Medicare Advantage may be a great fit. If you value flexibility and want to minimize out-of-pocket costs, Medigap could be your best bet.

📞 Need Help Deciding?

Choosing between Medicare Advantage and Medigap can be confusing—but you're not alone. At F.S.B.G., we offer personalized guidance to help you make the choice that's right for you.

👉 Schedule your free consultation today and let us simplify your Medicare journey.

Medicare Updates

As we move into 2025, several key Medicare changes are worth noting — especially if you’re already enrolled or about to become eligible. Here’s a quick rundown of what’s new and how it might affect you:

2025 Medicare Costs at a Glance

Part B Premium: $179.30/month

Part A Deductible: $1,664 per benefit period

Part D Coverage Gap: Continues to shrink due to the Inflation Reduction Act

Lower Drug Costs in 2025

New rules are in place to cap out-of-pocket drug costs at $2,000 per year for Medicare Part D enrollees.

Important Enrollment Dates

Annual Enrollment: October 15 – December 7

General Enrollment: January 1 – March 31

Special Enrollment Periods are available for major life events.

Need Help Navigating These Changes?

As a licensed Medicare specialist, I can help you decide if your current plan still fits or if it’s time to make a change.

📞 Call me at 813-716-7681

📧 Email: rscott.seniorbenefits@outlook.com

2025 Medicare Updates: What You Need to Know

Published by Ruth Scott, Licensed Medicare Specialist

Friendly Senior Benefits Group (F.S.B.G.)