Medicare

[Railsplitter]

I turn 65 in late May. Got my Medicare card in the mail recently. I am officially an Old Man!

My Medicare kicks in on May 1st but I still have to decide on additional coverage before it kicks in.

If I didn’t feel old before, I do now.

[LKSKNIVES]

Good for you RS,
You have made it this far. I turned 63 the other day only reason to keep working is the whole insurance thing. Hoping that if work has a big re-org code for layoff or many other terms hooked to it that I don't get the re-org ax for the second time in my career this time no trying to find new employment. Maybe someone older than us will chime in and have some good advice for supplemental insurance. Its amazing how we all of a sudden we are old and no going back.
Steve

[Railsplitter]

Hope you can hang in there, Steve.

I sometimes joke around that we should be physically miserable when we are young and get all spunky and healthy as we age but I guess that wouldn’t be any fun either.

Not that I am physically miserable. I’m actually in reasonably good health and I feel pretty good most of the time. I am very grateful for that.

I certainly am open to any advice that anyone might want to provide. Especially if there’s any costly mistakes to watch out for.

[bestgear]

We have a supplemental insurance policy (Medigap) to cover the out-of-pocket costs that Original Medicare (Parts A and B) does not pay, such as 20% coinsurance, deductibles, and copayments. It protects us against high, unpredictable medical bills, limits our maximum annual expenses, and allows us to use any doctor nationwide who accepts Medicare. The common costs covered by our Medigap policy include Part A hospital coinsurance and costs, Part B coinsurance or copayments (usually 20%), Blood work (first 3 pints) and Part A hospice care coinsurance.

Medigap plans do not cover long-term care, dental, vision, or hearing aids, and they do not include prescription drug coverage (which requires a separate Part D plan). The best time to purchase a policy is during your 6-month Medigap open enrollment period, as you cannot be denied coverage or charged more due to health issues.

FYI - as a retiree, health care is our #1 household expense. Our primary objective with Medigap and Part D coverage was to limit our maximum annual expenses, your objectives may be different. In 2026, most people pay a $202.90 monthly premium for Medicare Part B and $0 for Part A (if they worked 10+ years). Part B includes a $283 annual deductible, with 20% coinsurance for services.

[Railsplitter]

We have a supplemental insurance policy (Medigap) to cover the out-of-pocket costs that Original Medicare (Parts A and B) does not pay, such as 20% coinsurance, deductibles, and copayments. It protects us against high, unpredictable medical bills, limits our maximum annual expenses, and allows us to use any doctor nationwide who accepts Medicare. The common costs covered by our Medigap policy include Part A hospital coinsurance and costs, Part B coinsurance or copayments (usually 20%), Blood work (first 3 pints) and Part A hospice care coinsurance.

Medigap plans do not cover long-term care, dental, vision, or hearing aids, and they do not include prescription drug coverage (which requires a separate Part D plan). The best time to purchase a policy is during your 6-month Medigap open enrollment period, as you cannot be denied coverage or charged more due to health issues.

FYI - as a retiree, health care is our #1 household expense. Our primary objective with Medigap and Part D coverage was to limit our maximum annual expenses, your objectives may be different. In 2026, most people pay a $202.90 monthly premium for Medicare Part B and $0 for Part A (if they worked 10+ years). Part B includes a $283 annual deductible, with 20% coinsurance for services.

Thanks for the informative post, Tom. Some of that I knew but some of it I did not know. Quite helpful.

Much appreciated!

[just bob]

I've already been through this. Everything I ever knew about Medicare I learned from watching a Joe Namath commercial. When the time came, I sought out advice from several different people including my own insurance man and people that work in the healthcare industry. Additional Medicare plans are divided into 2 groups. Medicare Advantage and Medicare Supplemental. I was cautioned to avoid Medicare advantage plans because many of them are in -network and have severe plan limitations. You just need to check on specifics with the policy you're looking to purchase i.e. it is possible with some Medicare Advantage plans that if you go on vacation to Florida and have an incident you will be considered out of network and you will not be covered. I was told that Medicare Supplement plans higher than type F are considered the Cadillac of health care insurance. I have plan G and thankfully I haven't had a major need for insurance, a friend of mine that a heart procedure during last year ended up with a $350K bill and paid less than $500 out of pocket. I am happy with the choice I made. I have Mutual of Omaha Type G, and it costs about $150.00 a month but I get reimbursed $3K a year through my old employer for health care expenses, so it pays all of my medical and dental premiums. I'm eligible for VA healthcare and have been approved for that as well. I've just never felt the need to use it. It's a 50-mile drive to the VA hospital and I believe the local healthcare is much more convenient and better. Research and question are my advice. Each individual is different.

[bestgear]

I thought that Medicare Part C is the same as Medicare Advantage and Is only available to those with qualifying disabilities like ALS or End-Stage Renal Disease but I could be wrong. For sure the Medicare Supplemental plans (Medigap) is what you should be considering.

[Railsplitter]

I've already been through this. Everything I ever knew about Medicare I learned from watching a Joe Namath commercial. When the time came, I sought out advice from several different people including my own insurance man and people that work in the healthcare industry. Additional Medicare plans are divided into 2 groups. Medicare Advantage and Medicare Supplemental. I was cautioned to avoid Medicare advantage plans because many of them are in -network and have severe plan limitations. You just need to check on specifics with the policy you're looking to purchase i.e. it is possible with some Medicare Advantage plans that if you go on vacation to Florida and have an incident you will be considered out of network and you will not be covered. I was told that Medicare Supplement plans higher than type F are considered the Cadillac of health care insurance. I have plan G and thankfully I haven't had a major need for insurance, a friend of mine that a heart procedure during last year ended up with a $350K bill and paid less than $500 out of pocket. I am happy with the choice I made. I have Mutual of Omaha Type G, and it costs about $150.00 a month but I get reimbursed $3K a year through my old employer for health care expenses, so it pays all of my medical and dental premiums. I'm eligible for VA healthcare and have been approved for that as well. I've just never felt the need to use it. It's a 50-mile drive to the VA hospital and I believe the local healthcare is much more convenient and better. Research and question are my advice. Each individual is different.

I thought that Medicare Part C is the same as Medicare Advantage and Is only available to those with qualifying disabilities like ALS or End-Stage Renal Disease but I could be wrong. For sure the Medicare Supplemental plans (Medigap) is what you should be considering.

Many thanks to you both!

[philco]

If you get the part D coverage for prescription drugs, be sure to check any medications you are taking to make sure they are included in your coverage. Different plans vary as to what they will or won't cover. It pays to do your homework before hand.

[Railsplitter]

If you get the part D coverage for prescription drugs, be sure to check any medications you are taking to make sure they are included in your coverage. Different plans vary as to what they will or won't cover. It pays to do your homework before hand.

Excellent advice, Phil. Thank you!

[just bob]

I thought that Medicare Part C is the same as Medicare Advantage and Is only available to those with qualifying disabilities like ALS or End-Stage Renal Disease but I could be wrong. For sure the Medicare Supplemental plans (Medigap) is what you should be considering.

We shop for our plans through a marketplace and can purchase either Medicare Advantage or Medicare Supplemental from many different providers. Many of the advantage plans cost very little because the government subsidizes the providers. Where I live many of the retired city workers have Medicare Advantage plans because they have no choice. The rumor was the local hospital was no longer going to accept the Humana Medicare Advantage plans but finally agreed to accept it. They have signs up at the Dr. office that say Humana will not pay for your office call with an LPN so be prepared to pay out of pocket. We are also bombarded on TV with commercials for Humana urging people to enroll in their plans, because they get subsidized per enrollee. Humana may not be bad for many. It all depends on your health and location. I would think Medicare Supplemental would always be preferred, but there may be exceptions.

Yes, the federal government heavily subsidizes private insurance companies that offer Medicare Advantage (MA) plans through monthly, fixed (capitated) payments per enrollee. These taxpayer-funded payments, managed by CMS, cover Part A and B services and often exceed the cost of traditional Medicare, allowing plans to offer extra benefits.

[bestgear]

Thank you Bob, great post!

[just bob]

This is an important distinction between Medicare Advantage and Medicare Supplement plans that isn't explained to enrollees. My friend that worked in the office of a health care facility said people cried when they found this out. Your coverage is no longer governed by Medicare, but by a private insurance company and your coverage is governed by them. I have also heard that if you ever go off supplemental and go on an advantage plan it is really hard to get back in. Research and ask questions. It is very important.


Yes Medicare Advantage (Part C) replaces the way you receive your Original Medicare (Part A and Part B) benefits. Instead of the federal government directly managing your care, a private insurance company approved by Medicare provides your coverage, bundling A, B, and usually Part D (drugs) into one plan.

[OLDE CUTLER]

I have a Medicare, non advantage plan and unfortunately have had 5 surgeries since I have been on. I have paid only a few dollars for prescriptions from the hospital pharmacy that is not in my coverage for all of them. Medicare Advantage plans should be avoided if possible.

[Railsplitter]

Great advice, everyone! I really can’t tell you how much I appreciate it.

[LKSKNIVES]

Great advice, everyone! I really can’t tell you how much I appreciate it.

Great Question to start the ball rolling RS, I figured we would get real time data. I understand different area/situation requires different approach.
I can get a advantage plan through work no subsidies. I mentioned that to my Aunt who is older she said the Advantage plans are not good.
Thank you and everyone who has replied.
Not sure who mentioned going out of a advantage plan being hard. I spoke with a actual hr person about this a couple weeks ago. He said you can go in and out of the advantage plan if you like. Sounds like it may not be that easy to go out.
Steve

[Boji]

This will get long so, please bear with me.
A little personal background first. My late husband had been diagnosed with state 4 cancer, treated locally, surgery, chemo, radiation, was told nothing more could be done. He turned 65, got Medicare and a medicare suppldment (Mutual of Omaha) Referred to Mayo Clinic, more chemo, chinical trial stem cell transplant, more surgery, inpatient for over 30 days. The cancer was in remission. I have never figured up the total charges but we paid NOTHING out of pocket. An educated guess is the total bills were well in excess of a Million $$. When I turned 65 a got the same plan, yes, it is expensive, but I have the peace of mind that virtually any doctor or hospital bills will be covered in full. Any medical facility that accepts Medicare accepts a Medicare Supplement plan. Also, Medicare does cover cataract surgery and yearly eye exams.
Now about Medicare Advantage plans, cheap, yes but you get what you pay for. All care has to be in network. If you travel you are probably scewed.
Many of the premier medical facilities such as Mayo Clinuc accept few or none of the advantage plans. If you need to be referred to a specialist, good luck, most get turned down 2 or 3 time then maybe accepted.
Medicare Advantage plans are for someone who never gets sick or hurt or is rich enough the pay themselves, this was actually told me by an agent that sells the plans.
Something else I have read is if you opt for Medicare Advantage you cannot go back to regular Medicare, I'm not 100% certain on that.
Part D for prescription drugs. all depends on what prescriptions you regularly take. My 2 cheap ones only cost me about $100 a year so I don't have a plan D. An interesting side note, the amount a pharmacy charges the insurance is often much higher than what private pay is. Personal examples, one I pay about $8 for, they charge the insurance co. $29. Some eye drops I had one time I paid $20, insurance would have been billed $140.
If you have any more questions, I'll try to help sort it out.

[Railsplitter]

This will get long so, please bear with me.
A little personal background first. My late husband had been diagnosed with state 4 cancer, treated locally, surgery, chemo, radiation, was told nothing more could be done. He turned 65, got Medicare and a medicare suppldment (Mutual of Omaha) Referred to Mayo Clinic, more chemo, chinical trial stem cell transplant, more surgery, inpatient for over 30 days. The cancer was in remission. I have never figured up the total charges but we paid NOTHING out of pocket. An educated guess is the total bills were well in excess of a Million $$. When I turned 65 a got the same plan, yes, it is expensive, but I have the peace of mind that virtually any doctor or hospital bills will be covered in full. Any medical facility that accepts Medicare accepts a Medicare Supplement plan. Also, Medicare does cover cataract surgery and yearly eye exams.
Now about Medicare Advantage plans, cheap, yes but you get what you pay for. All care has to be in network. If you travel you are probably scewed.
Many of the premier medical facilities such as Mayo Clinuc accept few or none of the advantage plans. If you need to be referred to a specialist, good luck, most get turned down 2 or 3 time then maybe accepted.
Medicare Advantage plans are for someone who never gets sick or hurt or is rich enough the pay themselves, this was actually told me by an agent that sells the plans.
Something else I have read is if you opt for Medicare Advantage you cannot go back to regular Medicare, I'm not 100% certain on that.
Part D for prescription drugs. all depends on what prescriptions you regularly take. My 2 cheap ones only cost me about $100 a year so I don't have a plan D. An interesting side note, the amount a pharmacy charges the insurance is often much higher than what private pay is. Personal examples, one I pay about $8 for, they charge the insurance co. $29. Some eye drops I had one time I paid $20, insurance would have been billed $140.
If you have any more questions, I'll try to help sort it out.

Thanks, Boji. Some great advice there.

[bighomer]

The boss was in the business, a RN turned case manager and a patient advocate , she has seen some nightmares especially people traveling out of state with their advantage plans, her advice is stay away from advantages plans, it may cost more up front but in the long run it's best especially if you like to travel
Here's a little story, we were in Florida a few years ago ago and the boss got a bug from eating seafood we think, anyway she spent 8 days in the hospital and it cost us zero out of pocket.
My brother in law wife bought a advantages plan because cost her very little up front she passed away leaving him with around 40 thousand to pay off.
Everyone has different lifestyles so look long and hard
pay it now or pay it later.

[Boji]

.
Something else I have read is if you opt for Medicare Advantage you cannot go back to regular Medicare, I'm not 100% certain on that.

I did some research on this, You can go back to regular Medicare BUT if you have had a Medicare Advantage Plan for 13 months or more you likely would not be able to get a Medicare supplement plan if you have any pre=existing conditions. Which many/most do.

[Railsplitter]

So much good advice here. Thank you, bighomer and Boji for your recent replies.

I went to my Pharmacist to get one of my scripts today. I take 6 different medications each day. While I was there I asked the Pharmacist to calculate how much an annual supply of all 6 of my scripts would be if I paid for them without using insurance.

The grand total for 12 months is $9,886.56. Looks like I will definitely need Part D or something similar. I am currently on my wife’s health plan at her workplace but we are considering dropping me from her coverage at the end of this year.

On her plan, I have never paid any more than $35 for one 90 day supply of one script and more often than not, each one is much cheaper than that. So almost ten grand a year is not in my wheelhouse.

[rea1eye]

Very complicated post. My wife and I have been on Medicare , Supplemental Medicare and Medicare Part D for several
years now. We went to a free program just before we signed up for all this and he explained it very well. He
was an insurance salesman who sold several different policies and would give you individual attention if you
contacted him.

Everyone has a different perspective because their health needs ( and prescriptions) are different. Look at
all the options and ask a lot of questions. Most of the time your questions are answered fairly well.

The crazy part of all this is that every year you should look again at the plans. Your needs may have changed.
Your maintenance medications may be different. ( My wife's Medicare Part D insurance co. bowed out
for 2026, so she was forced to look at new plans)

Good luck to all the newcomers to this system. The federal government and insurance companies have
not made it easy.

Bob

[Railsplitter]

Very complicated post. My wife and I have been on Medicare , Supplemental Medicare and Medicare Part D for several
years now. We went to a free program just before we signed up for all this and he explained it very well. He
was an insurance salesman who sold several different policies and would give you individual attention if you
contacted him.

Everyone has a different perspective because their health needs ( and prescriptions) are different. Look at
all the options and ask a lot of questions. Most of the time your questions are answered fairly well.

The crazy part of all this is that every year you should look again at the plans. Your needs may have changed.
Your maintenance medications may be different. ( My wife's Medicare Part D insurance co. bowed out
for 2026, so she was forced to look at new plans)

Good luck to all the newcomers to this system. The federal government and insurance companies have
not made it easy.

Bob

Good timing on mentioning the free program. I got a book in the mail (unsolicited) from someone who offers the same thing. He only works with Medicare clients and charges no fees. He meets with the clients every year to ensure that they have the coverage that they currently need. Also free of charge.

I’m not finished with the book yet but so far it has been very up front and seemingly honest. He mentioned many of the same comments that are in this thread.

I think I might finish the book and then set up an in person appointment with this guy. He seems to have the client’s best interest at heart.

[LKSKNIVES]

I would like to say thank you again RS. Glad you asked such an important question.

A big thank you to all who have replied for such good information. The better half and are always saying how when we talk with others we gain so much knowledge.
Steve

[Railsplitter]

Well folks, I am all signed up. Did a ton of research and felt like I was pretty well educated on the ins and outs of Medicare. For anybody who might care to know, here’s what I ended up with:

Original Medicare: Part A and Part B
Medicare Supplement (Medigap)
Medicare Part D
An Umbrella package that issues a lump sum payout to help with the emotional hardships of cancer, heart attack, and stroke. The payout can be used for anything whether medical related or not. The package also includes Recovery/Skilled Nursing care which covers an additional 720 days of Assisted Living care after the 100 days covered my Medigap expires.

The following is something that I don’t speak about much but as I age, I don’t really give much of a crap what people think about me. So I am going to post it here to help convey how incredibly helpful you folks have been in this thread.

I am one of those guys that makes a lot of bad decisions. I am not a bad person. I just make bad decisions. Not being hard on myself. It’s just what I do. The more important the decision, the more likely that I’m gonna screw it up. I used to be confident making decisions in my younger years but I have proven over the years that I cannot trust myself to make important decisions.

You folks have been so incredibly helpful in this thread! And if you read my first couple of posts you can clearly see that I didn’t even ask for help. But you gave it to me anyway.

I can honestly say that I feel like I made a good decision here and the posts in this thread are the main things that led me down that path.

My new Medicare coverage is not cheap. In fact, it’s about 2.5 times higher than I am paying now on my wife’s workplace coverage. But I am confident that I made the right choices. It might be expensive but barring any unforeseen gigantic expenses, I should be able to afford it and the robust coverage will keep me from losing my house or my savings in the event of prohibitively expensive medical bills which are a real world risk as I age.

Heartfelt thanks to everyone.

Rick T.