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Medicare Open Enrollment Period Almost Here: Medicare Advantage vs. Original Medicare

Category: Health and Wellness Issues

September 26, 2017 — The Open Enrollment Period for Medicare Part D and Advantage Plans starts soon; it runs from October 15 to December 7. Since this is your window to make changes in your plan or sign up for new coverage, it is an excellent time reconsider if Medicare Advantage or Original Medicare is your best option, as well if you have the right Prescription Drug coverage plan (Part D). We gained a new appreciation for how complex this topic is as we wrote this article. It will provide you with some basic background information to start thinking about this issue, but do not make any important decisions like this without careful thought and research. This is part of a 5 Part series on Medicare.

Signing up for Medicare and Medicare Basics
You have 7 months to sign up for Medicare in all its forms when you turn age 65 with no penalties. That 7 month period starts 3 months before the month you turn 65, the month of your birthday, ends 3 months afterwards. Thereafter there are open enrollment periods when you have the option to change plans and coverage.

As a refresher, original Medicare includes Part A (hospital coverage) and Part B (doctor services). Almost everyone eligible for Medicare gets Part A at no cost, but Part B requires you to pay a premium ($134/month for most people, higher income taxpayers pay more). Medigap policies are available from private insurers and provide coverage on top of original Medicare. Part D is Prescription Drug coverage (you pay a premium). Part C is the Medicare Advantage program, which is offered by a list of government approved companies. Your Part C premium will which vary by type of plan and provider – sometimes it is $0 for certain “skinny” plans.

More about Medicare Advantage
According to the Kaiser Health Foundation about 28% of people on Medicare have Medicare Advantage plans, and that percentage is climbing. If you join a Medicare Advantage (MA) Plan you’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare. The government pays your MA provider a fee every month, and if you need services the MA pays them. However, each Medicare Advantage Plan can charge different out-of-pocket costs. They can also have different rules for how you get services, like whether you need a referral to see a specialist, or if you have to go to doctors, facilities, or suppliers that belong to the plan. Most Medicare Advantage Plans offer extra coverage like vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D). You usually pay a monthly premium for the Medicare Advantage Plan, which might or might not include your Part B premiums.

If you have a Medicare Advantage Plan you should receive a notice prior to the Oct. 15 enrollment period from your insurance company notifying you of changes in the plan for the coming year. It is important to review those changes to decide if: you want to stick with that company, shop around, or switch to original Medicare plus Medigap. Medicare Advantage has a separate Disenrollment period from Jan. 1 to Feb. 14 – this is when you can drop Part C and choose Original Medicare – but not vice versa.

Which Plan is better for you – Original Medicare (Parts A and B, plus optional Medigap coverage) or Medicare Advantage (Part C)?
There are two options for the people who want supplemental coverage beyond Parts A and B. You can opt for original Medicare Part A and B and add on a Medigap policy, or you can opt for Medicare Advantage for your supplemental coverage. Garrett Ball was interviewed in an informative article on the SquaredAway Blog about the advantages and disadvantages of Medical Advantage vs. original Medicare plus Medigap plans. Approximately 10% of his clients end up with Medicare Advantage vs. 90% who elect Medigap coverage. Ball is an insurance broker and the owner of Secure Medicare Solutions in North Carolina (his website, has some great resources on this complex issue).

Some pros and cons of Original Medicare vs. Medicare Advantage
There are “advantages” and “disadvantages” to both types of plans.
Original Medicare
– A big advantage of Original Medicare is you get out of network coverage. This is usually very important if you live in two places, travel frequently, or have to be able to access a wider network of medical providers or use services not authorized by your MA provider
– If you have a Medigap policy on top of your original Medicare, coverage on that cannot change (at least as long as we have Obamacare)

– Prescription drug coverage is a separate plan (and added expense)
– You probably need to consider adding a Medigap plan to pick up uncovered expenses and co-pays.

Medicare Advantage (MA)
– A big advantage is lower premium costs (even $0), since this is more of an HMO type approach to health care. However the lower the premium the higher your co-pays and deductibles might be
– MA plans might pick up deductibles and co-pays not covered by original Medicare
– MA plans offer the convenience of 3 plans in one – Medicare, prescription drug, and supplemental insurance
– Emergency and urgent visits are covered everywhere in the U.S.
– Prescription drug coverage and sometimes vision and dental are normally part of MA plans, while those are an extra expense and more providers to pay with original Medicare

– A disadvantage is that you must stay within a network of medical providers; going outside the network can be expensive
– You might be charged more if you later decide to switch from Medicare Advantage to a Medigap plan, since the latter can ask about (and charge you more for) pre-existing conditions.
– Doctors can come and go in networks. For that reason you need to check to see if your doctors will still be in your Medicare Advantage network
– You might have to get a referral to get approval for some services, which might not be covered by the plan.
– Congress has targeted the extra expense paid to Medicare Advantage providers in Obamacare repeal efforts, so in the future these plans might not be as attractive as they are now

What can I do in the Oct. 15 – Dec. 7 Enrollment Period
So, back to the upcoming Medicare enrollment period. Here are the things you can do during this 7 week period:
– Change from Original Medicare to a Medicare Advantage Plan.
– Change from a Medicare Advantage Plan back to Original Medicare.
– Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
– Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that offers drug coverage.
– Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn’t offer drug coverage.
– Join a Medicare Prescription Drug Plan.
– Switch from one Medicare drug plan to another Medicare drug plan.
– Drop your Medicare prescription drug coverage completely.

Bottom line
Whew! There is a lot to think about here. The big thing is to confirm that you have the right kind of plan for your needs, and that it will still do that next year. If it looks like your lifestyle or health is changing, or if your insurer is changing the plan or providers in a way that doesn’t fit you, this enrollment period is your chance to make things right. If you are shopping for a Medicare plan, go to and

Comments? Do you questions or war stories about deciding to use a plan from original Medicare or Medicare Advantage? Please share your thoughts in the Comments section below.

For further reading:
Part 1: So You’re Turning 65: Here Is Your Medicare 101 Course
Part 2: “Topretirements Members to Washington: We Like Medicare, Please Keep It That Way
Part 3: What to Do about Medical Insurance When You Retire Early
Part 4: Medicare Advantage vs. Original Medicare
Part 5: What Is Medigap Insurance and How Can I Find the Right Policy for Me

Medicare Shopping: 10 Rules
Kiplingers: Medical Advantage Plans Can Cut Premiums and Hassle

Posted by Admin on September 25th, 2017


  1. It should be noted that Original Medicare pays 80% and it is up to you to pay the 20%. Not all Medigap plans are created equal. Not all Medigap plans are offered in every State. Medicap prices vary from State to State. Also, consider, Plan F which pays all deductibles for hospital and doctors and pays the 20%. This leaves you, in most cases, no bills. Plan F is one of the most expensive Medigap plans. There is also, in some States, a high deductible Plan F. Also, be aware, Plan F will no longer be offered after 2020 but those who have it will be grandfathered and can keep it.
    Another thing people may not be aware of is that Medicare Part A (Hospital) has a benefit period of 60 days and a deductible that applies to each benefit period (rather than a calendar year deductible like Part B). As of 2017 the deductible was $1316 (per benefit period of 60 days). So if by some terrible chance you were admitted to the hospital 6 times (6 benefit periods) your deductible could be $1316 X 6 =$7896. That would be pretty unlikely but you never know. My Hub has Plan F and has undergone radiation treatments. The bills so far have exceeded $156,000. Medicare approved costs were something like $146,000 and we would have had to pay around $8,000. However, we have Plan F and have not received one bill so far. What a relief that is.
    Examine all the Medigap plans for what they offer. Each is very different in what they pay. Each is different in what they cost.

    by louise — September 26, 2017

  2. I’m nearing the point where it’s time to sign up for Medicare. I’m 99% certain that I want original Medicare but I’m undecided between Plan F and Plan G for a supplemental. I’d be interested to know what others think about taking Plan G (with a lower premium) over Plan F Higher premium but pays all of the deductibles).

    by Timothy Brew — September 27, 2017

  3. I am confused. It is mentioned above that:
    Medicare Advantage has a separate Disenrollment period from Jan. 1 to Feb. 14 – this is when you can drop Part C and choose Original Medicare – but not vice versa.

    What can I do in the Oct. 15 – Dec. 7 Enrollment Period
    So, back to the upcoming Medicaid enrollment period. Here are the things you can do during this 7 week period:
    – Change from Original Medicare to a Medicare Advantage Plan.
    – Change from a Medicare Advantage Plan back to Original Medicare.

    Isn’t Part C a Medicare Advantage Plan? Appreciate any further explanation of this.

    Editor’s Note: Part C IS Medicare Advantage. We mistakenly said Medicaid in the para above when we should have said Medicare. Sorry for the confusion.

    by Joan — September 27, 2017

  4. Question: I signed up for Medicare at age 65, and at age 67 am still working FT. I plan to leave my job at the end of this year or early in 2018. I am currently enrolled in Plan A, but because I have employer health insurance and pay into that system, I have not started to pay Plan B or have a Medigap or Medicare Advantage plan. Will all these options open up to me since I will no longer be covered by my employer’s health insurance plan? Anyone know? Thank you.

    by Elaine Cubbins — September 27, 2017

  5. What about the “F” plans for people with health issues?

    by Steve C. — September 27, 2017

  6. There is a confusing typo in the above article. The lines:

    “What can I do in the Oct. 15 – Dec. 7 Enrollment Period
    So, back to the upcoming Medicaid enrollment period. Here are the things you can do during this 7 week period:”

    Notice that it reads: “the upcoming MEDICAID enrollment period”, but should read: ” the upcoming MEDICARE enrollment period”.

    Editor’s Comment: Thanks Thomas for the correction. We were afraid we would make that mistake after we caught ourselves doing just that. Now corrected!

    Medicare and Medicaid are very different things!

    by Thomas Tomaszewski — September 27, 2017

  7. As long as you can prove continuous coverage you should be able to switch to a Medigap or MA plan with no problem.

    by MARY WILEY — September 27, 2017

  8. Elaine, good question. These options are available to you when you leave your FT employment. I recommend you evaluate your current employer health insurance plans as well as Medicare plans when you retire. Sometimes you can continue with your existing health care plan as a retiree. Each plan is different and each of our health care needs is different. Best of luck to you!


    by Terese — September 27, 2017

  9. Because of pre-existing conditions we have been turned down by Medigap plans to supplement Medicare A/B. Therefore we are “stuck” with Medicare Advantage Plans. Mind you, that isn’t a bad thing. We have been very happy with “most” of the Medicare Advantage Plans. Where we live now there is only one Medicare Advantage Plan, which so far meets our needs.
    Fair warning here: sign up with Medigap plans when you first are Medicare elgible. After the fact your chances of being qualified for Medigap plans approach zero.

    by Charles A Bradbury — September 27, 2017

  10. My mothers Medicare Advantage once covered the 20% that Medicare would have not. Then they added Vision, Dental, and Hearing Aids BUT also you are no longer covered for the 20% in most instances. So it is actually worse than Medicare for the possible costs. You cannot buy MediGap with an Advantage plan. The original point for the Medicare Advantage was to have the 20% covered. She has the highest option (which is a waste of money) and pays a lot each month. She pays essentially no doctor visit copays and the closer you read the plan the more you are on the hook for some big expenses. So I suggest you read the entire plan NOT just the summary. Nothing I can do to her make change. And some doctors in the plan were terrible and I (a surprise to them) fired some of their asses as we could do so since we could pick from a list. The local group were funneling patients to those MDs they liked or had some deal with.. At this point we have all good doctors and know how to deal with the system. The dentists are pretty much losers and the vision covered is a loss to the centers so they wish you go away and do not give you options that have to give if desired if they loose money on the deal.This is the normal way vision places work because around here they have to take all the insurance as a bundle not be able t pick and choose which they accept. Overall for me I would never step foot into that Advantage plan. It is the low cost option for a reason.

    by Drew — September 27, 2017

  11. I have had a advantage plan since January and have no issues with it. I made sure my GP was on the plan which was the most important to me. Additionally, the dentist I regularly use is also on the plan. I pay a premium of $66 monthly and $134 to Medicare, so a total of $200 a month. I have no co pays for well visits each year but $5 copay to see my GP, specialists are $15. I went to an ophthalmologist and had a complete check up including various tests and only paid $15. The doctor was excellent. So I guess the area you live in might contribute to how you feel about this plan. Additionally, I am very healthy, so this plan suits my needs perfectly. If my health deteriorates, I will probably change to regular medicare and a medigap plan since they cover more services. My mom pays almost $500 a month for all her coverage but never has a copay. She has had several surgeries and never had to pay anything. BTW my mom is 96.

    by Staceky — September 27, 2017

  12. Not all Medicare Advantage plans have strict provider networks. My wife and I are on her teacher’s retirement program benefit plan using Medicare Advantage via United Healthcare. We can use any doctor within or outside of their network without penalty. The combined cost of Medicare Part B and the MA premium are quite low compared to what I see for people with original Medicare plus a supplemental plan as some of those have steep premiums. I am sure we are enjoying some benefits simply due to the size of the teachers plan.

    by Michael — September 27, 2017

  13. My husband and I have used an Advantage plan for the 10 years we have been retired. Out of pocket medical expenses have been minimal, especially since we used a no premium HMO. Keep in mind the premium for a Medigap policy could run at least $2500 a year, plus you need a Drug policy. For a two person household that is an expense of around $5000 + a year that you MUST pay, whether you need a lot of medical or not. So, for the 10 years, we feel we have saved close to $50,000.

    My husband had back surgery,I mean major back surgery, L1 thru L5, by one of the best surgeons in the country. Take a look at the HMO Networks offered in your area. There are some great Doctors available in these networks. Look up the Doctors available in the different fields….it doesn’t mean you are getting the bottom of the barrel Doctors/medical care!

    by Linda — September 27, 2017

  14. Elaine,
    I used to be a SHIP counselor (never sold insurance but had to get my license just to counsel). Prior to quitting your job, sign up for Part B with Social Security. Have it start the month you no longer are working. It will automatically start on the first of that month (can’t start mid month etc). By signing up for Part B, you can then get a Medicare supplement without being denied for pre-existing. You will also have to get a D or RX plan. That is the only plan you will have to review each year. You do NOT have to review the Medicare Supplement yearly. That plan goes anywhere you do which is great for snowbirds. Have the medicare supplement And the D plan start the same date as your B starts. That way you won’t have to go without any insurance once you quit. Your local SHIP (see the phone number listed on the back of your Medicare & You Book) can help you with medicare supplement publications and guidance choosing one. They can also help pick a D plan. The reason these places are so important is because SHIP does NOT want to sell you a product, they are there to explain them to you.

    by Tracy — September 27, 2017

  15. Some answers:
    Staceky: you won’t be able to go from a medicare advantage to original medicare and a medicare supplement because the supplement WILL look at pre-existing and may very well deny you from getting coverage for that 20%. Some ways you can get into a medicare supplement is by moving out of the advantage area or if the medicare advantage leaves your area or quits on you.
    Timothy Brew: Sign up for the most coverage you can because they can deny you extra coverage in the future. I suggest getting the most coverage when you first sign up.
    Drew: totally agree
    Michael: Sounds like you are describing a Retiree Group plan, very different than a Medicare Advantage plan that most people have access to.
    One side point I want to mention is that getting a medicare supplement WITH ALL OPTIONS runs an average of $150/mo for someone @ 65 y/o. Quite a bargain for those who want to go anywhere and NOT see bills. However years ago Paul Ryan didn’t like how the medicare supplements were paying for everything and not having the customer “have skin in the game” so in 2020 he implemented a change coming to medicare supplements that to me is appalling. If the consumer wants to pay for the right to have everything covered, they should be able to. Info below:
    Beginning in 2020, Section 401 of the Medicare Access and CHIP Reauthorization Act 2015 (MACRA) will prohibit the sale of Medigap policies that cover Part B deductibles to newly eligible beneficiaries.

    by Tracy — September 27, 2017

  16. When looking at Medicare Advantage plans that may have a 20% copay in some situations, remember that there is also a maximum out-of-pocket cap (MOOP). So if you have a major surgery for which the total bill is $200,000, some might think you’d owe $40,000 due to the 20% copay. But that’s limited by the MOOP. The MOOP on my Medicare Advantage plan is $6,000, which is the maximum I’d generally be required to pay towards medical costs in any one year. Always check with a qualified, reputable Medicare insurance sales agent to determine the best plan for your particular situation.

    by Clyde — September 28, 2017

  17. Tracy, Who or what is SHIP? signed “lost and confused!”

    by amy — September 28, 2017

  18. Has anyone used, or had a parent use, a Medicare Advantage Plan while in an assisted living/nursing home. I guess I would be nervous that the assisted living/nursing home would not be careful to use “in network” Doctors for my care and I would be responsible for a slew of “out of network” expenses.

    by Linda — September 28, 2017

  19. I will be retiring in 2018, but I will have my regular insurance that I have a work now as a supplementary insurance. so should I get medicare advantage or medicare regular?

    by Patsy Jones — September 28, 2017

  20. Amy click this link to find a SHIP program in your state. STATE HEALTH INSURANCE PROGRAM
    Content Researched & Assembled by the Staff at and

    What is SHIP?
    SHIP is a free health benefits counseling service for Medicare beneficiaries and their families or caregivers. SHIPs mission is to educate, advocate, counsel and empower people to make informed healthcare benefit decisions. SHIP is an independent program funded by Federal agencies and is not affiliated with the insurance industry.

    SHIP Counseling is FREE of charge
    State Health Insurance Assistance Programs (SHIPs) provide free help to Medicare beneficiaries who have questions or issues with their health insurance. You can call a counselor or attend a workshop/presentation in your area

    by louise — September 28, 2017

  21. Amy this is the link that should have been first to look up SHIP in your State:

    by louise — September 28, 2017

  22. Louise, it’s highly unlikely that anyone would have as many as 6 Medicare Part A benefit periods in a year because a person must be out of the hospital for more than 60 days to start a new benefit period. For example, a person could be in the hospital January 1-10. After a person pays the deductible, he/she pays nothing for inpatient hospital stays for up to 60 days. If the person returned to the hospital more than 60 days after Jan 10, a new benefit period starts, the deductible is again due, but the person gets a new 60-day period. If the person discharged on Jan 10 returns to the hospital on Feb 15, less than 60 days later, it would count as Day 11 and no deductible is due, Doctor charges fall under Part B whether a person is in the hospital or not.

    by Jean — September 29, 2017

  23. Yes, Jean, if you reread my post I said it is probably unlikely someone would be admitted to the hospital 6 times in one year. But some people could be admitted to the hospital several times a year. My point is that a lot of people don’t realize that the deductible for Medicare Part A is not a once a year deductible, the deductible is good for a 60 day benefit period.

    by louise — September 29, 2017

  24. Many thanks for the helpful info on SHIP!

    by amy — September 29, 2017

  25. Tracey: That $150 amount for everything is certainly not in New York City. My mom pays around $500 a month for Medicare, AARP medigap and drug coverage. The plans that she has would cost her half the amount in GA. So you really need to consider the state that someone is in.

    by Stacey — September 29, 2017

  26. Medigap, Plan F is $240 a month in CT but like Tracy says, in some other States I have checked Plan F is around half the price. Every State’s insurance provider charges a different amount for Medigap plans.

    by louise — September 29, 2017

  27. My question is this. I have been retired for some years now. I have been on my employers retiree health plan sense my retirement and this plan also covers my wife. This was good as her employer didn’t offer any health after wife’s retirement.
    Now she retired when she was 62 and started her SS right away. We were both born in the same month one year apart. So next year I will turn 65 and go on Medicare leaving employer plan behind. At this time my wife will be turning 64. Will she be able to get medicare also ? She has collected SS for 24 months at age 64 so does this qualify her ? She is not disabled.

    by Marty — September 29, 2017

  28. Marty, I am not an expert but very doubtful your wife is eligible for Medicare. I am 64 and waiting for age 65 to get on Medicare. I am on Obamacare and cringing on the new price increase for 2018. My Hub is also 1 1/2 years older than me and we were both on Obamacare till he was eligible for Medicare at age 65 which started this March. I can start this coming August 2018. Since I am on SS my Medicare card will come automatically about 3 months before age 65. They offer Medicare B at the same time which costs $134. You can opt out if you wish. That is the Doctor part of Medicare. Unless you continue to work to have insurance for your wife, I am assuming Obamacare is what your wife will need. It is based on your family income in regard to receiving a subsidy. You might want to puts some figures on paper to see what your income will be to see if you can get a subsidy thru Obamacare. You might also consider working one more year till your wife turns 65 and is eligible for Medicare. Obamacare is not cheap! My Silver policy, which offers a subsidy, costs $950.54 and the subsidy pays $440 so my part to pay is $510.54 per month! Good luck!

    by louise — September 29, 2017

  29. Forgot to say Medicare B is $134 per month!

    by louise — September 29, 2017

  30. Louise,, Thanks for your input and info. I know everybody is in different circumstances when it comes to medicare. Right now I pay about the 510 a month you talking about but it covers both of us. The way I am understanding it I have to go on A at 65. I have talked with the company I retired from. They say I will take part A and B. I get a sentimental medicare policy with includes the drug plan i am on now from them. The drug plan qualifies under medicare rules. Plus they the company will pay me an amount in lump sum bases once a year to help with things not covered by Parts A and B.
    Being that I am already retired I did not ask about being able to keep plan for extra year through them to cover her.

    Now with all this being said I read the rules about taking medicare before your 65. It stated you could under these conditions, it listed. Disabled, Some kind of end stage disease, have been collecting SS for 24 months, one other I do not remember at this time.
    But the thing was it did not say (and) anywhere in that list. So I was thinking 62 to 64 is her 24 month period that she has been on SS.
    I was hopping someone else could confirm this. Or that they tried and failed to do it under his rule.

    by Marty — September 29, 2017

  31. I’ve been told lately by two people that their employer’s COBRA plans were significantly cheaper than buying insurance in the marketplace. Since COBRA can last 18 months, that could help some people reach the Medicare Supplement marketplace. It’s worth shopping around: call your insurance agent, check sites like AARP, AAA and Costco, and see what is else might be available! In anticipation of leaving employment in 2017, one acquaintance intentionally signed up for her employer’s high-deductible plan to get a lower COBRA payment.

    I’ve heard that there is also a form that you can submit if your Medicare premium is based on higher earnings when employed, in which you can request a reduction of premiums after retirement due to a lower retirement income. I’m trying to track down that form.

    by Kate — September 30, 2017

  32. I live in Georgia and have Plan F through Mutual of Omaha. The monthly cost is $170.00 for me and $152.00 for my wife. This plan does not include Part D.

    by Jim C — September 30, 2017

  33. Hi Marty,
    I am a SHIP counselor in California. “Have been collecting SS for 24 months” refers to people on Disability. After they have qualified for Disability and have waited 24 months, they are eligible for Medicare. Other than this and the other exceptions you list, there is no way to get Medicare before age 65. As a suggestion, if you haven’t already done so, you may want to compare the costs of your Retiree plan with the costs of Medicare before you switch over to Medicare. Include the costs of the Part B premium, co-pays or a Medigap premium, and especially the costs of drug premiums and co-pays. If you decide to keep your Retiree plan, you may also be able to continue to include coverage for your wife. It is worth asking about.

    by Karen W — September 30, 2017

  34. MARTY, my father retired thru GM and after his passing my mother is still receiving his pension, SS and his Blue Cross health insurance. SHE only pays $121 monthly for everything. I tell her how lucky she is. Is there a reason you can’t keep both??

    by mary11 — September 30, 2017

  35. I have the option of a Cobra plan when I retire and it is $700 per person in the family for 12 months. Renewable one year later. This option will enable me to retire before 65 yrs, to a part time job and wait for Medicare to take over. As long as the company doesn’t cut that from our benefits, that is.

    by William DeyErmand — October 1, 2017

  36. First thanks to all you for your responses.
    I have talked with past employer about this. They are the ones that help you switch over from their insurance plan to Medicare at age 65. They help you in this because you get your “gap plan” through them. The plan that helps or picks up what medicare doesn’t and also provides your drug plan so no need for Part D. On top of that you get a yearly stipend of 2000 to help with over non covered medical charges. Good deal I think.
    The question I didn’t ask was what about the wife that has been on my plan for the last 30 some years. So that is what I am trying to figure out.
    So Monday I will call them again ask these questions. Can I keep my insurance for another year to keep her covered ? Will my gap and drug plan through them cover her after she goes on medicare ? If this does cover her can I use it while she is on the open market plan for a year ? Is there a cobra plan that would cover her for the year ? I do not believe there is a cobra plan. I had a cobra plan for dental only after I retired but is was only good for like six months. I can not be the first to go through this and I am sure they can tell me if they can help out in anyway.
    I live in New York State and they run their health care through the state. Checking that it would work out to about 5 – 6 hundred a month for about the level of coverage I have now. No financial aid with that. I will let you know how my phone calls go tomorrow.

    by Marty — October 1, 2017

  37. I live in South Fl and I’m 65 can anyone recommend a good drug program that won’t break the bank? I’m on a total of five different med. three generic and two not generic. I’m on part A and B Medicare. There are too many different plans and I’m confused what is in my best interest not the person selling me the plan. Help!

    Any good suggestions would be appreciated.
    Skip from Florida

    by Skip P — October 2, 2017

  38. Skip – Check out for a plan of attack. You will have to do some of you own foot work because all plans don’t cover all drugs. Then you can go to a broker if you wish, but you’ll at least be informed. Or you can just sign up with a provider online. You can always change next year. I would suggest a broker because a single line agent can only sell his own book.

    by Peder — October 2, 2017

  39. How is Humana Medicare Advantage? They do a lot of advertising I noticed.


    by Jennifer — October 3, 2017

  40. @SKIP – This page has a step-by-step instruction sheet to comparing Part D plans on Medicare’s website: You can compare plans on Medicare’s website very easily and sign up on Medicare’s website directly. It is crucial to do that as different plans cover different medications, use different pharmacy networks, have different co-pays, etc. – if you are on a few medications, there can be differences of thousands of dollars a year from one plan to the next.

    by Garrett Ball — October 3, 2017

  41. Jennifer, I have Humana’s plan. I’ll soon find out how good it is. I just ran up a $7,000+ ER bill from a fall after Hurricane Irma. Needed a CT scan for a head injury and stitches. If it’s as advertised, my cost will be the $75 co pay.

    by Jennifer — October 3, 2017

  42. Are you an inpatient or an outpatient? Here is an article to explain hospital status. Seems having a medigap plan is a good idea. I went thru this in and outpatient thing with my Mother and it is not something you need when a loved one is so sick.

    by louise — October 4, 2017

  43. On a slightly different note, I have to say that I am being driven absolutely crazy by the calls I am getting from companies trying to sell me Medicare supplemental plans and information (not to mention the junk mail from insurance companies, financial planners and others). I will turn 65 in about 5 months. Yesterday I had 8 pieces of Medicare mail and six Medicare calls (3 today so far)r). Being on the “do not call registry” does nothing. Blocking the numbers doesn’t help. I get calls from my current state, the state of my cell phone’s area code, and calls from other states. I can’t ignore them since unknown numbers could be someone calling from my company, which has offices all over the country. I hope this harassment tapers off after I turn 65!!!

    by Kate — October 4, 2017

  44. Kate: I agree. They are so relentless that it makes me believe there must be a lot of profit in those plans.

    Phones have become as much an annoyance as a useful tool. I only answer calls on my landline and mobile phones if the numbers are familiar. I get messages from people who know me, but not from the sales people.

    Telemarketers hang up immediately upon realizing that their autodialing machine reached my voice mail machine. Computers seem to dislike talking to one another.

    by JCarol — October 4, 2017

  45. Call your telephone provider to see if NOMOROBO can be installed on your phone. I have a landline and my phone was ringing non stop all day long with robo callers. I was ready to tear my hair out. I am on the do not call list which only works for most legitimate companies. Most of these robo callers are dirtbags trying to scam you out of something. NOMOROBO has reduced my incoming nuisance calls to a few a day now. Problem is that these scammers keep changing their numbers so even NOMOROBO can’t keep up with it. Intermittently I will check on the computer to see who may have called and if they appear to be scammers I go to NOMOROBO website and plug in those numbers for them to check and hopefully put them in their reject system! Just the other day I got a phone call from the WINDOWS guy trying to scam me again for the 20th time that ‘they observed problems on my computer’. I told the guy he was a scammer and hung up. GRRRRR!!!

    by louise — October 4, 2017

  46. Follow up on my Humana plan experience with a visit to the emergency room. Don’t know why my post said it was from Jennifer. I don’t think I’ve changed my name, but who knows, I’m getting old and forgetful.

    Anyway, got the final bill from the hospital today. Of the $7,000+ bill, Humana took care of everything but the $75 co pay for ER visits. Hooray! How do people who have no insurance deal with such huge bills???

    by Linda — October 4, 2017

  47. Linda: Does your Humana plan have a specific name and wondering what your monthly charge is for this plan? Is it a Medicare Advantage plan or Medigap? Also, what state do you live in. Thanks

    by judy — October 5, 2017

  48. I admit, I haven’t read all the posts so I may not be giving new information. When I first started getting Medicare, I signed up for an Advantage plan – happy with the $0 premium but not so happy with the co-pays. While they weren’t awful, I was afraid of what they could become if I had a serious illness. Because the renewal period was less than 12 months after I signed up, I could have switched to Original Medicare and a Plan F. While searching for the best premium (it definitely pay to shop), Mutual of Omaha suggested Plan G. The coverage is identical to Plan F but you pay the Medicare deductible, currently $183. This brought down my premium significantly – currently $129.62. I was able to cover the deductible in 4 to 5 months compared to the premium for Plan F. You do, however, have to qualify medically for Plan G. If it wasn’t already stated, if you sign up for Plan F in the first 12 months of receiving Medicare, they must accept you.

    by Louise H — October 5, 2017

  49. I failed to mention that you still need a drug plan. I haven’t been too happy with Humana Walmart plan. My maintenance drugs are very inexpensive and the premium is around $18, but if you need a brand drug, good luck.

    by Louise H — October 5, 2017

  50. Judy, I live in Florida. There is no premium for my Humana plan. It’s a Medicare Advantage Plan. It’s called Humana Gold Plus. When I lived in Minnesota I also had a Medicare Advantage Plan with UCare. The premium there was $60/month. It had no vision and dental coverage. And they disallowed things like a postoperative biopsy of a lump removed from my arm to see if it was cancerous. Wasn’t too happy with them. Now I’m $720 ahead each year, so I can afford to pay some deductibles.

    Each state has different plans, so you need to do your homework. And, yes, the volume of stuff they send you is unbelievable! I was still working when I turned 65, so I just threw it all out. Then I suddenly got laid off at age 66 and had to scramble to find something to replace my employer plan. Good luck!

    by Linda — October 6, 2017

  51. These comments were moved from another Blog article for a better fit :

    Another thing many of you should consider is a Medigap plan. Like they say in the commercials, Medicare pays 80% and you are responsible for the rest. My Hub went thru 39 radiation sessions this summer. Besides the sessions there are a zillion other add on charges. Just received the Medicare Explanation of Benefits and it is probably 15 pages long. Most of it is hard to understand. However, we purchased Plan F Medigap plan when Hub turned 65 in March. He also had surgery last October and that was over $100K. The radiation was over $56K. When he had the surgery he was on Obamacare. We were very fortunate and only had to pay maybe $3K out of our pocket as we were on the Silver Plan. When Hub turned 65 we purchased Plan F Medigap thru AARP. It isn’t cheap for sure but we only received one bill and it was a mistake and is being resubmitted. Not ONE bill we had to pay! Plan F is not the only Medigap plan. I urge you all to investigate the Medigap plans. I also urge you to look into Medicare Advantage plans. I have no idea what that covers but be very careful because you may end up paying a ton of medical bills if you need heavy duty treatment. It is a God send to get treatment and not be wringing your hands on how the bills will be paid. Plan F is just one choice. There are others that may be more affordable. However, Plan F will no longer be offered after 2020 to new members but those who have it will be grandfathered. I turn 65 in August 2018 and am jumping on Medigap Plan F. Depending on what state you live in prices vary. Hubs is $241.50 per month in CT. Hub retired in 2015 at age 63 and never had been sick other than colds his whole life then a year later he had to have major surgery. Then this year radiation. So we never know what the future holds. Things look good right now!?by louise — October 18, 2017 |

    Those who have Plan F may want to consider Plan G. They are exactly the same except for one item. Plan G does not pay for the Part B deductible of $183.00. But the difference in cost is that the premium for Plan G is much less that 183.00. In my case Plan G cost me 138.00 a month and Plan F would cost 171.00 a month. That is 33.00 a month less or 396.00 a year savings that I can use to pay the 183.00 deductible and still have a profit of 213.00 in my pocket. Why would anyone have a plan G? Please compare where you live and stop overpaying for this stuff when you can have your cake and eat it too.?by Ron F — October 19, 2017 |

    OK, so after using the spreadsheet linked above, I realized that our retirement cost of living is about 20% higher than I’d previously figured! (Oops!) Since we are newly retired and have complex finances, it can be difficult to locate the leaks, or to even realize that there are leaks. Guess I need to be more vigilant on this front. Fortunately, between our nest egg and SS, we are covered. This was an incredibly important wake-up call and I thank Elaine again for sharing the info. ?Louise: If you hadn’t had the Medigap plan, do you have any idea what would your co-pays or deductibles would have been from your husband’s recent health challenges? I’m glad that you had adequate insurance and hope that he is improving with treatment. ?You offer good advice on insurance prices. As house, car and life insurance plans come up for renewal, I’ll quote them out to see about reducing costs. A poster on another TopRetirements thread recommended purchasing joint (first to die) life insurance to replace the two individual plans that DH and I now have. I never before knew that such a thing even existed! ?With respect to Prop 13 (I neglected to mention that it was passed into law in 1978), the prevailing wisdom is that it’s usually attractive to leave California for other states because our relatively high cost of housing yields big profits and therefore buys a lot of house at the next stop. However, it’s almost impossible to subsequently return to CA at the same housing level at which one left due to the tax problem and the faster rate CA houses have likely appreciated in the interim. So when people say they’re leaving a desirable area of CA for a less expensive area, their friends will often ask them if they’re 100% sure that the move is going to be permanent because there will likely be no coming back.?We can learn a lot from each other. I’m so grateful for this website and its posters!?by JCarol — October 19, 2017 |

    Mary11: Something is wrong if you’re paying so much per month over and above what social security deducts. Check further. Our insurance just dumped all retirees, and since my husband was leaving the country for seven months, we had three days to find an agent and program! It’s been h… this week. I lucked out with two good agents, and finally went with a Boston lady, who was an angel, explaining everything, and answering a hundred questions. We pay nothing monthly, a little for meds, with a $3,500 deductible. We’re very relieved. I’d be happy to pass on the names and contact numbers, if it would help you?…jay?by Jay kastel — October 19, 2017 |

    JCarol, No idea on how much we would have spent on copays and other expenses. I do believe Plan F paid like $10,000 on this year’s radiation treatments and other stuff. Last year he was on Obamacare. It still paid most of the bills and we had only maybe $3,000 in bills. ?Yes, a month ago we had good news that Hub was in remission. It was a glorious day for sure!?by louise — October 19, 2017 |

    Jay please pass on the info. I think many of us would be interested.?Thanks,?by Jennifer — October 20, 2017 |

    Jennifer….I don’t want to put my address on line….but if you don’t mind doing it, I’ll email you the phone number and names. The Boston lady deals with certain zip codes, but her colleagues that I spoke to, also sounded very nice and polite. I’ve had some doozie calls, with rudeness, hang ups…….it seems to me that each program suggested, is geared to the needs of the individual, and that’s as it should be. We get what we need, not a blanket for all,jay?by Joyce — October 20, 2017 |

    by Jane at Topretirements — October 20, 2017

  52. Admin – would it be possible to edit the comments you moved? Maybe add paragraph breaks?
    As presented, this is nearly unreadable.

    by JCarol — October 20, 2017

  53. Thank you for doing that, Jane!

    by JCarol — October 21, 2017

  54. JCarol

    Thank you for your suggestion!

    by Jane at Topretirements — October 21, 2017

  55. I just wanted to thank everyone who has shared costs. The info is very helpful for budgeting estimates. I was planning on giving my employer notice that I’d be retiring at 65, but just decided to try to wait a few weeks (lump….eeeeek) to get tests done under my employer medical plan. I did find out that the number of the SS document for appeals of the high income surcharge based on retirement is SS-44, by the way.

    Is Plan G also going to be eliminated in 2020, or is it only Plan F that will no longer be available for new registrations in 2020? Has anyone encountered a situation in which their Plan F carrier declined to continue providing Plan F coverage?

    by Kate — October 22, 2017

  56. Only Plan C & F will be eliminated to new enrollees who join Medicare Part A on or after January 1, 2020. Plan G (at this time) will be available. Don’t forget what I said in a earlier post that no one should have plan F. Those who have Plan F should replace it with Plan G. They are exactly the same except for one item. Plan G does not pay for the Part B deductible of $183.00. But the difference in cost is that the premium for Plan G is much less than 183.00. In my case Plan G cost me 138.00 a month and Plan F would cost 171.00 a month. That is 33.00 a month less or 396.00 a year savings that I can use to pay the 183.00 deductible and still have a profit of 213.00 in my pocket. Why would anyone have a plan G?

    by Ron F — October 22, 2017

  57. I think that RonF meant to end his post with the question “Why would anyone have a Plan F?” (Rather than as written, Plan G.)

    Thank you RonF for re-stating this information so clearly. The main reason I have Plan F is that I failed to make that calculation. It may be when I started with Plan F four years ago, there was some other difference, but regardless this can be corrected.

    by Rich — October 23, 2017

  58. Rich, U R correct – I did mean Plan F. Good eye – THANKS.

    by Ron F — October 24, 2017

  59. For what it’s worth, I went with a high deductible Plan F for $50/month (BC/BS, $108/month cheaper than their Plan F for my age). A $2200 deductible, but I’m in good health today and don’t need to pay for coverage I’ll likely not need, yet if I do, well, I can deal with it then. In the meantime, that’s about $1300 in premium savings that I can use to pay deductibles. I know BC/BS isn’t the cheapest, but I have plenty of experience with them with parents and relatives and they always pay, no argument.

    by Peder — October 25, 2017

  60. PS – I also took the BC/BS Basic PDP drug plan for $25/month, same reasoning as the Hi-D Plan F, as much to avoid the monthly 1% monthly premium penalty going forward as for the actual coverage.

    by Peder — October 25, 2017

  61. RonF, Following up on your suggestion, my wife contacted AARP UnitedHealth and switched us to PlanG with a monthly savings of more than $15 for the two of us. That more than covers the $183 deductible. Also, we were concerned that by staying with Plan F, as the number of people that stay on that plan after 2020 reduces, the shrinkage in that pool will cause the cost to increase much faster. Others interested should keep in mind that the deductible may well increase each year as that (as well as the Plans) is set by Medicare.

    by Rich — October 25, 2017

  62. I have a question…if one opts for a Medicare Advantage plan–do you still pay for the Medicare Part B? I would think that could be very expensive, but I read this somewhere and had not heard it before. So I just want to be sure that I would not be paying double. I do not reach 65 for two years.


    by Jennifer — October 26, 2017

  63. Yes Jennifer. You must pay your Medicare Part B premium when enrolled in either type of plan
    (Supplements or Advantage).

    by Ron F — October 26, 2017

  64. Ok Ron so I would be paying for Medicare Part B AND the Medicare Advantage premium if I understand correctly–not one or the other…do other people on this forum find this sustainable? I see no reason to have Medicare Advantage if I also have to pay for Medicare Part B…is there something I am not getting?


    by Jennifer — October 27, 2017

  65. Jennifer – No, the Part B premium is included in the Medicare Advantage premium. Medicare Advantage is all of Part A and Part B, plus any additional coverage (such as drug, dental, vision) that the insurance company chooses to offer and you choose to pay for.

    by Peder — October 27, 2017

  66. Regarding the Advantage Plan I’ve done research on this plan and several people said they were refused needed medical tests. Long story short at first glance Medicare Advantage Plan sounds great until you need to have certain tests run! I’ll get the MediGap Plan. You’ve heard the phrase you can pay me now or you can pay be later?. This my opinion and I would strongly urge you to do your homework including reading the very small print on terms and conditions.

    by Skip P — October 27, 2017

  67. Peder,
    I believe Plan B premiums are still deducted from your SS Check regardless of whether you have Supplement or Advantage.

    by Ron F — October 27, 2017

  68. Sorry, I guess I misunderstood. My error. From
    What is Medicare Part C, or Medicare Advantage?
    “Medicare Advantage plans are sometimes referred to as Medicare Part C. They are Medicare-approved private health insurance plans for individuals enrolled in Original Medicare, Part A and Part B. When you join a Medicare Advantage plan, you are still in the Medicare program and must continue paying your Part B premium.”

    by Peder — October 28, 2017

  69. Jennifer,
    You have to keep in mind that the (in general) You still have medicare part A & B – but when you get an Advantage Plan – it covers all Medicare services. Most Medicare Advantage Plans also offer extra coverage, like vision, hearing and dental coverage and drug coverage sometimes. But you give up selecting any doctor or hospital. You must go to approved doctors and or hospitals in the area. If you travel a lot or are a snow bird – you probably do not want an Advantage plan.
    Medicare does not cover 100% of the cost for many things. This is where Supplement Plans come in. They pick up the difference. And you can go to ANY doctor or hospital (Anywhere). They cost more than Advantage and you do not have Drug coverage (Part D) unless you buy one separately.

    by Ron F — October 29, 2017

  70. Ron F has again provided a quite complete picture. Add to his comments that, once you have chosen a Medicare Advantage plan, you cannot change to a standard medi-gap plan without going through a health exam. It is generally thought that it’s best to first use a standard medi-gap plan until you are positive that a Medicare Advantage plan will fully meet your needs and you are willing to settle down to one area permanently.

    We started with with a Medicare Advantage plan, but were later able to change due to a one-time option after my previous employer changed their medical coverage method. But while we had the plan, it happened that we went from NC to SC for a long weekend and I ended up in the ER with a heart attack — I was 65. The excellent Richlands heart center staff told me that I would be unlikely to live through a trip home to have the triple-bypass needed (two of the three arteries involved were completely blocked including the “Widowmaker”). But SC BlueCross/BlueShield is a different company than in NC. When my wife called to get PERMISSION for the surgery, she was told that it did not sound like a true emergency. With the involvement of the cardiologist/surgeon, we did get that PERMISSION. I was 10 days in the hospital, had all $200K+ covered and came through just fine — but no real thanks to the shock provided by our Medicare Advantage consultant. Thanks to the change of my previous employer coverage that I mentioned, we were able to change to AARP UnitedHealth the next year, we have stayed with them since and we felt comfortable traveling 8500 mile around the southwestern states over a two-month period in 2015.

    I second Ron F’s thought: “If you travel a lot or are a snow bird – you probably do not want an Advantage plan.”

    by Rich — October 30, 2017

  71. I just changed from Medicare Advantage to regular Medicare and Medigap plan. I did not have to get a health exam.

    by Debra — October 31, 2017

  72. Rich,
    Thanks for adding all that detail. It was extremely valuable.

    When you change to a supplement you only have to answer medical questions on an application. Depending on your answers will determine if the company will accept you or not.

    by Ron F — October 31, 2017

  73. Because Medicare Advantage offerings are defined by the state-level companies (and thus the limitations to in-state, company specified practitioners), specifics and cost may vary from state-to-state. The generally lower overall cost of Advantage programs derives from these individually, insurance company negotiated details including who you may see, where you can get medical service, and any inclusions such as dental and optical service.

    by Rich — November 1, 2017

  74. Keep in mind that if you are looking at Plans F and G (not sure about the others), the coverage is mandated. In other words, different insurers must all offer the exact same coverage. Advantage plans, like conventional plans, vary and can change from year to year. I didn’t like paying a portion of every doctor visit or test. I felt a serious illness could possibly bankrupt me.

    You are guaranteed acceptance in Plan F within the first year of enrollment. You must medically qualify for Plan G. Get a quote for Plan G, divide the difference in premium between Plans F and G, then compare the difference to the Medicare deductible. I’m sure you will see you will save money with Plan G. The potential downside is if the Medicare deductible goes up significantly, however, I suspect the Plan F premium will also go up to cover that increase.

    You’ll also need to allow for premium increases. My increases have about been around $10 a month for the last two years. It doesn’t sound like much, but it will add up over the years.

    by Louise H — November 1, 2017

  75. Louse,
    Just a point of clarification. When you turn 65 and are enrolled in Part B – ALL supplement plans including Plan G are guaranteed issue for the first 6 months. After that you have to answer medical questions.

    by Ron F — November 1, 2017

  76. It is a good idea to speak with someone trained, licensed, and annually certified to help explain Medicare. It doesn’t cost anything to get accurate information. I’m sure most people here do or will do that, but unfortunately, I see (daily) many people taking read online as fact, when in reality there is a good bit of misinformation and misconceptions online including some alluded to here. To clarify a few:
    -There is not an annual open enrollment for Medigap/Medicare Supplement plans. The open enrollment is 6 months and starts when you turn 65 or start Medicare Part B.
    -The open enrollment rules for Plan F and G are identical – 6 months from first day of the month you turn 65 or start of Medicare Part B. After that – for either plan – you have to answer medical questions and be “approved” (with a few state-specific examples that don’t ask medical questions). This also pertains to Advantage plans. If you choose an Advantage plan when first turning 65, you have to answer medical questions to be eligible to switch to Medigap later.
    -Existing Plan F policyholders are “grandfathered in” after 1/1/2020. Medigap policies are “guaranteed renewable” and can never be cancelled (unless you don’t pay the premium).
    -Just generally, it is very difficult to make any general statements about Medigap or Advantage being better as it is very state-specific. Some counties have 1-2 Advantage plan options (no competition), and Medigap premiums vary from $60-70/mo in some states to $250/mo in other states (for exact same coverage). You have to look at it through the lens of where you live and what is available to you specifically.
    -The Medigap plans are completely standardized – coverage, claims payments, doctor acceptance etc. However, even within the same area, prices can vary by as much as $100+/mo for same coverage. Companies charge whatever they want (or can get approved by the state DOI). In many areas, the “big name” companies are much higher in price for the exact same coverage/service.

    by Garrett Ball — November 2, 2017

  77. Can someone explain what level 2 rate is on a Medigap policy?

    Medicare Supplement Plan
    Compare Plans
    (up to 4)
    Basic Benefits
    Part A Deductible
    Part B Deductible + Part B Excess Charges
    Skilled Nursing Facility (SNF) Coinsurance
    Foreign Emergency Care**
    Plan F
    Benefit Table
    Standard Rate With Enrollment Discount

    Level 2 Rate

    by Louise — November 2, 2017

  78. I believe Level 2 rates are for those with one or more preexisting medical conditions as defined on the application.

    by Peder — November 3, 2017

  79. I plan to retire Jan 2019 , my husband is already 65 but is still covered under my health insurance.we plan to move to Arizona then due to his health problems.How does it work to start with health insurance here in NY then move to Arizona, if he takes plan G or F will he be able to keep it in Arizona or will he have to answer medical question and be accepted?

    by Sandyg — November 3, 2017

  80. Sandyg, I have wondered this too! I look forward to someone who knows the answers!

    by Louise — November 3, 2017

  81. I took F with Mutual of Omaha originally in GA after I retired in 7/16. Switched to G in November with no issues at the time we enrolled my wife and took G. The MOH rep was most helpful in this decision and in what to do going forward. We bought a home in AL in December, moved in June and updated our registered information with all insurers, including MOH. Smooth process albeit there were some rate changes applicable to AL as each insurer reviewed the new address with us. D went up a smidge as I recall and G went down a bit for both of us….in short, by talking with MOH as we were looking at retirement options, we were provided with the then G rates in place at each and what to do when actually moving in.

    by JeffH — November 4, 2017

  82. Sandyg,
    All supplement plans are mobile. That is one KEY reason people select it as well as using any doctor or facility that accepts medicare. The only change would be premiums as they are adjusted (Up or Down) by the area you reside in.

    by Ron F — November 4, 2017

  83. Ron F The real key is finding a good doctor and facility that accepts Medicare. Many people in Washington, DC have a very difficult time.

    by Jennifer — November 5, 2017

  84. Jennifer,
    Good point Jennifer. THANKS

    by Ron F — November 6, 2017

  85. The issue of finding Medicare accepting physicians can be problematic. Given our ages at this point, (approaching 68), my wife and I have only had an issue here in getting set up with an Internist. We always seek trusted referrals for most important services including doctors, legal, servicers for car, home and other repair or home project needs. It can be daunting if you are not accustomed to networking.
    We found that many doctors here within a reasonable distance are our age or older. Since a good reputation spreads, they either have a full plate of patients from long standing residents, or are cutting back on their load or, like us, are simply retiring from age or have to with their own or their wives’ infirmities. As such, we landed on one of the top local internist referrals…who is leaving. His partner is also well respected, not young but is taking us….but not until mid-January. So, in addition to Medicare program decisions, we also worked to have physician knowledge in place as we exited Atlanta for Fairhope. It’s also true that several of our own long-term physicians were leaving the business for age and other reasons and we faced a similar issue as we left as well.

    by JeffH — November 7, 2017

  86. JeffH.
    WOW! Never thought of this problem. I am planning on moving out of state next year and you gave me a whole bunch to check out.

    by Ron F — November 8, 2017

  87. I’d like to emphasize that you should find a trusted insurance BROKER who specializes in Senior coverage, i.e. Medicare Medigap/Medicare Supplement, and Medicare Advantage plans. This is the person who has factual, up-to-date information for your state and situation. Reading online is helpful to get some baseline and background information, but make a decision with the help of an expert. It’s too important to risk making the wrong decision.

    by Jean — November 8, 2017

  88. Comments from Ann and reply from LS moved here. (please, we love your posts but try to post under a topic that is relevant to what you are commenting about)

    I’m a retired Federal employee and I will be 65 this summer. My HMO will no longer be participating in 2018 so I must choose a new insurance provider. I was thinking I should continue with a high option insurance coverage and then switch to a lower option when medicare kicks in. Any thoughts, opinions or experiences?


    (Reply from LS – thank you!)

    You did not state if there is anyone else covered on you FEHB and why you need high option coverage. First, if you have a spouse or someone else covered and that person will not be eligible for Medicare at the time that you are, that person will only be covered by your FEHB plan. If that person has high medical expenses, switching to a low option plan may not be adequate coverage for them.

    If you do not have any other person covered by your FEHB plan, Medicare Part A and Part B, if you elect it, becomes your primary insurance and your FEHB plan will pay secondary. Most FEHB plans will waive the deductible, except for prescriptions, and the co-pays and co-insurance because Part B is primary. Unless you have very high medical expenses in areas that Part B does not cover or prescriptions that are not adequately covered by the low option of your FEHB plan, switching to a low option FEHB plan would provide you very good total coverage along with Part B Medicare.

    You also have the option to suspend (not terminate) your FEHB coverage if you enroll in a Medicare Advantage plan. These would be like the HMO plan you are currently in under FEHB. You would have to check if there are Medicare Advantage plans available in your area. They would have the same type of restrictions on which doctors you can use and getting approval from your primary care doctor to see a specialist. Advantage plans may also offer dental and vision benefits either as included or as an extra cost option.

    by Admin — November 9, 2017

  89. In addition to geographic differences in the numbers of physicians who accept Medicare and Medicare Assignment, there are some medical specialties where relatively few physicians participate. For example, I understood two staff answering the Medicare telephone line to say that about 65% of psychiatrists do not participate in Medicare.

    Given that the combined total of annual premiums for original Medicare Part B, D (Rx), and Medigap plans are substantial for most Medicare recipients, one may also want to consider the impact of the distinct possibility that Medical Expenses may Not be a deduction in future income taxes.

    by Frieda — November 11, 2017

  90. I have not seen anyone mention Medicare Cost plans. These are very popular in Minnesota and give the consumer much more freedom and more times than not, a cost savings. A cost plan is a Medicare health plan without drug coverage. You can find a plan that meets your needs as an A/B supplement and then look for a plan that specifically meets your drug needs -Medicare part D. By separating out the health and drug rather than tying them together in an Advantage plan, you open your self up to finding a drug plan that is lower cost to you and has all your drugs on their formulary. In Minnesota, I have seen people save money, 9 times out of 10 by going with a cost plan and then getting a part D plan. is a great resource and remember – insurance is state specific – what one state offers in the way of a plan is often not offered in another state. My husband has Medicare and in the last 8 years has had a different drug plan each year, except for 1 year. Everyone should do a check up during open enrollment to ensure the plans they are on continue to be the best ones for them. A few years ago A Humana Advantage Plan introduced a $1000.00 part B deductible to their plan. People who were happy with the plan one year didn’t investigate and were socked with this deductible the following year. And formularies change yearly! What is covered on year may not be covered the next. Need to do your homework!!
    Cost plans are scheduled to sunset the end of 2018 but we are hoping they stick around. My husband , as a Medicare beneficiary, is best served by the Cost plans – they are affordable and very portable. Great for when you travel because your Medicare is primary and then these plans pick up after Medicare. Less worry about being in/out of network!!! Medica, Blue Cross and Health Partners are the big three in Minnesota.

    Editor Comment. Thanks Kim for bringing this up – you learn something every day! Here is a link to more about Medicare Cost Plans, this is the first we heard of them. They appear to be a hybrid of orginal Medicare and Medicare Advantage. Sometimes they have drug coverage, sometimes not. But they don’t seem to offer the supplemental insurance that Medigap offers. They are only available in certain states (apparently Minnesota). Thank you!

    by Kim — November 16, 2017

  91. I may be forced into early retirement and am using a Health Sharing program for Health insurance. It will either be Christian Healthcare Ministries or Liberty Health share. Both are approved by the ACA and no penalties. It is much more reasonable than market based health insurance. Costs are shared between members. Check into it. I am 63 and not yet eligible for Medicare. It is one hard position to be in. I had hoped to work until 70, but my job was eliminated. I am looking for another job now and weighing all options available to me.

    by Jennifer — January 13, 2018

    Jennifer you no longer have to worry about your health insurance being accepted by Obamacare. That is one of the benefits of the new tax bill for 2018.

    by Admin — January 14, 2018

  92. I am on Obamacare and will be on it till July 31 and go on Medicare August 1st. I am just below the 400% poverty level to receive the subsidy. My question is if I exceed the 400% income limit during the year that will not be a little over a half year will I have to pay back the subsidy? The trouble is, with the subsidy it is based on yearly income but if I am only on Obamacare for 7 months and it isn’t a full year. Will they base family income for Obamacare for the first seven months of the year and disregard higher income for the rest of the year when I am no longer on Obamacare? I have looked all over the internet for a solution but cannot find any information. When we originally went on Obamacare, they disregarded my Hubs income for the first 3 months of the year because he retired and called it a special rule. But can’t find a special rule on when you drop off of Obamacare and go on Medicare.

    by Louise — January 15, 2018

  93. Louise – If it was me, I’d call O’care and ask to make sure and maybe a tax guy to confirm. Maybe even ask someone like Terry Savage on her site. I haven’t seen any prorated rules on income, just the hard rule of 400% of poverty in a calendar year. In that case, if you miss it by a penny, might as well miss it by thousands. All subsidies would need to be paid back. In my case, that would have been nearly $11K for 2017…

    by Peder — January 16, 2018

  94. Thanks Peder. I know it would be a blow if we had to pay back the subsidy for me too. It would be close to $7K. I did call our accountant yesterday but she hasn’t returned the call. I am figuring there is no special rule and we’ll just have to keep our income under the radar screen.

    by Louise — January 17, 2018

  95. Louise, if you need the tax payer subsidies due to poverty, what could an accountant do for you? Under the ACA do they count your assets and retirement savings?

    by Maimi — January 17, 2018

  96. ACA is not based on assets or savings but yearly income. 400% poverty level for 2018 maximum is $64,960 for a 2 person household and still receive a subsidy. Any income above that disqualifies you from subsidies. The accountant is for advice on if there is a special rule for year you phase out of ACA to Medicare.

    by Louise — January 17, 2018

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