Medicare 2026 Update Vid

[Jim Rogers]

@alarmguy I think you misunderstood my point.

Get used to that.

My point is, there are no easy answers. And it will likely get worse.

^^This is the true answer to all of this, and why I reject "it's all just simple common sense" answers.

I prefer market solutions, but one has to understand that healthcare is the classic example of market failure.

Asymmetric information, huge externalities, uncertainty in risk pooling-- healthcare has virtually every marker of market failure, so we can be pretty sure that markets alone won't solve healthcare problems.

Government has its own set of problems with a complex issue like this, so I don't think we can count on that either.

So, you are exactly right-- no easy answers and it will likely get worse.

I minored in Econ, I am a student of Adam Smith's Wealth of Nations.

Excellent! I would say that Pigou, Samuelson, and Coase have the most to say about the economics of healthcare.

And it's not comforting.

 

[JeffKeryk]

Ok, I guess I just dont see anything wrong with the system. Other than media hysteria. I wouldnt want health care anyplace but here.
AS you know as your friends are, my wife came from overseas a long time ago, still has family there and there are some REALLY good medical facilities there today but they have way more trust in our system and procedures to the point of maintaining homes in both countries with what I just said as a significant reason.

Let's consider the private sector regarding Medical Care... Here's 2 scenarios.

1 - Profits dictate too much of the decisions. How do you put a price on health, or even life? Does greed add too much cost?

2 - If the private sector provides clearly better health care, at the best cost, then let's reward them well so they continue to do even better.

Reality lies somewhere in between. It's complicated.

 

[alarmguy]

Let's consider the private sector regarding Medical Care... Here's 2 scenarios.

1 - Profits dictate too much of the decisions. How do you put a price on health, or even life? Does greed add too much cost?

2 - If the private sector provides clearly better health care, at the best cost, then let's reward them well so they continue to do even better.

Reality lies somewhere in between. It's complicated.

Can't agree and this is why. Insurance companies have to pay for medially accepted procedures/ Really simple and why they do everyday for 10s of millions of employee and private health plans. Seniors no different.

Profits are in the price of the policy and private companies weed out the corruption, misuse and fraud. Government does not.
Government health care could never compete with employee's private health care. To much waste and fraud is my feeling. AS stated over 100 billion worth in 2023 alone.

But we all have our own thoughts. I love my health care and very happy with it, I DO NOT want it to change... . All good.

 

[fantastic]

Interesting. Not sure what the results maybe. Im not concerned a lot of stuff has dried up anyway. I think based on my interpretation is the MA plans for people on Medicaid are going to drastically change. Anytime one searches for MA coverage, it's shocking at the array of benefits for people on Medicaid and/or Snap AND the number of plans offered are way more than people not on "assistance" I suspect that is what will go away. As far as those over the counter "free money" a lot of plans got rid of it with their "normal" MA plans now/
Great information and thanks for your post. I think (but could be wrong) I am going to look forward to the ending of the program. Maybe I am crazy but without the companies being forced to provide some of these benefits the normal MA plans might get more reasonable because right now, in many states companies are just walking away from offering them.
This VBID only same into play in 2017 at that time in 2016 close to 1/3rd the population still had MA plans.

Call me crazy *LOL* I like change, I get bored with the same old/same old ... and I see this as a government requirement that will be going away... it may (or may not work out for the people who pay and dont get assistance, either way, it will still provide the core benefits of MA or maybe possible companies wont offer them. I dont see the plans going away, even at a monthly cost. At times I chose MA plans that had small monthly cost to be in the plan and ignored plans, for instance. I could sign up tomorrow for a plan that will PAY me $180 a month to take the MA plan, I wont do it, the MOOP is to high, not worth it to me. So I am looking at a $0 a month company and I actually would pay $40 a month for a BCBSNC plan which is great and I still may or mayn't call them, a new hospital near us isnt in their HMO plan but is in their PPO plan. I think it's an error as all the other plans have that hospital and medical buildings in it. But either way a Humana HMO plan that has every conceivable medical network including DUKE Medical at $0 is available to me

Thanks again, I had no idea about anything VBID but now I think understand why there are so many Medicaid and Snap MA plans unavailable to the public and slim pickings for us not on those programs, ALSO plans specific to health issues that healthy people cant get into.

To be clear I don't believe there is a qualification or extra perks for a person being on SNAP (Food) assistance. When you mention "Snap MA plan" comment? There are the Dual Special Needs Plans (D-SNP) that perhaps you're speaking of? Yes, Medicaid is the qualifying requirement for those Dual SNP plans as far as I've seen.

Back to what you've mentioned previously about funding. You mentioned about how the gov't funding the plans was better but you're kind of saying the opposite now? I would have to say that the funding will be somewhat mitigated since a lot of plans will use the SSBCI funding mechanism to continue offering these perks BUT at the cost of more MA plan holder hurdles & less qualifying. Anytime there is a reduction of funding I agree with you that it isn't great. That being said I can understand why you may not be concerned about this since a lot of those plans are targeting lower income or the chronically I'll plans.

 

[alarmguy]

To be clear I don't believe there is a qualification or extra perks for a person being on SNAP (Food) assistance. When you mention "Snap MA plan" comment? There are the Dual Special Needs Plans (D-SNP) that perhaps you're speaking of? Yes, Medicaid is the qualifying requirement for those Dual SNP plans as far as I've seen.

Back to what you've mentioned previously about funding. You mentioned about how the gov't funding the plans was better but you're kind of saying the opposite now? I would have to say that the funding will be somewhat mitigated since a lot of plans will use the SSBCI funding mechanism to continue offering these perks BUT at the cost of more MA plan holder hurdles & less qualifying. Anytime there is a reduction of funding I agree with you that it isn't great. That being said I can understand why you may not be concerned about this since a lot of those plans are targeting lower income or the chronically I'll plans.

If you go to medicare.gov
Go to search for healthcare plans
Search for Medicare advantage plans
Put in your ZIP Code

And from my experience, you will see a wide array of Medicaid snap recipients plans only for them and for somebody not on those plans a very limited number available to those people

To be clear what I mean is if you are not a recipient of those programs, you cannot apply for that advantage plan and they outnumber the plans available to the general public

With that said this is a big country so it might not be where you are but here in the south east coastal area it’s prevalent

We might be talking about the same thing. I’ve spent so much time in here and my brain is getting scrambled.

 

[fantastic]

If you go to medicare.gov
Go to search for healthcare plans
Search for Medicare advantage plans
Put in your ZIP Code

And from my experience, you will see a wide array of Medicaid snap recipients plans only for them and for somebody not on those plans a very limited number available to those people

To be clear what I mean is if you are not a recipient of those programs, you cannot apply for that advantage plan and they outnumber the plans available to the general public

With that said this is a big country so it might not be where you are but here in the south east coastal area it’s prevalent

We might be talking about the same thing. I’ve spent so much time in here and my brain is getting scrambled.

I've searched every plan high & low for the 2026 plans available in my county zip & I've never seen SNAP (food assistance) as a qualifyer. I think we are talking about the same plans but understand them to mean two different things. I can see SNP can sound like SNAP but it's not the same. Again, these plans are for dual eligible meaning you need to qualify for both Medicare & Medicaid (dual eligible). I created a spreadsheet for the ones I've selected for next year to really have a comparison. Here's a snip of it...ha! PPO left side HMO right side. This was just a start. Currently wife's in the UHC HMO $3,200 MOOP but looking at others for next year since UHC has changed some things that may not work out for her. It's loosing Dental Comprehensive completely next year & referrals are required for specialists among other things. Looking at PPO's as a result. I do think the Aetna plan listed doesn't require a referral yet so that may be an option still.

 

[mk378]

SNAP doesn't have anything to do with health care though it is closely related to Medicaid.

Realize (as insurance companies have) that a person needs to be reasonably healthy to stay employed, which is the driver behind employer plans-- the meaty center where health insurance companies made most of their money. They lobbied the government to pick up the unprofitable sectors-- the poor (including too sick to be employed, thus poor), and the elderly.

 

[alarmguy]

I've searched every plan high & low for the 2026 plans available in my county zip & I've never seen SNAP (food assistance) as a qualifyer. I think we are talking about the same plans but understand them to mean two different things. I can see SNP can sound like SNAP but it's not the same. Again, these plans are for dual eligible meaning you need to qualify for both Medicare & Medicaid (dual eligible). I created a spreadsheet for the ones I've selected for next year to really have a comparison. Here's a snip of it...ha! PPO left side HMO right side. This was just a start. Currently wife's in the UHC HMO $3,200 MOOP but looking at others for next year since UHC has changed some things that may not work out for her. It's loosing Dental Comprehensive completely next year & referrals are required for specialists among other things. Looking at PPO's as a result. I do think the Aetna plan listed doesn't require a referral yet so that may be an option still.

View attachment 311518

SNP = Special needs plan. Not sure where snap came from, maybe me? if so the meaning the same to me and I am clueless about public assistance other than I can't get those plans and depending on area sometimes outnumber the plans available to the non dependent population.
Sorry you went through all that. So true, the plans are getting "expensive" lack of better word. Benefits are less. I did find two good ones in my area, yet on the other side of the border is SC I am shocked at the MOOP's there.
Honestly though, being the area I am in, I only go for HMOs and have done the same in our last home. Every medical center is in it, including all specialities. Never an issue.

Thanks for the education. If I see anything further... ill post
Ps. Wellcare does offer plans here. Except Part D drug plans which is fantastic. $0.00 cost this year. next year it goes up to $3.60 a month if I keep medigap but doubtful. Will make my decision first week of Dec.

 

[alarmguy]

This mornings thought. Just for the record.
If my Advantage plan was not being offered for 2026
and
If I was in a high cost area and saw a drastic reduction in Advantage plans as well as a drastic increase in out of pocket expenses.
I would certainly go to my Medicare.gov portal. Closely examine what plans are being offered both in Advantage and Medigap G (dont forget with medigap you also need a plan D for drugs. See what the costs are and if Advantage plans MOOP are too high or you concerned what might happen the following year for 2027. You may want to consider a Medigap Plan G (Dont forget you also need Plan D for drugs with Medigap) When an Advantage plan you are in is no longer being offered to you, this is your one chance if you want to go back to a Medigap plan (or if you move to a new area in some cases)

With the above said, if your in an expensive area and dwindling offerings of Advantage plans that means chances are your Medigap Plan G plans plus Plan D costs are also going to be way more expensive than most the country. Im shocked at the rates on Long Island, NY
Options are good, its ok and maybe advisable for some to use an agent if you are not informed on this stuff.
Even so you can check prices in your area so you are partially informed to ask questions of your agent.

I mean, all you have to do is go to https://www.medicare.gov/ and find out what is available. To repeat, if you are using an agent, I would continue too, its too late to learn everything in a couple weeks left but this will allow you to learn and ask questions about what plan you are going to take.

For others who spend hours and days, weeks and years on the subject, they already know the site, have their online accounts set up and do it themselves. But if you dont know what you are doing it is advisable to learn and then talk to your agent.

Ive been in Advantage plans for 3 years, they were great, better than GREAT, LOVED THEM. For the 4th year my plan was no longer offered and I was in a new home, new area, not fully aware of the fragmented Medical networks here, that were undergoing buyouts and being combined. Fresh with a cancer diagnosis I went to a Medigap Plan for 2025. Cost was $1,700 and honestly Cancer treatment in 2025 most likely would have cost me up to twice (read on though) that if I was still in an Advantage plan with Co/Pays (or close) However the costs were the same as the Advantage would have been paying Dental, Vision and over the counter/ which the Medigap does not.

Now with that said, having Medigap Plan N and D for 2025 was nice, but I am done with treatments and I now understand the various networks in our new home town and where I would go, there are still a few good Advantage plans being offered in MY area if I want to switch back.
I am almost certain to switch back to Advantage. There is a Humana HMO with a MOOP (max out of pocket) of $3,500 in my county.
Every network in the in the plan, including Duke Cancer Center and other cancer centers. All hospitals etc.
So my only fear is ever increasing MOOPs on Advantage plans and once in them most times the only way out into Medigap with guaranteed acceptance is if your Advantage plan is no longer offered. This is the only roll of the dice that bothers me. I would not accept a plan with more than lets say a $5,000 MOOP and in some places its impossible to find. Like many places in northeast.

Actually a friend, 4 miles over the border in SC next year. He and his wife do have an "out" of their Advantage plan should they decide for 2026. Can go back to Medigap because 2025 Advantage plan no longer being offered. They are thinking about it. All of a sudden out of the blue, all the plans over there MOOPs are going up to $6000 and higher. Now to be realistic chances of hitting those are slim but there can be times of course that you can. Chemo and whatever others are a possibility. So gosh this is only 4 miles over the border from me and a concern, yet. I THINK if they wanted to do that, they would have to cancel my plan and then I could once again go back to Medigap without underwriting. Both my friend and myself, it would be the only way to get back in.

Anyway, key is do you want to pay 100's of dollars month that increase yearly as you get older to many 100's plus your part B premium over the long haul for Medigap for piece on mind that is ok.

Or get an Advantage plan at no cost except your Part B premium with exposure to a POSSIBLE higher to much higher Max out of pocket cost in a year you may fall really ill. Otherwise it is a no brainer for many. Not only no cost but many places still free dental, vision and more.

Choices, choices... I find it fun but I know others stressful. Just be the clear on your choice and convictions.

 

[Jim Rogers]

This mornings thought. Just for the record.
If my Advantage plan was not being offered for 2026
and
If I was in a high cost area and saw a drastic reduction in Advantage plans as well as a drastic increase in out of pocket expenses.
I would certainly go to my Medicare.gov portal. Closely examine what plans are being offered both in Advantage and Medigap G (dont forget with medigap you also need a plan D for drugs. See what the costs are and if Advantage plans MOOP are too high or you concerned what might happen the following year for 2027. You may want to consider a Medigap Plan G (Dont forget you also need Plan D for drugs with Medigap) When an Advantage plan you are in is no longer being offered to you, this is your one chance if you want to go back to a Medigap plan (or if you move to a new area in some cases)

With the above said, if your in an expensive area and dwindling offerings of Advantage plans that means chances are your Medigap Plan G plans plus Plan D costs are also going to be way more expensive than most the country. Im shocked at the rates on Long Island, NY
Options are good, its ok and maybe advisable for some to use an agent if you are not informed on this stuff.
Even so you can check prices in your area so you are partially informed to ask questions of your agent.

What do you think about the plan G-High Deductible (HDG)? In my study of it, HDG seems to have nearly the low cost of MA (~$50 vs ~$0) and a much lower MOOP.

I've been trying to run some Monte Carlo simulation analyses (with limited success so far), and the preliminary results (not yet fully verified) seem to indicate that HDG may have only slightly higher costs (long-term) but without the risk denial of MA.

I don't think I've seen you mention that plan-- have you rejected it for other reasons?

 

[Jango]

When an Advantage plan you are in is no longer being offered to you

How does this exactly work. Let's say I am an Aetna member and the exact same plan number I am in is not offered for 2026 but they have other similar plans being offered under different plan numbers. Does that mean I can switch to a supplement?

 

[alarmguy]

How does this exactly work. Let's say I am an Aetna member and the exact same plan number I am in is not offered for 2026 but they have other similar plans being offered under different plan numbers. Does that mean I can switch to a supplement?

If you belong to a Medicare Advantage plan that is no longer going to be offered for the following year. You will/are supposed to get a letter in the mail saying so.

At that point you can sign up for supplement plan (Plan G and Plan N are the two most popular) and also make sure you sign up for Plan D drug plan.
At the time of application you will be asked what your current coverage is. Once you check Advantage plan it will go into further questions and one of those questions will be if you got a letter saying the plan is no longer offered discontinued. Keep in mind, all medigap and advantage plans are individual companies so what I type might vary a little between companies. All I can tell you is if your plan is truly cancelled you can get guaranteed acceptance to a medigap plan.

In the situation above, you are guaranteed acceptance with NO medical unwriting or questions.


This is straight from Medicare Click on the link below AND then you will see another link that says "Guaranteed Issue Rights" and it will take you to a chart that looks like this.
I encourage if you are unsure, simply contact a medicare licensed agent or the company sales agents themselves


https://www.medicare.gov/health-drug-plans/medigap/ready-to-buy

 

[fantastic]

What do you think about the plan G-High Deductible (HDG)? In my study of it, HDG seems to have nearly the low cost of MA (~$50 vs ~$0) and a much lower MOOP.

I've been trying to run some Monte Carlo simulation analyses (with limited success so far), and the preliminary results (not yet fully verified) seem to indicate that HDG may have only slightly higher costs (long-term) but without the risk denial of MA.

I don't think I've seen you mention that plan-- have you rejected it for other reasons?

I'm not @alarmguy but I'll add my 2 cents.

That G HD is Medicare like you mentioned so it has its own benefits to a degree. Otherwise, You're paying lets say $50 month like you mentioned $600 out of pocket every year + up to $2,870 = total Up to $3,470 OOP. Yes, it does cover Part A hospital & some medicare advantage plans can really put that whole $1600 on the member but if you found an MA w/$3,500 MOOP & decent Part A deductible it may come w/some extra perks to boot (Dental, hearing, etc). The MA plan would most likely pay on things like your PCP visits etc unlike the G Plan that would put the 20% on you until you paid 2,870. In my mind the MA plan might have an advantage but I've not really looked into everything just a best effort from what I've learned over the years. Other Medigap plans would be the better bet IMO. Even paying an extra $1000 a year to equal around $1600 might get you into a plan that covers the Part B coinsurance. I think the best use for Medigap is certainly to prepare for high out of pocket costs if you're really sick. It can be cheaper or at least more budget friendly in that case.

 

[Jim Rogers]

I'm not @alarmguy but I'll add my 2 cents.

That G HD is Medicare like you mentioned so it has its own benefits to a degree. Otherwise, You're paying lets say $50 month like you mentioned $600 out of pocket every year + up to $2,870 = total Up to $3,470 OOP. Yes, it does cover Part A hospital & some medicare advantage plans can really put that whole $1600 on the member but if you found an MA w/$3,500 MOOP & decent Part A deductible it may come w/some extra perks to boot (Dental, hearing, etc). The MA plan would most likely pay on things like your PCP visits etc unlike the G Plan that would put the 20% on you until you paid 2,870. In my mind the MA plan might have an advantage but I've not really looked into everything just a best effort from what I've learned over the years. Other Medigap plans would be the better bet IMO. Even paying an extra $1000 a year to equal around $1600 might get you into a plan that covers the Part B coinsurance. I think the best use for Medigap is certainly to prepare for high out of pocket costs if you're really sick. It can be cheaper or at least more budget friendly in that case.

If you're saying that MA would be cheaper than a HDG plan, then I don't disagree at all.

To my mind the tradeoff is this:

MA: Screaming good deal early on, but they ain't giving that deal because the like ya, they're going to get that money back in the end with high denial rates right when you need the coverage the most.

Supplement: Expensive (but manageable) up front, but the totally unfair way they generate insane rate increases through book-closing practices (average of 40% for G in 2026!) means that, yeah, they ain't gonna deny ya nothin' at the end, but you'll be bankrupt paying the premiums.

So, you get to choose between these two great options: A full bank account but no coverage at the end of your life, or full coverage at the end of your life while you lose everything you value in life because you're bankrupt.

Even shorter version? Toward your end, you can choose to be alive but ruined, or financially viable but dead.

I'm wondering if HDG might split the difference as the rate increases appear to be far less egregious than it is for G/N (the deductible tends to tame rate increases) but with the same late-life coverage as G and a MOOP (which will include the PCP costs you mentioned) that is in the ballpark of MA.

So, trying to figure out if HDG is the sweet-spot that captures much of the price advantage of MA, but has the air-tight coverage of G.

Answer unknown at this point.

 

[alarmguy]

What do you think about the plan G-High Deductible (HDG)? In my study of it, HDG seems to have nearly the low cost of MA (~$50 vs ~$0) and a much lower MOOP.

I've been trying to run some Monte Carlo simulation analyses (with limited success so far), and the preliminary results (not yet fully verified) seem to indicate that HDG may have only slightly higher costs (long-term) but without the risk denial of MA.

I don't think I've seen you mention that plan-- have you rejected it for other reasons?

I love all the Medigap G, N, and High Deductible G plans. All equal in what they offer in the entire country. Exactly the same plans.
Only big difference is cost from area to area, even county to county.

(oh boy)
High G is a tough one to pass up if you do not like the idea of an Advantage Plan or if the Advantage plans in you area dont fit your needs and if you do not want to pay hundreds or many hundreds a month depending on your age and location for a regular G or Plan N.
As I posted some of the Advantage plans to me, in some areas (not mine YET) the exposure I am willing to risk is far to high in many areas at lets say over $6,500 if even that I would strongly consider one of the Medigap's.

So, (round numbers) for me. Part B is a fixed cost for all plans of $200 a month (for the majority) x 12 months = $2,400.
1.With that in mind (my area) Plan N $150 a month x 12 months = $1,800.
Plan N medical deductible = $257.
Total cost of Plan N = $4,457 (including $2,400 Part B cost) and you barely have a medical bill for the year. Some doctor co-pays of $20, Emergency room $50 (Irrelevant to me)
No other costs, everything gets paid 100% as long as (which something like 95 or 95% doctors who participate do who accept Medicare pricing)
Also keep in mind you have to buy a separate drug plan. Plan D my cost is $0,00 a month others will be higher, sometimes maybe much higher.

2. Plan G = Same as above but there are no doctor co-pays AND in the extremely unlikely event that a particular doctor or health network does not participate in Medicare pricing but will except Medicare payments they are allowed to charge another 15% on top of that what Medicare is willing to pay. One can look up their own stats on this but it is very rare. Meaning participating doctors, almost every one of them who take Medicare agree to accept Medicare pricing.
The other tiny percent 2% (?) do not contract with Medicare price plans but will accept Medicare. Plan G will cover what is called Excess Charges of 15% which those doctors are allow to charge.
A. So Plan G $180 a month X 12 months = 2,160
Plan G deductible = $257
No Co-pays, no other expenses
Total Cost of G = $4,817 (including $2,400 part B cost)
No other costs, everything gets paid.
No other costs, everything gets paid 100% as long as (which something like 95 or 95% doctors who participate do who accept Medicare pricing)
Also keep in mind you have to buy a separate drug plan. Plan D my cost is $0,00 a month others will be higher, sometimes maybe much higher.

B. Plan G High Deductible $40 x 12 months = $480
Plan G High Deductible $2,850 You must pay before your plan pays anything. It may sound like you can hit this number fast, but not really in many cases. Keep in mind you are paying the first $2,850 of Medicare pricing for services, not retail cost. SO you can go many years always paying and never receiving any payments.
Total Cost $5,730 (including $2,400 part B cost)
You have to pay ALL bills up to the deductible of $2,850 and after that, everything gets paid.
No other costs, everything gets paid 100% as long as (which something like 95 or 95% doctors who participate do who accept Medicare pricing)
Also keep in mind you have to buy a separate drug plan. Plan D my cost is $0,00 a month others will be higher, sometimes maybe much higher.


3. Last but not least. Medicare Advantage Plan
No monthly charge
Total cost of plan ($2,400 Part B cost)
Total Cost is the part B cost of $2,400
The plan pays my medical care from Day 1 Plus a whole array of co-pays you must pay for services up to the plans Max out of pocket limit. $0.00 primary doctor co-pays and $5 specialist co-pays if you end up I the hospital expect numbers out of the air cost of $300 a day for the first 5 or 6 days $0 after. Also co-pays for MRIs CT Scans everything. It's all in the plan documents and they are all different.
MY MOOP would be $3,500 and then no more co-pays - Total possible exposure $5,900 and zero cost after.
Also keep in mind, this particular plans has great benefits, $2,500 dental per year, $250 for contacts or glasses, $50 every 3 months for over the counter drug items. A basic gym membership. $0.00 primary doctor co-pays and $5 specialist co-pays. It's an HMO with no referrals needed to see a specialist. It also includes a drug plan. (make sure you pick an advantage plan with one) Medicare Site will make sure you do or warn if you forget) Advantage plans also pay for a free annual physical. Medigap does not but you can still see a doctor for a Medicare annual talk or something like that.

So after another one of my stupid long posts, in my case, at least right now in my situation. (everyone is different and everyones plan offerings are different) It would be REALLY hard to hit my $3,500 in out of pocket expenses by only paying co-pays. I mean it could add up quickly if you are hospitalized or get chemo. But I never hit an out of pocket in the three years I had Advantage, not close. I may have hit it this year IF I had an Advantage plan because of my cancer treatment. Some advantage plans make you pay the Part B cost of 20% co-pay for Chemo and Radiation. There are variables. Keep in mind that that 20% is 20% of Medicares contracted rates much lower than retail.

I think the key is if you are in a really high cost area, with terrible offerings from Advantage plans and plan G, N and D costs are insane. Plan G high is a great option. Heck it would be a great option to for me too. MY cost here would be only $40 a month plus Part b cost. Then of course I have to pay another $3,107 plus the part B of $2,400 on an annual basis before I get any benefit

With an Advantage plan I pay just the Part B cost of $2,400 a year and co-pays for services throughout the year until I hit for this year the MOOP of $3,500 _ realistically for much of the country that is much higher but still, your getting coverage from the first day and only paying co-pays

It's really a tough call and I really am on the fence of what is better or worse for me. Right now, Advantage for me, however I did switch to Plan N and D this year, given the chance. The cost of these plans go up much higher as you get older. UHC the only one I know that does not use age pricing however it still does not mean they are cheapest.

One other caution, once in a High G plan, you cant switch to a regular G or N plan without going through underwriting for your entire life. Get cancer or something you are in HIGH G for life OR you can switch to an Advantage plan but not another Medigap plan, no one will take you. Meaning just because you are in a Medigap plan does not give you the right to change Medigap plans without underwriting. Also like all plans the deducible goes up every year>

Tough call. Full disclosure, All the above are my thoughts, understanding and particular circumstances in my particular zip code. I am self educated and not licensed. This is not advice, these are my thoughts on what is available to me.
I know you know but anyone reading this the source to go to is http://medigap.gov and also a licensed Medicare agent.

Now that I rambled on for an hour. (I am not re-reading this*LOL*) I see nothing wrong with your thoughts at all. Above is my thought process. I guess, (at least in here) I am one of a few that I have no fear of anything being turned down by an Advantage plan. I have never seen it happen and I have seen some really off the wall high cost testing and procedures not only on me but a sibling 10 fold. Nothing was ever turned down. I know I said this before but I had trouble with employee plans while I was working and also my wife still has issues with her employee plan at times. Just explaining for me, I have ZERO fear of a rejection for anything. If it's an approved medicare procedure they have to pay and the rare case if they dont, then go on line and dispute. Im one to think, most rejections are fraud or doctor documentation.

Also keep in mind states can have different regulations so my situation and pricing will not be that of others.
Bottom line. I liked taking out my one Advantage card when getting care. Paying whatever co-pays might be do, still a fraction of what I would pay otherwise and I get a benefit from day one, no deductibles, just co-pays.
Im fried with typing tonight *LOL* These posts help my thought process too. There is good in all plans and I am still going through tests and other things, meaning Im dont with treatments and technically things going well but still have specialists and things to work through. One if which starts Tuesday with yet another specialist. Plan N will take care of it but I already checked and if I go Humana MA next year, they are in it too.

Im still a little leery I dont know my future yet, it looks promising but only over time will I know the success of my treatment. Success rate is 90%. Im only torn because I have only just finished and not yet 100% done. One thing just like High G and Advantage MOOPs and deductibles go up every year. Now add some decades to that and wonder where will this end up?
However the same can be said for premiums on regular G and N.
I do know a rather wealthy older couple who just left Plan N and went to High G. Their premiums up in the Northeast were getting stupid... pulling a number out of my hat, maybe over 600 or $700 a month for the two of them. It was a no brainer to go to high G.
Someone did a REALLY good High G presentation on YouTube comparing situations like that. Where High G wins hands down. Im just not in that environment here, not yet anyway. I am cautious the way things are going... after all 4 miles over the border to SC the Advantage MOOPs are getting out of control, not as bad as the northeast but they are going that direction. I know someone considering High G while he can still get out of their Advantage plan since it's not being offered in 2026 and they have to pick another or a Medigap plan. Me personally would strongly consider one if MOOP get out of control here.

 

[fantastic]

I think we can all agree that going with Original Medicare ONLY is the worst thing you can do. Getting a Medigap, any Medigap plan, is the right choice to work with OM. A low MOOP MA is a great way to go as well. The only thing about Medigap is like alarmguy & others have mentioned that you'll want to choose which Medigap plan to stay in since it's hard or impossible to swap around. Getting it right the first time is good.

Here's a comparison video to show that even a Medigap G HD is no comparison to Original Medicare alone in savings if you have some really high bills.

 

[Jim Rogers]

Total annual cost of Plan N = $4,457

Total annual cost of G = $4,817

Total annual cost of G (High Deductible) = $5,730

Total annual cost of Advantage = $2,400

I summarized your cost analysis. You know these numbers better than I do, and they are about what I had calculated (back of the envelope) last year, so I'll assume they are correct.

Setting aside the question of late-life denials of coverage, the biggest problem with the numbers you list is that they are only for the first year, which makes the Supplements look way better than they are.

Insurance companies game the Supplement premiums by arbitrarily opening and closing what are called "books," and the bottom line is that they can manipulate those reasonable initial rates you provided over the long run, resulting in insane pricing after a couple of decades.

Advantage plans don't suffer this problem, and the high deductible in HDG mutes (but does not eliminate) the problem.

Here is a rough estimate (don't take it super-seriously) of what my initial simulations are showing for potential prices not today on medicare.gov (where you got you numbers), but 20 years after holding the policies (in constant dollars):

Total annual cost of Plan N on 20 years = $12,000

Total annual cost of G = $14,400

Total annual cost of G (High Deductible) = $8,000

Total annual cost of Advantage = $3,500

As you can see, after a couple of decades of premium manipulation, the G/N plan costs are much, much higher. HDG is a little higher. Advantage is only nominally higher (though there are other ways the make life difficult to achieve that minimal increase).

My current thinking is that many people make poor Supplement decisions based on those initial prices on medicare.gov, not understanding that those prices are going to rise significantly over time, and many will be forced at some point to bail on their Supplement and switch to Advantage simply based on cost.

That is the worst of all worlds-- you paid the high premiums for a Supplement so as to have air-tight coverage in your later years, but by the time you arrive at that point, you can no longer afford it!

You might as well have picked Advantage from the start, saved a ton of money up front, and be in the exact same boat you're in if you have to bail on the Supplement and switch to Advantage at the end.

I could stomach the extra ~$275/mo to have HDG over Advantage at the beginning, but what I'm currently trying to analyze is whether the $4-500/mo. extra for the HDG over Advantage at the end is worth the guaranteed end-of-life coverage.

You would say it's not as you're confident there will be no degradation of your Advantage coverage in your later years.

I'm not so confident on that, so I'm weighing whether it's worth it to start paying ~$275/mo extra for HDG at the beginning and watch that extra payment grow to $4-500/mo. extra over 20 years, or just take my chances (like you) that the coverage will be there and pocket the cash by choosing Advantage from the beginning.

As I said, with the framing I use, the choice is "alive but broke or loaded but dead."

 

[Jim Rogers]

I think we can all agree that going with Original Medicare ONLY is the worst thing you can do. Getting a Medigap, any Medigap plan, is the right choice to work with OM. A low MOOP MA is a great way to go as well. The only thing about Medigap is like alarmguy & others have mentioned that you'll want to choose which Medigap plan to stay in since it's hard or impossible to swap around. Getting it right the first time is good.

Here's a comparison video to show that even a Medigap G HD is no comparison to Original Medicare alone in savings if you have some really high bills.

I actually have the means to fully self-insure my medigap (including a few mega-expensive health events) and could actually afford to have no gap coverage at all and pay the 20% difference myself, pocketing all medigap premiums.

Thus, I ran that analysis hard-- nothing would have pleased me more than to have found out that self-pay was cheaper than carrying medigap coverage.

Alas, it wasn't even close. Unless you're fortunate enough to have no health problems and die peacefully in your sleep, almost certainly paying the premiums-- even the expensive ones-- comes out cheaper than paying your own way.

So, even though I was able to do it, it would be far more expensive to do it, so, as you advised, that option is off the table for me.

 

[fantastic]

This site you can click on your state to look at some details regarding Medigap. It told me that my home state of Missouri has anniversary rights to change Medigap plans but it's only for the same plan number from another company.

https://www.medigap.com/medicare-supplements-by-state/

I'm currently being told it's illegal for a Medigap policy to be pushed by sales agent if one has Medicaid?

 

[alarmguy]

I actually have the means to fully self-insure my medigap (including a few mega-expensive health events) and could actually afford to have no gap coverage at all and pay the 20% difference myself, pocketing all medigap premiums.
...

To me, this is actually a good option. I have thought about it myself, seriously. The 20% difference is not as expensive as some might think. With that said I could be wrong in certain situations because I havent looked into details.
What I have done, after being in the system for 4 years now briefly on the fly roughly figure out what my cost would be this year since its the only year I had a Plan n & D instead of an Advantage. However that is based on my treatment and there are a thousands other treatments that are far more costly I am sure.
Transplants comes to mind, certain cancers. I also havent looked in the effect of long term care and what the supplement plans/MA plans pay after Part B.

However in my situation of 4 years of medicare. If I had a supplement plan I am certain it would have been more costly in premiums than if I would have paid 20% of the medical Part B on my own. Making this statement I cannot be sure of its accuracy. As first of 3 years I had MA plans.

But stay tuned! Because I am going to do it this year being I had Plan N and D. I started and know where to get my numbers, thing is. I still have many claims out there and still have many visits and tests wrapping up the year.
SO pretty much, off the top of my head. The costs for Prostate cancer radiation treatments and tons of specialists, as well as tests I certainly would have lost money compared to $1,740 in Plan N premiums which pretty much paid for everything except a few small co-pays.

Only two questions remain in my mind that I havent looked at. Sort of because I know I am not going to go that route. (I might have felt differently only less than two years ago after having a pretty blessed healthy life with no major issues.) If you go without a Medigap plan and only use Part A & B I would think you cant get guaranteed acceptance should you want Medigap later on in life. Im also unsure of the same with MA (Advantage Plans)

Ok, with the above said, Im not sure if everyone understands. Your hospital Part A coverage is free (assuming you put into the system what was required) Part B covers everything else and you pay 20% This is KEY. You pay 20% not of what the medical institution, practice, lab or doctor charges. You pay 20% of the Medicare contract price. Meaning Medicare pays 80% of their contract price for the service and you pay the other 20%. You dont pay the retail cost. Which in MANY cases is greatly lower than retail but there are times I am surprised it come close to actual charges. x

You may have seen this in another post, this was one month billing cycle a 6 week radiation treatment. The costs seem huge but the Medicare contract price is much lowers. Im pretty sure but unsure the bill covers the treatment not the month. This was the highest 1 months of the year though I was seeing doctors and continue for a few more weeks.
SO if I didnt have Plan N I would have owed $1,593 for the month out of the $50,947.00 retail price.

Caution, I only haphazardly skimmed over my bills and what it would have cost with no supplement plan for fun. Im not going to drop my Supplement or Advantage plan now that I think about it. Because I am sure far worse can happen. I was just curious what if this year.
Since I paid $1,740 plus the Part B coverage of $2,250 for Plan N coverage and previous years I only paid Part B coverage and no premium for my Advantage plans.

Under my Advantage plans I did have some heart testing, stress test, echo, angiogram and cardiac ablation where the retail cost was I think close to $150,000. But my plan paid nothing close to that and for me if I had to guess maybe $1000 in co-pays. or not even that. Not bad for a plan where there is no cost to me except for my Part B premium that the average American $187 gets taken out of their SS check.

I love the subject but it does not pay for me to drop a plan because I dont pay for it when I have an Advantage plan. (heck I just answered my own post!!!) An Advantage plan is already free, and also contains drug coverage. Free meaning you will have co-pays for certain things and at the same time, free extra services as dental, vision, some hearing etc. Depending on area and plan.

Keep in mind whether you have a Medigap plan or not. You will want to get a Plan D