Medicare 2026 Update Vid

[alarmguy]

Im sad I think this Video that I am going to post in the next post on Medicare is a complete as unbiased as they come video that one will find. I think it deserves its own thread but I know it would be merged with @Pablo 's thread here

Sure, it's a business but man, this guy is on point for most everything. I do not agree with a very FEW things but he is on point of possible negatives. One thing is he states with Plan N you pay a $20 co-pay to see a doctor. True. I have the plan but I also seen an incredible amount of doctors this year for my Cancer treatment as much as one a week for months and during 25 radiation treatments 25 times. I did not pay a $20 co-pay each time, heck I am hard pressed to remember many at all. Medicare considers a diagnosis to treat as one co-pay. (or something like that) SO for example I was treated for Cancer, 25 times a doctor saw me after each radiation, never a co-pay. PLUS NEVER ending specialists for 14 months since... Stuff like that.

Next Excess Charges might sound scary but listen closely to his truthful statement. Which MIGHT be only 2% of doctors in the USA will charge an excess charge. Also keep in mind ANY supplement plan that is not Advantage such as Plan N or G you do need to buy separate drug coverage, so that has to be added to the costs for those plans. You need Plan D drug coverage in addition to Plan N or Plan G ... now where I live, my part D drug coverage for 2025 was $0.00 dollars a month. For 2026 it is $3.60 a month. No big deal, its a steal. However that is in my area, other high cost places will be higher.

Now MY PET PEEVE how come, after people worked for companies and had company health insurance that required approvals for procedures, had networks that they had to go do they knock Advantage plans that have the same? Example my wife needed a procedure with her company health insurance, she had to wait six months while her doctor working her procedure through the system.
Guess what? With Medicare, Advantage Plans MUST cover any procedure that Medicare covers, so in the UNLIKELY case where your Advantage plans tells your doctor no, chances are they will let him know more steps that must be taken first. However unlike your company health insurance, if you dont like the decision, you log into your Medicare site and file a dispute. Something like 80% of the time Medicare overrules the Advantage plan and says they must pay it. Also keep in mind those times are rare.

I mean, Medicare is a great system, the options are fantastic. Pick what works for you. You can pay through the nose for things that may never happen. Of course where you live also decides cost and that is why I like this video. Some expensive places like NY he gives examples which one of our own members @demarpaint just went through these rising costs.

 

[alarmguy]

Ok so here it is, a follow up to my post above. VERY informative. Really I think as accurate as you will find anyplace. I mentioned a few thoughts in the post above where I feel differently but also keep in mind I live in a low cost state. In addition most all Advantage plans make it easy to check the medical networks and doctors near you. IN fact if I chose to go back to Advantage next year. I already searched out over 100 miles from where I live and they are all my the HMO plan I am thinking about, including DUKE MEDICAL CENTER and the specialists a saw up there at the end of 2024 which was also covered at the time with my Aetna HMO plan. @demarpaint the video mentions NY a few times once well into it and @Pablo also covers the High G very well. Even states there is an experiment requiring some pre approvals toward the west coast for that plan.

Anyway this is a FANTASTIC video. Give yourself 38 minutes to watch it. WATCH IT TO THE VERY END, the last 4 minutes is also important. I already did a few times.




---

 

[Pablo]

No problem at all I have to take my learning from all walks of life. Hahahaha seriously though the subject is about as dry as a 5 hour overcooked turkey. Being somewhere on the spectrum I glaze over really quickly if I’m not interested. My wife is well versed as she was in the profession but she gets tired of talking at me like a 5th grader. We have a great resource here in the next town over. Claudia is very sharp with the WA state details.

I have been fortunate enough to have decent genetics - although I suspect brain atrophy will get me starting at some point. Also lucky and crazy enough to afford to balance some risk in the decision process.

WA we can change anytime. The premiums aren’t the lowest but the G high deductible is nice. The negative here is daggers into Advantage plans. In my county none are accepted and actually maybe only one left.

I’ve stated above basically why we are going G high. Every geezer and partner needs to do the details.

Side note. We have a zero premium drug plan. If you don’t have expensive drugs and use an in plan pharmacy the cost is zero. I was the idiot who found this out after I paid at my local pharmacy!

 

[alarmguy]

...

Side note. We have a zero premium drug plan. If you don’t have expensive drugs and use an in plan pharmacy the cost is zero. I was the idiot who found this out after I paid at my local pharmacy!

I have a zero premium drug plan too, though its going up to $3.60 a month next year*LOL* unless I go to Advantage.

It really does not matter if you have expensive drugs or not, you pick and choose what they may or may not cover regarding what they will pay. My drug plan paid over $14,000 this year, yet my Part D drug plan cost me $0.00
However then fly over to Long Island NY and the cheapest Part D plan you can get for 2026 is $36 a month.

Yeah, Im like that, if I am not interested in a subject. This is one that I am.

 

[Jim Rogers]

Ok so here it is, a follow up to my post above. VERY informative. Really I think as accurate as you will find anyplace. [...] Anyway this is a FANTASTIC video. Give yourself 38 minutes to watch it. WATCH IT TO THE VERY END, the last 4 minutes is also important. I already did a few times.

Just curious as to what you thought was so great about that video. While I agree it is informative and I don't disagree with any of the points made, it seemed like a fairly standard explanation to me-- I've seen over a hundred videos that give the same info and use just as clear of a presentation.

What made this one stand out to you?

Per our earlier discussion, my biggest problem with this video is the same with >90% of the Medicare videos I've seen. It's not that they don't do a good job explaining the differences between plans (I think they all do fine on that).

It's that they never discuss what (for me) is the critical question: What is the denial rate, criteria, and reasoning for high-cost care that tends to happen in later life (in particular, skilled-care facility coverage)?

Seems that critical topic is always skipped over in virtually every discussion, but to me it's pretty much the only thing I care about.

 

[alarmguy]

Just curious as to what you thought was so great about that video. While I agree it is informative and I don't disagree with any of the points made, it seemed like a fairly standard explanation to me-- I've seen over a hundred videos that give the same info and use just as clear of a presentation.

What made this one stand out to you?

Per our earlier discussion, my biggest problem with this video is the same with >90% of the Medicare videos I've seen. It's not that they don't do a good job explaining the differences between plans (I think they all do fine on that).

It's that they never discuss what (for me) is the critical question: What is the denial rate, criteria, and reasoning for high-cost care that tends to happen in later life (in particular, skilled-care facility coverage)?

Seems that critical topic is always skipped over in virtually every discussion, but to me it's pretty much the only thing I care about.

Well you are entitled to your opinion, we all are. But you do agree it was informative and you dont disagree with any of the points. Well? Then it's a great video. Honestly, much of the public is unaware of those 5 options and how they work because they make a phone call to an agent or a recommendation from a friend. All their options are never discussed in great detail and most people make a decision on the spot.
What made it stand out for me? I never saw such a detailed, complete, mostly accurate (except for some minor things I pointed out) and what I consider unbiased presentation. Never AND I REALLY MEAN NEVER.

I do disagree that I need to know denial rates anymore than I ever looked into the denial rates of any of my company provided health insurance or my self employed health insurance AND my wife's current employee health insurance. So I dont need to know denial rates and no one does anymore than with any health plan of my life.

That is a pet peeve of mine, I think many seniors are overly concerned about Medicare plans that are regulated by the US government/must offer the services that the US government dictates at a fantastic price far more benefits that they ever got in their entire working career? You have more protections than any insurance product on earth in your whole life and the cost is pennies compared to much worse employee insurance. All good, I love the system and I LOVE the Medicare Portal to administer my own plans.

Im more covered than I ever have been in my life, with regards if I ever had a denial. If Medicare covers a procedure, it HAS to be approved. It's not that complicated. If any particular company denies something, simple stuff to file with Medicare and contest it. This is what I don't understand why be concerned? It's all good if someone is concerned. I just don't know why.

BTW- I am just answering your question to me. I am not saying what is important or not important to you is irrelevant. Choice is good. I know, I am certain if I walked door to door through my community of thousands of well educated people, mostly retired that most would have no clue as to their plans denial rate. Let alone the knowledge that video provides of what is available to them, in a clear concise manner.

 

[Jim Rogers]

Well you are entitled to your opinion, we all are. But you do agree it was informative and you dont disagree with any of the points. Well? Then it's a great video.

I thought the video was fine, but nothing special about it. There are many other YT creators that (IMO) go into a bit more detail and provide a bit deeper and more nuanced analysis, so I would not rate this one as great.

But it was fine-- certainly not inaccurate.

Honestly, much of the public is unaware of those 5 options and how they work because they make a phone call to an agent or a recommendation from a friend. All their options are never discussed in great detail and most people make a decision on the spot.

True, but that fact has no bearing on how good the video was.

What made it stand out for me? I never saw such a detailed, complete, mostly accurate (except for some minor things I pointed out) and what I consider unbiased presentation. Never AND I REALLY MEAN NEVER.

Never? You must not watch many Medicare YT videos then. I could throw a rock and hit 10 videos at least as good and many would be even a little better.

The fact that you find this video so "FANTASTIC" is actually a bit telling as to the depth to which you've looked into this subject (see below).

I do disagree that I need to know denial rates anymore than I ever looked into the denial rates of any of my company provided health insurance or my self employed health insurance AND my wife's current employee health insurance. So I dont need to know denial rates and no one does anymore than with any health plan of my life.

Since by consensus the main issue with Advantage is denial rates toward the end of life, you most certainly do need to consider denial rates.

To make the conclusions that, because you didn't have to worry about insurance denial rates in your working years, you don't have to worry about insurance denial rates in your final years is not only a fallacy, it's a critical error in your analysis.

Im more covered than I ever have been in my life, with regards if I ever had a denial. If Medicare covers a procedure, it HAS to be approved. It's not that complicated.

Another critical error in your analysis. The reason you don't find it complicated is because, while you do have a good basic understanding, it's a fairly superficial understanding.

Technically, yes, If Medicare covers something then Advantage must as well. But that's very misleading, because traditional Medicare is fee-for-service while Advantage is a capitation model. So, how those services are accessed and approved can differ significantly, in particular for high-cost, later-year costs.

While it is undeniable that Advantage is cheaper early on, there are a great deal of data to show that Advantage plans make that up in the later years by higher denial rates for more expensive, later-years costs, with Skilled Nursing Facility claims being the most skewed in Advantage denials.

So, while what you say is true in a technical sense, it is not necessarily true in a practical sense. This is an example of why I call your understanding "basic, but superficial."

If any particular company denies something, simple stuff to file with Medicare and contest it. This is what I don't understand why be concerned? It's all good if someone is concerned. I just don't know why.

This makes my "basic, but superficial" point exactly-- if you "don't understand why be concerned," then you need to look more deeply into it.

For example, rather than just looking at the high success rates when Advantage claims are contested and concluding "there's no problem!", perhaps look a little deeper and see that even when an appeal is won, Advantage carriers often just issue another denial within days, in particular with high-cost, later-year, skilled care:

Notices of Medicare Non-Coverage (“NOMNCs”) stating that their Medicare Advantage plan (“Plan”) has decided to terminate coverage of their SNF care. Although enrollees who utilize their appeal rights usually go on to get that denial overturned, the Plans will issue a new NOMNC within a few days and force the enrollee or
their representative to work through yet another appeal over an essentially identical medical situation
https://medicareadvocacy.org/new-rule-for-repeated-snf-denials/

Note that this often happens in a serial nature, where the claimant is on a never-ending cycle of appeals.

And let me repeat, the fact that you (or others) may have had appeal successes early on (i.e., not in the later years of your life) is irrelevant because the issue is high-cost, skilled care in later life.

So, if you just look at things at face value, it may not seem complicated. Look a little deeper, and you might find things aren't so simple.




The bottom line is that you always tout the benefits of Advantage in the early phases (which are real and I don't deny) and always ignore the possibility that those advantages are coming with a tradeoff in the later years that will and up being a significant disadvantage.

For this reason, in any old-age health insurance analysis, it's important to not focus on how the plans work when you're in your 60s, or how they compare to plans when you were in your working years.

The difference in my analysis from yours is that I start with the premise that, with any insurance, it's important to play the long game, to not be lured in by all the short-term goodies they may give up front, and make sure one has the coverage they want and need in their later years when the chips are down.

If you have points to make on later-year tradeoffs, I would love to hear them as I always acknowledge that I could be wrong in my analysis (I'm certainly no expert on this topic).

If you are a healthy person, fit, and have good genes, Advantage might be a great choice even for the later years. But I would be careful assuming that will be the case for everyone because a superficial review concludes "it's all so simple."

Start analyzing at that level, and you might find the depth of analysis of that video a bit less satisfying.

Though, I do agree, that video is an acceptable generic starting point for anyone who has zero knowledge of the topic. I'm just not seeing anything "great" about it.

Choice is good, but only if one truly understands the choices! I say start with that video but quickly move on to deeper analyses.

 

[alarmguy]

I thought the video was fine, but nothing special about it. There are many other YT creators that (IMO) go into a bit more detail and provide a bit deeper and more nuanced analysis, so I would not rate this one as great.

But it was fine-- certainly not inaccurate.
…

You’re certainly welcome to post any videos that you think are better and help everybody out.
I love the benefits of the Medicare system the choices are outstanding compared to employee health insurance plans.

You can insure yourself for anything in life. It all depends on how much you want to pay.
Or you could go into the system and learn about it how to save money.

You’re turning this into an advantage plan versus a medigap policy debate. The excellent video that I posted addresses the most popular plans of both.
I’m starting to think we had this debate sometime ago and yet you insist on turning it into a debate about two. Post number 22 I raved what a great video that is it highlights both types of plans.

So I’m not understanding your what seems like an agenda and I don’t care too. The video in post 22 is an excellent video no matter which type of plan you select and I’m not going to get off the subject or debate any further. I’m also not going tell other people how to spend their money based on personal thoughts. Though I make those thoughts known

 

[Vil_Riker]

The hospital doesn’t charge $500 a day.
Your insurance company will pay all costs and your co-pay will be up to $500 a day for 5 to 6 days and then zero dollars per day for the policy owner after that.
In our state, it’s more like $$250-$350 per day for 5 to 6 days is your co-pay and then after that everything is covered 100% at zero co-pay.

Another example. I’ve been to the emergency room three times in the last two months. At most about two hours each time. Each time the bill was over $2000.
My co-pay was $50 and my insurance company pays the rest

BTW- if you choose not to have an advantage plan, Medicare Part A is what the average American gets for free, you are covered at 100% for your in hospital bills except for a $1726 deductible. Then if you elect for part B, which is just over $200 a month and most all Americans are automatically signed up unless you Opt out are taken out of your Social Security check and that covers all other medical expenses and doctor bills, you have to pay 20% of the Medicare approved charges Medicare pays the rest.

It’s only if you want an alternative to the above do you choose a Medigap plan or an advantage plan.

My opinion (and many others) is Medicare is a fantastic program, truly something the government gets right.
I don’t think anything is bad.

OK, I see what you meant by "charge" - i.e. the patient responsibility. In healthcare billing there are quite a few types of numbers that get described as "cost", "charge" or "price" by different lay people.

 

[alarmguy]

OK, I see what you meant by "charge" - i.e. the patient responsibility. In healthcare billing there are quite a few types of numbers that get described as "cost", "charge" or "price" by different lay people.

Yeah, I can understand from your side of health care billing "patient responsibility"
I have Plan N currently. I have been to the Emergency room 3 times since Sept about 2 hours actual treatment each time which still was billed as thousands of dollars but not much more.

Im supposed to have to pay a $50 co-pay under Plan N. My first detailed claim for the first visit has been finalized and paid. For some reason my co-pay was paid by the Plan. I'll never understand it and not going to figure it out. I know of others who have paid less co-pays then they expected under Plan N. Even though it clearly says I have a ER co-pay of $50. Maybe because it was a more simple service> It mentions something about non-complicated. I desperately needed steroids for face swelling two times and my tongue once.

It's been a reaction since finishing up a Prostate Cancer Drug. Heck, it's like I have "EZ-Pass" at the emergency room now. Give my card, no paperwork, they tell me to have a seat and in less then 5 minutes they take me to the back. (if that long*LOL*)

One time trying to avoid the emergency room I tried an urgent care center, by the time they got to me it was pretty severe and they wouldnt treat me and insisted on calling an Ambulance to take me to the ER. I refused and drove myself. My face blows up so much I look like SHREK and my iPhone does not recognize my face either! *LOL*

 

[nomas]

Well , I did the math . I'm coming out ahead just a bit .

 

[Pablo]

Well , I did the math . I'm coming out ahead just a bit .

How so?

 

[Jim Rogers]

You’re certainly welcome to post any videos that you think are better and help everybody out.

I would say the video in the OP was better than the one you posted. At the 17:00 mark, it discusses a negative trend in Advantage enrollment due to pricing issues. The coverage is brief and shallow, but at least it's there.

You can insure yourself for anything in life. It all depends on how much you want to pay.
Or you could go into the system and learn about it how to save money.

Not sure what you're saying here ("go into the system and learn about it how to save money?"), but if you're saying that learning about the system can help you save money, then I agree.

And the point I'm making is that the advice you give (and more importantly, the basis for that advice) indicates to me that you need to learn more about the system.

You’re turning this into an advantage plan versus a medigap policy debate. The excellent video that I posted addresses the most popular plans of both.
I’m starting to think we had this debate sometime ago and yet you insist on turning it into a debate about two. Post number 22 I raved what a great video that is it highlights both types of plans.

That's fine, but it seems strange (and telling) to me that you would "rave" about such a generic, basic information, "square-one" video that are a dime a dozen on YT.

So I’m not understanding your what seems like an agenda and I don’t care too. The video in post 22 is an excellent video no matter which type of plan you select and I’m not going to get off the subject or debate any further. I’m also not going tell other people how to spend their money based on personal thoughts. Though I make those thoughts known

On the contrary, it seems to me that all you do is make recommendations to people based on your personal thoughts.

And IMO those thoughts are not based on rigorous analyses, so every once in a while, I chime in to push back. So, my agenda is to make counterarguments to your arguments with the hope that the discussion benefits others.

​

Rather than relying on YT, I'm more a fan of reading primary analyses. In doing that, I run into quite a bit of concerning info as to:

​

--The “...central concern in the capitated payment model used in Medicare Advantage is the potential incentive for Medicare Advantage Organizations to deny beneficiary access to services and deny payments to providers in an attempt to increase profits.” and inappropriate denials concentrated in post‑acute care (SNF, rehab, home health). https://racmonitor.medlearn.com/fighting-back-against-medicare-advantage-snf-denials-part-1/​

​

--Documentation of repeated cases where MA plans issued Notices of Medicare Non‑Coverage (NOMNCs) to terminate skilled nursing facility coverage prematurely, and even when patients appealed successfully, plans often re‑issued denials days later, creating a cycle of interrupted care. https://medicareadvocacy.org/new-rule-for-repeated-snf-denials/​

​

--Analyses that show that, under capitation, insurers receive a fixed per‑member payment and this structure explicitly shifts financial risk to the plan, incentivizing them to limit utilization of costly services. https://www.cms.gov/medicaid-chip/medicare-coordination/financial-alignment/capitated-model​

​

--OIG summaries that note the capitated model creates direct incentives to deny medically necessary services late in care episodes, especially expensive ones like SNF stays. (from the above link https://racmonitor.medlearn.com/fighting-back-against-medicare-advantage-snf-denials-part-1/)​

​

--Industry billing manuals that explain that denials under code CO‑24 occur because services are “covered under a capitation agreement,” which is the direct mechanism of how capitation leads to denial of additional claims. https://www.mdclarity.com/denial-code/24​

I'll stop there but suffice it to say that there are many reports of this nature that you're not going to find in run-of-the-mill "here's a basic explanation of the plans" YT video.

While my (far more in-depth) analyses cause me concern regarding Advantage plans, I'm by no means an expert, and my guess is that someone who is a professional in the area might find fault in the bases of my conclusions as well.

Rather than responding "I’m not understanding your what seems like an agenda and I don’t care too, and I’m not going to get off the subject or debate any further," I would welcome a critical review of my conclusions and the data that caused me to arrive at those conclusions.

In other words, my mind is changeable-- yours does not appear to be.

Because you are so vocal, assertive, and convincing in what I believe to be flawed arguments/analyses, I will continue to critically review your conclusions and occasionally provide counterarguments to the points you make, which I hope will be to the benefit of others on the board.

Don't take it personally-- I do respect the input you provide. And even though I disagree with much of it, I don't believe your posts are made in bad faith or represent ill-will or ill-intent.

I believe you are well-intentioned, but incorrect.

I am also well-intentioned, and I do not rule out the possibility that I could be incorrect.

If so, I welcome correction!

 

[alarmguy]

....

On the contrary, it seems to me that all you do is make recommendations to people based on your personal thoughts.

And IMO those thoughts are not based on rigorous analyses, so every once in a while, I chime in to push back. So, my agenda is to make counterarguments to your arguments with the hope that the discussion benefits others.

​

Rather than relying on YT, I'm more a fan of reading primary analyses. In doing that, I run into quite a bit of concerning info as to:

​

--The “...central concern in the capitated payment model used in Medicare Advantage is the potential incentive for Medicare Advantage Organizations to deny beneficiary access to services and deny payments to providers in an attempt to increase profits.” and inappropriate denials concentrated in post‑acute care (SNF, rehab, home health). https://racmonitor.medlearn.com/fighting-back-against-medicare-advantage-snf-denials-part-1/​

...​

You can buy whatever insurance you want and you can pay as much as you want for the fear of something that might potentially happen. The same might potentially happen with any insurance. Oh heck, your doctor or hospital might potentially kill you. Over 200,000 USA citizens are killed by mistakes in hospitals every year. I would suggest anyone in either plan will have much greater odds getting hurt in a car accident then having an issue with any Medicare plan.

Buy what you like. 50% of the country is in Advantage plans and less that 50% in Medigap plans. Your choice, you can find any negative you want online involving tens of millions of people and make it sound like a big deal. As far as Advantage more people rate their plans 4+ stars.
There are people out there afraid of all the "what if's" in the world but they dont see the what if's of what they have. Yet willing to pay extra, actually thousands extra per year in many cases and that is all fine and well. Good, choices are good.

I love that word potential
-The “...central concern in the capitated payment model used in Medicare Advantage is the potential incentive for Medicare Advantage Organizations to deny beneficiary access to services and deny payments to providers in an attempt to increase profits"

Based on all your posts, I wonder if you're even on Medicare? I see no posts about that, just references to far out claims.
I have experience with both Plan N and Plan D plus 3 years experience with two different Advantage plans. I know many people in both and all are happy, buy what you want. I or anyone I know has not had a negative experience with either one.

If you feel I am an advocate for Advantage plans, that is wonderful, they are a great value and my opinion is just as valid as yours if not more so.

If you think I would tell someone who wants to pay an extra $200 to $400 a month Each (or more) for a Medigap plan, in addition to paying extra for dentists and eye care that they are crazy you are wrong.
If you think I would tell someone who wants an Advantage plan and save a boatload of money they are crazy, you are wrong again.

You seem to be debating with yourself. No sense going in circles. It would be a shame to see this thread shut down.
Cleary your fear says you should be in a Medigap plan, though you don't offer what you are in but that is ok, Medigap is for you.

Ps, you mention over and over that the video in post #22 is accurate in your mind. Well I know it is. Yet for some reason you say those videos are a dime a dozen. So what is the point of that statement? The video HELPS people understand what is available to them. Yet you keep attacking it and my opinion.

 

[mk378]

I have a simple question about conventional Medicare with Medigap. After Medicare agrees to pay the 80% for some treatment, does the Medigap company ever have a leg to stand on and try to deny the 20%?

 

[ARCOgraphite]

My wife and I watched it last night. I'm a little concerned with his objectivity with his affiliation with Chapter. Just a little, but he wasn't trying to push people toward Medicare Advantage. We do enjoy his videos.

Marvin Musick - The Medicare School is the man. He edumedicated me proper when I was approaching retirement a few year back.

When calculating her COLA, I think I told the wife that Medicare part B premium will increase to $202.90 for cy2026 - and that made her so happy. I don't even want to look at my Medigap plan N premium - but I won't see that until next May (unless I peek at the N.H. DHHS rate tables publication - a good comparison tool.

 

[2005jettatdi]

Oh yea so much for the 2.8% increase in SS. I love how Uncle Sam makes the math work for him.

There is insanity in the whole SS system. In February, I will receive my January "benefit" payment. However, if I should die any time before the end of February, they will take that January payment back.

I get a small SS increase this year since Medicare Part B is still not increasing more than my SS increase.

We are fortunate (is that the correct word?) that financial planning and saving means we do not have to rely on our Social Security.

 

[ARCOgraphite]

I have a simple question about conventional Medicare with Medigap. After Medicare agrees to pay the 80% for some treatment, does the Medigap company ever have a leg to stand on and try to deny the 20%?

There is no "agrees to pay". If your Doc/hospital accepts medicare assignment for procedure/treatment, that is what is "charged", then your Ins supplement pays the remaining 20% (for a plan G or N) after any copay and the annual deductible is satisfied.

Please understand the are more than one Govt regulated medigap plan with differing features, coverage and costs- some reinstall co-pays - and also understand there are practices that do not accept medicare assignment or can charge overages.

 

[alarmguy]

Marvin Musick - The Medicare School is the man. He edumedicated me proper when I was approaching retirement a few year back.

When calculating her COLA, I think I told the wife that Medicare part B premium will increase to $202.90 for cy2026 - and that made her so happy. I don't even want to look at my Medigap plan N premium - but I won't see that until next May (unless I peek at the N.H. DHHS rate tables publication - a good comparison tool.

Im currently paying just under $150 a month for Plan N in NC
Yeah, you are correct about part B going up to $202.90

(most likely going back to an Advantage for 2026) Humana has a good one here with a Max out of pocket of $3,500 plus all the bells and whistles 2500 dentist, I think 300 contacts 50 a quarter over the counter.
Most likley would never accept an Advantage with much more than a $5,000 out of pocket if ever then but I am not there yet so dont have to think about it, yet. The costs in the South are lower in my experience, much lower than Long Island NY... so ALL the hospitals, cancer centers (including Duke) etc are in the plan that I might switch too. I love this time of year, shopping around *LOL*

 

[demarpaint]

There is insanity in the whole SS system. In February, I will receive my January "benefit" payment. However, if I should die any time before the end of February, they will take that January payment back.

I get a small SS increase this year since Medicare Part B is still not increasing more than my SS increase.

We are fortunate (is that the correct word?) that financial planning and saving means we do not have to rely on our Social Security.

Yep that's the way it goes. Regarding being fortunate, if I had to live on my SS benefit, I'd die a slow and miserable death from starvation. Thank God my wife and I planned for the future.