Medicare 2026 Update Vid

[alarmguy]

...

I thought that you might be able to switch over to BCBS & use the Blue to Blue rule if you want to go back to Medigap? I'm sure you'll want to confirm on your end.

Yes, Blue to Blue is real can they ever end it? I would think maybe but if they did they might have to offer a one time out since it was marketed.
With that said, The Humana plan is so good with the lower MOOP that you could be in it forever. I believe Medicare limits MOOP increases like they limit all increases. Being a realist I would think maybe in time should it be not profitable enough for them, they will stop offering the plan which gives an out to go back to Medigap without underwriting or another Advantage plan. Which is exactly why I am in Plan N and D this year (2025) after 3 years of Advantage plans.
However Im certain (almost) to be signing up for a new Advantage in the coming days or hours (2026)

 

[alarmguy]

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.

( I think I promised to reply to something before the holiday but cant find it, a lot of posts in here)
Im getting close to a decision.. *LOL* After all I only have about 5 days or less left.

I think we covered and I confirmed for myself, however everyone should confirm for themselves. A High G plan you are only paying 20% of the Medicare approved amount. Which is 20% of what Medicare actually pays. The same goes for having no Medigap plan and only Part A, B, and D ... 20% of what medicare pays you will owe.
...
I dont consider MA plans have a high denial rate (6.3% in 2023) and almost certain to be many times lower or no different than private company insurance. Yet, unlike Medicare MA plans you have rock solid recourse if something is denied vs the company health insurance people had all their lives.

However if fear is a factor for someone, best take the more expensive route. We all buy what makes us happy!
Interesting article. BTW- it's strange, people get upset about not letting medical practices and doctors game the system, yet they are coming from the very same system they had their whole lives with company health insurance. I feel a lot of this stuff is media hysteria and a public who lost the ability to critically think ONLY if they are not going to MA out of fear of being denied.
SO they are ok with anything goes Medigap a system with no controls and a very minimum of losing 100 billion dollars a year to fraud.

https://www.naplesnews.com/story/ne...-roughly-6-4-of-coverage-in-2023/78209912007/

...
now compare the above and look at the denial rates of private health insurance (non medicare) to me personally its almost laughable that people have a fear of MA plans compared to the rates of private insurance plans form employee and self purchased.
https://www.moneygeek.com/insurance/health/aca-claim-denial-rates-by-state-and-insurer/

 

[Jim Rogers]

( I think I promised to reply to something before the holiday but cant find it, a lot of posts in here)
Im getting close to a decision.. *LOL* After all I only have about 5 days or less left.

I think we covered and I confirmed for myself, however everyone should confirm for themselves. A High G plan you are only paying 20% of the Medicare approved amount. Which is 20% of what Medicare actually pays. The same goes for having no Medigap plan and only Part A, B, and D ... 20% of what medicare pays you will owe.
...
I dont consider MA plans have a high denial rate (6.3% in 2023) and almost certain to be many times lower or no different than private company insurance. Yet, unlike Medicare MA plans you have rock solid recourse if something is denied vs the company health insurance people had all their lives.

However if fear is a factor for someone, best take the more expensive route. We all buy what makes us happy!
Interesting article. BTW- it's strange, people get upset about not letting medical practices and doctors game the system, yet they are coming from the very same system they had their whole lives with company health insurance. I feel a lot of this stuff is media hysteria and a public who lost the ability to critically think ONLY if they are not going to MA out of fear of being denied.
SO they are ok with anything goes Medigap a system with no controls and a very minimum of losing 100 billion dollars a year to fraud.

https://www.naplesnews.com/story/ne...-roughly-6-4-of-coverage-in-2023/78209912007/

...
now compare the above and look at the denial rates of private health insurance (non medicare)
https://www.moneygeek.com/insurance/health/aca-claim-denial-rates-by-state-and-insurer/

It's post 145 where I asked for you take (I quote it below as well).

However, there is no hurry-- feel free to get your 2026 coverage figured out before you worry about answering my question.

With this post (and the numbers you shared in it), you have brought something to my attention of which I was not previously aware: That the Medicare contract prices represent such a steep discount.

I knew there was a discount but didn't realize it was that steep.

I was able to confirm your point independently, and I agree with you that this fact makes full self-insurance of the Medicare gap far more actuarially feasible.

Given my earlier post where I showed how high Supplement premiums will get in later years ($1,500-2,000/mo.), understanding of this discount rate makes going without gap coverage and paying the full 20% (discounted) seem like the cheaper option than buying a Supplement.

In fact, this new understanding has caused me to re-consider Advantage:

It is true that, with those discounts, I could easily just self-insure, pocket the gap insurance premiums I would be avoiding, and apply that money to paying (highly discounted) gap costs.

However, there is no need to do that when $0 premium, relatively low MOOP Advantage plans exist (and even I agree work well early on).

It would seem the best idea is to get the highest-quality Advantage plan that has $0 premium and the lowest MOOP, and go ahead and harvest all the no-denial gap coverage, drug, dental, vision, and hearing coverage, and everything else the Advantage plans will provide early on.

At the same time, I could start saving every month the premium money I would have been paying with a Supplement.

If you (alarmguy) are right and the Advantage plan will not deny anything at end of life, then great! I had low-cost, excellent healthcare right up to the end.

However, if I'm right and the Advantage plan starts increasing the denial rate for even reasonable coverage as the years progress, I start using the avoided premium funds I had been saving over the decades (plus any of my current assets) to self-pay whatever Advantage denied.

In words, I don't fully self-insure, I just self-insure any gaps in the Advantage gap coverage. Sort of like "gap co-insurance" that is self-funded out of my premium savings.

As you have now made me realize, with the discounted Medicare contract rates, that "Advantage gap" coverage might not even be all that expensive.

E.g., I looked into it, and the cost of the later-life, full 100‑day stay in a Skilled Nursing Facility (that I've been worrying about because I believe Advantage has a high probability of denying) is ≈ $16,000 out‑of‑pocket in today’s dollars, and by year 20, with inflation, that might be closer to $25,000–30,000.

But given that Supplement plans are expected to have premiums of up to $2000/mo., that represents the amount I could be saving every month for the preceding decades by not paying Supplement premiums.

Thus, paying ~$25K out of pocket (using those accumulated premium savings) for a denied SNF stay in later life would actually be cost-effective vs. paying for a supplement.

In addition to the actuarial soundness of this approach, doing this means that I will be able to harvest the subsidy money the federal government is willing to contribute to my healthcare (that is expressed in the form of the federal subsidy the Advantage plans get).

Full self-insurance of the whole 20% gap would mean turning my back on federal subsidy funds that I am owed as I contributed greatly to that pool through my near 50 years of payroll tax payments.

In summary:

--With full self‑insurance under straight Medicare and no gap coverage, I would essentially saying: "I’ll pay the 20% coinsurance myself and decline any supplemental pooling." That means that not only do I have to bearing all volatility, I'm also declining the federal subsidy that flows through Advantage plans.

--With Advantage + my asset reserve (the majority of which will come from the savings of not paying gap insurance premiums), I will have:

1) Harvested the government’s subsidy to which I contributed for many years

2) Harvested pooled benefits in the early years when Advantage plans are generous and denials rare.

3) Saved the Medigap premium equivalent as a reserve, so I can self‑pay only the late‑life gaps that matter to me.

4) Be allowed to benefit should I be wrong and there are no Advantage denial problems near end-of-life.

So, perhaps the "Advantage + self-insuring and Advantage coverage gaps using premium savings funds" approach is the "split all the differences" strategy I've been looking for.

What is your take on this?

 

[alarmguy]

With this post (and the numbers you shared in it), you have brought something to my attention of which I was not previously aware: That the Medicare contract prices represent such a steep discount.

I knew there was a discount but didn't realize it was that steep.

I was able to confirm your point independently, and I agree with you that this fact makes full self-insurance of the Medicare gap far more actuarially feasible.

Given my earlier post where I showed how high Supplement premiums will get in later years ($1,500-2,000/mo.), understanding of this discount rate makes going without gap coverage and paying the full 20% (discounted) seem like the cheaper option than buying a Supplement.

In fact, this new understanding has caused me to re-consider Advantage:

It is true that, with those discounts, I could easily just self-insure, pocket the gap insurance premiums I would be avoiding, and apply that money to paying (highly discounted) gap costs.

However, there is no need to do that when $0 premium, relatively low MOOP Advantage plans exist (and even I agree work well early on).

It would seem the best idea is to get the highest-quality Advantage plan that has $0 premium and the lowest MOOP, and go ahead and harvest all the no-denial gap coverage, drug, dental, vision, and hearing coverage, and everything else the Advantage plans will provide early on.

At the same time, I could start saving every month the premium money I would have been paying with a Supplement.

If you (alarmguy) are right and the Advantage plan will not deny anything at end of life, then great! I had low-cost, excellent healthcare right up to the end.

However, if I'm right and the Advantage plan starts increasing the denial rate for even reasonable coverage as the years progress, I start using the avoided premium funds I had been saving over the decades (plus any of my current assets) to self-pay whatever Advantage denied.

In words, I don't fully self-insure, I just self-insure any gaps in the Advantage gap coverage. Sort of like "gap co-insurance" that is self-funded out of my premium savings.

As you have now made me realize, with the discounted Medicare contract rates, that "Advantage gap" coverage might not even be all that expensive.

E.g., I looked into it, and the cost of the later-life, full 100‑day stay in a Skilled Nursing Facility (that I've been worrying about because I believe Advantage has a high probability of denying) is ≈ $16,000 out‑of‑pocket in today’s dollars, and by year 20, with inflation, that might be closer to $25,000–30,000.

But given that Supplement plans are expected to have premiums of up to $2000/mo., that represents the amount I could be saving every month for the preceding decades by not paying Supplement premiums.

Thus, paying ~$25K out of pocket (using those accumulated premium savings) for a denied SNF stay in later life would actually be cost-effective vs. paying for a supplement.

In addition to the actuarial soundness of this approach, doing this means that I will be able to harvest the subsidy money the federal government is willing to contribute to my healthcare (that is expressed in the form of the federal subsidy the Advantage plans get).

Full self-insurance of the whole 20% gap would mean turning my back on federal subsidy funds that I am owed as I contributed greatly to that pool through my near 50 years of payroll tax payments.

In summary:

--With full self‑insurance under straight Medicare and no gap coverage, I would essentially saying: "I’ll pay the 20% coinsurance myself and decline any supplemental pooling." That means that not only do I have to bearing all volatility, I'm also declining the federal subsidy that flows through Advantage plans.

--With Advantage + my asset reserve (the majority of which will come from the savings of not paying gap insurance premiums), I will have:

1) Harvested the government’s subsidy to which I contributed for many years

2) Harvested pooled benefits in the early years when Advantage plans are generous and denials rare.

3) Saved the Medigap premium equivalent as a reserve, so I can self‑pay only the late‑life gaps that matter to me.

4) Be allowed to benefit should I be wrong and there are no Advantage denial problems near end-of-life.

So, perhaps the "Advantage + self-insuring and Advantage coverage gaps using premium savings funds" approach is the "split all the differences" strategy I've been looking for.

What is your take on this?

Yes! I found it and was replying to some of your posts as you were posting the reply!

Out of all our posts, to me personally keeping in mind that I always say we buy everything in life that appeals to us. We are all different.
My train of thoughts align with your points 1 through 4.
However I have no fear of denials.

My one real fear is the ever rising cost of the MOOP in MA plans, the curtailment of benefits (dental vision etc) and possible curtailment of the size of available network. Doctors, Hospitals etc. All these things can be done in the framework of a plan without canceling the plan (not offering it) for the following year.
Though Medicare does restrict the MOOP increases each year so if you start out low you should be ok. In my mind with no proof I am certain that should a plan want a higher than allowed MOOP the company can drop the plan and then you are free to choose a new one or go to Medigap with no underwriting. So for me that is a win for more options into the next year. I honestly do nto see how Humana will be able to keep offering the plan I am seriously considering with an MOOP of $3,500 (it was $3,100 I think in 2025 the BCBS plans I am considering had about the same % increase in the MOOPs)
It is a valid point, once in an Advantage always in an Advantage (in most states) unless the plan is dropped OR you are able to get through underwriting. I would never be able too.

It's a fascinating subject and no right or wrong, it's really an individual decision. I like the statement you make #1 well honestly the reason MA plans can offer (in my mind) the plans that they do is first government is paying roughly $1000 a month for the plans and private insurance (just like all employed Americans) are better at preventing fraud/ but MA plans, unlike private have the protections of the Medicare system which is full of holes and costs of over 100 billion a year in waste and fraud.
These are my feelings. Honestly I look to save money AND all the networks here take the plans so it's not as big of a deal maybe compared to high cost areas. If they were so bad, for instance, Florida has a 60% MA rate of people in MA. IM sort of anti modern media "news" as they only tell the exciting part of the story, people wont stay tuned in for the whole story.

 

[alarmguy]

@fantastic
I menat to respond to one of your posts.
Yes, I am aware you can sign up for as many MA plans as you want, the last one that you sign up for by Dec 7th is the one that will take effect. I dont because I will drive myself crazy but know I do have that option. I explained that it to a friend who almost switched as they need a special type of hospital in case things go wrong but found out Duke was in-network

 

[fantastic]

I watched this video. Im within days or hours of choosing next years plan.
I actually posted a question to them and they responded within minutes. It's such a basic question but when making what can be life changing financial decisions I need to see it in hard print form at least someone and I could not find it on the Medicare.gov site though I am sure it is there. I knew I saw someplace in print High G you are going to pay the first 20% of Medicare Part B approved cost. Not billed cost. The difference is HUGE as most know. However I wanted to see that in print someplace regarding Part B without a supplement plan and they answered the same. If no supplement plans you would be responsible for 20% of the approved cost of what Medicare pays. NOT the billed cost.

That's right, it would be the Medicare approved amount 20%. Doesn't hurt to ask!

 

[alarmguy]

That's right, it would be the Medicare approved amount 20%. Doesn't hurt to ask!

Yes, it would only make sense, but with such a huge price disparity, I needed to see it in print!

 

[alarmguy]

@fantastic @Jim Rogers

Well I made the decision last night and selected an Advantage plan previously discussed. I would have like to stay with BCBSNC but they made it difficult, their website had a nearby new hospital network missing from their HMO plan but was in their PPO plan, still Im sure an oversight still their website is a train wreck in some places. I did have them this year for Plan N and all was smooth though. I am sure if I called I could have confirmed it was included. However, that in itself was a pain, no easy number to call. I was willing to pay an extra $40 a month for the BCBS Advantage plan but they made it too hard.

So, the choice was Humana, whose website makes it easy to check doctors, networks and they are ALL there. Plus of course their HUGE nationwide network. $0.00 a month, no co-pay primary and $5 co-pay specialist. Both plans have no gatekeeper, no referrals needed for in network for specialists. $2,500 for dentists, only $150 for contacts and that is ok.

Signing up was simply a couple clicks on my Medicare.gov portal. They take care of everything. AS soon as I clicked for the plan in 2026 it removed what would have been my 2026 Plan N and D replaced it with this. AS fantastic pointed out, I CAN change my mind again before Dec 7th and click on a new plan, same procedure will replace the one I just choose.

Also keep in mind. I have a full 3 months in 2026 to switch out of that Advantage plan and into another if I want too. Who knows, maybe I will or wont. Does not matter, it's only a year, actually nine months from the end of March.

Like I say, the protections given to Medicare recipients is unmatched by the private sector such as employee health plans. But for some reason we get all twisted about stories, easy to find when ONE HUNDRED AND FIFTY FIVE MILLION Americans are on either Medicaid or Medicare. 88 million and 66 million respectively. I mean, that is the reality, easy news story to find bad outcomes but I would bet it's far, far worse with company health plans of working people.

This is the summary however due diligence I read over the 100 plus pages of the "evidence of coverage"
This plan is so reasonable like they all USED to be, I suspect it wont be offered next year (2027) and if not, big deal, I can go shopping again which I do every year even if I am not going to switch.

https://www.humana-medicare.com/BenefitSummary/2026PDFs/H1036335001SB26.pdf

..

 

[fantastic]

@fantastic @Jim Rogers

Well I made the decision last night and selected an Advantage plan previously discussed.

Excellent
You can actually get $250 for contacts if you find a Humana Plus Provider. Save $65 by going to primary dr instead of urgent care. CenterWell pharmacy has done a good job for us in the past. Obviously they are who you want to use to get the cheapest drugs.

Looks like Tier 3-5 has a $250 deductible that must be paid first before Humana pays anything. You may want to see if companies like GoodRX can help bring down the costs in those tiers.

No referrals for in network... can't beat that for an HMO. Part B premium payback gets you $12 back for the year to your SS check.

Not much really sticks out but that is a good thing. Low MOOP.

Thanks for sharing your choice.

 

[fantastic]

@alarmguy

I got to digging in the drug cost thing some more. Looks like you can use one or the other, Part D Humana or discount drug cards like GoodRX. There are other companies like cost plus drugs that have removed the PBM's from the order of profits to reduce costs. You can even see your cost of drugs on their website +15%+$5 S&H.

Now, if you use these discount cards it will NOT go towards your $250 deductible if they're Tier 3-5 drugs. If you plan on using more than $250 worth of drugs in a year then it may be wise to pay towards that deductible. Otherwise you can present the discount cards or have your Dr send script to Cost Plus Drugs if that would be a cheaper avenue for you. I've used GoodRX a few times in the past but mostly used Blink Health a long time ago for scripts that were cheaper for us and it worked out pretty well. You could reach out to these places to check on costs or ask the pharmacy which would be the cheapest, using your Part D Human plan or discount card...your choice.

• $0 deductible for Tier 1 and Tier 2. This plan has a $250 deductible for Tier 3, Tier 4 and Tier 5 drugs . You pay the full cost of these drugs until you reach $250 . Then, you only pay your cost-share.
• After your total out-of-pocket costs reach $2,100 you pay $0 for plan-covered Part D drugs.

Also, There is a Prescription Payment Plan with Humana (or any Advantage Plan w/Part D) that can help budget the money. I will say that your Humana Plan has a low deductible of $250 whereas others are at the max allowed $615 for 2026.

Between the wife & I we had over $11k in medicine so far this year (One of my pills is $1700 for a 90 day supply...ha!). We were subject to about $3k but the wife gets some assistance w/that so that helps. It doesn't sound like you're in that situation which is good.



He shows the flow of drug distribution process. Don't think he touches on GoodRX but again shows the flow of medicine distribution which is informative.

 

[alarmguy]

@alarmguy

I got to digging in the drug cost thing some more. Looks like you can use one or the other, Part D Humana or discount drug cards like GoodRX. There are other companies like cost plus drugs that have removed the PBM's from the order of profits to reduce costs. You can even see your cost of drugs on their website +15%+$5 S&H.

Now, if you use these discount cards it will NOT go towards your $250 deductible if they're Tier 3-5 drugs. If you plan on using more than $250 worth of drugs in a year then it may be wise to pay towards that deductible. Otherwise you can present the discount cards or have your Dr send script to Cost Plus Drugs if that would be a cheaper avenue for you. I've used GoodRX a few times in the past but mostly used Blink Health a long time ago for scripts that were cheaper for us and it worked out pretty well. You could reach out to these places to check on costs or ask the pharmacy which would be the cheapest, using your Part D Human plan or discount card...your choice.

• $0 deductible for Tier 1 and Tier 2. This plan has a $250 deductible for Tier 3, Tier 4 and Tier 5 drugs . You pay the full cost of these drugs until you reach $250 . Then, you only pay your cost-share.
• After your total out-of-pocket costs reach $2,100 you pay $0 for plan-covered Part D drugs.

Also, There is a Prescription Payment Plan with Humana (or any Advantage Plan w/Part D) that can help budget the money. I will say that your Humana Plan has a low deductible of $250 whereas others are at the max allowed $615 for 2026.

Between the wife & I we had over $11k in medicine so far this year (One of my pills is $1700 for a 90 day supply...ha!). We were subject to about $3k but the wife gets some assistance w/that so that helps. It doesn't sound like you're in that situation which is good.



He shows the flow of drug distribution process. Don't think he touches on GoodRX but again shows the flow of medicine distribution which is informative.

That is a lot of medicine that you need.
First time in my life I ever needed a tier 4 or 5 was only for 6 months this year. I'm all done now. It didnt bother me a bit that I had a $600 deductible. The cost of the drug was over $14,000 so the $2000 out of pocket kicked in anyway. For some reason the hospital pharmacy or the drug company themselves actually somehow kicked in about $1000 towards my deductible. I am unsure how but I know it was intentional because they put me on hold and came back with a lower out of pocket for me. I didnt care to ask how *LOL* Newer drug and not sure if it was widely being used in my area yet.

Anyway, I'll keep my fingers crossed but all I have is a statin that I take. There is another but that is also tier 1 or 2 and honestly pretty much not needed anymore, cant spell it but most would know it starts with TAM.

Yes, there are now about 3 of the bigger discount sites with goods the most well known. AARP rings a bell and some others.
I have a family member that takes about a dozen pills a day and does what you do for lower cost but I think ever since he went into Advantage plans he hasn't had too. (dont quote me on that)

Advantage plans with drug coverage dont use the terminology of "Part D" But I understand how you used the words, for clarity for others though I wanted to point that out. You cant not have a Part D plan with an Advantage Plan in almost all cases. MOST Advantage plans come with Drug coverage as part of the plan. I think that distinction is made because there are also Advantage plans without drug coverage, some might get that drug coverage through military or retirement plans. However you can not sign up for an Advantage plan without drug coverage and then elect to pick a drug company under Plan D

Im almost bored now that I selected a PLAN FOR 2026. True if I want I can change that plan again as long as I do it by the end of March 2026 but I wont. I'll wait until Nov 2026 before shopping for a 2027 plan

 

[fantastic]

That is a lot of medicine that you need.

hit by stupid Drunk 26 yrs ago.

First time in my life I ever needed a tier 4 or 5 was only for 6 months this year. I'm all done now. It didnt bother me a bit that I had a $600 deductible. The cost of the drug was over $14,000 so the $2000 out of pocket kicked in anyway. For some reason the hospital pharmacy or the drug company themselves actually somehow kicked in about $1000 towards my deductible. I am unsure how but I know it was intentional because they put me on hold and came back with a lower out of pocket for me. I didnt care to ask how *LOL* Newer drug and not sure if it was widely being used in my area yet.

Right, ..Don't ask! ha ha!

Anyway, I'll keep my fingers crossed but all I have is a statin that I take. There is another but that is also tier 1 or 2 and honestly pretty much not needed anymore, cant spell it but most would know it starts with TAM.

That's great to hear.

Advantage plans with drug coverage dont use the terminology of "Part D" But I understand how you used the words, for clarity for others though I wanted to point that out. You cant not have a Part D plan with an Advantage Plan in almost all cases. MOST Advantage plans come with Drug coverage as part of the plan. I think that distinction is made because there are also Advantage plans without drug coverage, some might get that drug coverage through military or retirement plans. However you can not sign up for an Advantage plan without drug coverage and then elect to pick a drug company under Plan D

Seems there is still a case to present the drug portion in an MA plan or Original Medicare as "Part D". You could have an argument & say I can't have a separate Part D if going w/an MA plan.

Medicare says "Medicare drug coverage (also known as Medicare Part D)". Link

When you get an MA plan you are getting Part A & Part B...right? So it's reasonable to say you are getting Part B through an MA plan as an example. We are getting Part A, Part B "Bundled" in an MA plan C. That would be an accurate description of what Part C is if explaining it to someone.

Also, Look at the question below along w/the answer from the Medicare website. Underlining emphasis mine.

https://www.medicare.gov/health-drug-plans/part-d/basics

You have 2 options for how you get Medicare drug coverage: ​

• As part of your Medicare Advantage Plan (Part C) or other Medicare health plan
  These “bundled“ plans include Part A, Part B, and usually Part D. (If you join a Medicare Advantage Plan that doesn’t offer drug coverage, in most cases, you won’t be able to add a separate Medicare drug plan.)

Im almost bored now that I selected a PLAN FOR 2026. True if I want I can change that plan again as long as I do it by the end of March 2026 but I wont. I'll wait until Nov 2026 before shopping for a 2027 plan

Ah, what will next year bring.

First thing we wait for is the Annual notice of change for the current years plan. May not need to switch if everything looks good.

 

[alarmguy]

hit by stupid Drunk 26 yrs ago.

Right, ..Don't ask! ha ha!

That's great to hear.

Seems there is still a case to present the drug portion in an MA plan or Original Medicare as "Part D". You could have an argument & say I can't have a separate Part D if going w/an MA plan.

Medicare says "Medicare drug coverage (also known as Medicare Part D)". Link

When you get an MA plan you are getting Part A & Part B...right? So it's reasonable to say you are getting Part B through an MA plan as an example. We are getting Part A, Part B "Bundled" in an MA plan C. That would be an accurate description of what Part C is if explaining it to someone.

Also, Look at the question below along w/the answer from the Medicare website. Underlining emphasis mine.

https://www.medicare.gov/health-drug-plans/part-d/basics

You have 2 options for how you get Medicare drug coverage: ​

• As part of your Medicare Advantage Plan (Part C) or other Medicare health plan
  These “bundled“ plans include Part A, Part B, and usually Part D. (If you join a Medicare Advantage Plan that doesn’t offer drug coverage, in most cases, you won’t be able to add a separate Medicare drug plan.)

Ah, what will next year bring.

First thing we wait for is the Annual notice of change for the current years plan. May not need to switch if everything looks good.

*LOL* Semantics to me but if you want to look at it this way that is ok by me.
You dont have Part A, Part B and Part D. You have plan C Government requires Plan C to cover everything Medicare A and B covers but at a different level of services and locations to get care.

I get your point though. But it isnt reasonable to say you "are getting Part B through an MA plan as an example." At least not to me.
Part B pays all my medical expenses and I am liable for 20% of the payments they make. I can go to ANY doctor or hospital that accepts medicare. I can not do that under many Plan C
Part A pays all my hospital bills but I am liable for whatever the deductible is.I can go to any hospital that takes Medicare I can not do that under many Plan C
Part D is drugs

Granted all the above is encompassed in Plan C however Part A and Part B is administered by the US government with a different cost structure.

Plan C is administered by the private insurance company you choose. Part C covers the 20% of part B for most services minus co-pays for almost everything and in some cases you pay the full 20% up to your MOOP.
Part A speaks for itself.

Under plan C you can be put into a network of facilities and doctors determined by the insurance company. Under Part A and B you can go anyplace that takes Medicare. IN plan C If you go outside the network you can be liable for the entire cost of your treatment. There is no network for A and B
Under plan C a panel can require authorizations and approvals for certain services.

To imply these plans are the same is dangerious.
My feelings are this and I believe to be correct as far as the public understanding.
Part A and B coverage is clearly spelled out, administered by the US government, go anyplace that takes medicare and you are responsible for 20% of medical costs.
Get a supplemental plan like Plan G which is added onto your Part A and B and you still have and need your PART A and B card plus the private Plan G card wherever you go, because you truly have Part A and B with no restrictions and Plan G picks up the cost of what A and B does not pay. Your plan G insurance company has NO say in your treatment or where you go.

Plan C you use one card, your private insurance card, everything goes through private insurance and whatever stipulations are in your one year contract with them, typically over 100 pages long. They must cover everything Medicare A and B covers but at a cost structure with co-pays and out of pocket limits and an approval process for whatever they put in the one year contract with you.

I left part D out of this, knowing most people will get part D. However with Part A, Part B medigap Plan G you are free to choose ANY part D drug plan offered by a wide variety of insurance companies based on what drugs you may need.

Again, Plan C you have one company for drugs and that is the Advantage plan you sign up for. You do not have the freedom to chose your drug insurer. Not all drug insurers cover the same drugs.

Whew! More than I care to discuss. This is my take. People under Plan C Advantage plans know they do not have the freedoms that Part A and B offer. They also know adding a supplement plan to A and B gives them complete freedom to seek whatever care they want at almost every medical facility in the USA with almost zero cost to them, except they pay a monthly premium for that benefit.

Under Plan C most but not all are premium free except for the monthly Plan B cost. However you are restricted, depending on plan and where you live to networks and MOOPs as high as into the $13,000

 

[fantastic]

Part A & Part B are supposed to have the exact same coverage under MA plans. That is similar or apples to apples. However, like you mentioned the Networks are different. That is not the same as coverage though. Even in all of these MA plans state that you must continue to pay your "Part B premiums". Medicare states Part A, B, & Usually D are "Bundled" into an MA Plan C.

When I talk about this stuff you know what I'm saying when I say MA or OM (Original Medicare) in the context of the conversation. I wouldn't just say "Use your Part B" for your Dr visit, or "Show your Part B card to your Dr"...LOL That could certainly get confusing & not really understandable conveyance.

All of these Evidence of Coverage pdf's continue to refer to these Parts by their respective alphabets. Handbook say "Include Part A,B, & Usually D, (Doesn't say Exclude) So...
We'll agree to disagree on that & agree that context matters to make the difference.

Medicare Handbook 2026

 

[oilboy123]

Wow I have some reading to do for when 2026 comes around. Thanks guys

 

[alarmguy]

Part A & Part B are supposed to have the exact same coverage under MA plans. That is similar or apples to apples. However, like you mentioned the Networks are different. That is not the same as coverage though. Even in all of these MA plans state that you must continue to pay your "Part B premiums". Medicare states Part A, B, & Usually D are "Bundled" into an MA Plan C.

When I talk about this stuff you know what I'm saying when I say MA or OM (Original Medicare) in the context of the conversation. I wouldn't just say "Use your Part B" for your Dr visit, or "Show your Part B card to your Dr"...LOL That could certainly get confusing & not really understandable conveyance.

All of these Evidence of Coverage pdf's continue to refer to these Parts by their respective alphabets. Handbook say "Include Part A,B, & Usually D, (Doesn't say Exclude) So...
We'll agree to disagree on that & agree that context matters to make the difference.

Medicare Handbook 2026
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View attachment 314173

I'll put this out there for anyone to read. This is my point of view. My point of view hasn't change in this forum for years.
I do not care what anyone chooses for health care. In years of posts in this forum I am a big advocate of Advantage plans. However that landscape is changing depending on your state. One needs to be aware of max out of pocket costs, changes to networks and cost.

You keep saying the coverage is the same. So let the public decide. I am the first in here to ALWAYS make sure people understand for years. IF MEDICARE COVERS A PROCEDURE under A and B, Advantage plans must also cover the service, after all the government pays the Advantage insurers your premium. There can be a rare exception such as experimental treatments but if Medicare A and B pays for that experimental treatment you may be able to convince your Advantage plan to pay for it OR Medicare itself may consider paying for it.

If you consider the following the same, that is good by me. To me, not close to the same.
1. Part A and Part B - you can literally get medical care and doctors anyplace in the USA, any facility. If they take Medicare which almost everyone does.
Advantage Plan - depending on what plan you have, you can not get care anyplace in the USA, when signing up for a plan, you need to make sure your doctors are in the plan, make sure any hospitals in your area and REALLY good hospitals outside your area are in the plan. With Plan A and B you do not, so is that the same?

2. WIth Medicare A and B for almost every procedure covered under A and B you do not need to go through an approval process.
With Advantage plans many procedures and tests must be submitted for pre approval (not a problem, doctor takes care of that, but its a big scare tactic still not the same as Part A and Part B. However as I said over and over, if Medicare A and B covers the procedure an Advantage plan must also. Though that procedure will have to be done in a facility that is in your Advantage plan.

3. With Medicare A and B you can also choose a drug plan Part D from an insurer. You can choose based on what drugs you may need and related costs.
IN Advantage plans you can only get the Drug plan that comes with the policy so you need to make sure if there is a specific drug that you need it is in the plan.

4. Part A and B do not include Drugs, you need to get a separate plan from a company. Part A and B not include many things besides a drug plan, an many Advantage plans include such as a vision plan, dental plan, money to buy over the counter items, cheap gym plan.

5. Advantage plans are all in one plans, I think they are great however since around 2021 for a 3 year period government has not given these plan insurers an increase in premiums. Many things have been tightened up. My concern is MOOPs (max out of pocket costs) have increased tremendously in some states, almost all but you can still find some plans with low MOOPs. I just signed up for a Humana with $3,500 MOOP. Which means no matter what happens to me the most I can pay out of pocket is $3,500. I checked all my doctors and medical facilities and they are all in the plan. Humana is also nationwide.

Great deal, you have to get really sick to hit that MOOP. Such as heart operation, cancer etc. My current plan even provides up to $2.500 of dental expenses a year and free vision check up plus $150 towards glasses or contact lenses. It also gives me $50 every three months to buy over the counter items you would find in a drug store, even suntan lotion, hand lotion, vitamins etc etc

Medicare only part A & B of course you need to also pick a Drug plan called Part D (and pay for it)
Medicare A and B also requires you to pay 20% off all Part B medical bills. Just think of the cost, lets say of getting cancer and needing Chemo you would pay 20% of those costs as an example. Most people, I think something like 90% or more buy Supplemental Private Insurance also known as Medigap to pay for the Part B medical expenses. Then you are home free. All your medical expenses are covered. You do pay extra every month for that coverage and it can get costly depending on ago and state in which you live. Over time these extra costs can easily get up to $300 a month. Price varies widely on age and state you live in, even county you live in.
"IN" hospital bills Part A is covered 100% but not medical costs.

@fantastic Posted a chart above in Post # 174, highlighting the differences in the plans. Simple stuff. It clearly outlines the differences in the Part A and B vs Advantage plans. If someone wants to call that coverage the same fine by me. I certainly do not see it that was. However as I repeated for years, as far as medical procedures if Part A and Part B medicare cover the procedure Advantage plans must also cover it.