quote:

Originally posted by 12131:
^^^^ To clarify what 6guns said, original Medicare, which is Part A and Part B, is indeed provided by the government, but Advantage and Supplement are provided by private insurance companies, as is Part D (aka Prescription Drug Plan).

Part A covers in-hospital care.

Part B covers outpatient care.

The reason for all other plans beyond original Medicare is that the original Medicare doesn’t pay for everything.

Thanks, Doc. I assumed Parts A and B were a given and that the next step only was under discussion. Sounds like SR knows what he wants.

That's just for readers who might be getting into it for the first time, which can be confusing. I know I was.

The topic is extensive and the terminology to those new to the concept is (deliberately?) confusing.

Much of what matters for this decision is both individualized (depending on your financial situation, medical conditions and risks, how much you do/don't travel internationally, the medical establishments that you use/are near, and who offers what coverage options in your particular state) and so, as much as we virtual friends want to help, our experiences may or may not apply to any other particular situation/location.

What I did when I got to that point a few years back was borrow a copy of this book from a friend who had just gone through the morass. "Get What's Yours for Medicare" I also got a referral to a company that represented a bunch of providers for the various Medicare bolt-on insurance 'parts' (as well as various 'advantage' options) and my guy there gave good, detailed answers to my questions as I considered alternatives.

For me, the 'advantages' of the 'Advantage' plans were purely financial (they're cheaper) and their many constraints made it well worth paying for the 'parts' that wrap around traditional Medicare and that's what made sense in my situation here in NC.

As to whether that would be optimal for anyone else....hard to say.

Best of luck.

Biggest reason I’m a no on this is the exit issues if/when you want back into standard Medigap plan.

Unless you’re lucky enough to die young, early into the Advantage plan, I’d expect to regret this choice.

quote:

Originally posted by 12131:

original Medicare, which is Part A and Part B, is indeed provided by the government

"Provided by the government," using money that has been taken from every one of your paychecks since 1965, so really paid for by money that you loaned to "the government" at zero interest.

quote:

Originally posted by Sigfan Roy:
I find it a bit interesting that a folks on here who would normally rather get a root canal than do business with the government are favoring government run health insurance over private health insurance simply because they turn 65.

I would rather stay on my current coverage with Christian Healthcare Ministries than go on any form of Medicare later this year! It has been better and cheaper than either my or the wife's employer's plans before we retired. This is what medical insurance should be.

My disabled sister is on Medicaid, which uses a Medicare Advantage plan for her. I despise all the phone calls (I receive as her guardian) trying to get her to agree to various home visits. No matter how many times I tell them NO, she is in a care facility with in-house continuous medical supervision, they just keep calling relentlessly.

Physical therapy approvals are slow, and on some kind of 6 week yes, 6 week no, system.

This plan has excellent drug cost coverage.

quote:

Originally posted by V-Tail:
"Provided by the government," using money that has been taken from every one of your paychecks since 1965, so really paid for by money that you loaned to "the government" at zero interest.

Yup. Everything the government “provides” us comes from our wallets.

As I understand it, Medicare pays the Medicare Advantage provider's premium. So basically the Medicare Advantage provider believes they can provide all my Medicare benefits, plus some extras, for the amount Medicare expected to pay for my benefits. They can do all this and still turn a profit. Somehow I have to think the profit comes at my expense. Not buying it.

quote:

Originally posted by Ranger41:
As I understand it, Medicare pays the Medicare Advantage provider's premium. So basically the Medicare Advantage provider believes they can provide all my Medicare benefits, plus some extras, for the amount Medicare expected to pay for my benefits. They can do all this and still turn a profit. Somehow I have to think the profit comes at my expense. Not buying it.

Bingo!

quote:

They can do all this and still turn a profit. Somehow I have to think the profit comes at my expense. Not buying it.

^^^^^^^^^^
These are private companies that are making money off of Medicare Advantage. Preauthorization is used to keep costs down. THe government has been concerned with the profits these companies are making.

Turned 65 last year and went thru the Advantage versus Supplement conundrum discussion with the wife. What drove us to the Supplemental Plan (G) is we travel a lot and the Advantage Plan limit your coverage to the area you actual live (if I remember correctly). We found a drug and dental plan for less than $100 month.

Just to follow up on the Medicare decision as I started Medicare August 1st.

I decided to just go with regular Medicare for the time being, along with my Tricare for Life supplemental. I had my dental and vision checks last month and will take the next few months to see how it all works out and then maybe revisit the Advantage Plans again for 2026.

Some info was a bit misleading and not surprising considering all the different terms and typical government verbalise. The info from the SHIP people was so basic as to be unhelpful, they must have to deal with some very slow people.

The Supplemental Plans are also referred to as a Medigap Plan (why 2 names?). As I understand it your ability to get a Supplemental Plan could be affected by a pre existing condition if you switch back to Medicare after having been on an Advantage Plan. Not that you can't get back on regular Medicare itself. Just would be stuck with no Supplemental Plan perhaps.

Since I have Tricare for Life as my Supplemental no matter what I don't see any issue with going back and forth should I decide to try an Advantage Plan one year.

I still need to figure out what I'm going to do for dental and vision in the next couple of months.

Thank you to all who provided their experience and advice.

quote:

Originally posted by neverfollow:
Turned 65 last year and went thru the Advantage versus Supplement conundrum discussion with the wife. What drove us to the Supplemental Plan (G) is we travel a lot and the Advantage Plan limit your coverage to the area you actual live (if I remember correctly). We found a drug and dental plan for less than $100 month.

I am in the same situation as you were. My wife and I do travel a lot. Since we live in the same state would you mind sharing the drug and dental plan you chose?
My email is in my profile if you prefer.
Thanks.

quote:

Originally posted by smlsig:

quote:

Originally posted by neverfollow:
Turned 65 last year and went thru the Advantage versus Supplement conundrum discussion with the wife. What drove us to the Supplemental Plan (G) is we travel a lot and the Advantage Plan limit your coverage to the area you actual live (if I remember correctly). We found a drug and dental plan for less than $100 month.

I am in the same situation as you were. My wife and I do travel a lot. Since we live in the same state would you mind sharing the drug and dental plan you chose?
My email is in my profile if you prefer.
Thanks.

For drug plans, you set up an account on Medicare.gov. It has a tool “search for plans.” Part of the process of finding a drug plan is entering your prescription drugs for you and your wife separately. You do this on your account and she on hers. After you enter your prescriptions like what drug and dosage, it spits out a list of available drug plans for your zip code. It’s by zip code, not state. It list the available plans in ascending order of costs and what pharmacies are in network. Each plan will have one mail order pharmacy and several brick and mortar pharmacies. Understand that under each plan, you’re going to have different total costs per in network pharmacy. The total cost is the sum of the monthly premiums plus copays for each medication. So there will be plans with low premiums but higher copays and vice versa. Total costs are often lower for the mail order. For 2025 and beyond, once you hit the catastrophic level of $2000 out of your pocket costs, your medications for the rest of the year is free to you. Every year like around October, you should get an idea whether your prescriptions will change for the coming year. Update your prescription list on Medicare.gov and have it find the lowest cost drug plan for you for the next year. You should check each year as plans change their premiums, copays, and drugs that they’ll cover.

As for dental plans, you should do a cost benefit analysis. You’re over 65. How much more dental work will you need? For my wife and I, we went without dental insurance. We just pay for cleaning twice a year and check up once a month. Paying for the occasional crown or filling with cash discount is better than paying premiums and copays.

Thank you Rey. I’m knee deep in the process you described but didn’t know it was by zip code, not state.

I have Anthem as a supplement. $200/mo. Go anywhere. No pre-approvals. So far they have covered everything that medicare hasn't.

quote:

Originally posted by neverfollow:
Turned 65 last year and went thru the Advantage versus Supplement conundrum discussion with the wife. What drove us to the Supplemental Plan (G) is we travel a lot and the Advantage Plan limit your coverage to the area you actual live (if I remember correctly). We found a drug and dental plan for less than $100 month.

I am in the decision process right now, and will go with a supplement rather than Advantage partially for the same reason.

However, Advantage will cover emergency care in the USA. For international travel we always get a travel insurance plan even though our present coverage (a Christian cost sharing plan) is valid worldwide, for the additional coverages such as air ambulance return to the USA and cancelation losses for flights, hotels, cruises, etc.

Bottom line is that for domestic short term travel, Advantage should be adequate for purely emergency coverages. The other negatives of Advantage are, for me, disqualifiers by themselves.

"Prepare for Medicare" by Matt Feret is an excellent book that clearly and simply explains how all of the options work. He doesn't advocate for or against Advantage or Supplement. He also explains how and when to select Part D, or switch from Supplement to Advantage.

I've had Aetna Medicare Advantage since June 2025 - its a PPO so there's no network of providers that I have to utilize. Any provider that accepts Original Medicare will accept my Aetna Medicare Advantage Plan.

It costs me $156/month. So far, there have been no out of pocket expense for prescriptions. I also get a YMCA membership for free through Silver Sneakers, which is nice.

By definition a PPO is a network of phyisicians. T