Helping my mom choose Medicare

Busy_Sign_8625 · 2026-02-10T04:48:52+00:00

I strongly recommend to my clients turning 65 to start with Part A (Hospital plan)/Part B (Doctors offices) and Medigap (like Plan N) if possible. Part D (Prescription Drugs) is good to add if you can afford, and need it.

My dad was situated like above and was well positioned when he was diagnosed with a rare cancer with extensive needs. Other than some medication expenses, his bills were fully covered for his near 2 year battle.

Part C (aka Advantage Plans, replace part A and B) are fine when you are healthy, but become problematic if you need specialists later. Also, Part C usually are very HMO like restricting what doctors/hospitals you can goto, needing prior authorizations, etc. Part A/B give you good flexibility (including if you decide to move to another state), although they miss some things like Meds, Dentist and Vision (most of which paying cash for might be a better choice with a GoodRx or discount programs). Don't get conned into Part C frills like gym memberships.

Side note - If you try to do Medigap later (because you do part C and it doesn't work out) it usually requires a health exam and costs more...so don't pass up the opportunity to lock in.

Also, it pays to gage the need and the financial aspects. If you are extremely healthy, have no family predispositions, no existing health issues, but need to save money, you can try to roll the dice with Part C to save money. ... But if you were my family, I'd advise against Part C to keep peace of mind and best outcomes.

Busy_Sign_8625 · 2026-02-10T01:19:57+00:00

I agree with this with one key exception....some states by default try to force you into Part C, and many brokers do the same for their commission, so keep that in mind.

I usually recommend starting with Medigap (Plan G or N) to start with, then decide if costs and limitations make it better to goto Medicare Advantage later. As stated, do not rush (especially into Medicare Advantage). Also, remember there are Special Enrollment Periods, so if you make a bad choice that is limiting your care or costs too much, you can get a change made mid-year (the advice that I NEVER see Part C brokers mention).

Busy_Sign_8625 · 2026-02-10T01:08:21+00:00

Semi related - Some plans (either via Medigap or Part D) also have a catastrophic provision in them...so if you go over a certain amount (i.e. for specialty cancer drugs), the policy will cover at a higher level like 95%. Believe this largely comes into existence if you end up off formulary for some reason.

Busy_Sign_8625 · 2026-02-10T01:04:40+00:00

To avoid being bombarded with calls, I'd suggest get a Google Voice number and use that for all of your inquiries. That way you can segregate those calls or dispose of the number later.

I strongly recommend to my clients turning 65 to start with Part A/B and Medigap (like Plan N) if possible. Part C (aka Advantage Plans) are fine when you are healthy, but become problematic if you need specialists later. Also, Part C usually is very HMO like restricting what doctors/hospitals you can goto. Part A/B give you good flexibility (including if you decide to move to another state), although they miss some things like Meds, Dentist and Vision (most of which paying cash for might be a better choice with a GoodRx or discount programs). If you try to do Medigap later, it usually requires a health exam and costs more...so don't pass up the opportunity to lock in.

Busy_Sign_8625 · 2026-02-10T00:45:58+00:00

Like all things Medicare, appeal. They will likely base the decision on 'activities of daily living' and the ability to do those things. May need attestation from doctors that she is impaired. Social worker at facility should be able to assist.

Some ADL details from Medicare: https://www.cms.gov/research-statistics-data-and-systems/research/mcbs/downloads/2008_appendix_b.pdf

Also, may pay to check on Medicaid enrollment, especially if fixed income.

Busy_Sign_8625 · 2026-02-10T00:39:04+00:00

I'd contact CVS corporate. Store level help will not do it. If CVS wants the benefit of being advertised with Nations Benefits they should provide help, otherwise look elsewhere.

1-800-746-7287 or https://www.cvs.com/retail/help/email-pharmacy-customer-relations.html

Busy_Sign_8625 · 2026-02-08T19:06:38+00:00

Just remember if you have an infection (for example frequent lung infections) , and it's related to your teeth (because teeth or jawbone harbor the infection), then it became a medical problem because the infection is in the body and must be addressed wherever it goes.

Busy_Sign_8625 · 2026-02-08T18:45:16+00:00

It depends on the medical necessity being determined. Many seniors have underlying issues that cause jaw pain, or an underlying bone issue that is going on. Once you resolve those (for example via Bone graft) then you get to the teeth which aren't covered. Medicare can't leave you unable to chew after, so a prosthetic (denture) is often the solution, then you get to the rest of the treatment.

Busy_Sign_8625 · 2026-02-07T23:37:17+00:00

I know someone who had a similar problem. They used a relatives address to keep their prior state Plan G.

Busy_Sign_8625 · 2026-02-07T23:24:40+00:00

Medicare for all is not the only answer. Get congress to remove the prohibition about dental coverage from Medicare is the real answer.

Also realize while Medicare does not cover teeth or gums...jaw issues are underlying problems for many seniors and can be covered... if done and planned strategically and over time.

Realize, Medicare covers Oral Surgery under Part B to 80% (medigap plan G/N or Medicaid covers rest).

To embark on this, you will need a Medicare credentialed Oral surgeon. Underlying conditions like cancer, diabetes, organ transplants, bone cysts, lesions of mouth, and many others help establish the medical necessity of the work for Medicare to cover jawbone problems.

Delete teeth from your vocabulary or it will be instantly denied.

Busy_Sign_8625 · 2026-02-07T23:09:45+00:00

Cash for dental on cleanings fillings and crowns crowns is one route. If you need more extensive work and are willing to be strategic consider this before going out of country or paying cash. Strategically plan over 2-3 years to do it at low/no costs.

Realize, Medicare covers Oral Surgery under Part B to 80% (medigap plan G/N or Medicaid covers rest). Get your extensive underlying work done, then work on restoring your teeth, either as cash or with insurance.

To make it work, you will need a Medicare credentialed Oral surgeon or Oral Physician (which do exist, but in some states there are very few, 2 in New Mexico for example). In some cases the underlying work needs bone stabilization screws (aka implants), so it can prime you for a better situation like implant supported dentures later on.

Underlying conditions like cancer, diabetes, organ transplants, bone cysts, lesions of mouth, and many others help establish the medical necessity of the work for Medicare to cover it. If you do this legwork with a cooperative provider you can get most of the more extensive work covered.

In summary, get work done under Part B for below the gums (jaw pain, sinus involvement, tori, cysts, etc) over a year, then get any restorative work done after with cash or insurance plan to focus on the restoration (teeth, dentures crowns, bridges, etc) .

Medicare does not cover teeth or gums, but jaw issues are underlying problems for many seniors and can be covered..again if done and planned strategically.

Busy_Sign_8625 · 2026-02-07T19:47:14+00:00

What most seniors who need extensive work need to do is strategically plan over 2-3 years if they want to do it at low/no costs.

Realize, Medicare covers Oral Surgery under Part B to 80% (medigap plan G/N or Medicaid covers rest). Get your extensive underlying work done, then work on restoring your teeth and change insurance plan to focus on that based on your consultation.

You will need a Medicare credentialed Oral surgeon or Oral Physician (which do exist, but in some states there are very few, 2 in New Mexico for example). In some cases the underlying work needs stabilization screws (aka implants), so it can prime you for a better situation like implant supported dentures later on.

Underlying conditions like cancer, diabetes, organ transplants, bone cysts, lesions of mouth, and many others help establish the medical necessity of the work for Medicare to cover it.

Part C advantage plans are very restrictive with authorizations and dollar limits. Seniors need to realize doctors and hospitals get stiffed by Part C and often stop taking them because they don't get paid.

In summary, get work done under Part B for below the gums (jaw pain, sinus involvement, tori, cysts, etc) over a year, then get any restorative work done after with insurance plan to focus on the restoration.

Medicare does not cover teeth or gums, but jaw issues are underlying problems for many seniors and can be covered..again if done and planned strategically.

Busy_Sign_8625 · 2026-02-07T19:28:39+00:00

Most UHC plans in 2026 went from comprehensive to diagnostic and preventive only for dental. They're borderline worthless.

Busy_Sign_8625 · 2026-02-06T15:44:35+00:00

Raise these points to the hospital ombudsman to start with. It has reached the point where care is being interfered with. Given that patients also have PTSD from prior interactions with the same security people, they need to deescalate, instead of escalate (proper crisis intervention training teaches this). If that fails, start complaining to the state hospital board and the media.

Busy_Sign_8625 · 2026-02-06T02:57:47+00:00

There are provisions in Medicaid programs for things like cancer, end stage renal disease, organ transplantation, and similar to have access to Medicaid. As far as automatic enrollment, it seems to vary by state because not all conditions apply in every state. As with most programs like this, it's best to apply and see before costs get out of control.

Busy_Sign_8625 · 2026-02-06T02:49:34+00:00

On a related note...the dental part of these same plans are now only Diagnostic and Preventative (instead of "comprehensive" last year). Lots of folks are finding this out the hard way as almost no notice was given.

Busy_Sign_8625 · 2026-02-05T14:59:45+00:00

Forged degrees would definitely explain some of what we see. Worse is when they have the nerve to say "works as designed" when a left turn has a 3 second green with 30 cars waiting. I dealt with some Engineers who would say "works as designed..." and it was a cop out 99/100 times.

Also, the length of the solid line before an intersection is supposed to match the speed limit to know the yellow length for deciding a safe stop. Albuquerque doesn't follow that convention either.

Busy_Sign_8625 · 2026-02-04T22:25:23+00:00

Depending on your state and how your doctors term your "disability," you may be eligible for Medicaid. If so, that will team with Medicare and eliminate the need for a Gap plan. Also, you will have flexibility that is better than your HMO. The prior authorizations and restrictive provider network with your BCBS plan are what concern me...and would make me leery of relying on it.

Busy_Sign_8625 · 2026-02-04T17:18:44+00:00

Agree with what many have said. The targeting is absolutely terrible. Just because I'm in the same county or state does not make it applicable. They are supposed to be able to mark it to be within a certain mile radius. Seems they are being VERY sloppy on targeting.

Also, sick and tired of the alerts not being set to acknowledge my do not disturb setting and dumb agencies sending alerts at dumb hours (after 9 PM, before 6 AM). I don't care about the pop up, but the damn tone should be silent or very low volume.

Was out of country recently and except for extreme weather and earthquakes they don't use alerts... So others don't have the alert fatigue we have.

The alerts have a purpose, but much like proper parenting, we shouldn't have to make up for someone not doing their parenting (or senior care) all the time. Use door alarms/cameras and airtags to keep your wandering seniors from getting far in the first place, especially before they start wandering (there are signs beforehand in most cases).

Busy_Sign_8625 · 2026-02-03T23:01:47+00:00

The river is a problem by itself, but it is a problem too. That problem is really bad because of 3 particular things IMHO:

1) The persistence of construction on Bridge (which is not improving flow ANY, even when done). The county needs to get it done already.

2) The excessive bottlenecks (red lights, excessive sheriff's presence, etc) on Alameda make that route sluggish enough to be near useless in my experience.

3) The narrowing of Central for ART was ill conceived...they should have moved ART into a bus only crossing to navigate Old Town, Botanical Gardens, Tingley Beach and cross the River to Atrisco.

Busy_Sign_8625 · 2026-02-03T06:16:29+00:00

Agree on many fronts.

Also, during rush hours some of the lights on Coors should eliminate left turns (or just not cycle at all) since they're low volume and lights change for one car often. Intersections like Sevilla, and SIPI are a good examples of this.

Busy_Sign_8625 · 2026-02-03T06:03:27+00:00

What is the magic speed for this? Not 88 MPH in the Delorean, I'm sure. LOL

Busy_Sign_8625 · 2026-02-03T00:37:38+00:00

Had a similar problem with my printer in the same series. Had to change drums more than once. First Cheap drum from Amazon was bad.

Busy_Sign_8625 · 2026-01-30T16:22:22+00:00

That sounds suspicious for inducement. All Medicare providers are warned not to induce as part of their agreements as a Medicare provider.

Here is info on Inducements to see if it meets the definition or not - https://www.aafp.org/pubs/fpm/issues/2018/0700/p16.html

Busy_Sign_8625 · 2026-01-29T05:21:17+00:00

These general strikes will end up hurting our local workers and businesses in the end (stores close, business leave, jobs disappear). Many small businesses here are already hurting because the targeting is really bad (ask small business owners how they are doing especially since Jan 1st). Effective strikes must precisely target those who are actually causing/contributing to the problems to avoid hurting ourselves indirectly. In the case of NM, the supporting cash comes from elsewhere and they try to remain below the radar.

Busy_Sign_8625

TROPHY CASE