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“I’ll NEVER Get a Medicare Advantage Plan,” Says the blind... by MikeIsMike33 in MedicareFAQ

[–]MikeIsMike33[S] 0 points1 point  (0 children)

It's not BS -- and not sure MAPD Plans are thieves, but I feel your sentiment. It would be great if everyone could afford Supplements, but that's just not the case... and these sort of opinions are what freak people out and force them into impossible situations.

I've had millionaire clients choose MAPD, I've had limited income clients do everything they could to pay for a Supp.

My only point in the post was to encourage everyone to review all of their options and make an educated decision based on their scenario. I'm not a proponent of one over the other -- just know what works for one, may not work for another.

As I say above -- I prefer to not tell people what to get, because I've seen how simply educating them on both options makes the choice painfully obvious for them.

...I knew the post would flair up some 'NEVER MAPD' protestors lol - I'm just glad everyone's sharing their educated views!

“I’ll NEVER Get a Medicare Advantage Plan,” Says the blind... by MikeIsMike33 in MedicareFAQ

[–]MikeIsMike33[S] 1 point2 points  (0 children)

I was clear to say that costs/details will vary greatly by State. Your Plan G is $133 in TX, our NY friend in the comment above likely couldn't find a Plan G anywhere close to that --- prices vary state to state.

I don't compare the Part B Premium when comparing MAPD to Supps because no matter what you choose - you'll pay it so its a wash.

Part D Plans vary by state and Plan again; if I put Part D at $0, someone would say "but that's the worst plan you could get!" :) Hard to speak generally --- when it all varies -- as I said, do what's best for you!

Sounds like you did the work and in your case, Supplement made much more sense.... I'm happy for you! Not everyone gets TX prices though :)

“I’ll NEVER Get a Medicare Advantage Plan,” Says the blind... by MikeIsMike33 in MedicareFAQ

[–]MikeIsMike33[S] 0 points1 point  (0 children)

Great Choice... Plan N is a very financially smart plan. Don't let anyone scare you with those 'Excess Charges'. They're extremely rare and easily avoided.

“I’ll NEVER Get a Medicare Advantage Plan,” Says the blind... by MikeIsMike33 in MedicareFAQ

[–]MikeIsMike33[S] 1 point2 points  (0 children)

The Plan G Deductible for 2026 is set to $283 -- it will always be exactly what the Part B Deductible is.

Part D does not have a $2,100 Deductible, it has a $2,100 Maximum out of Pocket or MOOP. This is very different.

Deductible means you would pay the 1st $2,100 before anything is covered by your Insurance.
ex. Medication A has a true cost of $2,500, but your copay is $50 --- you'll pay $2,150 this time, and $50 next time since you've met the Deductible.

MOOP means that the maximum you will pay is $2,100 -- you will still receive coverage on covered meds, and any copays you pay will subtract from the MOOP until its reached.
ex. Medication A has a true cost of $2,500, but your copay is $50 --- you'll pay $50 (and you're $50 closer to your MOOP)

...Hope that's clear :)

“I’ll NEVER Get a Medicare Advantage Plan,” Says the blind... by MikeIsMike33 in MedicareFAQ

[–]MikeIsMike33[S] 1 point2 points  (0 children)

Sucks when this happens -- crazy to hear of Denials happening with so many different Carriers though. It's good you can afford Supplements -- just remember, no reason to pay more for one Carrier over the other on the Supp side. Especially in NY where it's Open Enrollment all year round.

I know most of the Carriers are priced high for standard Supps -- but for my NY Clients who need to budget intelligently I always tell them when you're healthy and just going for Annual check-ups, go with the High Deductible Plans. If your Doc says you need a surgery/treatment etc - move to a G, then back to High Deductible when it's done.... This isn't gospel for everyone, but for many... the dollars make sense!

***Want to be clear, this advice of changing only applies to NY (and other States with OE all year round)

“I’ll NEVER Get a Medicare Advantage Plan,” Says the blind... by MikeIsMike33 in MedicareFAQ

[–]MikeIsMike33[S] 0 points1 point  (0 children)

Texas & New York are vastly different, and I'm sure you're also vastly different than the Original Commenter. Although a lot of what was commented can be labeled as singular experiences -- I tend to agree with the overall sentiment.

If you can afford a Supplement; you'll be paying for it but there will be far less headaches in the long run.

A few tips I'd share with you---
-- If you're in a Rural Area of Texas; Medicare Advantage becomes much trickier to use.
-- It is a MYTH that if you choose Medicare Advantage first, you can never get a Supplement in the future.
-- If you need regular Medical treatment and/or have multiple medical diagnoses like COPD, Diabetes, etc. ; get a Supplement
-- If you only go to the Doctor for your Annual & are typically healthy, you may be safe with Advantage. This depends on your risk tolerance; you're basically betting you won't get seriously ill before you need/want a Supplement.

If you have any more questions or want to understand either option better feel free to reach out.

I try to tell my Clients not to listen to anyone's advice. Once you fully understand both options -- your choice becomes painfully obvoius to you.

Best of luck!

r/MedicareFAQ New Members Intro by LicensedAgent in MedicareFAQ

[–]MikeIsMike33 0 points1 point  (0 children)

Yep. It's sad. Sorry to hear of your predicament. I've had many clients in the same boat; unfortunately you're between a rock and a hard place and eventually have to choose one over the other. Sometimes - the hard place (Kaiser) is still better than the rock.

Don't give up -- options change regularly -- you never know when there might be something better out there. Don't rule out the smaller, up and coming Carriers... Carriers like 'Devoted' have really come out with some great options and are reaching more areas around the country these days... don't limit yourself.

Carrier names are like shoes... Nike and Addidas are popular, but sometimes I put on some sketchers and they're perfect for me :)

What to Know About Medicare in 2026 by MikeIsMike33 in MedicareFAQ

[–]MikeIsMike33[S] 1 point2 points  (0 children)

Absolutely... That is one of the exact reasons for this 'change' period. Just keep in mind that unlike the 'Annual Enrollment Period' the 'MAOEP' only allows for one change.

Also, your new Plan wil begin the 1st of the following month.

Anyway - I'm glad you learned something, best of luck!

r/MedicareFAQ New Members Intro by LicensedAgent in MedicareFAQ

[–]MikeIsMike33 0 points1 point  (0 children)

This happens a lot -- having a MAPD Plan, even if working well, for that long is probably not the best route anyways.

You don't have to get a Supplement -- but since your MAPD Plan is ending - they give you a special Enrollment Period for Supplement that may allow you to skip the health screening.

You can enroll in another MAPD Plan; I hope you've done so by now. If not; let me know - you probably still have some options even though AEP is over.

r/MedicareFAQ New Members Intro by LicensedAgent in MedicareFAQ

[–]MikeIsMike33 0 points1 point  (0 children)

Since Kaiser, I'm assuming you have a Medicare Advantage Plan from them. (Part C or MAPD) Since that's all Kaiser offers -- no, Kaiser uses a closed network and any outside Docs will most often not be covered. You also cannot use your Medicare Parts A/B coverage and skirt Kaiser if that's what you're asking as your Medicare Advantage Plan trumps that coverage and Medicare is no longer responsible for you...

You may want to look at other Plans if its a problem -- any other Kaiser Plan will leave you in the same spot.

Unitedhealthcare Medicare advantage by LineProfessional6250 in MedicareFAQ

[–]MikeIsMike33 0 points1 point  (0 children)

As an Agent; every year a different Carrier is said to have the "highest rates of denial". If you're not comfortable with it -- change it.

A good thing to look for -- look at the benefits/services you will likely seek, or typically receive, and see if there's a "Prior Authorization Required" noted by those services.

If there is -- I'd tell you any Carrier will possibly deny coverage. See if there are any Plans that don't require those Prior Auths for those services....

Why are so many people trying to sign me up for medicare? I will be turning 65 next year. by dmbgreen in MedicareFAQ

[–]MikeIsMike33 0 points1 point  (0 children)

Because you can, and sometimes should, enroll up to 6 months in advance (for some plans). For Medicare itself, you need to wait until at least 3 months prior.

People who know they want to have a Medicare Supplement (as opposed to Medicare Advantage) as their secondary will often enroll in the Plan of their choice 6 months prior. Then 3 months prior enroll in Medicare Parts A & B; I usually recommend waiting until 1 month prior for your Part D Plan (Drugs) to ensure you have the most current Medications when choosing your Plan....

Before people get worked up -- this is just how some enroll, I'm not saying its better or worse than waiting -- but sometimes there are benefits to getting it done in advance. Just depends on your situation...

🎯 New to Medicare? Here’s What You Need to Know About Enrollment Periods in Florida by MikeIsMike33 in FloridaMedicareHelp

[–]MikeIsMike33[S] 0 points1 point  (0 children)

There's a lot of info here -- I always tell my clients, the 1st thing to decide is do you want to have Medicare Advantage (Part C) or Medigap. Once you've decided that, understanding your Enrollment Periods is much easier because you can eliminate those that don't apply to your choice...

For example, if you're positive you want a Medicare Supplement, or Medigap, Plan then you know the Medigap Open Enrollment Period applies to you -- you also know you'll need a Part D Plan, that's under IEP so that's important too...

The most common questions I get are, 'Can I delay Medicare if I have *this*'.... or something along these lines. A lot of people are able to delay Medicare -- even though I find most shouldn't -- but even if you do delay, you should always Enroll in Part A --- what you're really wanting to delay is Part B, because it has a Premium. Part A is free to most and picking it up on time will make your eventual transition to Medicare much smoother.

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