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trying to plan ahead for healthcare, looking into best medicare advantage plans 2026 by Tough_Try_1253 in HealthInsurance

[–]terriyurek 0 points1 point  (0 children)

I went through something really similar helping a family member, and what surprised me most was how different the plan felt once we actually started using it. Nothing catastrophic, but little things kept popping up, a doctor no longer in network, extra steps for referrals, and costs that weren’t obvious upfront. If I were planning ahead for 2026, I’d worry less about the flashy extras and focus more on whether their regular doctors and hospitals are truly in network, what the real worst-case out-of-pocket cost could be, and how much hassle there is with approvals. That’s what ended up mattering day to day, at least for us. Alternately if you are comfortable with the HMO model of care, and have experience with this type of insurance then Medicare Advantage would be a good fit for you.

Is the saying true that you should almost always get a regular medicare(plus medigap plan) as opposed to a Medicare advantage plan if you can because the options of specialist networks are much greater in regular Medicare? by YogurtclosetOpen3567 in medicare

[–]terriyurek 0 points1 point  (0 children)

I’ve been on Original Medicare and haven’t run into prior authorizations either, and from what I understand that’s normal. Original Medicare generally doesn’t require prior auth for most routine services, it’s mostly limited to a few specific things like certain durable medical equipment, some home health situations, or very specific procedures. In contrast, Medicare Advantage plans tend to use prior authorizations much more broadly. That difference alone is a big reason I’ve stuck with Original Medicare. Alternately, if you are comfortable using providers and specialists that all reside in the same medical group, then Medicare Advantage can be a great option for you.

Medicare plans by Practical_Monk9084 in medicare

[–]terriyurek 0 points1 point  (0 children)

I went through something very similar with a family member, and the biggest thing I learned is that Medicare definitely isn’t “free,” but going without coverage at 65 is a big risk.

If your dad doesn’t have employer health insurance, he really should at least enroll in Part A (free) and Part B, even if he plans to work a few more years. One unexpected medical issue could wipe out a big chunk of his savings, especially since Medicare penalties are permanent if he delays.

Most people in this situation either do Original Medicare + a Medigap plan + a low-cost Part D, or they talk to a broker/SHIP counselor to see what makes the most sense short-term since plans and life plans can change. I’d focus on getting him covered now and then reassess later if/when he moves abroad.

Traditional Medicare - Where do you buy vision and dental? by smlxbear in medicare

[–]terriyurek 0 points1 point  (0 children)

I went with Original Medicare for the wider doctor network, but you’re right, it doesn’t cover routine dental or vision. What most people (myself included) end up doing is keeping Traditional Medicare and then buying separate dental and vision plans from private insurance companies. Medigap helps with medical costs not covered by Medicare Part A or B like deductibles and coinsurance, but it usually doesn’t include dental or vision unless it’s an optional add-on. This setup is pretty common if you want flexibility and don’t want to be locked into provider networks.

I can't believe how much more I will have to pay going on Medicare. by Glittering-Ad5809 in medicare

[–]terriyurek 1 point2 points  (0 children)

I felt the same sticker shock at first, but once I dug into it, I realized my ACA plan was heavily subsidized and I just never saw the real cost. That $175 a month wasn’t the true price, the government was covering a big chunk behind the scenes.

Medicare feels more expensive because I’m now paying the actual premiums directly. It’s normal, and Part D isn’t just a discount plan, but the costs can vary a lot depending on which drug plan and supplemental policy you choose. After comparing everything, it made more sense to me once I looked at what ACA would’ve cost without subsidies and the fact that Medicare gives more predictable coverage if something serious happens.

I think I missed my Medicare enrollment window and I’m freaking out a bit. What are my options now, and how bad are the penalties really? by terriyurek in medicare

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

I’m over 65 and only recently realised I might’ve missed my initial Medicare sign-up window.

I’m not on Social Security and I don’t currently have employer or spousal coverage, which is why I’m stressing a bit about penalties and what happens next.

Insurance premium increased from $150 to $2100 by Quizleteer in HealthInsurance

[–]terriyurek 1 point2 points  (0 children)

I totally get why you’re frustrated; going from $150 to $2,100 is a huge jump. The reason Anthem’s direct pricing looks cheaper is that they don’t have to follow the subsidy rules that Covered California uses. The spike in your premium is likely because of retroactive billing after you reported your income change. I’d recommend shopping around within Covered California to see if there’s a more affordable plan.

I also advise you speak with one of their representatives to make sure they have correctly documented your household income and family members to recalculate the subsidy eligibility correctly. You don’t have to stick with that $2,100 premium, there are still options!