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Review of Medicare Parts and Plans Simply Explained


Glenn Stok is a systems analyst who thoroughly studied Medicare to understand its features. He has a knack for clarifying complex topics.

I'll give you a clear understanding of Medicare's parts A, B, C and D; and the optional Medigap supplemental plans.

I'll give you a clear understanding of Medicare's parts A, B, C and D; and the optional Medigap supplemental plans.

The purpose of this article is to give you a thorough understanding of the various parts of Medicare and explain the difference between its parts and its plans, which people tend to confuse with one another.

I always stay informed with the latest changes to keep this article accurate and up-to-date. When I turned 65 and became eligible for Medicare, I studied the rules and regulations so that I can make the right choices.

Once you understand the structure of Medicare, with the help of this article, you’ll know how to select the right coverage for your needs and how to avoid penalties.

So, You’ll Soon Be 65

Everyone has different needs based on how healthy or unhealthy they are and differing financial situations as well. For that reason, I can't tell you specifics about what to do. But I will tell you what I learned through my research and decision-making to get the most out of Medicare.

That should help you understand what you need to do and how to avoid the pitfalls.

When you are close to becoming 65, you will start getting a lot of mailings offering advice. These are agents who are focused on selling you insurance. They don't lie, but they don't tell you the whole story either. They will only tell you what will convince you to go with their insurance.

I also started seeing a lot of Google ads everywhere I looked on the Internet. That's how Google advertising works. They know what your interests are and what your needs are, based on your recent web browsing activity.

Many of these ads direct you to agent websites It's best to ignore all these agents and ads. Everything they tell you, you can find on medicare.gov. But that information is confusing to the layperson. That's why I wrote this article. I have a background in writing technical essays with an easy-to-follow logical format.

Are Medicare Agents Helpful?

When doing my research, I kept stumbling upon agent websites that looked like they were specific insurance companies. However, they were agent websites, and I realized what they were up to when they requested personal contact information before finding any useful information.

Another thing I noticed was that many agents gave me answers they knew I wanted to hear. After a while, I realized they were doing that to get me to sign up with them.

It's fine to talk with agents, but be cautious of these games and call insurance companies directly when you have specific questions.

New Medicare Cards Are More Secure

Medicare used to use your social security number as your account number. That is no longer used and helps avoid identity theft.

The Medicare number on the new card no longer is your Social Security number.

The Medicare number on the new card no longer is your Social Security number.

Unraveling the Confusion With Medicare Parts and Plans

Medicare has different "parts" that include insurance for particular things. Original Medicare consists of Parts A and B. In addition, Part D covers prescription drugs. It's optional, but if you don't include this, you will accumulate a penalty for the years that you don't have it. I'll explain that later in this article.

Medicare also has various "plans" as alternative supplemental additions.

Please pay attention to what word I'm using as you continue reading. This attention to detail will help you understand what many people tend to confuse.

The Parts of Medicare

Part A: This is the part of Medicare that helps pay the cost of inpatient hospital care, including nursing services after leaving the hospital, hospice, and some other home health services. The government pays the Part A premium unless you earn over a certain amount. For most people, it’s free.

Part B: This is the part that pays 80% of the cost of doctor services. You pay the Part B premium, but you can have it deducted from your Social Security payments if you’re already collecting it.

Part C: This is the thing that confuses people. It's an Advantage Plan. In my opinion, this should not be called a "part" letter. It’s an optional "plan" that replaces original Medicare.

The Plans of Medicare

Advantage Plans:

Advantage plans are confusingly referred to as "Part C" but replace everything with a single insurance.

You still have to pay for Part B if you want an Advantage Plan. However, you carry just one Insurance card, and you can still have your Part B premium deducted from your social security benefits.

Advantage plans are provided by private insurance. They can be an HMO or a PPO. They usually include Part D (I’ll get into that later) for prescription drugs, and they may have other benefits usually not included with original Medicare. In some states, all or part of the premium is paid by Medicare.

Unlike original Medicare, doctors need to register to be in any particular Advantage Plan. One plan I looked at did not include my primary doctor. That’s a problem you need to check carefully. If you choose a PPO, you can go to any doctor that accepts Medicare, but you will pay extra if they are not in the plan.

Supplemental Plans:

You can add a supplemental plan to original Medicare for extra coverage at your expense. It's known as Medigap insurance. All Supplemental plans cover the other 20% that Medicare doesn't cover, and you can go to any doctor that accepts Medicare.

Medicare Plans With the Best Coverage

By now, you most likely had grasped the most confusing concept:

  • Medicare "Parts" are known as A, B, and D.
  • Medicare "Plans" are the optional Supplemental Insurance, known as A through N.

I'll discuss the top two plans since they are indispensable for people with major health issues and need good coverage that won't leave them destitute.

  1. Plan F is the best Supplemental Plan, but the most costly too. It's best because you will never get a bill. It covers everything. If you have many illnesses, then Plan F would be the right choice so that they never have to worry about billing, other than the insurance premiums.
  2. Plan N saves you about $100 a month in premium. The only thing to watch for is doctors who have excessive charges. Plan F and Plan G cover excessive charges, and the other plans do not. Plan G has a low deductible but is not available everywhere.

You don't need to compare supplemental plans from one company to another because any plan (A through N) is the same everywhere. Only the premium varies among insurance companies.

Advantage Plans are different, however, and I cover that subject in another article where I describe the pros and cons of Part-C Advantage Plans.

Part D Prescription Drug Coverage

Part D Prescription Drug Coverage

Part D: Prescription Drug Plans

Part D is the prescription drug coverage. It’s optional but accumulates penalties if you don’t take it. Medicare requires you to have creditable prescription drug coverage to avoid penalties. Advantage Plans usually include that, so you don't have to worry.

If you are healthy and don’t need medications, except once in a while when you come down with a cold or have an injury that requires medication, you might think that you can pass up on Part D and save the cost of the monthly premium. However, you'll pay a penalty in the future when you need to include Part D.

How Part D Penalty Works

For every month you go without Part D, and you don't have any other creditable prescription drug coverage, you'll have a 1% penalty per month added to your premium in the future when you do end up needing it.

To be clear, that’s 1% of the national average cost of Part D for every month you delay, starting from the month you become 65.

For example, say you decide you need drug coverage when you’re 70. That’s 60 months since you were 65. So you’ll have a 60% penalty added to your premium (1% for each of 60 months you delayed coverage).

Think about that! Nobody does. Nobody complains to their congressmen about this either. We often vote for our politicians without realizing what we get in return. Politicians abide by the only people telling them what to do—the drug companies.

What Is Creditable Prescription Drug Coverage?

A creditable prescription drug plan is one that qualifies for Medicare to avoid the penalties I mentioned above. Any plan is creditable if it is specified as Part D by the insurance company.

You may also be covered by insurance from a current or former employer, union, or even a spouse’s insurance that is considered a creditable prescription drug plan. Make sure you get a letter indicating that it is creditable coverage. You’ll need that letter to avoid penalties if you join a Part D plan later.

Original Medicare vs. Advantage Plans

Original MedicareAdvantage Plan

Part A - Hospital

Part A - Hospital

Part B - Medical/Doctors

Part B - Medical/Doctors

Part D - Prescription Drugs

Part D - Prescription Drugs

Supplemental (Medigap)

Possible Extra Coverage

Optional Add-Ons to Medicare

The Part D Prescription Drug plan is an optional add-on to Medicare. However, as I discussed above, if you don’t start a Part D drug plan when you first become eligible for it at the age of 65, you will incur a cumulative 1% penalty per month that adds up until you start this plan. At that time, the penalty will be added to the monthly premium that you pay.

Advantage Plans usually include Part D and may also have additional extra coverage.

Instead of getting an advantage plan, you could consider a supplemental plan (aka Medigap) as an add-on to regular Medicare to cover the other 20%.

Is Medicare Void of Obamacare Regulations?

Here’s an interesting note: I began my Medicare in the middle of 2015, and my rates went up 20% by January of 2016 for the Part D drug coverage.

I thought that I'd get away from Obamacare once I’m on Medicare. However, the Affordable Care Act (Obamacare) included rules that negatively affected Medicare. Obama reacted under the pressure of the pharmaceutical lobbyists and did not allow Medicare to negotiate better drug prices.

“Part of the agreement of the Affordable Care Act is that Medicare cannot negotiate lower drug prices with pharmaceuticals.”

— Dr. Sanjay Gupta http://www.cnn.com/profiles/sanjay-gupta-profile

Your 20% Share That Medicare Doesn't Pay

Medicare only covers 80% of your doctor bills. And what’s worse, they don’t cover excessive charges that some doctors charge beyond Medicare-approved amounts. If you want to have insurance that pays your 20% share, you can do this with either of two methods:

1. Supplemental (Medigap) Insurance

The Supplemental plan, provided by private insurance companies, pays some of the costs not covered by Original Medicare. There are several plans to choose from, labeled from Plan A through Plan N. You can see a complete detailed listing of each plan at medicare.gov.

By law, each plan is precisely the same, no matter which insurance company you choose. Therefore, once you decide on the supplemental plan you want, the only thing you need to compare is the premium cost.

2. Advantage Plans

This completely replaces Original Medicare and rolls all coverage into one plan known as Part C. You need to do a lot of research to select the right one for your situation. The most important thing is to check if your doctors are in the plan you choose.

What's the crucial difference?

Despite the cost, many people feel more comfortable with Supplemental (Medigap) plans because you can use them with any doctor or hospital that accepts Medicare.

On the other hand, advantage plans require you to use doctors and hospitals in their network.

Based on your own needs, Advantage Plans can be a reasonable choice that's less costly. Some have a zero premium because Medicare pays them to handle your account. You just have to compare and know what you’re getting.

Of course, you can just go with Parts A and B without additional coverage, but remember that you have to pay the other 20% of doctor bills in that case.

Only Original Medicare Travels With You

Regular Medicare and all Supplemental Plans protect you when you travel anywhere within the U.S. You may visit any doctor or hospital that accepts Medicare patients. That includes specialists who accept Medicare with no need for referrals.

That is not true with Part C Advantage plans since private insurance companies run these. You’ll need to check their specific rules.

Medicare Part B Excessive Charges

When you see a doctor who doesn’t “accept assignment,” that means they don't accept Medicare’s approved amount as payment in full.

You need to pay this in addition to your 20% share, but only up to 15% more than Medicare’s approved amount. The doctor forfeits the rest, but it still is an additional cost to you that you may not be expecting.

Supplemental Plan F covers all of this, your 20% plus any excessive charges. Plan N covers your 20% but not excessive charges.

Why You Can't Deduct Supplemental Premiums from Social Security

You can deduct Advantage Plan and Part D Prescription Drug Plan premiums from Social Security benefit payments because both of these are primary insurances.

With Medicare Part B, you have a choice. You can pay for it yourself in quarterly installments, or you can have it deducted from your monthly Social Security benefits.

However, supplemental insurance is considered a secondary insurance, and therefore its premium cannot be deducted from Social Security.

When Do You Need to Start Extra Coverage to Avoid Penalties?

Remember that Medicare Parts A and B do not cover everything.

Part A covers hospital costs up to 150 days. However, you still share part of those costs, and you pay all the charges after 150 days.

Part B only pays 80% of doctor bills. You are responsible for the rest, including deductibles and excessive charges.

You may want to consider adding a supplemental plan or replacing original Medicare with an Advantage Plan.

Remember, you must sign up for a Supplemental Plan or Advantage Plan within six months of your 65th birthday month. That is your one-time Initial Enrollment Period. However, if you begin Part B later because you had insurance from an employer or a spouse, this six-month period starts when you start Part B.

Can We Change Plans Anytime Throughout the Year?

Supplemental Plans:

You can apply for Supplemental Insurance without penalty during the Initial Enrollment Period, which is within six months of your 65th birthday month.

You can also switch from one plan to another at any time. However, penalties may apply if started or changed after the Initial Enrollment Period.

Penalties include:

  1. Higher premium.
  2. Waiting period before covered.
  3. Refusal to accept preexisting conditions.

These Penalties do not apply during the Initial Enrollment Period.

Advantage Plans:

You can only change Advantage Plans annually.

Doctors can join or leave an Advantage Network anytime. And since you can’t change Advantage Plans during the year, you’ll have to select a new primary doctor or another provider if they leave the network mid-year.

There is an exception to the annual open enrollment period that I discuss below.

What Is the Open Enrollment Period?

Once a year, from October 15th to December 7th, one can change, join, or drop Advantage Plans. However, that does not apply to Supplemental Plans, which can be changed anytime with restrictions, as I mentioned above.

What Is a Special Enrollment Period?

If you move to a new location that's not covered by your present Advantage Plan, you can change your insurance midyear within a Special Enrollment Period.

Note that Supplemental Plans cover you all over the United States, so this only is necessary to consider if you have an Advantage Plan that might service only a local area.

What Is an Enrollment Exception?

You can also request a special enrollment period to change Advantage Plans mid-year if the insurance company you have is not following Medicare regulations.

You need to contact Medicare and register a grievance. After their investigation, they will make an "Enrollment Exception" if approved. At that time, you'll be able to select an alternate plan or go back to original Medicare.

How Is Shingles Vaccine Covered?

I include this discussion because several people have asked about this. I discovered there is some confusion about payment for Shingles Vaccination.

The vaccination is administered with two injections. The second dose is done two to six months after the first. The name of the vaccine is Shingrix. It's not covered by Medicare Parts A and B. However, some prescription drug insurance plans (Part D) pay a portion of its cost, and you pay a co-pay, which still could be around $150 for each dose.

Some Advantage Plans (Part C) will pay for Shingles vaccination. However, you still have to pay a co-pay for each dose.

Telehealth and Telemedicine Virtual Doctor Visits

The Medicare and You 2021 Handbook states that original Medicare and many Advantage insurance plans began covering Telehealth and Telemedicine virtual visits with primary doctors and specialists.

Check with your doctor if they can schedule appointments via video calls and if it's appropriate for your situation. Also, confirm that it's covered by the plan you're using.

Using Parts A and B Without Extra Protection

As a healthy person, I feel I can deal with paying the 20% Medicare doesn't cover. But that's a personal choice.

When you're first starting with Medicare and signing up for the first time at the age of 65, there are other things to consider.

You can wait up to six months to add a supplemental plan, but they can charge you more, refuse preexisting conditions, or turn you down altogether.

Then there's Part D for prescription drugs. As I explained earlier, they add on a 1% penalty for every month that you wait. So that's a 12% increase to your premium per year, and that would remain the rest of your life.

The Takeaway

Many of my friends who are older than me just took original Medicare. They didn't know of other options that offer more benefits at less cost.

They even had unexpected doctor bills that were not covered. And they found out too late about the irreversible penalties imposed for not starting a creditable prescription drug coverage in time.

Medicare is so unreasonable, in my opinion. They take advantage of the elderly who can't study complicated things and make decisions for themselves.

Now that you read this article, you should have a better understanding to help guide your decisions. Just remember that no one can tell you what’s best for your particular situation. Only you know that. Ask questions and be curious.

This content is accurate and true to the best of the author’s knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.

Questions & Answers

Question: Does Medicare include dental and vision care?

Answer: Vision care for medical conditions is included in all Medicare plans, but it does not cover eyeglasses or contact lenses. Dental is not covered.

If you want dental and eyeglass coverage, look at the Medicare Advantage plans available in your area. Some of them cover dental X-rays and two cleanings per year, as well as partial reimbursements on eyewear.

See how advantage plans differ from regular Medicare in the following article:


Question: Will I be charged for Medicare Part B if I don't retire?

Answer: Most people enroll with Medicare at the age of 65. That includes Part A for hospitals and Part B for doctors.

If you don’t retire and have group health insurance from your employer or your spouse’s employer, you can legally delay enrolling in Part B. There will be no penalty as long as you have other coverage from employment.

There is a catch, though. You can only delay enrolling in Part B under the above condition if your company employs at least 20 people. In that case, you must enroll in Medicare (both A and B). Also, your employer’s insurance is considered secondary since Medicare will pay claims first.

If you work for a larger company and can delay enrollment, as I mentioned above, then when you do eventually retire, you’ll have eight months to enroll in Part B without penalty. That is known as a special enrollment period.

Question: Are there any Medicare penalties if I take a leave of absence from my job after 65 but later return to work?

Answer: If your employer provides you with uninterrupted health insurance that includes pharmaceutical coverage, then there are no penalties.

© 2016 Glenn Stok


Glenn Stok (author) from Long Island, NY on December 07, 2018:

Cindy Moore, Congratulations on your upcoming marriage. Here is my reply to each of your questions:

1. You need to carefully check his insurance to be sure it covers the 20% portion that regular Medicare does not cover. In either case, you need to keep part B for doctor coverage. Part D for drugs is optional, but if you don’t take it, you will have a penalty later when you do need it, as I described in the article.

2. If you want eye and vision care then you should look into the various Advantage plans available in your area. This is known as Part C. In some cases they have a zero premium.

3. Disability follows different regulations. Depending on your type of disability, you need to check what’s available. Contact Medicare and ask for specifics in your case. Since you have a disability, you may not need to wait till you’re 65, but you need to ask them.

C moore from MB, NY on December 07, 2018:

Hi im hoping you can answer for me the following

1-im on ssd so i have my medicare due to that (im 47)i have A,B and D. Which as u said im responsible for the 20%. Im getting married next year. Im wondering do u advise i keep B and D and add supplemental for the 20% coverage or am i better leaving it as is and take his insurance as a secondary which does have hosp,drs,scripts?

2-I also dont have eye and vision care. His policy doesnt offer it. Do you feel i should take out coverage to include those and what kind would it be?

3- is there a difference between disability medicare vs 65 retirement medicare? If so,what?

once i hit 65 how does it work here in NY do i keep ssd medicare or it changes to retirement medicare, is there any difference?


David Hunt from Cedar Rapids, Iowa on February 28, 2018:

Also, as I understand it, Plan G is not going away. It is exactly the same as Plan F except you pay the deductible which is currently something like $180.

Glenn Stok (author) from Long Island, NY on November 14, 2017:

Thank you, David, for adding that info. It’s very useful for people to know that.

David Hunt from Cedar Rapids, Iowa on November 14, 2017:

Jay, whenever you go on Medicare you will have a window of time when supplemental insurance is not allowed to ask health questions or up the premium. Verify when this window occurs if you defer going on Medicare. Sorry I can't be more definite. Glenn, this is an article that just keeps giving!

Glenn Stok (author) from Long Island, NY on November 14, 2017:

Jay Dunham - That a legal question and I’m not an attorney so I can’t answer that with any authority. I would suggest you discuss it with the employer you are considering to so if they provide that option.

As for your health related condition, a supplimental Plan F is probably the best for you since it covers everything, if you decide to go with that instead of a HC coverage.

Jay Dunham on November 14, 2017:

I turn 65 this month. I've had employer-provided HC insurance for may years. I am still actively working and, frankly, don't anticipate "retiring"per se. I suspect I'll do so until I drop dead. Literally.

That said, I'd like to save my employer some money, if possible. As it happens, I'm an expert in employee benefits (ERISA) but only the litigation side.

Can my employer replace my HC coverage with Medicare and/or a Supplemental and/or an Advantage plan?

You should probably know I had a quad bypass about four years ago and, though I'm in very good health, I do have to take BP and cholesterol meds every day.

Glenn Stok (author) from Long Island, NY on November 09, 2017:

Nola Kent - You would need to pay the amount of your Part B deductible before Medicare kicks in. You might want to check out the Advantage plans in your area. Many of them cover the Medicare deductible as well as the other 20% that Medicare doesn't cover. Most of them even include Part D so you don't accumulate a monthly penalty that you have to pay when you end up needing drug coverage. Obama kept that penalty in there to force people to get drug insurance.

Nola Kent on November 09, 2017:

I had a dermatologist tell me I would have to meet my medicare deductible or I would pay more than the 20% I have part A and B only no supplemental, I had never seen this in any of my research, do you know what they were talking about?

Glenn Stok (author) from Long Island, NY on November 09, 2017:

Dolores Monet - You brought up an interesting point. Before I started with Medicare at 65, I lost my good insurance when Obamacare started. I was also forced to switch doctors, losing good ones I had for years.

When I talk about this with friends who were employed (I was self-employed) they couldn't understand why I had so many problems. It was because they were protected–being covered by their employer.

Now it gets worse. Just today the IRS announced that they are fining small businesses that failed to meet Obamacare reporting guidelines.

Dolores Monet from East Coast, United States on November 09, 2017:

Thanks for trying to simplify this complicated topic. It's funny how when you work and are at the top of your game, health insurance is pretty simple if you are covered by your employer. Then, once you retire, older now in a world that becomes more technically confusing every day, you have to understand the morass of extra insurance. Then you have crooks calling on the phone pretending that they are calling to help when they are really after your information. One is also faced with the fact that when you are on a limited income and have limited ability to earn more income, your health care isn't cheap.

Glenn Stok (author) from Long Island, NY on November 08, 2017:

WReidBrown - There is no tax advantage with having your premium deducted from your Social Security payments. It's just more convienient for most people.

Remember that only advantage plan and part D premiums can be deducted from SS. If you use a supplimental plan, you have to get a separate bill.

WReidBrown on November 07, 2017:

You mention paying the premium from Social Security funds. Is there a tax advantage to doing it that way? Or is it simply a convenience?

Glenn Stok (author) from Long Island, NY on October 21, 2017:

Sue C. - There is no rule that you have to have supplemental insurance. However, since Medicare only pays 80%, you’ll have to pay the other 20% out of pocket. Supplemental insurance covers that.

As an alternative, you might want to consider an advantage plan (Part C).

You will only be penalized if you don’t have a drug insurance (Part D) after age 65. The penalty is 1% of the average premium for every month that elapses without insurance after turning 65. But most advantage plans include creditable drug coverage too—another reason to consider that.

Sue C. on October 21, 2017:

When I am on Medicare disability insurance right now I will be 64 next month will I still be penalized for not having supplemental insurance when I turn 65

Glenn Stok (author) from Long Island, NY on October 17, 2017:

Thanks David. That’s the way to do the analysis, and this is presently the open enrollment period—so it’s the time to do it.

David Hunt from Cedar Rapids, Iowa on October 17, 2017:

Thanks, Glenn. I would recommend going to https://www.medicare.gov/find-a-plan/questions/hom... and follow the instructions. One section allows you to enter your medications. Though it may take some time if you take a lot, it really allows you to compare plans specific to your needs. You are allowed to save your list so you can come back later.

Glenn Stok (author) from Long Island, NY on October 17, 2017:

David Hunt - Your analysis is very important for others to understand. Everyone needs to do their own analysis of the tier ranges of each Part D plan that’s available in their area, to find the best fit for their situation.

As you discovered (and my opinion too) the star rating system is useless.

David Hunt from Cedar Rapids, Iowa on October 17, 2017:

A PS regarding part D drug plans. The "5-star" designation seems, um, a little fishy to me. I was comparing my wife's current plan (a 3-star) to a 5-star. The 5-star was almost $100 a month (compared to $33), but, more importantly the 5-star did not cover her two brands of insulin, which would have cost thousands more per year. As an addendum, the 3-star would put her into the donut hole months earlier than the 5-star. Sounds good for the 5-star? That's because paying for the insulin isn't counted-- only the cheaper drugs it DOES cover are counted. The 5-star (in our case) is worse by far. The devil is in the details.

Glenn Stok (author) from Long Island, NY on October 17, 2017:

Kathleen - That medication is in a higher tier and that’s why the copay is so high.

From October 15 through Dec 7th you have the opportunity to change your part D insurance. So this is the time to examine the options you have in your area. Each insurance company has different tier groups, so you’ll want to search for one that has a better copay for that particular medication.

Another thing you can do is ask your doctor if there are alternative medications that’s fall into a lower tier group.

Kathleen on October 16, 2017:

I am still so confused my insurance Humana will pay for some of my repatha med but the go pay is 455 dollars for 2, shots a month I tried getting help from manufacturer but I was denied because I have insurance I can't afford this copay so I even asked for help because the manufacturer has a 5dollar copay card but I am not eligible because I am on this insurance I need to choose a new plan because I just can't afford this I am 66 and so confused can you please direct me I really need help and don't know what I schould do

Glenn Stok (author) from Long Island, NY on September 22, 2017:

David Hunt - I can see that you understand everything about Medicare very well. You've definitely done your homework.

I haven't heard anything about Supplemental Plan F being phased out. Maybe only in your area.

By the way, there are two versions of Plan-F, but maybe not where you live. There is a regular Plan-F and a High-Deductible Plan-F that you mentioned, which of course has a lower premium. Both cover the the Part B deductible, unlike Plan G. But that's animal expense anyway. Thanks for your wonderful comment.

David Hunt from Cedar Rapids, Iowa on September 22, 2017:

Glenn, like you I worked in IT many years before retiring. I signed up for Medicare in March of this year. I also spent a lot of time analyzing my options (using medicare.gov). I am pretty healthy for my age; nevertheless I also understood the implications regarding extra coverage and drug coverage. I decided early on that I did not want an Advantage plan. When it comes to having to trust the government or trust for-profit corporations, the "gummint" wins hands down (sounds kind of incredible, but that shows my low opinion of health insurance companies). I take no medications, but have the lowest premium Part D drug coverage for exactly the reasons you state. Also, I opted for Plan G supplemental which is the exact same as Plan F except there is a small deductible. So, I actually have more coverage than I currently need, but, as you so correctly state, I've locked in for future downturns. Anyway, excellent article. Oh, and I wonder if you've heard anything regarding Plan F being phased out in a few years (though people already in Plan F will be able to keep it)? That's why I went with Plan G, but it was almost a toss-up for me.

Glenn Stok (author) from Long Island, NY on September 21, 2017:

Arcee Chow - If you only have Medicare, you still have to pay the 20% of bills that they don't cover.

I didn't underdstand what you meant that you also have a medical coverage. Is that in addition to Medicare? Will that cover what Medicare does not? Maybe you are talking about a supplemental plan. That wasn't clear in your comment. That will cover the other 20%, with limitations depending on which supplemental plan you have. I can't help you with that choice. You have decide how much you want to risk, compared to the premium for each plan option. That's a choice you make.

The other option is to go with an advantage plan, which completely replaces Medicare as I discussed in this article. That's also a choice you have to make based on your needs. Some advantage plans are better, some are worse.

It's important to review the plans available in your local area and match them up with you needs. Since you are planning to get cataract surgery, you may want to have that extra 20% covered by one of the options I just mentioned.

Arcee Chow on September 20, 2017:

Hi Sir!

I just turned 65 last April and i have medical and medicare part A and B.since i have no income only fr.surviving spouse SSA so i was automatically enrolled on part D prescription drug..just now i learned fr.this helpful tips of medicare.that there is a need to enroll in medicare advantage plan or suplemental plan..i dont know anything about these since i enrolled in medicare..how will i know if in the near future i have to undergo a cataract surgery is it for free since i have also medical?what is the best plan for me? Pls help..next oct. will be my sixth month in medicare..my monthly premium of $134.00 is paid by the state..can you pls.tell me what to do..i am now under L.A.Care health plan..

Glenn Stok (author) from Long Island, NY on September 01, 2016:

norlawrence - It's good he has a Supplimental plan and Part D for the medications. It's true that Part D does not cover all medications very well. This is because Obama signed a bill not allowing insurance companies to negotiate lower drug prices. As long as we have a system of government where drug companies can lobby the politicians and get what they want, Medicare will never be a perfect solution. Sorry to hear about Mike. I wish him well.

Norma Lawrence from California on September 01, 2016:

Very good article Glenn. I am fighting Medicare with Mike who has Heart and Lung problems. He now is in stage 3 Kidney disease which they say was brought on by medications. It is kind of like if the disease do not kill you the cure will. He has a supplement insurance so everything is going pretty well so far. His drug program went from 29.00 a month to 71.00. There are some drugs they will not pay for so there is the problem of finding a drug that will do the job that they will pay for. Thanks for article. Your supplied some great information.

Glenn Stok (author) from Long Island, NY on September 01, 2016:

Todd Elzey - Thank you Todd. Since you have been a Medicare Appeal Officer you definitely are an authority on this and I appreciate the time you took to add this information.

Advantage plans are very different from one another, unlike standard Medicare. I find them quite unclear what they actually cover. I even talked about how one agent failed to give clear answers when I asked about a particular Advantage plan, as you had noticed in my article. This is why I personally chose a supplemental plan instead. Thanks for adding that I could have reported that agent, and also for your other useful info in your comment.

Todd Elzey from Phelps, NY on August 31, 2016:

Mr. Stok: This is a very good article, but I would like to point out two things that you might wish to consider adding. First, in addition to being available to those 65 and over, Medicare is also available to those who are permanently disabled (according to Social Security Criteria), and who have received Social Security Disability benefits for 24 months.

Second, I worked as a Medicare Appeal Officer for Maximus Federal Services for 8 years from 2006-2014. In that job I adjudicated somewhere in the neighborhood of 10,000 Medicare Advantage (Part C) enrollee appeals. And I can say with certainty that Medicare Advantage Plans do not always cover the 20% coinsurance that is part of Medicare Part B coverage. In fact, the plans very widely nationwide. Some plans really aren't much more than what is covered with the exact same 80%/20% cost sharing structure as original Medicare (Parts A & B), while other plans cover almost everything with absolutely no cost sharing for the enrollee at all. And of course there is a lot of variation between these two extremes. Consequently, it is essential that individuals considering enrolling in a Medicare Advantage (Part C) plan look at the actual Evidence of Coverage documents for the plans they are considering to fully understand what is covered and what the cost sharing is for the covered services. By the way, the plan documents are required to be available on the Plan's website and any agent who tells a potential enrollee that they can't get the documents until they have signed up is violating Federal regulations and can be reported to CMS. I believe Medicare still considers it a type of Medicare marketing fraud. Thanks again for your article, and I hope these comments are helpful.

Jean Bakula from New Jersey on July 02, 2016:

Thanks, I'll check out plan F. That isn't something I recall reading about at the time I was deciding what plans to get.

But since I have been on Medicare, beginning Jan 1st of this year, I'm paying so much less. So it is getting better.

Glenn Stok (author) from Long Island, NY on July 01, 2016:

Jean Bakula - If you are having constant medical issues and you find yourself paying half the bills, you may want to look into switching from your advantage plan (Part C) to a supplemental plan. Specifically, Plan F will cover all your bills and you'll never get a bill from doctors or hospitals. Just the monthly premium for plan F. With a supplemental plan, any doctor that accepts Medicare will be covered. You'll have to compare the premium cost to your present medical costs to see if that works for you any better.

Jean Bakula from New Jersey on July 01, 2016:

Thanks for your kind words, my life has changed a lot. Especially in the health insurance area. When my husband first passed, his company paid my COBRA for 6 months, and then we split it 50/50 the rest of the year. We had been together for 39 yrs. and the company loved him. Then I had to get BC/BS of NJ, and it was really a ripoff, I paid almost $800.00 monthly, and it was going up to $1,000.00 monthly if I didn't get on Medicare a little younger than most. My ophthalmologist is on Plan C. I also always get weird, hard to diagnose illnesses, which usually sends me on a whirlwind of specialists, so I thought it best to just get everything. I'm still paying half of what I would have been if I hadn't gone on Medicare, so it works for me.

Glenn Stok (author) from Long Island, NY on July 01, 2016:

Paul Kuehn - Thank you for sharing that information about overseas limitations with Medicare.

Paul Richard Kuehn from Udorn City, Thailand on July 01, 2016:

While visiting the States in June of 2016, I met with a Medicare rep in the city near where my sister lives. I found out that because I live overseas I am not able to get any of the Medicare services available in the States. The reason for this is due to billing as the agent explained. As a veteran, however, I can get VA medical benefits while living overseas.

David Hunt from Cedar Rapids, Iowa on January 21, 2016:

This is by far the best, clearest overview of the choices one faces when nearing age 65 I have ever read. While I am more than a year away from my 65th birthday, I have gone through this with my wife. We chose original Medicare with supplemental/Plan F and a drug plan during her enrollment period. While supplemental premiums have increased each year, the increases have been extremely moderate for the healthcare industry and based on age (so far). The drug plan we chose has increased premiums from $31 a month to $61 over a three year period, causing us to choose a different drug plan which looks like it's better and cheaper. We utilized our state's Senior Health Insurance Information Program (SHIIP) to help us wend our way through Medicare choices, but articles like yours are a great foundation. I heartily recommend utilizing your state's SHIIP when making Medicare (and SS) decisions. And I thoroughly agree that non-governmental sources of information are biased (and that's being kind). I was NOT aware that switching supplemental plans (even during the annual window) was not simply a matter of switching but having to be accepted. That, I find disturbing, but I will almost certainly not put myself in the hands of an Advantage Plan. All I have to add is that our experience so far with Medicare has been very good so far. Again, two thumbs up for this fantastic article.

Glenn Stok (author) from Long Island, NY on January 21, 2016:

denise.w.anderson - Medicare starts when you are 65. Presently the Social Security full retirement age is 66. But you can start sooner or delay it. The longer you wait you get more monthly. But delaying may not be a good idea since the Social Security Trust Fund will be exhausted by 2037 unless changes are made financially. They tell you this in your annual statement, but most people never read those messages.

Denise W Anderson from Bismarck, North Dakota on January 21, 2016:

Thanks, Glenn, for sharing this information with us. We are getting closer to this time ourselves, and may have the situation where we will have employer based insurance when my husband turns age 65. Does one qualify for Medicare at the same time as they qualify for Social Security, or are there two different ages involved here?

Glenn Stok (author) from Long Island, NY on January 21, 2016:

MsDora - You're not the only one. Many people miss that requirement. I have a friend who never took Part D prescription drug coverage. I kept telling him about the penalty. He didn't believe me. Now he needs drug insurance so he started Part D and discovered he has a $62 penalty added to his monthly premium for waiting so long.

Dora Weithers from The Caribbean on January 21, 2016:

Very helpful. I was shocked to find that there were penalties for not accepting some benefits later than at the start. I'm paying for benefits I can never use here where I am, but just in case . . . New subscribers should this useful.

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