I’ll be 72 in October, 47 year type 1 (Tandem Tslim-x2, G7, Oklahoma) and retiring end of the year. What advice for Medicare sign up. Already have Soc Sec and therefore, Part A (worthless so far), I’m assuming Part B,Part D and a supplemental plan. What do I look for in those. What are people doing for dental. My wife (no major health problems) will probably go for a Medicare Advantage Plan (Part C?). Anybody have thoughts pro or con on that? Thanks.
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You lasted longer than me to pull the retirement pin. I did at 65. As to good supplemental plans I will lead that to those who have more recent experience with them.
I retired from Verizon and used a supplemental plan that was a retiree benefit for 2 years. It was very good. Then Verizon changed to a Medicare Advantage plan, 1st UHC later Aetna.
There was no real difference between these 2 plans because Verizon basically is self insuring usiing UHC/Aetna to manage their plans. I have had major surgery, get CGM, Tandem supplies and Urostomy suppliesat reasonable prices.
Thar said and I assume that your wife has no outstanding health issues, Advantage plans can be pie in the sky. They offer lots of perks but when needed don’t deliver. I would be careful with those.
Good luck on finding a supplement plan that will work well for you.
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You should talk to an advisor. Since you haven’t been paying Part B for seven years there might be a problem.
ATM please talk to a Medicare specialist.
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I agree with @jbowler, I know there are provisions for those still working and access to Medicare, but the rules are complicated (far beyond this mere mortal) and @lichan should seek out someone that “knows” the system well…even then it’s not a guarantee! You may want to check with the link where this is also being discussed: Medicare
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I believe there are a bunch of folks who have jobs as medicare advisors and are reimbursed (probably from insurance companies). They can be very useful in explaining a variety of different plans, and it is quite complicated. And they don’t charge you for the service.
We ended up with a medicare advantage plan from a local health insurer, Tufts Health Plan, here in Boston. It has worked fine so far. We did use an advisor and she was quite helpful.
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@lichan First, I realize AARP and UHC have questionable connections. Second, my wife was reading thru the Sep/Oct version of the AARP Bulletin about revisions (few are good for the average consumer) about sales of Medicare plans. It recommends talking with a SHIP rep (State Health Insurance Assistance Program, yeah they left out the “A”) to get reliable info about the pluses and minuses of various programs. Look for the name Tony Pugh and “What to Know about New Medicare Rules” and other articles. The artical says new changes allow sales agents to delay notificaiton about what plans they do “NOT” represent and allow superlatives like “best” “magnificent” etc. The article may be helpful in your research!
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I agree with the advice so far. Talking to an Advisor is a good idea because if you call Medicare twice in one day, you probably will get two different answers to any questions you may have.
I would strongly CAUTION you about going with a Medicare Advantage Plan. Yes, they are less expensive and have some great perks, but they also can be very limiting and not pay when you need them. One individual I know has passed out four times in the last couple of months while taking a walk. Something is seriously wrong. Doctors “think” it may have something to do with his heart, but they are not sure. His Advantage Plan Medicare doctor told him he might want to go to Mayo Clinic to get a definitive diagnosis, but his Advantage Plan will not pay for him to go since Mayo is not “in network” for his area. NOW his wife also found out that the Advantage Plan will not pay for any of the ambulance or hospital bills because the diagnosis thus far is “inconclusive.” She is stuck with a mountain of bills and his Plan doctors do not have the testing abilities nor equipment to find out what is wrong with him. She feels she is watching him die.
My dentist told us to take the money that we would use to pay a Medicare dental plan each month, and tuck it away into an account. He said that in the long run, we will come out financially ahead and will not have to hassle with submitting claims to Medicare. So far, what he suggested has been true. Our dentist even gives us a discount if we pay in cash at the time of the appointment.
My husband and I have original Medicare (yes, expensive and not getting any cheaper…) and Physician’s Mutual as a secondary insurance. What Medicare does not cover, Physician’s Mutual does. We started years ago with a high deductible for 3 years, and now we have no deductible. Physician’s Mutual and many other supplemental plans also DOES offer dental coverage if you wish to take it. Some even offer vision coverage. We have UHC for Part D. In the last two years, my husband has had over half a million dollars worth of surgery, and everything except for a rare $65.00 blood test has been covered.
IF you can afford it, get what will work best for you. Remember that the old adage “You get what you pay for” certainly is true when it comes to Medicare.
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Yes, to all the above. When I said “advisor” I meant programs like SHIP. I certainly concur with @bostrav59 about advisors who are supposedly independent; a few months ago I got a hard sell not from an advisor but from a non-diabetic neighbor who had saved money by going from “Original” medicare (A+B+Medigap+D) to Part C (“Advantage”), I assumed (charitably) that the Plan she had is MA+PD (i.e. Part C with Part D coverage), but she really wanted me to talk to her insurance agent.
But the very first advisor for those going on to Medicare is the Social Security Administration. They still talk to people on the telephone, they will explain the very major issues about eligibility (just because you get social security does not mean you get Medicare).
Both I and my wife had to update our data with the Social Security Administration (SSA) to get correct records. In my wife’s case her name was wrong and, having visited the SSA in person, she was able to fix this (they are very friendly) but was advised that this was a good idea because they are now checking up on everyone’s ID.
So, as of 2026, my steps would be this (based on having done it in 2025 but not quite in this order):
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Verify eligibility with the SSA. Even if you did it before, the rules changed in 2026; you may no longer be eligible. If you were on Medicare the SSA would have already contacted you, but maybe not…
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Now talk to a SHIP advisor; particular States have their own implementation in some cases, you Okies go here: State Health Insurance Counseling Program (SHIP) - Oklahoma Insurance Department
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Consider that, as a T1, you have specific requirements that neither SHIP nor insurance agents can help with; we have a predictable and costly monthly health cost. Using a non-disposable pump is a very major factor here because it goes on Part B not Part D/PD.
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On “Original” a “Medigap” (Medicare Supplement) policy is a necessity, unless you intend to die young and have a plan to make that happen. Medigap is the real cost of Original.
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Be aware that once in Part C the exit is costly and requires “risk assessment” for Medigap; SHIP should be able to explain this.
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Diabetics who are soon-to-be 65 should consider Medigap with the higher fixed premiums; they still go up with increased costs but they don’t go up with age.
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All I Can say is avoid Medicare advantage. It’s called Medicare disadvantage by people that know when they cut benefits, especially if you have any long-term or hospital illness.. it’s something the bush administration was pushing and now it’s about 40% of Medicare. It might be OK for a while but if you’re getting any long-term illness or medical care, you’ll be getting co-pays all over the place. I have had medical regular MEDICARE for over 10 years and have hardly had to pay anything plus my supplemental coverage pays a lot Empire United healthcare.. things like Hearing Aid’s Compression Stockings Diabetes Supplies. Next to no co-pay as well as prescription drugs hardly any.
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Don’t be fooled by the offers of Dental and vision care. I never got a supplemental coverage for that. I just pay for my Glasses and Dental. It’s a lot better than getting a $3000 bill for unpaid regular medical benefits. My husband just had a heart attack in the ER and hospital bills like 12,000 all paid except 100.
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MEDICARE advantages called MEDICARE disadvantage by people that know about healthcare abuses. They’re OK for run-of-the-mill stuff but any big bills or long-term inpatient you get hit with a lot with a Medicare advantage because their profit making private health insurance companies.
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You’ve gotten lots of good advice already. The main thing I will add is that you should very carefully check the supplemental company’s formulary for covered part D drugs and equipment before deciding. (I went on Medicare last year, live in Massachusetts and never seriously considered Advantage plans.) In Mass, the only company whose formulary covered everything I needed was BCBS. Even if the coverage percentage is trivial for an item you need, it’s vital all you need listed on the formulary because then the max annual cap on out of pocket part D costs will protect you. (This year the cap is $2100, an amount I reach in late January or early Feb.) Note that you will not see Part B items listed (e.g. Dexcom) in the formulary: that absence may cause you unnecessary worrying when doing your research.
Also note that all the dental plans I’ve seen mostly cover only routine expenses: if some serious dental work is needed, I think you will find that all will be out of pocket. As a side note, if you ask your regular dentist if he takes Medicare, he might say “no”. But that’s just because Medicare doesn’t cover dental itself - all that coverage comes from the supplemental company.
A caveat: don’t take anything I’ve written as exactly gospel; talk to all the professionals you have access to and read everything: the biggest difference between Medicare and pre-retirement insurance is that now you have to scrutinize all the details yourself.
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Thanks to all for the valuable information. Keep it coming. Any suggestions for what my wife should do? She just turned 65 and is healthy without any long term health problems as of right now.
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On Original flavour there is Part D, which is offered by a private health insurance company, and “Medicap” or “Medicare supplement”, which is offered by a completely different insurance company.
We chose each separately. On October 1 we get the chance to change the Part D provider; the provider of prescription drugs. Part D will have an OOPMax (Out Of Pocket Maximum) of $2400 next year; that’s the number that matters ($2100 is this year and we can’t change that now.)
Whether we can change Medigap depends on state. I can change my Medigap provider every April; that’s 'cause that’s the month I was born. I can only change to equivalent or worse plans.
Medigap plans are defined by the federal government; they have letters. If you are signing up now you really do want Plan G; on Plan G you pay $247 per year in addition to the premiums for all the Part B services. That means doctors, CGMs and, if you are using a non-disposable insulin pump, pump supplies, the pump itself, and insulin. Blood test strips are on Part B too unless you have a CGM.
@andrea8 this is why Part C (at least MA-PD; Part C with bundled Part D) is attractive. Yeah, it costs deep in the purse, but it’s simple. One insurance company, three premiums (two if you get Part A for free) and only one choice every year. On Original you have four premiums (three with free Part A), two insurance companies and lots of choice, twice a year.
The nice thing about Medigap is that there are very few plans, because they are defined by the feds, so the choice is fairly simple. The nasty thing is understanding what happens when the provider goes out of business; I got a “Cigna” Medigap G when I signed up, Cigna got bought out so their policy went into a limbo where no one can sign up for it. It is said (Reddit) that this results in the costs going through the roof. Things are really complicated for me now.
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One thing that is often misunderstood is that if you opt for traditional Medicare part A, B (and D) when first signing up, the insurance companies that offer gap plans must accept you at the Medicare negotiated price. If, however, you start with a part C plan and decide to go back to standard Medicare down the road, the insurance companies don’t have to even offer you a gap plan or they can charge you a higher premium than what Medicare requires.
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Deciding between a regular Medicare plan WITH a supplemental or an Advantage plan to me is more of a decision about what you can afford, not what looks easier and nicer to afford because Advantage plans are cheaper, but what you can actually afford.
Advantage plans are cheaper and even give you things, gym memberships, dental, medications, even money, but you are limited in what doctors to go to, what medications/DME you get, just general access is more limited. But Advantage plans save the government money and the insurers money and that should tell you a lot. They have to save money somehow and that is in the care you can get, sometimes the time frame of that care or the conditions or having the access to that care and what you can get. But if you are on a limited budget, they make getting medical cheaper. I’m not going to say that some of that can’t happen with a regular plan too, but always keep in mind Advantage plans are cheaper for a reason. We had a brief stint with an advantage type/HMO plan before retirement and some of the routine care was completely the same. Where it made a difference was getting into PT, getting into a specialist, having to have preauthorizations for everything, things like that. If you never run into issues like that you might not notice as much???
A regular plan allows you access to doctors you pick, more of a variety of medications and with a supplemental plan, very little if any costs, more choices. But you pay for the plan. In my case my husbands past employer picks up the costs for that supplemental and Part D. My Part D limited more medications this year trying to control costs. But when my medications (Omnipods and Humalog) weren’t listed and turned down this year my doctor wrote why I needed what I needed and it was approved and my hubby’s past employer/plan also has a way to appeal. That approval could be harder next year, who knows. A doctor willing to do that as it’s more work and knowing how is needed, because some doctors I guess don’t. But regular plans can have limitations too.
So regular Medicare plans are generally going to be much better for people that use a lot more medications, see specialists and use DME to get the variety and newer stuff we like to use. But the Advantage plan is a cheaper option, but has less options of choice.
I know they have exceptions for working people that are still covered through work, but you really need to talk to a non biased advisor. While a government rep is the best choice, know that even our government is supposedly pushing Advantage plans now because it cost them less so… And if you choose an advantage plan and then decide to go to a regular plan, there can be penalties, like not being able to even get a supplement/medigap plan later or at least not at a tremendous cost, where if you get it immediately you can. They even warn you of that on their site.
It can be very confusing when you don’t know anything, I know we were. We were told by a retirement advisor from my hubby’s employer that we would love Medicare and it would be so much cheaper, but couldn’t tell us why. It turned out to be very true but I wish they could have told us why. It’s because my hubby earned a percent towards medical determined by how many years he worked there. That money went towards paying for Medicare, the supplemental and Part D and since it was so much cheaper than them paying for the chunk that Medicare now covers, it covered the costs of the plans.
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I’ll try to explain that. Choosing or swapping from Part C (Medicare Advantage) has serious implications for anyone who already has high healthcare costs.
The Medigap insurers are in a bit of a bind; the government defines the plans so they can’t possibly afford to issue them to people who suddenly happen to benefit from them. However they are simply permitted to deny coverage to anyone who they think might cost in health terms; like the old, pre-ACA, insurance plans they can deep dive on our healthcare requirements.
The one danger for them; the one thing that creates risk for their cost estimates, is that they have to accept anyone, regardless of health, during the initial Medicare enrollment period.
After that all bets are off; they really can’t escape. At best (best from their point of view) they can play games by closing a plan down. However, as I understand it (and Medicare is one of the most complex human systems I have ever encountered), even then they have to offer an alternative.
Many states also allow Medigap policies to be changed without healthcare checks (confusingly aka as “Medical Underwriting”) on our birthdays. Oklahoma does this.
I believe @marie is slightly wrong; “tremendous cost” is not an option. Either we get the coverage at the standard cost or we don’t. But absolutely for sure if you have any doubts about Part C start with Medigap first. You can swap later and loads of people will encourage you to do so!
Here’s a third party though obviously political analysis:
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My suggestion is based on what my husband and I just did. He turned 65 in Jan and I turn 65 in Dec. I spoke with a SHIP counselor (who was terrible btw, luck of the draw) and did my own research. I knew we would both be taking A,B,G and D due to my T1 and hubby’s heart issues. I pulled up the plan options on the Medicare website (they are sorted by premium $) so I had a frame of reference. I called Boomer Benefits, knowing they are not able to quote all plans, but I also had the background research from what I had done. They suggested a plan that was almost the lowest premium, on the Medicare site. I inquired about the others, which were not as well-known companies, and I had also researched reddit for others concerns. Not only was his recommendation a good one for us, it was even better because by both of us signing up for the same plan we are getting an additional premium discount. So definitely inquire about that option, whomever you use to sign up. I know you said your wife does not have issues now, but IMO you would want to have protection as one never knows what the future holds. Speaking from experience—my BIL was hit by a car going 40mph while crossing the street several years ago and the surgeries and medical expenses could have bankrupted them if they hadn’t been adequately covered. In my State, one can move to an equal or lesser plan on birthday months, but not upgrade. So if I chose a high deductible G, I couldn’t then move to the regular G. If your wife doesn’t have a lot of health costs sometimes the price of the higher premium for a full G is greater than the amount one is paying for the higher deductible G—but …can you afford that higher deductible cost ( and you KNOW it will go up) in years ahead when your wife may have greater health issues? It is a gamble for certain, you just have to determine which scenario you are more comfortable with.
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One of the major downsides of he US health coverage system is that there is no uniformity, every state is different, and every locality in every state is different. But I do have 2 suggestions:
- stay the hell away from advantage plans. They are heavy-footed on the use of proper authorization peddle, and some have ridiculous requirements (I know people who have had to pay for the labs to “prove they still have T1D”. And it seems that they ignore prior Dx’s in that maybe you don’t have T1D, maybe you have tried other “step therapies” (and have the documentation).
Advantage plans have been known to “upcode” applicants/new po;icy holders. The more medical issues you have (i.e. upcoding they do) the ore they charge medicare for providing your coverage services. The original poster said he had T1D, so they will automatically “upcode” his wife to having T1D as well.
Advantage plans also change formularies and medical facilities that are in network at whim., From what I’ve read many HCP’s are no longer accepting advantage plans ( referring to the heavy handed overuse of proior authorizations).
- As was suggested, look into local SHIPA programs. They can give names of independent insurance brokers who are certified to advise on medicare programs and supplements. Agents also have better and deeper access to what is covered by various plans. Sometimes it takes signing up (and thus being stuck for a year) to learn if the pump you prefer is in formulary.
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I’m old enough I qualify for Type F (if my state has one available). It’s a little pricey but seems to pay everything but Part B premiums. Does anyone have Medigap F? It looks like I can get C, D, F, or G. Thoughts about these 4?
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