Last January I paid a huge co-pay to the cancer clinic. This must’ve put me over the top, drugs, supplies and doctor visits have been nada.
My pump warranty expired the 16th. Today a new pump arrived. I’ll set it up tomorrow, time to change sites, and put my old pump to sleep as a backup.
no charge!
They replaced it when it was still working? Oh well…
Depends on whether you are on Original Medicare or, as I’m coming to call it “Fruit Flavoured”, i.e. Part C/Medicare Advantage.
On Original a lot of the cancer clinic will end up on Part B (docs), not Part A (hospitals). Pumps are on Part B. If we do not have a Medigap policy (and everyone should have one) we end up paying 20% of everything and that can be a very serious completely unaffordable amount of money; tens of thousands of dollars or, in some cases, a lot more. With Medigap the cost is $286 for everything (plus the premium) except on Plan K and L where it is $8,000 or $4,000 (2026 figures; the booklet gives 2025 numbers). See the table on Page 76 of the 2026 booklet.
On Fruit Flavoured what we pay depends on the fruit flavour, i.e. the specific insurance company. I haven’t looked at Part C in detail but it is way more complicated than Original, see Section 4 starting at page 61 of the 2026 booklet and, in particular, the plan “types” starting on page 66. With the insurance companies I checked (a very limited choice where I live, just PPOs) the magic number was around $7,000 before the insurance kicks in. Unfortunately there is no simple table like there is for the Medigap plans.
ACA compliant plans, including employer plans, are like Part C but the absolute maximum is fixed; $10,600/stake-holder in 2026. However as with Part C individual plans have their own numbers which may be less.
Those numbers are really important because when the shyte hits the fan that’s what we need in the bank. Original Medicare is great with Medigap, well, Part A and Part B are great and Part D ($2,100 max) is OK. Medicare Part C (“Medicare Advantage”), Original with Plan K or L and the ACA are definitely the healthy rich man’s choice; affordable if you have around $12,000 in the bank and don’t plan to need health care.
Mazel Tov, @CarlosLuis!
If anyone earned a free pump from the insulin gods it’s you @CarlosLuis. Enjoy your new pump and your continued good health!
I have a Medicare Advantage plan that is a retiree benefit of Verizon, It is administered by Aetna, but Verizon is basically the insurer. This is much the same as when I was working. Our health insurance was administered by an insurance company but GTE and later Verizon designed and funded the plan.
I don’t know if that makes much sense.
I am dubious of Medicare Part C plans that are offered to the general public. Some may be good, but there is too much hype in their marketing to make me comfortable.
Yeah, that makes a lot of sense. I don’t know the first thing about the handling of employer retirement benefits and associated health benefits in the US; I was only ever offered a 401k, which is an individual fund. I can’t even remember what happened with my first US employer (a majority owned subsidiary of… AT&T…); that employer went bankrupt when AT&T pulled the plug. There’s no health with a 401k.
Retirement benefits shouldn’t be looking to make a profit; if we get them we paid up-front for them, much like Medicare itself. Individually purchased Part C plans are offered by insurance companies who are mostly legally required to make a profit, e.g. UNH. Public Part C plans are much more like individual (healthcare.gov) ACA plans, where profit is also often a requirement, and the costs reflect that.