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After reading Richard Quinn’s recent post about Medicare, I thought this would be a good place to solicit thoughts.
I have a 64 year old brother who is single, has no other immediate family, and is currently on Medicare disability due to mobility issues. He has a medicare advantage plan which has coverage for his prescriptions (Part D), vision and dental. As he is now within 3 months of his 65th birthday, he has the opportunity to switch to original medicare without underwriting, which he would fail (this window expires at the end of February). The out of pocket cost with a Medigap policy and Part D (not even considering vision or dental) would be considerably higher than he is currently paying, as he pays only the cost of the Part B premium now.
My brother’s financial position is precarious to say the least and he does not have the means to pay more for health insurance. The expected cost increases in 2026 alone are going to be a significant financial burden. Additionally, his disability social security benefits, while insufficient for daily living, are slightly too high for him to be eligible for medicaid or any other assistance in the state where he lives.
I am concerned that while his Advantage plan is considerably less money than original Medicare on the front end, the cost of co-payments, deductible, etc. will also be too much for him and serve as a disincentive to receive care that he might need (I have seen this already to some extent). His doctor choice is also much more limited, although his current doctors accept his insurance.
I have considered offering to pay for a Medigap policy (likely Plan G) and a Part D Plan for him so that he can convert to original medicare and continue to only be responsible for his standard Part B premium. My concern is that this will be an ongoing expense and I have no idea how that expense will rise over time. Of course, I also have my own medical costs to consider as well as my wife’s, not to mention retirement costs in general.
I am soliciting suggestions and views from those of you who have experience with this (I am a few years away from Medicare age myself). Is Medicare Advantage good enough?
I realize that many people live happily on Medicare Advantage plans, but I also have heard that those who have substantial medical issues tend to prefer original Medicare with a gap policy and Part D. I also know that changes to Advantage policy pricing and benefits are likely to be coming.
Thank you in advance for your thoughts.
Tough decision. He may not qualify using underwriting in the future or it could be very expensive. A few thoughts based on our situation and my experience as a Medicare SHIP volunteer. We moved from a large urban area where we had a high quality large network MA plan (Kaiser) to a small rural state with national plans but small MA networks and no 5 star plans. Yes, we know Kaiser isn’t perfect, but it towers above most plans. We chose to switch to straight medicare and supplement since moving allowed us choice without underwriting. We have been happy with the switch -everything paid for. There’s benefit to having a fixed cost without coinsurance, no preapprovals, etc. and, so far, no limit on providers. If I was in your situation, I’d look carefully at his policy for quality rating, his cost liability and extent of network. Read through complaints on the medicare website. If he cannot afford the supplement his copays and coinsurance could be devastating financially. If I was a helping financially and the plan was average, I would talk to a SHIP volunteer about better MA plans but probably buy the supplement for a more even cost. If the plan appears to be excellent, I’d put aside money to help with coinsurance etc. Finally, as a SHIP volunteer in the rural state, I had many people prefer nearly free MA plans when they were healthy only to return for a change to a supplement when their health declined and costs increased. They were usually surprised and very angry they now faced underwriting . His plan today probably is cheaper, but that could change tomorrow. Good luck. You’re a good brother.
Isn’t it the case that you can’t be refused for a Medicare Advantage plan? So he could switch back if necessary, while this is a likely one time opportunity to take Medicare plus Medigap.
Yes, exactly. The only real issue, I guess, is that he can’t afford it, so it won’t happen unless I make up the difference between what he would pay for his MA plan and what Original Medicare plus Medigap and Part D would cost. And once he is on Original Medicare, I suspect he won’t want to switch back. So essentially if I go that route and offer to help him out, it is likely going to be a lifelong financial commitment. On the other hand, I would like to make sure he has access to the care he might need. If he can get that through Medicare Advantage, that’s great. Unfortunately, it’s not really possible to know whether what works for him today will continue to work. And if it doesn’t, as you say, he likely won’t have that opportunity again.