Don’t make the wrong Medicare decision

Healthcare can be one of the biggest expenses you’ll face in retirement. That’s why it’s so important to make the right Medicare decision when you turn 65.

Medicare’s open enrollment for 2026  is October 15 to December 7, 2025 or 3 months before you turn 65. If you’re approaching 65 — or helping a loved one — here’s what you need to know before making a choice.

You Have Two Options at 65

When you sign up for Medicare, you’ll choose between:

1. Original Medicare (Parts A & B)
   Run by the federal government. You need to  add a Medicare Supplement (Medigap) plan to help cover out-of-pocket costs and a Part D plan for prescriptions.
2. Medicare Advantage (Part C)
   Sold by private, for-profit insurance companies. You no longer have Original Medicare. All your healthcare decisions are made by a for profit company.  These plans often advertise extra perks like dental, vision, and gym memberships — but there’s a lot they don’t tell you

What the Insurance companies won’t tell you about Medicare Advantage

I want to be upfront about this because too many people only learn these things when it’s too late:

1. A for-profit insurance company makes your healthcare decisions.

With Medicare Advantage, your insurance company — not your doctor or Medicare — decides what care you can have. And sadly, they sometimes deny or delay care you need.

2. Prior Authorizations can stand between you and your care.

Before you can get certain tests, treatments, or medications, your doctor has to get approval from the insurance company. This is called Prior Authorization and it’s a way to control costs — often at the patient’s expense by denying or delaying expensive care.

Original Medicare doesn’t do this. If your doctor says you need it, Medicare covers it.  There is no Prior Authorization with Original Medicare.

3. You’ll be limited to a network of providers.

Most Medicare Advantage plans have a list of doctors and hospitals you’re allowed to use. Top hospitals like Memorial Sloan Kettering and Mayo Clinic and top specialists usually won’t accept most Medicare Advantage plans because they pay less and require extra approvals that deny or delay care.

With Original Medicare, you can see almost any doctor or hospital in the country that takes Medicare. And most do.

4. Insurance companies profit more from Medicare Advantage.

Insurance companies receive a fixed amount from the government for each person enrolled in a Medicare Advantage plan — over $12,000 a year (in 2019). The less care they approve, the more money they keep. That’s not a system built to put you first.

5. Medicare Consultants get paid more to steer you into Medicare Advantage.

Sadly, many Medicare “consultants” make  3 times the commissions selling Medicare Advantage plans than Medicare Supplement plans. I always recommend working with someone who will honestly prioritize your needs, not their paycheck and recommend  Original Medicare plus a Supplement G plan.

6. Employer-sponsored Medicare Advantage plans aren’t always what they seem.

Some workplace and school district retiree plans promise you can see any doctor — but if you read the fine print, it often says, “as long as the provider accepts this .” Many top providers won’t.

Unlike all Medicare Advantage plans, Original Medicare allows you to be treated at any Hospital in the United States. 

Unlike Original Medicare, all Employer- sponsored Medicare Advantage plans require Prior Approval for most treatments.

7. Switching later may not be an option.

When you first enroll at 65, you have a guaranteed right to buy a Medicare Supplement policy — no health questions asked. But after 65, in most states you could be turned down or charged triple  because of Pre-existing conditions.

A few states — Connecticut, New York, Maine, and Massachusetts — allow you to switch any time, but most don’t.

A Personal Note

I’ve seen too many people regret their Medicare choices simply because no one explained how important that decision is at 65. Watch Medicare: What the Insurance companies won’t tell you.