[retiredguy123]

Originally Posted by GoRedSox!

There are some terms which have been used interchangeably throughout this thread which are not necessarily interchangeable.

Traditional Medicare: This is standard Medicare, around since the mid-60's when the program was created. There is a Medicare Part B premium of $174.70 in 2024 that is deducted from your Social Security payment, or billed quarterly if you have not yet started taking Social Security. Traditional Medicare basically pays 80% of the Medicare fee after the deductible is met. There is no limit to the 20% patient responsibility.

Medicare Advantage: The government pays a private insurance company to provide your Medicare coverage. Plans often include extra benefits such as dental, gym benefits, and eye care not available from Traditional Medicare, and often for no additional premium beyond the $174.70 already being deducted. There is a limit on out of pocket costs. The plan can require you to have a PCP, referrals, and require you to stay in their network. They can also limit you to a specific service area for non-urgent/emergent care. Medicare Part D is almost always wrapped in as a pharmacy benefit.

Medicare Supplemental (Medigap): This is insurance sold by private insurance companies that pairs with Traditional Medicare to insure the 20% coinsurance or some portion of the coinsurance. Part D coverage has to be bought separately. The benefits to this type of coverage is that it works all over the US with all doctors who accept Medicare and there are no referrals, networks, PCP's and pre-cert requirements beyond what Traditional Medicare requires. There are various plans to choose from, but the most comprehensive typically costs between $250-300 per month depending on Zip Code.

The Medicare Supplemental (Medigap) Open Enrollment time period is within the six months after you turn 65 and go on Medicare Part B. If you buy a plan during this time period, it's not subject to medical underwriting.

If you choose Medicare Supplemental (Medigap) at age 65 when you are first eligible, you can enroll with no medical underwriting. If you subsequently decide you want to switch to Medicare Advantage, you have one year to try it out and you can switch back to your old Medicare Supplemental plan if you don't like it.

If you are on Medicare Advantage, you can switch to traditional Medicare within 90 days of original enrollment. You can always switch back to traditional Medicare from Medicare Advantage during Open Enrollment periods.

I think the point that many folks are talking about here is that there is limited opportunity to buy Medicare Supplemental without medical underwriting if you don't choose it within the first six months of being eligible when you are 65. Unless you live in the four states (Connecticut, Maine, Massachusetts and New York) which don't require medical underwriting of Medicare Supplemental policies regardless of when you enroll.

To clarify, the Traditional Medicare premium is not $174.70 for all enrollees. Depending in your income, it can be more than 3 times that amount for the exact same coverage.