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HOW TO CHOOSE THE RIGHT MEDICARE PLAN FOR YOU
- Michael Braden
- Aug 8
- 11 min read
Updated: 2 days ago
Michael T Braden August 2, 2026 MEDICARE PLANS
HOW TO CHOOSE THE RIGHT MEDICARE PLAN FOR YOU
When it comes to deciding what the best Medicare Plan is for you and your family, you have to put some effort into the process. I mean, you could do the old tried-and-true "Guess and Be God" trick, but that rarely works. I get it, Medicare is not easy to understand; it seems daunting, so you want to get enrolled, pick a plan, and move on. But honestly, it takes a bit more effort on your part to set yourself up for success in retirement.
Oftentimes over my career as an Independent Medicare Broker, I hear people saying things like "My neighbor told me this is the best plan" or "a friend of my brother's said this was the best plan," there was a guy i talked to at Walmart who signed me up and said Humana was the most popular plan, so i went with them", and one my all-time favorites is "Susan, my hairdresser, said to get this plan".
EVERYONE ENROLLING IN MEDICARE HAS THREE OPTIONS FOR MEDICARE
Original Medicare
Original Medicare with a Medicare Supplement or Medigap policy.
Medicare Advantage
Let's take a quick recap of these three options.....................
ORIGINAL MEDICARE
Original or Traditional Medicare is an 80/20 Healthcare plan in which Medicare pays 80% of your covered services, and you are responsible for the remaining 20%. There is a nominal Annual deductible of $283 in 2026. And, you can see any doctor and go to any hospital that accepts Medicare. Nationally, about 93.6% of all Doctors and hospitals accept Medicare. There are no networks and the plan travels with you in all 50 states.
ORIGINAL MEDICARE WITH A MEDICARE SUPPLEMENT/MEDIGAP POLICY
The same benefits and deductibles as the above Original Medicare description; however, there are 11 separate options where you can choose a Medicare Supplement plan to reduce your exposure to an expensive procedure or a potentially catastrophic health scare.
You can reference this Chart to compare all Medicare Supplement (Medigap) plans side by side.
The most popular plans over the last 6 years are:
PLAN G
PLAN N
HIGH-DEDUCTIBLE PLAN G
The concept is simple: you pay a premium for a Medigap/Medicare Supplement plan that will cover all or part of the 20% gap left by Original Medicare. With Plan G and Plan N, the plan pays 100% of your 20% share for all covered/approved procedures and hospitalization, and aside from the premium, your only other Out-Of-Pocket costs are that $283 Medicare Part B deductible.
Every Lettered Medicare Supplement/Medigap plan is standardized. This simply means that the Benefits for a Plan N, for example, are exactly the same in all 50 states. The only differences are what each Insurance company will charge for premiums in a given state,
Historically, the highest Premiums for Medigap/Medicare Supplement plans are in New York, then in the Northeast, Florida, Hawaii, the Pacific Northwest, and California.
MEDICARE ADVANTAGE PLANS/MEDICARE PART C
Medicare Advantage Plans are what are offered under Medicare Part C. They were originally introduced and signed into law by President William Jefferson Clinton. These plans must cover at least what Original Medicare provides, and they can offer additional benefits not available under Original Medicare. These are plans offered by private, for-profit Insurance Carriers/Companies and are not affiliated with the government.
Here are the main points regarding Medicare Advantage plans...
Most companies offer HMO, PPO, SNP, and CSNP Plans. We will briefly touch on these types below.
Most Medicare Advantage Plans (MA Plans) are referred to as All-In-One plans because, in addition to covering hospitals and doctors, they also include Prescription Drug Coverage.
Most plans require you to choose a PCP, or Primary Care Provider, not unlike most Employer Group plans.
Plans are only good for one year, and each fall during the Medicare AEP (Annual Enrollment Period), you will need to elect a new plan or keep your existing plan if it is still offered for the next Calendar Year.
These plans have Co-Pays and Co-Insurance for everything.
Most MA/MAPD plans only cover you in the county you live in.
Plans can require you to get 2nd, 3rd, and even 4th opinions, and there is nothing you can do about it.
Plans usually require their members to receive approval in advance of any service or procedure. This is called Prior Authorization.
Most plans offer Health Club Memberships, plus options for routine Dental, Vision, and Hearing. But.....................there is a catch. All of these benefits are divided into quarters, and typically they do not roll over from one quarter to the next. So, a $1,000 Dental Benefit is only $250 per quarter. And, typically does not cover "Major" Dental work. Be warned that if you choose a Medicare Advantage Plan, you need to really understand the fine print. Most people only read the Summary of Benefits (SOB), but all the details are in the Evidence of Coverage (EOC) for each plan.
Nothing is free, so hearing or seeing an advertisement for a Medicare Advantage Plan with a $0 Premium is not the same as free. This is because you will have a Co-Insurance amount for Hospital Stays, MRIs, CT Scans, PT Scans, Physical Therapy, many prescription medications, etc.
There is a 20% Co-pay for all Cancer Treatments (Chemotherapy and Radiation; those average about 12K each.
Most plans confine you to providers and facilities within their networks.
Providers can leave the plan's network at any time.
Every MA/MAPD Plan has a MOOP (Maximum Out-of-Pocket) limit. The MOOP amount is the maximum you will pay for services in a given Calendar Year. Once you reach that (Prescription Medications are not included in the MOOP), the plan will pay for all of your care for the remainder of the year,
BACK TO WHY IT IS IMPORTANT TO CHOOSE THE RIGHT MEDICARE PLAN FOR YOU
In today's article, I am going to walk you through what 11 years of experience as an independent Medicare Broker and a Certified Medicare Planner (CMP) have taught me. First and foremost, the old saying that you never get a second chance to make a good first impression is true, and it definitely applies to Medicare. Everyone enrolling in Medicare must get enrolled in the right plan from the beginning.
Before getting into the crux of today's article, let me share with you a great true story of Scott. I had enrolled Scott's partner, Jerry, in a Medicare Supplement Plan G with Humana, so when Scott asked Jerry what he did, Jerry said I found a Broker who I really like, and I picked a Medigap plan from Humana. So, Scott cold-called Humana, told someone he needed to get enrolled in Medicare, and the Humana Representative/Agent did not conduct a proper "Needs Analysis" for Scott. Long story is he enrolled Scott in a Medicare Advantage plan, not a Medicare Supplement/Medigap plan like Jerry. Two months later, Scott had to have an Emergency Bypass surgery; he is fine, but he got the short end of the stick. You see, Scott's primary residence is in Miami, the company's office is in Phoenix, and his Mother and brother, whom he visits often, live in Oregon. Thankfully, he had the Cardiac Bypass Surgery in Miami, but he is only covered in Dade County. So his only options if he is in Phoenix or Oregon are to go to an Emergency Room or Urgent Care. Not ideal given his circumstances. So, Scott calls Jerry, and Jerry asks me to call Scott. I spoke with Scott, and after apologizing for him being given incorrect options, I informed him it would most likely be 2-3 years before he would pass medical underwriting to switch to Original Medicare and purchase a Medigap/Medicare Supplement Policy. You see, with Original Medicare and a Medicare Supplement (Medigap) plan, Scott would be covered for care in all 50 states and U.S. territories. And, he would have access to see any provider or get services at any hospital that accepts Medicare. Considering his living situation and lifestyle, this was the best option for Scott. And the nincompoop that he spoke with at Humana never explained this to him. You see, Medicare Advantage plans only cover you in your county of residence; your only option outside your county is to use Urgent Care or a Hospital Emergency Room.
TAKE THE TIME TO UNDERSTAND ALL OF YOUR OPTIONS WHEN ENROLLING IN MEDICARE
We recommend working with an experienced, Independent Medicare Broker, like us at Braden Medicare Insurance Services. It's easy: do a Google search for "Medicare Brokers Near Me," then start researching them. Check whether they have a website or just a Landing Page; this will tell you a lot. Also, check whether their email address matches their website; if not, move on to the next broker on the list. When looking at their websites, see if it looks warm, welcoming, informative, and up to date. Trust your instincts; if you do not like what you see, don't waste your time.
Now, start calling the brokers you like and introduce yourself. Let them know your situation and why you are calling. Then interview them by asking about their business, their knowledge, how many clients they have, their process for working with clients, and how many insurance companies they are contracted with. These are all fair, honest questions, but what matters is that you get a sense of their knowledge and personality. Then, trust your instincts and ask yourself if they seem like someone you would like to work/partner with. Conduct at least 3 telephone interviews, then decide who you think is the best fit for you. Remember, there is no contract, and you can always change your mind.
WHY WORKING WITH A MEDICARE BROKER MAKES GOOD COMMON SENSE
FACTORS THAT YOU NEED TO ADDRESS BEFORE CHOOSING THE RIGHT PLAN FOR YOURSELF & YOUR FAMILY
The first thing you may have noticed in this section is why I chose the words "Choosing the right plan for yourself and your family". I deliberately chose these words because sometimes people are not able to clearly see what is best for them as they age. At Braden Medicare Insurance Services, we regularly invite our clients to review their options with their spouse, siblings, a child, or a niece or nephew. You see, at some point, most of us will need someone to help us, and perhaps make decisions for us. Lastly, many people think they can get by on the cheap with their Healthcare coverage, without knowing that while they may be miserly, their family and loved ones want them to have the best coverage possible.
ASK YOURSELF THESE QUESTIONS WHEN YOU ARE EVALUATING PLAN CHOICES
Do you have multiple homes in different states?
Are you planning to travel or visit friends and family in retirement?
Do you want to explore the US in an RV?
Do you want to be in charge of your healthcare or a slave to your insurance carrier, where they act like the Wizard of Oz and you have no say in your own care?
Do you want to be seen at Barrow Neurological Institute, Mayo Hospital, Cedars-Sinai, Johns Hopkins, etc.? All of these hospitals, including all teaching hospitals in the US, accept Original Medicare, but very few, if any, accept Medicare Advantage plans.
What options are best to shield you from increased premiums in the future?
Understand that Medicare is completely different than your old Employer Health plan. Meaning that in the past, you had a lot of conversations, quarrels, and frustrating conversations with the insurance company, right? If you did, then having a Medicare Advantage plan will be very similar. But with Original/Traditional Medicare, doctors and Hospitals send the bills directly to Medicare, Medicare verifies your coverage, and then Medicare pays its 80% share. Medicare also sends a notice to your Medicare Supplement Insurance Company, informing them of what they need to pay to a given doctor or hospital for your care. You will most likely never need to speak with your Insurance carrier unless there is a change of address or you need a replacement card sent.
If you have a history of Health issues, a cancer diagnosis, coronary issues, chronic back pain, severe arthritic pain, etc, you want Original Medicare from the start, because if you do not choose a Medicare Supplement plan when you are first eligible for Medicare, your current or past health history could prevent you from being approved for a new policy in the future.
Find out if you live in a state that has Medicare Birthday Rules for Medigap/Medicare Supplement plan beneficiaries.
Understand what a Special Enrollment Period (SEP) is.
Do you have a Medicare Broker? If not, get one. It costs you nothing but will help you forever.
What things are important to look at now and in the future if you want to switch from one insurance company to another in the future? Here is a link to a previous article we posted about that: https://www.bradenmedicare.com/post/what-to-look-for-when-comparing-medigap-premium-quotes
Involve your spouse, son, daughter, niece, nephew, or sibling in your healthcare decisions.
I was the son of a career Air Force father who preached the 7-P's; most of you with Military family members will understand what I mean. For everyone else, refer to the 6-P's: Proper Prior Planning Prevents Poor Performance. The same idea is to measure something twice but cut the wood or pipe only once.
TYPES OF MEDICARE ADVANTAGE PLANS
I am not a big believer in Medicare Advantage plans overall, simply because when someone chooses Medicare Part C as their Health Care Provider, they give up control over their healthcare. Another reason is that just about every Medical Professional and First Responder I have ever asked for their opinion on Medicare Advantage just scoff, roll their eyes, and say, "You mean Medicare Dis-Advantage or Medicare No-Advantage."
Many people like the convenience of some MA/MAPD plans; they may live in an area with better access to healthcare professionals, or, heck, you may just prefer Medicare Advantage over Original Medicare. Whatever the case, I hope these explanations/definitions will help you.
Every Medicare Advantage plan has plenty of Co-Pays and Co-Insurance. Like a daily amount during a hospital stay, co-pays for imaging, co-insurance for Physical Therapy, Chiropractors, Specialists, Ambulance transportation, and more.
HMO PLANS
Health Maintenance Organizations (HMO) are Medicare Advantage plans with the strictest networks. You must choose a PCP (Primary Care Provider), who is the point person for all of your care. You will most likely need to obtain PA (Prior Approval) for any procedure. If you go outside of your network, you will pay for that out of your own pocket. Many HMO plans have $0 plan premiums, and some have lower MOOP (Maximum Out-Of-Pocket) costs.
PPO PLANS
Preferred Provider Organizations (PPOs) typically have higher-quality doctors. You can usually see a Specialist, without needing a referral from your PCP. And, if you are traveling, many plans will allow you to see a doctor in another state, as long as they agree to see you. It has been my experience that Aetna offers one of the top PPO plans. The doctors stay longer with PPO plans than with HMO plans, and they typically have more freedom to get approval for necessary tests, treatments, and services. Overall, client satisfaction is much higher than with HMO plans.
SPECIAL NEEDS PLANS (SNPs)
Special Needs Plans provide a Care Team to maximize complete care for Medicare Beneficiaries with Special Needs. Increasingly more and more individuals with Memory Loss or on the Alzheimer's spectrum benefit from these plans. And it makes sense; having more providers with greater experience in certain segments of healthcare is usually a win-win for Medicare Beneficiaries and their families.
CHRONIC SPECIAL NEEDS PLANS (CSNPs)
Chronic Needs Plans are a great benefit to those with Chronic conditions such as Kidney Disease, Diabetes and Coronary Disease. Many people have chronic respiratory conditions, but most CSNP plans do not count them. You must have a signed attestation from your PCP to participate in a CSNP.
Some of the additional benefits include unlimited transportation to Medical Appointments and Dialysis, as well as a monthly stipend for Health Food at the grocery store.
INSTITUTIONAL PLANS
Institutional plans are recommended for anyone in a Rehabilitation Facility or a Nursing Home. Enrollment in these plans allows you to change plans monthly, as your condition changes.
WRAPPING THINGS UP
As always, I hope you all found this article to be interesting and informative. Our goal is always to educate and inform everyone about what to look for when it comes to choosing a Medicare plan, and not just any Medicare plan, but the type of plan that is tailor-made for you, your lifestyle, your family, and your overall health.
Food For Thought:
Are you better off having a Medicare Advantage Plan with a $4,000 MOOP, or Original Medicare with a Medicare Supplement that has a premium of $130 a month or $1,560 for the year plus the annual Medicare Part B deductible of $283 in 2026? That totals $1,843 for the year, with no other co-pays or coinsurance, and you stay in charge of your own healthcare.
If you have any additional questions or comments, please feel free to email me directly at mike@bradenmedicare.com, text or call me at (480) 225-1393, or fill out a request for contact on our website at www.bradenmedicare.com
