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THE MEDICARE DECISIONS YOU MAKE MATTER
- Michael Braden
- Feb 13
- 7 min read
Michael T. Braden February 13, 2016 Enrolling In Medicare
HOW YOUR MEDICARE DECISIONS MATTER
Hi, and welcome to our latest Medicare Blog Article. Today, we are going to explain why the first choice you make when you first enroll in Medicare is essential to protecting your healthcare and your finances throughout your retirement.
Remember the saying "You only get one chance to make a good first impression"? Well, this phrase is certainly appropriate. Once you turn age 64, the sheer volume of information you receive can feel overwhelming. From Flyers, Brochures, Postcards, invitations to attend Seminars, and Dinner RSVPs, it can feel overwhelming.
However, your initial Medicare enrollment decision is one of the most significant financial and healthcare choices you will make in retirement. While it might seem like a simple decision for the upcoming year, that first choice sets a trajectory that can significantly impact your access to care and your budget for decades to come. Understanding the long-term implications of this decision is vital to ensuring your future security.
THINGS ALL NEW MEDICARE BENEFICIARIES NEED TO KNOW
KNOWING & UNDERSTANDING ALL MEDICARE ENROLLMENT PERIODS
Medicare operates on strict timelines. Most people are introduced to Medicare during their Initial Enrollment Period, a seven-month window surrounding their 65th birthday. This period is critical not just for signing up for Original Medicare (Part A and Part B), but also for choosing supplemental coverage.
During this initial window, you have unique rights that do not last forever. Specifically, you have a one-time, guaranteed right to purchase any Medicare Supplement Insurance (Medigap) policy available where you live, regardless of your health status. This means insurance companies cannot deny you coverage or charge you more due to pre-existing conditions during this specific period. Once you receive your Medicare Supplement (aka Medigap Policy), your policy can never be taken from you, unless you fail to pay for your premiums for 90 Days.
Medicare Supplements work seamlessly with Original Medicare to fill in the gaps left by Original Medicare. The most popular Medicare Supplement (Medigap) plans are Plan F, Plan G, Plan N, and High Deductible Plan G.
We have been a licensed, independent Medicare Broker and CMP (Certified Medicare Planner) for many years. Perhaps the biggest mistake we see new Medicare Beneficiaries make is failing to grasp the importance of the ramifications and potential fallout from their Initial Enrollment Period (IEP).
Most of those new to Medicare have a bad habit of listening to advice from friends, family, and co-workers about their Medicare options instead of taking a little time to do their own research, or to not contract a local Medicare Broker to assist them. Most people consider their health very good at age 65, so they justify choosing a Medicare Advantage Plan (Medicare Part C) instead of investing in a Medicare Supplement plan. Everyone has to make their own decisions; unfortunately, all too often these decisions account only for today, without considering what they will want from their healthcare 5, 10, 15, or 20 years from now.
MEDICARE PART C (MEDICARE ADVANTAGE) VS. MEDICARE SUPPLEMENTS
It is common for individuals turning 65 to be in relatively good health. You might take a maintenance medication or two, but you likely feel active and vibrant. When you are healthy, a plan with low premiums and higher potential out-of-pocket costs might seem like an acceptable risk.
When you view your first Medicare decision through a long-term lens, the value of securing a Medicare Supplement plan during your initial eligibility becomes clear. It is the only time you are guaranteed access to this type of comprehensive coverage without fear of medical underwriting. Look at it like this: Medigap/Medicare Supplement plans are preventive plans that protect you from serious financial risk, give you reasonable, predictable costs, and keep you in the driver's seat to steer the direction you want for your own healthcare.
In choosing a Medicare Supplement plan, you are choosing Original Medicare. And having purchased a Medicare Supplement plan during your IEP (Medicare Initial Enrollment Period) guarantees you access to the most doctors and the best hospitals from coast to coast. In Arizona, for ages 65-68, a Medigap Plan G has an average premium of $160-$180.
The numbers look like this: Your premiums would be around $2,000 for the year. You would have a Medicare Part B Deductible of just $283 for the entire year. And, all of your Hospitalization and Skilled Nursing stays are 100% covered. And, if that is not awesome enough, you are covered in all 50 States and all US territories. Your Maximum out-of-pocket expenses for healthcare (Not including any Prescription Medications) would be $2,300 - $2,500 per year. And there is no maximum in play with Medicare, which means that all medically necessary services and procedures for you are guaranteed for life, with no caps. And any future rate increases cannot be based on your claims history.
Conversely, even though a Medicare Advantage plan (Medicare Part C) might look appealing today, the fact is that a Medicare Supplement plan is often the superior choice for long-term peace of mind.
Now, looking at costs with a Medicare Advantage plan, most plans have a $0 monthly premium, and the average MOOP (Maximum Out-of-Pocket) amount for a Medicare Advantage Plan in 2026 is $5,700. The MOOP is the maximum you will pay out of pocket before your plan pays for all your costs for the remainder of the year. And, you have to go through all of the research every year, because every Medicare Advantage policy is only good for one year.
There are co-pays and co-insurance for pretty much everything else, from Office Visit co-pays and referrals to $350 for an MRI, $395 per night for a Hospital stay, mandatory 20% co-insurance for Cancer Treatments, and restrictive networks. Also, with Medicare Advantage plans, you are only covered in the county where you live. If you travel, you are only covered for urgent care or Emergency services from a hospital ER. Lastly, the Mayo Clinic/Hospital, Barrow Neurological Institute, and most teaching hospitals nationwide do not accept Medicare Advantage plans.
Remember the saying, " Nothing is as certain as change. Reality shows, and facts verify that most Medicare Beneficiaries develop more healthcare risks as they age, not less. A plan that works perfectly when you are healthy can become a financial burden when you become ill. Making your initial Medicare choice based solely on your current health, rather than your potential future health, is a common misstep.
CHANGING HEALTH PLANS IN THE FUTURE IS NOT GUARANTEED
Many beneficiaries assume they can easily switch Medicare plans whenever they wish. While you can change Medicare Advantage plans annually during the Annual Enrollment Period in the fall, switching to a Medicare Supplement plan later in life is often far more complicated.
If you choose a Medicare Advantage plan initially and decide five years later that you would prefer the stability of Original Medicare paired with a Medicare Supplement, you may face a significant hurdle called medical underwriting. Outside of your initial enrollment window, insurance carriers are permitted to review your medical history. They can decline your application or charge higher premiums based on your health conditions.
This means that if your health declines after your initial enrollment, you might find yourself forced to your default tethered to a Medicare Advantage plan for life, simply because you will not qualify for a Medigap policy or Medicare Supplement plan.
Some very common things that Medicare Supplement Underwriters can and do use to determine if someone is a good risk for a Medicare Supplemental policy. Let's look at common health conditions that can deny you approval for coverage:
Having a Defibrillator.
Past Cancer diagnosis and treatments, if within 4 years of diagnosis. Most cancers that are over 4 years old and in remission are okay.
Insulin-Dependent Diabetic.
Having been diagnosed with COPD.
Having two or more overnight hospital stays within 12 months of your application.
Having/Receiving Injections or Infusions for Arthritis.
Being diagnosed with Kidney Disease.
Heart Disease.
Being prescribed certain medications.
Having a "Pain Doctor".
Needing Monthly Physical Therapy.
Not completing the Activities of Daily Living unassisted.
Being diagnosed with Atrial Fibrillation
TAKE AN HONEST EVALUATION OF COST VS RISK WHEN IT COMES TO YOUR HEALTHCARE OPTIONS WITH MEDICARE
The fundamental difference between your main Medicare options often comes down to a trade-off between upfront costs and backend risk. Medicare Advantage plans often feature low or zero-dollar monthly premiums, which is attractive. However, these plans come with a downside: co-payments, co-insurance, and out-of-pocket maximums that can reach thousands of dollars per year if you need significant care.
Medicare Supplement plans, conversely, require a higher monthly premium, but they vastly reduce your exposure to unexpected medical bills. They fill the “gaps” in Original Medicare, covering costs like the 20% coinsurance for doctor visits. This allows for predictable budgeting, ensuring that a sudden illness does not deplete your retirement finances.
Remember, the definition of Insurance is the cost it takes to reduce or eliminate healthcare risk and exposure, protecting you from Financial Catastrophe.
ACCESS TO DOCTORS, CLINICS, AND HOSPITALS VARY BASED ON THE HEALTHCARE PLAN YOU CHOOSE
Your first choice also dictates which doctors you can see. Medicare Advantage plans typically utilize HMO or PPO networks. You generally must receive care from providers within that network to receive the highest level of coverage, and you may require referrals to see specialists.
If you choose Original Medicare paired with a Medicare Supplement, you have the freedom to see any provider nationwide who accepts Medicare. There are no networks and no referral requirements. This flexibility becomes increasingly important if you develop a complex condition requiring a specific specialist who might not be in a standard advantage network.
WRAPPING THINGS UP
Do not leave your future healthcare access to chance by choosing the path of least resistance today. Make a decision that protects your physical and financial health for the long haul. If you want to ensure you have predictable costs and access to the best care possible, we can help you find the right Medicare Supplement plan.
I know Medicare can be very confusing, with a lot of moving parts. If you have any specific questions about Medicare Supplement (Medigap) Plans that this article did not address, please reach out to me. I want to make sure you get all the answers to your questions. You can email me directly at mike@bradenmedicare.com, text or call me at (480) 225-1393, or use the contact form on our website at www.bradenmedicare.com anytime.
