Open dialogue for Medicare plans 2026

[bobcat]

Overview of Medicare Advantage plans as I understand them: (Again, please weigh in if something posted here is incorrect)

Pros: The main draw for these plans instead of Original Medicare is that they have a required built in maximum out-of-pocket, and they often offer services not covered by Original Medicare (Dental, vision hearing, and some prescription drug coverage), however each service will have a maximum and limitations, and there may be copays. Also, generally they are required to cover the same services that Original Medicare part A & B covers. Many are offered at no additional cost to you, other than what you pay in to Medicare. Other plans may charge a coinsurance amount in addition to your Medicare Part B monthly rate.

1. You Pay for Services – Throughout the year, you pay deductibles, copayments, and coinsurance for covered healthcare.
2. MOOP Limit Reached – Once your out-of-pocket spending reaches the MOOP amount set by your plan, you stop paying for covered services.
3. Plan Covers 100% of Costs after MOOP is reached – Your plan covers all in-network, covered medical expenses for the rest of the year.

Important: MOOP applies only to covered services. You’ll still have to pay for non-covered services, out-of-network care (if not included), and monthly premiums.

What Counts Toward Your MOOP?​

Deductibles
Copayments
Coinsurance

What Does NOT Count?
Monthly Medicare Advantage premiums
Prescription drug costs (Part D expenses have separate cost limits)
Dental, vision, or hearing costs (unless covered by your plan)

Cons: The major downsides of these plans is that you generally have to stay in your plan network. Anything out of network may be covered, but at a reduced rate. Also you may need a referral for some plans to see a specialist or preauthorization for a treatment, and those sometimes take time, thus delaying treatment, and they may also be declined if not deemed medically necessary by your plan..
These plans may also have their own yearly deductible amount that must be paid first before insurance kicks in, and they often have copayments for some services. Watch for hidden costs and limitations. If a treatment is denied as not being medically necessary, you can appeal, but it takes time.
Also, you cannot have an Advantage plan and a Medigap (Supplemental) plan. You can have Original Medicare and a Medigap plan, but not so with an Advantage plan.

 

[MACKTEXAS]

I was looking at plans Friday, but just now found this thread.

The term supplement applies to Medigap coverage in conjunction with Medicare only and is not to be confused with Medicare Advantage otherwise known as part C, which is an alternative to traditional Medicare. Claims on part C plans are paid (or denied) by the insuror (such as Humana, Blue Cross, or others). They do not pass through Medicare. An Advantage plan may or may not include drug coverage, but a Medigap plan by law cannot include drug coverage. If you get a supplement you will need to pay for your own drugs or buy a separate drug policy.

Some positives about a supplement (Medigap) have been mentioned - many of them pay what is still due after Medicare pays, but not all - it depends on which Medigap plan you choose. Another positive is you can see any doctor that accepts Medicare instead of only doctors in a network, and another (for me) was that traditional Medicare does not require pre-authorization for most medical procedures. If Medicare doesn't, neither can your supplement. [Almost all Advantage plans require pre-authorization for major procedures, and if the doctor fails to get it, you could be liable for thousands.]

It's not too helpful to compare Advantage plans in a forum since different plans are offered for almost every zip code. I can only tell you that I was very happy with my UHC Advantage pln in 2025, but it's being discontinued in 2026, and the plans UHC kept are horrible compared to the one I did have. I am probably switching to an Aetna Advantage plan for 2026 which most closely resembles the UHC plan I now have.

Like others have posted, I check with an agent in my area who is familiar in finding the plan of best value. But, I just don't think in a manner that allows others to make my selections for me - I have to first look on my own and compare what I find to the agent's recommendation(s).

The main negative about supplements is that they are far more expensive than Advantage plans, and the cost increases with each year of age. I had one that was $118 / month to start, and was over $200 / month when I switched to an advantage plan. I know 2 people who are some years older than me that are paying much more (one lady said hers was over $500 / month). When someone is paying a premium approaching $500 / month, that = $6000 / year. It is highly unlikely they would ever be out that much on the copays required by an Advantage plan.

If an Advantage plan is offered in your area, they cannot refuse you coverage based on bad health. A supplement can refuse coverage and will usually require you to go through underwriting and probably will not issue a policy if you have serious health issues.