Ned Woody lives in Bow.

Ahmed Kutty’s recent My Turn was a timely one. With Medicare open enrollment under way, seniors face what is often a confusing choice about their Medicare options. While I generally share Mr. Kutty’s opinion that original/Traditional Medicare (with a Medigap/supplement plan added on) is superior to Medicare Advantage, I would like to point out a few discrepancies which I think are important.

Importantly, Medicare Advantage plans are prohibited by law from charging higher premiums for people with pre-existing medical conditions (known as underwriting). The Affordable Care Act instituted this when it was passed in 2010, and this protection applies to most, but not all, types of health insurance, including Medicare Advantage. So they can’t “drop enrollees while needing expensive care.”

This next point is not a discrepancy, but a clarification. The 2024 survey which found that 12% of folks with Medicare Advantage were facing issues with deductibles and copays versus 7% in Traditional Medicare makes sense. A really important point is that between 80-85% of people with TM also have a supplement/Medigap plan or other supplemental insurance which will pick up their out-of-pocket costs.

This is huge because Medicare Advantage plans have an annual out-of-pocket maximum ($9,350 in 2025. This does not include prescription drugs under Part D which for the first time will have an out of pocket maximum of $2,000 in 2025), but Traditional Medicare does not. Traditional Medicare has a 20% co-insurance with no limit on out of pocket.

So, if you have Traditional Medicare only and are on a chemotherapy that costs $10,000 a month (this is quite realistic), your share would be $2,000 each month. Or $24,000 a year out of pocket. In this scenario, it is probably safe to assume that Traditional Medicare would lead to significantly greater financial hardship than a MA plan.

However, if you have a Medigap plan, it will cover either all or most of your 20% co-insurance. Only two of the 11 or so Medigap plans only cover part, the rest cover all of it. However, unlike Traditional Medicare or MA, Medigap plans can use underwriting. But they can only do it if you enroll outside of your Initial Enrollment Period, which begins the first month you have Medicare Part B and are 65 or older and lasts for six months.

During this time, you will pay the same premium anyone would pay, regardless of your health status.

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Depending on the state in which you reside, this protection generally goes away after this six month open/initial enrollment period ends. A few states extend the protection, but not many. Please keep that in mind. Depending on which state you live in, if you miss your initial enrollment period for Medigap you may not be able to buy it, and if you can, they can charge a lot more. So don’t think you can just pick it up later.

This stuff is confusing for sure. An under-utilized resource which can help is the State Health Insurance Assistance Program (SHIP) which is available for exactly this reason. Every state has a SHIP, and ours is right here in Concord.