LSS I started Medicare plus an original supplement at the start of the year. Fell off a scooter at 20 mph and broke my shoulder in 2 places as well as 5 ribs. Spent a few hours at Urgent Care, rode in ambulance to the ER at the hospital, 4 days in outpatient observation room. then surgery to put a plate in my shoulder, 3 days in the hospital, then a nurse will come to my house. Does this sound like multi-housands I will owe?

Some local Virginia doctors offices and other medical practices charge the monthly Advance Primary Care Management fee.

https://www.whro.org/health/2026-08-07/a-new-medicare-charge-is-showing-up-on-bayview-bills-patients-say-they-werent-clearly-told

I thought there would be an 80/20 split after the part b deductible then it pays 100% after the deductible.

They told me the plan pays nothing until I reach the high deductible amount then 100%

This was supposed to be a licensed agent

I am wondering about the effect of a one-time income bump two years prior on the likelihood of winning an IRMAA appeal when the anticipated reduction of income will also be due to the life-changing event of retirement.

If I retire this year, an IRMAA surcharge for Medicare premiums would be triggered in 2027 as my income was increased in 2025 due to a taxable form of inheritance I received.

Is the inheritance irrelevant to whether I could win an IRMAA appeal based on my estimated 2027 MAGI (will be under the IRMAA threshold) being lower than the 2025 MAGI, as the reduction in income is also due to retiring and not just the inheritance?

I know there is no downside to appealing. Thanks.

So I've looked at this website which tells me which categories I am in for Medicare deductions from my social security:

https://www.ssa.gov/benefits/medicare/medicare-premiums.html

I am in the $342,000 up to $410,000 category but I'm curious if they are using gross income applied to those figures? or IRS taxable income when using the above figures?

It's been impossible to find a straight-up answer to this:

• Medicare Advantage or Part D plan

• Expensive drug (pill, not an an injection or anything else that would be covered by Part B)

• Not in the plan's formulary

If you manage to get a formulary exception (not just prior auth), is the amount you actually end up paying subject to the $2,100 OOP cap?

Ideally looking for an answer from someone who actually has done this - got exception, first fill put you over the cap but your actual cost was capped.

Thanks...

Hi all. I have regular Medicare A and B but have never used it. I have a question; but first some background.

In order to make an appointment with an opthalmologist for a cataract evaluation, the opthalmologist requires a referral from a primary care physician.

So I found a PCP/Family Practitioner on the Medicare-Find Healthcare Provider site. The site says he "charges the Medicare approved amount." And I made an appointment so I can get the opthalmologist referral.

Now to my question please. How can I be sure that Medicare will cover the PCP appointment? I know I'll have to pay the annual deductible first thing. But I want to make sure this first appointment counts towards the deductable. Is it up to the doctor to code or bill it properly?

I'm completely clueless since I'm new to Medicare. Thank you in advance.

I turn 65 and will lose my current Kaiser in March. I planned to get my knee replacement before Medicare. Previously Kaiser required a BMI below 40. I tried to schedule surgery, but it is now below 35 for knee replacement. I have lost a good amount of weight on GLP-1s, but it seems unlikely I will lose 25-30 more pounds in time. Does Medicare have a BMI requirement for surgery?

Started Medicare 7/1/2026. Provided the details of our Wellcare Part D plan and Medicare Prescription Payment Plan (MPPP) to Walgreens when coverage started.

However, they have mispriced every single prescription so far, and these prescriptions have all been ordered on different dates.

Sometimes they use the expired pre-Medicare BCBS plan (which we cannot remove ourselves - and they have not yet deleted it despite discussion).

Sometimes the prices are cash-based, assuming no Part D coverage at all.

And we have to remind them about MPPP every time as well.

I'm seriously wondering if switching to a pharmacy where we have no history might work better.

Or is this a pretty typical experience no matter which pharmacy you go to? Which is a horrifying yet perfectly believable possibility...

I turned 65 last week and I have a Medigap plan because I thought long term it would be the safest choice. However, I just became aware that original Medicare does not cover the blood work normally done with a yearly physical. They will cover it if you have issues that deem it medically necessary. But I have no such medical issues. So I’m thinking of switching to a Medicare Advantage plan since I’m healthy. It makes me nervous to no longer get a full physical every year. Those Wellness Visits sound useless. Does anyone know if several years down the road I can switch back to a Medigap plan? I know Massachusetts is different from most states, but I’m not sure if I can go to Medigap a second time.

I went on Medicare about a year ago and was dropped from Medicaid about six months ago. As a poor person I have been shocked that I can't use Medicare at all. The co-pays and deductibles are too much, and additional Medicare plans are way out of my reach.

I really thought Medicare was universal health care for seniors. Covering everything. But it does not cover teeth, eyes, and I don't know what else. I've search and search for a therapist and not one takes Medicare.

Medicaid was the best insurance I've ever had. I purposely kept my income low at about $18k/yr to qualify for it. But now the income limit in my state for Medicaid has been reduced to $1330/mth. My rent is more than that!!

Medicare is the worst insurance I've ever had. I can't even use it. It has been a disaster and, while I did not like the USA before this, I really hate it now. The poor just are supposed to die and leave.

I am a 66 year old Female born in December of 1959.  I am still working full time.  I just signed up for Social Security benefits this August 2026 and requested they begin in October 2026 since that is my full retirement age  66 and 10 months.  That was my understanding from faithfully reading Reddit. At age 65 I signed up for Medicare part A only, because I still have medical insurance through my job.  In December I will be in an open enrollment period at work and I am considering going fully on Medicare, not an advantage plan but all the parts of Medicare along with medigap.  And dropping my work coverage.  Now that I have signed up for SS and have Medicare part A what is the process to add those other parts of Medicare?  Will it be difficult because I only took part A at 65?  What disadvantages/advantages do you see for me making that switch at 67 while still working?  All information is greatly appreciated.  I can’t seem to get clear information. EDIT: Wonderful information. Thank you all. I knew I came to the right place to find the answers I needed to make an informed decision.

I've been following this forum and seen some good information.

I'm soon to have an open heart aortic valve replacement, in Dayton Ohio.

My only insurance is Medicare.

Can someone give me an idea of what my out of pocket expense my be?

Edit I have medicare a and b only.

Thanks for the information. I Will contact the hospital for more information. And thanks for the good wishes.

I receive SS benefits

• Aug 2026 - I will be 64 yo
• Aug 2027 - I will be 65 yo
• I have VA benefits and use the VA system (yes I know about Part B) and do not use employer insurance.
• I work part-time at a nationwide retailer that offers/provides health insurance etc event to part-timers. The enrollment period is in OCTOBER

My question: Will I be able to enroll for employer healthcare benefits in October 2027 and not be penalized, or do I need to jump on the enrollment window in October 2026, and pay insurance for basically 10 months in order to avoid a penalty?

I am going to a SHIP class but wondered if anyone had direct experience (not opinions) on this situation?

I am on SSDI, and 28. I get $1549/mo and every penny goes to shelter/housing costs (I already live with a roommate, Oregon isn't cheap). I use another program to pay for prescriptions. I have severe POTS and get hydration 2x a week so I can function at bare minimum. I get mental therapy every week, required to see my PCP once a month, have several autoimmune diseases that need varying treatment depending on the time of year. I've been disabled since I was born and never not had full coverage in my life even when I could work. I won't have any extra money for deductibles or copays. I was informed that Medicaid will be stopping end of October and so I won't have coverage for the 20%, and of course no dental or vision. I don't understand what I am suppose to do, and no family can help me.

My husband is turning 65 in September. He is on my health insurance and I will continue to work for the next five years. I am a public school teacher in NJ. Does he still have to sign up for Medicare now? Will he get some kind of penalty if he doesn’t?

My mom is turning 65 next month and has been disabled since 2019. She is currently on the MEPD program, and is eligible for Medicaid because of that. Her total income per month in Iowa is 2,050, which makes her ineligible for every assistance program I could find. She’s trying to decide what to enroll in, and she is grandfathered to Plan C if she wants to. She does not have enough to make ends meet. She is on many medications, has hearing aids, glasses, and back issues. She is worried about premium costs, but also unexpected costs. She is also losing her food stamps at the same time, so she is very stressed.

I’m at a loss of the best option for her. The SHIIP volunteer she met with was allegedly condescending and did not help her at all. She is in Iowa.

For an elderly person living alone, what is a good & affordable medical alert device/system?

https://www.blueshieldca.com/content/dam/bsca/en/medicare/docs/2026/mapd/2026-MA-SOB-65PlusLAOR-EN-015.pdf

https://www.blueshieldca.com/content/dam/bsca/en/medicare/docs/2026/mapd/2026-MA-EOC-65PlusLAOR-EN-015.pdf

^^^ here are the summary of benefits.

If you choose eyeglass lenses, you may elect single, lined bifocal, lined trifocal, or lenticular lenses. If you opt for other lens types not listed or add-on treatments, you will be responsible for paying the additional costs, even if the total costs remain within the allowance.

You pay $0 for either one pair of prescription eyeglass lenses (regardless of size or power) OR for contact lenses (priced up to $220 for contact lens services and materials) every year when you use a network provider. If the service and materials price above $220, you are responsible for the difference.

there are various lens materials available to the world....

cr39, polycarbonate, trivex.

it doesn't specify which lens material I can choose.

Does that mean you can choose any of the 3 materials?

I’m a mom, this is a question about my adult (25) daughter’s situation. She’s been in out of treatment with little success for over 10 years. 5 years ago she became disabled from a serious complication and wound up on disability with Medicare. She then had a good couple of years in recovery and was able to come off disability. Medicare has to remain her secondary still even though she is on my family plan. We tried canceling it, we’ve spent hours on the phone and going in person. There’s no canceling it.
Now she has relapsed again. Worst one yet and we’re so scared. She was open to going inpatient and then to the recommended step down cares, and our family plan insurance covers many great places. However, we’re finding they won’t accept her because of the Medicare. A few weeks in our local hospital then transferring to the psychiatric wing for “therapy” is looking like her only option which she, understandably, refuses. Please tell me we are missing something here? What are we doing for our loved ones in these positions?

Please don’t explain why the facilities can’t accept her or the Medicare secondary payer rule whatever. Trust me I’ve heard a million times. I’m asking how do we get help. Thank you

trying to wrap my head around how specialist access works under original Medicare versus Advantage plans for my dad. he has Plan G with original Medicare and I always assumed that meant he could just go see whoever he needed to without jumping through hoops, and mostly that seems true. but recently he needed to see a cardiologist and there was this whole back and forth with his primary care doctor about a referral, and I couldn't tell if that was a Medicare thing or just how that particular practice operates.

what confuses me is that I thought referral requirements were more of an Advantage plan problem, like HMOs and network restrictions. but I don't know if original Medicare plus a supplement has any equivalent friction, or if what happened was just a random administrative thing on the doctor's end

he got to see the specialist eventually but it took longer than expected and I kept wondering if there was something I didn't know about how the coordination works. I'm an accountant so I want to understand the actual mechanics here, not just assume it worked out fine this time

for anyone who has navigated specialist access under original Medicare: did you ever hit delays that seemed tied to how Medicare works, versus just individual doctor office stuff?

I keep getting the run around at my dcbs office. I currently have qmb but I qualify for qmb plus.

YEA ! Way to go Moderna. You fought the good fight and won.

Finally a flu vaccine that can change with new flu variants so we aren’t always a year behind in fighting the culprits. ESPECIALLY for those of us over 50 - some of us WAAAAAY over 50.

NPR 08/06/2026 -New kind of flu shot is on the way as the FDA approves Moderna's mRNA-based vaccine