Medicare A Or A+B?

For nomads who have Medicare, did you choose only A, with no premium, or A+B with the $150 monthly premium? What was your reasoning? Thanks.


I think there’s even more choices than that. I’d go into a SS office and discuss it with them directly, so you’re sure to get the combination that’s most appropriate for you. I believe you can change your plans once a year if your needs change.


“Everything should be made as simple as possible." ~ Einstein

Yes, there are more options. The booklet that was sent to me spells it out very well. No thanks, I don’t want to ever talk to anyone at the SS office if I can help it. Fed up with dealing with gov’t people who rarely have my best interest at heart, have poor attitudes and are quick to tell a person that they have to do things that they do not have to do. The most that I do if I need answers from the gov’t is to send emails.

My hope is that someone who has Medicare will respond to this post. I want their opinion regarding their own situation about their Medicare choice. I have plenty of info and I know how to get more. I’ve pretty much made my choice. Just wanting to communicate with others in a similar situation.

You said you already made your choice, but wanted to hear what others have/had. Mine is a bit complicated, because I changed from one plan to another. Also, because I worked for Medicare for several years (as a nurse in their fraud department, a partnership with the DOJ/Dept of Justice), I am well versed in Medicare, so I did include information on all the options. If you don’t want to read this part, just skip it.

I originally had traditional Medicare A & B plus a second plan thru my partner that covered what traditional Medicare did not cover (20% of all charges) and all my prescriptions. I didn’t really need B at the time, since my partner’s plan would have covered it, but there is a penalty if you do not sign up when you are 1st eligible or cancel B and want to restart. See below.

From Medicare website: “If you didn’t get Part B when you’re first eligible, your monthly premium may go up 10% for each 12-month period you could’ve had Part B, but didn’t sign up. In most cases, you’ll have to pay this penalty each time you pay your premiums, for as long as you have Part B.”

When I came off my partner’s insurance, these were my choices:

  1. Stay on traditional Medicare A and/or B (Medicare pays 80%, you pay 20% of all costs - after you pay deductibles) & if wanted, pay a monthly fee for Part D (medications - also has a deductible and copays) and/or a monthly fee for a Medigap plan (Medicare supplemental insurance that covers some or all of your responsibility), or
  2. Temporarily turn my Medicare benefits over to a managed care Medicare Advantage Plan called Part C (this includes coverage for A & B, though there are still deductibles, copays/coinsurance, and usually medications, again w/ ded and copays).

You can make changes to your choices once a year during open enrollment Oct to Dec for the following year. There is also an open enrollment January 1–March 31 when you can switch from 1 Medicare Advantage Plan to another or switch back to traditional Medicare.

Personally, I always choose to carry Part B. It covers physician visits, outpatient therapies, and DME (medical equipment). Specialist costs are often very expensive and some include facility charges too, such as if you have a minor procedure in the office or outpatient surgery center. There is always a deductible and copays, but out-of-costs for services covered by Part B can be very expensive. Since the monthly fee for B comes out of my SS monthly deposit, I don’t make a separate payment, so I think of it as my Medicare payment.

My actual preference would be to switch from my managed care plan back to traditional Medicare. Traditional Medicare generally does not require prior authorization or many of the challenges that come with a managed care plan. I would carry:

  1. Part A (no monthly cost, but requires a 20% responsibility after deductibles),
  2. Part B (currently $170.10/month + $233 deductible and copays),
  3. Part D drug plan (various plans w/ different costs/month plus deductibles & copays) and,
  4. A Medigap plan. ( As noted above, Medigap insurance “…provides coverage for many of the co-pays and some of the co-insurance related to hospital, skilled nursing facility, home health care, ambulance, durable medical equipment, and doctor charges.” Medigap plans average $150/month).

That sounds like a lot of money (and it is for people on a fixed income), but A only covers hospitalizations and surgeries, skilled nursing facility care, home health care, and hospice care, plus lab tests and it is really not free. There are still deductibles and copays for every other item noted. Also Part A does not include medications (even if taken in the hospital if you lready take the drug at home).

I have not done the above (yet) because I am under age 65 and have Medicare because I qualify as disabled. Because of this, the cost of a Medigap plan in my state would be $400 plus dollars/month instead of the average $150/month. And, it would stay the same even after I turn 65. This is another one of those “penalties”, in this case, buying a Medigap plan before turning 65.

One other important note is that a managed care Medicare Advantage plan cost more when traveling out of your area. My current plan only covers services at the 2 hospitals in my city. If I go outside the network, they only pay 50% of costs. For those who travel full-time in a van or other vehicle, this makes quite a difference. Unfortunately, there are no plans that pay the full amount in all 50 states. Another reason for staying with traditional Medicare if you can afford it. It pays for charges at any facility that co

Some vanlife blogs mention catastrophic medical plans and travel insurance. Catastrophic plans only pay for medical emergencies and have a high deductible in order to keep the monthly rate at a reasonable cost. Some full-time nomads carry travel insurance. I am unsure how either of these would work with Medicare.

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Welcome, Sophie. Yes, I do have fairly clear thoughts about what I should do as it relates to my life and what would be comfortable for me. However, I am glad to have the chance to read what you have shared. Just letting you know that I’m going to take the time to do that and thank you very much for writing all of that out. I’ll reply after I’ve read.

You’ve shared what I understand from the booklet that I read, including details on penalties. I don’t understand why the gov’t would impose the penalties. Thanks again for taking the time to comment. :bouquet:

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Isn’t part B mandatory? Part A is just for the hospital, part B is what the doctors & such look at. I remember the money just being taken from the SS check.
Part B does not cover everything, there are a lot of different supplements sold to cover the part of the bill that B doesn’t.

No, Part B is not mandatory. It is optional. If you read @Sophie_Haricot’s reply above, you’ll get a great overview. Everything she shares confirms what I had already found in the booklet I rec’d from Medicare/Medicaid and from my online research.

The payment, currently around $150 monthly, is taken from your SS payment only if you choose to keep Part B or if you don’t let them know that you don’t want to keep Part B. DHHS automatically enrolls you in the paid Part B along with the no-fee Part A when you first become eligible, but you don’t have to keep Part B.

If you let them know that you opt out of Part B, you can also add it back at a later date and they charge you a penalty for not keeping it in the beginning. The penalty payment is added to your monthly fee and could last for as long as you keep Part B.

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Thanks, I wasn’t sure.
I think part B is a good thing, I never see the money anyway as it comes off the top. . I just go to the doctor if I need to.


Medicare Advantage vs Medicare Supplement insurance; Medicaid

I just spoke to a very knowledgeable insurance agent (an “insurance advocate”).

He explained to me some of the most important differences between Medicare Advantage and Medicare Supplement (“Medigap”) plans.

For many of us, health insurance is one of our biggest expenses. Those who travel a lot, or move between U.S. states during the winter and summer, should pay a lot of attention to the type of insurance coverage they get, and where it applies. What is available and where it can be used, depends a lot on the location of your official residence, as well as the type of insurance you get. Some areas, including the rural areas where you can buy or lease a relatively cheap official residence (I was once offered a trailer in the middle of nowhere for $5000, whose site rental was $50/month, though that was a couple decades ago), something some of you who travel a great deal might do for legal reasons, do not have Medicare Advantage plans available, but Medicare Supplement plans are available everywhere in the U.S.

Ordinarily, if you can get a Medicare Advantage plan in your geographic area, it is much cheaper than a Medicare Supplement plan, and is likely to cover extra things like Dental & Vision, and maybe other things like buying a certain amount of healthy groceries and/or non-prescription drugs.

Both might or might not cover gym memberships. I think the best of the bunch is the Silver Sneakers program which insurance companies like BlueCross/CareFirst might cover - because you can go to almost any gym, including some very expensive ones. United Health Care’s Renew Active program doesn’t cover as many gyms - and in my geographic area, United Health Care Advantage plans don’t cover Renew Active in any event. But that varies a lot area-to-area. Other aspects of many different gym programs were discussed in another thread,

But a Medicare Supplement programs is much better for people who travel a lot within the U.S. In particular, you can go to the 95% of doctors, who accept Medicare, anywhere in the U.S… In contrast, Medicare Advantage plans usually only cover care received in some counties in one state, and in most cases, only cover in-network doctors and other medical practitioners - though they may partially cover other doctors. (Except emergency care.)

Also Medicare Supplement plans include drugs administered by a doctor, whereas Advantage plans do not. For certain medical conditions, such drugs can be very expensive.

Ordinarily, you can’t switch from an Advantage plan to a Supplement plan staring 6 months after your Medicare starts without paying major fees, nor can you switch Supplement plans without paying such fees. You can switch Advantage plans once/quarter, without penalty – so if your medical costs are low now, and you don’t travel a lot, they might make much better economic sense. But if you move, you can switch between any two plans that you are eligible for- with no questions about pre-existing conditions.

He says a lot of people move after they develop an expensive condition, precisely so they can switch between plans.

Some of you may also be on Medicaid, because of certain medical conditions, or because of low income (and depending on other parameters and your state of official residence, on your assets.) That’s very important, because you may be able to sign up for a “dual-eligible” (Medicare/Medicaid) Advantage plan much cheaper than for a normal Advantage plan.

Medicare Advantage plans differ a lot, company-to-company, and plan-to-plan. Medicare Supplement plans of a given letter designation (e.g., a Medicare Supplement type G plan) have IDENTICAL coverage, for a given letter designation, even though they have different premium costs. There are various sites where you can see most all the Medicare Advantage and Supplement plans that apply to you - but even the government sites don’t list them all. E.g., in my state, Maryland, many of the Advantage plans aren’t listed on the U.S. government site, including some of the CareFirst (Blue Cross) plans, like their dual eligible plan. United Health Care plans are sometimes a bit cheaper, though I think fewer doctors are in-network for them, but not for dual eligible plans if you have 100% Medicaid coverage.

If you were on Medicaid, you can’t be discontinued from it at present because of the Medical State of Emergency created by Covid-19, even when you turn 65. (I’m not sure if that is true in all states! Medicaid rules vary a lot, state to state.) That was originally supposed to expire 12/31/21 (I think), but has so far been extended until 7/31/22 - and may keep being extended for a while. But many people say it probably can’t continue forever, because it costs too much.

Some people deliberately kept their income down (e.g., delayed pension and Social Security withdrawals didn’t take a pension or limited IRA withdrawals) so they qualified. I’m not sure how the state of emergency affects people whose income does go beyond certain limits. Ordinarily the end of the State of Emergency will discontinue coverage for people over 65 (if you qualified only due to low income), but I’m not sure if that applies during the Medical State of Emergency. But I’m pretty sure the 100% coverage is income limited even now.

(BTW, If you have certain medical conditions you can have or keep Medicaid regardless of income and assets, and that was true even before the Covid Medical State of Emergency.)

If you qualify for Medicaid with 100% coverage, Medicare Part B and a prescription drug plan are completely covered by the federal government. In addition, if you sign up for a Dual Eligible Medicaid/Medicare Advantage plan, you don’t have to pay anything for most prescription drugs, or much of anything else.

But Medicaid IS a state-administered program. Out of state travel limits or eliminates coverage (except prescription drug coverage in some cases.) Plus, with those income limits, you can’t travel as much, or do as many things, as many of you would like to.

Also - when the Covid Medical State of Emergency ends, all states will be required to re-examine the qualification of everyone on Medicaid. It is expected that many people will lose Medicaid because they don’t file the paperwork that might have to be done to keep it, and because the Medicaid offices will effectively have to redo decades of work, so will inevitably make mistakes. Many Medicaid offices around the U.S. have been hiring and training a lot of new people to try to deal with this expected deluge of re-qualifications.

One last thing: Some of you want a job you can work on-line, so you can work while you travel. Apparently many insurance agents and insurance advocates can do that.

I have Part A, B, and D. I have a couple of chronic conditions, so I chose a plan that covers me with minimal co-pays, since I generally turn out to be a heavy user of medical care.

I worked in healthcare most of my career, and I have seen some awe-inspiring and some very poor doctors. I wouldn’t go for a Medicare Advantage plan because there are situations where I might not be able to choose my own doctor, or treatment I chose might not be covered. There were abuses from managed care that I watched patients endure for many years, and I want to have some control over my quality of care.

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Thanks for taking time to share all of this info. The choices are very different for people who have chronic conditions and those who are rarely, if ever, sick.

BTW, I’m not speaking as an expert - just talking about what I found applied to me.

There is also a huge difference between different Medicare Advantage plans. Especially if you have specific doctors you want to see. Insurance companies have online lists of in-network doctors, but they are often inaccurate. You need to contact both the insurance company and the doctor’s office, to verify coverage. What is more, the doctor’s office may have more specific information than their medical group - e.g., my PCP is part of the “Medstar Medical Group”, but each doctor in that group chooses which insurance to accept, and the online info is wrong.

The majority of doctors in my area are in-network to both UnitedHealthCare and Blue Cross Blue Shield plans (and BTW, to Original Medicare too), but special needs plans (e.g., Medicare+Medicaid plans) often have a lot fewer participating doctors. Once I lose Medicaid (which will happen when the Covid State of Emergency ends), I will have a lot more choices of doctor. But for now, the federal and state governments are literally paying for everything - which came as a complete surprise - the state government notified me a month or two after I signed up that I was eligible for “extra help”, so I will be refunded all I have paid. For now, it doesn’t make economic sense for me to drop Medicaid by choice.

It’s all so complicated. You really need to research each doctor you might want to see, as far as which specific insurance they are in-network for. And you need to look very carefully at each individual plan you are eligible for. There is no substitute for doing the work. A really good insurance agent can certainly help, but you still need to verify with individual doctor’s offices.

I still think that if you are a true nomad, it may not make sense to accept the limitations of a Medicare Advantage plan that forces you to stay with physicians that service people living in a specific area, unless you are always able to return to that area for medical service. AFAIK, all Advantage plans are limited to certain counties, but Original Medicare and some Medigap plans are not. If I later decide to become a true nomad, I may have to pay extra premiums to get Medigap because I chose to go with an Advantage plan for now.