Don’t Make the Wrong Medicare Decision
Healthcare can be one of the biggest expenses you’ll face in retirement. That’s why it’s so important to make the right Medicare decision when you turn 65.
Medicare’s open enrollment for 2026 is October 15 to December 7, 2025 or 3 months before you turn 65. If you’re approaching 65 — or helping a loved one who is — here’s what you need to know before making a choice.
Below are your two choices for Medicare when you turn 65:
You Have Two Options at 65
When you sign up for Medicare, you’ll choose between:
Original Medicare (Parts A & B)
Run by the federal government. You need to add a Medicare Supplement (Medigap) plan to help cover out-of-pocket costs and a Part D plan for prescriptions.Medicare Advantage (Part C)
Sold by private, for-profit insurance companies. You no longer have Original Medicare. All your healthcare decisions are made by a for profit company. These plans often advertise extra perks like dental, vision, and gym memberships — but there’s a lot they don’t tell you
What the Insurance companies won’t tell you about Medicare Advantage
I want to be upfront about this because too many people only learn these things when it’s too late:
1. A for-profit insurance company makes your healthcare decisions.
With Medicare Advantage, your insurance company — not your doctor or Medicare — that decides what care you can have. Sadly, they sometimes deny or delay care you need.
2. Prior Authorizations can stand between you and your care.
Before you can get certain tests, treatments, or medications, your doctor must get approval from the insurance company. This process- called Prior Authorization, is a way to control costs — often at the patient’s expense by denying or delaying expensive care.
Original Medicare doesn’t do this. If your doctor says you need it, Medicare covers it. There is no Prior Authorization with Original Medicare.
3. You’ll be limited to a network of providers.
Most Medicare Advantage plans have a list of doctors and hospitals you’re allowed to use. Top hospitals like Memorial Sloan Kettering and Mayo Clinic and top specialists usually won’t accept most Medicare Advantage plans because they pay less and require extra approvals that deny or delay care.
With Original Medicare, you can see almost any doctor or hospital in the country that takes Medicare. And most do.
4. Insurance companies profit more from Medicare Advantage.
Insurance companies receive a fixed amount from the government for each person enrolled in a Medicare Advantage plan — over $12,000 a year (in 2019). The less care they approve, the more money they keep. That’s not a system built to put you first.
5. Medicare Consultants get paid more to steer you into Medicare Advantage.
Many so-called “Medicare consultants” make three times more selling Medicare Advantage plans than they do selling Medicare Supplement (Medigap) plans.
Always work with someone who prioritizes your needs, not their paycheck.
That’s why I personally recommend Original Medicare plus a Supplement G plan — it gives you real choice and predictable costs.
6. Employer-sponsored Medicare Advantage plans aren’t always what they seem.
Some retiree or school district retiree plans promise you can “see any doctor,” but the fine print often says, “as long as the provider accepts this .”
Many top providers won’t.
Unlike Medicare Advantage, Original Medicare allows you to receive care at any hospital in the United States.
And remember — all employer-sponsored Medicare Advantage plans require Prior Authorization for most treatments
7. Switching later may not be an option.
When you first enroll at 65, you have a guaranteed right to buy a Medicare Supplement policy — no health questions asked. But after 65, in most states you could be turned down or charged triple because of pre-existing conditions.
A few states — Connecticut, New York, Maine, and Massachusetts — allow you to switch any time, but most don’t.
Why This Matters
Medicare Advantage plans often lure people in with $0 premiums and extras like dental, hearing, and gym memberships. That sounds great — until you get sick.
Medicare Advantage companies make their profit by using Prior Authorization to deny or delay care or limit where you can go for treatment.
A Personal Note
I’ve seen too many people regret their Medicare choices because no one explained this to them when they turned 65. My hope is to help you avoid that mistake. Here is an article on my personal experience with my Mom.
Please take the time to review your options carefully and choose what’s truly in your best interest — not what’s best for the insurance companies.
You deserve care without delays, limits, or surprises.
NOT FINANCIAL ADVICE
The information contained in this article is for informational purposes only and shall not be understood or construed as financial advice. I am not an attorney, accountant, or financial advisor, nor am I holding myself out to be. I do not accept any fees or commissions from anyone or any financial institution.
I’d love any feedback on these articles.
