Date of Birth: 06/19/1961
Prepared For: John Doe
Location: IN, Marion County, 46201
My role is to explain how Medicare works, where common risks exist, and how different options are typically priced — so you can make informed decisions based on your own priorities, even if that decision is to make no changes.
All pricing in this report is an estimate based on Medicare.gov benchmarks and your inputs. We intentionally estimate on the conservative side so you’re not surprised by final pricing. It is therefore recommended to confirm pricing on Medicare.gov before making a final decision.
This guide is customized for:
John Doe, age 64, living in 46201
This section will help you understand how medicare works, how it works with other insurance you carry into medicare, and how it can work for you. It will help you get acquainted with terms, learn about prescription drug coverage, and where problems and expenses may arise.
Medicare starts with enrollment into Part A (inpatient) and Part B (outpatient). These two parts are your primary insurance — they “run the show.” Medicare pays providers first, then coordinates with your secondary coverage (if you have it).
From there, you choose a path for how your major medical and drug coverage will work…
Some folks' paths will come from pre-existing coverage, others will take paths regulated by the federal Medicare program.
We will start with the pre-existing paths, and then to Medicare regulated options.
The following information is specific to you, and a result of the information you input on our intake form.
You indicated no veteran-related healthcare coverage.
You indicated no veteran-related healthcare coverage.
Your Medicare choices are based solely on standard Medicare rules, provider access, and cost considerations.
None — veteran coverage does not factor into your planning. This keeps your Medicare decisions straightforward and based purely on access, cost, and flexibility.
Retiree coverage note
You indicated you do not have retiree health coverage available through an employer, so Medicare will be your primary coverage when you enroll.
Part A note (simple)
In practical terms, enrolling in Part A is usually a clean, low-risk step because it’s hospital coverage and (for most people) it costs $0.
You indicated you are not contributing to an HSA, so the common HSA tax/eligibility issue does not apply to you.
If you’re not claiming Social Security yet, you can enroll directly through SSA (online). If you are claiming, Part A is typically automatic.
Without active employer or retiree coverage, enrolling in Part B on time is essential to avoid gaps or penalties.
You’ll need to enroll through SSA
Because you’re not claiming Social Security, you typically need to actively enroll in Medicare Part A and Part B (for example, using SSA.gov) to start coverage on your Medicare effective date. You can also call social security, or go into their offices, but signing up on SSA.gov is often the fastest way.
What this means
Government-run primary coverage (Parts A + B) Covers at 80%
Most will not take this path, as 20% coinsurance with no ceiling could lead to catastrophic financial impact in a bad medical year.
This path starts with A + B covering you at 80% for inpatient and outpatient.
You can add a Medigap (Medicare supplement) plan to cover the remaining 20%. There are many plan letters, offered by many carriers. The most enrolled supplement plans today are;
Supplement plans are regulated by the federal Medicare program to be uniform in their coverage, and healthcare providers who accept Medicare A + B, accept all supplement carriers, no exceptions.
They’re all the same, and healthcare providers accept all of them. As a result of these facts, it is price that becomes the recommended focus point.
To summarize, supplement plans work with Medicare A + B to cover the 20% they don’t cover once applicable deductibles have been met. Deductibles and copays can change across supplement plan types.
If you take medications, you want to ensure they are covered by your drug plan.
Covered medications are assigned to tiers 1-5, or tier 6 known as the “specialty” tier.
Copays are driven by the assigned retail cost to each respective drug. For generic medications, retail cost is typically low, and therefore the copays can often be $0 or under $10. Brand name medications have higher retail costs, ranging from hundreds to tens of thousands of dollars per month.
The copay limit for 2026 is $2,100
Many drug plans have a deductible of $0, which applies only to tier 3 and above drugs on most plans. (The highest copays will often be a result of meeting this deductible when picking up a brand name medication.)
Some high monthly premium drug plans, which are often the least expensive annually for those with brand name drugs on their formulary, do not have a deductible.
Remember, devices such as continuous glucose monitors, CPAP machines, etc., as well as various accessories such as diabetic test strips, lancets, and hoses, masks, etc. are not covered by your Part D. They will fall under Part B of Medicare as DME or Durable Medical Equipment.
This path can be great for some people, but the tradeoff is:
Many people do well on Medicare Advantage plans — the key is understanding how rules and copays replace predictability, and deciding whether that tradeoff fits your preferences.
This is the foundation of your Medicare decision process. In this section, you’ll see how Medicare Supplement plans are priced and how people typically choose between them, using real examples and cost estimates based on where you live. You’ll also learn whether you qualify for Guaranteed Issue protections and where you are in your Medicare enrollment timeline. Finally, we’ll introduce the baseline costs of Medicare Advantage plans and review the potential expenses associated with optional coverage like dental, hospital indemnity, or cancer insurance.
Plan G is the most popular choice. It covers the 20% that A + B doesn’t cover, and the only thing you pay out of pocket outside your monthly premiums is the Part B deductible, which this year is $283.00.
Plan N is the second most popular choice. It has the same ‘coverage’ as G, including the Part B deductible of $283.00, but there are three total differences.
Plan High Deductible G is selected at 65 at a far lower rate than G or N, but is still an option some consider. It has the same coverage as G and N, but with High Deductible G;
NOTE: Plan F & C are only available to those born before 1955. Therefore no younger applicants are entering the risk pool and the price is jumping year over year at greater intervals than the plan G and N. Plan G replaced Plan F, and Plan N replaced Plan C.
How the billing works (simple)
If you are on Original Medicare and adding a Supplement plan, your total cost exposure is four monthly premiums, and the remaining out of pocket not covered.
Part A + Part B + Supplement + Part D
Add those together, and you will get your monthly premium total, but not your total out of pocket exposure.
As explained in the prior section, out of pocket exposure with supplemental insurance is derived from whatever expenses A+B+Supplement plan doesn’t pay. Below we break it down simply through the context of popular supplement plans.
With A + B + G + D, your typical out-of-pocket is monthly premiums plus;
With A + B + N + D, your typical out-of-pocket is monthly premiums plus;
With A + B + N + D, your typical out-of-pocket is monthly premiums plus;
This is simple math that looks past excess charges and the international travel coverage limit for the two most enrolled plans.
The way to do this is first by looking at monthly premiums for each of these supplement plans.
EXAMPLE MATH;
Plan N “wins” if the copays you pay are less than $50/month.
Because the Plan N doctor copay is $20, the break-even is:
So:
This isn’t a “right vs wrong” decision — it’s a frequency decision.
Age Attained Rating: An age-attained Medicare Supplement plan bases your premium on your current age. As you get older, your rate typically increases over time, in addition to any