Profile picture for user limartinez86
Lino M. Family Member

Medicare Advantage vs Medigap/Supplemental

Hello everyone, my father received his LVAD approx 2 years ago. He qualified for SSI Disability and will finally be covered by Medicare next month. He is still under 65, so the prices for Supplemental and Medigap coverage are unregulated and ridiculously expensive. We don't qualify for a plan under AARP/United because he is under age. Between the Medicare Premium and Supplemental the cost is more than we were paying for insurance coverage through the ACA State Health Exchange. What plans do you find best to cover all of your needs? Plan C & D? I've seen a couple people mention Plan F? The language is very confusing to me.

Our next option is to get Medicare Advantage. What is everyone's experience with that? Are most of your routine care, labs, medical supplies, and prescriptions covered? How is your monthly premium and deductible. The SSDI is the only income he receives so we are on a fixed budget. Thank you all.

Profile picture for user Stan_C
Stan C.

I was in the same position as your father last year.  He will qualify for a Medicare Advantage program but not for stand alone Medicare & Medigap because he is under 65.  I found an insurance broker and he stepped me through the whole process.  For me the AARP Medicare Advantage program was the best deal and does include drug coverage.  You still have to pay for Part A Medicare but my monthly premium with AARP is only $23.00 plus my co-pay for medications.  Some people do qualify for $0 monthly premiums but like me he probably will not due to the LVAD.

There is 3 things which is a pain with them.  1, they do have a Rx "doughnut hole". 2, they do not cover OTC meds like 81mg aspirin or other required vitamins for me. 3, although they have a $50 allowance for OTC medications every 3 months it is through Wal-Mart and they are always out of what I need or very small sizes.  Best solution for the OTC meds is Amazon and they are cheaper anyways.

Income wise check with your State as there should be a Senior assistance program that might be able to help in many areas.

Finally, you can check for your own Medicare Supplement on the Medicare website but I wanted a more knowlegable person than myself helping with this.  I can do it now myself but not when I was trying to figure everything out.

Good luck!


Profile picture for user limartinez86

In reply to by Stan C.

Lino M.

Thank you for your knowledge on the subject, it is greatly appreciated. I've started research with the Medicare Advantage options as they are more affordable upfront. I'm hoping that not too much changes with his medical expenses as the doctors have been changing his medication a lot due to his IAD going off.