"I want this settled before the Christmas cards," Mom said, which is how I knew she meant business. Mom is 79. She still plays cards every Thursday, still drives to the Middletown Kroger, and still reads every piece of mail that comes with a Medicare logo on it. This fall there was a lot of it.
For the last several years she's been on a Medicare Advantage plan. It had a $0 premium and it worked fine while she was mostly seeing her family doctor. Then this year she started seeing a cardiologist for an irregular heartbeat, and an eye doctor for early macular changes. Her plan's letter for 2026 raised the specialist copay and, more importantly, her cardiologist's group told her they would no longer be in that plan's network next year.
So she called me. I'm not a Medicare expert, and I told her so. But I'm good with forms and a calculator, and she's my mother.
The worksheet
We sat at her kitchen table on a Sunday afternoon with a legal pad. I drew two columns: Medicare Advantage on one side, Original Medicare with a Medigap plan and a Part D drug plan on the other. Under each I listed the same rows.
- Monthly premium, on top of the Part B premium she pays either way
- What a specialist visit would cost her
- The most she could pay in a bad year
- Whether her cardiologist, eye doctor and family doctor take it
- Whether she needs referrals
- How her three prescriptions are covered
- What happens if she travels to see Emily in Columbus
For the Advantage side, we looked at a couple of plans in her county. Premiums ran from $0 to about $45 a month. Specialist copays were $40 to $50. The out-of-pocket maximums for in-network care were around $5,000 to $6,700. Networks were the sticking point. Not one of them had all three of her doctors.
For the Medigap side, she looked at Plan G. With Plan G, after she pays the yearly Part B deductible, which is a couple hundred dollars, Medicare and the Medigap plan cover essentially the rest of her Medicare-approved care. Any doctor in the country who takes Medicare will see her, no referrals needed. The tradeoff is the premium. Quotes for a 79-year-old woman in her zip code ran about $195 to $240 a month. Add a Part D plan for her prescriptions at about $28 a month.
So roughly $2,900 a year in extra premiums for the Medigap route, against close to nothing for the Advantage route, but with real risk on the Advantage side if she had a heavy year. Her worst case on Advantage was over $6,000 plus whatever her out-of-network cardiologist would bill. Her worst case on Medigap G was the premiums plus that small Part B deductible.
The questions for her doctors
I wrote these out and she called each office herself, because she likes to be in charge of her own business. The questions were simple: Do you accept Original Medicare? Will you be in network next year for the Advantage plans she was considering? And for the cardiologist, how often do you expect to see her, and are there tests coming?
All three take Original Medicare. The cardiologist's office expected four visits a year and probably an echocardiogram. That made the decision feel less theoretical.
The catch we almost missed
Here's the part I want other daughters and sons to hear. Open enrollment, October 15 to December 7, lets you switch between Advantage plans or go back to Original Medicare and pick a drug plan. But it doesn't guarantee you can buy a Medigap policy. Outside your first window when you turn 65 and a few special situations, a Medigap insurer in Ohio can ask health questions and turn you down or charge more.
Mom had to answer a health questionnaire. Her heartbeat issue is managed with one medication, and she was accepted. I know not everyone will be. If you or your parent is thinking of leaving Advantage for Medigap, apply for the Medigap first and get the approval in writing before you leave your Advantage plan. Ohio's free Medicare counseling program for seniors can walk you through this, and they don't sell anything.
What she decided
She chose Original Medicare with Medigap Plan G and a Part D drug plan. The Medigap was approved in writing in mid-October with a January 1 start date. Then we enrolled her in the Part D plan during open enrollment, which automatically ends her Advantage plan on December 31. Everything lines up on New Year's Day.
Her reasoning was her own: "I'm 79. I don't want to call anybody to ask permission to see a doctor." She also liked knowing her costs would be about the same every month.
Would Advantage be the right choice for some people? Absolutely. If you're healthy, your doctors are in the network, and a lower premium matters more, it can make sense. This is just how one stubborn, funny 79-year-old chose. She wrote "DONE" across the top of the legal pad and went to deal the cards.
