Mom called on Thursday morning before cards. "My Medicare book came," she said. "I'm not reading it until you come over." Open enrollment starts again on October 15, and the annual notice for her drug plan had arrived. So on Saturday I drove up to Middletown with the green notebook and a box of her favorite cinnamon rolls.
A year ago we sat at this same kitchen table and helped her choose between Medicare Advantage and Original Medicare with a Medigap plan. She picked Medigap Plan G and a Part D drug plan, and they started January 1. She turned 80 in July. Now it was time to see whether the choice held up.
Twelve months of premiums
I added up what she's paid since January and what she'll pay through December, so we could look at a full year:
- Part B premium: $202.90 a month, $2,434.80 for the year. She'd pay this on any plan.
- Medigap Plan G: $214 a month through June, then $229 after her July anniversary. About $2,658 for the year.
- Part D drug plan: $28 a month, $336 for the year.
So beyond Part B, she's spending about $2,994 a year for the Medigap and drug coverage. That's the price of the choice. On the Advantage plan she was considering, her premium would have been close to $0. That's the number she grumbles about.
The visits
This year she saw the cardiologist four times, as they predicted, and had an echocardiogram in March. She saw her eye doctor twice. She saw her family doctor for a physical and once for a sinus infection. In August she hurt her shoulder reaching for a casserole dish and needed an X-ray and six physical therapy visits.
Under Original Medicare with Plan G, her only out-of-pocket cost for all of that was the Part B deductible, $283 for 2026. Once she paid that in February, the rest was covered. No copays, no referrals, no surprise network problems.
I tried to estimate what the same year would have cost on the Advantage plan she was weighing. With $45 specialist copays, physical therapy copays, the cost of the echo and the chance her cardiologist would be out of network, I came up with somewhere between $1,400 and $2,000, before counting any trouble with referrals or the cardiologist issue.
So she paid roughly $1,300 to $1,900 more this year for Medigap than she might have on Advantage. In exchange she kept every doctor she wanted, never needed permission to see a specialist and knew her costs every month. She thinks that's worth it. So do I, for her.
The surprise prescription
The one real surprise came in April. Her eye doctor prescribed a new brand-name eye drop for dry eye. At the pharmacy it came up at $95 for a month's supply, because it sat in a high tier on her drug plan's list of covered drugs.
Mom was ready to walk out without it. Instead, we called the eye doctor's office. They switched her to a similar drop on a lower tier, and it cost $12. If there had been no alternative, the doctor could have asked the plan for a coverage exception.
The other thing working for her this year is the new limit on Part D. Starting in 2025, out-of-pocket drug costs on Part D are capped each year, and for 2026 the cap is $2,100. Mom's drugs are cheap enough that she won't come close, but I'm glad it's there.
Would we make the same choice again?
Yes, for her. Mom is 80, sees specialists regularly and values being able to call any doctor without checking a network. The higher premium is real, but her care costs were low and predictable.
For a healthier 66-year-old with doctors in an Advantage network, I'm not sure we'd land the same place. And remember that switching back to Medigap later can require health questions, and you can be turned down.
This open enrollment, October 15 through December 7, we won't touch the Medigap. We'll compare Part D plans though, since formularies and premiums change every year. Her current plan's premium goes up to $34 a month next year, and the eye drop she uses now is staying on a low tier. We'll check two or three other plans with her exact prescriptions before deciding.
I'm not a Medicare expert, just a daughter who keeps good notes. If you're helping a parent, Ohio's free Medicare counseling program for seniors is a good place to start.
Mom's verdict when we finished: "Good. Now let's eat those rolls before they get cold." She'd already eaten one.
