I consider myself a reasonably informed person. I spent my career working with technology and complicated systems. I research things before making decisions.
Then I started seriously reviewing my Medicare coverage for next year.
What an education.
I currently have a Medicare Advantage PPO. My health is excellent. I take no prescription medications. I exercise regularly and remain active.
You would think choosing Medicare coverage under those circumstances would be fairly simple.
It isn’t.
My journey started with a basic question: Should I stay with my current Medicare Advantage plan or switch to another one?
One plan I reviewed has a $0 monthly premium and offers a $140 monthly Part B giveback.
That caught my attention.
That’s $1,680 a year returned to me.
Then the questions started.
Why does one insurance company give me $140 a month while another doesn’t?
I learned about CMS Star Ratings and Quality Bonus Payments.
Then I learned that Medicare pays private Medicare Advantage companies to manage our care.
Then I needed to compare deductibles.
Then specialist copays.
Then hospital copays.
Then maximum out-of-pocket limits.
Then doctor networks.
Then hospital networks.
Then dental.
Then vision.
Then hearing.
Then fitness benefits.
Then prescription coverage.
I don’t even take prescription drugs, but I still needed to understand Part D because going without qualifying drug coverage for too long might result in a penalty later.
One question kept producing another question.
Suppose I choose Medicare Advantage now but want Original Medicare when I’m 75?
Yes, I could switch.
But then I might want Medigap.
What’s Medigap?
It is private insurance designed to cover some of the expenses Original Medicare doesn’t pay.
Would I automatically qualify for Medigap at 75?
Not necessarily.
Outside certain protected enrollment periods, federal law doesn’t guarantee that a Medigap insurer will sell you a policy. Your health history might matter. Medicare itself warns that a policy might cost more because of past or present health problems.
So now I have another question.
Should I move to Original Medicare and Medigap earlier, while I’m healthy, instead of waiting?
And another.
If I get Medigap, what happens to Part D?
I need a separate prescription plan.
And another.
What happens if I switch back to Medicare Advantage?
And another.
What if I want Original Medicare again a few years later?
Welcome to Medicare.
The federal government confirms there are two basic paths. You choose Original Medicare, where you may add Part D and Medigap, or Medicare Advantage, where a private company provides your Medicare coverage.
More than half of Medicare beneficiaries are now enrolled in Medicare Advantage or other health plans. CMS reported 70.6 million Medicare beneficiaries as of June 2026, with 51.1% enrolled in Medicare Advantage and other health plans.
Every fall, millions of seniors face these decisions again.
Medicare Open Enrollment runs from October 15 through December 7. During that period, we can switch Medicare Advantage plans, move between Medicare Advantage and Original Medicare, or change prescription drug coverage.
Choice sounds wonderful until you realize how much you need to know to make an informed choice.
Original Medicare has advantages. You generally use any doctor or hospital in the United States that accepts Medicare. In most situations, you don’t need prior authorization.
Medicare Advantage has different advantages. Plans often include prescription coverage and benefits such as dental, vision, hearing and fitness programs. Some have $0 premiums or Part B givebacks.
But Medicare Advantage also brings provider networks, plan-specific copays, prior authorization requirements and annual benefit changes.
Medicare’s own comparison explains these differences.
I eventually found myself asking a much bigger question.
Why does healthcare for seniors have to be this complicated?
Why do I need to understand Part A, Part B, Part C, Part D, Medicare Advantage, Medigap, drug formularies, networks, deductibles, coinsurance, prior authorization, Star Ratings, maximum out-of-pocket limits and enrollment periods?
And why are we asking people in their 70s, 80s and 90s to navigate all of this?
That led me to another question.
Why can’t the United States have a simpler universal healthcare system?
Other wealthy countries have made different choices about financing and organizing healthcare. Some rely much more heavily on taxes and public systems. They still have problems. They still have budgets, waiting times, staffing shortages and difficult decisions.
Universal healthcare isn’t free healthcare. Somebody always pays.
The difference is how we pay and how much of the administrative burden falls on the patient.
The United States already spends an extraordinary amount on healthcare. CMS reports that U.S. healthcare spending reached $5.3 trillion in 2024. That’s $15,474 for every person in the country and 18% of the entire U.S. economy.
So when someone asks, “How would we pay for universal healthcare?” I think we should also ask another question:
How are we paying for the system we already have?
We’re paying through taxes.
We’re paying Medicare premiums.
We’re paying private insurance premiums.
We’re paying deductibles.
We’re paying copays.
We’re paying prescription costs.
Employers are paying insurance premiums.
And we’re supporting an enormous administrative system necessary to keep all these arrangements functioning.
I don’t pretend to have the answer.
A universal system would involve serious questions about taxes, government spending, provider payments, access to care and the role of private insurance. Reasonable people will disagree about those choices.
But after going through this Medicare exercise, I have become convinced of something much simpler.
We should be able to make healthcare easier for seniors to understand.
A 75-year-old shouldn’t need to become an insurance expert to figure out whether an MRI will cost $50 or $500.
An 80-year-old shouldn’t have to worry about whether changing plans today will affect the ability to buy supplemental insurance five years from now.
And someone who takes no medications shouldn’t need to study prescription insurance rules to protect against a future penalty.
Choice has value.
But complexity has a cost too.
I started this process trying to decide which Medicare plan I should choose for next year.
I ended up wondering why we built a healthcare system where making that decision requires this much work.
If you’re going through Medicare Open Enrollment this year and feeling overwhelmed, I understand why.
I’ve been going through it too.
And I still have questions.
George Frole, mGAP Coach