Medical Insurance

[BrianGSDTexoma]

You’re drawing SS, Brian?
Supposedly you are automatically enrolled in Medicare parts A & B when you turn 65 by already being on SS.
I would create an online account as soon as possible
I’m not sure how your marketplace works but can you stay on it until end of year and get a BCBS independent plan for 5 months of 2026?
I was fortunate to get BCBS through marketplace

Seems strange they would not take any marketplace ins. Never heard of an office using that as defining acceptance. I would shop for another provider till you medicare. I have Anthem and their site has a search that gets me started and can search by distance. I get the list then google the docs to see how they are rated.

Also - a broker for medicare is very helpful. I forget the ins and outs when my wife signed up, but there is a choice in coverage type that you can make only once. Im sure someone here on MC can speak to it.

I'm confused but that's normal for me Brian. I too have BCBSTX and I get it through the Health Insurance Market Place on line. My PCP is at TMC and although I do not endorse this quack I currently have as a PCP they only deal with BCBSTX and me - nothing is done by them through the market place. If you have BCBSTX you can log into their website and find every doctor in their network. You can refine the search by distance or type of doctor, ect........
I hate the Insurance industry as a whole but this sounds like something you can resolve if you're willing to find a different PCP.

Last time I looked, they're were a plethora of doctors in the Sher/Den area. You should have options.

Are your meds unaffordable without the insurance? When the ACA first started, it was affordable. Within a few years the price the gave me was literally over $3,000 a month in premiums with a high deductible. I had to go back to uninsured. I didn't stop going to the doctor or taking what meds I was on, I just paid out of pocket. The doctors/providers around here all had an automatic 50% for self-pay, about what they would get with an insurance claim. GoodRX and other discount systems can sometimes slash the price of drugs to lower than the insurance sets them. Harris Teeter (grocery and pharmacy) actually started using a different discounter and saved me even more money. It was more affordable than insurance premiums even before they skyrocketed back then. We dont get a dime in subsidy, so, nothing free for us...

On the medicare thing, definitely get with one of those places that provide guidance. My wife did that and they really helped her navigate the complexities. If you dont have an expert help you, you can end up leaving a heck of a lot on the table. She got an excellent setup and we have never have a problem with services. My employer provides a $300 stipend towards my current policy and takes the rest of my payment out before taxes, so, not a bad deal right now except my deductible and MOOP is high. But that was my choice to keep the premium lower.

I sent Doc a message and this what I got back:

Good morning, Starting January 1st 2026 we will not be accepting your certain plan. We are on regular BCBS HMO. Thank you, Kylie - Front Office Lead

Not much of an answer. So I guess BCBS is what they take instead of BCBSTX. I can not get BCBS through MarketPlace.

 

[BrianGSDTexoma]

I looking through MarketPlace and may be a couple options from someone called Ambetter from Superior HealthPlan and UHC. Guess just need to wait until open enrollment.

 

[processhead]

I looking through MarketPlace and may be a couple options from someone called Ambetter from Superior HealthPlan and UHC. Guess just need to wait until open enrollment.

You may have additional choices (or fewer) once open enrollment begins.
Seems like the list of insurers changes from year to year.

 

[texomakid]

They couldn't make it more difficult. I know I was kicked off a plan years back because they stopped allowing individuals to purchase PPO's. So I move to an HMO. Prior to that I was with Cigna (and they had a large coporate office next to TMC) and they stopped insuring individuals in Texas. For a while I had to drive over 50 miles to Bonhan just to have a PCP in network when I drove past 30 PCP's in the Sher/Den area that were only 20 miles away. It's ridiculous to have to go though all this just to receive health care.

It might be a case of your particular plan since there are so many plans and levels of insurance. I may be wrong but it was my understanding if you're living in Texas, any policy you get from BCBS is BCBSTX.

Good luck and don't give up. That's what they want you to do.

 

[sandyut]

My Anthem plan is being dropped in Colorado next year. Rumor is Anthem is dropping all their HMO plans here. The income tax credits are also gonna be much lower due to the current administration. So no matter what its gonna cost a lot more. Ive read anywhere from 30-70% more.

 

[jcam222]

I Mainly just need to keep med's going. Probably just have to pay the doc fee and try to get him to keep labs to a minimum. I will still have coverage for other things. Market Place will probably want a doctor listed as PCP.

Marketplace doesn't require you to identify a PCP but you need to try to find a plan that has that and hospitals near you to cover against catastrophic costs until you get Medicare in June. You may just have to pick a plan that isn't great but at least has some coverage in your area. Health insurance overall is a complete frustrating joke to me but it is what it is I guess.

 

[sandyut]

Marketplace doesn't require you to identify a PCP but you need to try to find a plan that has that and hospitals near you to cover against catastrophic costs until you get Medicare in June. You may just have to pick a plan that isn't great but at least has some coverage in your area. Health insurance overall is a complete frustrating joke to me but it is what it is I guess.

Agreed. Sadly it sounds like next year is gonna be more costly and at least in Colorado - fewer options.

 

[BigW.]

Just to add a few thoughts. As you mentioned, if you can get current Dr to get you at least a 3 months supply, if not more of meds going into 2026 that would be great.

I'd lean toward traditional Medicare A&B, and a Supplement Plan G & Part D for prescriptions. All of these will start June 1. You can go the Advantage route down the road if you wanted. Part D plans change ever yr, so always search every year on medicare.gov (easy to do)

Then for Jan 1-5/31 you grab a marketplace plan, find a Dr in your area who accepts it and hope you don't have to go to him/her. June 1, you can go back to your current Dr if you like him.

 

[jcam222]

Just to add a few thoughts. As you mentioned, if you can get current Dr to get you at least a 3 months supply, if not more of meds going into 2026 that would be great.

I'd lean toward traditional Medicare A&B, and a Supplement J & Part D for prescriptions. All of these will start June 1. You can go the Advantage route down the road if you wanted. Part D plans change ever yr, so always search every year on medicare.gov (easy to do)

Then for Jan 1-5/31 you grab a marketplace plan, find a Dr in your area who accepts it and hope you don't have to go to him/her. June 1, you can go back to your current Dr if you like him.

Is part J Medigap?

 

[BigW.]

Is part G Medigap?

Yes, Medicare Supplements are sometimes referred to as Medigap plans. I edited my post to correct plan error. Plan G is the most comprehensive plan available these days.

 

[Ishi]

You have 7 months to enroll and not get a penalty! Three months before your birthday, the month of your birthday, three months after your birthday making 7 months.
I’m on A&B and a supplement G plan. It’s doing great for myself with 258$ deductible per year.
Now if you’re wanting the Medicare C plan that you see all the advertisements on tv about go in with both eyes WIDE open!!
Also enroll in the drug plan even if you don’t take Meds to avoid the penalty down the road if you start taking Meds!
It sounds confusing but its not just talk with a trusted insurance agent and it will be clear as mud.

 

[jcam222]

You have 7 months to enroll and not get a penalty! Three months before your birthday, the month of your birthday, three months after your birthday making 7 months.
I’m on A&B and a supplement G plan. It’s doing great for myself with 258$ deductible per year.
Now if you’re wanting the Medicare C plan that you see all the advertisements on tv about go in with both eyes WIDE open!!
Also enroll in the drug plan even if you don’t take Meds to avoid the penalty down the road if you start taking Meds!
It sounds confusing but its not just talk with a trusted insurance agent and it will be clear as mud.

Are you saying the insurance agents aren't helpful?

 

[Ishi]

Are you saying the insurance agents aren't helpful?

No not saying that at all! Insurance agents will explain Medicare A&B and Medicare Advantage plans all I’m saying is the two plans aren’t the same thus the eyes wide open to hear both plans aren’t and determine which one fits best

 

[jcam222]

No not saying that at all! Insurance agents will explain Medicare A&B and Medicare Advantage plans all I’m saying is the two plans aren’t the same thus the eyes wide open to hear both plans aren’t and determine which one fits best

Gotcha, I read it as clear as mud even after an agent helps which would mean confusing.

 

[Fueling Around]

No not saying that at all! Insurance agents will explain Medicare A&B and Medicare Advantage plans all I’m saying is the two plans aren’t the same thus the eyes wide open to hear both plans aren’t and determine which one fits best

Insurance Agencies are commission driven. Some will go over all plans in detail as in Medi-Gap (part G) or Advantage (part C) as required by state regulations. However some will really gloss over some options and direct you towards the plan that generates them the most money.

 

[Fueling Around]

I sent Doc a message and this what I got back:

Good morning, Starting January 1st 2026 we will not be accepting your certain plan. We are on regular BCBS HMO. Thank you, Kylie - Front Office Lead

Not much of an answer. So I guess BCBS is what they take instead of BCBSTX. I can not get BCBS through MarketPlace.

That wasn't much of a detailed answer to me. Need to talk to them directly and see if they accept any plan off marketplace for your 5 months of 2026. Do explain to them you need something to get you to June 1st and also what Supplement or Advantage plans they accept while on Medi-Care after June 1st.

 

[dward51]

I thought if they took medicare they "HAD" to also take the part C plans from either employee pension plans or the marketplace? That's all a marketplace plan for anyone 65 or over with medicare is, a "medicare advantage or part C" plan. Unless your doctor just does not take medicare period, and some don't but they are rare. Don't decline your part B, they enroll you automatically at 65 and you get your card about 2 months before you turn 65. But if you choose not to accept part B, it cost more to get it later and that higher cost is forever.

 

[Ishi]

Insurance Agencies are commission driven. Some will go over all plans in detail as in Medi-Gap (part G) or Advantage (part C) as required by state regulations. However some will really gloss over some options and direct you towards the plan that generates them the most money.

I have no doubt on that. Money drives the ship. My wife and were a month apart on are turning 65 and for our needs we told our insurance agent we were going the A&B with G supplemental.

 

[BrianGSDTexoma]

That wasn't much of a detailed answer to me. Need to talk to them directly and see if they accept any plan off marketplace for your 5 months of 2026. Do explain to them you need something to get you to June 1st and also what Supplement or Advantage plans they accept while on Medi-Care after June 1st.

Yeah I sent them a detailed question and that what they replied. I also went down and they just said they not taking BCBSTX anymore. Hopefully I will find a plan they take during open enrollment. Just wont be as good as the one i have now.

 

[Fueling Around]

Yeah I sent them a detailed question and that what they replied. I also went down and they just said they not taking BCBSTX anymore. Hopefully I will find a plan they take during open enrollment. Just wont be as good as the one i have now.

That is the twist. Not familiar with BCBSTX so explain if is a HMO or stand alone.
After my wife's forced retirement we had to take Cobra until we got her medicare completed and I got on marketplace, Cobra is really expensive thanks to the insurance company jacking the rates from group insurance to individual coverage.