Answer: First and foremost, everyone on Medicare, those on Supplement or Advantage Plans, needs to pay attention to the bills they receive and understand what exactly they’re responsible to pay out-of-pocket for both medical services and covered prescription drugs. 

What to expect to pay with a Supplement 

Supplements are a bit easier to follow because bills for medical services are very limited. For those on Supplement Plan G, the only out-of-pocket expense is the Part B deductible, $283 in 2026. Keep track of the bills you receive, put them in a folder, and write them down on the inside cover. They should equal $283 to the penny! Those on Plan G should not get one more bill for medical services the remainder of the year. For those on Plan N, you also have the same deductible. Once that is met, like Plan G, there is no cost for blood work, X-rays, physical therapy, CT-scans or MRIs, surgery, a hospitalization, chemo, radiation, etc. The only other bills that those on Plan N should ever receive for medical services are up to $20 for a physician’s office visit, be that a PCP or specialist, and $50 for a trip to the Emergency Room. Any other bill received was almost certainly sent in error. Don’t pay it! And don’t let anyone at your provider’s office or a billing department tell you otherwise! 

Advantage Plan out of pocket costs a bit more complicated

As far as Advantage Plans, there are co-pays for virtually every medical service other than a PCP visit or bloodwork. Make sure you have and keep handy a “Summary of Benefits” which lists all your co-pays. Check and make sure what you’re billed matches up with what’s published in that document! Again, question any bills that don’t.

What to do when bills appear erroneous

It’s so common to receive erroneous bills and providers almost never research them for accuracy before mailing out demand for payment. It’s also common for billing department representatives to try and get you off the phone as quickly as possible by simply telling you the amount on the bill is accurate and owed without looking into the possibility of an error. Hundreds of millions of dollars patients aren’t actually responsible for are paid by those on Medicare every year.

Our clients never have to fight this battle because we instruct them to reach out to us whenever there’s a bill in question so we can get on the phone and fix it for them. Our agents do this every day! 

What about Part D prescription costs? 

You also need to watch what you’re paying for prescription drugs. You might think that it would be easier to track with the $2,100 Maximum Out of Pocket (MOOP) that’s in effect for 2026 because once that is met, all covered drugs are no cost the rest of the year!  However, almost everyone with Supplements and Stand-Alone Part D plans, and the majority on Advantage Plans now have a deductible on Tier 3 through 5 drugs, up to $615, to keep track of and a coinsurance of up to 25% on Tier 3 medications after the deductible has been met. 

In addition, most people hit their MOOP prior to spending the full $2,100. This is so ridiculously confusing to explain, I’m not even going to attempt it. The best way to get a good idea of how much you should be paying for your drugs each month and when you will meet the MOOP is by going to Medicare.gov and entering in all your prescription medications. There you can find a very and pretty accurate and detailed schedule of costs. I’m hoping to do a tutorial on how to use that tool sometime in the near future. 

Again, you must know what you're supposed to pay. Deductibles, co-pays, and coinsurance vary by plan and are published in your Summary of Benefits. Know what Tiers your drugs are, which are covered and aren’t, and what you should be paying as accurately as possible. Keep track of your out-of-pocket costs. Those who are clients of ours need to reach out to us when something looks wonky. Those who aren’t need to question the pharmacy, Advantage Plan or Stand-Alone Part D provider if the amounts don’t match up to the published information or what you found on Medicare.gov. And lastly, if you are told you need to pay any money for covered drugs after you’ve spent $2,100 out of pocket, that’s also a red flag that must be investigated. 

More items of importance as the new year begins

One other item I would like to make those on Supplements aware of is that you can change to a new plan or company all year round. There are still many people who have yet to see their large premium increase that was announced in 2025 but won’t go into effect until sometime in 2026. When that occurs, you can still move to a company or letter plan at a lower cost. There’s no need to wait until next October. In fact, I encourage everyone to be proactive. If you didn’t get your Supplement from The Health Insurance Store, you’re almost certainly overpaying. Reach out to get a quote or prescreened for medical underwriting.

Lastly, for those of you on Advantage Plans, you also can make a change in plans from January through March. You can move from an Advantage Plan to a Supplement or from one Advantage Plan to another. With any questions or concerns regarding this column or any other Medicare related topic, or if you would like to make an appointment for a no-cost consultation, give the office a call, 724-603-3403, or email me personally, Aaron@GetYourBestPlan.com.