Medicare Choices: Prioritizing Major Medical Over Perks

Will you choose medical coverage over perks?

When it comes to choosing the right Medicare plan, it’s easy to be distracted by attractive perks like dental, vision, gym memberships, and more. But what many retirees don’t realize is that the most important part of any Medicare plan is the major medical coverage. It is the major medical coverage that protects you from the high costs of serious illness or hospitalization.

If you're nearing age 65 or already enrolled in Medicare, this article will help you focus on what truly matters when making your decision.

Why “Perks” Get All the Attention

It is very tempting to choose a Medicare Advantage (Part C) plan because they come with many appealing extras: 

Free gym memberships (like SilverSneakers) 

Dental and vision benefits 

Hearing aids 

Over-the-counter allowances 

Low or no monthly premium

In addition, many Medicare Advantage Plans include coverage for prescription drugs.

These perks can sound great, especially when they're “free.” However, the catch is that these benefits may come at the cost of limited provider networks, prior authorizations, and substantial out-of-pocket expenses.

Why Major Medical Coverage Is Crucial?

Original Medicare provides major medical coverage. It includes core coverage for:

Hospital stays (Part A)

Doctor visits and outpatient care (Part B)

Together, they provide coverage for surgeries, chemotherapy, dialysis, and other high-cost treatments.

These are the services that could bankrupt a retiree on a fixed income if not covered adequately. And these are the services you really need your Medicare plan to handle well.

Here is a key question that every person on Medicare should ask themselves:

Suppose you had a stroke, needed cancer treatment, or had to stay in a skilled nursing facility. Would you rather have comprehensive coverage that allowed you to use the best doctors and hospitals in the country for that—or a free pair of eyeglasses and dental cleaning?

How Medicare Supplement Plans Protect You

Medicare Supplement (Medigap) plans like Plan G and High-Deductible Plan G, work with Original Medicare to cover your out-of-pocket costs like the Part A deductible and the Part B coinsurance. This significantly reduces your potential out-of-pocket costs without restricting you to a network.

Unlike many Advantage plans:

There is no networks allowing you to see any doctor who accepts Medicare 

You don’t need referrals or prior authorization for specialists or procedures 

Your coverage is predictable and consistent year after year 

Adding a Medicare supplement will require a monthly premium. And these plans may not come with "free perks," but they offer what matters most: peace of mind when serious health issues arise.

The Downside of Prioritizing Perks Over Protection

Let’s be clear: not all Medicare Advantage plans are bad, and most work well for healthy individuals. Even when faced with a serious illness, many still work well. In fact, both my wife and I were enrolled in a Medicare Advantage Plan for 6 years. But in 2023, I needed back surgery for spinal stenosis, and despite my orthopedic specialist knowing that the only fix was surgery, the Advantage Plan wanted me to try physical therapy first. And when my wife developed a rare cancer, we also had to jump through hoops.

Some of the common issues with Advantage Plans are:

You may need prior approval for procedures or specialists 

Your doctor could leave the network in the middle of the year

Care outside your plan’s network might cost more 

Hospital stays could result in higher out-of-pocket costs than with a Medigap plan 

Access to top-tier specialists may be limited 

In other words, you’re betting that these potential limitations will never matter. And that’s a risky gamble in retirement.

A Smarter Strategy: Combine Major Medical with Low-Cost Perks

If you want the best of both worlds, here’s a strategy:

 1. Choose Original Medicare + a High-Deductible G Supplement Plan 

2. Add a low-cost standalone dental or vision plan, if needed 

3. Pay for extras like fitness memberships out of pocket, only if you use them 

This gives you comprehensive protection for major medical while still allowing flexibility with your budget.

Final Thoughts: Don’t Let Free Perks Cost You Big

It’s tempting to choose a Medicare plan based on the shiny extras, but don’t let short-term perks distract you from long-term protection.

My wife and I were very lucky. The insurance company behind our Advantage chose to not renew it for the 2025 plan year. As a result, we were able to buy the High-Deductible G Supplement Plan regardless of health, so we changed. We changed because I had an Advantage Plan client whose oncologist left the network in the middle of his treatment. I did not want that to happen with my wife!

And I wanted a Medicare plan that prioritized my health, my freedom, and my financial future. I wanted great major medical coverage more than the dental benefits.

If you want better coverage and more predictability, explore what extras you *really*  and pay for those on your terms.

Need Help Choosing the Right Medicare Plan?

You don’t have to figure this out on your own. At The Empowered Retiree, I help you compare your options and make informed decisions based on what *really* matters - your health and your money.

You can schedule an appointment to talk (no obligation) by clicking here.