Which of Medicare's two paths are you on? Take-Home Notes, part one
September 28, 2026
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Show Notes
Eddie and Betty's Conversation
Welcome back to The American Retirement Advisor podcast. I'm here with Eddie, as always, and today we are getting into something that lands in just about everyone's mailbox eventually: Medicare. Specifically, a piece written by Ian Schaeffer, the COO here at American Retirement Advisors, that he published as a sort of take-home notes guide for a live Medicare workshop his team was putting on at two Phoenix-area libraries.
Yeah, and I'll say right off the bat, I read it expecting the usual overview, and there were a couple of moments where I genuinely stopped and thought, oh, that's a better way to frame it than I've ever heard.
Same. And one moment that made me laugh out loud, which we'll get to. But let's start where Ian starts, which is with this image of the foundation.
Right. So Original Medicare, Part A and Part B, hospital coverage and medical coverage, he describes them as sitting side by side on a slab, like the foundation of a house. And that's a pretty good picture because a foundation does one job and it does it well, but it's not a finished house.
And the crack in it is the famous one that I feel like people don't fully register until they're on Medicare.
Part B pays 80 percent of covered services. That sounds fine. What it means is you're on the hook for the other 20 percent, and here's the part that matters: there is no yearly ceiling on that 20 percent.
No cap at all?
No cap. So if you have a serious illness and your bills are substantial, your 20 percent could be very, very substantial.
That is one of those things that seems fine until it really isn't. Okay so the rest of the article is basically about what you do with that 20 percent problem.
That's a clean way to put it. Ian describes the workshop slide as showing five possible things you can do. You can leave the foundation as is, which is a choice, or you can build one of four things on top of it.
Walk me through the four quickly, because I think some people don't know all the options exist.
So one is employer or retiree coverage. Two is a Medicare Supplement, those are the lettered plans, A through N. Three is Medicare Advantage. Four is Medicaid paired with an Advantage plan, for people who qualify for both.
And the employer one has a quirk to it, right? Because the article flags something about the size of the company mattering.
Yeah, and this one I want to be careful about because the rules get specific. It says if you or your spouse work for an employer with 20 or more employees, the group plan can stay first in line and you may be able to delay Part B. Under 20 employees, Ian says the rules flip, and he calls it its own story. For the exact details of that, I would ask an advisor, because getting that wrong can be costly.
Smart. Don't guess on that one. Okay so the article says most people eventually land on one of two paths, not all five.
Right, and this is where the workshop gets focused. Employer coverage and Medicaid kind of fade out for most people eventually, and you're left with two directions: supplement your Medicare, or assign it.
And the language matters there. Supplementing versus assigning.
The first path means Original Medicare stays in charge. The Supplement plan picks up much of what Medicare leaves behind, and you add a separate drug plan on top. Assigning means you hand your Part A and Part B over to a private company, and that company runs your coverage.
That's Medicare Advantage.
That's right, and the article quotes Medicare's own language, that you're joining a Medicare-approved plan from a private company that offers an alternative to Original Medicare.
That word is doing a lot of work in that sentence.
It really is. It's not a supplement to Original Medicare, it replaces the role Original Medicare plays in your coverage.
So everyone listening right now is either on one of those paths or they're heading toward having to choose. And the article says to write down which one you're on.
Literally that's the take-home note Ian writes out: I supplement my Medicare, or I assigned my Medicare to a private plan. He says every other section of the workshop hangs on that one line.
I love that it's one sentence. It's not a form, it's not a quiz. It's one sentence.
And if you're not on Medicare yet, he says to write not yet. You still need to know which path you're going to take.
Okay. Now can we please talk about the mailbox moment? Because this is the one that made me laugh.
The seventeen-second scroll.
Yes! So the workshop apparently puts up a list of every company selling Medicare Supplements in the country, and it just keeps going.
More than 240 company names, counting each state subsidiary separately. And it rolls up the screen for about seventeen seconds.
Just names rolling past. And someone in the room asks, anybody getting mail?
And the co-presenter playing the client says it started last week. Which, if you have turned 64 and a half, you know exactly what that feels like.
It's like the mailbox just gets a notification that you exist.
Every company on that list wants the same customer. But here's the punchline, and Ian pulls this straight from Medicare's own booklet on Supplements.
This is the part. Say it.
All Medigap plans of the same letter offer the same basic benefits, no matter where you live or which insurance company you buy them from. Price is the only difference between policies with the same letter sold by different companies.
Wait. So all those envelopes, all those mailers, all that mail, and a Plan G is a Plan G is a Plan G?
They look different. The Plan G inside does not. That's Ian's line and I think it's perfect.
So what you're comparing when you get all that mail is price. That's it.
For the benefits, yes. That's the variable, the letter is the constant.
That reframes the whole pile of mail. It's not confusing, it's a price comparison exercise.
A very loud one, but yes.
Okay but then I want to make sure people don't assume Advantage plans work the same way, because the article is pretty clear they do not.
Completely different situation. Supplements are lettered and standardized by law. Advantage plans are not. Each one sets its own network, its own copays, its own extras.
So two of them from two different companies can look the same on the cover and work very differently at the doctor's office.
That's the article's framing, and it's right. And to show you what that looks like in practice, Ian pulls a specific example from the Medicare plan search tool.
One ZIP code.
One ZIP code in Scottsdale, 85255. On a specific search date in September, Medicare's own website listed 17 companies offering 88 Advantage plans for 2026.
Eighty-eight of them. In one ZIP code.
And that's for one year. The article notes that the search switches over to 2027 plans on October 1st.
So those numbers shift. Which means if you did it a few weeks later you'd see a different set entirely.
Yep. And Ian says the follow-up notes are going to walk through that search screen by screen, which I think is incredibly useful.
Okay here's a question I know people ask: what if I want to be on both? Like, can I have a Supplement and an Advantage plan?
No. And Medicare's language on this is not subtle. You can't buy a Medigap plan while you're in a Medicare Advantage plan unless you're switching back to Original Medicare. And you can't use a Medigap plan to pay your Advantage plan's copayments, deductibles, or premiums.
They don't work together at all.
They're designed for two different tracks. You're on one or the other.
Can you switch between them?
You can, but Ian makes a point of flagging that the two directions are not equally easy to reverse. And this is the part I think people really need to hear.
Say more.
Advantage plans let you switch every fall during open enrollment with no health questions. But if you're on Advantage and you want to go back to a Supplement later, the article says that can mean health questions. Which means in some situations you might not qualify.
The Supplement door can lock behind you.
That's Ian's phrase, and it's the right warning. The path you choose now may be harder to leave later than it was to enter.
That is not a small thing. That's a reason to think carefully about which path you pick in the first place, not just which one looks good this year.
Which is why the workshop apparently spends the most time on that five-options slide. Getting the original choice right matters more than most people realize.
And I'd imagine the specifics of when that door can lock and when it can't are pretty detailed.
The exact rules around Supplement underwriting and when guaranteed issue rights apply are the kind of thing I'd want to sit down with one of our advisors to go through. Because it depends on circumstances, and it's not a place to guess.
So let's pull back for a second. If someone is listening to this and they've never thought about any of this before, what's the simplest frame for what we just covered?
Medicare is a foundation, and we already talked about what that foundation looks like -- that open-ended 20 percent with no ceiling on your exposure. So almost everyone needs to build something on top of it. The two main options are either supplement it, where Original Medicare stays in charge, or assign it to an Advantage plan, where a private company runs everything.
And those two paths look different, cost differently, work differently, and aren't equally easy to switch between.
Right. And one of them comes with 240-plus companies flooding your mailbox, and the key fact is the benefits are standardized by letter, so price is the comparison.
And the other one comes with 88 plans in a single ZIP code, none of them the same, all of them requiring you to actually compare what's under the hood.
Which is a very different kind of comparison. You can't just look at the letter.
Ian starts the article with this image of the workshop asking everyone in the room to take out their wallet and prove they're covered. I thought that was such a good opener.
Because that's exactly what people want from Medicare. Not a lecture on insurance. They want to know that if something happens, they're okay.
And the gap between feeling covered and being covered is the whole point of the workshop.
Carrying a Medicare card and understanding what it does are two different things.
The article also mentions this is part one, and that there's more coming, specifically about copay, deductible, network, and maximum out-of-pocket, and apparently one of those surprises people most.
Which I am curious about. I have a guess but I'll keep it to myself.
Oh I want to know what you're thinking.
Maximum out-of-pocket. Because it works very differently depending on which path you're on, and most people assume it applies everywhere the same way. But that's a guess, not a fact, so we'll see what Ian writes.
Fair enough. We'll read part two when it comes out. Okay, for anyone who wants to go read this piece yourself, it's by Ian Schaeffer and it's worth five minutes of your time. The take-home note he gives at the end is useful: write down which side of the line you're on. Supplementing or assigned. If you don't know, that's your first question.
And if the answer is I'm not sure, or I picked something three years ago and I haven't thought about it since, that's a conversation worth having.
The team at American Retirement Advisors can sit down with you and help you figure out where you are, what your options actually are, and whether the path you're on still makes sense for you. That's what they're there for. We'll put the contact information in the show notes. Thanks for spending some time with us today, and go write down that one line.