Lifestyle

A Retiree Living on Social Security Almost Switched Medicare Plans. Then He Checked His Own Numbers: “That Was the Number I Needed to See”

By Mike Harper · October 31, 2026

Don Romans had a simple rule for Medicare open enrollment. Most years, if his doctors were still in the network and his prescriptions were still covered, he let his plan renew.

“This year was different,” the retired manufacturing leader, who posts about life on a fixed income as Retired and Trying, wrote in a post that accompanies his video.

What caught his eye was the cap on his costs. His Medicare Advantage plan’s in-network out-of-pocket maximum for 2027 is $7,150. “That’s a lot of money when you’re retired,” he wrote. “I live primarily on Social Security, with my YouTube income providing some additional breathing room. A surprise $7,000 healthcare expense would matter.”

So he priced the alternative: Original Medicare with a Medicare Supplement, or Medigap, policy. One Plan G quote came to about $214.81 a month, he wrote, and one Plan N quote was about $143. There was a catch. He is past his initial Medigap enrollment window, which means, as he put it, “I could have to go through medical underwriting.”

Then he looked at what his coverage had actually cost him this year, a year in which, he wrote, “the medical providers involved in my care billed more than $50,000.” The amount that had built up toward his 2026 maximum of $6,750 was about $839.26.

“That was the number I needed to see,” he wrote. He had been treating the maximum almost like a bill he expected to pay. “But it isn’t. It’s a ceiling.”

He decided to stay with his current plan for 2027 and to put some of the money he would have spent on Medigap premiums into savings. He was careful not to call it a verdict for anyone else. “That doesn’t make Medicare Advantage better. It doesn’t make Medigap better,” he wrote. “It means I’m deciding which type of financial risk I’m more comfortable accepting.”

Romans walks through his numbers in a video posted Oct. 5 on his YouTube channel.

His plan is one of many. According to KFF, 55% of eligible Medicare beneficiaries, or 35.2 million people, are enrolled in Medicare Advantage plans in 2026. A separate KFF analysis found that the average in-network out-of-pocket limit in those plans is $5,421 this year, that plans may not set it above $9,250, and that about one in five enrollees face in-network limits above $7,000. Traditional Medicare has no such annual cap. KFF notes that data on how many enrollees actually reach their limit are not available.

For people weighing the same choice, Medicare.gov says Open Enrollment runs from Oct. 15 to Dec. 7, with changes taking effect Jan. 1. During that window, people can switch from a Medicare Advantage plan to Original Medicare, though they may need to join a separate drug plan.

The Medigap piece is where timing matters most. Medicare.gov says the best time to buy a policy is the 6-month Medigap Open Enrollment Period that starts the month a person is 65 or older and signed up for Part B. Outside that window, it says, there is generally no federal guarantee an insurer will sell a policy, and one may cost more because of past or present health problems. It suggests checking with your state insurance department about rights under state law.

Romans offered his own checklist: the doctors you use, your prescriptions, the premium, the network, copays and the out-of-pocket maximum. “And, if you’ve already been on the plan for a while, look at what you’ve actually spent,” he wrote. “That last one was the piece I had been overlooking.”

This article is for general information and is not financial or legal advice. Medicare plan costs and rules vary by plan and by state. This article was produced with the assistance of AI and fact-checked against the sources cited by LightWave Reports.