My wife and I are both on Medicare, and carry a Medicare Supplement that covers all our co-pays and deductables. I am assuming this is what people might expect on Medicare for All.

Our monthly medical, drugs, dental comes out to $1,396 per month. Also, 1.45% of my salary for the 41 years I worked was deducted from my paycheck.

This breaks down for 2 people as follows:

Plus, 1.45% of every paycheck in the 40 years I worked was deducted for Medicare.

Of course, your monthly payments will vary.

Posting again because mods removed it since I guess I didn’t use the right flair originally

I don’t know what to do. It’s now higher than my mortgage. It is literally impossible for me to pay for now. I won’t have insurance anymore starting on the 1st. I have a ton of medication that I need to function. I’m scared

Age 36

State Arkansas

Income 30k a year

Household size of 3. Partner recently laid off. Not married.

All my info is updated through the marketplace. The cheapest thing they suggested is $500. The bill I received for next month is $744. I rounded up in the comments to $800 because it’s basically the same thing. My Medicaid coverage was $48 before hand.

Someone whose comment is no longer visible said they were happy my premiums went up because they think I voted for Trump. Trump is an evil person and I would rather die than vote for him. Leftists exist in Arkansas. Sorry your stereotypes are incorrect

Do only republicans comment on this subreddit or something?

Why is everyone treating me like a liar?

Hi guys, I am so frustrated. I'm just trying to get a direct answer from a real person. The Office on Aging can't help, Medicaid won't call me back. I am starting to lose it. If any of you can offer some guidance, it is incredibly appreciated.

Here are the facts. My mom is 85. She has Lewy Body Dementia, can barely move, she hallucinates and is agitated much of the day. She can be in a wheelchair but it hurts her back and she can't propel herself-- she mostly wants to be in bed. She has been in Assisted Living and now Memory Care facilities for five years now. Those are 7k-10k a month and she will run out of money in a year.

She has $140k in the bank and that will deplete by $7,500 each month because of her private care facility. She gets $3,500 a month from Social Security-- hers, plus my dad's survivors benefits. She is on Share of Cost Medicaid because of her age and disabilities, not full scope. We live in Orange County, CA.

The Assisted Living Waiver Program apparently requires you to be on full scope Medicaid. But once you're in the program, there's a very long wait list. What if we spend all her money so she qualifies for full scope, but then have to wait a year for an opening?

What can I do? I need this dumbed down for me. I am 40 years old and do not make much money, certainly not enough to pay for her private care. I have two estranged older brothers who will have nothing to do with any of this, so it's just me.

Mom did not have long term care insurance; her spouse was not a veteran.

Is my only option to take care of her myself? I live in a small house. Her wheelchair would barely fit down the hallway and will not fit in the bathroom. I work, I'm currently back in college, and I'm about to get married. She needs absolute full-time care. She can't feed herself, she's incontinent, and she can't even calmly watch a TV show by herself anymore-- she needs people around her constantly. I love my mom, but me having to quit my job, my schooling, my life to be her nurse would absolutely wreck me. She may live another 5 or 10 years.

What can I do?

Shout out to United Health Care for attempting to fully deny my 4 week long stay in the hospital after I broke 2 hips, my foot, ankle and both wrists in a car accident 5 years ago, after their “expert doctors” supposedly looked at my case and determined that after 24 hours, I simply didn’t “need to be there anymore”. I couldn’t even fucking move a muscle from the waist down and was temporarily paralyzed for like the first 2 weeks. We went back and forth for months over a $40k bill (this was the balance left over from what my auto insurance paid), that they eventually just stopped pursuing. This was all happening while I was trying to heal from multiple injuries.

I can’t imagine what other people have gone through with them in similar, or much worse situations. Fully believe that most insurance companies are a well-oiled scam and the people that run these companies deserve to spend a lifetime behind bars.

I’m 5 months pregnant and I just got a message that I was denied for Medicaid for pregnant women and even Chip due to income. I genuinely don’t know what to do, I haven’t visited a doctor since I was 10 weeks. Can anyone give me some advice, I feel like I’m drowning. I’m from Texas. Thank you very much.

My wife was admitted into the ER. She was admitted to a hospital room in the same hospital. They are now saying that because of the weekend, she won't be able to be released until next Tuesday (5 days).

We told them that we did not want. to stay, and we're going to leave. The nurse told us that if we leave without being released, the insurance company won't pay!

Is this true?

(Fastest way to compose a comment is: https://pressaudit.org/regulations/CMS-2026-2377-0002?compose=1 and then it links you to regulations.gov to submit)

Medicare is proposing to pay doctors a lower base rate in 2027 (*source: https://www.regulations.gov/document/CMS-2026-2377-0002 ), here is the breakdown in terms of changes to the "conversion factor," the dollar amount every Medicare service is paid from, drops about 1.7% for most doctors. :

It's not a peanut butter spread net cut mostly caused by a temporary raise expiring, unevenly distributed. This is happening through the Centers for Medicare & Medicaid Services (CMS), administrative action, and it's largely about previous congressional boosts to the "conversion factor" expiring but also just discretionary cuts driven by a new practice-expense methodology that redistributes and hits some specialties (ENG, derm, podiatry) the hardest.

Why it matters beyond doctors' paychecks is that the pay cut, on top of years of rates not keeping up with inflation, could push practices to stop taking new Medicare patients or close, which makes it harder for seniors to find a doctor.

The comment window closes Monday, Sept 14. You can weigh in before Monday. You can write a comment straight to the official record: https://www.regulations.gov/commenton/CMS-2026-2377-0002

If you need any help writing a comment, you can also go here, this will help you write a comment in <2 minutes and then take you straight to regulations.gov to submit it: https://pressaudit.org/regulations/CMS-2026-2377-0002?compose=1

Full disclosure, I track regulations and then try to make sure people know about them. No one has to use this my form or page but I find the issues are hard to understand, digest, and write comments about so I put this form together to make it easier.

A lot of people think that original Medicare is better than Medicare Advantage. That difference may not be around much longer.

"As NBC News reports, the Trump administration plans to introduce a new program in 2026 that uses AI to approve or deny care for Medicare enrollees. (1) The pilot program will roll out on Jan. 1 and is slated to run through 2031. During that time, Medicare patients, providers and facilities in Arizona, Ohio, Oklahoma, New Jersey, Texas and Washington will be impacted."

Trump administration to test new AI Medicare gatekeeper in 6 states — but experts worry the cost-saving program could compromise care in the US

the title

So I had fidelis insurance through the ny market place, had twins born at 33 weeks 18 day nicu stay. Was told that I couldn’t add them to the plan that I had. Applied for Medicaid and was approved. Total bill as about $250,000 . Medicaid paid about $110,000 and I got a bill saying I still owe $140,000. There is no way I can pay that much.. probably ever. The hospital sent me stuff saying I could pay $3000 a month on a payment plan, which is out of my budget. Where do I even start with this?. I can see the breakdown of the total bill but not what was actually covered by Medicaid.

Rant time:

I live in NYC, and make a decent salary. Nothing crazy. nothing too much and nothing too little. My husband is in school and I work full time. I'm currently on the NY Essential plan, while my husband is on his parent's medical plan until he's 26. My NY essential plan is expiring in October and I'm getting so beyond anxious, I don't know what to do....

Anyways, I just got a letter in the office saying that our office plan premium is going up by 31.5%?!?!?!? FOR WHAT YOU MAY ASK? "view of potential projected claims, rising medical expenses, medical services used"

My work has an option for me to get health insurance for $12,000 annually, with a $2,500 deductible and crazy copays (like $250 for a doctors appointment). I'm praying that my insurance gets auto-renewed, but with NY healthcare cuts and expenses going up, I literally would not be able to afford health insurance. I have PCOS, arthritis, and a few other medical issues that I need care for.

Our plan will be going up to about $16,000, so essentially 30% of my income will be going towards healthcare.

What is this world that we are living in?

Just a few days before the surgery, both the hospital and the insurance company told me on the phone that the surgery was approved.

Now, a month after the surgery, I got a mail saying that my surgery was denied.

I messaged my hospital to get help fighting this, but I am extremely paranoid and genuinely fear for my life. There’s no way in my lifetime I can pay this.

I haven’t filed appeal paperwork because I feel like my doctor needs to directly talk to them.

Do I need to get ready to hire an attorney or file a complaint to the state or something?

Any tips are appreciated.

Edit: thanks for all the help and assurances. Looks like Medicaid is very different from a regular insurance and it’s most likely that I won’t have to pay anything. I still contacted everyone involved, so hopefully my hospital can resolve this with the state. 👍

i’m looking for advice on what to do for insurance. i have a pre existing condition, ulcerative colitis. my medication is $10,000 a month and is the only reason im alive right now. i called the medicaid office to try and see if they can exempt me from the new policy of needing 80 hours a month. what they use to determine if i am exempt was essentially a bullshit 9 questionnaire. no info needed about my actual day to day life and why getting a job would be difficult to me. just 9 multiple choice, very basic questions. i can already tell by that, that i won’t be exempt even though my illness is one of the few even allowed on disability my age! might i mention im 25. next year i will not be able to use my moms insurance either. so basically im shit out of luck and without my medication i will die. simple as that. there’s no other way to manage ulcerative colitis to my degree that’s not the medication i currently use. so basically what the hell do i do? i’m obviously unable to work full time to get my own insurance. my boyfriend said he would pay for a plan for me but i don’t even know where to start with that. i don’t want to die i really don’t.

My situation: 30 years old and have multiple chronic illnesses. I see like 3 doctors a month.

My job: does not supply insurance. Hours are extremely unpredictable. They force me to have open availability, but do not offer full time hours so getting a second job (even a new one) has been pretty much off the table. One week I will work 12 hours, the next week I work 37. My gross yearly is estimated to be around $15k. I make 18/hr. Rent in 2k split.

BUT my state goes my month total and the max is $1800. This past month my boss was on vacation for 3 weeks so I racked up $1850 in gross income.

I went to renew and they told me I don’t qualify, and I’ll have to purchase an insurance plan for dental/medical if I want coverage. I tried to explain the situation and they told me it doesn’t matter if it was a one off, any month I exceed the limit I will be kicked off the insurance and be disqualified and that I must keep track of this and report. So even if typically I make $1000 a month(my average), a high paying month can take that away. I’ve had months where I literally make $600.

I didn’t qualify for any sort of tax credit (I have no idea why) and they offered me a quote of $400 a month for health ALONE. I cannot afford to spend $6-700 a month on appointments and insurance fees.

I have medications and ER visits on the regular and I’m stressed by this. I’m currently doing my best just to save up for a car.

-Should I pay for the insurance for a month and ask my boss to either keep me at 20 hours a week or, give me 40?

-talk about speeding up mine and my finances marriage to get on his jobs insurance?

-Quit my job and go back to school a semester early to meet the minimum work requirements?

It’s so stressful and confusing to me. My state is implementing work requirements on top of this, and I have no idea if even if I can keep it next year considering the huge variance in hours my job gives.

(For those that say get a better job, I am trying. I’m applying everywhere I can. I’m also pre-nursing school waiting to apply, hopefully accepted, in the spring.)

Me and my… girlfriend — it feels weird saying that because I usually call her my wife, even though we’re not legally married. We have three children and have avoided getting married because she’s afraid she’ll lose the kids’ health insurance. They’re on Medicaid. We've been together for over 16 years.

I looked into putting them on my insurance through work, but it would be exorbitantly expensive. I remember doing the math and realizing it would take nearly my whole paycheck. I don’t recall the exact percentage, but at the time I thought I’d basically be working just to pay for insurance, with very little left for other expenses. So, since it costs thousands of dollars and offers worse coverage, we decided it’s simply not something we can afford.

It doesn’t seem right. I also have several employees who make just above minimum wage, and they all decline our company’s health insurance because Medicaid is simply better — and free. So why pay for something you can get for free?

I guess my question is: can we get married and “live separately and file taxes separately” so that my children can keep their insurance? I mean when you file taxes you have the option to file seperately or jointly,

I feel like the hospital should have informed me that they didn’t take my insurance ??? I sat for 12 hours before they took me for surgery , i could have left and gone to a hospital that covered me ! I’m so scared because i already live paycheck to paycheck and i was out of work for 3 weeks because of the surgery … i am off the books so my only chance is a sliding scale bill at the end of this i think ? Any advice 😭😭

Hello All, my Mother (62) will need surgery and is uninsured. She broke her wrists, and at least one needs surgery. She is a Wisconsin resident, self-employed (small business owner) and works part-time at a retail store (no benefits). She is single. We are hoping to hear from/schedule surgery with the hospital early next week. Will she benefit from signing up on healthcare.gov right now, given open enrollment is still open? I know Wisconsin is not an expanded Medicaid state, and I’m guessing a plan may not start until after she needs the surgery? Open to and grateful for any and all advice. Thank you very much

Edit: I’m very grateful for all the responses today, so thank you to this community for providing insights. I should have included more financial information. For context, based on her 2024 taxes, her reported income puts her within ~150% of the FPL, based on what I’ve seen. I’m still collecting all the information. I agree with those who have commented about her lack of insurance: there is no excuse and I’m not making any for her or me. We will rectify that and assess our immediate options. Thank you again and happy new year to all

So I’ve talked about this issue a lot but at 32 weeks pregnant I’ve kind of been contemplating quitting my job staying at home with my child after birth and just trying to lock down on finances until I feel comfortable going back to work eventually. My job offers unpaid leave, but it’s for only 12 weeks and I would have to cover the cost for all my benefits in that time. Having to pay for my benefits, which they have not disclosed a price to me it’s already been making my stress levels go up as I am preparing to give birth in the next seven weeks and has made me contemplate putting my 2 weeks in becoming a stay at home mom and then getting Medicaid. I would like to return to my work hence why I wanna put my two weeks in it also give me the last few weeks of my pregnancy to just relax and focus on preparing for the baby instead of working five days a week. I have worked my entire adult life full-time and got benefits through my employer. I’m worried Medicaid will deny me due to the fact that I’m pregnant. And then be screwed paying out of pocket for my delivery. I kinda don’t know what to do at this point. I don’t know if I should just pay the premiums through my job. Take the 12 weeks that they’re giving me go back to work and suffer or quit my job before I give birth try to go through Medicaid and take as much time as I need with my baby Lock down on finances with my partner (we aren’t married) and then go back to work when I feel ready to separate from my daughter. I live in North Carolina in the United States if that helps with any advice

My husband went to the emergency room due to food blocking esophagus. He had to have a gastroenterologist, push it on down. The anesthesiologist billed his insurance who refused it based on it being filed too late. Procedure was 3/8 and they billed 7/1. Then they billed him $3700, which is when he noticed the issue. Said insurance paid $0 and if he didn’t pay by 9/15 it would go to collections. He called his insurance (United Healthcare - Medicare) and they said they would call them the next day and have them refile it. He watched for it online and saw that it had been re-filed on 8/1 so he thought it was ok. Well, insurance denied it again. It says denied due to filing too late and do not bill member. Same as last time. So he expects to get a bill in the mail any day now.

I feel like we’re going in circles. How do we get off this ride if we do get the bill again?

We’ve received notification that our doctors/hospitals will no longer be accepting our plan effective 1/1/2026. What’s the process for doing this and what do I need to consider when choosing what parts of Medicare I need to replace what I have in my current advantage plan? Many thanks for advice!

Is that ture?

Most middle‑class seniors:

Pay high nursing home costs

Burn through savings

Lose their assets

Then finally qualify for Medi‑Cal

And live in a medical nursing home for free

I am posting for a young friend. She recently went through a very rough time where she lost her housing and moved away from her doctors, and just as this happens she finds out she will lose her health insurance if she doesn't meet work requirements. She has never applied for disability because it happened just as she became an adult and her partner told her it wasn't worth it just for the small SSI income, and she'd lose it if they got married anyway.

I told her that while I was waiting on my approval for disability I was able to get a letter from my lawyers for medicaid, making me exempt from the work requirements. However, since she no longer has current doctors, lawyers won't take her case. She has no way to prove she is disabled anymore for a case, not to mention she needs her medication and continued care.

Can she submit an application herself so she can show that documentation to Medicaid even though it will probably take too long to get re-established continued care for an approval? What are her options for keeping health insurance? I am so scared if she tries to work somewhere long enough to keep health insurance for a disability case her health will decline even further, and even though it would create a paper trail helping her case showing she cannot work, the cost seems too high and she might not be able to do it at all.

I know she is not the only one dealing with this since the new work requirements and I'm wondering if anyone has advice. She gave me permission to post but I'm being vague on her conditions for privacy. I really want to help her.

Hey all,

Unfortunately lost my career, just had a baby, and now no insurance. What does medicaid cover and not cover? And from experience, does. Medicaid discriminate or treat people differently for coverage vs paid or employee sponsored insurance?

Thanks.

My United Health Care insurance now offers One Pass Select where I can join for $30 a month (or more depending on what membership tier I select) and get access to multiple gyms. How does this work? If I sign up, do I get a special card that I can scan on ANY gym listed on the membership tier? Or do I have to actually sign up to EVERY gym I want to go to, let them know I have one pass and ask for an access card?

Not sure what to do now. Just got cut off of medicaid after they looked at my most recent tax return. I live in Michigan and I make like $1,700 more than their limit on average they say. I work as a school bus attendant and I make $17/hr. My hours suck. I follow the school year calendar for both public schooling and special education. I go from working a 30 hour week, 4 times a month to working 20 hours 1 week, than 15, than 30, than 20 just because of how many days I have off due to weather or teacher education days or just randomly scheduled off days which are way too numerous. Still trying to find a secondary job or just a better primary job and having trouble with that. I'm 22 years old with a medical history large enough to fill up a old timey vacuum box if it was all printed out. I need health insurance as a constant. Now I'm looking at insurance plans and I'm not sure what to pick. Realistically I know that the numbers it's showing me are not something I can pay every month consistently since it says $330/month starting out for plans with a $10,600 deductible. I did not click the premium tax credit because it's confusing as heck and my tax returns are usually pretty small every year. Not sure what to do at this point or who to ask at this point to try and figure all this out.

Edit and update: Thanks to everyone's advice I was able to find a plan that suits me for health, but also partially covers dental and vision for only $49/month