Richard T. spent 30 years as a mechanical engineer in Columbus, Ohio. He was precise by nature. He optimized systems for a living. But when his HR department handed him a packet about Medicare six months before his 65th birthday, he did something he almost never did: he set it aside and hoped the problem would solve itself.
"I looked at it, saw all those letters, Part A, Part B, Part C, Part D, and I just thought: I'll figure this out later," Richard said. "Later kept getting pushed back."
He is not unusual. A 2024 survey found that 72% of people approaching Medicare eligibility felt confused or underprepared for the enrollment process. The average person spends less than 30 minutes researching their Medicare options before enrolling.
This is Richard's story of how he went from confused and overwhelmed to enrolled in the right plan, with $2,400 per year in savings compared to the path he almost took.
Disclaimer: TheSmartDad is not affiliated with Medicare or any government agency. This article is for informational purposes only.The Situation: Three Months Out, Zero Progress
At 64 years and 9 months, Richard was three months away from his Medicare Initial Enrollment Period opening. He was retired, collecting a modest pension, and his wife was still on her employer's health plan. He needed to figure out Medicare on his own.
His specific situation:
- Type 2 diabetes, managed with Metformin and Jardiance
- Sees his primary care doctor 4 times a year
- Has an endocrinologist he has seen for 8 years and did not want to give up
- Takes a statin (atorvastatin) and a blood pressure medication
- Generally healthy, no hospitalizations in the past 7 years
- Lives in a suburb of Columbus, Ohio
He typed "Medicare" into Google and immediately felt worse. "There were ads everywhere, different companies, 1-800 numbers. I had no idea who to trust," he said.
The First Mistake He Almost Made
Richard's neighbor had Medicare Advantage and loved it. His neighbor's plan was through a major insurer, had a $0 premium, included dental, and his neighbor raved about the low copays.
Richard was ready to call the same insurer and just replicate his neighbor's plan.
What he didn't know: his endocrinologist of 8 years was not in that plan's network in Ohio. He only discovered this by accident when his daughter suggested he verify before signing up.
"I almost signed up for a plan that didn't include the doctor managing my diabetes," Richard said. "That would have been a disaster."
Getting Real Help
Richard's daughter found TheSmartDad while researching Medicare guides online. She filled out the form to connect him with a licensed Medicare advisor.
Within 24 hours, Richard was on a call with a licensed advisor who specialized in Ohio Medicare plans.
The advisor started with four questions:
1. Who are your current doctors, and how important is keeping each one?
2. What prescriptions are you taking?
3. How often do you typically use healthcare in a year?
4. Do you travel or spend significant time outside Ohio?
Richard answered all four. The advisor ran the numbers.
What the Analysis Showed
The advisor compared three realistic options for Richard's situation.
Option 1: Medicare Advantage MAPD (the plan Richard almost picked)- Premium: $0/month (plus $185 Part B)
- His endocrinologist: out of network
- His Jardiance: covered at Tier 3 ($80 copay for a 90-day supply)
- Estimated annual total: $3,840 in Tier 3 drug costs alone, plus copays
- Premium: $29/month (plus $185 Part B)
- His endocrinologist: in network
- His Jardiance: covered at Tier 4 ($120 copay for a 90-day supply)
- Estimated annual total: $4,308 in drug costs plus copays plus premium
- Part B premium: $185/month
- Medigap Plan G premium: $127/month (Richard's rate for a non-smoker in Ohio at 65)
- Part D plan covering Jardiance at Tier 3: $38/month premium, $72 copay per 90-day supply
- Estimated annual total: $4,200 in premiums plus $288 in drug copays
At first glance, Option 3 looked the most expensive on premium. But the advisor walked Richard through a more complete picture.
The Number That Changed Everything
"The advisor asked me: what if you have a bad year? What if your diabetes leads to a complication or you need a procedure?"
With Medicare Advantage, Richard's out-of-pocket maximum for in-network care was $5,500. With Medigap Plan G, his maximum out-of-pocket exposure was essentially $257 (the Part B deductible) for the rest of the year after that.
The advisor modeled two scenarios: a healthy year and a year with one outpatient surgery.
Healthy year comparison:- Option 2 (Medicare Advantage): approximately $5,200 total
- Option 3 (Original Medicare + Medigap G + Part D): approximately $4,500 total
- Option 2 (Medicare Advantage): potentially $2,000 to $3,000 in cost-sharing plus premium
- Option 3 (Original Medicare + Medigap G + Part D): essentially $257 (the annual Part B deductible) plus monthly premiums
"When I saw those numbers side by side, it wasn't even close," Richard said. "I was paying more on paper with the Medigap route, but my actual exposure in a bad year was dramatically lower."
The Plan Richard Chose
Richard enrolled in:
- Medicare Part A (free, based on his work history)
- Medicare Part B ($185/month)
- Medigap Plan G through a well-rated insurer ($127/month)
- Part D standalone plan optimized for his medications ($38/month)
Total monthly premium: $350.
His Jardiance was covered at Tier 3 on his chosen Part D plan: $72 for a 90-day supply, or $288 per year.
His endocrinologist accepted Medicare and therefore accepted his plan without question.
His total estimated annual cost: $4,500, including all premiums and expected drug costs.
The $2,400 Savings
Before working with the advisor, Richard had been researching a Medicare Advantage plan through a major insurer he'd seen advertised on TV. That plan had a $0 monthly premium but his endocrinologist was out of network, his Jardiance was at a higher tier, and the out-of-pocket maximum was $7,500.
The advisor estimated Richard's cost under that plan, assuming he kept seeing his endocrinologist out of pocket and paid the higher drug tier: approximately $6,900 per year.
Under the plan Richard actually chose: approximately $4,500 per year.
The difference: $2,400 per year, or $200 per month."And that's just in a normal year," Richard noted. "If I'd had a health event on that wrong plan, with my doctor out of network, the gap would have been even larger."
What Richard Learned (And What He Tells Other Dads)
Richard is now 65 and has been on his plan for just under a year. He offered three pieces of advice for dads in the same position.
1. Do not replicate your neighbor's plan.What works for someone else depends entirely on their doctors, their medications, their state, and their health. The plan that saves your neighbor money might cost you thousands extra. Richard's neighbor was healthy with no specialists and no expensive medications. Their situations were completely different.
2. Verify your doctors before you enroll.Call the doctor's office directly. Ask: "Do you accept [Plan Name] from [Insurer]?" Do not rely on the insurer's online directory alone. Those directories are sometimes outdated by months.
3. Run your medications through the formulary.Richard's Jardiance was covered at completely different tiers on different plans. The difference between Tier 2 and Tier 4 for a 90-day supply of a brand-name drug can be $50 to $150 per fill. Multiply that by 4 fills per year and you're talking $200 to $600 difference just on one medication.
Your Situation Is Different. But the Process Is the Same.
Richard's numbers are his numbers. Your drugs, your doctors, your health history, and your state will produce a completely different analysis. That is exactly the point.
Medicare is not a one-size-fits-all program. The right plan for you requires looking at your specific situation, not at averages or what your neighbor or your brother-in-law chose.
TheSmartDad connects you with licensed Medicare advisors for free. The same process Richard went through, a 15-minute conversation with someone who knows your state's plans and can run the real numbers for your medications and doctors, is available to you at no cost.[Get matched with a licensed Medicare advisor now]
No obligation. No sales pressure. Just the information you need to make a confident decision before your enrollment window opens.
One More Thing Richard Said
At the end of our conversation, Richard said something that stuck:
"I spent 30 years as an engineer. My job was to find the inefficiencies in systems and eliminate them. I almost made a $2,400 annual mistake because I didn't apply that same rigor to my own healthcare. Don't be me. Get someone who knows this stuff to run the numbers for you."
That is smart dad energy right there.
TheSmartDad is not affiliated with Medicare or any government agency. The story above is a representative composite case study reflecting real scenarios. Actual savings vary based on individual circumstances, location, plan availability, and health needs. Verify your options at Medicare.gov or with a licensed Medicare advisor.