ECON Medicare Advantage plans to see 2025 base pay fall

[Heliobas Disciple]

https://www.axios.com/2024/04/02/medicare-advantage-insurer-pay

(fair use applies)


Medicare Advantage plans to see 2025 base pay fall
Maya Goldman
Apr 2, 2024

The Biden administration on Monday followed through on its proposal to cut next year's base payments to Medicare Advantage plans an average of 0.16%, despite pressure from insurers and their allies in Congress.

Why it matters: While the plans will wind up seeing a net increase once payments are risk-adjusted to account for the health of their customers, the news sent shares of UnitedHealth, CVS Health, Humana and Centene falling amid predictions of continued financial pressure.

State of play: The base pay decrease stems from the continued phase-in of controversial changes to the risk adjustment coding system the Biden administration started last year to make MA payments more accurate.

• Insurers get more money if their enrollees have more documented health issues, and the policy changes aimed to stop abuses of that system. But the health plans maintain that's akin to cutting seniors' benefits.
• The plans are expected to see an average 3.7%, or $16 billion, increase in payment once risk scores are factored in, the Centers for Medicare and Medicaid Services said.

Zoom out: More than half of Medicare enrollees now get their coverage from Medicare Advantage plans, which experts say are overpaid and cost taxpayers tens of billions of dollars more than they should.

• Insurers administering benefits report rising costs due to higher demand for medical services as patients catch up on care they deferred during the pandemic.

The industry suggested this winter that benefits could be cut if CMS didn't improve rates over the initial plan.

What they're saying: "These policies will put even more pressure on the benefits and premiums of 33 million Medicare Advantage beneficiaries who will be renewing their coverage this fall," said Mike Tuffin, CEO of the insurer trade group AHIP.

What we're watching: Biden administration officials say enrollees' benefits should remain stable next year, but plan bids due June 1 could show scaled-back benefits and premium adjustments, said Duane Wright, a senior research analyst at Bloomberg.

• "President Biden's team is gambling that MA beneficiaries won't realize before the election the benefits Biden's team is causing them to lose come January 2025," said Raymond James analyst Chris Meekins.

 

[Heliobas Disciple]

FreedomWorks Condemns Medicare Advantage Cuts - FreedomWorks

In response to the Centers for Medicare and Medicaid Services (CMS) announced rate cuts, Adam Brandon, FreedomWorks president, commented

www.freedomworks.org

(fair use applies)


FreedomWorks Condemns Medicare Advantage Cuts
By: Justin Longo
04/02/2024

In response to the Centers for Medicare and Medicaid Services (CMS) announced rate cuts, Adam Brandon, FreedomWorks president, commented:


“Yesterday, the Biden administration continued their attacks on the private sector option for seniors on Medicare, Medicare Advantage. This is the second cut in two years. This latest round of cuts will cost seniors an extra $33 per month. That’s a $396 per year rate increase for a cohort largely on fixed incomes and still reeling from terrible inflation. Medicare Advantage is so well-liked and so popular, over 50% of seniors – about 33 million – choose it over traditional Medicare. It’s incredible to me the administration is choosing to assault one of the most popular programs for our seniors.”

“Cutting a program as popular as Medicare Advantage seems out of character for most Democrats, unless these cuts are a necessary stepping stone towards one of their ultimate goals – Medicare for all. Democrats have been upfront about wanting a single-payer, Medicare for all type system. Perhaps Medicare Advantage and its 33 million customers are simply collateral damage in getting there.”

 

[KittyKatChic]

There are like 25 or so Advantage plans that aren't a rip off. The rest are trash! I would advise anyone to avoid them like the plague.

 

[Heliobas Disciple]

Joe Biden Moves to Slash Medicare Advantage

Joe Biden has finalized his move to slash Medicare Advantage as the 46th president has claimed Donald Trump seeks to slash Medicare.

www.breitbart.com

(fair use applies)


Joe Biden Moves to Slash Medicare Advantage
Sean Moran
3 Apr 2024

The Biden administration has finalized its move to slash Medicare Advantage as the 46th president has claimed former President Donald Trump seeks to slash entitlement programs.

The Biden administration on Monday will cut base payments for Medicare Advantage plans by an average of .16 percent despite pressure from Republicans and healthcare experts. This follows Biden making controversial moves in the risk adjusting coding system to allegedly make Medicare Advantage payments more accurate.

Biden’s move would impact more than half of Medicare enrollees, as many American seniors now look to Medicare Advantage for their healthcare needs. American seniors enrolled in Medicare Advantage could see their supplemental benefits reduced or cost-sharing increased by $33 a month in 2025, according to experts.

Chris Meekins, an analyst, said, “President Biden’s team is gambling that MA beneficiaries won’t realize before the election the benefits Biden’s team is causing them to lose come January 2025.”

Biden’s move to slash Medicare Advantage comes as Trump told Breitbart News he will never touch Social Security or Medicare. This runs contrary to claims from Biden and Democrats that he would cut entitlement programs.

“I will never do anything that will jeopardize or hurt Social Security or Medicare,” Trump explained. “We’ll have to do it elsewhere. But we’re not going to do anything to hurt them.”
A 2021 Commonwealth Fund study found that 90 percent of Medicare Advantage enrollees were satisfied with their care, which is about the same as traditional Medicare. Research has even shown Medicare Advantage outperforms Medicare on 16 different clinical quality measures.

As Breitbart News reported, Biden once sponsored a bill that would sunset and subsequently review and reauthorize programs such as Social Security and Medicare:

Further, Biden may have forgotten that he sponsored a bill in 1975, when he was a senator from Delaware, that would have sunset and subsequently required review and reauthorization — or not — of federal programs, which reportedly included Social Security and Medicare. This proposal is remarkably similar to Sen. Rick Scott’s (R-FL) original proposal, which Biden has frequently attacked.​

​

“We must… begin reviewing existing programs to determine whether they are still effective, and whether they are worth the money that we are putting in them. We must eliminate the wasteful ones,” Biden said when introducing the 1975 legislation.​

Republicans and conservatives are crying foul about Biden’s axing of Medicare Advantage.

Sen. Rick Scott (R-FL) said, “BREAKING: Biden just cut Medicare benefits AGAIN. 2.8 MILLION Florida seniors use Medicare Advantage & Biden’s cuts will cost them an extra $400 per year. Biden’s war on seniors is devastating & I’m fighting like hell to reverse this terrible decision.”

BREAKING: Biden just cut Medicare benefits AGAIN.​

​

2.8 MILLION Florida seniors use Medicare Advantage & Biden's cuts will cost them an extra $400 per year. Biden's war on seniors is devastating & I’m fighting like hell to reverse this terrible decision.https://t.co/Q3YIajBXG1​

​

— Rick Scott (@SenRickScott) April 3, 2024​

Rep. Kevin Hern (R-OK), the chairman of the Republican Study Committee (RSC), said, “The Biden White House attacks me for wanting to fix and save Medicare, meanwhile @JoeBiden is actively cutting Medicare for 33 million seniors.”

The Biden White House attacks me for wanting to fix and save Medicare, meanwhile @JoeBiden is actively cutting Medicare for 33 million seniors. FreedomWorks Condemns Medicare Advantage Cuts - FreedomWorks​

​

— Congressman Kevin Hern (@repkevinhern) April 2, 2024​

FreedomWorks President Adam Brandon said in a statement:

Yesterday, the Biden administration continued their attacks on the private sector option for seniors on Medicare, Medicare Advantage. This is the second cut in two years. This latest round of cuts will cost seniors an extra $33 per month. That’s a $396 per year rate increase for a cohort largely on fixed incomes and still reeling from terrible inflation. Medicare Advantage is so well-liked and so popular, over 50% of seniors – about 33 million – choose it over traditional Medicare. It’s incredible to me the administration is choosing to assault one of the most popular programs for our seniors.​

​

Cutting a program as popular as Medicare Advantage seems out of character for most Democrats, unless these cuts are a necessary stepping stone towards one of their ultimate goals – Medicare for all. Democrats have been upfront about wanting a single-payer, Medicare for all type system. Perhaps Medicare Advantage and its 33 million customers are simply collateral damage in getting there.​

Heritage Action wrote, “Biden is cutting Medicare Advantage benefits for 33 million Americans—and hoping they don’t notice until after the November election. Here’s how benefits for seniors are being cut.”

Biden is cutting Medicare Advantage benefits for 33 million Americans—and hoping they don’t notice until after the November election.​

​

Here’s how benefits for seniors are being cut.?https://t.co/zdhtmRid1E​

​

— Heritage Action (@Heritage_Action) April 2, 2024​

 

[Plain Jane]

Well, they have to find the money for all of the illegals from somewhere. Why not from aging Boomers! sarc

I have seen prognosticators including Neil Howe say that it is Boomers who are going to have to give up benefits in order for the nation to get on a sounder financial footing. But I don't see any of them question how the government is spending money elsewhere.

I suspect that there is too much grift going to their clients and the prognosticators don't have the guts to look at that.

 

[Lone_Hawk]

I don't think these reporters understand how this works. At 65 you automatically get Medicare. Medicare Advantage is a supplement to Medicare. It doesn't replace Medicare.

 

[et2]

I don't think these reporters understand how this works. At 65 you automatically get Medicare. Medicare Advantage is a supplement to Medicare. It doesn't replace Medicare.

My understanding is it takes over Medicare ( Advantage plan). You take an advantage plan and you give up your Medicare to the insurance company. You don’t still have “regular” Medicare and it’s choices.

 

[Lone_Hawk]

My understanding is it takes over Medicare ( Advantage plan). You take an advantage plan and you give up your Medicare to the insurance company. You don’t still have “regular” Medicare and it’s choices.

Well, as I am in the Medicare system, no. I carry both Medicare and MA cards. Medicare pays 1st, MA picks up most of the difference. Medicare only covers part A & B. MA covers parts C & D depending on the plan you choose.

 

[colonel holman]

I don't think these reporters understand how this works. At 65 you automatically get Medicare. Medicare Advantage is a supplement to Medicare. It doesn't replace Medicare.

actually, for the individual, MA plan DOES replace their regular Medicare. Supplement plans merely cover the deductibles and copays of regular medicare, with patient still covered by regular medicare. Advantage plans fully REPLACE regular medicare coverage. Many patients will purchase what they THINK is a supplement plan (such as AARP), but unknowingly got signed up on an advantage plan (because agents get 10x greater sales commission when selling a MA plan than they would get selling a supplement plan. I had patient every day show up to clinic ASSUMING they had regular medicare plus a supplement plan, only for us to discover they suffered a bait-and-switch and got signed up on the MA plan… resulting in many of us providers refusing the accept that MA ripoff plan. Patients go away really pissed and in disbelief, but the official medicare coverage online portal for providers to confirm coverage now shows they are on MA. Patient is stuck with a limited access crap insurance with very few approved providers, some far away.

 

[colonel holman]

Well, as I am in the Medicare system, no. I carry both Medicare and MA cards. Medicare pays 1st, MA picks up most of the difference. Medicare only covers part A & B. MA covers parts C & D depending on the plan you choose.

Wrong. You are describing a medicare supplement plan, NOT a MA plan. I have been in practice 50 years, dealing with this topic. HUGE confusion (as well as misleading agents) over this.

 

[Lone_Hawk]

actually, for the individual, MA plan DOES replace their regular Medicare. Supplement plans merely cover the deductibles and copays of regular medicare, with patient still covered by regular medicare. Advantage plans fully REPLACE regular medicare coverage. Many patients will purchase what they THINK is a supplement plan (such as AARP), but unknowingly got signed up on an advantage plan (because agents get 10x greater sales commission when selling a MA plan than they would get selling a supplement plan. I had patient every day show up to clinic ASSUMING they had regular medicare plus a supplement plan, only for us to discover they suffered a bait-and-switch and got signed up on the MA plan… resulting in many of us providers refusing the accept that MA ripoff plan. Patients go away really pissed and in disbelief, but the official medicare coverage online portal for providers to confirm coverage now shows they are on MA. Patient is stuck with a limited access crap insurance with very few approved providers, some far away.

This is why this whole system sucks. I am now reminded of the months of headaches trying to decide. I have supplement variety. They call different crap the same thing then polish the turd.

 

[Lone_Hawk]

Wrong. You are describing a medicare supplement plan, NOT a MA plan. I have been in practice 50 years, dealing with this topic. HUGE confusion (as well as misleading agents) over this.

Right, I should have said YMMV

 

[colonel holman]

My understanding is it takes over Medicare ( Advantage plan). You take an advantage plan and you give up your Medicare to the insurance company. You don’t still have “regular” Medicare and it’s choices.

THIS is correct. Many many patients assume they are on supplement plan, but are actually on MA plan, often without their knowledge or approval, due to insurance agent getting fat commissions to sign up MA plans. Patients don’t know this until a provider tries to bill for services and gets coverage denied.

 

[colonel holman]

This is why this whole system sucks. I am now reminded of the months of headaches trying to decide. I have supplement variety. They call different crap the same thing then polish the turd.

exactly. all based on greed, severely hurting the patient when they realize they have been short-changed and stuck with big bills while sick and retired

 

[colonel holman]

Literally EVERY DAY see several patients stuck in this trap. Appalling

 

[emiliozapata]

WellCare is the worst, it won't pay for squat

 

[bassgirl]

I will soon have to navigate all this BS. It makes my head hurt.

 

[llknp]

Well, as I am in the Medicare system, no. I carry both Medicare and MA cards. Medicare pays 1st, MA picks up most of the difference. Medicare only covers part A & B. MA covers parts C & D depending on the plan you choose.

Me too. My understanding is, my Medicare payment has been assigned to my Medicare supplement plan (think United Health Care, Humana, etc). I still have all of the benefits of Medicare plus what every else my plan provides. It is easier on Medicare because my plan administrates all of the necessary documents, paperwork, approvals and payments to providers. They then bill Medicare for their part. All Medicare has to do is send a check rather than deal with everything else.

 

[CaryC]

actually, for the individual, MA plan DOES replace their regular Medicare. Supplement plans merely cover the deductibles and copays of regular medicare, with patient still covered by regular medicare. Advantage plans fully REPLACE regular medicare coverage. Many patients will purchase what they THINK is a supplement plan (such as AARP), but unknowingly got signed up on an advantage plan (because agents get 10x greater sales commission when selling a MA plan than they would get selling a supplement plan. I had patient every day show up to clinic ASSUMING they had regular medicare plus a supplement plan, only for us to discover they suffered a bait-and-switch and got signed up on the MA plan… resulting in many of us providers refusing the accept that MA ripoff plan. Patients go away really pissed and in disbelief, but the official medicare coverage online portal for providers to confirm coverage now shows they are on MA. Patient is stuck with a limited access crap insurance with very few approved providers, some far away.

You are right Advantage does REPLACE Medicare.

But are wrong in one aspect. AARP may in fact offer an Advantage plan, but they do offer, in fact, Medigap plans. I have AARP United Healthcare Plan F, and since it isn't offered anymore, SB is going on AARP United Healthcare Plan G in about 25 days. Don't tell SB I just gave her age away, I may have to use my Plan F.

In our area and in our health care system no Advantage Plan is accepted, at present, I hear one is in the works by Aetna. I've used my Plan F over the last 6 years in our health care system, totaling around a half to 3/4 million dollars. Am doing some testing now for a problem which is just adding to that total.

 

[33dInd]

Don’t know if I’m lucky or not
My former employer (retirees) allows us to stay on our blue cross and blue shield supplement plan once we are eligible for full retirement and Medicare Employer pays half the supplement cost
Most take it some don't
Guess that’s a good deal

 

[CaryC]

Don’t know if I’m lucky or not
My former employer (retirees) allows us to stay on our blue cross and blue shield supplement plan once we are eligible for full retirement and Medicare Employer pays half the supplement cost
Most take it some don't
Guess that’s a good deal

I would say "blessed" but if the insurance covers your expenses, and the company covers the premium, like way yeah blessed.

My company gives us an "allowance" to cover premiums. Helps out a lot, but doesn't cover 100%. I'm still thankful.

 

[WFK]

There is information and misinformation in this thread!
Be sure to research your own situation carefully and listen to the professionals! (holman, above^^^^)
In general "Advantage" replaces basic Medicare Services and "Supplemental" adds to them.
However, "Advantage" plans may still require Medicare A and B premiums to be paid in addition.

"Advantage" Plans are run by Insurance Companies, and basic Medicare is run by the Feds.
The Feds pay Insurance companies to run Advantage plans for them.

If there had been honesty in naming the programs (!), the word advantage would not have been used, because they are
MEDICARE REPLACEMENT programs.

 

[hd5574]

We also have regular Medicare...when we worked that paid for Medicare Part A (hospital)....we pay for Medicare Part B (doctors) ...it is auto deducted from our Social Security check/auto deposit each month they government decides how much this will cost each year.. you are not required to have Part B..but it really a good idea...to take it as soon as you sign up.... and Part A and Part B plans are all the same....they have deductible amounts that can change...from year to year...and they do

There is also Part D. (drugs..rx)..You must pick your plan...not all are they same...if you are on RX meds you will need to research each plan for the best deal for you and your meds ...and they have different premiums ...the company determines the premium they charge..you do not have to have a Part D...if you are not on RX meds...you are not forced to have one...you can get one later if you need it but there will be a penalty...and you will pay more each...

We then made the choice to either have a Medicare supplement plan or an advantage plan..also know as Medicare Part C.....

When I first joined medicare....I had a plan F with united healthcare...I had no deductible for hospitals or doctors....then I switched to plan F with Blue Cross ...because I found out that United healthcare was much more expensive than the Blue Cross plan.....the plans are identical all the plan are identical they are regulated by the federal government..the only difference is the premium the company charges for their plan...
then I switched again from plan F to plan G .... because the premium on Plan G was several hundred dollars more per year than the out of pocket...for Plan G....the only deductible for Plan G is the doctor's office ...it is $240....for the year of 2024....

Where we Iive the medicare advantage plan.... cheapest one has maximum deductible of $6500 per person...so $13,000 for the two us...
I am 77 and DH will be 71 this month.....and our total annual premium...for both of us is far less than the $6500... deductible for one of us...

We don't need referrals...no restrictions on which doctors we use..we will with the supplemental plan

 

[patriotgal]

Skipped the so-called advantage plans. Local hospitals and physicians often opt out of accepting them. Created a nightmare when MIL needed to go from hospital to rehab. She ended up counties away. FIL got lost in another county trying to find her. It was a nightmare. Glad my friends can enjoy their advantage plan gift cards but don't want to be in their shoes when that advantage plan shows its fangs.

 

[Meemur]

Most advantage plans are not accepted at the hospitals / doctors I want to use.

I have traditional A & B, Part G through Iowa Wellmark (Blue Cross), and a part D -- I forgot what. I've not had to use it, yet.

Yeah, it was several months of very painful research. The biggest help: ask the doctors and hospitals you want to use what they accept. I wanted to use the Mayo Clinic Rochester Campus, so I called them directly. It became apparent quickly that the really good doctors didn't like advantage plans.

 

[amazon]

This affects already struggling hospital systems which makes it not good for anyone.

https://www.thestreet.com/investing/stocks/humana-tumbles-unitedhealth-and-cvs-slide-on-medicare-advantage-hit

I'm on my phone can't copy the article which is about the financial ramifications.

 

[WalknTrot]

Don’t know if I’m lucky or not
My former employer (retirees) allows us to stay on our blue cross and blue shield supplement plan once we are eligible for full retirement and Medicare Employer pays half the supplement cost
Most take it some don't
Guess that’s a good deal

That's pretty nice. I am on my employer's retired staff Medicare supplemental - about 6 different choices of companies and two levels of each. The coverage is unbelievable, because it's group negotiated every year along with the larger employee plan. Thing is (and I have fellow retired employees who regret it now) - if you don't stay with the employee supplemental plan (cuz some people want to cheap out when they are younger retirees) you can never come back into it.

Medicare Advantage plan? Have not and would not ever considered it.

 

[CaryC]

We also have regular Medicare...when we worked that paid for Medicare Part A (hospital)....we pay for Medicare Part B (doctors) ...it is auto deducted from our Social Security check/auto deposit each month they government decides how much this will cost each year.. you are not required to have Part B..but it really a good idea...to take it as soon as you sign up.... and Part A and Part B plans are all the same....they have deductible amounts that can change...from year to year...and they do

There is also Part D. (drugs..rx)..You must pick your plan...not all are they same...if you are on RX meds you will need to research each plan for the best deal for you and your meds ...and they have different premiums ...the company determines the premium they charge..you do not have to have a Part D...if you are not on RX meds...you are not forced to have one...you can get one later if you need it but there will be a penalty...and you will pay more each...

We then made the choice to either have a Medicare supplement plan or an advantage plan..also know as Medicare Part C.....

When I first joined medicare....I had a plan F with united healthcare...I had no deductible for hospitals or doctors....then I switched to plan F with Blue Cross ...because I found out that United healthcare was much more expensive than the Blue Cross plan.....the plans are identical all the plan are identical they are regulated by the federal government..the only difference is the premium the company charges for their plan...
then I switched again from plan F to plan G .... because the premium on Plan G was several hundred dollars more per year than the out of pocket...for Plan G....the only deductible for Plan G is the doctor's office ...it is $240....for the year of 2024....

Where we Iive the medicare advantage plan.... cheapest one has maximum deductible of $6500 per person...so $13,000 for the two us...
I am 77 and DH will be 71 this month.....and our total annual premium...for both of us is far less than the $6500... deductible for one of us...

We don't need referrals...no restrictions on which doctors we use..we will with the supplemental plan

Most of what you said is right.

Part D PDP varies greatly for the same drugs. And it does vary by insurance a lot. Last year under walgreens with a 30.00 premium I still had to pay almost 100.00 for 5 scripts, every 90 days. They doubled in premium this year so I switched to Cigna at 25.00 a month 4 scrips tier 1 are free, and 1 tier 2 is 6.00 for 90 days. All the same drugs. SB will be using Wellcare PDP at 0.50 a month and her 2 tier 1 drugs are free.

However there should be some caution with changing medical insurance. Reason: If you develop a certain type of disease, no one will insure you, and you won't be able to change Co.'s and will be stuck with what you have. From my own experience I developed kidney cancer and along with that, which I don't have yet, is Kidney failure. Am still in the early stages of Stage 3 Kidney failure. No one other than what I have, which is Plan F under United will insure me. Cancer is one of the diseases that will disqualify from changing companies, you along with Kidney failure, I'm sure there are other like heart failure/attack etc.

If you don't already have Plan F, it's to late, discontinued in 2020. Plan G is the new F. And because these plans can change any year as prescribed by the government, as noted in this thread. What you have now will be what you have then.

What you are on, when it changes will be, grandfathered in.

 

[hd5574]

Most of what you said is right.

Part D PDP varies greatly for the same drugs. And it does vary by insurance a lot. Last year under walgreens with a 30.00 premium I still had to pay almost 100.00 for 5 scripts, every 90 days. They doubled in premium this year so I switched to Cigna at 25.00 a month 4 scrips tier 1 are free, and 1 tier 2 is 6.00 for 90 days. All the same drugs. SB will be using Wellcare PDP at 0.50 a month and her 2 tier 1 drugs are free.

However there should be some caution with changing medical insurance. Reason: If you develop a certain type of disease, no one will insure you, and you won't be able to change Co.'s and will be stuck with what you have. From my own experience I developed kidney cancer and along with that, which I don't have yet, is Kidney failure. Am still in the early stages of Stage 3 Kidney failure. No one other than what I have, which is Plan F under United will insure me. Cancer is one of the diseases that will disqualify from changing companies, you along with Kidney failure, I'm sure there are other like heart failure/attack etc.

If you don't already have Plan F, it's to late, discontinued in 2020. Plan G is the new F. And because these plans can change any year as prescribed by the government, as noted in this thread. What you have now will be what you have then.

What you are on, when it changes will be, grandfathered in.

Since DH and I have no existing conditions and RX medications...we are and we're free to switch..plans...you can always talk to a different plan...to check what their premium would be ..with them in your current situation
We also did not get Part D drug coverage because...we are not taking. RX meds...I have only had about a hundred or so expense in RX prescriptions in the 12 yrs that I had Medicare
Just a few antibiotics and pain meds ....so I have saved..lot of $ just using an RX discount card..my mother passed in her 80's and she was not on any RX meds.....but that is not the case for everyone..

We changed companies because it just costs us so much less out of pocket..than the one we had....so that was money we didn't need to spend...We dumped plan F because it didn't make sense to pay hundreds more to $240.00 per year...
I have found that policies through AARP...not just health are more expensive.... than others on the market....we do save on our cell phones with consumer cellular having AARP...and on certain discounts at restaurants... between the 2 things ...we save more than cost of an annual AARP membership....

 

[CaryC]

.you can always talk to a different plan...to check what their premium would be ..with them in your current situation

BTDT, no dice.

 

[bassgirl]

I would check the cheap tier 1 drug list. If all your meds are on that then you really don't need RX plan. Most scripts are $8-$10 a month. If you do a mail order plan and get 3 months worth it's even cheaper. Nearly every type of med is usually under that in some form. You may have to ask your MD to write you for an older med rather than something new and expensive. Now if you are put in the Hospital as an observation patient make sure they let you take your OWN home meds. Do not use the Hospitals otherwise you will get an expensive med bill.

If you're in need some of the expensive Rheumatoid arthritis, or Diabetic meds etc, then it may help to have a RX plan.

I am at the age where I have to seriously question if I need some really expensive drug just to stay alive if it is even worth it. Usually quality of life is a question at that point.

If you can afford a RX plan then get one. But if it's really going to cut into your budget. There is almost always an older cheaper alternative to expensive new meds. For basic maintenance meds anyway.

If you have to carry a list of the tier 1 meds with you and as your MD to pick from that list.

 

[Meemur]

I thought that in 2024, if you don't have a Part D plan of some sort, you will pay a penalty. That's why I got a very cheap one.

I might be wrong about that, but that was my understanding at the time.

 

[Siskiyoumom]

An excellent resource regarding Medicare A, B, gap plans D for RX medications, F (not available for new enrollees, G, M, and Advantage plans is MedicareSchool.com videos on you tube.

That channel also addresses the myriad of issues facing folks working past the age of 65, military/teacher/Rail Road pensioners and todays video went over the very low COLA for Social Security recipients in 2025 and the increasing costs with all gap plans.

The channel has excellent videos on the six coverage gaps in Part A and B, as well as the true costs of having a D RX medications plan. Which is vital information if you take expensive medications and if you become very sick and require cancer or immune system medication.

The channel also has videos on the penalties for not enrolling in Part D.

 

[Meemur]

That's what I thought . . .

As far as I know, I'm as covered as I can be for now. How I'm going to keep affording it is another matter because I don't intend to take social security for awhile, but I'll re-evaluate that decision when I hit the 10 months in December (have to be age 65 + 10 months for a much higher payout). I need some time off to focus on my health.

 

[ainitfunny]

Once you are on an advantage plan you are DISENROLLED from government paid service under medicare. You are entirely transferred over to a private insurance company! (And whatever they do or don't cover!) What is covered is different with each private insurer. But, Your name is not on the regular medicare rolls any more.
The govt has gotten rid of you as its responsability.
I expect sooner or later they will not let you come back
to regular medicare.
But presently they are letting you cancel "Advantage" and return to regular medicare.
You will find out what isn't covered when you become "not so healthy".

 

[et2]

Well, as I am in the Medicare system, no. I carry both Medicare and MA cards. Medicare pays 1st, MA picks up most of the difference. Medicare only covers part A & B. MA covers parts C & D depending on the plan you choose.

See post 9 below yours. This is correct …. If you’re on a Medicare Advantage plan. The insurance company is your provider. No longer Medicare A or B. If you just have Medicare A&B you can go to any doctor … anywhere they accept medicare, even out of state. Many MA plans you can’t. You do not have “traditional” Medicare. You’re at the insurance company mercy on many things.

 

[Meemur]

You’re at the insurance company mercy on many things.

Which is crap. As long as I can afford it, I don't want some bean counter making my healthcare decisions.

 

[et2]

Most advantage plans are not accepted at the hospitals / doctors I want to use.

I have traditional A & B, Part G through Iowa Wellmark (Blue Cross), and a part D -- I forgot what. I've not had to use it, yet.

Yeah, it was several months of very painful research. The biggest help: ask the doctors and hospitals you want to use what they accept. I wanted to use the Mayo Clinic Rochester Campus, so I called them directly. It became apparent quickly that the really good doctors didn't like advantage plans.

Yes … spot on. A Medicare Advantage plan is completely different from from a Medicare Medigap plan… where you keep the actual Medicare A&B and the supplement pays its portion Medicare doesn’t. Plan G you have covers everything without hardly any cost from you other than you still pay your part B monthly.

I too just went through all this for two months. Doctors all said run away from Medicare Advantage plans. Some refuse them.

We finally decided on plan G. Wife and I it runs $310 mth not including the part B that we pay too. That also includes dental and vision and the drug plan supplements we had to pick. But we never ever have to worry about medical bills, denials, or choosing a doctor from a plan.

 

[ainitfunny]

Which is crap. As long as I can afford it, I don't want some bean counter making my healthcare decisions.

Then Stay on regular Medicare!

That's what I thought . . .

As far as I know, I'm as covered as I can be for now. How I'm going to keep affording it is another matter because I don't intend to take social security for awhile, but I'll re-evaluate that decision when I hit the 10 months in December (have to be age 65 + 10 months for a much higher payout). I need some time off to focus on my health.

Medicare and Social security are TWO DIFFERENT THINGS. GET Medicare as soon as you turn 65!
You dont have to wait until you are on Social Security to enroll in Medicare! And enrolling in Medicare is NOT
taking your Social security early!

 

[Meemur]

Ain't, my social security will pay for Part B. Right now, I'm paying for it out of pocket because I didn't take ss.
You've missed my other threads. I went on Medicare when I turned 65 a few weeks ago.