Medicare & Insurance topics

How would a Medicare Advantage Plan handle this . . . . ?

GailL1 — Sat, 16 Oct 2021 22:15:43 GMT

How would a Medicare Advantage plan, of whatever type - HMO, PPO, PFFS - handle payment to an out of network provider like a (medically needed) Air Ambulance or Medi-Helicopter?

Does CMS provide them with some standard guidance for situations like this?

2022 Generic Copay with PDP, Wellbutrin, Synthroid

somarco — Thu, 14 Oct 2021 20:52:32 GMT

Thought I had seen it all during the "window shopping" phase. Today I saw something I have never seen in all the years I have been running drug reports.

Generic Wellbutrin (bupropion) copay on a $13 drug plan is $384 for a 30 day supply. GoodRx $14 with Kroger.

Generic Synthroid (levothyroxine) is $150 on the same plan. GoodRx + Kroger = $13.

Be careful out there.

Free Webinar – Medicare and Parkinson’s Disease: Answering Your Frequently Asked Questions

ParkinsonsFndtnSBR — Fri, 08 Oct 2021 19:24:58 GMT

On October 21, tune in as we drill down into some of the most frequently asked questions about Medicare and Parkinson’s including coverage of rehabilitation and mental health services, long term care, social security disability insurance, and more. We’ll answer questions like: Are there annual caps on physical, occupational and speech therapy? What types of mental health treatment are covered under Medicare? Will Medicare pay for long term care services? Do I automatically receive Social Security when I enroll in Medicare?

Almost 90% of people with Parkinson’s disease (PD) are covered by Medicare. Whether you are approaching 65 or already there, navigating Medicare and understanding what it means for managing your Parkinson’s disease can be overwhelming. Join the Parkinson’s Foundation and AARP for another partner webinar as they strive to provide the best information and tools to help guide your journey with PD.

Learn more and register for free at www.Parkinson.org/AARPFAQ

Webinar Date: Thursday, October 21, 2021

Time: 1:00pm – 2:00pm ET

Those Prescription Drug Plans (Medicare Part D) with Low(er) Cost Insulin?

GailL1 — Fri, 08 Oct 2021 16:44:07 GMT

Are people finding this type of plan beneficial or NOT?

Beware of Robocalls

somarco — Thu, 07 Oct 2021 18:48:13 GMT

My voice mail box greeted me with this enticement . . . but I did not bite.

I wonder how many seniors will take the bait?

AARP Invalid Information

StevenT855650 — Wed, 06 Oct 2021 19:39:19 GMT

There's an awful lot of incorrect information ( call them lies) going around about Medicare. In particular, the initial sign-up period. According to the big thick book that the fed's mail out every year, MY sign-up period starts 3 months before my 65th birthday, and ends 3 months after my 65th birthday. That birthday is on Dec 4. Yet I get an emailing from AARP telling me that my signup ends on December 1. AARP needs to stop lying.

Medicare Drug Plan Finder is a Mess . . . Again

somarco — Wed, 06 Oct 2021 06:22:05 GMT

For the 6th or 7th year in a row (I have lost count) the Medicare Plan Finder is a mess. CMS doesn't know the meaning of the term "user friendly".

And don't expect to get accurated copay's, at least for now. Usually takes CMS a couple of weeks, sometimes longer to get the kinks worked out.

There are often discrepancies in what the PF shows for preferred pharmacy's, tiers and copays vs what you will see on the carrier site. BEFORE COMMITTING TO ENROLLING IN A PLAN, COMPARE YOUR PF RESULTS AGAINST THE CARRIER SITE.

On top of this there is consolidation of plans and carriers. ExpressScripts was absorbed by Cigna. The plan you are mapped to may likely have a premium that is 2x your current premium.

Lot's of cost-shifting going on. Consumers will be taking a hit, especially on generics. My suggestion is to only use your PDP for brand name drugs where there are no generic equivalents. Instead of your drug plan, pay cash, use the store "discount" or other discount plan like GoodRx. Consider 90 day refills, and in some cases look at 12 month refills.

This strategy may allow you to go with a lower premium plan if you only use your drug plan for brand name drugs.

Currently many carriers won't apply a deductible to tier 1 or 2 drugs. Most carriers for 2022 are applying deductibles to tier 2 and higher. A few carriers will apply the deductible phase to ALL drugs.

One carrier has only one preferred national pharmacy (Walgreens). If you enroll in their lowest premium plan you need to plan on filling only at Walmart.

Almost every plan has CVS, Costco, Kroger, Walgreens and Walmart as preferred pharmacy's. If you use any other drugstore you may be paying too much for your med's.

There may be more surprises coming, so buckle up. It could get bumpy.

Which insurance company to pick for Medicare Regular or Advantage

EdwardearlH892891 — Wed, 29 Sep 2021 16:09:48 GMT

How do you pick which insurance company to go with for your Medicare?

I"m trying to pick a Medicare Plan and have all the Plan A to N from Medicare. In Texas, there appear to be about 70 companies offering various policies.

When I talk to individual agents they usually only handle a few companies and are being paid commission on their sales so I'm a little skeptical that medicare agents are going to focus on the handful of policies they want to sell.

Where is the best place to get reviews or comments on people's experiences with the various companies?

Earl

Free Webinar: Medicare Open Enrollment

AARPRachelA — Fri, 24 Sep 2021 17:21:03 GMT

We’ve seen a lot of changes this past year, from a new vaccine rollout to a slow return to work. Your Medicare plan may look a little different, too. Join us for a free webinar where we’ll explore the top updates to Medicare open enrollment, coverage options and costs in 2021 — including what these changes may mean for your benefits.

Open Enrollment: What’s Changed in 2021 and How It May Impact Your Medicare Plan – Tuesday, September 28 at 7 p.m. ET.

Onduo

WilliamD866401 — Fri, 17 Sep 2021 16:34:02 GMT

I think this could be used to increase insurance rates by data mining the users. What do you think?

Can Medicare Part A be used to cover rent at assisted living center

EricW236758 — Thu, 16 Sep 2021 19:52:21 GMT

Well, to make a long story as short as possible, I've been contacting assisted living centers in search of a place to live. I'm getting quotes back for monthly rents which are almost exactly the same as what I'm getting on SSDI ($ 1,635 a month on SSDI). However, one of the rental agents mentioned that Medicare might pay for part of my rent, but she didn't know where I would have to go in order to make that happen.

I'm 59 years-old, I am in fact disabled, and I've been on SSDI since 2012. Is it really possible that Medicare might be able to pay for at least part of my rent in an assisted living center, or was the rental agent blowing smoke? How would I get the ball rolling on something like this?

Part D penalty

lg8227 — Wed, 08 Sep 2021 19:20:36 GMT

I would like to know if anyone can help me or give me any information on how to get rid of my part D Medicare penalty. Need help !! please respond if you can help.

UHC or Accendo for Plan G?

kb844472 — Tue, 07 Sep 2021 10:54:55 GMT

UHC vs Accendo Plan G

We are in the final stages of choosing our Plan G company. UHC and Accendo have rates within a few dollars of each other in our zip code. I’ve talked to several agents and get differing answers, so if you actually have either of these policies, I would appreciate your input.

If you have anything good or bad to say about either, please let me know. I want to pick something for life and not count on being able to pass underwriting in the future.

UHC

The enrollment premium gets reduced by 3% between the ages of 69 and 80. What happens on the years that there is no reduction in enrollment premium? Can there be an age related increase in price in addition to the reduction in enrollment benefit?

UHC offers a household discount of 7%. Is that guaranteed in the contract? Can it be reduced? What happens when your spouse dies?

I understand that the Renew Active membership can be withdrawn at any time. Are there any other benefits that can be withdrawn?

Accendo

Accendo offers a household discount of 14%. Is that guaranteed in the contract? Can it be reduced? What happens when you spouse dies?

Disenroll from Medicare Part B (due to Income Related Premiums)

SteveO59 — Sun, 05 Sep 2021 18:51:12 GMT

I am a retired federal employee, and my wife is on my FEHB health benefits plan. I was advised decades ago that for "most" federal retirees, Medicare Part B made sense, because it caused many of the copays and coinsurance premiums to be waived. My wife turned 65 and we started her Part B coverage about 2 years ago. At the same time, we have also been working on converting all of our IRAs to Roth IRAs, so ALL of the converted money is treated as income (even though not one dime of it has come to us, since we did 100% conversion and paid the taxes out of our savings). The problem is that Medicare thinks we have all this money, and we are now paying at the highest levels for the Medicare Part B income related monthly adjustment. We are converting just enough each year to stay in the 24% tax bracket, so we will have this "phantom income" for at least 3 more years - by which time I will turn 65 as well, and now our Part B premiums will double. We'll be paying about $1000 per month for Part B at that time. This won't go on forever - the IRAs will be converted in 3 years, but then each time I withdraw from my portfolio of investments, I will have some amount of long term capital gains, and that will most definitely also cause our premiums to increase. Apparently, we are not "most" federal employees, so now we need to reconsider.

We are seriously considering cancelling our Part B and Medicare Advantage plan (offered through the health insurance company that has our FEHB coverage). I know that cancelling Part B incurs a 10% penalty per year, and that it would impact me as well if I never sign up, but my FEHB plan covers everything I need (at present time) at about 1/3 the cost of $1000/month. My main hesitation to cancel is that if Congress changes the FEHB program, changes Medicare program, or goes to some sort of healthcare for all system, I could be screwed by some future decisions that I cannot predict. That said, $1000 per month is a hefty price to pay for a gamble on what Congress might do in the future.

I've seen other threads that talk about canceling Medicare Part B, but they all reference going back to work - and that is not in the cards for us. I've also seen answers to the disenrollment question that suggest Part B is better than the FEHB program, but I disagree - my FEHB coverage covers me when I travel, not just in the USA (Medicare does nothing in Canada, Mexico, or other countries, from what I've heard). So relying on Medicare vs. FEHB just doesn't pencil out for us.

I'm looking for any thoughts or advice on this scenario. I'm also looking for thoughts on when I can do this - can I do it at any time of year, or do I have to wait until some open season, and how does this timing impact the Medicare Advantage plan that is tied to both Medicare and my FEHB insurance?

Let's Start A Pool - Best GUESS Wins

GailL1 — Sat, 28 Aug 2021 23:52:02 GMT

The person that can guess the closest - WINS - wins what? I don't know.

What is your guess of what the standard (most people) Medicare Part B premium will be for 2022?

I believe it is $ 148.50 for 2021 -

My 2022 guess is gonna be .. . . . . . . . $ 164.00

This does NOT include any premium penalties.

This does NOT include any IRMMA additions.

Come on . . . give it a guess. 🙂

A BI-PARTISANSHIP Senate Bill that could SAVE Medicare Money AND Provide better Service

GailL1 — Mon, 23 Aug 2021 19:42:04 GMT

I really dislike GARGANTUAN legislative bills - I prefer ones with a direct plan and how they are funded - One:ONE; especially ones that have the services and the savings all together in the same service. To me, these seem pretty much NO Brainers.

Now this one - saves Medicare money AND provides better Medicare services to many people. Introduced in the Senate on 07/29/2021, current, it is supported by (8) - 4-Dems and 4-Rep.

The Choose Home Care Act of 2021, S. 2562 is a cost-effective and patient preferred home-based extended care benefit as a supplement to the existing home health benefit that supports patients to leave the hospital and recover at home with a mix of expanded skilled nursing, therapy, personal care, telehealth services and more. In this way, eligible patients can choose to recover at home in a safe home environment with appropriate and sufficient care tailored to meet their individual needs and reduced Medicare spending.

Eligible patients are approved by their doctor for this type of home care rather than a SNF recuperation period.

S.2562 Choose Home Care Act of 2021 (S. 2562) - GovTrack.us

So where would you rather recover from some surgery or medical treatment, if approved by your doctor(s) - at home or in a skilled nursing facility ????

To find out more about it - follow the links at the top of the above page:

Questions on Medicare application for senior parent

BariO908952 — Sat, 21 Aug 2021 12:42:22 GMT

Greetings to all forum participants,

I have several questions regarding Medicare application for my senior mother. She immigrated to the US in 2016 (she was 67 years old at that time) and I wanted to start buying Medicare for her but we were told that she has to wait 5 years to be eligible to buy Medicare.

This October, 2021 she will be in the US as permanent resident for 5 continuous years and she is eligible to apply for Medicare so we will be applying and have the following questions:

1. When I called local Social Security last week and explained my mother's situation, we were told that she can apply during January 1 - March 31 general enrollment period next year (2022) for Medicare coverage to start on July 1, 2022 . I am thinking maybe there was some misunderstanding since if she can apply when she is first eligible (October 2022) then why can't she apply during Annual Enrollment Period from October 15 to December 7 for coverage to start on January 1, 2022? If she can, I will be calling social security again to explain this.

2. There are Medicare late enrollment penalties for Part B/D premiums if someone applies not at 65 but at a later age. Even though my mother will be 72 when she first applies, I do not think these late penalties apply to her situation since at age 65 she was not even present in the US and also when she first immigrated to the US in 2016 she had to wait 5 years to be eligible to apply. So October, 2021 is the earliest time she is eligible to apply. Am I correct? And if I am, is there a way to point this out during Medicare application to make sure they do not apply these late enrollment penalties.

3. Finally, a question about income. In 2022 (when she hopefully will have Medicare coverage) I will be claiming her as a dependent on my tax returns (her own income is $0). During her Medicare application there is an income question (which I think is related to Income Related Monthly Adjustment Amount): should she give her own income or hers+mine income?

Thank you in advance.

I need to enroll in Plan B

EricW236758 — Tue, 17 Aug 2021 21:05:48 GMT

Well, to make a long story as short as possible, for the past eight years I've been living overseas while collecting SSDI, and next year I'll be sixty years old. Recently, a general practitioner in the country where I was living informed me that I might be suffering from colon cancer. This was about a month ago, and about two weeks ago I returned to California in search of medical care.

I tried going to an emergency room, but they told me that complaint was not an emergency, and that I should go to medical clinic. I went to a clinic in SF bay area, but they told me that my income was too high ($1635 a month on SSDI) and that I did not qualify for aid from the county. The staff at the clinic told me that I should apply for Medi Cal, and come back to their clinic after my Medi Cal was approved.

So, this morning I called Medi Cal, and was told that I could not get Medi Cal, because I'm already enrolled in Medicare Part A. However, Part A only covers overnight hospital stays, and the medical clinic won't accept it. I've been told by the staff at the clinic that I must get on Part B before they can see me, but the soonest I can get on Part B is sometime next week.

In the meanwhile I'm suffering from bloody stool, I'm feeling weak, and no one will see me. I need advice on where to go for help???

?Health Insurance Confusion?

individualmatter — Tue, 27 Jul 2021 03:13:49 GMT

If a person age 65 y o and older has not signed up for medicare thru the usa government or any other way can a person get health insurance thru healthcare gov? Also must a person age 65 yo and older be signed up for medicare thru the usa government to be able to get aarp united healthcare medicare advantage?

There's not enough points in my work history for me to get medicare with either no cost premium monthly. But some time ago in aarp I think I read that medicare Age Eligible people can choose either the federal healthcare gov federal health insurance marketplace or their state's healthcare marketplace if their state does not participate in the federal health insurance marketplace IF the person has NOT signed up thru the federal medicare website for medicare.

Maybe some body knows if any of this is true or false? I think either the federal health insurance marketplace OR my state's health insurance marketplace (whichever of those will be available for my state depending on upcoming governor race winner) OR aarp medicare advantage I think will be good for me Instead Of medicare thru the federal government's medicare website.

Does any body. know if a person age 65 and older who has not signed up for medicare thru the usa government medicare website is allowed to get either federal or state health insurance marketplace health insurance instead of medicare thru the usa government medicare website? or may be allowed to get aarp united healthcare medicare advantage if that does not require first for an applicant to be signed up for medicare thru the usa government medicare website?

Thank you for any thoughts, guidance, experience shared!!!!

Looking for Dental insurance

SrinivasaK839563 — Tue, 27 Jul 2021 01:59:31 GMT

Few weeks ago, I realized, I dont have dental insurance. I am wondering is there a way to get dental insurance from a market place? If it is possible what are the steps for a Texas resident.

Medicare - Dental, Vision, Hearing Benefit Question

GailL1 — Mon, 19 Jul 2021 03:12:55 GMT

A Question to those on Medicare -

Congress is contemplating adding some form of Dental, Vision and Hearing coverage to Medicare.

Don't get too excited, the deal is still FAR from done. They have to figure out some way to pay for it, but even before that - how much it will cost and the cost depends on the scope of the benefit - each of them.

My question to you is -

How do you see the scope of such coverage - in other words, what do you think it should cover and at how much of a benefit ?

Do you think your dentist, your eye specialist, your audiologist would accept a Medicare (payment) assignment?

Would you be willing to pay more in Part B premiums for such coverage? Or maybe they will make it another "part" altogether - We have Medicare Part A, B, C, D so maybe a Part E - who knows, the bill hasn't been written yet.

If this comes about, we will have some measure of how it meets your expectations.

Thanks to all who give their opinion here.

You're Invited! Two-Part Medicare Webinar - July 2021

AARPRachelA — Mon, 12 Jul 2021 17:36:47 GMT

Is your Medicare enrollment right around the corner? Now’s the time to start preparing. Join AARP for a two-part webinar series to find answers to many of your questions – such as what’s covered, what are the steps for new enrollees, how to avoid gaps in coverage and more. You won’t want to miss it.

Avoiding Gaps in Your Healthcare Coverage – Tuesday, 7/20 at 7 p.m. ET and 7 p.m. PT
Making Medicare Enrollment Decisions – Thursday, 7/22 at 7 p.m. ET and 7 p.m. PT

Changing jobs at age 65 and gaps in health insurance coverage

m906418g — Sat, 10 Jul 2021 01:32:10 GMT

I am just over 65 years of age and am changing jobs. My new employer will not cover me under their health insurance for 60 days. Am I in danger of being caught paying a penalty for not having continuous coverage if I don't enroll in Medicare immediately? My past two employers covered me from day one and I am floored by this. COBRA does not count as continuous coverage.

We Need a Law to Stop Insurance Companies from Giving Medical Advice

aruzinsky — Thu, 24 Jun 2021 17:22:03 GMT

Medical advice includes prescription reminders.

I have an Aetna Medicare Advantage plan and Aetna insists on making robocalls to my answering machine and their machine pretends that my machine is a person. Sometimes their machine starts talking before my answering machine goes beep. So, what to do? I have a device for blocking phone numbers and I block every robocall including Aetna's. So, what does Aetna do? It sent me this email:

So, I tell customer service to stop sending me harassing phone calls and emails or else I will complain to Medicare. To be continued.

Do You Support This Recommendation for this change to Medicare ?

GailL1 — Wed, 23 Jun 2021 04:20:57 GMT

On June 17, 2021, MedPac * in their Report to Congress - recommended that all recommended preventive vaccinations be covered under part B rather than Part D. WITHOUT BENEFICIARY COST SHARING.

The MedPac Report -

See Chapter 7 (Medicare vaccine coverage and payment) - begins on report page 241

http://www.medpac.gov/docs/default-source/reports/jun21_medpac_report_to_congress_sec.pdf?sfvrsn=0

From the Report:

To improve coverage and payment of preventive vaccines under Part B, the
Commission recommends that the Congress:
• cover all appropriate preventive vaccines and their administration under Part B
instead of Part D, without cost sharing;

The current recommended vaccinations for Medicare beneficiaries are:

Medicare & You 2021

Shots (or vaccines)
Part B covers:
• Yearly flu shots. See page 40. 100% covered already as well as the Covid vaccination
• Hepatitis B shots. See page 40.
• Pneumococcal shots. See page 45.
Medicare drug coverage (Part D) covers all other recommended adult
immunizations like shingles, Tetanus, diphtheria, and pertussis vaccines to
prevent illness

By this design, beneficiaries with only Part D coverage have to pay a copay for the recommended immunization depending upon it's tier rank on your Med D plan. The Shingles vaccine( Zostavax and the new, more effective one, Shingrix) is pretty pricey especially since it is a 2-shot regiment from 2-6 months apart.

With the passage of the ACA - all recommended vaccines for all other age groups are covered without any out of pocket cost under all types of private and public health care insurance coverage plans EXCEPT FOR MEDICARE.

Think we are due some fairness here - after all the point of preventive care is to prevent disease and its associate cost. Ever see anybody with a bad case of shingles? Those of us who have already had these vaccine won't see any benefit at the present time - but think about those who come after us who need these vaccinations. Or what IF more vaccines are recommended in the future - we might get some relief there.

Ask your Congressperson to support this MedPac recommendation -

* The Medicare Payment Advisory Commission (MedPAC) is an independent congressional agency established by the Balanced Budget Act of 1997 (P.L. 105-33) to advise the U.S. Congress on issues affecting the Medicare program.

Pricey drugs paid by Medicare lack cost-effectiveness data

GailL1 — Wed, 23 Jun 2021 03:31:33 GMT

So WHY should these even be included in any Medicare formulary if their efficacy, including price, has not been proven? They should not be on the Medicare formulary at all until proven to be not just effective but be the best drug for the cost and the effectiveness.

Why are people still taking the Brand when there is a generic already available ?

I assume that Medicare beneficiaries know how Medicare Part D works - cost are shared between the beneficiary, the insurance company AND the government (we are the government).

Axios 06/21/2021 - Pricey drugs paid by Medicare lack cost-effectiveness data

from the link~

Nearly $50 billion or a third of Medicare Part D costs in 2016 were for drugs with absent cost-effectiveness analyses, according to a report from JAMA Network Open.

Why it matters: The lack of a quality analysis that weighs the relative cost with outcomes of these drugs may create hurdles toward efforts aimed at addressing drug spending in terms of value.

Background: Reports have consistently showed higher drug prices are driving up Medicare spending.

By the numbers: Nearly half of 250 drugs with the greatest Medicare Part D spending in 2016 showed no available cost-effectiveness analyses. For the other half that did have studies, many did not "meet minimum quality standards."

Of these 250 drugs, 91 had a generic equivalent and the remaining 159 had some exclusivity.

The big picture: Some in Congress have supported the idea of policy reforms like improving the value of spending on prescription drugs by negotiating or setting Medicare drug prices.

The bottom line: Cost-effectiveness analysis has been an efficient way to compare clinical value across alternative treatments. However, "efforts for value-based reforms may be hampered by a lack of cost-effectiveness data," the authors write.

Intrusive Medicare Insurance AARP United Healthcare

KD779389 — Sat, 12 Jun 2021 17:30:31 GMT

I keep getting calls from United Healthcare to push me to their online pharmacy and to allow them to come to my home for a "House call" to consult on my health and care options. WHAT!!! I have a primary care provider...the last thing I want is an insurance company sending their doc here to butt into my care....I understand this is done so they can raise your risk score and get paid more by Medicare...I dont like United Healthcare's approach and will look for a less intrusive insurer next year. Curious as to whether anyone else has been repeatedly contacted by them.

Welcome to Medicare & Insurance

AARPRachelA — Fri, 11 Jun 2021 17:44:36 GMT

Welcome to our medicare & insurance forum! Here we hold discussions, offer resources and tips, and provide advice for the health of it! Our topics range from healthy living, mental health, health conditions, treatment, medication, and more. Political discussions are not permitted unless they directly relate to health.

United Health Care

guido95 — Fri, 11 Jun 2021 01:57:20 GMT

I'm appalled at United Health Care for wanting to charge people for their Emergency Room visits if they deemed it isn't necessary. Luckily I never bought into UHC for my insurance. This is backed by AARP I believe & I will not renew my membership with aarp if they continue to support & recommend United Health Care to seniors.

New Alzheimer's Drug -

GailL1 — Tue, 08 Jun 2021 01:45:47 GMT

I thought after I reading this - No Way will the FDA approve this med.

KHN 06/04/2021 - FDA Weighs Approval of a Alzheimer’s Drug, but benefits are iffy

Then Today I read this:

NPR 06/07/2021 - The FDA Has Approved A New Alzheimer's Drug — Here's Why That's Controversial

and Biogen's stock went up 40% TODAY !

Be your own judge - Do you think this medication should have been approved by the FDA from the information in these (2) links?

Budgeting for Medical Insurance

TomReader — Tue, 08 Jun 2021 00:07:06 GMT

Hello everyone,

I just turned 51 last month and plan to retire in six or seven years, by the time I am 57. I have been saving for this since I was 20 and feel prepared to manage costs off my savings until I am 59 1/2 and can access my traditional retirement funds. In budgeting for the several years until I can qualify for Medicare I am looking for ways to estimate covering myself: medical/dental/vision and hopefully long-term care. Are there recommended providers to consider? It is my wife and I, non-smokers without children or any pre-existing conditions. Can anyone share there opinion on expected costs or where they could get such an estimate? I have been using my own budget model of $1,400/month growing with historical inflation. I am starting to believe my estimate is too high and my growth rate of the costs too low. So, I am also interested in historical trends going back at least a decade for such insurance costs.

I am doing my own research and asking friends and family. I am putting this out here to case a wider net and get as much advice and suggestions as I can.

(This is also my first attempt at putting a topic out into the community.)

Thank you.

Tom

Part G in Massachusetts

StevenS12823 — Mon, 07 Jun 2021 19:26:08 GMT

Everything I see online suggests that it's impossible to keep your Part G plan if you move to MA, but UnitedHealth keeps telling me on the phone that I CAN keep the plan. I don't want to move to MA and change to their state specific plan and possibly be locked out of medigap if I moved back out of state in a few years. It's nice that MA has open enrollment for their plans, but you can be stuck shoveling snow for your whole retirement. Has anyone had any experience with this?

800-523-5800 incompetent automated attendant

ScottB517221 — Thu, 03 Jun 2021 15:33:28 GMT

I just called this number for the first time as I joined (AARP/United Healthcare) part G last month. The system failed to respond to any number key presses on my iPhone (this after the long "if you already are a member or are calling for someone who is a member or if it's Tuesday between 9:01 AM and 9:02 AM, etc." announcement). I ended up repeating- well yelling- the number instead multiple times after which the attendant wasn't sure it understood, of course. When I finally got a live person she claimed she hadn't ever heard anyone complain about this system before. Perhaps it is only competent on a landline. What an introduction. It immediately makes me want to switch to another provider next year...

Free Webinar- Medicare and Parkinson's Disease: What You Need to Know

ParkinsonsFndtnSBR — Fri, 14 May 2021 13:44:59 GMT

Almost 90% of people with Parkinson’s disease (PD) are covered by Medicare. As a disease that impacts both motor and non-motor symptoms, Parkinson’s can affect all aspects of a person’s life. Whether you are approaching 65 or already there, navigating Medicare and understanding what it means for managing your PD can be overwhelming.

On June 24, join the Parkinson's Foundation and AARP for a joint webinar to learn about Medicare and your coverage options, what Medicare means for your PD, what is “typically” paid for by Medicare, how to enroll, where you can find additional resources, and more.

Learn more and register for free at www.Parkinson.org/AARP2021

Webinar date: Thursday. June 24, 2021
Time: 1:00-2:00pm ET

What happens if you don't qualify for Medicare?

e994792f — Wed, 12 May 2021 03:57:04 GMT

My brother is 57-years old and has 29 Social Security credits (so he's 11 short of the 40 credits needed to qualify). He currently receives Obama Care subsidies for his health insurance based on his income. My understanding is that he won't qualify for Medicare when he turns 65 or he'll have to pay for coverage. I think his Obama Care subsidies will end at that point as well.

I realize a simple solution would be for him to earn the 11 credits but he was a caregiver for our mother for decades and has been out of the work force for a long time. His marketable skills are limited.

Can anyone clarify for me what will happen with Medicare when he turns 65? We're in California.

Thanks.

You're Invited! Two-Part AARP Medicare Enrollment Webinar

AARPRachelA — Mon, 10 May 2021 17:39:17 GMT

Are you nearing your eligibility for Medicare enrollment? Join us for this two-part Medicare webinar series to help you make the choices and decisions that are right for you.

10 Medicare Facts You Should Know - Thursday, May 20, 7 p.m. ET & 7 p.m. PT
Exploring your Medicare Options - Tuesday, May 25, 7 p.m. ET & 7 p.m. PT

Life Insurance

NancyV227386 — Mon, 10 May 2021 17:18:02 GMT

Hello, I am soon going to have to make decisions on life insurance amounts for myself and my husband that will be for the time after my last child is out of the house. I was wondering what amounts of life insurance people have into retirement? I know I may not need as much as when kids were young, but it seems an amount greater than $50,000 would be good. Yet not sure if we will be able to afford the premiums once we retire?. Thoughts? thanks, Nancy

Long Term Care Insurance

NancyV227386 — Fri, 07 May 2021 21:16:43 GMT

Hello,

I was looking into LTC insurance for myself and my husband and found it very expensive and I am unsure if we will be able to continue the premium payments into retirement, especially if the cost goes up. Does anyone have experience with Long Term Care Insurance and opinions on whether or not it is worth the cost?

thank you,

Nancy

Your Thoughts on Medicare Negotiating the Price of Drugs as a Health care cost containment method

GailL1 — Thu, 06 May 2021 21:32:38 GMT

An old (but new again) piece of legislation has been re-introduced in the House of Representatives on allowing Medicare to negotiate the price of medication - at least some of them.

The President supports Medicare negotiating the price of drugs to bring down the cost of drugs - although there maybe some unintended consequences -

Would you support allowing Medicare to negotiate the price of medication - at least some of them?

The CommonWealth Fund - 05/05/2021 Essential Facts About Drug Pricing Reform Allowing Medicare to Negotiate Drug Prices

What if your particular (expensive) drug is not included - would you switch to another one that is included or pay a higher price for the same one?

Would you be OK with taking a generic instead of a brand name drug if available?

Would you be OK with taking a generic of a type that gives the best price to Medicare and which may change from one generic manufacturer to another periodically depending upon who gives the lowest price to Medicare?

This is now in discussion at the (House) legislative level so I am just wondering what the actual medication users think about such a proposal.

Planning for Medicare and SS benefits

MikeC412889 — Wed, 05 May 2021 19:10:27 GMT

I was laid off from my corporate job in 2018 and have entered into semi-retirement mode. I have been contract consulting the last two year as a 1099 contractor. The salary, of course is not near what I was making at my previous job, but it is sufficient. When I was laid off, I become covered under my wife's medical plan.

This year (September 2021) I will be turning 64 and I want to begin planning now for Medicare & Social Security so I can make the right decisions. I want to defer my SS benefits until 68 maybe even until I am 70 to get max benefit amount.

Because my wife still works, I do not need Medicare when I turn 65 (and for the next 3-5 years after that). I have read/heard people say that once I reach 65 that I should sign up for Part A (because its free) but defer Part B. I have also heard that I need to have SS benefit payouts in order to get Medicare (Part A?). It is all confusing, so wanting to get guidance on this important topic so I am prepared for next summer.

Thank you.

Medicare Medical Savings Account Plan - Medicare Advantage

GailL1 — Wed, 28 Apr 2021 18:32:29 GMT

Does anybody have one of these Medicare Medical Savings Account Medicare Advantage Plans?

They aren't available everywhere but just want to know if you know about them or if you have one and your experience with it?

AARP/UHC - Medicare Make Clear - What is a Medicare Medical Savings Account Plan?

Medicare.gov - Medicare Medical Savings Account (MSA) Plans

Got An ACA Plan? Might Be Getting A Rebate for 2020 Premiums Paid.

GailL1 — Tue, 20 Apr 2021 17:18:04 GMT

Since 2020 because of the pandemic had lower than normal medical expenditures, health insurers in the ACA Individual Marketplace are having a difficult time with meeting their 2020 Medical Loss Ratio.

The Affordable Care Act requires health insurance issuers to submit data on the proportion of premium revenues spent on clinical services and quality improvement, also known as the Medical Loss Ratio (MLR). It also requires them to issue rebates to enrollees if this percentage does not meet minimum standards. The Affordable Care Act requires insurance companies to spend at least 80% or 85% of premium dollars on medical care, with the rate review provisions imposing tighter limits on health insurance rate increases. If an issuer fails to meet the applicable MLR standard in any given year, the issuer is required to provide a rebate to its customers.

CMS - Medical Loss Ratio

In 2020, because of stay at home orders or social distancing due to the pandemic, people did not go to the doctor as much as normal. Hospitals cancelled many elective surgeries adding to the lower use of medical care.

So maybe you might get some of your ACA individual insurance plan premiums back later this fall. But don't get too comfortable cause what comes down may again go up - we really haven't changed much else.

Repeal of the Medicare Prescription Drug Plan Part "D" Penalty (LEP)

RobertwG871324 — Thu, 15 Apr 2021 14:58:06 GMT

As senior citizens, my wife and I are part of the Medicare Health Insurance Program. Unfortunately, we did not sign up for the Medicare Prescription Drug Plan Part "D" when we each turn 65. Bad mistake. It was not until 2014 that we were convinced by our insurance advisor to begin participation within the Part "D" program even though we were healthy and not on any prescription drugs. This decision in 2014 is costing us a total of $300.00 to $400.00 a year in penalty cost added to our health insurance plan. This is a lifetime penalty as long as you participate in the program. This is not fair and wrong. I petitioned my US congressmen with little success. There response was "ITS THE LAW". I am not aware of how many senior citizens are out there that are experiencing the same dilemma. Is there an advocacy group for senior citizens to request Congress to rescind the penalty clause?

New to Medicare and secondary medical plan coverage

g936417g — Sat, 03 Apr 2021 00:04:44 GMT

New to Medicare and secondary medical plan coverage

First, I would like to thank all those who have posted questions and answers related to Medicare, and related Advantage and Supplemental Plans. Very informative! Simply having the ability to have access to a AARP user community forum that covers a variety of issues facing seniors is by itself worth the annual AARP premium. For the last few weeks, I’ve been trying to educate myself before I have a meeting with a Medicare plan agent who will guide me through the selection process and options I have to chose from. Anyways, here is what I’ve decided to do and I am looking for any confirmation based on my research. Thanks for any feedback!

I am choosing a Medigap Plan G vs any of the Advantage Plans Available:

Best if monthly premium is not a concern (disclosure: my former company provides a annual stipend or allocation for Medicare eligible retirees that can be used to help offset secondary HC insurance premiums)
Peace of mind knowing services will be covered and freedom to select HC providers
Appears that Premiums based on Community Rated is better than Attained Age Plans
Larger is Better when it comes to Supplemental Insurance Carriers as the financial health of the carrier matters and their ability to absorb or spread costs over a larger population
Customer service matters

Better to select a Medigap plan now when you are eligible for guaranteed enrollment vs later down the road when that option may not be available or you may be subject to underwriting

In Michigan, I am able to select from 5 carriers who offer Medicare Plan G. I am selecting the AARP sponsored Supplemental Plan G offered through United Health Care. Two of the carriers were regional and one was strictly a Michigan based Company. AARP premiums were in the middle of the 5 companies. In reviewing the various Plan Documents and future rates, it was obvious that the Community based rates were much lower going forward than Attained Age Plans. I guess that could change over time but when I looked Community based rates at 5-year increments were always significantly lower.

Will also be choosing a Prescription Plan pretty much based on (have not yet made a decision):

Are my prescriptions covered and what is their Tier Rating
Balance between monthly premium, deduction threshold, and number of prescriptions falling under Tier 1 or Tier 2
Deduction Amt may not be a concern if your prescriptions are all Tier 1 or Tier 2
Preferred vs Standard Pharmacy matters when it comes to co-pays (sadly it looks like I will have to change pharmacies as for most providers Rite-Aid is not a preferred provider)
Easy enough to change prescription providers during future open enrollment periods without fear of penalty

I have decided not purchase a Vision and/or Dental plan. Didn’t really seem to be worth the premium for the limited coverage or benefits provided. Chances are I will be no worse off simply paying all such expenses out of pocket vs paying monthly premiums.

Thanks again. I apologize for the long winded post!

United Health Care is Alarming

StevenH298027 — Fri, 02 Apr 2021 21:31:43 GMT

Been trying for months to get a refund from UHC. I switched to Blue shield in December of 2020. Unfortunately i forgot to cancel automatic payments. UHC continued to take my dues for two additional months after cancelling. Customer service said they are only authorized to return one month. which i received 40 days later. I called about other payment owed to me. they gave me an address in Georgia to send proof of coverage from January1 2021. To this date NOTHING! so i called again for the 4th time. after getting the runaround , Second agent asked what address i sent proof to? UHC billing Division po box 105332 Atlanta GA 30348. Agent tells me wrong box number should be 105331 ! I said a company your size post office threw my letter away? I told her i was going to small claims court! she said have a nice day.. Shame on UHC i will never go back to them...

Your Pocketbook - Same Surgery, Same Place - Different Bill & Out of Pocket Cost

GailL1 — Wed, 24 Mar 2021 16:05:42 GMT

Those of you on Medicare need to be aware of this new Medicare rule if you are contemplating some surgery with your doc and it is being planned as a (hospital) outpatient surgery. This could get fixed; but who knows how long it will take -

Kaiser Health News: 03/23/2021 - Under New Cost-Cutting Medicare Rule, Same Surgery, Same Place, Different Bill

I will try to summarize as much as I can.

The issue at bay is which Part of Medicare will pay for these types of (hospital out-patient) surgery - Medicare Part A or Medicare Part B.

Medicare classifies surgeries under in-patient and out-patient. Of course, those that are more dangerous or extensive are done on an in-patient basis, where the beneficiary is actually admitted to the hospital. Others are deemed less dangerous and can be done as out-patient. Medicare Part A pays for hospital in-patient (admitted) care and Medicare Part B pays for out-patient care.

Medicare defines out-patient care as expected to be released within 24 hours. Beginning in 2021, several more surgeries have been added to the list of approved out-patient basis and more may follow. The problem is (see the KHN link) while removing the surgeries from the inpatient-only list, the government did not approve them to be performed anywhere else. So patients will still have to get the care at hospitals. But because the procedures have been reclassified, patients who have them in the hospital don’t have to be considered admitted patients. Instead, they can receive services on an outpatient basis.

CMS (Medicare) pays hospitals less for care provided to beneficiaries who are outpatients, so the new policy means the agency can pay less than it did last year for the same surgery at the same hospital and Medicare outpatients will usually pick up a bigger part of the tab.

So just as a heads-up - when you and your doctor are scheduling a surgery - make sure you know what your status will be if it is being done in a hospital - are you in-patient or outpatient - and know what your follow up care (recuperating) will be and what your financial obligations will be under Medicare (who pays Medicare Part A or Medicare Part B).

Hopefully, CMS will correct this shortly - they will just add that under these (out-patient) procedures, they don't have to be done in a hospital - they can be done in other types of ambulatory surgical centers.

Call Centers

pjm57 — Wed, 17 Mar 2021 21:51:27 GMT

Curious why customer support is outsourced to Columbia ?

The line quality isn't very good.

Paperless Medicare Premium Bill (CMS-500)?

rm7683 — Mon, 08 Mar 2021 17:07:29 GMT

I'm enrolled in Medicare Easy Pay, so my monthly premium payments are payed by automatic deduction. I still receive, every month, a paper Medicare Premium Bill (CMS-500) which states plainly at the top right corner, "THIS IS NOT A BILL."

I thought, okay I'll just go paperless for this billing since I don't need a paper bill which is not a bill, and can look up the bill on-line if I need to. Besides, receiving this bill every month is problematic on two fronts. It's a security issue, because my medicare ID number, Medicare reminds me needs to be protected to reduce fraud, is printed twice on it and I have to deal with securely destroying it every month. Secondly is an environmental issues because of the waste it unnecessarily generates.

I was surprised, when scouring the medicare.gov website, that there was no option for me to go paperless for this bill. I chatted with a chat agent who said, indeed, there is no way to entirely avoid receiving paper bills, but I could opt for one annual paper bill. For that, I would have to call the main medicare number. After enduring a long wait on hold, the agent had to go off and investigate. She eventually came back and said she would have to "escalate" my request. So now I'm to wait ? days for a call to see if that worked.

Am I the only one who longs to go paperless for this monthly bill?

INSULIN COST - 2021 Medicare Prescription Drug Plan Prices -

GailL1 — Sat, 27 Feb 2021 03:46:39 GMT

Have you noticed any pleasant surprises in your Insulin out of pocket cost this year?

Just curious to see what people think of it IF their plan has such new coverage.

Thanks for your observations.

From: Medicare.gov - Insulin coverage

Insulin savings through the Part D Senior Savings Model

Starting January 1, 2021, you may be able to get Medicare drug coverage that offers broad access to many types of insulin for no more than $35 for a 30-day supply. You can get this savings on insulin if you join a Medicare drug plan or Medicare Advantage Plan with drug coverage that participates in the insulin savings model. This model lets you choose among drug plans that offer insulin at a predictable and affordable cost.

Part D Formulary Change

somarco — Fri, 26 Feb 2021 17:04:07 GMT

During the year, a Part D plan may make changes to it formulary — dropping some from coverage or adding some it hasn’t covered before — according to Medicare regulations. If the change involves a drug you’re currently taking, the plan must take one of two actions:

Send you a written notice at least 60 days before the change takes effect; or
At the time you request a refill, notify you of the change in writing and provide a 60-day supply of the drug under the same terms as before.

However, if the plan has ceased to cover your drug because of a safety issue — for example, the national recall of a drug that has proved harmful in some way — the plan is not required to inform you.

https://www.aarp.org/health/medicare-qa-tool/medicare-formulary-rights-protections/

NON-MEDICAL SWITCHING DRUGS

RKSK359581 — Thu, 18 Feb 2021 17:34:19 GMT

Where is on the issue of non-medical switching of drugs and increasing co-pays? My husband and I have been with AARPUnitedHealthCare Part D since 2007. Suddenly, they have started refusing to cover stable medications and are demanding that we switch to other medications. My husband has been doing well on Invokana for his type 2 diabetes and his doctor is very pleased with how this medication has worked for him. Now, UHC wants to switch him to another medication that he had tried earlier that did not work as well. The primary reason seems to be that by switching the med, they increase the co-pay to 4x what the Invokana co-pay was.

I am encountering the same issue with a med that my dermatologist wants me on. UHC is refusing to cover the med, instead wanting to require me to do injections at the Dr's office every week. Surely this is not cost-effective!

Obviously, they make these switches immediately after the closure of the period when one can change plans, so that the client has few options for nearly a year. Perhaps AARP should pull their sponsorship from UHC?

Discount Healthcare Benefits Membership

DenisecP732139 — Thu, 18 Feb 2021 05:11:59 GMT

Discount Healthcare memberships includes, dental, telemedicine and more for an entire household. Ask me how.

Free AARP Medicare Webinar 2/25/2021

AARPRachelA — Thu, 04 Feb 2021 19:39:43 GMT

Join AARP for a free Medicare webinar to learn how Medicare works, when to enroll, what options you have, and where to get help.

Medicare Made Easy: A What-to-Do Guide for Americans Eligible for Enrollment

Thursday, Feb. 25, 7 p.m. ET & 7 p.m. PT

Medicare at 64

cmtrahan — Wed, 03 Feb 2021 14:23:50 GMT

I am in desperate need of health insurance. I am 64 & drawing my retirement benefits for 2 years now a decision my husband and I made due to health issues. Since the start of COVID our lives and his livelihood have been turned upset down. We have both maxed out our 401k plans ( I know we shouldn’t have) but we needed the money . He is working his butt off delivering refrigerated trucks all over the US and that is keeping us afloat but we can not afford private health insurance. I keep seeing advertisements on TV for getting Medicare at age 64 ( I turned 64 in mid December) but can not figure out what the requirements are to qualify. Any help will be greatly appreciated

Thank You

Can't get medicare card

pahat56 — Thu, 21 Jan 2021 01:36:00 GMT

I am turning 65 in February and I want to sign up for Medicare but when I call they tell me there are no appointments in Colorado for anyone to sign me up. The scheduler goes out 3 months. I have called 5 times and every time they send me a letter telling me that I must apply for medicare with in 6 months or I will face a big penalty. How do I get an appointment to sign up for Medicare when there are no appointments? Has anyone else had this issue in Colorado or any other state?

Medicare Part D issue

xStork — Tue, 19 Jan 2021 16:45:32 GMT

When, at 65, I did not initially sign up for a Part D plan. About 6-9 mos later I decided to have a Part D plan in case I really needed it. I went with the Humana Walmart plan knowing I would be penalized on the premium for not going with it initially. My starting rate was $18+ per month. Over the next 3 years my plan went up to $55.30! Keep in mind that with this great amount of premium increase it should be noted that I never used it even once! I therefore wanted to go off the plan and either shop around for a new one or go off Part D altogether. I called them in Oct. ‘20 to cancel it and was told I had to wait till 10/15 for official open enrollment. I called to cancel on Oct. 15, and this time I was told that it had to be in writing and that they would send me the form or I could mail it to them or fax them the written request. They never told me with a total of two phone calls that it would need to be in writing, until then. With the delay in mail with COVID, I faxed them a cancellation request, to be effective immediately, after just paying for the next monthly premium. They continued to bill me and after I emphasized very politely that I had cancelled the plan, and my autopay, They told me that Medicare still had to be notified by them. I then searched for new plans and came upon a SilverScripts plan through Aetna that was reasonable. I called them to see if I would again have a surcharge to my monthly bill if I was not covered for a while. They happened to be informative and gave me a specific number to call Medicare and ask how this would work. She told me that if I was uncovered for something like 63 days in a row I would be subjected to a higher monthly rate for Part D. Just to avoid that, I mailed in a check for one additional month to my old Humana plan, still emphasizing that I had cancelled their plan going forward. Now, already on the new Aetna Part D plan, I am still getting billed for the last two months of the old Humana plan. A phone call to them revealed there is nothing they can do. My question is, am I still obligated to pay the last two months of the old plan I had cancelled? Despite my cancellation, does the plan remain in effect till the next plan takes over? Please help. Also, avoid Humana like the plague!

Medicare After Health Sharing Ministry

MichaelS37672 — Tue, 12 Jan 2021 14:36:19 GMT

I am currently 62. When I retired two years ago, I joined a health sharing ministry and dropped my employer coverage. I plan on enrolling in Medicare when first eligible in three years. Since I will not have been covered by insurance during that five year period, are there any restrictions or "gotcha"s related to signing up for Medicare and Medigap, and receiving full coverage under those plans?

Covid Hit

ShweetaK687450 — Sat, 02 Jan 2021 06:50:20 GMT

Hello,

This pandemic has affected everyone and in a very bad way some more than others. I am one of them. I lost my job that was my only source of income and my insurance does not cover covid care what should i do?

I desperately need money for daily survival I am even willing to take out a loan Any suggestions?

Filing for Medicare Part A only

StevenW450294 — Wed, 30 Dec 2020 23:01:46 GMT

Turned 65 today, will still be employed for at least a couple of years, so filing for Part A only. (employer does have more than 20 employees). On the SS Form, it asks if covered under a Group Health Plan (yes) and if covered through current employment (yes). Date when employment started, 30 yrs ago. Date employment ended (still employed). Here is my problem: next question asks when did Health Insurance start? I've had group health insurance through employer ever since I started (30 years), but employer has had many different health care providers, blue shield couple of years, blue cross couple of years, and others. So do they want when CURRENT health care provider started, or the original health care plan started?

Thanks, Steve

The YMCA has dropped Silver Sneakers Nov 2020

Huntn — Wed, 30 Dec 2020 22:40:31 GMT

I got a call in November from my local YMCA that "unfortunately we've lost our Silver Sneakers contract". Well it turns our the YMCA jettisoned their contract renew because they wanted more money from Silver Sneakers. This coming from the "Non-Profit, Community Organization", yeah sure.

Now the local Y (Houston, Texas) did offer a $30 per month plan to replace SS, which is substantially more expensive than SS itself, and as I primarily use the pool for my exercise, that is actually pretty hard to beat as a deal because of their large lap pool, except for one thing. I also have a Lifetime Fitness nearby which started accepting SS in 2020 and they have a very nice facility, including a 5 lane pool for lap swimming.

The other thing is if you just use the gym, there are several competitors out there honoring SS, such as Gold's Gym (have since changed their name Fitness Project?). I like the Y, but suggest if you are a Silver Sneaker's member, that you go someplace else for your exercise. Maybe the Y will get the message if they really care about serving the communities they are located in.

Avoid Optum RX - Worthless

jp65591993 — Sat, 19 Dec 2020 13:55:17 GMT

Been 10 days since order and prescription never received. Tracking claims shipped yet USPS has no record of receiving package. United Health Calls handled in India with severe communication issues. Waiting for high blood pressure meds and cant get anyone to reslove.

State Attorney General needs to review OptumRx practices.

Community Rated vs Attained Age Rated Supplement Policies

PatriciaG692637 — Tue, 08 Dec 2020 16:26:34 GMT

I am covered now by an Attained Age supplement (Mutual of Omaha) in the State of Michigan. AARP/UHC has accepted me for a policy to begin 1/1/2001 at an annual savings of about $450 to the existing policy. While UHC is called community rated the presence of the discount for younger users may make it behave more like an attained age product, maybe even higher increases initially than an attained age product. I am looking for a comment on that. Also, I am concerned about negative customer service ratings for UHC as the experience with MOO has been good. Also, I have read that AAPR is easier to get into, medically, than others. Gets to the ease of moving back at some point if needed.

I did get off to a bad start with UHC. They accepted my application, immediately debited my first months premium almost two months before the policy was to begin in violation of when they told me the debit was to begin. I have disputed that charge with my bank. It's hard for me to believe this was a mistake and this action causes me concern.

Thanks.

United Healthcare- Should not be sponsored by AARP

ElliotS204698 — Sat, 05 Dec 2020 00:41:29 GMT

I went to the Medicare site and looked for a company that might have a plan to replace my pathetic plan by Emblem. My wife and I looked at which doctors were part of the United Healthcare AARP plan. When we started, my primary care provider was listed so I went ahead and applied. I got a confirmation letter. Since my wife is being treated for lymphoma and has more doctors than I do, we looked up all of the doctors treating her and NOT one was listed as participating. We looked up five and none were listed.

What really upsets me is the wait for a representative but more importantly that they transferred me three times and I wound up in sales because the other representatives would not help me as they probably wanted to transfer me to sales.The sales person told me that she would look on the list to see if there was a mistake and I had "misread" the doctors list. I am a retired teacher - an English teacher- and to imply that I could not follow the list was insulting. The representative insisted on looking it up and she claimed that one of my wife's doctors was listed. I questioned this and she looked again and saw that the doctor took certain United plans but NOT plans involving Medicare Advantage. What bothered me the most is that like the lists at my "beloved" Emblem, the lists were very wrong about things. I even saw on a list that was for pharmacies that are participating, a listing of a pharmacy in my neighborhood that had been closed for THREE years.

I asked the sales representative why the lists are so incorrect and outdated. She told me that entries are changed or taken out if the doctors or pharmacies update them and notify United. REALLY? And you have the customers make his decision about a plan based on a list that is inaccurate. . Wow! If I owned that pharmacy, the very first thing I would do if I were closing was to call United. It would be my ultimate responsibility. Seriously? Shouldn't they revise their lists (United and Emblem) by hiring help to check the lists, to update them. BAD BUSINESS!!!! So sad, so inept, so dumb!!!

Increase in supplemental plan?

ka4778 — Thu, 03 Dec 2020 21:20:35 GMT

My supplemental plan went up 7.5% for 2021. Has anyone figured out what their increase is? I'm wondering if that was a standard amount.

insurance companies determining treatments and medication choices is no favor

unlistedmoniker — Wed, 02 Dec 2020 23:53:28 GMT

I was not particularly surprised to see the increases in monthly premiums for the AARP sponsored health insurance packages, but I was disgusted to receive my 'personalized' notice that my medications were no longer going to be covered as in the past. What is it that has inured us to insurance companies deciding what is and is not acceptable treatment or medication based on their ability/inability to make a profitable deal with drug companies? The company was kind enough to send me their recommended alternatives, both of which I tried and both of which created unacceptable side effects. I suppose that is nothing compared to the consideration of corporate profits. I consider my doctor to be the one to provide the best alternatives in treatment for health issues. We're long past due to complain long and loud until this practice by insurance companies is halted.

Dental and Vision Plans with Medicare Advantage

fr8935 — Fri, 27 Nov 2020 16:00:01 GMT

Hello,

I would appreciate advice re the following question:

My Medicare Advantage plan (Aetna PPO) for 2021 offers Dental and Vision coverage. I can also buy separate Dental (Cigna) and Vision (VSP) insurance. Should I buy the extra Dental/Vision coverage?

Thanks in advance for any guidance on this.

Regards.

Medicare supplement for eye surgery and dentures

DebbiM890977 — Mon, 23 Nov 2020 22:10:14 GMT

My husband needs eye surgery and lower dentures next year. Is there a Medicare supplement that would help with those two situations?

Medicare supplement plans and preexisting conditions?

ReTiReD51 — Sun, 22 Nov 2020 15:28:26 GMT

Question?

In my state United Health a few years back allowed its members to switch from plan F to any of their other lettered plans no questions asked any time throughout the year. Then with 4 months left to go before plan F was phased out for new enrollees UH started requiring you to answer questions pertaining to any possibilities you might have a preexisting condition which might prevent you from switching from their plan F to any other of their lettered plans.

My question is what constitutes a preexisting condition?

If I was taking a statin to help lower my cholesterol levels to reduce my risk of a heart attack with plan F, would that be considered a preexisting condition in being accepted for another UH supplement plan?

What about a pill to reduce inflammation symptoms (arthritis) and improve quality of life? A preexisting condition?

Hopefully you get the gist of what I’m asking, what constitutes a preexisting condition?

And not to pick on UH because many other insurance carries refused from the beginning to allow anyone to switch plans without answering preexisting condition questions.

ACA Open Enrollment 2021

AARPRachelA — Fri, 20 Nov 2020 20:52:26 GMT

The Affordable Care Act open enrollment for 2021 is taking place now until 12/15/2020.

Though open enrollment ends Dec. 15 for consumers who get their coverage through the federal marketplace, 10 states and the District of Columbia have set later deadlines for when people can either make changes to their existing plans or sign up for the first time through state marketplaces:

Minnesota, Dec. 22
Colorado, Nevada, Pennsylvania and Washington, Jan. 15
Massachusetts and Rhode Island, Jan. 23
California, New Jersey, New York and Washington, D.C., Jan. 31

Healthcare.gov has a calculator to help you figure out if you qualify for a tax credit and/or cost-sharing subsidy and the amount you may qualify for.

For more information, check out this handy article from AARP.org: ACA Open Enrollment for 2021 Runs Until Dec. 15 for Most.

Can I secure Medigap online quotes - no personal data required?

relentlesslyawesome — Fri, 20 Nov 2020 18:03:27 GMT

Is there an online site that will provide quotes without having to provide your phone number and address? I'm not finding one so far.

Medigap F versus G

relentlesslyawesome — Wed, 18 Nov 2020 19:50:42 GMT

I've noticed that the AARP sponsored Medigap plan F is much more expensive versus Plan G, although a deducible is paid ($203) under G. Even with the deducible Plan G nets a savings of around $350 annually.

On the other hand, Plan F has stopped accepting new subscribers this year and if one moves out of Plan F you cannot go back.

I'm wondering why Plan F is more expensive versus Plan G. My understanding is that 50%+ of Medigap participants are in Plan F, but with Plan F not accepting new participants perhaps the aging of that group causes an increase in the monthly charge? Plan G does have younger - new participants signing up so perhaps the lower cost is the impact?

With that said, a couple can save $700 annually by switching to G from F, but are there other considerations? Of course, Plan F going away for new participants is another puzzling event and perhaps connected to pricing in some way.

Input will be appreciated.

United Health Care

markwalker — Tue, 17 Nov 2020 18:56:27 GMT

I am a very frustrated AARP Member in Massachusetts who has been trying for more than 3 weeks to sign up with a UHC Plan. I talked to a representative from Florida, another from Georgia and someone from god knows where. Each time I call I am told someone will call me and no one has. I would like a call from someone who is going to help me decide what my options are. Anyone please reply to this post.

Optum RX is totally the Worst

kn8885 — Tue, 17 Nov 2020 02:20:51 GMT

Have had multiple issues with Optum over the years, but it is getting worse by the month.

Latest, they screwed up listings for two of my prescriptions. Put name of medication on prescription that they had nothing to do with. I had paid cash at local pharmacy for that one. Original prescription they could not refill because medicine name was on two different numbers. Their solution was to delete both from system and get new prescription from doctor.

They screwed that up with wrong doctor information on one web page than another.

Several phone calls and call backs consuming hours of my time.

New prescription for same medication I have been taking for years.

Web site says estimated delivery 11/10. Today is late on11/16. Web site says it shipped on 11/10---huh? Says 1-2 days tracking info will be there. It is not. Called, same recording saying hi traffic volume, but someone answered within 2 min. However, after explaining situation, she put me on hold for 25 min. Came back to tell me it was USPS problem not theirs. That USPS had told them they would not be updating tracking information.

USPS says that label and number are generated by Optum at Optum's facility, not by USPS. That USPS does not start tracking until it is received and scanned in by them. Optum says it is USPS problem because they put it in the bin and sent it out the door.

Optum will not do anything until after 19th. But the charge on my credit card cleared on the 11th.

Unfortunately, this is not the first (not even close) time that Optum has screwed things up. My wife gave up over a year ago and gets her medications filled at Walmart on time. Sometimes a little more, but sometimes a little less cost........and a helluva lot less hassle.

Seems like a good idea. United Healthcare sends her letters regularly about how she could save lots by going to Optum. Not from her experience.

Do yourself a favor do not use Optum for anything.

COVID test insurance

ExPatBrit — Sun, 15 Nov 2020 06:46:45 GMT

My GP issued a prescription for a Covid nasal test and sent it to an independent lab.

I went to the lab where the nasal specimen was obtained for forwarding to a local lab for analysis and report.

The intermediate lab then charged me a $30 fee, gave me a "superbill" and receipt and said they don't bill insurance.

I am somewhat annoyed since I thought either my GP would take the specimen in his office and send it to the lab or he would give me an order to take to the lab.

How do I claim this via the Medicare A/B system?

Do I somehow send it directly to Medicare?

Do I send it directly send to my "Medigap" insurer?

Located in California, if it is relevant.

How To Select Best Employer Sponsored Heath Insurance Plan For 2021

wpollock — Tue, 10 Nov 2020 16:43:16 GMT

Because my wife and I are thankfully healthy and only typically visit our primary doctors for annual wellness exams which are 100% covered and take few prescription drugs, we normally opt for a higher deductible/lower premium plan with an HSA. However, I will in all probability have major surgery on my hip in 2021 and would like to ask how I should compare our 2021 plan choices to select the best one from a perspective of total out of pocket expense we will have to pay. We have three choices that offer a HSA as follows:

Annual Premium Rewards* Cost of Coverage Annual In-Network Deductible**

Plan 1 7181.08 1200.00 5981.08 1400.00/2800.00

Plan 2 5281.84 1200.00 4081.84 2800.00/5600.00

Plan 3 4169.26 1200.00 2969.26 3300.00/6600.00

* Incentive rewards are a premium credit for meeting certain biometric screening values and lifestyle goals such as tobacco free etc..

** Individual/Family

Thanks for any feedback,

Medicare Part c and contacts at AARP

RafaelG498626 — Thu, 05 Nov 2020 20:36:27 GMT

Applied for Medicare Part C, via AARP UnitedHealth care Medicare Advantage over 10 days ago. Got a confirmation number and that is the last I heard from them, no documents to examine nothing.

Part of the reason I get teed-off at AARP is the lack of communication as shown on their website. Paying and signing up is not a problem, when an issue shows up the only way I see to communicate with AARP is via this forum, wait on the phone or send a letter. Show the little AARP has for their customers, they give pleanty of Lip Service, but no way to email customer service. Please do not refer me to social media, I did not enroll with them.

how can I reach UHC

wahorserider — Thu, 29 Oct 2020 21:35:56 GMT

When I call 800-523-5800 it tells me they are closed and ends call. I want to change my plan but cannot reach anyone. It is 2:23 PST time here and they close at 11pm EST so what the hell is happening.

Medicare Advantage

RuthM940163 — Thu, 29 Oct 2020 17:50:18 GMT

Why is there not somewhere you can call for general information on a plan you are interested in without having to give your personal information. If you don't like the plan after getting the information and want to check out another one, just think how risky this is to keep giving out your personal information to a sales person you don't know. This is not good for members. You should be able to ask general questions, even specific one about the various plans without first having to divulge personal information. When I refuse to give it, the person just hangs up on me. I have some general questions about a plan I may be interested in. Who can I call just for answers ONLY.

Choosing an insurance plan

ss11943859 — Mon, 26 Oct 2020 20:25:06 GMT

Confusing ! I'm likely changing plans next year, but finding a new one is no day at the circus. Can't

afford the high premium plans, but the no premium plans don't cover much, as I found out.

Thinking of a low premium plan next. Possibly find a part-time job. Anyone have suggestions as to a good no premium or low premium plan ? Thanks !

Everyone keep safe & well ! 🌄

Quest Diagnostics should be dropped as AARP UHC preferred lab.

corgi67530 — Sun, 25 Oct 2020 22:28:16 GMT

Quest Diagnostics should be dropped by AARP. It only accepts one insurance at a time, Medicare, and then bills the patient for the amount that AARP UHC Supplement covers.

This can only be remedied by going to the Quest web site and jumping though loops to change the insurance on there to the supplement. Many seniors will pay the amount not realizing it should have been paid for by their supplement.

This happened to me last year and has again happened this year. I am deeply disappointed in UHC for their choice of Quest Diagnostics as their preferred lab.

Others accept both Medicare and the Supplement and the patient does not receive a bill. WHY is AARP using Quest Diagnostics?

My blood tests are automatically sent to Quest since it is the preferred company chosen by UHC. Why would AARP select a company who does not accept both Medicare and the Supplement's information. Other companies do. This practice of Quest is harmful to seniors causing them out-of-pocket cost that should have been paid for by their AARP Supplement insurance.

Why are we being penalized all these years for signing up late for Medicare

r280416r — Sat, 24 Oct 2020 06:17:42 GMT

It's been 9 years that I've been charged approximately $140 out of my Social Security because unfortunately I was on Obamacare and then they said oh you can't use that you have to be on Medicare and you're late for signing up. So you need to be penalized 10% each month.

How many other people out there are going through the same thing I am and why are we still being penalized?

I could see a one-time late fee being charged, but this is ridiculous. Once again the government just sucking up money from us older people who don't have much to get in the first place.

Medicare Discount Card phone calls

BobtheScott — Thu, 22 Oct 2020 23:27:23 GMT

Surely others must be getting these calls?? I receive at least 1 to 2 a day from mostly local (California) numbers, a few from Florida or Texas, all of them picked up by voicemail since my IPhone is set to allow only those numbers on my contacts list to ring thru.

every call starts "HI, I'm from Medicare Discount Card "...I've blocked all of the numbers but new numbers keep getting thru. They always leave a callback number, and I've noticed that many of the calls reference the same few callback numbers.

This has been going on for several months. I am on the national do not call registry.

2021 Part B Premiums - Gonna Be A Little Tricky This Year

GailL1 — Thu, 22 Oct 2020 19:54:57 GMT

The 2021 Medicare Part B Premiums are not out yet but Congress has already passed a limit on them.

On 09/28/2020, Congress passed a provision to limit a possible (Medicare Part B) premium increase to 25% of what it would be otherwise is included in a short-term budget bill.

CNBC: 10/01/2020 - Congress caps Medicare Part B premium spike for 2021

The COLA for 2021 is 1.3% of your total SS check - let's say on average that would be about an additional $ 20 to your benefit. By the SS Law, simply put, any increase in Part B premiums cannot make your SS benefit $$ go down from one year to the next - so there is already this limit - which normally, the Part B premiums would be limited to that $ 20 (or below)

Now with this new (but temporary one) Part B premiums would be limited to 25% of that increase limit - in this case, about $5.00.

The way Part B works is that beneficiaries pay about 25% of the program's cost in premiums. These premiums go into a fluctuating Trust Fund of in (premiums) and out (medical cost) monies called the SMI Trust Fund (Supplemental Medical Insurance) - the other 75% of the cost of Part B medical care is paid by the government out of general funds.

Nowadays, we are probably very lucky that the previous limit is there (by SS law) and now we seem to also be blessed with this newest (but temporary) limit. I say temporary because the bill only covers 2021 - I think until Sept 30, 2021 - the end of the government's fiscal year.

But this worries me somewhat because we know that because of Covid-19, medical cost (Part B as well as Part A) have been high and well, folks, somewhere down the line this is all gonna catch up with us in premium cost. And who knows what we will do about Medicare Part A and it's financial problems - that the Hospital portion Trust Fund that comes from payroll taxes.

Medicare for Veteran's.

JohnS417386 — Thu, 22 Oct 2020 16:08:44 GMT

I have been going exclusively to the VA. What should I sign up for? Do I really need the alphabet of medicare? Will parts of the medicare packages effect my VA coverage? I am a disabled veteran for hearing and have been receiving 100% of my medical services through the VA. What won't the VA cover if I do not sign up for medicare other than part A?

Thank you,

John

OPTUM-RX is the WORST

sg79844031 — Wed, 21 Oct 2020 15:31:05 GMT

Cannot say anything good about OPTUM-RX. After 5 years, I am dumping United Health Care Medicare Part D. I got robocall yesterday saying that my medication had been recalled due to carcinogen contamination. After that robo-statement, the robocall immediately went to a busy signal and cut off. So I called customer service. Spent the next 25 min. on hold trying to confirm or deny the recall. Hung up. Sent message to OPTUM. The message reply next day did nothing other than promise to open a case file and to confirm that I agreed to deal with my issue via email. [WHAT???] So, today had phone call with customer service rep (not a pharmacist) who immediately told me to stop taking the medication (which, by the way, was delivered to me AFTER the recall notice had already been issued by the Food and Drug Administration). I asked the customer service rep for details. He put me on hold and five minutes later got back on line and corrected his statement. Told me OK to take the medication, that the lot issued to me had not really been recalled. I searched around on internet and found an OPTUM phone number to call to demand to speak with a pharmacist (NOTE: the OPTUM website does NOT notify you of your right to speak to a pharmacist; nor does it give you a phone number to connect to a pharmacist). I finally got a pharmacist, who confirmed that my medication had in fact been recalled and promising to send me a replacement. This is dangerous and puts my health at risk. Note: This is only one of about 10 complaints I have logged with OPTUM-RX over the past five years. This is one of the most expensive Part D plans on the market. My annual Part D charge is almost $1,000. The service is the worst.

Medicare Open Enrollment Guide

AARPRachelA — Tue, 20 Oct 2020 20:42:05 GMT

Medicare open enrollment has begun! Open enrollment takes place on 10/15 - 12/7/2020 for 2021 plans. Give the coronavirus pandemic, it's especially important to review your coverage and make changes if needed.

Check out this guide for medicare open enrollment.

HSA Question

wpollock — Tue, 20 Oct 2020 19:33:32 GMT

I have a fast approaching 27 year old son whom my wife and I claim as a dependent on our annual tax returns. We are currently researching possible individual health insurance plans for him since he can no longer be covered under my wife's employer sponsored plan. Regarding allowable uses for HSA contributions, can we use her HSA account to pay for any of his medical expenses such as prescription drugs, doctor/dental visits etc.?

Thank you for any replies and please stay safe and vote early!!

Two Medicare Supplement Plans

brian552020 — Tue, 20 Oct 2020 15:37:51 GMT

Hi all! I'm curious to know if it's okay to have two Medicare Supplementary plans. I'm on my wife's work plan now, but I'll be turning 65 in November and I was thinking of switching to my own work retirement supplement plan. Though I think mine is better for a few reasons, I'm not positive about it. So, we were thinking it might be good if I kept the old one while taking the other as well.

Aetna Medicare or United

DonnaI729360 — Sun, 18 Oct 2020 16:14:38 GMT

I have Aetna and have not had any issues with them but they took OFF my primary doctor and he was the first doctor I actually liked. He said to go for Florida Blue but my orthopedic is NOT on Fl Blue and I have bone on bone both knees and will eventually have to have surgery. Anyone have either plan? Should I look for new primary or try to switch now that open enrollment is happening?

Any help would be greatly appreciated. I do not have any medical issues except for my knees, not on any meds either. Donna

Medicare Open Enrollment 2021 BE AWARE

l993995l — Sat, 17 Oct 2020 02:11:17 GMT

I have become dismayed with the Medicare Plan Finder and in some cases the drug companies too. The main issue is that I cannot count on the Plan Finder for Medicare to be correct. I am not talking about estimated pricing, I know of that. I have discovered that the price quoted for a drug on the plan finder does not match the drug company cost for the drug by as much as hundreds of dollars. (This is not just me but others I know have had similar problems)

Until last year the plan finder could be counted on as being right, now I have no confidence. To over come this very disappointing turn of events, I tried checking the drug company website for the drug price but some did not provide any pricing and some were difficult to use. It appears that I am going to have to call the company to get the drug price.

What a shame that a good plan finder was reinvented to not work. Bottom line, you can use the plan finder for possible companies but then call the company to be sure the prices are right. I know what I am doing and I feel sorry for those who do not. Be Aware and don't get caught by surprise when you go to the pharmacy to pickup your drug.

Insurance options for parents

mkschmidtjr — Wed, 14 Oct 2020 17:27:08 GMT

Hello Everyone, quick question. I live in Virginia and I was wondering if there are health insurances that cover parents. My wife and I are employed full time but our insurances do not allow us to add parents. I have seen in some discussion groups insurances offering employees to add their parents if the parents are dependents of the employee. Oh and the last time I checked heathcare.gov the basic insurance wanted $1,200/month premiums w/$8k deductible; not doable.

Thanks in advance for anyone's input & recommendations.

Are we responsible for payment because the doctor did not get prior authorization?

cougarlinz — Wed, 14 Oct 2020 13:24:17 GMT

I received a question from a follower that I need help answering. She askes "My husband is on Medicare and has AARP as his supplement. He had a procedure done by a cardiologist. I am just now finding out that the insurance would not pay for this because the doctor did not get prior authorization. My question is: are we responsible for this payment because the doctor did not get the approval first?"

Baby thermometer

JoanaP700669 — Wed, 14 Oct 2020 12:07:26 GMT

Who can recommend a quality thermometer for the babbies? Found only this review miniscreeny.com/best-baby-thermometer

Medicare Cutting Payments To Physical Therapy Providers

rw92658117 — Tue, 13 Oct 2020 08:20:12 GMT

Effective January 1, 2021 Medicare is reducing what they will pay to physical therapists and totally eliminating telehealth services provided by physical therapists. I have been using services for a bad lower back and separately tweaked my shoulder and am just beginning therapy for that. I am worried about these cuts because

These changes will:

Reduce access to physical therapy for Medicare Beneficiaries.
Physical therapists may be forced to reduce the volume of Medicare patients seen
Some practices may opt to discontinue the treatment of Medicare patients entirely
The elimination of telehealth services for physical therapy will negatively impact some of Medicare's highest risk patients during this pandemic
This will impact the solvency and financial stability of physical therapy offices during a pandemic in which the cost of providing care to patients has increased. Doesn't AARP lobby congress on our behalf? I think this change is a bad thing for members

Where are the No Premium Part D Plans?

somarco — Tue, 13 Oct 2020 11:31:02 GMT

Where are the $0 premium drug plans?

I get this question from time to time. Someone, often an agent, more often a home office carrier rep OR someone with Medicare.gov, will plant the seed. WHY are you paying a drug plan premium when you don't have to?

So where are these drug plans that don't have a premium?

There are none.

Part D is OPTIONAL coverage for self-administered medications sold at retail. You are not REQUIRED to buy a drug plan, but if you don’t enroll in a plan when first eligible, you will pay a lifetime late enrollment penalty.

The only direct connection to Medicare is, you must have Part A OR Part B before you are allowed to buy a drug plan.

You are not REQUIRED to enroll in Medicare Part A, but most people will. The majority of seniors qualify for Part A without having to pay a premium. Medicare Part A is funded via payroll taxes.

Medicare Part B is OPTIONAL. Part B premiums are not included in your payroll taxes. The beneficiary pays the FULL premium unless they qualify for a low income federal subsidy.

Medicare Part B is not required unless you want a Medigap plan, or an Advantage plan. In those situations you MUST have both Part A and Part B.

Likewise, Part D is optional and funded by beneficiary paid premiums. Payroll taxes do not fund the drug plans. Except for low income subsidies, the beneficiary pays the full premium.

Vision and dental benefits are optional. Those who want vision, dental, “extra” cancer coverage, “extra” hospital indemnity pay the FULL cost of those benefits. There are no taxpayer subsidies.

Medicare supplement (Medigap) is OPTIONAL coverage. Beneficiaries pay the full premium.

Medicare supplement plans do NOT receive federal dollars. As such, you will not find a $0 premium Medigap plan.

Medicare Advantage, sometimes referred to as Medicare Part C, is OPTIONAL coverage.Beneficiaries can CHOOSE to receive health care benefits from original Medicare or from an insurance company. When a beneficiary enrolls in an Advantage plan money is transferred from the Medicare “trust fund” to the carrier. The Treasury can do this because they are not responsible for your health care benefits or claims.

Many Advantage plans have a $0 premium. They are able to do this because of direct funding from the federal government. Carriers use that money to determine the benefit structure (deductible, copay, coinsurance, MOOP) and pay a portion of your claims.

Carriers also negotiate provider contracts that let participating providers know which services are covered, which are not. Par providers also know how much they will be paid, and HOW they will be paid, by the carrier.

Providers are not required to accept Advantage plan patients unless they participate in Medicare.

But providers are not required to participate in ALL Advantage plans in their area.

Unlike original Medicare which has almost universal participation in Medicare, patients with Advantage plans should choose only PAR providers unless they are willing to pay more for their care. Some Advantage plans will ONLY pay claims submitted by providers who have executed a contract to provide services to plan participants.

Some Advantage plans have a $0 premium because of federal funding.

But there are no $0 premium stand alone Part D plans.

Now you know why.

Medicare Part D explained plus federal funding - Wikipedia

From a budget perspective, Part D is effectively three different programs:

About 40% is spent for low-income Medicare beneficiaries (20% of those on Medicare overall) mentioned above and the drug costs of low income people on Part C. This expense was previously (before Part D) mostly covered by Medicaid, the Veteran's Health Administration and state pharmaceutical assistance programs. A very large percent of this first group is also on Medicaid.

About 40% is premium support that allows middle-income Medicare beneficiaries and the rest of the people on Part C (about 40% of those on Medicare overall) get drug coverage. After the first five years of Part D, government-accountability-office research shows that this part of the "Part D budget" appeared to be holding down other Medicare costs related to provider services because beneficiaries were more consistently taking their medications. As a result, the middle-income portion of the Part D program may actually pay for itself in the long term.

About 20% of the Part D budget covers re-insurance for catastrophic drug costs as described above. Part D pays 95% of costs over the TROOP. This part of the budget helps about 1% of the people on Medicare who are very ill. https://en.wikipedia.org/wiki/Medicare_Part_D

Keep Employer Coverage or Enroll in Part B and/or Advantage Plan

f635200b — Mon, 05 Oct 2020 20:15:25 GMT

I turned 65 in August and I signed up for Medicare Part A and have my card. I'm still working and plan to keep working a few more years, so I still have my employer health coverage. But now we'll be doing open enrollment soon and will likely have a premium increase again and I want to know if there is an advantage to cancelling my employer coverage and simply buying a medicare plan that would cover basically the same thing, and wonder if I could possibly save money doing so.

Two Medicare Policies Should be Changed

aruzinsky — Fri, 02 Oct 2020 00:29:17 GMT

1. Every Physician should display a list of Medicare Advantage plans to which they are an in- network provider.

As it is, only insurance companies have to provide a list of physicians and health organizations that are in-network. The problem with the current policy is that many, if not most, in-network physicians

are not listed by name but only by their employer who signs the contract with the insurance company. In some cases, it is difficult for the patient to know the name of their doctor's employer. For example, my primary care physician (PCP) was employed by MacNeal Hospital, which was purchased by Loyola Medicine, which is owned by Trinity Health, which employs 5300 physicians. Oh, gee, what could go wrong? I accidentally selected a Cigna Medicare Advantage Plan to which my PCP is out of network. I submit that the current policy is error fraught.

2. Prior authorization of drugs should be between the patient and Medicare instead of between the patient and the insurance company.

As it is, a patient and physician have to fill out large amounts of paperwork, to get the same drug approved, every time the patient changes insurance companies, and, each time, approval is uncertain. That policy stifles competition between insurance companies by providing an unfair incentive for a patient to keep the insurance company that approved the drug.

State Farm Medicare Supplement

KarenD104232 — Thu, 24 Sep 2020 20:51:49 GMT

Does anyone have a Medicare Supplement plan with State Farm? What do you think of it? I have most of my other insurance through them and just learned they provide these policies too. I am looking a Plan G or possible Plan N.

Thanks for your help!

Confusing drug pricing

MikeD848313 — Wed, 23 Sep 2020 00:02:32 GMT

I have Silver Script Part D. I had to refill a couple of heart medications I take. One for BP and the other for Cholesterol. I put a refill in with CVS and both had gone up over almost 100% since I last filled around 90 days ago. I called Silver Script to see if their tier status had changed. It hasn't and I told the agent these were huge increases. I take 6 prescription drugs on a daily basis for various health issues. I had already had met my deductible early in year. Frustrated I searched on the Internet for lower costs. I had seen GoodRx on TV and thought it was some gimmick. I went to site and see that you have to click on coupons. I priced the two drugs at a local supermarket chain using the coupons and the price is for real. One drug price dropped from around $90 to $14 for a 90 day supply. It was the identical drug. It was already a generic but under Silver Script it was ranked as a tier 3. The other drug was a brand name and I am getting the same drug at the supermarket.

Why do they make it so difficult to find the lowest price for a drug for seniors. There should be one price under medicare Part D and one if you don't have Part D. Obviously with GoodRx I am not using Part D. This is a game like buying a used car or a new mattress. Every senior on Medicare should pay the same price. What's sad is someone like my father who is in his nineties and is not on the Internet is paying higher prices for drugs because he is not computer savvy. So now I have to fill two of my drugs at a supermarket and four at CVS because the price on the other four was still lower with Silver Script. I am saving over $400 a year a now because I shopped the drug prices.

I shouldn't have to do this. GoodRx does show you the pricing at the various outlets so if I went to the site first when I got Medicare 3 years ago I would have seen the price difference. Not using SilverScript doesn't work every time. Another drug I take is $177 for 90 and the best price on GoodRx was $456 for $90. That is the point I am getting too. The lowest price should always be the Part D plan but that is not the case and the price difference is significant on two of the drugs.

Delta Dental

bw94366415 — Mon, 21 Sep 2020 13:34:05 GMT

I enrolled in the Delta Dental DeltaCare plan several months ago and one of the main reasons I enrolled is that they advertised Crowns would cost $395. I went to a participating dentist and had a exam and received a dental treatment plan. The cost of the crown was $805. I asked the dental office to explain the fees and they gave me a breakout of the cost. I called Dental Dental to discuss the cost and they informed me I had to filea grievance I filed a grievance and the response was that I had to pay the $395 plus $80 for a "build up" and $5 office visit. I called the dentist office back and they had received a letter from Delta Dental and said they could not do the crown for that small amount of payment and would file there own grievance. It has now been 6 weeks and no results. When you call Dental Dental they put you on hold and tell you to leave a message. In the mean time I have called 10 other dentist on the approved list of providers and none of them will preform a crown procedure for the $395 advertised Delta Dental does not pay them any more.

I think this is miss advertising and AARP should take some responsibility for this. I need to have several crowns done which is going to cost a lot more that $395 each.