Bluesky and message about posts

Thank you Nicole for your response. Took them 4 months to do it, but it is probably about politics.

John

@sc26974933 wrote:   . . . .  I am on traditional Medicare and paid this year for my deductible of $270 and after that I am billed for "0" money. Nothing for surgeries, procedures, diagnostic tests, specialists, primary care doctors, ER's, hospital stay or blood work. I paid nothing other than that $270 deductible.  I pay $130 mo. for my Senior Supplemental, 0 for prescriptions, $5 mo. for vision insurance and $32.86 mo. for Delta Dental through AARP.  So, my coverage out of pocket for any medical treatment/procedures, eye, dental and medication is $2,284 (includes deductible) for one whole year. 

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You don’t seem to know a lot about Medicare - Traditional or Medicare Advantage.  Allow me to help you with some knowledge.

1.  You pay for Medicare Part A and Medicare Part B just like every beneficiary does - Well, except for those who get Part A by being a spouse who as never worked.  Premium-FREE Part A is paid for by working and paying contributions into the program for 10 years or 40 quarters - you and your employer.  For others, who have not gone this route, they pay a premium .

Part A cost $ 518.00 per month for those with no work history or $ 285 per month with some work history but less than 10 years.

Medicare.gov Cost At a Glance 

Part B or SMI is voluntary participation ( but if you don’t buy it when 1st eligible you are penalized with a late enrollment premium that last forever.).

Part B is paid for by beneficiary premiums which represent normally about 25% of the cost of the program - in 2025, that is $ 185.00 per month.  The remaining 75% of the cost of the program is paid for by taxpayers out of the General Fund.  UNLESS you are a beneficiary with higher income ( single over $106,000 annually and up) then you pay a higher amount as a premium which represents a bigger share of the cost of the program.

For those beneficiaries who are very low income - their Part A (if not premium free) and Part B premiums are paid by their state under the  Medicare Savings Programs

Medicare.gov - Medicare Savings Programs 

2.  Now NOT every beneficiary has access to or can afford a  Medicare supplemental plan.  Now that supplemental coverage can be some associated program like employer retiree coverage, military coverage like TriCare for Life or even a veteran linked program for dependents like CHAMPVA or even Medicaid for those who are low income,  

OR it can be for those who actually buy the GAP coverage in a Medicare Supplemental Plan of their choice, of which each pays a bit differently.

The later type is premium based and the premiums are based on the use of the program, medical inflation and reserves held for claims, as well as the rating method.  These premiums are under the control of the state - and so are many of the rules of participation.  Therefore some states have much higher premiums than others.  

Some states don’t allow those with Medicare who are less than 65 years old any participation in a Medigap plan or they restrict their participation in only one or two of the Medigap plans.  Premiums for those less than 65 who are getting Medigap coverage tend to be on the very high side until they reach the age of 65 ands then they get to choose over again based on being eligible due to age rather than disability.  

I know people today who are paying in excess of $ 400 a month for a supplemental plan - regular beneficiaries and disabled beneficiaries.  

Having Traditional Medicare without access to some sort of supplemental plan is financial suicide because Medicare has NO limit on out of pocket expense and one major accident or illness can send one into bankruptcy.  

Picking the right Medicare Advantage plan can save the beneficiary a lot of money.  And for those who understand employer /commercial health insurance, picking one that meets their needs is not a big deal.  

You pick the one that is highly rated and that has the option on both in and out of network coverage.  You pick the one that has your meds on their formulary at a good price or you find some other method to buy them (the cheapest) if possible.  You understand what step therapy, prior approval means and you work within that realm with them.  You DO NOT pick the one that has the most give a ways nor the one that has the cheapest premiums.

Most MA plans today have a built in prescription drug plan so that too saves some premium cost - these are known as MAPD - Medicare Advantage with Prescription Drug Coverage.  

Your supplemental plan (Medigap)  is rather cheap at the present time but these premiums rise over time and unless you stay very healthy for the length of it or if your state allows a time period to switch without underwriting then one may find it difficult to switch to a cheaper premium plan down the road.  

Same is true of your Prescription drug plan - if there ever comes a time when you may need a higher cost drug or biologic, you may find that your premium for the plan will go up - you might even need an enhanced plan which has a more far reaching formulary.

 Looking into the future - the Medicare Part A Trust Fund is already on shaken financial ground so it is gonna have some added premium cost for it to keep paying benefits as it does now or benefits will have to be modified.  Since Medicare Part B is premium based - those can continue to go up, up, up.  

You buy what you need in your Medicare prescription drug plan - a drug plan that is ran by private insurers just like a MA plan  

My conclusion is that Traditional Medicare is gonna have to be modified with some managed care in order for it to stay as a viable option to many beneficiaries since cost is always a big  concern - now and later.