Medicare & Insurance

Last year i ended up in a GA hospital while visiting family. I live in New York State and had Blue Cross Medicare Supplemental Insurance at the time. The original hospital ER sent a bill to Medicare and Blue Cross. The hospital for the last 11 months has said the secondary payer has not paid the bill and want me to pay it. After numerous hour long conference calls in the spring I discovered the problem. The hospital (or Medicare) had sent the wrong hospital name and address for the bill. The hospital had been taken over by a large regional hospital, but this had happened 2 years before I was there. For the first few months the hospital claimed they had not received the original Blue Cross check but later they admitted they had it. It was decided among all parties that a corrected form would be sent by the hospital to Blue Cross and then Blue Cross would send a new check and void the old one. I am now told, months later, that form was never sent and my account has not been fully paid. I

Beginning in 2025 my state (Connecticut) has a new law that requires medical insurance companies to cover the cost of cardiac calcium scans. Unsurprisingly, no one involved with my upcoming scan--cardiologist, insurance company, or radiology center--knows anything about this law. It's a state law, and AARP touts its legislative advocacy branch--how would I get them involved to try to attack what appears to be willful ignorance of this law? Thanks.

 I am sure that the changes to part D planes next year will help a lot of people but not all.My mother will be paying over $1,000 more out of pocket for her medicine due to these changes. Same drugs same insurance but she will be paying $1998.70 out of pocket next year compared to just over $900 this year. One of her medicines that cost her $2 a month for 10 months this year and $142 a month for the last 2 months of the year will cost her $142 all 12 months next year. I feel bad for those with much higher drug costs and I am glad they are getting some relief, but it seems the relief is not coming from the drug or insurance companies or from the government but from people like my mom. Fortunately, she can manage it for now, but some may not be able to. Is this happening to anyone else? 

Does anyone know how the $ 2000 'limit' for medications is calculated? With the previous 'doughnut hole' method, the combination of what the insurance company paid and what the individual paid was used to calculate the amount to get you to the 'doughnut hole.'  Once the individual reached the 'doughnut hole,' ONLY what the individual paid was used to calculate the amount needed to reach the catastrophic coverage level.   This article uses the word 'sharing.'  Does that imply that both the insurance company's and the individual's payment(s) will be combined to reach the $ 2000 limit?  Or are we to assume that only what the individual pays counts towards the $ 2000 limit? Thanks.  This could make a significant difference in whether or not to use the extended payment program offered in 2025. Dave

You trust your doctor. He prescribes a test, image or treatment but wants you to sign an ABN (Advanced Beneficiary Notice of Non Coverage) - So what is your choice on the ABN if you trust your doctor?  I know what I do - but what do you do? Option 1: You want items or services that Medicare may not pay for. Your provider or supplier may ask you to pay for these items or services now, but you also want your provider or supplier to submit a claim to Medicare.If Medicare denies payment: You’re responsible for paying. However, since a claim was submitted, you can appeal to Medicare.If Medicare does pay: Your provider or supplier will refund any payments you made (not including your copayments or deductibles).Option 2: You want items or services that Medicare may not pay for, but you don’t want your provider or supplier to submit a claim to Medicare. You may be asked to pay for the items or services now. Because you asked your provider or supplier not to submit a claim t

FROM THE ARTICLE - SEE ARTICLE FOR MORE!!! 5 Actions to Take for 2025 During Medicare Open Enrollment. Tips for choosing a Medicare Advantage or Part D prescription plan in a year of historic change. By Kimberly Lankford, AARP. Published October 04, 2024. Be prepared for one of the biggest changes to the Medicare prescription drug program ever: In 2025, out-of-pocket costs for covered drugs will be limited to $2,000 annually. The new cap applies to stand-alone Part D and Medicare Advantage (MA) plans with drug coverage. But the change is rippling down to other costs and coverage. https://www.aarp.org/health/medicare-insurance/info-2024/open-enrollment-action-plan.html

Really good article here on AARP and how they make 3 times as much money from insurance sales commissions from United Healthcare (yes that one) than they do from member dues.  https://prospect.org/blogs-and-newsletters/tap/2024-12-11-how-aarp-shills-for-unitedhealthcare/ Everyone here should understand AARP finances and if this post is removed by the moderators then you know they do not want to be honest or transparent with us.  Follow the money

Apologies if this posts twice, first one "authentication failed."My 91 year old mother-in-law lives in an independent living facility near us. She is having a partial knee replacement in January. She needs a cane or walker to get around and can walk up one step, maximum. She does not have a driver's license. Talking with the doctor's nurse yesterday, I was informed that she is ineligible to receive home physical therapy after surgery (but will need PT 3 times a week for 6 to 8 weeks). The nurse said that: not driving is not a criterion, she can take a ride share; this is elective surgery so she can't have in-home PT; she "does not qualify for that level of ". I looked at the Medicare handbook, as did she, and we are interpreting this differently! Also just had a friend with a knee surgery get in-home PT so not sure what to do next! Any thoughts on how to pursue this? This is a well-known surgical center and I've had friends (younger) who have gone there with no problems; we like the do

Just so everybody is clear - A royalty payment is a regular fee paid by a licensee to a licensor, in exchange for the use of the licensor's intellectual property. This happens when both parties enter into a licensing deal, which could be as part of a franchising arrangement or as a more standard intellectual property licensing agreement. Business owners (for profit and non-profit) receive royalties for their intellectual property or real property assets. A royalty payment is a payment made to an owner for the use of their intellectual property, creative works, or natural resources. The payment is made through a license or royalty agreement.  In the case of AARP - AARP ®️ the letters put together as their logo is their registered trademark, and is their marketable intellectual property.  

Hi,AARP's Medicare Supplemental Medicare Insurance sounds great... but I decided that before I purchase it I should read the reviews.I was astounded! Consumer affairs reviews were the worst I have EVER seen for any product or service from any company. People were talking about outright misrepresentation of services, copays, non-existent customer service. Representatives simply hanging up on customers, drug formularies not covering many common medications. Increasing co-pays. A litany of misrepresentation and worse. Now I understand the Internet. You will always find people more willing to badmouth a product or service than to praise it... but I looked for positive reviews and found none... http://www.consumeraffairs.com/insurance/aarp_medicare.html Is it really this bad? If so why does AARP tolerate this if they are, as they claim, an organization that exists to promote the best interests of senior citizens? Have I simply been looking for reviews of AARP United Heal

  I found this article to be very interesting from the Medicare Advantage viewpoint to the Medicare Supplemental (Medigap) viewpoint.  NCHealth News - 12/06/2024 - Medicare Advantage is popular with NC seniors, but the program has come under increased scrutiny.    Maybe we just need to get back to the basics of Medicare -  only cover what is deemed to be covered by Medicare (CMS) [medicslly necessary].  No more gym memberships of whatever type - premium or sub-premium or ground roots.  No more dental, vision or hearing coverage.  Got a problem with this coverage - change the law.  No more OTC benefits or Part B premium rebates, unless one is approved for a Medicare Savings Program.no more Medigap coverage unless it comes with an adequate high deductible - perhaps like the High Deductible plans - < $ 2800 or so.  No more 1st dollar coverage or even after the Part B deductible.  Coverage is the same, deductible would be

Yahoo Finance News 12/04/2024 - CMS recalculates Medicare Advantage stars for UnitedHealth, Centene  from the link:  UnitedHealth and Centene have received a valuable boost in their Medicare Advantage star ratings for 2025 after squaring up against federal regulators in court.The CMS increased stars for 12 UnitedHealth contracts and seven Centene contracts in revised ratingsreleased Monday. UnitedHealth had three more contracts reach the all-important four star threshold, giving them access to lucrative bonuses for the first time, while two contracts were upgraded to the highest possible rating of five stars, garnering the maximum rebate from the federal government. Many health insurers cried foul when the CMS released star ratings for 2025 in October. Regulators tightened standards for reaching the highest scores, resulting in a small dip in stars across the board. That translates to serious financial repercussions for some insurers, given the stars have a direct i

The original thread has become unwieldy, and has outdated information in it, so I'm starting a new thread. From the Renew Active location finder website: Starting Jan. 1, 2025, Orangetheory Fitness, The Exercise Coach and Xponential Fitness brands including Club Pilates, CycleBar, StretchLab, Rumble, Pure Barre and YogaSix will no longer be in the Renew Active fitness network. This applies to both Advantage members and people who have a Medicare supplement.  So nobody with Renew Active will have access to these gyms. Advantage members have received letters from UHC stating that they will no longer have access to gyms identified as "premium" in Renew Active's network.  Supplement holders have received no such notification concerning "premium" gyms.  UHC sent letters to supplement holders listing gyms they visited in the past that would no longer be available, and in my case the only gyms listed were among the ones listed as no longer being in the

In response to all of the comments about UHC, the fact remains that there has been a continuous pattern of claim denials and increasing profits for this company. Here are the facts. UHC denies more claims than any other health insurerUHC is a for profit entity and raises their premiums higher because of both health care costs and to increase their profits.UHC also very aware that patients will sometimes need to jump through hoops to challenge a claim denial through legal means which means time and money. It can result an a reversed decision on the claim, but it can be a long, painful process.UHC is using AI algorithms in determining a claim eligibilityAARP promotes UHC and receives royalties from them. You can research everything I stated, along with UHC and their overall profit margin, and come up with a fair and educated understanding of the problem. Here are possible and ways to address the problem. Write or call your Congressman or Congresswoman. I contact

I'm 65 and still working, with an employer sponsored health plan. It's a high-deductible plan with HSA so I haven't enrolled in Medicare Part A in order to be able to have the HSA. It's a pretty good but not great EPO plan. Thee employer offers a $6K-per-year opt-out incentive payment.I could get much better insurance if I were enrolled in Original Medicare with Medigap and opted out of the employer insurance, and even though that would cost considerably more than the insurance from my employer plan, the $6K opt-out incentive would cover most of the difference.Questions:1. Is this allowed?2. If it is allowed, do I have to do it during a specific enrollment period or would this considered a special enrollment situation?

Found out today that Lifetime Fitness has dropped AARP UHC Medicare's Advantage Plans from their clubs for 2025. They say they are now all “Premium” clubs and will not recognize Renew Active 

On the medicare.gov website, I see star ratings for insurance plans but I see no opportunity to review a plan. Among other things, Wellcare Ins. Co. apparently cancelled my OTCH account with CVS thereby robbing me of my debit card balance for over the counter drug store products.

 I am 61 years old.  I retired in 2023 and receive a pension.  As part of that pension I am allowed to, and do, pay for the same health insurance that I was getting as an employee.  The difference is I must pay post tax instead of pretax.  Anyway, I have an HSA with substantial funds in it from when I was younger and had a low cost high deductible plan.  My current plan is not low cost high deductible. My question is, since I pay these premiums post tax, am I allowed to reimburse myself from my HSA?

This from Fast Company...If AARP wants to make a dent in the cost of prescription drugs, here where it can start: Pharmaceutical Benefits Managers Pharmaceutical Benefit Managers    

I've been following the complaints about the above-average denials for aftercare, especially the elderly (the Senate issued a scathing report on this). I'm considering AARP Gap Insurance, but now I don't know.

Beware of AARP United Healthcare. We were given a favorable quote over the phone so we signed up. When the actual first bill showed up, the premium had increased significantly. We were simply lied to and they swept it under the rug as a “rate increase” just 9 days after our coverage began. Had we known, we would have had an opportunity to shop around. Poor business practices.

This thread has been removed for violating community guidelines.

No where can I find where this is specifically addressed so hopefully I can at least get some thoughts here.I subscribe to a Medicare Supplement plan not a Medicare Advantage plan.I am entering my annual renewal phase and would consider changing to United Healthcare (but sticking with a supplement plan) specifically because United Healthcare touts additional benefits on their plan website that interest me. However, they do not specifically clarify under which plans these additional benefits are available.  Even my insurance agent has been unable to get a direct clarification.So, here goes: Does United Healthcare include Renew Active benefits with Medicare Supplement plans or only with Medicare Advantage Plans.  

I live in California and am covered by Medi-Cal. Is there anyone that has experienced any coverage problems?

I was told by Club Pilates, StretchLab and The Exercise Coach this morning that AARP/UHC has removed them as a gym for Renew Active for 2025.  As one who has benefited incredibly from these three providers, I am unbelievably disappointed in this decision. My health has gotten better and now they’re taking that away. I feel like it has been a bait and switch.  It blows my mind that they are taking away a benefit that is saving UHC money, in medication,  doctors office visits and hospitalizations.  Where is AARP to protect us and our health and interests?  And please don’t try to tell me that community gyms offer the same services as those three providers listed above. It is simply not the case. All of the providers have said that the information from UHC has been sparse. I spent a hour yesterday on hold just to talk to a representative. Who had no idea what I was talking about. Then I spent more time on a chat and that representative. Also had no idea what I was