Medicare & Insurance

FROM THE ARTICLE. AARP Endorses Senate Legislation to Stop Medicare Advantage Plans’ Excess Billing.Bill would curb plans’ ability to inflate patient diagnoses, increase government payments. By Tony Pugh, AARP. *** There are 3 comments on the AARP website. Stop by to add yours. **? Published July 16, 2025. AARP is backing bipartisan congressional legislation designed to stop Medicare managed-care plans from inflating patient diagnoses to boost their payments from the federal government.This practice from privately run Medicare Advantage plans, called “upcoding,” is expected to increase the cost of care for Medicare Advantage plan enrollees by $40 billion this year, compared with the cost to cover similar patients in original Medicare, according to the Medicare Payment Advisory Commission. USE LINK BELOW TO READ THE ARTICLE. https://www.aarp.org/advocacy/medicare-advantage-excess-billing/

I went to change from UHC supplement G+ to G as that would save me about $70/mo. Getting actual useful information out of the medical underwriting people is like pulling teeth and then some.  I failed - not because I should have but because of mistakes in my medical record (eg coding errors and in two cases people listing in my visit notes issues I neither saw them for nor have). As a result of that in care everywhere (where EPIC/MyChart parks your diagnoses) I have wrong things (that are causing me to fail - although it took 3 phone calls to finally get a list). And some wrong codes have been listed with billing me. I have corrected all but 2 things on that list and can't figure out how to do those last two. In one case I called the head of billing and she had codes corrected in their system and then re-submitted the bills with the corrected codes.In the other two cases I had one person fix his visit notes but can't get him to report this to billing so they can fix the

I have gone to several different optometrists during the past several years for what I believe are routine eye exams and got new eyeglasses when my prescription changed. I believe those exams were pretty much the same at each place, and included “refraction” to determine my eye glasses prescription, plus they checked my eyes for glaucoma and cataracts, and looked at my optic nerve - none of which I’ve never had any issues, luckily.   These exams each took about 30 minutes each optometrist. Two of these optometrists charged me about $125.00 for the exam, which I paid.  The 3rd optometrist charged $253.00 for the exam, asked me to pay them $45.00 for the refraction portion of that charge (which Medicare does not cover), which I did pay them, and then they billed Medicare for the remaining $208.00 (which Medicare subsequently paid to them). I have looked at the Medicare website, all of the invoicing codes and descriptions for this optometrist’s billing to Medicare

What is AARP's position on Medicare's soon to be enacted pilot program in six states that would require prior approval for certain medical procedures? 

 I have recently been diagnosed with cancer.  Fortunately, I have a Colonial cancer policy to assist my regular health insurance and medicare coverage.  Is there someone with AARP that can assist me in filing my claims?  I am insurance challenged. 

Medicare Program; Implementation ofPrior Authorization for Select Servicesfor the Wasteful and InappropriateServices Reduction (WISeR) Model Has anyone heard about this going into effect? Shouldn't we be concerned? It is going to impact 6 states to start with. This is for standard Medicare. New Jersey, Ohio, Oklahoma and Texas, Arizona and Washington. It will mostly impact procedures that deal with pain mitigation.  

I could not find the HOUSING board so I am posting this here just so you can stay informed at what some states are doing for the elderly/disabled. KFF Health News 08/18/2025 - Health Care Groups Aim To Counter Growing ‘National Scandal’ of Elder Homelessness  Medicare.gov - PACE from the link ~Program of All-Inclusive Care for the Elderly (PACE) is a Medicare and Medicaid program that helps people meet their health care needs in the community instead of going to a nursing home or other care facility.If you join PACE, a team of health care professionals will work with you to help coordinate your care. Read a lot more at this Medicare link to tell you all about the PACE program - Does your state have a PACE program?Medicare.gov - What States Have A PACE program  CMS.gov- Program of All-Inclusive Care for the Elderly (P.A.C.E.)    

  It is possible to do, without underwriting, but it takes staying on top of it and making sure that the timing is perfect. And this may also involve managing your health care expenses for the time that one is under the MA plan. Medicare.gov - Learn How Medigap Works  from the link ~  Trial Rights:If you drop a Medigap policy to join a Medicare Advantage Plan for the first time, you’ll have a single 12-month period (your trial right period) to get your Medigap policy back if the same insurance company still sells it once you return to Original Medicare. If it isn't available, you can buy a Medigap policy you qualify for that's sold by an insurance company in your state (except for Plans M and N). You may also have an opportunity to enroll in a Medicare drug plan at this time.

Does Anybody Have Their Medigap Policy with ALLSTATE? If so, have you gotten a letter from them on closing out the plans (closed book) ?You can keep the plan but they will be selling no more to new beneficiaries.  This is gonna cause your premiums to rise down the line.    Pay attention to any communication that comes from them on your Allstate Medigap plan.  

Worth the read:KFF.org Health News - 08/15/2025 - Breaking Down Why Medicare Part D Premiums Are Likely To Go Up  excerpts from the linked article ~Medicare enrollees who buy the optional Part D drug benefit may see substantial premium price hikes — potentially up to $50 a month — when they shop for next year’s coverage. Increases are expected to mainly affect stand-alone Part D plans, not the drug coverage offered as part of Medicare Advantage, the private sector alternative to original Medicare. Policy experts say premiums are likely to go up for several reasons, including increased use of some higher-cost prescription drugs; a law that capped out-of-pocket spending for enrollees; and changes in a program aimed at stabilizing price increases that the Trump administration has continued but made less generous. One thing is surer than ever, say many policy experts: Beneficiaries should not simply roll over their existing stand-alone Medicare drug plans. ===

Open Enrollment for Part C (Medicare Advantage Plans) and Free Standing Part D Prescription Drug Coverage plans will be coming out later in the fall for everybody to review their plans.  Open Enrollment starts October 15 - December 15 for 2026 plans. There is gonna be some changes again this year - like some PPO plans will go away and there will also be some changes to the rules governing the Prescription Drug Plans. You should get something from your private insurance company by about October 1 and you need to read and take heed of what changes are being made to your plan and then make any necessary changes.   If you need help with deciding this, your state offers some help  and of course, there are LOCAL Medicare Plan brokers that can also help you in deciding which plan maybe the best for your and your needs.   The Medicare insurance marketplace is going thru some changes and it is important for you to make sure that the plan you need is the p

I Have been paying on my insurance acquired through AARP for the last 14 years. Handled ultimately by N.Y. Life. I retired July 2021 and in July 2022 I was notified that my rate would increase by $41.00 per month for the next 5 years. It would increase again in another 5 years. Let's remember that retired means fixed income. The notification letter states that you can change to a permanent plan which will prevent further rate increases. I expected that to mean my rate would be the same. Nope. I called NY Life and was hit with the bait and switch information. In order to have a fixed rate I would have to pay over $300 / month! That would be a 300% increase in monthly payments! Being irate and appalled I requested to cash the policy out and go somewhere else. Low and behold the policy I have been paying into, recommended by AARP,  is one that does not gain portfolio value. Read: NO CASH OUT VALUE! In order to benefit from this insurance I have to die and in the mean time keep paying

Has anyone received this notice from their health care provider?  I read about it on AARP that it was supposed to happen in 2024 then it said 2025.  Now it might be 2026.  Does anyone know when we are supposed to get this?  As I understand it, it would be sent out to all members on a Medicare Advantage plan that usually have perks or benefits not normal in original medicare.  Like if you have a gym membership or OTC benefits and maybe you are not using it because you are not aware of it.    This is not the same as a notice you might get from your provider in the fall so you can compare plans for possible switching the next year.  This is a personalized letter that is supposed to enlighten you about benefits you may not be aware of.  It is supposed to mailed out between June 30-July 31.

While AARP Is strongly and with good zeal calling out these Pharmaceutical companies for ripping off Seniors for their staggering prices on life saving drugs.    I have another issue. Why is AARP pushing for United HealthCare. I recently wanted to switch from my existing secondary healthcare provider to AARP and lo and behold hey wanted to triple my costs. Please excuse me if I’m wrong but i have always been told that AARP backs their Senior Citizens. So if that is the case then IMHO, AARP should NOT be in the business of Healthcare Unless they’re here to lower the prices of our insurance. Hence as i said before, this is without a doubt ‘A Conflict of Interest’.

Both of my parents have had an AARP Medicare Advantage plan from United Healthcare (UHC). In both cases, after they went onto hospice, UHC refused to cover any non-hospice services (those that are not related to their terminal prognosis), even though the Evidence of Coverage contract says they would. (Note that hospice-related charges shift to Original Medicare, even if one is on a Medicare Advantage plan.)For example, my father has a pacemaker, which undergoes routine evaluations. Those evaluations are not hospice-related. Just because someone is on hospice does not mean that they are ready to die based on a problem with their pacemaker. However, UHC is refusing to pay claims related to the pacemaker and insisting that the claims be submitted to Original Medicare instead. When I called UHC about this and spoke with a supervisor, he said that there were "hidden things" that do not appear in the Evidence of Coverage. In addition to having a higher cost for patients (deductible

Not sure why, because I did not request it, but I was automatically enrolled in Part A Medicare. I was collecting widow benefits under my deceased spouse's Social Security starting 2 months before my (what Social Security considered) full retirement date. I switched over to my own Social Security when I turned 70 earlier this year. I still work full time and have been working for the last 40 years with full creditable health care coverage at work. My questions are:1. How did I get automatically enrolled in Part A--did it have anything to do with switching to my own Social Security from the the widower benefit?2. If I sign up for Medicare Part B before I retire and still keep my health insurance at work (which I can do) are there Medigap plans offered that do not require health questions or exams? I live in Florida and would plan to retire after Part B and a medigap policy is in place.

If you're both on the same plan, in the year that the older of you will switch to Medicare, put the younger person as the primary member for the plan. Else, when the older one switches over, the insurer (in our case Blue Shield) will terminate the existing plan and start a new one for the younger person, ie they won't let the remaining member continue the existing plan as the primary member. This means the younger one will lose any $$'s they've accumulated so far that year towards deductible or max out of pocket, because the insurer won't bring those $$'s over to the new plan, they have to start at 0 again.Not too bad if it's a few hundred but when it's a few thousand you can see why they do it, and just guess how much the insurers are making every year out of this policy. 

I received a letter noting my AARP-UHC Plan G policy premium is going up 13% as of July 2024. It also stated the cost will go up another 5% on top of that for January 2025. Did AARP dropped the ball for their membership in going with UHC again this year? What's with a mid-year price increase, regardless of the magnitude.  Is it our responsibility to rescue UHC management or their shareholders when they miss their profit targets that badly? What exactly justifies an 18% price increase in seven months time (from June 2024 to January 2025 premium payments), especially with most of it taken mid-year with very little notice and opportunity to say NO to it?   Could AARP kindly use this situation to investigate what happened and inform members about it,  across ALL the AARP-sanctioned Medigap healthcare plans? Why did this happen and what are AARP and UHC going to do to effectively contain costs so we don't see another huge price increase anytime soon? 

Medicare.gov has this listed: "Community Pricing: Premiums are the same no matter how old you are. Premiums may go up because of inflation or other factors." So, is it this, where everyone goes up the same each year, or is it "Age Attained Pricing like most of the other plans? I joined AARPUH because of the supposedly balanced cost adjustments for all, not per how old each person is, or how ill. If it is not the case, them Medicare needs to change this, as it VERY different coverage than attained age.Mine went up substantially now, 2 years in a row. Plan G.Thanks

FROM THE ARTICLE. Medicare’s Financial Health Worsens.A new report expects the funds for Part A hospital insurance are at risk after 2033.By Tony Pugh, AARP. Published June 18, 2025. Medicare trust fund that helps pay for inpatient hospital stays, known as Part A, won’t have enough money after 2033 to pay all of Medicare beneficiaries’ expected hospital bills — three years sooner than was projected last year — according to this year’s Medicare Board of Trustees report published June 18.At that point, the Part A Hospital Insurance Trust Fund’s reserves “will become depleted and continuing program income will be sufficient to pay 89 percent of total scheduled benefits,” the trustees said in a message to the public, published alongside the report. USE LINK BELOW TO READ THE ARTICLE. https://www.aarp.org/medicare/trustees-report-2025.html

Good Day,I am a long time AARP member who got sick after working 40 yrs. and received a dual early retirement judgment and disability from court in 2013 (or 12).  I got Medicare at the beginning and have been retired over 10 yrs.  I am now 65 yrs. old.In May, 2023, I was robbed of my Medicare card and Medigap card.  I have to wait for the police investigation to end to get my card back, but old providers have honored a copy of it.  I can’t get a couple of surgeries I need done without the card….so far.I’ve been told a recalculation might result in a large increase in my benefit, but I don’t want to risk Medicare.  I am retired under old rules where a person can retire at 65, but my birth year requires retirement at 67, if the new law sticks.  If they can change retirement from 65 to 67, can I lose Medicare/S.S. in spite of my court judgment?  If so, would a recalculation subject me to refiling for Medicare, then being thrown off due to age?  I am

Medicare Supplemental plans have asked the New York Dept of Financial Services to approve a rate increase at the % of increase stated per each company. New York Dept of Financial Services 07/02/2025 - Summary of 2026 Medicare Supplement Requested Rate Actions NEW YORK STATE DEPARTMENT OF FINANCIAL SERVICES 2026 MEDICARE SUPPLEMENT INDIVIDUAL AND SMALL GROUP REQUESTED RATE ACTIONS 07/03/2025  NewYork is one of the few states in the Union that has continuous enrollment into Medigap plans without any Underwriting.  Thus it opens the door for Adverse Selection - where beneficiaries that are, perhaps, sicker and using a lot of Medicare can obtain a Medicare Supplemental plan at anytime without underwriting and the cost is shared by everybody. Adverse selection occurs when lower cost or healthier patients opt out of more expensive plans or forego buying insurance until they need it, while higher cost orsicker patients actively buy more protective insurance&

Various changes can be made to Medicare at different government levels.  How do you find out about them especially if they are very beneficial to you? For example, the addition of a new preventive service available at no out of pocket cost.  In the last few years, Medicare has added PrEP coverage under Part B with the associative monthly blood work all covered - This is covered under Part B but it seems many who need this coverage still have this med submitted under Part D and that is costing them lots of money.   Or another example would be how approved immunizations are now covered as NO out of pocket.  Another would be the addition of a preventive test - like the low dose CT Scan for lung cancer if one is a smoker or was a smoker sometimes in their life.  Or at the state level, a change in state law that would allow you to switch your Medigap plan to another carrier or plan (equal or lesser usually) with NO underwriting which may save premium

I never know if people use my links within my post so here is the list of the Medigap insurers - individual and group - that have requested a premium increase from the NY Dept of Financial Services for 2026 and the % amount they are requesting.. https://myportal.dfs.ny.gov/web/prior-approval/medsupp/summary-of-2026-requested-rate-actions The above is the link where the below info was taken.  I copied and pasted the (2) photos as best I coul.   

I need some advice. I will be 70 years old in November. I am still working and have my health insurance through my employer.  Because my Primary care physician does not belong to my insurance group I had to switch to a much more expensive tier in order to keep my primary care physician that I’ve had for over 20 years not to mention that it is costing me about two hundred more each pay period. I’m confused as to what I should do.   I’m not sure if I should apply for Medicare or stay where I am.  Any help would be greatly appreciated. Thank you!!! Anthony LaMonica alamonica@aol.com