Medicare & Insurance

Trying to determine if medicare patients have the right to refuse the annual wellness visit or is it mandated by law?

After reading today's New York Times Article "United Health Applies Pressure to try to Quiet Critics",  I ask that you, AARP, rethink your relationship to this insurer. They have numerous lawsuits to take down videos, social media postings, and newspaper articles critical of them. Intimidating critics shows how these people are probably on the right track. I made the decision to drop them during Open Enrollment for Medicare.

California Health Benefits Review Program (CHBRP), University of California, Berkeley- 04/20/2025 - SB242  This is the Report to the 2025–2026 California State Legislature by this organization about this legislation.  It was introduced this year in the California Senate. It has not yet been passed by both the Senate and the Assembly and then signed into law by the Governor. The bill is focused on expanding open enrollment periods for Medicare supplement coverage.  I am only posting some of the highlights - Understand that this does not affect the “Birthday Rule” in the state where a beneficiary can switch their Medicare Supplemental plan to another plan - of equal or lesser value.     This is actually opening up the Medigap marketplace to those who do not yet have a Medigap plan - they either have nothing or they have a Medicare Advantage (MA) plan.  It also gives those with ESRD a period to get a Medigap plan.  So this is an

Just a note to let you guys know that if your phone is not compatible with their drive app your premium will go up ~$25 a month!   I have a Motorola Android that is not compatible (which I didn't know about until after I had received my quote and changed coverage from my previous Ins carrier) so my premium has gone up $25 and change a month.  Seems to my this is their problem not mine.  We shouldn't be charged because their software isn't compatible.  So I should have to go out and buy a new phone just for their app? Needless to say I am upset.  I could have stayed with my previous carrier for the same coverage, a lower premium and their drive app works perfectly with my Android.  

The Street.com 07/08/2025 - Retired workers to see frustrating change to Medicare in 2026 from the link ~A Medicare change is coming next year, and your wallet will not like it. It’s only an estimate — but if history is any guide, it’s one you’ll want to watch.Tucked deep inside the 267-page 2025 Medicare Trustees report is a projection that the standard monthly Medicare Part B premium could rise to $206.50 in 2026.  That’s an 11.6% jump from the $185 premium set for 2025 — and it would be the largest single-year increase since 2016, when premiums climbed 16.1%, from $104.90 to $121.80. This estimate, however, is not the final number. In fact, it could be even higher.more at the link ~  Yes, this is an estimate by these Wall Street numbers folks but this likely estimate is born out by the 2025 Social Security Trustee Report on Medicare Part B or the Supplemental Medical Insurance (SMI) part of the report. CMS.gov - 2025 ANNUAL REPORT OF THE BOARD

I just got refill of xarelto...$360 for 3 month supply. That is a hike of 200% from previous refill. Does anyone know the reason for this outrageous price hike 🤬 

I was recently forced into retirement, at 68 years old. Until this time I had corporate-based medical insurance, so I figured there was no reason to register for Medicare until I did actually retire, which I was planning to do when I turned 70 (I loved my job). I did receive notifications suggesting I register for Medicare, but ignored them as long as I had corporate-based insurance from one of the top-3 providers.  It turns out, that it is not really an "option" to register for Medicare as soon as you turn 65, but in reality, in the eyes of the top-3 medical insurers it is a requirement! These days they deny full coverage, and only pay "what Medicare would not have paid" even though you continue to pay the same full price for insurance from them that you did before you turned 65, in addition to what your employer is also paying on your behalf.  This doesn't seem fair (nothing in life is fair) as they do not reduce your premiums, while they drastically cut your cove

Just FYI in case you get one of these notifications or a new Medicare card.CMS.gov 06/30/2025 - News Release - CMS Notifies Individuals Potentially Impacted by Data Incident  from the link ~What Happened? On May 2, 2025, CMS’ call center began receiving inquiries from beneficiaries who received letters confirming the creation of Medicare.gov accounts they did not initiate. CMS promptly launched an investigation and discovered that malicious actors had fraudulently created new accounts between 2023 and 2025 using valid beneficiary information, including Medicare Beneficiary Identifiers (MBI), coverage start date, last name, date of birth, and zip code. Once these unauthorized accounts were established, bad actors may have accessed additional beneficiary data, including: Provider informationMailing addressDates of serviceDiagnosis codesServices receivedPlan premium detailsCMS is not aware of any reports of identity fraud or misuse of the information as a direct r

Can someone help me understand Medicare a little bit more than I do.  I have traditional Medical Part B, D and Plan G.  I had a procedure done recently for which the hospital billed Medicare $60,000.  The Medicare approved amount was around $1,800, or 3% of the billed amount.  How is Medicare able to reduce their price to 3% of market?  Why would any physician want to do business with Medicare given that they pay 3% of what the market pays.  What is in it for them? My second question has to do with Plan G.  When I signed onto Plan G I was thinking that the Medicare approved amount was going to be closer to market, like maybe a 15-20% discount.  This would still leave the patient with a sizeable co-pay on expensive surgeries.  But if a $60,000 surgery is negotiated down to $1,800 then the co-pays are peanuts…20% of $1,800 is $360.  I would have to have a $1MM medical procedure once every three years for the Plan G Premium of $185/mo

FROM THE ARTICLE. Get Help Paying for Medicare Premiums, Deductibles, Copays.Find out if you qualify for a federal or state financial assistance program or prescription discounts. By Kim Lankford, AARP. Reviewed by Leigh Purvis, MPA. Published January 28, 2022.➡️[*** Updated June 30, 2025. Medicare covers most of your health care expenses after you turn 65, but it isn’t free.You’ll still have out-of-pocket costs for Medicare Part A hospitalization, Part B doctor and outpatient services, and Part D prescription coverage. If you’re part of a Medicare Advantage plan, also known as Part C, you’ll have cost sharing, too. USE LINK BELOW TO READ THE ARTICLE. https://www.aarp.org/medicare/financial-assistance/

I received my letter informing me how much I’ll receive and hound expect my first payment June 10th or around. Was wondering if anyone know how long this first delay can be?

GREAT- NPR 06/30/2025 - DOJ announces a record-breaking takedown of health care (MEDICAID) fraud schemes   

Yet another newflash study reaching the same conclusions. The risk of being trampled by the MA cash cows herded by Wall Street is greatest for those most in need and least able to react. The original article is behind a paywall but summarized in the second (along with editorial comment.) As always and especially in healthcare, YMMV. Medicare Advantage Plan Disenrollment: Beneficiaries Cite Access, Cost, And Quality Among Reasons For Leaving. Health Affairs Vol. 44, No. 6: Payment Policy, Medicare Advantage & More Churn and Burn: Why Medicare Advantage Patients Walk Away. American Council on Science and Health

Well let’s see if the government can make a difference without all the draconian rules and regulations -   KFF Health News 06/24/2025 - 5 Takeaways From Health Insurers’ New Pledge To Improve Prior Authorization  Sounds like an ultimatum from Government -  “So either you fix it or we’re going to fix it.”Worth watching how it develops in the next few months -  

Humana, the second-biggest Medicare insurer, has told congressional staffers that it will support moves that would curtail billing practices worth billions in extra payments to the industry, according to staffers and a document viewed by The Wall Street Journal. The stance by a leader in the Medicare Advantage business—in which insurers offer privately run Medicare plans—represents an important development in a growing debate over how the companies are paid in the $460 billion program. This is from an article in the WSJ to which I do not have free access but am taking the same info from Reuters which has some of the same info - read either to which you have access. Now what is the best way to get all the insurers onboard?  Support - just saying. WSJ 06/05/2025 - Humana to Back Curbs to Medicare Advantage Billing Practices(Healthcare) Reuters 06/05/2025 - Humana to back curbs to Medicare Advantage billing practices, WSJ reports  (Business)

24 months in and my supp G premiums up 18% cumulatively.  The starting point was outrageously high. Not a prior 'age discount' related increase. .  The reason(s) explained via scripted included 'rising healthcare costs, increased utilization'...etc,   Providers and insurers system broken vertically and horizontally, and this UHC plan is at the head of line. Open enrollment, goodbye UHC

I would love to thank Aarp reduced prescription drug program. My eye doctor recently wrote a prescription for an eyedrop which naturally fell under my deductible with my prescription drug program. The medication would’ve cost me $186 for a small bottle of eyedrop. I then went to a brand-name pharmacy Where initially the price would’ve been $334 had they not had prescription drug program I went to good RX, which offered a generic prescription for between 60 and $70 which was not available. I then went to Aarp and made a phone call and spoke to a young lady who told me the same medication Through the reduced Aarp prescription drug program would cost me $75.15. It’s just amazing the way that the cost for the same prescription can vary so much and this actually needs to be looked into. I would love to thank Aarp for all the great work. They’re doing For the seniors as well as the money that they are saving seniors so they do have a choice whether to take a medication and or eat and or just

If you use a different address on your medicare enrollment form than is listed with social security, will the medicare enrollment be denied? Also if they do deny the enrollment, do you have to appeal? These questions assume that you otherwise meet the qualifications to enroll and the denial would be based only on the information mismatch.

Hi. I'm 61 and newly divorced. I'm about to get kicked off my ex-husband's healthcare plan and I'm overwhelmed with trying to figure out ACA. The free state help offices are booked past the date I need to start. Where can I go for help? Thanks.

I saw some dialogue in a previous post regarding this subject. It looks like the potential exists for a double premium billing the 1st month that you receive social security benefits with the Part B premium auto-deducted. I reach FRA this month and get my first check next month (July).My last quarterly Medicare payment covers me thru the end of July.My understanding of my benefit payment next month is that my SS benefit is paid in arrears.But the Medicare premium deduction is in advance.That means my June SS check I receive in July is paying for my July Medicare premium. Am I understanding this correctly?If so, it appears that would create a double premium payment for the month of July. I'm sure I'm not the only one this has happened to and wonder if SS/Medicare addresses it. Thanks. Chuck 

 “.. . . when Medicaid was created in the 1960s lawmakers did not include work requirements because it “never dawned on anybody that able-bodied people who work would be on Medicaid.”   CMS Administrator Dr. Oz Mehmet Now, we are asking these ABLED-BODIED Medicaid beneficiaries to either work 80 hours a month or volunteer or take care of a low income needy loved one or go back to school in order to preserve their ACA Expanded Medicaid benefits.   In listening to CSAN’s Washington Journal this morning during the open forum call in - I could not believe the people that are scared to death they would be losing their MEDICAID benefit even though they are on the program by being a low income elderly, blind, or disabled, a low income child, a low income pregnant woman and then the newborn for at least a year in most states (maybe in all by now).  They will not -  I get so tired of our legislators confusing the ignorant public with this ”name” recogniti

I believe there is a place where many beneficiaries will have some agreement in Medicare Reform and it is one that the Senate is currently looking into - it would involve NO cuts to benefits for beneficiaries.  POLITICO 06/05/2025 - Medicare is a target as Senate GOP faces megabill math issues  from the link:   Senate Republicans are currently discussing folding in language that would target overpayments to privately-run Medicare Advantage plans, which enables older Americans to buy private plans offering health coverage. It would help them recoup tens of billions of dollars, and it’s an idea that has also attracted bipartisan interest. … . . House lawmakers briefly floated the idea of overhauling Medicare Advantage into their version of the megabill but it failed to gain traction, as a band of House moderates is deeply uncomfortable with the concept of touching Medicare — even if it is in the name of slashing “waste, fraud and abuse.” Yes, there

For Medicare Supplemental plans, regardless of the insurer - your premiums can increase due to several different factors - some are policy specific (#1 & #2), others are based on market, usage and legal requirements (#3).  1. The (YOUR) Explanation of Coverage - this will explain any declining discount schedules and set amounts of increases, if applicable based on the policy.  This is the contract with the insurer.2. How your Medigap plan is rated - Community RatedAttained AgeIssue Age3. The (Your) State Dept of Insurance cause in most states, the state received the info for the premium increase from the insurance companies like amount of claims (amount paid out), amount of premiums paid in, and amount that is kept in reserve per the law and their forward looking requirements that may already be in the pipeline.   Do these increases all have to happen at the same time?  NO (#1 & #2 ) goes by your specific data - your Medigap insuranc

I am a senior, AARP member, a pharmacist, and still working in a hospital oncology department. I have been specifically working in oncology for around the last fifteen years. Unfortunately, as we get older, our chances of having a cancer diagnosis increase.Elderly Medicare patients that have worked their entire lives and paid into the Medicare system are now being denied treatments that are part of standard, specific to their disease state protocol, better tolerated by their age group, and life extending just because they are now requesting that certain genetic markers be present before approval. Most of these are immunotherapy treatments, one being Keytruda. FDA has approved these medications for several types of cancer because they have been shown to work, and the tumors are seen as highly susceptible to immune attack. These medications have been added as a part of the treatment protocols for these cancer types.The cancer treatment medications are part of specific protocols

To my fellow Senior Citizens, to those who have loved ones on Medicaid (parents in nursing homes), to those whose children receive CHIP, and to all Americans who expect healthcare once they reach 65, It appears the Republican budget bill awaiting a vote soon in the House of Representatives has the potential to cut a half TRILLION dollars from MEDICARE in addition to gutting Medicaid, the Children’s Health Insurance Program and the Affordable Care Act. I am attaching information below. You can Google for yourself. You may be interested in the links to the Congressional Budget Office analysis.https://democrats-budget.house.gov/news/press-releases/cbo-confirms-gop-budget-bill-triggers-medicare-cuts