PLEASE - REVIEW YOUR MEDICARE COVERAGE FOR 2025

[GailL1]

Lots of changes are happening in Medicare Advantage plans and Prescription Drug Plans for 2025.  Notices of change are beginning to go out before open enrollment begins the middle of October.

Don’t just look at the premiums - look at the details of the plan and just make sure you have one that meets your needs be that meds on a formulary, its price or pre-qualifications of getting it or a network provider - doctors and hospitals - or even your MA deductible limit and of course, premiums..

Remember IF your specific Medicare Advantage insurer or plan disappears from your geographical area for some reason, this might open up a guaranteed period for you.

It is just real important that you review everything for this 2025 policy period because of all the legislative and CMS rule changes that have gone into place for the up and coming year.  As with all insurance products - expand the benefits and everybody share in the cost of coverage.

In addition, Part B premiums for 2025 will be announced in October also - that is unless they are delayed for some reason (remember we have an election in beginning of Nov)

Happy 2025 Plan Shopping - but PLEASE do it.

[MarcsyPE]

I am currently battling with my Medicare Supplement provider Aetna over how they are raising our Plan G rates. Key is that they are opening up new plans under new subsidiaries and then offering lower rates for the same Plan G. What is happening is as the rates on our attained age policy is going up by about 1.8%-3% plus a rate increase for claims losses, (which they claim they can multiply together instead of just adding the percentages together we are seeing higher increases than their original premium schedule in the outline of coverage seemed to imply for aging. i.e. for 2024 we are seeing a 14.81% overall increase even though the state regulators allowed only a 12% for our plan plus a 2.43% increase due to age (based on the difference in age on my original OCC table for 70-71.)   I think they should be additive, and my increase at least should be only 14.43%. Their way of multiplying both increases together results in 14.81% increase. Makes about $70 difference in premium so I think it is significant.  I am thinking this should have been spelled out in the policy and the OCC originally. 

More to the point because of their increases in our plan people who can pass underwriting are bailing out to the new lower cost plans or to advantage plans. Her in Texas we saw a buildup in our Plans offered on the subsidiary I am with to about 15,000 policies and as soon as the plan got closed to new applicants and the new plans were opened the number in our Plan G has dropped precipitously.  This is obviously shifting the policyholders in our plan to more older and more costly claims. This is causing the rate increases to spiral up into the double digits. With the higher age attained rates being multiplied in this is causing the rates to double.  My original 2017 rate was $104 and now it is $238. My wife is similar.  Again, we aren't seeing our SS benefits COLA increase at those high percentages. My small pension amount is fixed. Where do they think this money is going to come from?? We are in our 70's and have been diagnosed with long term illnesses that prevent us from passing any health questions, so we are stuck with our current provider until they price us out. Then I may have to go to an Advantage plan which my wife refuses to consider, and most of those have buried cost I cannot afford. It is not a pretty picture.          

[GailL1]

@MarcsyPE 

A Medigap plan closing book on a plan that isn’t profitable isn’t that much different than Medicare (CMS) closing access to a particular plan - like Plan F or C (closed in 2020) or several others that were closed in 2010.  Medicare (CMS) and Medicare insurers do it for the same reason - that is to say, to stop the bleed.

Both measures will produce the same result - higher premiums for those who remain in the plan whether they are forced to remain in the plan because of medical underwriting or because failed to move when they perhaps could.

Most likely Medigap Plan G will be the next discontinued plan although that might be several years away - like maybe 2030 - If you still have it at that time, you might be given the opportunity to switch to a lesser plan at that time (with a time period).  

I cannot help you with the math on the increases in premiums - but if you feel strongly about this, you would begin your complaint with proof with your state’s Dept of Insurance.  That’s where the math is legislated and that is where it is checked.

As to going to a MA plan - which would be an option - Most of them today have an included Prescription Drug Plan which are much more reasonable in design that the free-standing prescription drug plan you have at the moment with your choice of Traditional Medicare + a Plan G medigap + a free standing Part D plan.

You know you and your wife don’t have to have the same Medicare plan choice.  Everybody’s health care needs are different.  I know many people that are overjoyed with their highly rated Medicare Advantage plan.  Each of you are free to pick the plan that is best for your health care needs.

Yes, I feel strongly that with each change in plans available within the Medigap program, we will find plans with less and less benefit coverage just so that Medicare(CMS) can move everybody into more of a managed care type program.  It can only be this way because of the cost of medical care.  

Part B premiums for 2025 will be announced in a few weeks - I look for a sizable increase - not just because of medical inflation but also because of new benefits being added to the Medicare program like early stage Alzheimer’s testing, treatments and monitoring.  Also like more coverage for Part B infusion drugs.  None of these things are gonna be cheap. 

Just make the best decision that you can make considering your health needs and your pocketbook.  

Good Luck

[MarcsyPE]

It appears that they are causing the bleed. I would note that under Texas law if a company closes book on a plan they are not allowed to do another similar plan for five years. Yet they are doing it by setting up another subsidiary.  The NAIC has a special task actuary task force "B" that in their Spring National Meeting the Nebraska DOI put forward a presentation that seems to clearly outline the strategy being employed, I have filed a complaint with the Texas TDI asking for a determination that because the Company is not disclosing this to potential policyholders and this does have a major impact on future premiums they have misrepresented their policy to us. Remember misrepresentation can be by omission.  It may be legal to do what they are doing but without full disclosure which is required by both federal statutes and rules and state statute and rules, they should open the policies up to voluntary termination by the policyholders and allow for guarantee issue privileges due to misrepresentation.  That is my story and I am sticking to it.    

[GailL1]

The bleed occurs because of premiums charged to those in the plan before and after the book is closed by the insurer OR the whole Medigap plan is  closed by CMS.   Either way, the plan has no new blood coming in to balance out those who are within the plan.  And premiums rise.  

The way I understand it, the subsidiary is just the acting agent of the plan that has been closed to new enrollees - it is the same plan with the same beneficiaries just being serviced under a different subsidiary of the insurance company.  Same benefits, same plan

Now when a plan is closed whether by an insurance company or a move by CMS to close the whole Medigap plan to new enrollees, should these participants be given a chance to enroll in another plan by the same insurer or even a different one.  Maybe, but would underwriting be required - probably.

I can almost bet you that the plan that they closed probably started out with a premium that may have been lesser than other insurance companies for the same plan - then premiums started to rise to cover expenses and reserves because they may have some high users in the plan.  Hard to really tell - 

You are doing the right thing with the insurance commission but I think the problem goes further than state level although the state can correct the problem with the insurers and many have by expanding their guaranteed issue periods - but in those states, premiums are always higher because they give this benefit.

Something also needs to happen with CMS closing whole Medigap plans.  Because the same thing occurs with premiums for those who remain in a closed plan.  That’s a federal problem not a state one.

Medigap plans aren’t health insurance, they are financial protection insurance products that protect the beneficiary from financial ruin in case there is a health catastrophe.  So I wonder if that makes any difference in the legalese.  I don’t know.

Stick to your guns and let us know what transpires or responses from the NAIC.  

I don’t have one - I have other coverage but fine this very interesting in principal both at the various state levels and the federal level.

[MarcsyPE]

My wife and I are in Texas. We had a major shock as our Silverscript Super Saver that we paid $9.95/mo each (and it covered all my drugs in Tier 1 with no deductible applied to Teir 1 so I had almost no extra costs for the year) is just going away!  Aetna which has taken them over has decided to just roll it into their Silverscript Choice which was going to apply all Tier 1 to the deductible (about $590) plus now charge us each $43.95 +/- per month. Since all our drugs were going to have to be paid out of pocket my costs was going to escalate from my $9.95 per month or a total annual cost of $120 to about $1000+ since I was never going to satisfy my deductible.  Ouch. My wife has two tier 1 drugs and on Upper Tier drug.  Same sort of scenario. We are in our seventies and do not have an extra $2000 for just our drug plan.  I priced our other plans in our Area and Wellcare has three plans two of which are extremely low priced. One is their Value Scripts which is $0 per month (yes no premium) and Tier 1 and 2 do not apply to the deductible. If I go to our regular CVS pharmacy it is a preferred one and my costs of each of my five drugs is supposedly no cost. I even called them up to confirm cause it seemed too good to be true. Their agent reported it was correct.  Unless anyone else on this site can tell me anything different my wife and I are going to switch to them.  My wife's cost for her tier 4 drug is going to be about $98 per year. It may not be as good if we have other high-cost drugs prescribed for us later in the year but based on our current needs it looks like a $1.900 a year savings for us.  So do look around. Go to "My Medicare" and it will show what is available in the area for you.      

[sktn77a]

There's a reason all of these has-been celebrities are selling their souls advertising Medicare Advantage plans - the insurance companies are making killing profits (literally) by rationing care but collecting full Medicare payments in the process.  You definitely need a Medicare supplement plan with original Medicare and when I can no longer afford those premiums, I may be forced to get a Medicare Advantage plan.  But until then, I wouldn't touch Medicare Advantage with a 10 foot pole!

[GailL1]

For several reasons, the insurers are making less money this next year (2025) thus the modifications to the plans - MA AND PDP - In fact, some are just gonna disappear altogether or perhaps just in certain areas.

It is your choice as to what to pick - which plan or which type plan - Advantage or GAP.  I am glad people have this choice cause I don’t think many would be able to pay out of pocket what Trad. Medicare does not pay especially for some catastrophic event.

But if people continue to buy these MA plans instead of sticking with Traditional Medicare, then this might indicate to CMS that establishing a rather high MOOP annual cost cap in the Traditional program is warranted an analysis.  Maybe in combination with a new Medigap plan with a higher deductible and lower premiums.  

All I know is cost is of a concern to everybody that pays for their health coverage.  It is also a concern to the insurers - public and private.

[SharonS710833]

I just received the 2025 benefit changes for the AARP Medicare Advantage PPO plan that I have had for 2 years.  I was so happy with the plan.  I knew there would probably be “cost shifting “ because of the negotiated rates that were applied to some drugs.  I was shocked, however, when I read the changes…..increase in maximum out of packet, cost sharing going from a copayment to a percent of allowed amounts, copayments increasing in most benefits, dental services stripped to a minimum, etc!  Unfortunately, because of some legalities in my state, I cannot change to a supplemental plan, so I will have to chose the best of the worst advantage plan!

[ad50834513]

AARP Medicare Advantage has left California so I don't even have that option anymore. This will be the second time in two years that I've had to change in order to go to physicians who aren't two hours away. This isn't rural Idaho, it's the San Francisco Bay Area.