Since many are of Medicare age. This needed sharing

[southernlady]

Hospitals take aim at Medicare Advantage

“Hospitals have been dropping Medicare Advantage plans over high claim or prior authorization denial rates since at least 2018, but it was an uncommon move until recently. Some systems have noted that most MA carriers have faced allegations of billing fraud from the federal government and are being probed by lawmakers over high denial rates.”.

Charles ran across a YouTube on this which is why I went looking for the article.

Charles and I have Medicare Supplement plans. Yes, it’s pricy, especially since we are both on the grandfathered Plan F. Charles looked last year at all the Medicare Advantage plans in our area, his issue was not all our current physicians were on a plan, oh they all accepted Medicare but there wasn’t a single plan common to all.

So before making your choices this fall, do your due diligence and make sure you won’t run into issues with hospitals in your area not accepting the plan you choose.

 

[JackieOnLine]

I not to Medicare age yet (65?) but it's complicated enough I need to start learning more now.

so thanks, Liz.

 

[southernlady]

Found another article. How accurate it is, I don’t know. It’s more of an opinion piece. But it’s concerning anyway.
https://www.msn.com/en-us/news/poli...e&cvid=167e97aac7c740ce8c309e0ef195a3de&ei=43
'This should be a national scandal': Medicare Advantage plans using AI for denials’
“As Medicare Advantage plans rely increasingly upon artificial intelligence to determine—and often deny—payment for patient care, a group of Democratic U.S. lawmakers on Friday urged Medicare's top official to strengthen oversight of AI and algorithmic tools used to make coverage determinations.”
continued in article.

 

[southernlady]

Another tidbit I learned this year poking around on Medicare.gov, many Medicare Supplement plans offer Household Discounts if both spouses are using the same company. Example, my husband and I are with USAA, and I called them yesterday to ask, yes, they do offer it. Sending us the paperwork to apply. But if you don’t ask, you don’t get it.

 

[Spiky Bugger]

And…just an aside. The REASON I was irritated (on another thread) that his retirement system stopped offering our supplement plan was because I thought all Medicare Advantage plans were HMOs and I’m too persnickety for HMOs. But we have a Medicare Advantage PPO plan. We can go to “in-network” doctors AND to doctors who accept Medicare. It’s a super-dooper plan that costs his retirement system a pretty penny…like $864/mo, for the two of us, plus the $200+/mo they reimburse us for Medicare. Office visits and specialist visits are covered 100%. Meds cost $5 or $10, or for the Tier 4 stuff a max of $95/mo or $190 if a three month. AND, they return to us the money that is deducted from SS checks for Medicare. So we are covered AND retirement sends us $2600+ annually, because…I dunno, because he was upon a good union? Probably.

This is all part of a trade off. He did a kind of work that paid VERY WELL with independent contractors, less with govt/quasi-governmental agencies, but few or no benefits/retirement plans. If he had gone that way, we would have had to save a lot for retirement…and we’d be broke now Because we aren’t that reliable. He opted for a lesser working income but decent benefits and retirement.

And the retirement thing! His system calculates something like:
“average of three highest years base pay x years of service x whatever percentage they are using.”
His “overtime whore” buddies who are still working have a base pay of around $165k. But with the insane overtime hours they work, they are EARNING +/-$450k now. They go into COMPLETE shock when they retire and start receiving A PERCENTAGE OF that $165k base pay.

It’s a weird country we live in…so many have their later years’ comfort dependent on decisions they made in their 20s.

Oh…and we are barely middle class. Certainly not WEALTHY. But we do get regular checks with a tiny bit of inflation protection.

 

[Georgepds]

FWIIW... I found a low cost partD supplement plan in my area, $0.50/ month (wellrx)

Suits me fine since I use goodrx for my needs

The only reason I keep part d is someday I might need it, and then I'll rely on the out of pocket limit. My understanding is if you let part d slide, it's more expensive to get back in

This whole business is one long aggravation. The really difficulty is, when you need help, you are often too sick to argue with insurance about coverage

 

[southernlady]

FWIIW... I found a low cost partD supplement plan in my area, $0.50/ month (wellrx)

Suits me fine since I use goodrx for my needs

The only reason I keep part d is someday I might need it, and then I'll rely on the out of pocket limit. My understanding is if you let part d slide, it's more expensive to get back in

This whole business is one long aggravation. The really difficulty is, when you need help, you are often too sick to argue with insurance about coverage

I’m using the same one this time. Actually I've found that SingleCare sometimes beats GoodRX, and Kroger (who is in my area) has their own program that can beat both of them. So I keep all three “in my back pocket”.

 

[JackieOnLine]

The really difficulty is, when you need help, you are often too sick to argue with insurance about coverage

yes, and just in general the harder life is (for whatever reason) the less you can deal with all the details and confusion.

 

[southernlady]

This is an article from the National Association of Benefit and Insurance Professionals (NABIP). It is going to be an interesting Open Enrollment Season for anyone who is on Medicare. My husband’s cousin works as Medicare Insurance Agent in NC so she keeps us aware of what’s happening with Medicare in general.

-----------------------------------------------------------------------

Seven insurers are planning to exit various Medicare Advantage (MA) markets in 2025, signaling potential disruptions for beneficiaries. Among these, Centene will no longer offer its Wellcare MA plans in six states but will continue to provide prescription drug plans there. Other insurers, like BCBS Arizona and Clear Spring Health, are also withdrawing from specific states, while BCBS Kansas City is leaving the MA market entirely due to regulatory and financial challenges. Aetna and Humana are also scaling back their MA offerings, with Aetna expecting to lose a significant portion of its members as it focuses on profitability.

The exits are part of a broader trend where insurers are re-evaluating their participation in the MA market due to financial pressures and regulatory challenges. Cigna Group is also divesting its Medicare business, selling it to Health Care Service Corp. in a deal expected to close in early 2025. With these changes, the landscape of available Medicare Advantage plans may shift significantly, potentially affecting the options available to beneficiaries.

 

[Spiky Bugger]

Wow.

 

[southernlady]

FWIIW... I found a low cost partD supplement plan in my area, $0.50/ month (wellrx)

Suits me fine since I use goodrx for my needs

The only reason I keep part d is someday I might need it, and then I'll rely on the out of pocket limit. My understanding is if you let part d slide, it's more expensive to get back in

This whole business is one long aggravation. The really difficulty is, when you need help, you are often too sick to argue with insurance about coverage

My husband found out that WellCare will be discontinuing offering the part D plan completely effective Jan 2025. In other words, you can not renew this one. They are getting out of the Part D market.

 

[Spiky Bugger]

My husband found out that WellCare will be discontinuing offering the part D plan completely effective Jan 2025. In other words, you can not renew this one. They are getting out of the Part D market.

You guys aren’t in the VA system? MrSue’s meds get sent by mail and cost either $7 or $11 each. I have had zero copay surgery and my OUTDOOR rollator always gets comments or “Where can I get one like that?” Inquiries.

Drive GV974RD Rollator Walker Red F-22 - 300lb Max - Foldable, Height Adjust | eBay

Drive GV974RD Rollator Walker Red F-22. 300lb Max - Foldable, Height Adjustable.

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Getting it all started can be a hassle, but once established, they arrive like clockwork.

(I just spent a GREAT DEAL OF TIME, asking for appointments and figuring which clinics are walk-in…Geriatric, Audiology and Dermatology for him, Ortho and Optometry for both of us, Neurology for me, and vaccines for both of us. Once I GET the appointments, I can try to juggle the dates to do a couple on each day. That’s because the drive can be 45 minutes to two hours EACH WAY. Not easy for us.)

 

[southernlady]

No, while I’m a vet, I’m at the lowest tier for health care. Only served active duty 3 years and not disabled under their criteria.

I did tell Charles I needed to see if I qualified for any care whatsoever, especially dental.

When we added all my heart medications, we did use WellCare, only one I had to actually pay a copay on was my Carafete to keep my stomach safe from the aspirin I’m required to take. Gastritis is terrible and I’ve had 2 bouts so I have to be careful. The aspirin was OTC, but the rest had $0.00 copay. I was pleasantly surprised.

 

[tysweetpea]

My husband found out that WellCare will be discontinuing offering the part D plan completely effective Jan 2025. In other words, you can not renew this one. They are getting out of the Part D market.

Oh wow didn't know that.. my husband has term for part d.

 

[tysweetpea]

My husband found out that WellCare will be discontinuing offering the part D plan completely effective Jan 2025. In other words, you can not renew this one. They are getting out of the Part D market.

My husband has wellcare for d. No way to shop around now for the new changes but I guess we know it will be coming. Just as we get comfortable. Since medco is acquiring Cigna...I guess my part d will be changing too