Medicare choices
 

Not sure when we last had an active Medicare thread, but now is a good time, since October 15 - December 7 is the Medicare open enrollment period, when folks can choose their plan for 2025. Like a lot of things in the US, there are arguably just too many choices, none of which are perfect.

I’m 74 so have had Medicare for nine years. I chose to go the Medicare Advantage route, which arguably made sense - I’ve had zero or very low additional premiums to pay for nine years, and, as it happens, have very rarely gone to the doctor or incurred any treatment or prescriptions for all those years. Not really happy with the whole idea of Medicare Advantage though, so I’ve pretty much decided to change horses and go with Original Medicare for next year. I realise I’ll be paying significantly more, what with Medigap and Part D premiums.

Anyone else thinking of a change this year? Or any other thoughts about Medicare?

Re: Medicare choices
 

Are you aware that when switching back to Medicare from Advantage, you are not guaranteed to be able to buy a Medigap plan without underwriting and pre-existing condition exclusions? (I think the rules vary depending on state). This was a major red-flag for my wife when she was weighing the options at her enrollment. She chose original Medicare for that reason - you can get a Medigap policy without exclusions only during the 6 months after you initially become eligible for Medicare, or something like that. These kind of subtle traps drive me absolutely insane (and the fact that the rules are state-specific despite Medicare being a national program).

I'm still a few years short of enrolling but having seen the research my wife had to do and the complexity of the process and the cost (she originally had to pay for Medicare Part A too....) I was pretty disgusted. But then again I've been disgusted with the medical system complexity in this country for years, so I guess I shouldn't have been surprised.

Re: Medicare choices
 

Yes, the reason I decided to finally do this for 2025 was that, out of the blue, I got a letter from my Medicare Advantage provider about two weeks ago - they are no longer offering plans in New York, so I have to find a new plan. This gives me a big advantage, as because of my plan being discontinued, I’m exempt from the underwriting & possible exclusions you mention. You’re right about complexity, though. When I was first eligible for Medicare, I spent months researching. The book Medicare for Dummies is good. But that potential disadvantage of Medicare Advantage, that you may be stuck with it for life, somehow escaped my attention. There are just so many ifs & buts.

Re: Medicare choices
 

I've been on Medicare Original since I joined Medicare.
This year I'll be changing my plans, mainly due to costs.
I have been on Humana Part D for several years, but this year's costs have caused me to look around. My plan was going from $75 a month to $110; and I don't even take prescription drugs! Am considering Cygna Saver at $21 - still quite a solid formulary.
Also changing to Healthnet for my supplementary plan from Blue Cross, Blue shield. Going from $444 per month to $285.
I had no problems with either Humana or Blue Cross, but costs are getting ridiculous. My supplementary plan is Plan F which pays all the deductibles and the additional 20% that Medicare Original does not pay for. Don't know whether you can join Plan F's anymore.
With a supplementary plan (medigap) I like the freedom of going to any doctor that takes Medicare and not having to have referrals.

Re: Medicare choices
 

Yes, that’s one reason I want to move to Original Medicare; while it (Medicare Advantage) really hasn’t affected me adversely, since I’ve sought vey little medical care over the last nine years, I’d rather have the freedom in the future to go to any provider who takes Medicare. Especially if we start spending more time in Massachusetts, California and other possible US vacations.

Good observations on Part D, thanks. I’ve noticed that a lot of plans are up there now - $120 per month or more. It’s hard to choose a plan based on their varying formularies, when I’ve very rarely had a prescription, and never been on anything long-term. I know that from 2025, there will be a much lower oop on prescription pharmaceuticals. That may be why premiums are getting higher..?

Re: Medicare choices
 

Think one reason is that in the Inflation Reduction act of 2022, that donut hole in RX plans was removed. So anything over $2K you spend on prescription drugs has to be picked up the the plan. However, the insurers have just increased premiums. Not currently taking prescription drugs so this Reduction plan has certainly not helped people like me.....!

Re: Medicare choices
 

Hello, Glad this post came up as I'm slow to start my medicare research options (just turned 62) and I can see there's a whole lot that I DON'T know !
What I DO know is that as I qualify with Tri Care via my retired military spouse, That I will certainly opt for original Medicare as Tri care covers most of the prescription costs too.
Therefore I know I DON'T require any advantage plans but unsure if I need any additional supplement plans ?
Anyone with any knowledge on Tri Care with Medicare, I'll receive their knowledge with gratitude and use that as my research starting point.

Re: Medicare choices
 

I can't speak to TriCare or VA spouse benefits, but the main point to understand about Medicare supplements is that they are private insurance plans designed to pay your out-of-pocket Medicare costs. Medicare only pays 80% of your costs, with no out-of-pocket maximum, so you are on the hook for 20% of everything without limit. Obviously that leaves you exposed to potential huge costs if you have a chronic condition. Discovering this feature of Medicare is a shock to many people because most insurance plans such as employer-based ones usually have an annual out-of-pocket maximum. That's always been the case for me and my wife, so Medicare is the first time we've come across an insurance plan which could - worst case - bankrupt us. Needless to say, we regard some kind of 'Medigap/Medicare Supplement' as financially essential.

Re: Medicare choices
 

I don’t know about Tri Care specifically, but maybe it’s similar to my wife’s situation. She worked for New York State and gets medical benefits for life. So, from age 65, Original Medicare was her primary, and her NYS healthcare was her secondary. So, no need of a Medicare supplement (Medigap) plan. I’m guessing it’s somewhat similar with Tri Care.

The basic, historical situation being as Pierre_Tete describes; Medicare is great, but only covers 80% with no out of pocket max, so a secondary plan of some kind is necessary (or prudent.) Medicare Advantage being the other option, because it takes those Medicare premiums and juggles them around, to create policies that DO have an oop max

Re: Medicare choices
 

My wife and I have Medicare and Tricare from my Navy retirement. It can’t be beat. We are both healthy and neither take any medications but I unexpectedly discovered I had a benign pituitary tumor requiring major surgery about 5 years ago. I was free to choose the best place for this surgery looking at both the Mayo Clinic and Emory university in Atlanta, with no worries that some advantage plan would try not to pay. I chose Emory and paid zero with an excellent outcome.

Re: Medicare choices
 

As far as I understand Tri Care, it is the equivalent of a private supplementary plan, which is only open to retired military personnel.
So Tri Care picks up all those additional costs which Medicare does not cover - the 20% not covered by Medicare, the deductibles and co-pays.

Re: Medicare choices
 

Correct. Plus it has a no cost drug part D. I know some retired military who have been scammed into signing up for an advantage plan.

Re: Medicare choices
 

Lucky people to have a no cost Drug D plan....mine was going up to over $100 a month.

Re: Medicare choices
 

I have wondered how much my tricare would cost on the open market. It’s certainly a great benefit to have with the many other great benefits from being retired military.

Re: Medicare choices
 

I don't have a lot of choice without changing my primary care doctor, which I am not prepared to do. His office doesn't accept original medicare and only accepts a few medicare advantage programs.