Medicare 2025 Discussion

[turkeyrun]

Yes your numbers are correct. There are about 15 part D plans available for me in Oklahoma. The Wellcare Value shows 0 deductible and 0 generic drug costs for me. How??? The plan I am looking at shows $7.90 monthly and generic tier costs $10. Probably what I will choose for 2025. Hope there are no hidden surprises.

We have WellCare for '24 on Plan F.

Have a cousin that is Insurance Agent in Edmond. Will be talking with him about Plan F vs Plan G.

We have been extremely happy with what we have for this year.

Part B, we have AFLAC, my cousin recommended both AFLAC and WellCare.
He also recommended staying away from disadvantage Plan.

 

[JD8]

I think it depends on the patient. Advantage plans have no monthly premiums and offer extra benefits like vision & dental but they restrict your choice of providers and require preauthorization for some stuff. You won't have those problems with traditional Medicare with a supplemental plan, but you'll pay a lot more every month.
So, if you’re healthy & not on a lot of expensive meds, an advantage plan will be a LOT cheaper. If you have multiple health issues, then the traditional MCR would prob be better.
Biggest prob I’ve seen with advantage plans at work was getting our patients insurance auth for transfer to a SNF, or rehab hospital, or an LTACH. But, if I’m a patient trying to get into a SNF or LTACH, I’ve got a lot bigger problems than insurance to worry about.

So in theory Advantage plans work if you're relatively healthy. However, what happens to every person since the dawn of time? Unfortunately, when you actually get sick, you find out they limit your coverage, dictate your treatments.... and restrict your network. By then it's generally too late, as you are underwritten to get back on any sort of supplement coupled with medicare, although the new "birthday rule" may help with that.

God forbid you get cancer because I saw Advantage plans refuse certain treatments (non-experimental) for easily treatable cancers such as prostate cancer.

 

[JD8]

Also, Medicare Advantage plans are touted to those that are on a limited income basis. They don't tell these people what the drawbacks are, just that they won't have to pay a monthly premium. Some people can't afford to pay for medicare + a supplement and I get it. Just saying the government knows what it's doing.

 

[Snattlerake]

Yes your numbers are correct. There are about 15 part D plans available for me in Oklahoma. The Wellcare Value shows 0 deductible and 0 generic drug costs for me. How??? The plan I am looking at shows $7.90 monthly and generic tier costs $10. Probably what I will choose for 2025. Hope there are no hidden surprises.

They take your SS payment?

 

[Snattlerake]

 

[okcBob]

So in theory Advantage plans work if you're relatively healthy. However, what happens to every person since the dawn of time? Unfortunately, when you actually get sick, you find out they limit your coverage, dictate your treatments.... and restrict your network. By then it's generally too late, as you are underwritten to get back on any sort of supplement coupled with medicare, although the new "birthday rule" may help with that.

God forbid you get cancer because I saw Advantage plans refuse certain treatments (non-experimental) for easily treatable cancers such as prostate cancer.

Well, you already know the coverage & network going in. So, that’s not a surprise. If your hospital & docs are all in network, it’s not an issue. Plus, if you have an Advantage PPO instead of an HMO, your network isn’t restricted.

I’ve seen lots of traditional Medicare patients get hit with huge bills and have their options for post acute care limited when they run out of their lifetime reserve days. Also seen them get denied for SNF transfer because of Medicare episode of care rules. Traditional MCR can limit your coverage too.
So, it really depends on your health & what benefits you want to have. Compare both & ask what coverage am I getting for my money, & what coverage do I need? Do i have expensive meds, travel a lot, have frequent hospitalizations or procedures? It all plays into that decision.

Add: just remembered, we also see traditional MCR patients get denied transfer to LTACH’s because they don’t meet the MCR requirement for ICU days.

 

[okcBob]

He even says “some Advantage plans are good options for some people”
Which is exactly what I’ve said as well. So I agree with him.

It depends on the patient & what your needs are. Plus there are crap advantage plans & good ones, like there are good & bad traditional supplement plans. People have different needs & there are different plans to choose from. Due diligence is necessary when researching

 

[TerryMiller]

I think it depends on the patient. Advantage plans have no monthly premiums and offer extra benefits like vision & dental but they restrict your choice of providers and require preauthorization for some stuff. You won't have those problems with traditional Medicare with a supplemental plan, but you'll pay a lot more every month.
So, if you’re healthy & not on a lot of expensive meds, an advantage plan will be a LOT cheaper. If you have multiple health issues, then the traditional MCR would prob be better.
Biggest prob I’ve seen with advantage plans at work was getting our patients insurance auth for transfer to a SNF, or rehab hospital, or an LTACH. But, if I’m a patient trying to get into a SNF or LTACH, I’ve got a lot bigger problems than insurance to worry about.

I understood Advantage plans to be getting a monthly premium from one's Social Security account that goes to the Advantage plan company. Is that wrong?

 

[Chief Sapulpa]

Our situation is different than most. I get 100% care and prescription from the VA….

So did you op-out of Medicare Part B? Do you have to go all the way to OKC for healthcare?

 

[okcBob]

I understood Advantage plans to be getting a monthly premium from one's Social Security account that goes to the Advantage plan company. Is that wrong?

Don’t think so, The SS check amount doesn’t change after you enroll in an Advantage plan, if that plan doesn’t have a premium.
Addendum:
Oops, maybe if the Advantage plan has a premium, it comes out of the SS check. But an Advantage plan without premium won’t have anything deducted from the SS check.
BTW, some Advantage plans do have a small premium & some don’t. There are tons of plans out there with all different coverages. It’s best to get advice from an expert in this stuff