Medicare and You! Questions and Answer Thread!

[The Brews Cruise]

Originally Posted by palehorse89

I just dread what is coming on the TV.........EVERY COMMERCIAL BREAK

And we get to watch Joe Namath waving his hands all over the place. Tired of these incessant commercials!

[palehorse89]

Originally Posted by The Brews Cruise

And we get to watch Joe Namath waving his hands all over the place. Tired of these incessant commercials!

I would like to give old Joe a good swat in his windpipe! He and other's including Tom Selleck(Reverse Mortgage) had ought to be ashamed of themselves!
Commercials for insurance company's that lead old people to think that they are calling Medicare!

[Dieselboy]

Originally Posted by TexasJeff

Batten down the hatches. Here comes the call centers bombarding our phones.

DB: Are there any new laws or Medicare changes that we should be aware of moving into the new coverage year?

Yes, when it comes to call centers calling they are not allowed to do so unless you gave them permission to call. Meaning you should feel at liberty to immediately interrupt them and tell them you did not give them permission to call and that you are reporting them to CMS for that violations. They are also required to record all parts of the call and notify you that they do not represent all the plans in your area. This disclaimer MUST be read to you over the phone before any part of the call takes place. If they don't, they are again in violation of new CMS rules and should be reported.

[Dieselboy]

Originally Posted by gatorb8

If wife and I are currently on Medicare and a supplement plan in one state and plan to move to another state, will the transition of coverage be similar? Will there be any qualification or pre existing issues?

You should be fine leaving your existing Supplement plan in place when moving. I have known people to have been issued a Sup plan in one state and moved and had no issue. That being said, sometimes there may be rate differences with the new state and it may make sense to pursue getting a new policy issued (because of possible savings) but you'd want to look up those state Medicare guidelines to verify if you'd have to go through medical underwriting or not to switch.

[Dieselboy]

Originally Posted by palehorse89

I would like to give old Joe a good swat in his windpipe! He and other's including Tom Selleck(Reverse Mortgage) had ought to be ashamed of themselves!
Commercials for insurance company's that lead old people to think that they are calling Medicare!

This behavior will only change as more and more people complain to CMS. It's very predatory behavior and it needs to stop. In fact, I believe another CMS rule going into 2024 is company names cannot include the word (or wording) of Medicare anywhere in a title/email address/phone number etc. It does exactly what you are upset about - tricky people into thinking they are reaching out to Medicare directly.

[TexasJeff]

A question comes to mind that I'm not sure if there's an absolute answer, but I'd be interested in your thoughts in any event.

I'm continuing to see the articles expressing concern that Medicare and Social Security are nearing their funding limits. The usual story goes that if congress doesn't do anything to help increase funding, then benefits could be cut.

Specifically with respect to Medicare, in order to extend solvency, the government will need to either charge more, or spend less, or maybe a little of both. My wife and I were discussing this the other day and thought occurred to me of the possibility of original Medicare getting phased out and everyone getting moved to Medicare Advantage.

What are you hearing at the watercooler regarding potential moves the government may eventually make in coming decade? Any tea leaves yet?

[Prof_T]

Originally Posted by TexasJeff

A question comes to mind that I'm not sure if there's an absolute answer, but I'd be interested in your thoughts in any event.

I'm continuing to see the articles expressing concern that Medicare and Social Security are nearing their funding limits. The usual story goes that if congress doesn't do anything to help increase funding, then benefits could be cut.

Specifically with respect to Medicare, in order to extend solvency, the government will need to either charge more, or spend less, or maybe a little of both. My wife and I were discussing this the other day and thought occurred to me of the possibility of original Medicare getting phased out and everyone getting moved to Medicare Advantage.

What are you hearing at the watercooler regarding potential moves the government may eventually make in coming decade? Any tea leaves yet?

This is my opinion only. Baby boomers are retiring and are a significant voting block. Politicians will be politicians and will tell you what they think you want to hear and pontificate back and forth. Social Security and Medicare are two fundamental programs that US citizens expect to remain in tact as currently administered. Yes some tweaking may occur but current beneficiaries will not be affected IMHO. Any changes would affect future beneficiaries. Too many baby boomers vote.

[Dieselboy]

Originally Posted by TexasJeff

A question comes to mind that I'm not sure if there's an absolute answer, but I'd be interested in your thoughts in any event.

I'm continuing to see the articles expressing concern that Medicare and Social Security are nearing their funding limits. The usual story goes that if congress doesn't do anything to help increase funding, then benefits could be cut.

Specifically with respect to Medicare, in order to extend solvency, the government will need to either charge more, or spend less, or maybe a little of both. My wife and I were discussing this the other day and thought occurred to me of the possibility of original Medicare getting phased out and everyone getting moved to Medicare Advantage.

What are you hearing at the watercooler regarding potential moves the government may eventually make in coming decade? Any tea leaves yet?

It's a real concern and a valid question. The current administration has made some cuts from Medicare Advantage to put towards other projects. Regardless of your take on that, we must navigate it. I just sat in a very large 2024 rollout for a major insurance carrier with nearly 1000 people in attendance. The head of this insurance company plan benefit design spoke about these cuts. Every carrier offering Medicare products will be seeing them. They are to play out over 3 years. Their goal they achieved for this next year (and prospected into 2025 and 2026) was that they would be able to keep their plan options stable. Meaning no drastic increases in copays but also not much for expanded benefits either, like expanded dental allowances. To me this was encouraging considering the cuts the industry has received. It was also encouraging to hear this individual speak about basically eating the costs to maintain a stable environment for their current client base (a very large one nationwide).

I'm not sure how other companies will handle this situation but the implication was that Supplemental plan rates would also likely increase proportionally. I would be very wary of chasing the shiny object this coming Annual Enrollment Period as it may not be around the following year, meaning the plan will likely have drastic changes to it. Stability is the new name of the game for the next three years.

As far as lawmakers are concerned, certain things are political suicide. It's typically off limits for SS and Medicare if you want to get re-elected. What I have heard from multiple higher level employees with insurance carriers is that the shift to Medicare Advantage is happening. The government can offload risk and administrative duty by allowing established insurance carriers to handle the paperwork and risk. They already have the infrastructure to do so. So why not have the Gov just fund them to do so. What this means is that someday we may not see Supplemental plans as an option anymore. At least in their current form. You may have to seek a Med Advantage plan unless you're grandfathered in. When that happens? Who knows. Even if it happens is up for debate.

I will say this though, there is SO much fraud, waste and abuse in Medicare and the government does a horrendous job of preventing that. So original Medicare and a Supplement are taken advantage of, driving costs up for everyone. Private insurance carriers do much better with this through things like prior authorization, step therapy etc. I know many have complained about these two things because it manifests in denied care and they always feel like the insurance carrier is out to get them. But the majority of the time someone has a denied anything is because they didn't do a simple test first to rule out the need for the more expensive scan etc. Doctors need to do better with this. But alas, they don't.

[TexasJeff]

So, after selecting your Medigap plan and knowing that if you change plans, you may require insurance underwriting approval to do so.

But what about if someone decides to go with AARP/UnitedHealthcare Plan N + wellness extras? Let's say they're now 70 years old and want to just drop the wellness portion of the UHC plan. Are they technically still within the Plan N coverage and medical underwriting is a non-issue? Or, is that decision completely up to UHC even though the wellness extras are not part of Medicare/Medigap coverage?

[Dieselboy]

Originally Posted by TexasJeff

So, after selecting your Medigap plan and knowing that if you change plans, you may require insurance underwriting approval to do so.

But what about if someone decides to go with AARP/UnitedHealthcare Plan N + wellness extras? Let's say they're now 70 years old and want to just drop the wellness portion of the UHC plan. Are they technically still within the Plan N coverage and medical underwriting is a non-issue? Or, is that decision completely up to UHC even though the wellness extras are not part of Medicare/Medigap coverage?

It would be a decision up to UHC. There is an agent plan change form I have access to but it does not specify +Wellness changes. Likely because the +Wellness benefits aren't in every state and that form covers all states. What the form does say though is if an individual is outside their initial guarantee issue then they would go through underwriting for any plan change. Technically the Plan N and "Plan N+Wellness" are two different plans and that's how UHC views it.

Great question though. This is why I love this thread. Keep them coming!

[pokgunner]

I am concerned about you statement "What I have heard from multiple higher level employees with insurance carriers is that the shift to Medicare Advantage is happening."

Because as I understand it Medicare Advantage only works if you live in an area where their participating service providers are. In my case that is a 4 hour drive, one way.

Being Type one diabetic for 50 years I have a plethora of medical problems, but all of my doctors are covered under my medi-gap plan and are less than an hour away.

If "they" are transitioning to Medicare Advantage for every one are they making provisions for rural America where Medicare Advantage does not work?

Recently there became one exception to all my doctors being an hour or less away. The two Rheumatologist closed their office and the nearest alternative is 4 hours away. They closed because they did not want to continue spending more time in red tap than in practicing medicine. I fear that this is the tip of the iceberg as a doctor shortage is jsut beginning. Caused by an every growing bureaucracy. I think that Medicare would prefer no doctors, only PAs sitting in front of a computer.

The recent "Medicare and You" booklet is a testament to how convoluted the system is. Clearly most of the people that created the mess desire an unearned income by providing an unwanted service.

[Dieselboy]

Originally Posted by pokgunner

I am concerned about you statement "What I have heard from multiple higher level employees with insurance carriers is that the shift to Medicare Advantage is happening."

Because as I understand it Medicare Advantage only works if you live in an area where their participating service providers are. In my case that is a 4 hour drive, one way.

Being Type one diabetic for 50 years I have a plethora of medical problems, but all of my doctors are covered under my medi-gap plan and are less than an hour away.

If "they" are transitioning to Medicare Advantage for every one are they making provisions for rural America where Medicare Advantage does not work?

Recently there became one exception to all my doctors being an hour or less away. The two Rheumatologist closed their office and the nearest alternative is 4 hours away. They closed because they did not want to continue spending more time in red tap than in practicing medicine. I fear that this is the tip of the iceberg as a doctor shortage is jsut beginning. Caused by an every growing bureaucracy. I think that Medicare would prefer no doctors, only PAs sitting in front of a computer.

The recent "Medicare and You" booklet is a testament to how convoluted the system is. Clearly most of the people that created the mess desire an unearned income by providing an unwanted service.

It is more a statement of general direction Medicare seems to be headed. Understand these things move at a snails pace and I wouldn't worry about it if you are already on Medicare. It is unlikely that Supplemental Plans will just "go away" soon. You'd also be grandfathered in, similar to how individuals on a Plan F or even older Plan J can keep it even though they are no longer offered to people just turning 65. The transition would likely see insurance carriers offering plans that cover networks that are even more extensive than they already are. Meaning plans that cover whole states and nationwide networks. etc. Yes, everyone is dealing with doctor shortages. This is just the new norm after Covid. So many doctors retired. That is it's own issue everyone is navigating.

It sounds like you live quite a ways away from a major medical center or city. Please correct me if I'm wrong. If true, this also makes receiving quality care even more difficult because your options are even fewer.

But overall, I wouldn't worry about your current supplemental plan going away.

[UFO Pilot]

I am being "forced" onto a UHC PPO advantage plan if I want continued health care insurance thru my former employer. There is no monthly premium but almost everything has a copay with a max out of pocket of $900 except for prescriptions.


Are there any problems to watch out for with this type of coverage?

[MAXEPR]

Medicare Advantage plans are as different as fingerprints. We have run into some doctors who will not take any new Medicare patients. We have an Advantage plan that has the same coverage for both in-network and out-of-network coverage in an attempt to have more choices on health care. Our plan has higher premiums than some other ones because of this.
And even this plan has its flaws. One specialist we contacted will not take any Medicare and the Mayo Clinic in AZ will not take any Medicare Advantage Plans. We tried to self-pay at Mayo and they say that is not legal for a Medicare patient to do that. Our insurance provider says that is correct.