Medicare advantage plans for 2025 - Page 7

Trinity11 · ‎11-16-2014

@Carmie wrote:
@Trinity11 wrote:
@Carmie wrote:
@Grnthumb wrote:
I live in Michigan and have had the same advantage plan for several years but what really ticks me off if that in 2025 they put a cap on part D presciption drugs of 2000.00 and then raised the out of pocket on everything else like ambulance, hospitalization, out patient, etc....Just another way for these insurance company's to make sure you don't get something for nothing.
The current administration capped the RX drug out of pocket at $2000 for everyone on Medicare under a new law called the Inflation Drug Act. In addition,they capped insulin at $25 a month. There are ten drugs with caps for 2025.

Prices had to go up somewhere else. Someone has to pay for these perks. Hang on....it's gonna get more expensive going forward.
Very few insulins are capped at $35.00 for seniors. Levemir stopped production as there was not enough profit. Novolog pens were dropped from the majority of insurance plans. One box is $153.00 with Drug RX. It has been a nightmare for many insulin dependent diabetics. Fiasp was also stopped and impossible to find. Since Type 1 diabetics such as myself need both basal and mealtime insulin, we need to fill two prescriptions for it per month. Most insurance companies do not offer the $35.00 cap and yet this myth continues to be perpetuated.
This is not a myth. It is the law. Insulin is capped at $35 a month. It has nothing to do with insurance companies. The contract has been made with the drug companies.

You are correct that some insulin drugs are now not being manufactured. The drug companies are fighting back.

If they have to sell at a loss or for little profit, they will just ditch the drug.

This is a big problem. Currently 52% of insulin users are on Medicare, so that's a lot of people.

There is a promise of getting this cap for everyone, even those without Medicare. I can't see this happening.

I don't want to get political, but I will say, this is a pipe dream and will lead to problems with getting enough necessary drugs for those who need them.

It may be the law but it sure isn't being enforced. I live it @Carmie , I am on Medicare with a Cadillac health plan and both my insulins were pulled from the formulary. I was forced to go on an insulin that does not work leaving me with dangerously high blood glucose readings. I had to fight the insurance company but that took weeks until it was approved. So don't always believe what you read @Carmie .

CalminHeart · ‎03-09-2010

For many reasons, I'd never have a Medicare Advantage Plan (MA). Just a few...

Restrictive Networks
Out-of-pocket costs could be high
Can only make changes at certain times of the year
Endless referrals and authorizations

Every procedure requires authorization in most MA plans. This requires more work from the doctor and his/her staff as well as takes time....time that you don't have in some cases.

CelticCrafter · ‎03-09-2010

@CalminHeart wrote:

For many reasons, I'd never have a Medicare Advantage Plan (MA). Just a few...

Restrictive Networks
Out-of-pocket costs could be high
Can only make changes at certain times of the year
Endless referrals and authorizations
Every procedure requires authorization in most MA plans. This requires more work from the doctor and his/her staff as well as takes time....time that you don't have in some cases.

And just because a doctor accepts XYZ Insurance from a non-Medicare patient, they may not accept XYZ Insurance from an Advantage Plan patient.

Carmie · ‎10-25-2010

@CalminHeart wrote:

For many reasons, I'd never have a Medicare Advantage Plan (MA). Just a few...

Restrictive Networks
Out-of-pocket costs could be high
Can only make changes at certain times of the year
Endless referrals and authorizations
Every procedure requires authorization in most MA plans. This requires more work from the doctor and his/her staff as well as takes time....time that you don't have in some cases.

This is NOT true. Only HMO Advantage Plans require referrals. Some Advantage Plans do not have any deductible or coinsurance due for anything. Everything medical pays 100%.

Some also cover providers in and out of network. Plus, there is usually RX, vision, dental and sometimes a gym membership, a card to get free over the counter items and hearing aids.

Of course, these types of plans are not sold everywhere, but they are available to some people.

Sage04 · ‎07-10-2011

@Carmie this is something I will never understand. We go through this every year on the Forums. Some are talking about something they know nothing about. I will never talk about Traditional Medicare because I know nothing about it.

I've always had an Advantage Plan and it works for me. Each State is different and yes I get vision and everything you mentioned. Now if I can only get myself into the gym.

Carmie · ‎10-25-2010

@Sage04 What makes things so difficult is that the advantage plans are all so different.

Some are horrible and pitiful. Some are much better than Traditional Medicare, and some are just about the same, but less expensive.

Every county in every state offers different plans. There is no uniformity at all. Some people do not have access to good Advantage Plans.

Some Advantage Plans have zero monthly costs, some are over $200 a month.

There is no one size fits all and you can't make a blanket statement that Traditional Medicare with a supplement is better than a Advantage Plan.

Some supplements are priced according to your age, the older you get, the higher the prices are. Over time,these plans become unaffordable. People should look for plans that are not priced according to your age.

Many are drawn to these plans because the cost is outstanding when you are 65.

There are so many variables with health insurance and so many choices.

I just hope everyone finds something that is right for them. I am happy you found a plan that works for you.

Hemi 659 · ‎07-23-2016

@Carmie wrote:
@conlt I have an Advantage Plan and will keep it unless my benefits change. It cost me less than $50 a month and everything is covered 100%. I have no deductible or coinsurances at all....in or out of network.

If I need to change, I will change to Supplemental PLAN C. Because I was 65 before this plan was dropped,I am eligible to pick it up. For me it is much better than PLAN G or F. But so far, so good.

I don't need referrals and lucky for me, in my area, all of the hospitals are in network as well as most professional providers and I don't need preapproval for any services.

Some areas of the country have wonderful Advantage plans and in some areas they are a headache to have especially if you are very ill.

I understand not everyone has access to a great Advantage plan that is affordable and is better than traditional Medicare and a supplement, but there are plans out there that are. Mine is one example.

At one time, I was against Advantage plans too, but not anymore.

I have a superior knowledge of Medicare, Supplemental Plans and Advantage Plans. I worked with these plans for 25 years and have done volunteer work to help seniors negotiate benefits and in choosing a plan.

I recommend anyone who is confused or looking for a new plan call the SHIP HOTLINE in their state. Volunteers like me will help them and there is no charge or commissions to be made.

@Carmie I appreciate your info. And everyone's here. Just wondering if you would share the plan u are with? I turn 65 next year. I've read the 2025 Medicare book that my husband got in the mail, he has original Medicare already. Just trying to understand how all this works in real life. My retiree ins from my employer will become secondary once I get Medicare, so I have to pick something by the summer. At least I have time on my side. Thank you!

Carmie · ‎10-25-2010

@Hemi 659 I currently have an Advantage Plan. It's a really excellent plan that costs me about $47 a month.

I got it through my past employer that was a health insurance company. I get a discount as part of my retirement benefit. Without the discount, it would cost $187 a month.

It is only available to those who live in my state and county.

If for some reason,this plan is discontinued, and it could happen, I will choose Supplemental Plan C, which is no longer available to those who were not 65 by January 1, 2020.

If too expensive,I will choose Supplemental Plan G and also a plan D which is RX coverage.

Then I will cry because I lost my dental, vision, gym membership and hearing aid benefit.

Hemi 659 · ‎07-23-2016

@Carmie ok. Thank you for the info.

Teddixat · ‎10-04-2010

@gidgetgh I presently have A Medicare supplement plan G but it has gotten so expensive at $295 a month abd going to $365 in 2025, plus my monthly prescription drug plan. I don't even take medications but forced to pay a monthly fee. I am considering UHC AARP Medicare Advantage PPO plan for $49 a month. That's going to save me over $3000 a year. Coverage and benefits are great