Medicare & medical & prescription costs

I am by no means an expert but have been on Medicare for several years now. The question was raised in another thread and I didn’t want to hijack it so thought I would start a new topic.

Medicare will pay 80% of most medical costs. For the other 20% you will need a supplemental insurance. There are several different plans all paying different levels and some with deductibles and copays. The monthly costs differ depending on which plan you choose. My advice is to get the one that pays the most with no copays or deductibles. For me that was plan F. It picks up the whole 20% with no deductibles or copays. It’s monthly cost is probably the most expensive $190/month) but well worth it in the long run and compared to what private insurance would cost. For instance I pay $0 for my entyvio infusions. I think plan F is no longer available but if not then plan G is pretty close.

Then in addition you need a plan D for your prescription medications. These are the real issue because as of now there’s no yearly cap and UC medications are enormously expensive for the most part. I’ve been using GoodRX a lot. But mark Cuban’s Cost Plus Drugs is a good choice. They only sell generics but they just added a generic for Lialda that they sell for about $40 for a month supply. I think the cost on my plan is around $250. Criminal isn’t it but that’s another topic.

Another option is to contact the drug manufacturers and ask if they have another assistance program for those who don’t qualify for the copay program (Medicare patients do not) and can’t afford their medications. They don’t really advertise these so you have to call and ask.

I was told the Medicare advantage plans don’t pencil out that well and have a lot of hidden costs but I don’t know anything about them personally.

It’s well worth your time to talk to a Medicare specialist before you sign up. There’s no cost to you and they get paid by the government and not by the insurance companies so are impartial to the different companies.

I did a lot of research and stayed with Regular Medicare with a Supplemental Plan for 2023. Here is some of the information that I found out about the Advantage Plan that is now offered through the Company I retired from.

I checked with a Friend/Golfing Buddy who is a broker for senior insurance and he looked at all the information I had on the Plan being offered. He said this plan is not available on the open market and he had not seen one this good. He said it had the lowest MOOP (max out of pocket) he had seen for Medical A & B (C on Advantage Plan). He said the issue becomes what is required for Part B services (Biologic Drug )approval.

As far as prescription drugs the Advantage plan offered has no deductible and all my drugs were covered. Also the Cap was also below most plan before 100% coverage. This issue may go away in 2025 if the Cap of $2,000 for drugs takes place in 2025.

I will check with some of my Retiree friends that opted for this plan to see what their experience was to help me make my decision next year.

Just my experience. I think getting help from an advisor could be beneficial when choosing which options for Medicare or Advantage plans.

Sorry to ramble on.
Golfing Bob

This is helpful. Question: do the Advantage plans completely replace Medicare -- it's not just a supplement to Medicare, correct?

CCinPA said...
This is helpful. Question: do the Advantage plans completely replace Medicare -- it's not just a supplement to Medicare, correct?

That is correct. Advantage Plans replace Medicare Part A and B.

I plan to use a broker to help with the decision along with actual feedback on the new plan. Now that the plan is available in 2023 will be able to check coverage for Entyvio compared to Part B Medicare plus Supplemental Plan cost compared to MOOP deductible.

I stayed on Regular Medicare for 2023. Just looking ahead to 2024 since my Retiree Insurance will no longer help with Gap Plan coverage-just offering Advantage plan for 2024.

I don't understand this. So, once I get older and retire, then I can no longer get my Xeljanz (or whatever I'm on then) for free/super cheap because I will no longer be eligible for the co-pay assistance plans. That's absolutely ridiculous and horrible.

You are correct. You need a Supplemental (Gap) Plan to Bridge the 20% Gap from regular Medicare coverage..

Thank you Old Hat!

With private insurance they can change their Rx drug formularies pretty arbitrarily, a valid reason to opt for original Medicare over the Advantage plans. The Alliance for Retired Americans is one of the seniors' organizations that has been watchdogging Advantage plans in recent years, and reporting to Congress on harmful aspects of their management practices affecting policy changes. (Meaning: Advantage plans can mislead and cheat seniors out of some needed care coverage.) / Old Hat (40+ yrs with left-sided UC; in remission taking Colazal)

Advantage plans are not medicare,they are insurance.
Anyway I have been on Plan F HD for the past 9 years about 65/month so in round numbers
between me and the wife save about 300/month over regular plan F. Wife been on longer,so just go with 10 years. That is like 36,000 savings. Last years surgery was about, 180,000 I paid about
2400. But had to put up with the billing paper work.which is ok if you can function.
Of course now evey year they keep raising the deductable,and of course medicare cost more every year.
Then of course I can get screwed with higher rate increases since no one else can get plan F,and those who
can switch to G without underwritting may do so. Therefore plan F is left with old sick people.
Medicare is a minefield for old folks to figure out,research well. Lots of good youtube videos
on pitfalls. Community rated supplement plans might be best if you can find one.

Oldmike

@CCinPA, as long as your employer has no clauses on active working employees turning 65 you can continue to use private insurance. You can verify this with HR. Also, check at SSA.gov it will also give you info.

I thought if you didn't sign up for Medicare within a few months of your 65th birthday either you could NEVER signup later or there is a big penalty for signing up later. I forget which.