{{ Most of the brokers and agents say they’d personally choose Traditional Medicare with Medigap over Medicare Advantage plans. The reason? Better coverage and choices, especially as people get older. }}
As the old saying goes, "Them’s “selling apples”, not eating apples.
intercst
Much depends on your health needs. Medicare Advantage is much less costly. I save $2K/yr vs Medicare Supplemental and part D. All my doctors and local hospitals are in network. And i get dental care, glasses, and hearing aids included, no extra cost.
We shall see how it comes out. So far I can’t tell the difference except for lower cost. But yes, they can make life difficult forcing you to use in network providers or limiting coverage of meds. Then co-pays can become prohibitive. At the moment I’m thinking the first $60K in extra costs is merely catching up from that $2K savings for 30 years. But who knows how it will all come out.
No one knows. But I like pocket the cash when you can.
It would be interesting to understand how Part D plans that you are eligible for would cover Jardiance vs. your Medicare Advantage. From my understanding, most Part D plans cover Jardiance at a better price than you have indicated Jardiance is covered on your current plan. Of course, Jardiance is one of the first dtugs that Medicare will be allowed to negotiate on, so it shouldn’t matter in a couple of years. But until then, how much are you really going to be saving by using the Medicare Advantage vs. Traditional Medicare and a supplement?
AJ
So far i have been able to get Jardiance for much less than $2k/yr.
It would still be interesting to understand how Part D plans cover Jardiance vs. Medicare Advantage. Personally, the fact that insurance companies are pushing Advantage plans so much makes me want to run away from them.
AJ
This article explains it. Now that all the big insurers own captive PBMs, they can price gouge on generic drugs to increase profits and funding for excessive Executive Compensation, but when the customers fills the prescription at the inflated price on the insurance side, that’s a medical claim rather than overhead and profit. Lots of ways for the savvy health insurance MBA to scam you. Both Medicare Advantage and stand-alone Part D plans do this.
Read 3 or 4 paragraphs after Table 1 in this article on the “Share of medical spending sent to related businesses”. Kaiser Permanente is a particularly successful practictioner of the scam, collecting excess skim on over 60% of it’s medical spending.
intercst
There are at least 3 types of MA plans whose operating structures can be very different.
The other big difference is unlike straight Medicare + Medigap + part D, MA plans are regional.
We’ve been enrolled in the Kaiser Senior Advantage MA plan since 2016 and 2017. Premiums are $0 and includes a cost sharing Part D. We’ve both had minor surgery, get our routine care and vaccines there. Kaiser is large and so can be bureaucratic if things ever get complicated. With the exception with one payment snafu that was finally resolved in our favor, we’ve been very satisfied. They send us reminders on drug refills, need for a follow-up visit and vaccine reminders.
Judging from the many comments on our local NextDoor local social media site, many locals are not at all happy with two of the local Point of Service PPO MA plans, which from what I gather offer independent choices but also a high risk of snafus and higher cost sharing.
Actually, your premium for the Kaiser Senior Advantage MA plan is $164.90 per month or whatever amount you pay for Medicare Part B premium. Kaiser is not charging you an additional monthly premium for their MA plan.
Were I to sign up for the Kaiser Senior Advantage MA Plan, I would still be paying $527.50 per month for Medicare Part B due to RMD triggering the IRMAA premium.
As a disabled Vietnam Era veteran with a 90% disability rating, I use the VA Health Care System. The VA might be a little more bureaucratic than Kaiser but medications are free and delivered to the mailbox plus they deposit a disability compensation payment in my savings account each month.
We just got a letter from our Part D carrier Aetna. DW and my Part D premiums are going from $6.80/month to $15.70/month in 2024. This is for minimal drug coverage as we are thankfully pretty healthy and on low cost generic maintenance drugs.
Are we now subsidizing the recent change in Medicare coverage for these more expensive drugs?
'38Packard
Not sure what ‘recent change in Medicare coverage for more expensive drugs’ you are referring to. The recent changes to Medicare drug coverage are to allow Medicare to negotiate prices on 10 drugs effective in 2026, rather than having to pay whatever the drug manufacturer decided they wanted to charge. This should actually save Medicare money, rather than being more expensive and needing a subsidy. What may need to be subsidized is the new caps for seniors who have been paying more than $2000 a year in drug costs, although the savings in costs on the 10 drugs should cover a significant portion of that. Even then, since the changes won’t be effective until 2026, I’m not sure why your 2024 premiums would be impacted.
That said, I’m sure that the extra $214 you and DW will be paying for 2024 will subsidize someone’s very expensive drug for less than 1 day. 
Actually, what you’re doing is subsidizing your Part D insurance carrier. They may use the money to pay for drugs, overhead, or be declared as additional profit. In return, they are giving you access to their negotiated drug prices.
If you are unhappy with the price increase, you could always look for a different Part D plan.
AJ
“Actually, your premium for the Kaiser Senior Advantage MA plan is $164.90 per month”
No, our MA premium is $0 per month. The monthly payment subtracted automatically from Social Security payments is the cost to access Medicare Part B whatever coverage plan is chosen, even if the insured carries no Part B coverage but elects to continue access to Part B.
As long as you’re checking your insurance company generic drug prices against what GoodRx charges, you should be OK.
As a 30-yr investor in the drug industry, I’m pretty sure that the drug companies won’t be giving up much in the “negotiations” on high-priced, name brand drugs. The industry has too many “bought & paid for” Senators and Congressmen that will do their bidding.
My bet is that the $2,000 annual out-of -pocket limit on Part D that starts Jan 1, 2025 will be funded by price gouging on generic drugs (90% of the prescriptions filled by seniors.) You can’t increase premiums very much on Part D before people start dropping insurance coverage. Too many people are coming to understand that it’s a scam.
intercst
MCCrockett’s problem is that RMDs are now causing him to pay maximum IRMAA (over $6,000/yr for Part B coverage.) His first-world problem is whether it’s worth paying that much for Part B health insurance he’ll unlikely use since the VA covers his health care.
If MCCrockett had a $0 Medicare Advantage plan, he’d be paying the same $6,000/yr IRMAA charge for that.
intercst
To piggyback on intercst’s post, it may be beneficial to do a large enough Roth conversion to bring your RMD down enough to eliminate the very high IRMAA that you will pay for the rest of your life.
Paying some extra taxes for a year or two might be cheaper than an extra $6k (or more) forever.
If you’re paying max IRMAA, you’d likely be paying hundreds of thousands of dollars in income taxes on a $1 MM plus IRA Roth conversion to get your Medicare Part B back down to the $164.90 minimum. You’re probably wealthy enough to shoulder the risk that in an emergency, you’ll end up in a for-profit hospital for a day or two before you can get transferred to the VA. It might be cheaper to just cancel Part B and go bare.
intercst
My brother was stationed on the USS Midway that carried Agent Orange to some port in Vietnam in 1970. He had nothing to do with its handling. He had a 10% service connected disability from ships rigging falling on him and knocking him out, but this was enough to give him access to the VA Medical facilities upon discharge. In early 2022 suddenly money began showing up in his checking account and then he got a letter from the VA saying that his exposure to Agent Orange put him at a 70% service-connected disability, which gave him priority access to the VA, coverage for any emergent care outside of the VA and $1,800 tax free dollars per month for life. He discontinued his Medicare part B
MCCrockett has 90% disability. If the VA gives him the same coverage for emergent care outside the VA, cancelling Medicare Part B and the $6,000 annual IRMAA penalty is a no-brainer.
intercst
I really love it when the Military keeps it’s promises. Glad to see anyone getting their VA benefits.
Andy
Haven’t been here in a while. Good to see most posters incl AJ and Intercst giving their usual great advice and posts. Have some questions as also seen an increase with Aetna(Silverscript) for next year but a very strange thing happened which I will explain later.
I have Medicare and as a supplement United American and for some reason instinct told me to increase my monthly fees at the end of last year and go for one of their top plans. Sure enough(never been in hospital before) woke up in early Jan and couldn’t open my eyelids, then two days later eat, talk or breath. To cut a long story short, ended up in 2 different hospitals over 6 weeks diagnosed with Myasthenia Gravis. Life changing and slowly recovering, but will be on pills galore for a long time until I possibly have some sort of remission.
Insurance paid for everything and what I saw, they(the hospitals) charged Medicare plus United is shocking, so feel very fortunate here as must have had at least 30 doctor visits and again, all paid for.
So coming back to Part D discussion here, over the past few years I checked on a few prices of prescriptions, shampoo, creams, just ordinary stuff and found that GoodRX was way cheaper(sometimes as much as $50.00 for a simple rash skin cream) and just stopped using Aetna as GoodRx coupons beat them all(not to mention the deductible was $505.00)and my Pharmacist automatically has me in the system to find me the best coupon, so wondered why I even bother to keep paying Part D each year.
If I stopped next year, would I have to pay a fine later on if I restarted in the future?
Anyway, I have been having weekly infusions that take up to 2 hours each time and recently the same Company brought out the same product but in an injection application plus now have a nurse coming to my home to administer this drug(Vyvgart Hytrulo) that now will only take 90 seconds plus save me 2 hours of travel there and back when I went to an infusion centre(and the infusion took 2 hours) plus no longer fear being stuck several times as couldn’t find my vein.
So what I’m getting at is this. 2 days after receiving the letter from Aetna discussing the monthly increase next year(but did you notice they decreased the deductible to $280.00!) I received another letter from them stating I have been approved for the injection as long as I remain enrolled in Part D and until the end of 2023. And this stuff is exorbitantly expensive!
Now, previously with the infusions, Medicare paid 80% and United paid the rest. Why the sudden change to Aetna? Is this because it’s now administered in injection form, or did United refuse to pay the balance this time round?
Now I’m very grateful to have all of this now done from home and not complaining, but just wondering, as if it’s too good to be true, well, you know the rest? What am I missing? Perhaps nothing and it’s all good.
Medicare Part B pays for drugs administered in a doctor’s office or infusion center. If a drug is a self-administered syringe, then it’s covered under Part D. I guess that also applies if they send a nurse to your home for the injection to “train” you. I imagine their hope is you’ll eventually be able to give yourself the injection.
Medicare Part D isn’t much of a benefit if everything you’re taking is a generic drug. But it quickly becomes indispensable if you need an expensive name-band drug. That’s why the best bet is to just get the cheapest Part D plan and use a GoodRx coupon when you’re only taking generics. This year I’d shop around for the Part D plan that gives you the lowest all in cost for the list of drugs you’re taking. It may be that a plan with a higher premium might offer a lower cost for the mix of drugs you’re taking.
By the way, United American doesn’t make any benefit decisions. They just pay what Medicare tells them to pay. The benefit and coverage decisions are made by the Medicare contractor that processes the paperwork for your region. And they’re just blindly following whatever Medicare’s coverage rules are for your diagnostic code. If something isn’t covered, it could be because of a wrong code somewhere.
As far as the fines for stopping Medicare Part D, it’s 1% of the average Part D premium per month for the period that you’re out of the program. Miss a year, that’s a 12% permanent increase in your Part D premium plus a 12% increase in any IRMAA penalties for having a high income.
For example, my monthly premium for the Aetna Part D plan is $1.60/month for 2023. But the national base beneficiary Part D premium is $32.74 in 2023. Your 1% per month penalty is based on the $32.74, unless the drug plan you choose has an even higher premium than that.
intercst