Medicare advantage not going away

[WheatenLover]

My mother had original Medicare and a Medigap plan (F, I think). It was a bargain for her because she had a lot of serious illnesses including 2 kinds of cancer (twice). Frankly, health insurance is an actual bargain only if you are very sick. You are basically betting against yourself, that the extremely high costs will be worth it. But whatcha gonna do? So many illnesses are random and cost a lot to treat.

I still can't get over how cheap drugs and medical care are in France compared to here. My daughter has gone to the ER several times, had drugs prescribed, and been to a specialist about her cat allergy. Turns out she is in the top 5% of people who have cat allergies -- those are the people whom the allergy can kill. I hope the specialist figures out a way to treat it because cats are everywhere.

I am on my daughter's list. I accidentally wished her a happy 31st birthday. She is 30. I knew I should have counted on my fingers.

 

[Trade]

The least they could do is post the yearly cost to themselves with whatever they have, & what if any copays they have. Would also be helpful for comparison of their surgery, hospital, specialists & med costs.

Lol! Why would I do that when you obviously don't want to hear anything negative about Medicare Advantage?

I read part of the article. I stopped at myth #2.

 

[MACKTEXAS]

Mack, it could be location, but on another forum people in many other states were also on the well care plan that was free for the past two years so I don’t think it’s that uncommon. Actually this will be the third year that I’m on wellcare and that’s been the longest I’ve been on a plan because for a while I was switching on a yearly basis.

I was worried about getting priced out of a Medicare supplement plan as I aged, but now that my Social Security has increased so much that’s no longer a worry. I won’t consider an advantage plan because I know a few people that are only alive because they could seek the best medical care out of state.

There are many considerations we take into account for the choices we all make. In my case, I want basic care and I'm trying to stay healthy as long as possible. If I develop a grave illness requiring chemo, radiation, out of state care, extensive surgeries, and so on, I will not pursue those remedies. At this juncture of my life, I have no desire to go through all of that, then succumb to some other age related disease a few years later. I might feel differently if I was 40, but not now. My doctor knows this and my wishes are expressed in directives on file.

People have all sorts of perspectives and needs, and many may make different choices than I do. And that's fine. There is no "one size fits all." I just expressed my point of view while it's all still fresh on my mind.

Since my UHC Advantage plan discontinued the plan I've been on in 2025, I have a letter from them informing me I have the indisputable right to return to original Medicare and Medigap (no underwriting) within the next 63 days. I've already had a Medigap plan in the past; there will be no going back. Last week I chose a Humana Advantage plan for 2026, and I have put the matter to rest.

 

[Teacher Terry]

The least they could do is post the yearly cost to themselves with whatever they have, & what if any copays they have. Would also be helpful for comparison of their surgery, hospital, specialists & med costs.

I heard this or not happy with how capitalism works as input IMO really isn't helpful.

My Medigap plan cost me 190/month. It does go up every year as I age. I have no co-pays whatsoever and the Medicare yearly deductible I think is 256/year. My part D plan which is my prescription plan was free for the last two years and this year it’s going up to 2.76/month.

 

[Teacher Terry]

Mack, i’m glad you were able to find a new plan that works for you. Like you I’m just not going to automatically pursue every type of medical care that’s available. I’m going to look at each situation individually and decide at my age if that is something I’m willing to do or not. Cancer would be one of those situations where I’d have to weigh the negatives of treatment to the possible outcomes for the time I would have left. I have no interest in spending my final years just sick than dying.

it really depends on the prognosis, but if I need a specific surgery where the outcome would not be good unless I had a certain surgeon that would be the type of case that I could see myself really using my insurance. Odds are probably small that would happen, but like I said, I’ve known a few people where that was the case.

 

[Knight]

My Medigap plan cost me 190/month. It does go up every year as I age. I have no co-pays whatsoever and the Medicare yearly deductible I think is 256/year. My part D plan which is my prescription plan was free for the last two years and this year it’s going up to 2.76/month.

Thank you for posting the cost to you for your health care coverage. $2,280.00 a year isn't a lot to pay if you are able.

 

[Aunt Bea]

These threads always seem to become a them against us sort of thing.

My choice of the BCBS zero premium plan is simply about the best coverage, for my situation, with the lowest annual out of pocket.

If my health or circumstances change I may go to original Medicare or some other plan that makes financial sense during the annual open enrollment period.

I have more loyalty to my brand of peanut butter than I do to my health insurance provider.

 

[Teacher Terry]

In

These threads always seem to become a them against us sort of thing.

My choice of the BCBS zero premium plan is simply about the best coverage, for my situation, with the lowest annual out of pocket.

If my health or circumstances change I may go to original Medicare or some other plan that makes financial sense during the annual open enrollment period.

I have more loyalty to my brand of peanut butter than I do to my health insurance provider.

In most states, you can’t return to regular Medicare from an advantage plan without passing medical underwriting. Most seniors have difficulty with that and that’s why it can be such a big decision.

 

[Aunt Bea]

In

In most states, you can’t return to regular Medicare from an advantage plan without passing medical underwriting. Most seniors have difficulty with that and that’s why it can be such a big decision.

I’m in New York, from what I understand it’s a guaranteed issue state that allows us to
move freely among plans.

If that’s not true or if it changes, I’ll figure something out.

 

[RandomName]

Liking this thread. Very informative. Here's my story. I have an MA plan through Highmark Blue Shield. Got the letter saying it was going away. Went to Medicare.gov and my exact plan was still there, lol. But significantly more expensive. Letter also said I 'may have the right' to enroll in a medigap policy.

I already made he agonizing choice to go with MA years ago. I'm 71. I don't want to have that choice again, but I do, lol. I suppose I will stay with MA, possibly the same plan that is supposed to be going away, but isn't, and just pay more for it.

I had high copays with the 2025 MA plan, and will have most copays go higher with the 2026 version. Outpatient hospital procedure $350 in 2025, now $450 in 2026. Ambulance $350? in 2025, now $450 in 2026. Primary care office visit still free in both years. Annual wellness visit still free. Specialist was $25, now $50. Basic blood tests to go with physical still free. Still have same dental coverage, but vision coverage is worse.

My girl friend has a UHC medigap policy and her monthly premium is $240. She is 73. She likes the coverage (all free except some drugs have co pays) and uses lots of doctors. She's seeing some specialist once a month at least. Her Part D does not cover some new drugs at all, like Ozempic, etc, and some drugs that are covered have enormous copays, like $400 per month. But she gets all the drugs she actually needs, for about $10 a month. Metformin and Glyburide.

I was getting $35 per month giveback on monthly Part B premium, , that will go down to zero giveback in 2026.

Knight, is your MA plan with UHC an HMO or a PPO ? No cost to you for 8 days in hospital? Amazing. My cost would be $350 per day for first 7 days !

 

[Teacher Terry]

One of the challenges if you use part D the RX plan, you have to actually enter your drugs into each plan and see what they cover. Luckily I’m only on two medications that are generic so I have no problem finding a part D that is cheap.

My sister takes some more expensive drugs and some of the part d plans don’t cover them at all so every year she has to spend time entering her medications to see who will cover them.

 

[Knight]

Knight, is your MA plan with UHC an HMO or a PPO ? No cost to you for 8 days in hospital? Amazing. My cost would be $350 per day for first 7 days !

UHC / PPO after I had my spinal surgery about 2 & 1/2 weeks in rehab at no cost. I like what we have but obviously no all advantage are equal.

@Teacher Terry
Same here for generic prescription needs. Probably the best feature is it's mailed to us & we are on auto refill. Auto refill means the pharmacy calls the doctor when refills are needed. Never been without meds & actually have 100 days supply ahead at all times

 

[Aunt Bea]

My drug coverage deductible and copays are increasing significantly this year with an out of pocket max of $2,100.00.

I have secondary coverage through a free New York State program known as EPIC, Elderly Pharmaceutical Insurance Coverage, that helps.

It is income based and offers various levels of assistance to seniors with incomes up to $100,000.00. Once it’s on file with your pharmacy all prescriptions are run through it and once you are enrolled they automatically check your eligibility by bumping their file up against the state income tax records. Once a year they send an enrollment notice with your new deductible and coverage amount.

https://www.health.ny.gov/health_care/epic/

It might be worth checking to see if your state offers a similar benefit.

 

[JustBonee]

In

In most states, you can’t return to regular Medicare from an advantage plan without passing medical underwriting. Most seniors have difficulty with that and that’s why it can be such a big decision.

Don’t know about other states, but in Texas if your MA is ending, and you don’t step in to change anything, they put you on Original Medicare automatically in January 2026.
Part B costs are then removed from monthly SS payments.

 

[Teacher Terry]

Don’t know about other states, but in Texas if your MA is ending, and you don’t step in to change anything, they put you on Original Medicare automatically in January 2026.
Plan B costs are then removed from monthly SS checks.

Yes, I realize that and I think it’s that way in every state but I wasn’t talking about that. I was talking about if you are on a Medicare advantage plan and want to switch back to regular Medicare in most states you can’t do that if you can’t pass medical underwriting. New York State is one of the few exceptions that I know about to that rule.

 

[JustBonee]

Phone calls to both Medicare and Social Security this morning gave me a headache!! ..lol

… at least they all seem to be working during the shutdown.

 

[OneEyedDiva]

Doesn't bother me. I would never leave original Medicare for one of those Advantage scams.

My plan is through my retiree benefits with the State of N.J. I had Aetna HMO, for which I paid no premiums and when it was time to get on Medicare, I was told I had to provide proof of the original Medicare coverage, but not to use that coverage. The state then slid me seamlessly into Aetna Medicare HMO and for the first time in my decades of coverage, I had to pay premiums. If it's a scam, it's one I'm very happy with!

I've had two invasive eye surgeries, plus 2 laser surgeries. I had a cardiac ablation and was in the hospital for almost two days. I did not pay a penny for any of those procedures or the hospital stay. Also, all lab and imaging tests as well as post op visits are at no cost to me. A couple of years ago, I switched to the PPO plan so that out of network doctors wouldn't cost me extra. That saved me $260 on 2 visits to my optometrist. Additionally, when I visit our glaucoma specialist, my co-pay is $10. My son works for a great company, but their health insurance sucks. We have joint visits to that doctor but his co-pay is $75 for the exact same care.

 

[Teacher Terry]

Diva, employer Medicare advantage plans tend to be much better than ones that people can buy themselves.