First to all you with "original Medicare" (that means you have A&B and a supplement, plus drug plan).
You can call 1-800-Medicare and ask them to help you evaluate your drug plan choices for 2025. 12/7 at midnight is the last chance you'll have to change drug plans for 2025. There are no mulligans for supplement users! Currently, there's a $9.80 drug plan that's going up to $44.60 a month on Jan. 1. Yet another plan for $0 a month premium, may cover you just as well. That's a $500 hickey that won't go away anytime soon. You could buy a half of one percent of a BitCoin with that kind of $$$.
So many supplement users do not evaluate their drug plans in the fall each year. Not unusual to find a 70 years old with 5 year old drug plan choices. CRAZY, LAZY, WASTEFUL! Take that.
Get with it. Call 1-800-Medicare with a all your medications in front of you. That way you can answer questions. Hang on the phone all day if necessary! I helped an old buddy in deep E. TX with his drug plan recently. Said his wife was OK and would keep her current plan going forward! I said "let me be the judge of that, give me her list !"
I saved her $1150. This is not an unusual event. Rolling over your drug plan without running the nos. is a kind of financial Russian Roulette. I have protected my clients from such screw ups for years!
But don't call me NOW. I'm back to the wall trying to help them all get under the deadline.
Do call me after 12/10 to discuss your Medicare supplement, as to whether it can be rewritten. What makes a good rewrite? You convincing an underwriter that you are SO healthy that his/her company will make $$$ on you. NO stents, No diabetes plus neuropathy, most cancers over 3 years past with no current treatments, recent major surgery (last 3 years often), possibly some expensive medications, AFIB (one co. may work with you if you are VERY healthy otherwise). I have rewritten over 175 plans, including my own 3 times, as recently as this past June.
If you are VERY healthy, and have had your current supplement more than 3 years, you are a PRIME rewrite candidate.
Is it worth it? Well I saved $70 a month in June, meaning $840 a year, for how long? As long as I can fog a mirror! Those savings don't just work for a year but go on with you at least in part into perpetuity. Email me your name, birthday, zip code and current plan type and I'll call you between 12/10 and 1/10 to review your options. I'll send you a two page document that will ask you YES / NO questions. Any YES on the two pages, it's over !! Most of those questions are about VERY pricey health conditions. If you take a few generic meds only, you are probably an ALL STAR candidate.
......................
Now to all you Advantage plans folks. Read your booklets before 1/1/25. Most of you don't know S... from Shinola about what happens if you are hospitalized. All Advantage plans have networks, and no, every doctor does not have to see you. The commercials overlook that the doctor has to be WILLING to see you. And if they are willing, you will get billed the "OUT OF NETWORK" price !! Also you might call MD Anderson to see if they would take your Advantage plan and if "it's in network?" I expect them to decline HMO's and tell you on plan is in network billing wise for Adv. plans but they will bill you Out of network rates. Often $9000 to $14,200 for the year.
70 to 72% of Advantage plan surgeries are screened, to see if your health company can deny, delay or change your surgery to something cheaper for the company. This is called the APPROVAL Process and NO, Supplements (also called Gap Plans) do not need such APPROVALS. Surgeries and hospital stays with Supplements are mostly ZERO billed. Yeah, why do you think we have been paying a monthly premium?
Next, if you are hospitalized, you will find out what a MOOP, maximum out of pocket cost is. It runs from about $4500 to $14,200 (the out of network maximum charge). Oh, you thought this was the "FREE PLAN?" Well it is FREE for a monthly fee, a family doctor visit, some part of your dental, vision and maybe exercise. But when it hits the fan, get out your checkbook! I think of this much like having cheap car insurance which works perfectly and give you braggin rights, right up until the collision.
Do I think Advantage plans are horrible? Well if you are flat broke they are a Godsend. So much better than A&B alone which makes you pay 20% of your hospitalization, bankrupting most Americans. A&B alone will let you see a wide range of doctors, get you in almost every facility in America. BUT .... you'll owe the A&B deductible (almost $2000 together) and 20% of the total bill. That's why if you have A&B only, email me ASAP, don't wait a day so we can get you on a plan before 12/8 for 1/1/25.
Back to Advantage plans. In my 21st year of writing Medicare plans at a very high volume, would I take one? Only if I was dead broke! They look good on the front end when you have no major health challenges, but when those develop, and they always do, such plans tend to disappoint the users greatly. From blocking access to doctors and facilities, withholding or altering the approval for surgery, to introducing you to you MAXIMUM payout, from forcing you out of your recuperative stay by using an algorithm (Google this!) and finally to the realization that you CANNOT now move to a supplement, because they will no longer take you. Like life insurance, you needed to buy it when you didn't need it. If you need it, they no longer want you. But in the first 6 months of entering Medicare supplement as NO MEDICAL questions at all, Guaranteed Issue is what that's call. Your ADV. plan selling agent rarely mentions this major issue!!
After the first year in Medicare, when Supplements are available with NO HEALTH QUESTIONS asked, with no cost markups, you can only get a supplement by 1) applying around 10/1 or so (can't quit your Adv. plan until the end of the year) and 2) you MUST pass underwriting. Again is that hard? Not if the underwriter thinks you are a good candidate to become a member of their plan (and MAKE THEM MONEY!).
One good lesson from all this conversation, get an independent agent when you come to Medicare that has proven themselves to work for the clients best interest. And not one of current work force that wants to make a double commission by selling you an Advantage plan without even discussing the supplement path. That's right, the companies now game the sales system by double commissioning the agents for the FIRST ADV. Plan Sale! That should be illegal.
If you find an agent only presenting an ADV. plan on a home visit for example, and it happens thousand of times a day, stand up and say "thanks for your time" to the agent and find an agent that explains BOTH major paths.
I'm covered up through 12/7 at midnight. Can't really help anyone new in these last 5 days. But call me 12/10 to discuss"
Turning 65 / rewriting your supplement / Leaving your work plan / possibly even quoting your group insurance (have a great benefits co. to do this) or even U65 (I refer that to a good friend, but 12/15 is the last day for U65 sign ups !!!
Gary Smithey / 713-376-5608 / ges01@comcast.net / please don't TEXT ME! / and don't email me without a phone no. as I don't play guessing games / 21 year Texas licensed health insurance writer, last 13 years of it 99.9% Medicare plans only / former site sponsor for OB over 8 years, starting in 2006 / over 400 active Medicare clients today / my goal is to give people the information needed to make good choices and help them find plans that fit them, saving them as much $$ as possible / my fees, I have none / the companies pay the agents not the clients / all specific Medicare plans come with only one price no matter where you get it / so no fees, always the lowest rate / all 254 counties in TX / Hook 'Em!
You can call 1-800-Medicare and ask them to help you evaluate your drug plan choices for 2025. 12/7 at midnight is the last chance you'll have to change drug plans for 2025. There are no mulligans for supplement users! Currently, there's a $9.80 drug plan that's going up to $44.60 a month on Jan. 1. Yet another plan for $0 a month premium, may cover you just as well. That's a $500 hickey that won't go away anytime soon. You could buy a half of one percent of a BitCoin with that kind of $$$.
So many supplement users do not evaluate their drug plans in the fall each year. Not unusual to find a 70 years old with 5 year old drug plan choices. CRAZY, LAZY, WASTEFUL! Take that.
Get with it. Call 1-800-Medicare with a all your medications in front of you. That way you can answer questions. Hang on the phone all day if necessary! I helped an old buddy in deep E. TX with his drug plan recently. Said his wife was OK and would keep her current plan going forward! I said "let me be the judge of that, give me her list !"
I saved her $1150. This is not an unusual event. Rolling over your drug plan without running the nos. is a kind of financial Russian Roulette. I have protected my clients from such screw ups for years!
But don't call me NOW. I'm back to the wall trying to help them all get under the deadline.
Do call me after 12/10 to discuss your Medicare supplement, as to whether it can be rewritten. What makes a good rewrite? You convincing an underwriter that you are SO healthy that his/her company will make $$$ on you. NO stents, No diabetes plus neuropathy, most cancers over 3 years past with no current treatments, recent major surgery (last 3 years often), possibly some expensive medications, AFIB (one co. may work with you if you are VERY healthy otherwise). I have rewritten over 175 plans, including my own 3 times, as recently as this past June.
If you are VERY healthy, and have had your current supplement more than 3 years, you are a PRIME rewrite candidate.
Is it worth it? Well I saved $70 a month in June, meaning $840 a year, for how long? As long as I can fog a mirror! Those savings don't just work for a year but go on with you at least in part into perpetuity. Email me your name, birthday, zip code and current plan type and I'll call you between 12/10 and 1/10 to review your options. I'll send you a two page document that will ask you YES / NO questions. Any YES on the two pages, it's over !! Most of those questions are about VERY pricey health conditions. If you take a few generic meds only, you are probably an ALL STAR candidate.
......................
Now to all you Advantage plans folks. Read your booklets before 1/1/25. Most of you don't know S... from Shinola about what happens if you are hospitalized. All Advantage plans have networks, and no, every doctor does not have to see you. The commercials overlook that the doctor has to be WILLING to see you. And if they are willing, you will get billed the "OUT OF NETWORK" price !! Also you might call MD Anderson to see if they would take your Advantage plan and if "it's in network?" I expect them to decline HMO's and tell you on plan is in network billing wise for Adv. plans but they will bill you Out of network rates. Often $9000 to $14,200 for the year.
70 to 72% of Advantage plan surgeries are screened, to see if your health company can deny, delay or change your surgery to something cheaper for the company. This is called the APPROVAL Process and NO, Supplements (also called Gap Plans) do not need such APPROVALS. Surgeries and hospital stays with Supplements are mostly ZERO billed. Yeah, why do you think we have been paying a monthly premium?
Next, if you are hospitalized, you will find out what a MOOP, maximum out of pocket cost is. It runs from about $4500 to $14,200 (the out of network maximum charge). Oh, you thought this was the "FREE PLAN?" Well it is FREE for a monthly fee, a family doctor visit, some part of your dental, vision and maybe exercise. But when it hits the fan, get out your checkbook! I think of this much like having cheap car insurance which works perfectly and give you braggin rights, right up until the collision.
Do I think Advantage plans are horrible? Well if you are flat broke they are a Godsend. So much better than A&B alone which makes you pay 20% of your hospitalization, bankrupting most Americans. A&B alone will let you see a wide range of doctors, get you in almost every facility in America. BUT .... you'll owe the A&B deductible (almost $2000 together) and 20% of the total bill. That's why if you have A&B only, email me ASAP, don't wait a day so we can get you on a plan before 12/8 for 1/1/25.
Back to Advantage plans. In my 21st year of writing Medicare plans at a very high volume, would I take one? Only if I was dead broke! They look good on the front end when you have no major health challenges, but when those develop, and they always do, such plans tend to disappoint the users greatly. From blocking access to doctors and facilities, withholding or altering the approval for surgery, to introducing you to you MAXIMUM payout, from forcing you out of your recuperative stay by using an algorithm (Google this!) and finally to the realization that you CANNOT now move to a supplement, because they will no longer take you. Like life insurance, you needed to buy it when you didn't need it. If you need it, they no longer want you. But in the first 6 months of entering Medicare supplement as NO MEDICAL questions at all, Guaranteed Issue is what that's call. Your ADV. plan selling agent rarely mentions this major issue!!
After the first year in Medicare, when Supplements are available with NO HEALTH QUESTIONS asked, with no cost markups, you can only get a supplement by 1) applying around 10/1 or so (can't quit your Adv. plan until the end of the year) and 2) you MUST pass underwriting. Again is that hard? Not if the underwriter thinks you are a good candidate to become a member of their plan (and MAKE THEM MONEY!).
One good lesson from all this conversation, get an independent agent when you come to Medicare that has proven themselves to work for the clients best interest. And not one of current work force that wants to make a double commission by selling you an Advantage plan without even discussing the supplement path. That's right, the companies now game the sales system by double commissioning the agents for the FIRST ADV. Plan Sale! That should be illegal.
If you find an agent only presenting an ADV. plan on a home visit for example, and it happens thousand of times a day, stand up and say "thanks for your time" to the agent and find an agent that explains BOTH major paths.
I'm covered up through 12/7 at midnight. Can't really help anyone new in these last 5 days. But call me 12/10 to discuss"
Turning 65 / rewriting your supplement / Leaving your work plan / possibly even quoting your group insurance (have a great benefits co. to do this) or even U65 (I refer that to a good friend, but 12/15 is the last day for U65 sign ups !!!
Gary Smithey / 713-376-5608 / ges01@comcast.net / please don't TEXT ME! / and don't email me without a phone no. as I don't play guessing games / 21 year Texas licensed health insurance writer, last 13 years of it 99.9% Medicare plans only / former site sponsor for OB over 8 years, starting in 2006 / over 400 active Medicare clients today / my goal is to give people the information needed to make good choices and help them find plans that fit them, saving them as much $$ as possible / my fees, I have none / the companies pay the agents not the clients / all specific Medicare plans come with only one price no matter where you get it / so no fees, always the lowest rate / all 254 counties in TX / Hook 'Em!
Last edited:
