The 2022 Inflation Reduction Act has hit the beaches. Go to YouTube and see any of at least 50 YouTubes on how it's roiling the market place. 1/1/25 Medicare will cap (limit with a maximum amount) your out of hospital drug costs to $2000 for the year. Some statistician said 2 million will actually spend that much and 64 million will not yet the 64 will pay significantly more for their medications. Way to go Medicare!
Wellcare and Aetna, the two most common drug plans in Texas are making huge changes. Wellcare is going from the INCREDIBLE 2024 price of $.50 a month to ZERO a month in 2025 (yet limiting the drugs they will provide severely). Yep, ZERO cost. Is it the right plan (or any other company) for you? First does it have your drugs from last year? How will you know if you don't properly use a software program to know? My plan dropped my most expensive medication making it impossible for me to stay on it! And you won't know which plan is best for you (15 to choose from) until you run your drugs through the software program designed to show you next years rates and the scope of the formulary (like a pantry of meds). And which drug store will deliver them for the best price.
Agents are being cut out of writing many of these plans as many have decided to block the agents from participating and by NOT paying them anything to help the client! I think it's been hard to find a competent agent to help annually with drug plan evaluations but now that the plans will pay the agent nothing to work though all the data, update annually the data entry and update their software expertise, only to find that you are on a non commissionable drug plan! That doesn't stop YOU from getting the plan, it stops the AGENT from wanting to spend a great deal of time only to help for free, during their busiest 53 days of the year! What will most agents do? Go sell Advantage plans to the market instead, it's a much easier sell in many ways and always pays the agent a full commission.
Fortunately some very large organizations that link agents together, often called FMO's, have written software for the average person to use to sort out the pricing and apply, a one stop deal. Do not make the mistake of focusing on your drug plan's monthly cost alone! That's what Zig Ziglar would call a case of "stinkin' thinkin'!" The software will do it right, taking in the monthly fee for the plan, the cost per drug and showing you the best outlets (drug stores, etc.) to buy it at. Drug outlets often have widely varied rates for serving up the same plan. Make sure you know the store with the best rates. If you LOVE your pharmacy and it's only $60 a year higher than another plan, I ask people to think before changing. Maybe it's worth $5 a month to stay with a friendly crew that you know? Or not, up to you!
10/15 I'll put a link out for your use if you'd like to compare drug plan properly. There's no charge to use the software and if the company works with agents, I'll end up being your agent. If it's non commissionable, you'll be THEIR client.
You will have until 12/7 to apply for your plan. I'd personally try to have this over before the last two weeks, when computer networks start slowing down, etc. Medicare MAY extend the season this year. It would be a first but it could well happen in a year with this much change. The software I will share is owned by Alliant and has Colonial Penn Life in it's background. It is a HUGE network of collected insurance writers through a major insurance network. The software will help you to see what your options are, scanning all 15 Texas plans and then when you find your best plan, it will also help you pick which drug store, etc. to use throughout the year.
Now that's it's after 10/1,24, Advantage plan users that want to move to original Medicare (A&B plus a supplement and Part D drug plan) can apply to pass underwriting and accept a 1/1/25 move to what many think is a far safer plan, with more choices and depending on the claims you have, may not cost you any more.
I firmly believe that Advantage plans are best used for those that can't afford Medicare Supplements. Kaiser Foundation ran a survey several years back that showed a supplement netted $700 a year profit for an insurance company, and Advantage Plan $1700. Advantage plans make the agent more money and are easier to sell in many ways. Why would an agent even try to sell you a plan that's more complicated with real costs? Uh, because the are convinced that it's better for the client, or most clients (I'd never say ALL CLIENTS).
Medicare dominates the rules and payments of supplements. Insurance company networks dominate who you can see, if surgeries will be conducted, how much your maximum out of pocket can be, etc. So if you want to have a hip replacement for instance it's a no brainer on a supplement. Your Advantage plan has to APPROVE of 70% of their surgeries. What if they tell you they will put a pin in your hip instead? Send you to therapy instead? What are your options. Now you are not battling Medicare but the lawyered up health plans.
An Advantage plan, working out of network, can spend between $8900, to $9500 and even $13,200 out of network for say cancer treatment in a calendar year. A supplement would have no extra charge after the $240 deductible. So, Advantage plans may work great if you have a PPO to get good care but still hit you with high, unexpected bills. ,
Who changes from an Advantage plan to a supplement? People that want their spouses to have the best care in the market, is one answer I get! Healthy people can move from Advantage plans to supplements (you must pass underwriting), I have sold Medicare 20 years and I DO NOT have an Advantage plan. I'd make a good deal more on my own plan's commission if I had an Advantage plan? And on yours ! Why don't I have one? I don't think it's a better option, pure and simple. I don't think "free" (only applies to a few things, monthly premium, GP costs, and the throw in bennies) stuff followed by very expensive care when it all goes wrong, served up with networks in the way, is what I want. When I have explained the choices between Original Medicare (A&B) with a supplement, vs an Advantage plan over the years to my clients properly, few want Advantage plans. (Clark Howard at Clark.com, a famous product and cost saving specialist examined the makeup of the plan and promptly called it the "DisAdvantage plan!" )
Are you comfortable being in a network plan that can block certain types of surgeries and still charge up to $13,200 in a worse case year? $13,200 is the govt's. OON (out of network yearly maximum). $9500 with a top name PPO Adv. Plan is more the norm. What if that happened twice in 2 years? See how pricey the "free" plan can be? Maybe you feel lucky? Ask someone that has lost a wife to cancer (like me) what the best plan for such treatment is. If you fully understand the way the plans work, it's not even close!
If on the other hand you don't care who treats you or your wife (some really and truly don't) and want the lowest cost health care available for seniors, get an HMO Advantage plan. Call me, I'll find you one! I can write those plans if you want one! But I'd only do it if we review the good, bad and ugly of the plan choices in the market place.
Seriously I don't expect many of you to change. Some cannot due to their health. Some have yet to experience any downsides of the plan. So if you have and keep your Advantage plan, move to a PPO so your options are much greater, your network is much larger and the options to treat serious diseases are far greater .
I'll be back again on 10/15 with the link that aids in picking your best option of the 15 drug plans in Texas (if you have a supplement). Advantage plan folks, call your agent and have him run your plan, putting your drugs through their model. What if you could find a plan, with your doctor and similar benefits, that was $200 or more cheaper on meds?Do not roll over your Advantage plans each year without kicking the tires a bit. You may be leaving $$ on the table. It would be good to know what to expect your drugs to cost in 2025 and each coming year. Ask your agent to tell you!
Gary / OB poster since 2006 / 1500 posts, all health insurance / Former paid advertiser on OB for 7 or 8 years, pre Obamacare / 450 or so active Medicare clients / Please email me, don't text !! Put your phone no. in the email or call me directly. I will not type long and hard with those who won't even speak to me! This is a critical year to evaluate your drug plans (if you have a supplement), rewrite your supplement if you are healthy enough to (to cut up to 1/3rd the rate off), move to a PPO Advantage plan from an HMO one, etc. 713-376-5608 (call 12-6PM) or email me at ges01@comcast.net / same address I have used on this site since 2006 / I do prefer supplements and sunny days but I do help with Advantage plans as well !!
Wellcare and Aetna, the two most common drug plans in Texas are making huge changes. Wellcare is going from the INCREDIBLE 2024 price of $.50 a month to ZERO a month in 2025 (yet limiting the drugs they will provide severely). Yep, ZERO cost. Is it the right plan (or any other company) for you? First does it have your drugs from last year? How will you know if you don't properly use a software program to know? My plan dropped my most expensive medication making it impossible for me to stay on it! And you won't know which plan is best for you (15 to choose from) until you run your drugs through the software program designed to show you next years rates and the scope of the formulary (like a pantry of meds). And which drug store will deliver them for the best price.
Agents are being cut out of writing many of these plans as many have decided to block the agents from participating and by NOT paying them anything to help the client! I think it's been hard to find a competent agent to help annually with drug plan evaluations but now that the plans will pay the agent nothing to work though all the data, update annually the data entry and update their software expertise, only to find that you are on a non commissionable drug plan! That doesn't stop YOU from getting the plan, it stops the AGENT from wanting to spend a great deal of time only to help for free, during their busiest 53 days of the year! What will most agents do? Go sell Advantage plans to the market instead, it's a much easier sell in many ways and always pays the agent a full commission.
Fortunately some very large organizations that link agents together, often called FMO's, have written software for the average person to use to sort out the pricing and apply, a one stop deal. Do not make the mistake of focusing on your drug plan's monthly cost alone! That's what Zig Ziglar would call a case of "stinkin' thinkin'!" The software will do it right, taking in the monthly fee for the plan, the cost per drug and showing you the best outlets (drug stores, etc.) to buy it at. Drug outlets often have widely varied rates for serving up the same plan. Make sure you know the store with the best rates. If you LOVE your pharmacy and it's only $60 a year higher than another plan, I ask people to think before changing. Maybe it's worth $5 a month to stay with a friendly crew that you know? Or not, up to you!
10/15 I'll put a link out for your use if you'd like to compare drug plan properly. There's no charge to use the software and if the company works with agents, I'll end up being your agent. If it's non commissionable, you'll be THEIR client.
You will have until 12/7 to apply for your plan. I'd personally try to have this over before the last two weeks, when computer networks start slowing down, etc. Medicare MAY extend the season this year. It would be a first but it could well happen in a year with this much change. The software I will share is owned by Alliant and has Colonial Penn Life in it's background. It is a HUGE network of collected insurance writers through a major insurance network. The software will help you to see what your options are, scanning all 15 Texas plans and then when you find your best plan, it will also help you pick which drug store, etc. to use throughout the year.
Now that's it's after 10/1,24, Advantage plan users that want to move to original Medicare (A&B plus a supplement and Part D drug plan) can apply to pass underwriting and accept a 1/1/25 move to what many think is a far safer plan, with more choices and depending on the claims you have, may not cost you any more.
I firmly believe that Advantage plans are best used for those that can't afford Medicare Supplements. Kaiser Foundation ran a survey several years back that showed a supplement netted $700 a year profit for an insurance company, and Advantage Plan $1700. Advantage plans make the agent more money and are easier to sell in many ways. Why would an agent even try to sell you a plan that's more complicated with real costs? Uh, because the are convinced that it's better for the client, or most clients (I'd never say ALL CLIENTS).
Medicare dominates the rules and payments of supplements. Insurance company networks dominate who you can see, if surgeries will be conducted, how much your maximum out of pocket can be, etc. So if you want to have a hip replacement for instance it's a no brainer on a supplement. Your Advantage plan has to APPROVE of 70% of their surgeries. What if they tell you they will put a pin in your hip instead? Send you to therapy instead? What are your options. Now you are not battling Medicare but the lawyered up health plans.
An Advantage plan, working out of network, can spend between $8900, to $9500 and even $13,200 out of network for say cancer treatment in a calendar year. A supplement would have no extra charge after the $240 deductible. So, Advantage plans may work great if you have a PPO to get good care but still hit you with high, unexpected bills. ,
Who changes from an Advantage plan to a supplement? People that want their spouses to have the best care in the market, is one answer I get! Healthy people can move from Advantage plans to supplements (you must pass underwriting), I have sold Medicare 20 years and I DO NOT have an Advantage plan. I'd make a good deal more on my own plan's commission if I had an Advantage plan? And on yours ! Why don't I have one? I don't think it's a better option, pure and simple. I don't think "free" (only applies to a few things, monthly premium, GP costs, and the throw in bennies) stuff followed by very expensive care when it all goes wrong, served up with networks in the way, is what I want. When I have explained the choices between Original Medicare (A&B) with a supplement, vs an Advantage plan over the years to my clients properly, few want Advantage plans. (Clark Howard at Clark.com, a famous product and cost saving specialist examined the makeup of the plan and promptly called it the "DisAdvantage plan!" )
Are you comfortable being in a network plan that can block certain types of surgeries and still charge up to $13,200 in a worse case year? $13,200 is the govt's. OON (out of network yearly maximum). $9500 with a top name PPO Adv. Plan is more the norm. What if that happened twice in 2 years? See how pricey the "free" plan can be? Maybe you feel lucky? Ask someone that has lost a wife to cancer (like me) what the best plan for such treatment is. If you fully understand the way the plans work, it's not even close!
If on the other hand you don't care who treats you or your wife (some really and truly don't) and want the lowest cost health care available for seniors, get an HMO Advantage plan. Call me, I'll find you one! I can write those plans if you want one! But I'd only do it if we review the good, bad and ugly of the plan choices in the market place.
Seriously I don't expect many of you to change. Some cannot due to their health. Some have yet to experience any downsides of the plan. So if you have and keep your Advantage plan, move to a PPO so your options are much greater, your network is much larger and the options to treat serious diseases are far greater .
I'll be back again on 10/15 with the link that aids in picking your best option of the 15 drug plans in Texas (if you have a supplement). Advantage plan folks, call your agent and have him run your plan, putting your drugs through their model. What if you could find a plan, with your doctor and similar benefits, that was $200 or more cheaper on meds?Do not roll over your Advantage plans each year without kicking the tires a bit. You may be leaving $$ on the table. It would be good to know what to expect your drugs to cost in 2025 and each coming year. Ask your agent to tell you!
Gary / OB poster since 2006 / 1500 posts, all health insurance / Former paid advertiser on OB for 7 or 8 years, pre Obamacare / 450 or so active Medicare clients / Please email me, don't text !! Put your phone no. in the email or call me directly. I will not type long and hard with those who won't even speak to me! This is a critical year to evaluate your drug plans (if you have a supplement), rewrite your supplement if you are healthy enough to (to cut up to 1/3rd the rate off), move to a PPO Advantage plan from an HMO one, etc. 713-376-5608 (call 12-6PM) or email me at ges01@comcast.net / same address I have used on this site since 2006 / I do prefer supplements and sunny days but I do help with Advantage plans as well !!
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