Heard a lot of bad news from one of the country's largest firms that represents thousands of health agents today. I have been hearing about the 2025 changes that we professional agents might expect, but the tone of today's excellent seminar was much more dire than I expected. The changes that appear on 10/15 (not a day before) may well cause many people to change their coverage. No matter how unlikely this sounds, like Sam Cook sang "A Change is Gonna Come!" Do not sit out the coming fall season. So much is changing due to several key events.
The Inflation Reduction Act, passed in August of 2022 and the lack of significantly more revenue paid to the insurance companies who sell and administer Advantage plans in 2025 (the govt. cut what the cos. were expecting to get) will have likely have huge repercussions in costs for 2025 Medicare users.
First, the act in 2023 lowered the price of insulin from as high as a $100 a month to a fixed $35 amount. Well that was very helpful to those on a limited budget, who take insulin.
2nd, the plan dramatically reduced ultra high total drug costs in the "Catastrophic Coverage" area of Medicare in 2024.
3rd, in 2025, the third and final drug repeal will CAP, or limit client costs on meds at $2000 a year.
If you have some very costly drugs (over $2000) you may see some serious savings here. But your provider may decide not to carry certain meds in the future, to avoid paying for them! Some plans will simply drop out of the 21 drug plans available (to supplement buyers) as an option. 6 companies have 3 plans, some will drop one and our choices will be fewer.
The companies may eliminate the agents from getting paid who charge you nothing to help you shop for the best plan (assuming they use Medicare.gov's software) at no charge to you. They make $50 a year but most don't want to go through the hassle for researching and then filling out the long federally required forms.
Now, in the fall, what if the companies to cut cost, decide not to pay the agent at all. Supplemental plans can't change their provisions but due to the post covid rush back to the doctors office, stiff increases in monthly premiums that we have seen this year, will surely continue forward. We expect Medicare Advantage plans in particular to drop many benefits and possibly add a monthly fee, though I think they will only do that as a last resort.
When all these changes hit the market in 2025, the insurance companies will be forced to pick up some of the cost the public now pays. And how will they react to picking up more of your drug costs? If you thought "they'll raise my monthly premiums, limit my access to certain drugs, some plans will be cancelled, and maybe my agent will get disconnected from helping me, etc." you and I are thinking alike.
Let's review this now. More costs for the drug companies will make the drug companies greatly change how and for what price they are selling them to you. Advantage plans usually charge nothing in fees for access to their drug plans and sometimes cover the deductible. I can't see that happening next year.
Supplement "stand alone drug plans" may jump their monthly fees from $20 to $40 (you can guess as well as I can here) a month to your plan cost. I think that's more likely than increasing drug prices, but that could happen as well. This will cause some to drop their drug plans all together, but that has a very dark downside. Try not to do this as you might desperately need their deep discounts with cancer meds, Eliquis, Ozempic, etc.
"Step therapy", where an insurance co. forces you to try a lower cost therapy, operation or buy a lesser to drug to see if that low cost path works instead of filling your doctors request has a real chance of becoming far more common. Ever had the pharmacy refuse to fill a prescription? "Sir (or ma'am), we can't fill this tonight. You'll need to call your drug provider and most likely your doctor will have to get involved!" Sound bad? Advantage plans do this same thing with surgeries. They MUST APPROVE all surgeries on Advantage plans. STEP THERAPY! It's an ancient insurance company approach to protecting their bottom line.
You can Google the the Inflation Reduction Act of 2022 and find MANY articles on these topics. Forbes has one that is a bit long on dealing with how this affects the agents and is covered up with AETNA advertising to learn more about this. But there's some good stuff in there. It was not behind a paywall when I found it.
What to do? First, within the next two months, if you have a supplement and it's 3 years old or more AND if you think you might be able to pass underwriting (I can send you a form to help outline your chances of passing) I'd do that I would try to rewrite my supplement. I rewrote my supplement last week, 3rd time! Dropped my cost from $210 a month to $141.
Supplement users rarely seem to know that they can attempt to change plans, even staying with the same companies often, all 12 months a year. One does not have to wait till fall when the agents are massively busy to try and rewrite a supplemental plan! Lots of healthy couples out there in their late sixties and up, that pass and save $600 to $1200 a year through a good rewrite. Especially if you have Supplement F. Supplement F has outlived his time . I saved $840 a year when I moved away from F 7 or 8 years back and got all the same benefits but I paid my own Part B deductible.
Again, can I pass underwriting and lower my supplement costs? I have a two page document that will give us both a pretty good idea if you can. Many agents do not do this. A lady in my subdivision told me her agent did not do it. She was a very health 70 something year old lady. I got her approved and saved her over $1200 a year, and that savings, all or part of it goes on year after year. I am rewriting a 77 year old woman tonight. I have successfully rewritten over 150 supplements. Should you try? Why not it costs you nothing to try !!
Advantage plan members, look for serious cuts to you freebies. Transportation, $50 to $150 over the counter items w/ free purchasing each quarter, kick back plans that have paid up to $165 a month (did you know about them?), maybe exercise classes, dental coverage over 2K, etc. All such outstanding benefits will be viewed by the companies as a way to spend less on you, to cover the new drug price increases passed on to them and cover the lack of a strong increase in payments from Medicare to them in 2025.
Stand alone drug plan buyers (these folks have supplements), be light on your feet. I'll email my clients a good deal of information once the plans tell the us all (the ins. cos. must reveal all rates and provisions by 10/1) along w/ all plan details. Will your agent? Do not sleep on allowing your drug plan (or your Advantage plan) to slip right by you between 10/15 and 12/7 this fall without examining your options closely. 1-800-Medicare promises to help you but I can see holding the phones for hours to get that done.
Gary S. / on the site since 2006, 9 years a paid sponsor, 20 year independent agent / 713-376-5608 / call between noon and 6 daily / ges01@comcast.net / Please do not send me an email, without a phone no. !! / 450 or so active Medicare members
The Inflation Reduction Act, passed in August of 2022 and the lack of significantly more revenue paid to the insurance companies who sell and administer Advantage plans in 2025 (the govt. cut what the cos. were expecting to get) will have likely have huge repercussions in costs for 2025 Medicare users.
First, the act in 2023 lowered the price of insulin from as high as a $100 a month to a fixed $35 amount. Well that was very helpful to those on a limited budget, who take insulin.
2nd, the plan dramatically reduced ultra high total drug costs in the "Catastrophic Coverage" area of Medicare in 2024.
3rd, in 2025, the third and final drug repeal will CAP, or limit client costs on meds at $2000 a year.
If you have some very costly drugs (over $2000) you may see some serious savings here. But your provider may decide not to carry certain meds in the future, to avoid paying for them! Some plans will simply drop out of the 21 drug plans available (to supplement buyers) as an option. 6 companies have 3 plans, some will drop one and our choices will be fewer.
The companies may eliminate the agents from getting paid who charge you nothing to help you shop for the best plan (assuming they use Medicare.gov's software) at no charge to you. They make $50 a year but most don't want to go through the hassle for researching and then filling out the long federally required forms.
Now, in the fall, what if the companies to cut cost, decide not to pay the agent at all. Supplemental plans can't change their provisions but due to the post covid rush back to the doctors office, stiff increases in monthly premiums that we have seen this year, will surely continue forward. We expect Medicare Advantage plans in particular to drop many benefits and possibly add a monthly fee, though I think they will only do that as a last resort.
When all these changes hit the market in 2025, the insurance companies will be forced to pick up some of the cost the public now pays. And how will they react to picking up more of your drug costs? If you thought "they'll raise my monthly premiums, limit my access to certain drugs, some plans will be cancelled, and maybe my agent will get disconnected from helping me, etc." you and I are thinking alike.
Let's review this now. More costs for the drug companies will make the drug companies greatly change how and for what price they are selling them to you. Advantage plans usually charge nothing in fees for access to their drug plans and sometimes cover the deductible. I can't see that happening next year.
Supplement "stand alone drug plans" may jump their monthly fees from $20 to $40 (you can guess as well as I can here) a month to your plan cost. I think that's more likely than increasing drug prices, but that could happen as well. This will cause some to drop their drug plans all together, but that has a very dark downside. Try not to do this as you might desperately need their deep discounts with cancer meds, Eliquis, Ozempic, etc.
"Step therapy", where an insurance co. forces you to try a lower cost therapy, operation or buy a lesser to drug to see if that low cost path works instead of filling your doctors request has a real chance of becoming far more common. Ever had the pharmacy refuse to fill a prescription? "Sir (or ma'am), we can't fill this tonight. You'll need to call your drug provider and most likely your doctor will have to get involved!" Sound bad? Advantage plans do this same thing with surgeries. They MUST APPROVE all surgeries on Advantage plans. STEP THERAPY! It's an ancient insurance company approach to protecting their bottom line.
You can Google the the Inflation Reduction Act of 2022 and find MANY articles on these topics. Forbes has one that is a bit long on dealing with how this affects the agents and is covered up with AETNA advertising to learn more about this. But there's some good stuff in there. It was not behind a paywall when I found it.
What to do? First, within the next two months, if you have a supplement and it's 3 years old or more AND if you think you might be able to pass underwriting (I can send you a form to help outline your chances of passing) I'd do that I would try to rewrite my supplement. I rewrote my supplement last week, 3rd time! Dropped my cost from $210 a month to $141.
Supplement users rarely seem to know that they can attempt to change plans, even staying with the same companies often, all 12 months a year. One does not have to wait till fall when the agents are massively busy to try and rewrite a supplemental plan! Lots of healthy couples out there in their late sixties and up, that pass and save $600 to $1200 a year through a good rewrite. Especially if you have Supplement F. Supplement F has outlived his time . I saved $840 a year when I moved away from F 7 or 8 years back and got all the same benefits but I paid my own Part B deductible.
Again, can I pass underwriting and lower my supplement costs? I have a two page document that will give us both a pretty good idea if you can. Many agents do not do this. A lady in my subdivision told me her agent did not do it. She was a very health 70 something year old lady. I got her approved and saved her over $1200 a year, and that savings, all or part of it goes on year after year. I am rewriting a 77 year old woman tonight. I have successfully rewritten over 150 supplements. Should you try? Why not it costs you nothing to try !!
Advantage plan members, look for serious cuts to you freebies. Transportation, $50 to $150 over the counter items w/ free purchasing each quarter, kick back plans that have paid up to $165 a month (did you know about them?), maybe exercise classes, dental coverage over 2K, etc. All such outstanding benefits will be viewed by the companies as a way to spend less on you, to cover the new drug price increases passed on to them and cover the lack of a strong increase in payments from Medicare to them in 2025.
Stand alone drug plan buyers (these folks have supplements), be light on your feet. I'll email my clients a good deal of information once the plans tell the us all (the ins. cos. must reveal all rates and provisions by 10/1) along w/ all plan details. Will your agent? Do not sleep on allowing your drug plan (or your Advantage plan) to slip right by you between 10/15 and 12/7 this fall without examining your options closely. 1-800-Medicare promises to help you but I can see holding the phones for hours to get that done.
Gary S. / on the site since 2006, 9 years a paid sponsor, 20 year independent agent / 713-376-5608 / call between noon and 6 daily / ges01@comcast.net / Please do not send me an email, without a phone no. !! / 450 or so active Medicare members
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