Turning 65 within the next 6 months? Reach out and I'll help you get Medicare A&B and offer a bit of plan advice.
10/15 will be your first glimpse of what plans will charging for Medicare drugs next year. Thanks to the 2022 Inflation Reduction Act, Medicare is at play this year as an election tool. You'll be hearing about what your government has done to lower your drug costs.
Is it true? Well it's certainly complicated and may cost you instead of save you money. I see 4 major changes in the way Medicare is now or will be in the future changing your current Medicare drug plans.
1) the $35 limit on insulin, down from as much as $100 a month
2) Wiping out the donut hole, the Coverage Gap to purists
3) Starting 1/1/25 your maximum expense for the year under your Medicare drug plan will be $2000
4) Drug price negotiation is slowly becoming a thing. Starting in 2006 or 7 the govt. was NOT supposed to negotiate the price of medications, just post them so you could shop them. This starts with 10 medications the first year, the ones that cost the govt. the most, then will gradually ramp up over time. I'd be surprised if they are not ALL negotiated within 5 years. We pay too much for them now, without a doubt. A decent sized group insurance plan buy meds cheaper than over 50 million seniors get them! Sound about right?
5) And what could go wrong? Well if the cost is passed to insurance companies, who set your rates for the plans, won't they just raise the price of the drug plans? You betcha! Maybe add some more to it?
So if you are on an inexpensive drug plan today with your supplement, and don’t spend over $2000 a year for meds, you will now be sharing in paying for those who have much higher costs! So by helping the few who overspend this no., your costs will rise. Is that helping you? That particular piece of the plan will clearly cost more people $$ than it saves.
How much more? You'll know when your current plan informs you between now and 10/1. Annual Notice of Change letters must be sent telling you of next year's pricing each fall no later than 10/1.
With "stand alone drug plans" (that supplement folks have) you'll see the price of your plan going up, substantially we believe.
On an Advantage plan, it may be a bit more subtle. Might add a deductible to your drug plan, though some plans have them now. If your plan has had a drug deductible (say of $250 to $750) it might go up. Regardless, Either style of coverage that you have, unless you are one of the ones with very high medication costs, this will not BENEFIT you, but PENALIZE you.
Another way you may see this increase in the supplement side of the market, we have had 21 plans in Texas. Some plans are throwing in the towel and are leaving (Mut. of Omaha for example.) Some with three plans will now have two.
And many of the drug plans have decided this is the perfect time to quit paying agents to sort through your drug plans in this season no longer paying the agents for their time to help you pick the right plans by using the Medicare.gov software to help you save money. With agents not being paid some may now send you an email with a link that takes you to a software program that allows you list all your meds, make an educated decision and sign up on your own, with no direct intervention from an agent at all.
......
Advantage plans had their first BAD financial year, in 2023. We were told that the 2nd largest co. lost money on their Adv. plans and the no. 1 company in health broke even on them. Not like the runaway profits from past years. These plans are removing themselves from low population areas. Choices away from the cities will be fewer and costlier.
Supplement plans are taking larger increases than normal it would appear the last 6 months. Just seems that Medicare plan costs are going up for the providers and not surprisingly those costs are being passed on. Expect Advantage plans to drop certain benefits! The ones they think you'll miss least. Transportation? Exercise plans? Drug store credit each quarter? Trimming back the maximum amount your dental plan will pay? They'll try to maintain the zero monthly if at all possible, you can be sure of that and your $0 cost primary doctors visits. But the govt. is now supplementing their costs less, thus the profits are declining and the benefits and costs will be adjusted !!
Things to do now?
1) Keep a typed drug list of all your medications, list the strength, times per day or week, and list a favorite drug store with its phone no.
2) Get your agent to run your medications through the pricing/benefit model when he/she looks at your plan options for 2025
3) Get a local independent agent, call me if you don't know of one and I'll help you get sorted or
4) call 1-800-Medicare / they say they'll help with your plan selection but I can't imagine how long the lines will be on the phone
5) Oh, and do this before 12/1 !!! Waiting till the end puts you in 5 o'clock rush hour with all those that delayed dealing with these issues.
Advantage Plan people should shop their plan each year as well, if for no other reason than your drug prices change each year / Supplement plan folks should ALWAYS, EACH YEAR re-shop their drug plans between 10/15 and 12/7. After 12/7, you cannot change your drug plans for a year (in the Supplemental side).
REWRITING YOUR SUPPLEMENT: And know supplement folks that after about year 4 on your plan, if you are healthy (the underwriter is the judge of that) you should attempt to REWRITE your supplement. You can do it 12 months a year, not boy in the fall, if you can pass underwriting . I'm going to hit 200 rewritten supplements within the next year. Not all agents do this, but they should. Cutting you pr costs over $500 to $1000 a year is normal if you pass. I use multiple companies to try and get your approved. I have rewritten my own plan 3 different times. Costs you nothing to try!
Turning 65 or leaving your corporate insurance plan before or after 65, give me a ring 3 to 4 months prior to the date. No crying in baseball, no procrastinating when turning 65. No overestimating your ability to sort this out well! You'll generally be much better off with an independent agent advising you who writes the market year after year than calling any insurance co. directly. The agency is not your best friend in the advice area. They don’t look for the best deal in the market for you, they sign you up with a a second thought. Let someone who deals with 10 companies or more for years help you instead.
Gary / ges01@comcast.net / 713-376-5608 / Texas independent agent 20 years, 450 active Medicare clients / posting on OB since 2006 / please include a phone no. if you email me, I refuse to get carpal tunnel syndrome giving out free advice!
10/15 will be your first glimpse of what plans will charging for Medicare drugs next year. Thanks to the 2022 Inflation Reduction Act, Medicare is at play this year as an election tool. You'll be hearing about what your government has done to lower your drug costs.
Is it true? Well it's certainly complicated and may cost you instead of save you money. I see 4 major changes in the way Medicare is now or will be in the future changing your current Medicare drug plans.
1) the $35 limit on insulin, down from as much as $100 a month
2) Wiping out the donut hole, the Coverage Gap to purists
3) Starting 1/1/25 your maximum expense for the year under your Medicare drug plan will be $2000
4) Drug price negotiation is slowly becoming a thing. Starting in 2006 or 7 the govt. was NOT supposed to negotiate the price of medications, just post them so you could shop them. This starts with 10 medications the first year, the ones that cost the govt. the most, then will gradually ramp up over time. I'd be surprised if they are not ALL negotiated within 5 years. We pay too much for them now, without a doubt. A decent sized group insurance plan buy meds cheaper than over 50 million seniors get them! Sound about right?
5) And what could go wrong? Well if the cost is passed to insurance companies, who set your rates for the plans, won't they just raise the price of the drug plans? You betcha! Maybe add some more to it?
So if you are on an inexpensive drug plan today with your supplement, and don’t spend over $2000 a year for meds, you will now be sharing in paying for those who have much higher costs! So by helping the few who overspend this no., your costs will rise. Is that helping you? That particular piece of the plan will clearly cost more people $$ than it saves.
How much more? You'll know when your current plan informs you between now and 10/1. Annual Notice of Change letters must be sent telling you of next year's pricing each fall no later than 10/1.
With "stand alone drug plans" (that supplement folks have) you'll see the price of your plan going up, substantially we believe.
On an Advantage plan, it may be a bit more subtle. Might add a deductible to your drug plan, though some plans have them now. If your plan has had a drug deductible (say of $250 to $750) it might go up. Regardless, Either style of coverage that you have, unless you are one of the ones with very high medication costs, this will not BENEFIT you, but PENALIZE you.
Another way you may see this increase in the supplement side of the market, we have had 21 plans in Texas. Some plans are throwing in the towel and are leaving (Mut. of Omaha for example.) Some with three plans will now have two.
And many of the drug plans have decided this is the perfect time to quit paying agents to sort through your drug plans in this season no longer paying the agents for their time to help you pick the right plans by using the Medicare.gov software to help you save money. With agents not being paid some may now send you an email with a link that takes you to a software program that allows you list all your meds, make an educated decision and sign up on your own, with no direct intervention from an agent at all.
......
Advantage plans had their first BAD financial year, in 2023. We were told that the 2nd largest co. lost money on their Adv. plans and the no. 1 company in health broke even on them. Not like the runaway profits from past years. These plans are removing themselves from low population areas. Choices away from the cities will be fewer and costlier.
Supplement plans are taking larger increases than normal it would appear the last 6 months. Just seems that Medicare plan costs are going up for the providers and not surprisingly those costs are being passed on. Expect Advantage plans to drop certain benefits! The ones they think you'll miss least. Transportation? Exercise plans? Drug store credit each quarter? Trimming back the maximum amount your dental plan will pay? They'll try to maintain the zero monthly if at all possible, you can be sure of that and your $0 cost primary doctors visits. But the govt. is now supplementing their costs less, thus the profits are declining and the benefits and costs will be adjusted !!
Things to do now?
1) Keep a typed drug list of all your medications, list the strength, times per day or week, and list a favorite drug store with its phone no.
2) Get your agent to run your medications through the pricing/benefit model when he/she looks at your plan options for 2025
3) Get a local independent agent, call me if you don't know of one and I'll help you get sorted or
4) call 1-800-Medicare / they say they'll help with your plan selection but I can't imagine how long the lines will be on the phone
5) Oh, and do this before 12/1 !!! Waiting till the end puts you in 5 o'clock rush hour with all those that delayed dealing with these issues.
Advantage Plan people should shop their plan each year as well, if for no other reason than your drug prices change each year / Supplement plan folks should ALWAYS, EACH YEAR re-shop their drug plans between 10/15 and 12/7. After 12/7, you cannot change your drug plans for a year (in the Supplemental side).
REWRITING YOUR SUPPLEMENT: And know supplement folks that after about year 4 on your plan, if you are healthy (the underwriter is the judge of that) you should attempt to REWRITE your supplement. You can do it 12 months a year, not boy in the fall, if you can pass underwriting . I'm going to hit 200 rewritten supplements within the next year. Not all agents do this, but they should. Cutting you pr costs over $500 to $1000 a year is normal if you pass. I use multiple companies to try and get your approved. I have rewritten my own plan 3 different times. Costs you nothing to try!
Turning 65 or leaving your corporate insurance plan before or after 65, give me a ring 3 to 4 months prior to the date. No crying in baseball, no procrastinating when turning 65. No overestimating your ability to sort this out well! You'll generally be much better off with an independent agent advising you who writes the market year after year than calling any insurance co. directly. The agency is not your best friend in the advice area. They don’t look for the best deal in the market for you, they sign you up with a a second thought. Let someone who deals with 10 companies or more for years help you instead.
Gary / ges01@comcast.net / 713-376-5608 / Texas independent agent 20 years, 450 active Medicare clients / posting on OB since 2006 / please include a phone no. if you email me, I refuse to get carpal tunnel syndrome giving out free advice!
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