Social Security Retirement & Disability COLA 2025

[alarmguy]

Yet -there are a few on here that think it's sub standard care....I don't get it. You are proof it's not.
Good luck going down this road....

Thank you, appreciate that.
It makes no sense the "sub standard" thinking, the health network you go to is either in the plan or not. Either the Advantage Plan is a PPO or HMO/POS. For some to think they discriminate based on what plan you have is crazy thinking. Heck, no one but administrators know what plan you are in when you see a doctor or hospital.

I do make sure by reading the paperwork ahead of time that a referral isnt needed to see a specialist. Very rarely in this area have I see where you do but I do make sure, just to eliminate and extra step.

 

[CKN]

Thank you, appreciate that.
It makes no sense the "sub standard" thinking, the health network you go to is either in the plan or not. Either the Advantage Plan is a PPO or HMO/POS. For some to think they discriminate based on what plan you have is crazy thinking. Heck, no one but administrators know what plan you are in when you see a doctor or hospital.

I do make sure by reading the paperwork ahead of time that a referral isnt needed to see a specialist. Very rarely in this area have I see where you do but I do make sure, just to eliminate and extra step.

My plan requires no pre approvals as well. My agent said this is a big thing for most people. Not waiting for a referral- but making an appointment directly with a specialist.

 

[Rmay635703]

Alarmguy: Thanks for pointing out that Aetna 2024 plan. I enrolled in it and got $1,200 paid back on a nice new bicycle. I wouldn`t have seen that without you pointing it out. I am changing insurers in 2026 as Aetna`s benefits are not as competitive as other Medicare Advantage plan options available to me.

Competitive isn’t the issue 2024 there were 24 plans, now there are ZERO advantage plans and only 3 Medicare options in total

 

[Pablo]

 

[alarmguy]

Pretty good, a bit of an informercial but informative.
I liked this one too.


Personally in the last 4 years I never had an issue with and Advantage plan (3 years) or Medigap Plan N (this year) and will return to an Advantage plan for 2026 (most likely Humana) As far as I am concerned being in the medicare system I have far more protections than the working population.

Having undergone cancer treatment and procedures with both types I have a lot to say on this. One day in a thread. Ive had medical insurance my whole life, mostly self employed but also as an employee for a short term. The only issue I ever got denied on was an MRI in 2017 for prostate cancer and that was with company provided health insurance! They made me wait for one more bad PSA test 6 months later.
I feel I have WAY more protections with ANYTHING when associated with Medicare.

Another thing, I mean, there is a lot of wealthy people in here and I am not so convinced you need supplement at all. Other than plan A,B and D
Being responsible for 20% of medical other than hospitals covered at 100% isnt all that bad. I went over but still need to tally this year as I still have a lot of claims coming in. That 20% you are responsible for is medicare approved charges. Meaning you pay the medicare rate not the billing rate. Just as an example. Not factual because I dont want to dig up my paper work. But let's say a months worth of radiation treatment for cancer is $41,000 well part of that is covered 100% under part A and the actual Part B medical bill that goes to my Medigap plan would have cost me $845 for some radiation treatments. Dont get me wrong, I think it's foolish not to have any supplemental insurance but that maybe because of my limited knowledge. My fear would be if you needed a bit long term care in a nursing facility, self insured that maybe quite expensive without supplemental. I dont know other than it's expensive even with supplemental.

Another thing, he talks about the reduction of the Medigap out of pocket drug costs. Here I think he is flat out wrong. Yes the $5000 (or whatever) it is donut hole is gone and I am thankful for that. However medicare plans used to have to pay for the first few thousands dollars of drug costs before you hit the donut hole. Now you pay upfront, the first $2000 is the deductible and nothing is covered until you pay $2000 first, so I am not so sure of how much more it cost insurance companies. SO many people are contributing $2000 first that would have never hit that donut hole. I do think though, that this change it good. Everyone contributes. I might feel that way because my drug this year would have cost me $5000 instead of less than $2000. Being a newer drug, I dont know what the hospital pharmacy did but they got a cost reduction for what I pay. SO my part D paid $14,000 and I paid less than $1000
If the donut hole was there I would have been libel for thousands more.

 

[Pablo]

Pretty good, a bit of an informercial but informative.
I liked this one too.

I was going to add some commentary, but I timed out (excuse is first head cold in years, worse than covid for me)

Anyway in short I liked the part about the way things are reported, ie......questions asked to stimulate something more than logical discussion. We have some of that here.

Yeah my Humana plan was cancelled last year and plans dwindled now as well. Farewell, I loved thee much.

 

[alarmguy]

This is an example.
A radiation oncologist setting up my treatments. If I didnt have Medigap Plan N I would have had to pay $44.95 for this doctor bill.

 

[alarmguy]

Here is a more costly one and I dont understand it fully except to think that Part A pays for part of this.
Its roughly a month of radiation.
But I would have only been libel for $845. My Medigap Plan N paid it. Dont get me wrong, these are only snippets of the bills being paid this year. I hope by late Jan 2026 I can add it all up in a meaningful way. There is no doubt that having supplemental, in this case, Plan N medical saved me many thousands over what I paid for the plan and Plan D drug saved me $15,000, interestingly my premiums for Plan d were $0.00 a month but going up to $3.60 a month for 2026 should I not go to an advantage plan. So plan D is a must if you dont get advantage, I do think some wealthy people most likely forgo the Medigap Medical part though like Plan G or N or better yet, in a high cost state you can save a bundle with a high deductible plan G where you pay just shy of the first $3,000 in bills for the year then have $0.00 cost after that. Of course you still need plan D for drugs. I can get Plan G high deductible plan in my state for $40 a month. My current plan N is $144 a month, if I still lived in NY it would be $200 per month more for the same plan.

 

[alarmguy]

I was going to add some commentary, but I timed out (excuse is first head cold in years, worse than covid for me)

Anyway in short I liked the part about the way things are reported, ie......questions asked to stimulate something more than logical discussion. We have some of that here.

Yeah my Humana plan was cancelled last year and plans dwindled now as well. Farewell, I loved thee much.

Feel better, could you maybe have it again?

 

[Pablo]

Feel better, could you maybe have it again?

Tested negative just a cruddy cold from an air travel donor

I never felt sick when I had actual Covid. Runny nose one day. Then 7 days constipated. Yep. Some few of us had that symptom

 

[fantastic]

Pretty good, a bit of an informercial but informative.
I liked this one too.


Personally in the last 4 years I never had an issue with and Advantage plan (3 years) or Medigap Plan N (this year) and will return to an Advantage plan for 2026 (most likely Humana) As far as I am concerned being in the medicare system I have far more protections than the working population.

Having undergone cancer treatment and procedures with both types I have a lot to say on this. One day in a thread. Ive had medical insurance my whole life, mostly self employed but also as an employee for a short term. The only issue I ever got denied on was an MRI in 2017 for prostate cancer and that was with company provided health insurance! They made me wait for one more bad PSA test 6 months later.
I feel I have WAY more protections with ANYTHING when associated with Medicare.

Another thing, I mean, there is a lot of wealthy people in here and I am not so convinced you need supplement at all. Other than plan A,B and D
Being responsible for 20% of medical other than hospitals covered at 100% isnt all that bad. I went over but still need to tally this year as I still have a lot of claims coming in. That 20% you are responsible for is medicare approved charges. Meaning you pay the medicare rate not the billing rate. Just as an example. Not factual because I dont want to dig up my paper work. But let's say a months worth of radiation treatment for cancer is $41,000 well part of that is covered 100% under part A and the actual Part B medical bill that goes to my Medigap plan would have cost me $845 for some radiation treatments. Dont get me wrong, I think it's foolish not to have any supplemental insurance but that maybe because of my limited knowledge. My fear would be if you needed a bit long term care in a nursing facility, self insured that maybe quite expensive without supplemental. I dont know other than it's expensive even with supplemental.

All good points, I did want to pick your brain a bit about why you're perhaps moving away from Medigap. When that time comes I'll not do a Medigap, b/c I'm poor..ha!, but it's always an interesting option. Is it because an Advantage Plan could end up being cheaper for you on average? (more below)

But I would have only been libel for $845. My Medigap Plan N paid it. Dont get me wrong, these are only snippets of the bills being paid this year. I hope by late Jan 2026 I can add it all up in a meaningful way. There is no doubt that having supplemental, in this case, Plan N medical saved me many thousands over what I paid for the plan and Plan D drug saved me $15,000, interestingly my premiums for Plan d were $0.00 a month but going up to $3.60 a month for 2026 should I not go to an advantage plan.

As you know an Advantage Plan could be a better deal. If you get a low deductible plan, let's say $3500 MOOP, & stayed in network at all times it could work out to be cheaper if healthy. Granted it all depends on which Medigap plan were comparing it to but if you pay $2500 a year for Plan N for example you could potentially save a lot by just paying the MOOP instead on an Advantage Plan (MOOP may end up being less than a Medigap premium). I think that is essentially what you're getting at. I do think you'll agree that it's basically mandatory to get a supplement plan if you're relying on Original Medicare though. That at least protects you from Unlimited out of pocket coinsurance costs.

So plan D is a must if you dont get advantage, I do think some wealthy people most likely forgo the Medigap Medical part though like Plan G or N or better yet, in a high cost state you can save a bundle with a high deductible plan G where you pay just shy of the first $3,000 in bills for the year then have $0.00 cost after that. Of course you still need plan D for drugs. I can get Plan G high deductible plan in my state for $40 a month. My current plan N is $144 a month, if I still lived in NY it would be $200 per month more for the same plan.

You can guarantee the wealthy go with the original Medicare & the best Medigap available to them or at least that's what I'd do.

 

[CKN]

All good points, I did want to pick your brain a bit about why you're perhaps moving away from Medigap. When that time comes I'll not do a Medigap, b/c I'm poor..ha!, but it's always an interesting option. Is it because an Advantage Plan could end up being cheaper for you on average? (more below)

As you know an Advantage Plan could be a better deal. If you get a low deductible plan, let's say $3500 MOOP, & stayed in network at all times it could work out to be cheaper if healthy. Granted it all depends on which Medigap plan were comparing it to but if you pay $2500 a year for Plan N for example you could potentially save a lot by just paying the MOOP instead on an Advantage Plan (MOOP may end up being less than a Medigap premium). I think that is essentially what you're getting at. I do think you'll agree that it's basically mandatory to get a supplement plan if you're relying on Original Medicare though. That at least protects you from Unlimited out of pocket coinsurance costs.

You can guarantee the wealthy go with the original Medicare & the best Medigap available to them or at least that's what I'd do.

In Utah you will get the exact same Doctors and Hospitals whether you have original Medicare or an Advantage Plan. I understand other states may be different-but I am guessing in less populated states like Iowa, Nebraska, Hawaii, Montana etc., it's going to be the same.
54% of those eligible are now enrolled under an Advantage Plan.

 

[fantastic]

In Utah you will get the exact same Doctors and Hospitals whether you have original Medicare or an Advantage Plan. I understand other states may be different-but I am guessing in less populated states like Iowa, Nebraska, Hawaii, Montana etc., it's going to be the same.
54% of those eligible are now enrolled under an Advantage Plan.

I've seen some USAA style plans that seem to be positioned for Veterans & I often wondered if those networks are more towards Vets. From what I've seen they are the Advantage plans that leave out a prescription drug plan as the insurance company probably wants that cost take up with VA footing the bills more so.

 

[alarmguy]

In Utah you will get the exact same Doctors and Hospitals whether you have original Medicare or an Advantage Plan. I understand other states may be different-but I am guessing in less populated states like Iowa, Nebraska, Hawaii, Montana etc., it's going to be the same.
54% of those eligible are now enrolled under an Advantage Plan.

Yes, you are correct pretty much the same experience in North and South Carolina for us.
What @fantastic doesn’t know I have been in advantage plans for three years before this years 2025 stint with a Medigap policy and I am going back to an advantage plan next year.

I’m really into the subject so I will give him a full reply to his message to me, but I may not get to it for a couple days right now. I have to go out to dinner with my wife and depending on how the day goes tomorrow. I’ll definitely get to it within a few days. One thing for sure you do not have to be wealthy to get in a Medigap plan. For me it’s about value and convenience in an advantage plan.

The landscape has changed a little bit, and there are certain things to be aware of, but I’ll save that for another post. One thing for sure for those that discredit advantage plans without knowing the facts are doing themselves a disservice, with that said there are some things I want to say but I can’t get into it right now. So you’re all lucky no long winded post. Right now

 

[alarmguy]

I've seen some USAA style plans that seem to be positioned for Veterans & I often wondered if those networks are more towards Vets. From what I've seen they are the Advantage plans that leave out a prescription drug plan as the insurance company probably wants that cost take up with VA footing the bills more so.

If your VA drug plan, you get a better deal on an advantage plan because they don’t have to have the drug plan included so you get the benefit of either a cost reduction or more benefits in the advantage plan because of that. Some of the advantage plans for veterans are very good. In fact,
I’ve looked into it to see if I can get my own separate drug plan under plan D in order to get one of those advantage plans without drug coverage but they won’t let me do that or anyone else for that matter.

 

[fantastic]

Yes, you are correct pretty much the same experience in North and South Carolina for us.
What @fantastic doesn’t know I have been in advantage plans for three years before this years 2025 stint with a Medigap policy and I am going back to an advantage plan next year.

I’m really into the subject so I will give him a full reply to his message to me, but I may not get to it for a couple days right now. I have to go out to dinner with my wife and depending on how the day goes tomorrow. I’ll definitely get to it within a few days. One thing for sure you do not have to be wealthy to get in a Medigap plan. For me it’s about value and convenience in an advantage plan.

The landscape has changed a little bit, and there are certain things to be aware of, but I’ll save that for another post. One thing for sure for those that discredit advantage plans without knowing the facts are doing themselves a disservice, with that said there are some things I want to say but I can’t get into it right now. So you’re all lucky no long winded post. Right now

I assumed you've used both Advantage & Medigap as I've seen some of your posts mentioning it. No need to rush or reply at all I'm just curious about a real user of the Medigap set-up that's all. You've had a great experience on your old Advantage plan & that's going to have an appeal again I'm sure.

If your VA drug plan, you get a better deal on an advantage plan because they don’t have to have the drug plan included so you get the benefit of either a cost reduction or more benefits in the advantage plan because of that. Some of the advantage plans for veterans are very good. In fact,
I’ve looked into it to see if I can get my own separate drug plan under plan D in order to get one of those advantage plans without drug coverage but they won’t let me do that or anyone else for that matter.

Why didn't they let you do a separate Part D plan if you were choosing a MA plan w/o Drug coverage? Am I misunderstanding you?