So far we have been very fortunate that both my and H’s multi-thousand/month Rx are covered by a discount plan because we have drug coverage from H’s old drug plan that is part of his BCBS insurance. If we had Medicare D drug plan, we wouldn’t be able to be in discount plan! My drug under plan has $0 copay and H only has $25/month copay.
The downside is we don’t qualify for the $2000/year Rx cap but this works better for us!
This amount was from 2024 (I couldn’t afford it in 2025, and only could in 2024 because at some point I met my deductible of $4000). It’s the difference between a Part B drug and a prescription drug.
But yes, the $2000 max is helpful (especially since UHC limited mine to $800 through creative accounting). I’ve already decided that next year I’ll be dropping my two most expensive drugs and telling my doc to pick something else as that’s how I got to the $800 with those 2 (As Seen on TV) drugs.
I think it should be illegal for drug companies to advertise their drugs on TV. Advertise to doctors, but not to us and cut the price. It’s not production costs, it’s advertising costs that are driving the costs of Eylea, Ozempic, Jardiance, and a bunch of other drugs that I don’t even know what they do sky high levels.
Yes, it would be far better for the drugs to be more affordable and ban advertising as they do for most of the rest of the world. It’s awful for patients to be an able to afford the treatments and yet keep having the option shoved in their face at extremely high prices due to all the ads.
In our area, one could have difficulty getting a PCP as a new patient with Medicare. You can get care with walk in urgent care facilities that are part of the large hospital system in our area. Many specialists no longer require physician referral, and I don’t know of any that don’t take Medicare - although since they all take BCBS they all take our supplement BCBS plan and IDK about MA difficulties. There is one MA plan in our area that I believe is something really linked in with medical care in our area.
When we move in 2026/2027 we will have to figure that out in our new city and state. But we plan to carry BCBS as the supplement there, be it still with our current plan or it we transfer to the BCBS in that state. I think we need to stay with our current plan if we can.
In the almost 4 years DH and I have been on Medicare and Supplement, we have had no charges other than drug copays outside of our Medicare deductible. DH’s name brand blood thinner (there are two that continue under patent, and he uses Xarelto) is the only ‘expensive’ drug - so we pay more for his drug plan, and we pay the co-pays every three months when we have that daily pill filled. IDK about things like eye injections or other things that can perhaps have expenses for out-of-pocket as described by some on this thread.
We will continue Vision Service Plan for DH which is $15.66/month - this helps with discount on optician exam and cost of glasses. Since he sees a MD retina specialist annually (he has floaters and other things) he doesn’t need to see an optometrist annually - and when he has maybe 3 pair of glasses eventually, we may drop the vision plan. Since he had cataract surgery on both eyes, he really could use cheaters - but we keep having his more expensive lenses made up - he is used to glasses all the time and DD2 says “dad you look better with glasses”. The lenses with the discounts was $357. I don’t have cataracts bad enough to meet standards for surgical care, but I have needed to get glasses for watching TV and for driving due to headaches and/or eye fatigue with eye strain - the glasses were $160. I can legally drive w/o glasses. I probably will make up a 2nd pair at some point. DH and I noticeably feel ‘aging’ when it comes to our eyes. DH chooses not to have surgery for his floaters and I wouldn’t either - DH’s brother had a detaching retina so of course he had to have the surgery where they drain all the fluid out of your eye etc. To handle the floaters surgically, have to do that procedure (drain the fluid out of your eye).
In certain areas, it seems dental can get quite high based on seeing comments on this thread and the CC retirement thread (“How Much do you think you need to Retire…”). Outside of our yearly ‘plan’ with our dentist of $375 each, DH has just needed one crown and that out-of-pocket was about $1200.
So one has to weigh out things. IMHO the health care outweighs the dental and optical, but if one is really tight on money and needs to have overall costs be contained with a MA plan - and maybe MA in your area covers well all your needs. We are very happy with our dentist and the routine services we get every 6 months with our teeth.
DH got sent to ER from urgent care - it had to do with a cut finger that wasn’t handled properly, and due to his blood thinner, when the stitches were to come out…plus he wasn’t given oral or application antibiotics…we had no ER co-pays. All was covered under his Medicare/supplement. Other than this visit, DH nor I have never gone through ER in all our medical history, except when I was 16 and had broken my leg - but ER was not like ER now. MD offices/care was M - F and everything else of urgent nature went through ER. DH’s broken leg last year went through orthopedic group’s urgent care clinic.
Is your marketplace plan for both of you together and you are changing to marketplace for just you? Premium due Aug 25th - can you not talk to them about the changes for Sept 1? Him off for Sept 1, and your plan continuing?
The marketplace plan is for both of us. I’m changing it to just myself. I’ve already talked to the broker, BCBS who the plan is through and the marketplace.
All say the same thing. It needs to be canceled by the marketplace on Sunday August 31.
I get it that you cancel his, but do you have separate billing for each of you - or do you have auto pay with one amount each month. I think it is crazy to pay and then get reimbursed instead of just paying for the one on the auto pay Aug 25th. If I knew the amount for continuing on the one, and if there is a 10-day window or such for late pay, it doesn’t make sense to advance pay for him and then wait for a refund. I understand you do not want to have him w/o insurance. “BCBS who the plan is through” - surely you don’t have to advance pay for the plan he is dropping. I would talk to the ‘right’ customer service individual.
However, being on Medicare and supplement starting Sept 1, it should not be difficult to getting refund on your marketplace plan. How long a wait, IDK. How much you have to follow up, IDK.
It’s a joint plan.
I can call BCBS and ask if I can either pay late or only pay one premium for the month of August.
I didn’t think about that. The only advice I was giving was to turn off autopay. That didn’t seem prudent
I’m in NY and was able to cancel on 8/1 for an 8/31 cancel date. In NY if you don’t make a change by the 15th of the month, they will not honor the change the next month. I did get conflicting information when I called, but eventually i had them do the cancel for me.
I get why you don’t trust the process!
I am in MA and last year we had to change our marketplace plans from both of us to only me, as my husband was going on Medicare. We were keeping the marketplace Dental for both of us and my plan only. It was not an easy feat. It took several calls before they got it right. The big issue was the the marketplace had my husband as the primary and me as the spouse on their account. Having the primary leave the marketplace plans was harder to do. We spoke to several very helpful marketplace customer service reps, and they finally got it right. I wouldn’t worry so much about the payments. Ours was autopay and I think in the end I ended up with a credit on my husband’s plan which was then applied to my plan payment.
Thanks for that information
I am the primary, my husband is secondary. The broker suggested that to make the transition easier 
@SOSConcern when you move to a new state, you can (and probably must) change to that state’s plans. BCBS may not be available or may not offer a MA plan or may only offer an MA plan. All insurance is state by state.
When I asked my broker (who is very knowledgeable and licensed in several states) she said BCBS here is not a good plan, not accepted at all the hospitals. I don’t know why, but she was really against it.
I think one way to get off a MA plan and back to plain medicare plan is to move! Sort of drastic but if I really wanted to change that’s what I’d have to do.
Yes, moving to another is a qualifying event which allows you to change your insurance. Things are very different across states, even in the naming of the parts. In Massachusetts, BCBS is the only game in town for Medicare supplement, they own something like over 90% of the supplement market. Keep in mind that Blue Cross Blue Shield is not a single entity but a federation of 36 independent health insurance companies operating in different states. I discovered the same thing was true of Delta Dental, different company in different states.
We are not MA - we are BCBS supplement – that is why we may not need to change, and why we won’t change if we don’t have to. With continual BCBS supplement from age 65, we are protected under rate increases. BCBS supplement in TX might be a ‘start over’ coming in at the ages we come in - IDK. BCBS is very strong in AL, and it is strong in TX. We lived in TX before many years ago, but DH’s AL employer had HQTR in TX so we were under both (I think the company could handle AL employees better under AL BCBS).
Some states, BCBS has issues - IDK the exact reasons.
I doubt that DH and I will ever go to a MA plan unless we are quite old and in our no-go years or very slow-go years. That is quite a while from now and a lot can change with health care and insurances.
I think what could be an issue is your present BCBS might be a different company than the one in Texas. I considered Blue Shield of Ca or Anthem Blue Cross for my supplement. They are two different companies here. I’m just starting Medicare in the fall and I know there will be lots to learn.
From my friends I do know their are specialists who don’t take Medicare, specialists who don’t necessarily take Medicare but take what Medicare covers and the supplement picks up the rest and thirdly those that take Medicare.
We possibly can continue the BCBS supplement w/o living in AL. Yes, I understand each state BCBS is independent of the others, and also handle their own claims. BCBS in TX actually works along with IL and I believe AZ in their claims (they did so when we had BCBS of TX with DH’s employer).
We will research medical providers and sign on as patients and follow through with what we need to do on our Medicare insurance choices.
This is maybe a bit of bragging. I was lucky enough to find a great doctor who specializes in elderly care, a geriatrician, for my mom. She speaks Chinese and is a caring doctor. I decided to have her as my primary doctor. She told me that I was too young for her. I said, no worries, I will get there at some point.
I really notice a difference in how she treats my mom vs her other doctors before.
Yes, mom & dad had an excellent geriatrician. She was very patient, listened to family members (who were more accurate reporters) and patient and made more time for them than other docs. She also helped prioritize so we kept the more important issues at the front.
I agree that a great geriatrician is priceless!
I called BCBS today about my husband going on Medicare September 1 and about the premiums due August 25.
I was told that I am liable for the premiums due August 25. Once my husband’s marketplace insurance is cancelled on August 31, his portion of the premium will either be refunded or applied to the next month’s premium.
@twoandone - I’m worried about you skipping your injections. I have traditional Medicare and plan G. I do get Avastin but I am pretty sure that plan G would cover the other injectables. I pay about $600 for three months. I was originally on Medicare Advantage but my Retinal Specialist convinced me to change. My plan G is blue cross and they were the only one that would take me with a pre-existing condition. I don’t pay anything now when I get my injections. Obviously, you have to wait until the open enrollment period. I wish you the best.