That’s because brokers aren’t making much money from selling Part D and many people change yearly and it’s a lot of work for the brokers. They can sit on their residuals from Part B because very few people change the plans year to year.
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From the article:
"As it stands, traditional Medicare requires prior authorization for a substantially smaller set of procedures and services than most Medicare Advantage plans.
The situation is very different for Medicare Advantage plans. While they must cover all medically necessary services that Original Medicare covers, for some services, MA plans may use their own coverage criteria to determine medical necessity. Almost all Medicare Advantage enrollees — 99% according to KKF — must obtain prior authorization for some services. These are typically higher-cost services, such as inpatient hospital stays, skilled nursing facility stays and chemotherapy."
Which still argues the case that traditional Medicare has fewer hoops to jump through to get the care you may need.
I presently don’t take any medications. I still have a bit of time. I do know I don’t want an advantage plan. I don’t think there is much difference between the plans the broker sent over at least as far as local providers.
My PT office just stopped taking Medicare. I’ll continue to see them but it will cost me more but it’s worth it to me. My PT said they were turning away a lot of patients and Medicare reimbursed them so little.
Just just worth noting, anyone on Medicare cannot use any of those coupons that pharmaceutical companies sometimes offer to discount the price of a medication.
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They can use the coupon instead of Part D if the price is lower. It just won’t count toward the Part D deductible.
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Medicare Advantage plans “must cover all medically necessary services that Original Medicare covers”
I don’t plan to jump through hoops when time is of essence for prior authorization for services my MD or health care provider says is needed.
Chemotherapy, obtain prior authorization…
I had chemotherapy at age 53 under our insurance coverage that is now our supplement coverage. My cancer was aggressive, and I needed immediate care. I went from stage I to stage IIIa in 10 weeks (misdiagnosed). I was fortunate to survive long-term with the cancer in my lymph systems, but I required 10-year oral medication, that as a side effect, gave me fatty liver disease. Have to take the side effects to survive the cancer. Priorities are priorities.
I can understand stand-alone offices like PT needing to stop taking Medicare. It is all or none, and I believe Medicare reimbursements are very limited. A shame that a treatment plan and a PT aide could not have Medicare reimbursements to make that work for patient care.
That’s helpful to know. I was told by a friend who was offered a coupon to use on an expensive dermatology med that was not on her formulary, that the pharmacy would not accept the coupon because she was on Medicare.
You need to be a CPA to figure out all the prescription charges and how to work the system.
This is the first year with the $2000 max. I had Aetna last year and they charge the max allowed by medicare ($590 deductible, then 24% of the tier 3 drugs, less for the tier 1 and 2) to get to the $2000. This year I have United and I am charged the $590 deductible, then $147 for a 90 day supply of a tier 3, $30 for a tier 2 but nothing for a tier 1 (as a copay). BUT, I’m given credit for a higher amount as a copay toward the $2000. How much more? That’s where you need to be the CPA to figure it out. In Jan I picked up a tier 1 drug and paid nothing OOP, but got credit for $12.39. In April picked up the same drug and got credit for $3.13. Same drug, same 90 days, but NO ONE can tell my why it is credited differently. In total for the year, I will pay just under $800 OOP to meet the $2000 max. With Aetna, I would have paid the whole $2000. It is not fun to pay the $800, but better than the $2000.
I could pay less with some of the GoodRX or Simple RX type programs, but then they don’t count toward the $2000 at all, so if you are going to meet the max, it makes no sense to use the discount programs.
These are MA programs. I don’t pay a premium.
It might have been cheaper last year to do the Part D and Part G, but not this year. I know for Part G my friend pays about $140/mo, then had about a $300 deductible (almost $2000 just in premiums and deductibles) , but she has no dental or vision benefit and her prescriptions cost a LOT more (some kind of inhaler that wasn’t covered at all).
I top out at $4000 OOP (medical), but if I don’t use it, I don’t pay it. I get:
$2250 dental
$300 vision
gym memberships (worth about $1000/yr for me, but you can use as many memberships as you want)
bonuses for doing things like getting flu shot, $10/mo for work outs, $50 for in home health check
$260 in OTC benefits per year filled through Amazon or local store
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This thread is interesting in terms of the dominance of traditional Medicare, I just looked up the percentage of Americans on Medicare Advantage and it is over half:
As of 2024, approximately 54% of eligible Medicare beneficiaries are enrolled in Medicare Advantage plans This percentage reflects a significant increase in enrollment, indicating a growing preference for private insurance options among Medicare beneficiaries.
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I just figured I’d post that my husband turns 65 this month and been able to pretty simply sign up for Medicare, get his card, and get things worked out with his PC doc and pharmacist.
As a federal retiree he won’t be selecting any D or G plans, because we have very good insurance that will now be his secondary.
We are both a little nervous about moving to Medicare as primary, but if it doesn’t work out we can discontinue Medicare and carry only the BCBS plan we are used to. For now he’s moving to a lower cost BCBS option, and they will “credit him” something like $800 because Medicare is primary.
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Perhaps because the population at large has lower incomes and perhaps researches less than the representative sample on CC.
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I don’t think so. I would think the unresearched bias would be towards traditional and there is misinformation about Medicare Advantage for the public at large. I did months of research and visited three financial consultants who specialize in Medicare choices, and all three recommended Advantage wit BC/BS. I think the source of variation may just be the differences among states and companies in the quality of Advantage Plans. Mine is a PPO, Prior Authorizations are easy and quick and in addition to vision, dental and hearing I get a flex card worth $700 to use as I wish in those areas. Since I have 5+ conditions they also provided home visits and home labs and x-rays. Co-pays are $0 for any primary care, $40 for specialists, imaging is $100, and there is an annual cap, which was important to me and may be available with supplements as well. I am doing a daily injection of an expensive medicine for a few more months at $100/month.
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I think the difference is in different people’s needs. Advantage plans wouldn’t work for us.
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Not sure I agree. You’d be surprised at the number of people who get their “information” from ads on tv or social media sales people pushing MA plans.
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I think brokers get a better commission from those who pick advantage plans
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Not here. I’m not sure how they get paid, but no commissions.
That Kiplinger article has quite a few positives mixed in with the negatives of prior authorization requirements, and “limited networks.” It seems to focus on United, Humana and CVS-Aetna.
My PPO BC/BS Medicare Advantage allows me to see any doctor I want, in any hospital system in my state. So not a limited network.
Again, plans vary from state to state and company to company. That article more than once states that people are happy with their plans. I have more than 5 serious medical conditions but it works for me. Last post! I just don’t want folks to get upset reading this thread if they have MA!
- Aetna: Exited several counties and is expected to lose up to 10% of its Medicare Advantage members.2
- Humana: Exited 13 Medicare Advantage markets, primarily in the Southeastern states, affecting approximately 560,000 members.2
- WellCare: Closed its Medicare Advantage business in six states: Alabama, Massachusetts, New Hampshire, New Mexico, Rhode Island, and Vermont.2
- Cigna: Exited Medicare Advantage markets in eight states, affecting about 5,400 members.2
- Moda Health: Discontinued all individual Medicare Advantage plans in Oregon.2
- Premera Blue Cross: Will not offer Medicare Advantage plans in 2025.2
- MVP Health Care and University of Vermont Health: Stopped offering their joint Medicare Advantage plan in Vermont.2
- Southwestern Health Resources: Shut down its Medicare Advantage plan, Care N’ Care, in Texas.2
- BCBS Arizona: Will not offer MA prescription drug plans in Arizona.2
- BCBS Kansas City: Exited the Medicare Advantage market at the end of 2024.2 These insurers are among those that have announced their plans to stop offering Medicare Advantage plans in 2025, primarily due to financial pressures and changes in reimbursement rates.2
The following google search will show how Medicare agents earn commissions
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