Negative Changes Ahead for Medicare Advantage Plans

Brace yourselves for benefit reductions and or cost increases on Medicare Advantage plans in 2025.

Most people on these plans have experienced steady improvements in these plans over the past 12 years.  Lower costs, lower out of pocket maximums have been the trend.

Plans have added dental, vision, hearing, transportation, personal emergency response devices, over the counter allowances and a plethora of other benefits.

For next year it looks like reimbursements for Medicare Advantage plans are going down.  These are the payments these plans get from the government for each person enrolled.

Many plans had their Star ratings reduced in 2024 and a commensurate reduction in their reimbursements.

Due to the 2022 Inflation Reduction Act plans will be forced to absorb much more in drug costs.  In 2025 there will be a cap of $2000 on what each person will have to spend for “Part D” drug costs.  This cost will be borne by these plans.

CMS “final rule” may also add more costs to these plans in 2025.

It’s possible plans might choose to absorb this cost and not raise costs or reduce benefits, but that seems unlikely.

What should you do?

#1. Take full advantage of all the extra benefits you have in 2024.  Don’t assume any benefits will still be on the plan in 2025.

#2.  Do Not call your carrier or agent or provider right now and ask what to do.  We won’t know anything until July and probably won’t have any sort of clarity until October.

#3.  Watch for communications from your health plan.  In September you should receive your Annual Notice of Change.  This document will spell out any changes in your plan.

#4.  Watch for changes in the provider network.  We had some significant disruption in plans in 2024 due to some provider groups dropping their contract with Medicare Advantage plans.

#5.  Get in touch with your primary care doctor and/or medical group and find out what plans they will be contracted with for 2025.

#6.  Don’t immediately think of changing to another plan.  Every plan will be under these pressures and we don’t know if there will be any “safe havens” to switch to.

#7.  Around September It would be prudent to load all your drugs into your mymedicare.gov account or whatever platform your agent uses.  This will allow price comparisons based on your drug regimen.

#8.  Plans release information October 1, but we find it’s best to wait until October 15 for the dust to settle to start shopping and comparing plans.

#9.  When shopping for a Medicare Advantage plan you want to:

  1. Search for plans that allow you to see the doctors you want to continue to see.
  2. Make sure your preferred hospital in the network?
  3. Compare drug costs. Look at the “preferred pharmacies” for your plan.  Even within their preferred network prices can vary.
  4. What is the MOOP? Maximum Out of Pocket for 2025
  5. What are the copays for services you expect to need?
  6. What extra benefits do the plans offer that you will actually make use of.

Is it time for a change of plans?  Perhaps it may be time to consider a Medicare supplement plan. 

In California:  If your Medicare Advantage plan has more than a 15% increase in cost or a 15% reduction in any benefits you will be able to enroll in a Medicare Supplement plan on a guaranteed basis during the Annual Election Period. These plans have a significant monthly premium, but they provide unfettered access to a national network of Medicare contracted providers.  On these plans the insurance company has no say so in your course of treatment.  I’ve never seen something that required prior authorization on these plans.  On these plans the carriers are told by Medicare how much to pay and to whom.  Sorry, they don’t come with many bells and whistles.  The plan we most commonly recommend is plan G and this year the out of pocket maximum is $240.

Paul Davis is an Independent Insurance Agent specializing in Medicare Health plan options.  Supporter of ONE generation since 2003.  CA licensed since 1985.  0669770.  www.pdinsure.com 818 888 0880.

 

 

 

 

 

 

 

Do you need travel insurance when you have Medicare?

When you’re traveling outside the Unites States, it’s important to consider the possibility that you might need medical care while traveling.

If you’re on a Medicare supplement plan, your plan offers up to $50,000 lifetime coverage outside of the United States.

If you’re on a Medicare Advantage plan, this coverage varies from plan to plan.

Thus, if you’re planning a big adventure on another continent, I recommend travel insurance.

No, I don’t offer travel insurance, but Rande and I have been using the travel insurance quote site squaremouth.com for years. That site shops a bunch of different travel policies and gives you choices in cost and coverage.

At squaremouth.com, check the dates you want. Note that it’s a good idea to add 5-7 days at beginning and end as that usually doesn’t change the price, yet it accommodates minor schedule changes.

Ideally, you should purchase travel insurance shortly after making your initial travel arrangements. That way pre-existing conditions are covered.

Use the squaremouth link, but also put my agent code at the end so I get a finders fee: 21587

If you have questions, call their toll-free number. I’ve found them to be very helpful.

https://www.squaremouth.com/21587

Below, you’ll see a sample for an upcoming trip we’re taking. Trip cancellation is the most expensive part, and it’s an option. You can choose to include trip cancellation coverage or not. When we do a trip with a LOT of cash outlay, we usually insure the trip.

I always want the policy to be a primary payor.

Safe Travels!

Paul

Paul Davis

Lic No CA 0M47932, 0669770

Phone 818-888-0880 Fax818-993-1497

Web www.pdinsure.com Email paul@pdinsure.com

P.O. Box 7265, Van Nuys, CA 91409

Required Medicare disclaimer:  We do not offer every Medicare Advantage plan available in your area. For Los Angeles we represent 8 organizations which offer 62 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Medicare.gov presently shows 116 plans available, some of which don’t allow agents to represent them.

We do not offer every Medicare Part D plan available in your area. Currently we represent 7 organizations which offer 19 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Medicare.gov presently shows 23 plans available, some of which don’t allow agents to represent them. We look at all 23 plans.

Presently in Los Angeles we are contracted with Anthem Blue Cross, Blue Shield of California, Wellcare, Aetna, Cigna, Humana, UnitedHealthcare, SCAN health plan for Part D and/or Medicare Advantage plans.

California shows 1182 Medicare Advantage plans and 515 special needs plans available.

We are licensed in 23 other states where we are contracted with 5 carriers:  Wellcare, Cigna, Humana, Aetna, and UnitedHealthcare

Facey Presents Paul Davis on Medicare Health Plans in April, May and June

Let Facey help you understand your Medicare options.

Come to this free Zoom workshop where you can listen to Paul Davis discuss the available options among the Medicare Health Plans. Paul is looking forward to answering your questions.

Take your choice of the workshops in April, May or June.

Monday, April 15, 2024, 10:00 a.m.
Register at: https://tinyurl.com/PDIS-04-15-24

Friday, May 17th, 10 a.m.
Register at: https://tinyurl.com/PDIS-05-17-24

Thursday, June 13th, 10 a.m.
Register at: https://tinyurl.com/PDIS-06-13-24

March 21 – Facey Presents Paul Davis Workshop on Medicare Supplements

Let Facey help you understand your Medicare Health Plan options.

Come to this free Zoom workshop.

Listen to Paul Davis discuss the available options among the Medicare Health Plans. Paul is looking forward to answering your questions.

Thursday, March 219, 10:00 am:

Click on the link to register for November 28:
https://tinyurl.com/2v6w5tmk

November 28 – Facey Presents Paul Davis Workshop on Medicare Supplements

Let Facey help you understand your Medicare Health Plan options.

Come to this free Zoom workshop.

Listen to Paul Davis discuss the available options among the Medicare Health Plans. Paul is looking forward to answering your questions.

Tuesday, November 29, 10:00 am:

Click on the link to register for November 28:
https://tinyurl.com/PDIS-11-28-23

Join Us on July 18 or August 15 – Facey Presents Paul Davis Workshop on Medicare Health Plans

Let Facey help you understand your Medicare options.

Come to this free Zoom workshop.

Listen to Paul Davis discuss the available options among the Medicare Health Plans. Paul is looking forward to answering your questions.

Take your choice of the workshops in July and August.

Tuesday, July 18, 10:00 am:
Click on the link to register for July 18:
https://tinyurl.com/PDIS-07-18-23

Tuesday, August 15, 10:00 am:
Click on the link to register for August 15:
https://tinyurl.com/PDIS-08-15-23

See the full flyer: