Medicare plans drop the Advantage plan?

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Medicare plans drop the Advantage plan?

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My mom has been on Medicare Advantage plans but for the third year in a row the plan is discontinued. I’m planning to have her move to original Medicare and purchase a drug plan. For those that are familiar with this, how do you handle dental and vision care? Purchase separate dental/vision insurance or pay out of pocket? Buying these separate plans (or paying out of pocket) and the drug plan will be more expensive than the Advantage plans were, but this year there are no Advantage plans that work with the pharmacy her AL facility uses, so that would be really difficult to manage. I suppose I was naive before getting involved in her medical care a few years ago, but it surprises me how expensive routine health care can be even with Medicare.

Care Plan Medicare Advantage Plans Medicare Open Enrollment Paying for Care

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Just an update! I spoke to our local Medicare counselor (thanks for the tip @Grandma1954) and she helped me find a plan D drug plan that works with her facility’s pharmacy and will save her a lot of money. And she gave me a lot of info on the Medigap plans I was considering. She is eligible to join any Medigap plan without underwriting bc her Advantage plan is being dropped. She is in a guarantee issue window. I was looking at plan F or plan F high deductible because the coverage is comprehensive. She recommended also finding out if there’s a plan G that will take her - often they only offer G to younger folks, but not always. She said G has more enrollees and a younger population so the premiums are lower.

Anyway, still more work to do for the Medigap piece but I did enroll her in the drug plan at least. Before I spoke with her, I didn’t know that drug costs with Medicare Advantage are capped at $2k per year. I need to go through her paperwork for the past 2 years bc I am pretty sure she paid triple that in 2024. And when I look at possible Advantage plans for 2026 on Medicare.gov, several estimate drugs costs (out of network with her pharmacy) at $10k+. Why is that if they aren’t allowed to bill patients more than 2k for drugs? The pharmacy went in and out of network with her plan in 2024.

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Reply to HappyGarden

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Glad this helped you!!

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Switching between MA to a plan D will subject mom under scruitany for her advanced problems, which is why she will pay more to plan d. This seems to be an out of program pharmacy. Can you speak to the DON about alternative pharmacy options? Are the differences in drug prices worth moving her to another facility? You will have to figure if all will be worthwhile to pay for dental or vision.

Have you considered making an appointment with an independent Medicare insurance agent? They act as fiducieries and make their money by enrolling into plans.

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Reply to MACinCT

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Medigap is only a supplimental to Medicare. Please talk to someone who can look at what Mom already has and how it can be made better.

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Reply to JoAnn29

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Thanks all! I’m going to research the Medigap plans and figure out which one to choose (and if there are limits to her eligibility). I don’t know why she chose an advantage plan way back when she enrolled in Medicare instead of a medigap plan. She doesn’t understand much about insurance now, but she used to be a detail person. I wonder if she ever understood her options.

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Reply to HappyGarden

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Many (healthy) seniors initially choose an Advantage plan when they first are eligible for Medicare because it is inexpensive and gives you low-level perks. They usually find out the hard way that they are terrible plans that step in front of original Medicare and gate-keep your care, operating more like an HMO. My MIL (back in 2014) had a Humana Advantage plan. Whenever we'd go to a new doctor they would look at her insurance card and just sigh and shake their heads --- literally. We used to call it "Inhumana". Many people cannot fully understand what their plans cover, so don't judge your Mom over it too much. I've been an employer for decades and had to deal with healthcare insurance every single fall and I hated it. Then I was managing my in-laws and got an education on Medicare 10 years before I needed it. My husband is 2 years older than me and so we learned a lot the hard way when he stubbornly chose an Advantage plan his first year -- but again, he is exceptionally fit and healthy. Then, they found a melanoma on him (which they removed and he is cancer-free) but it unnerved him so we opted to pay for better coverage.

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Talk to a SHIP counselor in your area. Most Senior Centers have them on staff. Or just google "SHIP counselor in my area" and you will have several to select from.
A SHIP counselor is a person that is trained to go over each plan available and help you select the best one.
This service is FREE
The SHIP counselor is unbiased and does not get paid from ANY of the insurance plans.
By the way SHIP stands for Senior Health Insurance Program.
Each person that is a counselor has to go through a training course and pass certification.

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Reply to Grandma1954

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Thank you! I will look into this.

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First, you need to talk to Medicare and see if you can revert back. Its been said if you start out with a Medicare Advantage instead of traditional Medicare you may not be able to change back.

My Mom was on PAAD for her prescriptions. See if Mom qualifies for a State prescription plan, they are free. When Dads employer stopped supplying their insurance giving them so much a year towards buying their own I had to get involved. I chose traditional Medicare with Medigap. But Medigap does not pay for dental or vision. With the money left over from getting Medigap, I let it accumulate for Moms dental. Her vision? It was easier to pay out of pocket than to get the insurance.

Your Office of Aging can help you manuver thru all this. There are brokers too.

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Reply to JoAnn29

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JoAnn, it is the supplemental gap plans that would require underwriting if you have one in a certain year (for the first time), then go off of it the next, then want to go back to one again. Advantage plans, because they pay for so little, don't care and don't require this. If you are approved to go back onto a supplemental plan, your premiums may be higher than if you had never dropped it, and if your health status or healthcare usage has changed/increased in the new coverage year.

I'm dubious about vision insurance and probably wouldn't get it if I didn't get the discount for my (and my husband's) contacts... if you have a medical problem with your eyes, it would be mostly covered with Medicare (and any supplemental plan).

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Me, my husband and my Mom (96) are all on original Medicare with supplemental BCBS medical, Rx, dental and vision (all separate).

We have always had dental insurance through our corporation. In order to stay with the dentist that we trust and have been with for a decade, the don't take self-pay patients, plus they have a large network, which is convenient (we live in the suburbs of Minneapolis). My Mom has most of her teeth and they're in good shape and she's still able to go to the dentist twice a year.

We have vision because the premium basically pays for itself from the contact lense discount it offers.

The Rx plan is based upon what meds we are on and what the plan covers. However, the BCBS Rx plan premium has doubled this year, so I'll be checking out a local provider's plan.

We chose BCBS because it allows us to go to the Mayo clinic if necessary; it is actually accepted across many states (and most plans don't cross state lines) and we travel out of the country and it has travel coverage.

My Mom needed to be treated in the ER then stayed in the hospital -- out of state -- last spring, for 2 days. The total bill was $19K. The only amount we had to pay was $598 for medical and a very small amount for Rx. The older one is, the more sense it makes to pay for a supplemental plan. Think of it as like making pre-payments for future care.

I would never consider an Advantage plan, even if they continue to exist.

https://www.agingcare.com/discussions/open-enrollment-to-advantage-or-not-to-advantage-that-is-the-question-496804.htm

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Reply to Geaton777

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My mom is on original Medicare, with separate medigap and drug policies. She does not have a dental or vision plan. She just pays her dental visits out of pocket. My guess is that eventually she will get to a certain age and will just stop going to the dentist.

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Reply to olddude

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Your mom should go to the dentist for as long as she is able....I was a former CNA and dentists would actually teach me how to clean teeth using the proxibrush, floss etc...when patient couldn't make those visits anymore. It is very easy to get an infection in your guns when dental care is poor and those infections can get in your blood stream.

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Medicare plans drop the Advantage plan?

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