Medicare D 2025, the $2000 out of pocket, and tricky rules with that.
7The $2000 out of pocket isn’t as straightforward as one might presume. If your plan is a “basic” one you do actually pay $2000 out of your own pocket before meds are free. But if it one of others then you don’t actually personally pay $2000 out of your pocket before meds are free. You pay less. As a result your total (meds plus premium) might mean a more expensive premium Medicare D is cheaper overall. Confused? Then watch this really good video that explains how this actually works with examples. The guy is a good teacher.
You may find this a useful tutorial to learn how to compare Medicare D plans online at medicare.gov:
- 2 comments, 4 replies
- Comment
This was very useful but not on my phone. Whats the links so I can follow on youtube, please.
@KSchweitz had to break it up as posting the link just gets the video loaded again. Take the spaces out.
https://www. youtube. com/watch?v=IjJNTbuFu0o
https:// www. youtube .com/watch?v=0jNoG_NWJB8
Thank you for this. My mom’s Medicare broker got in touch with me to help with her enrollment and all of this is very new to me.
@ironcheftoni The rules changes on D makes that new too. Especially with how the premiums have changed. That man’s youtube has useful information. Of course he is looking for clients but putting that aside his videos are very educational.
The agents get more commission and monthly payments if someone signs up for an advantage plan so be careful with that.
Getting out of an advantage plan because health systems pulled out (which they are doing) and so hardly anyone now in network or need a specialist out of network and suddenly out of network care is expensive has passing medical underwriting associated with the ability to then (not originally) buy a medigap/supplement plan. To get medigap supplement beyond the original sign up you need to pass underwriting. It is way more expensive to have A&B without medigap if you fail medical underwriting if you want to switch out so can’t get a medigap then (no out of pocket limit with no medigap; with G, for example your only out of pocket is the deductible $240 this year, and then meds with whatever D she picks and costs there).
Advantage plans stab people in the back on the back end with large deductibles and out of pocket, a lot of denied referrals, etc. Your mom may be healthy now and sees it as a money saver but if she then isn’t and needs regular medicare good luck with that as she will likely fail medical underwriting and so only then has A&B and can’t get medigap. In Advantage plans they need to buy B too. The only exception is if they also have medicaid as that takes care of that.
IF she is low income she could get medicaid assistance to pay the premiums. Talk with your state’s SHIP medicare help organization to find out all the details if you don’t feel like googling.
Be careful that this broker (as you can enroll with all these things without using a broker) isn’t pushing your mom to the plans that give him/her a higher commission. For example they no longer get a commission with wellcare and a couple of others. It is worth going, yourself to medicare.gov (you don’t need to create an account to use their services), put in her zip code and meds, age, etc. and then see what plans come up. You will not get spammed doing that.
Also there are three risk pools for medicare supplements - age attained (the most expensive when you are old as everyone in it is the same age), age signed up (less expensive when you are older) and community rated (everyone pays the same - that being said usually the first 5-10 years you get a discount off of what you’d pay at 75+, this is the cheapest when you are older). Also don’t get lured in by “extras” that won’t be used or won’t be used your entire life time. That starts to be expensive. One can also buy dental and vision insurance rather than paying a higher rate (even though they claim it is free) for life… like you are going to use a fitness center when you are in a nursing home or assisted living or can’t drive anymore to get to one? The real problem is that unless you are very healthy you are more or less locked in to whatever you pick for life if changing involves having to pass medical underwriting.
If you want to talk about this on the phone whisper me.
@Kidsandliz thank you. I’ve already asked about a supplemental policy but she is too old to get one at this point.
@ironcheftoni Age wouldn’t be the issue, medical underwriting would be the issue. United Healthcare has the most lenient criteria (but you have to join AARP too).