Medicare enrollment changes for 2025

This is the time of year to reexamine your Medicare insurance and make changes that will be in effect in 2025.  For those of you who elected to enroll in the UHC Medicare Advantage plan, I urge you to look at the 2025 information you have received.  Medicare Advantage plans are reducing benefits and drug coverage because they are making less money (off the federal government).  Make sure you look at what has changed. 

 If you opted out of the IBM insurance and stayed in traditional Medicare with a separate part D plan, look at your part D plan to be sure it will still be the right plan for you in 2025.  You can do that by looking on www.medicare.gov or by calling Medicare (1-800-633-4227).

The biggest change that happens in 2025 is the change to the structure of the drug coverage.  All the phases and changes to copays as you move through the phases are GONE.  The copay you pay for a drug (after you met the deductible) will be the same until your total out of pocket for all copays for all your drugs (and includes the deductible) is $2,000.  At that point, there are no more copays for the rest of the year. As a result, the insurance companies are not making as much money on the providing of drugs.  Therefore, they raised the drug insurance monthly premiums.  The change in drug plan structure happens for MA plans too. 

Some retirees believe, because IBM sponsored the UHC MA plan, IBM is giving UHC money to keep the benefits robust.  I seriously doubt IBM gives UHC any money at all.  If anything, UHC probably gives IBM money!  Reminder, the federal government gives UHC a boat load of money every month for every Medicare Advantage policy holder.  If the policy holder has few claims, UHC gets to keep a  lot of government money.  Your tax dollars at work. However, IBM did give UHC a huge gift when they pushed retirees to UHC.  No need for UHC to spend money to advertise on TV to woo retirees to the plan, no need to pay insurance agents money for commissions, or if UHC does pay commissions, they pay it to IBM!!  

I continue to hear horror stories about Medicare Advantage denial of coverage for policy holders which sometimes ended in a denial of life saving procedures.  When something is too good to be true, it often isn't true.

Never enroll in a Medicare Advantage plan (it is a hazard to your health)

 AI used by brokers to pick plans to sell:

https://generations.asaging.org/medicare-decisions-should-not-be-left-ai

Prior Authorization prevents you from getting the health care you need:

https://ldi.upenn.edu/our-work/research-updates/the-billing-bottleneck-how-medicare-advantage-insurers-use-prior-authorization/

MA patients have lower rate of hospitalizations, and that might not be a good thing:

https://www.fiercehealthcare.com/payers/study-details-why-medicare-advantage-avoidable-hospitalizations-lower-compared-traditional

Humana decided there's more money to make in selling Medicare Advantage that selling Employer Group Health Plans:

fiercehealthcare.com/payers/humana-shed-employer-group-commercial-business

Surprise Billing:

https://www.fiercehealthcare.com/payers/cms-astronomical-volume-surprise-billing-dispute-cases-taking-toll-agency

Kaiser discussion on 2023 Medicare Advantage payments

One of the speakers, Tom Kornfield, spent 10 years at CMS before he went into the private sector.  He has a vested interest in disparaging the payment changes the federal government is trying to make to MA plans.  I point this out because this CMS changes affect his clients and thereby, indirectly affects the consulting fees his firm will get. I find it hard to believe his spin because of it. This is his background: Tom also spent 10 years working at the Centers for Medicare & Medicaid Services (CMS), where he held a variety of positions focused on MA and Part D payment policy. Specifically, Tom analyzed MA bids and payments and changes in MA payment rates, and he created a policy to allow for 5-star MA plans to market and enroll year-round. 

https://www.kff.org/medicare/event/march-21-web-event-unpacking-the-controversy-over-medicare-advantage/

Action Now Initiative March 3, 2023 letter to CMS captures why CMS needs to rein in the excesses of Medicare Advantage Billing:

https://www.arnoldventures.org/stories/whats-going-on-with-medicare-advantage-arnold-ventures-experts-explain

Analysis of how MA plans are sucking money out of Medicare.  It is soooo complicated.  Why won't the federal government stop the shenanigans?

https://www.healthaffairs.org/content/forefront/born-third-base-medicare-advantage-thrives-subsidies-not-better-care

Never enroll in a Medicare Advantage Plan (because they overbill the government)

 This is great analysis about the insurance industry siphoning off  Medicare funds (aka your tax dollars) and destroying Medicare:

https://www.morningstar.com/news/marketwatch/2024032679/medicare-advantage-is-overbilling-medicare-by-22

Never enroll in a Medicare Advantage Plan (ever)

 The interview in "MedPage Today" is great.  It is with a former CMS Administrator who was a doctor.  There are now many, many news reports about the problems with Medicare Advantage insurance. It is a wonder they are still legal!  Just search Medicare Advantage in the "News" category of your search engine and you'll see them.  Some legislators, like Elizabeth Warren, are trying to sound the alarm. 

https://www.medpagetoday.com/special-reports/exclusives/108980