I got my 2025 IRMAA statement a few weeks ago Starting in Jan my net SS check is going down even though my benefit is going up. Why? Bigger IRMAA in 2025 than in 2024.
When I retired in late 2023 I put in an SS-44 form to reduce my IRMAA to zero for 2024. That was a good faith honest move based on my plans / expectations for a low taxable income that year. Then last month my finance guy and I decided to take out a bunch of IRA money as a “pre-RMD” and pay taxes on it now, not later.
Which at a stroke vaulted my 2024 AGI well into IRMAA range. So now I’m going to owe them 12 months of back IRMAA once they figure that out. Ouch!
Medicare Open Enrollment is here. Remember my quick start guide:
Get the best Medicare Supplement plan you can pay for
If you cannot, get the Medicare Advantage plan with the lowest Maximum Out Of Pocket (MOOP)
Things like copays, coinsurance, etc, matter, but not as much as MOOP. Pay attention to them, of course, but a health insurance plan with $50 doctor visits and a $3,000 MOOP is almost certainly better (in a financial sense) than a plan with $0 doctor visits and a $13,000 MOOP.
Remember that drug prices vary wildly by pharmacy. Just because a drug costs $400 at Walgreens doesn’t mean it costs the same at CVS (or Rite Aid or whatever).
If you’re on a treatment plan that will extend into 2026, it’s likely best that you keep your current MA or MS plan.
My employer was putting aside money, for 10 years (1500 a year), which then got interest credited. It’s 20,000 or so. This is to be used for retiree health coverage - i.e. Medigap.
Only, 2-3 years ago, they changed it so that it could ONLY be used on some specific Medicare Advantage programs. Dammit.
Medicare Advantage could become the default health-insurance program for all older adults.
A recent proposal in Congress would automatically enroll older adults in a Medicare Advantage plan and then lock them into that plan for three years - unless they actively opt for traditional Medicare coverage.
The proposal sponsored by U.S. Rep. David Schweikert, an Arizona Republican, would automatically put people 65 and older into the lowest-cost Medicare Advantage plan in their area starting in 2028. Those enrollees would be unable to change to any other plan for three years.
The proposal, HR 3467, does allow people to opt out and choose traditional Medicare, but the process for doing that is not detailed in the bill, and critics said many people may lack the insurance savviness they might need to choose that option.
The bill also doesn’t require the private insurers who provide Medicare Advantage plans to keep the same network or cost structure over those three years, said Ari Parker, co-founder of Chapter, a private company that helps people navigate Medicare plans and the author of “It’s Not That Complicated,” a guidebook to Medicare.
That means an older adult could be locked into a network that becomes more expensive over time or becomes less relevant to them, for instance if the network changes and they lose their doctor, Parker said.
According to this website, HR 3467 has only been referred to committee (Ways&Means and Energy&Commerce), and hasn’t progressed beyond that point. But IMHO it should be getting more notice than it’s had.
An interesting message from my husband’s employer: As of next year, their lowest-tier health insurance plan will no longer count as creditable coverage for Medicare Part D - so if we were using that plan, we’d need to sign up for Part D immediately in order to avoid a surcharge.
This means we really need to look deeply into our options for next year to make sure we’re okay. I think the plan we are on (HDHP) still counts. If not, we’ll want to switch to a non-HDHP one, or at least quit contributing to the HSA, and sign up at least for parts A and D as of January.
Or we could switch to my employer - though that would mean ensuring that all our current doctors are still in-network.
I started looking into Medigap - and right now, almost all the ones offered in my county for plan G are age-related (I forget the terminology): lower now, could get much higher. The two AARP / UHC plans are the only ones that are community-rated. None are “attained age” (based on the age at which you sign up).
And what’s with Level 1, Level 2 or Level 3? Very different costs for those but nothing tells me what the differences are.
IIRC, you can see the differences between pharmacies on the Plan D signup website. They are indeed substantial. Some suppliers are preferred. I changed pharmacies when I went onto Medicare due to this.
Many plans split medications into Level 1, 2, 3, plus a ‘specialty’ category. Level 1 will often be the low or free cost tier for generics while brand name versions would be in Levels 2 and 3, which may also differentiate for medications from different, preferred vendors. If your prescription is for a non-generic brand name drug that is a “non-preferred” version rather than the preferred one on your plan, the coverage could well be quite different.
@JohnT, I’ve passed your advice on to my former wife, especially your advice to go with a Medicare Supplement plan vs. a Medicare Advantage plan. Nevertheless, she went with a United Healthcare PPO Advantage plan when she first signed up three years ago.
This year, UHC has apparently dropped all of their Medicare Advantage PPO plans here in Connecticut, so she is going with an Aetna PPO plan instead. I talked to her again about your advice, because it seems like the Advantage plans are getting worse every year and also because insurers are dropping out.
Also, it is my understanding that you can switch to a Medicare Supplement plan with no medical review if your insurance provider drops coverage.
But we also have been told that you can do this at any time (or maybe only during open enrollment) due to laws specific to Connecticut.
So her plan is to stay with a Medicare Advantage plan for now, and switch to a Medicare Supplement plan if the Advantage plans get really bad or stop being offered.
She is working with some local Medicare specialist who has been giving her advice through all of this. What do you think?
As long as the person advising you is not an insurance agent, go with their advice. I’m licensed (but not practicing) in Texas, so have ZERO ideas about CT rules and regs.
Insurance Agents get a commission which makes them biased. Advocates help you find the best thing among all available choices. They are typically paid hourly.
They can be free through state SHIP programs. Trained, unbiased advisors available for the asking. State Health Insurance Programs are federally required and subsidized to advise on the best possible Medicare decisions for an individual. Every state has one. Here is the one from Connecticut, since that is the state someone’s mother upthread was asking about:
You can find the SHIP for any state by tapping the blue rectangle labeled “Find Local Medicare Help” in the upper right hand corner of the CT page above.
They can also advise about which Part D drug plan is going to be the best for you next year when Part D open enrollment starts, which is right now until December 7. The drug plan that was best for you this year with your slate of medications might no longer be the best one next year.
Right, I figured this agent was getting paid somehow, presumably from the insurance companies. And I’m sure the insurance companies prefer the Advantage plans over the Supplement plans, so I have no doubt they have inducements to get the agents to push those preferentially.
But this is for my ex-wife, so it would probably be difficult to convey her that she should find and pay for a Medicare advocate instead. And ditto for my mom, especially when she lives halfway across the country (in Texas).
Both of those people can get free advice and advocacy from their respective State Health Insurance Programs. Here is the locator of those free programs: