2025 DRUG PLANS - HOW WE GOT IN THIS MESS

Late last month, the Centers for Medicare and Medicaid Services (CMS) announced a new “Premium Stabilization Demonstration” for Medicare Part D plans intended to offset the higher premium costs expected to arise from the Inflation Reduction Act’s (IRA) Part D redesign, which shifted more financial liability from the government to Part D plans.  

To prevent these politically unpopular premium increases in the lead up to the election, CMS’ “voluntary” three-year stabilization plan would attempt to stave off significant Part D premium increases by funneling $7.2 billion to insurers. In other words, CMS’ plan is not so much a demonstration as it is a bailout. While the demonstration is marketed as “voluntary,” all insurers effectively must participate to maintain competitive prices. Most alarming is that CMS will allocate this additional 382.3-percent increase in subsidies (compared to last year) without congressional approval.

https://www.americanactionforum.org/insight/cms-puts-part-d-on-life-support

Congress is busy making sausage . . . .

WHY IS THE PINK HOUSE PINK?

In 1771, a man named James Habersham Jr. began construction an elaborate mansion. While it is common even today to experience delays in a new home’s construction, James experienced a rather unusual homeowner setback.

The mansion’s main structure was made of red bricks, which were then completely covered with white plaster. Perhaps the quality of bricks or the plaster job itself weren't very good, because the red bricks would bleed through the white plaster, turning the mansion a shade of pink.

Eventually, descendants of Habersham sold the mansion, which saw many different owners over the years. Throughout those years, all who had lived there continued to paint white over the frustrating pink hue.

But in the 1920s, a woman bought the mansion to open a tea room, and decided to go with the flow – she painted the entire mansion pink. Since then, the mansion has been known for its trademark color.

https://genteelandbard.com/southern-history-haunts-folklore-journal/2022/11/21/savannahs-olde-pink-house-a-house-of-many-faces

DOWNSIDE OF AGING IN PLACE

Sooner or later, you will have to hire people to cook, clean and care for you as well as maintain, repair and remodel the house

While Americans these days seem to have marked differences of opinion on many topics, there is one subject that enjoys almost universal agreement. A recent study indicates that a whopping 88% of adults 50 and older say they want to age in place.

Almost 75% of falls occur in the home, with the vast majority of them taking place in bathrooms or on steps and stairs. As you age, remaining in a house that has not been modified poses increasing safety risks.

https://www.nextavenue.org/the-overlooked-downsides-of-aging-in-place/

10 MEDICATIONS NEVER MIX WITH COFFEE

Thyroid medication

Diabetes medication

Osteoporosis medication

Antidepressants

BP medication

https://www.health.com/medications-to-not-mix-with-coffee-7561446

Why Isn’t My Medicare Supplement Plan Paying Anything?

A long time client posed this question a few months ago. My quick response was . . .

Either you are really healthy, or you are really sick and Medicare is doing the heavy lifting. Above all else, DO NOT PAY BILLS until AFTER Medicare and your Medigap plan pays their portion.

The longer answer . . .

Over the course of a few months this lady had incurred over $300,000 in medical bills from two hospitalizations (unrelated conditions) plus several outpatient charges including surgery.

In her words, Medicare paid a pittance and the same for my Medigap plan. Am I responsible for the balance?

In a word . . . no.

The claim process starts with Medicare. They review the claim, approve eligible charges, discount the charges then pay their portion. You can review the claim totals in your MyMedicare account or wait on the MSN (Medicare Summary Notice) to arrive weeks later.

From there the claim goes to the Medigap carrier.

Medigap carriers are only responsible for claims approved by Medicare.

The patient is not responsible for claims denied by Medicare.

The MSN only tells part of the story. One hospital bill was $44,105 . . . the MSN says Medicare paid $2,291 and you (the patient) may be billed $898.

A second hospital bill was $20,965 . . . Medicare paid $527  . . . you may be billed $134.

The Medigap carrier paid $898 on one bill, $134 on the other. Patient responsibility $0.

At this point, the bills submitted to Medicare total over $65,000 and the patient owes $0.

More bills and MSN’s will follow but the pattern will be repeated and the patient will be responsible for nothing.

If she had a Medicare Advantage plan she could have easily owed $5,000 or more plus charges denied by the Advantage plan.

Final word on 2025 Part D plans

I expect to see fewer plans, higher premiums, deductibles applied to all tiers before your copay kicks in, fewer preferred pharmacies and fewer expensive meds on the formulary. I will continue to find ways to lower your drug costs.

Some plans will not work with agents in 2025. And many agents will only show plans that will pay them a commission.

Many of you know this, but I have never taken a dime in commission from drug plans and have no plans to change. This allows me to show plans you will not see from other agents.

I should have more details on the 2025 Part D changes by the time the October newsletter is ready to publish. Don’t forget to update your current medication list and get it to me no later than the end of September.

Call or email questions. Feel free to forward this newsletter to your friends.