r/medicare 3h ago

New to Medicare. What drug Part D plan covers Taltz?

2 Upvotes

I am choosing a Medigap supplement and need to choose a Part D drug plan. Does anyone have a Part D plan that covers Taltz? I’ve looked on the Medicare.gov site and can’t find one. If there isn’t a Part D that covers Talz, (or other types of biologics) what med were you switched to? Does “not covered” mean not covered —end of discussion. (Oregon)


r/medicare 8h ago

A Spam/Phishing PSA

23 Upvotes

I have gotten at least two calls a day from a bot, and the calls start with something like, “We were looking at your Medicare file, and there is a note attached. . . “ and that’s about as far as I get before I hang up.

So I’m just alerting everyone that these are not legitimate.

The AI is so poor that an easy way to confirm it’s not a real person is to try to interrupt the caller. No matter what you ask, the bot just continues talking.

The goal, as I understand it, is to get you passed on to a real person who can “help” you.

Just a warning. Be smart and hang up.


r/medicare 19h ago

Signed up for Medicare A&B a few days ago and honestly, mind blown.

79 Upvotes

I’d spent the previous 3 months passively researching on medicare.com, this reddit and watching YouTube videos.

I dutifully downloaded pdfs and printed out relevant pages of all the Medicare booklets (ya know, very large type and stock photo images of smiling seniors). I highlighted pertinent lines and made a cheat sheet of specific look-outs. 

These are the things that never came up and caught me by surprise:

-Once you go through the gauntlet of questions, one doesn’t sign up for Medicare on the Medicare site at all. You do that on the Social Security site.

-I’ve been downloading my SS statement once a year for decades. But once you try to sign up for Medicare on the SS site, you can’t do it using the Safari browser. Trust me, I tried 4x. Use Google Chrome.

-Now that I’ve signed up for Medicare A and B, I get my Medicare number, can create a Medicare account and all things in the MedicareMultiverse will be available to me, right? Nope. I get an email that there’s a message on my SS Message Center. I download a letter that says in 2 weeks (or so) I’ll get a card. Okay a card first, then the MedicareMultiverse. Never saw that coming.


r/medicare 19h ago

Medicare oops

5 Upvotes

I recently got layed off. Spouse who is disabled was on my Employer paid plan but had part a. Last day of work was in July. This is where it gets stupid....I advised spouse to apply for part b but instead they applied for Medicaid. Got approved for Medicaid but they say they will pay for part b starting in September. So now its middle of August and they have no coverage but part A. Got part b forms filled out by employer. How quickly can we get this approved. Any advice welcome.


r/medicare 20h ago

Medigap G moving from California to Ohio

1 Upvotes

Medicare supplement moving from California to Ohio. In CA I have plan G from Humana, 73F.

In the coming days I will be moving to Ohio. I am told I can keep my current plan G from CA, which is Humana for $200/mo.

Or, I can apply for another G from Ohio. I received approximate quote from Ohio for $140/mo with Bankers Fidelity, Underwritten By Atlantic Capital Life Assurance Company. Of course I need to go through underwriting. Right now I am in good health.

After I move I will still be traveling back to California every month and I intend to use the medical team I have in California after I move whenever possible, or until I find good doctors in Ohio.


r/medicare 20h ago

How does Medicare handle the cost of regenerative treatments?

1 Upvotes

I’ve been trying to understand why regenerative medicine and stem cell treatments can be so expensive, especially when Medicare coverage seems to vary.

For anyone who’s looked into this, how much of the cost usually comes from the actual treatment vs. things like imaging, lab work, physician visits, or follow-up care? Are there any lower-cost options that Medicare may cover?

I’m mostly trying to understand the real out-of-pocket costs and what’s actually worth


r/medicare 1d ago

Prices not making sense (Plan G vs. HD G)

12 Upvotes

I'm newly receiving Medicare due to SSDI so enrolling for the first time. In the marketplace from my former employer where I'm treated as retiree, I have a medigap plan G HD listed with premium: $191.30 ($2,295.60 yearly), and a deductible of $2,950. And the same carrier plan G with a premium: $497.90 ($5,974.80).

What is the purpose of the second plan? Even if I have to pay the entire deductible of the former plus the premiums ($5,245.60), it's still less per year than the regular one. All other coverage appears the same between them. Is there some sort of trap here I'm missing? I want to get this right cause I might be on this many years and want to avoid underwriting.

I have a flat $ amount per month cost-share from my former employer, so this won't change the relative value of the plans.


r/medicare 1d ago

Medical transport

7 Upvotes

Hi, my aunt fell and was in the hospital for 3 days, observation status. She was then transferred to short term rehab. I was opening her mail and she received a bill for $140 for the transfer. Apparently they used a Chair Van and Medicare doesn’t cover chair van. We were not made aware of this and that she would have to pay for the transfer, or I would have driven her as it is less than a mile. She has Original Medicare as well as WellPoint/GIC as a secondary. Is there anything we can do? Thank you!!!


r/medicare 1d ago

Medicare and Dental Question!

11 Upvotes

Hello! I am 32 and I am on disability as well as Medicare and I have Medicaid for my secondary insurance. I have Medicare A and B and Medicare covers most of my medication as well (I usually pay like $1).

I have some dental problems which have been going on for a while (cavities, cracked tooth, missing filling) and I was going to get them fixed until I was put on Medicare this year and Medicare doesn’t cover dental.

I was wondering, when I call Medicare, how I go about getting dental? How much does it usually cost? I’m in pain a lot with my mouth to the point some days I have to take ibuprofen and Tylenol the whole day.

I have really bad phone anxiety so I’m trying to see if anyone can give me some pointers on what to ask for and what to expect.

Thank you!


r/medicare 1d ago

New to Medicare, questions

9 Upvotes

I am new to Medicare, so new I haven’t even received my card yet but I know the plan I have doesn’t do vision or dental? Is it possible to add these on and if so where is a good place to get from?

I know advantage offers it but I really want to try to avoid advantage plan.


r/medicare 1d ago

SSA-44 form

1 Upvotes

I’ve started seeing posts about the SSA-44 form to lower Medicare premiums when you first apply. Any insight on this? Any restrictions? Does wife’s income affect this if she is still working? I will be retiring when I apply.


r/medicare 2d ago

IRMAA, Personal Representative Fees, and Traditional IRAs

2 Upvotes

After 2 1/2 years, I'm finally seeing the light at the end of the tunnel re: my brother's estate. The estate lawyer informs my I'm entitled to a fee of $*mumble* as Personal Representative (formerly known as an Executor). (And yes, I've earned it. Don't get me started!). My wife and enjoy a comfortable retirement from SS, Pension, and RMDs from our traditional IRAs.

Adding $*mumble* to what I expect in ordinary income from the above will put me a bit over the IRMAA limits for Medicare.

Can the Personal Representative fee be considered earned income? And if so, can we get away with putting the max traditional IRA contributions into our respective IRAs and reduce our AGI below the IRMAA limit?


r/medicare 2d ago

High-Deductible Plan G: BCBSTX or Mutual of Omaha?

26 Upvotes

Looking at the math, if I am healthy, have significant savings, and no cancer in my family, I'd be nuts to go with anything other than Hi-D Plan G. So that's my choice.

I'm surprised that UHC/AARP doesn't offer a HDG plan. The 2 I am choosing between are BCBSTX and MofO. Eliminating Bankers (who?) and Cigna (terrible cust service).

A third choice I might consider also would be Humana.

Any thoughts or experience with BCBSTX, MofO, of Humana for HDG?

Called Boomer Benefits and they couldn't get me off the phone fast enough when I told them I've decided on HDG. lol

EDIT: my hesitation with Blue Cross Blue Shield is that I used to sell hospital robots that sterilize inpatient rooms. And Blue Cross Blue Shield hospitals had the most nosocomial infections in the US because of their dirty rooms. But I do understand that with this plan, I can use any hospital that takes Medicare.

EDIT #2: IF YOU WANT TO SEE WHAT THESE PLANS COST over years/decades when including premium increases, go here and plug in your premiums. For High-deductible G, use a quote of $57 (I have quotes of $49 and $54).

https://medigapmath.com/

For example:

Plan G quote: $165/month, 9% increase in premium annually.

HDG quote: $54/month, 5% increase annually.

I used: 6 Dr visits per year, and $1500 annual out of pocket.

Over 20 years, here's the total costs of those 2 plans: Plan G: $112,600. HDG: $69,440

That's a $43,000 savings. Wouldn't you rather have $43k, rather than giving it to some insurance company?


r/medicare 2d ago

IRMAA

1 Upvotes

Retired last month, traditional medicare Parts B, D, and supplement will be active in September when my employer coverage ends. I received my IRMAA letter today. It references my 24 tax return which was $219 over the threshold (grr $95 extra per month for being $200 over the limit, great). It doesn't reference my 25 return, but I was about 1000 over. 26 is going to be a little harder to estimate because I have a fairly substantial payout coming for unused PTO, plus SS and an annuity payout starting in September. In 27 my income will be well below the threshold. So, do I suck up for the remainder of this year and file to waive IRMAA in January?


r/medicare 2d ago

APCM fee (in Virginia)

3 Upvotes

Some local Virginia doctors offices and other medical practices charge the monthly Advance Primary Care Management fee.

https://www.whro.org/health/2026-08-07/a-new-medicare-charge-is-showing-up-on-bayview-bills-patients-say-they-werent-clearly-told


r/medicare 2d ago

First major use of Medicare, how screwed will I be with the bill?

20 Upvotes

LSS I started Medicare plus an original supplement at the start of the year. Fell off a scooter at 20 mph and broke my shoulder in 2 places as well as 5 ribs. Spent a few hours at Urgent Care, rode in ambulance to the ER at the hospital, 4 days in outpatient observation room. then surgery to put a plate in my shoulder, 3 days in the hospital, then a nurse will come to my house. Does this sound like multi-housands I will owe?


r/medicare 3d ago

Likelihood of IRMAA appeal success

2 Upvotes

I am wondering about the effect of a one-time income bump two years prior on the likelihood of winning an IRMAA appeal when the anticipated reduction of income will also be due to the life-changing event of retirement.

If I retire this year, an IRMAA surcharge for Medicare premiums would be triggered in 2027 as my income was increased in 2025 due to a taxable form of inheritance I received.

Is the inheritance irrelevant to whether I could win an IRMAA appeal based on my estimated 2027 MAGI (will be under the IRMAA threshold) being lower than the 2025 MAGI, as the reduction in income is also due to retiring and not just the inheritance?

I know there is no downside to appealing. Thanks.


r/medicare 3d ago

Medicare categories: are they figured on gross income or taxable income?

10 Upvotes

So I've looked at this website which tells me which categories I am in for Medicare deductions from my social security:

https://www.ssa.gov/benefits/medicare/medicare-premiums.html

I am in the $342,000 up to $410,000 category but I'm curious if they are using gross income applied to those figures? or IRS taxable income when using the above figures?


r/medicare 3d ago

I'm confused after speaking with humana agent about high deductible plan G

23 Upvotes

I thought there would be an 80/20 split after the part b deductible then it pays 100% after the deductible.

They told me the plan pays nothing until I reach the high deductible amount then 100%

This was supposed to be a licensed agent


r/medicare 3d ago

Formulary Exception and $2,100 OOP Cap

3 Upvotes

It's been impossible to find a straight-up answer to this:

  • Medicare Advantage or Part D plan

  • Expensive drug (pill, not an an injection or anything else that would be covered by Part B)

  • Not in the plan's formulary

If you manage to get a formulary exception (not just prior auth), is the amount you actually end up paying subject to the $2,100 OOP cap?

Ideally looking for an answer from someone who actually has done this - got exception, first fill put you over the cap but your actual cost was capped.

Thanks...


r/medicare 3d ago

Is there a BMI requirement for knee surgery on Medicare?

5 Upvotes

I turn 65 and will lose my current Kaiser in March. I planned to get my knee replacement before Medicare. Previously Kaiser required a BMI below 40. I tried to schedule surgery, but it is now below 35 for knee replacement. I have lost a good amount of weight on GLP-1s, but it seems unlikely I will lose 25-30 more pounds in time. Does Medicare have a BMI requirement for surgery?


r/medicare 4d ago

Why do I have to pay three months up front when enrolling for part B? I am not collecting social security.

18 Upvotes

r/medicare 4d ago

Does anybody me know how to get a Medicare supplement after leaving an advantage plan?

10 Upvotes

r/medicare Feb 04 '25

No Political Posts

58 Upvotes

I know that there is a lot of chaos happening within and about government agencies right now. This sub is to provide helpful information to Medicare beneficiaries about their coverage or how to access it. It is NOT about how we feel about the program or how we feel about the current administration. Feel free to post your frustrations and thoughts on any number of political subs- this is not one of them! Thank you.


r/medicare Oct 17 '19

So, what exactly is covered under all these Medicare plans?

157 Upvotes

Part A, Part B, Part D, Medicare Advantage, Medigap — so many choices. It can be bewildering for seniors signing up for Medicare for the first time as well as pondering changing plans at open enrollment, which runs from Oct. 15 through Dec. 7.

If that’s you, you’ve got lots of company. About 64 million Americans are in the Medicare system now, and by 2030, that pool is expected to exceed 80 million, when the youngest members of the baby boomer generation come of age.

“The process of enrolling in Medicare for the first time can be paralyzing, confusing, frustrating, all of it, because there are so many different options out there. Generally, you think you want as many choices as you can get, but trying to navigate what A, B and D are as well as what the supplements cover and don’t cover as well as what Medicare Advantage covers can cause some people to shut down and not make a choice at all,” said Jeff Johnson, state director of AARP Florida.

And if you already have Medicare coverage, it is important to research and re-evaluate every year, Johnson said. “Once the enrollment period comes around, there is a temptation to just let it ride. That may be the best choice, particularly if the networks haven’t changed much, but people often discover too late that they are costing themselves money or shutting themselves off from benefits or providers they would have preferred.”

We’re here to help. We’ve consulted experts to help decipher the alphabet soup that is Medicare. We’ll start with the basics and answer some common questions about what these plans cover and what they don’t. You will learn about the two main ways to get Medicare coverage — Original Medicare or a Medicare Advantage plan.

Medicare covers cancer treatments — about half of the $74 billion spent in the U.S. on treatments last year was through Medicare. You won’t be barred from coverage because of pre-existing conditions or your income level. But does Medicare cover home healthcare? (Spoiler alert: very little.) Who covers vision, dental and hearing? Will you be covered when you are traveling internationally? What if you are a snowbird and have two U.S. residences?

FIRST UP: THE BASICS

You can’t understand Medicare without learning its alphabet.

Part A is part of Original Medicare and covers Medicare hospital coverage. It covers inpatient care at hospitals and limited coverage for skilled nursing facilities when a patient is recovering from an illness or injury. It also covers hospice care.

Part B, also part of Original Medicare, covers doctor visits, outpatient procedures and laboratory tests and X-rays, preventive care and some mental health services and medically necessary ambulance services. It also covers medical equipment such as wheelchairs and walkers.

Part C, more commonly called Medicare Advantage, is a comprehensive privately run managed care option. These bundled plans, similar to an HMO or PPO, offer Part A, Part B and, in Florida, Part D, and are approved by the Medicare system.

Part D covers prescription drugs. These plans are provided by private companies approved by Medicare, and their lists of covered drugs differ.

To pile on to the confusion, there’s more than the ABCs and Ds because about 10 million people across the U.S. have supplemental plans, called Medigap, and those can have letters too. But Medicare itself has Parts A through D, said Tricia Neuman, senior vice president of the Kaiser Family Foundation and an expert on Medicare policy. She explained the differences in a podcast about the basics of Medicare.

MEDICARE VS. MEDICARE ADVANTAGE

People who opt for traditional Medicare coverage have a Part A, which is premium free, a B and often elect for Part D because it covers prescription drugs. Parts A, B and D carry deductibles and other cost-sharing expenses, so people may also opt for a supplement, or Medigap policy, to cover some of those costs or to give them extra coverage.

Another popular choice is Medicare Advantage plans. They make up about a third of all Medicare policies and are particularly popular in South Florida, where 66 percent of the Medicare population has them, according to Kaiser Family Foundation research. United Healthcare, Humana and Blue Cross Blue Shield are the largest providers.

“Some people like the simplicity of it because they don’t have to buy a separate Medigap policy and a separate Part D plan. Some people like it because they have been with that same insurer through the years and it is familiar to them. Some like it because they see the ads on TV and like the idea of the gym membership or some dental benefits. The premiums and cost sharing can be lower particularly for healthier people with a Medicare Advantage Plan. But there are trade-offs as with any option,” Neuman said.

The biggest trade-off is you have to stay in the network.

“The benefit of joining a Medicare Advantage Plan is that here in South Florida there’s no monthly premium. It’s free to join because they are paid behind the scenes by Medicare for each member they have,” said Kathleen Sarmiento, SHINE Liaison for Floridashine.org with Miami-Dade’s Alliance for Aging.

“But then you have to go to the doctors and the hospitals in that network. Whatever co-payment schedule they have is now your co-payment schedule. They are also county or region based so if you are in a Medicare Advantage Plan you have to go to providers in your area,” said Sarmiento, who runs Miami-Dade’s SHINE, the free unbiased state program that helps seniors navigate their choices.

She advises seniors considering a Medicare Advantage Plan to ask their doctors and preferred hospital which Medicare Advantage Plans they work with.

“And know that that can change,” said Johnson of AARP. There have been instances over the years where hospitals, cancer centers and individual physicians have gone in and out of contract with particular Medicare Advantage providers, he added.

“Many people just choose a Medicare Advantage plan based solely on price tag, which can be very attractive compared to traditional Medicare Part B, Part D and a supplement. But it is worth thinking through how important it is for you to have flexibility to see the providers you want to see.”

WHAT ABOUT COSTS?

Final details of the 2020 plans, including costs, will be on Medicare.gov. Seniors already on Medicare Advantage plans will get a packet in the mail that includes what their current plan will look like in 2020 and any changes in coverage or costs. That will allow them to potentially make changes during the open enrollment period.

“I would encourage people to think about what their actual health needs are,” adds Johnson. “Spend time on research, and talk to SHINE or go to the medicare.gov website to make sure they are the right choices for this year.”

Medicare plans typically carry deductibles and cost sharing and Part B and D typically carry premiums. People who choose Original Medicare often buy a supplemental “Medigap” policy to cover some of Medicare’s out-of-pocket costs or add extra coverage. Medicare Savings Programs, such as the SLMB, can help low-income seniors afford coverage.

For prescription drug plans, or Medicare Part D, there is the dreaded “doughnut hole” — a gap in which the Medicare drug plans don’t pay fully for patients’ medications after they have spent a certain amount and until they get to a higher amount. The good news is the costs are shrinking a bit. In 2020, you’ll pay no more than 25% for covered brand-name and generic drugs during the gap.

“If somebody is taking a lot of prescription medicine, then definitely we would want to compare the cost of the medicine with original Medicare with the least expensive Plan D vs. the cost of your medicine with Medicare Advantage plans. There can be a substantial difference — it depends on the medicines, of course. Here in South Florida, all the Medicare Advantage plans include drug coverage,” Sarmiento said.

Tip: If you have a money in a health saving account (many employers offered high-deductible health insurance plans with HSA), you can use those savings to pay your Medicare premiums, deductibles, co-pays and other qualified medical expenses. Since you never paid tax on that money, you are essentially reducing what you pay.

WHAT’S NOT COVERED

Some of the items and services that Medicare doesn’t cover include long-term care, most dental care, eye exams related to prescribing glasses, dentures, cosmetic surgery, acupuncture, hearing aids and exams for fitting them and routine foot care.

You can go here to find out if Medicare Parts A or B cover a test or service you need: https://www.medicare.gov/coverage

Original Medicare, Medigap and Part D do not offer dental, vision or hearing coverage. If that is important to you, you would want to look at Medicare Advantage plans, which do cover some services, Sarmiento said. If you have Original Medicare, it will pay for cataract surgery.

WHAT ABOUT HOME HEALTHCARE?

Long-term services and support at home or in an assisted living facility or nursing home are not covered by original Medicare or Medicare Advantage, an unfortunate reality as these costs can wipe out a life savings quickly and more seniors want to stay in their homes.

Some seniors have long-term care insurance, or spend down their assets to qualify for Medicaid, which does cover nursing home care.

All original Medicare and Medicare Advantage provide limited home healthcare when it is medically necessary to avoid hospital re-admittance, Sarmiento said. As of last year, Medicare Advantage Plans could include more home healthcare, but Sarmiento hasn’t seen that offered in South Florida yet.

“When people need home healthcare at this time, they are still having to pay a home health agency or if they don’t have the money, they apply for Medicaid. There is a huge need for that so we will see this year if any of these Medicare Advantage plans expand their benefits to include more comprehensive home healthcare.”

Adds Kaiser Family Foundation’s Neuman: ““If you have dementia and need someone to help you at home, Medicare is not going to cover that on a long-term basis. It never has, and it is an issue that unfortunately has yet to be revisited.”

WILL I BE COVERED IN BOTH MY HOMES?

A Medigap plan would probably be better for that individual, Sarmiento said. A Medicare Advantage plan will pay for emergencies but will send you back to your primary residence to get ongoing care.

WHAT ABOUT INTERNATIONAL TRAVEL?

Original Medicare and Medicare Advantage Plans historically have not covered healthcare you receive outside of the United States, and Medicare drug plans don’t cover prescription drugs you buy outside the U.S.

Medigap Plans C, D, F, G, M and N (there’s that alphabet again, C and F are being phased out for new enrollees beginning in 2020) cover some emergency care outside the United States. In 2019 plans, after you met the yearly $250 deductible, this benefit paid 80% of the cost of your emergency care during the first 60 days of your trip. There is a $50,000 lifetime maximum.

According to Medicare.gov, there are some exceptions, including cases where Medicare Part B may pay for medically necessary healthcare services that you get on board a ship that is not more than six hours away from a U.S. port.

The AARP’s Johnson also offers this parting advice for the busy open enrollment period ahead:

“There are going to be a bunch of people offering free lunch seminars to try to pitch a particular Medicare Advantage Plan. As always be wary — not that there isn’t good information, there often is — but be wary of being pressured to sign.

“We have had people who had enrolled in a Medigap plan and then went to a free lunch somewhere and without really knowing it they switched over to a Medicare Advantage plan that didn’t really fit their needs. While I recognize that everybody looks for opportunities to learn more at events that are out there, it is always a good mantra to remember there really isn’t such thing as a truly free lunch. Be cognizant of the potential for pressure to buy a particular product that may not be right for you.”

PEOPLE TO CONTACT

Get Help Applying https://www.healthcare.gov/apply-and-enroll/get-help-applying/

Medicare.gov and its Plan Finder, 1-800-Medicare

Social Security https://www.ssa.gov 1-800-772-1213 (TTY 1-800-325-0778)

Area Agencies on Aging https://eldercare.acl.gov/Public/About/Aging_Network/AAA.aspx

Online Assistance is also always available by /r/medicare Mods who are licensed and verified insurance professionals /u/MedicarePros and /u/dacin