r/medicare

I recently signed up for Medigap coverage with AARP United Healthcare. It is plan G. I've read all about the issues with this plan. I wish I had seen the complaints earlier.

But I'm giving a heads up to folks still in that plan to check your list of "Health Conditions."

That data isn't available on their website. But it is available on the UHC iPhone App. (From Home, click "Member Card." Then Click "Medical Information." Next, Click "Health Conditions."

Along with the actual real health conditions I have, I've discovered they list me as addicted to anxiety medication, They claim I was born with an abnormal heart blood vessel as well as Colitis and a benign rectal tumor.

None of these conditions are anything I have had. They cite specific Doctors as the source. But when I call those doctors, they tell me that information didn't come from them and is not in my records.

My concern here is, if I ever have to undergo underwriting this will drive up my premiums. Perhaps that is even the plan. If this information is shared with another insurer, I'm very unlikely to get a decent rate from anyone else and I'll be stuck with AARP/UHC.

I've spent the last two days on the phone with them. They can't seem to help me. In fact, they have advised me to ignore it.

I won't do that. I won't have an insurance company using incorrect data to decide on what conditions they'll cover and approve. I also won't leave incorrect data in a file used by underwriters to set policy prices.

I've asked that it be expedited to a supervisor. I'm told someone will call back within 48 hours. But I'm not holding my breath on that.

I'm hoping other customers can examine their own health records in the app to see if my situation is unique or something that is happening regularly.

I’m not having any luck finding a therapist in the Cincinnati / Northern Kentucky that takes Medicare, is not video based, and therapist that are at least 40 yrs old?
Too much to expect?

August 2026 I subscribed to United Health care aout 6 months ago. I signed up because I was assured that it would reimburse me 300 dollars for each Prolia injection I had to take up to 6 times a year. I sent off my first claim along with all required documentation including my bone scan results that showed my bones were like chalk ready to break at the first opportunity. I had already broken a left hip. Since my regular insurance wouldn't cover the total cost of the injection I had to pay 330.00 per injection. So it seemed like I at least would recover most of my injection expense. After several calls to see what was takiing so long for my reimbursement it finally took them 90 days from the time I recieved my shot to deny my claim saying injections and immunizations were not covered under my plan. I argued with them since UHC was using Golden Rule to cover my policy I fought with them also pointing out what the policy stated and of couse they had a different interpretation of the policy then I was given. Needless to say I got no where and I recieved no reimbursement. I canceled the insurance that very day. UNHAPPY Kay Ogden. Dupo, IL.

I have been on Medicare since 3/1/26 in addition to my work insurance (I am disabled and have one more year of coverage through my work). According to the work insurance rules, as of my 65th birthday last month, Medicare is primary and the work insurance is secondary. We have met the out of pocket maximum for myself and my dependent on this plan. The plan year ends 12/31/26.

My spouse's work plan has open enrollment ending 8/20 with a plan year from 9/1/26-8/31/27; I had previously talked to a broker who indicated that as long as spouse's insurance is creditable coverage, that I could go on spouse's insurance and drop Medicare.

I have done extensive research and am about to pull the trigger to go on my spouse's insurance (with the dependent), also stay on my work insurance through 12/31/26, and then drop Medicare as of 9/1/26.

BUT I AM SO NERVOUS to drop Medicare! Terrified that something bad will happen and I will be penalized forever.

Do I call the broker again? Do I talk to Medicare themselves? Do I have faith and trust that it will all work out as long as I can prove that I had insurance every single month for the next 6 years (until spouse retires)?

Thank you in advance for pointing me in the right direction!

My mother takes 3 prescription drugs and it's cheaper to do CostPlus and SingleCare compared to Part D by $20. In total with Part D, it's only $40.

However, with the late enrollment penalty for Part D, I'm not sure what's the best approach here.

For example, if she needs more drugs due to declining health when she gets older, and if Part D is the most cost-effectice, then she'll get hit by late penalty enrollment.

She's in CA if that matters.

My pops just had a couple of prescriptions filled and it cost him $2.40 for one and $2.44 for the other. He said they didn't charge him anything in the past so wondering why this small amount now? Both are 3 month supply.

EDIT to say I’m in Pennsylvania.

Having just retired, my husband and I will both be starting Medicare on September first. We are going through the process of picking plans right now. He is service connected VA so he will just get an Advantage plan as a backup plan. I have no other coverage so I will be going with original Medicare under part N and part D. My question is this, since we are just now choosing, what will happen during open enrollment this year? Since it’s so soon should we do anything to review other plans or just let things ride with what we are choosing now?

Update on my Aetna Medicare Advantage SNF appeals — and getting closer to home

I wanted to come back with an update because several people here were incredibly generous with their time while I was trying to navigate my mom's SNF appeals.

Over the course of her SNF stay under Aetna Medicare Advantage, I successfully appealed five separate terminations of coverage. The sixth termination was upheld, as was the reconsideration. I still have the option of pursuing ALJ review on that last decision, so technically that piece isn't over yet.

When coverage terminated, my mom did not leave the SNF. She remained there and we began paying privately for her care. Two days after the coverage termination, the SNF sent her to the emergency department, and she was ultimately admitted to acute care.

She's had a longer hospital stay than we expected because of several medical issues, but we're now getting much closer to bringing her home.

I've also filed a formal grievance with Aetna and a complaint with Medicare regarding the broader handling of the repeated coverage terminations and discharge process.

In the meantime, I've shifted a lot of my energy toward figuring out what a safe home plan actually looks like. We have a hospital bed, home health is coming together, I'll have caregiver support, and I'm working on the remaining gaps in her home-based medical care.

Mostly, I wanted to come back and thank everyone who helped me understand this process. Five successful appeals gave my mom additional covered time when she needed it, and everything I learned here helped me ask better questions and make better decisions. We're not quite home yet, but we're getting there.

I am only 46 and granted disability in July due to my health issues. With that I was placed on Medicare A & B. I know I need to add more coverage but not sure if which one, MediGap or Medicare Advantage??
I am finding Medigap is extremely expensive if you are under 65. I also know you only get this time to get it or penalty/denial later. The quotes I am getting are $600-1400 a month for Medigap simply because I am 46 years old. That is not even doable for me but I don’t want to make things worse for myself as I get older by not taking it now.
Medicare Advantage is very affordable but I am reading so many bad things about MA. Is it really that bad?? I figured if I do go this route I would at least do a PPO, I found one that covers all my medications and doctors and doesn’t look bad at all cost wise either, especially compared to Medigap cost. Also Advantage offers vision and dental which would be nice to have. Why do so many people not like MA? Is it better for someone my age on it?
I was relieved to get awarded disability but depending on this insurance it might just all be going to insurance. I am nervous to make the wrong decision and appreciate any advice. My current health insurance has notified me that they are aware I was placed on Medicare so will terminate me on Aug 28th as I can’t have both so I need to make a decision this week on what supplemental insurance to go with.
Any advice from others on Medicare under 65 due to SSDI and what has worked best for them? This is very overwhelming!
I do not qualify for Medicaid if that info is needed. I am just on Medicare A & B for now and just need to pick a supplemental insurance for Prescriptions and doctor visits.

Well, I had wrongly assumed that the part D part of Medicare would be the easy part. I have been taking tadalafil for ED and testosterone for weakness/lethargy and my employer prescription plan had been covering them. But then the first time I went to get them refilled after retirement with my new Medicare Part D plan (through Humana), I learned that Humana required prior authorization for both of them. Went through the process to get my doctor’s office to communicate with Humana, and the prior authorizations were denied for both medications by Humana.

I kinda get the tadalafil denial. It seems insurance companies don’t want to pay for ED treatment, but I was surprised by the testosterone denial.

My questions: Is it worth the trouble to appeal the denial? Are such denials common for part D plans when a prior prescription plan was already covering them? Am I likely to have luck getting them covered if I change to another part D provider? Suggestions? Thanks!

I retired 12/25 at FRA, am collecting social security, and am currently on my husband’s employer health plan. I am enrolled in Medicare Part A only now because it was cheaper to move to husband’s plan - I pay about $280/month for my share of his health plan. He is planning to switch to part-time work with the same employer sometime in 2027, either April or November (has not decided yet). My cost share of his healthcare plan will be much more than I currently pay because the rates are higher for part-time employees, so at that time I’d like to switch to Medicare B with a supplemental plan. Can I do that without any problem or penalty?

I've been dealing with repeated SNF coverage terminations for my mom under Aetna Medicare Advantage. After going through multiple expedited appeals, I filed a formal grievance with Aetna about the broader handling of the coverage terminations and discharge process.

Aetna has now contacted me about the grievance, and I'm wondering what to expect from here.

For anyone who has been through the Medicare Advantage grievance process, what happened after the plan acknowledged or contacted you about the grievance? Did someone actually investigate the underlying issues and speak with you about them, or was the process mostly an internal review followed by a written response?

I'm not looking for predictions about the outcome. I'd just like to understand what the process typically looks like from this point forward.

Thanks — I've learned a lot from people here who have already navigated parts of this system.

If so, he's being told he should sign up for Part B. He's getting different answers from different people, even from Medicare.

Edited to add: He didn't retire from the military. He's a vet.

apparently by law OTs can’t work with you if you’re on Medicare and they don’t accept insurance. like I can’t even pay out of pocket to see one legally which is absolutely insane to me. I am looking for very specific help with mental health disabilities and I cannot find a good one that takes Medicare. how on earth are you guys finding qualified OTs to treat you? is anyone being seen under the table?

For plan year 2027, the Centers for Medicare & Medicaid Services (CMS) has updated eligibility requirements for Special Supplemental Benefits for the Chronically Ill (SSBCI) for Chronic Special Needs Plans (C-SNPs) and Dual Special Needs Plans (D-SNPs).

There are 4 key changes:

As we previously communicated, beginning with new enrollments starting Oct. 1, members will no longer receive temporary access to SSBCI benefits while eligibility is being verified. Members must first meet all SSBCI requirements and complete the verification process before benefits become available.

A qualifying chronic condition alone no longer automatically qualifies a member for SSBCI. To qualify, a member must:

Have a qualifying chronic condition.

Be identified as at risk for hospitalization or adverse health outcomes.

Be identified as needing intensive care coordination.
C-SNP members, like D-SNP members, will require verification to access healthy food (which is a change from 2026).

Existing members who may currently be receiving SSBCI benefits will be required to complete re-verification to confirm SSBCI benefits for next year.

These updates support a consistent and compliant eligibility process while helping ensure SSCBI benefits are available to members who qualify.

Learn more in the updated "SSBCI" 2027 Agent Quick Reference Guide.

Can someone new to Medicare submit SF5510 before their start date and before they get any actual bills? Will this start electronic withdrawals starting with the first payment? Do these electronic payments include those for part B, part D, and any IMRAA? I believe his supplement plan is billed separately and not included in this electronic payment.

thanks

My FIL said he’s getting the anthem food card . Can someone explain this to me because he can’t . He doesn’t know how to properly grocery shop.

trying to understand how Medicare works as a primary payer when my dad also has retiree coverage through his former employer. he just aged into Medicare this year and kept his old company's retiree plan because the premium is low and it felt like a safety net. but now I'm hearing that coordination between the two can get messy depending on which one pays first and how claims flow through

he has original Medicare with Plan G, so I assumed the supplement covers most of what Medicare doesn't. what I genuinely don't know is how the retiree plan fits in now. does it basically become useless since Plan G is already covering the gaps, or does it kick in somewhere? and the Part D piece is a separate question entirely because his retiree plan has drug coverage too, and I have no idea if he was supposed to drop one of them

I do a lot of spreadsheet work for a living so I can handle complexity if someone explains the actual logic. every article I find either oversimplifies it or assumes I already know what coordination of benefits means in practice. his HR contact told him to call Medicare, which is not a useful answer.

has anyone actually dealt with layering retiree coverage on top of original Medicare and figured out whether it helped or just added friction?