r/medicare

What is supposed to be done at an annual wellness exam? How comprehensive is it? What is reviewed?

My UHC advantage plan is ending - I’m in WA state where I’ll have guaranteed issue to a Medigap plan.

I was thinking I couldn’t afford the high deductible - however after seeing what I’d paid so far in 2026 - 3,330.00 looks like 2970(is that correct for Plan G HD?)
I need to speak to SHIBA - to make sure that my Medigap plan and plan D will coordinate well.
Sometimes just reading over your previous plan is all a person needs.

The Humana Medicare Advantage PPO plan I am covered with for 2026 is terminating. There is another Humana Advantage PPO plan I am comfortable enrolling in for 2027.

No communication from Humana has been received yet - nothing in my online portal, nothing in the mail.

When I contacted Humana early last week via a phone call, the agent simply stated to contact my enrollment agent of record and said words to the effect they were have trouble getting the non enrollment letters out to some members. FYI, both my spouse and I are in the same plan, and neither of us have received any communication.

Should I just let this go and continue to wait? At what point should I file some type of complaint and to whom?

Fully satisfied with PPO coverage. Two healthy individuals saving thousands of dollars each of the last five years with the means to pay out of pocket max should that occur. At some point in time should all PPOs go away, I will consider whether to go to a supplement using the guaranteed issue that comes with a plan termination.

My husband is retiring at the end of 2026. He has had substantial income the last few years as he has been paid for his shares in the company. Our income of course will drop dramatically on January 1 as all payments have been made. If I am understanding correctly, our only option is to file an appeal with Medicare right away to see if the IRMA charge can be reduced sooner rather than later.

Is there anything I am missing?

I'm comparing Medicare Advantage plans for 2027 in Brooklyn, and dental is the deciding factor. With Aetna (dental through Liberty Dental), many dentists listed as in-network turned out not to actually take it. For anyone in NYC on Medicare: which plan do you have (Aetna/Liberty, Humana, UnitedHealthcare, Healthfirst, Emblem, Wellcare/Fidelis, or a stand-alone dental plan like Delta), and did you find a dentist who really accepted it? How did coverage go in practice with things like crowns, root canals and dentures, denials, the annual max, and wait times? Office names you're happy with would be a huge help. Thanks!

It's time to get my husband on Medicare, and we want to make sure we don't make a mistake, so I have a question. He is currently employed, has insurance through a large employer, became eligible for VA in July (long story), has an HSA, and turned 65 in January 2026. We have decided to drop his insurance/HSA on December 31, 2026. Then, enroll him in Medicare Parts A, B, and D on July 1, 2027. Will that cause us any penalties?

Starting Medicare in 2027. Can anyone with a HD-G plan with CPAP experience please tell me what their out of pocket cost was for 1) a Sleep Study and 2) CPAP machine. Trying to plan for future expenses…thanks!

Medicare just started 9/1/26 so I’m new at this. I am in PA and I have A, B, D, and N (Humana). I had a couple appointments and a surgery in September so my $283 deductible is paid for this year.

I have an appointment with the ophthalmologist tomorrow morning. I just received the estimate through my medical app. The estimates are normally spot on. They will expect me to pay before the appointment. The estimate is stating that 20% ($40.83) is what I am responsible for. Since I have N, I thought it would only be $20. What am I missing? (Yes they have all of my insurance info, including Humana.)

This is not a political post, but it is important that people set their expectations accordingly about that $90 payment they think they may be getting.

As noted in the CMS FAQ, for some bizarre reason, evidently the administration doesn't understand that Medicare Advantage (Part c) enrollees are also Medicare recipients who pay for Part B premiums. Point of fact, they'd deducted from our Social Security, just like they're deducted from the Social Security of Medicare/Medigap people.

Also point of fact, Advantage holders would probably proportionately benefit more than Medicare/Medigap enrollees.

Whatever. It's just important for Advantage people to know we're getting shafted.

https://www.cms.gov/newsroom/fact-sheets/medicare-improvement-fund-premium-rebate-frequently-asked-questions

Update

As noted in comments, and in this post, it seems to be related to the origination of the fund.

'The key difference appears to be where the money comes from. The payments are made from the Medicare Improvement Fund, which was created for improvements to Original Medicare’s fee-for-service program. CMS does not give a separate explanation for excluding Medicare Advantage members, but it says plainly that they are not eligible.'

And it is true, Advantage folks are covered under Part C...but we pay Part B premiums. So regardless, this is going to cause a lot of bad feelings in the 55% of the people covered under an Advantage plan. We already feel, frequently, like second class citizens compared to Medicare/Medigap/Part D folks...including in this subreddit.

https://moneyinstructor.com/money/medicare/medicare-90-payment-october-who-gets-it/

Second update

This from the CBO explains the purpose of the Medicare Improvement fund. As noted, it is for use with traditional Medicare, but the purpose has to do with payments to physicians and hospitals, nothing to do with premiums. For instance, the funds could be used to provide extra payments for services performed by rural hospitals, specifically to support their viability and ensure Medicare recipients have access to nearby hospitals.

'The original purpose of the Medicare fund was “to make improvements under the original [Medicare] fee-for-service program under parts A [Hospital Insurance] and B [Medical Insurance] for individuals entitled to, or enrolled for, benefits under part A or enrolled under part B.”1 The Congress has since amended the name and purpose of the fund several times; the last change to the purpose of the fund was made in October 2014. Today, the purpose is similar to that in the 2008 statute, but the permissible activities have been expanded to include “adjustments to payments for items and services furnished by providers of services and suppliers under such original Medicare fee-for-service program.”2 In other words, the funding may be used to make improvements to Medicare’s hospital and medical insurance programs in ways that may include adjusting the amounts that Medicare pays to health care providers.'

https://www.cbo.gov/publication/59115

I just started Medicare this month with Part A, B, D (Wellcare Value Script) and Medigap with Blue Shield. I'm in California. Before I picked Wellcare Value Script, I put my medications into their pricing tool, and I could see that half my meds were reasonably priced at one pharmacy, and half were reasonably priced at a different pharmacy. However, I am stumped as to how to now price my meds and have my doctors send to the pharmacy. For one thing, one of my meds comes back as can't give me a price (looks like a Tier 4!) I can pick a "primary pharmacy". Does that matter? I am a little confused, and considering trying another plan at open enrollment. Any thoughts from others here in CA with this plan?

My wife recently had surgery and the surgeon prescribed Journavx for the pain. The initial prescription was for 29 tablets, a double dose loading followed by a single dose every 12 hours.

Towards the end of the 2 weeks, she asked for a refill for another 2 weeks as she still has some pain. This was turned down based on the quantity limits that Wellcare has.

Looking this up on their formulary, it appears that this drug has a 30 pill limit per 90 days. How does this even make sense. We tried appealing for an exception but that was turned down.

So, instead of a non opioid pain killer, she now has to rely on a narcotic, which she was hoping to avoid totally.

So my Aetna Signature PPO plan is ending and and being replaced with the Elite PPO plan. I am in Massachusetts. My plan is to stay on MA in 2027. So, my other zero premium Aetna option is the Signature Extra PPO. The Elite plan has a deductible of $1250. The other differences don’t seem major. Why would anyone want the deductible plan? Am I missing something?

Hey gang, I just signed up for part A. I'm retiring next week (65 in Sept.) and will be without healthcare for 3 weeks, (my wife's HC begins covering me in Nov.) When I sign up for Part B, will I be penalized for not having continuous HC for 1 month?

Thanks in advance!