Have other pensioned retirees on the KT seen similar changes?

No, we have not. The costs and contributions for 2023 have been available for a while on the CalPERS website. For this calendar year (2022), the State's contribution towards our health care costs is $1,548 per month. For calendar year 2023, the State's contribution towards our health care costs will be $1,699 per month. That's enough to cover our premiums, including the IRMAA premiums.

It's encouraging to hear positives about the Advantage plans. I'd heard that they are good for younger, healthier people, but not so for the elderly with more chronic illnesses.

maddielee -- Is your insurance a PPO plan or an HMO? I may soon require Revlimid to fight my multiple myeloma. Retail is just under $30K a month; $2300/mo with my current Part D. For the past four years my infusions ($40K/mo) have been completely covered by Medicare Part B, but Revlimid is an oral med, not administered 'in hospital', and thus a Part D expense. I wonder if my treatment would actually be cheaper with one of these plans.

I'm going to add this: our Medicare supplement is such that we essentially have a PPO. We go to whomever we choose. Nothing requires a pre-auth or a referral.

We have regular Medicare with the UHC supplement (thru AARP). Regular Medicare does not require preauthorizations, and neither does the UHC supplemental plan. Zalco, perhaps regular insurance, not medicare supplement, thru UHC is different. But Medicare and insurance available to those not 65 are two vastly different things.

“maddielee -- Is your insurance a PPO plan or an HMO?”

PPO - always do research about covered services/facilities in your area before committing.

OT

Maddie260, BTW, your argument against the concierge practice when I posted about that, absolutely convinced me it was not worth it, my husband, however had made up his mind. I truly appreciated your input and know you are right.

Chisue, my mother had a Kaiser supplement to her Medicare and approx age 80, or close to that, changed to the Kaiser Senior Advantage. For the same cost as what she'd been paying monthly plus her out of pocket for two dental checkups and cleanings, it gave her the dental coverage, some hearing coverage. When you consider she'd been paying cash for any dental work, it was less money annually for her.

As her medical POA, I was more than pleased with her care and coverage (went with her to every appointment). I'm not sure if that's true if living in a smaller community but she was located where she had access to all the Kaiser facilities and those rare times they didn't have a specialist on staff that met her needs, a referral was quickly produced. Other than some co-pays ($5-$10 for prescriptions, maybe as much as $25 for a specialists appointment), all her expenses mostly covered and I can't think of a time I could fault the care she received.

DH and I have never had an advantage plan for ourselves. There are none offered to residents of this county in this state. I'm not completely convinced it would meet our needs at this age, but even if we did want to, could not enroll in one.

For all medical insurance, not just those that dovetail with Medicare - the cost of buying insurance depends on medical cost charges and price inflation, the insurance company's claim experience with whatever the "group" a is person is in, and what benefits are provided. Often for employer "sponsored" plans, the employer (together with consultants and/or the insurance company, or both) will go through a cafeteria list of choices and decide what needs to be covered and what optional extras may get included. The insurance company is like the cashier at a store - it charges for what was purchased. Whether you have a retail plan, the provisions of which are set by the insurance company, or a private plan that an employer decides what to cover, that's how it works.

For large employers, there may be little or no actual "insurance" involved with what the Insurance company's involvement is. Large employers are often self-insured (they pay claims) for all but catastrophic situations - because that's cheaper. The "insurance company" may only administer claims and benefits and send regular bills to the employer for reimbursement of the benefits paid.

Suggest anyone considering Medicare Advantage read this:

https://www.commondreams.org/views/2022/08/30/medicare-dis-advantage-shortchanging-patients-while-enriching-insurer

@chisue...Thanks for posting THIS thread. I'm trying to decide what to sign hubby up for. He turns 65 in a few months time.

nicole it would depend on his health insurance if any. Be aware that if he does not sign up for part B there is a penalty that will be added to the premiums for each year he does not have it. Last time I looked it was 10% for each 12 month period.

If he is still covered by employee insurance, he may receive a letter stating that his insurance covers medicines. If he does keep that yearly letter. It takes the place of Part D and if the insurance is terminated or changed, unless laws change like they do, there is not supposed to be a penalty for not having Part D when he would go sign up. You should ask your CMS office about this.

I've had a Medicare Advantage Plan for many years and haven't had any problem with it. I don't need a referral to see any doctor in the network, and all of the specialists I've seen have been very good doctors. Dental, hearing and vision coverage is included.

I have a Medicare Kaiser Advantage plan, and have been very happy with it. I’ve liked almost all the doctors I’ve seen, and if I didn’t care for a particular physician it was quite simple to schedule my next appointment with a different physician.

@maifleur03..Advantage has FREE plans through "everyone". The paid versions don't cover that much more.. He takes thyroid meds, $4 a month by using a free generic savings card. No other medical issues. We buy our own medical & have Delta dental insurance right now. He's keeping the dental plan we have. I thought a FREE Advantage plan through Kaiser sounded fine. Thoughts?

China! Just waving, Hello! I hope you are having a great time.

Nicole sounds good but double check to see about the Part D and if Part B is required. Some of the "Free" Advantage plans I have seen do not cover meds. They tell you that you need Part D. When I go to Medicare.gov I see some of the Advantage plans list that you need to pay for Part B.

Since each state has different plans, my comment is general and only covers what is available for 2022 and not 2023 as those are not yet available in this state. When I look at the yearly offerings I look more for the maximum out of pocket and if it includes or excludes drug costs. I was already doing this but the year my husband was admitted to the nursing home still needing medical care after his knee surgery he reached the maximum in September and I did not have to pay any of his charges for the rest of the year. Since you never know what will happen just purchasing a policy because it states it is free without seeing what it actually does cover can be the wrong decision.

Health Care in the US will continue to cost all of us more to provide a lower standard of public health as long as we allow Big Pharma and an Insurance Industry to continue as middlemen -- deciding what's available and how much we must pay for it to keep *them* healthy.

In 2022 DH and I will exceed the $11,000 we budgeted for "Health".

Medicare Part B -- $4082.40

Medicare Supplements -- $1236 for his Plan F High Deductible; $3761 for my Plan F

Medicare Part D -- $186 for his; $83 for mine (Allowing us discounts on overpriced meds)

OOP for meds -- $480 for him; $1546 for me (Based on 2021 OOP)

This year DH paid the entire deductible for his Medicare Supplement -- +$2800

This year DH was prescribed a new med in July -- +$2500 OOP 6 mos

My oncologist wants me to start taking Revlimid in October -- +$7065 OOP 3 mos

Our 2022 Health costs will more than double -- $23,600. Add the increased OOP for a full 12 months for 2023 means our "Health" witll cost ~$50,000.

Taxpayers, Medicare (you!) have spent half a million dollars a year just for the medications (Velcade, then Darzalex) that have kept me alive since my diagnosis of Multiple Myeloma four years ago. Thank you, but, like the Revlimid, most of this is profit for Big Pharma. Note: Much of the research for MM meds has been done with government money.

Wow, chisue. Reading your post, it seems so acceptable at first, and then the 50k. How many can afford a number like that?

The way our healthcare system is set up is terrifying. The opacity alone shows you how much ugliness there is to hide.

Hi Zalco! I’m waving back at everyone- and yes, a great time! I spent last week in Utrecht, and am currently in Brussels visiting family; day trips to Bruges yesterday and Antwerp today- Ghent on Thursday. Friday- Uzes in the southwest of France, then Paris, where I’ll be with my DS and DIL. So great to travel abroad again!

@maifleur03.." PAID polices don't cover that much more." I DID compare. B = benefits D = Drugs

I hope to cover the part B with a FREE advantage plan supplement. The D part, I'll have to pay for, even tho we don't need it now Chisue makes a valid point about what could happen. I appreciate you all coming forward with THIS information. We have a Colorado.gov site that often beats everyone elses prices. I'll be able to see next years prices in November.

Nicole -- Medicare requires that policy holders buy Part D insurance unless they are covered by government accepted similar policies -- usually from an employer. If you don't take a Part D you'll pay a penalty that increases for every year you failed to buy it after you took Medicare. You can choose the cheapest-premium policy available to you while you don't have many prescriptions to fill.

The Medicare.gov site has been my go-to for comparing Part D and Medicare supplements open to me in my state and specific county. I search and compare every year. We've usually saved by switching Part D plans; Companies count on people being too lazy to see when their current year's Part D is no longer their best bet.

OMG! Just reading this thread is making me anxious. I will definitely have to get help from my nieces on this. No way I will be able to make a decision on a health plan.

Free counseling is available through your local Area Agency on Aging/county office on aging. etc. The program is called different names in different states, but it is a free Federal program. Do not use an insurance agent for this, they are trying to sell something.

I just signed up for Medicare this year, and already I'm getting the "time to decide for next year" solicitations! Aaargh! Let me at least see how this year's plan works out first.

Ha-ha, JustDoIt...you will be able to Do It. Look at the Medicare.gov site once it is up and running for 2023. It will show you your options and rank them according to various factors. I look at what's generated as best for my Part D according to total cost of premium and my specific prescription meds. If you are unlikely to require expensive meds next year, I'd take the plan with the cheapest premium. You also need to see which pharmacy is most favored by your plan; meds will cost you less OOP there than at non-favored pharmacies.

nicole once again with your quotes following my name "" PAID polices don't cover that much more."" make it appear that I wrote that not you. As I stated each state is different and here durable equipment may not be covered in some plans but will be in others. Even this year, 2022, a few plans covered hearing aids and the testing while most do not.

Bpath depending on what you mean by waiting to decide if this year's plan works out for the entire year. You have to sign up before the first of the year so if you are planning on waiting until your anniversary date you will have missed the annual sign up. Some plans do continue if you do not elect to make a change. This depends on the state

I have an Advantage policy but could not keep my previous health care practitioner when I moved. Original Medicare will allow you to go outside of your immediate area.

I have UHC Advantage as my only option through teacher's retirement. I have Medicare also.

No, when you have an Advantage plan you no longer have regular Medicare. You have a private insurance policy.

I hope to cover the part B with a FREE advantage plan supplement.

You can have traditional Medicare parts A & B plus a supplement OR an Advantage plan (Part C) Advantage plans are stand alone plans - not supplements to Parts A and B.

Maifleur, I've used my Medicare and supplemental insurance only once so far, at the urgent care, and haven't been for an annual yet. So I don't know if I like my supplemental yet or not!

Bpath for most people it is just there in case you need it. Part of Medicare is most of the annual physical so your supplemental may not even come into play unless you need additional tests.

Terrarosa and others you may want to do a search about Medicare Part B and Advantage plans. The plans may or may not pay part of Part B.

I have a pile of paperwork I sent off for. :0) I know we currently don't do more than a once a year check up. I know that could change. I DO appreciate ALL the honesty about what you've spent THIS year on medical bills. The out of pocket expense that just seems outrageous for a retired person to have to fork out. Chisue I'm so sorry your having to pay so much.

"Advantage plans are stand alone plans - not supplements to Parts A and B." Thanks. I didn't know that. In 6 weeks...I'll go sit down with an agent at the medicare office and sign up there, in person with DH in tow. :0)

Ya know.....I really didn't want to be a Medicare expert. Or....a social security expert. 😂

Amount out of pocket may not mean what most people think it means. It does not mean you have to pay all of the doctors charges until you reached the maximum before the insurance pays for anything for most policy's. There are some high deductible ones where this is not true. What the maximum out of pocket means is if you have a bad health year once you reach the maximum normally you pay nothing more for the year. My husband met it once the year he had knee replacement and several attempts at regulating his afib. If you go to a doctor for something and pay a co-pay depending on your policy that co-pay generally goes toward your out of pocket.

For many people a disadvantage is if you need medical care either from a doctor who is not in the network or across the country you pay the out of network co-pay. It does not mean you are not covered although there may be a limitation of the amount of coverage. I use an HMO which is very similar to an Advantage plan. If I became ill or was injured and was admitted to the hospital as soon as I am stabilized and the doctors agree I must return to my home area for treatment or they will not pay for treatment. If this is a problem Supplemental policy's are best for you.

"I use an HMO which is very similar to an Advantage plan. If I became ill or was injured and was admitted to the hospital as soon as I am stabilized and the doctors agree I must return to my home area for treatment or they will not pay for treatment."

You may be confusing terms. As I understand it, Medicare Advantage plans come in two flavors, Advantage HMO plans and Advantage PPO plans. HMOs are usually considerably less expensive. HMO medical insurance, whether of the Medicare Advantage type or in general, have greater restrictions concerning what physicians and facilities can be used (network) and what kind of out of network are covered if at all (sometimes not at all). They usually require a primary care physician referral before an in-network specialist can be seen.

PPOs tend to be more flexible and offer broader options for providers. And broader benefits than HMOs. Some, like the one I have, treat in network and out of network the same - both are fully covered, nationwide.

Edit to add - also typical with PPOs, no referral from a primary care doc or anyone else is necessary to see a specialist. You want to see one, make an appointment, whether or not it's something previously discussed with your primary care doc. Sometimes that's helpful but often it's not and in HMOs it's just another step to delay or discourage the use of specialists, for cost control purposes.

My Advantage HMO will not pay for an out of network provider to be a primary care which is what I wanted. The different Advantage plans offered are different, prior to signing up it is good to review what a particular one offers.

I am not sure whether I will go to traditional medicare next year.

If you have health issues it can be difficult to purchase a Medigap supplement to traditional Medicare after you have been on an Advantage plan for more than a year, as the companies that sell the supplements are allowed to ask you health questions and turn you down.

When you first start on Medicare you have the guaranteed right to purchase a supplement without answering questions about your health during your initial enrollment period, but lose that guarantee after that time.

Terrarosa and others you may want to do a search about Medicare Part B and Advantage plans. The plans may or may not pay part of Part B.

Advantage plans replace Parts A and B, and sometimes D with private insurance.

Terrarosa my comment still stands since there are people on here from many states. In my state you still need to purchase Part B with the 0 cost plans. It all depends on state requirements.

We are fortunate to be grandfathered into an excellent retiree supplemental plan though DH's former employer. However I did look at all the options before we decided. The inability to switch after a year was a big one for me.

This article explains the cons of Advantage plans quite clearly. Great for healthy people but not so great if you become severely ill. If I had to go on an advantage plan I would be sure to have a health saving account to self insure should the need arise.

Advantage Plan Pitfalls

Regardless of which state you live in, when you opt for an Advantage plan you will be dealing only with a private health insurance company, not Medicare.

From this article: However, a person cannot enroll in both Medicare Advantage and Medigap.

Medicare Advantage programs are private insurance companies paid for by the federal government, not the state, so yes, you must be enrolled in Part B and continue to pay the premiums although some plans may offset the cost a bit. The Advantage Plans vary from state to state but still must follow federal guidelines. You cannot join any plan without being enrolled in Part B.

Some positive news on affording the Revlimid that costs $28,000/mo retail and $2300/mo under my Part D. The manufacturer will help if a patient's total OOP for meds is 3% of (joint) taxable income. It seems to me I'd 'only' have to pay $2300 for a short time for our total OOP to qualify, especially now that DH has a med that's $22/day OOP.

What a peculiar way to do business! It probably prevents the bad publicity of bankrupt families marching on company headquarters with tar and feathers.

wildchild that was what I was mentioning in my earlier posts based on what I read when I went to the Medicare site and checked on what was available in my zip code. Today I received the annual book from Medicare and it contradicts that information on page 61 where it states Medicare Advantage Plans provide all of your Part A and Part B benefits. Very confusing. Something to talk with the company that is chosen before signing up.

I have had an HMO for much of the last 20 years and it may be one of those state by state requirements but I had both in and out of nextwork co-pays. I now use a POS plan which is an HMO but I no longer need approval to go to a specialist nor am tied to a group of doctors.

"This article explains the cons of Advantage plans quite clearly."

I think whoever wrote that article wasn't well informed. It mentions 2 disadvantages of Medicare Advantage policies. Disadvantage #1 describes what clearly seems to be one structured as an HMO. Many, many are not. Disadvantage #2 concerns certain pitfalls that relate to SOME people, not all. That section would have been better described as "negatives that can affect some people, be sure to consider the following possibilities if they may apply to you".

"Great for healthy people but not so great if you become severely ill."

That's true for some people in some circumstances, not for everyone everywhere. It's not an area where generalizations are useful.

maifleur03 I got the book out and I think it is in the wording. They will provide all your Part A and Part B benefits. Then it goes on to exclude the benefits not covered such as hospice.

I can see how it would be quite confusing how it is written. But they are talking about services covered, not who pays the premium (Part B) for them. So it could be seen as contradictory but really isn't. I guess you have have to go over each individual plan to see if they subsidize the cost any of Part B at all.

On page 82 they mention Part B in discussing the drug coverage fee.

"Most drug companies charge a monthly fee that varies by plan. You pay this in addition to the part B premium."

BTW if you are receiving Social Security the Part B premiums are automatically deducted from your social security payment. If you are social security eligible but still employed and insured through your employer you can opt out of part b B. But once you lose that coverage you have to sign up for Part B if you are 65 or older. I think there is a 3 month window but don't quote me on it. Very low income people, and no one wants to be in that category by choice, get their premiums waived, like those on SSDI.

Thank you Wildchild. I just received it late this afternoon and only looked as far as the bottom of that page. Many people are not aware that Medicare does not pay for the charges. It is farmed out to various insurance companies you bid on it. The bidding used to happen every ten years. While it sometimes appears seamless there have been difficulty's.

In Section 11, second page of section labeled 120. Item 2. "Amount you pay each month for coverage, in addition to your Part B premium." Premium is highlighted in blue.

I am paying attention because last year there was a mention that federal retirees, me, who kept their health insurance would have a hybrid health insurance plan with the intention of removing retirees from the regular plans. Last year there were a couple of plans that on the informational sheets there were two columns. One for younger employees and one for those on Medicare.

maifleur03 We are in a similar situation. Our health plan is no longer offered to retirees but we are grandfathered in. At least so far. We called and were told that should my DH (he is the primary) precede me in death I would still be able to keep the plan along with the company contribution to the premiums. But I want to be sure. This link gives some useful info. I am going to request a copy of our SPD.

https://www.dol.gov/sites/dolgov/files/ebsa/about-ebsa/our-activities/resource-center/publications/can-the-retiree-health-benefits-be-cut.pdf

Spd is summary plan description.

DH's retiree health benefits administrator has released more detailed information on it's dedicated United Healthcare website. It offers two choices of PPOs. Essential Plan has a max medical OOP of $5,000; Enhanced Plan, $750. The company suggests that most retirees will want the Enhanced Plan -- I suppose more want to pay the small premiums and have the lower limit OOP. Essential has no premiums and annual HRA contributions of $1300 plus another $300 towards the Part B premium -- projected to be around $165/mo in 2023.

Most of the medical benefits listed are actually Part B benefits, but these Advantage Plans include Part D coverage and limited Dental, Podiatry and Eye benefits, plus some 'frills' like gym memberships. Essential Plan medical copays are higher than Enhanced. Our prescription meds cost less under our current Part D than with either plan, but Tier 5 meds are the same: 30% of retail. The 'gap' and 'catastrophic' OOP limits are the same, as mandated by Medicare.We still pay Part B with either plan, but would stop paying Medigap premiums ($313/mo each for Plan F). We'd skip paying our current modest Part D plan premiums ($11/mo for DH; $7/mo for me), but we'd pay pay same or more OOP in copays at the pharmacy.

The company is paying a 'transition credit' of $1,200 to retirees "without survivor benefit, LTD and MDIP". IDK what MDIP is.

I'm not sure what to look at to choose a plan, beyond the medical max OOP. We have to take one of these plans or lose all health care benefits from the company.