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Medicare

Q&A: Be aware of these issues when switching between Medicare Advantage and Medicare

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Dear Liz: I am planning to retire this year. If I choose a Medicare Advantage Plan, am I able to switch back to original Medicare without paying a fine?

Answer: Medicare won’t charge you extra, but you won’t necessarily have “guaranteed issue” rights for a Medigap supplemental policy. If you want to switch after the first 12 months, you could pay a lot more for this important supplemental coverage.

To recap, Medicare Advantage plans are the all-in-one alternative to original Medicare.

Medicare Advantage plans may offer types of coverage that original Medicare does not, such as hearing, dental or eye care. Many people like the fact that their Advantage plans seem to include more than original Medicare, and do so for a low or even no additional monthly premium.

But Medicare Advantage plans are offered by private insurers, which typically have networks of medical providers. These networks, as well as other benefits, can change from year to year. If you get care outside the networks, you typically pay more — sometimes a lot more. The rap on Medicare Advantage plans is that they can be great when you’re healthy, but depending on the plan may not be so great if you get sick.

With original Medicare, benefits remain the same and you can use any provider that accepts Medicare (the vast majority do). But original Medicare coverage has significant gaps, which is why you’ll need a Medigap plan offered by a private insurer.

If you opt for original Medicare when you are first eligible, insurers are required to issue you a Medigap policy and can’t charge you more based on your health status. Without guaranteed issue, an insurer can refuse to write you a Medigap policy or charge you a lot more.

You also have guaranteed issue rights if you buy a Medicare Advantage plan when you first become eligible for Medicare, but decide within 12 months to switch to original Medicare.

Q&A: Medicare Part D Premiums: Balancing Costs and Coverage in 2025

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Dear Liz: I would like to comment on your response to the letter about the high cost of Medicare Part D prescription drug coverage. You correctly noted the $2,000 cap on covered drug costs, starting next year. However, there is no cap on the cost of the monthly premiums. My cost for the Part D monthly premium went up about 25% for the 2025 year. So, although my annual out-of-pocket expense for my prescription drugs will be less in 2025, my total costs including premiums will be higher when compared to 2024.

Answer: The original writer implied that Medicare’s prescription drug coverage is always expensive, when in reality people’s costs vary depending on the drugs they take and the coverage offered by the private insurers they choose.

Monthly premiums for Part D range from $0 to more than $100, according to KFF, the nonprofit health research firm. The average premium for a stand-alone Part D plan is projected to decrease from $41.63 in 2024 to $40 next year, according to the Centers for Medicare & Medicaid Services.

As noted in a previous column, insurers are constantly changing their “formularies” of the drugs they cover. That’s why it’s important to shop each year during Medicare’s open enrollment to make sure you’re getting the best deal.

Q&A: Why Shopping for the Right Medicare Plan Matters

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Dear Liz: In the past, you’ve discussed the pros and cons of Medicare Advantage plans versus original Medicare. There is one more point I think you need to tell readers, and that is the high cost of Part D prescription drug coverage for people who choose original Medicare. For example, if you need just a few expensive drugs that are Tier 3 or higher, coupled with the monthly premium, you can easily pay $3,000 a year or more. I am not saying original Medicare is bad. On the contrary, it gives you great freedom of health choice. However, Part D is expensive.

Answer: Let’s start with the news that in 2025, Medicare Part D will have a $2,000 out-of-pocket maximum. The cap applies to Part D plans purchased by people on original Medicare as well as to Medicare Advantage plans that have prescription drug coverage. Once you hit the limit, you won’t have to pay more for covered drugs for the rest of the year.

Note the phrase “covered drugs.” Prescription drug coverage is provided by private insurers, and their lists of covered prescriptions can change every year. An insurance plan that covers a drug this year may not cover it next year, so every year during Medicare’s open enrollment — which ends Dec. 7 — you should be shopping to make sure your plan provides the coverage you need. If you don’t comparison-shop during the annual open enrollment period, you can wind up paying substantially more than you expected.

As background, Medicare Advantage plans are provided by private insurers as an alternative to original Medicare. Whereas original Medicare allows you to choose any doctor who accepts Medicare — and the vast majority do — Medicare Advantage has provider networks and may not cover care outside those networks, or may charge more. Also, Medicare Advantage networks and benefits can change from year to year.

Fortunately, Medicare offers a comparison tool to help you sort through your options. Entering the drugs you take and your preferred pharmacy can help you select the best plan for your circumstances. Now’s the time to compare and switch plans if necessary.

Q&A: Skipping Medicare drug coverage now can mean paying more later when you do sign up

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Dear Liz: I did not enroll in Part D prescription coverage when I enrolled in Medicare in 2005 because I was not taking any prescriptions at the time. When I enrolled a few years later, I was penalized $11 per month for late enrollment and I must pay this penalty until I die. What is the reasoning and logic behind this rule except to benefit the insurance companies? I’ve complained to Medicare.

Answer: You can complain until you’re blue in the face, but this is how insurance works.

Insurers — and the largest payer of healthcare services, Medicare — need a large pool of healthier people paying premiums to offset the costs incurred by the sicker ones. If only sick people bought insurance, premiums would skyrocket, making healthcare even more expensive than it already is.

This week’s money news

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This week’s top story: 5 big changes to Medicare Part D for 2025. In other news: Weekly mortgage rates, Mega Millions will raise ticket price, and sports betting can be a gamble for your financial health.

5 Big Changes to Medicare Part D for 2025 (And What to Do About Them)
Watch out for big changes to Medicare Part D plans in 2025 as you get ready for Medicare open enrollment.

Weekly Mortgage Rates Rise as Refi Opportunities Fluctuate
This week was a great example of how much mortgage interest rates can change in a short window of time.

Mega Millions Will Raise Ticket Price to $5 Per Play in April
An overhaul of the game is expected to improve players’ odds and give away big jackpots more frequently.

Sports Betting Can Be a Gamble for Your Financial Health
A breakdown of the important differences between sports betting and investing.

Q&A: Beware of penalties that can come with delaying Medicare enrollment

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Dear Liz: I have a high-deductible insurance plan from my employer and I contribute to a Health Savings Account. I understand people on Medicare can’t contribute to an HSA. If I’m still working at full retirement age, can I start my Social Security benefit but avoid enrolling in Medicare?

Answer: No. Once you start Social Security, you’re automatically enrolled in Medicare if you’re 65 or older.

If you delay Social Security and don’t plan to enroll in Medicare at 65, you’ll want to make sure your employer-provided health insurance will allow you to avoid penalties for late enrollment. These penalties, which are permanent, result in higher premiums for Part B (which covers doctor visits) and Part D (which covers prescriptions). You can avoid those penalties if your employer has 20 or more employees and your health insurance provides at least as much coverage as Medicare. Check with your company’s human resources department.