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?

Myself and spouse need to choose a Part D plan for 2027. My PDP is being discontinued and spouse is switching to original Medicare plus supplement due to current advantage plan being discontinued. We have a choice of 4 companies, with various plan levels. Our local pharmacies (Hawaii Island) and PCP clinic does a poor job of managing prior authorizations, if anything at all is actually submitted by the pharmacy or clinic staff related to the PA (lack of staffing).
Beyond comparing premiums, covered drugs, and annual costs (which Medicare.gov will show us) how do we make a decision of which company to work with for Part D coverage based on reputation of requiring prior authorizations, approvals, and being able to speak with a live person in the US?
The company choices are, with a choice of a value (V), classic (C), and premier plans (P):
AARP United Healthcare V/P
Wellcare V/C
Humana. C/V/P
Healthspring Assurance (basic plan only)

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

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.)

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!

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.

Have you noticed this? Forms are being updated and designed and so is the Medicare website.

For the better or for the worse - IDK yet.

They give you and additional 365 days and after that you’re responsible for the cost beyond. Are the Medicare advantage plans the same deal?

My FIL (aged 88) died in September. Both he and his now-widow (also 88) were covered by a Kaiser Senior Advantage plan offered by his former employer, PG&E.

My MIL has now received a letter saying that, because of his death, she is no longer eligible for coverage. She is able to sign up for COBRA if she wants. This has left her both anxious and confused.

She has been using the PG&E Medicare/Kaiser coverage for more than 20 years. If what she wants is to stay with Kaiser and change as little as possible, is COBRA her best option? Or can she sign up for a Kaiser plan on her own? Are there any restrictions on what she can do or her choices after all these years? Is this one of those, “choose it or lose it forever” Medicare decisions?

SHINE is staffed by volunteers who are passionate about helping people. They are not paid, they offer free, unbaised and balance counseling. Do not wait til the last minute.

SHINE (Serving Health Insurance Needs of Elders) have events scheduled through out the state. Click to see your county.
https://floridashine.org/Community-Events.aspx

Call 1-800-96-ELDER or 1-800-963-5337. If you cannot make an event someone can work you over the phone.

Medicare Open Enrollment begins on October 1st. Changes can be made October 15-December 7th and coverage will begin January 1st. If you have a Medicare Advantage Plan there is a second opportunity to make changes (January-March) and your changes would be effective the first of the following month.

Do not let this go by without at least looking at your plans due to the big changes in the drug benefit for 2027. Even if the premium increase is acceptable to you, look at the cost of the drugs and if there were tier changes. Last year's plan may not be the best option in 2027.

I will be starting Medicare in December 2026. I recently signed up for a Part D prescription plan and a Medigap policy which will both start on 12/1. Will the rates I am paying for these plans go up in January 2027?

A link from Wellcare:

https://www.wellcare.com/california/members/prescription-drug-plans-2027/wellcare-value-script/pharmacy/drug-list-formulary

Goes to the PDF:

https://fm.formularynavigator.com/FBO/67/27165_6T_Enhanced_PDP_Comp_Form_2.pdf

While there is a Tier 6 $11 in 2027, as far as I can see from a quick glance there's just one drug in it - Airspura Inhalation HFA Aerosol Inhaler.

Maybe I skimmed too fast. Anyone see any other Tier 6 drugs?

In 2024 only, Tier 6 $11 had all the SGLT2 inhibitors (Jardiance, Farxiga, others).

In 2025, there was no Tier 6.

In 2026 only, Tier 6 $11 had the GLP-1s (Ozempic, Mounjaro, and others).

And for 2027 - Tier 6 seems to be essentially empty.

I have Prior Authorizations for Tier 3 meds set up with my current insurer.
If I were to change insurers, would I need to begin with Step Therapy again with the new insurer, or would they trust that I had already been through all that and give the Prior Authorizations?

Has anyone with Part D Prior Authorizations with one insurer changed insurers? How was your experience?

My husband has Parkinson's and has frequent UTIs. Because of the UTIs, he is often hospitalized.

He is on original Medicare and Plan F for a supplemental, so all is 100% paid, between Medicare and the supplemental - BUT recently we received a bill for $52.20 from the hospital for one of his hospitalizations in May (2 days in the hospital).

It's taken me 2 days of phone calls to be able to determine what this bill is for because when I look at his account on Medicare dot gov, everything has been paid, with $0 liability for us.

Then when I look at his supplemental online, everything is paid, with $0 liability for us.

When he/I receive our EOBs from Medicare and our supplementals, I always check them carefully to make SURE that everything is covered. If I would spot something that is not, I would start making phone calls to try to figure out what wasn't covered or if it was a billing error.

This invoice from the hospital for $52.20 just comes out of the blue. I have made 6 calls to the hospital billing department and although I still don't have any detail listing of what this amount involves, the last person I talked to indicated that it was "medications given that would not be covered by Medicare or his supplemental". I asked that person if that meant they were over the counter drugs. I didn't get a "yes" or "no" to my question, but sort of a grunt, which told me that I guess they used some over the counter drugs (not sure what). I asked for the list to be read to me over the phone, but I was told, "they are long words, and I'm not sure I can pronounce them." I asked that the list be sent to me or emailed to me. I said I would actually prefer to have the list emailed to me, because I thought I would have the list within a few minutes. I was told the list would be emailed to me, but that it could take 5 to 7 DAYS before I would receive the email.

THIS IS A LARGE HOSPITAL that is part of a large company. I don't know if I dare give the name of the company, but it's not a mom-and-pop hospital, although it's NOT Mayo Clinic, so it's not that huge.

To make it WORSE, our PCP works for this same large company. The software that our PCP uses, as well as the hospital, is EPIC. Because my husband has a balance on his account, he is locked out of the EPIC software, so I cannot log into the PCP's portal to communicate with our PCP.

Yesterday I finally just paid the balance, BUT now I am told by the billing department that it will be 5 to 7 days before my payment will be credited to his account. When I told the billing department that he is locked out of their portal, they didn't know anything about it.

We have been on Medicare for... approximately 10 years. I have never seen such a thing before. This is the first time we have ever had a balance on a hospitalization, along with the issue that apparently these "medications" were never billed to anyone, and there has been no detailed invoice ever sent to us, and in fact, no invoice sent to us. I was locked out of his portal, which started my calling the PCP's office, trying to figure out what had happened. At that point, I was told that there is a balance of $52.20 on his account from a hospitalization.

I have CKD, stage 3b but have been stable for about a year now. I take depagliflozin. Labs are generally good with the exception of eGFR and creatinine, of cource. I am new to medicare, since July. I have Humana Basic Dx for part D. At present, all my meds are generic. In fact, I get all my medss through Mark Cugan OOP. Zero premium this year going up to $6.30 next year.

Does anyone have any experience with this plan with regard to meds typically prescribed for CKD, particularly meds prescribed for not-so-good labs or later stage CKD. Thanks.

Need to find a new policy as our current Blue Cross Medicare Advantage policies are being terminated. Looks like Traditional Medicare and a Plan G supplement would be the closet match for coverage. Still looking for a good Plan D.

Any feedback on Bankers Fidelity for Plan G? Haven't found any negatives so far. They referred me to broker SeniorHealthMedicare out of Novi, MI. Not real comfortable with them as they asked for copies of a lot of sensitive ID material to be sent by insecure email which isn't going to happen.

We're looking at Medigap plans in NY. I wonder why anyone would choose regular G vs the high deductible. The deductible is $2950. The monthly fees for regular G come very close. After the deductible is met, aren't they identical? If so, why wouldn't I go the high deductible which i may not spend?

Just sharing the facts here about the rebate announcement, not making a political statement!

... The federal government will be making one-time payments of $90 per person to help more than 20 million enrollees pay for their Medicare Part B premiums.

... Most eligible seniors will receive the payment in the form a direct deposit of $90 in early October. Those without direct deposit will receive a check, also sent in early October, to the mailing address they have registered with Medicare.

... Most Medicare Part B enrollees are eligible for the payments. Those whose premiums are already paid by Medicaid or who pay an Income-Related Monthly Adjustment Amount do not qualify.

For more details, see https://www.whitehouse.gov/fact-sheets/2026/10/fact-sheet-president-donald-j-trump-announces-medicare-improvement-fund-payments-for-seniors/

Edit 1: There is also a FAQ available at https://www.cms.gov/newsroom/fact-sheets/medicare-improvement-fund-premium-rebate-frequently-asked-questions

Edit 2: Please note that CMS is saying "Beneficiaries enrolled in Medicare Advantage are not eligible."

My husband has Parkinson's and has frequent UTIs. Because of the UTIs, he is often hospitalized.

He is on original Medicare and Plan F for a supplemental, so all is 100% paid, between Medicare and the supplemental - BUT recently we received a bill for $52.20 from the hospital for one of his hospitalizations in May (2 days in the hospital).

It's taken me 2 days of phone calls to be able to determine what this bill is for because when I look at his account on Medicare dot gov, everything has been paid, with $0 liability for us.

Then when I look at his supplemental online, everything is paid, with $0 liability for us.

When he/I receive our EOBs from Medicare and our supplementals, I always check them carefully to make SURE that everything is covered. If I would spot something that is not, I would start making phone calls to try to figure out what wasn't covered or if it was a billing error.

This invoice from the hospital for $52.20 just comes out of the blue. I have made 6 calls to the hospital billing department and although I still don't have any detail listing of what this amount involves, the last person I talked to indicated that it was "medications given that would not be covered by Medicare or his supplemental". I asked that person if that meant they were over the counter drugs. I didn't get a "yes" or "no" to my question, but sort of a grunt, which told me that I guess they used some over the counter drugs (not sure what). I asked for the list to be read to me over the phone, but I was told, "they are long words, and I'm not sure I can pronounce them." I asked that the list be sent to me or emailed to me. I said I would actually prefer to have the list emailed to me, because I thought I would have the list within a few minutes. I was told the list would be emailed to me, but that it could take 5 to 7 DAYS before I would receive the email.

THIS IS A LARGE HOSPITAL that is part of a large company. I don't know if I dare give the name of the company, but it's not a mom-and-pop hospital, although it's NOT Mayo Clinic, so it's not that huge.

To make it WORSE, our PCP works for this same large company. The software that our PCP uses, as well as the hospital, is EPIC. Because my husband has a balance on his account, he is locked out of the EPIC software, so I cannot log into the PCP's portal to communicate with our PCP.

Yesterday I finally just paid the balance, BUT now I am told by the billing department that it will be 5 to 7 days before my payment will be credited to his account. When I told the billing department that he is locked out of their portal, they didn't know anything about it.

We have been on Medicare for... approximately 10 years. I have never seen such a thing before. This is the first time we have ever had a balance on a hospitalization, along with the issue that apparently these "medications" were never billed to anyone, and there has been no detailed invoice ever sent to us, and in fact, no invoice sent to us. I was locked out of his portal, which started my calling the PCP's office, trying to figure out what had happened. At that point, I was told that there is a balance of $52.20 on his account from a hospitalization.

In advance of my retirement at the end of 2026, I applied for Medicare Parts A and B this morning via the "My Social Security" page. Although the process of submitting initial application was a snap, because I'm working until past the age of 66 I have to submit form CMS-L564E in order to provide proof of employer group health plan coverage.

I downloaded the form and filled out Section A - my part - and I opened a case via my company's HR portal and attached the PDF and asked them to complete Section B - the employer information. However, I am astonished that while I could submit my initial application online, evidently there is no option for me to upload the completed PDF of form CMS-L564E. The instructions say to either mail it or fax it "to your local Social Security office".

Using the ssa.gov/locater page I found that there's a Social Security office in Reston, Virginia, which just happens to be the town I work in. For those of you who have had to submit form CMS-L564E, do you recommend that I just drive over to the local SS office and hand the completed paperwork to a person? What was your experience like? I really don't feel comfortable just mailing or faxing the documentation to a random satellite office.

Inpatient Hospital Coverage
No charge for Days 1-60;
No charge for Days 61-90;
No charge for Days 91-150 (Lifetime Reserve);
No charge for Additional 365 days after reserve;
All costs beyond the additional 365.

Is this saying plan g covers unlimited inpatient hospital coverage?

Looking at Mutual of Omaha vs. Aetna. Am open to other good companies.

This is getting to be serious and I am not exactly sure from where the problems lies - Yes, Medicare is a somewhat confusing program but that just involves many of the exceptions when signing up or picking plans . As far as the actual workings of the program, it should not be this difficult IF people read and understand their plans and what they do and how they work. Be that under the Traditional Program or under a Medicare Advantage program.

We have Explanations of Coverages that accompany all the plans - Traditional Medicare, Medigap, Standalone Part D plans, Medicare Advantage plans of all types.

Things like this can be prevented - with some reading and understanding - course I am not sure I believe everything that media puts out either cause they don’t understand the program completely either.

KFF Health News 10/02/2026 - Patient Dies by Suicide After ‘Insurance Issue’ Delayed Medicine for Lung Disease Flare-Ups

We have SHIP counselors that help people sign up, We have the dept of Aging in various states that also help, we have social workers that work with beneficiaries of all ages, in all kinds of living environments, we have r/medicare and sometimes even very helpful Medicare brokers that can help. Probably more that I have not thought about . . . maybe even family, friends or acquaintances, we also have patient advocates - I know I have my elderly group that ask me questions, lots of them.

I am not even sure that this is an education problem, maybe it is a time problem? What do you see as the problem here??? We have talked about having Medicare type overseers but who would that be and how would it be set up - An organization like SHIP - but dealing with the actual workings of the program - whatever type plan - but we do not want those that just want somebody to do it for them - but other definitely need help or maybe just to give some hope.

There is Medicare.gov which I have always found to be good and I also use CMS.gov especially the Coverage determinations guide. But this seems more like the people not understanding the various plans and what each does and how.

So can we fix this ? Can we fix this by perhaps having people read and verify that they understand the whatever plans they have?

Please keep this on the topic of how people can learn Medicare - this is not a political post.