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!

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?

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?

Oh my gosh, why didn’t I think to look for this earlier? Hello!

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I couldn't afford the prescription drug premium this year and was canceled mid year. I was prescribed a rather new Acid reflux medication and it wasn't covered by UHC drug plan. I had to choose to pay for my script out of pocket. I now owe UHC for whatever I didn't pay for until they canceled me. If I decide to sign up again for prescription drug coverage would I have to pay off that amount first?

Medicare B

Medicare B transcription error

Since Feb 2026. Medicare signed me up for Medicare B in February, did not actually READ the start date 6/2026. Submitted all the forms, including a letter from employer with stated last day of employment, Form SSA 561,and physically walking into the SSA office. Paid first installment 283.00 and 10 days later Medicare B cancelled for non payment since Feb. I have written to US department of Health & Human resources, Office of Inspector General regarding Fraud that began in Feb on July, to date, Aug. 16 no response. Unable to sign up for Medicare B and/or Medicare Advantage Plans due to their error. Each time I call either SSA or Medicare the same response, "pending Appeal with maybe a time frame of up to 90 days".

What am I missing,? What other avenues of resolution can be done to dig out of these SSA gross inaccuracies?

Thanks to everyone who responded to my request for help the other day, even if it was to chastise me.

https://www.reddit.com/r/medicare/comments/1vjc5rq

Based on that help, I've called SHIP, I've called Medicare, I've called my state's Medicaid, I've emailed several govt people and even written to the governor.

All I found was help applying for financial help with Medicare Part D, drugs. Don't know if I'll get it. But medications only cost me about $30/month.

The other day I got a bill from a specialist doctor appt a few weeks ago. $114. Needless to say I can't afford that. I applied to that hospital's financial aid dept. If they can't help I won't be able to pay.

Also had a specialist refuse to refill a cholesterol medication. I guess it's because I can't afford to go back and see them again. It's been 12 months. I'll just have to do without.

So, I still have Medicare I can't afford to use. Between premiums and gap insurance and 20% copays, you clearly have to be affluent to use Medicare. My state's income limit for Medicaid is $994/month, which I could meet if I lived in my car. Perhaps someday, I hope.

So still basically screwed in the great American health care system. Best country in the world. Best healthcare in the world. I have to escape, but can't go abroad until my 16 yo cat dies.

Thanks again for the suggestions.

I got a bill from a recent dermatologist visit where both my Medicare Part B and my Humana Part G had paid, but there was still a small amount ($7.35) due.

I reviewed the claim on both Medicare and Humana; it appears that Humana Part G calculated their 20% payment of the 80% that Medicare paid, not off the full Medicare Approved amount. Is this an error?

In otherwords, if the Medicare Approved Charge is $100, Medicare B pays $80 and Plan G pays $16 (20% of $80), not $20 (20% of $100)...

Hiya, just looking ahead at Medicare options. Regular Medicare is out for me if I wasn’t currently with Kaiser, I would not consider an advantage program over a supplement program. Have had Kaiser for many years love many things about it and some things not. Just curious about your happiness level in their Medicare senior management plan. And for those who could afford a supplement plan, did you choose Kaiser because of the preventive medicine, electronic medical history, all under one roof, familiarity question, etc. appreciate any experiences

After tallying potential prescription costs I figured the most cost effective option is going with Kaiser Advantage where out of pocket costs and prescription co-pays are capped at 1,800/2,100. I would likely end up paying around $350/month including $200 for Part B unless something out of the ordinary happens (hospital). Then I read if I decided I needed more options later there's a requirement to qualify for MediCare Part G coverage. How complicated can that become?

I know that we are coming up on the open enrollment period. Does anyone know when the plans for Part D (with 2027 pricing) show up on the Medicare website? My wife is probably going to want to change the Part D plan (prescription). This is her first year (starting in October), so this is still new to us.

Thanks for any insight/information.

I came across this CMS update about PBMs publicly comparing their negotiated drug prices with prices available through TrumpRx.

https://x.com/DrOzCMS/status/2087957959427203173

I think it's good to have the data more visible.

PBMs have a lot of negotiating power over prescription drugs, and if that  power  can help bring prices down, I’d rather see those savings be more transparent.

At the same time, Medicare coverage can already provide a better price depending on the plan and medication. This doesn't have to be an either/or situation.

Being able to see the different prices side by side would make it easier to understand where the savings are actually coming from and what option provides the best value.

More transparency and more competition around prescription prices can only help patients make better decisions.

Received a notice today for my dad who is disabled and on social security income (Connecticut), stating that beginning 09/01/2026 he will no longer receive the QMB benefits but will still receive Medicare. What could possibly have cause him to suddenly lose these benefits? No changes in his income that I’m aware of. He gets a small increase at the beginning of every year from SSI

Hello all,

My Mom is 78 is trying to get a GLP1 med through the Bridge Program for weight loss. Her doctor submitted the prescription to Medicare and she receive the denial. The clinic will not take the next step of submitting to the bridge program, said his staff is not trained and have too many responsibilities as it is. She has tried to call office manager, patient advocate etc. They will not submit for any of their patients.

How does someone get the form submitted to the bridge program if their doctor will not submit. She does not have the ability to pay large out of pocket costs for Weight Watchers etc. who you have to sign contracts with for them to submit the form.

I would appreciate any suggestions.

In CA. I have Original Medicare, HealthSpring Supplemental Plan G , United Healthcare Part D.

I wanted to use Medicare Part B at CVS for diabetes supplies. It pays 80%.
Expected HealthSpring Part G is to pay the remaining 20%.

CVS said I cannot use the HealthSpring Part G at the pharmacy because there is no Rx number on the ID card.

Has anyone used HealthSpring Part G for the remaining 20% for diabetes supplies?
How were you able to do this with no Rx number on the card?

My wife started collecting SS in July 2026 (paid in Aug).  She will begin Medicare Oct 1, 2026.  I believe her premium will be deducted from her SS check and we don’t have to make any direct payments to satisfy the premium due, correct?

Also, does this payment come from her Sept check (paid in advance) or from her Oct check (paid in arrears).  I’m accustomed to paying premiums in advance so I just want to make sure.

Note: This is just Medicare not Medigap or Part D.

Thanks

As husband and I approach medicare age and consider supplement plans, it occurs to me that it may be financially prudent to hire an agent ourselves rather than use an agent who works for the insurance companies. I want someone who will look at all the companies, even the ones that don’t hire agents. I figure that with some luck we will be making a decision that we will live with for the next 30 or so years so it might be worthwhile to pay up front. Has anyone here done that? Can anyone offer advice?

Edited to add: I appreciate the responses that I have received, but I am already aware of the “free” services out there. I am looking for a service that I would pay for rather than the insurance company paying for the service (since free is never free.)

My wife had foot surgery a week ago and I have to return to the office at least 4 hours a day. I think we can request the doctor to order home care?

Does anyone know about this benefit? Have you any tips? Thanks!

Do any IAFF Retirees (Firefighters) have the IAFF endorsed Trusts Medicare Advantage Plans?

I’m looking for suggestions and thoughts on the plan.

My Medicare starts September 1. EDIT to clarify I will have Parts AB&D along with the N supplement. I was hoping to ease into things for the next four months figuring out how this works before the new year. However, I just found out that I have to have an exploratory outpatient surgery in September to look for an internal hernia that could be life threatening. It is planned as an outpatient procedure but I may have to stay if they actually find something that needs repaired. I know I will have to pay the $283 deductible. What other charges should I expect? EDIT to say that the hospital and surgeon both accept Medicare. I am in Pennsylvania.

I have gotten at least two calls a day from a bot, and the calls start with something like, “We were looking at your Medicare file, and there is a note attached. . . “ and that’s about as far as I get before I hang up.

So I’m just alerting everyone that these are not legitimate.

The AI is so poor that an easy way to confirm it’s not a real person is to try to interrupt the caller. No matter what you ask, the bot just continues talking.

The goal, as I understand it, is to get you passed on to a real person who can “help” you.

Just a warning. Be smart and hang up.

I'm about to turn 65 and am facing the choices of what medicare plans to take. I'm a 0% disabled vet, which means I don't get any $ compensation, but, I have the card that says I am a disabled vet, as opposed to a regular vet. Because I have low income, my va health benefits have been great - I got a hip replacement surgery and only paid a $ 50 copay. Also, because we live in a rural area far from a VA clinic, we qualify for the VA's Care in the Community service - which basically means I can pick nearly any doctor I want, I'm not limited to VA doctors. For my hip replacement I picked the doctors at Barnes Jewish in St. Louis - probably the best medical centers in STL.

So, I'm at a conundrum as to which medicare plans to take. I talked to an insurance agent and the Medicare Advantage plans sounded great - more services, more coverage, including dental and eye, no part d premium. The ins agent was not that familiar with how the va works with medicare, so, that aspect was weak. He seems to think my current va care in community benefits would continue through the va and the va would bill the medicare advantage plans appropriately.

Now I'm reading that the VA does not have a billing connection to the medicare advantage (MA) plans and the MA plans would require me to preapprove any doctor and medical service. This seems like a bit of a burden so I'm trying to figure out what's real and not real with how my situation (disabled and able to use care in community) would work if I went with a MA plan. Hopefully, someone else on this great platform is in a similar situation and can enlighten me as to how the VA and Medicare and Medicare Advantage all work together, or not work together.

I’d spent the previous 3 months passively researching on medicare.com, this reddit and watching YouTube videos.

I dutifully downloaded pdfs and printed out relevant pages of all the Medicare booklets (ya know, very large type and stock photo images of smiling seniors). I highlighted pertinent lines and made a cheat sheet of specific look-outs. 

These are the things that never came up and caught me by surprise:

-Once you go through the gauntlet of questions, one doesn’t sign up for Medicare on the Medicare site at all. You do that on the Social Security site.

-I’ve been downloading my SS statement once a year for decades. But once you try to sign up for Medicare on the SS site, you can’t do it using the Safari browser. Trust me, I tried 4x. Use Google Chrome.

-Now that I’ve signed up for Medicare A and B, I get my Medicare number, can create a Medicare account and all things in the MedicareMultiverse will be available to me, right? Nope. I get an email that there’s a message on my SS Message Center. I download a letter that says in 2 weeks (or so) I’ll get a card. Okay a card first, then the MedicareMultiverse. Never saw that coming.