I finally have rid myself of United Health Care

[moniss]

and the way they ripped me off in 2025 on the drug plan. They never sent me a notice about premiums skyrocketing until it was after the end of open enrollment for 2025. I ended up paying almost $100 per month plus $15 per prescription for just basic minimal dosage blood pressure pills and a statin.

So now my new plan from Wellcare is $0 monthly premium and $0 for my prescriptions. No income considerations needed. That gives an idea of how big the ripoff is that UHC has been getting away with. I have been an AARP member for years but their coziness with UHC is making me reconsider and I don't know whether I will continue because I get better discounts on travel etc. without it and my roadside service plan is better and cheaper through my insurance company. I know they lobby but that tie to UHC really troubles me.

[hedda_foil]

1. AARP is an insurance broker that shills to seniors.

They also have a pretty good magazine.

[erronis]

7. Long ago they figured out that seniors don't do independent research. Are easily led by the nose.

Just like RW media outlets.

AARP prints lots of pretty brochures with lovely "older?" people having beautiful teeth and in some semi-idyllic spot.

That ain't 90% of the people in my age bracket (70-80+)

[Scrivener7]

2. My union just switched us to them. Pisses me off. 35% denial of claims.

[lostincalifornia]

4. If you are referring to UHC, Atena, etc. your Doctor should be able to write a letter to them telling them

that the drug they denied is necessary for your situation, and it will get approved.

The thing is your Physician needs to write an appeal and tell them why the drug is necessary, and I suspect some physician offices may not be motivated to do that, which is why the patient needs to push the doctor to do that.

At least that is my experience.

[lostincalifornia]

3. As long as you don't need more exotic drugs such as repatha, jardiace, or drugs that aren't generic,

it should be no problem. but if you need more specialized drugs, I think you will see sticker shock.

Sometimes, the pharmaceutical companies who make the drugs will give significant discounts.

If the drug is a brand name and no generic, I don't think you will find Wellcare, GoodRx, etc. can beat the price under part D.

[moniss]

5. My deductible is less than $700. I don't know

what you mean by "beat the price under part D."

[lostincalifornia]

14. If it is a non generic newer drug like repatha or one of the GLP1 drugs

Are you saying welcare will cover it, because I would be pleasantly surprised if they did.

I have a brother in law who was denied coverage for repatha under welcare

[moniss]

15. I'm saying I don't understand what you mean by what I put in quotes.

You didn't specify a company you just broadly said Part D. So are you saying that something is better than part D for certain drugs?

[Ms. Toad]

20. repatha is a different matter.

It is a monocolonal antibody, and is covered under a combination of medical coverage and drug coverage. It will almost certainly be a specialty drug (a category that is dealt with differently than run-of-the mill drugs), and most insurance companies will only authorize one for a particular a treatment target. If that one doesn't work there are a series of steps to gain approval. Medical has to weigh in because they generally cover the All Part D plans will cover something, but which drug is covered may be different from plan to plan.

GLP1 drugs are covered for diabetes, but not for weight loss. That's the rules - it won't matter which Part D plan you're on. Again, which one is covered may vary from plan to plan, but they will all cover one form of the medication and other varieties will be by appeal.

I've been on Wellcare for 4 years, and my spouse (with complex drug needs) has been on it for 2 of the 4 years. We've had zero trouble with it.

[Joinfortmill]

23. Good to know

[Ms. Toad]

19. That's nonsense.

Wellcare is a Part D plan. The overall price on the expensive drugs will be far cheaper than the UHC plan. My spouse is on Januvia and has been on Jardiance. Wellcare has been either the cheapest overall, or next cheapest, over the 3 years she has been on Jardiance. UHC, for those same 3 years has been the highest or next to highest. (I compare every year, and have for the last 4 years.)

GoodRx is a different matter. It is not an insurance plan (so doesn't benefit from the out-of-pocket cap). It is generally cheaper than part D plans for drugs in the $50-$200 price range. It is more expensive for the $0 drugs most plans include, and it is comparable or more expensive for the >$200 price range. But if you are buying lots of expensive drugs - and will hit the cap - it is probably better off to buy all drugs using insurance.

[iluvtennis]

6. Thanks so much for this post - will looking at Well Care for my 2026 Medicare Advantage Plan. n/t

[littlemissmartypants]

10. If possible, I would consider getting off the so-called "advantage" plan.

But I know everyone has their reasons. Nevertheless, I suggest you consider it.

❤️

[Scottie Mom]

12. I totally agree -- MA is bad news.

I got on MA by mistake and got off as soon as I could. The difference between MA and Original Medicare is like night and day. My PCP orders an RX and it gets done. I have WellCare for RX coverage and have had no problems at all.

[littlemissmartypants]

13. Is it ok if I link this to iluvtennis?

[iluvtennis]

16. I saw your message for looking at non Medical Care Advantage plan - I will explore all the options. Thank you! n/t

[littlemissmartypants]

17. Oh, good! Contact your local Senior Center. They are really helpful.

I hope you find something that works well for you.



❤️

[Joinfortmill]

8. Thanks for the info. I'm switching from Advantage plan (qualifying event) to Original Medicare

and I chose Wellcare for my drug plan.I am likely to get my medigap plan from Fidelity's insurance division. I worked for them in their retirement plan division many years ago. They are a good company.

[Ms. Toad]

21. Make sure you price check all plans available,

Including running the numbers out until they stop age-based increases.

Over an anticipated lifetime some plans that were available to me cost more than double what other plans cost. When I checked, UCH was cheapest by far (same when my parents signed up 25 years earlier). I don't recall whether Fidelity offered a plan in my area.

Once you sign up for one plan, you're stuck - so make sure you don't skip this once-in-a-lifetime opportunity to compare prices.

[Joinfortmill]

22. Thanks much

[dlk]

9. Every year, all insurance companies change their Medicare Part D plans

The formularies and premiums change. It’s a good idea to do a Medicare plan review every year for MA and Part D plans during the Medicare Annual Election Period, where you hsve the option of changing your plan, for coverage effective January 1.

I have enrolled retirees in UHC Part D plans because they were the most cost effective, given the Rx they were taking, as compared to Wellcare and other plans

Every insurance has a different Part D formulary, a list of drugs covered under a specific plan, and which tiers they’re categorized in.

Everyone’s needs are different snd it pays to be a savvy consumer and have your insurance agent do an annual plan review.

[littlemissmartypants]

11. Excellent points. I think some believe that one can...

Do the initial enrollment and that's it. When that isn't the case.

❤️

[dlk]

27. Not at all

In general, we are lacking comprehensive education for the way Medicare works. It’s complicated. There are lots of rules and lifetime, financial penalties if the rules aren’t followed.

Most seniors are overwhelmed by all of the rules and how they actually work.

[littlemissmartypants]

30. The system is extremely complicated...

And the pharmaceutical and insurance industries manipulate it horrendously. That's one major reason why I don't support 'Medicare For All' suggestions.

If we ever get in power again we need to bring these leeches to heel and enact universal healthcare. No amount of education can adjust for the venture capitalists entanglement in our benefits. That WE paid for and they have been able to sink their claws into with help from past governments.

If there's any money left in the Treasury ...once they (R's) have fullfilled their dreams of comingling it with crypto and tariffs then depositing it in their newly established bank account.

The entire government now is definitely a 'criminal enterprise' like Malcolm Nance has said repeatedly.

Thanks for your reply, dlk.



❤️

[dlk]

31. Yes, and Rx price gouging is at an entirely new level for 2026

Low cost generic prescriptions are being kept off formularies, so sky high prices can be charged. I’m seeing seniors with estimated 2026 Rx costs in the thousands and tens of thousands.

Most people don’t realize is that if an Rx is not included on a plan formulary or if it is filled outside of the plan (such as using a discount card), the $2,100 cap does not apply, and the sky’s the limit for drug pricing.

I’m not suggesting collusion between insurers. However, it seems odd the exact same generic drugs have been omitted from all the formularies of the major carriers, and the cost to fill with each of their plans is astronomical.

This situation requires legislative intervention I’m not against Medicare for all but there needs to be more legislative limits and protections for consumers. Currently, there is too much wiggle room for corruption. However, it is a problem that can be solved.

[Ms. Toad]

18. Insurance companies are free to charge whatever the market will pay for their plans.

Wellcare has been around with similarly priced plans for at least 5 years. I've been on it for 4 years, my SIL for 5, and my spouse off and on for 4 years (her costly meds mean that a different plan is sometimes better). I check every year during open enrollment. I do a pretty complex analysis (including comparison to Costco and GoodRx prices), but Medicare.gov does a good quick analysis that will at least get you in the ballpark. It's always been right about the best plan for me. My spouse's is more complex - so it doesn't always choose the best plan for her when we buy meds off-plan.

BUT - even though we buy our Supplement from UHC, UHC has never been in the running for drugs, since it offered (for at least the last 5 years) either the highest or next highest set of plans in our area.

Just calendar a few minutes every October to check the prices so you don't make bad choices in the future. Wellcare seems relatively safe. It's had a good track record for the 5 years I've been checking. But you should never take it for granted that it will continue to the best (or even a good) plan.

[Sogo]

24. This is the first year that Wellcare is available in my state, and I just signed up for it.

nt.

[Ms. Toad]

25. My point wasn't to sign up for Wellcare -

it was to check every single year during open enrollment, because prices vary wildly and one should never wait for the company you are with currently to tell you what their price is for the next year.

Wellcare has been the best plan for me since I started on Medicare - it can be a bit clunky changing from year to year, because they sometimes switch the back end provider from year to year so it's almost like getting a new plan in terms of figuring out where your prescriptions need to be sent.

[Sogo]

26. I didn't sign up because of anything you said.

I was just making the point that I recently signed up for Wellcare.

I responded to the mention of Wellcare. That's all....

[dlk]

28. Wellcare is a good option for seniors taking certain generic prescriptions

However, some of its other Rx are very high in comparison with other plans.

I’m afraid seniors will have sticker shock for 2026 Rx prices. In general, they’ve gone through the roof, including the prices for many common generics.

[Ms. Toad]

29. Plug in your actual drugs - don't go be the generic pricing

Add in the premium cost. And remember there is a $2000-ish out of pocket cap on drugs, not premiums. So paying more in premiums to lower the generic cost of expensive drugs is often penny wise-pound-foolish.

My spouse is/has been on both Jardiance and Januvia - two of the expensive drugs with no generic equivalent. This year the best plan for her was Wellcare. A quick look suggests it will still be Wellcare. Last year it was the next cheapest (a $10 premium).