Forced to switch to biosimliar of Prolia by local provider clinic

When I retired and researched the Medicare options, I decided to go with original Medicare “just in case I got a bad disease and wanted to go doctors or hospitals anywhere.” A year and a half later I got my bad disease, and though I pay more for my coverage than I would with an Advantage plan, I have never paid more than my annual Medicare deductible each year or had to worry about finding in network physicians. Surgeries, specialists, therapies- everything has been covered 100% with no copay. Needless to say, I feel like I made the right choice. It is one less worry while dealing with cancer and the many issues afterwards.

You do well to go with Original Medicare when you turn 65.
Advantage Plan requires you to go to their network of doctors, to get approval to see a specialist etc. with copays for everything. Cheap only if you never need a good specialist.
Another important fact is that at 65 all insurance companies have to take you regardless of pre-existing conditions. Later after first enrollment period they do not have to accept you and can charge you more. So if someone first signs up with an Advantage Plan and later wants to go back to Traditional Medicare they are at risk of not finding a Medigap plan or will be charged higher premium if they do accept you.
And with Original Medicare you don't need to check each year to see if your doctor is still in the Advantage network! You can go to any doctor that takes Medicare.
And if my independent clinic is not providing a drug for financial gain, one can be sure that the Advantage Plan will not do it either!!! They are famous for denying coverage and making people get preapproval for tests!

@vic83 actually, if you're on an Advantage plan, you can only switch back to traditional Medicare after the 1st year, one time only. After that one year mark, you're on Advantage for life. I think it's a rip off. People sign up because it's cheaper, and you hedge your bet that you'll stay healthy as you age. Once you start having health problems you'll start paying out the wazoo. It's a scam, in my opinion. My mom fell for the zero premium and zero copay for prescription. She's always been healthy as a horse, but at 91 ½, she's starting to have problems. It makes me furious

@rngma1118 There is one "loophole" to beware of as insurers drop out of the Advantage marketplace. You can switch to traditional Medigap if your insurer stops offering the plan. There are other rules as wel,, but it gave some of my friends a new chance this year.

@vic83 actually, if you're on an Advantage plan, you can only switch back to traditional Medicare after the 1st year, one time only. After that one year mark, you're on Advantage for life. I think it's a rip off. People sign up because it's cheaper, and you hedge your bet that you'll stay healthy as you age. Once you start having health problems you'll start paying out the wazoo. It's a scam, in my opinion. My mom fell for the zero premium and zero copay for prescription. She's always been healthy as a horse, but at 91 ½, she's starting to have problems. It makes me furious

@sueinmn If someone switches back to Original Medicare from Advantage plan, what about getting the Medicare supplemental plan (Medigap plan) to cover the 20% Medicare does not cover? I have read that at the time of initial enrollment in Medicare all insurance plans must take you regardless of existing health problems. After they are no longer required to accept you and can refuse or charge you more.

If you are not 65 then are you on Medicare for special condition or are you on Medicaid? Will insurance companies be required to accept you during the initial enrollment period if you are already on Medicare now as you would not be the typical person enrolling at age 65. Advantage plans have a network of doctors, to go outside that network is to pay out of pocket. And not all clinics take Advantage Plans...for example Florida and Arizona Mayo don't. In Minnesota some insurance companies have made a deal with Mayo to have Mayo in their network. But every year networks change.
https://www.investopedia.com/articles/personal-finance/010816/pitfalls-medicare-advantage-plans.asp.

@vic83 I fully agree that there are disadvantages to to an advantage plan. Yes I have Medicare because of a medical condition (quadriplegia) since 2012. In the beginning no one under 65 could get any sort of medigap policy. A few years ago they changed the law requiring companies to offer medigap policies, but they didn’t go far enough in specifying the types or costs. I have lived in Virginia and Maryland. Both states only offer plan A, which is the most basic plan. Every year I do my due diligence and get a price quote from the few companies that offer it. My quotes this year, similar to those in the past, were in the $2000-2500 / month range. So I am much better off with an advantage plan.

John’s Hopkins offers a variety of advantage plans, so every doc at Hopkins is in network. I feel my needs are being met without going out of network as of now.

I do worry that when I turn 65 there will be an increase in my medigap premium since I didn’t enroll immediately. But I don’t let it turn into anxiety or overly worry about it as there is nothing I can do except write my representatives in congress which I do every few years. One year I actually got a response from mark warner (Virginia senator) himself, not just one of his subordinates, as i usually get.

@laura1970 Laura, I do not think the penalty for not immediately choosing a plan applies to those who are covered before age 65. Have you read the fine print? Or consulted a Medicare directly?

@sueinmn no I hadn’t actually looked into as like I said, there’s nothing I can do about it. But your question spurred me to action and I found this:

People under 65 get a fresh six-month Medigap open enrollment upon turning 65, allowing purchase without underwriting.

So thanks so much! One less thing to worry about ❣️