The Crazy Plan To Start Auto Enrolling EVERYONE Into Advantage Plans | May 4th, 2026

There’s growing discussion around a major shift in Medicare — one that could change how people end up on their plans in the first place.

On today’s Medicare School Daily, we’re breaking down the idea of automatically enrolling people into certain Medicare plans, what’s being proposed, and why it’s getting so much attention.

We’ll talk through how something like this could work, what it might mean for your choices, and what to watch for as these conversations continue to develop.

Transcript

SPEAKER_06 0:03

There's a new Medicare idea being discussed in Washington. What if seniors were no longer defaulted into original Medicare, but instead were automatically placed into a Medicare Advantage plan or what's called an ACO? Supporters are calling it coordinated care. Critics are calling it a quiet takeover of original Medicare. We're going to be talking about that on today's show. This is very important. I hope that you pay attention. We are so happy to have you here today. The show is brought to you by MedicareSchool.com. I'm here with my dad, Marvin Music, in the studio today, and we're just so excited to be with you explaining Medicare so that you don't make a mistake and you get the coverage that is right for you. Guys, outside these studio doors, we have about a hundred people that come to work every single day wanting to help you explore your coverage. So if you need help with Medicare, whether that's enrolling it in a supplement plan, an advantage plan, a drug plan, a dental plan, whatever the type of insurance is, we are here to help you. You're in the right place. The phone number to reach someone at our company is 800-782-6676. We're right here in uh the heart of America, Kansas City, Missouri, and we are just uh just just here to serve you. Uh the great thing about working with MedicareSchool.com is you, uh, when you become a client, you are given a dedicated client care manager, somebody that you can talk to anytime about your situation. So if you lose your ID cards, if you have a billing issue, a claims issue, if you move across town or across the country and need new coverage in place, we can help you. You are not going to be transferred to some call center on the other side of the world with someone who doesn't know English. So we love uh to work with you. It's free to work with us, and so give us a call, 800-782-6676. If at any point you want to be a part of the show today, whether you have a Medicare question or a Social Security question, retirement question, maybe you have an experience uh that you think would be helpful to our listeners. We'd love to hear from you. It helps all of us get better. This is your opportunity to talk to my dad, Marvin Music, truly the nation's leading educator in a non-sales environment. We're not gonna try to sell you anything. We're gonna listen, we're gonna answer your questions to the best of our ability. We've helped millions of people over the last 15 years, and we would love to help you. So there's a new Medicare idea being discussed in Washington. What if seniors were no longer defaulted into original Medicare, but instead brought up placed into a Medicare Advanced Plan or an ACO supporters call it coordinated care critics, call it the quiet takeover of Medicare Choice. We're gonna be talking about what an ACO, what Medicare, well about all this rule of Medicare or people being forced into these plans.

SPEAKER_00 2:39

All right. So uh what's in the news right now is a comment by uh one of the leaders in the CMS uh as they uh were discussing the possibility of doing uh what is called default enrollments. So when when uh uh people enroll into Medicare A and B, uh we know and many people know that they have some options. Uh they can do A and B and they can get a supplemental plan, or they can uh enroll into an advantage plan. Uh but what happens is some people decide to do nothing. Okay, they're not sure what to do, uh, maybe they are afraid uh to making the wrong decisions, so they simply stay in just original A and B, which of course is the fee-for-service plan. And so what happens when people say in A and B, uh no one is is helping manage that care. Uh they know that many people in that don't even go to the doctor because they are afraid what is going to happen financially. And so the government is concerned about this. They would like to have some kind of coordination of care for these people, to help them, to make sure they are doing their preventive visits and they're you know getting their medications and all the things that they need. And so the government uh is is moving more and more towards they want people to be in coordinated care plans. And so uh uh to facilitate this uh uh need to make sure people get care, uh they uh they are proposing that uh that either they would enroll them into a Medicare Advantage plan or into an ACO plan. And ACO uh stands for uh accountable care organization. So that would happen automatically. Well automatically, exactly right. Okay. And so meaning they didn't make a choice. Now that doesn't mean to say that no one would have a choice. It just means those that just enrolled in A and B would required to be in something if they didn't uh opt in one of the one of the programs, uh then now they're gonna be automatically enrolled. Okay, so uh so the the biggest issue and the really the fear is well who is gonna decide that uh because one size doesn't fit all. And so what happens is if if they were to automatically enroll people into advantage plans, there's gonna be some issues there. Uh who is gonna make sure that the person's doctor is in network, the hospital is in network, uh, who is gonna check to make sure they would know exactly what the max out of pocket is going to be and the and the pre-authorizations and how that system is gonna work. Who will decide? That well, the government's not gonna do that, so what will probably happen? Uh they would we they they would kind of do a round robin. So this person is that plan, the government. That's exactly right. We've seen this happen before with drug plans and on Medicaid. So the point is that's scary because no one's gonna take the time to really see if that's a good fit for the people. And then what would happen? Well, most of those people, they were enrolled in the plan, they think that's their option, they stay in it, and if they stay in that Medicare advance plan for now more than a year, now they're stuck on that plan, possibly for the rest of their life, because if their health changes, they can't get off of it. So that's a that's a little bit. Exactly. Yeah, that's a little that's a little troublesome. So uh not only are they giving up choices, they're also could have a lifetime interest. Yeah, and that's why they're gonna get a lot of pushback on this idea uh uh as far as enrolling into Medicare uh advantage points. Now, the other option was it would be ACO. Totally different slides.

SPEAKER_06 5:47

So what is that?

SPEAKER_00 5:48

Uh accountable care organization. Let me just give you a great definition of this, really, for you and everyone. An accountable care organization is a group of doctors, hospitals, and other providers who work together to manage your care under Medicare. So the way to look at it is this is someone that enrolls in original Medicare A B, and the ACO is a layer above that. Is this like a hospital network or a hospital system? Or is this not it's yeah, it is. Who's paying these people? Okay. Well, Medicare. This is still the original Medicare system. The payment system doesn't change. And so what happens, though, is these doctors and hospitals, and I'm gonna read a couple to you in just a minute, uh that they group together, and now what they're gonna do is manage the person's care. And I'll show and I'll tell you why they do it, but they're gonna manage the care. So we have two now managed care options Medicare Advantage, and uh and now we have ACOs. And so, but what happens with the Medicare Advantage is they manage that care, what are they trying to do? Make a profit. Uh they're trying to at some times uh impose uh you know restrictions upon people, so there are limitations by networks and pre-authorizations where that managed care many times may not be in the best interest of the client. And so we see doctors and hospitals that say, there's a better way. Let us do that, let us manage the care within original Medicare. And uh so they have put together these large, I mean huge groups of doctors and hospitals that now will manage the care versus the private health insurance company. So it is still that Medicare A and B system. Now here's the thing. Financially, if someone uh is going to a provider that's in an ACO, they don't really get any benefit from that.

SPEAKER_04 7:23

Okay.

SPEAKER_00 7:23

Okay. Who who gets the benefit would be Medicare as well as the providers. Because here's the way it works. Let me just give you a quick example. Let's say that uh Medicare says that typical service or that typical health condition with the surgery and all that all that's involved may cost us $10,000. So what the what the what the ACO will do is say, hey, we'll provide that service for $8,500, and the difference will split it. The ACO. The ACO disgroup. And Medicare. Okay. Yeah. So what I'm saying to you that they're gonna they're gonna manage the care at a better price, and they are accountable to that because Medicare says, okay, we're gonna give you $8,500 because you said you could do it for that. We have typically been paying $10,000 for that. We will pay $8,500 and we'll split the difference. And so now there's $1,500. Uh Medicare saves $750, and um uh the uh in uh the the group uh made an additional $750. Okay. And so here's the point, Josh. Uh now we don't have numbers on 2025 yet, but in in 20 uh 24, there was like two and a half billion dollars that Medicare saved through uh these ACA type ACO type of arrangements. Okay. What I like about it is because this we know with advantage plans there's restrictions, networks, pre-authorizations, one-year plans. This is still original Medicare, so they still have the freedom to go to any doctor that they want to. Now, is every doctor part of an ACO group? No, uh for sure not. But these are beginning to grow and grow. So they're having a huge right now, there's 14 million people that go to uh an ACO doc or going to do that. And they don't even know it. They don't and and again, it's not like they're picking out the plan. They picked out the provider who has chosen to be a part of one of these organizations. And what's the advantage to the provider? Uh well, the provider is uh they have uh they have a little bit more uh uh uh uh quality care because the the primary care doctor is coordinating with the specialist who is coordinating with the hospitals and the surgeons, so they all get to kind of collectively manage this care together.

SPEAKER_04 9:26

Okay.

SPEAKER_00 9:27

Uh so that's their advantage. And if they do it at at a at a you know better dollar, then they're gonna get some of that profit. And so here's the whole point. The the gripe that people have about fee for service is no one is managing the care. The patient has to do it on the on their own. If I have a problem, what do I have to do? I'll call my primary care doctor, he refers me to a different specialist, and so there's a lot of movement. This brings it all that care underneath the umbrella still of original Medicare, uh, but now these docs can coordinate together. And it's working, they're collaborating, and it truly is successful. It is. Yeah, I want to learn more about that. And I do as well. But let me just share this real quick and then I'll close out. I think this is important. So uh what happens with the ACO model is the providers get this target spending amount, so they'll say 8,500, and then if again they do it better, then they're they're gonna get you know get to make additional money. I like that. But let me let me list a couple off and then we'll close out. Okay. Okay, so uh the here's some of the larger groups. Get this. There's one called Trinity Health Integrated Care. It's an ACO, Josh, 130,000 members on Medicare. Uh there's one in Texas, huge. Baylor Scott and White Quality Uh Quality Alliance. Another one called Mass General Brigham ACO, 130,000 Medicare lives. Advocate physician partners out of Chicago, huge group. Caravan Health, 250,000 people. Um Palm Beach Accountable Care, uh Privia Quality Network, uh Home Health, uh excuse me, health.

SPEAKER_06 10:51

There are people that are probably, I mean, you if you may be listening to this show, you may be a part of it and they don't even know.

SPEAKER_00 10:55

Yeah, they probably don't know because it really doesn't affect them as far as their, you know, their pocketbook. Their med sub still play pays the same, they're still paying everything the same. So they really don't save anything, but I think it is an opportunity for them to probably get better quality care than just a regular fee-for-service uh doctor. So I'll I'm almost done. Listen to this. Mercy Health, of course, here in Missouri and Kansas, um uh uh huge in this area. Here's another one, Banner Health, 400,000 Medicare lives. Uh another one out of uh uh uh the uh the East Coast, New York uh City Health and Hospitals. So the point is huge groups. So again, about 14 million people on Medicare right now that are covered by um uh a prov or seeing a provider that's what a part of these groups.

SPEAKER_06 11:39

So in your opinion, and when we talk about like um, you know, getting auto-enrolled in something, it seems like you know, we're talking about them talking about auto-enrolling in advantage plans, and you're saying that's probably not gonna happen, at least anytime soon, which I think there was a deputy general or something of CMS that said, yeah, we're not planning on that. Um but ACO is another model for essentially helping these people that just have Medicare A and B. So if you're on this, if you're listening to this, you got Medicare A and B only, right? Nothing else. Well, or maybe you even have a supplement plan. Right. Right? Being a part of some sort of an ACO could help you have better.

SPEAKER_00 12:14

Yeah, so you know, you could ask your doctor, then they may already be a part of one. Or if you're looking for a doc, maybe find one that is. Uh again, you're not gonna save any money, but it there's that what Medicare is trying to do, and so eventually this will probably happen, but it could be five, ten years down the road. But they want they want value-based care. They don't want it just to be, you know, order this test, that test, but can we can we can we improve the the health of the patient and do it at a better price? And with and as I look at this, I'm much more excited about ACO than whether it'd be advantageous because we get to stay in original Medicare. Um, and I think that's you know a great option.

SPEAKER_06 12:49

Let's get to our first caller. We've got Fred calling in from Texas. Fred, can you hear me? Yes. Hey, what's your question, sir?

SPEAKER_01 12:58

Yeah, I got a couple questions here. I guess we'll start with one of them is about Medicare. Uh I went to my I'm still on my work insurance. I have all my accounts set up. I went with Charles Agent called Jesse for uh Jesse Fox. Jesse's a wonderful guy. Yes. Yes, I know that we spent about an hour and a half fitting this stuff. So he took his time with me, and I was very pleased with his service.

SPEAKER_06 13:21

Did he tell you about his side? Did he tell you about his side business? He makes custom fishing lures. They're like $100 a piece. Yeah, he's he's a fisherman with a great epic beard, but I don't know if he tells people about that or not. No, he did not. Interesting guy. Okay, uh, yeah, go ahead with your questions.

SPEAKER_01 13:39

Okay, my first question is I went to for my six-month checkup, which it sale got built through my uh employer insurance because I'm still employed. Um and I told her my next visit in six months, I would be on uh Medicare with a Medigap plan. And she said, Well, when you call in, make sure you set this up as a physical. Does Medicare pay for physicals?

SPEAKER_00 14:05

Yeah. Well, first off, I I wouldn't use that uh initial uh terminology. I would say uh would like to have what is called the welcome to Medicare physical. Okay, because Medicare doesn't play pay for a full-blown physical that you would be accustomed to receiving on your employer plant. Uh they're gonna cover you, but it's not the same, so it's not it's not apples to apples for sure. So just tell them you want your welcome to Medicare uh physical. Um they're not gonna draw they're not gonna draw blood.

SPEAKER_06 14:34

Welcome to Medicare physical or welcome to Medicare visit.

SPEAKER_00 14:36

Yeah, either one. They call the the ones after the first 12 months uh annual wellness or something. Annual wellness visit. So it's it's a visit, but it's not it's not really a physical, but it is the welcome to Medicare. Um uh is uh you get to do that within 12 months of your B date. Uh and so uh what will happen is it's really just a review of your present situation. They're gonna do height and weight and body mass and check your blood pressure, and you know, they're gonna do a few things, but I promise you they're not gonna draw blood. Uh it's not gonna be a full-blown physical that you've been accustomed to. Um, if doc you know, if doc sees something or is concerned about something, then they'll just set up another appointment and and uh you know uh dive into other issues. But uh that first visit, uh, Medicare only covers the things that uh will be are very specific to that that visit.

SPEAKER_01 15:22

Okay. Or I just can tell her I just wanted my six-month checkup when I make my appointment and just skip the physical part.

SPEAKER_00 15:29

Yeah, well, I wouldn't say that. I mean I just would not, because you're you're going if you're gonna be on Medicare during that time, you want to say, I want I I want a set I want to set an appointment up for my welcome to Medicare visit or welcome to Medicare physical. Okay? The key, the key is welcome to Medicare. And the reason I'm saying that, Fred, is because uh once your B date has started, uh you have this 12-month opportunity to have this particular visit. And then after 12 months, you you can't get that one. You can get annual wellness uh checkups, but not this one. So I wouldn't say physical. Okay, unless you want to say welcome to Medicare physical. Enough of that.

SPEAKER_06 16:02

Yeah. If you get so uh do you have a plan G? Yes. Yeah. So if you if you do something other than that, you know, in the beginning, you you will be billed, right? For if it's outside of the scope of the annual or the the part of me, the welcome to Medicare. Separate appointment, though, Josh. Yeah. Yeah. Yeah. It's gonna have to be separate appointment. You're gonna be billed. You're gonna have to pay your deductible, which is $283. So it's just not your if you're your six-month deal is it's just gonna be different. Yeah.

SPEAKER_00 16:29

If Doc says he's concerned or she's concerned about something, then they're just gonna set up another appointment for you to go through some kind of evaluation. Diagnostic work exactly. Yeah.

SPEAKER_01 16:39

Yeah. Okay. So it's not like I need to make two appointments because every six months they want to take my blood always to check, you know, for cholesterols and all that good stuff.

SPEAKER_00 16:48

Mm-hmm. Yeah. Yeah, that's fine. And so what's going to happen though, uh with with with Medicare, uh, if they're if they pay for that blood work, it has to be medically necessary. Uh they're not going to do it uh just as some form of preventive measure like your group plan uh has been doing. It's it's totally different, Fred. It just is. Oh, it has to be medically necessary for them to cover those type of things. That's why I'm saying you have this, you want to say you want to welcome Medicare physical, so then if doc says, hey, you know, we need to check your blood every six months, then they're gonna they're gonna code that differently as medically necessary. It's not preventive, it's not a physical.

SPEAKER_06 17:26

And you're probably not the only Medicare welcome to Medicare visit that this doctor's ever done. So he should understand and know that. Right. But you do have to give them a little bit of direction.

SPEAKER_00 17:35

Yeah, but I've said for years, when you when you go to this visit, you don't go in there and tell the doc what you want. Uh, you know, doc, I want this, I want this, I want this. You say, Doc, I just want whatever Medicare is gonna pay for that's included in this initial visit. That's what you want to do. Yeah. Hey, I've had plenty of people in my career that have gone in and told doc what they wanted during that physical, and they end up getting a bill for four or five hundred dollars. Why? Because Medicare doesn't cover everything you want. They're gonna cover things that they're gonna sp uh you know specifically say is covered by that visit.

SPEAKER_01 18:04

Okay, okay. So then down after I make this appointment here and go down the road, like every six months he he wants to check on your your blood and all that, he's gonna have to code it different.

SPEAKER_00 18:15

That's correct to get him to pay it. Exactly right. And and and I I trust me, I believe they're gonna be there, they know how to do that. They want to get paid.

SPEAKER_01 18:24

Okay.

SPEAKER_00 18:24

Oh yeah.

SPEAKER_01 18:25

Okay. Okay. All right. I got that down. Um, and as for medical, physical, welcome. A welcome Medicare or whatever. Welcome to Medicare. Okay. Yeah. Okay. Now, my other questions are to deal with the part D plan, which I have not set up yet. Um it's gonna be I'm gonna do that next month. Or Jeffy told me don't do it too early because the day start you the next month whenever you sign in. So I will be going because I have my company, my uh company covers me all the way till May 31st. So I'll be going on part D June 1st. So my question is, so my question is, um he we we set that up and he sent me like a video how to set that up on uh Medicare, the drug plan, yes, sir and all that stuff. I've got all my drugs listed. So when I went yesterday to my primary doctor, he changed one of my drugs and switched it out to something else. Do I need to get with Jesse to redo that thing he sent me to the house?

SPEAKER_06 19:33

What's the medication that was added? Oh, let me go get it.

SPEAKER_01 19:38

Because if it's just a generic. I know if it's for it's for it's for intergestion, it starts with I know it's a VT, something like that.

SPEAKER_06 19:46

Oh, father's 40 milligram. Ameprazole, 40 milligram? Uh-huh. Okay, yeah, that's not gonna change anything. Like it's not an expensive brand. It's that's covered by I would assume every single plan that's out there.

unknown 19:59

Yeah.

SPEAKER_06 19:59

So yeah, don't worry about that. If you if you said some expensive brand name medication like Eloquist or something, then I'd I would tell you something different. But Ameprazole, you'll be fine.

SPEAKER_01 20:09

Okay. All right. That'll work there. And my other question is my wife has a few issues. We all signed up together with Jesse Fox, and we're going through the the role with the you know, the part D coming up, I think June 1st, like I said. Say if she has a doctor, uh, go has a doctor and he has some high-dollar drugs, because we decided on a premium for like $108 for her now. And if they uh the Dr. Keith Earl's drugs, and then let's say like Eliquist, that's one of the drugs he takes. Yeah. Uh say three three months down the road, he says, you know what, we no longer need to be on this drug. Sure. So we will not be are not no longer. Will your will your monthly premium adjust if you're off a high dollar drug?

SPEAKER_06 20:54

Yeah, no, it's so the way that's gonna work is every year uh from October 15th through December the 7th, uh you have the opportunity, you have the opportunity to change your prescription drug plan. So the plan that you enroll in that's gonna start June 1st, that's gonna be her plan for the rest of the year, right? But in October, um, and it's really easy to do, go back into Medicare.gov, put in the your zip code, put in your medications, choose your pharmacy, and then it will tell you what the right plan is for you. Right? The plan that loads up at the very top, this is the plan you need to be on. If that's different than the plan that you're on currently, you click enroll and five minutes later you're done. It's a very simple process.

SPEAKER_00 21:31

Yeah, and we'll reach out to you, Fred, yeah.

SPEAKER_06 21:35

Yeah, we reach out and we give you instructions and kind of hold your hand through that process. We do a daily, um, actually drug plan only live stream where you can tell us your meds and we'll we'll tell you what plan to go on, that sort of a thing. But it's it they've made that process pretty simple um now. And so, but you won't you don't it's not gonna change middle of the year. It's gonna you're gonna change it from October 15th to December the seventh with your new coverage starting January first.

SPEAKER_00 22:00

Fred, is that uh one oh is that that one oh eight that you mentioned, is that your Part D premium? Yes. Okay.

SPEAKER_01 22:07

I think if I remember right, it's gonna be a mana, I think. Humana? Okay, very good. Okay. Yeah, yeah. That's great. Yeah, she takes uh then she takes another one, a brella or something like this for migraine headaches. That's another high dollar drug. That's why her premium's way up there.

SPEAKER_00 22:22

Yes, yeah. Well, it's smart to have a high premium if your meds are covered, and then she'll probably max out. So that sounds good. We see the plan. It's called Humana Premier. So the good formulary and good plan, I does it have a deductible on it this year. Uh no. Okay, zero deductible.

SPEAKER_01 22:39

Good. Yep. On on that max out thing, which could possibly it won't happen this year, I don't think, because we just got six months left there. But like next year, you know how you have that uh you could do that op thing where you take that twenty one hundred dollars or whatever, divide by twelve, and that's what you pay monthly. Uh-huh. Yep. That's it. Do I set that do I set that up through Medigav or do I get with Jesse to help me out with that?

SPEAKER_00 23:03

No, you actually set that directly up with the insurance company. So with Humana. Yeah, if if Humana is still the best for you for 2027, you'll you'll enroll in that in the first year. And they'll take that in next year. Now listen, it'll probably be maybe 2,200 next year. I don't know what it'll be. They use your raise a little bit. Uh, and uh it's just called a Medicare uh prescription savings program. Medicare prescription savings program. So you'll you'll enroll in that with the insured carrier. Um and that's what they'll do. They'll they'll take it and divide it out uh over 12 months so you don't have to come up with uh that deductible or a large amount uh just initially. Okay? Good good program. Okay.

SPEAKER_01 23:40

Yep. And then if I understand that program right, because I've been reading it a little bit about it. You pay, say, say I'm gonna throw a number out there, $167 or whatever. Uh-huh. I think that's what it comes out to if you take that amount and divide by 12, 167 or something. You you when you pay that, you're gonna pay that always to the insurance company. So when you go to a pharmacy, you're gonna pay zero for all your drugs, correct?

SPEAKER_00 24:02

That is correct. Yeah, the the plan will actually bill you for that. And by the way, just so you know, it's not gonna be $2,100 divided by 12. It doesn't work that way. Okay, it it will not. Uh uh, what'll happen is it's gonna be close to that, but it's never because they recalculate that amount every month. It'll just not be any more than 2100. Oh, yeah. That's correct. Yeah, they do not pay at the pharmacy. Okay.

unknown 24:23

Yeah.

SPEAKER_00 24:24

The insurance company will cover all that. And then they they bill them. Oh, okay. Yeah, yeah. Interesting. All right, all right, cool. And a good program, especially if you know you're gonna meet the 2100. And some people that would say, hey, I have the 2100 in my bank account, I'll go ahead and get out of the way. Then they don't have to worry about it. There's be zero, you know, the rest of the year. But if you want to spread it out, nope, no problem at all. That's what it's there for.

SPEAKER_01 24:46

Okay, and then the last question, say when you get how do I get to see what drugs that Humana carries that you don't take? Like, you know, you go to the doctor and say, hey, we're gonna have to put you on something different.

SPEAKER_00 24:56

Yeah, they should they should have an online formulary uh that you can access through the Humana's website. Uh and then another thing you can call that formula. Yeah, and then another thing you can do is if I know you can get the formulary for sure, but if you didn't, you can always go to Medicare.gov and put that medication in and see if it's covered by that plan. So two ways you do that.

SPEAKER_06 25:16

But again, Yeah, the key word is called a formulary, and that's kind of a hard word. Formulary is just a list of medications that the prescription drug plan covers. So it's called a formulary.

SPEAKER_00 25:25

Yeah. All right, Greg. Is that everything for today, sir?

SPEAKER_01 25:29

Uh that is it. And uh, like someone to say, uh keep up your videos. They're very helpful. I've been watching you for two years now.

SPEAKER_00 25:36

Wow, that's great. Well, listen, it's our privilege to serve you.

SPEAKER_01 25:40

Yeah, this Medicaid and uh Social Security thing, that's a process, let me tell you. Yeah, it is there's a lot to it. Yes, and you really can get screwed over if you're not doing the right thing.

SPEAKER_00 25:51

Yeah, you're right. Well, you made some good choices. Uh number one, you know, you went with a great plan. Uh we we love we love the G and still good as well, but uh I think I think the the uh options you have now medically as being able to go to any doctor and no pre-authorizations, uh your your money is well spent. So good choices on that, sir. Good to talk to you as well. Yeah, my part, my my plan for G was sickness. Yeah, good. Yeah, that's very good. And too, I have also. Uh yeah, I'm gonna do it. All righty. All right, uh good, good, good talking to you, sir. Thank you. Have a good day. Thank you.

SPEAKER_06 26:25

Let's talk to Rob in North Carolina. Rob, can you hear us? I can hear you loud and clear. Uh, welcome to Medicare School Daily. What's your questions today, sir?

SPEAKER_02 26:37

Yeah, Marvin, thanks for uh having me um and what you're doing out there on YouTube. Um my question is concerning um disability and Irma. Um I went on just I went on disability back in February of um last year, 20 uh 25. And um after a 43-year uh aviation career, and um I turned 65 last May, and with you all's wonderful help, I applied for Medicare and I was a fairly high-income um employee up until the end of my employment, which was March 20th of this year, and I'm on disability for another year and uh a little over a year, and I'm still making pretty good income on disability. But my my question is the IRMA. I have appealed Irma once for part B, and uh was denied. And I was sort of told, hey, keep um keep appealing. And I just wanted your thoughts on appealing Irma while I'm on disability, but still at a fairly high income of disability for another year.

SPEAKER_06 27:53

So when did you you said you were did you just retire March the 20th, you said?

SPEAKER_02 27:59

Yeah. Uh yeah, I went out on disability. Uh yeah, uh I my employment ended March 20th of this year. Okay. I went out on disabil I went on on disability over a year ago and was staying an employee for almost a year um until they needed to uh release my headcount to uh grow the the department I was in. And we came to agreement that it was time to uh separate ways, and we did that amicably. So I am fully retired from them, but I am on disability. Okay. But I'm paying I'm paying quite an amount for uh for Irma and would like to uh appeal that. Okay it's eating into my retirement, but um uh okay.

SPEAKER_06 28:42

So let's let me ask a couple let me ask a couple questions if we can. What was your income uh approximately in 2024? Because that's what this 2026 premium is to be based on. Yeah, it's uh around uh 300,000. 300, okay. And then in 2026, what do you expect it to be?

SPEAKER_02 29:02

Um it's probably gonna be around two with the disability. Now part of it is um uh my supplemental disability, and part of it is their uh the company's disability. Uh it's probably gonna still be 250 250 and then and then what let I skipped a year.

SPEAKER_06 29:20

What was 20? What do you think 2025 is?

SPEAKER_02 29:23

Or yeah, when I filed my taxes, it was it was almost 400 because I was forced, not forced, but um I had to sell some stock during that time, so I reported almost 400,000.

SPEAKER_06 29:36

Okay, so 300, then 400, then 250.

SPEAKER_00 29:40

Yeah, let's talk about the one that got denied. So you say you appealed and they denied it. Um are you filing individual or do you file joint? You married filing joint return?

SPEAKER_02 29:50

Individual. I'm currently I'm currently saying on divorce.

SPEAKER_00 29:53

Okay. Okay, that sounds good. We understand. All righty. Well, go ahead. Okay, well, uh the any anything above 205,000 is going to carry uh that that sizable IRMA that you're paying right now. Okay. That IRMA looks like to be what $390, $391 on the B IRMA. Um so uh what's gonna happen, yeah. Well $391 is the IRMA and then you got $20290. Uh so your your total B is about looks like about $650 a month. Is is that is that correct? Because that's what we're seeing.

SPEAKER_02 30:29

It seems like I'm paying over seven, about $720, $730 a month.

SPEAKER_00 30:34

Yeah, you've got a D IRMA in there as well, probably $75 or something. So uh the the point Yeah, the the point is when you when you made your appeal, what what month was that that you did that?

SPEAKER_02 30:47

Uh well I didn't go on Medicare until uh you all helped me get on Medicare back in I think June or July of last year.

SPEAKER_00 30:56

Okay, good. So what happened? Yeah, you did you didn't really the reason they denied is because you did not have a life-changing event. And so here's the issue, though. You could appeal the IRMA, but the but that there's no re they're not gonna give it to you. Now you have a life-changing event that happened March 20th. Uh and so, but you're still gonna be in the URM.

SPEAKER_06 31:15

If it's over 205 and less than 500,000, you're you're not gonna save any money. That's right.

SPEAKER_00 31:20

You have a qualifying life changing event, but your income didn't go down because of that, so you're gonna have to continue to pay the IRMA. What do you think it'll be next year?

SPEAKER_02 31:29

Uh my income next year after after disability is probably gonna be uh down to maybe 90 to 100,000 a year as I draw as I draw Social Security and from more retirements yeah.

SPEAKER_06 31:42

So if you can keep it that this year, and it'll bump up a little bit next year, if next year you can keep it below 109, you know, it'll probably be maybe 110, 111 next year. There'll be a new chart for 2027. But if you keep it below that, you know, that first threshold, then all of that will drop off. Exactly right. But I don't know if you're gonna be at 250 this year. Yeah, you can't there's no reason to waste your time. There's nothing that's really you're not gonna be able to do anything.

SPEAKER_00 32:09

Yeah, and and you don't have to just pay pay your ERMA this year, and then as Josh said, and when we were on the 2027, you're gonna get a notice in December saying that you're gonna have an ERMA because they're looking at 2025, which is 400,000. And so what you're gonna do is you're gonna appeal, you're gonna say work stoppage, uh, and you're gonna put in your new numbers. You use what you just told us, $90,000 or whatever it's gonna be, uh, and then you will submit that to the local office or through SS, you know, the SSA.gov system, uh, and they you will you will win that appeal. They'll drop it off. So this December he'll get that notice. That's right, he'll get a notice, he'll he'll he'll fill out the SS-44 form. It's an eight-page document. You only have to submit three pages. That's it. The other five pages are all about instructions. Uh and if you need help because you're our client, we're happy to assist with that.

SPEAKER_02 32:56

Okay, so the life-changing event is not a reason enough to um go ahead and appeal on the has to be life-changing and reduction of income.

SPEAKER_00 33:05

Both both items. Income has to go down. Now, it didn't sometimes doesn't have to go all the way down. We could we can go down IRMA levels, but for you, you're gonna eliminate the IRMA totally based upon the numbers you're giving us.

SPEAKER_06 33:16

Yeah, and this year it's like yeah, if you're still gonna be two over 205,000, there's not really much point in you doing anything about this year other than regretfully pay the tax. Yeah, yeah.

SPEAKER_00 33:27

You're not you it truly would be a waste of time to appeal, but next year will not be. Yeah.

SPEAKER_02 33:33

Okay. Well, that makes that makes perfect sense. I mean, uh this, you know, you if you if you make it, you pay, that's for sure. But I was just hoping I could um uh eliminate it. But yeah, thank you so much for taking my comments. Thanks, Rob. Appreciate your help. Appreciate it. Thanks for letting us serve as your broker as well.

SPEAKER_06 33:47

Take care. Absolutely. Y'all have a good day. Bye-bye. Take care, Rob. I'm assuming that disability payments are considered earned income as well. Okay.

SPEAKER_00 33:57

Everything is counted if it's going to be reported on the yeah, because he sounds like he's getting social security disability as well as private.

SPEAKER_06 34:04

Yeah. Boy, it's crazy. There's like 109 to 137, 137 to what like it's not moving up very much money, and that chart just goes up so quickly. Yeah. So I I I have just noticed um it feels like we uh there are way more people that have IRMAS now than there were 10 years ago. Is that because this chart changed, or is it just because in wage inflation and the chart hasn't kept up with it? Do you uh I mean it just feel like it was like used to be, you know, one five percent. Now it seems like it's a lot more.

SPEAKER_00 34:35

Yeah, twelve, it's probably twenty percent. Yeah. I think they're projecting in twenty thirty maybe maybe twenty-five percent of all people will be paying more hermit. Exactly right. So um yeah, it's because a lot of people have you know, they make they make great money.

SPEAKER_06 34:48

Yeah. Uh and that chart hasn't kept probably kept proportional.

SPEAKER_00 34:52

They just with minor inflation, and that's it.

SPEAKER_06 34:54

Interesting.

SPEAKER_00 34:55

Exactly right.

SPEAKER_06 34:57

Okay, let's do uh another call. Let's get to Yolanda, lives in looks like Louisiana. Yolanda, are you there? Yes, I'm here. Hi, welcome to Medicare School Daily. Uh, what questions do you have?

SPEAKER_05 35:14

Okay, I'm making um 65 in September.

SPEAKER_06 35:18

Okay.

SPEAKER_05 35:18

And I was wondering uh I I I won't retire until I make until 2027. And I'll be 66 and I'll retire. But I'm confused because my job has medical insurance. I am getting medical insurance. But I'm confused because I think they have A. But do I feel that I still get AB with Medicare?

SPEAKER_06 35:44

So let's ask a couple of questions real quickly. Uh is your employer over 20 people? Okay, over 20 people. Do you use an HSA right now? Health savings account.

SPEAKER_05 35:58

Um no. I have a retirement, a teacher retirement.

SPEAKER_06 36:02

Okay. Okay, sounds good. And then uh Are you still working?

SPEAKER_05 36:08

Yeah. I will be still working when I'm at the age of 65.

SPEAKER_06 36:12

Okay, just so you're planning to retire next September? 2027. Okay. Yes. When you're 66. Okay.

SPEAKER_00 36:21

Yeah. So you're planning on going on Medicare then October of 2027. Would that be pretty close to it?

SPEAKER_05 36:30

Could I get could I apply for it then?

SPEAKER_06 36:33

Oh, absolutely. That's what Josh was trying to figure out. Yeah. What do you pay for your coverage right now? How much?

SPEAKER_05 36:39

Well, it comes out of my check, and all my coverage is like um it's like about uh $400 and something dollars.

SPEAKER_06 36:47

That that you pay every single month?

SPEAKER_05 36:50

Yes. Take it out of my check.

SPEAKER_06 36:52

So $400 a month. Let's talk a little bit about that. Is there a deductible?

SPEAKER_05 36:57

Yes, I have a deductible of uh $1,700. $1,700 deductible.

SPEAKER_06 37:03

And then what is the max out of pocket? I mean, if everything went bad.

SPEAKER_00 37:08

What's the most you'd have to spend in a given in a given year?

SPEAKER_05 37:13

Well, any given year, um, well, I do well in this, but any in given year it doesn't um uh about two thousand.

SPEAKER_06 37:21

Yeah, so there's so usually there's like a deductible, which you said was seventeen hundred, and then let's say you had a car accident, got cancer, and broke your leg, and you were in the hospital three or four times, what's the most you'd have to spend? Is it two thousand?

SPEAKER_05 37:35

Yes, two thousand and seven, uh twenty five hundred.

SPEAKER_00 37:38

Twenty five hundred. Okay, so your teacher has a good plan. One thing we also need to know in that four hundred dollars a month, what all is included in that?

SPEAKER_05 37:47

I I have a cancer plan in there, dental is in there, I is in there, and my uh medical.

SPEAKER_00 37:54

Okay, very good. We just want to make sure on that. Go ahead. Okay, yeah, so I I I I don't think that you're really overpaying right now. Medicare may be a little bit of a better value, but not a whole lot. You you really do have a good group plan. It sounds like you're happy with it. Would that be correct?

SPEAKER_05 38:13

I'm kind of happy with it because I just had surgery and I still have to come up with $1,700.

SPEAKER_00 38:17

Okay, okay. Now are you single or married?

SPEAKER_05 38:21

I'm married, but uh me and my husband file separate. He's different. Oh, you you file I'm not on his, I'm on my own.

SPEAKER_00 38:28

Okay, and so what what's what was your income in 2025? What'd you make? How much?

SPEAKER_05 38:34

Uh uh 33 uh three thirty-three thousand hundred and forty.

SPEAKER_00 38:40

Okay, 133,140. Okay. All right, we just want to make sure. So what we what we can do is we can uh give you um uh kind of a ballpark of what Medicare would cost you. And as we do this, I want you to know you don't have to go on Medicare. Uh in fact, you're you what I would do, I'd either go on Medicare fully or I would just stay on the on the group plan with your employer. Okay, don't do both. There's no reason at all to do both at all, to be a total waste of your money.

SPEAKER_05 39:08

Because that's what I was confused about because I I don't want to be penalized. Yeah, and I when I do retire.

SPEAKER_00 39:12

Yeah, and we don't want you to be penalized either. So what we're gonna do is this we're gonna let's do like an you know, maybe an in or something, Josh, that market? She is 160 and is 115.

SPEAKER_06 39:22

115.

SPEAKER_05 39:22

You take any expensive medications or are you pretty uh Yes, I take um pressure medicine, stomach pill, uh not really nothing that's you know, over the counter.

SPEAKER_00 39:34

You mean brand no brand names? No brand names? No. Okay. All generic. Okay. All right. So let's do this. If I were in your position and kind of looking at this uh as an option, give me a price on a drug plan there, Josh. How much?

SPEAKER_04 39:49

Hang on.

SPEAKER_00 39:50

Okay, yeah. And so um uh again, you're you're not in a bad position where you are. Uh he's gonna look up one more number for us. There's zero dollar. Okay, good. So here here's here if if I were uh you know you looking at at kind of a good comparison, I think uh you would if you if you did Medicare A and B, uh you would you could also do a very good uh supplemental plan, which is uh uh a plan in. Plan in, uh and all that combined, including your drug plan, would cost you about $325 a month. $325. Okay. You're paying $400 right now, but that also includes a cancer plan. Uh it also includes dental vision. Okay, so by the time we by the time we added uh a cancer plan in there and um uh dental vision, uh we're probably now we're pushing $380, $390, so just around about the same amount. Now here's the difference though.

SPEAKER_05 40:43

But I was excuse me, but when I was told when I get ready to retire, the cancer the doc they're they're automatically gonna pay for my insurance, but they won't pay the cancer. That would be dropped.

SPEAKER_00 40:55

Okay. You're you're saying your employer's gonna cover your insurance?

SPEAKER_05 40:59

Yes, when I retire, they're gonna cover it.

SPEAKER_00 41:02

Okay, okay, very good. Okay. Sounds like to me then they're gonna cover it. Okay, fully. Is that is that until you die?

SPEAKER_04 41:10

Yeah.

SPEAKER_00 41:10

Okay, lifetime. Okay. Okay. Well, I I would almost assure you that what's gonna happen is they're gonna put you on some kind of a Medicare Advantage plan. Uh so you need to find that out. Uh uh I'll be shocked if they're gonna they're gonna let you stay in original Medicare and they're gonna pay for your insurance. I just don't think that's gonna happen. Uh they're gonna roll you in some some type of a Medicare Advantage plan, which may be fine. You may be happy with that. Uh and so have you ever seen my my uh our our our homepage on our on our um our company website before? Have you ever been there before? No. Okay, you need to. And here's what I want you to do. Please do this. I want you to go to MedicareSchool.com, MedicareSchool.com, that's our and our our website and a home page, and you're gonna see on the very front page it's gonna say uh watch a free workshop. Okay, and you'll find that you need to watch that workshop. It's not very long, it's 50 minutes, but it's gonna give you a good uh explanation of your different options because I can almost guarantee you when you when you retire in October, they're gonna offer you an advantage plan. And you may but you may decide you're happy with that, but you need to make sure uh because there's other plans called supplemental plans that give you more freedom. The advantage plan is gonna put you in a network of doctors, hospitals. It's also gonna require that at times you're gonna have to have a pre-authorization, and those plans change every year. Okay, so supplemental plans uh give you more freedom. Go to almost any doctor you want to, no pre-authorizations, that kind of thing. But you have to decide which one of those systems is gonna work for you. Okay, again, half go half go advantage, half go sucks. So uh there's no really right or wrong, but you just gotta decide what's best for you. Okay, so that's what's gonna work. So you can stay right where you are now. There's no penalties. Let me tell you what I would suggest doing, though. Uh I would suggest if you stay on your group plan, uh, do enroll in Medicare A only, Medicare part A. Okay. You do not have to take B. Okay. You don't at all. Okay. So Josh, add anything. Um anything that we've you want to add there. Uh so you lambda.

SPEAKER_06 43:14

Here's one thing I may add is ask your employer for what that plan look is gonna look like if they're going to offer you some sort of advantage plan. Get the details on that. At retirement. Yeah, get all of it, get all of that because it may be great, it may be terrible. I don't know. Yeah. Um if it looks terrible though, I think there's an argument to be made that you could go into Medicare even before you retire, probably end up with a little bit better coverage for the same price. Um Right. Yeah. But we just we need to know. And then you can call in, you can call into us. We'd be happy to compare it with you. You can call to someone on our team once you get the details of what that plan is going to be at retirement. Um Do you have our office phone number?

SPEAKER_00 43:55

Yeah, we'll make an honest comparison with you, Alonda. One more thing I'm gonna share Josh.

SPEAKER_06 44:04

I'm gonna give her an office number. You got a pen?

SPEAKER_00 44:08

Yeah, give me a pen. And why do you grab that?

SPEAKER_05 44:23

Okay. Okay.

SPEAKER_06 44:25

Office phone number is 782 800-782-6676. 800-782-6676. And you can call with those details, talk to someone on our team, and they can make a comparison and just help you understand. And they'll do a Zoom call with you, right? So you can kind of see the stuff on their screen and all that. Makes it a little bit easier than just the phone. Okay, my dad has one more comment. We got to get to our next call.

SPEAKER_00 44:50

I want you to know this. They are not going to cover your Medicare Part B. If they do, I've never heard of it. Okay, so yeah, you're saying they're going to cover your insurance, and I I would suspect that's going to be an advantage point, but you'll still have to enroll in a Medicare Part B when you retire. Not now. We're doing A only now. We're going to do B at a later date. But that B premium right now is $203. And so it'll be probably a little bit more next year, but I guarantee you they're not going to cover that for you. Okay? And again, call us, call us when you're ready. We are happy to help you make that comparison. And um, you know, we'll be your broker if you want. That's totally up to you. Okay? Okay.

SPEAKER_05 45:25

All right. Thanks.

SPEAKER_06 45:26

Take care. Appreciate the call. Let's talk to uh Tim in North Carolina. Tim, can you hear us?

unknown 45:33

Tim?

SPEAKER_06 45:34

Yes, I'm here. Hi, welcome to Medicare School Daily. I understand you have a question about your mother's supplemental plan.

SPEAKER_03 45:42

Yes, I sure do. Uh appreciate you guys, and uh I watched a lot of your videos. Well, thank you. Um my mother's facing a bad situation. She's 82 and a widow and lives only on Social Security. Uh she has her own home. But her supplemental insurance plan, she had Combine, and they went out of business a few years ago. They will not uh move her or do anything, and she has a plan F, uh, but her premium went up to five hundred and fifty-seven dollars this last year a month. So that's pretty much unsustainable. Um so uh I called the company, they offer no alternatives or no help. And um so I will just basically we couldn't ch the other thing was we couldn't move her because of her health. No one would accept her in another company because she has AFib.

SPEAKER_00 46:39

Okay, well, okay, she has AFib. Okay, so let me tell you, I can do exactly what I would do if I were in your position. I want you to know I I think F plans are great, but if you can't afford it, you don't stay on it. So what I'm gonna recommend, yeah, I know she is, yeah. Well, but we can do a chronic snip. And so what happens is this uh uh really honestly up until almost this year, she would have to stay on that plan until later this year, and then we would go on we'd go on an advantage plan. Um and and advantage plans are gonna have a few restrictions, but listen, if you can't afford 557, that's a lot of money. Yeah, so we go on advantage plan.

SPEAKER_03 47:13

We actually tried that. Uh we we tried we tried to put her on another plan, and uh an insurance agent helps shop around for us, but they all denied her because pre existing conditions.

SPEAKER_00 47:24

I know that, but you they didn't try an advantage plan. There's no underwriting with the advantage plans, Tim. So they tried to put her on a different supplemental plan. That's not the solution here. The solution is to find an advantage plan, put her on that plan, and we'll talk more about that, but we're gonna find, see if there's a chronic SNP plan, you know, heart disease, Josh, there usually is. All right, sounds good. So here's what I'm gonna recommend. We're gonna give you, we're gonna give you our number. I want you to please, Tim, call in because we could still do this for an effective date of 5-1. Okay? And so uh she she she qualifies for what we call a chronic uh SNP plan. Uh and and the doctor's gonna have to verify that she has, you know, this heart issue, which we can do, but that but we have to do that to uh for you know for this plan to go through. Uh but that way she can get some relief off the 557. Is there any premium on that plan, Josh? Uh no. Okay, no premium either. So this is what she needs to do. Uh and if you'll call in, uh he'll give you the number. And what I want you to do is just ask for an agent. Now, you're you're I I assume your mom can, you know, she's verbal and all that, there's no problem. Where are you or her power of attorney? Are you doing you are doing this for her? I don't have power of attorney. Okay, well she I don't have power of attorney. Okay, if she can talk, that's all we need to do. And that you know, the uh you can have a you know, she can be on the phone with you, and then um uh one of our agents will explain exactly what you need to do. It's called the chronic SNP plan. Chronic meaning she has a chronic health condition. SNP is an acronym that stands for Special Needs Plan. And this is uh an advantage plan that's designed specifically for uh someone with a chronic condition. And the beautiful thing is this uh we can do this now uh because you you you have one once once a year if you have a chronic condition, you can go on these plans, and this would be a great plan for her, probably long-term as well. Zero premium. Now listen, it it it she's gonna have some out-of-pocket expenses when she goes to the doctor, if she sees a specialist. But again, pay as you go, but it's not here right now. What are you you're paying $1,100? See, you're paying uh uh what over almost $7,000 a year on this thing. Okay. So the max out-of-pocket on that is what, Josh? What are we looking at?

SPEAKER_06 49:34

Well, there's a United Healthcare one with $5,400. Okay. Um just trying to see. Yeah, there's two different chronic SNP plans in your in her zip code. Um one's through United Healthcare, one's through Humana. So and we're we're gonna have to need like we need to look at your doctor, her doctors and stuff to see what we're doing.

SPEAKER_00 49:54

And we're not gonna make this switch if it's not in her best interest, Tim. But if I were you in her position, that's exactly what I would at least look at. And the agent can take the time. We can't, of course, do that on our program here, but uh we'll take the time to make sure it will give her the doc coverage she needs, the hospital coverage, and um the uh medications as well. But I want to make sure you know uh uh they do require, I think it's when thirty within thirty to sixty days of the plan, uh the doctor does have to verify that she has the chronic condition. It's a real simple form, but that does have to be completed. And the agent, again, our agent will tell you about that. But that's really all you have to do. And and then what'll happen is um if we get it set up today, um uh and by the way, I'm not trying to rush you just so you know, we can start this June 1, too. It doesn't matter. Um really uh whatever you're you all are comfortable with. But the point is, as soon as we know that that's going to go into effect, uh then you can call uh the insurance company and cancel that F plan, effective 5-1 or 6-1, uh, whatever agent advises on that. Okay? So to me, that's that's the solution here, sir. Anything else you want to add to that, John? Okay.

SPEAKER_06 51:02

So I our office number, let me give that to you, is 800. You got a pen?

SPEAKER_00 51:05

Mm-hmm.

SPEAKER_06 51:06

800-782-6676, 800-782-6676. Yeah. And I I do just want to clarify, like, we we often um, you know, we're we're probably gonna recommend a Medicare supplement plan um more often than a Medicare Advantage plan. It's just that, golly, it almost six hundred dollars a month, and who knows what it'll be next. Who knows what it'll be, you know, later this year or next year. Yeah. I imagine um moving to one of these kind of special plans um that's you know, for either diabetes or heart conditions probably is going to make sense.

SPEAKER_00 51:44

I think it makes financial sense as well.

SPEAKER_06 51:46

I I do. She's also paying her part B. So now we're at if you're at 583 plus 20290, she's spending and her social security check you said was how much?

SPEAKER_03 51:56

It's about twelve hundred dollars.

SPEAKER_06 51:58

Yeah, so she's got four hundred dollars left. So I'm sure your you or the other siblings are coming out here.

SPEAKER_00 52:03

Is that all is all is that all of her income, twelve hundred? She didn't have any more income than that?

SPEAKER_03 52:08

That's it. Okay.

SPEAKER_00 52:12

Yeah, well, what I'd be applying for, and you can do this with her, you need to be applying for um a couple things. Uh, one is called extra help, but she's gonna also qualify for, I think, a Medicare savings program, which will help offset that Part B premium as well. So you need to be calling Tim. I'd call the North Carolina Medicaid office. And um and and you can apply for um it's called a Medicare savings program. You can do it through uh Medicare, Social Securities, uh, you know, the local uh Medicaid office, because you can probably get some help with her Part B premium as well.

SPEAKER_06 52:45

A couple things on that. Does she uh is so I think the the limit in North Carolina is eighteen hundred and sixteen? Okay, so she's below that for income. Uh-huh. Is there an resource limit? It's like 10 grand.

SPEAKER_00 52:57

Okay, does it count the house though?

SPEAKER_06 52:58

I doubt it. Okay. Usually doesn't count. Does she have other assets outside?

SPEAKER_03 53:02

Any other money? No, she has a home and and and the farm. Uh show she has some land.

SPEAKER_00 53:09

Is it producing is it producing any income right now or just just just vacant land?

SPEAKER_03 53:16

Uh my brother uses it. Yeah, he he grazes cattle and stuff like that. But does does he pay her? But no. Does he pay? Uh that's something I don't know for sure.

SPEAKER_00 53:27

Okay. Well, okay. So I I for some reason I didn't think they counted um uh so much house on it.

SPEAKER_06 53:34

You should call the you should call the Medicaid office in North Carolina. Please do. Talk talk about her situation because you may end up, you know, you you if she could save, you know, get that $202.90, the $203 a month she's paying for Medicare Part B eliminated, right? Right. And then get the $583, you know, she could have an almost $800, $900, $800 a month income swing.

SPEAKER_00 53:57

Pay increase. Okay, so call state Medicaid office. Do you have a number for that, Josh? Yeah, I was gonna look up. Yeah, call this 10. It didn't hurt to try. You know, and you may uh may not go with it, but hey, it's it's definitely worth it worth the time.

SPEAKER_06 54:08

Okay, it's eight the Medicaid office, eight hundred pardon me, pardon me, pardon me. It's eight eight eight two four five zero one seven nine. Eight eight eight two four one seven nine.

unknown 54:23

Okay.

SPEAKER_06 54:24

That's their maintenance.

SPEAKER_00 54:25

And and yeah, and just so you know, uh that would be a separate decision from what you and I talked about. She can still move forward with this chronic SNP plan for sure. Uh it would just be a little bit more attractive on on her medications if she qualified for Medicaid. Okay. So yeah, but anyway, so and she may not if they count the house and land against her and all that, but still, we can at least get her this help with this uh this you know supplemental uh F premium. That's pretty high.

SPEAKER_03 54:52

Yeah, absolutely. Ridiculously high. Okay. Okay. So um she's I live three hours away, so uh I'll need her on the conversation with the agent. Yes, probably also the Medicaid office.

SPEAKER_06 55:04

Um probably yeah, I would start with the medic, I would start with the Medicaid office, probably. I mean, I guess you could do them both. The Medicaid office could also determine what are the plans she's eligible for, and there may be a better D SNP than a C SNP.

SPEAKER_00 55:15

Okay, that sounds good. Okay, good. So, John, my only thing is I don't know how fast they're gonna be. Oh, yeah, that's right. But yeah, I was just trying to see if we can save her that premium for for uh the month of May. But then again, that's pretty fast, so it's fine. Yeah, just go ahead. That might throw her. But the Medicaid, the Medicaid applications sometimes do take some time. I'm just saying too, she can get on this chronic SNP plan, uh, save the 557, and then if if she uh does qualify for Medicaid, then we can see if there may be a better uh plan as well. That's all.

SPEAKER_03 55:47

That sounds fantastic. Okay, Tim. Appreciate it. Thanks, Tim. Take care.

SPEAKER_00 55:51

Good talking to you, sir. Have a good one. Thank you. Thank you very much. Love your shows. Thanks.

SPEAKER_06 55:57

Okay. Uh that is what's that? No, I was just that's a really good reason not to go with some fly by night insurance company. I don't know. I never heard of it. What do you call it? Combine. Combine? Yeah, I I that's a yeah, yeah. So when we generally like recommend an insurance company, we're gonna go with a big name brand carrier, name name brand carrier. Right. Yeah, you're not a traditional carrier. You know, there I just remember there were always people that were trying to get us to sell like peaking life or there was uh like a falconry group that sold a Medicare supplement. I was like crazy stuff.

SPEAKER_04 56:33

Right.

SPEAKER_06 56:33

I know. So that's so this that that insurance company went out. Now her coverage didn't change, right?

SPEAKER_00 56:39

Oh well, she had they have to service that for life.

SPEAKER_06 56:41

Yeah, but at the end of the day, the premiums are up, everyone who's healthy switching off. That's right, and she's stuck because she can't switch off.

SPEAKER_00 56:47

That's really, really unfortunate. Yeah, that's why. And it didn't mean to say every regional carrier is is bad, but I wouldn't do that. You want to go with a national carrier.

SPEAKER_06 56:55

I remember there was a a care a company in, I think it was Missouri, that kept badgering us to sell their plans, and I looked up how many lives they had, and they had 5,000 lives. Right.

SPEAKER_00 57:06

I know who you're talking about.

SPEAKER_06 57:07

Yeah. I mean like 5,000 people on your entire insurance plan. Right. And you're, I don't know, it was just crazy. Yeah. And when you've got plans out here that have millions that you're spreading your risk pool and risk profile across. That's right. Guys, join us tomorrow. Uh we're gonna be talking about Social Security and whether or not you should take it early, because there's some information coming out from the trustees report about Medicare or rather Social Security running out of money. So we're gonna talk all about that on tomorrow's show. So make sure you tune in. Um, if you all would like to be a part of the show, the phone number is down there below at the bottom of the screen, 800 eight two four uh 2004. We would love to chat with you if you need immediate help. We are a team of insurance brokers here at medicareschool.com, and we are able to help you sign up for your advantage plan, your supplemental plan, your drug plan, whatever it is, we would love to help. When you become a client of ours, the thing that's different is you get assigned a dedicated client care manager, and this is someone that you can talk to. When life changes, when life happens, you have someone that's here in the United States that you can talk to that you know, um, that's able to help you with anything uh that comes up. You're not going to call a faceless 800 number that sends you to the other side of the world to somebody that you can't understand. And so just want to uh throw that out there. We would love to help you. Uh, it's no cost for our services. We write in all 50 states, have customers all over the country, uh, and uh try to do our best. So uh call us. That phone number is 800 782 6676. We will see you tomorrow talking about taking Social Security early and whether or not that's a good idea. All right, thanks.