Working After 65? The SIMPLE Medicare Guide To Avoid Mistakes

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Working past 65? Your Medicare decisions may look very different.

Join us live as we walk through how Medicare works when you’re still employed, what to consider before enrolling, and how to avoid common (and costly) mistakes.

Call in with your questions—we'll be answering LIVE!

Transcript

SPEAKER_03 0:03

Many of you are going to work past 65, and there's probably a lot of questions, a lot of things that you are hearing, whether that's from friends or maybe a Medicare sales agent, something you're reading on the internet, something you've asked Chat GPT, whatever it is, there's probably some points of confusion on do I need to take Medicare now? Am I gonna get penalized? Will I limit my options if I don't do something right now? All of those things have a little sliver of truth. And we're gonna share with you truly a step-by-step plan today. If you are planning to work past 65, what you need to do to be able to make sure you get uh the best coverage you can and set yourself up for the future correctly. I'm joined in my studio in the studio today by my dad, Marvin Music. Guys, listen, if at any point you have a question and you'd like to uh talk uh to Marvin, who's truly like the leading expert in the country, has educated more people about Medicare than anyone else, this is your opportunity to call in. Ask him a question about your situation, whether that's Medicare related, retirement related, social security related, and get a a really expert opinion. I really encourage you to take advantage of this. The phone number is 833-824-2004. 833-824-2004. Call in, get your question answered by somebody who's not trying to sell you something. So much of the information out there today is from people who have an agenda. They want to sell you something. And we're obviously not going to sell you something when you call in. Our goal is just to make sure that you are set up for life because Medicare can be confusing. Uh, and you deserve to know and have the truth. So let's talk about uh turning 65, gonna keep working. What are the steps that somebody needs to take to make sure they have all of their options open in the future, to make sure they don't get penalized, to make sure there's not gonna be any gaps in coverage or find themselves without coverage in the future.

SPEAKER_01 1:55

All right, so for those that are working past 65, if that's you, uh the first issue that we look at is uh the size of the employer uh payroll. Uh because Medicare says that if you are uh working for a company that has 19 employees or fewer, then you are required to take Medicare A and B. So that's the first thing. How how how large of employer? And it's payroll size, uh part-time, full-time, just payroll size is all that matters. And so uh you uh have uh some specific things you have to do if there's 19 or less. If there's 20 or more, then we're in a different uh kind of a scenario. So let's work through those of you that have small employer plans. So you must enroll into Medicare A and B. And the reason for that is because the present insurance company that you're covered by uh at work is gonna move to the second payer position. And trust me, many people are not aware of this, but that's what's gonna happen. Medicare is gonna pay first, the employer plan is gonna pay second. So if you fail, then you just don't do what I'm telling you to do, and you go ahead and just have the employer plan and you have some kind of a large claim, I guarantee you what's gonna happen is that insurance company is only gonna pay second and you're gonna be the first payer. I have seen this before. So huge mistake.

SPEAKER_03 3:06

So translating that means you're probably you go into the hospital, you're gonna be responsible for Medicare's portion, which is 80 percent.

SPEAKER_01 3:12

Uh-huh. Yeah.

SPEAKER_03 3:13

Right? Yeah, but be the it'd be the be deductible.

SPEAKER_01 3:15

It would be the 80 percent for all the docs. Yeah, yeah, yeah. Exactly right. So you're gonna pay that tremendous amount of money. And so you become the first payer instead of Medicare. Yeah. Uh and so uh uh that uh group plan is gonna pay second. So you have to enroll in in into Medicare if you're in that scenario. Now, I can tell you from a practical standpoint, what the majority of people do is they go ahead and and come off of the group plan entirely. Trevor Burrus, Jr.

SPEAKER_03 3:38

Because usually if it's a smaller employer, the plan is expensive, but it's not that great. Exactly. You may run into a different situation.

SPEAKER_01 3:44

But even if it is great and uh it maybe if it's a reasonable price, it's still gonna pay second. So what we would encourage you to do is is to ask your employer uh to um uh give you a raise. Uh because uh I know what it costs us, Josh. What we're spending $1,000 probably a month on every employee, and so your employer is uh spending a lot for that. So what I would recommend doing is saying to uh going to them and saying I'm I'm gonna go on Medicare, uh and uh since you don't have to pay for my insurance premium anymore, uh could you give me a raise to help offset that? And I will tell you if you're valuable, we would do that in a heartbeat. Yeah. Okay? And so now an employer can't incentivize people to do that. Not at all. No, the rules are 19 or less. You're making the choice. Yeah. And I'm not you know, I'm not saying we're up to something here. I'm just saying to you, I've seen this happen many, many times in my career where an employer will will pay some of that. So when you look at it this way, uh you're looking at a couple hundred dollars for your Medicare B, you could get an in-planned or a G plan for one, $150, uh, get a drug plan. So you're probably looking at about a $400 package uh with a very small deductible. Uh you're probably right now uh paying more than that, or at least your employer is, and you uh uh probably have a higher deductible as well. So my point is you win and your employer wins. And so you have to go on Medicare anyways. Employer goes to second payer position, so by uh you can prove your position by coming off the plan totally and get A and B, get a supplemental plan, or get A and B uh with an advantage plan. And so I think that's a very good decision. So that's those of you that are with small employers, 19 or less. Now let's talk about the other uh of you that would be working for large employer, which is certainly the norm. There's 20 employees or more on the payroll. So in your situation, um uh you don't have to do anything at all. Um and so you don't have to do A and you don't have to do B. Uh now, but but I would still recommend mm taking the time to compare uh your um employer plan with your Medicare option. And just so you know, we're happy to do that with you and for you. Just call in and say, hey, here's my employer uh details, here's uh uh you know when I'm paying a premium, uh, this is the deductible I have on the plan, this is my max out of pocket. So we want to gather a little bit of information and we will help you lay those plans side by side and make a good determination whether Medicare makes sense or not.

SPEAKER_03 6:01

Yeah, because our caller uh just a few minutes ago, um, or a recent caller we had, he was saying that he yeah, he was paying like $250 a month, but he just had a surgery with a $6,500 deductible that he had to pay. So now it back's out of pocket, you're right. Yeah. So at the end of the day, like if you can go, if you can maybe spend a little more on premium, but you get your deductible lower from $6,400 down to the $300.

SPEAKER_01 6:24

But his issue, Josh, his issue was his wife was covered. Remember? She was two years younger. So the point is I think we have to bring that into the equation as well. We wouldn't want you to go on Medicare if you're gonna you know sometimes spouses have somewhere else to go. But if your spouse doesn't have somewhere else to go, or you have children that are covered by the plan, which they are up to age twenty-six, then sometimes you would have to even stay on the group plan, even if you'd like to get off, just because it's gonna negatively impact other people in your family. Uh but let's go back to what I was saying. Take the time to make the comparison, lay them side by side. And so if Medicare uh makes sense, then your employer has to let you go. Um and so you just make that comparison. Now, if you do have a spouse or children that recover the plan and you have to stay, and that is fine as well. But what you may want to consider is doing A only. And we do recommend A only as long as you're not contributing to an HSA. Health savings accounts are wonderful, money goes in pre-tax, you put money in, sometimes employer puts money in, and uh that account can grow and can be used for medical expenses. So it's pre-tax, the account grows, uh tax deferred, and it's tax exempt if you use it on qualified medical expenses any time in your life. In fact, I had a call last night with a gentleman, Josh. Uh he had um uh I think he had sixty thousand dollars in his HSA. Uh so I mean people have accumulated some wonderful money. And I do want to say something about HSAs to those of you that have them. If you have a sizable amount, and this is what I shared with him, he wasn't aware of it. What happens is uh if we if we uh take that money out of an HSA prior to 65, um uh we're actually penalizing, you've got to pay taxes on it. But after 65, what happens if uh it's so large and you think you'll never use that money, then you actually can pull that out, pay the taxes on it, but there's no penalty at all. And so, HSA. Just like an IRA.

SPEAKER_03 8:15

Uh-huh.

SPEAKER_01 8:15

And and I'm and I would agree with that.

SPEAKER_03 8:18

No. Because if you have other IRAs like what you would spend through that before you'd get into your HSA, because that money can always be used tax-free for forever. And maybe you're like 90 years old and you want to take everyone on a cruise, just pull it out.

SPEAKER_01 8:30

Yeah, pull it out. Exactly. But it is um something to take advantage of. But back to what I was sharing, I kind of uh you know got diverted there. Uh but uh if you're working for a large employer, uh what happens is 20 or more, then they are going to pay first. And if you if you did have Medicare, then Medicare is gonna pay second. So that's why we're saying if you do anything, take A only. Don't take B. There's no reason to take B. If you have a lousy employer plan, then you should take A and B and get you know get off the uh the group plan.

SPEAKER_03 8:59

Now, if you use an HSA, you should not take A.

SPEAKER_01 9:02

Don't take A, don't take A at all, and I promise you you will not be penalized. And even if someone says you're gonna be, listen, as long as you have paid into the Medicare tax system for at least 10 years, they call it 40 quarters, four four quarters a year, or your spouse has, you'll never be penalized on Medicare A. I don't care if you take it at 65 or 95. There's never a penalty as long as it's zero premium.

SPEAKER_03 9:23

And we tell people to take part A because it may pay something, even if you have group coverage, right? It may end up paying a little bit of something. But also it makes the transition to Medicare down the road a little bit smoother. It does. You've got a Medicare card, you've got a Medicare number. Now it's just a matter of filling out a couple of forms, bringing into Part B and then starting Part B. Exactly. Yeah.

SPEAKER_01 9:43

So we do recommend it. That doesn't cost A, unless you have an HSA. So don't do anything, and then uh as you know, get ready for retirement down the road, then you need to you have to stop your HSA uh contributions a little bit earlier. Uh but uh I would just recommend uh uh don't don't take A if you have an HSA. And don't worry about people who say you're gonna be penalized, they just simply do not know what they're talking about.

SPEAKER_03 10:07

The government would prefer that you work till you're 150 years old and they never have to spend a dime on you covering you under Medicare. So they're not gonna penalize you for staying on an employer plan at all. They're gonna penalize you when you go without coverage, you don't have an employer plan, then all of a sudden something changes in your health, and you've got to get on Medicare all of a sudden because they know, oh, it's because there's gonna be a financial outlay, it's because they're sick, it's because they got cancer, it's because they had a heart attack. We gotta get on, we gotta get on Medicare, and now Medicare is starting to shovel out money. That's when they'd penalize you because you chose to go without coverage.

SPEAKER_01 10:42

Yeah, you're right.

SPEAKER_03 10:42

So if you have a group plan, so you have no problems. So this is all great, wonderful. Uh, you know, you're gonna work till you're 67, we know the plan, we don't have to take A. Uh we can take A. Don't take A if you have an HSA. We should compare group coverage um to see if it's better, all that's great. What if they did all that? They decided I'm gonna stay on my group plan because it's a hundred dollars a month and it's a thousand dollar deductible, it's great coverage, then they get laid off. All right.

SPEAKER_01 11:08

Then what happens? Okay, well, uh, and that does happen. And so number one, don't panic because we can bring you into Medicare very quickly. And so for instance, if if this happened to you today, you lost your job and it's May uh in May, we can start you by June 1, no problem at all. Okay, so in fact, I have literally brought people into Medicare uh the the the very last business day of the month for the for the for the for the next day the first. So now we don't have cards in place, but you will be covered if you have a heart attack. So don't panic uh at all. Uh so if you are in that position and you lose it, I would get moving as quickly as possible because we do have to get some additional paperwork uh taken care of for you. Uh but again, it's it's not really a big deal. It's not. Uh the other thing that I'd like to mention to those of you that are on Social Security, very, very important. And and also keep this in mind when Josh and I talk to you about uh employer, remember it could be your employer, it could be your spouse's employer. It doesn't matter. Okay, as long as you know you're married or uh you're you're covered by that spouse's plan, all the rules that we're talking about still applies uh to you. So now here's what I want you to realize. If you are on Social Security, you're gonna be automatically enrolled in Medicare A and B. So if you're still working and you have a group plan 20 or more, or your spouse does, then uh if that uh group plan is good, then we would recommend disenrolling for Medicare B. If you're on Social Security, you have to stay enrolled in A, but you do not have to take B. So when the Medicare card shows up, I recommend to you that you just simply sign on the back of the card, send the card back in, and they'll drop off B. That way you don't have to pay for B, uh, and then they'll send you a new card, Medicare A only, and you can pick up B at a later date. And the reason I'm telling you that is because, in my opinion, it's a waste of money. If the employer has 20 or more, uh group plan pays first, Medicare pays second. So I wouldn't want to pay $202.90 a month to have Medicare in the second payer position. So send the card back in, disenroll uh for Medicare B.

SPEAKER_03 13:06

Okay, let's uh get to our first caller. We've got Richard from Tennessee. Richard, what are your questions?

SPEAKER_00 13:16

Well, I'm just uh I'm I'm questioning options as far as the advantage plan versus the uh Medicare supplemental plan. Uh it's it's confusing and you it sounds like you've got one shot at getting it right without costing you. And I just how do you make those decisions exactly confidently?

SPEAKER_01 13:40

Okay. Uh Richard, first off, um I think you have to decide, sir, what is what's most important to you. And and we're all different. I can say this that if if if it's most important to you to be able to go to any doctor that you want, then that's that's leaning towards a supplemental plan. Now, if you're comfortable allowing the insurance companies to pick out uh your providers, doctors, and hospitals that you can go to, then again, that's the way advantage plans are going to work. Secondly, uh if you are fine with the insurance company having some say-so in some of the health care needs that you have, such as you may need an MRI or you may need a knee replacement or hip replacement, or you want to uh uh you know go to a specialist, uh uh if you if you uh are are fine with the insurance company having some say-so, then you're fine with an advantage plan. But if you don't want them to have any say-so, meaning you don't want to have to go through the pre-authorization process of the insurance company agreeing with what the doctor recommends, then that's going to be a supplemental plan. And then one of course I could go on on, I'm not going to, but one other thing is if you would like to have something that's permanent, it can never be canceled on you, uh, that's a supplemental plan because advantage plans are one year at a time only. Uh, and the insurance companies can pull them. Last year we saw uh over two and a half million people lose their advantage plans. No one that was on a van on a supplemental plan lost their coverage because those can never be canceled by the insurance company. Now, I share all that with you because so many times, Richard, uh uh people just want to look at premium as though premium is everything. Premium matters, but it's not everything. What really matters is how do you want your insurance to work. Now, I personally went on Medicare in January. If you've been, you know, um uh listening to us, you would know that. Uh, but I chose a supplemental plan because I did not want insurance interference. I did not want insurance company choosing my doctors, I didn't want the hassles of having to renew plans on an annual basis. So that worked for me. So you have to decide what's best for you. Obviously, if you're going to get a supplemental plan and you get the benefits of that quality coverage, you're gonna have to pay a premium to do that. But you're pretty well done. I have already met my deductible this year. It's $283, I'm done. Every service I get the rest of the year, it will be at no cost to me. Uh if I was on an advantage plan, or if you were on an advantage plan, you wouldn't pay a premium, but you go to the hospital, it's gonna cost you $400 a day. So either way we're going to pay. You just have to decide, would you rather uh pay as you go, that's advantage, or would you rather just pay a premium that you can afford, and then you're gonna pretty pretty well be done. So that's really what it boils down to. They're both insurance, they're both fine options, but they're different. And now here's the issue. If you decide to uh go with an advantage plan and you stay on that long term, you stay on it a year or two years, three, four, five years, in order to get off of that in the state of Tennessee, and for you to move on a supplemental plan, now you're gonna have to medically qualify. Now, you don't have to be in perfect health, but I guarantee you this if you have rheumatoid arthritis, you're a diabetic, uh uh you've had any kind of a heart issue, whatever, you're not gonna move. You'll be on that advantage plan for the rest of your life. So those are the differences, and that's the that kind of thing you're gonna have to weigh out. Now, I want to ask you a question. Have you have you seen um uh My Essentials workshop on our our website? I have not. Okay, I would encourage you to do so, sir. Um uh if you'll go to Medicare go to MedicareSchool.com and uh uh you'll see on our homepage there's a place where it says uh you know schedule an appointment or watch a workshop. Watch a workshop. You don't need an appointment, you need to watch a workshop. It's about 50 minutes long, and I promise you it will give you all the details, the ins and outs of what you need to be thinking through. And then uh just decide what's best for you, because there is no right or wrong or best. Okay? Now I do want to share something with you just so you're clear. Uh when we have a supplemental plan, we're we're gonna have to pay a premium. Uh my son Josh looked up some or some rates in your area. Now, just so you know, this rate uh could be a little bit lower if you're married or live with someone, uh, those are called household discounts. But basically the the the rates right now on a G plan in Tennessee are gonna be about $149 a month, $149. The N plan, which is also a great option, is $101. So you're gonna see that's about about a $50 a month difference between G and N. Uh I live in Missouri. Uh I took I chose a G. There was only $35 difference. Sometimes there's $50, sometimes there's $70 or $100 between G and N. Uh but that but I think both are great options. The difference would be your G is going to be the most comprehensive plan, covers everything but be deductible. You meet that once a year, the EN, you've got some copays when you go to the doctor, uh, you're responsible for the deductible as well as excess charges. Now, the reality is, uh Richard, you're probably not going to see an excess charge, but if you did and you had an end plan, then you'd have to pay that extra 15%. So those are the differences. Any of the questions that you have for us, sir?

SPEAKER_00 18:33

Well, that's just, you know, it's it's that's costly. Uh uh for one person, that's not too bad, but like like you said, I have uh I have a wife, and so I'm gonna be spending if I go with if I go with the G plan, if I go uh um it's gonna end up costing me about double what I'm paying for my health insurance today.

SPEAKER_01 18:57

Yeah, and and that could be the case. Medicare is definitely not always cheap, uh, but I do want to remind you of this whether you go with an advantage or supplemental plan, you still have to pay that part B premium. So that's gonna be the system. Absolutely. Yep, exactly right.

SPEAKER_03 19:10

So you've got you could have $400 right there for two of you.

SPEAKER_01 19:13

Exactly right. So and yeah, I'm not minimizing the the pain of that for sure, but again, advantage plans are still fine insurance. Uh it's just the system is a little bit different, and we want people to make sure they know what they're what they're getting. Okay.

SPEAKER_00 19:27

And so uh anything uh uh neither one of us will be able to go with the uh with the advantage plan. I'm diabetic. And my and my wife has other issues as well.

SPEAKER_03 19:39

So are are you all both gonna go on Medicare around the same time?

SPEAKER_00 19:52

I should go on it two years before her. Okay, okay.

SPEAKER_01 19:55

Yeah, Richard, are you still working, sir? Yes, full time, and are you planning on retiring anytime soon?

SPEAKER_00 20:08

I just turned 65 in April.

SPEAKER_01 20:10

Okay, all right. Sounds good. So you're gonna work two more years then, so your full retirement age, probably, right?

SPEAKER_00 20:17

That's the plan that we've that we've had. My wife is ready for me to go on and retire. She retired for health reasons. Okay. She retired for health reasons two years ago. She's younger than me. So she's not she's not on Medicare yet.

SPEAKER_03 20:32

Okay, when will she be eligible? When does she turn 65?

SPEAKER_01 20:36

She said two years.

SPEAKER_00 20:37

In two more years. Okay, so yeah. That's why I was waiting until 67.

SPEAKER_01 20:42

Sure, sure. Now, uh, your employer plan, um, is your employer, is there at least 20 people uh at the company or more?

SPEAKER_00 20:51

Yes, yes. We have 11 locations nationwide. We we probably have multiple thousands.

SPEAKER_01 20:57

That's good. I just want to make sure you're on a large employer plan, so that's very good. Uh, what does it cost you right now to be on your group plan?

SPEAKER_00 21:05

Um it is It is about $120 every every two weeks.

SPEAKER_01 21:12

Every pay period. So about $250 a month in got have both of you covered. You're right. You're gonna be spending more when you go on Medicare. But I would say this I would I would suspect your deductible is probably a little bit higher than $283. Uh so you'll you'll probably it yes.

SPEAKER_00 21:27

Oh, absolutely. I I had surgery in February and my out of pocket was was $6,400 for me.

SPEAKER_01 21:34

Yeah. And you know, you divide that by $12. There's $500 a month right there. Uh so it's going to cost you a little bit more to be on Medicare when it's time. Uh and and really there's no hurry. You've got it, you've got a great plan. Just remember, uh Richard, when you come into Medicare, uh all we have to do is verify that you've had credible insurance uh back to sixty five. Uh very simple to do. Um, there's a form we fill out, and we of course we'll help you with all this when it's time to do it. But um Did you take did you? Take Medicare part A in April? Yes.

SPEAKER_03 22:03

Okay. Okay. That's good.

SPEAKER_00 22:04

Yeah, I just signed up for it. I just signed up for it in April.

SPEAKER_01 22:07

Okay, that's great. Yeah.

SPEAKER_03 22:08

And you don't you you don't you don't use an HSA, is that correct?

unknown 22:14

No.

SPEAKER_01 22:14

You're not contributing to one.

SPEAKER_03 22:16

Good. If that ever becomes available, don't yeah, if you have Part A, you can't use an HSA. So just in the future, you know, the next couple of years. What is an HSA? It's called a health savings account. It's basically where you have a high deductible, then the employer puts pretax dollars into an account, blah, blah, blah. You understand. Yeah.

SPEAKER_01 22:33

So Alrighty, sir. Well, listen, we uh appreciate the opportunity to talk to you. And when it comes time, uh let me let me tell you what I would do, sir. Uh 90 days before you get ready to retire, that's when you need to get serious about getting enrolled. You you can't do it six months in advance, even if you want to. Uh, Medicare will not process that that B paperwork. It's called the special enrollment. So 90 days is the perfect window, excuse me, uh as you um approach retirement, set the date back to the clock three months, give us a call, and we'd be really privileged to be your broker. Perfect. Okay, Richard. Appreciate you calling in, Dave. Nice talking to you, sir.

SPEAKER_03 23:08

Bye-bye. Thank you. If you ever need help with Medicare, uh it's a big confusing world out there. There's a lot of people trying to sell you things, there's a lot of misinformation floating around. Uh, MedicareSchool.com, we are a team of insurance brokers, right? And if you need help, we would love to help you. Whether that's getting a Medicare supplement plan in place, deciding between a G and an N, what are the lowest rates from a good uh rate stable carrier? What uh drug plan do I need? You're gonna go an advantage plan. I uh you know I look at uh Advantage Plan options all the time and you type in a zip code and there's fifty different Medicare Advantage Plan options in a single zip code. It is very confusing to understand what is the right coverage for you. So if you need help, we would love to help you. I'm gonna give you our office phone number. It's 800-782-6676. 800-782-6676. When you call in, uh you're gonna be uh speaking to one of our licensed agents. These are all people that are trained by Marvin. And uh what we think is important is people who are uh go ahead.

SPEAKER_01 24:18

And if you're wondering if um uh there's any cost to our services, the answer is no. Uh I have many times people say to me, Well, it surely costs something, and it doesn't. Uh we're no different than your homeowner's insurance agent, your uh auto policy uh agent. Uh they're paid by the insurance company, and so are we. So we truly are free to you. Uh so relax about that. I mean, all the services that we'll provide for you, enroll you into Medicare, help you with SCP paperwork, all those kinds of things are truly at no cost.

SPEAKER_03 24:47

Okay, let's go to our next caller. Diane uh in Florida wants to discuss supplemental plan G versus N. Diane, can you hear us? Hi there. Uh what questions do you have?

SPEAKER_02 24:58

Hi. Um I am kind of looking for an opinion. Um my husband is a very good idea.

SPEAKER_03 25:06

Well, you've come to the you've come to the right place if it's about Medicare. We've got a lot of opinions. Okay. Go ahead.

SPEAKER_02 25:13

So we're our whole adult life, we've had care at a major medical center that was one of the last that um started to not accept a few.

SPEAKER_03 25:28

Okay.

SPEAKER_02 25:28

Um we're debating the N plan versus the G plan. We would like to continue to get care there, but that 15% excess fee kind of scares us. I don't know if the government has put things in place that that most institutions will not go back to that. So I don't know if that you know truly is something that we need to fear in the future or um, well, I would say this Diane, yeah, I don't think there's a tremendous amount of fear there.

SPEAKER_01 26:00

Uh okay, but but the it still could happen. Uh you may never encounter one. The likelihood of you uh you ever encountering excess fee is very low. I think less than a three percent chance. Uh so I don't think you'll see it, but you still could. It would be wrong of us to say to you there's there's no risk involved because there's a slight risk. Okay? Uh I think what really what it boils down to, uh, you know, there in the state of Florida, uh uh excess charges uh are allowed. Uh it's it's not one of the eight states where they can't even charge it. But the likelihood, again, is going to be small. So if I were you, I would look at I would look at my budget uh because I know in Florida many times, and Josh is gonna run some for you. What what is your zip code? Do we have that? Okay, good. I guess we have your zip code already. So he's gonna look up some rates, but there could be as much as you know, $75 to $100 a month difference between the G and the N. And so I think that's that's what I would look at if there's substantial. Uh you probably heard me say I I live in Missouri, the difference is $35 a month. Not significant, but there can be in bar. I guess right now Josh is saying the difference is $50 a month between the G and the N in the state of Florida.

SPEAKER_03 27:05

So for times two, that's $100 a month, $1,200 a year. Yeah, $1,200 a year.

SPEAKER_01 27:09

So we're not talking $20,000 here. Uh but it's still significant for sure. And so I think it uh for me, I think number one, you're wise and you you know a supplemental plan is gonna give you your your your premium, you know, really best insurance, in my opinion. Uh I love I love the subs because of you know, no hassles. And uh you have the freedom to to really be in control of your health care instead of some insurance company doing that. So I think you're making a good decision there. So I don't think it's bad either way. Look at your budget, say, hey, we can afford the G or now. That's gonna make things a little tighter. Then I would say get that in plan because it's a great plan.

SPEAKER_02 27:44

Okay. With regards to the 15, is that for absolutely every test, uh, procedure, no ma'am. Or that is just a physician test?

SPEAKER_01 27:57

Physician only. Yeah. Hospitals can't add to it, uh durable medical. No, no one else can add to it except for your physicians, which would typically be in the cancer field, is where we see it more than anywhere, and that would be uh a specialist. It could be a surgeon, um uh that then they could add the 15 percent. But just so you know, what happens is when they get their original reimbursement from Medicare, they actually are only going to get 95 percent of the original Medicare price. So it's truly uh just an additional 10 percent. I mean it's it's a it's truly 15 percent added, but at the end of the day, the they don't get the full hundred percent, they get ninety-five percent reimbursement. That's the way it works. Uh yeah. Yeah. So um but look at your budget. That's what I would do.

SPEAKER_02 28:39

Okay, yeah, we had kind of looked at the prices in our area. My husband is um also applying in his is like a sixty-five dollar difference. So it was a little bit less for me, probably female versus male, but um you know, we just didn't want to get hit with you know thousands of dollars in the future if um if they reversed you know that Medicare assignment.

SPEAKER_01 29:05

Exactly right. And you know, and there is some risk involved in that. Right now, we know less than three percent of doctors do it, but that could change during yours in my lifetime. I hope it doesn't. Um but uh it it could for sure. Diane, is there anything else that you want to ask us? We'd be happy to talk about anything else that's on your heart and mind today.

SPEAKER_02 29:22

No, I think that's it. I appreciate your taking the call.

SPEAKER_01 29:25

Okay, good. If we can help you in any way, please uh let us know. Thanks, Diane.

SPEAKER_02 29:29

Okay, thanks so much. Uh-huh.

SPEAKER_03 29:33

Okay, let's get to uh Kevin and Oregon. Kevin in Oregon. Uh welcome to Medicare School Daily. What questions do you have, Kevin?

SPEAKER_04 29:44

Well, I I I won't personally be on Medicare till June of 2027. Okay, next year. Uh my wife starts December, and so we've been looking through the you know the Medicare.gov. We've been watching you guys, and you guys are awesome. Well, thank you. Appreciate it for your encouragement, sir. Yeah, you've educated us well. So anyway, so my problem is I take two medicines that are pretty high dollar medicines. One is Epler known, one is Rapatha.

unknown 30:16

Okay.

SPEAKER_04 30:16

And I've heard Marvin say a few times on some of the other shows that there really is no reason for anybody to ever have to pay over like a $50 copay for Rapatha. But when I look at the plan D's, they're showing like sixteen hundred and ninety-five dollars. Okay, so I don't do me a second letter.

SPEAKER_03 30:33

I'm gonna pull this up. So Rapatha, uh, what's the uh what was the other one?

SPEAKER_04 30:38

Uh Eplarone.

SPEAKER_03 30:39

How do you spell that?

SPEAKER_04 30:41

E T L E R O N E, I believe. Oh, okay. Sounds good.

SPEAKER_01 30:48

Hey, do me a favor. Uh what is that Eplarone for? What's what's that prescribed for?

SPEAKER_04 30:53

It's uh it's a blood pressure medicine. And so my problem is I can only take this group of medicines that I take. Okay. Um because I'm yeah, because I'm allergic to a lot of other medicines. I see. So it's very, very vital I take these.

SPEAKER_01 31:08

All right, gotcha. And then what's what's the repatha uh treated for?

SPEAKER_04 31:12

I've heard of it for uh like like what? Yeah, cholesterol.

SPEAKER_01 31:18

Okay. Okay, very good. So it's so it's not a statin. You probably couldn't take a normal statin. Is that what is that what it is? No, no, I can't take statin. Yeah, it replaces a statin.

SPEAKER_03 31:28

Do you get uh do you get it comes in a pen that's sold in a pack of two? Is that correct? And you you you get one fill of that every month? I mean you use two pens a month? Yes, I use two two pens a month, yeah.

SPEAKER_01 31:39

And that's a repatha. Yeah, that's okay. All right, and so as Josh is looking those up. Let's clarify some things. Um, Kevin, okay, so here's here's the way it works.

SPEAKER_03 31:47

One question. Okay, quick. 25 on the Apple Rome, 25 milligram tab once a day. Um or is it a 50? I think so.

SPEAKER_04 31:56

Yeah, it's it's 25.

SPEAKER_03 31:57

25, okay.

SPEAKER_04 31:58

125 a day.

SPEAKER_03 31:59

Yeah. Yep, 125. And then what pharmacy do you usually go to? Well, we usually use uh Walmart. Walmart, okay. Sounds good. All right, toss a couple of things. Yep, Redmond, Oregon. I got it.

SPEAKER_01 32:12

All right. So let's let's talk about the structures. He looks these uh specific plans up. So uh when you're on a standalone Part D plan, which means that it's a plan you selected, um uh it's an addition to your Medicare supplemental plan. When pe uh when you Well, if you were to get uh an advantage plan, then they embed an uh the a drug plan as part of that. So we're talking about standalone drug plans here. Um and so what the way they are structured is this uh there could be, and usually it's a deductible. That deductible this year is sixteen, six hundred and fifteen dollars, excuse me, six fifteen. And so that deductible is definitely going to apply to these medications. So you would be out of pocket this first six hundred and fifteen dollars unless the plan waives the deductible. And the reason they would do that is because there could be a higher premium. So sometimes when we have a premium that's you know $50 a month or $100 a month, and sometimes uh those um uh deductibles are waived. But my my point to you is that uh we have to deal with this deductible. Either you pay it out of pocket or the plan waives it. So the first six hundred and fifteen dollars is is on you. After that deductible is met, then we move into what is called the coinsurance phase. This is called the initial coverage by Medicare. And so what happens here is the max that they would ever they could charge you would be 25 percent of the retail. Okay? Now, that doesn't mean they're gonna charge you that, uh, but they could charge up to 25 percent of the retail. And so what happens was we add our deductible and we take our 25 percent coinsurance or whatever our co-pays are, all that money out of pocket can can add up to $2,100 max. And that's it. Okay, so uh no uh no matter if your meds are $30,000 a month, it makes no difference. You'll never pay more than $2,100 for the year as long as that medication is is within the formulary. Now, that $2,100 does not include your premium. That could that's different, but it does include all out-of-pocket expenses. So I just want to clarify that because you made a statement there about you know, about Marvin said about $50. And and so there are some meds that are fifty dollars a month, but there are some where you're gonna have to meet the deductible and then uh you pay the 25 percent coinsurance. Okay, Josh, what do what do you have for us? Okay. Okay, Josh.

SPEAKER_03 34:21

So it looks like so the Eplarone is not uh I guess it must be a brand name, but it's not super expensive. Walmart's like $37. I don't know if that sounds right to you. Yeah, in a copay. The the Rapatha. Yeah, the Rapatha is uh it's got a retail cost, I believe, uh what, $12, $12. I mean, it's yeah, it's pretty expensive. So you're gonna pay a percentage. What Medicare.gov is showing is that obviously the first month you're gonna have to pay your deductibles, so that's $615. And then after that, for both of those meds combined, it's gonna be about $105, $108. Okay. Per month.

SPEAKER_04 34:56

And then the Epler known, the Epler known I also notice is like not in the formulary of a couple of, you know, we don't have a lot of, you can see there, we don't have a lot of uh insurance companies. I think there's 12 or there's 10 drug plans, yeah. Yeah, and I saw two or three of them had Epler known not even in the formulary, so I didn't know how easy that would be to get them to do it if it's a company we want.

SPEAKER_03 35:21

Yeah.

SPEAKER_04 35:21

Yeah.

SPEAKER_03 35:21

Well what I mean it's listed as a generic. So I I pulled up United Healthcare. Yeah, it is listed as generic.

SPEAKER_01 35:28

What I'd recommend for you, sir, is you you want to get a uh a plan that's going to cover that. There's some that will, then you make a decision based upon that. Uh and and these the these um online tools actually will shop all the plans, put them in order of cost and coverage. And so we uh would typically say to you, be sure to just pick the the the plan that's at the top. Which is which one, Josh?

SPEAKER_03 35:48

Uh the uh a UHC plan. So it's $38.40.

SPEAKER_01 35:53

Okay. And that it's on a monthly premium.

SPEAKER_03 35:54

Yeah. Okay. All right. So you've got your meds are covered, and then it says, you know, if when are you good when are you are you starting medi oh you're starting Medicare next year. Next year, exactly right. So I mean for the rest of the year is about $1,500. So my guess is he's gonna hit that cap being on Rapatha. Yeah.

SPEAKER_01 36:11

What was the retail cost of Rapatha?

SPEAKER_03 36:13

$1,200 or something.

SPEAKER_01 36:14

Okay. Yeah. So more than likely you'll you'll you'll mat you'll he'll hit the cap, which is which is wonderful. You know.

SPEAKER_03 36:20

That's what it's there for.

SPEAKER_01 36:21

Exactly right.

SPEAKER_03 36:22

It used to be you'd have to.

SPEAKER_01 36:25

Hey Kevin, anything else, sir, that we can talk about with you? Any other questions?

SPEAKER_04 36:29

Well, we're we are uh we'll we'll both be using you guys, and I just wanted to let you know that because you guys have just won us over. Well, thank you.

SPEAKER_01 36:37

We are glad and it will be our privilege. Last question for you, sir. Now, are you you still working is uh or you have you already retired?

SPEAKER_04 36:45

No, no, we're both on we're both on social security, we're both retired. Okay. Um the only other question I would have is on uh uh of spousal benefit, but I don't know if you guys have time to go into something like that. Go ahead, sir.

SPEAKER_01 36:59

Go ask away. We're happy to discuss it.

SPEAKER_04 37:01

Well, so so Bambi started, she's six months older than I am, so she started her social security six months before me. Then I came in, we both retired, um, and so she only gets about $877 a month. And so we were thinking about, you know, because we both want to go with a G plan if we can, they're kind of expensive, but we we don't want advantage plans because we live here in Central Oregon. In central Oregon, the the main hospital group that runs everything, it's like got has the monopoly, is dropping a whole bunch of companies out of their advantage plans to cover it. Yeah. But and we also like the supplemental. We really like plan G, really like plan N, except for the cost of plan N. So anyway, so you know, we're just wondering if she could uh what it takes to know if she qualifies for that. Okay.

SPEAKER_01 37:50

Well, here's here's the here's my question to you. Uh have you all been married more than a year?

SPEAKER_04 37:55

Yes, uh 41 years.

SPEAKER_01 37:57

41, I guess so. So you had to be married more than a year. Now that now that you have um applied, I mean now that you're taking your own social security, she would be eligible for spousal. Let me explain how this is going to work for you. Uh the spousal benefit is is would be her spousal benefit, it would be 50 percent of whatever you are eligible for at your full retirement age. Not what you're taking now, but at your full retirement age. But if she took hers before her own full retirement age, then there will be a reduction uh you know, it's good that's going to be reduced.

SPEAKER_04 38:30

Yeah, 30 percent or something.

SPEAKER_01 38:32

Well, it's actually higher than that. Spousal benefit is 9.375 percent a year for the first three years, and then five percent after that. So it's a hefty amount. But again, what let me ask you this. What what what what is your full retirement age uh benefit? Not what you're taking now, but you know what it would have been if you'd if you would have waited to six months.

SPEAKER_04 38:51

No, I don't know. I don't know how to find that information. Yeah, I don't know where to find what it would have been. Okay.

SPEAKER_01 38:56

Then what I would do is this I would call Social Security, call them directed, they'll have all the information for you, and they'll they'll transfer you who knows where around the country. Uh that's the way their system works today, and say uh we're considering my wife uh taking spousal if it's gonna be more. And even if it goes up, you know, 200 bucks a month or whatever, it's uh certainly worth it. But they will tell you that, because they'll calculate it probably right over the phone or at least set an appointment up for you all uh to be able to see if indeed uh they can increase that. And they will do that uh if if it will be more. Okay. And and and and the reason I'm sharing all this with you, you probably found out that she wasn't eligible for espousal until you applied. Uh the old system we could do that, but no longer. So you're thinking right, so call them.

SPEAKER_04 39:36

Yeah, we both Okay, because we've both been on like uh what a year, two years? Yeah, we went at 62 and we're 64, yeah. So we've been both on at 60 or for two years.

SPEAKER_01 39:48

So well they'll do they'll do the c calculation for you and let you know if there's more, and then you can uh apply right over the phone typically with them, or they'll set appointment up to transfer from uh from her own retirement benefit to your spousal.

SPEAKER_04 40:01

Cool. Okay. All right. Well, thank you guys very much.

SPEAKER_01 40:04

Yeah, we look forward to helping you in the future, Kevin.

SPEAKER_03 40:07

Yes, sounds good. Take care. Hey, hey, are you there still? Bye-bye. Yeah. I was I was just gonna give you one little tip. So um you should so December, uh, if that's when she's wanting to start Medicare, which it sounds like it is. That's her B date, yeah. That's her okay. Um obviously that's the annual enrollment period. So it is crazy, right, crazy time, basically, for anyone who works in this business and for everyone who started trying to start insurance around that time. So here would be my recommendation. Call sometime, call our office, and I can give you that number if you don't have it, but call in probably you you do you have it? Yeah, I have it. Remember, and we already made an appointment. Oh, you already did. Okay, when it's September That's all I was gonna say. Okay. September 1st, yeah. Yeah. See, you guys taught us that. Okay, sounds good because it gets a little bit crazy. Okay, right.

SPEAKER_04 40:59

And her card is Cooper, a nice guy named Cooper told us that. So's great.

SPEAKER_01 41:04

That's wonderful. Yeah, and and remember, uh, her card will show up in August, about August 20th.

unknown 41:10

Okay.

SPEAKER_01 41:10

Uh, because she's on Medica already on Social Security, so the card will arrive in August, and we're looking forward to helping you, sir.

SPEAKER_04 41:18

Oh, yeah. Yeah, we we are looking forward to you helping us. Yeah, all right. Take care.

SPEAKER_03 41:22

Take care. Bye-bye. Thank you. When you start Medicare, you oftentimes are thinking about what to do with your IRAs and 401ks and 457s and all these retirement accounts because you're gonna be living off some of this money that you saved. Um, but there is a big tax bomb uh that a lot of people don't realize, even financial planners don't understand as it relates to Medicare. And so we're gonna be talking about that in tomorrow's uh program. So you can be prepared for that so you don't unintentionally do something that causes big tax liability down the road. So join us tomorrow if you have a question for us. Maybe you have an experience uh as it relates to Medicare or Social Security and you want to share that with us, we would love to hear that. All of our audience gets grows and gets better together when we know more things that are happening out there in the real world. So if you have a question or an experience you'd like to share with us, we'd love to talk to you. The phone number is down there at the bottom of the screen. It's 833-824-2004. And if you need immediate help, uh, meaning you have a need to sign up for insurance, whether that's an advantage plan, a supplemental plan, a drug plan, a uh vision plan, a dental plan, whatever it is, uh we'd love to talk to you. So if you need help with a Medicare supplement plan, a Medicare Advantage plan, a Medicare uh prescription drug plan, whatever it is that's Medicare related, you've come to the right place. We can help you. And so we'd love to do that. Our phone number is 833, pardon me, it's 800-782-6676, 800-782-6676. Uh, when you work with us, you don't pay us anything extra. We don't upcharge for your insurance, we're never gonna send you an invoice. We're here for life. Uh, the I think the most special thing about it when you become our client, you are assigned a dedicated client care manager. This is someone that when you move or you have a billing issue or a claims issue or anything comes up in your Medicare journey, we are able to help you. You can call the same person over and over and get assistance. So uh give us a call, 800 782 6676. We have people standing by ready to help you navigate this crazy world of Medicare.