How To Avoid A Tax BOMB When You Start Medicare

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There are a few Medicare-related tax surprises that can catch people off guard—and they’re often not talked about until it’s too late.

On today’s Medicare School Daily, we’re breaking down how Medicare can impact your taxes, where those unexpected costs can come from, and what to watch for as you get started.

We look forward to taking your calls!

Transcript

SPEAKER_03 0:03

When you are retiring, you're going to be making a lot of financial decisions. And you'll probably be getting help maybe from a financial planner or for friends or from the internet. And there's a little known thing that happens whenever you're retiring, and it relates to a tax on your Medicare. And most people don't know about this, most financial planners don't know about this. So we want to share that with you today. We talked to a lady uh just a couple of days ago, and she was given some very bad advice that is going to cost her about $6,000 extra dollars just in the year that she retires, um, and even more next year. And so we're gonna talk about how that happens and how you can avoid that. Because if you're uh starting Medicare, if you're retiring, there can be a lot of unanswered questions, a lot of confusing things. We're so glad you're here with us today. I'm in the studio joined by my dad, Marvin Music. And if you want to be a part of today's show, if you want to call in and get your question answered from truly the nation's leading expert on Medicare, this is your opportunity to talk to him. And so the phone number is down there at the bottom of the screen. It's 833-824-2004. 833-824-2004. Call in if you have a retirement question, a social security question, or a Medicare question. We would love to talk to you. So, Dad, talk to us about this tax time bomb, this thing that can happen uh that most people don't know about as it relates to Medicare.

SPEAKER_00 1:34

Well, the issue that we're dealing with uh around uh this topic has to do with uh Medicare Part B and drug plans. Um we all know that Medicare A has no premium, but everything beyond A is gonna have a premium. So when you go on Medicare, uh your Part B premium is gonna be established uh based upon your what is called modified adjusted gross income. So modified adjusted gross income, very simple. It is um your adjusted gross income plus line 2A on your tax return. So let's say we're on Medicare this year, you are uh 2026, the government looked at your 2024 modified adjusted gross income. And the government establishes thresholds. So there's several thresholds uh for today. I'm just gonna give you two of them. Uh so if you are um uh single and you file an individual return, the threshold for you will be $109,000 a year. So we're on Medicare 2026, they look at 2024 modified adjust gross income. And if you are uh $109,000 or less, then you do not have this problem we're talking about. If you're married, you file a joint return and you're below $218,000. Again, you do not have this uh this tax bomb problem. But if we're above $109 or we're above $218,000, then this uh could apply to you. And so what happens is anything above the thresholds, then you have this additional surcharge called an IRMA. It's an acronym that stands for IRMAA, income-related monthly adjustment amount. And just look at it as a separate Medicare tax. And so what oftentimes happens is that as people get ready to retire, uh they may be uh uh uh doing a Roth conversion, pulling money out of uh uh of an IRA or 401k and moving over to a Roth. Or uh maybe they're uh you're you're gonna uh r do a big you know house remodel and you're gonna pull out. We've had people uh I had a guy that was uh uh uh gonna pay for a very expensive wedding, $50,000 for a wedding, so pull money out of his IRA. So when you begin to pull money out of your IRAs or 401ks, uh either it's for a Roth or any other purpose, you have to pay taxes on that. And so that becomes income on your tax return. So if you're on Medicare in 2026 and they're looking back at 2024, it could be possible that that um uh uh uh you're above those thresholds, then the government is going to charge you this IRMA. Lowest IRMA is about $90 a month, highest ERMA is about $575 a month. There's actually five different levels of IRMA. And so uh one way that a person could um avoid having to pay uh these additional taxes is if you will do a Roth conversion or pull out for whatever reason one year or two years before you actually begin Medicare, uh then you have an appealable offense, you have an appealable uh life-changing event that says to the government, hey, I uh uh retired or I semi-retired, and I don't want you to look back two years, uh, I've retired. So let me give you a kind of a better example. So if I'm on Medicare uh in 2026, I know they're looking at 2024, and my income could have been up because of whatever reason, but if I retire in 2026 and go on Medicare, I can tell them don't look at 2024. I'm gonna give you 2026 numbers, and they will look at 2026. And so you can appeal. We do that with a form called an SS-44. And so they don't source where the money came from. As long as you have a qualifying life-changing event, which is normally work stoppage or work reduction, we retired or semi-retired, then we get to have the ability to give them new numbers, right? And so that's when you can take advantage of not having to pay these ERMAs if you tied them correctly. So my advice is this if you know you're getting ready to retire, you'll let's say you're gonna retire in 2027. Uh if you do a rough conversion, pull up money of the IRA in 25 or 26, uh, you retire in 27, uh, you have an appealable offense.

SPEAKER_03 5:32

So you can get those ERMAs reduced. So you need to do it uh kind of there's almost like this two-year forgiveness period for lack of a better term. It's not really forgiveness, but it's just allows you to use that life-changing event of retirement, which is the most common. Right. Um, and then get that IRMA appealed. So the biggest ways we see you know people get charged this tax, this IRMA, is just from income. That's probably the biggest thing, right? Oh, I just I made above the threshold. So you're going to you're you're gonna need to appeal it if you retired, right? And then that you'll probably win it.

SPEAKER_00 6:07

Yeah, and if your income was affected by your retirement, meaning it went down, you you will win the appeal.

SPEAKER_03 6:13

Yeah, exactly. So then if you're going if part if you're working with a financial planner and part of that strategy is, hey, we're gonna pull money out of do one of two things. Either pull money out of an IRA or take IRA into a Roth conversion, meaning you're taking it from a pre-tax account, you're paying tax and going to put it in this thing that you're discovered. Yeah. Either way, whether it's a defer uh uh distribution or a withdrawal from an IRA or a Roth conversion, it's gonna be treated as income. And so if that's part of your strategy, you need to do that around that time when you're going to be retiring as well.

SPEAKER_00 6:50

One or two years before.

SPEAKER_03 6:52

One or two years before.

SPEAKER_00 6:52

Exactly. Right, because they're gonna look back too, and I can give them current numbers. Aaron Powell, how about selling a house? Okay. Well, when you when you sell a house, first of all.

SPEAKER_03 7:01

Trevor Burrus, Like I was reading a story yesterday about somebody who bought a house in 1996 for $67,000. They just sold it for $1.2 million. Right? That's maybe they put a little bit of money in it. So let's say maybe their basis was $200,000. That's still a million dollars of equity gain. How does that happen into all this at all?

SPEAKER_00 7:19

Well, as long as they lived in that home two of the last five years and owned it, uh then they would can exclude a single person can exclude up to $250,000 of profit. A married couple filing a joint return can exclude up to $500,000. But anything above those exclusion limits then will still be treated as capital gains.

SPEAKER_03 7:38

Does that come into the Irma calculation? Absolutely. So let's say this person got a million dollars worth of equity of capital gain. They're able to exclude $500, because let's say they were married. Right. And so they've got an additional $500 that's going to go on their income in that year. Now, if they do that in the year that they are retiring, one or two years before. One or two years before it. That's right. They can appeal it. Because it the Social Security doesn't care where the money comes from. They just care that you had a life-changing event. So if you coordinate all that, boom, you're fine. You can appeal it, get that Irma tax dropped off. But if you don't, right, and you just continue working, or maybe you retired five years ago and now you go ahead and sell that house. That's going to be counted as income.

SPEAKER_00 8:23

That's exactly right.

SPEAKER_03 8:24

And there's not anything you can do about it. That's right.

SPEAKER_00 8:26

It has to one of any of those events that we get to use that would be financial, as long as it happened one or two years prior to our life-changing event, then we have an appealable offense. Trevor Burrus, Jr.

SPEAKER_03 8:36

Okay. Let's let's fast forward the clock a little bit. So there's a lot of things uh or a lot of there's something that a lot of people don't realize, and this topic called required minimum distributions. Um that's basically where the government says, hey, you've been saving money in your 401k, you've been saving money in your IRA or your 457, your TSP, whatever it is that is in a tax-deferred account, meaning you put in the money, you haven't paid taxes yet. And the government says, Hey, great, you did this for a long time. We need some tax revenue off that. So at 73, they force you to start taking money out of those accounts. And it starts around 4%. So if you had a million dollars in that, you're at $40,000 that you have to take out. Whether you need it or not. Yeah. So if you have Social Security and a pension and an additional $40,000, that's going to push a lot of people over that limit. So between now and then, part of your planning can be, and we can help you with this. We have a financial planning team here at MedicareSchool.com that can help you. Um, we've been doing that for 15 years. You can do some planning now to say, okay, what if we pull some of that money out for the next six, seven years between 65 and 73, and lower, get some of that money out to the point where whenever we hit 73, we're not there's not so much money in there that we get pushed into Irma land. Exactly. Right? So you can kind of look at this as the retirement thing that's happening now, but if you have sizable account amounts of money in the a tax-deferred account, you need to start thinking about that now. Are there steps you can be making? Because no one wants to get into 73 and realize that, oh, my Part B premium went from 2029 up to $400. Like that's just, you know, all because the government's forcing you to take money out of your accounts. Right.

SPEAKER_00 10:30

So anything that we would do one or two years prior, uh, they will not hold against us if if indeed we have that life-changing event.

SPEAKER_03 10:38

But in the future, that's right. Or if you've retired five years ago and you sell your your house now or do a Roth conversion now, you're I mean, you're kind of out of luck. Let's get to a caller. Uh, we've got Greg in Pennsylvania. Greg, welcome to Medicare School Daily. What is your question, sir?

SPEAKER_01 10:58

Yes, uh it's kind of confusing, so bear with me. Okay. I had a uh PET scan done earlier this year, and uh I had a doctor send me a bill for $21.55, and the hospital sent me a bill for $283. I already paid the the $2155 because that bill became about a month two months before the hospital bill. Having a supplement plan, I don't know what the $21.55 is for.

SPEAKER_03 11:29

Do you have a plan G?

SPEAKER_01 11:32

Plan N in Taline.

SPEAKER_03 11:34

Okay.

SPEAKER_00 11:39

Okay, so well well the 283, uh, that's this year's deductible, so that sounds very accurate. Uh so what what I would do to correct the problem is this I would call the insurance company. Who is your insurance provider, Greg? Humana. Humana. Okay. So you have a seminal plan with them? Yes. Okay, very good. So I would call the Humana Customer Service Department because they they will keep very precise, accurate records, and you can tell them tell them what happened. Uh so probably what what you you probably should not have done is paid that that maybe that $21.55. Um but it could have been the very first bill that came through, so that's what they processed. So I'm assuming that what happened was they they um uh that must have been 20 percent of whatever that particular visit was was uh uh you know bill debt. That's that's my guess. But listen, uh to have no no questions, call Humana and they will tell you exactly what to do. And it could be that um you'll you'll get a refund from someone. I think that's what'll happen.

SPEAKER_03 12:40

Assuming you had not already paid your part B deductible earlier in the year, is that correct?

SPEAKER_01 12:46

Correct. I I know that the tw the bill from the hospital 283. Oh, I called the uh Humana and they agreed with me with what you're saying that the the 2155 should be applied to the deductible. So I should only owe the hospital the difference. When I call when I called the doctor that charged me the 2155, he says that's his that's his copay for reading the he and he's the one that interpreted the PET scan.

SPEAKER_00 13:18

Okay.

SPEAKER_01 13:19

And I'm thinking if if that's the copay, then why did he charge me $2155? He should only be charging me $20, correct?

SPEAKER_00 13:26

Well, the truth is he's really you're not even eligible. I mean, you're not even required to pay him anything, because the copies are for when you actually see someone that's a primary care doctor, that's a specialist. Uh that's when those copies come into existence that would that cannot exceed $20. Uh so he should have been paid entirely the 20% coinsurance uh by the uh by the plan, by Humana. So that's how that should have happened. Yeah, there's only like 15 codes that the that that uh a copay actually applies, but it's when you actually see someone face to face. So if he if he read it, that should have been covered by coinsurance.

SPEAKER_01 14:03

Well, I also called the hospital about the the 283, and they told me that's my deductible, and I told them I already paid $121.55 towards that. And they said that doesn't matter. You still owe us the deductible. What the doctor charged you is his copay.

SPEAKER_03 14:18

Yeah. Okay. There's no chance there would have been a doctor copay involved in that?

SPEAKER_00 14:22

Well, no. Well no, because he didn't he didn't see that doctor. So that the You never you never met with this doctor? No. No, no, I could see. He just interpreted that. Yeah, yeah, yeah. I I could see how that would we anything that doctor did could be applied to the to the to the uh you know to the deductible, but it would have been more than 2155.

SPEAKER_03 14:41

Right.

SPEAKER_00 14:42

So I'm just saying you you you should not owe a copay for that service. However, Greg, here's what you're gonna have to decide. Uh I my my view is I would I would fight it if I were you a little bit, and then I I would just I'd walk away. Okay, it is not worth the frustration.

SPEAKER_03 14:58

Yeah, I mean you could look at it as though it's a $20 copay and they charge you a buck fifty five extra.

SPEAKER_00 15:02

That's probably the way I would view it. And I'm not minimizing, you know, the frustration because you I'd be frustrated if I were you as well. But uh you start fighting. You start start trying fighting these things, and sometimes you never win it. It's like, hey, go play with your grandkids, go have a good go you know, go have fun doing something instead of fighting these providers.

SPEAKER_01 15:21

Humana did tell me they'd resubmit the bill.

SPEAKER_00 15:24

Yep.

SPEAKER_01 15:24

And which they did, but the hospital still says no. You owe me two eighty-three.

SPEAKER_03 15:29

Well, I mean, you're gonna have to pay that you have to pay that two eighty-three deductible anyway. Yeah. Correct. So yeah.

SPEAKER_00 15:36

Yeah. Who really owes you the money is that doctor for the 2155. That's what that's that's what should happen. So I'm just saying good luck on that. I I feel you're paying on it, but uh, yeah. I'm I'm glad it wasn't multiple hundreds. Go ahead.

SPEAKER_01 15:51

Here's here's another question I have. I was told by the hospital that this doctor is non-participating. Oh. So is is he is he allowed to is it is he allowed to charge me an excess fee? Sure is.

SPEAKER_00 16:14

Well, here go ahead. Does it mat does it matter if my PCP referred him? No, no, it really it really does not matter. But yeah. So that that could be it. What's interesting about that though, he he you he is a physician. Is is that okay, he is, yeah. So only physicians can add excess. So that that really could be it. That's interesting.

unknown 16:36

Yeah.

SPEAKER_03 16:37

Because he could show you. Yeah, you should find that out. If that if ask him if it pushes him on the Humana, if that's an excess charge. And you and you live where? Where do you live? Pennsylvania. Pennsylvania. Oh, yeah. Well, wait, did it happen in Pennsylvania?

unknown 16:52

Yeah.

SPEAKER_03 16:52

Like does that doctor live in Pennsylvania or is he off the online or something?

SPEAKER_01 16:56

That I don't that I don't know. All I know is I sent the bill to Indiana. Oh, so this is a I don't know if that I don't know if that's a third-party administrator that I sent the bill to or what? I don't know.

SPEAKER_00 17:09

Yeah, well, you think the provider, though, you know, in in Pennsylvania shouldn't be able to add excess. Go ahead. Why couldn't he? Well, because it's one of the states.

SPEAKER_03 17:20

Indiana still doesn't have access. No, Pennsylvania. I know. But if you go across the state line, they can charge excess.

SPEAKER_00 17:26

But he didn't. He just think the administrative of the billing department came from out of India.

SPEAKER_03 17:30

I wonder if that doctor was.

SPEAKER_00 17:32

Have you talked to them about that? Did you talk to the uh billing department?

SPEAKER_01 17:37

Yes, I did, but they told me I had to call my insurance company. Okay, yeah.

SPEAKER_03 17:44

The thing to know is that, you know, with the Plan N, uh you you know, most people in Pennsylvania, or a lot of people in Pennsylvania do choose a Plan N because there is no excess charges. But anytime there's a service performed in another state, they can still charge an excess, and when that happens, you're responsible to pay for that.

SPEAKER_00 18:00

But that's not his situation. He went to He went to Pennsylvania.

SPEAKER_03 18:03

I know, but maybe the doctor who read it was in Indiana because he paid a bill to Indiana.

SPEAKER_01 18:08

Exactly. Well, is my participating hospital allowed to go out of state to get the doctor to read the bill?

SPEAKER_00 18:16

Yes they can. I've never heard of it. I just never have heard of that. But uh that that could be the issue. He had a couple things going on there.

SPEAKER_03 18:22

Well you should sort this out with human and then call us back and tell us. Because I I really think it makes all of you know, it makes everyone smarter to understand how these little nuanced things work.

SPEAKER_00 18:32

Yeah. Yeah, but this is a new one on me for sure, Greg. So um All right. Anything else, sir?

SPEAKER_01 18:39

I'll look at but like you said, I mean, it's a dollar fifty-five, and it's not worth you know, credit.

SPEAKER_03 18:45

I think the lesson, I think the lesson could be bigger if there's something with non-participating and then excess charges. Uh you know, just a good I mean, you're gonna be on Medicare for probably 30 years or who knows. So it'd be good to know these things.

SPEAKER_01 18:57

Well, I was all yeah, I was also wondering, I mean, if this is something that just happens and I gotta live with it, who how many other people are they doing this to?

SPEAKER_03 19:06

Yeah, absolutely. Yeah. Well, uh do a little research, let us know. It's very interesting. I I will do that.

SPEAKER_00 19:13

But we kind of we kind of nerd out over this. Yeah, yeah. Stay in touch, Greg. We'd we'd love to hear how this uh works out. Wish we could help you.

SPEAKER_01 19:20

I I've learned a lot just listening to MedicareSchool.com. That's why I question all this stuff.

SPEAKER_00 19:25

All right. Well, good. We're glad we've been a help, and now we're ready to learn from you. Let us know what happens. Thanks. Take care, Greg. Okay, I will. Thank you very much. Have a great day. Thanks for calling. Bye.

SPEAKER_03 19:34

A lot of people that are in these states where they don't, you know, if you're if you live in one of the states, what are the states?

SPEAKER_00 19:39

Okay, they are New York, um, uh Ohio, Rhode Island, uh, Pennsylvania, um I'm gonna say Minnesota, Connecticut, and Vermont, I think. Okay, yeah, no, that sounds right.

SPEAKER_03 19:52

Yeah. So if you're in one of those states, there's not an excess charge that's applicable. And what is an excess charge? An excess charge is uh if you see a non-participating, meaning the doctor does not take Medicare assignment, and you have a uh which Medicare assignment is just jargon for saying Medicare is going to pay $100 for this. The doctor can participate in that, or the doctor can not participate in that. How many doctors participate in that?

SPEAKER_00 20:17

95% at least.

SPEAKER_03 20:18

So then there's five percent of doctors that are non-participating. I mean whatever Medicare pays, they say, nah, that's I'm not gonna have this contract, I'm not gonna do that. So then what happens is that non-participating provider says, I'm going to accept $95, right? 95%, right? $95 from um Medicare, and the other 15% I'll with bill, they can bill up to 15% directly to you, right? Directly to the person receiving care. And so if you're in one of those states that um doesn't allow doctors to charge excess, that extra 15%, um, a lot of people will go with a plan N, right? Because they think, hey, my state doesn't allow excess charges, so I'm gonna get a Medicare supplement plan N, because the doctor's never gonna charge that, right? The reality is that's true for um doctors that are in that state. But if you ever cross the state line, a lot of us live in cities where you may get care on both sides of the state line. And if that other state across the state line doesn't have coverage or doesn't have this, you know, no no excess charge rule, and you have a plan in, you're still gotta pay it. Right? And so I think that's maybe the lesson here.

SPEAKER_00 21:33

It is it is excess charges are rare, yeah, uh for sure, but when they occur your responsibility, that's exactly right.

SPEAKER_03 21:41

Okay, let's talk to John from California. John, welcome to Medicare School Daily. What are your questions, sir?

SPEAKER_02 21:49

Yeah, so my question is is my uncle's turned to 80. Okay. And he's not very healthy. Um his United Healthcare PPO in California. Yeah. Cancelled his county in January. And he switched to a terrible advantage provider. Okay. An HMO versus an PPO. Um what carrier? Because there's not United Healthcare.

SPEAKER_03 22:16

Okay, so just switched from a UHC PPO to UHC HMO.

SPEAKER_02 22:21

No, he actually they uh they they don't even have an HMO. Oh, what oh I thought you said he got carried to an HO.

SPEAKER_00 22:30

Oh, okay. So UHC was his provider, they just dropped it completely.

SPEAKER_02 22:35

Yeah. Okay. Okay, who now he's on. Go ahead. No, you go ahead.

SPEAKER_03 22:44

No, it's what are we gonna ask? We were just gonna ask what carrier what carrier is he on, this HMO. What did he get moved? What did he move to?

SPEAKER_02 22:53

I have no clue. It's a really small one I've never ever heard of. And it's in a really so it's it's a really small county uh and it's it's not really well populated. It has a large population, but not a huge population. So can he get out of his um plan? Can he go switch over to plan G or Plan M or HCG without underwriting?

SPEAKER_00 23:20

No, he cannot. Uh so I'm assuming he's been in the advantage system for some time. Would that be correct, John?

SPEAKER_02 23:27

That's what I think. Okay. At his age, he's not real clear.

SPEAKER_00 23:32

Yes, sure, sure. Understand. Okay, so when when they when they when the plan is dropped, he did have a period of time where he would have had the right to be able to go to a Medicare supplemental plan without underwriting. Um, but uh he's probably has probably lost that right now because he went back into another advantage plan. So I would say that he's he's probably on that. What's his health kind of uh does he have diabetes? Does he have heart issues? Does he have lungs like COPD problems, anything like that?

SPEAKER_02 24:04

Uh he has diabetes and he has uh uh CPAP and we he's at a yeah, go ahead.

SPEAKER_00 24:12

Okay, that's good. That that's probably enough. So is there any any chronic plans there? Yeah, there there is. Okay, there there is there is a type of plan he could move to. Uh this is an election that can be made uh once a year uh so he can move to what we call a chronic uh special needs plan. And and we'd be happy to help him with that to look at the details. I'm not saying that that's what he needs to do, but I think it is worth exploring to see what his medications are, his doctors, his hospitals, and all that, and then we can see if that would be a good fit for him. Um no, are you his power of attorney or you're just assisting him because he's a relative?

SPEAKER_02 24:50

I'm assisting him because he's a relative.

SPEAKER_00 24:52

Okay, very good. So what I would recommend doing is if you can do make like do a three-way call into our office, and you can ask for an agent, and then uh an agent can go through all of his meds, his doctors, and we can see if moving to a chronic special needs plan would work. Now I'll explain something to you on this, John. A chronic condition, of course, and and diabetes is is is one of them and and the most common. Um we we would have to eventually, I think think if it's what, Josh, 30 or 60 days, then we actually have to have that verified. There's a form that the doctor fills out to say, yes, indeed, he has this uh chronic condition. And then that allows him to stay on that plan. And and they're really fairly attractive. Uh but again, I I don't know enough about his present plan to tell you a chronic plan would be better, but it's very likely that it could be. And we'd be happy to explore that option if you'd like. What do you think, Josh? Yeah, yeah.

SPEAKER_03 25:44

So the the the carrier what you might do, I'm gonna I'm gonna say something slightly different. So there's two there's two carriers in his zip code that offers uh chronic special needs plan. One is called alignment. I don't know if you've ever heard of that carrier, and one one is called Imperial. Um and I think with both of those, you have to go directly to the carrier to enroll. So I want to give you their phone numbers. The first step, there's there's there's three things. I think the first one is um will they will he qualify based upon his health conditions? And it sounds like he probably will. Like alignment has one that's called alignment, health, heart, and diabetes care. Right? There's there's there's three different options here. So can he qualify? The second one is are the providers that he needs to see covered? In the network. In the network, right? And then the third step is of between alignment and imperial, do you know his medications?

SPEAKER_02 26:55

No, I don't at all.

SPEAKER_03 26:56

Okay, so we yeah, you're just gonna need to say, okay, here's the meds, tell me what he's gonna have to pay um for them. The good news is if he's on a bunch of expensive meds, it doesn't really matter as long as they're in the formulary, it caps out at twenty one hundred dollars for the year in terms of his actual out-of-pocket.

SPEAKER_00 27:13

Um He's not on Medicaid by chance, is he, John? Medicaid?

SPEAKER_02 27:18

No, he's not.

SPEAKER_00 27:19

Okay. Yeah.

SPEAKER_03 27:24

Okay. So I would let me I'm gonna give you alignments. I'd probably I'd I'm gonna give you two different phone numbers and then I would call and chat with them. This is gonna be the only opportunity he's gonna be able to move kind of in the middle of the year.

SPEAKER_00 27:38

And let's tell him why, just because he yeah, he's beyond what we call the the Medicare Advantage OEP. We just finished it at the end of March. He could have moved January 1 to March 31.

SPEAKER_03 27:49

Yeah, yeah. So you you're you know, about you know, 40 some days or 36 days outside of being able to actually change just into a normal plan. So the only plan he can get is one of these chronic special needs plans, which do work out pretty well. So the phone number for alignment is you got your pen ready? Yeah. Okay, it's eight eight eight nine seven nine two two four seven. Okay, that's the phone number for alignment.

SPEAKER_02 28:17

That's probably 979-2247.

SPEAKER_03 28:21

888-979-2247. And both of their C SNP plans, chronic special needs plans, are both four stars. So four out of five, that's a very good star rating for a plan. Hardly any plan ever has a five-star plan. So I would both of those look good. Um the Imperial has a three and a half star rated plan. So I would probably go to this secondly. Uh, you know, like I would look at this if the alignment doesn't make sense. And their phone number is 800-838-5914. 800-838-5914.

SPEAKER_00 29:00

Yeah. So it all boils down to are his doctors in the network and are his medications covered well by the plan? And does he qualify for the plan based upon his health conditions?

SPEAKER_03 29:09

Like you need to ask that. Yeah. Probably will, but don't assume.

SPEAKER_00 29:12

Yeah. So they're called Chronic Special Needs Plans, Special Needs Plans. And so we just use the acronym C SNP, SNP, Chronic Special Needs Plan. And so uh he could move to one of those uh, you know, if if indeed he's uh eligible and he likes the plan. Otherwise, he's gonna have to stay where he is, and then uh you can help him move later this year, which would be October 15th through December the 7th.

SPEAKER_03 29:36

Yeah. And if he the reason I'm giving you their direct phone numbers is because we we aren't able to represent those two plans. If neither of those work out, call us, because we have the rest of the market that's available, call us during the annual enrollment period, which would begin October um 15th, and then we can say, okay, uh beyond these chronic special needs plans, is there something that's going to make more sense? Maybe a PPO or something that that is a little um uh you know just more expansive and will work for him. So I think that's your best best plan. How's that sound? That sounds great. Yeah. Yeah, these are just regional. Do they have any special exceptions for what? Yeah.

SPEAKER_02 30:21

Uh for switching for his birthday or anything?

SPEAKER_03 30:25

No, no, because he's not on a Medicare supplement plan already. There is a there is a rule that allows people to switch in California from one supplement plan to the next one. But you gotta be on one.

SPEAKER_00 30:36

Right. So yeah. Oh, okay. Yeah. His only opportunity would have been after United Healthcare canceled him, he'd had a chance to go to uh a Medicare supplemental plan. But sometimes people have the right to move to a supplemental plan, but they don't have the money to be able to afford the premium. So I'm not sure where he stands financially, but again, I think that that window is already closed on you.

SPEAKER_02 30:57

Well, that was in January that he switched. You mean that makes a difference?

SPEAKER_00 31:03

Well, do you mean that yeah, they terminated the plan, I'm assuming December 31. Is that correct?

SPEAKER_02 31:11

Uh that could be.

SPEAKER_00 31:12

Yeah, and and then normally what they do is they give you they give you 60 days to move uh to a submodal plan under guaranteed issue right. Uh so I'm saying that would that probably would have ended at the end of February. So anytime an advantage plan is terminated, then you have a right, guaranteed issue, no underwriting to return back to original Medicare and get a submodal plan. Now for him, because of how old he is, he had had to get a plan F. Uh and those can be you know kind of pricey. He would not have been get a G or an N plan. Okay.

SPEAKER_02 31:45

So uh okay.

SPEAKER_00 31:47

But this is a viable option, it really is, unless you know Alignment or Imperial does not have a plan that is going to take care of his needs, you know, docs and meds, hospital choices.

SPEAKER_02 31:58

Right.

SPEAKER_00 31:59

But I think it's well worth the call, John. You're you're welcome. Glad to be of help. And if they again, if they can't help you, uh just give us a call later this year, we'd be delighted to to come alongside him and see if we can improve his uh situation.

SPEAKER_02 32:13

Okay. Well, thank you very much for the advice. I appreciate it.

SPEAKER_00 32:16

Nice, nice to talk to you. Appreciate that. Thank you.

SPEAKER_03 32:18

Take care.

SPEAKER_00 32:20

Thank you. Bye.

SPEAKER_03 32:23

If you are a Facebook user and you like interacting with other folks uh to learn uh from their experiences in Medicare and learn from people who aren't just um trying to sell you something like a lot of the Medicare experts are in today's world, I want to invite you to pull up your Facebook app and type in Medicare School Community. Medicare School Community is a place that's got, I think, 60,000 people in there. Um some are customers of MedicareSchool.com, but many are not. And it allows you to be able to go in there, type in your question, and get answers from real people that are on Medicare. We do have one team member that is in there that's kind of moderating to make sure things don't get out of hand or everything becomes political or people are giving bad information. Uh but this is really a good opportunity for you to talk to other people, connect with other people, get your questions answered about what's really going on out there in the Medicare world. So pull up your Facebook app, uh, type in Medicare School Community, uh, and then you'll see our group. You'll have to answer a couple of questions, and you will be able to join and uh start interacting with folks right away. We've got a question in here we're gonna answer from yesterday. Uh Melissa Matthews uh says, Does Medicare cover chiropractic care? I think I read somewhere that it covers an adjustment.

SPEAKER_00 33:40

Okay. All right. Well she is correct. Uh Medicare will cover adjustments of the spine only, and that's it. Other than uh some chiropractors will do acupuncture. And Medicare does have uh uh some acupuncture coverage. It's I think it's 12 treatments a year. There has to be progress. They have some rules with it, so it's not just across the board we will cover acupuncture, but they will also sometimes. So uh when it comes to the adjustment of the spine, it would be 80-20. Uh Medicare is going to pay 80 percent, then you as the patient would be responsible for 20 percent, unless you had, of course, a submental plan that would uh cover that for you. But it's an 80-20 uh type of a situation.

SPEAKER_03 34:19

But just an adjustment, an adjustment of the spine. I don't know what else the chiropractor does. Trevor Burrus, Jr.

SPEAKER_00 34:23

Well, uh well, oftentimes chiropractors could do other types of therapy, they could do traction, they could do x-rays, all that is not then. Not gonna be covered. Just an adjustment at the chiropractor. Exactly right. And it can be a carpunction. Exactly right. Yeah. So even if the chiropractor takes Medicare, it doesn't mean the services you're gonna get at the doc's office will be covered other than the adjustment. Okay.

SPEAKER_03 34:44

So uh how about how does this differ if you take a supplemental plan, like a plan G or a plan N versus an advantage plan?

SPEAKER_00 34:53

Okay. Yeah. What's gonna happen with the advantage plan is uh they'll cover adjustments as well, it'll just come with a copay. And normally it's twenty or thirty dollars. Okay. Uh so you'll pay a copay where if you if you did go to the chiropractor like I do, I have a G plan. And uh going to chiropractor doesn't cost me anything. Trevor Burrus, Jr. Yeah, I've got to do it. Because we dumped up, yeah, of course. If you had a plan N. Okay. Yeah. Plan N, it probably you'd have to pay up to a copay of twenty dollars. Aaron Ross Powell, Jr.

SPEAKER_03 35:20

So a plan N and an advantage plan would likely have a very similar out-of-pocket outlay. Trevor Burrus, Jr.

SPEAKER_00 35:25

Exactly. Yeah. The difference would be, though, Josh, would you if you're on Advantage, you have to make sure that chiropractor is in a network.

SPEAKER_03 35:30

Trevor Burrus, Jr.: Not only it does it accept Medicare, but is it in that plan's network? Trevor Burrus, Jr.: Exactly right. Yeah.

SPEAKER_00 35:34

And there are a lot of docs, uh, Medicare uh you know, chiropractor that will take Medicare for sure.

SPEAKER_03 35:39

Okay. But if you have a plan G, is there a cap to the amount of visits that Medicare will cover? Like some I I like chiropractors, I go to a chiropractor, but sometimes chiropractors kind of feel like you're in an annuity to them. Like, you know, you got to come every single day for the next 12 weeks. I mean, it's a lot. So in that sort of a scenario, the best coverage would probably be a plan G, because once you've met your deductible for the year.

SPEAKER_00 36:02

Yeah, I've never read anything where there's a limitation that it of course has to be medically necessary. So however often uh Medicare says it would be allowable for you to go. Uh I've never had a client ever complain about coverage with that at all.

SPEAKER_03 36:14

Yeah. That's interesting. Okay. Good question, Melissa. Violet Rose. It's a beautiful name. Probably a fake name. Violet Rose. And she's got a picture of her bird as a profile photo. Says I recently switched carriers for my Medigap policy. I had a doctor appointment the day before coverage ended on the old one, and then the next one started. Right. Does the old insurance company cover doctor charges that occurred during their coverage period? Or are those charges covered when Medicare has processed them? Good question. Just curious because I would have met by deductible with the old plan, but not with the new high deductible plan. Wow. Okay. Well, let's just answer the first question.

SPEAKER_00 36:53

Okay. Yeah. First off, you uh it's very simple. Date of service. Date of service. Okay. Exactly right. So date of service, whoever you had that day is the one that's going to be responsible for that bill. Trevor Burrus, Jr.

SPEAKER_03 37:03

Then she switched to a high deductible plan. So that's an interesting question. Uh that I've I've kind of wondered. And maybe this is more of an advantage plan question, actually. So if you let's say, because a lot of people will switch um during the OEP for Medicare Advantage Plans, which runs from January 1st to March 31st. Let's say they did something in the month of March. They switched their advantage plan from March, you know, i in March to start in April. How is the maximum out of pocket calculated? Because let's say they were on a plan for three months and had a $4,000 max and they spent $2,000 of that.

SPEAKER_00 37:40

It does not carry over. It does not carry over. Yeah, you have to start over when you change those plans for sure. Because it's tied to that plan. Now, if someone in let's say they someone were to move Metsups, then that deductible would still apply because that's a Medicare deductible. And then so it's already been satisfied. But how does it work with drug?

SPEAKER_03 38:00

Of course, you wouldn't change drug plans middle of the year.

SPEAKER_00 38:03

Yeah. But drug plans would would be accumulative if you had the if you did have the right to change it. I guess you could if you moved.

SPEAKER_03 38:09

Well, so let's say somebody moved. Many people moved.

SPEAKER_00 38:12

They'd still be underneath the max out-of-the-art.

SPEAKER_03 38:18

So if they were with Humana in Texas and they moved to Florida and they're with United Healthcare now.

SPEAKER_00 38:24

Yeah. I believe I believe that it's the total $2,100 would apply across the board.

SPEAKER_03 38:29

Because the Medicare is like keeping track of that kind of behind this scenario. Exactly.

SPEAKER_00 38:32

Yeah, but the reason the advantage plan would change because it's just tied to that particular plan.

SPEAKER_03 38:37

Hey, if you have a situation like this where you've switched plans middle of the year, we'd love to chat with you because I think it's a great opportunity for you to share and for us to help everyone who listens to us and help all of us get smarter by knowing exactly how some of these deductibles and stuff have carried over in your experience. There's a lot of different insurance carriers, there's a lot of different plans and a lot of different stories and things that we, you know, help people work through. So if you're in that situation where you've changed plans middle of the year, expecting your deductible or maybe your max out of pocket or your cumulative drug expenditure to um to carry over and it didn't, we'd love to hear about that. Uh it's an opportunity for all of us to learn.

SPEAKER_00 39:19

Josh, we I've had this happen plenty of times. We've had people that um were working and had a cancer diagnosis uh and just under and and and underwent treatment while they were still working, but then retired because the cancer is very serious, and then they go on Medicare. And so as soon as their Medicare begins, that Medicare is going to start covering those cancer bills, the treatment bills. Uh group plan would have been responsible uh for anything, you know, during that that particular date of service. But a lot of people worry about that. Well, I'm I'm and it's a cancer treatment. Can I go on Medicare? Yes. From day one moving forward, uh, Medicare will cover those.

SPEAKER_03 39:53

Uh had an interesting situation. Uh was talking with someone and they had were in the middle of service, and uh service switched over. They were supposed to go have um some treatment done, um, but went to get the treatment and found out that it was an advantage plan, found out that that treatment that was scheduled the previous month, they'd been going to see this person, all of a sudden wasn't a network. Right. And so now they're showing up the place and the insurance company saying, No, you can't see him. That's right. It's just crazy. Yeah. That doesn't happen if you're on original Medicare, but it definitely put a big wrinkle and a delay in their whole treatment cycle because then they had to sit around and wait. Um find new doctor, find a new doc, get assigned somewhere else, and you're in the middle of treatment. So it's just very, very scary sometimes if you're in the middle of treatment making those plan changes.

SPEAKER_00 40:41

Yeah, that's why when you look at something as a zero uh premium on it, yeah there's usually some catch to it. And that would be a network, and there can be difficulties.

SPEAKER_03 40:52

If you are confused about your Medicare options, uh maybe you're on a supplemental plan that's gone up in price, maybe you're on an advantage plan that you can't see your doctors, uh, or maybe you're brand new to Medicare and you're just learning, you're just starting out, but you need coverage. You know coverage is gonna start in the next month, two, three months, whatever it is, that's you. We would love to help you personally. Um, when you call our office, so we we not only do a lot of education, we actually have an insurance brokerage. Um my dad and I have been helping people with Medicare for the last 15 years. Uh, we're located in in uh the heart of America in Kansas City. And when you call us uh to get help with setting up an advantage plan, setting up a supplemental plan, getting drug coverage, whatever it is, you call in, you're gonna talk to someone that's right here in our office, uh, that you will have um that you'll be able to communicate with them. You're not going to somewhere else across the world with a language barrier. You're gonna be able to talk to someone that's trained by my dad. Um, and it's just a great opportunity. We consider it honor to help everybody that we get to help. And you don't pay us anything extra. We can't surcharge you for insurance. All of those insurance carriers that are filling up your mailbox that are uh, you know, buying ads on TVs and hearing ads on the radio, we write for these carriers and we're able to sit down and compare all these options. I look at uh advantage plans with people when they call in and put tub of their zip code, and there's 68 different options somebody had yesterday. How in the world do you decide between 68 different options? Well, we know how. And we figured out how to make this very, very simple. So if you need help, our services are free. We don't work for free, we're paid by the insurance companies, but we don't cost you anything extra. And our value, I truly believe what you can expect to get from us is not only are we going to help you uh sign up for your plan, but you're also assigned a dedicated client care manager, we call them. And this is somebody that if you move, uh if you uh uh have a billings issue, if you have a claims issue, if you lose your ID cards, whatever it is, we are here to help you, um, not only at the beginning, but also for life. And it's the way we've set up our company, it's the way we've tried to do business for the last 15 years. You can look at us on Trustpilot, Facebook, Google. We've got thousands and thousands of five-star reviews. Um, and we would love uh to help you. So if you would like help with that, you can call in, schedule an appointment with someone from our office. Doesn't matter where in the country you live, uh, we're able to help you in all 50 states. That phone number is 800-782-667-6800-782-6676. Uh, we'd consider it an honor and a privilege to help you. So on Monday, uh, we'll be back. We're gonna be talking about why your first two years of retirement are your biggest risk. We're bringing uh one of the guys that works at our company, the uh gentleman who leads our financial planning division. We're gonna bring him uh and just have him share with you guys a little bit of why the first couple years of retirement are the biggest riskier years that you don't want to mess up. So uh make sure you join us. Uh we'll be back here Monday at 11 a.m. Central Time to noon, just like We're here every day, 11 to Central Time, taking your questions, uh, sharing just a little bit of what we know so that you all can do Medicare just a little bit better.