Why Medicare’s 20% Coinsurance Is So Dangerous… And What To Do About It

Medicare School Daily airs Monday–Thursday, 11 AM–12 PM CST.

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For immediate Medicare enrollment assistance, call our team at 800-782-6676

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Many people are surprised to learn that Original Medicare generally covers about 80% of approved medical costs, which means you may be responsible for the remaining 20% with no built-in out-of-pocket maximum.

On today’s Medicare School Daily, we’re breaking down how Medicare’s 20% coinsurance works, where people commonly run into unexpected expenses, and why this becomes especially important during larger or ongoing medical situations.

We’ll also talk through how different types of coverage approach these costs and what people should consider before enrolling.

We look forward to taking your calls!

Transcript

SPEAKER_08 0:03

If you're retiring uh soon, or maybe you've already retired and it's time to start living off your investments and go on Medicare, uh, there are a few mistakes that we see people make uh pretty consistently. The first two years are the times that most people will make the biggest mistake, mistakes that affect their retirement. Uh so today you're gonna learn about what those big mistakes are so that you can live not only for a couple years, but your whole entire retirement and make it very, very comfortable. I am joined in the studio today by uh the gentleman that leads our financial planning team here at MedicareSchool.com. His name is Eric. Welcome. Glad to have you here. Great to be here. Yeah. So you guys are gonna get to learn a little bit from somebody who's been doing this for the last 30 years, and uh, you'll learn a lot, I am confident. If you want to be a part of today's show, if you have a question for us, call in. We'd love, love, love to chat with you. It's your opportunity to really get your questions answered in a non-sales environment. We're obviously not gonna sell you anything on a live stream, but it's your opportunity to call in, get your questions answered. Medicare is confusing, Social Security is confusing, retirement planning is confusing, income planning, taxes, all of these things are difficult. And when you uh retire, you've got to make sure that you do it right. So that's what we're here for. You've come to the right place. Thank you uh for being with us. So, Eric, please share with me, share with all of us just about what happens in the first two years that can really derail a retirement.

SPEAKER_00 1:41

Yeah, let's let's talk a little bit about that exciting two years, right? Big decisions to be made. Imagine that uh first day of retirement. You uh a lot of people, I think they kind of echo the sentiments of Dr. King when they say, free at last, free at last, right? They put in all this time, their careers behind them, and now they got this whole bright future ahead of them. There's a lot of things that are going through people's minds at that time. They're thinking not only about Social Security, security and Medicare, they're thinking about if they possibly have a pension, 401k, what do we what do they do with all this? But really, truly, deep down inside, they're thinking about bucket list. Yeah, there you go. That's right. And and uh there's statistics to back it up. So they have a list of things that they want to do that they've kind of been putting up because they've been working their whole life, and now they have time and they have money, and usually when you add those two together, it equals spending. Yeah, yeah, it's true, yeah, yeah. And uh the bucket list items, you know, it can be anything from house repairs to a new car. RV travel is a big one right now. A lot of a lot of people driving around buying RVs, driving RVs. They are expensive, they are expensive, yeah, yeah. But they love them, they love them, and it's a great way to see the highways and the byways of the United States in particular. But uh, visit family, all of these types of things that they they've been put on this bucket list. So if you think about that first day that you're retired and you're looking out at this bucket list, you gotta think what's this gonna cost, right? Yeah, and where does this money come from to pay for it? Am I gonna pull this out of savings? I'm gonna pull it out of 401k. There's all these different things.

SPEAKER_08 3:27

All these things.

SPEAKER_00 3:28

Absolutely what are the tax implications. So let's talk about that statistically a little bit. Okay. Yeah. So let me throw some numbers around this. So I've read various numbers on this, and it's about 77% of Americans when they go to retire, they experience this thing called the freedom surge. Okay. Okay. Freedom surge. I never heard of that. Yeah, the freedom surge. So that's that time plus spending and the bucket list, and that's that's what they're doing. And it makes perfect sense because you're young enough, you're healthy enough to do all these things, you've been saving up to do these things, so you might as well do them. And we never want to dissuade anybody from enjoying retirement. That's that's uh what we want to do is just make sure that they don't make mistakes that have long-term ramifications. Sure. Yeah, right. Absolutely. So uh you mentioned taxes, obviously that's a big one, right? Tax implications of the freedom surge. Uh what we generally see is the freedom surge uh lasts about two years. Okay. And then uh there it just sort of s settles down.

SPEAKER_08 4:35

Like, oh, this is new. This is I'm used to this, I've gone everywhere I need to go, I've had enough fancy meals or whatever it is.

SPEAKER_00 4:41

No, that's what it is, right? And and now I got the tax. What's next?

SPEAKER_08 4:44

Yeah, yeah, there you go.

SPEAKER_00 4:46

Yeah, and they and and retirement really, if we look at it, I know that a lot a lot of planners will go out there and they'll uh take a four percent withdrawal rate over time. Right, yeah.

SPEAKER_08 4:56

Pretty common rule, four percent rule.

SPEAKER_00 4:57

Very common, right? But actually, when we look at spending, uh what we see is it's more shaped like a smile as opposed to a line.

SPEAKER_07 5:05

Okay.

SPEAKER_00 5:05

You get spending up front and spending at the end, the big expenses, and then it kind of normalizes out in the middle. So yeah, so we really want to be careful with that spending up front so that we can do that spending at the end.

SPEAKER_08 5:17

Although the spending at the end isn't any fun, probably.

SPEAKER_00 5:19

Yeah, it's not as fun. Not as fun.

SPEAKER_08 5:21

Not as fun. But I guess the opposite of that is making your kids or the state take care of that.

SPEAKER_00 5:27

Yes.

SPEAKER_08 5:27

So you want to be able to have control of all of that spectrum. Absolutely.

SPEAKER_00 5:31

Yeah, take control. Don't leave it over to the IRS to take control. Uh we are kind of our mantras is we want you to live the life that you want to live and that you deserve to live. Uh I want you to never run out of money and never have to adjust your uh cost of living or your lifestyle downward, right? That's that's that's those are the those are the two big solves. So I had an experience with this. Okay. Uh not too long ago. This is one of the things that we always want to keep our eye on is taxes, right? And I always think of it as a little bit like March Madness. So when March Madness rolls around, all of a sudden you have all these shows on ESPN and stuff, and they're called bracketology, and everyone's putting their brackets together. Well, we the for us, that's a year-round game, uh, because it's tax bracketology. Okay. Yeah, so we're keeping our eyes on those tax brackets. So uh what his situation was, uh with he and his wife had just retired. They had uh a combined income of about $75,000, uh, with and that was all the benefits and pension and and everything that they were drawing. And I had them sketch out the next two years. So let's let's talk about this freedom surge and see what this looks like. And for them, they had just a series of a lot of little things. And they didn't think it was going to be much. It's a thousand dollars that they thought for the gutters and you know, house repairs, this trip here and there. But when we s when we penciled it out, uh it was about twenty some thousand dollars, almost thirty thousand dollars. And uh so the big question is is where is that coming from, right? And also what's the most tax-efficient way that we can get we can get that? Right because that's we're playing the game of bracketology. 75, and just this is not uh um with deductions, this is just gross income. They go from a 12 percent uh federal tax bracket, just federal, not state, and that bumps them up to a 22 percent tax bracket. So that's a that's an additional ten thousand dollars that that they're gonna be paying just in federal taxes on that on that. So that's a big jump. That's a big jump. So uh now just to uh cut to the chase on the solution here is what we were able to do was uh take the money out, but spread it out over two tax years. Sure, yeah. Yeah, so divide it up. Yeah. Yeah, absolutely. Cut that tax bill down.

SPEAKER_08 7:54

Now, if the freedom storage lasts longer than two years, obviously there's a little more planning. Is there I mean, I I think I kind of know the answer, but maybe speak to like the kind of the softwares that you are utilizing to help people do this planning, because it is important. Yeah. Why not save the money on the taxes?

SPEAKER_00 8:10

Yeah. Yeah. Yeah. Like uh so we we use a lot of different softwares, right? Yeah. And part of the reason for that is uh we want to be really accurate. We we we really want to uh stress test and make sure we're getting it right. Not only on the tax side, but also on the saving side. So there's this uh one software that we use, and it's it's relatively common, a Monte Carlo simulation. And what that allows us to do is to stress test their plan thousands and thousands and thousands of times with all these different scenarios, and helps us come up with a number. And uh based on that number, we know the probability uh of them never having to decrease their style uh style of living and never running out of money. Now, for us, uh and I think a lot of people, we're always looking at 90% plus in probability. We never we're never gonna go below that. So, yeah, important to stress test, and that's a big piece of the software that we're looking at.

SPEAKER_08 9:06

But like so, if I'm retiring, I know hey, there's all these things I need to, I'm gonna spend, maybe I want to take the kids on vacation. I don't know what it is. So do you have the ability to s to kind of map that all out, put that all in, and it says, hey, here's exactly the buckets to pull from, because a lot of people, you know, if you're listening, you you you may have like a you know a 401k, you may have some savings somewhere, you maybe have like you know, obviously Social Security, and Social Security taxation comes into this as well. Because if you're taking an extra dollar out of your so out of maybe something that like an IRA or something that can put you up and even having more of your social security be taxed. Like all these things work together. And of course, if it's too much, then you could have a Medicare tax on top of it. So there's all these different taxes. So I I feel like it's important um that you have an actual written plan with like, okay, here's how I see the first two years, three years, four years going, and how you know how best we can reduce some of our or you know, fund some of these things in a very tax efficient manner. Um, and I mean I think the first time I helped somebody with this was 12 years ago. So we've been doing it for a while. Um, but it's it's just very important uh that you guys take advantage. And if you don't have someone that you're working with, you can work with Eric and his team on mapping how retirement goes. No, you're absolutely right.

SPEAKER_00 10:25

Yeah, yeah. No, that's a perfect example. And and and that that's exactly what we do. And uh, especially during those first two years, the freedom surge, right? We want to map that out and really look at it from the tax standpoint, like I was just talking about a little a little bit ago. But then also, where's that money coming from? What's the most tax-efficient way we can do that? But the other thing is, and you touched on this uh when you talked about social security, is social security is an interesting uh uh vehicle because there's no give backs on it, right? Yeah, yeah. Once you start that social security after that first year, you're locked in, locked into that benefit. And so we would not only want to look at uh Social Security now and your benefit, but but but do we possibly delay? Yeah or um how does this impact you later?

SPEAKER_07 11:13

Right.

SPEAKER_00 11:14

And like you tied in, how does this impact you know your Medicare? Yeah, yeah. So though all those factors, and and we it it can it sounds hard to figure that out alone. I know.

SPEAKER_08 11:25

That's why we me how hugged you it's hard to sit down and map that out. It's yeah, yeah, it's a there's a benefit. Okay, we got Susan from Delaware. Susan, welcome to Medicare School Daily. Are you there?

SPEAKER_04 11:39

Yes, I am.

SPEAKER_08 11:40

Hi, what are your questions?

SPEAKER_04 11:43

Hi, uh, my name is Susan, and I had started my retirement um in July of 2025. Now I did sign up in the enrollment period in July, and then I did sign up for the enrollment period. I guess what's that, October, November?

SPEAKER_07 12:00

Yeah, okay.

SPEAKER_04 12:00

Do I have to sign up again in July since I started in July?

SPEAKER_08 12:05

Okay. Okay, let me ask you just a couple of questions. So you signed up for Medicare last July, is that correct?

SPEAKER_04 12:14

Uh well, actually, I retired July 2005. So I went totally, because I signed up with the A plan for the hospitalization. And then I started my B plan in July.

SPEAKER_08 12:25

Okay, and then 2025. Oh, of 2025. So you're kind of wondering like, do you need to switch plans or anything?

SPEAKER_04 12:33

Yeah, because I did sign up in the enrollment period. Sure. You know, in October or November. Can you tell me what plans you have? I have um I have AARP for my supplement.

SPEAKER_06 12:46

Okay.

SPEAKER_04 12:47

So United Healthcare. And then I have I had to change my prescription of um in January. I had to change it to the PPO plan of well well care.

SPEAKER_08 12:59

Wellcare, yeah. Pretty common, very common, probably the most common plan in the country. Your supplement plan is a head signal. Yeah, yeah, understood. Yeah. Do you have uh do you have a plan G or do you have a plan N?

SPEAKER_04 13:11

Uh G.

SPEAKER_08 13:12

Plan G. As in girl. Okay, yeah, as in girl. Okay, awesome. So yeah, so that plan, uh, there's nothing that you have to you actually don't ever have to change that plan G ever. That plan is yours for as long as you want to keep it. They can't cancel it on you. They can't change the benefits on you. Uh the only thing they're gonna do is they're gonna raise the premium, probably every year. Right. And I'm sure you've kind of experienced a little bit of that. The last couple of years, the last three years, they've been the most interesting years in terms of price increases for a long time. So United Healthcare, uh, for about 20 years, they had about a 2.9 percent rate increase every year. That's like below inflation, right? It's very, very low. Then post-COVID, there's been a lot of medical inflation, there's been a lot of overuse of plans, and there's been a lot of fraud that has been introduced into Medicare. And so what's been happening is we've seen those supplement plans start to go up um a little bit faster. And so you've maybe experienced that. So you can move you can move off of that plan into another plan, but you would have to medically qualify. Um but there you're there's never anything you have to do with that plan. It can be yours for as long as you want it, okay?

SPEAKER_04 14:26

All right, because I know that it is going up to $202.90 come July.

SPEAKER_08 14:32

July.

SPEAKER_04 14:33

I'm getting my my notice in May.

SPEAKER_08 14:35

Yeah. How's your health? What's what's kind of the what's kind of the it's not too bad.

SPEAKER_04 14:40

I mean, I I was diagnosed with MS. I have uh poor bone structure, so I'm working on that so I go see a specialist for my bones. And um I'm I have diabetes.

SPEAKER_08 14:50

Have you had any fractures?

SPEAKER_04 14:53

Uh actually, no, I did have a uh I um I did fracture my shoulder because of the dog yanked me and took me to the ground. That was two years ago.

SPEAKER_07 15:04

Okay.

SPEAKER_04 15:05

So that was before I became fired, but yeah.

SPEAKER_08 15:08

So Yeah, it might be a little bit it might be a little bit difficult to switch, but here's what I would tell you. Um we're expecting, we're hoping, we're expecting this to be the last year where there's kind of these bigger price increases, and then we think it'll hopefully normalize. Um out, you know, to kind of go back to that trend that they were on for a long time. And I do want you to know you're not alone in terms of, you know, United Healthcare is not the only carrier that's had to take those increases. It's been every carrier. So you're probably not gonna be able to save a whole lot of money by moving. Um and the other thing, do you use the do you use the gym membership that it's a part of the the UHC supplement plan?

SPEAKER_04 15:49

I don't that well, you know what? It turns out that the YMCA does not they're in the network, but they don't give a discount. I just signed up with the YMCA.

SPEAKER_07 16:01

Okay, gotcha.

SPEAKER_04 16:02

So I found out they're in the network, but they don't give a discount. I said, well, what are they in the network for?

SPEAKER_08 16:07

Yeah, what yeah, what does that even mean? Yeah, that's that's interesting.

SPEAKER_04 16:10

Yeah, that's what I said. What does that mean? Yeah. Um, I think you gave us $55, but you're not alone.

SPEAKER_08 16:17

All the premiums are going up. And if you're healthy, uh don't have any uh the the multiple the MS with a fracture in the last two years is probably gonna be very difficult for you to switch plans. So I think probably just stick tight with where you are for now. Um as far as your drug plan, October 1st or October 15th, rather, that's the beginning of annual enrollment period. It sounds like you've kind of figured out how to navigate switching those plans. Did you use Medicare.gov for that?

SPEAKER_04 16:45

Um I use Medicare School, actually.

SPEAKER_08 16:47

Okay, okay, okay. Sounds good. Well, that's I mean, that's our company, so yeah. Uh well. Well, thank you. Okay, what are the questions you have, Susan? Anything?

SPEAKER_04 16:59

That's that's really all I have. Thank you for the same.

SPEAKER_08 17:01

Okay, well, hey, you take care. You too. Bye-bye. Okay, we've got another caller here. Let's go to uh let's see, we've got Raju in California. Raju, can you hear me? Yes.

SPEAKER_01 17:15

Uh the question is about uh Medicare and HSA. Okay, so I'm 66, my wife is 64. Okay. This year. My wife, she lost a coverage in March. Um retroactively, we came to know about it in April of this year. So she can be added on to my insurance.

SPEAKER_06 17:36

Okay, good. And do you have Medicare part A? No, I have not, uh I had asked you guys and I have not taken a lot of time. Yeah, yeah. So yeah, you don't you don't want to do that.

SPEAKER_01 17:46

Yeah.

SPEAKER_08 17:47

Further, you want to you you want to stop any Medicare contributions about nine months. Pardon me, you want to stop any HSA contributions about nine months before you're going to go on Medicare. So are you clear on that? Isn't no, isn't it six months? Well, here's here's why. So it and I said about. So whenever you apply for Medicare, um you they are going to backdate your part A date six months because you're over 65.

SPEAKER_06 18:18

Got it.

SPEAKER_08 18:18

So if you if you retire and if you apply for Medicare, you know, you can most people do it about 90 days in advance. So that's why I said if you do it 90 days in advance, they're gonna take that application date, back the clock up six months. So that's where I got to nine months. But if you do it 60 days in advance, then it'd be eight months. If you do it, you know, 30 days in advance, we're kind of getting down to the wire. Now you're at you know, six, seven months. So it it's not from they're gonna backdate it six months from the date of application, is my point. Okay. Yes. And you can do that as early as 90 days.

SPEAKER_01 18:50

Yeah, I I was not aware of the nine months because of the application date. Okay, that's uh very good uh yeah, good to know.

SPEAKER_08 18:57

Good to know for sure. So, yeah, okay, so I think I have an understanding. So then where is what's your question?

SPEAKER_01 19:02

So in June, I'm going to start contributing to a family plan HSA.

SPEAKER_07 19:07

Okay.

SPEAKER_01 19:08

Because she's she's going to be on my plan.

SPEAKER_07 19:11

Okay.

SPEAKER_01 19:11

As well. So now the problem is would I get a full 8750 plus thousand catch-up for me and a thousand catch up for her to be done, or will it be pro rata? That is my first question.

SPEAKER_08 19:27

Okay, so yeah, so I I believe that the um the max, so if we look at the family max for 2026 is 8,750. Um, and then I believe only one, I think the only I I think the thousand dollar catch up can only be used for one spouse. No, okay, they're both eligible. You're both over 65.

SPEAKER_06 19:55

Yeah, so 10,750.

SPEAKER_08 19:57

10,750 is your max for the year.

SPEAKER_01 20:03

Right, but uh is it pro ratea? Because see, uh first uh five months, I'm individual. Yeah, no, I don't believe me. I don't believe so. The second part of the question is if I have to contribute whatever the amount, whether pro rata or otherwise, sure. Uh I'm gonna I'm planning to contribute in the first three months of starting June. Yes. So she's going to apply three months before that, right? Okay. December also will be counted.

SPEAKER_08 20:30

This is only if you're over 65 do they backdate anything. If she's just turning 65 in October, she can contribute all the way up until September. Does that make sense? They're not going to back, they're not going to backdate anything. You can apply for Medicare part A and B up to 90 days in advance of when you want it to start. Okay. They're going to take that application date and they're going to back the clock up six months, and that's when your part A is going to be, and you can't have contributed from that A date on to an HSA. Okay. Yeah. Okay.

SPEAKER_01 21:07

Okay. I think you answered all my questions. Thank you.

SPEAKER_08 21:10

Okay, hey, thank you, Raju. Take care. Yeah. Thank you so much. Bye-bye. Uh, let's talk to Terracita from California. Terracita, can you hear me? Hi, I understand you have a question about uh maybe switching supplement plans. Is that right? Okay, go ahead.

SPEAKER_03 22:04

Supposedly 'cause I'm not I'm I'm turning fifty seven.

SPEAKER_06 22:08

Okay.

SPEAKER_03 22:09

And I retired at sixty-six from the postal service.

SPEAKER_07 22:18

Okay.

SPEAKER_03 22:18

And then um I enrolled to well thinking about the benefits of of uh enrolling into Medicare Part B versus the PSHB, I dropped my PSHB and enrolled in Medicare B and then enrolled in he enrolled me into a high deductible key. My DJ is when I joined Yeah, so you are listening to you guys.

SPEAKER_07 22:58

Yeah.

SPEAKER_03 23:00

Okay. If you're listening to you guys, you know my DJ should be the D I go to the B.

SPEAKER_08 23:09

Okay. Do you have a red, white, and blue Medicare card?

SPEAKER_03 23:13

Yes.

SPEAKER_08 23:14

Okay, what is the do you does it have an coverage A or you know a part A and a part B coverage start date?

SPEAKER_03 23:21

Uh yes, it does. Okay, what are B is 5-1-2024.

SPEAKER_08 23:27

Part A and B is 5-1-2024?

SPEAKER_03 23:31

No. Part A is 5-1-2024. Part B is web one twenty twenty-five.

SPEAKER_08 23:39

Okay. So what are your so then what's your question? Do you I mean because that I mean that's logical, but that is what it is. We're not gonna change that.

SPEAKER_03 23:53

Right. But uh can I move to uh to plan regular G.

SPEAKER_08 24:00

Yep. Yes, underwriting growing. Yeah, yeah. So let's let's talk about this. So you're in California, correct?

SPEAKER_05 24:09

Right.

SPEAKER_08 24:09

Okay, so California has what they call a birthday rule, and it allows you um to be able to move supplement plans without underwriting. However, there's a catch. You have to go to a plan that has equal or lesser benefits. Okay, so the most common application of that is people who go from a plan G to a plan G, or maybe they go from a high deductible G to a high deductible G. Or maybe they go from a plan N to a plan N, kind of lateral moves from one carrier to the next. They can do that without medical underwriting. They can also go down in coverage. So meaning moving from a plan G to a plan N, that would be kind of down in coverage. Moving from a plan F, which is like, you know, most people can't get a plan F, but moving from a plan F down to a G or an N, that's kind of a downgrade of coverage. So they can do that without medical underwriting. But to move up in coverage requires medical underwriting. So to move from an N up to a G, or to move from a high deductible up to an or a high deductible up to a G requires medical underwriting. Okay. So that you need to know that. The second part of your question is I think you're actually pretty lucky, and I'm glad you called in. So because your B date is 12.1, you have six months from that date. You have you're in this period called a metagap, which is another word for Medicare supplement, Medigap OEP, which stands for open enrollment period. So from six months of your part B date, which was 12.1 for six months, so until the end of this month of May, you can actually go ahead and get your G plan no medical underwriting. How does that sound?

SPEAKER_04 25:52

Oh, okay, great.

SPEAKER_08 25:54

Great, great, great. That's good. Okay. So uh I'm happy to hear that job. Yeah, no, that's very good. So um, if you want, can I give you our office number and then you can call in. I've got it. Oh, you got 800-782-6676.

SPEAKER_03 26:10

That's correct. Yeah, yes, yes, I guess.

SPEAKER_08 26:12

Yeah, so call in and then just tell them, hey, I'm in my last month of my Medigap OEP. I need to get a plan G. I'm in California. Can you get me to someone who can quote me all the different options? Cool.

SPEAKER_04 26:25

All right.

SPEAKER_08 26:26

And they can do that today or tomorrow or whenever. Okay, Teresita, take care.

SPEAKER_03 26:32

Thank you. Bye bye.

SPEAKER_08 26:34

Thank you. Okay, let's get to another caller. We've got uh Lisa. Uh Lisa in Ohio. Welcome to Medicare School Daily. Yeah. Hi there. I understand you've got part A, you're still working, and you kind of want to talk about a drug plan maybe without part B. Is that correct?

SPEAKER_02 26:55

Correct. Okay, maybe get us up to speed.

SPEAKER_08 26:57

Okay. Uh so you're still working, you have part A, and you want to get a drug plan, but don't have Part B. Do you have credible drug coverage through your employer?

SPEAKER_02 27:07

I do. Okay, and can you do now the re Yeah.

SPEAKER_08 27:11

Go ahead.

SPEAKER_02 27:11

The reason why I'm looking at this is please understand I work in healthcare.

SPEAKER_06 27:15

Okay.

SPEAKER_02 27:16

I'm a financial analyst. I get I work in reimbursement, so I get the Medicare updates. I'm looking at the Medicare GLP 1 bridge that starts July 1.

SPEAKER_08 27:28

Okay.

SPEAKER_02 27:28

That's why I'm c I'm asking this question.

SPEAKER_08 27:31

Okay. So to get a drug plan, you have to be eligible for part, or do you have to be on part A, which it sounds like you have? I think the consideration would be like coordination of coverage and who's going to pay first. I I don't know that I've ever had anyone ask me. The answer is yeah, you can get it. I just don't know how it's going to like necessarily work. I don't think I've ever heard of anyone who has a drug plan and an employer drug plan. Um but that GLP, that makes a lot of sense. I bet we're going to start getting more questions about this.

SPEAKER_02 28:03

Um I just I've just got the update from Medicare this this morning. So I'm looking at this and I'm like, oh, wait a minute.

SPEAKER_08 28:13

Oh no, I mean that's a if it's you know gonna be is it fifty dollars? Is I think that's what it is. If that's gonna be a thing, I I bet that's gonna be it.

SPEAKER_07 28:21

Yeah.

SPEAKER_08 28:21

So um yeah, yeah, I think you can take it. I think the coordination of that will be something interesting. Do me a favor, we've got your number obviously saying. Let me do a little bit of research, and then uh I here's what I will do. In the next couple of episodes, we'll talk about this. Um, and you can call back in if you want. But give me give me a moment to just because I feel like we're gonna get this question a lot, and how are those gonna coordinate? So let me do some research. I just don't want to tell you um the the wrong thing here, but you are correct in that you can um you can get a drug plan as long as you have part A. You don't have to have part B.

SPEAKER_02 29:02

So Okay. I mean, I yeah, my employ, like I said, I work in healthcare. My employer has uh a plan through Anthem, but we're self-insured. We don't cover this stuff. Yeah, you know, we've got a very limited formulary, so this isn't even covered. It's not even don't even question it.

SPEAKER_08 29:20

Oh, you mean like the GLP the GLP1 stuff?

SPEAKER_02 29:23

Right. Yeah, well, they don't cover this stuff.

SPEAKER_08 29:27

And it is it is expensive. So um Yeah. Yeah, I let let me uh yeah, and here's the other thing that I would probably do. I would want to in some of this I I wouldn't actually be able to tell you. I think it would be worth you, so you guys self-insure. Who's the benefits like administrator? Like, do you know who kind of like manages, I can't remember what they call that, TPA or something?

SPEAKER_02 29:51

I believe it's I think it's true scripts.

SPEAKER_08 29:53

Okay. I would I would be wrong, but I think it's true scripts because you're kind of gonna have double coverage, more or less. I mean, you you're not gonna try to probably you know run it through it. I would chat with whoever is like the TPA for your self-funded plan and ask them if I do this, is my coverage going to be changed on your end? You know, but um from that that that insurance carriers perspective. So it might it may not be like, yeah, you can do it, but then they're gonna say, Oh, but we're gonna drop you or we're gonna make it so you can't get any meds through us or something. You should have find that out.

SPEAKER_02 30:30

Right.

SPEAKER_08 30:31

Okay.

SPEAKER_02 30:32

Okay. So they won't they wouldn't be primary then, they would be they would fall into the secondary. Yeah, I gotcha. Okay.

SPEAKER_08 30:40

Yeah. So I would I would just talk to them. I think that's probably the best thing. Um you can do it, yeah. But how what is that gonna mess up your employer coverage in any way?

SPEAKER_02 30:51

Okay. Right. Right. Well, I've been considering just dropping my coverage anyway because I need a hip replacement. Oh, are you eligible for Medicare? My deduct.

SPEAKER_08 31:02

Oh, yeah, oh, obviously you are. You have A. So you're 66. Well, let's talk about that.

SPEAKER_02 31:07

Yeah, I'm 66.

SPEAKER_08 31:08

Let's talk about that. Um, so uh you are in Ohio. Let me just like run a scenario for you if I can. Do you have for on your employer coverage? How much do you how much do you pay for that?

SPEAKER_02 31:23

Uh I would say roughly $50 a month. Oh, so it's no, no, no, $100 a month. $50 a pay period. A pay period. About $100 a month.

SPEAKER_08 31:31

Okay, sounds good. And you are born in February of 1960.

SPEAKER_05 31:37

Correct.

SPEAKER_08 31:38

Okay. And then are you living with anyone over the age of 50 in your household?

SPEAKER_02 31:45

No, it's just me.

SPEAKER_08 31:46

Okay, sounds good. And are you in Miami or Montgomery County?

SPEAKER_02 31:51

Montgomery.

SPEAKER_08 31:52

Montgomery. Okay. Let me just look up.

SPEAKER_02 31:59

Montgomery County.

SPEAKER_08 32:00

There you go. Okay, so you can get golly, you can get, so Medicare, let's talk to Medicare. So part A is free, right? You know that. You have that. Right. Um, part B is $20290, let's call it $200. Okay. So it's basically $200. If you were to get, do you know the differences between like plan G and plan N? Yeah.

SPEAKER_07 32:24

Yeah.

SPEAKER_08 32:24

Okay. So there are, there's, there's a you can get a plan G for about $140, and you can get a plan N for about $105, $110. Um, so there's about a $30 price difference there. So, but let's just say you're gonna go with a plan G. We're gonna call it $140. So you're at you're at $340, right, on Medicare. Do you know your deductible on your current plan?

SPEAKER_02 32:51

I believe it's I can't I don't even remember right now. It's either six thousand or ten thousand.

SPEAKER_08 32:57

Okay, but it's pretty high, right? And you need to get this hip replacement, right? Yeah. So let's say it's let's say it's six grand, and I bet it may be six grand deductible with a ten thousand dollar max out of pocket. I mean, it could be something like that. I don't know. Probably but a lot of times there's a deductible, yeah, and then you pay a coinsurance, meaning you're gonna pay a percentage of the bills up to that maximum out of pocket. Um, so you're paying $100 a month, but you've got between six and ten thousand dollars that this is gonna cost you. Whereas if you go with Medicare, do you take any other meds?

SPEAKER_02 33:31

It's only gonna cost me the Um I take I've got high blood pressure. I take three uh high blood pressure meds, and lodipine, lecinopril, and hydrochlorothiozide.

SPEAKER_08 33:43

Okay, well, those are all those are all very cheap.

SPEAKER_02 33:46

Couple dollar couple dollar a month.

SPEAKER_08 33:49

Yeah.

SPEAKER_02 33:50

So yeah, nothing major.

SPEAKER_08 33:51

I'm just gonna check and see. Uh I'm gonna put those into uh, well, here. I'm just gonna see what drug plan. Yeah, so there's several plans that are maybe a drug plan is gonna cost you between zero and ten bucks a month. So let's just call it ten bucks a month. Okay. So we've got 200 for part B, 140 for a G plan, and $10 for a drug plan. You're at $350. That's what it's gonna cost you. So it's gonna cost you an extra $250 a month. But if you go to Medicare, but you're gonna have a $283 deductible. After you meet that, it's 100% coverage. See, it does because after this hip replacement, what are you gonna have to do? Rehab a bunch of a bunch of rehab, right? So then you're gonna be paying a copay or whatever it is, you know, uh the surgery is gonna be expensive, and then there's all of that too. So you could switch. I mean, if I were in your shoes, and then also just kind of considering this GLP one thing, um, it might be a good idea to go ahead and take a look at that. Yes, your premium is gonna go up a little bit, but your total exposure, you know, meaning what you're gonna have to come out of pocket if something goes bad or if you get this surgery, goes way down.

SPEAKER_02 35:05

Right.

SPEAKER_08 35:06

Kind of tracking with that?

SPEAKER_02 35:09

Yeah, I do. I I know what you're saying. I mean, I've followed you guys long enough that I've been kind of, you know, I've been bantering this around back and forth, going, okay, wait a minute. It was like the other doctors like I can give you another shot in three months, but I'm right in the middle of gardening season. So it's like, you know, hip replacement's not gonna happen until after the garden's over with.

SPEAKER_08 35:29

There you go.

SPEAKER_02 35:30

Well, I'll I'll hobble around for another you know, three, six months, you know. Sure. Okay, well let me won't happen until the end of the year.

SPEAKER_08 35:39

So let me share one other thing with you. So have you worked at this same employer since you became eligible for Medicare and went on part A? You've worked Yes. Okay.

SPEAKER_02 35:49

So whenever you do Yeah, I've been there for what, eight years now? Okay, okay, that's good. Yeah.

SPEAKER_08 35:54

So whenever you do start Medicare, uh part B, whenever you want it to start, about 90 days before, you can work with us, but you know, we'd love to walk your walk you through this, hold your hand, show your options, fill out the paperwork, all of that stuff. Um but you are gonna have there's gonna be a document. Yep, L564, and then 40B. L564 goes to the employer, that with the 40B goes to the Social Security Office, and that gets you enrolled into part B. The good news is you already have a Medicare number. So it's gonna process quickly. They're gonna add Part B, um, and then you can apply for your drug plan, you can apply for your supplement plan, really about 90 days before is that perfect window. And again, we walk your well hold your hand through that. Um, but sounds like you've got a little bit of a plan. I mean, maybe this is just a go on Medicare in 2027 plan, you know.

SPEAKER_02 36:44

Okay. Well, I was yeah, the reason why I, you know, I'm looking at this, you know, this GLP bridge, it's only July twenty-sixth through December of twenty-seven.

SPEAKER_08 36:55

Oh, getting the GLPs.

unknown 36:58

Yeah.

SPEAKER_02 36:58

Yeah, so you want to start planning for a limited period.

SPEAKER_08 37:02

If you want to go to Medicare and get your GLPs and get your hip replacement done this year, I mean, you can start it. You know, we could start Medicare as soon as June first and get everything set up. So you're you've got options for sure.

SPEAKER_02 37:18

So uh at least on the part D side, I probably should talk to Talk to your employer. Uh the Yeah, talk to the employer and the prescription, and I believe it's true scripts. It may be somebody else, but it used to be true scripts a few years ago.

SPEAKER_08 37:34

Um so I'll talk to them, see if there's any or who's gonna be paying what first, who's in who's in the first, you know, yeah, and then make sure it's not gonna mess up your mess up that plan in any way. That's what you want to be careful of. Okay. And then if you decide it's just better to go on Medicare, just I mean, we can do it quickly. You can get everything in place. And you already have a Medicare number, that's what really makes it go quick.

SPEAKER_02 38:03

So easier, yeah. Okay.

SPEAKER_08 38:06

Okay. Super Lisa, do you have our office number if you need to call back in to talk to someone? Do you have our office number? Your 800 number. Yep.

SPEAKER_02 38:13

Yes, your 800 number, yes, I got it.

SPEAKER_08 38:15

Sounds good. Okay. Thank you, Lisa.

SPEAKER_02 38:18

Thank you.

SPEAKER_08 38:19

Medicare.

SPEAKER_02 38:20

Bye. Bye.

SPEAKER_08 38:22

Okay, uh, let's get to another caller. Panita in California. I feel like everyone's calling from California. Panita, are you there?

SPEAKER_05 38:30

Yes, hello, I'm here.

SPEAKER_08 38:32

Hi, welcome to Medicare School Daily. What's your questions?

SPEAKER_05 38:36

Thank you. Um, pleased to be here. So I turned 65 later this year, and I'm a breast cancer survivor and also have some autoimmune uh disease.

SPEAKER_06 38:47

Okay.

SPEAKER_05 38:47

So my question is in looking at uh what what is the best plan for my needs? Medicare original or Medicare Advantage?

SPEAKER_08 38:58

Sure. Uh I mean, with what you've described so far, for me it's gonna be a very easy go with the supplemental plan if it fits your budget, right? I mean, at the end of the day, you are gonna have a lot more access to providers. You're not gonna have an insurance company saying, ah, we're not gonna approve that service. Autoimmune uh diseases can be very, very tricky. You know, all the infusions and the flare-ups and things that happen um that kind of are unexpected, and you're trying to get this provider to accept it or get approved. It can be very, very difficult sometimes when it comes to advantage plans because now you have a network, you've got pre-authorizations, you've got all that sort of stuff. So a supplemental plan, 10 times out of 10, as long as it fits your budget. Okay.

SPEAKER_05 39:46

And that's that's the original.

SPEAKER_08 39:48

That's original Medicare with a Medicare supplement. Yes, a Medigap Medicare supplement. Those are both the same thing. Yep. So then from there, you've got, you know, do I decide between a G plan and an N plan? And so um yeah, let me do this. You want me to run some just low, just let me run a quick quote on what that is, and then you can just oh you got it in your mind. Obviously, you're not signing up right now for it, but I can just at least give you a ballpark. Um and then your process, are you on Social Security right now?

SPEAKER_05 40:20

Uh yes, I am.

SPEAKER_08 40:22

Okay, so you are actually going to be receiving your Medicare card shortly. So you're gonna get that card mailed because you're on Social Security already. It'll show up in your mailbox, and when you get that, that's really kind of your green means go. It's time to figure out what coverage is gonna make sense. Do you live with anyone over 50 in your house?

SPEAKER_05 40:43

Yes, my husband.

SPEAKER_08 40:45

Okay. Uh is he on Medicare yet?

SPEAKER_05 40:48

Yes.

SPEAKER_08 40:50

Okay. Do you know what carrier he's with? Does he have a supplement plan?

SPEAKER_05 40:54

Uh he has advantage.

SPEAKER_08 40:57

Okay, okay. Sounds good. So you kind of know how that works a little bit. So plan G probably in your neck of the woods for your age, around $190. Plan N is about $40 cheaper. $150, $155. And the rates may change a little bit between now and then. Let's just call it $150. So given everything.

SPEAKER_05 41:22

What is the difference between these plans?

SPEAKER_08 41:24

Yeah, yeah, yeah. So uh a plan G, so so let me start. So for years there was something called a plan F. And a plan F was a full coverage plan, meaning that once you paid your Medicare premium, part you know, B, and you had your plan F, it was a hundred percent coverage. It didn't matter if you had cancer, you had a 16-car pileup, and you got, I mean, like everything went wrong in a year and you had a million dollars worth of bills, it was a full coverage plan. Okay? Did never have to pay anything other than your monthly premium. Okay, so the next plan that became very popular because that was phased out back in 2020 for most people. Um, so the next plan down is called a G. And the G is almost like an F plan except you have a small deductible. A deductible is what you have to pay before the plan kicks in and pays anything, right? And so that deductible for 2026 is $283. So once you pay that $283, it's 100% coverage after that. Okay, so that kind of makes sense. So the next plan down is called a plan N. Okay? And these plans G is still the most popular, um, but the next plan down, you know, in terms of coverage and the next plan that's the most popular is a plan N. And so the difference is there's a couple differences. The first one is is you are going to, when you go to the doctor, you're gonna have a copay. Okay. So you're gonna have that same $283 deductible, right? But you'll also, um, once you've met that, anytime you go see a doctor, there's a $20 up to a $20 copay. Okay? Secondly, if you go to the emergency room, there's a $50 copay. Okay. And then the third difference between a plan G and a plan N is that on a plan G, there uh so there's this concept called Medicare assignment. Okay, and what Medicare assignment is, and that's that's when a doctor, and this this only relates to physicians, that's when a doctor says, yes, Medicare, whatever you want to reimburse me, that the assigned amount, I'm going to accept that as payment in full. Ninety-five percent of doctors accept what Medicare says they are going to pay as payment in full. There's about 5 percent of doctors who say that's not enough. And so they can charge what is called an excess charge. And so a plan that can be up to 15 percent above, okay, the amount. So in that scenario, so let's say you add a $100 bill. Uh the medic doctor that accepts assignment says, okay, I'll accept the $100. Right? That's payment in full. A doctor that doesn't accept an assignment, they can charge up to 15% more. The G plan pays that 15%, the N plan does not.

SPEAKER_05 44:10

What about international travel?

SPEAKER_08 44:12

Let's say you're going to go to Brazil. Okay. You're in Brazil, you're at Carnival, and something happens. And you go to the doctor's office or the hospital or the clinic or whatever it is, and you pull out your red, white, and blue Medicare card. They aren't going to have any idea what that is. Yeah, it's like okay. Right. Cool. That's a nice piece of colorful paper. They don't know what to do with that. So whatever happens is gonna be on you to pay. Okay. Now, a Medicare just doesn't cover outside the country and you know, like whatever Virgin Islands and Guam and the territories. Um so outside the country, it's on you to pay. Now, a Medicare supplement plan, uh, the way it works is they will reimburse you for up to $50,000 of expenses lifetime. So if you had a $10,000 bill, first you're gonna have a $250 international deductible, and then it becomes an eighty-20 plan, and they will spend, I guess, up to two thousand dollars in that case, right? Because it's gonna be eighty twenty. And over the life, if you did it a lot of times, you know, if you you could use up to fifty thousand dollars. So what we tell people, you're traveling internationally, let's not rely on Medicare, let's get travel health insurance, budget budget it in at the cost of your trip, two, three hundred dollars, right? If you're gone for ten days or whatever it is, and you will uh sleep much better every night.

SPEAKER_05 45:40

Got it. And then what about dental envision on plan G?

SPEAKER_08 45:45

So uh first off, Medicare, original Medicare, um, along with your supplement plan, has really good vision coverage, right? The only thing it really doesn't cover is your I need to go in, get my annual eye exam and get new glasses and lenses, right? It it's not preventive, it's not it doesn't cover that. But anything medically, glaucoma, yeah, I mean just anything, anything that's medically necessary, they're gonna cover well. Okay.

SPEAKER_05 46:13

Okay.

SPEAKER_08 46:14

Dental is not really like that. Dental, you're gonna need to get something on your own uh that has some coverage. And we've got a lot of different options for that. I would budget $30 to $50 a month. It depends on how bad your teeth are, or uh you know, or what you expect to happen. You know, I need some crowns and all that sort of stuff. But it is important if you're coming off of dental coverage, which I'm assuming you have with your employer right now.

SPEAKER_05 46:45

Uh well, I'm not employed.

SPEAKER_08 46:47

Okay, do you have dental coverage then? I'm sorry.

SPEAKER_05 46:49

I buy it privately. Yes. Okay, so I buy it, I think it's a good idea.

SPEAKER_08 46:52

Oh, well then you already know how this works. Okay, yeah. So then you can probably just keep that if you like it. Yeah. If you just buy it by it privately. Yeah, just there's not, it's you're not gonna get something that's like this is for Medicare. It's a it's a private dental plan. Um, just like uh I I could buy the same plan. Like it's not, there's nothing Medicare related.

SPEAKER_05 47:11

Thank you, sir.

SPEAKER_08 47:12

Okay, well, hey, take care.

SPEAKER_05 47:14

Thank you.

SPEAKER_08 47:15

Bye-bye. My dad's gonna be uh back with us uh tomorrow, and we will be talking about the topic is the ending, the debate on plan G versus N. So he's gonna go and get all the nitty-gritty details about how do you decide between plan G and N because it can be confusing. If you are retiring, uh need to go on Medicare, maybe you are turning 65 and need to go on Medicare, we would love to help you. Uh our office is located in Kansas City, Missouri. So when you call in, you're gonna talk to someone that's been trained personally by my dad and myself. Um, and you'll be able to talk through your situations, your medications, your doctors, your budget, your health situation, all of these things to make sure that the plan that you get is the plan that is right for you. And our promise here is this whenever you become a client of ours, you are not just another number, somebody that just fades off. And you can actually call in. You have a dedicated client care manager that knows your situation, knows your history, and is there for when life changes. So if you move across town or across the country, if you uh lose your ID cards, if you have a billings issue or a claims issue, uh and you need assistance, we are going to be here for you. You don't have to call some faceless 800 number, be connected to someone on the other side of the world that doesn't speak your language. You can call us right here and we would be honored to help. If you need help uh with your financial planning, some of these things we talked about today, about taxes, about planning, what's the right way to spend through um some or you know, fund uh a retirement uh in a tax-efficient manner that doesn't uh put you largely at risk. Uh, here at MedicareSchool.com, we do have a financial planning division led by Eric. And he and his team would be honored to take a look, give you a second opinion on what you are doing to make sure that you can retire and maintain what he always says is like we want to make sure you don't run out of money and we want to make sure that you don't have to change your lifestyle because we all get accustomed to how we live, right? And the last thing we want to do is run out of money and then be forced to change our lifestyle. So thank you for joining me today. Uh, we would love to help you guys. We'll talk to you tomorrow.