Ending The Debate On Plan G vs Plan N

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Plan G vs. Plan N is one of the biggest debates in Medicare—and today, we’re breaking it down clearly.

On today’s Medicare School Daily, we’ll talk through the real differences between these two popular Medicare Supplement plans, including premiums, out-of-pocket costs, long-term considerations, and who each option may fit best.

If you’re trying to decide between Plan G and Plan N, or just want to better understand the tradeoffs, this is a great conversation to join.

We look forward to taking your calls!

Transcript

SPEAKER_01 0:03

If you are starting Medicare soon, you probably have a question about whether or not you need a Medicare supplement plan G or a Medicare supplement plan N. And we are gonna be going deep into both of those options and kind of ending the debate once and for all on which plan is right for you. Because in some areas and for some people, Plan G is the right move, and for some people and in some areas, Plan N is the best option. So stay with us today. We are going to walk through all of that for you. You're listening to Medicare School Daily. I'm joined in the studio by my dad, Marvin Music. If you are confused about Medicare, maybe you're getting a bunch of different conflicting opinions on what to do, you are in the right place. Welcome, welcome, welcome. We just can't wait to share with you everything that you need to know to get your Medicare benefits in place perfectly the first time. If at any point you have a question, uh please call in. The phone number is down there at the bottom of the screen. It's 833-824-2004. We would love to talk to you. If you have a question about your personal situation, or maybe you have an experience that you had either enrolling in Medicare or using your benefits, we'd love to hear about it and uh just chat through that with you because at the end of the day, we all get smarter whenever we share stories of what's going on out in the real world as it relates to Medicare. If you need help uh enrolling in a supplement plan, enrolling in an advantage plan, enrolling in a drug plan, whatever it is, comparing all of your options, there's a team of people outside these studio doors that would love to help you work through your personal situation and get you enrolled. You're not calling some faceless 800 number on the other side of the world with someone who doesn't speak English natively. Uh you're calling directly into our office right here in Kansas City, Missouri. And uh we're here. We've been doing this for 15 years. We have tens of thousands of customers, and we would love to help you. The phone number to get assistance is 800-782-6676. 800-782-6676. So, Dad, let's talk about uh plan G versus plan N. Who's it right for, where, all the stuff. Right. Teach us.

SPEAKER_00 2:21

We'll do that. Uh, but I I think we need to go back a little bit, uh, Josh, because we know there are some that uh may decide they want an advantage plan.

SPEAKER_01 2:29

Okay.

SPEAKER_00 2:30

Uh you said that if you're going on Medicare, you're gonna choose a G plan or an N plan.

SPEAKER_01 2:34

That's because that's all you like to do. Exactly right.

SPEAKER_00 2:37

But uh uh there may be some uh that you may decide you want uh an advantage plan. So I think what we're gonna do today, let's talk about those that may want an advantage plan, and but those that uh decide that an advantage plan is gonna be uh in your best interest, uh, and those that decide uh Medicare supplemental plan is in your best interest. All right. And so when it comes to uh supplemental plans, um as we compare the G and the N, what you have to realize is that uh they have uh a lot of things that are very similar. Uh that's what uh the beauty of supplemental plans. Uh you, whether you have a G plan or an N plan, you can go to any doctor that you want to. Uh that's why I chose a G plan, because I want to make sure uh I was not going to allow some insurance company dictating uh who I get to see, what hospitals I want to go to. In fact, I just read uh an article um I think it was Thursday or Friday that uh there were uh 21 recent hospitals that uh dropped advantage plans. They take none of them. And I'm not talking about one hospital, I'm talking about groups of hospitals, 21 of them just recently. And why is that? Well, because they're tired of the slow pays and the no pays uh and the and the issues. Yeah, the on advantage plans exactly right. And so um uh you may be making this decision, why would I spend money on a supplemental plan? G-orient, why would I do that? Um and the reason is because you may uh have a priority in your life to say, I don't want uh an insurance company dictating who I can see or who I can't see. And so my my point is that when you decide to take a supplemental plan, you can go to any provider that you want to. Whether you have a G plan or an N plan, doesn't matter. Uh there are no networks with either one of those. Well, they have to take Medicare, right? Yeah, exactly. Well of course. Yeah, they are gonna have to be enrolled in Medicare A and B, so you'll have to do that. Uh but I think that's one of the beauties of um of uh Subental Plan's G-Orient, go where you want. Uh so I like that. The second thing that you have to realize is that when you get uh a subnotal plan, you also are not going to deal with any insurance company interference, meaning you don't have to get permission from your insurance company to have a knee replacement or to get an MRI or a CAT scan or to stay in a skilled nursing facility for the the the right length of time. Because uh G or N, either one of those, those insurance companies cannot dictate anything uh upon your health care. Your doctor uh gets to make all the decisions. And so that's wonderful. And again, that's one of the reasons you may decide I'm gonna pay uh a premium. Uh and then lastly, uh I want to mention that when you decide to get a supplemental plan, remember this is a plan that you get to keep your whole life. You don't have to worry about the insurance company deciding uh that they're gonna pull that plan and that they're not making any profits, so it's no longer available to you. Advantage plans are like that. You choose an advantage plan, it is no longer than one year. That's it. It's uh it's a contract year, uh uh January 1 through December 31st. But when you decide to get a submodal plan, G or in either one, uh you uh never uh can worry about you don't have to worry about losing the plan. You pay your premium, it is yours for life.

SPEAKER_01 5:40

And so uh So if you're on an advantage plan, you have to change that every year?

SPEAKER_00 5:44

Yeah, don't necessarily will you have to change every year, but there's a good possibility because if the insurance company says that plan is not profitable, there's not enough people that are enrolled, they actually can pull those plans. And they do that. In fact, last year we had uh 2.5 million people across the country that lost their advantage plan.

SPEAKER_01 6:01

There was a carrier last week that came out and said they're ending the market. June 1. June 1st. Yeah, all their advantage plans just over.

SPEAKER_00 6:08

That's exactly right. Yeah.

SPEAKER_01 6:09

So then you're just left in the middle of the year trying to scramble around with a two-week notice to get insurance. Right. Which, if that's you and you've gotten a notice um from a carrier, we can't say the name on uh uh on on here, but if you have gotten a notice, which you will, call our office 800-782-6676, and we can walk through what is really the the next best option for you. Trevor Burrus, Jr.

SPEAKER_00 6:31

Right. Exactly.

SPEAKER_01 6:33

Crazy. So okay, go where you want, no networks, no insurance company interference, which is kind of just an easy way to say there's no pre-authorizations, meaning the company isn't getting involved in saying, nah, you can't get that knee replacement. Why don't you do a year of rehab first? Trevor Burrus, Jr.

SPEAKER_00 6:46

Yeah. You don't have to seek the insurance company's permission for anything on a supplemental plan G or N.

SPEAKER_01 6:51

And the third thing you mentioned is it's yours for life, meaning they can't, you know, can ever be canceled. So you're never going to get a notice that says, hey, you know, go find new insurance. Right. But even then, people switch advantage plans uh more con like more often than just if because that not only can the plan just leave, right? But it can also degrade its benefits over time, and oftentimes it does. And so a new plan may come in. So you're you're kind of in this situation. So even if the plan is available every year, you need to go back and see. Yeah, because the plan can change. And on a supplemental plan, that doesn't happen.

SPEAKER_00 7:27

But it is a year-long contract.

SPEAKER_01 7:29

Yeah, if you want all of those perks, there's a cost. You've got to be able to afford that uh Medicare supplement uh monthly premium.

SPEAKER_00 7:38

Right. Right. Right. So if you're in this place where you're gonna make a decision to engineer in, let's talk about the debate. Okay. Uh because I think each of us are a little bit different in what what matters. Uh when I went on Medicare, what I wanted um uh I I could afford it just a little extra. I just decided I wanted the most comprehensive coverage available. And you may be in the same position. You're saying I don't want to worry about um uh you know copays, I don't want to be concerned about anything other than uh maybe a small deductible. And if that's the case, then you're gonna select the G plan. Uh and about 60 percent of all Americans today are doing that. So you may decide I have the money, I can afford the G plan, it's the most comprehensive.

SPEAKER_01 8:17

So what I would say, 60 percent versus 40 percent for the end. Yeah. There are some. And there's still people that get F plan, right? Yeah.

SPEAKER_00 8:23

Very few, but a few. I would say, you know, one or two percent may get some type of the plan, maybe a high G or an F or uh for sure. But the majority of people today, so if you're making this decision and you want the most comprehensive and it fits your budget, then you would certainly get the G plan. And why is that? Well, because w when you when you think about Medicare, uh Medicare pays first, but Medicare doesn't pay for anything 100 percent other than preventive services. So you will be responsible for the balance of the bill on anything that's non-preventive. And so there are we call these gaps, and so you have six gaps. Three gaps on the A you're responsible for, three gaps on the B. And so when we we compare the G and the N on the A side of Medicare, that hospital inpatient side, they're identical. There's there's no difference. So whether you have a G or an N, everything on the A of Medicare will be paid, the A deductible uh multiple times a year, the the uh uh hospital co-pays, uh which are for extended uh hospital stays and then and the hospital, excuse me, skill nursing co-pays. Uh when we have those after days, uh you know, first 20 days, again, G and N are gonna pay the same on the A side. Now, what's going to be different for you is if on the B side, this is where the G and the N are gonna vary. So uh what we have on uh the the B side is the B deductible. This year it's $283. So whether you have a G or an N, you're gonna meet that deductible. I met mine very quickly because of my I. And so once that deductible is met on the G plan, you're done uh for the whole year. I'm I'm done. I've had to go back a couple times to have the I looked at and all that, and and I paid my 283 and I'm done. Right. So if you're looking for something most comprehensive, then uh I think you'll probably decide I'm gonna go the G I talked to late last week, that literally goes to the doctor three or four times every single month. Every month. I had a lot of you know serious health problems. So if that's you and you frequent a doctor, you're probably gonna lean towards the G. And here's why. Because uh the difference in the G and the N, N, yes, you meet that B deductible, but then after that, uh anytime you see a doctor, a specialist, um uh, or you were to go to the emergency room, what happens is the coinsurance uh is not going to pay 100%. Uh the G plan, the coinsurance is covered 100%. But on the N plan, you have to uh uh pay a $20 copay to see a doctor, you have to pay the emergency room $50 copay. So once you've paid your copies to the doctor in the emergency room, then the your end plan will pay 100% of the balance of the coinsurance. And then uh if you by chance see a doctor that uh charges the extra 15 percent, that's called excess, you would be responsible for that as well on the end plan. That's the difference. So I'm just trying to teach you that as you look at the compare that you compare these two plans, the difference is on the B side of Medicare. A is the same, covers everything, but the B side is going to be different because N will not cover the full coinsurance. You will have to pay those co-pays $20. You know, if you're saying, well, I don't hardly ever go to the doctor, well, then again, you may decide uh the end plan will work for me. You may live in a state where they uh can't charge excess. Let's talk about that a little bit.

SPEAKER_01 11:31

So well, let's talk about other one other thing, too. So uh and I think it's at least m maybe somewhat well known that a lot of people we talked to I talked to a lady last week, and she was thinking about going on Medicare because she was going to need a knee replacement. And of course, it's gonna be cheaper if she goes on Medicare and has that knee replacement with like some sort of a supplemental plan, because her group plan had a I think a $6,400 deductible. So she was like, man, should I go? I'm gonna work for a couple more years, but should I go ahead and go on Medicare now? And uh one of the considerations was between G and N, is once you have some sort of a knee replacement or something, you're doing a lot of rehab, right? And so in a situation like that, my assumption would be she's gonna have some copies for that rehab. Is that true or not? I would say that is not true. Okay.

SPEAKER_00 12:23

No, I I don't think so, because I don't think that copies apply on a rehab. It would apply.

SPEAKER_01 12:27

It's only like going to see your doctor.

SPEAKER_00 12:29

That's exactly right. Yeah. My understanding is there's 15 diff different codes for doc office visits, but it but it I don't I don't think the rehab would be included in that. Now, I'm not saying uh some doctors it definitely would apply, but I don't think the rehab side of that.

SPEAKER_01 12:44

Okay. I don't think she wouldn't have it doesn't matter between G or N. You're not gonna pay that copy.

SPEAKER_00 12:48

She's gonna have some follow-up uh visits for sure, you know, with the with her uh docs, but but as far as the rehab is concerned, I don't believe it applies in that side of the case.

SPEAKER_01 12:56

So is it well? I think I would be curious to know, like, what are those if there's just so so is it literally going to see your primary care for an annual? Or or is it you go see the doc who did the surgeon? I mean, that's a physician, right? Was there gonna be a copay with that?

SPEAKER_00 13:09

Yeah, I I think when when they went back to see the orthopedic surgeon, then I think there would be a copay with that. That's seeing a doctor face to face, but a rehab is typically going to be a physical therapist, it's just different. So it's a different uh different coding. Um so you know, if now if someone had the G plan, it wouldn't be a non-issue anyways. But the N plan, uh it's I think it's 15 different codes.

SPEAKER_01 13:33

Okay, so uh I have a question. Do you know so emergency room has a fifty dollar copay on uh a plan N where the G just recovers 100%? What is urgent care? Do you know?

SPEAKER_00 13:46

I don't know for sure, but yeah. Yeah. I would I would think urgent care would would would have a $20 copay. Uh why you're seeing a doctor face to face for some type of health issue diagnostic. That's the way I'm gonna see that.

SPEAKER_01 14:00

Okay. I'm gonna I think we'll I should look at it. Find that out. Yeah, and I'd like to know which doctor visits have that copay apply versus not. It's interesting. Okay it is okay. Let's talk about excess charges if we could. Uh so talked to a guy last week. He got uh I think he had his his uh X-ray or MRI or something red in a different state, and we were kind of going back and forth on excess. So let's talk about excess. There are some states where it really does make a lot of sense to get a plan in because the cost differential is so much, and there's no excess because excess is kind of the big thing that scares us, you know, $20 copay or a $50 ER copay, okay, like whatever. But if you go have a $10,000 surgery and all of a sudden you have that surgeon didn't accept assignment, you got a 15% excess charge, that's an extra $1,500. That's meaningful to many people. So let's talk about excess.

SPEAKER_00 14:56

All right. Well, as you said, excess does not happen often. Uh I think statistically, uh we can say three percent of the time or less that it would happen. And the reason for that is because uh the majority of doctors uh will take assignment, they're participating physicians, so they're not they're under a contract with Medicare that will not allow them to charge you excess that extra 15 percent. So what happens is there's eight, eight states, eight states that have some limitations. Um six of those will not allow excess at all. But there's two that uh limit them. So New York would be one that limits it. So New York limits it to five percent. Okay, instead of fifteen percent. Instead of fifteen percent. So why do it? Uh you know, that's why you would uh hardly ever see an excess in New York. I'm not saying you wouldn't, but but it would be r but would be rare. Ohio, uh no excess. Uh Rhode Island, uh no excess, uh Pennsylvania, no excess. Um uh Massachusetts, uh no excess, Minnesota, no, no excess. Then you have Connecticut and um uh Vermont. And so um Connecticut uh says no excess if you're if you're um uh um LIS, you know, low income subsidy, which how often is that gonna happen? In Vermont, no no excess. And so there's eight states that uh cannot charge excess. I mean, excuse me, eight states that had the limitations. So if you're in one of those states and you get care within, we're not gonna worry about excess. But beyond that, uh the one you're talking about, that that person was from Pennsylvania. I remember the caller, Pennsylvania. But so in Indiana. Yeah, yeah. Right. Yeah. And so that doctor uh charged excess. So that can't happen. Uh but I think what happens is that when when people can they look at and this is what I would encourage you to do, to compare the G and the N. For instance, Josh, I I have a G plan. Just started in January. And in Missouri, the difference between G and N was $35 a month.

SPEAKER_01 16:45

What's $35 times $12?

SPEAKER_00 16:46

Uh $420.

SPEAKER_01 16:48

Okay.

SPEAKER_00 16:48

Yeah. So I I I I could have saved $420, but now I'm responsible for excess. I have, you know, I have copayes and those kind of things. So for me, it was pretty a pretty simple decision. Sure. Uh and I think for most people, if it's going to be $50 a month or less, they're probably going to lean towards the the G. Why hassle with copayes? Why put yourself in a position where you uh are even taking on the risk of excess. And may I remind you, just because uh there's only eight states now that don't allow it doesn't mean in the that could change. We could see more excess being charged or l or less excess in the future.

SPEAKER_01 17:22

So I think the thing with that is like I guess the way I would my perspective is if all of a sudden a ton of doctors started charging excess and the plan G had to cover it, the plan G prices are just gonna go up. Like I don't think it's you're probably saving a lot of like that. Oh, well what if what that happens in the future? The plan G, like it's not like insurance companies have piles of cash that they're like, yeah. I mean, at a certain point they're making all the numbers work, and if all of a sudden they're starting to pick up an expense, like an excess charge, because all these doctors are charging it, what are they gonna do? Yeah, they're gonna turn around and they're gonna pay more fear for your plan G. So e but but what's the alternative? Being on the plan N and paying the excess out of your pocket. So what would you probably rather have? Probably the extra charge. Yeah. Exactly.

unknown 18:06

Yeah.

SPEAKER_00 18:06

So uh when when you are making this decision, you have to decide what's gonna give you most peace of mind. And for me, I was w it was worth the extra $35 a month to have the peace of mind knowing that I only have one bill a year, and that is the B deductible. And you may think the same way. Or you may say, you know what, I haven't gone to the doctor for 15 or 20 years. And so you may be comfortable with an end. And uh just so you know, I don't think it's ever a bad decision to take an end plan.

SPEAKER_03 18:32

No.

SPEAKER_00 18:32

Uh for I think it's very good. In fact, we know in some states, and you may be in one of those, and that's there's sometimes a hundred dollars a month difference between G and N. And so it it is truly a more budget-friendly uh option with just a little additional risk. But again, if you're seeing a doctor multiple times a month or you know, one or two docs, I would go ahead and get the G plan. That way you don't have the hassle uh with it.

SPEAKER_01 18:55

Aaron Powell What about people who say, you know, the plan G is it's gonna have less rate increases?

SPEAKER_00 19:01

Trevor Burrus mean mean mean N will have less rate increases.

SPEAKER_01 19:05

Yeah.

SPEAKER_00 19:06

I mean obviously you don't really feel like I would say that across the board we can't well I'd say we could we could prove that with with maybe some blocks of business, but it but across the board, it's not like people are not using their in plan. They are using their in plan. Sure. Yeah. So that's what causes price increases to occur.

SPEAKER_01 19:22

And as I've seen the ones that have been coming out this year, it's been on both.

SPEAKER_00 19:25

Yeah, right.

unknown 19:26

Yeah.

SPEAKER_01 19:26

I do think there was a there was a little kind of gap in time where the plan G was increasing a little quicker than plan N. But from what I see, it's it's just the same now for the most part.

SPEAKER_00 19:37

Yeah, I don't think anyone is can can guarantee you that the end is going to be uh more stable long term. Yeah. I mean the price are fifty dollars lower and some so if they take a seven percent increase, it's gonna go up, you know, whatever. A little less because of that. Uh but uh but really what it boils down to is what what gives you peace of mind. And uh listen, and and both are great decisions, and I think it is well worth the investment for you to say I uh will pay $120 a month or I'm gonna pay $150. Mine is $212 a month. I'm happy to have that. I really am. Yeah. I love the fact that I can go to any doctor, any hospital, any city. In the country, please go. It truly is a national plan. I don't have to worry about ever losing my coverage. Uh the only thing that can change is the price.

SPEAKER_01 20:20

And so that's something to be said for like if you can afford it, just peace of mind, right? Knowing you don't have to think about it. I mean you have to think about the drug plan. But the drug plan every year is just 10 minutes, 15 minutes. For some people, if you take some a lot of meds, it can definitely be a little bit more.

SPEAKER_03 20:38

But yeah.

SPEAKER_01 20:39

I mean, if I knew I could get obviously I can't yet maybe another 30 years if Medicare is around. Uh you know, if you knew you could get a plan and it was yours forever, sign me up. I don't like to think about it. I don't like to try to figure out what's the right plan, which you do when you go on an advantage plan. Literally, you have to like have a meeting with someone or you have to read through all these documents. I've I've been going through Medicare.gov lately, just you know, being doing this program every day. It is terrible for Medicare Advantage plans. Like I can't even get to the information that's relevant. You can't eat it's a very high in the drug. Yeah. It's right. Yeah. This is wild. So unless you work, I guess, with a broker like somebody like us, I don't know how well why does it happen, Josh?

SPEAKER_00 21:21

I'm telling you why those sites are pitiful. Because there's nobody that's been in the business that has to use those sites. You're talking about people. I mean, not to say they don't care, but but they have a desk job. And all they're doing is putting putting generic information in. They have no idea that the the the relevancy will ever get an answer in there. Yeah, well, they have no idea. Yeah. And so when you're in the business, uh then you understand. I I had I did a live workshop not long ago and had one of the ship counselors uh that showed up. And she asked me, Why don't you recommend ship counselors? I said, Well, the reason is because uh number one, I I know that some of them know what they're doing, but some of them don't. In fact, there was a government report that came out recently that said uh they were thinking about Dropping the program because of that. And that's not the bad mouth then. That's just simply as to say.

SPEAKER_01 22:04

Are they paid or is it just volunteer?

SPEAKER_00 22:06

No, it's all volunteer. And so what I said, when you all are not in the business, there's an aspect of our business that you don't understand.

SPEAKER_03 22:12

Yeah.

SPEAKER_00 22:13

Yeah. And so that's exactly what it is with people who upload information to Medicare.gov. They do not understand the whole of the business.

SPEAKER_01 22:20

Trevor Burrus, Jr. Yeah. I haven't found the I was looking at someone's drug plan last week on Medicare.gov, and it it it doesn't differentiate the cost of each of your individual meds. It just says all of your meds will give you cost you this much. Right. How are you supposed to make great well, that's fine for making a decision, but like it doesn't tell you like if you were to try to go see what, you know, should I get this med at this pharmacy or this med at that pharmacy, it doesn't do that. It's kind of interesting.

SPEAKER_00 22:46

Yeah. Um and yet that's where they're trying to drive everybody to that.

SPEAKER_01 22:50

Yeah.

SPEAKER_00 22:50

Uh which is unfortunate.

SPEAKER_01 22:51

But yeah.

SPEAKER_00 22:52

Yeah, that's that's where we have to go today.

SPEAKER_01 22:55

Let's get to our first caller. We've got uh Adrian in Florida. Adrian, welcome to Medicare School Daily. Understand you have a question. Uh, you're covered under your wife's insurance, so why don't you tell us a little bit more?

SPEAKER_02 23:08

Yeah, hi, how are you doing? How are you guys doing today?

SPEAKER_01 23:11

Doing well, thank you.

SPEAKER_02 23:14

Yeah, my wife, I'm covered under her medical um benefits. And I also receive Social Security, so I think I'm automatically um, you know, uh through Social Security, they automatically place me under A and B. Uh correct me if I'm wrong, but um, I'm just looking for direction on what should I do? Should I keep just A and continue with Aetna, our provider? Um, and uh so I'm kind of I was listening to Marvin last night. I got a little bit of it, but we do pay through at HSA. And so I was just looking for your suggestions.

SPEAKER_00 23:54

Okay. First off, uh, is your wife gonna work, Adrian, uh a little bit longer, a couple more years, five more years? What do you think about that?

SPEAKER_02 24:04

It's uh indefinite, she's a lot younger than I am, no judgment call here.

SPEAKER_00 24:08

Okay, okay, yeah. So I mean, yeah, she's not planning on retireing the next six months to a year.

SPEAKER_02 24:13

Right.

SPEAKER_00 24:13

Okay.

SPEAKER_02 24:14

Correct.

SPEAKER_00 24:14

Okay, that's that sounds good. Have you been pleased with that Aetna plan?

SPEAKER_02 24:20

Um, I don't have any complaints um per se. I haven't looked at it that at it that deeply. Okay, and that's there are other other options.

SPEAKER_00 24:30

Do you know what it cost your wife to cover you on her plan? On a monthly basis?

SPEAKER_02 24:38

That's a good question. That that was part of my uh inquiry. Yeah. I don't really know. You know, I wonder if there would be Yeah.

SPEAKER_00 24:46

You need to find that out. Yeah, you Adrian, find out. And I'll tell you something else you need to do, sir. I want you to find out if she if you came off the plan, what would it cost her uh by herself uh to be on the plan? So it would be employee only or an employee plus spouse, but you're not gonna really know what to do with Medicare until you find the answer to that. And then we're happy, we'll give you enough information today to really help you, but you need to know that. What's it cost her to cover you on the plan? Now, and then the second thing you want to know is if you were diagnosed with cancer or you needed to have a hip replacement or knee replacement or something happen that could be on the expensive side, what would that cost you? Uh would it cost you $5,000, would it cost you $10,000, meaning what is your deductible, and what is your max out of pocket on that Aetna plan? Okay?

SPEAKER_02 25:33

Gotcha.

SPEAKER_00 25:34

So you need you need to find that out.

SPEAKER_02 25:35

Very good.

SPEAKER_00 25:36

All right. So the the other thing I want to mention to you, and Josh, you can come in anytime, son. But I I also want to make sure, and you told me that you're on Social Security. So that that means you should have received your Medicare card in the mail about April 20th. Did you get that card?

SPEAKER_02 25:50

I did.

SPEAKER_00 25:51

You did? Yes. Okay, that sounds great. All right, very good. All right, Josh, you have something you want to uh tell us like a plan N is probably $200.

SPEAKER_01 25:59

So I don't know if you just want to kind of work through that scenario. Okay, on 200. Yeah, so we can at least compare.

SPEAKER_00 26:05

All right. So uh the two plans that uh the majority of people are going on right now, and what you would decide between the would be the the end of the G plan. And so just write this down if you will, please. I want you to write down the G plan is $260 a month in Florida, your zip code. Yeah, $260 a month. Okay, yeah, just call $260. And your end plan is $195. So $195 to $200. All right. Now, you and your wife, is your is your all's income below $218,000 a year combined?

SPEAKER_02 26:38

Yes.

SPEAKER_00 26:38

Okay, very good. So we're right down then your part B premium is gonna be two just uh I'm gonna I'm gonna I'm gonna round up a dime. So it's $203 because it's really $202.90, but let's do $203. Uh, and that's whether you have a G plan or an N plan. Okay, so so far right now we're we're at $463 or we're right at $400. Okay, $395. Um and so that's our B and that is our our our G plan. Do you take any medications?

SPEAKER_02 27:07

Yes.

SPEAKER_00 27:08

And what do you what are you taking right now?

SPEAKER_02 27:11

Oh blood pressure.

SPEAKER_00 27:13

Uh you take a generic uh lacintibril, um uh uh you take a torvas, uh Lysartin. Okay, Lysartin. Okay, very good. And you are you taking anything for cholesterol?

SPEAKER_02 27:26

No.

SPEAKER_00 27:27

Okay, anything it'd be like some kind of a statin. A lot of people take a torvostatin. Um there's a variety of of cholesterol meds.

SPEAKER_02 27:38

Oh, I take Jardians.

SPEAKER_00 27:40

Oh, you do take Jardians, okay. You want to put that in there real quickly, son? Why don't you put a Jardiance in? And then we'll give you we'll give you a ballpark here on like a part D plan. So you're taking Jardians, uh, you're taking uh Losartan. Anything else?

SPEAKER_02 27:54

Norvask or Lapro, I guess. Is it no, it's not Lusinopro, it's umlotopine.

SPEAKER_00 28:02

M Lodipine, okay. Okay, that's a very inexpensive generic as well, but we want to look at the Jardians. All right. M Lodipine, Jardians, what was the other one? So is Norvask the the brand name? It's the same as Umbrella Pine, sorry. Okay, that's right. It's the same as Umbrella Pink, yes. Okay. Is that everything?

SPEAKER_02 28:24

Yes.

SPEAKER_00 28:25

All right. Okay, so let's go back to this. He's gonna give us a part D plan. So right now, when you when you pay for your Jardiance, what's it cost you out of pocket to pick it up at the pharmacy?

SPEAKER_02 28:35

It's not it's not charging me now. Yeah, I'm not sure.

SPEAKER_00 28:38

So your Jardiance is zero?

SPEAKER_02 28:40

It's covered, yeah.

SPEAKER_00 28:41

Okay, very good.

SPEAKER_01 28:42

Did you was it was it January and February, did you have to pay anything, or was it just always zero? As far as I know, it's always been zero. Okay, yeah. Okay, he'd have to pay the zero dollar plan. He'd have to pay the deductible, and it's about seventy-five a month.

SPEAKER_00 28:57

About that. Okay, very good. Okay. So um let's say so about 70. Okay. So here's here's your numbers that you can compare to right now. Um so there's a zero there, and you said 75 a month after he met a deductible. So you know what the retail cost was on that? Yeah.

SPEAKER_01 29:15

Well, he's gonna meet the deductible in a couple months. Okay, it's a couple months. And then maybe three or four hundred bucks, maybe.

SPEAKER_00 29:22

All right, so um we'll call it four months. Yeah. So that'd be three hundred. So we'll just call it a thousand dollars for his meds.

SPEAKER_01 29:28

Yeah.

SPEAKER_00 29:28

All right. All right, so here's the your numbers. If you were to go on Medicare and you chose a uh uh uh Medicare A and B and you had a G plan, uh that's gonna cost you about four hundred and sixty-five dollars a month, four sixty-five. Okay. And uh what you're gonna spend out of pocket beyond that is gonna be about thirteen hundred dollars for the whole year.

SPEAKER_01 29:52

That's for your meds? That's meds. And to pay the part uh B deductible, two eighty-three. Yeah.

SPEAKER_00 29:58

So just call thirteen hundred dollars. So let's just keep it simple. That's about $100 a month there. So that direction, A, B, and a G in your drug plan, you're gonna be out of pocket everything about $565 for the whole month. And then if we went with uh an end plan, uh that's gonna save you about six, it's gonna be about five hundred dollars a month. And that is that's that's full coverage.

SPEAKER_01 30:20

Capital coverage is great.

SPEAKER_00 30:21

That'd be five hundred dollars a month on the end, about five sixty-five on the G plan. Uh so what you have to decide is uh number one, find out what what what it's costing uh your wife out of her paycheck to have you on her plan. Um and I would suspect it's probably not probably not that much. But it could be.

SPEAKER_03 30:38

Yeah.

SPEAKER_00 30:38

Uh yeah, but you but you need to find that out. And so if it looks like that your wife's plan makes more sense than Medicare, then what I would suggest you do is uh you look at your Medicare card, you turn it over on the back side, and it gives you the option to disenroll from Medicare B. Um and just turn the turn the card over. You check the box, sign your name, and you mail the card back in, and then Medicare will send you a new card that'll be a Medicare A only. Uh so you do not want to keep B if you're gonna stay on her group plan. But let's say it's costing her $400 a month to cover you and you have a $6,000 deductible, then to me, Medicare makes sense. Uh because we just said we have full coverage at $565 a month, we have almost full coverage at $500 a month with an end plan. So uh until you find out what it's what's costing your wife, you're not gonna be able to make a decision. But again, don't keep B if you stay on her plan, please. Just send the card back in, disenroll. That's what I would be doing. Okay, otherwise it's a way it's a waste of your money for sure. Okay.

SPEAKER_03 31:39

Sure. Sure.

SPEAKER_00 31:41

Did that answer all your questions?

SPEAKER_02 31:44

Pretty much, yeah. Um, I'd like to follow up with you all, but um I'll find out what she's paying, which I suspect it's not that much. I think it's in two 200s, 230 or something like that for me. Uh, we also have a child on that plan, but um yeah, uh I will find out and maybe follow up with you all and and see if uh we can work out something with you or or I should stay on her plan.

SPEAKER_00 32:07

Sure, sure. How how how old is your child on the plan?

SPEAKER_02 32:13

Ten. Okay, wow.

SPEAKER_00 32:16

Okay, very good. You're staying busy. Yeah, yeah. More than likely, it's probably employee plus family.

SPEAKER_01 32:23

Yeah.

SPEAKER_00 32:24

Uh so I would say that's it. So since you have a 10-year-old, probably is not gonna make a lot of sense to to for you to go on Medicare. Uh now, if the deductible is crazy high or whatever, I could see it. But you know, Bank of America probably has a pretty decent plan for you all.

SPEAKER_01 32:37

Did you tell him he's gotta send that we do he's gotta send that card back? Yeah, right.

SPEAKER_00 32:40

Yeah, he knows that you're gonna sign it, you're gonna sign the card uh on the back of it, send it back in, and then have them drop off B, and then down the road you can come back into Medicare. Now here's the key. Uh once you send that card back in, you have to you have to now stay covered by an active employment provided plan. Active. So she has to be working somewhere if you're not gonna go back. And if she were to get laid off or lose her job or whatever, even go on Cobra, then you have to go on Medicare. Okay? But you're fine to delay B for sure, no problem at all.

SPEAKER_02 33:12

Awesome. So uh yeah, that's good information. I thought I could call in and and uh drop the B, but uh I need to send it back to them.

SPEAKER_01 33:19

Yeah, you cannot do that. Then they'll issue a new card that just shows part A only and they'll mail that back to you. Exactly right. And that sounds like probably good be worse.

SPEAKER_00 33:27

Did we talk about the HSA thing though? Okay. Oh, and that's right, yeah. Good point. I'm really sorry. I forgot all about that. So yeah, you just want to make sure uh that that moving forwards from from the from the month of August forward, that your wife can continue to continue to she can contribute uh full family amount, uh no problem, as long as you just have A only. Now, uh most people think that if they have A only, they can't contribute any HSA, but as long as you are still covered by her group plan, you can still contribute the family amount, which this year I think is eighty-seven hundred and fifty dollars for the whole year.

SPEAKER_01 34:07

And and if you if it was based on your employment and you were covered by A, then you couldn't contribute. But since it's your spouse's and you have A, you're fine to have her continue contributing that family amount.

SPEAKER_00 34:19

That's right. Yeah. So if she I don't know how much how much she's putting in or the company's matching or whatever, but you can still do family portion. Because just like John said, because it's not your plan, it's her plan, and you have a only, it'd be fine. Okay.

SPEAKER_02 34:34

Okay.

SPEAKER_00 34:35

All righty, good to talk to you, sir.

SPEAKER_01 34:38

Take care. I appreciate you. Bye-bye. Have a great day. Bye-bye too. If you're wondering who you can trust, uh, whenever you're trying to understand what this whole big Medicare world is about, I want to give you a resource uh that you can use. Uh, if you use Facebook, you can open up your Facebook app and type in Medicare School Community. And uh you're gonna have to answer a couple questions and then join the group. And it's gonna give you access to be able to talk to people. Uh, there's about 60,000 people in that group who are on Medicare, who are using their benefits every day, who have Medicare Advantage plans, who have Medicare supplement plans, who've had to deal with pre-authorizations, who've seen their Medicare premiums go up, who've had to change drug plans. Like every scenario that you're going to experience, there are people in this community that are talking. You can ask a question about a carrier. What do you think about this plan? Hey, I'm gonna have this medical service or this procedure done. What do I need to do? Like, and you will get an answer from a dozen, two dozen people that are gonna weigh in on, you know, maybe the best plan for you or give their opinion. And it can really help you protect yourself from making a mistake. So I just want to encourage you to uh join that Facebook group. My dad, uh Marvin, goes live in that group, I believe once or twice a week. What is it?

SPEAKER_00 35:54

Go on tonight, five o'clock.

SPEAKER_01 35:56

Yeah, so Monday, we call it Medicare Monday, five o'clock central time. He will uh go live and will teach on a Medicare topic and then uh take your questions as well. And so I encourage you to join that. It will be a great resource for you. You will learn a lot, you'll uh keep yourself from making mistakes and uh hopefully, you know, learn how to get the right uh coverage for you. So we're gonna answer a couple of comments that are from people inside that that Facebook group. But if you want to join, open up your Facebook app, go type in Medicare School Community, and answer a couple questions and click join group, and then you'll be instantly um approved. Okay, Carlos uh May 8th said, I signed up for Medicare today, and if I'm reading this correctly, Medicare is going to be really expensive for me because the last two years I've been selling my property so I can retire. So my income was really high, and they use that to calculate my Medicare payments, even though from now on my income is going to be way lower. Will I be able to adjust my Medicare payments in the future once my IRS returns show significantly less income?

SPEAKER_00 36:56

He can. In fact, I've had this happen before. Um, same scenario. I had a guy that had 150 uh single family homes.

SPEAKER_01 37:03

That sounds like a pain.

SPEAKER_00 37:04

Yeah, he he sold off two-thirds of the inventory, went to 50. And so what we did, we did it uh we appealed his Irma using the um uh work uh reduction. Exactly. So uh obviously he sold his property, so his work is going to go down. So I would appeal an Irma uh for sure. So what what's happening, he's if he's going on Medicare this year, they're gonna look back at 2024 uh to decide the Part B premium. And so if that's you and you had the situation happen, what you do is you do work stoppage or work reduction, um, and then you would give them the new numbers for 2026. And so in 2024, if he sold properties, you were gonna appeal now. And uh next year, 2027, sounds like he sold properties in 2025. Uh so he's gonna have IRMA a couple different years, but he can use uh the work reduction reason. And then when he uh sells uh all of his properties, then he could do work stoppage. Uh yeah, be and it's true. Trevor Burrus, Jr.

SPEAKER_01 37:57

So what's the point? Because like we've we've talked about this before. Like if I have a rental property and I sell it, you know, and so I'm not getting that income anymore, is that a life-changing event?

unknown 38:07

Yeah.

SPEAKER_01 38:07

And I think we've said no.

SPEAKER_00 38:09

No, that would not be. That's totally different. This is someone who sounds like that's what he did for a living. Yeah. So I mean, in my opinion, it it it's not whether if he worked at some l large corporation or he had his own business, he is still working less. So I think he has everyone. So what's the point?

SPEAKER_01 38:24

Is it like one house, two houses, a hundred houses, ten houses?

SPEAKER_00 38:26

Well, I think if it is someone's full-time job, then I think they have the reason to say I'm now working less, or I've I've totally uh you know no longer working.

SPEAKER_01 38:35

That's the way he had two properties. Yeah. He just I wouldn't call that a that's not a full-time job. Yeah.

SPEAKER_00 38:41

No, that's just an investment.

SPEAKER_01 38:42

Yeah.

SPEAKER_00 38:42

Uh for sure.

SPEAKER_01 38:43

Um obviously your guy who had 150. That's he did. 150. That's a lot of people job at that point.

SPEAKER_00 38:49

Yeah, that that is that is full-time employment. That's all he did. If someone has two rental properties, then they're probably working some of the job, and so it wouldn't be legitimate.

SPEAKER_01 38:57

So it's going to be a little dependent. Um the the second part of his question, I think, though, is relevant. So let's say that he did have like a property or two. It not really legitimately his job, it was just an investment. He sold them so he didn't have to deal with it. The second part of his question is still relevant. Will I be able to adjust my Medicare payments in the future once my IRS returns show less income? The answer is yes. Uh we talk to people who think you know, if they enroll into Medicare and they get this Irma, this surcharge because they made a lot of money, that that's what their Part B premium is gonna be forever. And that's not the case.

SPEAKER_00 39:29

No. Right. Yeah, Part B premiums are uh re-reestablished every yeah, recalculate every year. Right.

SPEAKER_01 39:35

Always looking back to Carlos, I mean, it it's gonna go down in the future anyway. But you might as well appeal it now. Why does he want to pay for a year or two?

SPEAKER_00 39:44

Well, he's gonna have to get his IRMA bill first, and then then he can appeal it. So what I would be doing if I were him, uh we're talking about 2026, starting Medicare, he's clearly gonna get an IRMA from 2024. Uh so set a date. Uh when did you close on that you know that last property where you've reduced your inventory? So pick the date, and I would call that my semi-retirement date, and then I would say work reduction. Exactly right. And then once he liquidates fully, work stoppage.

SPEAKER_01 40:10

Okay. Let's go to another uh question. Okay. Uh May 8th, let's see. Fun hedgehog 2321 says, I am losing my employer health care due to dropping to part-time. Is there any form I would need for Social Security to prove that it was dropped and to get my part B started? Good question.

SPEAKER_00 40:29

Okay.

SPEAKER_01 40:29

I mean it's kind of interestingly worded, but exactly right.

SPEAKER_00 40:33

So in order to get you the Part B started, it sounds like you already have Part A. So if you are beyond your uh basically four months of your 65th birthday, you're going to have to come into Medicare using what's called the SCP special enrollment period. So the paperwork um it is not really notifying Social Security about anything, it's really notifying the Social Security uh Well it is kind of, but it's not for Social Security, it's Social Security manages the Medicare enrollment. That's right. So so so you would get the L564 is the form you're talking about, L564. Uh your employer is going to complete that form. You initiate it. If you work with us, we'll initiate it for you, but you have to initiate the L564 uh and you send that to your HR department with the uh your present company, they'll uh verify you've had credible insurance coverage. Uh and then uh that form along with another form called the 40B, and that's this simply a form that you use to decide when you want to start Medicare. So if you want to start uh June 1 or July 1, wherever you want to begin, you're gonna put that on the 40B form saying, please begin my Medicare B, uh, whatever the date is. And then so the L564 and the CMS 40B will go to uh the Social Security Administration. You can either get get that to your local office or you can actually upload that into SSA.gov today. That's what you do.

SPEAKER_01 41:50

And uh if she had had multiple employers in the time that she since the time she turned 65, she would need multiple. Multiple L564 to prove all the way back. Yeah, we have to have covering. But don't we have a guy once who had like eight?

SPEAKER_00 42:03

Well, I've I've I've helped someone have five. Okay, four, okay. So yeah. And he was what happened was he he was a consultant, but he would he would go on the payroll as an employee. Yeah. So he just got you know moved around.

unknown 42:14

Yeah.

SPEAKER_01 42:15

Well what happens when like a company's gone out of business.

SPEAKER_00 42:18

Yeah. Well, officially, you actually can fill out your own L564. Uh who signs it? And you just leave it unsigned. And then you'd put a note in there that uh I cannot get it from my employer. I've had I've had that a couple times. I didn't know that. Yeah, it can't. Now, I would I would suggest we we go through the HR for sure, but uh technically you could you could do it on your own. Now, what's gonna happen then? You better have proof of that.

SPEAKER_01 42:39

And so that's payroll like uh payroll receipts or something.

SPEAKER_00 42:42

That or that or every year the insurance companies will send you a credible coverage letter saying that you were covered. Really? Oh, yeah, they're required to do that. Oh, sure. Yeah, once once you turn 65, they and they'll they'll even do it before then, but they have to at 65 to say that you've had credible coverage. Makes sense. Okay. Yeah. Typically we're using the L564, but if we can't get it, you do it on your own. And if you got audited and they say prove it, then again, pay stubs uh and the and the uh uh annual uh you know letters of credible coverage can be used.

SPEAKER_01 43:12

Okay, Herbert uh says I'm 73 years old, my wife is 70 years old. We live in Florida. I have a supplement plan G with Mutual Omaha. The premium is very high. Am I eligible to change to a different company if it is cheaper?

unknown 43:26

All right.

SPEAKER_01 43:26

Well, you've got yeah, well, one thing going for you is in many places in Florida, supplemental plans are pretty high. Um but also mutual can raise their rates as well. Right.

SPEAKER_00 43:39

And so he can move, but he in the state of Florida, he's gonna have to medically qualify to move uh from G to G or G to N. Uh it's not one of those states that would have it's not a birthday rule state. It's not like Missouri anniversary real state.

SPEAKER_01 43:53

So you can. The answer is yes, you can. You've got to answer some health questions. Exactly. What are like big knockout things that would keep Herbert from being

SPEAKER_00 44:00

Anything major with a heart, lung, liver, kidney. Cancer in the last 36 months, diabetic problems. You can be a diabetic and get approved, but if you're using more than 50 units of insulin a day, probably not going to get that approved. Or if you have diabetic uh neuropathy, uh you know, retinopathy, any of those kind of things, you're not gonna get approved. So those would be your big things. Heart, lung, liver, kidney, cancer, diabetes.

SPEAKER_01 44:24

Things like high blood pressure, high cholesterol, it doesn't matter. Trevor Burrus, Jr.

SPEAKER_00 44:27

Not an issue at all. And even diabetes are not an issue as long as you know, insulin dependent, we've got to be limited on how much you're taking. But if you're type 2 diabetic and you're taking oral meds, as long as you know those have been consistent, there's no problem there whatsoever.

SPEAKER_01 44:38

Is there any is does is AFib a knockout? A lot of people have AFib.

SPEAKER_00 44:42

Most most companies, yes. But we was talking about it. I think Mutual of Omaha will take you, but I think there's some limitations on how much medication you're taking. But but use the AFib with most carers is definitely going to be a knockout. And and rheumatoid arthritis can be an issue. So there are several things beyond what I've seen.

SPEAKER_01 45:01

Yeah. I mean uh MS. Uh what is it? Uh, osteoporosis, thank you. Sorry about that. Yeah.

SPEAKER_00 45:11

Osteoporosis with fractures. But we have some cares, if you have osteoporosis, uh they'll decline you. But there's some will say with fractures. Definitely declinable.

SPEAKER_01 45:24

Probably stuck.

SPEAKER_00 45:25

Yep. Can't can't move unless they're in a you know year-round open enrollment type state.

SPEAKER_01 45:33

If your uh Medigap plan, your Medicare supplement plan uh recently went up because they're going up this time of the year, a lot of people think your Medicare supplement plan goes up uh on January 1st. That's almost hardly that that rarely happens. Usually Medicare supplement plans go up one of two times, either on your anniversary date, meaning 12 months, 24 months, 36 months, 48 months after you had your policy started. So on your anniversary date, or they take their rate increase generally between April and June-ish, um, is how a lot of carriers do it. So if you've recently got a rate increase notice, number one, I want you to know that like you're not alone. They're still going up. We've had two or three years of this. We're hoping this is the last year where your med sub um can increase double digits. Um, so, but there are some things you can do. And so in uh tomorrow, we're my dad and I are gonna be chatting about that. What are your options? If your Medicare supplement has gone up recently, you've got that rate notice. Uh, how can you get help? What options do you have? Uh, and how can you save some money? Because every dollar obviously matters, especially in this economy. So join us tomorrow. We'll we will be chatting all about that. If you need immediate help uh with your Medicare supplement plan, with your Medicare Advantage plan, with signing up with a drug plan, comparing your options, getting quotes, whatever it is, I want you to know that there is help and you're in the right place. We would love to help you. When you call into our office, uh, you're gonna be talking to somebody who is not on the other side of the world world. They're right here in uh in Kansas City. You're gonna be talking to someone who's been trained by my dad, Marvin, who really is an expert at Medicare expert at comparing things. All the tools that are publicly available don't work very great for helping figure out what's my health, what's my budget, what are my meds, what are my doctors, all of these things. And then together, you guys can come up with a plan. And so our services are free. It doesn't cost you anything to work with us. You're not gonna have to pay anything extra for your insurance. And the thing that I love the most that when you work with us, what you get is what we call a dedicated client care manager. And this is somebody who literally is your point of contact, right? And it doesn't matter if you move across town or across the country, if you need new ID cards, if you have a billing issue, a claim issue, a question, something you need to work through, that dedicated client care manager will be there to help you. You are not alone. We have uh really two goals here at MedicareSchool.com. And the first one is we want you to purchase a plan or enroll in coverage that serves you for many, many years. And secondly, we want our service to be so good that you tell all of your friends about us. And so we'd love to help you. The phone number to uh to reach someone at our office is 800-782-6676. We're open from 7 a.m. to 7 p.m. Central Time. Call in, schedule an appointment, talk to someone live, and you will get uh wonderful assistance by somebody on our team. If you want to be a part of uh any of these Medicare School daily shows, we would love to talk to you, hear your questions, hear your experience. Phone numbers 833-824-2004, 833-824-2004. Call in and it's your opportunity to talk to truly the nation's leading expert on Medicare. We will see you tomorrow.