Medicare School Daily
The team at MedicareSchool.com led by Marvin Musick answers REAL Medicare questions from our callers, and help bring clarity to the VERY confusing Medicare System.
Medicare School Daily
Are GLP-1’s PUSHING People To Medicare Drug Plans Early?
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GLP-1 medications are changing the conversation around Medicare drug coverage.
On today’s Medicare School Daily, we’re talking about whether the rising popularity and cost of GLP-1 drugs are causing some people to reconsider their Medicare timing, coverage choices, or Part D decisions earlier than expected.
We’ll break down how these medications interact with Medicare drug plans, what people should understand about coverage and costs, and why this topic is getting so much attention.
We look forward to taking your calls!
Welcome to Medicare School Daily. My name is Josh Music, and I'm here in the studio with my dad, Marvin Music. Whether you're just starting Medicare, you've been off for on it for years, or maybe it's time to start Social Security and you're not sure exactly how to do it, you're in the right place. Over the last 15 years, over 75,000 people have called in to our office and have navigated through this successfully, and we want you to be the next one. In just a moment, you're gonna learn everything you need to know about this Medicare GLP1 program that's getting ready to start. If at any point you have a question and you maybe have a story or you have a scenario, like an enrollment situation that you're not sure how to navigate through, we would love to talk to you. Uh, this is your opportunity to get your questions answered from truly the nation's leading expert, my dad, Marvin Music. So take advantage of that opportunity. If you have something that's gone great with Medicare or something that's gone really wrong, we want to hear about that too, because everyone, all of us get smarter when you share what's going on out there in the real world of Medicare and Social Security. Uh, you can have all your questions answered from 11 a.m. to noon Central Time. We're here Monday to Thursday. So call in and we would love to talk to you. The phone number is 833-824-2004, 833-824-2004. Don't let that uh burning Medicare question go unanswered. Don't make a Medicare, don't make a Social Security mistake. Uh just make the call, 833-824-2004, and get your question answered. So, Dad, share with us a little bit about uh kind of what this whole bridge GLP1 program is about and maybe a high level, then we can go deeper and how it applies to individual folks.
SPEAKER_02All right. Well, there are uh some right now that are uh on GLP 1s that are certainly covered by Medicare and their Part D plans. But the zigzag the existing system, uh you're covered if you have um uh uh sleep apnea, if you have um uh uh some type of cardiovascular type of disease, then you can still get GOP ones. And so as GOP1s began to uh be very effective uh for also weight loss, uh there uh has been a movement to try to get Medicare to cover GOP ones just strictly for uh weight management. And so uh there's been some movement within Medicare to actually do that, but it's very complex when you you know you when you add this because you are forcing the insurance companies to cover them and you know pharmaceutical companies to have certain pricing structures. So uh as they moved in that direction, they actually had a program called the Balance Program, uh, but they actually have put that on hold uh and they've come up uh with a method of of covering GOP ones, and it's kind of like a pilot, kind of a demonstration. So again, it starts. A bridge, exactly right.
SPEAKER_00How long is the bridge?
SPEAKER_02The bridge is for 18 months, it is going to start uh July 1 of this year and goes through uh the you know December 31 of 2017. So basically 18 months as a demonstration.
SPEAKER_00So this program that's coming out, you may be able to take advantage of for 18 months. You would expect this to change in some shape or form at that point.
SPEAKER_01Exactly.
SPEAKER_00And people are on these drugs for a lot longer, right? It's not generally like, oh, I'm gonna lose it 35 pounds and then maybe stop. I think they tend to be maybe even like lower dose maintenance. Right. So it's gonna change. Yes.
SPEAKER_02I think I think this is uh the government's way to say this is the direction we're going, it's gonna take some time. And so this will this uh is a program we're gonna test for a while to see if some of the things that we're implementing will will be useful, will be helpful, can we make this happen?
SPEAKER_00It's almost a data collection. It is, I would imagine. Right. Yeah.
SPEAKER_02Yeah. So if uh you presently are on Medicare and you have a Part D plan, and remember, uh your Part D plan could be through your Medicare Advantage plan or it could be a standalone Part D plan if you're on a Medicare supplemental plan. And so if you're already on um GOP1s because of against sleep apnea, cardiovascular issues, diabetes, uh uh, then uh you're probably not going to be able to take advantage of this program. Uh yeah, because in order to to uh uh uh qualify for the bridge program, it has to be about weight management only. Okay. And that's it. Okay. And so it's gonna help a lot of people because there are some that uh this is their issue, and they have at this point in time, you have not been able to get it covered for weight management only. But now that's going to change.
SPEAKER_01Yeah.
SPEAKER_02Okay. All right.
SPEAKER_01Good.
SPEAKER_02And so um uh as we look at this program, and it's something that you may be able to take advantage of, uh, first off, uh uh what's happening is you have to keep this in mind, I think this is the big thing that I learned as I studied this, this is outside of Part D plans. However, you have to have a Part D plan to be able to qualify for it. But you're not gonna run the GOP ones if you qualify for it. It's not gonna be ran through uh your your Part D plan. You just have to have a Part D plan, meaning what? This is for people that are on Medicare. All right.
SPEAKER_00Uh and so um A and B or just A with a drug plan or A and B with an advantage plan.
SPEAKER_02If you have A only, and that's all you have, then you would you could uh possibly qualify to get uh these meds through the Bridge program. If you have a Medicare Advantage Plan, the same thing would be true. Um if you have you know A and B is fine.
SPEAKER_00Trevor Burrus Because I could see people uh who maybe have employer coverage and they want to keep it and they're gonna work for a few years more years, but they have Medicare Part A, can they sign up for a drug plan? Absolutely. And then that would make them eligible. It would be perhaps. I mean there's other qualifications, but that would be kind of the first step.
SPEAKER_02It would be.
SPEAKER_00Okay. Yeah.
SPEAKER_02So we mean of course we encourage uh we'd encourage you to take A only uh as long as you don't have an HSA anyways. Right. Uh but if you have chosen not to take A just because you didn't have to and you weren't worried about it, this may be a reason to do so if it's only about weight management. Yeah. Because then you know you're you're going to use it for that purpose. Trevor Burrus, Jr.
SPEAKER_00Okay. So it's about weight management. If you are on if you have a for sleep apnea, cardiovascular diabetes, that's still going to be covered under your drug plan. So when you say it's outside of the Part D plan, what does that actually mean? Trevor Burrus, Jr.
SPEAKER_02Okay. What that means is that uh the the all the the Part D rules uh are not going to apply to this. Uh the structure of Part D plans, uh if you're on a Part D plan, you probably have a deductible of $615. This wouldn't apply to that deductible. Uh we have different phases on Part D plans, uh the deductible initial and then catastrophic. Uh this again does not apply to that. Uh Part D plans have their own preauthorizations, uh uh uh step therapy, quantity limits. So all the rules that uh exist within the Part D plans have nothing to do with this plan. So it's truly outside of that. So that's the whole point. Now, they have their own rules, uh, but um uh uh the if you qualify, it's not gonna be subject to your Part D plan. It's kind of interesting.
SPEAKER_00Does the money go towards their true out-of-pocket?
SPEAKER_02No, not at all. So it has nothing to do with the Part D plan. Okay.
SPEAKER_00So there's gonna be about six hundred if it's fifty dollars a month, that's about six hundred dollars. Yeah, six hundred dollars for the year, but it's not. So if you're already on a drug plan and you're you know maybe on maybe a couple of expensive medications and you're using this bridge program, don't expect for that $2,100 cap. This doesn't apply to that. It's outside of it, so it's just six hundred bucks. Exactly there.
SPEAKER_02That's what you'll spend.
SPEAKER_00Which is not bad. No, no, it's very, very good. Okay, is it all of them? Because there's so many.
SPEAKER_02Okay, let's talk about here's what's interesting. There's really only two main manufacturers of these medications, Josh. Uh one would be Novo Nordisk, and they have three meds Ozempic, uh uh Rebelsus, and then Wagovi. Uh that's the ones they have made, and then you have uh Eli Lilly has two, which are Zetbound, and one that's called um, I think Foundo, if I'm pronouncing it correctly. But the reason I even mentioned that is because we're we're talking about five meds. And so what happens, there's only three of the five meds that will be eligible for the program, and those are a little bit restricted. And so uh they will cover um uh uh all formulations of this found foundale. Okay, meaning it can be. Never even heard of that one. Yeah, me either, uh, until I study this. But uh it'll cover all of the formulation, which means um uh it's in it's in pill form only, so they're gonna cover that.
SPEAKER_00Um, it's not an injectable, no, that's interesting.
SPEAKER_02Yeah, well, that's what's interesting about um uh the yeah, the kind of the whole this whole uh market. Uh Ozimpic is injectable. Sure. I don't think it's in pill form. No, no, it's but but but the the rebelsis is is Ozimpic in pill form. Oh, really? Yeah, exactly. Because you know, some people uh struggle with the needles, they don't want to have anything to do with needles, and that would cause them to not even take this. And then um then I think Wagovee may come uh both ways, Josh. I'm not really sure about that. Uh but the whole point is we we uh they're only going to cover Wagovi, um, and um and they'll cover only one form of Zetbound, which is very, very effective, and but it's the quick pin. And it's the quick pin, what they do is they put in it's a it's a it's a month fill. So there's four different weekly injections within that. But in order to have that one, uh it's not just uh like uh you have to put a needle on each time. Sure. So people would be a little bit versed in needles. But m but it here's what's covered the the the foundale, uh wigovey, and the quick pin in the Zetbound. And that is it.
SPEAKER_00Uh what is the Wigove? Any form? Uh well Do you know it is yeah, it says all formulations of Wagovi? Wagovi. Okay, but Zbound's only quick pin and then all forms of rebellious?
SPEAKER_02Uh no, you no, no, not no rebelsis. Okay. Uh that found it. Fandeo. Okay. Sounds good.
SPEAKER_00So there's a limited uh number of options. It's not like whatever GLP one you want. That's true. Um it has to be for weight management only. It's going to be billed outside the Part D plan. How do you get qualified for it? Okay.
SPEAKER_02Well, uh let's talk about a normal path of a Part D medication. You would go to your provider, the provider submits that to the Part D plan and goes through all the rules and and then you know you go the you you go to the pharmacy. Here, we're not going through a Part D plans. So what they have set up is a uh a processor to process all this happens to be Humana. Oh, not Humana Part D plans. Humana has a very organized system. So they're they're called the claims processor. So the doc, and that doctor could be a you know cardiologist, it could be uh, you know, a regular primary care doctor, but probably a bunch of weight management claims pop up.
SPEAKER_00That's right.
SPEAKER_02So they're well, they will submit that to the claims processor uh for prior authorization.
SPEAKER_06Okay.
SPEAKER_02And so the prior authorization really has pretty much everything to do with body mass. Uh so the body mass index. Uh and so what we have is anyone that has a body mass index above 35. So over 35? Over 35 would just automatically qualify.
SPEAKER_01And if someone's curious, if you're curious about your body mass, yeah. You gave me the thing. I was gonna run some stuff here. So I've I've got some examples here too. Okay, go for it. Yeah, yeah.
SPEAKER_02Anyway, so um but let this let's say you take someone that's 5'10. They're 5'10 and they weigh 245 or above, they would automatically qualify because that would be within that moderate to severe obesity. So that's 510, 245, and above qualify. 5'6, 217 pounds and above, automatically qualify. So the formula, uh, for those of you that are curious about this, you take your weight in pounds times 703 and divide that by your height in inches, and that is your body mass index. So again, anyone 35 and above automatically qualifies. So uh they would um uh you know submit the the prior authorization based upon the BMI. Now, uh you don't have to be above 35 to get it, but if we're lower than that, the next range is 30 to 34.9. And so uh that would be someone that's 510 that weighs 210 and above, or they're 5'8 and weigh 210 and above. And so, but the BMI alone is not enough to qualify in this range here. So what happens is this uh they have to have other significant health conditions. So if they have some type of a heart failure, they have uh blood pressure that's uncontrolled, they have chronic kidney disease, those types of things that would allow them, though they're not above 35, but they could still uh qualify. So the prior authorization would go through. Okay, not done yet. So then the next would be anyone that's 27 to 30. So obviously these folks have a lower body mass, they still can qualify. It's just a kind of a hard path to get there. Okay, so they have lower body mass, but they could qualify if they're pre-pre-diabetic, they prior uh they previously had a heart attack or a stroke, or they have some type of an arterial you know disease or whatever. So they can they can still get that. So um uh that's that's the pathway. Now, remember if someone is um uh you know like a uh a type two diabetic, uh they have you know all these other other you know diseases, then they still may have to run uh their medication through uh the Part D plant. So what I think what people are gonna be tempted to do is to say, well, I can get that medication for fifty dollars, my drug plan's caught uh you know, charging me $125. And so they may tempt it to do it, but they're gonna get caught doing that. Uh because there's gonna be this the system is actually gonna be double checking to make sure could could uh have you previously used that medication through your Part D plan? So you can't get all Part D plan and go on this plan because it's cheaper.
SPEAKER_00Are they ever gonna check like I guess uh maybe that's a dumb question, but like employer coverage? I guess not.
SPEAKER_02No, because it wouldn't matter. If you've been paying cash, using a discount program, uh rent through employer plan makes no difference at all. Okay. Yeah, you'd better switch that. Yeah, especially if you're you know new on your if you've never used uh your Part D plan before. All right. So that's what it means. It's gonna be outside. And I I I personally think it's excellent on the on three.
SPEAKER_00Well, yeah, and it'll be interesting to see how it plays out, I think, over 18 months, because in my mind, the kind of the big concern is we've already seen so much an upheaval as it relates to uh you know Part D plans and how they're kind of struggling financially. Um and then you know, advantage plans have changed a lot too in terms of reduction of benefits over the last year or two. And now all of a sudden, if the carriers have to now take on the cost of all this expensive GLP ones, what's that gonna do? So I would assume the next 18 months is how is what's the utilization of this benefit going to be before it gets put on the backs of the insurance carrier? Let's talk to uh Ernest in Pennsylvania. Ernest, uh welcome to Medicare School Daily. What questions do you have for us?
SPEAKER_04Hi. Hi. So uh very briefly, a little bit about my history. I joined I signed up for Medicare uh for December 1st of uh 2025. I joined my supplement replan uh on uh January 1st of 2026. And the uh gentlemen that I signed on with, I'm not gonna say any name, I had asked him a few questions, not a dozen questions, and he could only answer about maybe nine of the three of the twelve questions. Like I decided to sign on with him, and he had told me that one of the things that he could not answer was the uh the policy that I signed up with, what their uh through his previous experience telling his policy of the G plan, of course. How uh how how much was the premium increase on the year-to-year base? Okay, he said that he couldn't answer that question, I would have to call it. And uh so I try to do some research and basically don't advertise what your premium is based, you know, increases year year just. Well, after signing a contract, my broker then told me that through his class experience that the premium increases between seven and ten percent annuals. And I thought that was uh a big increase. And I'm surprised that I was actually a little bit upset because I had asked that question before I first of the policy that I you know this the claim that I took and I signed with him, and after I signed with him, he then indulged his information. So I just didn't feel like he was a problem to me. This has been bothering. Sure. And I'm wondering within six months, from what I understand, I can switch my my coverage, or can I also switch my broker?
SPEAKER_02Yeah, you you can. Let me ask you this, Ernest. Is that your uh last question? So I can because I don't want to switch and switch your broker. Okay, very good. But yeah, let's let's go back. So I just want to be clear. So what you're telling me is that your A and B date is uh 12.1 of 2025. Is that correct? A and B. Yes. Okay, very good. Yes. All right. Uh so first off, when it comes to um uh stability of rates, uh, in in the past, uh Josh and I have been doing this 15 years now, uh we have been able to with confidence tell people that we're normally going to see anywhere from about a three to seven percent uh price increase. But but but uh uh from COVID years on, everything changed. And so it's not like that any longer. So uh it is it is i I think it's uh difficult for us to give numbers to people because companies have been going up ten and twenty percent. So it's you know very disheartening that that that's kind of where the market is. Now in regards to we we don't expect that to last forever. Right, but yeah, we we do think that there's gonna be now that that correction has occurred. We're certainly hopeful that we'll we'll see uh a return to stable rates. But what happens is this not all carriers do report uh their their previous price increases. Many do. And we actually have access to information, uh, but not all do. And so sometimes you know people even will ask us, hey, can you tell us? And we'll tell you what what's available publicly. But again, not all report that. So uh once you know about that. I do think rates will become more stable, uh, but no agent can predict how stable a company is going to be because we don't know how many claims are gonna be within that that group. We have no idea uh how large the group is going to be. So there's a lot of factors that actually come into play when it comes to uh predicting what the stability of the rates will be. In fact, uh Josh and I were in a meeting yesterday with uh a bunch of our agents, and you made the comment uh you know, don't overpromise, don't tell people we know this is gonna be uh uh you know a real stable company. And they have in the past they have been. That does not mean that we need to be making a promise moving forward.
SPEAKER_00Let me give you an example. So our number one carrier for probably a decade, uh always in they had a they had a, I think it was like a 21-year track history of this, uh said, hey, we have an average of a 2.9 percent rate increase, so 3 percent, right? Um and that was like a big selling point, and that lasted for 21 years. The last two years, that carrier has taken back to back between 15 and 20 percent rate increases. And that's not the insurance company's fault. Right now, there's been a ton of fraud that's happened within Medicare ever since kind of the COVID thing, um, you know, ever since COVID happened. There's been an increase in the individual market and in the group plan market that has pushed deductibles up. And so people are waiting, and they're waiting for things like knee replacements and shoulder replacements and gym, you know, all these things to do it once they get on Medicare. And they do that the first month they get on Medicare. And so now these the utilization of these plans have gone up, and it's been doing that for the last three years. Now, there are a lot of initiatives underway to put a stop to that, to, to kind of measure and blend that out. And so we do expect that to even out. Um, hopefully, uh, you know, this is the last year. Maybe there's one more year of these larger than normal rate increases. Um, but I don't want, I don't I don't want you to get kind of like, oh, my broker should have a crystal ball into the future. No one knew COVID was gonna happen. No one could predict all this fraud that was gonna take place. No one could predict that the individual market and the group plan market was gonna raise their deductibles and max out of pockets so much that people were gonna wait till they went on Medicare. Right. Like these are things that your broker isn't gonna be able to predict. It's things that happen and then the market shifts so that insurance companies can stay in in business. All right. So that that was kind of a long tirade. Let me can I ask you what what carrier, if you can say, what carrier is the one that that you went with?
SPEAKER_04So I did get the G plan and I went with uh um Wellaby.
SPEAKER_00Well, okay. Okay. So so Medico Wellaby. Yeah, we've we've helped a lot of people get on Wellaby. They're kind of known for, especially for people who are um who were able to get quite a few things through underwriting with them. They've been pretty lenient with letting people who are outside of their open enrollment period you're you know, you're in a time period right now and that it ends at the end of the month, um, that you can get any plan you want, and it doesn't matter what health qualification or health issues you have. But beyond the end of this month, you're gonna have to medically qualify to switch plans. And medico has kind of been known the last 12, 18 months of like, hey, we'll we'll accept people that are maybe a little higher risk profile. Trevor Burrus, Jr.
SPEAKER_02So you can change, Ernest. Yeah, you can change. If you want to do that, if you want to get off Medico Welleby, uh I I would tell you this, I don't think they're a bad carrier by any of the things that we're doing.
SPEAKER_00We've been medical or wellby brokers uh for a decade. Yeah, many years. But they only became really price competitive the last 18 months.
SPEAKER_02Yeah. So uh if you want to if you want to move, you can. Uh and we'd be happy to help with that. Just you know, call in and uh uh you don't have to medically qualify, you just simply switch. And the way we would do that is we'd submit the application, it'll automatically go through, and then you would have to call Medeco and cancel that effective uh 531 or June 1st, and then your new one would go into effect.
SPEAKER_00Yeah, June 1st.
SPEAKER_02June 1.
SPEAKER_00So you still have time to do that, sir. It's easy to do if you need help. Do you have our office phone number?
SPEAKER_04I do. Okay. What about my broker? If I were to drop the broker that I have now and go with uh the Medicare school, uh you guys, would you still be compensated like she would be? Oh sure. Yeah.
SPEAKER_00So when you switch your plan, we would become the new we would become the broker for policy. Agent of record for that policy.
SPEAKER_02We'd be happy to do that for you, sir. And then the good thing about us is you you have, you know, we have we have a you know fairly large company, so you have uh a a dedicated um um client care manager.
SPEAKER_00So you'll be you'll have a person, you know, if you lose your ID cards, if your premium goes up, if you move across you know the state line and need to change your plan or you have a billings issue, whatever it is, you're assigned a person. It's not an 800 number. You know, a lot of these call centers use outsourced, you know, across the across the country, you know, across the world. That's never gonna happen with us.
SPEAKER_02Yeah, we do it within in-house, so we'd be delighted to serve that way. So if you want to call us, um we'd be happy to make that switch for you.
SPEAKER_04That sounds great. Now, can I keep the Wallaby uh plan that I have and just change my broker?
SPEAKER_02No, sir. No. No. No, the the original broker that set that plan up will will still continue to be agent of record. Um has to be that way. Yeah, unfortunately, but that's that's the system. But if we can help you, you uh let us know. Ernest, any of the questions you have for us before we let you go?
SPEAKER_04That's that's it. Okay, okay, thank you.
SPEAKER_02We we appreciate your call. Take care.
SPEAKER_00Okay, let's talk to uh Andrew in New Jersey. Andrew, are you there? Welcome to Medicare School Daily. Hey there. What questions do you have? I'm sorry. I said, what questions do you have for us?
SPEAKER_03All right. I I I'm going you spoke to a uh a person caller maybe two or three calls back where he asked you about Medicare advantage versus you know the supplement plan. Um basically you said if you're healthy, then an advantage plan may good be good for you. But what if somebody gets sick after they're on the advantage plan uh and then they want to try to switch unless they're in the year trial the one year you know trial period, then their A and B has to be the same month that it was effective. So how can somebody get around that uh that rule, if you will?
SPEAKER_02Yeah, well there really is Sure. Yeah, Andrew, there really is no way around that unless you live in uh Connecticut, New York, Massachusetts, or Maine. That's it. Outside outside of those those four states. Um and um and we know you you you you live in New Jersey. So uh what happens when when we talk about being healthy, there are some people that will decide they don't want to spend a premium. They just don't want to pay a premium. So if that's you and you say, uh, I don't want to pay a premium, then we would tell someone then then you know it's uh all right to consider an advantage plan. But you still are going to have some limitations, meaning if your health were to change um after that you know that first year period, you're probably gonna be stuck on that advantage plan for the rest of your life. Uh that's why as a company, 75% of the of the people that we assist who you know look to us for uh for guidance uh and become the broker, they go on Medicare supplemental plans. Uh I can tell you that.
SPEAKER_03I'm a big fan of Yeah, I'm not I am not at all a fan of advanced plans.
SPEAKER_02Yeah, and and I'm yeah, I'm on Medicare. I'm not either. I didn't go on one, and I wouldn't, but but the one reason I didn't is because I see the differences and I was willing to pay a couple hundred dollars extra a month to make sure that I could pick my docs to make sure I didn't have insurance interference, I could have a plan for life. So there's a lot of reasons that I've chosen to pay a premium. And again, most people, when they realize uh, yeah, the advanced plan is zero, uh, but what are you getting? Well, you're also getting an insurance uh who has the final say so on your on uh you know your your health conditions, your your health care services you need. You get limitations on providers, so there's a lot of things that come with that. But there are some people that do not want to pay a premium, and we're uh then we'd say it's a lot better than having A and B only. Uh so I think Yeah, I think that you know the advantage plan is second best. I think the best is still supplemental, but frankly, there's some people that just don't uh want to pay. They can't afford a premium, and and that's certainly fine. And there's still they still have uh you know fine insurance with the advantage, but they have some hoops to jump through. And those of us that can afford and are willing to uh spend a little extra money, I think we get really a lot of value for our dollar. Now, are you already on Medicare, getting ready to go on Medicare?
SPEAKER_03Oh no, I still got a couple of years. Okay. Um let me ask you this also. In your experience, are you seeing a lot of people going with the N now versus the G, uh, even with that $20, you know, Dr. Copay?
SPEAKER_00There's definitely there's definitely been an increase of that. So if we look back 15 years, everybody bought plan Fs, right? And then uh then it kind of quickly became a transition into everybody uh buying a plan G. Uh they were just so much cheaper, and then the government also made it impossible for most people to get a plan F. Uh, we have seen an uptick of people getting plan N versus G because there is a premium decrease, and it varies based upon where you are. In some areas, it's a $30 a month difference. In other areas, it's $75 a month. So that's gonna be a little bit region specific in terms of where that that kind of happens. Um both there are still more plan G's uh that are purchased today than there are plan N's pretty healthy margin. Um but that that kind of shift is happening uh for sure. Who knows how long it'll be till it's equal or where plan N outpaces um plan G. It'll be a few more years for sure.
SPEAKER_02Yeah, but I think as far as go ahead.
SPEAKER_03No, you go ahead, Andrew, please. I was just gonna I was just gonna say it's it's like you said, more going on N. And it seems like the only drawback with N is that twenty dollars. I mean, I know they say excess you know get the excess fees, but in my experience, that's not often. Yeah, it's pretty much. Yeah, pretty pretty rare.
SPEAKER_00It's not often, and if it did become more and more often, you'd probably you know, if G plans were having to pay that, there's just going to be a corresponding rate increase, right? But there's still a depending on where you are, uh that that G is less risk. Yeah. And and also for minimal amounts of money, it's it's a good decision for a lot of people. But if it's a big difference, plan in all the way, 100%.
SPEAKER_02I think they're both uh great decisions. Um, I mean, uh most of us have different deductibles on our automobiles than our homeowners' insurance. So that's really what it boils down to. Are you willing to take on a little extra risk for uh some premium savings? And some people say, yes, that's what I want to do, and that is not a bad decision.
SPEAKER_03Well, that $20 copay, is that just for doctors, or could it be for lab work? Uh X-rays, let's just say when you see a doctor.
SPEAKER_02When you see a doctor. So that would be a specialist, uh, primary care doctor. It's not rehab, it's not lab work. Uh my understanding is there's 15 different codes uh that are billable when it when a doc actually sees a patient face to face or even telehealth, and that's when that $20 copay would apply. Of course, emergency room would be $50 copay. So again, now listen, we we have people that that go to the a doctor three or four times a month. It just happens. They have a lot of health issues. Well, it wouldn't make any sense. I I had a lady recently that uh goes to Mayo Clinic once a year. And uh she said, hey, I know access exactly right. So the point is there are some cer circumstances where it just makes sense. For me, uh uh it was $35 difference. That was a no-brainer. Um the $35 is not going to break me. I now have no risk if I did have access, and I don't have to hassle with copies. So I like that. But again, Josh said, in some states it's $75 to $100 difference a month, and that's substantial.
SPEAKER_03Oh, you're absolutely right. Uh I let me just say, guys, I really watch your videos the whole time. I think you guys are exceptional uh in the information, and I really enjoy. I hope you keep posting YouTube videos. Yeah, we don't plan on stopping anytime soon.
SPEAKER_02All right. Andrew, hey, we appreciate the encouragement. Thanks for the call. We'll help you in a couple years. Okay. All right, let's get to our next caller. We have Holly from Colorado. Holly, good to talk with you. Uh, what are your questions today?
SPEAKER_05Oh, hi. Um, I had a question about um the AARP United Healthcare. It says that it includes a renewed fit active card, and I'm interested in that. I was wondering if other insurances would include that or if that's just part of the United Healthcare one.
SPEAKER_02All right. Is that your only question, Holly?
SPEAKER_05No, I have a couple more.
SPEAKER_02Okay, very good. Well, I'll address that one then first. Uh yes, uh, your new active is actually a gym network that um United Healthcare has put together. I would say this, it is very similar, uh not identical for sure, to the Silver Sneakers Network. So what we typically find are companies are, I mean, that are uh gyms and uh different um uh you know workout facilities that uh are in the Silver Sneakers Network will be in the Renew Active. Uh but if you're going with United Healthcare, uh then then you they have to be in the Renew Active Network. Now, uh United Healthcare actually has two different types of Medicare um uh supplemental plants, and one of them does include uh the renewactive uh free gym membership, and the other one does not. Uh and so uh what this simply means is that uh they will pay for that gym membership, providing that you know that that particular gym is actually within their network. Okay, so that's renewactive. Uh I would tell you that there's only one other carrier that uh on a regular basis will offer a gym membership, and that would be Humana. Humana Medicare supplemental plans will also, uh, and that is typically silver sneakers. Now, I'm not saying every Humana subplan will, but there are some that do. So again, that's pretty exclusive. Um most subentral companies, uh it's Aetna, Cigna, um, Healthspring, those companies are are typically not offering any kind of gym membership at all. So if that's important to you, then United Healthcare may be a wonderful option. I have clients right now that are um um uh they they go to a gym that cost $100 a month. They had one recently that was literally $150 a month, but they're in the renewactive uh network, and so it costs them nothing. So that really makes uh you know that United Healthcare uh subnotal plan very, very attractive. Okay? And so hope that helped. But that's that's the way the system works. Uh what other questions do you have, Holly?
SPEAKER_05Um, when I went to the Medicare website and was looking at the different prices for the different kinds of plans, um, they they really ranged anywhere from 116 to over 200 for the for the plan G I was interested in. And I was wondering, um they they supposedly they all have the same coverage, right? Not not that we're new to active, but yeah, everything else would be the same. That some of them say preferred, and some of them say substandard, and some of them say underwritten by. I didn't understand any of that.
SPEAKER_02Okay, okay. Well, preferred and standard, it just simply means that a preferred rate means you're non-tobacco. Uh standard rate, it means smoker, uh, or use tobacco products. Uh now, usually when we are first uh on Medicare, uh they don't we don't even ask the tobacco question, anyways. But for people that are maybe they've already been on a supplemental plan and they're switching, then we do have to find out if they've used any tobacco products in the last 12 months. And so if they have, that's a standard rate or substandard rate versus preferred. So that's the difference. Underwritten means this. Uh if you live in Colorado, and so the way Colorado works is that uh when you first go on Medicare, six months of your Medicare B date, uh you will not have to go through medical underwriting, which means uh the insurance company has to approve your policy, uh, they have to cover all your pre-existing conditions. Uh so you will get that that that um uh that uh policy issued. That's called guaranteed issue, and that's tied to your B date. Just give you a quick example. I started Medicare in January this year, so that's my B date. Now I can apply for a supplemental plan three to six months in advance. Uh it won't go into effect until my B date uh does, but uh my B date was 6-1. But I still am for another month within my six months of my B date. So I started Medicare January uh uh one, uh so I cancel January, February, March, April, May, June. So all the way through June, January 1 to June uh 30th, I'm in this what we call a Medigap OEP. Uh and uh this is the time when there's no underwriting, insurance companies cannot charge me extra, they must cover my preexisting conditions, uh they have to approve the policy. But after that six-month window of my B date, then if I ever want to get a Medicare supplemental plan in any state other than um uh New York, Connecticut, Maine, Massachusetts, anywhere else, uh I have to now medically qualify. So you would have to medically qualify after six months of your B date. And that's what that means by underwritten. That means that it's not guaranteed that they will approve the application. All right. And there's no there's no additional uh premiums because someone has to go through underwriting. Whether they get it six months of their B date or they get it uh through underwriting, there's there's no difference in price. The price difference uh differences would be whether you're a tobacco user or not.
SPEAKER_05Wow. Thank you for explaining that.
SPEAKER_02Yes, and then let me just clarify one more thing about the difference in rates. First off, uh and I'm not bad mouthing Medicare.gov site, we love that site for drug plants, okay? But I would tell you that it is typically not up to date and not very reliable when it comes to the med sub premiums. So it's not really accurate. I would use someone like us, whether you use us or any, you know, whoever you want to use, uh, because we have access to live quotes all the time. It's live, and that system is not live. So I wouldn't put a hot uh a whole lot of uh credibility with that. Uh but but but there still will be, even with us, you may uh uh call us and we're quoting uh premiums, there could be as much as $30, $40, $50 a month difference between the carriers. And the reason for that is because uh what carriers do, uh they decide what markets they're really going after, where they want to be competitive. They all have different medical loss ratios. So you have actuaries that actually come up with these premiums. And so depending upon a company's profit margin, depending upon their medical loss ratios, there's a lot that's gonna go into uh that uh you know that rate. Let me just give you a quick example, Holly. Uh just so you know, we don't we don't sell auto policies and homeowners at all. Okay, we that's not our business. We're we're retirement planners. Uh but here's what I do know. Uh you probably own your own home. I could take your home, uh, same roof, same age of home, same condition, everything. And if you got a price from State Farm or from Geico or from American Family or from whoever, I'll guarantee you they're gonna give you different prices. Same home, same roof, same everything, but different prices. And that's just the way insurance works. If we were to insure your life, same thing happens. It's still you, uh, we could do a term policy with one company and they'll have a different price than another. And that's just insurance. There's different prices because companies have different profit margins, different markets, they're more aggressive in, and that's just kind of the way it works. Okay, so I hope that helped because there will be a variance for sure between the carriers, even though the coverage is the same. If you get a G plant or you get an N plant, no matter who you go with, the same bills are paid, the same type of bills, the same amount of bills will be paid for you for sure. It's just the premium uh that will vary.
SPEAKER_05Oh, that's very helpful. Thank you.
SPEAKER_02Okay, you're welcome. Anything else before we let you go?
SPEAKER_05Uh no, I just wanted to reconfirm. If the gym membership thing is is really important, I probably need to go with the the AARP or one of those Humana deals.
SPEAKER_02Yeah, exactly right. And I th I think the UHC um, of course, U United Healthcare is the insurance company. ARP just uh uh you know endorses those plans and of course receives a royalty for it. Uh and and truly, we uh we have written tens of thousands of policies uh with United Healthcare, and historically they've been very stable. Last couple years, not so much, but the but the truth is most of the companies have not been very stable. We're hoping to return to uh more stable rates in the future. But uh United Healthcare really I I believe is a good company. Uh and so if you need some help, uh I don't know if you have our 800 number, but if you want to call us, uh we'd be delighted to help in any way. Do you have our number?
SPEAKER_05Is it 800-864-8892?
SPEAKER_02That's yes, it sure is. That's one of them. 800-864-8890. It's about the only we have a couple of them. That's the one I've memorized. So you call that and uh we'd be delighted to um uh the reception team would put you uh into um uh uh an opportunity to be able to talk to one of our agents, an agent that I know that I've trained, that I know would do a good job for you. And and our philosophy of business is this we're we're we're we educate people to make sure they understand their options. Uh there's no pressure, we're not going to, you know, push a certain plan uh at all. We're just gonna tell you here are your options, uh, here's the ins and outs of this particular company, and so we'll be honest about our opinions and we really approach it very unbiasedly. Uh our agents are paid the same no matter what plan you go with. We decided when we started this company uh 17 years ago, uh we decided we weren't gonna do that. It was gonna need we want we wanted our our advice to be very unbiased, not commission driven, uh, because we don't think that's right. We think we should uh give you the facts regardless of you know how much we're gonna get paid. Okay, so that's the way we try to treat everybody. Thank you very much. You are welcome, Holly. Uh joy to talk to you. You take care. See ya.
SPEAKER_05You too. Bye bye.
SPEAKER_00If it's time for you to go on Medicare, maybe you're turning 65 or you're just now retiring, uh, you probably need some help. And so that uh if you need help comparing plans, whether that's uh comparing advantage plans or supplemental plans, or maybe you've decided on a supplement plan, but now you need to decide between plan G and plan N. Maybe you're on three or four meds and you need to make sure that your medications are covered. Uh, maybe you've decided on an advantage plan because it's gonna work well for you. You gotta make sure all of your doctors and the hospital systems are in network. What I'm trying to say is there's a lot of decisions and it's hard to do this all alone. And it's scary to do it all alone because maybe you don't know what you don't know. So if you find yourself in that situation and you want to get help from someone who's been trained by my dad Marvin Music, I want you to just consider calling in. The phone number to reach our office is eight uh is 800-782-6676, 800-782-6676. And when you call in, you're gonna be connected to someone who can do a screen share, like a Zoom call with you, or just talk over the phone, whatever your preference is. And they're gonna compare all of these options. And you're gonna see, you know, that I we talked to somebody last week and they had, you know, 25 different advantage plan options and they had 10 different supplemental carriers in their state or their zip code. That's a lot of different options that you have to choose from. And so you're gonna be able to talk to someone who can throw out the bad ones. Hey, these people raise their price a lot. This one, your medication isn't covered well. Um, this one, your doctor is in a network, whatever that is, you can work with someone who's been trained by my dad to be able to work through your situation, your financial, your health, your physicians, and all of the all of the considerations and help you come to the right decision. Uh, we'll also help you assist, uh, we'll also assist you with uh IRMA paperwork, Part D uh enrollment, uh Part A and B enrollment, Social Security enrollment, whatever it is, you can get help and you don't have to do this alone. So if you need help, call in 800-782-6676. You can get immediate help. It's free, it doesn't cost you anything, and we would love to serve as your insurance broker. Whenever you turn 65 or you're beginning Medicare, uh, but especially when you turn 65, you are like a minnow in an ocean full of sharks. What do I mean by that? Well, when you turn 65, everybody knows about it. Insurance companies, call centers, literally like your mailbox starts filling up with mail, and all of a sudden you are getting bombarded with information. And a lot of this information is sales information. And there's a lot of bait and switch that happens in this industry, unfortunately. Can't tell you how many people go, they sign up to get a quote, and all of a sudden they start getting phone calls. You've probably experienced this. You sign up to get a quote for a Medicare supplement or a Medicare Advantage plan, which one's right for me? You fill out some quiz, and all of a sudden you're getting bombarded for weeks or months by dozens of carriers or insurance call centers or reps or whatever it is, because your information is sold over and over and over again. So join us tomorrow. You're gonna be learning what are the most common bait and switch things that happen when you first are starting Medicare because we we want you to end up in coverage that you love, not coverage you find out you're disappointed in and you can't change.