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
6 Things Medicare Will NEVER COVER
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Many people assume Medicare covers everything once they enroll. The reality is, there are important gaps people often don’t discover until they need care.
On today’s Medicare School Daily, we’re breaking down 6 things Medicare generally will never cover, why these gaps matter, and what people should understand before making coverage decisions.
From long-term care to dental, vision, and more, we’ll talk through some of the biggest misconceptions we see every day.
When you go on Medicare, you may think it's wonderful coverage, you may think it's terrible coverage. And the truth is, it's probably somewhere in between. There are six things that Medicare never covers. And beyond that, it's pretty good coverage. We're going to talk about those six things today. Welcome to Medicare School Daily. My name is Josh Music. I'm here in the studio with my dad, Marvin Music. Whether you're just starting Medicare or maybe it's time to start Social Security and you have a question, maybe you're confused. The reason we are here today is to help you through all of that. So if you have a question, I want to encourage you to call in. The phone number to uh get your questions answered is 833-824-2004. 833-824-2004. So if you have a question or you have a sh a story that you want to share with us to help us all get a little bit smarter as it relates to Medicare or Social Security or retirement, call in 833-824-2004. You can get all your questions answered from 11 a.m. to noon Central Time, Monday to Thursday. So don't let that burning Medicare question go unanswered. Don't make a Medicare or Social Security mistake. You're in the right place and you can get your questions answered. Dad, let's talk about these six things that original Medicare or that Medicare is never going to cover.
SPEAKER_01All right. Well, the first uh item that you need to be aware of is that and by the way, this is this is disappointing to lots of people. Uh, and that's the fact that Medicare is not going to cover uh an annual full-blown physical for you. And that's frustrating. And I'm gonna tell you why, because most people have been accustomed to um getting an annual physical that's provided by their insurance company at work, and they're really very good. And so you probably be getting that.
SPEAKER_00Pardon me? As you get older, you get less than that. That's so weird.
SPEAKER_01It's true. Well, you know why? Listen, when Medicare began in 1965, the whole idea behind it was to cover things that are medically necessary, meaning a disease, an injury, an illness, an accident, something. That's right. So they look at a lot of these items and they just say, we're not gonna be able to do that. Yeah. I I think it would be. But what can you expect?
SPEAKER_00What do you get?
SPEAKER_01So well, here's the way it works. Uh you uh were gonna be eligible for the first 12 months. Once you start Medicare A and B, you're uh gonna be able to get what is called a welcome to Medicare physical. Not very thorough, uh, but it it's it's it's something. Uh but basically an opportunity to be able to make sure that uh you know your doctor is happy with your meds, they're gonna check your height, your weight, check your blood pressure and your vital signs and all that, and kind of get things set up and see if there are any problems you're dealing with. Uh but it's not a full-blown physical. You're not gonna get your uh blood drawn and and analysis with you know blood work and all that. That's not gonna happen. So so that's number one. No annual physicals. The only thing you get first 12 months, you get uh a little bit more of an extended uh situation. Then after that, it's really minimal, and those are called wellness visits. We get one of those a year, and they're even less than than the first one. Uh so that's number one. Number two.
SPEAKER_00Okay. On an advantage plan, do they get a better physical?
SPEAKER_01Uh well, I've never been on advantage plan, number one. So what I what I do I do know what they say is that they're gonna give you uh a kind of a root a routine physical. It is not full-blown either. Okay. It may be a little bit more than than the original Medicare. I mean, remember, uh uh, you know, Medicare advantage plans, they're gonna they're supposed to be matching.
SPEAKER_00Yeah, they're supposed to they also want to manage the care a little better. Can be a good thing and could be a bad thing.
SPEAKER_01Yeah. But I I think that the they're both are gonna be very similar on that. Number two, though, let's talk about the other thing that Medicare will not cover that can be really disappointing, and this is of course in the news right now, and that is uh any type of a long-term custodial care need, long-term care. Long-term care could be in a nursing home, it could be in assisted living, uh, but Medicare doesn't cover that. Uh so Medicare exists to cover things that are medically necessary. But if you need just normal, what we call assistance with activities of daily living, you need help bathing or dressing or or eating or taking the right amount of medications, you have Alzheimer's, you have dementia, those kind of things are not covered by Medicare. Um, there is an agency that will cover you on those, and that is the uh Medicaid. But in order for Medicaid to cover, you're gonna have to be broke or almost broke. And so Medicare is not going to cover. Now, I want to clarify something. If you, let's say you um uh uh have Alzheimer's and then and someone has a stroke, while the uh medical system is taking care of your stroke, uh rehab, whatever's going on, then they will cover your long-term care needs. But once we a rehab is over and now we're we're done, we're back on our own when it comes to the custodial care. So again, custodial care by Medicare terms is not medically necessary. Okay, number three, uh when it comes to chiropractic care, now there is some coverage for chiropractic, but it is very limited, and that is this adjustments of the spine only. Uh I know there are uh people get chiropractic care that includes uh traction, uh different types of therapy that chiropractors uh you know will will uh use, but those are not covered, all the adjustment of the spine. So chiropractic care, very, very limited. All right, number four uh would be dental. Uh very uh surprising and disappointing to a lot of people, but Medicare is not going to cover your normal routine dental care, meaning preventive cleanings, x-rays, uh um extractions and fillings and root canals and implants and and uh bridges, those kind of things are not covered by Medicare. If you want them covered, you're going to have to get a separate plant. In our company right now, about half of all the clients we have have dental plans. They have made uh the you know that their oral health a priority and they get a plant. Now, some people have very healthy teeth and they don't get a plant, and that's fine. You can self-pay on that. But Medicare is not gonna pay for anything unless it's very extreme. If you get jaw cancer and uh there has to be uh some removal of some of the jaw bone, well, that's gonna require your teeth to be reconstructed. Reconstructed, Medicare will cover that. Uh if you're getting ready to go in for a a kidney transplant, that your oral health is very important uh prior to that surgery. They're gonna cover those kinds of things. So again, we have some, but limited, limited for sure. And then also when it comes to vision. Now, this is a little bit different than the dental. Medicare on the vision side covers you well. I mean, excellent. You have glaucoma, you have cataracts, uh, you have uh uh macular degeneration, whatever is going on with your eyes, Medicare is gonna cover that. Here's what they won't cover though. They will not cover any preventive eye exams, uh, and they will not cover any eye wear unless it's after cataract surgery. All right, so what happens? Uh if you want an eye exam, and again you need to be truthful, but you need to go and say, hey, doc, I'm seeing floaties, my vision, my vision is not right. That is a medically necessary eye exam covered by Medicare. But if you go in and say, hey, doc, I just want to see if my eyes are healthy, I want to get an exam for my eyewear, not going to be covered by Medicare. Now, the exception to preventive eye exams would be diabetics. They actually get two a year because it's medically necessary because diabetes has such an effect on the eyes. All right. But anyway, so Medicare, great coverage on eyes, but just not eyewear and uh preventive eye exams. And then the last thing would be hearing aids. Um if you need hearing aids today, most people just simply you know do over-the-counter. You don't have to have prescription to get very good hearing aids today, but those are not covered by Medicare. Now, I will say this there are some people that will actually go on an advantage plan uh for that very reason because they want hearing aids uh covered by Medicare. So Medicare Advantage plans will, but I think you need to know this. If you get an advantage plan just because of hearing aids, I don't think that to me, I would never do that. But if you do, you want to make sure that uh the hearing aids that you want are covered because the way advantage plans cover hearing aids, typically they have a network of one brand or something. Very limited, uh, and you'll have a copay based upon the the quality of the hearing aid. That's the normal way. No, no, no. But but sometimes what they'll do is they'll actually give you, they'll say we'll cover up to $1,500 per year per year. You know, so it's it's decent. Other times it's a network uh limited, and then you just pay a copay, company pays the rest. I'm not knocking the hearing a coverage on advantage. That's not my point. My point is you have to make sure, though, that that what you want, you're gonna be able to actually get you know get. Trevor Burrus, Jr.
SPEAKER_00Medicare is not covering some of these things you mentioned. I just want to specifically talk about the dental vision hearing. So what are people's options? You mentioned briefly advantage plans, but maybe walk us through how do people get this coverage? Because these are real things.
SPEAKER_01Oh, absolutely. Well, um if you want to have dental, and I I have a dental plan, I'm glad I do. Of course. I think it's very, very important. And if you think it is, then uh you can you can get a standalone dental plan. Um and uh with the with those plans, here here's the way you uh here's what here's your options. Um you can get a dental plan right now. Uh what you're looking at is uh what kind of coverage do they offer? The majority of plans are going to give you 100 percent coverage on your preventive. There may be a small deductible, fifty or a hundred dollars once a year on that. And then 100 percent of preventive. Your basic services are your are your uh uh less expensive services, extractions and fillings, those kind of things. Those are covered at 80-20. Uh insurance company pays 80, you pay 20. Uh when it comes to major services, now we're talking uh, you know, root canals, bridges, uh uh, you know, crowns, those kinds of things. Those are normally covered at 50-50. Um you pay 50, they pay 50, or maybe they pay 60 and you pay 40. Sometimes we'll see that. But the whole point is um uh other than preventive, nothing's gonna be covered 100 percent, but you're gonna get some substantial help uh with those dental plans. And so there's a premium that you have to pay. And the premium you pay is really based upon the annual benefit that you're getting. Right now, I'd say the average is gonna be somewhere between about $40,000 to $50 for a really a good plan. A plan that's gonna cover you maybe $3,000 and maybe $5,000 in annual benefit.
SPEAKER_00And that's normally enough for meaning so most people. So let's say you went in and had a $5,000 dental bill, right? Which is I mean, I was talking to somebody last week. They got I think their bills were twenty thousand for the year. Right. So um depending on you, you you can customize these plans to what you expect or how much coverage you want. That's right, pretty common. So uh they're going to pay uh their 50-50 if it's major, their 80% if it's basic, their 100% if it's preventive, up to the point where they've spent their $2,000. Or their $3,000 or their fourth, whatever that maximum is, they're gonna set that ceiling.
SPEAKER_01Yeah. So the plan sets the benefit the maxim benefit that they will pay.
SPEAKER_00So if you had multiple dental plans?
SPEAKER_01You can't. You can't.
SPEAKER_00And they'll be able to do that. And I think the biggest we have is a ten thousand dollar maximum. So if you know you just chronically have um things going on or one implants, or yeah. Um there's this there's also this concept that's called credit for prior coverage. We call it CPC. Uh and it's very important if you're coming off an employer plan, uh, to see if there's a plan that's available in your area or in your state that has credit for prior coverage. And what does that mean? So uh on a dental plan, they're saying, hey, we're gonna cover your preventive up front. That's that's pretty universal across the board, two cleanings, two x-rays, two exams a year. Beyond that, they may institute some sort of a waiting period, and nobody likes a waiting period. But basically, they're saying, hey, you gotta be on the plan for a little while before we're gonna pay a lot. And the reason for that is imagine if you picked up a dental plan, you paid $50 for that in one month, you went and had $2,000 worth of work done and they paid out two grand, and then you canceled the plan in month three, right? So they've received $150 and paid out two thousand. The dental plan would very quickly go out of business and it would be over. Right. Right. So they have to institute a waiting period. But there's this thing called credit per prior coverage, and it's not available everywhere, but sometimes there's a plan that has credit for your employer coverage that you're maybe becoming off of, or maybe some other type of coverage. And they're saying, well, hey, if you had coverage, then there's a good chance you probably were taking care of your teeth along the way. Yeah, you're not delaying. And we're going to go ahead and honor that, and we're going to waive those waiting periods. And again, that's not everywhere. That's not all the time. That's definitely not on any plans. Um, it is rare. Uh but but we can still find it, find it in many instances.
SPEAKER_01Yeah.
SPEAKER_00So that's the best time to buy.
SPEAKER_01That's the way we teach it. You you want to get a dental plan. If you want one, you want to get it uh usually within 30 to 60 days once you've lost that employer-provided plan. Okay. Because that credible coverage.
SPEAKER_00Trevor Burrus, Jr.: A lot of your vision or your dental plans will also, there's the ability to add a vision plan onto that. Right. And it's 10, 15 bucks a month.
SPEAKER_01Yeah, $15, $20 right now. So you have two networks. Uh you have available the VSP network, which is the largest, and then you have iMed, which is still very large and a good network. So usually when we add on a um an iMed network for your vision, that's usually about $15. If VSP is going to be $20. But the reason you may want to consider that, uh, and by the way, I don't have one. I'm going to tell you why, because I don't I don't I don't wear glasses. So when you get a vision add-on, uh it makes sense uh because number one, they'll give you a uh preventive eye exam once a year that Medicare doesn't cover, they will, but they'll give you discount on your lenses and your and your your uh you know frames and all that. So if you're getting glasses on a regular basis, it's gonna pay for itself. Sure. So I think it's a very good option for sure for those that you know have eyewear, and a lot of people our age do.
SPEAKER_00So you mentioned hearing aid coverage on an advantage plan. Is there a way to get hearing aid coverage on some of these things?
SPEAKER_01Well, what happens is when you buy a uh a combination plan of dental vision hearing, and they're out there, there's there's there's some options. What happens is they will actually give you a credit. Normally it's about $500 a year of that overall benefit that could be that can go towards hearing aids.
SPEAKER_00So let's say you got a plan that had a $3,000 max benefit. You're saying that could be used for vision, could be used for hearing, can be used for dental.
SPEAKER_01A hearing aid too, exactly right. So the hearing is normally limits about $500.
SPEAKER_00Trevor Burrus, Jr. So if that but if hearing aids are in your future, then you may you know call and talk to us if there is a what we call a DVH, dental vision hearing, kind of a combo plan in your area that you can look at and consider. And then it kind of allows you some freedom to use the money for dental vision, hearing, whatever.
SPEAKER_01Yeah, get some flexibility.
SPEAKER_00And those I would say those are not the most common, but if hearing is something that's important, then that's something you probably will look at. Let's talk about long-term care. How do people how do people address that?
SPEAKER_01Okay. Well, a couple options. Um if if they can self-pay, and that takes a tremendous amount of money, but some people choose to do that. Usually they're going to have to uh you know have a family member take care of them. That's one. Second way is to uh have the government take care of them, which is Medicaid, which means you have to spend down all your assets or transfer those assets five years prior to needing care. Uh so that's an option. A third option would be if you would like to get some type of insurance, which I think is very smart, and you get two options. Well, yeah, yeah, I'm seeing if you want to get some some you know a transfer of some of the liability, uh you can do it one of two ways. You can do traditional long-term care insurance, which is v difficult to qualify for and very expensive. Premiums change.
SPEAKER_00So are people still buying that? Oh, yeah. There are some. It's got to be rare. Yeah. I mean, I feel like it was rare ten years ago. Yeah, yeah.
SPEAKER_01There's they're still out there, but again, Josh, i if someone buys it at 40 or 50, probably not too bad.
SPEAKER_00Yeah.
SPEAKER_01But if you're buying it in the 60s, it's not going to be real good uh price. And plus it's very difficult to qualify for, but it's still out there. We call that traditional long-term insurance, or you have the option to actually attach a long-term care benefit to another another type of product. Could be a life insurance product, could be an annuity. And so what happens is you're buying a rider uh and it and that that means that that um uh life insurance money, face value policy or your annuity, uh, those funds could be used if you had a long-term care need. So what happens is uh you have this life insurance policy, and if you never you use uh the uh the long-term care benefit of that, your beneficiaries are gonna still get that policy. If you have an annuity, same thing is gonna happen. So you know, with traditional long-term care, one of the problems is it's difficult to get, it's expensive, and if you don't use it, you lose it. And so most people don't like that position. So that's why we will oftentimes attach um uh this long-term care need to another type of product. So the chassis is uh life insurance or annuity, but you you can still use that money for long-term care if you have a need. And so it it means this. If you had uh there are six activities of daily living, if you if you have two of those where you have a need, that's triggering uh the long-term care uh writer, and now you can use some of that life insurance money, annuity money to pay that that nursing home. Okay, and so uh it's a great way to go. It's what I would definitely do for sure if I were looking into it.
SPEAKER_00And if you if you're concerned about this, maybe you have a family history or maybe you know you've had some friends or just have experience, you don't want to be a burden to your children. We do have a financial planning team here at MedicareSchool.com that can talk to you about those options um for long-term care and how to find some protection. So you can call in, um, ask to talk to that team, and they will uh get you over to the correct person who can explore your options.
SPEAKER_01Yeah, and if it's something you're interested in, don't put it off because uh it just gets more difficult to get and more you know expensive.
SPEAKER_00So okay, let's talk to Sandra in New York. Sandra, welcome to Medicare School Daily. What questions do you have, folks?
SPEAKER_06Um what my question is is I wondered if you have any insight. Um I'm in United Healthcare, and they changed their policy this year to where all your doctors need referrals from your primary. And we're having nothing but issues with the insurance company, and all of our doctors they're all fed up with the insurance company with all the extra work it's causing, and they don't want to hire extra people to take care of all these referrals. Um a lot of our doctors are saying they're not going to carry this insurance anymore, and they're not taking new patients because of it. Um, there's a lot of anxiety on our part of what we're supposed to do. Um every time we need a referral, um that's piling in my primary doctor, and it takes time to get the referral, and we don't get it in time, and uh the doctors are threatening that if they don't get these referrals, they're gonna cancel our appointments on us. So there's a whole lot going on.
SPEAKER_00Are you a Buffalo area? Or where are you? Yeah, okay. Okay, and you're on United Healthcare, is that what you said?
SPEAKER_01Yes. Okay, okay. And we are we're assuming that you're on an advantage plan. Is that correct, Sandra? Yes.
SPEAKER_00Okay, okay. And this is a new thing you're experiencing, right? So sorry for the 20 questions. We just want to make sure you have the context.
SPEAKER_06Yeah, no, no. It it it it last, uh I just retired a year ago, and we got in this insurance last year, and there was no referrals needed.
SPEAKER_07Yeah.
SPEAKER_06And then January came around and they changed it to where you need a referral for any doctor that you go to except for your primary. And um the doctors are all getting fed up and they don't have the the people to handle all this extra work, and uh they're just saying they're not gonna carry us anymore.
SPEAKER_01Sandra, let me ask you this. Is there any way possible that well well first off, how how long have you been on this advantage plan? How long? Uh since May of last year. So May of 2025.
SPEAKER_00Okay. Okay. And is it a free? Is it I'm assuming it's like an HMO plan, correct?
SPEAKER_06Yeah, yeah. I just pay my monthly and that's a HMO Medicare Advantage plan.
SPEAKER_01Yeah. HMOs require uh that uh you have to have a referral uh in order to see a specialist. And basically what's happening is your primary care doctor is is forced to become the gatekeeper to make sure that you really do need to see a specialist, number one. Number two, that you're seeing somebody that is within the network so that it'll be covered. That's the purpose of that. So, Sandra, my question is is there any way at all that you could afford to go on a supplemental plan? Uh have you looked at some of the places? I don't know.
SPEAKER_06I'm no, I'm I'm totally lost. When we called last year and I got set up, um they said that this was the best plan for us for our area.
SPEAKER_01Yeah, and again, yeah, and again, it really could be. It could be for sure. Uh I'm not saying it's not. I'm just saying too, I was just curious if maybe you could uh go on one. If this is the primary issue, the only way you're gonna get away from having to get referrals is to go on a supplemental plan, because original Medicare and supplemental plans do not require referrals at all. The problem in New York is the prices. Uh, they're very expensive. So that's why I can see exactly why someone or even if us would have recommended an advantage plan. They just simply make sense for, you know, uh uh up there. Another way that you could avoid this, and by the way, Sander, I I'm just sharing thoughts with you. I'm not telling you what to do because you're you're really, you know, you're in a difficult situation. Another thing, if I were you, uh I would probably look at what is called a high deductible G plan. Uh I'm and and just so you know, as a general rule, I'm not a huge fan of high deductible G plans. But the reason I'm saying that is because at least then you would um you wouldn't have to deal with referrals. Now you would be responsible to pay for the first $2,950 out of your pocket. Uh Medicare pays first, and then your your your plan is not gonna pay anything until you've you've paid the $29.50. But that's $250 a month. You take that $3,000, you divide it by $12. So it's basically about $250 a month on average. Your G plan is gonna be, you know, fairly um reasonably priced.
SPEAKER_00High deductible one, yeah. Yeah.
SPEAKER_01Yeah, the the regular G plan is is very pricey in New York. And again, uh across the country, I would I would not even give this advice, but where you are, uh you're just in a very difficult situation. So what I hear you saying is, hey, do you guys have any ideas to get me some relief from this uh requirement to get referrals? And frankly, this is the only way to do it.
SPEAKER_00Well, I mean, PPOs, right, could be an option. Yeah, are there PPOs in her Yeah, there's there's there's some PPOs that are available. You'd have to here's the thing. So in the Medicare Advantage Plan world for a long time, I would say the last five years, there has been a really big push and trend towards getting people on PPO plans, because PPO plans are a bigger group of doctors, you don't need a referral. If you go out of network, you have some coverage. The problem is it's put a lot of strain on these Medicare Advantage plan carriers. And so now they are all trying to get everybody pushed back into an HMO plan, which it sounds like is what happened to you. So this isn't just happening to you, it's happening to a lot of people because they can't make the economics of the PPO plans work. So we're expecting to see over the next uh probably five years a big push from people going from PPOs to an HMO. Um and it's gonna have to. Yeah, it just has to, because those PPO plans are literally starting to go away. Um and when they and if they're not going away, then they're making the benefits so bad, like the max out-of-pocket is you know $14,000 or something. It's just it's a lot of people.
SPEAKER_01You know, make them attractive enough where anyone wants them.
SPEAKER_00Yeah. So you're kind of in this very interesting position. There are some PPO plans that are still available. Um, they've got pretty high max out-of-pockets. Um, and you know, what I my suggestion would be let's talk, maybe call into our company when it cut gets rolled around an annual enrollment period, which would be October, and let's see if we can see what PPOs are available for the 2025 for 2027. That being said, we expect for there to be fewer than 2026, just like there were fewer in 2026 and then 2025 and and so forth.
SPEAKER_01Yeah. And then the then I unlike Josh's idea, I think I think it makes sense. Uh the what are the premiums, are there premiums premium ones.
SPEAKER_00So those those in-net workmax out of pockets are almost all ten thousand dollars.
SPEAKER_01Right, right. So I I like his idea. The other thing that you may want to look at is what I had suggested would be the high deductible G. Yes. Um that's that's that that is definitely a possibility.
SPEAKER_00And then you eliminate it for she can't do that until this annual enrollment period.
SPEAKER_01No. No. She is in New York, and so I think that's something I don't think she can, but that could be an exception. Yeah. Yeah.
SPEAKER_06The the um I was wondering how that's gonna how how does that affect like the insurance companies? All these doctors are jumping ship and don't wanna do that.
SPEAKER_00Well, but they're but they the the it's kind of working out according to plan for the insurance carriers because they don't want that care. Yeah, it's kind of right, right. Yeah.
SPEAKER_06The doctors are all telling us that the doctors are all telling us that this is their way to get you know, get out of having to pay for anything for the people.
SPEAKER_00And that's probably true. Yes.
SPEAKER_06They're trying to slow down the whole process so everybody gets aggravated.
SPEAKER_01This is the way they control cost. It's true. It's it's yeah, because they bring friction to the doctors for uh friction to you as the uh uh the patient, and they succeeded. It's very unfortunate. The insurance companies today have way, way too much power in this whole uh this whole uh you know scheme of health insurance. It's ridiculous. So we've we feel your pain, but right now, um and of course, you know, I know that uh New York is an open enrollment state, so I'm not sure that you would have an opportunity to go to a submodal plan right now. Josh is saying no. So you're gonna have to stay where you are, jump through the hoops, but hopefully be able to improve your position. So meaning going stay on advantage, go to PPO plan standard, or uh look at the possibility of going to a high deductible G plan in New York. I and again, those rates, I'm not even sure what they are, but we've looked at them before, and I think they're they're halfway decent. You just have to have that $3,000 set aside in case you know something were to happen. Now, that that doesn't mean you're gonna meet the the that high deductible, but it does give us a way to to get away from this whole network issue that you're dealing with right now and referrals. Okay. Okay. Okay. So give us a call uh as we approach the open enrollment season October 15th, December 7th, and we'd be delighted to help you, and hopefully we can get you in a better position.
SPEAKER_06Okay, great. Yeah, you guys helped me a lot last year. Yeah.
SPEAKER_00Okay, well let's talk, let's talk in October and we'll look at see what PPOs are available for next year, and then look at high deductible G's as well. All right. Okay.
SPEAKER_01Thanks for the call, Sandra. Nice to talk to you. Take care. Thank you.
SPEAKER_00Let's talk to Lisa in California. Lisa, welcome to Medicare School Daily.
SPEAKER_04Hi.
SPEAKER_00Hi. Uh welcome, welcome to Medicare School Daily. What questions do you have for us?
SPEAKER_04I'm sorry. I was watching you on the TV.
SPEAKER_00Oh no worries. We're here for you.
SPEAKER_04How are you doing?
SPEAKER_00I am doing well. How's Gal's California?
SPEAKER_04Oh, great, of course. You know, that's what we pay all this money for, right? I spoke with you guys a few weeks ago and um I watch your show all the time. And so I asked you about I got I I got Medicare because of disability. And so I went ahead and I we spoke about it, um doing the advantage plan until uh I turned 65 and then doing the supplement. But then I hear I hear you talk about all the time the B date, the B date, the B date. Right? Yep. And so I'm like scared that maybe did I did I misunderstand you and I'm stuck with it.
SPEAKER_01No. No. Hey Lisa, is is that your only question? Or do you have other questions besides that?
SPEAKER_04There's a follow-up. Okay. And the follow-up is you want me to tell you now or wait.
SPEAKER_01No, you go right ahead. Let's hear your questions, then we'll we'll address both of them at the same time. Go ahead. Okay, great.
SPEAKER_04I heard um, I heard you talking about you can change you can give up the advantage if you have it less than a year. And I don't know, is that after the B date? Okay. Is that is that you're trying to do that after the B date?
SPEAKER_00You're turning 65 in January, right?
SPEAKER_01Of next year, 2027. Okay, very good. What what what day is your what day is your birthday? It's not on the first, is it? Is it is it uh No, it's the 29th. Very good. Okay. It's almost February. Okay, that sounds good. So right now, what you're telling us is that you're on Medicare A and B because of disability. Is that correct? Correct. Okay, very good. So uh what happened in most states, California being one of them, uh uh either the the you can't get on Medicare supplemental plans or they're just priced out of the market. So obviously that's what's happening with you. You're on an advantage plan, and that is fine. And so just I'm not trying to be overly technical with you, but I want you to know we call that your initial enrollment period, whether you're coming into Medicare at 65 or you're coming in as you did uh because of um uh being on disability and and have Medicare that way. But what happens is uh when you turn 65, you're gonna get what we call the the initial enrollment period two. So this just simply means uh, Lisa, it's your second opportunity to now be able to pick out any plan that you want. Um and and then which will be in January, you're gonna be able to start that supplemental plan of your choice. You can do a G plan or you can do an N plan or whatever you would like to do. And um so it it that particular period is really not tied uh to your particular B date uh because you already have the B date that that uh has been established. Normally, uh the B date matters hugely. Uh for instance, my I I turned 65 this past January, so my B date was a big deal because I didn't come into uh Medicare through disability. I just came in the normal way I aged in. And so when we age into Medicare, uh we can we can apply for a MedSub plan three months or to six months before we actually start B. But once the B date has been established, now we have six more months where we're still in that period of time that uh it's called the the Medigap OEP. And that's a time when you don't have to go through underwriting, we can't ask any health questions, you will get the policy that you apply for. So that's why I we make a big deal of the B date. But for you, there's an exception uh because your B date has already started, and now you're gonna get a second opportunity come January uh to get that plan. So let's back up the clock. So anytime after October the first, you can apply for a Medicare supplemental plan of your choice, G or N, uh, to start January one. All right. And really uh and and we'll help you do all that, of course. And what's the nice thing about your situation is after October one, all the 2027 drug plans will be out. So we'll be able to help you pick out that drug plan that's gonna be perfect for you. And what's gonna happen behind the scenes is that drug plan that we select is actually gonna kick out or or or cancel your advantage plan effective one. The new drug plan starts one-one, and the supplemental plan that you chose starts as well. Everything goes into one-one. And there's still no underwriting, you haven't missed anything, you don't have the the trial right uh on advantage plans has nothing to do with you uh whatsoever. Uh for some people it it matters, but in your situation, does it matter at all? Now, to me, Lisa, that made sense. Did it make sense to you? I hope it made sense to you. Okay, are you sure?
SPEAKER_04Yes, okay, that made sense. Okay, so now I have a question regarding the the um the the having the advantage plan for less than a year.
SPEAKER_07Mm-hmm.
SPEAKER_04Yeah. I got an advantage plan.
SPEAKER_00Um but this won't it's not it doesn't it doesn't impact you.
SPEAKER_01Yeah, it won't impact you at all. Let's talk, let me say this, Lisa.
SPEAKER_04Lisa, wait, I was away something. I was gonna just tell you the reason I got this advantage plan is it's like the medical group I have it's the UCLA medical group. Because you you know UCLA is a good place. Sure. Um and it's like the medical group made an advantage plan. It was like a miracle, for real. And um so I I picked that one. They haven't been around that long though. So you know, they don't know. What's the company called It's called um UCLA Health Medic Medicare Advantage.
SPEAKER_00Okay.
SPEAKER_04And they have two plans, a premium, I guess, and a prestige.
SPEAKER_00Sure.
SPEAKER_04And so and it seems like the the thing is, it seems like it's too good to be true.
SPEAKER_00Well it may be, but not enjoy it for this year. Yeah.
SPEAKER_04That's what I see that that was my question. I want to give it I know that this is um well until the the first part of the year.
SPEAKER_00Yeah.
SPEAKER_04I was thinking of maybe if if if I could give it a little bit more time to make a decision. I know but I know in my heart I'm not gonna keep an advantage plan there you go. Because I I don't I need to be able to Okay.
SPEAKER_01Lisa, when did you go on that plan? When did you go on the plan? Three years.
SPEAKER_04Um The first of the month, actually.
SPEAKER_01Okay, so you just started on the you technically would still be within your um your trial right all the way through uh the end of April. But it doesn't matter. She can't get a subplant, right? Oh well she not right now she can't, but I'm saying next year she'll be 65.
SPEAKER_00So if you wanted to keep the plan a little bit into next year, you're fine. But even then, how long does the IEP two last?
SPEAKER_01It's just like a normal IEP, three months, four months up, three months after. Exactly right. So here, Lisa, I can't. But do I start over? Start over with your Medicare Biden. New York. Okay. So here's here's what's gonna happen. Um you you could exercise your trial right uh uh all the way up through the end of April and go on a supplemental plan. Uh if you were to stay on that advantage plan uh more than uh beyond May 1 of next year, to me you you would have you would have made a mistake. But you're fine to to go ahead and do that uh through four. And Josh, the way we would submit that, we'd still submit it as Medigap OEP because she has six months of uh her birth month. Yeah. Okay. Yeah. So point is if you're if you're asking me how long can you stay on it without losing the right to be able to get uh a Medicare supplemental plan, uh then it would be you would need to start the subplan at the very latest 5.1. You can start it as early as 1.1 if you want with no underwriting, but you still won't have our underwriting all the way through uh a 5.1 effective date. And then after that, in my opinion, you've made a mistake. Now let me give you some prices real quickly, Lisa. Uh the G plans in your area uh right now are about $200 a month, and the N plans are about $182. Is that an eight or a six, Josh? That's a six. Sorry about that. I can't read his writing. Uh G Plan 200 a month, N plan 162. Uh in addition to that, of course, you're going to have a drug plan. There are several very low-cost drug plans in California. Uh so that would be the difference. But the beauty is, Lisa, if you can afford those premiums, now you don't have to deal with any kind of network. I know you're happy right now with that UCLA plan, and I hope it remains great. But I will tell you, I've seen this happen many times. We see these uh these plans introduced, and then they don't make a profit and they pull those plants, okay? It just happens.
SPEAKER_04So I d I I know, I know, like I say, I know in my heart I'm not gonna keep it. I just was wondering how long I could give it a shot.
SPEAKER_07That's right.
SPEAKER_04But no, I have every intention of giving it up and doing the the supplement, and I don't care how how much the um the premium. The premium is okay.
SPEAKER_01That's good. See, you can you can start at one one or you can start as late as five one. That's the answer to your question. Okay.
SPEAKER_04Yeah, I'll I'll start I'll start it at one one. I already I already have a uh a um um an appointment schedule. Appointment with Yes, with Josiah. So I can't wait. All right, that's my little brother.
SPEAKER_00Yeah.
SPEAKER_01That's my son, Josh's brother. So uh he'll he'll take good care of you.
SPEAKER_00If he doesn't take good care of you, call us back so easy the hell out of him.
SPEAKER_04Oh no, no, no. I found that out. I I I was singing, I was singing um Mr. Music's praises, you know, because I've been watching watching you for a while now, and I was telling him how much I liked what you said and the way you say things, and you know, you you're you're you're for real. And so um he says, Oh yeah, that's my dad. And I'm like, Oh my god, thank God I said nice things. Yeah. That's good. Okay, Lisa, we gotta get to our next. You guys keep it in the family. Yeah, we're gonna be able to do that.
SPEAKER_01Thank you so much for your work, guys. I appreciate it. Bye-bye. Good to talk with you. Take care. Thank you. Bye-bye. See ya.
SPEAKER_00Let's talk to uh James in Illinois. James, uh Okay. We've gotta wake up, Daniel. Okay, welcome to James, uh James in Illinois. Welcome to Medicare School Daily. Hello. Hi what questions do you have for us, sir?
SPEAKER_02Um well I currently have um a Medicare supplement in Illinois. Um it's AARP and United Healthcare. Um I'm actually pretty satisfied with the supplement. I've had no transfer supplement, so I would continue to stay on in. But they've increased or about to increase my um premium for the second time, I think, in less than a year. So going up next month. Um I'm so I'm in good health. Um so I just want to understand my options in terms of shopping for another uh supplement in with another provider.
SPEAKER_00Sure. Do you know what uh the rate is going up to? $202. Are you on a plan G?
SPEAKER_01N, he said.
SPEAKER_00Oh, you said plan N?
SPEAKER_01Yeah, with you on healthcare. Yes. All right. So Josh is looking up some rates. And James, you took you said that you are healthy. No health problems right now?
SPEAKER_02I have no health problems.
SPEAKER_01That's good. Good. Okay, he's gonna look some rates up for you to see. Uh looks like to me you are um what, you're 66? Yeah, be sixty-seven this year. So 66? Yes. All right, sounds good. Let me ask you this as he looks those up. Are you using the the gym membership that's embedded within the uh I do.
SPEAKER_02You do use that I probably would like another option with the same sort of thing, because it does save me some money.
SPEAKER_00How much does it save you? Yeah.
SPEAKER_02Well, I'm a member of a Y, and that Y membership is like $50 a month.
SPEAKER_01Okay, yeah.
SPEAKER_02Yeah. I yeah.
SPEAKER_01I would say Or more, actually. Oh yeah. Well, hey, we we have some in our area, the membership's hundred, $125 a month. And so United Healthcare covers that. So I doubt you're gonna be able to you're gonna switch just for that reason. Do you do you live with anyone over the age of 50?
SPEAKER_02No. Okay. Okay.
SPEAKER_01And the reason we ask that is because uh there's there can be with some cares what we call household discounts. So right now we're looking at a plan in um uh another carrier, and um we're gonna give you our number, you can call in, we'll take care of you, but uh about $115 a month on a plan in. And it can that that company is not going to include uh gym membership, so you'd have to be out of pocket on that. But you know, they take 50 plus 15, you got $165 versus your 202. Um but yeah, United Healthcare is one of the few companies. Every now and then we'll see a plan from Humana that will do it. But again, I I'm I'm you know they're not as stable in my opinion, and um I uh they don't all their plans don't include it. But again, most of the carriers are not gonna include a gym membership. Every now and then we'll have a carrier anthem, blue cross with Shield May. But in your area, I think United Healthcare is about the only company that's gonna offer that gym membership. But you can get in for $115. Um looks like to me that would save you money versus the 202. Um and otherwise everything else is going to be the same. I know in your plan, you do have a 24-7 nurse line. Uh they give you some discount on dental vision and hearing kind of things that no one else is going to. So I think that's what you have to decide, James. Is is that is that important enough to you to you know to maintain that uh So we're talking about, what, $40 a month?
SPEAKER_00Yeah. So $40, $12, $40,000. Yeah.
SPEAKER_02I like to see the info. Yeah.
SPEAKER_00So let me give you our let me give you our phone number to call in. Yeah. Call into our office and just tell someone you spoke with Marvin and Josh on the Daily Show, and they said to call in and get uh different quotes for plan N because you're getting a price increase on your current plan, and they'll get you to somebody that can help you. Okay. Okay. Okay, the phone number for the office is 800-782-6676. 800-782-6676. And everyone you're gonna be able to talk to, they're all trained by my dad, Marvin. They're gonna be able to steer you in the right direction, show you the options, kind of walk through, because there's a few different options. There's one that's 115, there's one I think that's 117. Um, so there's a few different options there.
SPEAKER_01Yeah. So just for that gym membership, you're you're paying quite a bit for that if that's the only other thing you're using. Because these carriers that will quote, they're gonna all gonna pay the same bills as you know healthcare would pay. So the coverage will be identical. It's always that way.
SPEAKER_02All right, thank you for your help.
SPEAKER_01Okay, James, good to talk to you, sir.
SPEAKER_02Thanks for calling in.
SPEAKER_00See ya. Bye-bye.
SPEAKER_02All right, take care. Bye-bye.
SPEAKER_00Okay, let's talk to Sonia, Sonia in California. Sonia in California, welcome to Medicare School Daily. What questions do you have?
SPEAKER_05Oh, it starts right now. Um I wanted to know what is the uh dollar amount for the state, hospital state when it um comes to part A.
SPEAKER_00The dollar amount for the hospital state when it comes to part A. Assuming you just are talking about if you have original Medicare part A only? Or just part A? Or no supplement or advantage or anything?
SPEAKER_01Yeah, you're you're talking about the A-deductible. So that's $1,676. 1676. $1670, $1676. So if you're in the hospital one day, five days, 10 days, anything up to 60 days, $1736. $176 transpose. Sorry about that. $1736, yeah. Uh yeah, $409 times four, you're right. Uh my bad. Yeah. So $17.36, and then that deductible is not annual. It can uh occur more than once in a year. So if someone's admitted to the hospital, they pay that deductible, and that they're out of the hospital for 60 days or longer, they're rehospitalized, they have to pay it again. That's called the A-Ductible. Got it.
SPEAKER_05Okay. Okay. And then part B, the mu uh monthly premium is $185.
SPEAKER_01No, that used to be it's $202.90 right now. $202.90.
SPEAKER_05And so that um for the most part comes directly out of uh people's uh social security. Social security check.
SPEAKER_01Yeah, if they're on social security. If they're not, they're gonna have to set up some other kind of payment arrangement direct bill, or it can uh come out of uh uh what they call Medicare Easy Pay, uh, or they can pay online. So there's multiple ways to pay it. But if you're on Social Security, it has to come out of your check.
SPEAKER_05It has to come out of the check. And then what about um so Medicare Advantage um basically offers what the original Medicare original offers with additional perks across the state.
SPEAKER_01That is true, but they're the the rules are they're supposed to match, but they have some additional rules that are attached to Medicare Advanced plans that do not exist within uh the original Medicare system. So it's not really apples to apples. It's two totally different types of systems.
SPEAKER_05Can you give me two examples?
SPEAKER_01Absolutely. Yeah, if I stay in original Medicare and have a supplemental plan, uh I'm rarely, rarely, rarely going to uh have to face a pre-authorization for any health care service.
SPEAKER_05Uh Medicare Right, that's for a supplement, but what about advantage?
SPEAKER_01Yeah, advantage plan, I'm gonna have it much of the time. In fact, anytime I'm gonna go to skilled nursing, anytime I have a surgery, if I'm going to have to have an MRI or a CAT scan, 100% of the time, I'm gonna have to have a pre-authorization, meaning the doctor makes the recommendation, the Medicare Advantage Plan must approve it before I get that service. And if they don't approve it, I pay, I have to pay out of pocket. You'll never have that happen, or I should say, rarely will you ever experience that uh with the original Medicare. They have they have a they have a few items that require pre-authorization. Uh but it again, it's very rare. That's a that's a big uh big difference. Another big difference is advantage plans are only annual plans. Uh Medicare supplemental plans are lifetime plans. Uh so that's a huge difference.
SPEAKER_05I'm sorry, you kind of like come you kind of um did two and one, supplemental and advantage, and I I wanted to focus on advantage. Um I know that supplemental costs a lot more, it's almost like a PPO. Um I find that people just leave incorporate corporate, you know, they've retired, but they kind of like want that same type of coverage, if you will. Um but as far as advantage goes, Medicare Advantage, how is that it it's like equivalent to Medicare Part B, um, but it has perks. Like, what's the difference between those two?
SPEAKER_00The difference between which two. And I I think you're a you're a Medicare sales agent yourself, right? Yes. So are you trying to get some training here? Or what are you trying to drive at?
SPEAKER_01What I'd recommend doing, yeah, Sunday. Go go to my go to our go to our uh if you want some training, go to go to YouTube channel. Am I trying to get what? I said if you want some training, what I'd what I'd recommend doing, go go to our um our YouTube channel. I have literally 1,500 videos on YouTube and uh Right, but are you able to answer that though?
SPEAKER_05Like what why would someone want Medicare Advantage versus the original Part B?
SPEAKER_00Because you have a maximum. If you're on original Medicare A and B, you have an unlimited uh you have an there's no cap on the amount of bills that you would have to pay. On a Medicare Advantage, at least you're going to have a maximum out of pocket. That's the primary reason.
SPEAKER_01Yeah, that's right. So what you're saying, what the way Josh took your question was why would why would someone uh why would someone have A and B only versus an advantage plan? It's a very good question. Yeah. And we are not A and B only fans uh at all. There's too much risk because you you're responsible for all the financial gaps with A and B only. So in my opinion, A and B only is the worst uh worst uh kind of coverage. The next best would then would be uh your advantage plan because there is a limit uh that you'd have to pay. It could be five thousand, it could be eleven thousand, whatever, but at least we have a limit. And then I think the highest quality coverage, of course, is submental plans for you know some of the reasons I just stated. Okay? And again, we have a we have a great.
SPEAKER_05That sounds great because that's like uh uh, you know, me telling them like, oh, you get a debit card from CDS. You know, it's like that can't be the reason why someone created maybe to carry advantage for these.
SPEAKER_00No, a lot of that's going away. A lot of that's going away because that's not financially even the the insurance companies that they're gonna be insolvent if they continue, you know, adding all of those extra things that are non-medical, right, into insurance as a way to entice people onto a plan. There's a big trend in this industry of getting away from that, which is good for consumers over the long term.
SPEAKER_01Yeah. Sounds all good on the surface, but but when they're giving away something, they're taking away something as well, which means great medical care.
SPEAKER_00Okay, hey, Sonia, nice to talk with you. We've got another call we're gonna get to. Thanks.
SPEAKER_01Hey, we wish you the best of luck in the business, too.
SPEAKER_05What is the website that I can go to for training?
SPEAKER_01Yeah, you yeah, we have a YouTube video.
SPEAKER_00Yeah, just go to yeah, just on YouTube, type in Medicare.medicare school.com. I mean, you found us, I guess maybe you're you're listening to us right now. So yeah. Okay, good to talk to you. Take care. Okay, let's talk to Frank in Tennessee. Frank, uh welcome to Medicare School Daily. Thank you. Hi. What questions do you have? Hi.
SPEAKER_03What can we do for you, sir? So uh my question has to do with Social Security. I'm uh 66. I'll be 67, full retirement age in February of 27. And I know there's a uh limit of the amount that you can earn uh before you get to full retirement age, and I think this year's limit is like 24,000 or something like that.
SPEAKER_01Yep, 24,480. 24,480 for you right now.
SPEAKER_03Okay, so the question is uh if I wanted to apply, um, I don't know, when do they start counting towards that limit? The beginning of the year or when you apply? Yeah, it's no I make about sixty-five thousand a year.
SPEAKER_01Yeah. Well, here let me let me ask you this. So uh are you thinking about uh retiring soon or retiring this year or you're gonna keep working?
SPEAKER_03I'm gonna keep working, but I know there's no limit on what you can earn after full retirement age.
SPEAKER_01That that's right. Okay, that's what I was gonna say. Because if you're gonna retire later this year, then my answer is different. Okay, so because you're not, then the annual amount this year is twenty-four thousand four hundred and eighty dollars for you in wages.
SPEAKER_00If you were to take right now.
SPEAKER_01If you're to take right now. Right. That's the most you can make, and obviously you're making sixty-five thousand. So let's just keep it simple. Let's say you're forty thousand above, that means they're gonna withhold about twenty thousand dollars of Social Security checks from you. So probably not front load that. Yeah, exactly. Right. Oh, yeah. Yeah, you're not gonna be able to do that. So you may not even get much of a check if you maybe you may get a couple checks at the at the end of the year if you were even to start right now, because they're gonna withhold that penalty amount up front and then they turn on Social Security. So uh Frank, it's not gonna make sense this year if you're gonna keep working. Now, if you said, hey, I'm gonna retire in October, it can make sense because they they they they will give you the best of both worlds. You're above the 24480, and they know that because you've been working. But when you retire, then they'll say, okay, we'll give you the monthly amount uh the first year that you retire. And so if you were to Oh wow, pardon me? So let's do the math. Okay, let's do the math. So let's just say you did retire and you're you're done working at the end of September and you start your Social Security in October. Then what they'll do is they'll let you make uh whatever twenty four four eighty divided by twelve is it'd be what two thousand uh be two thousand forty dollars or whatever. Yeah. So you can make a little over two thousand dollars after you start your Social Security if you're no longer working this year. Did that make sense? Yeah. Okay, very good. Now let me share one more thing. Now, next year, as you roll into um a Chris you're you hit for retirement age February, but the month of January, uh, if you want to start your benefits that month, uh your earnings test for that one month would be sixty-five thousand one hundred and sixty dollars. So if you get them to front load twelve months, yeah, you can truly make sixty-five grand in January uh and still take your Social Security with no with no penalty.
SPEAKER_03And that's just a month or the but because January is the first month of the year, I could I could conceivably uh collect on January first.
SPEAKER_01That's right. Because what happens is the year you turn, they raise that number up. And they raise it up substantially. So it moves from 24,480 to 65,160. And it's not prorated, it's an annual amount. So whether you have 10 months or one month or four months, it doesn't matter. But then it's a hundred percent February and February, exactly.
SPEAKER_00So really you're you're you don't have unless you're gonna make over sixty-five grand in January, your earnings test goes away January one.
SPEAKER_01Exactly right. You're not gonna have to deal with it at all. So you could actually apply for your Social Security, you know, September, October, whenever, uh, and then tell them you want to start your benefits January one. Uh and when you do that, you'll get your first check in February.
SPEAKER_00It's always paid a month later.
SPEAKER_01Exactly. Now the issue is also it's gonna be a a half a percent less because you took one month early. Yeah. Because remember, for every month we take early, we lose a half a percent. I mean, that's it's insignificant. But if you want to wait without any penalty, then start your benefits in February. No earnings test any longer, you'll get your very first check in March. And you can make you know a million dollars a year doesn't matter because no earnings test once we hit our full retirement age month and year. Okay? All right. Okay. Okay, anything else, Frank? Thank you very much. Okay, hey, good to talk to you. Appreciate the call today.
SPEAKER_03Good to talk to you. I appreciate your help. Thank you very much.
SPEAKER_00Social Security is no doubt going to be a large part of your retirement income. And for some of you, you have an option, or for many of you, you have an option of when I should start and what makes the most sense. Well, there's actually a way that you can increase your Social Security check by up to 54%. Uh and on Tuesday of next week, we're going to be talking about that. Uh, we will not be here on Monday. It's going to be Memorial Day, but we will see you back here on Tuesday, 11 a.m. Central Time, talking about how to increase your Social Security check by over 50%. See you then.