Medicare School Daily

Supplemental Plan Companies - What’s The Difference Between Them?

• Marvin Musick

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

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Medicare Supplement companies can feel confusing because there are so many names, prices, and options. But here’s the key: Plan G is Plan G. Plan N is Plan N. The coverage is standardized by plan letter.

So what actually makes one company different from another?

In this episode, we break down what to compare, including premium, rate history, financial strength, customer service, and household discounts.

Call in with your questions! 

SPEAKER_05

So it's time for you to get a Medicare supplement plan, and it's probably difficult to know which carrier you should choose. I get it. People have been choosing plans correctly and incorrectly for the last 20 different years. Today you're going to learn what are the differences between all of these Medicare supplement carriers so that you can make the right decision for you, not only for today, but also for the long term. We've got about seven things that you're going to learn today to help you make a good coverage choice. Welcome to Medicare School Daily. My name is Josh Music. I'm joined by Garrett McKinsey. My dad is out of the country right now, so we're going to be filling in several other people from our company. And Garrett's been helping people with Medicare for about five years now, knows actually far more than me, probably pretty close to the level of knowledge that my dad has. So it's going to be a good opportunity for you guys to learn. But also, uh, if you have a question about your situation, whether that's about Medicare, whether that's about Social Security, this is a great opportunity for you to call in and get your question answered. We're not going to sell you anything. We're just going to share with you what we've seen over the last 15 years. The phone number to call in is 833-824-2004. 833-824-2004. You can have all of your questions answered from 11 a.m. to noon Central Time from Monday to Thursday right here on the channel. If you're joining us from a podcast, we welcome you to call in as well, 833-824-2004 from 11 a.m. to noon Central Time every day. So Garrett, uh Medicare supplement plans, they all have standardized coverage. Can you break down what that means?

SPEAKER_01

Yeah, 100%. So standardized coverage just means it's been set up by the federal government, right? And so there's not one plan that covers uh you better than another when it comes to carriers. So if somebody offers a G plan, let's take it for any one of the carriers that could be out there. There's lots of large name carriers that that we operate with. Um one carrier doesn't cover better than another. If one covers cataract surgery, it's not like the other one won't. It's been standardized by the government, so they all must cover the exact same way. So a G plan only has that part B deductible gap, the 283 that we would be responsible for for this year. Where the N plan, it has that part B gap as well for the deductible, but also doesn't cover for those excess charges for those doctors who do charge excess charges. So standardization just means hey, this is this is the level of coverage that you are guaranteed, that you are promised whenever you sign this contract here. Um and not one carrier is gonna cover you better than another one. The carrier is standardized.

SPEAKER_05

So if you buy from like Blue Cross and Blue Shield, they're not gonna have better coverage than say United Healthcare or Humana. It's the same. The government sets up the benefits and the insurance companies get to decide, do I want to offer that coverage? And if they do, it's the same benefit, but what can vary?

SPEAKER_01

Yeah, I mean there's a um there's a couple things. So one could be like discounts they get offered to you up front. Um so there could be like household discounts. Yeah, yeah. So household discounts is one. Um like there are some carriers where you have to have two active policies in the household to get the household discount. Um and then there's another other carriers that have uh called living with someone discounts. Most of the time, if you have somebody who's over the age of 60, you've been living with for more than 12 years, at that point um you actually get a discount up front. So hey, they may not be eligible. That policy for the other person may not be effective just yet, um, but you are gonna get a discount ahead of time.

SPEAKER_05

Okay, so let's break that down. So the first one is like typical bundling. If you buy multiple policies, maybe you and a spouse, they're gonna give you a discount. What what do those discounts range from?

SPEAKER_01

Uh generally we're between about five to seven percent. Um whenever you have so and I'll say this um this is more for the living with somebody discount versus the multi-insured. Okay. The multi-insured can be as high as generally that's seven to fifteen percent. That's actually.

SPEAKER_05

Isn't there a carrier that has like 20, or is that no longer um no, no longer.

SPEAKER_01

Okay, they'll go okay.

SPEAKER_05

Yeah, yeah. So if you if it's two people living together over the age of 60, right, you're gonna get a discount, probably five to seven percent, seven to fifteen percent if there are two people that actually have the same insurance policy.

SPEAKER_01

Correct.

SPEAKER_05

Now, insurance policies on Medicare supplements, they're all individual. There's no like family policy. Right. It's all individual coverage. But if you buy it from the same carrier, you could get a discount. Okay, let's talk about um another let's talk about this, because I I think we've all seen carriers uh that maybe are quite a bit cheaper than other carriers. Can we talk through that? Because if I'm looking at, let's say I'm on Medicare.gov or I'm talking to an insurance broker, I'm calling all these insurance carriers, um, there can be some pretty wild price differences. Yeah. So how how does someone navigate through that?

SPEAKER_01

Man, so uh well, one, obviously it's where brokers come into play a little bit and they provide you some of that information. But for these folks, like the folks that are listening in here, um, a lot of that comes to down to what portion of the market share is this carrier one trying to grab? So this is like uh so we talk about you kind of made mention of the 20%. Um there was a carrier where uh they had the 20% originally, they offered that, they've since pulled that back just a little bit, the 15% mark, because they're trying to capture a significant portion of that market share, saying, hey, come with us. We're a little bit new in the area, we've got to get to a place where this is sustainable business for us and we're profitable, and we can cover if somebody does have claims. Um also uh something else that goes along with you know, how do we handle these prices is there are some carriers where, hey, this is what like the actuary actuary set the price for this is what we believe it takes to cover somebody who's 80 years old, somebody who's 75 years old. And the actuaries just arrive at a different number. Um it's the same thing.

SPEAKER_05

Like if you go get if you go get um auto insurance quotes from Allstate and GICO and Progressive and you name it, whatever insurance carrier, it's can you can actually have the coverage all be the same, but they're going to be different prices. Yep. I mean, as homeowners insurance, I was quoting some the other day, it was like a thousand dollars a year difference, and it's the same coverage. And it just depends on that insurance company, what their actuary says they need to have for their risk tolerance. Um and yeah, it's it's kind of interesting.

SPEAKER_01

Yeah, it's I mean, it's super interesting because you get I mean, that's one of the questions we get most often on the phone for the guides, is whenever we're out there, we're saying, like, how could it be so vastly different? It's like, well, there's a lot, there's some factors that come into play, and that's one of the biggest ones. It's kind of hardest to explain if you've never kind of been in the industry game. But I mean, your reference there, and that's what we generally use, is you have homeowners or car insurance that it can be different if you go with Geico or you go with Allstate or you go with whoever, state farm, um, where you know it's it's just different. But the coverage can all be the same. Yeah.

SPEAKER_05

Uh talk to me a little bit, if you can, about underwriting. Because obviously, whenever you start Medicare at age 65 or even beyond, but whenever you first begin Part B, you have a once-in-a-lifetime right to get any Medicare supplement plan that you want um without any health questions after that. Yeah. Beyond that, um you most people, unless you live in a couple of different states, you have to go through underwriting, which means underwriting is just like an insurance jargon turn term that means you have to answer health questions and they're going to probably run a prescription drug check. So uh Garrett actually here at our company leads our team of agents, the licensed agents, that if you work with our company, you're gonna call in, you're gonna talk to somebody, um, then Garrett manages and leads that team. And so you probably have a lot more inside scoop than I do on what like what what talk to me about underwriting. Yeah. Like how are there carriers we can get more things through, less things through? Are they all standard? Like, what's the nouse? What's it?

SPEAKER_01

They are different. Yeah, you gotta, and that's and that's what's interesting, we've got to have the knowledge, and it's it's an ever-changing landscape. We just saw there was a carrier that entered the market or bigger player for us towards the fall of last year. We're like, okay, we can actually help more people with this carrier uh given the way they go through the underwritten process. So I'll just kind of start. So there's a couple carriers that we like that we know are uh more lenient when it comes to like heart-related conditions, okay. Right? So if we've got stable medications for like the last two or three years, dosage and frequently hasn't frequency hasn't changed. Generally, like um, you know, any sort of like AFib or sort of chronic heart condition um that's being managed by prescription, that's almost an always an auto decline for a lot of carriers. But there is a carrier that, once again, if your meds have been stable, you're not taking more than two medications for your heart and it's been stable, the dosage frequency has not changed in the last two to three years, that you can probably still make that change. Um and so there's one. I mean, there's another that like some people ask about 50 units of insulin a day, some people don't. Uh so if you're diabetic and you're taking, you know, more insulin, and this is why we go through this uh the process as guides, you know, for the discoveries if we don't have that interaction, we can't personalize this plan to you to make sure you're getting the right coverage. And then there's another carrier where they actually don't even ask health questions. What they do is they run a report to see uh it's called a Millenment report on the back end, and they just run a report to see, hey, you know, what's your history going to the doctor? What sort of tests do you have? Um, have you had done? You know, what's your what's your essentially health history?

SPEAKER_05

Because all of our information goes into the Medical Information Bureau. Yeah. Yeah. I'm sure we could probably stop it. All information goes somewhere, but you know. Probably true. It's all being exploited. Uh but yeah, so then they just run that. And I think actually all carriers do that. Oh, yeah. I think they all do that back in check. They're not just gonna take what you write on an application as as truth and be like, oh, you know, if not, we could just lie about it and that would that then there would be issues.

SPEAKER_01

And I will say, too, just kind of uh on the heels of that, is like we all we have also dealt with folks that they get denied through underwriting. And it's like, well, you know, they're living in let's just say hypothetically, North Carolina, and they're like, well, actually, like you got denied for this. Like, we can't ever see that. The carrier sends that directly to them and it'll be reconnect with a customer. Um and when the customer calls back then, like, I've never seen a doctor in California. I got declined for something that happened in California. So sometimes those medical records, yeah, they're wrong. And so what we can do is say we come alongside people and say, Okay, well, we have to, you've got to be able to reach out to this individual, to this doctor, and say, Hey, why is this on my record? How do you correct that? Kind of go through a dispute with it. Okay. Yeah. That's it. You almost always have to get to the um the doctor who prescribed it, or the doctor who made that writing, and like, hey, you need to go back and correct this because now it's on my medical file. Um, that or you go directly to, I forget the name of the department, but they have to go to a like the medical records department of the country and they say, Hey, this actually wasn't me, and but then they they go to the doctor. So it has to get back to the doctor who originally wrote that. Anyway.

SPEAKER_05

Uh I think that brings up an important thing. So if you are on a Medicare supplement plan right now, and maybe that cost has been going up, and we're gonna get to like price increases here in a minute. Um, but maybe you've seen that those prices start to go up over the last couple of years, because they have been pretty aggressive the last last couple of years. And you want to save money uh by switching to another thing. First, we learned today is standardized coverage. So you can go from a G plan with your carrier to a G plan with another carrier, or an N plan to an N plan, and your coverage isn't going to change. It's gonna stay the same. What's gonna change is your premium and the name on your card, like the insurance carrier. Yeah, but your coverage is gonna be the same. Um we should talk about maybe networks here in a second as well, because I think that's a a question. Um so if you want to save money, you can switch, go laterally from G to G into N, whatever it is, um, within carriers, your coverage is going to stay stay the same. Um and I think you know, for most people, you're gonna have to go through these health questions. So if you're working by yourself or you're trying to figure this all out alone, that can be pretty difficult because there's 25, 30 different insurance carriers that offer supplemental plans in most regions. And so you can like call all of them and try to go to through health underwriting. That just sounds like an absolute pain. Um or you can work, and this is kind of a funny term. Uh I remember 10, 15 years ago, my dad would always describe what we do as uh we are field underwriters. Have you ever heard that term? Oh, yeah. Okay, so yeah, like field underwriters, meaning like we're gonna go out into the field, which is where I guess everyone lives. Like, I don't know. And and we're going to underwrite, meaning we're gonna ask some questions. And we know, your team knows, um, hey, if you've got a heart condition, let's go with this carrier, because they're most likely going to accept. It would be a waste of time to apply at these four because they're going to decline you absolutely. Yep. Hey, if you're a diabetic and you take this much insulin, this is probably the one carrier. So it's important, uh, I think, for you, if you're thinking, hey, how can I switch money? Work with a broker, somebody who knows these sorts of things. And if you talk with someone who's like, nah, that's you know, maybe maybe you call Humana. Um, and I'm not picking on Humana for any other any reason at all, just an insurance carrier. Call Humana like, nah, we're gonna decline you. And then you take that thinking, well, I'm gonna get declined it everywhere. Right. That may be true, but it also may not be true. And so you owe it to yourself, if you want to save money, to work with maybe a broker like us or somebody else like us that that that can help you navigate through those things. Um so brought up a question. Let's talk about networks real quick. Because if you're switching, most people don't want to switch because they're nervous, their coverage is gonna change, or they're not gonna be able to see their doctors. So speak speak to that if you could.

SPEAKER_01

Yeah, so this goes back to the standardized coverage, right? And so with a with a G plan, um, you can take this or an N. Or an N. Yeah, any sort of med supplement plan. Uh, you can take across the country to see any doctor as long as they accept original Medicare. And you can go to Medicare.gov to actually locate that and be able to find, hey, you know, does this does this doctor accept original Medicare? Uh are they gonna do excess charges? Um, we can maybe talk about excess charges too, but I mean, there's no there are no networks for these plans. You can take them across the country and you can see the same doctors you've been seeing if you go from United to Aetna or Aetna to United, however you decide to go, there are no networks for these. Now if Medicare takes it, any supplemental plan is gonna take the difference. Exactly right. Exactly right. Um now I know they are test piloting programs in Texas about with some of these networks, and they are some select plans. There are select plans.

SPEAKER_05

That's a good point. So if you ever see uh that that's it, that's a good thing. So or a good good thing to bring up. So there are select plans. Yep. They're usually called like G select. And what that means is you've got to stick within this little network. Yes.

SPEAKER_01

We don't really recommend those efforts. More as it pertains to like hospitals is really where they're that's where they're starting right now. Uh and I don't know if they're gonna go any farther with it. I haven't done any research about it, but it's a total cost. 100%. Yeah. Because I mean if and that's why, you know, advantage plans they operate in that way, is we have an agreed-upon cost. This is a you know, cost sharing to the customer and cost sharing for the insurance company, trying to keep things low, right? Um that's the same thing with what they're kind of test piloting, or the select plans is they have a network that they have to stay within as it pertains to the hospitals um of hospitals they want to go to to keep the cost down. So I feel like you get a supplemental plan because you want freedom.

SPEAKER_05

Oh, yeah. Like you don't want to want an a pre-author, which we should talk about pre-authors as well. You don't want a pre-authorization, you don't want a network, you don't want an insurance company getting involved and saying you can't go see this person or you can't have this service. So you get a supplemental plan to do that. So if you go with one of these select plans, and they're not that common.

SPEAKER_01

I mean, we I've known about them for years, but I don't think generally large metropolitan areas is like the highest volume of where they'll be. Yeah.

SPEAKER_05

Yeah. It just seems like you're you're you're almost signing up for like a version of an advantage plan or something. Which advantage plans aren't bad, they're just different. You've got to know these different. So let's talk about a little bit about we've got a caller uh we need to get to, but let's talk a little bit about claims handling. Yeah. Um so uh as it relates to is one insurance carrier going to pay claims better than another insurance carrier if you get a supplemental plan?

SPEAKER_01

Aaron Powell No. That's the simplest way to say it is no. They they're gonna run through the same process. And so back to standardization of care. If Medicare will pay for something, the supplement plan, whatever it be, G or N or F or whatever people have, um, is going to follow suit. Uh so if Medicare covers it, the G plan will also cover it, or the N plan, the Medsub.

SPEAKER_05

Well, my understanding is like at that point of service, uh where wherever you what wherever the bills are you know being sorted, it's gonna go to Medicare first. Yep. Medicare is going to approve it, pay their part, and then the rest is going to be sent over to the supplemental plan. And they're just 10 times out of 10, pay that. Like they don't say, ah, we don't cover that. It's like Medicare paid their part.

SPEAKER_01

Yeah. It's time for me to pick up my portion. They paid the 80, here's my 20. Yeah. You know? So yeah, absolutely. What about what about pre-authorizations? Uh so with these plans, yeah, we don't have to worry about pre-authorizations. This is something where um them, so I say them, you guys, and your doctors are the ones who decide, you know, what can go on. As long as something is deemed medically necessary, and that's the thing that we have to have the conversation with people is just because you want something done doesn't always mean that's gonna be covered for you. It must be deemed medically necessary. By Medicare. Exactly. And at that point, then it's gonna be covered. Um, but yeah, you don't have to go through the pre-authorizations where you know the insurance company is reviewing this because just as you said for the claim section, it goes to Medicare first. And if Medicare is like, yeah, we pay for this stuff when it's deemed medically necessary, then the supplement plan goes, okay, I'm gonna pay my portion as well. It's that simple.

SPEAKER_05

Okay, let's talk to uh Brenda from Minnesota. Brenda, welcome to Medicare School Daily. What questions do you have for us? Hi Hey, we're doing well. Thanks. What questions do you have?

SPEAKER_02

So I have been listening, I'm gonna make sure I've muted myself here. I've been listening to you guys. I did sign up. I was working with Randall.

SPEAKER_05

Okay, true.

SPEAKER_02

So I will be going on um Medicare here in August. Okay. I I am taking the widow's benefit and Social Security, so I got my Medicare card in mid-April. So I'm signed up to go. Now Randall told me that um I've got a situation here. So I retired at the end of uh December 2024. And so that will put me into like the second level of the IRMA brackets.

SPEAKER_05

Okay.

SPEAKER_02

If if I'm using that one. So what I wanted to know if I could file to change my IRMA so I'd be at level one for five months. And then in 2025, I did do a large Roth conversion, would which would put me in the single bracket just under the 200,000 $205,000. So I know I'll have one year of a high IRMA, but um, Randall said I could do it, but looking at the paperwork, it looks like it goes back, it could go back two or three years.

SPEAKER_01

Two years, yep. So for you, with you making $114,000 this year and that being the the number for you, um it is going to do you uh a service to at least, you know, file that IRMA, but you uh you're not gonna be able to escape that that first level since that's what you're making this year. Because most of the time, whenever it comes to those um the irmas, we are we're appealing to try to get under that threshold. But at least whenever you appeal, you are gonna be saving some money. Have you have you gotten a notice of what your your of what it's gonna cost?

SPEAKER_02

I have not. So that was my question. So Randall told me to try and get my SSA 44 form in by the end of May here.

SPEAKER_01

No.

SPEAKER_02

And he said send it in or drop it off at the Social Security office, which I can I can drop it off. Um, but I I just I have not gotten a letter yet. And you guys have always talked about getting the letter on the onboarding, they said, you know, wait for your letter.

SPEAKER_05

Yeah, generally uh when when when should she get that?

SPEAKER_01

It's generally like 10 to 20 days before the Part B effective date is the notice. You're gonna ask about the notice of surcharge.

SPEAKER_05

Yeah, the notice. So it probably just it probably is not gonna come until probably a month to six weeks from now if you're starting August 1st. So sometime in June or even July. And at that point, you can fill out the IRMA. So you're not going to be, I think what you want to do is you want to just appeal it, put your 2026 income down, and at least you're gonna go down to that second level. Because the second level, so the first the threshold is 109, right? So if you're below 109, there's no surcharge. From 109 to 137, that's what you're going to try to appeal to. Or you will, and you'll win it. You'll be fine.

SPEAKER_00

Yeah.

SPEAKER_05

So you you put in 114, you'll put in the date of your life changing event, and you can use that life changing event twice, right? So you'll be able to do that again in uh in next year. Right.

SPEAKER_02

But that wouldn't would I be able to do that? Because now I retired in 2024.

SPEAKER_05

Yeah, yeah. You should, yeah, you should be fine. So in 2026 for this year, you're gonna appeal it. You're gonna put in $114,000 as what you make, right? And they'll drop you down from, you know, from whatever the 143, which is the third tier, um, down into the second tier. And then for 2027, you're gonna do it again because at that one, you are up in the fourth tier, right? And so then they're gonna drop you back down into the second tier. So you'll use that twice. Now, if you're gonna be at 114 going forward after that or even higher because of social security and pension, you might kind of always have an IRMA. Yeah. And there's not gonna be a whole lot you can do about it.

SPEAKER_02

Yes, I figure I'll always have an IRMA. Yes, yeah. And so so will my Roth conversion, so then if I do an IRMA appeal next year, you're saying it should get me down into the 137 to 171 bracket, roughly, if I was looking, you know, looking at this year's numbers.

SPEAKER_05

Now, uh yeah, I mean, if if I was in your shoes, I'd probably consider doing, I mean, I'd probably if you're gonna be at 114 this year, I I don't know. I I don't see I I mean you can do I guess you could probably do the Roth conversion this year. Uh but I I don't know. Then you're I did it last year.

SPEAKER_02

I did it last year.

SPEAKER_05

How much more are you trying to do?

SPEAKER_02

I don't know. I should do more. But my accountant said we'll watch it closer and just stay in that first level or second level bracket.

SPEAKER_05

Yeah, yeah, absolutely. And you can, I mean, you can always do you can always do more. Just know as a part of your cost, you gotta set aside the money for the taxes. From the Roth conversion, the you know, the the IRA to Roth IRA, and then you're gonna have an IRMA part. So it just makes that Roth conversion a little more expensive.

unknown

Yeah.

SPEAKER_05

More expensive.

SPEAKER_02

So I guess one of the things I was just trying to figure out, then so do the appeal this year for the five months, do the appeal next year. Yep. And then when will that 2025 Roth conversion come into effect to be higher?

SPEAKER_05

Well, it they're in 2027 next year. They're gonna look back at 2025. So they're gonna see that Roth conversion. So you're gonna fill out the paperwork and you're gonna say, Hey, I only make 114,000 now. Drop me down. And then they will. Yeah.

SPEAKER_02

Oh, okay.

SPEAKER_05

Yeah, yeah.

SPEAKER_02

Even though I was at 191 that last year.

SPEAKER_05

Yeah. Yes. Because you can use that life-changing event for two years. So you're gonna use it this year and next year.

SPEAKER_01

Yeah. So Josh brings up a good point. I want to make sure your retirement date, was that December 31st, or were you officially retired on January 1st of 2025?

SPEAKER_02

No, December 31st. Our company required you to retire on the last day of the month.

SPEAKER_05

Okay, gotcha. I mean, they're not gonna I don't think they're allowed to be able to do that. Yeah, I don't believe it. I mean, basically, you know, if you have a life-changing event and then you you sign this affidavit saying you did, and they see the income changes. I've never heard of anyone going any deeper into that to be like, what was the exact date? You know, that's just they're not gonna do that. So they've got too much to do. They're trying to process the stack of paperwork on their desk. Yes. Okay. And make sure that's it.

SPEAKER_02

But definitely wait for that Irma letter, right? Yeah, wait for it.

SPEAKER_05

I mean, you can have it all filled out and ready to go, but I think if you send it in now, they would know what to do with it. Yeah. They they're not gonna be able to recognize it.

SPEAKER_02

That's what I was that's what I was afraid of.

SPEAKER_05

Yeah.

SPEAKER_01

Yeah.

SPEAKER_02

And stuff. So when I drop it off at their office, do I have to put anything on the envelope for them or do they ask you what's in it?

SPEAKER_01

Yeah, what I would recommend that you do whenever you get that notice of surcharge, it's gonna have it's gonna tell you on there you have 60 days to appeal this um before it goes into effect. And so all you have to do, they should have a return slip in there. Just use that return slip um where when you put the the 40 the 40B or not 40 B, SSA 44. You put that Irma appeal form in there, uh, and then just send that right back in. It'll go right to the right place. So just wait for that notice of surcharge, is what you're looking for. Make a copy of it, include that.

SPEAKER_02

Yeah, and you said that's about a month, a month out or ninety.

SPEAKER_01

Two to four weeks. Yeah, correct.

SPEAKER_02

Okay. So you'll be fine. Thank you very much for additional information. I wasn't so sure how far away.

SPEAKER_05

Thanks a lot. Other than the Irma, any other questions that you have?

SPEAKER_02

No, uh-uh. Everything went really good. I appreciate the help.

SPEAKER_05

Okay, sounds good. Thank you. Thank you. Take care.

SPEAKER_02

Thanks. Bye.

SPEAKER_05

Okay, let's talk to Laura Sanchez in Colorado. Laura, welcome to Medicare. Hi, welcome to Medicare School Daily. What questions do you have for us?

SPEAKER_03

Hi. Um, my my husband is already on Medicare. He has part A. We together we have private insurance because I wasn't um eligible yet for Medicare. And now I'm becoming eligible next month or in two months.

SPEAKER_04

Okay.

SPEAKER_03

And I'm wondering if I should just get A like he has and keep our private insurance, or if I should enroll for A and B, and can I now enroll him in B as well? Like our private insurance costs a little over $13,000 a year. Well, this past year, and like now, my husband had a tumor in his brain. Oh, okay. So we he was in ICU for two months, and then you know, then he had care afterwards, which, you know, he had he was in an LTAC and then he went into specialized uh like a nursing facility, and now he's home receiving a little bit of home health care. Um, so he's kind of not great. Honestly.

SPEAKER_01

How long ago did you say was that this earlier this year for him? It was it was October. October, okay. Um I will say with like as relatively close as that for kind of what's gone on. Um like I just looking at the numbers based off of this, uh more than likely your husband would have to pass medical underwriting to even make that change to move into if it was a supplement plan. He doesn't have B. I understand that, but he also doesn't have a eligible election code right now. Because he's not on her plan. Yeah, he would have to wait till GEP to even do it. But there's nothing you can do. Yeah, I mean then yeah, uh once we get B in the beginning of year next year. When he turned 65?

SPEAKER_03

He turned 65 nine years ago.

SPEAKER_01

Oh he's ten years older than I am. Whenever you turn 65, obviously you can move into part B of Medicare. Um and that's whenever obviously you'd start paying the really the almost six hundred bucks, the five twenty-seven fifty is what the premium would be for both you and your husband, given your income level. So uh if you wanted to move into a supplement plan, which would probably be so what Josh has been talking about of that really comprehensive coverage, that coverage is gonna take care of you really well. Um I would say I'm ballparking it here probably between for your husband, probably 220. Realistically, like if I was gonna give you a ballpark um of of what the costs were, you're looking at five twenty-seven fifty. That's if we're talking the same thing next year, that's what it would be. So that's pure part B. Um and then for a G plan for him, we're just gonna call it Yeah, we'll just call it $200. We'll just do easy math for us for right now. Um so you're looking at $727.50, with that would be just for the G policy, which given his health situation, that's what I would recommend. Um, in case God forbid something like that crops up again. Um, because your max out of pocket is just your part B deductible for the year, which is only $283 this year. So you're paying um a higher premium, uh, because you're probably paying roughly like if you both went on to the plan, you're looking at fourteen hundred dollars a month for you both. Um if and your premium be a little bit lower, so maybe not maybe not quite that high, but um with the IRMA, just because of your level of income, um, you're probably right around fourteen hundred bucks a month is a safe number, including drug coverage. Uh so just to kind of ballpark it for you, if you did decide to move off of the Cigna plan, because you know, we've hit the max out of pocket, um, there's co-pays whenever you go in. If you want to avoid those co-pays and make the change, um, you would have to do that by um going with a with a G plan, but you're looking at fourteen hundred bucks a month for you guys for that. Um but luckily when you go in, you're only paying 283 bucks, but there is something else that's gonna be a good thing. Yeah, so you're gonna have premium two.

SPEAKER_05

You're gonna have premium that go your premium is gonna go up, but you will have far less maximum out of pocket.

SPEAKER_01

Yeah. Does that make sense?

SPEAKER_03

Yes.

SPEAKER_01

With your husband not have having had part B. So if you're no longer actively employed, Medicare says, hey, you've got to take part B. Luckily, with your FEHB coverage, it's one of the only instances where you don't have to have part B. Yeah. Um, because it's still seen as credible coverage, which is great. However, if you ever decide that you want to take part B, you're still incurring a penalty on the back end. So at this point, he's been without coverage for nine years. So you're looking at a 90% penalty if you were to get enrolled right now. Which is basically an extra probably one 180. Yeah, but by the time we get to next year, if he was eligible in January, you're you can't start till February. So you're looking at double the premium of part B plus an Irma for him. So you're looking at about four, you should nine hundred.

SPEAKER_05

So he his coverage alone will cost you probably what you're paying for both of you.

SPEAKER_03

Well, let me ask you a question. Hold on a second. Hold on one second, I have a question for you. You said if not actively covered by an employer, you get a penalty, but he was actively covered. So why is he paying a penalty?

SPEAKER_05

Active actively working is what I meant. Yeah. So it's coverage based upon active employment. Yes. It is not retiree coverage. Yeah, it's coverage based upon your actively working. So I think you have a couple options. Number one, you could just, you know, kind of stick and you're gonna have a similar kind of story as what he would have. You do it for 10 more years, you're gonna have a Part B penalty, you're gonna be limited on when you can enroll, all of that sort of stuff. Yeah, you could also decide, hey, let's let's leave, you know, let's let the best thing for him is to stay where he is. For me, you know, you, Laura, I, you know, I I think I'm gonna go ahead and go on Medicare. I'm gonna sign up. I know I'm gonna have an Irma, but uh I'm gonna have a far lower maximum uh uh out of pocket. Because if I look at this thing, as I'm looking at your your benefit uh details here, it's actually 5,000 per person. So it's it's 10,000 per family, and I think you can eat into each other's benefit there. But if it's just one, then you've essentially, if he's the only one on it, you've essentially lowered that maximum out of pocket exposure from $10,000 down to $5,000 for him.

SPEAKER_03

How do I go now and enroll in all these things? I don't want to go to one of these insurance brokers because they're just trying to sell me advantage.

SPEAKER_05

Yeah. Well, okay, so you're calling in MedicareSchool.com. We are just one of those insurance brokers. But the difference is we try like really hard not to push people into advantage plans. So we have we we can help people into advantage plans, but here's the deal. If you call and want to work with us, number one, Doug cost you anything. Number two, uh, we're just gonna lay out all the different options. Like we're gonna show you all the different Medicare supplement plans. We're gonna show you the different Medicare Advantage plans if you want to talk about that. I wouldn't. You don't need to talk about Medicare Advantage plans. So it's really gonna come down to like what's the right drug plan for me? What's the right Medicare supplement plan for me? Uh whether that's G versus N, I probably recommend G, you know, but you can an implant's fine as well. It saves you a little bit dollars in premium. Um, but then you're gonna have to enroll into Medicare. Did you say you have part A? Did I hear you say that?

SPEAKER_03

I no, I haven't done it.

SPEAKER_05

We can we can help you facilitate that all. It's done online, it's not very difficult. You know, you gotta log in, got to go through the steps. We help people enroll in Medicare A and B every single day. Um and then, you know, we kind of hold your hand through the process, get all the the other things. And then when you work with us, you're also assigned uh what we call a dedicated client care manager. This is someone who you're not calling some faceless insurance company on the other side of the world that doesn't speak your language, right? You're you're you're calling someone, we our headquarters is in Kansas City. So, you know, we're we're just across Kansas from you. Um and you know, we just you have somebody you can call. If you have a billings issue, a claim issue, you move, your covers changes, you lose your ID cards, you've got somebody on your side, and that's that's what we offer as a broker. So comparison, enrollment assistance, and then long-term support. So okay. I'll shut up. Do you have the number? Do you have our office number? Well, that's good. That's good. No, we don't, but I would love it. Okay, the office number. And you can call in, tell them you tell them you just need uh need to schedule an appointment to get yourself on on a G plan. Is there anyone that you feel like could help her navigate on your team really successfully?

SPEAKER_01

Uh I mean, there's a number of people that could really do it for you. Give her a couple names. Okay, I mean you've got Andrew Irwin. Um a guy named Andrew. Andrew Irwin, Evan Cruz, Nick Oberly, Dylan Blank. Um just a few names. People that Josiah music.

SPEAKER_05

I mean, is it No women?

SPEAKER_01

Oh, we mean you got I mean, you got a couple of women. Kate Kirby was my he cut me off. My list was getting longer.

SPEAKER_05

If you don't work with a woman, you've got that's a wonderful lady. Her name's Kate.

SPEAKER_01

Yeah, Kate Kirby's good. Kimberly Schiazza, Chaff and Devera. Yeah, we're gonna be. I'm joking. I'm joking. That's good. Thanks for putting us on the spot, though. That was fun.

SPEAKER_05

Okay, phone number the phone number is 800-782-6676-800-782-6676. Cool?

unknown

Perfect.

SPEAKER_05

Okay, well, Laura, uh nice.

SPEAKER_03

Guys, this has been incredibly, incredibly helpful. Thank you. Good, good.

SPEAKER_05

Okay, well, hey, thank you for calling in. Tell your friends, we need more people to watch the show. So appreciate it. Sure will. Thank you, thank you. Bye-bye. Let's answer a question from our YouTube channel. You guys can go uh leave comments on YouTube videos, and we will answer them uh either in person or live on the show. Edmund Burke says I'm 83 and in Maine and on an MA plan. I know that I can switch to Medigap and I know that the premiums will be much higher, but I have thought I would have to go through underwriting. You say here that I don't have to go through underwriting. Are you sure that is the case?

SPEAKER_01

Yes, that is the case. So in the state of Maine. There's only a couple of states like this. There are. There are not very many. Um and it always seems like it's in the northeast part of the country. Yeah, that are the well high northwest Washington State as well. But uh anyway, so yeah, with these plans, you can actually move into a supplement plan without going through medical underwriting. You have what's known as year-round guarantee issuance of these products. So no questions asked, you can get right in. The catch for you, uh Edmund, here, is you've got to be able to go through a uh the MA or the Medicare Advantage disenrollment window because you just can't make that switch and just cancel the plan. We've got to call up today and be like, hey, yeah, I want to get on a subplan. You've got to have a reason to do it. And so a lot of folks, and this is not uncommon, um, where if we even if they could medically qualify, which you're in a unique state where you don't have to, but um, other folks in other states um with they would have to go through the medical underwriting process to do the same thing you're doing, we still have to be able to find a way to cancel that advantage plan or replace it with drug coverage because the supplement plan doesn't have that drug coverage.

SPEAKER_05

You would think you could just like cancel your advantage plan, but you can't. You can't but it has to be done during a certain window. So the window for that is the end of the year, right? It's October 1st through uh December 7th is when you would uh and the way you actually cancel this is by picking up a drug plan. Yep. A standalone prescription drug plan, you enroll in that, and then that will automatically between October 15th and December 7th, that will automatically kick out the Medicare Advantage plan, affect your January 1st, and then your supplement plan would start then on January the 1st. So probably your first opportunity um it's not right now, it's probably towards the end of the year. Right. Um and you know, we'd be happy to help you compare carriers and figure out what is the right plan. Uh is there any chance of being able to do it sooner?

SPEAKER_01

Yeah, so there might be. Uh so the kind of the time of the year we're in right now. So you've talked about AEP, the annual enrollment period. Uh, we have the first part of the year, which is the open enrollment period for folks that are on advantage plans. And this is kind of SEP season, is what we like to call it. SEP means special enrollment periods. So people have special rights. Correct. Which you may or may not probably don't. Yeah. More than yeah, more than likely you probably do not, but there's a different uh there's about some of these special enrollments. So you have like uh like FEMA disaster codes. So like people that were experiencing like some flooding. Like the hurricanes. Yeah, hurricanes, things like that. High winds here in the state of Missouri. So like uh yeah, well, for like tornadoes and stuff like that.

SPEAKER_05

Like so if they're if their homes are getting knocked over and they weren't able to make their insurance switches within the you know designated time, it doesn't really matter if their home actually blew over or not. Correct.

SPEAKER_01

If you were in an affected county, because they go by county. Okay. Yeah, yeah. And so it but keep in mind it's not just, hey, there was like a tornado nearby, so I want to change plans. It's not how this works. Okay. Yeah, you have to have missed a window. You have to have missed a window. So like I have to have missed my IEP. There has to be I missed an opportunity to get in, or like I missed my I left my employer coverage and I missed a window to use that election code, so I'm gonna now use my this disaster code or FEMA. So there's FEMA. What else is there? Um so you have like five-star plans. So if you want to move into like a five-star plan, you could switch mid-year anytime. Um, you have chronic special needs. So, more than likely anything heart-related, diabetes, COPD, or end-stage renal disease, so like liver failure, um, or I think that's right, your kidneys. Kidney, kidney, TFX. Um, so anything like that, you can also make a change mid-year on that as well. Because they have those plans have more directed care for the chronic conditions that they that they cover. So um, and there's uh there's a myriad of them if you move. So, like let's say you're hey, you're moving, you know, moving states, moving out of the zip code area. And keep in mind, like, if you're just moving down the street, that's not gonna qualify. Move out of a service area. Service area. Yeah, exactly.

SPEAKER_05

Which I think there's 30. I don't know, but I think there's about 35 service areas in the country. Because it's like metro areas. I don't think it's just like 50 service areas because there's 50 states.

SPEAKER_01

Uh I actually think it's probably more than that. Because generally you're yeah, because like down in Florida, like there's like there's like multiple service areas in the state of Florida. Okay. So I think it's significantly more than that.

SPEAKER_05

So but basically, like if the plan that you're on isn't available whenever you move, like it's going to change, you're gonna have to change plans. That's when you have uh a way to do that, a special enrollment period. Yeah.

SPEAKER_01

And the carrier is gonna let you know that too, because once you tell them, like, hey, I moved, you're gonna get a notice that says, hey, you've got 60 days to use this request to make change, and then after that, we're not covering you because you're no longer in the service area.

SPEAKER_05

So Okay, so move FEMA, um, five-star plan. Five-star plan. We talked about chronic special needs plans.

SPEAKER_01

Um, if you've lost, like, let's say for some reason you go have a retiree plan and God forbid something happens to where no the the retiree plan is no longer covering you. Okay, loss of credible coverage. That's another one where you can do that as well.

SPEAKER_05

Uh is there one for like if your doctor leaves the plan?

SPEAKER_01

Is that a thing? Um yes, it is. Uh it is a boy, I have to remember the name or the code off that off the top of my head. But yeah, if the if your doctor leaves a service area, like your primary care, your PCP, if they leave the area, um, or they leave the network, because it's not the area, if they leave the network, then yes, you have the opportunity to do that.

SPEAKER_05

So a lot of these kind of like big call centers, uh you know, they're uh they've done a lot of SEP special enrollment period abuse. The one that I found like blew my mind, I've learned about recently, was it's it's special enrollment period called ACC. Do you know what it stands for?

SPEAKER_01

Is this the um being able to read like the legible letters? Accessibility.

SPEAKER_05

So like if you if your agent signed you up on a plan and they didn't mark that you wanted large print, yes, or like braille, I guess, then uh these Carl Sculcenters were like using that as a way to say, oh, they need large print, so let's switch their plan. Obviously, a way for for that person to make a commission, switch you into a plan that probably wasn't in your best interest. But there's been a lot of abuse in that over the years, kind of kind of interesting. So there's been a large crackdown. So let's get back to Edmont. Probably, yes, you can switch, you don't have to go through health underwriting questions. You need to wait until the end of the year. Uh, we would be uh happy to help you kind of shop the carriers and be your broker if you would like. Uh if you are uh if it's time for you to sign up on Medicare, it's time for you to sign up on Social Security, it's time for you to get all this retirement stuff done, and you want somebody to help hold your hand through this process, uh, you can call in our office phone number. This is different than calling in, get your questions answered on the show. Call into our office, it's 800-782-6676, 800-782-6676. When you call in, you're gonna be talking to someone who's in our office right here in uh right outside of Kansas City, and uh you're not talking to someone on the other side of the world that doesn't know your language. Uh when you sign up, you we become what's called your uh broker of record or agent of record. And so you're gonna call in, we're gonna go through all the different options, supplement plans versus advantage plans. You're gonna learn, do is a plan G right for me, or is a plan N right for me, uh, how to get drug coverage set up, uh, you know, are all my doctors covered? Everything as it relates to signing up for Medicare, you're gonna get that done for you. We're gonna hold your hand through that process. And then you are also going to be assigned a dedicated client care manager. This is someone that anytime throughout the year, if you have a billings issue, a claims issue, your rate goes up, your uh you move across service areas and you it's time to switch plans. Whatever the issue is, you can call in and get to the same person and they're going to be able to assist you with whatever uh needs you have. So I encourage you to call in. Our services are free. You're not gonna pay us anything. There's no surcharge for your insurance. You're calling a broker, just like you know, if you were to call a broker on your home and auto. Like, you know, we're paid a commission by whatever insurance care you represent. And Garrett leads the team of people that uh uh help help all of our customers all over the country. Phone number 800-782-6676. You've probably gotten in your mail one of these discount cards, right, for prescription drugs. Maybe you've heard of Mark Cuban's uh Cost Plus RX, you've heard of Good Rx. We've all probably used Good Rx at one time or another. Tomorrow we're gonna be talking about how does all of this work with Medicare. Good RX versus Part D, which one actually saves you more? What are all these options for getting your prescription drugs built? Because some of it can be really good and some of it can actually hurt you. So in tomorrow, tomorrow join us. We're gonna be talking all about that so you can make sure that you're saving money and using your insurance in the best way that benefits you the most.