What Medicare Actually Covers When You Have Cancer - Plan Breakdown

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What does Medicare actually cover when you have cancer? In this episode, we break down how cancer care may be handled under Original Medicare, Medicare Supplement plans, Medicare Advantage, and Part D drug coverage.

We’ll talk through the key differences in costs, networks, prior authorizations, chemotherapy, radiation, scans, hospital care, and prescription drugs.

Watch to better understand how your Medicare coverage may work during a cancer diagnosis.

We look forward to taking your calls! 

Transcript

SPEAKER_02 0:03

One of the biggest questions you may have when you start Medicare is what happens if I get cancer? And in today's episode, you are going to learn exactly what your options are for getting coverage for cancer treatment and everything that relates to that. We're going to talk about networks. You're going to learn about what it costs if you go with a Medicare Advantage plan versus a Medicare supplement plan. You're going to learn some of the preventive things that are covered by Medicare. And then you're going to learn something that not a lot of Medicare sales agents that you may talk to will share with you and how to get extra coverage for if you have a cancer situation come up. Welcome to Medicare School Daily. My name is Josh Music. I'm here in the studio with Corey Caldwell. He's one of our Medicare agents here at MedicareSchool.com. My dad is out of the country, and so we're asking several of our agents here at MedicareSchool.com to fill in for him. This is your opportunity to see who you are going to be calling and talking to whenever you call in and work with MedicareSchool.com. If you have a question about Medicare, if you have a question about Social Security, a question about retirement, we would love to talk to you live on this show. And so you can get all your questions answered from Monday to Thursday, 11 a.m. Central Time to noon. Call the number 833-824-2004. I think it's at the bottom of your screen, 833-824-2004. Don't let your Medicare questions or Social Security questions go unanswered. You deserve to have someone who is not trying to sell you something answer your question. And that's what we can promise here when you call in to this show. So, Corey, let's talk about cancer treatment and everything that surrounds that on Medicare.

SPEAKER_03 1:46

Well, I have a great story for that. I talked to a gentleman, and this was back in 2023. He hopped on the phone with us and didn't really have an understanding of what Medicare is. He didn't understand the difference between a supplemental plan and Mr. Medicare Advantage Plan. So what we did is we took that time uh to go over the difference between a supplemental plan and a Medicare Advantage Plan. We really emphasize the networks.

SPEAKER_04 2:07

Okay.

SPEAKER_03 2:07

And when you look at that, when you have original Medicare with a supplemental plan, what you're really doing is you're keeping that original Medicare network.

SPEAKER_04 2:13

Okay.

SPEAKER_03 2:13

You're allowed to see uh doctors nationwide with in that Medicare network. And by end of this phone call, you know, we we came to the conclusion it was going to be in his best interest, he wanted to go with a Medicare supplemental plan. All this time he was leaning towards that Medicare Advantage plan that his neighbor had. So by moving forward with that Medicare supplemental plan, six months down the road, this gentleman got diagnosed with cancer and he was not taking any medications at all. So he's a healthy guy. Healthy guy, you know, a lot of them up out of nowhere. Yeah, a lot of the folks we talked to, they're not taking any medications. You know, they want to look at these options, they want to get that top plan because you're getting that guaranteed issue when you initiate Medicare. Well, fast forward, you know, uh to this year, uh, he reached out, got on the phone. It was now his wife's turn uh to sign up for Medicare. He said, Corey, I want to do the same thing, but he wanted to share a story with me.

SPEAKER_04 3:09

Okay.

SPEAKER_03 3:10

He developed cancer six months after he started that supplemental plan. Okay. Uh his his son. Did he get a plan G or a plan A? He got a plan G. Okay. He got a plan G. And then getting that plan G, he went to get that same plan G uh for his spouse. But the story they shared with me is that his son-in-law's uh mother, mother-in-law, uh, at that same time, they turned 65 at the same time, she went another route.

SPEAKER_02 3:35

Okay.

SPEAKER_03 3:35

She talked to a different agent, she signed up for a Medicare Advantage plan.

SPEAKER_04 3:39

Okay.

SPEAKER_03 3:40

The big difference, his story and her story, is the networks. He went right in, he got to see the top doctors. Uh, for his mother-in-law, it was six months before she was able to get in to see some of those top doctors. A couple of those doctors she went to see, she could not see because they were not in network. So the issue that she was having was that network. She could not go see some of those top doctors because of that replacement plan, that Medicare Advantage plan. So let's talk about that.

SPEAKER_02 4:08

So, because we had written down like a few things that we wanted to talk about. So let's just let's let's double click into the whole network issue. Because when you start Medicare, right, you can either, or I guess at any time, you can have either a Medicare supplement or a Medicare Advantage plan. Medicare supplements, talk to us about that network.

SPEAKER_03 4:28

When you have a Medicare supplemental plan, you know, one thing that we like to point out is the hospitals. We always talk about the Mayo Clinic in Rochester. You know, there's a lot of folks in Texas, uh, MD Anderson, uh, the Cleveland Clinic, you know, they all accept original Medicare.

unknown 4:43

Okay.

SPEAKER_03 4:44

Which means they'll accept a Medicare supplement plan. Absolutely.

SPEAKER_02 4:47

Because there's no networks for the COVID. There's no network.

SPEAKER_03 4:49

Yeah. So when you think of that supplemental plan, think of that, that's the gap plan. That's the plan that's coming in there and picking up that 20% gap. By keeping that original Medicare, that means you can see any doctor visiting the hospital nationwide.

unknown 5:00

Yeah.

SPEAKER_03 5:01

No restrictions. No restrictions. As long as they take Medicare. As long as they take Medicare. No, no, no, no, pre no preauthorizations, no referrals. Now, when we hop on the other side and we look at that Medicare Advantage plan, now this plan, what it's doing, it's it's replaced the Medicare. Okay. So now these guys are in charge. Now these guys are gonna say yes, they say no. You might want to go see that top doctor at the Mayo Clinic. They're not gonna accept your Medicare Advantage plan.

SPEAKER_02 5:29

Yeah, like I I've I've seen new, I think we've got even some YouTube videos on this. Like Mayo Clinic doesn't accept Medicare Advantage plans. Standalone, they do accept some group. Okay, okay, but like your regular private advantage plans. MD Anderson, same story. Same story. Cleveland Clinic, same story. Same story. Okay. I can't remember what some of the other big, huge hospital, you know, famous for cancer is, but I I I point taken, like these specialty clinics, and even in your own city, like any sort of Medicare Advantage plan is going to have a network. That is correct.

SPEAKER_03 6:02

So you need to stay within that network. That is correct. And you think it's too the top facilities that might have the new technology, you know, they're gonna accept that supplemental plan, you know, where because you have original Medicare. Uh the Medicare Advantage Plan, you know, because it is a network, you might have to go to another option. Because all hospitals are not created equal by any stretch of the imagination.

SPEAKER_02 6:24

No. I mean, it's it's just walking through I walked through some of that with my mom last year. It's just like some of these smaller hospitals, they don't even they don't have the capability, they don't have the expertise, they don't have the specialist, or maybe they've got one specialist for this particular issue and he comes around, you know, every two days. It's just very different than, you know, a more uh one of the people.

SPEAKER_03 6:47

I can relate to that story too with with my mom. Uh she lives in small town Iowa. You know, we just had a conversation. My mother has a supplemental plan. You know, one of the biggest reasons is because she lives in a small town. Her hospital in her town is the only one opened up in in her area in a 60-mile radius. They've closed three hospitals in the last three years. Wow. So having that Medicare Advantage plan, she's she would have to travel, you know, 120 miles. That is a problem in these rural areas.

SPEAKER_02 7:15

It's becoming a big problem right now. Because they can't, because the advantage plans pay slow or they pay low or whatever it is, and they can't operate off of that.

SPEAKER_03 7:22

That's correct. Yeah.

SPEAKER_02 7:23

So they end up dropping it. Okay, so networks obviously are a big differentiator if you have cancer. Where can you go? Can you see the top people? Can you go to the top hospital in your city? With a Medicare Advantage plan, it's a question mark.

SPEAKER_03 7:38

It's correct, yeah.

SPEAKER_02 7:40

Uh with a Medicare supplemental plan, like a plan G or a Plan N, you've got a lot more flexibility. Uh let's talk a little bit, if we can, about uh some of the preventive stuff, and then we'll get into costs, we'll get into uh pre-authorization, some other stuff. But from a preventive perspective, obviously we want to prevent cancer. How does Medicare cover that? And maybe what are some differences there between advantage and SUP? If there are, there may not be on preventive.

SPEAKER_03 8:05

Preventative care, there's not gonna be difference in the coverage itself.

SPEAKER_02 8:09

Between advantage and SUP? Correct.

SPEAKER_03 8:11

Yeah. You've got that deductible with the plan G, that 283, and you could have some costs with that Medicare Advantage plan. You know, looking at that $45 average cost to see a specialist. Uh but generally, you know, you're gonna have the same coverage for preventative. Uh the restrictions, uh you know, example lung cancer. You know, some folks have used tobacco. You're gonna be able to go in once a year and get that screening uh with that. Same with the colonoscopy and the manograms, you're gonna be able to go in and get those screenings uh with the preventative care.

SPEAKER_02 8:42

Okay. So all that stuff is gonna be covered whether or not you're on a Medicare Advantage plan, whether or not you're or you're on a Medicare supplement. That's good. That's correct. You know, obviously that makes sense. We want to do as much preventive stuff as possible. So let's talk about costs then, because I think that's going to be a big differentiator. Correct. Because a lot of people come into Medicare and they hear that this Medicare Advantage plan is like low cost, doesn't cost anything, you know, good coverage, you get all this extra stuff that Medicare doesn't cover. Um and I think that's all good and true and right while you're healthy. But do we buy insurance for when you're healthy, or do you buy insurance for when you're sick? Obviously for when you're sick. So break down those cost differences.

SPEAKER_03 9:19

Yeah. So when when you look at a supplemental plan, you're going in for that chemotherapy, you know, you're going in for those high-cost shots, you know, you're you're gonna meet that deductible with that plan G, and that's $283 or something. It's almost irrelevant as it relates to cancer treatment. Yeah, it's nothing, you know, compared to some of those fees that we've seen and talked to these customers, uh, $300 and thousands of dollars with that. Now, the Medicare Advantage plan, uh, when when you look at this plan, you know, because remember, this is replacing Medicare. Right. So they're gonna have cost associated with that. Generally, when you see a cancer, you're gonna see a 20 percent coinsurance. Okay. What is coinsurance? What coinsurance means to you is whatever that coinsurance is towards that treatment, you're responsible for 20 percent uh of that.

SPEAKER_02 10:07

So if it's a $10,000 or $100,000 for cancer treatment, it must be $100,000, right? Then you're responsible for 20% of that. That's correct. For unlimited?

SPEAKER_03 10:18

No. Generally, the one advantage of an advantage plan is this they have what's called a max out of pocket. Okay. So they're gonna eliminate that twenty percent and they're gonna give you a max out of pocket. National average today, you know, throughout all 50 states is $10,000. Okay. You know, some states it could be lower, you know, but we're looking at about $10,000.

SPEAKER_02 10:37

So that's a maximum out of pocket. If you get cancer, you've got you're gonna pay 20% up until the max. Makes sense. I think most people probably understand how that works. What if you're on a Medicare supplement plan? Because that's on a Medicare Advantage. $283.

SPEAKER_03 10:49

If you're on a plan G. Plan G. $283. Now the plan N, you brought that up earlier, uh, you're you're you are still responsible for that $283. Now they have a coinsurance, you know, uh up to a $20 co-payment for a physician visit uh with that. But depending on the state you're you're in, you could have what's something they call the excess charge. Uh some physicians Which is rare, but could happen.

SPEAKER_02 11:14

We talked to a a guy yesterday, and he um his doctor charges excess. And it was some sort of a surgeon, which could be applicable, obviously, in a cancer environment.

SPEAKER_03 11:23

A client that I talked to uh with the excess charge. Now, her daughter called in, you know, to kind of figure out why she was getting charged this extra amount of money, uh, but that was a five thousand dollar excess charge and it was due to an infusion.

SPEAKER_02 11:38

Ah, so she they were on the if you had a plan in, you're on the hook to pay for that. And there's no cap on that. There's no cap. There's no cap on that. So if she had a plan G, she's not gonna get that extra bill. So that's interesting. For an infusion, those are expensive. They're very expensive. That makes sense.

SPEAKER_03 11:53

Yeah, $5,000. They had no no idea why that happened. And we sat down, we looked at the bill uh together, and we realized that her mom made a switch. Yep. Uh she was in a state where she could make that switch. Went from that plan F. Remember, this lady was full coverage. She was 20 years on this F driving this Cadillac, and somebody reached out to her, made a switch to a plan N to save some money per month. She had no idea she was responsible for that access charge.

SPEAKER_02 12:22

Corey, let's talk about uh this last this last thing that uh getting extra coverage beyond what Medicare covers, beyond what a Medicare Advantage plan may cover, beyond what a Medicare supplement plan may cover for just for cancer. Can you talk to us a little bit about that?

SPEAKER_03 12:37

Yeah. So uh they're they're they're what they call indemnits. What indemnity product is that it's it is it it is. What does it mean? What it means is it's gonna give you extra coverage. You know, it's gonna pay you with that. So when when you when you look at these two different two different options that we talk about, Medicare supplemental plans and Medicare Advantage plans, let's start with the supplemental plan. You know, when when we we know the cancer is covered, you know, with with with original Medicare and that and that plan G or that plan N, you know, but there's there's costs that affect you travel. You know, what you know, God forbid you get cancer, uh your your diet could change. There's a lot of extra cost added to so many things.

SPEAKER_02 13:20

I'm just and my mom didn't have cancer, but she had an autoimmune thing that popped up. And I'm just amazed. I mean, it was beyond what the insurance covered. Correct. I mean, it was like $25,000, and you know, you have to have care, you have to have you know special diet stuff, transportation to go to some specialty clinic, hotels, overnights, all this extra stuff. Uh just you don't I mean, you you may have great insurance, but there's all this extra stuff that you don't think about. The travel.

SPEAKER_03 13:48

You know, uh growing up in the Midwest, a lot of folks would say, hey, we're gonna go to the Mayo Clinic. That was the number one clinic that folks would go to you know, for that cancer treatment. You know, there's room and board, uh-huh. Their stay, you know. Uh some folks, you know, might need a caregiver. They might want to bring in their son, their daughter to come sit down with them. Or a professional. Or a professional for sure. You know, for and that's expensive. That's a couple grand a week. That's expensive, yeah. You know, so when you look at a uh an idemity product like a cancer plan, uh, you get diagnosed with cancer, they they will give you a lump sum. You know, it could be five thousand, it could be twenty thousand dollars to help offset some of that cost, that travel. You know, bring in bringing your son or daughter. You know, one customer of mine, he he had uh a cancer plan. You know, how he chose to spend that money, he flew his daughter home. There you go. You know, he was able to fly his daughter home and she'd come stay with him for a couple weeks and and she took care of him.

SPEAKER_02 14:42

So we I was talking with somebody that works here last week, and they said they had was it you or was it maybe it was Dylan? Did you hear the story? Dylan, yeah. Yeah, they had a he had a it was it a cancer or something, something happened.

SPEAKER_03 14:55

Critical illness plan.

SPEAKER_02 14:56

Yeah, and he had one of these plans and it was I think he got a $25,000 benefit.

SPEAKER_03 15:01

Yeah.

SPEAKER_02 15:01

They called, uh did the filing insurance company sent him a $25,000 check, and didn't they go to Vegas or something?

SPEAKER_03 15:09

Yes, that they they took the money and they took it right and put it all down. Yeah. I I've got one, a very close friend of mine, not cancer-related, but an indemnity product type plan, uh had a liver transplant. Okay. You know, and ended up losing, losing his job, you know, being forced to go on to to Medicare with his spouse's group plan, but financially they were strapped. Sure. You know, by by collecting all the time. Lots of income. Yeah. So he this this plan kept him in his home. Yeah. This plan kept his marriage going. Yeah. You know, by having that extra income coming in, really helped him and his family out. You know, it's a really good option to have to cover some of those costs outside with the medical. What is a what is a plan like this cost? And typically, you know, you can look at you know, $15 a month, you know, for for the lower end. You know, you know, you you're gonna go up to the the $20,000 uh mark. You're you know, depending on where you're at, you know, it could be anywhere from $25 to $35 per month uh for that. You do have to medically qualify uh for this plan.

SPEAKER_02 16:16

You know, so I think it when is it is it always medical qualification, or is there that do they have a similar window like when you get a Medicare supplement plan? You don't uh or is there you always have to medically qualifying? Because they probably don't want to like give it to people who maybe are on cancer. Yeah, it makes sense. So you get that something comes up. And is it does it only cover cancer, or does it also cover because I think there's like heart attack, strokes?

SPEAKER_03 16:42

Yeah, you've got different critical illness plans like heart attack and stroke uh with that. They can offset some of the costs too with some riders for ambulance uh for that. There's multiple different riders you can put on there to offset that cost.

SPEAKER_02 16:54

That's interesting. And we we I feel like it will probably half or over of the people that we uh bring on purchase some sort of extra insurance beyond.

SPEAKER_03 17:06

You have it okay. I have it myself. I've had it for for for many years, but I do have a critical illness in cancer policy myself that that I've had for many years.

SPEAKER_02 17:14

Okay. Well, if if you're if you guys are interested in this and want to learn more, maybe you already have a Medicare supplement, maybe you have a Medicare Advantage plan and you're healthy still, right? You're not undergoing cancer treatment and you want some extra coverage, like one of these we call them critical illness or uh cancer, heart attack, stroke, something like that, call in to our office, 800-782-6676, and we can see if you can qualify, because you do have to medically qualify to get one of these plans. But it's a great way to make sure that whenever something happens, generally as we get older, it's when, not if. Uh, but when that happens, you are able to continue your lifestyle. You're able to not put your kids, you know, put a burden on them because you can afford a special caregiver or whatever when these when those things happen. So call in 800-782-6676, and we can give you the rates, give you the options, all that sort of stuff. Myra in Washington, welcome to Medicare School Daily. What questions do you have for us?

SPEAKER_01 18:17

Hi. Uh yes, um, so I'm wondering about uh timelines. Um, I signed up for Medicare Part A on May 1st, and I haven't been approved yet. And the background is is that I was covered uh under my company's plan, so I didn't uh sign up when I turned 65. I waited, but then got laid off in late April. Okay, and so signed up May 1st for part A, and I'm waiting for getting my benefits verification letter. Um and then I need to sign up for part B. So I'm wondering what the timeline is on that. And I've also signed up with Health Spring for Medigap coverage, and I'm you know, also gonna be signing up for part B. Uh I was advised to wait until June to sign up for that. So the goal is to start everything July 1st because my company covered uh Cobra for me for a couple months, and that's gonna end uh at the end of June.

SPEAKER_02 19:22

Okay, so you signed up for part A. Did you do that online? Yes. Okay. Uh and you did that in did you do that in April or in May? Uh I did that on May 1st. May 1st, okay. And so the idea there is that your part uh A will start. Well, they're actually gonna backdate it. When'd you turn 65?

SPEAKER_01 19:45

Uh a couple of years ago. Um well, year and a half ago, I'm 66 now.

SPEAKER_02 19:49

Okay. And then you haven't signed up for part B yet.

SPEAKER_01 19:54

Uh yeah, correct. I was advised to do part A first because that might be quicker. It hasn't turned out that way. Um, but I'm I've got the forms uh to sign up for part B. There's like two forms I need. Yeah, I think it's 40B and L something. Can't remember.

SPEAKER_02 20:12

L564, and so that's already been signed by the employer.

SPEAKER_01 20:16

Yes.

SPEAKER_02 20:17

Okay.

SPEAKER_03 20:18

My recommendation uh in this situation, what I what I would do is you don't have a Medicare number yet, uh, I would I would uh fill in your Social Security number. I would drop that like 40B. I would drop this information off at your local Social Security office. And and we know that you can't just walk in there anymore, but they would have a drop box uh with that. That my recommendation would be to drop both of those homes off this time.

SPEAKER_02 20:43

I also want to challenge your kind of your thinking on because you're are you when are you planning on doing the part B? Because you said July? Yeah, I'd like to start it July 1st. Okay, so I here's here's what a lot of people don't know, and so I just want to make sure you're aware of this. When you are so because you're having Cobra paid for by work, right? And so you're saying, hey, I don't need to start this until the Cobra's over. Is that kind of your line of thinking? Okay. So whenever you are eligible for Medicare, Cobra is going to take a secondary position. Okay? Which means if you go into the hospital tomorrow, you are the first payer. Cobra's gonna pay secondary. Right. Okay. Okay. Which means you're responsible for 80% of the bills. Okay. So whoever told you wait until wait to get original Medicare, you know, A and B set up until the Cobra ends, that was not good advice.

SPEAKER_01 21:41

Because if I I don't I wasn't advised to do that necessarily. Um it's just my goal to my goal is to have everything in place by July 1st. Sure. Well So if I need to sign up for part B at an earlier date, I'll go for that.

SPEAKER_02 21:58

So two things. Uh on that 40B form, because you have that, and you're way ahead of most people by having that in the L564, so excellent work there. On that 40B, I would recommend in the notes and the remarks section, I would ask them to start at June 1st. I I to me it's a lot of risk for you get in a car accident, get who knows what could happen. And all of a sudden, you are the first payer, and Cobra is going to decline to pay bills until you've paid your part. And you're going to pay a percent of the bills. So I, you know, we're calling you're at the end of the month. I would do exactly uh what Corey just said, which is hey, take those documents in, get them dropped off to the Social Security office today, tomorrow, um, and put in that 40B form. I want my Medicare part B to start June the first. So at least you've got in to start it May 1st? No, they're probably they're probably not gonna backdate that. Yeah, I I I don't think they're gonna do that. Now, your part A, interestingly enough, they're actually gonna backdate that in six months. So it's gonna end up being sometime last year, probably November or December 1st, which it doesn't matter. Um have you logged into SSA.gov to do to see if they there's a little button in there, I think. What's it called?

SPEAKER_03 23:09

Yeah, there's gonna be a PDF uh that's gonna state that if everything's in force uh this time.

SPEAKER_02 23:14

Have you logged into SSA.gov to look for that recently, like last few days?

SPEAKER_01 23:18

Uh yes, I I checked yesterday and it was still in progress.

SPEAKER_03 23:23

Yeah, you might yeah what do you think? Did you apply for Social Security at the same time when you applied for part A?

SPEAKER_01 23:30

No, I haven't applied for Social Security and I wasn't planning on applying for it for you know for a few years yet.

SPEAKER_02 23:36

That can delay it sometimes if you do them together, but doesn't sound like they just may be behind.

SPEAKER_03 23:40

Yeah. It's generally two two weeks to a month uh at this time right now for folks who are trying to get A only. Yeah.

SPEAKER_02 23:46

Now, are you going to get a supplement plan or what are you thinking on top of original Medicare A and B? Where's your kind of head on that?

SPEAKER_01 23:54

Uh I want to do the uh the uh supplement uh plan, not uh not the advantage plan. The Health Springs. I know there's like a Oh yeah, you already got that set up. Yeah, through Health Spring, yeah. Okay, good. Um and I know they're and they're asking for the uh Medicare number on the comeback form. Correct. And uh I'm I'm like, you know, I I I know there's a two-month window to accomplish things. So that's why I'm a little bit uh jittery about it.

SPEAKER_02 24:20

Yeah, well, you're you're fine. So you actually have six months for that Medicare supplement plan um from the beginning of the part B. So don't worry too much about that. Like they you need what when you get that Medicare number, get it to them, right? Obviously. Do you know what effective date you put? Did you put July 1st on that Health Springs plan? I believe so, yeah. July 1st. And that's probably fine because as long as you the the key thing is original Medicare A and B being in place as soon as possible when you have that Cobra. Because if something happened in the month of June, Cobra's gonna pick up probably a lot of what Medicare doesn't pay. We just don't want you to be uh standing in the place of Medicare as the primary first payer.

SPEAKER_01 25:04

Right. Yeah, and my goal is to like, you know, do this without any additional fees and you know, get everything in place.

SPEAKER_02 25:11

Yeah, yeah. And then your drug plan, uh, you're fine on once you get your Medicare number, you know, either we can help you or Medicare.gov. Do you take some medications? I don't. Okay. So let me do you know, do you have a plan on which drug plan you're gonna get? Because I can look them up for you here real quick.

SPEAKER_01 25:28

Yeah, no, I uh I yes, I do. Uh it's one that you don't like pay anything for. Um probably welfare. Yeah, wellcare sounds right, yes.

SPEAKER_02 25:38

Yeah, welfare classic. There's a welfare value. Yeah, there's there golly. You got well, if you wanted to keep everything with Health Springs, you could. Healthsprings has a zero dollar drug plan as well. Um then you just have one carrier. It doesn't really matter though. The Wellcare, the Wellcare, yeah, you've got Wellcare, Humana, and Healthsprings all having $0 drug plans. Um Okay.

SPEAKER_01 26:00

And I mean I can change that on a yearly basis, right? I think I'll just stick with what I've got going right now and then deal with it at the end of the year. Oh, yeah.

SPEAKER_02 26:10

Absolutely. Okay. Okay. So main takeaway for me is get those documents into Social Security before the end of the month, right on the 40B form. You want it to start June the first. Yeah. And it sounds like beyond that, you got to get a drug plan in place and you're going to be squared away.

SPEAKER_01 26:27

So when you say it's six months, is like because I know that like if you if you don't do the uh supplemental plan, like if you go on advantage first and then you try to go to supplemental, that they'll sometimes require like a health evaluation. Yeah. But do I have six months with no health evaluation?

SPEAKER_02 26:47

You have six months from your part B date. Correct. With no health evaluation. Yep. Okay.

unknown 26:55

Cool.

SPEAKER_02 26:55

Okay, I thought it was two months, but um No, the two months would be the two months is probably maybe where that's coming from. Is whenever your credible drug coverage ends, you have two months to get on a drug plan. That's probably what it is. Which is less of a big deal for you. We're talking about a free drug plan. You don't take any meds. I mean, you know, you need to get on a plan, but yeah, that's the two months. Yeah.

SPEAKER_01 27:17

Okay. Okay, got it.

SPEAKER_02 27:19

Got it. Two months from your last day of work. Oh, okay. Oh, really? So not so the Cobra doesn't count as credible? Cobra is credible. Okay, yeah, Cobra is credible. That's correct.

SPEAKER_01 27:29

Okay. Yeah, I I I do have those letters, you know, that that it's that those were credible plans. Good. So um okay, so by I just need to get the drug plan in place by the end of June, then.

SPEAKER_02 27:43

Yes. There you go.

SPEAKER_01 27:45

Okay. All right.

SPEAKER_02 27:46

Okay. Well, hey, modernized to talk to you. Yeah, thanks. Take care.

SPEAKER_01 27:51

Nice to talk to you. Thank you.

SPEAKER_02 27:53

Bye-bye. It is interesting how many times like we answer the same questions. Like you've run across that scenario a uh a a thousand times. But it's it's new for everybody. It's new for the first time. It's the first time.

SPEAKER_03 28:04

That is correct. That's all I always say. This is new to you. You know, this is new to you. It's hard, it's difficult. There's all these different options out here. One person is talking to you about this, the other person, but your story today is unique. So we take the time and make sure we put you in that direction, get you signed up the correct way. Yeah.

SPEAKER_02 28:21

It's it would be uh it would be I mean, I I I re we started my dad and I started helping people with Medicare in I think 2011. And it took us like three years to even figure out what we were doing. So like it if you're if you're doing this alone, you don't have to. There are people, there are companies like ours uh that you can call and get free assistance. Uh when you work with MedicareSchool.com. So let's say you need help with a Medicare Advantage plan, a Medicare Supplement Plan, getting a drug plan, when you call in, you're gonna be talking to someone that's been trained by my dad, Marvin, right? You're gonna talk to somebody like Corey here. Been doing this, helped thousands of people walk through thousands of situations. And there's just no reason to do it alone. Uh you know, there's no extra cost to you. We don't upcharge for the insurance or anything like that. You just get somebody to hold your hand through that process to make sure you're not making a mistake. There's always things we uh things we don't know. And so by working with somebody like us or ourselves, uh, it's an honor to help you. If you want to work with us, uh you can call and you can ask for Corey. Phone number is 800-782-6676, 800-782-6676. Let's bring Russ from Florida. Russ, welcome to Medicare School Daily. What questions you got? Yeah, who am I speaking with? Is it Marvin or Josh? This is Josh. You got the short straw.

SPEAKER_00 29:42

Well, trying to make a long story short. An old guy, I'm 74 years old. I've been employed with a company for 16 years in furniture, and they went out of business the end of March. Always had my health insurance with them, okay? Only signed up for plan A so I wouldn't have to pay for plan B out of my social. So finally got all the documentation, which is a big hassle, so I can prove that I had health insurance from the time I turned 65 to show that to them, I guess, or so uh I think I've got that done. My questions are the plan itself, um you know, uh I want a least expensive plan uh because I I'm relatively healthy. Uh uh you need to hear my medical history, I could go through that.

SPEAKER_02 30:29

Um, no, not not necessarily not yet. But tell me what what are you kind of thinking? So you're gonna have A and B, obviously. Um what else?

SPEAKER_00 30:39

Is that something you can help me with on the B, or is that something I just gotta call?

SPEAKER_02 30:42

Yeah, no, we can well see it it's pretty easy. So you've got uh you have your you've it sounds like you've done the hard work. So there's two forms. The first one is called uh CMS40B. Do you have that form? No, I haven't done all I was doing was the L564. Do you have that one?

SPEAKER_00 31:02

No, I haven't done anything on that. Again, I end of March, I was out of uh out of work. Another thing I did here. I had a roof put on my house and then chasing down the money they owed me for my teeth because it was it was a very sad, angry kind of scenario after being wanted to do. So I would have been very distracted with a lot of that minutiae, plus this, um which is a concern I have. Uh you know, I haven't had I don't have any doctor coverage. Uh you don't have hospital coverage. Sure. So um what I need to do is to get on plan Bart B data.

SPEAKER_02 31:42

Yeah. So to let me let me describe the process uh and then uh hopefully it won't be too difficult. Um, and then also how we can help if you want to use our services. So the first thing is there's gonna be two forms that you need to do to get part B in place. The first form is called 40B, CMS, which stands for Center for Medicare Services, 440 and B, as in boy. Okay, that is the application for part B. You fill in your Medicare number at the top, you fill in your name and address and all that stuff, and then in the remarks section, you just put in uh when you want Part B to start. So for you, if you were to do this today or tomorrow or the next day, you could write in I want it to start June the first. Okay, that's one form. The second form is called L564. So Larry564. Um and we are we can send these to you no problem. Uh, but that is the forum that somebody at your company it needs to say, yeah, uh Rust worked for us and had coverage since, you know, whatever 16 years ago, whatever year that was, I guess 2010, 2011. Um I turned five, right. Yeah, yeah. Yeah, exactly. And so that they need it, well, do you think you can get someone from HR or somebody there to just sign off on that? Nope. I was contacting somebody with email. He sent me a letter that said I had coverage for those dates. Okay, but it does it, but does it say is it the is it the Medicare form that's called it says L564 down on the bottom? It says the top of it says request for employment verification. Is that is it that form or is it something that he he created?

SPEAKER_00 33:17

No, no, no, no. He just sent me and I printed it out a uh a copy with the Schottenstein Corporation uh logo link and okay.

SPEAKER_02 33:25

Just we can we can help you get this set up, but we need a signature on this Medicare form. Okay, so those forms together can go into the Social Security office, you can drop them off in the Dropbox and put in the remarks. Hey, I want this to start June 1st. If you can get your person over at that company to do this, you know, in the next couple of days, I guess by tomorrow, probably, um, then uh then uh then you can have everything start January 1st, or pardon me, June 1st. Okay.

SPEAKER_00 33:54

Okay. So I've got to get gentlemen, okay, just to slow it down and stop you a minute. Jason Gossett is the director of benefits. He only he only goes with his email, and I'm sure he's a very busy guy uh handling on thousands of employees. But um uh so I need to do what? Just send him an email with a copy of the form for him to sign and then send it back to me, and then I can print it. Exactly right.

SPEAKER_02 34:20

You got it. You got it, and it's called L564, request for employment verification. So those two documents, the 40B that you fill out and sign, the L564 that he does, those go into the Social Security Office. Now, you're not gonna have Part B cards by June the first, right? It's gonna take a few weeks for all that to process, but they'll backdate it to June 1st. Okay, so then you'll have your doctor coverage. Yep.

SPEAKER_00 34:43

Yes, good question. Uh, where do I get the forms?

SPEAKER_02 34:46

Uh we can we can if you uh it we can email them to you, or you can just go in and literally type in CMSL564. Um, and it's a lot faster, and then I can print them up right away here. Yeah, yeah, yeah. Yeah, hang on just a second here. Beyond that, you need to then decide are you gonna get a Medicare Advantage plan or are you gonna get a Medicare supplement plan?

SPEAKER_00 35:08

Do you know not sure about talking to one of uh the other um people that uh have a show like yours, only it was uh only over the phone. And they were talking about an advantage plan based on uh what I was talking to them about, uh, you know, uh limited funds that that would only cost me maybe about 30 bucks out of my uh social security. Yeah.

SPEAKER_02 35:32

So here's what here's what I would probably recommend you doing. I want to, because this is, you know, this is our kind of live daily show. I I want I'm gonna have somebody reach out to you from our company. They can walk you through those different options. Okay, they can also help you with the L564 and the 40B. And I can have them do that. I can have somebody reach out to you probably in the next hour at the most. Is that fair? And then they can they can walk you through different advantage plan options, they can set up all that paperwork for you, um, and they'll get it all handled. Is that cool? Does that work?

SPEAKER_00 36:03

Uh that's good. That sounds good. So you know. Okay, old guy you're talking about. Oh download it, yeah. So you're gonna send me the forms, I can look for those in the next half an hour.

SPEAKER_02 36:16

Yes, sir. And I can fill them out myself, and then send it back to you, or do you need to copy that? Let let's do this. Let me have somebody reach out to you, and they will fill out the forms with you. And get it all we'll just make it easy, okay? Perfect. Is that fair? Yeah, just make it easy. Then it goes to the your HR person or Jason Goth or whatever you said his name was, and then get those back. You can apply for part B. And then the person that I have reach out to you can also kind of shop around and say, Okay, this is with your doctors, with your medications, this would be a good advantage plan option for you to consider. Is that good? Okay. Get it all done pretty quickly. Okay, what other questions do you have?

SPEAKER_00 37:06

At this point, that's pretty much it. You know, okay, because I can answer questions once we get them on. And who is it that's gonna be calling me?

SPEAKER_02 37:12

Well, I'm gonna I'm gonna go. It'll probably be, I I don't know. I don't know yet. Uh, but I will I'll send you an email with their name and their contact info because you gave me their email, your your email. So I'll give you a heads up. So keep an eye on your email in the next couple of minutes. And is it the whoever reaches out to you, they're gonna they've they've been trained by Marvin personally, so they'll be able to walk through everything, make it easy, okay?

SPEAKER_00 37:31

Okay, okay, okay. And what kind of phone number are we gonna be getting a phone call from so I don't start?

SPEAKER_02 37:37

Either a 913, that's our local area code. We're in like right outside of Kansas City. Um, so either them it and they could also call from an 800 number. Um I I don't know what it it I think the system kind of randomly decides what it's gonna call from. So either a 913 or an 800 number. So just but I'll I'll they'll they'll leave a voicemail if you know you don't pick up. Um but I would I would get on this so that you can get everything done by the ready for June 1st.

SPEAKER_00 38:05

And I'm gonna be looking in the next uh 20 minutes for the email, right? Yes, to make sure I got it. Yes, sir. And then he's gonna walk me through it, he's gonna help me fill it out, and then if I give him the email, he can actually send it to my director of benefits.

SPEAKER_02 38:18

Uh yeah, yeah, I mean, sure, he could send the email. I think it will be more effective coming from you with a message of like this has to be done like no later than noon tomorrow, because I got to be able to print it and drive it off to the Social Security. Otherwise, I'm gonna be without coverage, something like that. Like, I think it should come from you. Like, maybe it'll you'll have more urgency because if not, they'll be like, who's this random email from? Requesting information.

SPEAKER_00 38:40

So, okay. I'll look for the email and uh I'll wait for the call.

SPEAKER_02 38:44

Okay, Russ. Nice to talk with you. Take care. We'll be in touch. Bye-bye. When you're starting on Medicare, it can feel overwhelming because it seems like everybody who wants to give you advice is really just trying to sell you something. So I've got a resource here that you can take advantage of. You can, if you use Facebook, you can go into your Facebook app, you can type in Medicare School Community, and you can join that group. And there's 50 or 60,000 people in there that are on Medicare, that are on plans all over the country. And if you have a question, uh you can post it up in there, and you will get probably a dozen, 20, 30 replies of people sharing their experience. We do have um one person on our team that's dedicated to making sure that people are telling the truth and aren't leading you astray. But it's a great opportunity for you to get what's happening in the real world on Medicare and Social Security and the experience there. So we're gonna answer one of the questions that uh was posted in here, I believe, yesterday, Kim Webster said, My dad's Cigna advantage PPO plan has changed to Healthspring, and he lost his doctors in his hospital. This is so confusing. Has anyone else experienced this? What did you do? Speak to that.

SPEAKER_03 39:52

Yeah, in a situation like that, what you really want to do is with with Cygna into Healthsprings, that's that's a name change. Yeah. Uh with that. So you're you're you've got the same network. So what what happened?

SPEAKER_02 40:02

I mean, it sounds like I mean there could have been another change in here, but I think it does like underscore the fact that we hear of people mid-year. Doctors leave networks. Correct. Right? Hospitals can leave networks, correct. Which is crazy.

SPEAKER_03 40:15

Yeah.

SPEAKER_02 40:15

So you've bought an insurance plan. So the thing about Medicare Advanced Plans is they last a calendar year, right? Yes. And you're in that thing. Yeah. And if your doctors change or your hospital leaves the network, what do you do?

SPEAKER_03 40:27

In that situation, you have to find a new doctor if there's no special enrollment period for you to make a change. You know, so that that special enrollment period is October I'm sorry, the AEP and enrollment is is is October 15th, December 7th. That's an opportunity to look at your plan, verify that your doctors, your hospitals are all still in that plan each year, because these are one-year contracts with that. And you got another uh option during the OEP, that's gonna be January 1st, uh March 31st. And you get another opportunity to verify and check and make sure that everyone is. But if you're outside that window, uh the only way you can make a switch if you have a special enrollment period. Uh they really lock you in that plan, you know, in situations like that. So the answer is you're gonna have to probably find a new doctor until you can get to that annual enrollment period to make a change. Yeah.

SPEAKER_02 41:15

I mean, it it is a PPO plan, so maybe you could go out of network, perhaps. Perhaps, maybe, maybe not. But maybe they don't even take advantage plans.

SPEAKER_03 41:23

Correct. Yeah. Just because it's a PPO, yes, you're gonna pay more money to see that specialist, but that specialist might not accept that plan. So that is is not necessarily uh a guarantee to see that doctor.

SPEAKER_02 41:35

It may sound like we uh beat up on Medicare advantage plans a lot. I don't I don't think that's really our heart. Um it's just more of let people see situations like this that happen. When somebody if you were to call in, uh let's say 100 people call in, probably 25 percent of you are going to end up on a Medicare Advantage plan if we help you, because it makes sense for your budget. You like the supplemental plan would make you insurance poor. You can't literally afford it. And that's there's no shame in that, there's nothing. We're gonna get you on the best Medicare Advantage plan. Right. Um but you have to know some of these things will happen to you. Uh another question here. Will Medicare cover cover oral surgery? I need eight teeth removed.

SPEAKER_03 42:17

No. Probably not. No, it's got to be medically necessary. Like maybe if you had a wreck and you got your jaw busted up. Automotive accident, you know, that but no, medically necessary. Uh they don't see that as medically necessary. So what do you do? Uh you're gonna need to get a standalone dental plan to cover that. You know, there's a lot of uh plans out there. You know, one of the things that you really got to focus in on when you need that dental plan, you want to start that early. There's a lot of pre-existing the missing tooth clause. What is that? Missing tooth clause, if your tooth is missing, they're not gonna replace it. Yeah, they're not gonna give you an implant. They're not gonna give you an implant. You know, depending on the bridge, it's really difficult with that. So it's it's one of those things when you're leaving that group plan, it's really important to continue that coverage as you go uh on to Medicare. And there's multiple different options. There's basic plans, we've got we've got the Cadillac plan out there that's gonna cover you know up to $10,000. You know, we've got multiple different options out there.

SPEAKER_02 43:13

Let's talk through dental plans, because there's these things called waiting periods. How do those work and why are they there?

SPEAKER_03 43:18

Yeah, so uh lots of times a lot of these plans, you're gonna get your preventative cover. You know, you're gonna see 100% coverage. Yeah, 100% coverage as long as that doctor is in network. But you know, we're really only looking at PPO plans when it comes to dental coverage. So you might pay a little bit out of pocket uh for that dentist that's not in network, and then with a percentage, you think of basic, a basic like a filling, a simple extraction. You're gonna have day one coverage uh with that, generally anywhere from maybe fifty percent. It's gonna increase to about eighty percent after one year. And then you look at major. You know, uh major, you might get twenty percent day one. You know, you really got to think about is this dental insurance really want to come in and pay for an input?

SPEAKER_02 44:00

Plant uh uh day one, it can't and then you get all your eight teeth removed and then you cancel the insurance next month.

SPEAKER_03 44:06

And you cancel that plan, so you're gonna have lower costs. But as that plan goes that one year anniversary, you're gonna see that percentage increase. It could be 50, could be 65 percent, but you see you will see an increase uh with that plan. You've got multiple different options because you are doing this on your own. Yeah. You know, you're choosing to take out this dental plan, so there's a lot of freedom in that. You can sign up today, tomorrow. There's no enrollment period by when it comes to dent. Whenever.

SPEAKER_02 44:33

So for uh so somebody like this, uh eight teeth needing to be removed with a missing tooth clause, kind of let's keep that in our mind. Yeah. You probably want to get the you probably want to get the insurance in place before you get the teeth released. Oh, absolutely. Because if not, they will never pay anything to the other. They will not pay anything towards that.

SPEAKER_03 44:51

That that tooth were the teeth implant that is currently in place. Yeah, you're gonna want to get a plan in place. And eight teeth is a lot. It is a lot. You're gonna come out a lot out of pocket costs with this, but you're gonna be happy, you know, once that insurance kicks in, you know, for that year, and you're gonna get some emplacements, or it might be a bridge, might be some implants, might be dentures. We don't we don't know. We're not dentists.

SPEAKER_02 45:11

So we I know we've got a plan that covers up to $10,000. So you get a plan, let's say it covers up to $10,000, and generally it's like a $50 on these major things like implants, all these surgical things, they're gonna cover uh the dental plan's gonna pay about half of the cost. So you're gonna have to cost share the other half. Correct. And then they have a lot a limit or a maximum. So when I say we've got a $10,000 max plan, that means you probably had $20,000 worth of dental bills. Correct. They're gonna pay out to half, which is wonderful. Yeah, right? That's a great, great value. But if your plan is to get your teeth extracted right now, before you have dental insurance, then forget it, they're not gonna cover anything that you need to get done after that as it relates to replacing the teeth. That is correct. So get your dental insurance in place right now. Yes. Get your teeth extracted, it's probably gonna cost you some money. You can go to uh, I mean, wherever, it's the cheapest. Get that done. And then after a year of being on your dental plan, then you can kind of walk through how do we get these implants or whatever it is.

SPEAKER_03 46:09

Is that fair or is that 100% fair? And then one nice thing feature about that plan you're talking about, it's got a lifetime deductible of $100. Oh, okay. Once you meet that deductible, you're covered. There's gonna, you know, you're just gonna be PD the cost share uh for that procedure.

SPEAKER_02 46:23

And I think that that particular plan is a is a MetLife network.

SPEAKER_03 46:26

It is a MetLife network.

SPEAKER_02 46:27

And we've got a lot of, you know, there's a lot of different options. If you call in, we can walk through all the different options anywhere from probably plan to cost 20 bucks a month up to $100 a month, depending on your level of benefit and level of need. Medicare is filled with timelines and deadlines and penalties and all of these different things that really can trip you up. Join us tomorrow. We're gonna walk through the three biggest timing rules that people get wrong because you shouldn't do that. So we will go through all three of those tomorrow so that you can protect yourself and not make a Medicare mistake.