When to Switch From Plan G to Plan N (and When Not To)

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Thinking about switching from Plan G to Plan N?

On today’s Medicare Daily Show, we’re breaking down when moving from Plan G to Plan N could help lower your monthly premium, and when the trade-offs may not be worth it.

We’ll talk through what to consider before switching, including copays, excess charges, underwriting, and how your health needs could impact the decision.

Call in with your Medicare questions and get clear, practical next steps!

Transcript

SPEAKER_01 0:03

Fourteen million people today are on Medicare supplemental plans. Uh 30% have F plans, 40% have G plans, 30% have implants. You may be on one of these plants, and so you also may be interested in trying to save some money. And that's the topic of uh our uh program today, our broadcast. We are going to be talking in detail about how you can save money, especially those of you that are on G plants, since that's the majority of people today. You may want to move to an implant, so we're doing that. Uh I have with me uh our sales manager, uh Gary McKinsey, been with us several years, a great uh man, a great father now, uh, has twins. I'm excited about that. But uh he is uh one who uh uh leads uh a lot of our efforts in making sure that you are taken care of as our clients. And so he is uh with me in the studio today, and so together uh we're gonna address this very important topic of how you can save money, if indeed you'd like to do that, uh moving from one plant to another, specifically from the G plant to the N plant. All right, so if you have any questions at all regarding uh Medicare, uh Social Security, whether you are already on Social Security Medicare or not, or just really beginning that journey, uh this is for you today. We'll take uh your your calls. We'd love to talk with you. Uh any specific uh issue you're having with a problem, a question, uh Garrett and I would be privileged today to uh that'll take your call. Let me give you the number you need to call today uh to get uh uh uh with us, and that is eight three three eight two four two thousand four. Again, eight three three eight two four-2004. Uh we'll any question that you have, uh we'll do our very best to give you accurate information that will help you make great Medicare decisions. Uh our uh show every day is from eleven to twelve, that's Central Time, uh Monday through Thursday. So we'd love to have uh you call in either today or sometime in the future again every day, Monday to Thursday, 11 to 12. So Garrett, you have sold thousands of these plans and you lead a team that sells uh, you know, about fifteen hundred plans or so every single month. So you've got a lot of experience and people uh going on submannel plans, considering exactly what they need to do in order to uh to switch plans. So let's start there. Let's just talk first off about um uh the similarities uh between the G plan and the N plan, and really even the app plan. There are some things that are similar. Let's talk about that.

SPEAKER_00 2:14

Yeah, so it's a great place to start, and that's for for everybody whenever they're coming onto Medicare. What's important for them to really know is like, hey, what are the differences here and what are the similarities? And so with a G plan, that's the basic uh for what people start with. And uh that has a $283 deductible this year for the Part B deductible. Every other gap of Medicare is covered with that. So any sort of hospital co-pay, any sort of part A deductible, the inpatient uh hospital stay, things of that nature, all that stuff is covered for you. Um when it comes to and that's the standard for everybody this year. We have the F plan, there's special rules for people to be able to be qualified for it. Well, talk about that real quickly.

SPEAKER_01 2:51

Who it who could get an F plan today if they wanted one?

SPEAKER_00 2:54

Yeah, absolutely. So uh you had to be born before January 1st of 1955 to be eligible, or you had to be eligible for Medicare before January 1st of 2020.

SPEAKER_01 3:03

Aaron Ross Powell Okay. So if we're uh uh starting Medicare after 1-1-2020, born after 1-155, not going to be able to get that F plan. Okay, sounds good. And hey, I of course I've been in this business 17 years, and so lots and lots of F plans. In fact, I still have lots of clients that are on F plans. Yeah. Uh they were full coverage plans. We loved them, uh rates were great, uh never got a bill other than had to pay the premium for it. So those really were awesome plans. But the government said no more uh F plans after uh 112020 effective dates, just because, frankly, there was just too much use. The actuaries within Medicare said no more. Uh they cost us too much money. And so they said they want uh consumers, they want you to have skin in the game, and so that's really what happened with the F plans. So uh but let's talk about the difference just between those two plans, between F and G. What is it?

SPEAKER_00 3:50

Yeah, so that I mean that is the deductible. Like you said, there's a full coverage plan. So with the F plan, there are no gaps. Like you said, the usage was so high because you pay that premium. After that, you slide your cards across the table and you don't have any bills, and it's fantastic coverage. But anymore with those, because there's no longer new people going into that, those premiums sometimes have a tendency to increase a little bit faster than others. This isn't everywhere across the country, but it is something that people should be leery of. Um and so even with us going into the G plan um for the majority of folks nowadays, great recommendation, and it's it's a very good plan, the probably the most comprehensive form of coverage that folks can have uh if you're not eligible for the F plan.

SPEAKER_01 4:27

Yeah, exactly. By the way, that's what I chose. Uh I don't think everyone should do that necessarily, but I chose the G plan for that very reason. And so if you are looking for the most comprehensive plan available on the market of the day, that absolutely is the G plan. Now there is an additional uh price on that. We'll talk about that. But let's let's clarify. Uh I want to make sure that everyone understands uh uh what this B deductible is all about. How does that work? How you know when will they see that? Uh you know, the changes, all those kind of things. Make sure that I want to make sure everyone understands how that be deductible will work.

SPEAKER_00 4:59

Yeah. So whenever you go into the doctor's office uh at the beginning of the year, because this change just resets every single calendar year. So January 1st of this year, because I think that's whenever your plan started for you. It did. Uh so um you're responsible for the first $283 of the outpatient side. So the part B, that's the outpatient side of Medicare. Uh part A is the inpatient side. I kind of like to say rule of thumb for us, if you're staying longer than 24 hours inside a facility, generally gonna be an inpatient uh related cost. If it's less than, probably gonna be outpatient. But for for you, so if you if and when you do go to the doctor's office, you're responsible for the first $283 of the year. Uh that's what you're gonna be responsible for. Once you exceed that mark, whether that's um your second doctor's visit of the year or after you have your you know, welcome to Medicare physical for just the first time that you come into Medicare, um, you know, you may hit that out of the gate. But then after that, any time, any other time you go into the doctor's office, no other bills you're gonna be responsible for.

SPEAKER_01 5:58

So really 100% coverage once you've met the be deductible.

SPEAKER_00 6:02

Right. Yeah, the deductible is something you're responsible of a hundred percent. Yeah, that's correct.

SPEAKER_01 6:06

Well, I I I want to make sure that you understand that this deductible is a calendar year deductible. Oh, yeah. Uh we'll have people that uh will start Medicare in July and they see that deductible and they think that's gonna be 12 months. It is not. Right. Okay, so let's address that.

SPEAKER_00 6:21

Yeah, every single year. So that and there's and as changes happen with Medicare, because we generally get those in about October, November time, we get to see what the new numbers are gonna be for next year, what's the Part B premium, uh always kind of what we're looking at there, the Irma thresholds, things of that nature. Also, the Part B deductible, which is most important to you guys because you have those G plans. Uh, and so how does that increase each year? So as soon as we cross that threshold from 1231 to January 1st, Happy New Year, you get to pay that deductible all over again. So as it goes forward.

SPEAKER_01 6:50

Yeah. So if you're on a G plan, that's the all that's the only bills you're gonna get is that first 283. It could be uh and for me it was multiple because I didn't have some you know big MRI or some kind of hospital stay. Uh I just uh had a couple doctor visits. So it took a couple of those to get me to my 283. I've made it through that because of this detached written issue. Uh and so I'm you know 100 percent coverage. And so I I think uh those of you that are on that, that's probably what you were thinking. Hey, I want the the most comprehensive. However, we also know uh in regards to G versus N, we also know that's uh also the most expensive. Right. All right. And so uh now as a general rule, uh let's discuss uh across the country. And I of course we're brokers in all 50 states, but uh as a general rule, what will be the difference today between that G plan and N plan as far as a monthly premium is concerned?

SPEAKER_00 7:37

Um we're probably seeing right now, you're probably looking about between twenty to thirty bucks generally. Really? It really isn't uh as big uh in some areas as it is in others. And this is it's always based upon the demographic and there's a whole bunch of different things that goes into this. But uh generally twenty to thirty bucks is typically what we're seeing. Now, as you continue to age into Medicare, that gap continues to grow. So uh for you guys with uh that have had G plans a bit longer, there might be a bigger disparity between the G and the N plan. But for a lot of folks that are still entering into Medicare, uh, $30, that's probably about the sweet spot of what you're seeing generally for the difference.

SPEAKER_01 8:12

Well, you know, it's interesting. That's what it was in Missouri where I live. It was $30, or Max E $35, uh, but it wasn't much. But I have noticed in some states, Florida is gonna be more than that, isn't it?

SPEAKER_00 8:22

Oh, yeah. Oh, absolutely. Yeah, that's gonna be close to probably $80 a month.

SPEAKER_01 8:25

Okay.

SPEAKER_00 8:26

You're seeing, and that's like uh kind of going back to what I said, with depending upon the area in which you're in, there could be a massive difference. Like if we're also talking about Minnesota or Wisconsin, there can also be a big difference there. Now they have specific state plans that may not be seen as G or N, um, but they have plans that are allow you to add riders that are essentially is the same. Uh and that's yeah, neither here nor there, but it's all the same. But yeah, no, it just varies across the country. But I would say as a majority, you're probably looking at about 30 bucks, especially as you're first coming into Medicare at 2065.

SPEAKER_01 8:55

All right. Well, we know that uh uh some of you could uh be on a G plant or even an N plan, and you've been on that for maybe three, four, five years. Uh and so what would you uh recommend for those that have been on their plan for a while, at least things they ought to be considering to save some money?

SPEAKER_00 9:11

Yeah, I mean I think you you kind of weigh the cost for for what you're going through right now. Uh so how frequently are you hitting that deductible? Uh if this is something where you have a G plan currently and you hit your deductible January every single year, um, I think you're probably in the right plan. Uh there's probably really no reason to make a change because you have that such a comprehensive level of coverage. And this kind of goes into the differences between the G to the N. Because with the N plan, you still have that part B deductible you're responsible for, but there is that excess charge that is also that's covered by the G plan that's not covered by the N. How frequent is that? Uh it's generally pretty infrequent. Uh about five percent of Medicare doctors really charge that. Uh it's really what I like to call super specialist, like the household name, doctors, your MD Andersons, your Mayo clinics, people like that.

SPEAKER_01 9:58

Okay. Okay, sounds good. So as a general rule, you're not going to see the excess, but it can happen. It can. Yeah. I I I've uh you know, as we talk with our agents and train them, we uh r like to remind them, don't say there's no risk in excess because that would not be true. There is some risk. It's minimal, but it could happen. Yeah. I have had plenty of clients through the years that go to these specialty places that know they're going to get excess charges. And it just uh makes sense if that's you, you definitely would want to have a G versus N, even though you have to pay a little extra for it. Uh that excess can add up quickly if indeed you get services from one of those kind of providers. All right. Okay. Let's talk also I want you to address uh for everyone to make sure they're clear on how the copays work. Because we know G's have no copies, uh meat can be deductible, we're done for the year, but not so with Nt. So we've saved that $30, $40, $50 or maybe more a month, but we also take on some copay. So please let's make sure we're all clear on that.

SPEAKER_00 10:51

Absolutely. So yeah, so for any and every doctor visit that you have, it's a twenty dollar copay. And a lot of people think this line is drawn for the twenty dollar copay at just the doctor's office when you go to the office. But this does actually come into play for physical therapy visits as well. So that's why whenever you think about like, hey, what is a doctor's visit to me, when are you seeing somebody who is a professional in the medical field? Um so fifty dollars. I always like to add that there's a little tidbit in there, but for just so for twenty dollars for any sort of doctor visit, but fifty dollars for any sort of emergency room visit. So those co-pays, uh that's the difference there between the G and the N. The deductible, uh the excess charge, and then you've got co-pays with the end, those are the gaps, or essentially whenever you're responsible for with end planning.

SPEAKER_01 11:32

All right. So I think sometimes the rationale for people, and I think this is proper rationale, would be to if I rarely uh go to the doctor, uh, I don't meet my deductible. Yeah. I feel very confident that I'm gonna make sure I'm uh not going to go to one of these specialty clinics that they may want to go ahead and save that money. And uh and and and that uh I think over time it it may uh be a good decision. But those I think that have some ongoing serious health issues, I think the risk involved uh by taking that in probably not gonna save any money.

SPEAKER_00 12:03

Yeah, and also we have to take into consideration how can we make that change, right? Uh because most of the time that change has to happen through medical underwriting. We've got to ask those underwriting questions, we've got to make sure that you know we're not taking too many medications of a certain degree, um, and the carriers all go through that aspect on the back end. Um but we'd like to your point, if we have things that are ongoing, I wouldn't really recommend that we're we're changing too many plans. But if you are somebody who's relatively healthy, you're hard you may hit your deductible or half your deductible in a year, you're seeing your doctor once a year, twice a year, it's something you can consider. And I think probably once we get north of about sometimes that $40 threshold or more, um, then that's something worth considering financially.

SPEAKER_01 12:46

Right. Yeah. I think I think you're uh right about that. And so if you happen to be on a G plan and say, hey, I would like to save some money, this is a great way to go because you're you're not really uh uh uh you know, having lesser of a type of quality of coverage. Right. You can still go to any doctor that takes Medicare. You still are not going to go through the pre-authorization process. We know Medicare has a few, but very few. Uh we know that you have a nationwide plan, uh. We know it's permanent, so all those kind of benefits that come with the G are also on the end plan. You just have to pay that $20 copay, be careful on the excess. Uh and so if that is something that makes sense for you. I do want to clarify that if this is uh really what Garrett was mentioning, uh if you want to do this, uh there is no there's no really risk, uh there's no harm uh to to attempt to do this, uh but we do have to go through a medical underwriting. And that really is our job as your broker to make sure that we try to find a carrier uh that will uh get us through a uh approval with underwriting. And some carers are picky about one thing and not about another. And there's some people, uh carers that will ask about your height and weight, other carers don't care about that. Uh always uh uh you know it's mind I'm mindful of one carrier that if you're taking depression medications for two years or more, they decline you. That's the only carrier that does that. And so the point is if you want to make this switch, our job is to help you do that. But if you do not make it through underwriting, no harm done. You still have the policy that you have, uh no one's canceling that. Uh we would never uh suggest you canceling that until, of course, we've made it through the underwriting process. And we do that for you. And what the neat thing is, let's talk about this. Uh uh how we get immediate decisions today many times. Yeah. And that's new. Hey, I've been doing this a long time, and it didn't used to be that way. Sometimes uh Garrett, we're literally we had to wait two weeks, sometimes three weeks before we would get an answer. So let's discuss that really the great thing that technology has done in this regard of going through the underwriting process.

SPEAKER_00 14:37

Yeah, this has been something that's made a lot of agents extremely happy, as well as customers too. Because whenever you're sitting on the other end of the line and you've answered all these questions, you want to know, well, did I get approved or not? Uh rather than having to have that two-week wait like there used to be. Uh, a lot of times there is an instant decision. Um and sometimes that's instant approval, sometimes instant denial, and sometimes it says pending, so we do have to wait. It goes to an underwriter. Uh sometimes folks have to make a phone call. But really, it is uh it's a pretty quick, maybe no more than two minutes for most carriers. And sometimes at the end of an application, you hit submit and it just pops back up green with a check mark, and you're like, hey, congratulations, you're approved. All right. So yeah. Uh but I liked your point there about saying there really is no risk for people to do this either, to at least attempt this. Uh, because at while you still have that great coverage in place, while you've got the G plan, if you if this does make sense for you and you want to try this transition, because it like you said, it makes sense um financially or health-wise, however you like to go about it. Um, even if you do get denied that policy, that great G plan that you have is still in place there for you, which is fantastic. And and I'll tell you too, like uh Marvin said, like if you know we would have the opportunity to be your brokers and help you through this process. Um this is something where we do ask field underwriting questions. So, hey, we know there's probably about 20 or 30 on the back end, but we're gonna have a rough idea on the front side just by asking a few probing questions to say, hey, you know, is this maybe something that you could even qualify for? Something that's worth our time to sit here and uh, you know, cross our fingers and hopefully we get through.

SPEAKER_01 16:03

That sounds good. Well, and also keep in mind you can do this anytime.

SPEAKER_00 16:07

Yeah.

SPEAKER_01 16:07

Right? A lot of folks think that, hey, I can only move my plan during Medicare's open enrollment season. Hey, that's true if you're on a vantage plan or a drug plan, but supplemental plans are not tied to the October 15th through December 7th date. You can change any time. In fact, uh, if you did this today, we absolutely could say as long as we got the underwriting, that new policy will go in effect July 1. It's it's really that simple. And so again, don't feel like you got to wait if this is something you want to do to try to save some money. And by the way, you could be on a G plan and you've been on that for five years, seven years. I have people on them that long for sure. And if you just want to move from G to G, uh at times we can save some substantial money making that move also. Resetting the clock, going into a different group that's healthier, probably larger. And so again, that's something that you could do. If you're on an implant, same thing could happen. Maybe I'll find a carrier that would offer you a better price as well. Okay, and so we'll hold your hand uh through that inter process to make sure if it's possible, uh, we'll help you save some money. All right, Garrett. Uh we uh of course get a lot of questions uh through our YouTube audience, and so today I want to address a couple of those. I think they're very good, and so I think it'd be helpful to um uh explain what people need to do as far as these questions they've asked uh on YouTube. And by the way, those of you that uh come to our YouTube channel, anytime you leave a question for us, we'll do our best to address it either on this program or some of the four men. All right, so uh Harley Ryder writes in and says, Who should I ask for to sign up for Medicare Part B and a supplemental plan for my wife and I? Uh she will retire into December 2026. Uh we have the Medicare first part, which of course means part A, but we will need the B and the supplemental plan, no health issues or or medicines uh taken currently. All right, so we have someone here that's uh going to retire uh end of December. So let's assume that uh they want to start their coverage, I would assume, January 1. Right. Okay, because usually if you're covered by a group plan, that plan will take you through the end of the month. Now, there are exceptions. And by the way, you if that's your situation and you're approaching retirement, you need to find out will that employer plan cover you for the whole month or is it over uh the day you stop working? And I don't know how you feel about Garrett, but I'd say roughly what 80 percent of the employer group plans will cover through the end of the month, uh maybe 80, 20, I don't know, 90 percent of the yeah.

SPEAKER_00 18:20

Yeah, I would probably say 80, 85 percent. And if for and generally it's never a surprise for people whenever they're figuring out, oh, mine ends at the end of the month. Because a lot of times for me, whenever I was on the phone helping somebody out, I said, you know, does it say on your paperwork there you're gonna be done on the 14th? And they're like, Yeah, on the 14th of the 10th. Okay. We got to honor that then. So we're done on the 14th. And so we always backdate that coverage to make sure there's no gaps going on. Yeah, exactly. Most of the time, 100%, uh about 80% of people, you're 100% right. 80% of the people, they're gonna have that coverage to the end of the month.

SPEAKER_01 18:49

All right, so sounds good. So let's assume uh that uh uh they want to start Medicare January 1 of 2027. Yeah. Work through the process with them.

SPEAKER_00 18:58

Yeah, absolutely. Well, uh, I love that we've added in, you know, there's no health issues and medicines currently taken. Um it's that's fantastic. I'm happy for you. It actually doesn't mean a whole lot to us right now because what we're coming into, because we're leaving this employer plan is an open enrollment window for them. Uh so we've actually got six months in advance to get signed up for a supplement plan. And so we actually, if we're talking today, um, I can give you an idea of what a quotes are gonna look like, but I am a little too far out to actually get anything set up for you right now. So here's kind of what the uh what the plan would be for you. Um so what we would do is we would get back together with you guys uh next month, um, walk through a plan and walk through the enrollment process to make sure you get set up on a supplement plan that's gonna go into effect for you on January the first there.

SPEAKER_01 19:43

Um Right now, let's let's let's address starting part B because uh uh there's a couple ways we start part B, and I think everyone needs to really understand that. So we know this one is uh a special enrollment period. Right. Let's talk about that one and then let's address uh the enrollment period for those that are coming in at 65. So this one first, please.

SPEAKER_00 20:01

No, yeah, absolutely. So with the for the SCP, we have three months in advance we can handle that Part B enrollment. So uh with a 1-1 start date, we can actually start having that uh process with you. Start the Pelp the paperwork, which is an L564 and a 40B. Uh and I'll explain what those are here in just a minute. But we can start that in October. As of October 1, that's when we can start. 90 days in advance. 90 days in advance, exactly right. And so um in the L564, I'll start there. This is just proving that you've had existing coverage up to this point because Medicare does want to make sure, hey, if you are over the age of 65 and you're actively employed, we must have credible coverage. And that credible coverage comes from an active employer plan with 20 or more people on the payroll. So as long as those two criteria are met, hey, we just want to make sure that's the case, because otherwise there's penalties for that on down the road. And we don't want you guys to have to deal with any penalties. Right.

SPEAKER_01 20:50

And that's your your coverage or your spouse's coverage. It doesn't matter.

SPEAKER_00 20:54

Either way, continue on, please. Correct. Uh and then there's the 40B. And this is just a request of a start date, really, for part B. Uh put in your information there saying, hey, we're gonna go ahead and request a start date for January the first uh in this situation here, and we can put those together. Uh so what'll happen is we'll fill out the top half of that L564 for you, just stating who you are, your information. And then you're gonna take the second half of that uh document that we send to you, completed with the top half completed, and it's gonna be filled out by your employer. Uh you're gonna have plenty of time to do this. Ninety days is plenty of time. So you hand it to them. Generally, folks get it back within about five to really ten days. It's pretty quick anymore with the error of email that we're in. Um and then uh you attach those two documents together uh and you can fax them, uh you can mail them, uh drive by and drop them off at the local social security office. And we always recommend you do it more than one way, always two ways. That way there's uh the little bit of a paper trail there for you.

SPEAKER_01 21:49

Yeah, exactly right. And I want to emphasize, uh, just so you know what Garrett is saying is that we will do this for you and with you.

SPEAKER_02 21:56

Yeah.

SPEAKER_01 21:56

Uh in fact, I I would say probably one of the few uh companies in In this business today that would do that. We don't get paid for that, but we know how important it is. So we do that truly as a free service to you. So if you want help with it, and and I I you know most folks are plenty smart to do it on their own, but they sometimes are concerned about making a mistake. And so if that's you, please reach out to us and uh we will walk you through this process entirely. Every single one of our agents knows how to do this and will need to help with it.

SPEAKER_00 22:22

Yeah, and we we do this every day. So even if you have any sort of hesitancy towards this, really, guys, we uh we help people do this all the time, have plenty of the information. We'll make sure we get you set up on the right step. It's uh it's what we do every about every hour.

SPEAKER_01 22:35

And while we're addressing it, since we know that we'll help you with this, let me just give you the number to call. Now, again, this is not the number for the show. Uh that's another number. But if you need assistance with this or really with anything, moving that G to an N or repricing things and checking, make sure you got the best uh price possible uh for your plan, uh the number to call into our office to speak to one of the agents that Garrett oversees, that he and I together have trained for sure. Uh that number is 800-782-6676. Again, that call uh uh the office 800-782-6676. We're open uh 7 a.m. to 7 p.m. uh. Monday to Friday, that's Central Time. Uh that's not true. Monday to Thursday Central Time, 7 to 7. On Friday, we close one hour early. Yes, that's 7 to 6. All right. So 800-782-6676. We'd be delighted uh to help anyone through uh this particular process to make sure this special enrollment period is done. Now let's talk about this. We know that not everyone has to do an L564 and a 40 B. Right. Why is that? Let's make sure everyone knows that.

SPEAKER_00 23:36

The uh so this is as it pertains to the IEP, right? So if we are getting Explain the acronym. Yep, IEP. I will. Uh initial enrollment period. So as we are getting ready to turn 65, and this is for the majority of folks. There's another circumstance we can address in a minute. But the IEP is for almost 90 percent of the population as we're turning 65. It's three months before your 65th birth month, and then three months after your birth month, a total of seven months, because you're what I skipped around there was your birth month specifically, three months before it and three months after it. So seven month window total. So those starting Medicare at 65. At 65, exactly right. Now, if you're taking Social Security ahead of that time, you're gonna be automatically enrolled in the parts A and B. So no paperwork for you. Card just shows up in the mail uh about 90 to 100 days ahead of time. Uh a lot of people end up uh putting it in the junk mail or they end up accidentally throwing it away just because it it comes as just paper. It's not in a shiny envelope saying, Welcome to Medicare. It is just a piece of paper that says, here's your Medicare card. So if that is you, please be on the lookout for it because it can kind of sneak by you.

SPEAKER_01 24:38

It's gonna show up. I mean, I've countless people that I've known through the years have thrown away their Medicare cards. So a hundred days prior to your birth month, your Medicare card A and B is gonna show up if you're on Social Security. Correct. If you're not, nothing is showing up. Okay, so that's just those that are automatically enrolled. So point is uh if you are going to start Medicare at 65, you're gonna be in that initial enrollment period. You have you don't have to do an L564, we don't have to do a 40B. Right. Uh, it's a whole different process. And so, but it is that seven-month window, and so you don't want to miss that. All right, and so uh uh Harley, I hope that helps. Uh uh this special enrollment period again is the way you're gonna come into Medicare, and we'd be delighted to help with that. All right, let's take another question here. Yeah, absolutely. All right. All right, so we had uh someone uh uh on the again through YouTube come in and said, I did a stupid thing last year and renewed my Part D without checking costs. Umce uh one of my meds skyrocketed from a $12 copay to $86 copay for over three months supply. So basically uh from $4 a month to uh whatever, you know, $86 for three months. And I was aghast. Uh good RX uh came to the rescue, $24, and I can live with that cost lesson learned. So again, uh we love it when people uh you know mention these kind of things, these this happens. In fact, I I wouldn't venture to say probably hundreds of thousands of people this happened to. Uh we know there's what, 70 million people on Medicare, 80 percent of those have Part D plans, and so sometimes people uh do not address this. So but let's talk about this, uh kind of work work our way through this. Uh and so uh uh I think everyone needs to know that when you are on a Part D plan, uh those plans may be available the next year, but they not may not be in your best interest. And so that's what happened here. They assumed uh that uh uh this was gonna be a good plan. This is the plan was still in existence, but the plans have the right to change anything that they want to. All right. And so let's discuss, please, and share with uh our group here uh the kind of how these plans auto-renew, but how they can stop that auto-renew if indeed they need to.

SPEAKER_00 26:50

Yeah. So um these plans auto-renew every year uh if you do nothing. Because they don't want to leave you without any sort of coverage. Uh so they are gonna keep you in the same plan that you're in, but premiums change, tiers change for medications, and formularies change. So some medications may not be covered from one year to the next. Super important that we do this. And uh, unfortunately, I'm glad we're learning lessons here, which is a great thing. Um you'll get an annual notice of change that comes that kind of gives you this heads up. Hey, here's what's changing going on.

SPEAKER_01 27:17

When does that come?

SPEAKER_00 27:18

It comes in at the end of September. Uh most of the time is whenever folks are receiving it then. Um but the time that they can change during that annual enrollment period, that October 15th through December the 7th, uh, that's whenever they can make a change that goes into effect for them January 1st of next year.

SPEAKER_01 27:33

And that's what he's saying. It's seven weeks and that's it. Yeah. And so this person realized too late, made a mistake. All right, so what happens?

SPEAKER_00 27:41

Yeah, at this point, you've got to have a vowed election code, is what we call it. And unfortunately, it looks like at this situation didn't really have one. And most folks don't pass this, which is unfortunate. Yeah, they're stuck for a year. Exactly, stuck for a year, and then never to make the mistake again, hopefully. Um, but then from there, hey, we do have uh a good RX. There's uh single care, there's cost plus drugs. I think I know Amazon does this as well, where and I'm glad Good Rx was here, but this is uh a service that you would pay for. Generally, it's about a $10 membership. Sometimes it's I don't know, I'm not quite sure if it's still free or not, but I know they went to a ten-dollar membership, you got a little bit of a little bit of a little bit of a little bit, but yeah, people can still do it for Zero, but I think there's some additional benefits on the other. Yeah. And so what they'll do is as long as you have a prescription for that medication, and this medication is offered through the Good RX discount program or any of the other ones that I mentioned for you. Um, you're gonna take your phone or that discount code that you have and just take it to the pharmacy. They'll scan that pharmacy, and as long as you've been prescribed that medication, they will honor that discount, and that's the cost that you'll pay.

SPEAKER_01 28:42

That's good. Yeah. So and that's what's great about this because it looked like it was $12 for three months, moves to $86, so they're not using their Part D plant. Right. Uh don't have to. Um and and in this situation I wouldn't because the cash price was better through the Good RX. Right. Uh now this probably would not be the case if it would have been an expensive brand name medication, but because fairly low cost low cost generic, that Good RX uh worked very good for them, and I'm glad.

SPEAKER_00 29:07

Yeah, and you bring up a great point here, too, because this is separate from the drug plan. So any money that goes towards like a Part D deductible or any sort of the cost sharing that you're responsible for, this money that you're using the Good RX for is not going towards that. That is a separate thing altogether. So that's really important for people to understand.

SPEAKER_01 29:24

All right. So just remember, well, every October 15th and December 7th is your annual opportunity to be able to find the right drug plan for the following year. The plan you're on may be right, but you've got to check to make sure, because as Garrett said, uh, they have the right to take that plan of yours and change anything they want. Formulary, uh copay's tierings, all things change, uh, or at least you're subject to change for sure. So we want to make sure you are on the right drug plan. All right, we have another great question here through our uh YouTube uh audience, and it says this what happens when you're on a Part D drug plan and you get diagnosed with cancer? But the six-figure medication your oncologist says you need is not in the formulary, meaning not covered by the Part D plan. I assume the insurance company would not be motivated to make an exception for you. Can people on a Part D plan still be financially on the hook, basically, if an expensive med they need later is not in the formulary? All right, Garrett. So let's let's address this. And so, first off, I think it's important for us to make sure that you know that when we see a six-figure medication, what's the likelihood? Uh who's going to cover that six-figure medication normally, Garrett?

SPEAKER_00 30:35

That is almost always covered by Part B. Almost always. Exactly right. Yeah. That's if that's a medication that's administered by a physician, you are generally going somewhere special to have that taken care of for you. Exactly.

SPEAKER_01 30:46

Now, we there are exceptions for sure. There will be people that uh maybe prescribe something that is truly an oral medication. They're taking it on their own. There is no you know chemotherapy equivalent, so we know it certainly can happen for sure. Uh and so what normally what my experience has been uh that it will be covered um uh by a Part D plan. You may have to jump through some hoops, we have to go through the formulary exception. Uh but if it's out there and it is really the only thing that would be uh available for treatment, it's probably gonna get approved. But it's gonna have to uh doctors are gonna have to say why we need this and those kind of things. But let's say worst case, that a person uh cannot uh get this uh added to their formulary, they can't uh go through the formulary exception. Do they have any other options?

SPEAKER_00 31:31

Oh man. Unfortunately, in a lot of these situations, really the one that we have used is uh a manufacturer uh drug uh assistance program. You can always reach out to the manufacturer and see if they're open to giving a cost reduction so that you can get the medication that you need. You and your doctor believe that you need it. So that's generally how it's always been the second step, if at all possible, to say, hey, manufacturer assistance program.

SPEAKER_01 31:55

Yeah, very, very common. Yeah. Yeah. Uh because because they understand that the average person is not going to be able to afford $100,000 a month of medication. Right. And so they could have some type uh of an assistance uh program available that would be affordable. So that would be it. So the first thing we would do is of course we want to make sure you try to get it through on the formulary. Uh hopefully it is covered by part B so we don't have to address that. But I I will say this uh through the years, I've noticed that sometimes there is confusion. Uh people think that just because I'm on medication, that I have to run it through my drug plan, and not necessarily. Right. Uh if that manufacturer got that approved through the Part B system, then B is going to cover it. Which means if you have a supplemental plan G, once you've met your deductible, that medication is going to be 100% covered. Right. And really the same thing on an implant as well, because there's no copay there, it's going to be covered by your supplemental plan. All right. And so uh in these in these situations, if you're our client, we will also get involved. We'll help you through our um uh customer service team to make sure that you know the process involved to be able to make this formulary exception.

SPEAKER_00 32:56

Yeah, absolutely. Hold your hand along the way with this, because unfortunately, this does happen to folks. Uh like a uh a lot of people have this happen to them. And so they need the next steps of, hey, how do I get to the help that I need, right? And so we provide that service to you to make sure you are taken care of.

SPEAKER_01 33:12

Right. I think it's also important to note that that's why uh we would encourage you to make sure you do have a Part D plan. Oh my goodness. Because if you needed a medication that's expensive and it is covered by the formulary, remember you will only spend $2,100 this year. I don't care if the med is $100,000 a month. I I have clients right now that are on uh Stellara. It's anywhere from $18,000 to $30,000 a month. Yeah. And so they will spend $2,100. So if that's you, even if you don't take any medications, please get a Part D plan. Uh plenty of plans out there today, less than $10 a month, some of them are even zero premium. So you want to get on the plan. Not only uh if you don't have a plan, you're gonna be penalized, but the biggest penalty is needing an expensive medication that would be covered by the D plan, but you don't have it, and you just can't pick it up when you want. You can only pick it up October 15th through December the 7th. That's right. All right. So uh hopefully uh that uh helps uh answer your question. There is a surprising statistic for those of us that are on Medicare, and that is this that every 40 seconds someone has a heart attack. And during that same 40 seconds, someone has a stroke. Okay? So what happens uh if you're on Medicare and you have a heart attack? Well, that's what we're gonna talk about during tomorrow's show. Uh it's a course tragic health event, but it also can be a very expensive as well. We'll be addressing that tomorrow.