Medicare School Daily
The team at MedicareSchool.com led by Marvin Musick answers REAL Medicare questions from our callers, and help bring clarity to the VERY confusing Medicare System.
Medicare School Daily
Heart Attack On Medicare? This Is What You Can Expect To Pay…
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Heart attack on Medicare? A serious health event can bring a lot of questions about what Medicare covers and what you may owe.
In today’s live Q&A, we’ll talk through how costs can look different depending on whether you have Original Medicare with a Supplement or a Medicare Advantage plan.
If you want to know what expenses may come up during a major medical event, this conversation will help you understand what to look for before a surprise bill shows up.
Call in with your questions! We look forward to hearing from you.
Every 40 seconds, someone in America has a heart attack. That's 800,000 every year, 2200 every day. That's a lot. And depending on what your Medicare coverage looks like, could uh decide the impact or the quality of that care. Learning about the best Medicare coverage for a heart attack is what you are going to learn about today. Welcome to Medicare School Daily. My name is Josh Music. This is my dad, Marvin Music. We are so happy to be here with you today. Whether you're just starting Medicare, or maybe you're starting Social Security, you're retiring, and you want to make sure you do it right, you are in the right place. So welcome. We are excited to be here with you. In just a moment, you're gonna learn everything you need to know as it relates to heart attacks and all the different Medicare options and where you can get your best coverage. Uh, but if you have a question about uh your situation, about your enrollment timelines, about your plans, anything as it relates to Medicare, Social Security, or retirement, we would love to get those questions answered. You can call in and be a part of today's show by calling 833-824-2004, 833-824-2004. We're here Monday through Thursday, 11 a.m. to noon Central Time, taking your calls, answering your questions. So don't let that question go unanswered. Get it answered by the nation's leading expert on Medicare. So, Dad, let's uh talk about heart attacks on Medicare, coverage options, um, kind of how all the coverage works out.
SPEAKER_03Yes. Well, this uh whole heart attack issue made me think about uh my grandmother. That's how she died. Okay. Yeah. In fact, I was just 11 years old. So that's been a long time ago. But um had a heart attack. I mean, massive heart attack, uh passed away immediately. So old was she? Uh she was um uh that's a good question. I know she's mid mid-sixties. I'm actually forgetting that. Yeah. Yeah. But what is interesting about um uh meaning of heart attacks at this age is that uh the average uh heart attack uh uh for a male uh age 66 or for a ladies 72. Really? Yeah, yeah. So that's young. Oh yeah. So the the the majority of people that are having heart attacks, those every 40 seconds that you mentioned, are going to be people that are 65 and above. Maybe just one on Medicaid. Yeah, yeah. And another uh interesting thing is that it's the most expensive acute medical event that people have uh would be a heart attack. Yeah. So um unfortunately, let's talk about why.
SPEAKER_00The ticker. Yeah, exactly. It makes sense it's expensive.
SPEAKER_03It is. So and then normally, you know, we we got uh lots involved with a heart attack.
SPEAKER_00Yeah.
SPEAKER_03Uh number one, uh probably it's an emergency situation, so they're gonna have to have an ambulance ride, and more than likely gonna have to go to the emergency room uh for care there. Uh uh almost always gonna be have to be admitted to the hospital. And if it's not you know just precisely, you know, right now they're gonna operate with them where they're gonna do a catheterization to figure out where is that blockage, what are they gonna do? Uh sometimes uh they can uh you know put a balloon in there, kind of get that vein artery expanded, and then put stint implants. Uh sometimes they have to do open heart surgery if it is more of a severe situation. My whole point is there's just a lot involved when uh what comes to a heart attack, hospital stay for sure, uh rehab afterwards, and so there are gonna be a lot of different expenses that will be involved uh with a heart attack. So let's talk about what happens. So uh once it's been uh determined what they're gonna have to do, uh uh then the that hospital stay on average, they say right now for a mild heart attack is anywhere from about two to five days. Uh for kind of a medium grade type heart attack could be is you know four to six days. But if someone has a severe heart attack where they're gonna have to have open heart surgery, that's gonna be anywhere from eight to ten days. And so the whole point being is it's probably gonna include a hospital stay, and then it's gonna include some rehab after that. Uh and uh cardiac rehab, it's interesting, Josh, less than 30 percent of all people actually follow through uh with their cardiac rehab. Less than 30 percent. What is it? Well, they they need to go in for therapy. Okay. They just don't. Oh, uh, yeah, exactly. And Medicare covers all that. Okay. And so as I read that stat and thought, why is it that only 30 percent of people do it? And here's why. Think about it. Because 55 percent of all people today are what? Covered by advantage plans. And so what happens with a heart attack now, not only are they, you know, got an ER copay, they got a surgery copay, a hospital daily copay, to go to those 36 sessions of cardiac rehab, they're gonna have to have it, they're having to copay every single one of those. 50 bucks a pop, whatever. Right. And so that's what happens. So they don't want to do that. Maybe they'll go to a handful, I feel great, don't want to pay anymore. Uh and so yeah, uh almost always, if if someone is uh they have a heart attack, uh they're going to max out on their advantage plan. Sure. Can't say always, but almost always.
SPEAKER_00So if your max amount of pocket is six thousand.
SPEAKER_03You're you're probably gonna hit that. And so as we talk about a heart attack, and let's say me, if I had one, I hope I don't, but if I did, that heart attack would cost me what? Well, now nothing, because I've already met my B deductible. Okay.
SPEAKER_04Everything is gonna be covered on a plan G. You've already met your deductible for the year. That's right. I'm done.
SPEAKER_00Heart attack, nothing. Exactly. All the rehab, all the surgeries, all the everything. Right.
SPEAKER_03Yeah. So the cost of the average heart attack situation is is going to be about 18 to about $20,000. Now, if I'm on an advantage plan, I'm not gonna hit that. I'll hit my max out of pocket. Okay. But if I have a G or an N, I'm you know, it's gonna be very, very little out of pocket.
SPEAKER_00Interesting. So uh uh there are So the biggest thing for you is like, I mean, obviously you're on the advantage plan, you're gonna max out. That's why people who say, oh, the advantage plans are cheap. Oh, yeah, if you're healthy, yeah, right? But if you're not healthy, you have something happen, and there's no way you can predict. Well, there's maybe some ways to predict the likelihood, but there's no way you can predict when something's gonna happen. It just happens. And then all of a sudden you're hitting your max out of pocket, at least in that year, and then perhaps in the next year, right? I mean, if you're doing 36 sessions of uh of rehab at $50 a pop, I don't know what that is, another $1,500, $1,600.
SPEAKER_03Right.
SPEAKER_00You know? Yeah.
SPEAKER_03Plus what happens, the likelihood is sad, but the likelihood of further heart problems uh after a heart attack.
SPEAKER_00Yeah.
SPEAKER_03Uh congestive heart failure, uh, normally people are dealing with irregular heart rhythms, AFib, those type of things.
SPEAKER_00Well, and I think the biggest impact is if you have an event like that and you're on a Medicare Advantage plan, you may be stuck on that Medicare Advantage plan for the rest of your life.
SPEAKER_03You could be, especially if you're if there's an AFib situation where you're being treated with medication.
SPEAKER_00Because maybe you want to switch to a sub. Okay. Sorry, you can't, but we're declining you. Right. And that will happen all the time. Yeah, a standard protocol for cardiac rehab consists of spans about 12 weeks, consisting of roughly 36 sessions, typically meeting two to three times a week. Phase one is supervised aerobic and resistance exercises while connected to an EKG. Phase two is dietary counseling, weight management, smoking cessation, and phase three and four is transitioning to an independent or maintenance group to solidify lifestyle habits. That's interesting, right?
SPEAKER_03Yeah, Medicare will cover all that. Yeah.
SPEAKER_00Okay. Daniel, what do you think? Um it is 1140. So what do we think? We got any more callers, or do we want to? Okay, let's uh let's try to see.
SPEAKER_03Can I can I just make one more comment or you can put it in here? Okay. So I think really when the bottom what the bottom line is with heart attacks would be this statement here a heart attack is not the time to discover how your Medicare coverage works. That's not when you want to find out at all. So understanding your cost before a heart attack or any kind of emergency happens is really one of the most important uh Medicare decisions that we're gonna be making.
SPEAKER_00Are there any like would there be any network differences or any like you know, not only cost, but quality of care or freedom of care as it relates to if you have an advantage plan, heart attack, like just go to the nearest hospital. Right. There's not any network issues, right?
SPEAKER_03Not at all. Um but afterwards, if let's say you you know they've stabilized you and you want to have surgery, uh, it could be that the uh cardiologist or cardiac surgery surgeon you want to use doesn't take your advantage plan, you have to find somebody else. That happens for sure. Yeah. Um even that the cardiologist you you'd like to use long term, they're gonna have to be within that network. Okay. Uh especially on HMO plants, uh, which the majority of them are today.
SPEAKER_00So there's always a possibility of a network issue. I feel like a lot of cities have like, you know, this hospital's great at cancer, and this hospital's great at heart attacks, and this hospital's great at whatever. Um on an advantage plan, uh you gotta make sure the hospitals that you want are in network because they're not. You know, and especially as the trend uh for advantage plans is now going like pretty much into HMO world. I mean, the PPOs that were very popular for uh I would say from 2020 to about 2024, 2025, the advantage plan carriers are pulling those plans back, they're pulling them off the market. Just come and there's gonna be that happened in 24, it happened in 25, and it's getting ready to happen again in 2026. The insurance carriers are announcing, hey, we're pulling back on some of our plan offerings because there's 5,500 different advantage plans where there were, I don't know how many there are now. You know, but what, three million people lost their plan last year? That's a lot of people, and it's gonna happen again this year. And what's gonna happen? The PPOs, because the insurance carriers can't figure out how to do it profitably, they're switching everyone into HMOs, they're leaving their HMO there. So if you have a favorite hospital, you're on a PPO plan right now, and that plan's going away. Do you want to go to an HMO plan? I don't know, probably not. So maybe a supplement plan um is your best choice.
SPEAKER_03Well, Josh, we just had this happen in the Kansas City market. Uh there was one hospital that only took one advantage plan.
SPEAKER_04Yep.
SPEAKER_03And they just added a second one. But how many advantage plans do we have in this market? Many. Yeah. And the hospital only only took one, now they take two. Uh so if that's your hospital preference, you're not going there.
SPEAKER_04Yeah.
SPEAKER_03Uh unless you're on uh a limited uh type of uh advantage plan or any supplemental plan, of course.
SPEAKER_00Okay, let's talk to Sarah in California. Sarah, welcome to Medicare School Daily. What questions do you have for us?
SPEAKER_05Hi. Um yes, thank you. Um so I'm gonna be turning 65 in a couple of months, and I am working for what I think is considered a small employer. There's about 18 employees. And I'm gonna can be continuing to work for a while. Um, and I'm just trying to figure out what my options are. So I'm wondering if um I can stay on my employer plan once I turn 65, or do I have to switch to Medicare?
SPEAKER_03Okay, yeah. Well, you can stay on your employer plan for sure, Sarah. But the issue is um that that employer plan is going to move to the second payer position. So you can keep it, but you are gonna have to enroll in a Medicare A and B as well, uh, because that employer plan insurance company uh has every right to move to the second payer position. And trust me, they will. They will. Why? Because they're they don't have to assume the risk. Medicare set the rules years ago saying that if you're still working, uh if the employer uh payroll is 19 or fewer, then uh they will take the first day, meaning Medicare will take the first payer position. And so if you do keep your uh group plan, then that's certainly fine to do so, but they they're only gonna pay second. So we'll have people that don't uh are not aware of that or don't want to believe that. And trust me, you would find out if you had a heart attack uh or if you had some kind of a serious cancer issue, uh that insurance company will only pay second.
SPEAKER_00So you'll be the first payer if you don't take seconds.
SPEAKER_03Right. So yeah, you're you're gonna have to enroll in to Medicare, Sarah. And if someone tells you differently, because I I've been doing this a long time, I've had people say, well, my insurance company said that they will continue to pay the same way. Well, that's fine, but I'll guarantee you one thing, you better get that in writing. And if you don't get it in writing, then I would not believe that for a second. And so I doubt you're gonna get in writing uh for sure. But Sarah, let me tell you what a lot of people do in your position. Uh now, again, it is is the is your do you have a spouse or children that's covered by the employer plan, or is it just you?
SPEAKER_05So right now it's just me. My husband's self-employed, so he's already on Medicare and a supplement program.
SPEAKER_03Okay, good, good. Okay, very good. I was just asking because the the my answer does vary depending upon the circumstances. So a couple of couple or a couple of option options you have, uh, and that is um uh if you if you do stay on the employer plan, and the only reason people ever do that is because maybe the employer pays for the full expense. If you do that, that that that just means that you know you're an A and B, you're still gonna pay your B premium, and then your employer plan will pay second. Um and so uh if you decide to do that, the only issue will be this. Once you retire, and now you're going to um uh uh you know drop the employer plan, you can come uh and get a supplemental plan, uh, but you will only be able to get what's called a guaranteed issue product. You're not gonna be able to choose the plan you want. Uh you're only requ the insurance companies uh would have to write you a G plan, but they don't have to write anything else. Uh so that would be the issue there. Now a G plan may be what you want, but you don't know exactly probably when you retire, so we don't know what the Medicare landscape is going to look like. Now, if you stayed on the employer plan and you stayed healthy, then you could medically qualify to you know to get any plan. But that's that's the ramifications of keeping an employer plan. So what we highly recommend is to go to your employer and say, I'm you know, I've got to go on Medicare, um, and uh see if they'll actually give you a raise, because I I'll guarantee you, because I know what our our what it costs us to cover our employees, I think it's well over $1,000 a month for everyone. So your employer is paying something for the plan. Uh and then you may uh uh uh ask them if they'd be willing, since you're going on Medicare, uh, to give you a pay increase. Uh they they can't pay your premium for you, but they certainly could g give you a pay increase. And then really, you get the best of both worlds, Sarah. Uh they win and you win. Uh your your insurance is probably gonna be better. The premium is certainly gonna be lower as well, and they're gonna be out of pocket less also. So we see that uh happen all the time. Now, some employers say, no, I'm not gonna do that. Well, you're still gonna have to go on to Medicare A and B, you have no choice, and then you'll have to decide uh financially, does it make more sense to keep the employer plan, knowing that down the road you may have to medically qualify to get a plan or go and just come off the plan fully and uh you know choose a submental plan or advanced plan, whatever is in your best interest. Did that make sense to you, Sarah?
SPEAKER_05Yes, that does.
SPEAKER_03That's really helpful. Okay. Sounds good. And then uh keep in mind as well, when you do come off of that uh plan, which you know you probably will do, then you know you're gonna have to get a prescription drug plan also, um, you know, if you get a submental plan. It sounds like that's what your husband did, so you're probably aware of that. Do we ask how much is that the impact? That is what it is. Yep. Hey, but Josh just asked a question. How much uh does it cost you uh out of your pocket as far as premium goes for your employer plan right now?
SPEAKER_05Yeah, so actually I am paying, and um it's about $400 a month.
SPEAKER_03So plus you have a deductible, no doubt, I'm assuming.
SPEAKER_05Yeah, now they do have a um medical expense reimbursement plan that works with it that the employer um you know pays for um that gives us additional coverage. But um in total, uh yeah, I it's probably gonna be better for me to get A and B plus a supplemental uh plan right now.
SPEAKER_00Yeah, plan N will run you about 150, uh plan G, maybe 200. If that's a range, it can be a little higher, a little lower than that. But yeah, that's that's gonna be a better deal.
SPEAKER_03Yeah, plus if you get a plan G, you know, it's $200 a month, then you have a uh B deductible once a year of uh $283 is 100% coverage off. Yeah, 100% coverage. So um probably makes sense. Or an implant. In plans are great also, just you know, depending on where you're for you're falling with your budget. Okay. Okay. Okay.
SPEAKER_00Thanks, sir. Hey, I'm gonna give you I'm gonna give you our I'm gonna give you our office number if you want to call in and talk to somebody that can compare all those options and even help you do the uh A and B enrollment and just hold your hand through the whole process. Um phone number is 800. Yeah, 800-78782-6676. 800-782-6676. And when you call in, uh you're gonna call in our office is in is in Kansas City, so you're not calling somebody on the other side of the world. Yeah, we we do a lot of business, obviously, in California, and so very familiar with those plans. Uh and then they can go through advantage plans, supplement plan options, drug plans, make sure all your doctors are covered, all that sort of stuff, and there's no cost.
SPEAKER_03So no cost to you at all for our services, Sarah. We are paid by the insurance companies, not by you. We'd love to love to serve you. Take care.
SPEAKER_05Okay, I will do that. Thank you so much. Appreciate your help.
SPEAKER_03Yeah, appreciate the call.
SPEAKER_00Okay, let's talk to uh uh Amel in Colorado. Amel, welcome. Hey, how are you doing? Hey, welcome to Medicare School Daily. What questions do you have for us?
SPEAKER_02Uh got a couple questions, and first I'll start it off with uh um closing in on converting to Medicare, and I think you all do a pretty good job of educating people, a lot of info. So uh thanks for that. Well, thank you. Uh my questions are having not been through this, entirely new to Colorado, uh, I'm not perfectly well connected and not sure where to turn. Uh, I do know that I don't want an advantage plan. I do know that I want to buy A, B, D, and G, but what shows often like yours and others, one thing they don't cover enough of is who to choose as the underlying carrier, United Healthcare or others. Now, that's just setting the stage. My question is uh, how do I know what I don't know? I've got local people, solo brokers that are pushing one plan. What are they pushing? For example, the uh positioned mutual modified G. Yeah, innovative G. Sure, yeah. But but there's places I've called in that are larger operations like yours that say they cover coast to coast, but they can't even sell this plan. And so I'm wondering uh how do I make a decision?
SPEAKER_00Yeah, yeah, for sure. Yeah, the innovative G is an interesting product. Um, it's not in uh very many states yet. I think it's in maybe 15 or so. Um you know, we've we actually we we we used to do a fair amount of business with Physicians Mutual back in the day. And then they kind of became somewhat non-competitive, and then this innovative G is their new kind of foray and push back into back into this world. And I know the people there, uh good people. I think it's a good product. You have a, you know, you basically have a Part B deductible, or uh Part B, you have a high deductible G for a couple of years, and then it converts to a just regular G. Um, so yeah, if you signed up for an innovative G in August, it sounds like is when you turn 65, you would have that for the rest of this year. Um that high deductible, then you have the high deductible G for two additional years, and then at that kind of two and a half year mark, um, then that's when it would switch over to just a regular G plan. Um so yeah, it's uh it's a fine, it's a fine product. Uh what they quote you on that.
SPEAKER_02So but the you know, I don't have the number right in front of me, but it was a competitive prize. Uh it's usually a little bit cheaper. It seems to be it seems to be a dead pool because it only applies to one zip code. The zip code I'm calling from, so I'm wondering that's limited headcount over the next 20 years. Well I don't think your company They don't have a pool in just one zip code.
SPEAKER_00Like it's probably the whole state of Colorado, or I don't know exactly how they break that up, but I can assure you they're not underwriting uh, you know, thousands of books of individual business based upon zip code.
SPEAKER_03Yeah, because they'd have to get each one of those approved by the insurance commissioner. So Josh is right.
SPEAKER_02It's it's you'll have to look into it. I I'm pretty sure it's based on your zip code. Your price is which kind of protects them.
SPEAKER_03Yeah, yeah. You're like Josh said, your price is based upon your zip code for sure. But the the group increases that will occur, because Colorado is good. It may be issue age, but uh the point is group increases are going to be more than you know than than your one zip code. That group would be uh could be whole state, could be you know part of the state, but it's definitely larger than um zip code.
unknownYeah.
SPEAKER_03Price.
SPEAKER_02My question and the question that probably a lot of your listeners want to know is so physician's mutual modified G, uh, why choose that as opposed to united healthcare? They all have goods and bads, I'm sure. Uh, but we'd like to hear a lot more shows that cover that because most people know you want A, B, D, and G, uh, unless you want to go on the limb with uh advantage. But with those key ones, the there's big questions, which is Who are you going to sign up with and why? And that's what I don't know. And I'm not sure your firm even sells this product in Colorado, which complicates things too, because you might have access to all 50 states, but if you don't have access to all products, it's hard for people to compare. So uh all I want to say is you guys are doing a good job. Uh but cover more from that end. And if there's others out there, back me up that they want to hear this type of thing because some of it's clear-cut. What's not clear-cut is who do I sign uh as the underlying carrier. Sure. Thanks so much.
SPEAKER_03Yeah, well, let me explain one thing just so you're clear. We really have never, we've been in business 17 years now, we never steer people towards one particular company. Uh number one, we're all over the we're all over the country, so it is going to vary. There are some regions where carrier may be very strong, very competitive, and we may encourage people to really take a serious look at them. Other areas, they're they're not so strong. Uh a great example is our home office. We're actually in on the Kansas side in Kansas City uh area, but uh Kansas, uh where we are, our law office is very, very healthy county. And many carriers are quite competitive here. And certain ones really love this area, so they truly are very competitive. Here we're in other markets, they're not going to be. So we do try to be somewhat neutral uh with Josh and I's you know educational program here because uh you know we're covering all 50 states. So uh we're we're happy to tell you the rate stability if indeed the carrier will report that to us. Uh we can we can only give you enough information based upon what the what the carers provide. And some of them will give us uh five-year or ten-year history on on you know on their price increases. And we love that because we're trying to uh uh you know find carriers that are as as stable as possible. No agent can predict stability. So that's why we we're all so cautious. Um I will tell you that uh for years and years, Josh, one of one of our biggest carriers was United Healthcare. And the reason for that is because historically, uh we wouldn't see any more than a three to five percent uh price increase on an annual basis. We'd love that. Well, the last uh three years it's been about fifteen percent uh probably on average. And so uh we just don't want uh uh folks to you know we we don't have the the you know the crystal ball. We can't figure out what's going on. And so we just want to be honest about that uh and cautious when we're saying, hey, go go with this carrier. We're not captive agents, we're independent programs. Yeah, so I think you understand what I'm saying.
SPEAKER_02But that's that's the reason we're hesitant. Beyond that is ha have a show and you don't have to steer people, just clearly say what are typical pros and cons. A United Healthcare con is probably stability over time, but recently bad. And then, however, if you look at United Healthcare, maybe a pro is, but if you sign up in August of this year, uh they're gonna be competitively priced. So, what do you care about the 15% increase two years ago because they've just already brought it to market level? Good. And maybe it goes in other words, and then so you would buy on price, maybe you're gonna buy on customer service. This is the information that would be helping me right now. Yeah. Uh, and that's what I feel I don't have. I I've got the broad information, A, B, D, and G. Now what? So uh pretty much.
SPEAKER_00Well, it will be hard, but the good work. I will encourage you, it will be hard to make a perfect decision. Um, you know, for for year, just to stick with United Healthcare example since we were talking about it, 2.9% rate increase for 20 years or 19 or 20 years. And then all of a sudden, you know, back to back to back 15% rate increases. Somebody who bought four years ago, man, they were buying what they thought was the best thing ever, and then all of a sudden, wham, wham, wham. And but they're they're not an isolated incident. Everybody's, you know, been taking these price increases. And the innovative G, um, I think the one, you know, number one, it's not an incredibly old product. So you're gonna have a lot of people say, it's gonna go up less and less and less. Well, pretty much or like it's gonna go up less than others. Well, pretty much any brand new block of business is going to have that, right? You're going to just they're they're getting all these new premium dollars constantly. There's not an aged population, an older population that's using more. So it's one thing to say, hey, we're going to we're gonna have less price increases. Okay, it's a new block, right? It's a relatively newish product. So yeah, you're probably gonna have less price increases, and and you're getting people that perceive themselves as going to be a little bit healthier, they're able to take a little risk in cost sharing by having that deductible for the first couple of years. So like I I think there are some good advantages. But fast forward the clock 15 years under Physicians Mutual, no one can tell you what's gonna happen. Fast forward the clock five years, seven years, ten years. Right. So it's just gonna be hard to make a perfect decision. I think obviously, yeah, I don't know if you're how your health is or not, but priority would be figure out how to do what you can to stay healthy, right? So that if something does happen with any of these carriers, you still have some options to switch.
SPEAKER_03Yeah, and I'll uh I'm uh I'm I'm on Medicare. I started, you've probably been listening to us in January, and I didn't I could have taken a high G. I I take no meds. Um I'm very, very healthy. I didn't. I don't want to hassle with it. Uh I went with Cygna, who has since uh you know done a name change, brand change to Hellspring. Um I pay $212 every single month for my G plant. I'm thrilled to have it. Uh I don't have to worry about a deductible, and that's not you, you're gonna have to worry about $29.50 for a couple years. That I just so I'm not saying uh G is high uh high G is bad, but we're all different. We just look at this decision differently. Uh but I want you to know we appreciate your recommendation. We want that we want this educational program to be helpful for sure, and we don't just want to broad brush everything, but uh I think we just want to explain.
SPEAKER_02Well, you can help me with one last question. Uh because you've been on Cigna, which has the new name now for six months-ish. Uh how did you make that decision versus United Healthcare, if I can ask? Because that's what I'm faced with. We both want A, B, D, and G.
SPEAKER_03Sure. Well, the reason I did is they they they are competitive in my market for sure. Number two, uh, and I like United Healthcare, but I I I have my own home gym. So one of the benefits of using United Healthcare uh is they typically are going to cover uh a gym membership. And we have places in Kansas City right now that are $115 a month, $150 a month, and United Healthcare covers that full gym membership. Well, that brings the price, net price down on that that uh G plan really, really low. So, but I again I have my own gym, I do work out, but it I don't go anywhere. So it just didn't make sense to me to pay an extra about $50 a month for uh United Healthcare. That and that's what it is in Missouri.
SPEAKER_00It may or may not be more rate state. Oh, yeah. I mean, who knows? I think they're I think they're both great companies.
SPEAKER_02Yeah, you view them as about equal on price, about equal. You don't have a crystal ball, but then you look at what other benefits in the healthcare thing. I agree for United Healthcare, that's uh where I'm tipping because of that.
SPEAKER_00Don't blame you. I and I think we've got one of our agents here uh uh who's worked for us for a number of years. He's on Medicare, has a plan, he might have a plan in with United Healthcare, maybe a G. He goes to four different gyms. I mean, you know, I don't know that he actually goes, but he's got memberships of four different gyms. Yeah, and so it it cuts his cost weight out.
SPEAKER_03Exactly. All right, sir. Hey, we we appreciate your call today.
SPEAKER_00We'll do it we'll do some, we'll take you up on this recommendation and try to do some pros and cons sort of stuff because it is difficult. And it's difficult in every single market. The other thing I'm gonna tell you about or that that is somewhat difficult is if we get two specific pros and cons, the insurance companies will directly reach out and tell us to remove the video. So we that that that is a little bit of why in a public forum we it's it's been we've done stuff like that in the past, and then they're they basically say, Hey, this doesn't follow our compliance guidelines, unfortunately.
SPEAKER_03Yeah.
SPEAKER_00So kind of weird.
SPEAKER_03All right. Good talking to you, sir. We appreciate your uh listening.
SPEAKER_00Okay, let's talk to Jose in Texas. Jose, welcome to Medicare School Daily. What questions do you have for us?
SPEAKER_01Yes, sir. Hello, how are you doing? Uh I have two questions. The first one is uh if I switch advantage how do I know that my advantage plan is uh I'm getting the most out of the money that I'm paying for is because I hear that I can switch without losing my provider or my doctor? Okay.
SPEAKER_00What plan are you on right now? Uh advantage? Okay, but what carrier, insurance carrier? With Aetna through Affleck. Through Affleck?
unknownYeah.
SPEAKER_00What do you pay for that every month?
SPEAKER_01They went from one uh eighty something to uh two or three. They went up for $25. Okay, so you're are you on a medicit plan.
SPEAKER_00Okay. Yeah, I think it's Affleck though. Yeah, I I Are you sure you're on an advantage plan or are you on like a plan G or a plan N? It's a plan G. Plan G. Okay, sounds good. So just so you're clear, that would be that would not be, we that's not an advantage plan, that's called a Medicare supplement plan. So we're on the same page now. Understand what you're saying. So your question is like, can can you switch since they took a price increase? Is that kind of what it is? And what changes if you do make a switch? Is that a fair Yeah?
SPEAKER_01Yeah, yeah, okay. Yeah, the question is can I get a better price without losing any provider or doctor?
SPEAKER_00Yeah, absolutely. Absolutely. Let me just I'm gonna pull up some stuff. Dad, you want to speak to that real quick?
SPEAKER_03Okay, Jose. Um, so have you been on Medicare ever since you were eligible uh back in um which would would have been uh uh November of 2024? Yep. Okay, very good. Okay, very good. All right, so so what happens in the state of Texas and most states, in order for you to get off of that uh uh AFLAC plan, which you're right is administered by Aetna, uh you're gonna have to medically qualify. So we are gonna have to ask you a series of health questions for you to be able to make that move to either another company's G or uh you know to an N or whatever you'd like to do. So are there any health issues right now that are that are major that you're dealing with? Heart, lung, liver, kidney cancer, diabetes, anything like that?
SPEAKER_01No, uh I just went on a 20th. That was my second question on a twenty make 20th. I went to the doctor. They sent a bill for $1, uh $174. And the insurance pay $1,026. So I got a bill for $148.33. But when I went to the Medicare.gov, it said they already met my $283 deductible.
SPEAKER_03Okay. Okay.
SPEAKER_01I understood that they will pay the difference, right?
SPEAKER_03Yeah, they sure will. They sure will. Now, did you have multiple um issues going on? Uh meaning, did you see a couple different doctors or have a couple of different tests at that same time?
SPEAKER_01I had about a 20 minutes visit and uh they draw blood and that's it. You didn't take me more than half an hour in the hospital.
SPEAKER_03Okay. Well, you're right. You are you're only responsible for your your B deductible, that's it. Okay, so uh um you make sure you don't spend any more on 283, and then I would uh go through the uh uh customer service department uh of AFLAC and make sure that everything processed right. What happens is sometimes we have multiple bills coming in, uh, and then sometimes people end up paying a little bit more out of pocket because the dust is not yet settled.
SPEAKER_04And did you get that did you get the blood drawn in a hospital? Is that what you said? Yeah, in the same hospital.
SPEAKER_01Okay. Yeah. In the same place. It didn't take more than uh half an hour for the whole thing.
SPEAKER_03Was it an emergency uh situation or just a just a No no no?
SPEAKER_00This is a uh one-Dier checkup. Okay. Well, the the only there could be a couple things at play. Number one, that that physician, whoever you know, whatever facility you went to, you could call them and say, Hey, I got a bill, I don't think I'm supposed to pay this. Can you kind of rerun that? And then that may flesh out all the issues and fix it all. Lots of times there's a there's a coding error somewhere, and so you have to tell them to review it and then resubmit it.
unknownRight.
SPEAKER_00The other thing that it could the the other thing it could be is that the doctor ordered some sort of blood draw or some sort of test that Medicare says is not medically necessary. And so in an instance like that, if Medicare doesn't pay, the Medicare supplement, like your plan G, AFLAC, is not going to pay either. So if the doctor ordered something that isn't covered by Medicare or medically necessary, then the supplement's not gonna pay either. The supplement plan G pays the difference after Medicare pays. So if Medicare said, we're not gonna cover that, then the med supp isn't gonna cover that at all. And so you need to be careful, and this happens sometimes for people who have yearly visits, is the doctor orders some extra things that isn't medically necessary and isn't approved by Medicare. And unfortunately, if that is the case, if that's the case, you may have to come out of pocket on that, perhaps. But I would start first with seeing if there's some sort of a billing issue, coding error. A coding error, and then and then ask them if, hey, was this is this a Medicare approved? Was this medically necessary? And if not, you may have to pay it, and then you know for next year, hey doc, let's not, whatever that was, let's not do that again.
SPEAKER_03You know, okay. But I would definitely talk to Affleck first, they should be your good source of information.
SPEAKER_00Yeah, to go back to your first question. So you went up to about did you say about 203 or somewhere in there? The the monthly cost? Yeah. Yeah, okay. So we went about $28 or something. Yeah, yeah. Did you are do you live with someone? Do you live alone? I live with my wife. Okay, your wife, okay. Sounds good. 65 years. Yeah, yeah. So so there is, if that's the case, we've got plan G's as low as one, we got one for 148, we've got one for 175, we've got one for 184. So you have some other options. And it's not a bad time, you know, to you've been on that athlete plan a couple of years, uh, almost. It's not a bad time to, and you can do that anytime. You can call into our office and say, hey, I want to, I wanna, you know, run me these quotes and let's see if I can qualify. And that's a really easy process. It's a it's a 10-15 minute phone call, put the application in over the phone, they tell you if you're declined or not, you know, approved. And then once you get that approval, then and you could do this as soon as July 10. No problem. Um but once that goes through, then you you cancel the AFLAC and you know you have you're on your new your new carrier. So you definitely can save 50, you know, 25, 50 bucks a month for sure, and have the same coverage. You're not gonna lose anything at all.
SPEAKER_03Yeah, it's the same identical coverage. Jose, do you have our number?
SPEAKER_00Yeah. The medicator score? Yeah, yeah, yeah. The the but not not not the number for this this uh show. The regular one, yeah, yeah, yeah. Yeah, yeah, yeah. Okay. Sounds good. I have that one. All right, okay, call us and let's see if we can save you some money, okay? 600 bucks a year is a lot. Sure.
unknownOkay.
SPEAKER_00So thank you very much, thanks, Jose.
SPEAKER_04Thanks for calling.
SPEAKER_00Take care.
SPEAKER_04Have a good day. Bye-bye. Bye.
SPEAKER_00Did you know that just about any physician is able to charge 15% above uh the Medicare approved amount. That is called an excess charge. And when you go on Medicare, there are some plans that pay that excess charge, and there are some plans that don't. So join us tomorrow. We're gonna talk about the plans that cover you for that and the ones that leave you exposed so you can make the best decision for your financial situation when you go on Medicare. See you tomorrow.