The 3 Biggest Challenges You’ll Face When Starting Medicare

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Starting Medicare can feel simple at first, until you realize how many decisions, opinions, and plan choices are coming at you all at once.

In today’s episode, we’re talking about the biggest challenges people run into when they first start Medicare, especially when they’re trying to sort through conflicting advice and make a decision they feel good about.

We’re excited to discuss this topic and provide insights that may help you navigate the start of your Medicare journey with more clarity.

 As always, we look forward to taking your live calls! 

Transcript

SPEAKER_04 0:03

When you begin Medicare for the very first time, there are a bunch of challenges that you're probably going to face. But we've identified three that it is very important that you know about. And you're going to learn all about what those three biggest challenges are when you start Medicare and have how to navigate through those in a way that doesn't leave you in a bad position down the road. Welcome to Medicare School Daily. My name is Josh Music. I'm here with my dad, Marvin Music. My dad's the nation's leading expert on Medicare education. If you want to talk to him, if you want to get your questions answered, you can call into the show 833-824-2004. 833-824-2004. And you can talk to him. We're here every day from Monday to Thursday, 11 a.m. to noon. So I encourage you to call in. Don't let your questions go unanswered. Don't risk making a mistake. So Dad, let's talk about these three big challenges that we see a lot of people face as they're beginning Medicare.

SPEAKER_03 0:56

All right. So these challenges are certainly not in the order of importance. Okay. Just I'm going to talk about what I think would be the big three. The first one would be problems with agents. Just really annoying activity that happens. Agents call. I'm already on Medicare, Josh, and last week I've had three calls, had one this morning. Truly. You get one every day. Oh yeah. And what happened, once they found out I was on a submetal plant, I promise you, click. It wouldn't even kind enough to say, okay, we have great covers.

SPEAKER_04 1:25

Hang on. You share that story all the time. Everyone's going to realize it wasn't this morning at a certain point.

SPEAKER_03 1:29

Okay. Well it happened this morning. Again. Again? I promise you. I didn't make that up. Yeah. Yeah. We don't share the story, but I did happen this morning. I show you the number. I was like, well, you talk about this all the time. Her name was Chandra this time. Oh yeah. And then she put me through to somebody in in wherever, the Philippines. And uh he starts to ask the questions.

SPEAKER_04 1:49

How do they how do they sell insurance with people who are outside the state?

SPEAKER_03 1:53

Because they st they start the United States. Because they say we you you know we we see that you have not done I wish I knew how to record. I'd love to record it so we could use it.

SPEAKER_04 2:02

You can record uh that's a great idea. Yeah. Yeah, you can actually record on your iPhone. I don't know how to do it.

SPEAKER_03 2:07

I think right when you're on the call, record. Yeah. Oh really? Okay. Yeah, because that's how they they scare people because you have not yet done your update yet for 2026. Okay. And so that you know, people what's going on? So um and then they asked me, was I on Medicare A and B? And I said yes, and then went to an agent. Uh and then they started going through all the spiel because I'm listening to trying to see what they're gonna say.

SPEAKER_04 2:27

We should try to figure out the company that is like ultimately behind that. Yeah.

SPEAKER_03 2:31

Okay.

SPEAKER_04 2:32

Interesting.

SPEAKER_03 2:33

All right. So point is I don't have to tell the story again. I'm just saying to you that uh number one, uh there's gonna be a lot of agents reaching out to people, uh certainly a lot of opinions that uh people are going to have about all of this, and that's really the first thing that can be quite challenging. Who can you believe? Who do you trust? Uh the majority of people today are, of course, pushing one plan, advantage plans. That's the uh you know the most profitable plan for insurance companies, so that's what agents want to sell, whether that's in your best interest or not. Uh and so because there's so much hype about advantage plans uh that you know agents are pushing, people tend to kind of gravitate there because they're not really sure uh why they would want something else, because they're packaged as though they're they're wonderful.

SPEAKER_04 3:14

Aaron Ross Powell Well, that's all they're talked about.

SPEAKER_03 3:16

That's right.

SPEAKER_04 3:16

Like if I came to you and only talked to you about one thing and then I went to another somebody else and they only talked about one thing, and then went to another somebody else and they only talked about one thing. At a certain point, you'd be like, well, there's only one thing to buy, right? Because that's all these agents are trained on is how to sell a Medicare Advantage Plan that gives you a little bit of little dental benefit, and you can go to the gym. They don't actually talk about that.

SPEAKER_03 3:35

Yeah, and really the the you know, the people that are uh healthy uh they tend to say, well, I guess uh that sounds good. I don't need to go to the doctor uh ever. And so uh agents, number one. Number two, uh would be all the options that are available. I mean, just in any kind of local market, we have probably average of about 40 different advantage plans.

SPEAKER_04 3:52

Well, I was looking at the guy this morning that we were uh one of the one of our callers, and it was uh I think there was eighty-six different Medicare advantage plans. Wow. In his zip code. That's amazing. How in the world like what is the point of all that? 86 options? I just I number like I don't even I don't understand. How could you and that that's not even talking about supplement plans?

SPEAKER_03 4:14

So then you have you have another dozen companies use the offering supplemental plans in most markets today. Yeah. And so what are the differences? The coverage is the same, but we know there's differences of stability. So And there's fine print everywhere. Yeah, right.

SPEAKER_04 4:26

Like who knows what this, that, or the other is actually going to end up like Trevor Burrus, Yeah.

SPEAKER_03 4:29

It's overwhelming. And you you add to that people's fear of making the wrong decision, uh, and then they're not not sure exactly what to do. So agents uh can be annoying. Uh all the options can be very, very confusing uh for sure. People want to make the right decision. So how can you find someone that will actually take the time to educate you about all that so you can make a good, confident decision? And of course, we built our business doing that.

SPEAKER_04 4:50

Yeah.

SPEAKER_03 4:50

Uh and that's how we believe uh you need to be treated. Let's explain your options, let's do uh at least a uh a decent or ample amount of education so you're really clear what you're doing.

SPEAKER_04 5:02

The other thing that I think probably most people, you may not be real realize, is when you talk to someone, sometimes there is different financial incentives for them to push one product over another. A Medicare Advantage Plan is gonna pay you twice as much as a Medicare supplement, for instance. And so a lot of these places that you're gonna call into, maybe they're gonna push advantage a lot harder because they're gonna get paid more as an agent. One of the things that we've done since day one of starting MedicareSchool.com is to align the cop such that it didn't matter if they recommended an advantage plan or a supplement plan, they were going to be paid the same. If you call in, you're gonna talk to someone who is going to be paid the same no matter what plan you purchase. Right. Which you know takes the bias out of their advice. Yeah.

SPEAKER_03 5:46

Well, I think then you know then you know that uh they're they're not looking out for their best interest, the agent they're looking truly out for yours. So uh that's number two. Then number three, uh price. Some people uh they look at the price of uh what it's gonna cost them beyond Medicare, and especially if you're high income, uh it costs more. It just does. Now, as we talked to the last caller, having uh a higher uh premium in IRMA is a great problem to have, but it's still very annoying. And so those of you that are high income by Medicare standards, which means you're single and you make above $109,000 a year, or you're married and you file a joint return, you're above $218,000 a year, then you're gonna have some additional surcharges. Uh those are called ERMAs. Again, they're not huge, but uh they um can be annoying to people when they find out, wow, it's gonna cost them a little bit more to be on Medicare because of their high income. Now, uh we just talked to a gentleman that was a pilot and his income is gonna change now. Uh and so you do have the right to appeal the ERMIS. So in his situation, uh he started Medicare this year, 2026. They looked at 2024, very high income, but now he's gonna retire and he's gonna be able to appeal the ERMIS. Uh and so we help you do all of that to make sure that we can get those premiums um, you know, to a reasonable amount for you.

SPEAKER_04 6:59

So agents are a challenge. Why? Because maybe they're trained differently, they don't know much. Yeah. Some do, some don't. Obviously, there's great agents, great companies in this industry. Um lot of people that do want to help and do care about you, but they can be pushy, they can be biased, they can be untrained. Uh secondly, uh options. Maybe a hundred options, and you're used to spending, you're used to working out at an employer who gave you three options. Right. All of a sudden you have a hundred. How are you going to figure that out alone? You have to get a PhD in health insurance in order to do that. Um or you can call somebody like us or other people like us who really are able to decipher and filter all that down into what makes sense based upon your doctors, your medications, your budget, your health situation. And the third thing is IRMA's. I always call it the great aunt IRMA, the tax, the surcharge if you make too much money. You got to pay more for Medicare. Um and but there are ways around that. Uh one thing that's related to IRMA that a lot of people don't realize, there's really two times when IRMA becomes an issue. The first time is obviously when you're retiring. We can generally appeal that, um, depending on your situation. You know, some people downsize, sell a house, and that kind of messes up the whole plan, too. But there are other things that can impact your IRMA. But generally, the first time, there's a good way to appeal it because you have what's called a work reduction or a work stop. It's you have a life-changing event that gives you the right to say, hey, I don't make that much money now, let's readjust my Part B premium down from $600 a month down to $200 the base, right? That's the first time. The second time uh IRMA becomes a problem is whenever you are probably around $75, so maybe 10 years from now. And most people don't know about this. But this is when uh if you have 401ks, if you have an IRA, if you have a 403B, some sort of tax-deferred account, um, meaning you've put money in something, you haven't paid taxes on that. A lot of people think, hey man, that's my retirement savings that I'm going to live off, but ends up you don't even have to take it. And some people don't actually use it. They just let it sit there for a rainy day. They figured out how to do with Social Security, maybe a pension, maybe other stuff, figured out how to live. Well, the government doesn't let you leave that money in there forever, right? They they're they're not gonna say, Oh, yeah, I never paid taxes on it. No, the government actually, around 75, it depends a little bit on your age, will force you to start drawing money out of those accounts. And that money gets tacked onto your so or tacked onto your tax return, your income, and it can push you up into those Irma brackets. And there's no box you can check and say, hey, I don't want to pull that money out of those accounts. No, you are forced to. And in fact, if you don't, you have a penalty, and that penalty is 50%, 5-0, 50%. So if you if the government said you need to pull $50,000 out of these accounts this year and you didn't, you would have a $25,000 penalty. And they'd force you to pull the money out. So now you're at $75,000 and you got to pay taxes on that full $75,000. So now that $50,000 you're supposed to pull out that you didn't cost you $100,000, right? Uh, with a 25% tax rate. So it becomes an issue if you have these taxable IRAs, these 401ks, these pre-tax accounts that are growing. You know, they've been growing for maybe 50 years at this point. And now the government says you got to pull the money out, and that can put you up into Irma. We have a financial planning team here at MedicareSchool.com that can help you plan for this because there are ways that you can kind of plan and get around this, um, uh reposition kind of tax status of things. So if you need help with that, you can call in to our office, asset hook the financial planning team, because you have these types of accounts, and they will help you um orient and uh formulate your situation in a way that when you're 75, you don't get this bill saying, hey, you know, I'm gonna have to pay a lot more for your Medicare Part B premium. Okay, let's talk to Kelly in Florida. Kelly, uh, welcome to Medicare School Daily. What questions do you have for us?

SPEAKER_00 10:54

Hi, thank you for having me. Yeah. Um, I'll be turning 65 this October. Okay. And I'm contemplating applying for my social security benefit. Okay. But I'm sure I should apply for my own benefit or my deceased husband's benefit. Okay. And his benefit was greater than mine. Also, but I have had conflicting information on whether I'm able to collect my own benefit initially and allowing my deceased husband's benefit to increase in value and then claiming his benefit at a later time.

SPEAKER_03 11:33

Okay, let me interrupt, Kelly. That last statement you just made is not accurate. So, yeah, you're not gonna be able to um uh take yours and allow his to grow. That doesn't work that way. So, whatever he was eligible for when he passed away, that would be your widow benefit, your survivor benefit. So, what I would suggest doing, if that is greater than your own benefit, then you just apply for a survivor benefit. Then what's gonna happen is that then your own benefit will continue to grow. So once you get to full retirement age, it'll grow another 8% every year. So then it's maxed out at your age 70, and it would have grown 24% beyond your full retirement age amount. So if that at age 70 is greater than what his is uh presently, then you'll stop taking survivor and you'll take your own benefit. But if your amount never exceeds his, then you'll always be taking the survivor benefit. Okay. Yep, promise you, that's exactly the way it works. Okay. Uh so taking his initially and allowing mine to grow. Yeah, it's exact that will happen. The only benefit that'll grow when we take another is survivor benefit. So you may or may not be larger.

SPEAKER_04 12:40

So what's what is your benefit amount and what's his benefit amount?

SPEAKER_00 12:45

Not much. Um I think his was around two thousand, and mine's mine at sixty-five will be about fifteen, sixteen hundred.

SPEAKER_03 12:54

Okay. Well, at at sixty-five, well what you do you know what it is for retirement age? Would it be maybe seventeen, eighteen hundred?

SPEAKER_00 13:02

Yeah. Okay.

SPEAKER_03 13:04

Well, it's gonna it's gonna go twenty-four percent. So if you take let's say by then it's well, what is it? Well, let's say it's seventeen hundred for retirement age, add twenty-four percent to that. So that's gonna go. You'd be over a little over two grand, probably.

SPEAKER_04 13:16

Yeah, twenty-one oh eight. So yeah, it'll be a toss-up by age seventy, kind of what that looks like. But at age seventy, make sure you go back and does she need to manually go back to them and say, hey, recalculate this, I'm gonna switch it up.

SPEAKER_03 13:27

Oh yeah, you have you have to switch it. It will not happen automatically. Now, Kelly, are are you still working? I'm self-employed. Okay. Yes. Okay, is your income going to be below $24,480? $24,000. More than likely. Okay, good. Because even though it's a survivor benefit, you're still subject to the earnings test. Um and so, which is fine. You keep it, you keep it below the earnings test, uh, then there's no issue. Then once you hit your full retirement age, there is no earnings test. You can make as much as you want. But yeah, take survivors, just call them up. You're gonna have to, of course, give them a death certificate if they don't already already have that on record uh and start those benefits. ASAP. That's what I'd be doing.

SPEAKER_00 14:07

Okay, so don't even wait till I'm 65 in October and just start start it right now.

SPEAKER_03 14:11

Yeah, I'd yeah, because the the benefits not gonna change it's yeah, yeah, take it now. Um yeah, and in fact, it and when when did your husband pass away? In 2023. And believe you me, I've I was asking these questions back then. Okay. Well, you know what they may do, uh, and again, I'm I I I'm I don't I'm not gonna be dogmatic about this with you, but you you may ask them, can they, you know, maybe backdate it six months? Uh and they may do that. Um I have seen that happen before where they'll backdate some, you know, because he's been deceased a while, you've been eligible for a while, so tell them that. Say you got conflicting information, you're confused by it, someone said you need to apply for those benefits now. Is there any way I can get any, you know, we all sometimes they will. Yeah, I know they will. Yeah. So ask them if if they will.

SPEAKER_04 14:55

Give you a lump sum for the last six months or something. Yeah.

SPEAKER_03 14:57

That'd be awesome. And of course, you know, that they'll they're gonna need a copy of the death certificate, but you'll be able to upload that or, you know, you know, down uh and put it on their site or take it to a local office uh as well. But just call the main Social Security office and tell them what you want to do. And um that kind of application cannot be done online. Uh you'll have to initiate that by actually calling them.

SPEAKER_00 15:16

Okay. Yep. I actually have a uh telephonic uh meeting with them next Thursday. So this will help me.

SPEAKER_03 15:24

Good. Yeah, you just take survivor benefits. That's what you want to do, and hopefully maybe one day yours will exceed his. And if it does, then uh you'll you'll you'll change. But I'd I'd run that out to 70 if it were me.

SPEAKER_04 15:35

Okay. Very good. Thank you. Okay. Take care. Bye-bye. Nice to talk to you. Thank you. You're very nice to talk to you. The survivor benefits, there's no penalty if you take before full retirement age?

SPEAKER_03 15:45

Oh, yeah, there's there's a reduction benefit. Oh, yeah.

SPEAKER_04 15:48

Okay. So but the recommendation, like maybe they're going to go back, then she would it'd be a little bit less, right?

SPEAKER_03 15:53

Mm-hmm. Okay.

SPEAKER_04 15:55

So there wouldn't it's not like yeah, I thought you made a statement of how like the benefit isn't going to change or something.

SPEAKER_03 16:00

What I'm saying, whatever whatever his benefit is going to be, whether she takes it now or or or or before, it's it's not it's not.

SPEAKER_04 16:06

So there's no reduction based upon if she would have taken it two years ago.

SPEAKER_03 16:12

Just like normal. Yeah, exactly. Exactly. Yeah, for sure. Okay. What I'm getting at is there's no reason for her to um if if I'm an advisor, I'd say do it now. Yeah. So there will be a little bit of impact. Yeah.

SPEAKER_04 16:22

Right, right. But it's gonna take, you know, a ways for that to make an impact. Okay. Exactly right. Makes sense. I just want to be clear on that. Okay, let's talk to uh Paul in Michigan. Paul, welcome to Medicare School Daily. What questions do you have for us?

SPEAKER_05 16:37

Um basically I I have a high spend down, I have uh not full Medicaid, only a spend down limit of basically $1,050. I have uh Medicare savings plan, right? Currently I'm on a C SNEP plan. Uh my question is I've been in Medicare since 98. I'm only 60 years old right now, and I don't know about the guaranteed um right uh if I was able to get a spend down plan. How does that work with Medicaid? And you have to be 65, can you be under 60 or 60 years age to be able to qualify for a a um supplemental plan?

SPEAKER_03 17:17

Um Okay. Paul, uh when you say you have a thousand fifty spin down, is that annually or monthly?

SPEAKER_05 17:23

Monthly.

SPEAKER_03 17:26

Okay. Uh do you think that uh financially your situation is ever going to change where that spin down is going to come down?

SPEAKER_05 17:35

When you mean reduce to zero now.

SPEAKER_03 17:38

Yeah. So you mean is there something in the future your income's gonna be adjust and you're gonna pay less?

unknown 17:45

Okay.

SPEAKER_03 17:49

Okay, well the again, to me, when you have a thousand dollar, you know, thousand fifty dollar spin down, that you basically have hardly any any help at all from Medicaid. Uh so uh I I mean I I'm gonna almost treat it as though you don't you don't get benefits. So uh it looks like to me, based upon what uh our screener has said here, you are on a chronic SNP plan. Is that correct?

SPEAKER_05 18:09

Chronic does SNP plan.

SPEAKER_03 18:11

Okay. What what is your what is your chronic condition that uh qualifies you to be on that plan?

SPEAKER_05 18:16

Diabetic.

SPEAKER_03 18:18

Okay. Okay, that sounds great. All right. So, Josh, could you do me one thing? Um uh could you see if uh there are uh SUPS available in Michigan? Uh that's we're gonna check on that. Uh you know, we we we write in all 50 states, but I'm not uh familiar with every single state rule. Uh but I am assuming that did you go on uh the Medicare Advantage Plan because you were not able to get a supplemental plan when you first went on Medicare?

SPEAKER_05 18:43

Uh way back I technically I oh I think I was on a supplemental plan way back. Uh however, uh those rates went skyrocketing, and somebody in a disability can't afford that.

SPEAKER_03 18:54

Sure, sure. Okay, I got it. Okay, very good. So they just price they're available, but they're priced out of the market. So here's what here's what I would suggest that you do. Uh uh I would continue to be covered by just the normal advantage plan that you're on. It's a chronic SNP plan is fine. Uh how long have you been on that that uh that plan that you're on right now?

SPEAKER_05 19:13

Uh this current plan of this year. Just started January 1st, or did you switch in the middle of the year? May May 1st, actually. Okay. And who helps switch from it another um Medicare. You just called Medicare and they they did that? Okay. I called them directly because uh the health I I have a health alliance plan and uh they wanted the Medicare to take care of that to switch. Okay, so do yeah, yeah. Do you like this C SNP plan? Um I do what I I I'm disabled. I think I have to rely on transportation. That's why I like it.

SPEAKER_04 19:51

Sure. Makes sense. No, that makes a lot of sense. Sometimes these C SNP plans get pushed because they the insurance companies actually make more money. Right. And so people really try to push on them, and sometimes they're good, sometimes they're bad. But it sounds like, you know, if you need the transportation, then that does make sense.

SPEAKER_03 20:06

Right. Yeah. So what's gonna happen? Oh, go go. Well, let me let's finish first. That's right, Paul. Uh you're you're gonna stay on it on a Medicare Advantage plan. You're gonna have to. Uh, you're not gonna be able to switch uh uh to a supplemental plan at good rates until you hit uh 65, which is gonna happen in February of 2031. So you're gonna have to be on it for another five years. But once that happens, Paul, you're gonna be able to get out of that Medicare Advantage world and you'll be able to get a supplemental plan uh at uh you know very good rates, uh very competitive rates. Uh and again, the Medicaid is doing you no good if you have to spend 1,050 out of pocket before they pay anything. So uh I see no benefit to that at all. So I think you're sitting well. Uh I I would make sure that on an annual basis, you're making sure that you are covered by the best advantage plan that's possible in your market. And so if you would like us to you know get involved with that uh later this year, we'd be happy to help.

SPEAKER_04 21:01

Um Is it through what's the carrier, the insurance carrier?

SPEAKER_05 21:05

Right now it's uh HAP. Hap, HAP, okay. H A P Henry Ford plan. Yes. Yeah. Okay. All right, it's a follow-up question though. If you're on the M plan and you're going for physical therapy, the specialist writes the script for physical therapy, so it's a 20-hour copay when you're on the M plan. But when you see the actual physical therapy, if you got to go three times a w uh a week for a month, is it $20 each time or only for the the initial script to go to physical therapy?

SPEAKER_03 21:41

Yeah, it it is not physical therapy. You do not have to pay a copay for that. Uh there are I I think about 15 different codes where you actually see a doctor uh you know for a visit that would be subject to the to that 20 hour copay, but not every time you go into physical physical therapy. If you hear differently, get back with me on that. But as I've studied out the end. plan and the implications of that, I came to the conclusion uh people are not having to pay a copay on their physical therapy. Okay? Yep. Good to talk to you, Paul. We appreciate the call here.

SPEAKER_04 22:12

Golly, there's just so many these people are pushing these special needs plans. And sometimes it's good, but like the the maximum out of pocket on that plan um is uh let's see. First off he's paying a premium about it's only eight or ten bucks a month, but the maximum amount of pocket on that plan is 9250. Right? And we're talking about an HMO plan. Wow. HMO plan max out of pocket of 9250. Yeah. Somebody probably sold him that made it seem really good.

SPEAKER_03 22:40

That's right. The specialized you know really local regional plans like that are are and they're in the probably in the news? Oh yeah well yeah they they they can't get enough people enrolled in those plans and uh they're they're just not solid. Interesting.

SPEAKER_04 22:56

HAP rebrands oh they just did a rebrand is Health Alliance plan by Henry Ford Health. Yeah interesting okay let's talk to Jarius in Georgia. Jarius welcome to Medicare School Daily I understand you got a question about Social Security and approaching your 25th month on disability is that correct yes that's correct.

SPEAKER_01 23:16

Okay tell us what's going on I need to know a little bit about disability and Medicare because I understand that you know there's many people that own disability and that have Medicare but they're under the age of 65. And I also wondered about um you know you know the 20 24 month and I believe that on the 25th month I'm eligible for a Medicare and uh another question that I had was um with me being on my teeth group plan employees over a hundred and um how much would Medicare pay when they put me on on Medicare A and B understanding that they will be paying I believe in the second position?

SPEAKER_03 24:17

Okay Jerry you got a lot of moving parts here. Okay we want to help you but so let me let me just interject for a second. First off does your does your wife's uh employer are there more than a hundred people on the payroll yes okay i is is that plan a good plan do you like it uh and it is it what's the price of that what does it cost her to cover you okay I believe that's a good plan is uh Signa Signa and uh it's about it's about four hundred and uh fifty dollars per month for both of you or just you uh just me just you okay okay yeah that that that would not be a good option in my opinion okay so I think um of course Josh is there any underage subs in Georgia? I'll look okay let him let him look real quickly so are there any underage uh I mean there are but again they're you know crazy high yeah five hundred dollars for a plan G let me tell you what I would do I'm it's it's really simple Jarius uh because your wife has an employer plan of more than a hundred when you are when you receive your Medicare card uh it's gonna come in the mail your coverage is gonna start in December so let's back up the clock we've got eleven we've got uh ten we've got nine in during the month of August you're going to get your Medicare A and B card with an effective date of 121. Okay? And so what I would recommend doing is I would send the card back in, you're gonna sign the back of it and I'd mail it back into Medicare and I would drop off Part B. There's there's truly no reason for you to have part B um uh at all. Uh so send the card back in you're gonna have A only and your wife um uh her plan and she she's gonna keep working isn't she uh yes that's correct okay if she's gonna keep working then then you're gonna be covered by her plan and they're gonna they're they'll they'll they'll pay first and you're only going to have Medicare A because having Medicare B is going to be a waste of your money. So mail the card back in uh and then you'll have A only so if you went to the hospital uh your wife's plan is going to pay first and Medicare A is going to pay second and then everything related to outpatient and all that that's just gonna simply be your your your wife plan is going to cover you. Okay and then what's gonna happen uh as you uh get closer to 65 uh which will happen in August of 2028 so about three months before then uh you can then apply for a normal good advan a good supplemental plan in the state of Georgia uh and then at that time since you're paying $450 a month just for your coverage then you'll come off of her group plan and you will just be on Medicare with it with a supplemental plan. That's the that that's the way I would handle that if I were in your your position. I like supplemental plans uh right now for you. The problem is uh the the Georgia prices are too high so it's a better value for you to stay on your wife's plan. So you're gonna have A only and then you're gonna pick up um uh B uh as you approach your 65th birth month and all we have to do is prove that you've had credible coverage through your wife's employer and then we can bring you into uh Medicare B uh when you turn 65. That's the way you handle that get off her plan, get on submetal plan a drug plan. When you're 65. Yeah when you're 65. It's just not it doesn't make financial sense right now to do anything other. And I don't want you to take B now because then that's gonna hurt you down the road.

SPEAKER_04 27:34

Trevor Burrus Yeah because then you won't be able to get a Medicare supplement in it in as easy of a way.

SPEAKER_03 27:38

Oh yeah yeah we yeah exactly right so and plus it's a waste of money because uh you're you're you're you're gonna say on your wife's employer plan so they're gonna pay first anyway so why pay you know $200 a month for part B when it's hardly even going to be used. Right. So send the card back in and as long as your wife keeps you know keeps working is covered by an employer plan um you'll be fine to come in later.

SPEAKER_04 28:00

What questions do you have?

SPEAKER_01 28:01

Well yeah the question is I understand that my wife plan would do uh uh insurance will pay eighty twenty and the the issue is the twenty so I was thinking that if if I receive uh Medicare A and B and they being in the second payer position that Medicare would pay to twenty percent because that's the issue. I understand that my wife can play the 80% but I I'm thinking about the 20% because you know if you have a a $40,000 bill they will pay 80 well but there's a maximum on that do you know what the maximum out of pocket is on that 20%.

SPEAKER_03 28:50

That would be worth finding out yeah and also Jarius are are you sure that every single bill that comes through uh hospital bill doctor bill whatever your wife's plan only pays 80% and she's responsible for 20?

SPEAKER_01 29:04

Are you sure are you sure about that? Uh boys I know why do you ask that particular question?

SPEAKER_03 29:10

Well because you're you're making a decision based upon well you're you feel like you have a full 20 percent responsibility and I'm saying to you that would not be that would not be the norm. It just would not be especially in a hospital. It's not but ma and maybe it is but then the second question is even if you were responsible for 20 percent Josh is asking what's the max out of pocket? Because there's going to be a limit to that. So so if you did have a $40,000 bill I don't think you're gonna have to pay you know $60 uh $8,000. Find out the max out of pocket before you make the decision.

SPEAKER_04 29:41

And listen if you find that out we're happy for you to call back in and we can have another conversation we need to know what is the deductible on that plan. Remember deductible is generally you know if you have a hospitalization what do you have to come out of pocket before the plan kicks in, right? And then the second piece is coinsurance and that's a big jargony turn but it's that 20 percent. What is that amount? And when does it apply? Aaron Ross Powell when does it apply but then what's the maximum out of pocket? Right. Because if if he is spending $450 a month for that and there was some sort of an A and B plus an advantage plan with a $3,000 max and his max is six or seven or eight thousand dollars I don't know what that plan is. But he's not paying an insignificant amount for that coverage.

SPEAKER_03 30:24

Aaron Ross Powell Oh I totally agree.

SPEAKER_04 30:25

And if if if uh there were submill plans in Georgia that were competitive I wouldn't even give him this advice right exactly but if there's an advantage plan that's available use that for a couple of years that that an advantage plan that's just as good as his group plan. I don't know if there is or not but if there was and then he's got the opportunity to switch to a submittal plan at 65.

SPEAKER_03 30:43

That that that's fine as well.

SPEAKER_04 30:44

Trevor Burrus Yeah it's uh it's hard to make a comparison without knowing the you need to try to track down the summary of benefits of your group plan. That's right. Summary benefits of that plan. What's the premium, what's the deductible, what's the max out of pocket. And then you can um kind of make a little bit of a better comparison. Yeah so what you're saying Josh he he could have kind of a mediocre or average group planning that he's paying $450 a month for okay and he could switch to A plus B paying $200 a month with no premium advantage plan that's just as good as his at his group plan and then switch to a supplement when you hit $65.

SPEAKER_03 31:16

Hey great great idea. So Jerry why don't you find more details out give us a call again we'd love to talk with you.

SPEAKER_01 31:23

Okay I just had a question about that that uh what he just spoke about when he was when he talked about uh the advantage plans because one you know typically even in either case I really don't like advantaged plans because uh I know that they come with pre-authorizations and with some with some of my medical issues that's why I'm staying away plans even in this uh because I I uh you know with my uh MRIs and and PET scans and different things like that, uh I don't need the pre-authorizations. That's why I'm gonna stick with a medi uh original Medicare when it comes available.

SPEAKER_04 32:03

Yeah when it comes available it's just not available right now. So the question is would a Medicare advantage even with a little bit of restrictions it would save you probably $250 a month and is there one that's pretty comparable to what you're paying $450 a month for on your group plan?

SPEAKER_03 32:18

Yeah but what he's saying Josh he doesn't like the you know the preauthorizations and and I don't I don't blame I'm not trying to sell you an advantage plan. I'm saying there is one other one other option you can consider yeah that's that's a very valid option uh you know if you'd be comfortable with here's what you probably should do.

SPEAKER_04 32:35

Find that information out okay on on um your your your your uh group plan the deductible the max out of pocket we need to know your medications and then call our office schedule an appointment with somebody on our team that can truly take the time not in this kind of a setting to look at all your medications to look at your doctors to really compare these things side by side so you can make the best decision. You have your pen handy I'm gonna give you our number for the office yes I have my pen. Okay it's 800 782 6676. 800 782 6676 and when you call in you're gonna talk to someone who's been trained by my dad and they can go through your doctors go through your medic uh go through your uh medications and compare hey what does this group coverage look like versus using an advantage plan again the point isn't to sell you advantage plan but if you can save three four thousand dollars a year and get a plan that's better than Cygna it might be worth it and then you'll already be on track for down the road and then you'll get a supplement yeah because you will be able to get a supplement plan down the road when you turn 65 and it'll be pretty easy. Yeah.

SPEAKER_01 33:45

Okay that number is 1-800-782676.

SPEAKER_04 33:52

Yes sir you got it okay well thank you very much for your time Jerry's good to talk to you sir thank you okay let's talk to Mark in Utah Mark welcome to Medicare School Daily I understand you have a question about Irma.

SPEAKER_02 34:07

I do I um actually I will I spoke to the gentleman early and asked if I could ask two questions the first simple go for it is that okay I just no I was giving you a hard time you're good we're ready okay good good all right um so I turned C25 last month uh mandatory retirement for a an airline pilot so we have gone with a uh with part G with you guys and a um uh a prescription part G plan as well my wife who'd you work with Delta Airlines I'm sorry um Delta's interesting but yeah who in our company set you up yeah sorry I should have listened to the whole thing I believe it was uh Brock West.

SPEAKER_04 34:48

Oh okay awesome good so Delta just just pause so Dell you have to retire I didn't know this you had to you have to retire at 65 is that all airlines airline it's it's the FAA yeah I didn't know that okay wow okay well we sure do there you go you know you know what you're gonna be done with it makes it easy yeah yeah I'm very yeah hey hey let me is your mark about that did that did that age used to be younger it did it it was 60 until yeah until 2009 okay and it's it's kind of funny it's um it it was all purported to be health based and you know cognitive ability and then all of a sudden in 2009 when the economy went in the crapper they said oh you know what we can go to 65 okay money drives everything all right I just heard I thought it used to be uh less than that so sorry you had to retire but hey hope hopefully you you no no no wow you're you're you were ready huh so ready okay got it so ready good well we all right my wife is a couple years older so we we did the appropriate CMS forms and and everything went well and then I watching your videos I was told to expect the uh LEP letters from good the the sub provider I I did get one from the um prescription plan and I made the call and spoke to someone I hope hopefully that went well yep uh but I I haven't heard anything from the um supplement provider and I was wondering that's only for the drug plan that's only for the drug plan. So you can't get anything yep okay just the drug plan.

SPEAKER_02 36:19

Okay so we're all set. Okay good all right now now to the tricky one about Irma. Okay. Um so my my last years as an airline pilot I I did very well obviously and I think Marvin you said this earlier about what a what a nice problem to have.

SPEAKER_04 36:36

It's still not one we want to pay it's a nice problem but we let's get around it if we can.

SPEAKER_02 36:41

Exactly so uh looking at the um appeal process to me looking at Medicare Forum it it seems that you need to drop a tier in order to um do the appeal now even though I stopped working I I literally got my last paycheck um Monday I I still with the income that I made this year with the first half and then the um vacation payout and all that stuff I I'm not actually dropping a tier in 2026. Okay. You would I'm wondering about the I have not taken a penny out next year so I I plan to have zero income next year. Okay so I my question is timing on on the appeal should I wait until next year?

SPEAKER_03 37:30

Yeah you're yeah you're gonna have to uh there's yeah there's no reason if if your number that you would give them because at where it sits right now you retired so if you gave them 26 and it's not less than 24 I wouldn't waste my time at all. So what you're gonna do is this uh around November December they're going to be recalculating the Part B premiums and ERMAs for 2027. You'll get a letter because they're gonna look at 2025. Obviously you're a very high income man, so you're gonna be assessed an IRMA. Once you get the letter in hand now you can appeal. Okay? And so what you're gonna do is uh you'll you'll put in the thing, you know, the uh check the box that says work stoppage. You'll put the date down which is you know here in the last uh you know few weeks put that date down and then you'll submit that uh through the Social Security system or uh drop it off at a at a local office you've probably seen the form. It's called an SS44. Um and you'll put one on you and also one on your wife of course if you file a joint return. And then you get to the local office. It will take them usually two weeks, three weeks to process that and then the IRMA should go away uh in you know for January. So you'll just have to pay your ERMIS through December and all should go well. All right and then what's gonna happen? And then we go to 28, they're gonna be looking at 2026 and then you're gonna appeal again because you use the same appeal. Yes sir. Now let me tell you what here's my view. When you look on the second page of the um of the SS 44 it it it it it you you're you're gonna give them the life changing event and then it's gonna ask you for some numbers and you're gonna put in there uh uh your you know your 2027 income and then there's another uh space where you can put in additional numbers I would not do that uh I just just give them the the the fill out the middle part leave the other part blank because I'm telling you you're gonna have to appeal twice anyways. Okay. I think the thought was originally hey if your if your next year's income is even going to be uh you know less then give us that as well and then you don't have to deal with appealing twice. I've never seen that happen okay they'll just they're gonna send you another letter at the end of 27 so that's the way I'd handle that. Okay. Okay. All right and and if I drop off a form from my wife does she need to be there or am I allowed to drop it. Oh yeah she just has to sign it. You can drop it off no problem. Okay. And what I would do is put an envelope just say you know Irma Medicare Irma appeal steal the envelope you keep copies of it and the there's usually a guard at the at the uh front uh door you know front desk and give it to them and they'll get it processed for you. And if you haven't heard let's say if you haven't heard within three or four weeks then I'd be calling them and saying hey haven't heard yet but give them give them a couple weeks you know it's not uncommon for it to be you know two to four weeks. Okay.

SPEAKER_02 40:06

Okay great. All right that's it that was less complicated than I thought. Thank you very much.

SPEAKER_03 40:10

All right Mark hey great great talking to you thanks also for letting us serve you. We appreciate the opportunity to be your broker. Oh yeah you bet.

SPEAKER_04 40:16

Okay take care thank you very much sir my dad went on Medicare in January and he went with a Medicare supplement plan G, probably as no surprise to many of you, but there's five reasons he did that as he kind of compared all of the options that were available. So Monday we're gonna be back and you can learn those five reasons he ended up with a plan G. We'll see you then