Medicare School Daily

The $10,000 Medicare Trap MORE Seniors Are Falling Into

• Marvin Musick

Share episode

Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.

0:00 | 48:04

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

Book a call-in slot for upcoming shows here:
https://medicareschool.com/medicareschool-daily/

Call in directly to the show at: 833-824-2004

For immediate Medicare enrollment assistance, call our team at 800-782-6676

-

Nobody wants a surprise $10,000 Medicare problem.

But more seniors are running into this trap without realizing it.

Today on the Medicare Daily Show, we’re breaking down what’s happening, why it matters, and how to be more prepared.

We look forward to taking your calls live after our discussion!

SPEAKER_01

Medicare has a few financial traps that you need to be aware of. And some of these financial traps are quite large. And today you're going to learn about a trap that many people uh have no idea could actually exist, and that's what we call the $10,000 trap. And you may be on a plan that has this ten doll uh ten thousand dollar trap. So we're gonna go through and uh teach you about it to make sure you know exactly how you may be able to avoid that. Uh, welcome to uh Medicare School Daily. My name is Marvin Music. Uh normally I'm in studio with uh my son Josh. Uh we do this program together, but Josh is at a conference, and so we've invited one of our top agents, Justin Cohen, to uh be in the studio today. He's been here before. Uh we love him. He's a great agent, a real pro in this business. So Justin, uh glad to have you uh with us today.

SPEAKER_00

Glad to be here. Thanks.

SPEAKER_01

All right. So whether you're just starting Medicare or you're already on Medicare, uh it could be that you have something you want to share with us or have a question today. Uh some of you may have questions about Social Security. So Justin and I will field uh any question you have about Social Security, Medicare, uh any retirement question as well. And so, but the number to call uh for today's uh program is 833-824-2004. Again, 833-824-2004. We'd love to hear from you uh with any question that's on your heart today. So just before Justin, we get into that $10,000 trap, uh just briefly explain to people when they uh are ready to start Medicare the options that they have. And I know uh one's terrible and the other two, you know, are different, but the point is I want everyone to know because uh some of you are out there and you're just now getting into the Medicare system, you're getting knowledge because you want to make the right choice. So tell them what the three options would be.

SPEAKER_00

Aaron Powell Absolutely. So when somebody's coming on Medicare for the first time, there's really three main ways to do it. Uh the first option is to just get Medicare A and B only. When you have Medicare A and B, what you have is called original Medicare. And it's great health insurance, but generally just considered to be a good start.

SPEAKER_01

Yeah, exactly. Only I always say that's the first option, but the worst option.

SPEAKER_00

Yes. Uh lots of liability uh if you just get Medicare A and B. So we're going to recommend getting something else to go along with it. Either a Medicare supplement plan, otherwise known as a Medigap plan, plan G or Plan N. Uh that's the second option. Many would people would tell you that's the best, although it is the more expensive of the three, uh, at least from a monthly premium perspective. And then the third option would be to get uh what's called a Medicare Advantage Plan, otherwise known as Medicare Part C. Most people have to choose between these three. Trevor Burrus, Jr.

SPEAKER_01

All right. Well we know that uh a little over half of all people have chosen advantage plans. So let's uh for kind of the duration of our teaching time here, let's talk about that because that really is uh where the trap exists. Um we know that uh when people enroll into Advantage Plan, uh uh you will be responsible for co-pays, uh, you're responsible for coinsurance, uh, and so advantage plans uh will usually be offered to you at a zero premium, but they're not going to be free uh at all. So explain some of the expenses that are involved uh with Advantage Plans.

SPEAKER_00

Yes. Uh so when you get on a Medicare Advantage Plan, what you're doing is replacing Medicare A and B with a private health insurance company's managed care program, either an HMO or a PPO. And yeah, these are popular because they have a $0 monthly premium. So the price is right. But uh when you have one of these, you don't pay up front to have it. You only pay when you go and use it in the form of copays and coinsurance. Few of them will have a medical deductible, but not very much. Um these copays are generally reasonable, but when somebody gets chronically ill, those copays tend to add up and start to eat their lunch to the tune of maybe $10,000, $11,000 a year, depending on the area and depending on the plan. So these are pay as you go plans, Marvin.

SPEAKER_01

Yeah, exactly right. So uh if you happen to be on an advantage plan, you are paying as you go. Uh it could be reasonable, but again, as Justin had said, if you have a chronic condition, uh could be hospitalized, could have an operation, uh, multiple uh visits to doctors, so copay, copay, copay, copay, and then you're responsible for a maximum out-of-pocket. Some of those are as high as $11,000 to $12,000. Uh and so when we talk about uh this $10,000 trap that you may be in, it's because you're on an advantage plan. Now the average right now, advantage plan, is $5,900 max out of pocket, but there are some truly as high as uh uh a little over eleven thousand dollars. And so that's a trap that uh the majority of agents are not going to talk to you about. They want you to take the advantage plan because it pays a very nice commission and it pays a lifetime residual income. So they want you on that advantage plan. So what is typically done is they're gonna withhold uh the uh reality of this trap, and that is that max out of pocket could be very, very uh expensive. I had a lady that uh was diagnosed with breast cancer uh and she was on a plan that had a $6,700 uh max out of pocket. So she gets diagnosed with breast cancer in September. Uh she is going through treatments, radiation, chemotherapy, surgery, and she very quickly maxed out. She hit her $6,700. The problem was her uh cancer treatments were not over yet. And so we carry into the next year, and now uh the max out of pockets reset. Now her plan didn't go up max out of pocket, it stayed the same sixty, seven hundred dollars, but she's under treatment. So literally uh within a matter of five, six month range, she hit her max out of pockets twice. Towards the end of one year, resets in January, she hit it again. So she spent $13,400 uh within a matter of less than six month period of time because she maxed out twice. And usually when people get cancer and they go through all the treatment options, or you know, radiation chemotherapy, uh surgery, you're gonna max out uh in that situation. So that's the trap. And again, agents are not gonna tell you about it, uh, but it is a reality. And so we want to make sure that you're aware of that trap. Now, let's talk about um uh the fact that some people would love to get off their advantage plan, but they can't. Uh, and this happens. And again, another uh a trap that uh people will fall into not understanding the rules about actually switching advantage plans. So let's talk about when people can get off their advantage plan and when it's not going to be possible, please.

SPEAKER_00

Yes. Well, your client in particular, I'm sure, was trying to get out of that Medicare Advantage plan and back to original Medicare and a supplement plan. We we only call it a trap because it's really difficult to get out of. Once a person is diagnosed with something chronic or uh serious, uh that person is no longer eligible to get anything but another Medicare Advantage Plan due to the medical underwriting. So it is a sticky trap, and we try to make sure people understand these things before they make a decision. Trevor Burrus, Jr.

SPEAKER_01

Exactly right. Uh I had a lady um um uh just a couple years ago, the kind of interesting story. Uh very healthy, turned 65, uh, went on advantage plan. And her her her whole plan was this, and she told me, she said, Marvin, I'm gonna take it advantage of my healthy, take no meds. But when I turn 70, I'm gonna come back to you and I'm gonna get uh on a supplemental plan. And I said, that's fine. Of course, we as a company will write advantage plans if that's what you want. No, no problem whatsoever. And so that's her plan. She stayed on advantage within five years. She is ready to move uh off during an open enrollment season, and she literally was on my calendar, on my calendar to make the switch. And um I saw that she was on there. I remember her very vividly, and then I noticed her appointment went away. Uh and so I called her and said, uh uh, why did you cancel your appointment? We can we can get together. And she said, Well, let me tell you what happened. And so I'll tell you what happened. Uh she uh was 70 years old, uh ready to switch. She goes into a dermatologist just right before our appointment to you know make the switch, and she has uh melanoma. So they what happened? They removed a mole and did the biopsy and it was melanoma. And so now she has cancer. And so what happened is uh that is a a a knockout uh uh condition. Any form of cancer in the last 36 months, if you're uh uh you have that, you're not gonna be able to switch. So she had to stay on her advantage plan and still is to this day. Um and so she has to be cancer-free, treatment-free for three years, sometimes five years on s with carrier. So if that's you and you're planning uh to switch and you're just kind of rolling the dice and you're still healthy, I hope that works out for you. But it may not, as it did not for her. And that's really, really sad uh because she truly wanted to be on a supplemental plan for the rest of her life, and so now uh she's still on her advantage plan. So my point is you may be on a plan that has this trap, and uh you may be stuck with that. You really may. Now, let's talk about uh justin those people who uh would like to stay on their advantage plan, they're concerned about the trap. What may they be able to do?

SPEAKER_00

Well, there's a few things that you can do. Uh cancer indemnity insurance is growing in popularity, probably with the growing rate of diagnosis in this country leading that. You can get a cancer indemnity policy that will pay you a lump sum tax-free amount of money with no strings attached within 48 hours of diagnosis. So anytime one of my clients is going to get a Medicare Advantage plan, I ask about it. And if they don't already have it, um a cancer diagnosis that is, we'll often recommend that they get one of these lump sum policies that will pay out in the event of a diagnosis to either cover the maximum out of pocket or cover the cost of travel to stay in another city for months on end while receiving treatment. Over half people don't even get treatment in their home state. So cash is king when it comes to these things. If you can't get a supplement plan, you can have the benefit of the cancer indemnity plan.

SPEAKER_01

Most people that are getting these, what would you suggest that they do as far as the size of a cancer policy? Trevor Burrus, Jr.

SPEAKER_00

I would recommend at least the amount of the max out of pocket, maybe twice that again in your agreement. $10, $20,000? $10,000, $20,000. Most people are asking for about $20,000. And uh you want to think about uh incidentals? Again, you're not thinking about these ahead of time, but you want to think what would it cost to travel to the place that I would want to receive treatment from? What would it cost to stay there? What am I gonna do? Eating? Uh is my family gonna show up? Am I gonna be needing to feed them or house them? Are they gonna try and go along for the ride? Uh more is better than less.

SPEAKER_01

All right. So a lot of expenses then in in that regard. So again, if you're on a vantage plan, you're gonna stay on it. That may be something you want to consider. Let me give you the number that you can call in uh because if you want to talk to someone about getting one of these, uh you can do those any time. You do not have to wait to the open enrollment season. You can call today, and we'd be happy to discuss uh one of these cancer plans, critical illness plans, heart attack, stroke, uh, those types of plans, call 800-782-6676. Uh we are open 7 to 7 every day, but Friday we're 7 to 6 p.m. on Fridays. Uh but you can reach uh one of our agents and they'll take the time to explain your options, give you pricing, and see if this is something that uh would really be helpful you for additional coverage. So 800-782-6676. Go ahead, sir.

SPEAKER_00

I might just add to that, uh, you know, some of these cancer indemnity policies uh have a return of premium writer available. Okay. Uh in some states, if you never get cancer, it'll never pay you a dime. And then uh the best thing you can hope for, quite honestly, is to waste the money on one of these policies. But if you live in a state where they have a return of premium rider available and you add that for a small additional monthly cost, then if you never get cancer and you pass away for some other reason, then every dollar you spent your entire life in premiums is returned to your beneficiary.

SPEAKER_01

Good. That's really good. I I did not realize that some states allowed that. Yeah, that's awesome. Great benefit. Very good. All right, let's talk to Jody in California. Hello, Jody. Welcome uh to our program today. Uh glad you called in. How can we help you today? What questions do you have?

SPEAKER_05

Hi, Marvin. Thanks for taking my call. Um, I um have been on United Healthcare PPO for 25 years, maybe longer. Um, I have had breast cancer twice. I am currently on a drug called Cape Collie. Um, that is very, very expensive as you can imagine. Um, the co-pay, so I've not had to pay a drug. Um has not been income based. So I'm wondering if I'm turning 65 in October. And I'm going to be choosing a plan B that covers this drug. Is there any way, any programs that cover the deductible?

unknown

Okay.

SPEAKER_05

So that way I don't have to reach the deductible to get everything paid for.

SPEAKER_01

Sure. Jody, let me ask you this first. Uh now, is that medication uh is that something that's an oral medication you've taken home, or are you going somewhere for an infusion for that?

SPEAKER_05

No, it's an oral medication.

SPEAKER_01

Okay. All right, that sounds great. Justin Cohen's with me in our studio today. Give us um uh why don't you look up Medicare.gov. Let's look at that medication uh real quickly. And spell it for us, please.

SPEAKER_05

Sure. K-I-S is in Sam, Q A L is in Larry, I.

SPEAKER_01

Okay, very good. Okay, so why he looks it up, and Justin, interrupt me anytime. But as he looks that up, uh he's just going to Medicare.gov to see if that medication is covered by Part D plans. And so if it is, if it is, here's what happens. Um you would probably have a deductible, maybe, maybe not, but usually have a deductible. Is it covered?

SPEAKER_00

Looks like it's going to be on the formulary for several drug plans.

SPEAKER_01

Good, good. That's great. Okay. So let me explain now. Let me ask you this, Justin. Is there is there a plan uh some of the lower premium plans or the higher premium plans covering it?

SPEAKER_00

The lowest premium plan is covering it.

SPEAKER_01

Okay. What's the premium on the plan?

SPEAKER_00

Zero dollars a month.

SPEAKER_01

Who is it? It's Health Spring right now. Okay, Cigna Health Spring. Okay, that sounds good. So let me explain, Jody, how it's going to work uh once you you know go on Medicare effective. So you're gonna start your Medicare 10 of uh of 2026, of course. And so if you are making that decision today in which the drug plans are not going to change between now and January 1 of 2027, so you could be on a plan that is uh Healthspring. Healthspring is um uh a company that actually bought uh Cygna uh about a year or so ago, and so it's called Cigna Healthspring. And so they have a uh a Part D plan in your zip code that's a zero premium. Now, what you're gonna have to do is you will have to meet a deductible on that medication. Would that be correct? In fact, you're looking at the screen, you tell her you're rambling on.

SPEAKER_00

You go right ahead, sir. It's a six hundred and fifteen dollar deductible, but that's not where it's gonna stop, Jody. Um that medication has a very high retail cost. And uh What is the retail cost?

SPEAKER_01

Yeah, just so we're I'd like to know.

SPEAKER_00

You know what? It's not telling me here, but uh it's high enough that uh you're gonna hit that $2,100 drug max out of pocket on the first fill. Okay. Um you'd be able to split that into those three months, October, November, and December.

SPEAKER_01

Um what he's saying is that uh it is covered in formulary. Uh and so all drug plans for this year, 2021, the most you will spend out of pocket would be $2,100. Um uh and that would be any medication that's in formulary. So since it is, you would spend the $2,100. Looks like to me, she goes to pick the medication up her first her first time, then she would pay that $2,100, or you're saying she could spread that out then if she enrolled into the uh uh prescription payment plan.

SPEAKER_00

That's right. Could be split up. Uh let me ask you this, Jody. You said that you're not paying any copay for that medication now. Is that because you have a manufacturer's uh coupon?

SPEAKER_05

It's Navartis. I don't know, but when I went when I go to Refill it at the CVS specialty pharmacy, they offer they partnered with Navartis, and this was all done for me.

SPEAKER_01

Okay, let me let me interject something here. When you get that medication, are they aware that you're covered by United Healthcare PPO plan? Yes. Okay, so the the bottom line is United Healthcare is picking up uh some of the tab on that. I'll I will guarantee you. Yeah, for sure. Okay, so the point is because if you do go on Medicare, are are you thinking about starting Medicare 10 or or are you gonna keep working?

SPEAKER_05

I'm not working, so I will be getting on Medicare um July 1, yeah.

SPEAKER_01

Okay, that sounds great. Uh and so what's gonna happen is uh you're gonna be out of pocket, but the the good thing is that Max is 2100. So Justin, explain her how she could enroll into that payment plan. If you don't want to spend the the $2,100 the first time you get the fill, you can soften the blow a little bit. Go ahead.

SPEAKER_00

That's right. Um when you enroll in the drug coverage that we will help you get, uh when you get your packet in the mail, there's gonna be information in there about the prescription payment program, the PPP. This program allows people who are gonna hit that $2,100 max to spread it out evenly over the remaining months of the year. That's only gonna be three months for you. Uh uh next year it's gonna be easier. Next year it'll be a $2,400 cap. Split that up. That's just $200 a month, which is a great deal. Um but I want to know i i there's a possibility that you're gonna be able to maintain that current zero dollars. It dip and we'll talk to you about it more specifically later, but uh if you are getting a manufacturer's discount, those programs usually last for 12 months at a time. Once you're on Medicare A and B, you should not be able to renew that program, but you should be able to exhaust the remaining months you have left. There's a possibility you won't have to pay $700 a month for that medication the last quarter of this year.

unknown

Okay.

SPEAKER_01

And what and how long and just I was not aware of that. That's awesome to know. So uh when did you start that then? That medication.

unknown

Yeah.

SPEAKER_05

Well, um uh it's I've been on it for approximately five years. So it just keeps rolling over to the next keeps renewing.

SPEAKER_00

Okay, if you can find out what the anniversary date of that will be.

SPEAKER_01

And who would she call Navardis for that information? Or I would think so. Okay, okay, that sounds great. So the good news is we know worst case scenario, you're gonna spend $2,100 this year. So they've already set the 2027 max out of pocket, $2,400 then. Okay, so worst case scenario, uh, you'll spend $2,400 next year, but hey, it's informulary, you're gonna better get your medication. And so um I think that's that's great news. Now, I would uh encourage you, Jody. I'm not you know trying to uh pressure you to do something in the future, but uh we would love to help you uh because this is a big decision, especially with your cancer treatment. If you can afford uh a supplemental plan G or an N plan, uh I would highly recommend you do that, please.

SPEAKER_05

Okay. Marvin, uh I'm going I'm choosing the G extra, the the best one for sure. Thank you for that. I have a one quick question about this follow-up because I have extra of this medication. So is the does the deductible start January 1 or on my birthday anniversary?

SPEAKER_00

It's the calendar year, Jody. Calendar year, January 1st, it restarts.

SPEAKER_01

And that count and that deductible is included in that max. Yes, it is. Okay, remember that. So as long as it's in formulary, that's the most you'll spend, including deductible. And then what will happen, Jody, is that you'll you'll decide on a drug plan for this year, and then within a couple weeks after that, you're you're gonna have to decide on what's gonna work for 2027. And it may be that the 2026 plan is still the best, but it may not be. Uh, but we'll give you uh some instruction and you know direction for that as well.

SPEAKER_05

Okay.

SPEAKER_01

Okay. All right. Any any other questions?

SPEAKER_05

Very helpful. No, that's it. Thank you so very much.

SPEAKER_01

Yeah, we appreciate your call. You take care. Keep talking to you.

SPEAKER_05

Okay. Okay, thank you. Bye-bye. Bye.

SPEAKER_01

Okay, we're gonna go to Eunikia in Texas. Hello, Eunikia. Good to have you today. Uh what questions do you have? And before I uh kind of open the mic up for you here, I just want to make sure I'm clear. Uh it looks like you are turning 65 in August, still working full-time, covered by a group plan at work, plus you have TriCare Prime and planning to work till 67. So is all that accurate?

SPEAKER_03

Yes.

SPEAKER_01

Okay, that sounds good. So uh one question I have before we we start um our dialogue with you, uh, so is your employer plan uh yeah, or do the do you have insurance with the employer or are you just on TriCare Prime?

SPEAKER_03

No, I have insurance with the employer.

SPEAKER_01

Okay, so TriCare is paying second then. Okay, that sounds good. We just want to know about that. So you're gonna work for uh until 67, I guess, maybe at a four retirement age or something. Would that be correct? Okay, okay, that sounds good. Okay, I'm gonna be quiet now, and uh you can ask us your question.

SPEAKER_03

Or questions at my retirement, I want to get a Medicare or a Medicare advantage plan.

SPEAKER_01

Yes, okay. So first off, you are not gonna be penalized in any way. Okay. In fact, Medicare is thrilled that they are not gonna be responsible for you. They're glad that you're working covered by a group plan to have TRICARE. And that's why they make it so easy for you when you get ready to retire to come into Medicare and sign up, no penalties and no problems. Okay, and you would start that process three months and no sooner, three months before you're ready to retire. That's that's what you're gonna do. And so what I'm gonna do, uh Justin Cohn is with me in our studio and he's a pro. So, Justin, if you'll walk her through that process the three months before she turns, and why it is that there be no penalties and what uh you would recommend she do.

SPEAKER_00

Absolutely. In fact, I want to tell everybody out there if you're working and you have employer group health insurance. And you're approaching 65 and you're wondering, do I have to do anything? Remember these three criteria. Number one, if you have employer group health insurance, which you do. Number two, you have it because you're still actively working for the employer providing it, or your spouse is actively working for the employer providing it. And number three, that employer has to employ at least 20 people. If you meet all three of these criteria, you are not going to be penalized by waiting to start Medicare until later. Again, three months before the process, we'll want to talk to you. We'll help you get signed up for part A if you haven't already. And then there's going to be a couple of forms to fill out. One of them signed by your employer. That's your golden ticket, Eunikia. Your employer will sign a form that says, don't penalize her. She's been working for us, covered by us every month, every single month, by the way, since August of 2026. You can even change employers before going on Medicare, just make sure you don't miss even a single month of employer group health insurance in the meantime. And then Medicare lets you sign up for Part B, and part A for that matter, later, as late as that needs to be. You know, last year I helped a guy retire and go on Medicare at 92 years old. Wow. No penalty, Unikia. None at all. That's amazing.

SPEAKER_01

My oldest so far has been 83. So 92. Work that long. That's amazing. That is. Okay. A couple things, uh Unique, I would like to add to that. Uh are you contributing right now to an HSA at work? An HSA called the Health Savings Account. Okay. What we would recommend you do, and you can do it now. I would tell you if you don't have an HSA and you know you're not going to have an HSA between now and 67, then I would go ahead and sign up for Medicare A only. I would. You don't have to. You're not signing up because you're worried about a penalty. You're just signing up because what's going to happen is there's a possibility if you ever got hospitalized that Medicare could pay. Now they pay second. Your group plan is going to pay first. So there is no harm at all in getting Medicare A only all set up. And you can do that. And again, you don't have to. We can take care of that down the road. But I would if I were you. And they'll issue a Medicare A-only card. There's no cost for the Medicare A premium. So to me, that's a good move. And then 90 days before you get ready to retire, contact us or whoever. We'd love to be your broker, but contact us and we will uh help you with that paperwork that Justin uh talked about. Uh we'll initiate it, we'll we'll fill it all out for you, we email it to you, you get it to the employer, and then to Social Security office. And so that's the process. It really, really is uh very simple, and we'll hold your hand at that time. Okay, now let's address for her. Uh you're in a very unique situation. You have TriCare uh Prime, which will become TriCare for Life when you go on Medicare. Now, is that because you served in the military and retired, or is that your spouse?

SPEAKER_03

No, that is that is because I served, and the other thing is I have to go ahead and sign up for the Medicare Part A and B for my ID card, which is about to expire next month. So I am signed up right now for A and B. Okay, well I have to do that. Otherwise, my TriCare for life would disappear.

SPEAKER_01

Well go away. Okay. I I do not think it works that way, Uniqia. Okay, I really don't. Justin what you do weigh in. Let me let me just talk to you though, just for a second. No, no panic. I'm just saying to you this. If you have a group plan that is paying first, TRICARE uh for life uh will pay second to that to that group plan. I do not think you have to have a you now if you didn't have that group plan, you would have to have A and B. But because you do, you need to get back hold of TRICARE and say, hey, I have an employer plan, they pay first. So I think, and it's not too late, I think you are gonna have every right to go ahead and drop the B, the B that you're gonna have to pay for every month.

SPEAKER_00

So Justin, please weigh in. You know, uh I was gonna ask you this anyway. You do you know how much that employer group health insurance is costing you on a monthly basis?

SPEAKER_03

Nothing. Not for me.

SPEAKER_00

Nothing at all. Yeah. Are you using it to provide health insurance to anybody else in the family right now? No. Okay. Yeah. So Yeah, I mean, having Medicare and Tri-Care for Life is really, I mean, between you and me, it's the best kind of insurance you'll ever have in your life. It's fantastic coverage. But if you really don't need to pay the $203 a month for Medicare Part B just yet, and I also think you really don't, you're not required to, um we can help you get rid of that part B as a simple 1763 form.

SPEAKER_01

Yeah. And we'll of course she she signed up herself. So you're right, she went auto-enrolled, so there is a form that uh would allow you to disenroll from part B. Uh Justin, would you mind if she called you? No. Okay. Yeah, Unique, uh I want you to I want you to call our number and ask for Justin. And if you can't reach him, just leave a voicemail, he'll call you back, okay? Uh because and again, all all we're we're all we're doing is telling you what we would do if we were in your position. I I think you can drop the B. It it in my opinion, it's a it's a waste of money right now. You don't have to pay it because your group plan is gonna pay first. TriCare uh will will be in that second pair position. But Justin will show you how to disenroll from this. It really is quite simple. And it's not too late because your your your B is not going to affect until August, and then what will happen is then you'll drop the B and you'll have A only until you get ready to retire. I know that's gonna work for you, but he'll he'll he'll double check on that with you, okay? Got it. Got it. Okay, I shall do that. Okay, do you have our our main num not not the show number, but the number to call our office? I'll give it to you if you don't. Thank you, please. Okay, 800 782-6676. 800-782-6676, and ask for Justin Cohen, and he'll take good care of you, okay?

SPEAKER_03

I appreciate you. Thank you so much.

SPEAKER_01

You are very welcome. It's you're nice to talk to you. Have a good rest of your day. All right. See you later. Bye-bye.

SPEAKER_03

Thank you. You as well. Bye-bye.

SPEAKER_01

All right, we're gonna go to Carol in Oregon. Carol, welcome uh to the show. We're glad to have you. Um what questions can we answer for you today?

SPEAKER_04

Well, my question, and I'm sure you've never heard this before, is uh we're we're getting kind of priced out here on our supplements. Okay. Um and my concern is my husband's had you know some health issues, nothing major, but nothing light either. And um I haven't had any, but we keep going up like thirty percent, thirty percent, thirty percent. And we're talking year after year. Um it's I'm hesitant to ever make any change because changes seem to not work out like they present them. Sure. Not that people deliberately mislead you, although I believe they do.

SPEAKER_01

Uh hey Carol, are you are you all on F plans or G or N plans? What are you on? G? You're on G plans. Okay, sounds good. In in Oregon, I know it's and it's a birthday rule state, so I know there's times that you can move and not so is what what are you paying right now for your Aetna G plans?

SPEAKER_04

Well, currently uh you want the one he's gonna get because I already know what his increase is gonna be.

SPEAKER_01

Oh, sure. Let's compare apples to apples, that's perfect. Yeah. Okay. Uh his is gonna be two eighty-six. 286. Okay. And what are you what are you paying right now? I'm paying 240. 240. But mine will be 312. 312. Well, that's just that's a steep increase then. Okay, so uh Justin, do you have everything you need to look at some rates for them for um switching?

SPEAKER_00

Yeah, Carol's gonna love this. Uh your ability to change around the month of your birthday is gonna save you guys quite a bit of money. Hus your husband's rate could be as low as between $160 and $175 per month, depending on the carriage we choose.

SPEAKER_01

So one sixty to one seventy-five for him, so that's gonna go down a little over a hundred dollars uh for him. And how about hers? The same. Same? About okay good. The same. Okay, very good. Yeah, ladies are a little bit cheaper as a general rule, anyways. You get a multi-policy discount, I'm assuming, on that. And so uh so Justin, specifically, what is is the birthday rule sixty days from from uh birthday in Oregon, or do you know? Because I I don't is is that what it is?

SPEAKER_00

Each carrier is allowed to have a little bit of variation on that. But generally speaking, Carol, we're gonna want to talk to you uh the month of your birthday before your birthday, if possible.

SPEAKER_01

All right. So him now. All right him now. So let's let's talk about him, uh, and then uh we can, of course, you know, quote yours and everything, and you get that household discount as well. So that's what I would do. The other option, just which I guarantee you that's exactly what I do. Let's let's let's move you. Uh we'll help you with that move. Uh do you have uh our number? In fact, you know what I think you ought to do, if you don't mind, when you call in, why don't you ask for Justin? Yeah, I mean that. Just just ask for him. Will that be the easiest way or do you have a direct line she can reach you at? How do you want to do that?

SPEAKER_00

Any of the receptionists that answers the call, just ask for me, Carol. I'll be happy to help you. We'll get specific rates, we'll review your drug coverage, we'll make sure you guys are all set and not wasting any more money.

SPEAKER_01

Yeah, please ask for Justin Cohen, C O H E N. He'll take good care of you. Uh he's just a just a wonderful agent. Okay, let me give you our office number or do you have it?

SPEAKER_00

800 782 6676.

SPEAKER_01

All right. 800-782-6676. Ask for Justin and he will help you. We'll go through all the details. And uh we're we we don't talk a lot about the carrier specifically on this program because you know there's certain rules, but we we he'll tell you everything you need to know, I promise you. Okay, Carol.

SPEAKER_04

And does the coverage make any difference? I mean, is there any changes?

SPEAKER_00

Oh, forgive me. I take that for granted. Uh no, there won't be any difference in your coverage. We won't be changing your primary insurance. That's Medicare A and B. You'll continue to have access to any provider in the country, no preauthorizations. Not one carrier pays better or worse. They're all charging different prices per gallon for the same gallon of plan G gas. So we'll get you absolutely everything the same, just more money left over for the year.

SPEAKER_04

And why why is there such a difference?

SPEAKER_00

Well, why do two gas stations charge two different prices per gallon, different overhead?

SPEAKER_01

Yeah, and also because you've been in that group for a while. So that group uh no longer has new money going in, so people pass away, uh, people switch plans, people do what you're gonna do, and that's get off of it, so that group begins to shrink. And so the the burden of those health care claims are not spread out to as many people. Uh so that group shrinks, and that causes those rates to go up. So I'm grateful you live in a birthday rule state because now even with your husband with the AFib, there's no health questions. Now, uh the majority of states don't have that. Uh Oregon does, but in most states, uh he probably wouldn't be able to switch. Now you could, uh depending upon your health, but uh you don't have to worry about it in Oregon. No health questions asked, and just can Justin can help you make that move. Okay, Carol? Any anything else?

SPEAKER_04

Uh yes. Um Go ahead. Now, how the Medicare keeps going up all the time, and there's no control over that, obviously. That's correct. Right.

SPEAKER_01

Yeah. Now are are is your all is the income above two hundred and eighteen thousand a year? No, not at all. Okay, okay, all right. So you should be paying right now $202.90, and we say expect that's probably gonna go up a little bit. Hopefully it'll maybe, you know, five, ten dollars or whatever. We're not sure yet. We won't have those numbers for a few more months, but uh it usually doesn't go up crazy high. Okay.

SPEAKER_04

Yeah, that one didn't seem crazy like the supplement game.

SPEAKER_01

Yeah, the supplement you get you got a hefty increase on that. So again, it's primarily listen, Aetna's a good company. Uh it just so happens you're in a group that's just getting smaller and smaller. Because that's the only way they can raise prices is if that group is losing money, and they clearly are. More money is going out in claims than it's coming in through premiums. So uh the state insurance insurance commissioner uh authorized them to raise the rates in your group. So we're just resetting the clock, putting in a new group, younger, healthier, larger. Uh so I think I think it's gonna be a good move for you, Justin. Uh, we'll take great care of you. And they're credible groups. Oh, sure. I promise you. In fact, I I'm not sure who you recommended, but I think it's probably the company I have. Uh so anyway, so no, he'll and he'll go over on that with you on the call. No, no, yeah, it's your choice.

SPEAKER_04

But it it makes you nervous as you get older and there's any health issues that everything is gonna be fine.

SPEAKER_01

But the only thing's changing is the is the name on your card, I promise you. Uh you'll move from Aetna to another carrier, and that's it. A G is a G is a G is a G is a G. No coverage difference whatsoever, because there can't be. Medicare standardizes the plan, and no matter what carrier you go with, uh they pay the same bills, the same type of bills, the same amount of bills, I promise you.

SPEAKER_04

And that should be probably the best place for us to be anyway in a G, from what I understand.

SPEAKER_01

I that's what I have, and I sure would be. Now just not old enough to be on Medicare, but uh I am, and I have a G plan, and I'm glad I do.

SPEAKER_04

One last question.

SPEAKER_01

Yes, ma'am.

SPEAKER_04

The this Medicare advantage, I view it as a nightmare.

unknown

Mm-hmm. Mm-hmm.

SPEAKER_01

Well, we view it as a nightmare as well for most people. Okay. Okay, now especially when they have problems. Now here's the thing. I want to, you know, I want you to know and really everyone to know that there are some times when people have to do an advantage plan. The reason is because it just may not fit in their budget uh to uh have a supplemental plan. And that happens uh because you have to pay a premium. In fact, I'll I'll be frank with you, Carol. Um uh there are people that are in your situation that that live in states where they cannot get off of their um uh their supplemental plan like you get to do. Uh so those rates bump up so much and they're pushing 85, 90 years old, whatever, and they can't afford uh their subinental plans any longer. And sometimes we have to tell them your best move is to go to an advantage plan. Because really it's their only other option because they can't afford it. Fortunately for you, we're gonna, you know, jump drop this thing down, you know, $100, $120 every single month. So it's still gonna be within that really attractive, affordable range for you. Okay? Yes, yes. Yes. So I wouldn't do an advantage. Thank you. Uh some have to, and and there's no shame in that by any means. But uh advantage isn't bad insurance, but again, you can't go to any doctor you want to. You have to go to network docs. You have pre-authorizations you have to deal with instead of where you, you don't have that. Medicare covers, the something look plank covers, no interference, uh, nationwide coverage. There's just so many wonderful benefits to control.

SPEAKER_04

Which is just unique unique to Oregon and G.

SPEAKER_01

That's right, unique to Oregon and G, and there's other states as well: California, Washington. Uh, there's a few states that have the birthday rules as well. Not not most for sure, but a few do. And uh you get to take advantage of that.

unknown

Okay?

SPEAKER_01

Wonderful. All righty. Well listen, it was great talking to you. We appreciate it. Give Justin a call, he'll take care of you. Okay? Thanks, Carol.

SPEAKER_04

I will. Thank you. Okay, bye bye. Bye-bye.

SPEAKER_01

All right, we're gonna talk to Lawrence in Colorado. Lawrence, it's uh Marvin Music. Welcome to uh Medicare School Daily. Uh, what kind of questions do you have for us, sir?

SPEAKER_02

Uh good morning. Good morning. I uh I am a disabled person. I uh lost my right leg to uh a bone infection, and I'm on social security disability and on Medicare.

SPEAKER_01

Um Is that Medicare A and B, Lawrence? A and B, I'm assuming. Yes. Okay, good. Just wanted to make sure.

SPEAKER_02

Yeah, I'm um I'm on uh sorry. That's all right. Yeah, tell us what you're doing. I've been I've been uh I've been dealing with uh like 123 calls in the last week alone. And it it's just it's like that almost every week of spammers and scammers calling about Medicare plans and uh it's just it's just incredible how much how much I how many automated calls I'm getting.

SPEAKER_01

Sure. Well let me ask you this real quickly. Beyond the A and B, uh do you have other insurance such as a supplemental plan or a Medicare Advantage? What do you have?

SPEAKER_02

I have a Humana supplemental plan.

SPEAKER_01

Okay, very good. Is that a G plan or an N plan? Which one?

SPEAKER_02

I believe it's a C and D. Okay. I don't know what I don't know what a G plan is.

SPEAKER_01

Okay, and that's fine. So a Humana uh C and D plan, just that would be a Humana Advantage plan, is what you're on. Right. Um and I'm not every state's a little bit different. There are actually many states where you cannot even get a supplemental plan if you're uh on Medicare prior to age sixty-five. So would that be the way it works on that one, Justin? Colorado allows it. Uh they're just extra expensive there. Yeah, yeah. So uh Lawrence, uh I do we just want to have a good understanding of what you have, and then so uh so go ahead if you can just ask now specifically what questions do you have for us.

SPEAKER_02

Well, the only thing that that they keep dangling that uh has any interest to me at all is that they they keep talking about Medicare plans that offer yeah, food cards or you know, that that that offer uh you know a um a debit card that you know gives you like $150 a month for paying uh bills like utilities and uh groceries and things like that.

SPEAKER_01

Okay, Lawrence, are you on Medicaid as well or just just Medicare?

SPEAKER_02

Just Medicare. I was a IT professional and I made I used to make enough money to uh uh yeah that that my social security disability takes me out of the poverty level so that I don't uh I I don't qualify for Medicaid, at least at this point.

SPEAKER_01

All right. Sounds really good. So I think uh we have a good understanding of your situation. Uh and it is very common for um Medicare Advantage agents to try to dangle a few carrots uh to see if they can get you to bite so that uh they can begin to try to uh come up with an uh another plan for you and try to get you to switch a plan. Uh so first off, and what I'm gonna do, I'm gonna I'm gonna let Justin weigh in because he's on the phones every day, all day talking to people that ex having the same experience that you're having. Uh but right now, just so you know, as a general rule, you're really outside the window where you can do anything. Uh what they're trying to do is uh find out if you have Medicaid eligibility or trying to find out if there's a chronic kind of a condition. Uh but that's that's the game that's played by Medicare Advantaged agents. Uh and by the way, I'm on Medicare. I get those calls every day as well. And so uh that's just that's just what they do for a living, trying to get people stirred up to get them to doubt the decision they've made, to see if there may be some uh plan out there that's better. Probably it's not, uh at least not at this time, but that's that's kind of the the that's what's happening to you. So Justin, if you weigh in and uh talk to Lawrence a little bit about the situation with the food cards and all those kind of things, please.

SPEAKER_00

Yeah, Lawrence, thanks for calling. Um I wish I knew a way to get them to stop calling you, but uh the truth of the matter is they're not gonna stop. Um aside from the lack of a food card and these other benefits that they're mentioning to you, is there any trouble with your plan?

SPEAKER_02

Is it not allowing you to see the doctors you want to see, or is it No, no, I I I I've got I've got a decent plan that uh, you know, and I was on a uh a a different plan that had been you know kind of tailor-made that uh when I lived in Loveland, Colorado. But when I moved way out in Sterling, Colorado, which is way up in the northeastern plains of Colorado, way away from the Denver metro area, um, I was disqualified from the plan I was on, and I had to change to uh the Humana plan. Makes me there weren't there weren't that many there weren't that many plans out here that supported you know rural areas.

SPEAKER_00

Right, gonna be less options the farther out from town you get. That's right. But uh as long as you've got something that allows you to see the doctors you need to see that covers the medications you need covered, that doesn't, you know, toss you huge medical expenses. Generally speaking, everybody that calls you just wants to put you on something else so they can get a commission. Yeah.

SPEAKER_02

Um Yeah, I I I beat dialysis and everything else after losing my leg. I was in the hospital for uh for a half a year. And uh lost I lost everything. But uh I was able to get my health and uh back up to the point where I don't you know all I'm now all I'm on is just uh a blood pressure uh blood pressure medication and my blood pressure is almost back down to normal.

SPEAKER_01

All right. Well hey, that that's thrilling. So I think uh really our advice to you is stay where you are, hang up when the you know you're getting these phone calls. But here's what I'm gonna ask you to do, Lawrence. Um as we approach the next season of of Medicare Advantage switches, which is October 15th through December the 7th, uh we'd be happy to at that time to see if there would be something better. But the 2027 plans uh do not officially come out until October 1. Uh however, sometimes it's it the first couple weeks of October uh uh then eventually we're we'll have everything by the 15th. So we would be happy to discuss other options with you. And there may not be something better for sure. Uh that may be the best plan for you even going into 2027. But here's what I want you to to know. You are going to enter into an opportunity for you to get a supplemental plan at and at not a crazy high rate. And that's going to happen for you in December of next year, 2027. You came into Medicare through disability. Uh the supplemental plans in Colorado, uh, the insurance commissioner allows supplementary. The carriers, insurance companies, that charge high rates on those. So that puts most people out of the market. So that's why you're on a vange plan. But I'm telling you, uh come December of next year, you're going to be able to get a supplemental plan. In Colorado, the rates are very good there. Uh you can get a G plan, you can get an N plan. Both of those are wonderful options for you. Uh and you do not have to go to the G and N. Okay, hang on just one second. And you I want you to know this you you do not have to go through underwriting. So you came into Medicare through disability. We call that your IEP2 initial enrollment period. I mean, excuse me, my initial enrollment period one. But in December of next year, you'll be in your initial enrollment period two. And the point is you're going to have a chance to reset the clock to start all over. Now, your your Medicare number is the same, your A and B dates are the same, but we actually could submit a MedSup plan for you effective 12-1 of 2027 that the insurance company uh will approve. They cannot deny you, regardless of any health conditions you have. So you want to take advantage of that. And you can come off the advantage plan then, and then when you go on that supplemental plan, yes, there's gonna be a small premium, but you're gonna get a lot of bang for your buck for that. Okay, so I'm gonna have Justin just real quickly uh I talk to him about that. What's the G, what's the N? Explain that if you could, and then also the why I I'm making that recommendation, because you know why.

SPEAKER_00

I do. Yes, it's gonna be an important opportunity, Lawrence, because it might be the only other opportunity you have in the entire rest of your life. See, right now you've replaced your original Medicare A and B with a Humana plan, and not a bad one, uh still a replacement of original Medicare. And the opportunity you'll have is to get what's called a Medicare supplement plan or a Medigap plan, which will put Medicare A and B back in the primary payer position, giving you access to all the doctors, not only in Colorado, but across the United States. You mentioned you'll live in a rural area, sometimes it can feel like a desert for providers. You'll all of a sudden have access to every doctor, every hospital in the country that accepts original Medicare, which is uh, by and large, all of them. You'll no longer be subject to pre-authorizations, you won't need referrals. You'll have 100% nationwide coverage on a plan G. And on a plan N, same thing with a couple of copays. We'll tell you all about it, but be excited, Lawrence. You got an opportunity coming up.

SPEAKER_01

Yeah. So what you'd want to do is basically three months before that, so really time in September uh one on, you could call in and I'll give you the number, but you can call in and then uh we'll take the time to compare your options. Uh we'll we'll quote G and N so you have an idea for that. We'll also help you make a drug plan decision because right now your Humana plan has an embedded drug plan. They selected that plan, and it's probably good. Uh but when you have a supplemental plan, we actually select a separate drug plan, one that fits your meds, your pharmacy, and all those kind of things. But that's something that we'd be delighted to walk through that process with you. Just a little premature to do it right now, but again, uh if you want to look at other advantage, let's do that later this year, October 15th to December 7th, and then don't miss this opportunity to be able to get a good supplemental plan um uh next year in 2027. Okay, so after September 1, we can help. Any other questions, uh Lawrence at all? That's it for now. Okay, sounds good. Hey, we appreciate you calling in today. Have a good rest of one, okay? See ya.

unknown

All right.

SPEAKER_01

Thanks so much for being with us today. Uh tomorrow, I'm already excited about being with you because we're gonna talk about a particular Medicare uh plan that you probably don't know about, but you need to know about. And so that'll be our program tomorrow. We look forward to having you with us uh again. If you need immediate assistance, and sometimes uh people need that. Let me give you the number you need to call uh for immediate assistance. Uh when you call in, you'll get an agent that I know personally that I have trained. Uh that number is 800 782 6676. That's to get an agent, 800 782 6676. We'll see you tomorrow.