Medicare Just Started A New Program That Provides More Coverage

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Medicare just launched a new program that could expand coverage for certain GLP-1 medications.

Today on the Medicare Daily Show, we’re talking about the new GLP-1 bridge program, what it could mean for beneficiaries, and why this may be an important shift in how Medicare approaches these medications.

After we break it down, we’ll be taking your Medicare questions live. We look forward to hearing from you!

Transcript

SPEAKER_00 0:03

Medicare has started a new GLP 1 weight loss program that allows certain people to get these GLP 1s, only certain ones and only certain people, for $50. You're gonna learn about those stipulations, the guidelines, how to get access to it today. Well, welcome to Medicare School Daily. My name is Josh Music. I'm here in the studio with my dad, Marvin Music. And whether you're just starting Medicare, just starting Social Security, you're just now retiring and you're trying to navigate this big governmental bureaucratic system and it's confusing, you are in the right place. You can learn everything you need to know about how to start Medicare right here. In just a moment, you're gonna learn about these GLP ones and how to get them for $50. But if you have a question or you have a sh story that you want to share with uh all of our listeners, we would love to talk to you. The phone number to be a part of the show is 833-824-2004. 833-824-2004. We're here taking your calls, answering your questions from 11 a.m. to noon Central Time every day, Monday through Thursday. 11 a.m. to noon central time Monday to Thursday. So don't let your questions go unanswered. Don't make a Medicare mistake. Call in. We would love to chat with you. So, Dad, let's talk about these GLP ones. Give us the rundown on how people can get these uh and all the guidelines around it.

SPEAKER_01 1:23

All right.

SPEAKER_00 1:24

Sounds good.

SPEAKER_01 1:24

Well, it's interesting about this program, of course, called the Bridge Program. Um there's uh a time when Medicare tried to actually include uh these GLP ones for weight loss only, but Part D sponsors would not get on board. That actually was called the balance program. So really mentioning that is because uh this is really this this new program that just started July 1 is uh uh it's a demonstration. It's just a an opportunity test. How long does it have 18 months? So it will go from July 1 uh this year, of course, to uh the end of 2027. And what they're hoping is that through testing this, through more stats and more involvement and all kinds of things that are gonna go on with the program, that some of these Part D sponsors will then get on board so they can start this balanced program when Medicare is actually going to cover um uh weight loss drugs.

SPEAKER_00 2:16

Why would they why I mean why would a drug plan like I guess from what would be their incentive to be a part of this? Yeah, well the only- Everyone's gonna lose weight. They're gonna come off all their medications. Like if I'm a drug plan, like I make money off people having meds. Yeah. So it's another demonstration.

SPEAKER_01 2:31

Unless they can figure out a way to make a profit on it, there's no way they're gonna participate at all. So I just mentioned that because they they've tried this and it just wasn't successful. But this is good. This is a good bridge, exactly right. So let's talk about the how the how the bridge works, who can uh get their meds this way. But I think the first thing to really specify is that uh if you're uh uh on a um uh medication that would be a GLP 1 for just weight loss, that's the key. Weight loss, uh it uh it can't be for uh type 2 diabetes, it can't be for cardiovascular issues, it can't be for exactly right.

SPEAKER_00 3:08

So if you are already getting it, that's right or you have a medical condition other than weight loss, you're gonna have to get that filled through the normal channels, not through this brick.

SPEAKER_01 3:16

Trevor Burrus, Jr. That's exactly right. RD plans. And so even if even if your cost would be less expensive to get that medication uh through this, you cannot get it. It has to be totally weight loss, it has to go through the pre-authorization process. So if they see that you have already been on this medication prior because of these other health issues, you're not you're gonna get denied. In fact, what's interesting, they said you can try it, you can try, you can try again, but they're not going to approve it. Uh so those of you that are already taking these meds for other reasons, again, uh this bridge program is not for you. All right. So there's some criteria involved, and I think it's worthy to make sure everyone you would understand how this is going to work. So um uh how you qualify is uh has to be based upon body mass. And so there's basically three different levels of body mass. So anyone that has a body mass of 35 or greater right out of the gate, they immediately qualify for this. And and the reason this matters is because you do have to go through this pre-approval pre-authorization process. So the provider that is actually going to write this prescription for you to actually be submitted through the bridge program has to go through through that pre-authorization. So number one, body mass 35 or greater. Uh I don't know, Josh, if you want to discuss what the formula is for body mass dead matter. Okay. So uh and then what happens is anyone uh that's between 30 and 35 uh body mass, they can as long as there's some underlying comorbidities um as as part of you know the other health issues that they have. So plus so it's 30 MI plus what is the pluses? Well, it would be anyone and again, there there's a lot of different terms here, but let's just say basically heart failure. Uh now what's interesting about that uh heart failure, there's different degrees of it. So this is heart failure where there's you know some additional kind of precursors to it. But number one, heart failure. Number two would be someone that has uncontrolled blood pressure. So we again we're talking b BMI of 30 and above, not quite to 35 yet. So that just means on the low side.

SPEAKER_00 5:13

Uh well, I feel like it's always all controlled by medication. Yeah. Unless it's like in a flux where they're figuring out the medication. Maybe I'm wrong.

SPEAKER_01 5:20

No, I I think you're right, because most people we're dealing with have been on blood pressure meds for a while, it has been controlled. But I'm saying that's one of the pressure. Yeah, I understand. And so you know how they have the different numbers. So the first number is it has to be if it's uncontrolled, you gotta be above 140 and or above 90.

SPEAKER_00 5:35

Okay.

SPEAKER_01 5:35

And so if you are, then again, that would be a comorbidity that qualifies, and then also uh chronic kidney disease, uh, you know, uh which is be stage three or above.

SPEAKER_00 5:45

Are you on dialysis at stage three, or is that just stage five?

SPEAKER_01 5:47

Yeah, I I don't I don't really know that. I I'm not sure about that. I just know it's chronic kidney stage three and above is the qualifiers. And so uh 30 above, and then uh then they have another uh lower range, and that's 27. Now this is interesting. This is body mass of 27. Um, and this is someone that uh uh here's the the the comorbidities to be anyone that's pre-diabetic or had a prior heart attack or a prior stroke or has some type of an uh our artery disease. All right. And so anyone below that, in fact, as I was studying for this, I checked my own body mass since 25. So I wouldn't qualify. Um but yeah, the whole the whole point is uh yeah. So that's what they're looking at, body mass.

SPEAKER_00 6:28

Now I want to know what the BMI calculation is. Yeah, I'll give it to you. Okay, you know what is it?

SPEAKER_01 6:32

Oh it is. You you take your weight, so like I weigh 185, and you multiply that times 703. 703.

SPEAKER_00 6:40

Is there an age component in there?

SPEAKER_01 6:41

No. Well, you have to be above eighteen. Oh, so that's not an issue. And then here's how you you just take someone's height in inches and it's height squared. So I'm 511, uh, I think that's 71 inches, so you square that. So 71 times 71. So you take that uh the the the top number um, which is uh you know weight times seven oh three divided by uh your your inches squared, and that is your BMI. Trevor Burrus, Jr.

SPEAKER_00 7:06

You can also just Google BMI calculator and it'll tell you put all that stuff in, it'll tell you exactly what it is. Sounds great. No, I'm just saying that's if you're if you want, just literally Google BMI calculator, a thousand of them will pop up. Type in your height and weight and do it for it.

SPEAKER_01 7:19

Okay, so bottom line, we're below twenty-seven, not gonna qualify. So anywhere from you know twenty-seven up, there's uh you know some criteria. So the way the program is gonna work, there's at this point in time, okay, this will probably change in the future, but as it stands, there's actually only uh two different manufacturers that are participating in the program. There's three meds, but two manufacturers. So Eli Lilly uh has a medication that's called Foundaleo, and it's an oral tablet. They take it daily. That is covered by the program. Uh Eli also has a um uh an injection, uh, but the only one that qualifies is the one that's actually a weekly injection. So it's a pen. Uh what is it called? And it's called Zetbound.

SPEAKER_00 7:58

Zetbound, you've heard of that.

SPEAKER_01 8:00

Yeah, so that's the injection formed by Eli Lilly. Uh Oral was the found found Deo. And then the only other one uh uh covered is uh Novo Nordisk, which is a I think it's a Swedish or Denmark company, uh called the Wagovy. Wagovy. And again, it's a weekly injection as well. So that's it. So you and I know there's lots of other these type of meds, but for now, none of those participate in the program. So what's happening is there are other manufacturers that are developing meds that will probably come on board.

SPEAKER_00 8:26

We don't know if that'll happen, you know, during this 18 years, and these are all I'm assuming these are GLP1s. Obviously, we're almost to GLP3, like because they hit other receptors essentially, GLP1, GLP2, I think like TERS, Zepitite or whatever is called the GLP2, and now there's like red or true tide that's coming out, it's a GLP3. So as these get more and more advanced, obviously they're starting with kind of the things that started. Maybe not uh semaglutide or whatever it is, but like pretty similar. Yeah. Like first generation meds. Right. Which is good. Yeah, it is good. They're the least expensive at this point. Right.

SPEAKER_01 9:01

So we have our criteria, body mass and uh other issues. We know uh what meds are covered only for weight loss, or and you also have to commit to you know, continue to to you know have high uh lifeth changes. That's kind of part of the pre-authorization process. Trevor Burrus, Jr.

SPEAKER_00 9:15

Does it just last forever, the full 18 months, or is there like continuing like No, I'm there's no further pre-authorization. Exactly right. And okay, I have a question. Uh do you do you get this filled at your pharmacy? Does your do you have to tell your does the doctor know what to do? Yes.

SPEAKER_01 9:29

Yeah, because everything is being uh actually processed uh through uh Humana. And so what happened? Humana. Humana's process and the reason for that is because Humana's already put together a network for low-income type situations. Okay. So they're using that same tech uh to be able to.

SPEAKER_00 9:45

Is it all mail order or do you go to a pharmacy?

SPEAKER_01 9:47

No, you you go to pharmacy, so it's very simple. All these companies, or these two companies of these three meds, they set a net price. That net price is two hundred and forty-five dollars. Okay. Net price. So what happens is uh the beneficiary, the Medicare beneficiary, uh will pay a fifty dollar flat copay, and then that $195 then is then submitted um uh uh by the pharmacy and and uh the Humana Network will actually process the payment for the government. So Medicare pays $195, patient pays fifty dollars. There's no discounts, there's no coupons.

SPEAKER_00 10:19

Uh can you so you can go to any pharmacy? Yeah, anyway, that's right. Yeah, I mean pretty much.

SPEAKER_01 10:23

There's really no network at all. Uh huh.

SPEAKER_00 10:25

Is it related at all to your drug plan? Like if you're on a well-care drug plan, nothing.

SPEAKER_01 10:29

It doesn't matter. In fact, they they point that this this stands outside of the whole Part D system. Okay. Right. So you're not going to use in fact you're you're out of pocket $50. It doesn't count towards your own. So it's totally kind of a standalone plan.

SPEAKER_00 10:43

And it's a test. So we'll see how it goes.

SPEAKER_01 10:45

Yeah, exactly right. Uh yeah. So I I think uh you know, if someone uh you know gets this pre-authorized and they have this BMI issues or comorbidities, then I think it's a wonderful thing. Uh I don't think they're gonna be able to get that type of a medication for that that price. Uh so I think it's it it's a great value.

SPEAKER_00 11:03

All right. So I just Google this. Over 12 to 18 months, most people taking a GLP1 medication lose an average of 15 to 22 percent of their total body weight. So you could be down to 20 percent. Right. So if you weigh 200 pounds, that's 40 pounds. Or if you weigh 300 pounds, that's 60 pounds, right? Yeah. What's 50 times 18? Uh half of that would be nine times. 900. Yeah, 900.

SPEAKER_01 11:29

Okay, 900. Okay.

SPEAKER_00 11:31

Whatever it is. Or maybe 50 times 18. We're terrible at this.

SPEAKER_01 11:34

Yeah, no, it'd be nine. It's a nine.

SPEAKER_00 11:36

Yes, $900. So for $900, you could lose if you weigh 300 pounds, 60 60 pounds of the next 18 months on this program.

SPEAKER_01 11:42

Yeah. And what the government is hoping is that uh the you know, as they have the data come in, that uh these Part D sponsors will get on board so that they can continue this because it's a fact that some people, once they get off the GOP ones, that weight comes back.

SPEAKER_00 11:57

I was reading something, obviously I don't know anything about this, but I was reading something where like you you need to stay on it like a year past your target weight, so your cell's like memory resets to like, oh, this is what my new standard is. I don't just need to go and expand. No idea if that's true. This is not medical advice. All right, I'm not a doctor.

SPEAKER_01 12:14

All right. So it's a good plan, uh, easy to participate in. Uh once the doc submits the paperwork, you know, for pre-authorization, uh, go get it filled, and you pay your $50.

SPEAKER_00 12:26

Okay, let's talk to Anthony in Kentucky. Anthony, welcome to Medicare School Daily. Uh, why don't you tell us your question, sir?

SPEAKER_02 12:35

Sure. Uh, first off, good morning. Uh morning. The question I have, I'm a government employee and part of my retirement package. I'm looking at retiring, by the way, the uh end of November. Um part of my retirement package is I have several different options on insurance coverage going forward. Uh, two of those are advantage plans that I'm not particularly interested in. I have one plan that the state offers that is they term it a supplement plan, although there is no letter associated with that. I have looked at the coverage, and it's somewhat comp comparable to a V plan. Um and the last option, I can go and get my own uh individual supplement plan and they will reimburse me for up to $200.

SPEAKER_01 13:34

Um is it $200 a month? $200 a month? Yes, sir. Okay, okay.

SPEAKER_02 13:41

Just want to make sure really I guess my question is if I go with the state sponsored supplement plan and for whatever reason don't like it, can I go to a private supplement plan without going through underwriting?

SPEAKER_01 14:04

Okay. So here's the way it works. Uh if you make that decision within six months of your B date, no problem whatsoever. Uh so where you could have a problem is in the future, beyond six months of your B date, what happens is you have voluntary termination and involuntary termination. So it sounds like to me that you're saying if you don't like it, then you would be voluntarily terminating that plan. And then I would not say that you you're gonna have a guaranteed issue right to go to any plan that you want to. Uh now you may, we can check that every state's a little bit different, but the whole point is uh voluntary termination um uh could restrict your uh you know could restrict that. Uh now let me ask you, let's talk a little bit about this. Um uh the yeah, and you're right, it doesn't have a letter, so we would call that a secondary plan. It's not supplemental, it kind of works like it. And what's what's the premium that you're responsible to pay on that plan?

SPEAKER_02 14:59

Uh this year, and it changes, of course, every year like everything else, but it's right around $200.

SPEAKER_01 15:05

$200. Okay. Does that include drug plan or would that st would that be separate? No, that is separate. Separate. Okay, that sounds good. Have you already retired? I mean, are you are you ready to to start this in July or I mean August or September? Have you already gone on Medicare?

SPEAKER_02 15:21

Uh I've signed up for part A. I am still working and will continue to work till November 30.

SPEAKER_01 15:29

Okay, so very good. So you're looking at about a 12-month start date if you do anything. Would that be correct? Right. Okay, that sounds good. Are are you married or single? I'm single. Okay, very good. Um, and so right now, uh what we're seeing, you know, just with our our our type of plans that we write, uh, the if you want to write this down, the G plan right now is about $215 in your area. Okay. And I just rounded a little bit there. And an N plan $135. Well, that just seems like if you were to go, I mean why would you not go with an N? Yeah, exactly right. I mean, that's that's typically, you know, whenever we see someone that's got a $30 or $40 a month difference between G and N, uh you know, G may make sense, but uh that's that's kind of sizable. You know, we're talking eight dollars.

SPEAKER_00 16:17

Twelve months is fourteen hundred dollars a year. Yeah. So probably gonna go with a plan N if you'd be about a thousand.

SPEAKER_01 16:23

Yeah. Times twelve. Yeah. Yeah.

unknown 16:25

Yeah.

SPEAKER_02 16:26

That turns into real money.

SPEAKER_01 16:28

Yeah. Yeah, it does. It is. So but it's you know, you're you're still pushing a thousand dollar savings there. And that's what you you you have to decide then. We're not telling you not to get a G. If you want a G, and that's that's certainly fine. I went with the G, but in my state, uh the difference was uh $35 a month. Uh but that's sizable. Uh and so I think what you have to look at is um uh what what would be the reason why you think you wouldn't be happy with that secondary coverage? Have other uh people that recovered by the plan been disappointed.

SPEAKER_02 16:59

Well, I can tell you people that love it and people that hate it. I see. The thing that scares me on it is right at the bottom below all the coverage is there's some boilerplate about pre-authorizations.

SPEAKER_01 17:12

Oh, really? Well, that's interesting.

SPEAKER_02 17:14

Yes, sir. Yeah, well that would yeah, that's the thing that makes me a little nervous.

SPEAKER_01 17:19

I would I would pause on that a hundred percent. Okay, so you I don't blame you. Do you take medications?

SPEAKER_02 17:25

Uh yeah, but they're pretty minor.

SPEAKER_00 17:28

Um actually have drug plans and oh you looked at them? Okay.

SPEAKER_01 17:33

Okay. Good.

SPEAKER_00 17:34

There's some zero dollar drug plans. Medicare.go. Yeah. Yeah.

SPEAKER_01 17:38

Josh says there's a few plans in your area that are gonna be very low premium, ones even zero, probably Wellcare, I guess. Or was it Humana has a zero plan there? So that's nice. Well, i if you're if they're already disclosing that there's a possibility of pre-authorization, that just tells me that then uh you know they could they could interfere.

SPEAKER_00 17:56

And not to mention, he's got friends that love it and hate it. You're not gonna find anyone who hates a supplement plan. Yeah. Yeah. And that's true. I mean, like if you're already and I don't understand why we'd go with something that costs $200 a month when you're probably gonna be better covered by an end plan on the private market for $135. Right. And $10 for a drug plan.

SPEAKER_01 18:13

As you as you think uh Anthony, as you thought about G versus N, were would you be leaning towards an N plan? Are you aware of the differences?

SPEAKER_02 18:21

Well, I've I I am tried in the last six months to educate myself on some of this, and it's pretty darn confusing, honestly, some of it. But uh Yeah, I've looked at both the G and the N. The uh the supplement plan through the state is most comparable to a G plan.

SPEAKER_01 18:45

And that's why I was floating the you just have to meet we have a deductible you have to meet, and pretty much uh you're done after that.

SPEAKER_02 18:53

Pretty much, yes. And actually, they're a little bit better on a couple of coverages than than your G plan is, actually. But they can get into like skill nursing and stuff like that.

SPEAKER_01 19:06

Wow. What would what if you don't mind, what what would they offer beyond what the Neural Medicare with the G plan offers in skill nursing setting?

SPEAKER_02 19:14

Uh skill nursing is zero after you're deductible for days one through one hundred, then twenty percent uh for one hundred and one through three hundred and sixty-five. Uh this plan pays one hundred percent of your Medicare part A for the 21st through the 100.

SPEAKER_01 19:35

Uh-huh. Yeah. Well, that's exactly the way, yeah. Now that what what what that differs from would just be the days after 100. And uh honestly, I've been doing this 17 years and never heard of someone covering after 100 days. Uh so but the G would be just like that. Uh G is going to cover your A deductible, then G is going to cover everything from days 21 to 100. Uh you'll you would not be out of pocket. But that that other thing beyond uh 100 for skilled nursing. Average day right now is about 40 days or so. So over 100 days, that's oftentimes more of a long-term care situation versus skilled nursing. But you're right. That that's that's definitely different. But we also have to deal with that pre-authorization. So to me, that's kind of what it boils down to. Is there was there anything else beyond skilled nursing that uh that looked like that plan may be favorable? Yeah.

SPEAKER_02 20:23

Uh other than that, it's pretty much comparable.

SPEAKER_01 20:26

Yeah, yeah, that makes sense. Yeah. And I would say that is uh they know there's probably that's probably never gonna happen, or very, very small risk. So that's probably why they're covering that. But hey, and and you know, uh you got a few more months to think about it. So if you want us to help you, we'd love to. Just one more thing before we let you go, because we've got a couple of people waiting. But Anthony, remember, as you come into Medicare, you're you're gonna have to come in, you know, using that special enrollment uh period. So you've got your uh L564 that your employer will need to complete. You initiate it, they complete it, and then you have your 40B that's gonna select what day you want to start your Medicare coverage. Okay? So don't forget, you know, you don't have to take care of that. And you cannot do that any sooner than 90 days of when you want to start your plan. So if you do want to start December 1, uh you know, then you can start that what uh October yeah, you can start that anytime after September. They will not process those documents any sooner than 90 days of your of your um uh requested effective date. Okay?

SPEAKER_02 21:23

Uh I'm I'm making some notes here. Okay, yeah.

SPEAKER_01 21:28

Some people get anxious and they're ready to get it done, but that but you can't have those documents dated any sooner than 90 days. So again, for you, if you start 12.1, uh that's gonna be anytime after September 1, you can get those completed and upload them into Social Security or drop them off at an office. Or if you start 1 1, you know, you just start that then after October 1st. Okay. And we'd love to serve you, sir, if you decide to to not uh be in that um you know secondary plan with your work. Uh we'd serve you, help you do all this stuff for you and with you and be available for you, you know, down the road as uh things come up and things happen. Yeah, claim issues. Okay. All right. Well, hey, we appreciate your call, Anthony. It was uh nice to talk to you and stay in touch with us. And do you have our our main number if you do decide to to um not go on the group plan?

SPEAKER_02 22:11

Uh yes, sir, I do. Okay, sounds good.

SPEAKER_01 22:14

I'm uh a regular listener to your to your show. All right. Well, hey, we appreciate that. Keep it up. Have have a good rest of your day. Take care, Anthony. We'll see you, sir. Okay, thanks, sir. You guys have a good holiday.

SPEAKER_00 22:25

Yes, you as well. Let's talk to Linda in Pennsylvania. Hi, Linda. Welcome to Medicare School Daily. I understand you have a question about changing brokers. Can you tell us about that?

SPEAKER_04 22:38

Yes. Yes. I have a very reputable broker. I mean, he's local, but he's very good. Um, very benevolent. He he took a lot of time with me when I needed to sign up for Medicare.

SPEAKER_00 22:53

That's amazing.

SPEAKER_04 22:54

I couldn't get to him, and he actually spent an hour on the phone explaining the differences between original Medicare and an advantage.

SPEAKER_00 23:03

Gotcha.

SPEAKER_04 23:03

And what did you end up with?

SPEAKER_00 23:06

I'm sorry, go ahead. What did you end up with?

SPEAKER_04 23:10

I ended up with a pl well at the time, this was back in 2018.

SPEAKER_00 23:16

Okay.

SPEAKER_04 23:17

I took the Cadillac, I took the Plan F.

SPEAKER_00 23:20

Oh, okay. Okay, sure. Because you could still get it. Okay.

SPEAKER_04 23:23

But then it was getting too costly for me, so then I did drop down to a G. But but but my question was was he's a few and and I wouldn't trade I wouldn't change him unless he unless he retired, which would be my question. He's only a few years younger than me. If you would happen to retire, I know I can't change brokers without changing plans. If I wanted to stick with my G, I would have to stay with him, correct?

SPEAKER_00 23:57

That's yeah, that's generally generally correct. Yeah, you're not the insurance companies will not allow you to change what's called the agent of record, usually without changing the plan.

SPEAKER_04 24:07

Right. But if he would retire.

SPEAKER_00 24:11

Yeah, I mean your contract is your contract.

SPEAKER_04 24:19

And go from a G with him to a G with you.

SPEAKER_00 24:22

Well, what state are you in, Pennsylvania? Pennsylvania.

SPEAKER_04 24:25

Pennsylvania.

SPEAKER_00 24:27

Yeah, it doesn't really work like that. It's him retiring. What would probably happen is he's either just gonna stop answering your phone calls or he's gonna have somebody else in the office that he has, and I'm gonna like you can't see me, but use air quote, sold his book of business to to service that book of business because there's probably still some work to do.

SPEAKER_04 24:46

Okay, because he he is in the office alone. He is he's just the one one man operation.

SPEAKER_00 24:52

Well, maybe you find somebody to transfer it off to. I d I don't know, but you may end up kind of just orphaned, we call it.

SPEAKER_01 24:58

Yeah, well let me let me make this suggestion as well. As long as you stay healthy, it is always wise uh to reshop your plan every two or three years. So right now, by the way, I appreciate your loyalty. Uh we have people just like that. They would not move from us. And I'm glad you're gonna be loyal to him, and I think you should be. But down the road, if he does retire, uh then um you can reach out to us. We'd be delighted to see you know where the market is. And it could be, and again, I'm just making this up. You may be with Cygna, and five years down the road, uh United Healthcare may have a better price or whatever. So as long as we can get you medically qualified, we can move you to another carrier at a lower price. We would want you to win in this too. Uh, but that'd be a way this could also happen. So did you come in under in disability?

SPEAKER_06 25:42

Yes.

SPEAKER_01 25:42

Okay. Because you said 2018, so yeah, that makes sense.

SPEAKER_00 25:45

So how is your how is your health?

SPEAKER_04 25:48

Oh, my health is great. It was a um well, I hate to say it on air, but oh you're fine. You don't have to worry about it. Yeah, yeah, sorry.

SPEAKER_00 25:55

All all is well. What are you are you neuron plan G? What are you paying for it?

SPEAKER_04 26:00

Uh right now it's it just went up. It went up twenty percent.

SPEAKER_00 26:03

Okay.

SPEAKER_04 26:04

But it went up to 169.15.

SPEAKER_00 26:07

Yeah, I mean that's still a great price. Yeah, that is good.

SPEAKER_01 26:09

So, and and obviously he's not ready to retire yet, but when he does, that would be uh my recommend recommendation to you. Uh reach out to us and let's see if we can improve your position, and we would be happy to do that. Yeah. Um great, great. Okay.

SPEAKER_04 26:23

And I also had a story. Okay, well, this happened a few years ago. This happened a few years ago. And I'm not gonna mention the carrier um uh for my part D.

SPEAKER_00 26:36

Okay.

SPEAKER_04 26:37

It was in December, it was during open enrollment, and they had called a couple times and I ignored it. Then it was in the evening one night, and I thought, well, oh well, maybe there's maybe there's something up with my plan or something, maybe something happened. So I answered. Here he was trying to sell me an advantage plan.

SPEAKER_01 26:54

Of course. You're broke your broker?

SPEAKER_04 26:56

No, no, no, no.

SPEAKER_00 26:57

Somebody from the drug plan. Yeah.

SPEAKER_04 27:00

The drug plan.

SPEAKER_00 27:01

Yeah, which carrier was that? I'm curious to know. Yeah. I I believe it was Humana. Humana, yeah. They're pretty notorious for doing stuff like that. They're aggressive, welfare can be aggressive. Because they're gonna make way more money if they can get you on an advantage plan. So it's in their best interest to call through every single drug plan member and try to switch them to an advantage plan. Yeah.

unknown 27:20

Yeah.

SPEAKER_04 27:20

And so he is like, um, oh well, we can do this, we can do the gym memberships and this and this. And I said, Are you gonna pay all my claims?

SPEAKER_00 27:29

Maybe. Yeah.

SPEAKER_04 27:31

And it was like violence. And then he goes, Well, no. I said, Am I not gonna have copies? Well, yeah, you'll have copies. Yeah. I said, then I don't want you.

unknown 27:44

Yeah.

SPEAKER_00 27:44

Isn't that frustrating how frustrating how actually he hung up on me? Yeah. Well, you weren't a prospect in the city.

SPEAKER_04 27:51

He hung up on me.

SPEAKER_00 27:52

Yeah. It's frustrating how yeah. 80% of this industry at least, they just want to push an advantage plan. And we're not anti-advantage plans, but you they they just talk about the pros, they don't talk about the cons, they don't talk about the co-pays, they the max out of pocket, the pre-authorizations, the network limitation, all of these things. They just talk about, hey, you can get a free gym membership. Okay. I don't even go to the gym. Yeah.

SPEAKER_04 28:19

And I'm thinking when the time comes, if it if this gets too out of line for me, I'll just go down to an inn.

SPEAKER_00 28:27

Yeah, go down to an inn. Yeah, it's a great, great move. You know? No, I mean, I don't I wouldn't say it's I wouldn't say it's necessarily better. Uh in Pennsylvania, they don't have excess charges either. So the only difference really for you is if you happen to have care from a provider out of state um that happened to have an excess charge. I mean, that'd be a pretty rare scenario, but if it did, then that would because excess charges um, you know, are kind of a state thing. So if you had a plan in, and let's say you went into, I don't know, Ohio or something and had some service and they charge an excess, that could become a deal. But that's so rare. Um and then you have a $20 copay for seeing your doc or $50 for the emergency room. Yep. It's a good move for you know, maybe you're what how old are you? 67? Yeah, 70, 75, 70, 19. 67. 67. Yeah. That's good. Okay, Linda, we're gonna get to our next call. Appreciate you. Thanks so much for calling. Stay in touch.

SPEAKER_04 29:20

Thank you so much. And you you guys are great. And I I've been listening to you for years, and it's just awesome.

SPEAKER_01 29:25

Appreciate the encouragement.

SPEAKER_00 29:28

Okay, let's talk to Jody in California. Jody, understand you want a Medicare supplement plan G and you want to know about premiums and any customer service issue. That's what popped up on my screen. So tell us what your questions are.

SPEAKER_03 29:41

Yeah. Yeah. So I had cancer. I'm trying now, but want to make the best choice because I'm turning 65 in October. Um, so about to sign up probably this weekend for Medicare. Congratulations. Then we'll thanks. And then um, yeah, so I know that there's various plan G's, and I heard that there's a plan G extra. So just would love as much information as possible is the best way to go for me.

SPEAKER_00 30:11

What was this? The the plan G extra. Uh what carrier was that?

SPEAKER_03 30:16

I I I just heard through the grapevine that there's a plan G extra that covers like I don't know, international travel or some extra little benefits. Um I don't have specific information.

SPEAKER_00 30:31

Yeah. Sometimes you sometimes carriers try to so they, you know, all these plans are standardized by Medicare, right? So there's not technically a plan G extra, but sometimes a carrier will be like, okay, how could we toss in well not a gimmick, but you toss in something and then they'll call it an extra or a plus or whatever. So I see. Okay. That would that would not be like something that would be offered by probably anything more than maybe one carrier.

SPEAKER_06 30:57

Yeah.

SPEAKER_00 30:57

Um it doesn't mean it's not legit, it doesn't mean it's bad.

SPEAKER_01 31:00

It's typically you have some kind of a marketing um tactic really that they use. We've had we've had carriers that would uh even on a seminal plan throw in a gym membership or some kind of a dental benefit or something like that. And that may really uh be good. Uh I will tell you that all the G plans are going to cover uh some foreign travel emergency benefit, uh, and that is uh $50,000 a lifetime. So if you were outside the U.S. or outside the U.S. territories, uh all the G plans will pay up to $50,000. Um it's $80, 20. The insurance company pays 80 percent, you pay 20 percent, but their 80 percent stops at 50,000. All right, so that wouldn't definitely be any difference, unless they're gonna you know make maybe make that a richer benefit, I'm not sure. Um but I think you're wise in looking at Gs. Um I'm on a G. Uh I'm just a few months older than you, I started in January. Uh but uh as far as the G's go, I know in California I think there's a there's a uh a slight difference between G and N, but it sounds like you've done your homework, so you've pretty well decided G is gonna be the best fit for you. Would that be correct? Okay, good. Yeah. And you've got a history of cancer, so I I don't blame you. You know, something I I hope it stays in remission forever. Uh but if not, at least it gives you the possibility if you had to go to a uh you know a cancer specialty uh you know facility that did charge excess. We know that G is gonna cover that. So And if the extra little bit of money is no no big deal in your budget, then I think G is wonderful. That's what I did. You know, it just didn't matter to me.

SPEAKER_00 32:35

I got a question for you. Are you you single, married, do you live with someone?

SPEAKER_03 32:40

Single.

unknown 32:41

Okay.

SPEAKER_00 32:41

I am single. Okay, okay. Sounds good. So I know there are some discounts. I was just gonna run some little rates here just to give you kind of a ballpark range.

SPEAKER_03 32:48

That'd be great. And then and then, you know, I've been with United Healthcare PPO. Um it's been a frustrating experience, and I don't know because I've only been with them if that's just sort of across the board with insurance or if there are better options available to me.

SPEAKER_00 33:05

What what's been frustrating about this? About that.

SPEAKER_03 33:10

Oh, I mean, it's just your classic sort of like everything gets lost in the shuffle. I have to submit claims over and over again, and then I mean, I'm dealing with it now. It's it's it's a weekly issue. Well, um and I it feels like deliberate sometimes that you know they make it so complex and everything.

SPEAKER_00 33:35

I I will say this, you know, we hear those types of stories uh from people who have advantage plans more often. If you're on a supplement plan, like a plan G or a plan N, it is really easy. Not to say there's not ever a billing issue or a coding issue that happens, but it is very, very rare. Yeah. The way I mean, by law, right, it once Medicare pays their part, then the supplement plan is you know, they're going to pay um whatever they're responsible for 10 times out of 10. You're not gonna have the runaround, you're not gonna be fighting over networks, you're not gonna be fighting over is this covered or is that covered. Once Medicare pays this part, 10 times out of 10, they're gonna pay the difference. So it's just very easy. So that's I think that's probably exciting, right? In October, all this is over. You know, you're not gonna be wasting your time running around doing those sorts of frustrating things. There's nothing worse than having to call insurance carriers and figure out why you're getting bills. Yeah.

SPEAKER_01 34:28

Um, and I do think you have to realize, Jody, what's happening as well is you're you're you're you've been covered by group plans, so that's administered by an entirely different uh uh uh group of people. Uh when it comes to Medicare, it is really uh quite simple. Medicare pays and uh and and we and truly we have tens of thousands of people with United Healthcare, and uh we get zero complaints. But frankly, whether it was Detna or Mutual Vomaul or Cigna, Healthsprink, whoever's not we just don't get complaints with those. And the reason is because that insurance company really has no say so with your supplemental plan. Nothing. Medicare and your doctor have made our made all the decisions, they're just simply the secondary payer. On your group plan, it's different. Uh they have rules that uh they can enforce and they will enforce those rules, but you will not be subject to that when you're on a supplemental plan, regardless of the carrier. I'm not saying you should go with the United Healthcare, but I I don't think you're gonna experience that uh on the Medicare side.

SPEAKER_03 35:26

Okay. Okay. That's why I was asking about like which has the best customer service to put so important.

SPEAKER_00 35:33

I yeah, and I don't think it's not gonna be a big problem. I will say some one of the rates I quoted you was a United Healthcare. One of the rates I quoted you was a Cigna.

SPEAKER_01 35:41

So did you give her some rates, son?

SPEAKER_00 35:42

Yeah, I did. Oh, did I not? Yeah, I don't think so. I'm I'm just I wrote it down. So I see a plan N as low as about 175. Um let's just focus just on G to the lowest I see is two thirty-three, um which i is actually uh UHC. But the next one up is only a dollar more. That's a Cigna plan. Um so you've got some options.

SPEAKER_01 36:06

Yeah, what I I does that plan also cover do you go to a gym uh or do you work out at home or don't work out?

SPEAKER_03 36:12

Okay, well, no, I yeah, go ahead.

SPEAKER_01 36:15

If you go somewhere, then uh that that United Healthcare, does it include a gym membership in California? If it does. Yeah, that is awesome. Because they'll you know the network is called the Renew Active. That's United Healthcare. You know, there's two big networks. One's called Silver Sneakers, which that's the norm uh uh normal network, but United Healthcare is so large they develop their own gym membership network called Renew Active. So if your facility takes that, they will cover your gym membership. So that in in our area in Kansas City, we have gyms that are $100 to $125 a month that are covered by United Healthcare uh submental plans, which what what a great value that becomes. So and I I think you'd be served very well by them. And and truly, as Josh and I have been doing this a long time, and historically we have seen United Healthcare be very stable. Now, that is not the case the last couple of years, but none of them have been very difficult.

SPEAKER_00 37:08

Yeah. So I think you are hope we hope we're shortly returning to stability. Yeah. For for years and years, Medicare supplements were just so stable. And then what happened is like the group plan market started to move up in terms of deductibles, and so everybody on work plans stopped getting all of their expensive things done, waiting until they were going on Medicare. So the second they go on Medicare, they get their joint replacements and hips and knees and everything done, which drove up everyone's cost that was on Medicare. That's right.

SPEAKER_04 37:38

So we're trying to get interesting. Yes.

SPEAKER_00 37:40

So we're trying to get back to market stabilization, and it's not even Medicare's fault, it's all the employer plans that went up. Yeah. So people delaying those surgeries.

SPEAKER_03 37:51

Good this is all very good information. I just was wondering if um uh blue cross or blue shield, whatever, that is there are there other options that are I mean, if if the premium amount is not an issue, I've been paying a lot of money for my premium.

SPEAKER_00 38:09

Oh yeah, you're gonna go have a pay increase then.

SPEAKER_03 38:12

Yeah. So I'm just like like just would be so curious, like, are there other options or are these are you suggesting these are the two things?

SPEAKER_00 38:21

Oh, I there's definitely more options. Yeah. And if you call in and like work with somebody on our team, um they can go through everything, they can compare drug plans, all the different carriers. So on this, we're just kind of you know trying to give you a ballpark. Yeah, ballpark. Yeah, Jody, do you have our number? Our office number?

SPEAKER_03 38:38

I'm sure I do.

SPEAKER_00 38:39

Okay.

SPEAKER_03 38:39

I will get it. Yeah.

SPEAKER_00 38:40

Yeah, it's at well, let me write you got something to write down, I'll tell it to you anyway, just in case.

SPEAKER_03 38:44

Yeah, sure.

SPEAKER_00 38:45

It's 800 800-782-6676. 800-782-6676. And when you call in, you're gonna talk to someone that's been trained by my dad, Marvin. He's sitting right here with me. And we're all here in uh right outside of Kansas City, Missouri. So you're not being shipped to the other side of the world or talking to an AI agent uh who's not even real or somebody who doesn't speak your language. So just call in. They're all been trained, we're all insurance brokers here. And maybe two things that I think make it a little bit different. I'm not trying to be salesy here, but number one, yeah, our agents aren't paid any different based upon what plan that you go with. So there's no incentive for them to be like, go with this one or go with that one. So it's right, it's just base, which is nice. And then the second thing is you're assigned um into like a pod, a group of people, if there's six people in it, um, but you'll have one dedicated client care manager. And this is somebody if you move, if you have a billing issue, a claim issue, your premium goes up, your something happens in your life and you need to have uh assistance, you've got one person you can call. Okay, and that's just how we try to serve serve our customers.

SPEAKER_03 39:56

Okay, all right, wonderful. I've I'll give them a call, and I really appreciate the information.

SPEAKER_00 40:01

Thanks, Jody. Good to talk to you, thank you.

SPEAKER_03 40:03

Okay, okay, bye-bye.

SPEAKER_00 40:07

Okay, let's talk to Julie in Texas. Julie, uh, I understand you got some questions about your husband, Medicare, Medicaid, he's on disability. Would you fill us in and ask us your questions?

SPEAKER_05 40:20

Uh okay, so my husband is uh totally disabled.

SPEAKER_00 40:23

Okay.

SPEAKER_05 40:24

And he refused Medicare. And my question is, would he qualify for both Medicare and Medicaid?

SPEAKER_01 40:33

Uh we have two properties. Yes. You say you have some property?

SPEAKER_05 40:41

Yes. We have two properties, one that our daughter lives in, and the other one is in a truss with my husband's name on it. His mom is still alive.

SPEAKER_01 40:52

Yeah, yeah. I don't I don't think I I'm not sure all the qualifications Josh can look up in in the state. Usually it's income-based. I don't know if it's asset based or not, but he may be able to see that. He's looking it up up right now. You know, we're we're brokers almost.

SPEAKER_05 41:06

Yeah, I I yeah. So that's good. I I did read up a little bit. You know, I don't know other logistical legal on it.

SPEAKER_01 41:13

So when you did your research, did it look like there was any uh asset-based um uh qualifiers or was it just income only?

SPEAKER_05 41:22

Uh well it was kind of like both. Okay. I still work. I'll be retiring in December, so they won't consider my retirement payments.

unknown 41:32

Okay.

SPEAKER_05 41:33

Um but I was kind of confused about the property part.

SPEAKER_01 41:36

All right. Well Joshua's gonna quick question, Julie. What what is your husband's like what are his A and B dates? When did he first go on Medicare? Uh uh about August or September of 2020. Okay, so he's been on for a while then. All right. So right now is he, I'm assuming, uh now d is he on Medicaid right now? On Medicaid, no, he's Medicare. Okay, so uh I know in uh Texas you cannot get supplemental plans, so is he on an advantage plan?

SPEAKER_05 42:08

Yes. Okay. I didn't know about all this other stuff since I ran into you guys.

SPEAKER_01 42:13

Sure. Yeah, so right now, here's the way this works. Josh is gonna give you some numbers. Go ahead.

SPEAKER_00 42:17

Yeah, I could give you this. Yeah. And you would want to verify this, obviously, with you know, like a social worker or something. Best I can tell. Married couple, income limits fourteen hundred and ninety-one dollars. Um, you can have up to $752,000 of equity in a primary home that you andor your spouse live in. But above, so there's some limits, like uh maybe up to an additional, like I don't know, maybe it says $33,000 to $162, and additional assets above that that are kind of more in your name, but that that asset rule is three thousand dollars.

SPEAKER_01 42:55

So if you've got multiple properties, it sounds like he's uh he's part of a trust.

SPEAKER_00 43:03

Okay. So I don't know that that's you have a social worker in Medicaid in Medicaid that you've you've spoken with about kind of your income and assets and that sort of stuff.

SPEAKER_05 43:13

Not yet. I was trying to get more information. Like I said, I was reading up on it. Yeah, I think that would probably be your best.

SPEAKER_00 43:25

I do have a phone number for that.

SPEAKER_01 43:27

Yeah, he'll give that number to you. And I want to ask you about so we know you got property in trust, and what was the other the other property?

SPEAKER_05 43:34

Uh my daughter lives in one of our properties. We only have well, sorry, I don't want to say only. Uh so she lives in a pro a house that we bought when we were in our twenties.

SPEAKER_01 43:45

Okay. How much is it? How much is it worth? Uh right now about two fifty. Yeah, is it is it free and clear? Yes, uh-huh. Okay, very good. Okay, yeah, that that could probably be an issue. Go ahead, Josh.

SPEAKER_00 43:58

Yeah, let me just give you their phone number. And then I would just call them and Texas Health and Human Services, 877 541 7905.

SPEAKER_01 44:11

Okay. Yeah. Julie, I want to I want to make a suggestion to you. Okay. Uh again, I don't know where you all are financially, but Texas is a very competitive state when it comes to med subplants. So if I were in your shoes, unless money is really an issue, you're going to have a wonderful opportunity in November of 2028. Got a couple years before it happens. But right now, the only thing available in Texas for your husband's situation are would be an advantage plan. We would be happy each year to check the next couple years to make sure he's on the right one. But come November of 2028, he is going to be able to have a chance to kind of reset the clock, and then he can get a very high quality Medigap policy. And that's what I would have you to do. I'd either get a G plan or an N plan. And's a little bit uh more budget friendly. It's a great option. Uh but I would do G or N because your husband does not have to medically qualify to get that plan. I'd get him out of that, I'd get him out of that advantage world if I were you when you can, because you can't now. Right now, it's that's the best he can do. Um so the issue is if you can't qualify for Medicaid, uh then you can get a Medicare supplemental plan uh here just in two years. And that would be wonderful coverage. Yeah, for the rest of his life. Because what happened, yeah, if he qualified for Medicaid, you cannot get a supplemental plan. You can't. Uh so I think you're gonna have uh uh enough assets where you're not gonna qualify. But if if not, I'm just saying to you, really think that through. Uh again, you got a couple years before it happens, but that'd be my suggestion to you. Okay, Josh, you want to add something to that? Okay. Okay. Did all that make sense? I know I can get to rambling sometimes. And did didn't you clear on that? Okay.

SPEAKER_05 45:49

Yes, I just don't have to wait two more years, which is fine. I mean, we didn't know that we didn't have to choose our advantage. Yeah.

SPEAKER_01 45:59

Yeah, that's the federal law, and most states follow federal law. Uh insurance companies are not required to write Medicare supplemental plans for people that are under 65. Uh now, some states make insurance companies. Texas is not one of them. That's why it was not an option for you, but it will be in two years. Okay. Okay, sounds good. All right, stay in touch. We'd be happy to help you. Thank you.

SPEAKER_05 46:22

All righty, thank you. Bye-bye.

unknown 46:23

Bye.

SPEAKER_00 46:25

Okay, there are four rules that you need to know about when it comes to Medicare before you enroll. If you find out about these four rules after, it's too late. So join us tomorrow. We're gonna be talking about the four rules uh that you need to know before you make a Medicare choice so you don't make a Medicare mistake. If you need help uh from our company on enrolling into Medicare supplement plans, enrolling into advantage plans, getting drug coverage set up, dental coverage, hearing, whatever it is, we would love to help you. Our services are free. We're located right in Kansas City, and so you're able to talk to someone that's been trained by my dad, Marvin, uh, and they are not paid any different based upon what plan you choose. So we try to remove the bias out of their recommendations. Once you become a customer, that's probably the most important part, and you will become a client for life, assigned a dedicated client care manager, someone that you can call for whatever life happens to throw your way. You have someone on your side. The phone number to get help from our company is 800 782 6676, 800 782 6676. We'll talk to you tomorrow.