Medicare School Daily
The team at MedicareSchool.com led by Marvin Musick answers REAL Medicare questions from our callers, and help bring clarity to the VERY confusing Medicare System.
Medicare School Daily
DON'T Make A Medicare Choice Until You Understand These 4 Rules
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Medicare decisions are a lot easier when you know the rules first.
Today on the Medicare Daily Show, we’re covering 4 rules that can impact your choices, your timing, and what options you may have later.
Join us live for simple clarity, real answers, and your questions. Call in with your Medicare, Social Security, or retirement situation. We look forward to providing clarity!
Most of us hate rules or maybe even being told exactly what to do. But when it comes to Medicare, there are some rules that the government imposes and the insurance companies enforce that you need to know about so that you don't make a mistake or get caught breaking one of these rules and then finding out you have no options and you're penalized or just generally stuck on a plan that you don't want or don't understand. So pay attention to these next few moments. My dad is going to share what these four rules are. If you have a question, if you want to be a part of the show, you can call in 833-824-2004, 833-824-2004. My name is Josh Music. I'm here in the studio with my dad, Marvin Music. Guys, and this is an opportunity for you to talk to the nation's leading expert and ask your Medicare, retirement, Social Security questions and get answers from almost 20 years of doing this, helping tens of thousands of people through the Medicare, Social Security, and Retirement System. So call in. We're here every day from 11 a.m. to noon central time, Monday to Thursday, 833-824-2004. Don't let your questions go unanswered. And if you need help one-on-one, working with someone that my dad has trained to compare advantage plans, supplemental plans, drug plans, dental plans, whatever it is, whatever kind of insurance it is, we are insurance brokers and we would love to help you walk through that and hold your hand through that process. The phone number for our office is 800-782-6676, 800-782-6676. You can call in, talk to someone live that is available, or schedule an appointment for sometime in the future. Dad, let's talk about these four rules that people need to know about so they aren't uh uh punished or penalized. All right.
SPEAKER_04Well, let's begin uh with uh the rule that I think is very important for uh you if you're still working. A lot of confusion about Medicare when people start working, you'll hear certain things that are accurate and some that are not so accurate. So let's start with this one. If working or your spouse is still working and you're gonna continue to work uh past 65, you don't have to do anything with Medicare. You don't have to take whatsoever. You don't have to take B. Uh A or B is not required. Uh people uh will hear, you may hear that you'll be penalized if you don't take A, and that also is not true. And so if you are still working, spouse says you don't have to do anything with Medicare A or B. So let's talk this through a little bit with you. First off, um uh I would suggest if you uh have a work plan, still take the time to compare that work plan uh with uh your Medicare options. Sometimes work plans are better and sometimes are not. So you may be on a plan that's mediocre, it may be expensive, and if it is, you actually can go on Medicare if you want to. However, you may have a plan that's excellent, or your spouse's plan is excellent, has a good uh price, good premium, good coverage, and you love that plan. And so if you're gonna continue working, spouses don't do anything with Medicare, not A or B. Now, I would suggest that as if you don't have a health savings account that you're contributing to, no HSAs, then I still would in that situation encourage you to take Medicare A only. It is fine. It's uh there's uh uh no premium for A for most people. Uh I I would not have you enroll into it because I'm worried about you be you being penalized in the future, because that wouldn't be true. But uh I would I would take A only if I don't have an HSA. All right.
SPEAKER_00So I've always heard you say there's a I think it's five or six groups of people that do have to take Medicare.
SPEAKER_04That's gonna be rule number two. Okay. So let me just finish so it's okay. Number one, uh be sure to compare, make sure that Medicare is not a better option. Uh if it's not, then stay on your group plan.
SPEAKER_00How does someone compare How does someone compare their employer plan to Medicare?
SPEAKER_04Two options. They you can do it on your own or you can call us, and we'd be happy to do that for you. But look at your premium. What does it cost you to be on the plant? How much is coming out of your checks? It's usually payroll deducted.
SPEAKER_00And if you're on your spouse's coverage, or maybe your spouse is the one that's going on Medicare, you need to find out from your benefits person what would it cost for just me, or what does it cost? Employee only. Yeah, employee only. Right. That way they can you have a true understanding of what the cost is. All right, so compare the premium. What are they comparing it to, though?
SPEAKER_04Well, they're gonna compare it to what the Medicare option would be. And so usually Medicare is gonna be in that $300, $350 a month range. And that would be for a plan G or a plan N, depending on where they live. But again, A and B uh and a and a and a plan uh supplemental plan is gonna be in that $350 range. Um and so if you're paying $400 a month or more and you have a uh $3,000 deductible, Medicare is probably gonna make sense. But again, you want to make sure you look at the premium, look at the deductible, do you ever meet the deductible? What's the max out of pocket you're responsible for if you had cancer, uh, and then also how your medication is covered. So those are the things that you need to look at, and we'd be happy to have that conversation with you to make sure that you are making the right decision. Uh it doesn't take long for us to uh gather information and give you uh what our suggestion would be. And we're gonna be honest with you. Uh regularly we'll tell people, hey, stay on the group plan, it's it's a better option than Medicare, but other times it's just not. So that's number one. But uh also I think what's important uh for people that um uh are uh um uh still working to to know that uh you can come into Medicare in the future. So don't worry about it. You don't have to come in at 65. And when you do that, you're coming in through what's called the special enrollment period. Uh it's seamless, it's easy. As long as we've had credible coverage and we can prove that, uh then you're gonna be able to come into Medicare with no problem. So that's rule number one. You don't have to come in Medicare, A and B, either one uh at 65. Rule number two is what you were just referring to, Josh, and that is there's some people that must. Even if you don't want to. Yeah, even if you don't want to, you have to come into Medicare at 65. So that means you or your spouse are no longer working, uh, you're on Cobra insurance, you're on TRICARE, uh, you're on a small small employer plan, you're on Affordable Care Act plan, or you're on Medicaid. All of those scenarios, if that's you, you have to go on Medicare at 65. And the rule is you only have seven months to do it. And those seven months are tied to your birth month. So we take our birth month, and we know three months before you can enroll, you can enroll your birth month, and then you can enroll three months after that. So that's a seven-month window. And if you miss that window, you're gonna uh be penalized. Now you can get into Medicare for sure, but uh you're gonna have to wait until uh what we call the general enrollment period. So we don't want you to miss that. So that's the rule. If you have to go on Medicare at 65, uh then I would suggest you enroll three months in advance. All right. Now some of you are gonna be automatically enrolled, uh, and that's because you're on Social Security. And so what happens with auto-enrollees, your Medicare card shows up a hundred days prior to your birth month. So it's gonna show up in the mail. And the issue is, in fact, I just uh got an interesting uh uh uh correspondence today from a gentleman. He didn't know what to do, enrolled in Medicare, didn't need to whatsoever. He was enrolled automatically. Exactly right, or or just enrolled because he didn't know what to do. And so, but if you if you're auto-enrolled, just know that if you still have a group plan that's working, you can get out of B. You have to have A because you're on Social Security, but you don't have to take B. And I I would suggest if you have a good group plan to uh uh decline part B and pick it up at a later date. And how do you decline part B? Well, if you're auto-enrolled, auto-enrolled, your uh the back of your Medicare card that you'll receive in the mail will give you the option to be able to uh opt out of B. It says, I do not want medical insurance, which is part B. You have to sign the card, you send it back in to Medicare, and that will allow you then to uh have A only, and then you'll pick up B when you lose the group plan. Right. So people oftentimes uh keep the Medicare card when they should be sending it back in because you have a good group plan.
SPEAKER_00Aaron Powell The only thing I want to clarify is you you said so there's is it six groups of people? Six groups. Okay. One of them was small employer plan. And Medicare defines a small employer plan as less than twenty employees. That's right.
SPEAKER_04Nineteen or less. Exactly right. And so and that's on the payroll. So if you have a small company, payroll size is 19 or less, then uh you're required to go on Medicare A and B because Medicare pays first. There's probably a very good chance.
SPEAKER_00I mean it it depends, but there's probably a good chance that the Medicare is gonna be uh a step up in coverage compared to that small employer plan anyway.
SPEAKER_04Yeah, more more than likely. Yeah.
SPEAKER_00Yeah.
SPEAKER_04It uh usually happens that way. And and you know, uh we find that many times employers uh are happy to you know let you leave your group plan and maybe give you a pay increase to cover uh what it's gonna cost you beyond Medicare, they win and you win as well. All right, so that's rule number two. Just know you only have seven months to go on Medicare if you are turning 65 and have no group plan. Rule number three. Rule number three. Uh this would be anyone that is uh starting Medicare uh and this would be at 65 or it could be at 67 or 72. But when you uh uh are done with group plans and you're starting Medicare A and B, you do not want to miss uh your once-in-a-lifetime opportunity to get a Medigap policy with no underwriting. And the key to understanding this rule is it's uh this this the six-month window is tied to your B date. Uh so let's say you start Medicare A only at 65, and then you uh retire three years later and we pick up B and now you're 68, then that uh B date is tied um uh to when you begin Medicare, so now you're 68, so now you have six months of the B date. Uh if you start at 65, we have six months of our B date again. So the point is six months after your part of B date. That's the key to uh getting this eligibility to get a Medigap policy with no underwriting whatsoever. I mean, Josh, I've everything could be going wrong in your health. I have I have written scores of policies, sadly, with people that were going on Medicare and they had cancer, but uh they got Medicare supplemental plans because uh the insurance companies cannot ask you any health questions during six months of your B date. They have to write the policy, they have to cover your preexisting conditions, uh you don't have to worry about it. So that's the point is you can have this once-in-a-lifetime opportunity and don't miss it. And the key date is the B date. Six months of that. All right. And that's why we encourage you uh to um uh if you're gonna keep working and you do get enrolled automatically enrolled in Medicare A and B, to send that card back in and get get uh uh A only, because then you haven't lost the opportunity uh to get that Medigap that rule is called the Medigap OEP. And then lastly, there's one uh that is very unique, and that's if you are starting Medicare at 65, um uh let's say you're you're doing it this month, July 1, 2026, and that's your A and B date, uh, and you decide to get a Medicare Advantage plan. Half of all people do, so you may decide you're gonna do that. But just remember this there's some rules for getting off your Advantage Plan and getting back into uh the original Medicare system. So here's the rules. If your A and B uh uh starts at 65 and you enroll into an advantage plan, you have what is referred to as a trial right. And that trial right, it lasts for 12 months. Anytime, any reason, during the 12 months of uh that A and B date uh at 65, you can return to original Medicare, get a supplemental plan of your choice, uh, no problems whatsoever. But if you stay on that advantage plan, uh beyond that 12-month trial right, now to get off of an advantage plan ever, now you're gonna have to medically qualify to make that move. And so many people are not aware of this. They believe that they can just get off and no problems, no hassles, and that's just not true. You are gonna have rules for switching. Now, I'm gonna clarify something. Let's suppose that you uh do A only at 65, and then at 68 you pick up B. You do not have a trial right. Uh trial right is only for starting advantage plans at 65. So, in that example, 65A date, 68 B date, now uh you do not have a trial right. So anytime you want to get off that Medicare advantage plan, now you have to medically qualify, which means we have to ask you 40 health questions, check your medications, maybe get a statement from your doctor, you're going through the underwriting process, and that insurance company now does not have to take you. And so many people are not aware of this rule, and they're highly disappointed because their health changes, they want to get off their advantage plan, and now they can't do it ever. And now they gotta l live with networks, pre-authorizations, annual plans instead of a quality Medsap plan.
SPEAKER_00There is a there's a strategy that some people employ uh that sounds smart, and that is, oh, I'm you know, gonna my my health is pretty good, I'm going to use this trial right, and obviously I'm gonna switch to a Medicare supplement because that's what I want. And if something happens in my health over the next, you know, nine to twelve months, I can just switch to a Medicare supplement plan with no health questions asked, use this uh uh, you know, this this guaranteed issue period, the 12 month trial period, and everything's gonna be fine. And I just I think it's important to say like that is a strategy, it works if everything works out perfectly. But oftentimes we see that blow up in people's face. And I just want to like paint out a scenario. Let's say your plan is I'm gonna at you know, at month 11 or month 10, I'm gonna save a year's worth of not paying for a Medicare supplement plan. Something changes in your health, it's October, November, whatever, you're 11, 12 months into this, you're in the hospital, right? Something comes up. How are you going to know? Oh, I gotta get my my insurance switched around. Oh, I gotta, you know, but what if you're incapacitated? What if who knows what it is? Maybe the last thing on your mind is like changing your insurance plan. Try maybe you're not even able to do that. And so we just see people that that make the this mistake of thinking they're gonna play the play the game, play it smart, um, save a year's worth of no pain for a Medicare supplement. But for what? To save a thousand dollars? To say, I mean, what if what if you what if you get you know you have something that comes up on October the second and you have to go and have a hundred thousand dollars worth of bills, you're gonna hit your six thousand dollar max out of pocket on your advance plan. You just played the whole thing totally wrong. Like you can't time when things happen with your health. So I just if your plan is to, I'm gonna be smart and use this 12-month trial period and save a month, you know, a year's worth of premium, it's not a great strategy. And the other thing to know is the insurance companies know of this game. And so they intentionally try to make it difficult for you to use this 12-month trial period. You can use it, okay? If your dates line up and everything technically works, you can use it. But in practice, what happens is people have something changing their health, they try to switch back. The insurance company has this rule where they do not and they will not place your new Medicare supplemental plan into effect, issued, approved, mail out the cards, all that stuff until they have received a disenrollment letter from termination notice from your advantage plan. So the way the calendar works out, and let's say you're undergoing cancer treatment, like when all this happens, the calendar works out like this. You have to cancel your advantage plan. So let's say you you find out you want to cancel it, it's it's um the third or fourth of a month. You call in to cancel. When does that cancel? That's gonna cancel at the end of that month. Then you're gonna wait two weeks to get a dis or a termination notice, and then you're gonna send it to the insurance carrier who's gonna take a week or two to process it, and then they're gonna place your policy into effect. So your smart plan ended up with you being stressed out for 58 days of trying to figure out how to just save a little bit of money by you know messing around with this trial period. You can tell we're not big fans. Yeah, well, if it all works out perfect, great. Yeah.
SPEAKER_04It's being it's being penny wise, pound foolish. That's really what it is, folks. So you save twelve hundred dollars. Uh, but but the risk of uh of something going wrong is very, very high. If you want to do it, do it. Certainly you have the right to do that. But you're right, it backfires on a lot of people.
SPEAKER_00Okay, let's talk to Dina in North Carolina. Hi, welcome to Medicare School Daily. What questions do you have for us?
SPEAKER_02Yeah. Um I have the first question is I am working for a very good company, and I am on their insurance. And I only pay $125 a month. And there's a new um and the GP1 just came out, as you know. Everybody is gonna pay anything on a medical. So am I eligible for the GP1, like the zip bound, not the compound. Oh, the program that just came out as of July the first, and how do you do it?
SPEAKER_04Okay. Yeah, you are eligible just if you have A-only. You have to have a drug plan to be able to use the the the bridge plan. You don't have to have a MetSUP, you don't have to Medicare Advantage plan, so you can do A only. Now, did you enroll in A only uh when you had the opportunity, or do you have nothing at this time?
SPEAKER_02I did.
SPEAKER_04Oh, you didn't?
SPEAKER_02No, I I did A because I was told it was best to.
SPEAKER_04Okay, yeah, and and and that is true. Now the issue is right now uh you cannot add a drug plan. Now you may be able to figure out a way, but um uh we we're we're outside the open enrollment season to be able to actually add a drug plan. There may be some rules in North Carolina that would allow you to do that. Josh, you can kind of give your opinion about that. But you can enroll into the bridge plan uh with just Medicare A only. You don't have to have B. So if you cannot pick up a drug plan right now, you can add a drug plan later this year, October 15th through December the 7th. Uh and that plan, drug plan, would go into effect um uh uh January 1 of 2027. All right, so you may have to wait a few more months to do that. So then what's gonna happen is because now you have a Part D plan, you're not gonna use it to get your GLP 1, but you're gonna be able to um uh uh actually get uh your your drugs outside of that drug plan. But I do not think that with A-only she can do the bridge, Josh. I think she has to have a actual enrollment into a drug plan. And that's something we can check on. Yes, it's uh we're not we're not uh you know unfamiliar with the bridge plan, but it is still fairly new, so there may be some rules that I want that we're gonna check on. So the question is, can you uh qualify for bridge plan with having no Part D plan? I didn't think so. I thought she had to have a Part D plan. Uh because Part D plans do cover GLP ones, but it has to be for other health issues, type 2 diabetes, uh sleep apnea, uh cardiovascular issues. So those that don't have those and just want GLP ones for the purpose of weight loss, uh then the bridge program would be available to them. So can you find that, son?
SPEAKER_00It's gonna take me a minute.
SPEAKER_04Okay. Yeah. Anyway, so if what I'm sharing with you would be accurate, and I think it is, that you have to have a drug plan first, uh then um uh you again you can add one uh the October 15th to December 7th. Okay. Uh there are some there's a thing, Dina, that are that's called an SEP code. SCP stands for special enrollment periods, special election periods, and there are some times that people can actually uh get in get involved, uh enrolled into a D plan uh uh outside of the open enrollment season if there's an SCP code. Go ahead, son.
SPEAKER_00You do have to have a drug plan.
SPEAKER_04Yeah, I thought you did. Okay, so you do have to have a Part D plan, but again, they're very inexpensive. Uh there's some out there. You want to look and see in her zip code, Josh? Yeah, I can't. Many of them uh are very low cost. I'm on a drug plan, uh, Dina, that's $9.60 a month. That same plan I'm on in many states is zero a month. So there are plans out there. Okay.
SPEAKER_00Does she have a drug plan and her employer coverage? I mean, is all that work how does that work?
SPEAKER_04She has credible coverage through her employer, so she you don't need a drug plan um you know, because you're you you have it at work. But this would allow you to do what you're trying to get accomplished.
SPEAKER_00Yeah, there's a plan welfare plan for $300.
SPEAKER_04Yeah. Okay, hey, Dina, there is a plan in your zip code right now that's $3.60 a month. So if you were enrolled in that drug plan, uh then you could do exactly what I'm talking about. Now, I don't know what that plan is going to be in 2027, but there will be some low-cost plans available. Um, so that's my advice to you. Unless you have an SCP code. Let me let me tell you how you could do this. If you want to try, Adina, um, you could you could go to Medicare.gov and you could put um uh your information in, uh, and you don't even have to put any medications in at all. Just just you know, give them your your information, your Medicare number, and then um uh you they'll it'll you'll give them your zip code, it'll show you what plans are available in your zip code. So again, Medicare.gov. And there's probably 10, 12 plans available. And so uh what you can do is just enroll in the cheapest plan, and Josh says that's a welfare plan for $3.60. So I want you to try to enroll in that, and then what's probably gonna happen on the site is gonna say, okay, uh what's happening in your life that uh that that would allow you to enroll into a drug plan outside of the Medicare open enrollment season. And so they'll list several items. Have you moved? Have you lost whatever? They'll just do different, they'll ask you a series of questions. And so if it looks like that, you can honestly answer one of those questions.
SPEAKER_00Yeah, North Carolina. All of the the those SCPs, the the last one expired uh uh six days ago.
SPEAKER_04Oh it did June 30th. Okay. Okay. So what Josh is saying, Dina, is we don't see a way that you can pick up a drug plan mid-year, but you can later. Okay, so you know, October 15th, December 7th comes, go to Medicare.gov, look at the plans, just take the cheap plan, uh, whatever it is, enroll on that plan. It goes in fact January 1, 2027, and then you now qualify to use the bridge plan for all next year. Okay.
SPEAKER_02Okay, that's okay.
SPEAKER_04Yeah, it's outside the drug plan, is the whole point. You gotta have a drug plan, but but but this GOP one bridge program is outside of that. And then what happens is your provider is going to have to uh get a preauthorization, which will be based upon body mass, uh, and they'll get a preauthorization, they will submit that to It's called the processor, which is Humana, and the providers will know all about this. And then that will get approved by Humana. And you'll go to the pharmacy of your choice, you'll pay $50 copay, and then the balance of that will be paid by Medicare. Okay, so that's how the system works. And then it should mean existence all year next year, and then we'll see if they're going to extend it after that.
SPEAKER_02Okay. Okay. Okay. So that was that was that question. My other question.
SPEAKER_04Okay, no, what what is your other question?
SPEAKER_02The other question is um I I I am planning all the work with $69 or $70 if my health stays good and it's good as of now. So I want to know will it pay me to go ahead and collect my Medicare, the pre you know, the money.
SPEAKER_04Are you meaning social security?
SPEAKER_02Is it best? Because right now I went into my plan and it says that uh as of right now, I can get uh it's around about 21, something like that. But in next year I get almost 22, get 21, 930. So would it pay for me to go ahead and sign up for Social Security or wait?
SPEAKER_04Okay. So what you can do, you can apply for those benefits uh three or four months in advance, but you would tell them that you do not want to take a reduction uh from your full retirement age benefit. So you want to start when you hit full retirement age, which will be January 2027, because the application is going to ask you that. When do you want to start? Uh so you'll tell them I want to start 1120-27. And that way you don't have to take a reduction in benefit, and that way also you can make as much money as you want, and there will be no impact to your Social Security check. So I think it's a great idea. I really do. Now, if let's say that you had uh a spouse that was uh younger and that didn't have their own Social Security or something, then I may say, ah, yeah, you may want to wait. Uh but for if I were you, I think that's a that's a good move. You don't have to spend the money, you can just take your money, you're eligible for it, and then uh you can always invest that. You can save that. Okay? So I don't think you're hurting yourself at all. We we're not taking a reduction at all, and we don't have to worry about uh how much money you make either. Okay. So I I would give you the thumbs up on that idea.
SPEAKER_02Okay, and on the income tax, you should have taxes took out, correct?
SPEAKER_04Yeah. Well, you actually have to fill a form out uh and submit that to Social Security saying you want taxes to come out. And that form is a W V2 or something like that. Josh, you want to look it up? I always forget that form. But but it's not automatic. Uh the the you they send you the gross amount, so if you want uh taxes taken out, you'll have to submit that form. It's very simple. I think you can take out seven, ten, or twelve percent or some other amount.
SPEAKER_03So it's called form W for V. There we go. So V for voluntary. So it's a voluntary withholding request. Good. W for V. You have to fill that out and submit that. Okay. And then they can they will take it out either at seven, ten, twelve, or twenty-two percent.
SPEAKER_0422 percent.
SPEAKER_03Okay, very good. All right.
SPEAKER_04So you just check the box and uh they'll take those uh taxes right out of that for you. Most people do 10. Oh, you do what you want.
SPEAKER_02Um the reason I want I just wanted to let you know I've been watching y'all on Facebook and y'all are very good. So my question, I if I have a chance, I just wanted to let uh let you know. I've helped a couple friends sign up for their Medicare and I they have enrolled into the vintage and it is true they cannot go to the supplemental, not un unless they have to answer questions about their health. Is that correct?
SPEAKER_04That is correct. Now here's the way it works, real quickly. Uh Dina, if they started it at 65, and meaning right when they were first eligible, uh A and B was a 65, then they actually have it, they had they had 12 months to uh go back to original Medicare, get a SUP with no underwriting. So if that 12 months has expired, uh you the only way they're gonna get it is to medically qualify. You are exactly right. Now, let's say it was you. Let's just use you an example, Dina. Let's say that you uh you you you turned uh 65 uh March of 2024, okay? And you did. You told me you took A, right? And let's say you retire next year, uh and now you're um uh 60, that'd be 68, and now you pick up your B. You do not have a trial right. Your your your A date started at 65, your B date would be starting at 68, and uh now day one, if you ever want to get off your advantage plan, you must medically qualify to make that move. So some people have a 12-month trial right, but many, many do not, and you definitely would not. So what you're sharing with them is accurate information. And what's sad about this, uh, Adine, is this uh so many agents today push advantage plans like crazy, and they don't tell people uh the about the rules of actually switching. Uh so people get stuck on these advantage plans and they like to get off and try to get a Met Sub, but they cannot medically qualify. And that's heartbreaking. I mean, I've met thousands of them in my career. It really is very, very disappointing. So you keep uh you keep telling people, warning them about that. And we don't we we write advantage plans. We don't think it's bad insurance, but there are some issues that you have to address, things you're gonna have to be comfortable with, pre-authorizations, networks, you know, annual plans instead of permanent plans. And there's a lot of things that come up with advantage that folks are just not aware of. Why? Because agents want to tell people, hey, and we want to talk about dental benefit and some over-the-counter card and uh these little perks that they throw in instead of really focusing on how is my insurance going to work. Okay.
SPEAKER_02Okay. Well, that's all I want to know. And you are a broker, and that's really what you want to use, a broker, not the customer service of all these companies. Yeah. Because you don't know who you're gonna get. They're not gonna answer questions.
SPEAKER_04Yeah. And they're only there is.
SPEAKER_00This daily program.
SPEAKER_02No, like this topic.
SPEAKER_00Oh, it'll show it'll air tomorrow. We have to we always have to scrub all the personal data out to make sure that uh there's no nothing, nothing out there. So it always gets aired a day later.
SPEAKER_04Yeah, yeah, because we have to be HIPAA compliant. Um, we don't keep the rules, so that's why. Yeah. So this would be this would be.
SPEAKER_02And the name of it Okay, it is MedicareSchool.com.
SPEAKER_00Yep, that's the name of our company, yes.
SPEAKER_02Okay. Well, thank you. Y'all are y'all just keep doing your job. You're doing a fantastic job, and I have learned a lot about Medicina.
SPEAKER_04We're glad nice to talk with you today. Thank you.
SPEAKER_02Uh-huh. Thank you. Bye-bye.
SPEAKER_00If you have been enjoying the show, I want to ask you to click that little subscribe button on YouTube. It's obviously for free. Just click subscribe so that the YouTube uh algorithm knows that you liked it and will push this video out to other people who may benefit from watching this uh program. We really appreciate it. If you are on Facebook, I want to encourage you to join the Medicare School Community Facebook group. There's 50 or 60,000 people in there that are on Medicare. They're not trying to sell you anything, and you are able to ask your questions about whatever your situation is and get feedback from real people on Medicare. We're gonna answer a couple questions from within that that were posted in there uh the last couple of days. Uh, Rhonda says, Am I allowed to change drug plans any time of the year? And that kind of goes along with our last caller a little bit. No, you're not able to allow, you're not able to change drug plans any time of the year. The time to do that is October 15th through December the 7th. And that new coverage would start January the 1st. So October 15th to December the 7th, new coverage would start January the 1st. Um, the only other alternative that would be if you were had some special enrollment period, which most people really don't, but sometimes there's weather-related special enrollment periods or disaster or these different things.
SPEAKER_03Um Yeah, people that are institutionalized, maybe in a you know nursing home or something, they have but but again, you're right.
SPEAKER_00Normal fear in the mail, you just have to wait till the end of the year. And it is a good idea. Uh now only probably 10 to 15 percent of people do make changes to their drug plan on an annual basis. So there's I don't want you to ever have this idea that you need to change your drug plan every year. You should review it. You don't have to, but you should review it. And it's really easy to do. You just go to Medicare.gov, they've got a great site for this. Medicare.gov, put in your zip code, put in the name of your medications, choose your pharmacy, and then it'll list out the drug plans. Now, 10 years ago, it used to be a lot more complex. The technology wasn't as good, and there were 25 different drug plan options. Now, in most areas, there's like six or eight. It's just been reduced down quite a bit. So Medicare.gov, zip code, name of the medications, your pharmacy, and then it'll list them out. And the one up at the top is the one that will be your lowest cost plan. If you're not on that plan already, uh click enroll. Five minutes later, you will be done, and then your new cards will show up about two weeks later. Um, the uh nice thing is you don't have to cancel your old plan either. So if you do this during the annual enrollment period, the old plan will automatically cancel when the new one gets put into place. Okay, another question from Darlene. I have Medicare B with an in plan, assuming a Medicare supplement in plan. I just received my EOB or explanation of benefits for my annual wellness visit. Why is a portion going to my deductible? I thought there isn't a cost to me for my annual visits. Any info would be appreciated. Right.
SPEAKER_04I would suspect that it was uh that visit to the doc was not coded correctly because that annual wellness visit uh would be covered 100 percent uh by Medicare. Your seminal plan doesn't have to pay. Uh so another question that I would have uh for this situation would be was that your first 12 months on Medicare? Because if it was, then that's a different code. That's that welcome to Medicare physical. So I I've heard of times when a doctor uh gave the code, the the wellness code, which is a year two thereafter, the first year it's a different code. So I would go back to the provider and and check to make sure that it was uh coded correctly, billed correctly, and if not, have them resubmit it, because there should be no out-of-pocket uh expense to you whatsoever on either one of those scenarios.
SPEAKER_03It just has to be coded correctly.
SPEAKER_00I feel like nine times out of ten, it's just a coding error whenever you get a bill that looks kind of off. Right. The other maybe ten percent of the time would be your doctor could have ordered something that doesn't fall, is not medically necessary, like you know, maybe your old insurance used to cover this full battery of tests that Medicare doesn't. And in that sort of a scenario, your supplement plan's not gonna pay because Medicare doesn't pay. Because the way Medica, Medicare supplements work is if Medicare approves it, pays their portion, ten times out of ten, the Medicare supplement plan is gonna pay the difference. But if Medicare doesn't approve it, it's outside of what's considered medically necessary. Your doctor just ordered it because he orders a full battery of whatever, um, and he did that without knowing you're on Medicare, then in that scenario, Medicare is probably not gonna pay, and neither is your Medicare supplement going to. So that would be on you. But that's that's pretty rare.
SPEAKER_04If I'd call your supplemental company, uh, I would. I just call them and say, hey, I'm I'm getting a bill for this. Can you explain why? And uh they typically can tell. They can. And if if push comes to seven, you can always call Medicare as well. But I'd start with the subcompany.
SPEAKER_00Yeah, and if you're a customer of ours, Darlene, you can call us. Uh you have a dedicated client care manager that would be happy to call the insurance companies with you, help you sort through that to make sure you're not paying anything extra. Okay, Colleen says, question please. If I make a decision for a Part G plan in November or December, eligible for Medicare beginning February of next year, 2027. So if I make a decision, November, December, what happens if the premium jumps on 1-1? My concern is that the 2027 premium will not be available, and then come the new year, surprise. The premium is 15% higher. So I think I'll answer this couple things about this. Number one, most Medicare supplement plans don't necessarily take a January 1st price increase. A lot of times those price increases happen between March and June of any given year. In some states, for some carriers, it does follow a calendar year, but that is more um rare. Um, yeah, doesn't usually work that way. Uh, but what would happen is if you're eligible in February and you make your choice in November or December, and something happens and you do get a notice, hey, your premium isn't going to be up, is not going to be what it was originally quoted, because that will happen sometimes. You still have six months from the beginning of your Medicare Part B date to switch. You could switch every single month if you wanted. You could go to six different carriers in that time. Nobody does that. But the point I'm trying to make is if you get into a situation, of course you can switch. No health questions. It is not a that that period exists for the full length of your Medicare Part B and then for six months, your Medicare Part B effective date and for six months. It's not just a once one-time election code that once it you once you use it, it's gone forever. It doesn't work like that. You can make switches, and people do sometimes within the first six months of being on Part B.
SPEAKER_04And I'd say historically, Josh, if someone is going to start in her example, February, and we're quoting them in November, those rates are going to be pretty accurate.
SPEAKER_00Yeah.
SPEAKER_04It could happen, but the likelihood is not. Now, if uh we were quoting today in July and you're going to start in February, well, then then more than likely there will be some kind of a price difference. But usually within two to three months of the effective date, uh those prices should be very accurate.
SPEAKER_00And I would make one tip you can follow or not, but I would recommend it, is you're going to have a lot of advertisements that you're going to see during this fourth quarter of the year. This is called the annual enrollment period, annual election period, and everything, you know, it's all going to say by December the 7th, you've got to make your choices. Just know that that does not apply to you. That only applies to people who are already on a plan trying to switch a plan, a drug plan or a Medicare Advantage plan, right? This is not for people who are just starting Medicare for the first time. In fact, my recommendation would be to wait until after December the 7th to let things kind of slow down, settle down, so that if you work with a broker like us or anyone else, they've got a little time to breathe. Help you walk through just a little bit slower so you can make uh truly the best decision. And also, when you make application and those applications go into the insurance carrier, they don't sit in a backlog behind hundreds of thousands of other people, right? Because all that gets flushed through pretty quickly. So if I were in your shoes, I would wait until probably December after December 7th, so December 10th, 12th, 15th, somewhere in there, where you can have a little bit of slower, your application doesn't get sidelined to the back of the queue while they prioritize other people, and it will be a less frustrating experience for you. You're probably getting calls weekly, daily, I don't know, pretty often for people who want to help you switch your Medicare supplement plan or even your Medicare Advantage plan. And some of that is good, uh, you should switch, but a lot of it is not great. So tomorrow we're gonna go through what is why are these people calling, how to know if you know you should be making a switch or not. Because we all don't want to make a bunch of unnecessary uh, you know, choices about our insurance because who knows what the risk is? Who knows what we're not being told? So tomorrow we're gonna break all that down. How you should know if you should answer one of these calls and go down that path of switching your insurance. So join us tomorrow, guys. If you want to be a part of the show, if you have questions about your personal situation, we would love to help you. 833 824 2004, 833824-2004. Uh, we look forward to talking with you tomorrow.