The Biggest Difference Between Plan G and Plan N

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Plan G and Plan N can look very similar at first glance.

But there’s one difference you need to understand before choosing between them.

Today on the Medicare Daily Show, we’re breaking down what sets these two popular supplement plans apart, and how the difference could impact your Medicare decision.

Have questions about your Medicare, Social Security, or retirement situation? Call in live. We’d be happy to help bring some clarity.

Transcript

SPEAKER_00 0:03

If you are starting Medicare soon and you're wondering should you get a plan G or a plan N, then welcome. You're in the right place. You're going to learn the differences between these plans and how to know which one is right for you. There are some stakes, some areas, some situations where you would be wiser to get a plan N. And then the opposite is also true. There's situations where some of you should be getting a plan G. So stick with us today. You're going to learn exactly if you should get a plan G or an N and the pros and the cons of that. Welcome to Medicare School Daily. My name is Josh Music. I'm here in the studio with Justin Cohen. Justin's been with MedicareSchool.com for many years now. He's a delight to work with. And you can actually call in and request to work directly with Justin, and he will help you walk through your situation. When you call in and work with Justin or anyone here, you are going to get uh hand holding through this whole process. Enrolling in Medicare A and B, uh knowing when to enroll, how to enroll. Uh, you're gonna learn how to enroll in Social Security. We will do that for you. Uh you're gonna get comparison between plan uh G, Plan N, Medicare Advantage plans, Medicare supplements, drug plans, vision plans, dental plans, the whole package so that you can have the coverage that will set you up well for life. In just a moment, you're gonna learn about the differences between Plan G and N. But if any point you have a question, uh you have something that would help the listeners learn something about Medicare. Uh maybe it's a situation that you or a family member experience, uh something about your personal situation that you are unclear on. Call in. The phone number is 833-824-2004, 833-824-2004. You can call in, get your questions answered. 11 a.m. to noon Central Time, Monday to Thursday, 11 a.m. to noon central time, Monday to Thursday. It's your opportunity to talk and get answers from someone who's not trying to sell you anything. You're just gonna get answers straight from almost 20 years of doing this, helping uh tens, if not hundreds, of thousands of people, millions of people educated online through our YouTube and other uh channels. So call in, don't like your questions, go unanswered. Justin, let's talk about G and N. Let's start from the very beginning. Why don't we do a little intro on like A and B? So not everyone knows like how all this stuff works together. A and B, maybe let's draw some comparison between a supplement and an advantage plan and then deep dive into G versus N.

SPEAKER_04 2:24

Uh we'll start at the beginning. Medicare uh is made up of two main parts, part A and part B. Part A being the hospital coverage, think of that as the inpatient half of your health insurance. And Medicare Part B being the medical or the physician service insurance, think of that as the outpatient half of Medicare, and that's the one you pay a monthly premium for. When you have both Medicare A and B, what you have is called original Medicare or traditional Medicare, and it's just health insurance from the Federal Government designed for retirees, people who worked and paid taxes for at least 10 years. And it's great health insurance. In three main ways, it differs from the health insurance that most people have. And number one, it has no network restrictions. Medicare is accepted at virtually everywhere in the country, certainly every major hospital. And about 98% of all doctors in the country accept Medicare. So there's no network restrictions. You can pick and choose doctors from anywhere in the country.

SPEAKER_00 3:20

And if if you don't take Medicare, that cuts out a huge chunk, you know, 30 percent of the popular or 25, whatever it is.

SPEAKER_04 3:27

Yes. Well, I understand that if hospitals don't accept original Medicare, they don't get any federal funding.

SPEAKER_00 3:32

Okay, there you go.

SPEAKER_04 3:32

So I think that's a big part of the Trevor Burrus.

SPEAKER_00 3:34

So original Medicare, no network.

SPEAKER_04 3:35

No networks, that's the first thing we like. The second thing we like about it is there's no referral requirement, generally speaking, to see a specialist. You don't even have to have a primary care physician on Medicare, much less need their permission to see somebody else. Uh so no referral. Make your own appointment with any doctor you want that accepts Medicare. Um And then the third thing we like about Medicare is no pre-authorizations. All right. Um Medicare will approve anything ordered by a doctor that's FDA approved. Uh generally speaking, no pre-authorizations are required, so you get your procedures and your services more quickly without delays and really no denials. So Medicare is great health insurance. But as good as it is, it's not enough by itself because at the end of the day, they're only going to pay 80% of your medical bills. And the 20% left over could be a big problem. Now, before Medicare pays 80% of your bills, there's a small annual deductible. And that deductible is currently $283 in 2026. We don't know next year's deductible yet, but expect it to be around $310. Um but after that deductible has been met.

SPEAKER_00 4:48

Yeah, I mean it's like it's like a a couple doctors' visits.

SPEAKER_04 4:51

It's an odd number, but at least it's a small number.

SPEAKER_00 4:53

Yeah, yeah, yeah. Oddly small. Okay. Um It is odd. Because usually deductible is like a thousand or fifteen hundred or seven fifty.

SPEAKER_04 5:01

That's right. Yeah. People laugh at me when I tell them the deductible amount and they say that's you can meet that in one day. Yes, you can. Yes, absolutely. Uh but it's the twenty percent out of pocket that comes after that that we need to be worried about. And that's the reason we get a supplement plan or an advantage plan.

SPEAKER_00 5:16

Does the twenty percent stop?

SPEAKER_04 5:18

No. There is no annual limit. There's no max out of pocket.

SPEAKER_00 5:22

So if you somehow could figure out how to rack up a million dollars worth of bills. You wouldn't have to figure too hard. Yeah. Well, my mom was in the hospital, and I think her bills were like this was last year, like 1.2 million or something.

SPEAKER_04 5:33

Imagine paying 20% of that. Yeah. Incredible. So uh anyway, that's the problem with original Medicare is this 20% out of pocket with no cap, uh no limit in sight. So that's why we get something to go with Medicare. And everybody gets to choose from two different things. You can get a Medicare supplement plan, uh, which supplements your Medicare and covers that other 20%. There are two main supplement plans to choose from are Plan G and Plan N, and we'll get into those. But not everybody's going to choose a supplement plan. Some people will choose to replace Medicare rather than supplement it. And those people are choosing to get Medicare Part C, which is a Medicare Advantage plan, which is a replacement of original Medicare with a managed care program from a private health insurance company. That's another video. That sounds scary.

SPEAKER_00 6:27

But but hang on, like generally speaking, what would be the differences between original Medicare and a supplement and if somebody chooses to get a Medicare Advantage plan?

SPEAKER_04 6:36

Well, those first three things we liked about Medicare, remember no referrals, no networks, no pre-authorizations. If we replace Medicare, then those things are out the window. And you do have networks. And you do have pre-authorizations. And you might need referrals.

unknown 6:50

Yeah.

SPEAKER_00 6:51

Pretty commonly. Okay. So those three things. What else mechanically, how does it work? So you're going to have some restrictions. Um and then but you're not going to have the 20%. So that seems like a good thing, right?

SPEAKER_04 7:03

Oh yeah. Uh Medicare Advantage Plan is certainly better than having just original Medicare. Uh now you don't have the freedom, you don't have the control. But what you do have is an annual max out-of-pocket. Okay. Around sixty.

SPEAKER_00 7:15

So that's the thing that original Medicare doesn't have.

SPEAKER_04 7:17

Right. And an advantage plan is going to have some perks. It's going to include some dental and some vision. There'll be a gym membership, maybe a small allowance to buy over-the-counter supplies, band-aids, and cotton balls. But generally speaking, uh people choose advantage plans because they are so inexpensive on a monthly basis to have them. Cheap to have, uh, but certainly can be expensive to use. If we get a chronic illness, you're going to pay that max out of pocket.

SPEAKER_00 7:44

I was watching a Jerry Seinfeld episode last night, the very first one. He was talking about cotton balls. He's like, why does why do women want cotton balls all the time? He's like, they just get bags and bags of cotton. When you said that, it just made me think of that. Like, men, we don't know it. Like, what are they doing with these things? Okay, so you get some over-the-counter benefits, some things that they can um, but just to back up a little bit, so my understanding is that the way a Medicare Advantage Plan works is you're not gonna have the 20% that you're responsible for. In fact, you're gonna pay co-pays for everything that happens. So if you see your doctor, it's maybe $10. If you see a specialist, it might be $40 or $50. If you have an uh X-ray, it's gonna be $100. If you have an MRI, it's gonna be $200. If you have an outpatient surgery, it's gonna be $400, $500, $600. You spend a weekend in the hospital, it's probably $400 a day for five days. So now you're at you know, two grand. So all of these bills are being added up to equal this max amount of pocket. So if we were to compare original Medicare, which is like you're much more in control of your health care, but you have because Medicare started back in 1965, right? And it was kind of the same mechanics, right? 80-20. Well, back then, you know, a hospital save was probably like $40, right? So you could handle the 20%. Um, or a doctor, you know, was uh probably very inexpensive. It would be interesting to go back and look at what those costs were back in 65, but as medical inflation has gone up tremendously, you're in a situation where Medicare, original Medicare, still hasn't set a max out of pocket, and so that's why you get something else.

SPEAKER_04 9:17

That's right. And that's something else. Uh again, we'd love to help people get a Medicare supplement plan to go with it. So you maintain these great benefits, no networks, no referrals, no pre-authorizations, and now no 20 percent.

unknown 9:32

Okay.

SPEAKER_04 9:33

Because that's going to be covered by your supplement plan G or plan N.

unknown 9:37

Okay.

SPEAKER_00 9:37

So we've got a caller. Let's hop to this caller here just a second, and then we'll come back. We'll talk about, we've kind of laid the groundwork. A and B, not great. If you have A and B alone, you need to do something. It's simply too much risk. So you have two options Medicare Advantage or Medicare Supplement. When you go into the Medicare Advantage Plan world, you've got I looked at somebody last a couple weeks ago. She was in Michigan, she had 86 Medicare Advantage Plan options. That is crazy. How are you gonna figure out you know, you got doctors, you've got medications, you've got hospital networks. How do you figure this out? You can call MedicareSchool.com, we would be happy to do that. Phone number to do that is 800-782-6676. So if a Medicare Advantage Plan is right for you, you can call us. 800-782-6676, you're gonna talk to someone who can help you sort through that world. Well, we kind of set the stage. Original Medicare A and B, you're either gonna get this advantage plan that at least has a max out of c max out of pocket, but it's going to replace all of the great things about original Medicare. No referrals, no preauthorizations, no network restrictions, those sorts of things. So instead of getting a Medicare Advantage plan, you can get something that instead of getting a Medicare Advantage Plan that replaces original Medicare, you can get a Medicare supplement that sits alongside in the supplement's original Medicare. And there's two great options for that, plan G and N. So let's talk about those.

SPEAKER_04 10:57

That's right. Uh the option to supplement your Medicare rather than replace it gives you the opportunity to enjoy no network restrictions, no referrals and no pre-authorizations, and then have the supplement plan or Medigap plan, as it's also known, cover the Medicare gaps, cover the leftover 20 percent, as we say.

SPEAKER_00 11:16

Aaron Powell Yeah. When you hear uh Medicare supplement or Medigap, those are two sides of the same coin. They mean the same thing. It's just different terminology that's been passed down through the ages.

SPEAKER_04 11:27

That's right. It's a Medicare supplement plan because it supplements your Medicare. It's a Medigap plan because it covers the gaps. Trevor Burrus, Jr. Same thing. Same thing. So whether we get a supplement plan uh or Medigap, we'll call it what you want, it's the same thing. It's either going to be a plan G or a plan N for the most part. Now there are actually ten different Medicare supplement plans to choose from, but seven of them are very obscure and don't cover a lot of the gaps. So for a long time, people have been choosing between plan F, plan G, and plan N. Now, plan F is no longer available for people turning 65 or eligible for Medicare on or after January 1st, 2020. Trevor Burrus, Jr.

SPEAKER_00 12:04

Which is probably you.

SPEAKER_04 12:05

So you're going to be choosing between a plan G and a plan N. Now G is the tippy top, that is the most comprehensive supplement plan you can get. Trevor Burrus Gold Star. The tippy-top Cadillac, so to speak. Both plan G and plan N, we call them a Cadillac because you pay them more on a monthly basis, but you have all these great benefits, all the freedom, all the control. And really no out-of-pocket. It's a bulletproof kind of a thing. Plan G covers all of the medical gaps in Part A and Part B of original Medicare except for the Part B deductible, $283 this year. So if you have a plan G, that $283 is your only out-of-pocket each year. So it's your max out-of-pocket each year.

SPEAKER_00 12:50

I mean it's like uh like almost perfect insurance. I mean, I guess full coverage, 100%, nothing ever spent would be would be perfect. But a $283 deductible is almost the same.

SPEAKER_04 13:01

So that's right. Yeah, it's an odd number, again, but a small number. So plan G, great. I'd say 85% of people choose a plan G.

SPEAKER_00 13:10

Yeah. Your number's not far off. Yeah. I think the data is it's it's between 80 and 85. Like still, you there's been more of a trend towards plan N. Um, and that's picked up some steam in recent years as premiums have gone up on Medicare supplements, but still plan G by far and away is what is most people are purchasing.

SPEAKER_04 13:29

That's right. And they get that because they like the idea of no copays, no excess charges, no surprises. Yeah. All right. That's the better safe than sorry option, I suppose. But Medicare supplement Plan N is really not all that different. The deductible is the same. It's the same Medicare part B deductible of $283. But then after that, you kind of still have to take your wallet to the hospital because you have two copayes and only two. Under a Plan N, a doctor's office consultation is going to be $20. Now that doesn't matter if it's a primary doctor or a specialist. If it's an office visit, it's $20 on a Plan N. And if you have an emergency room visit, that's the other copay. An emergency room visit that does not result in a hospitalization, it carries a $50 copay. These are the only two copies. Yeah. It's strange that you would pay $20 to see a doctor, but pay nothing to go under the knife. Yeah. But that's how it is. Yeah, there you go. $20 for doctors and $50 for emergency room visits. Those are the only two copays. No copay for physical therapy, for surgeries, for ambulances, just $20 per doctor visit. And these two copayes are really the only differences that most people actually experience on a plan N versus a plan G. So people who don't go to the doctor very much, like one of our callers, they'll often choose a plan N for savings. $40, $50, $60 a month less leaves room for plenty of doctor's office visits at $20 a pop. But those two copies are not the only differences between Plan G and Plan N. There's one other difference, and that is something called excess charges. Excess charges are fees that are charged by some providers who accept Medicare but who do not accept Medicare assignment. When doctors sign up to accept Medicare patients, they're shown a list of fees. Medicare is a private fee for service. You provide this service, you get this payment. And about 97% of all doctors have decided that that's enough. That's payment in full. They'll accept that assignment.

SPEAKER_00 15:38

So if Medicare says, I'm going to pay you a hundred bucks for that particular code, a doctor that accepts Medicare assignment says, cool, paid in full.

SPEAKER_04 15:48

But a few doctors out there have decided that that's not enough money, that they want to be paid more. And so they accept Medicare, but they don't accept Medicare assignment. And so if you see one of those providers, then you can expect to see a bill for up to an additional 15%. If it's a $100 service, it's $15. If it's a $500 service, it's $75. This is pretty rare. This doesn't happen all that much. Again, 97% of doctors don't assess these additional excess charges. But some of them do. So you have to ask or call or look them up at Medicare.gov. The website will tell you whether they do or whether they don't. Accept assignment. Accept Medicare assignment.

SPEAKER_00 16:30

So on a plan N, if you go to a doctor that does not accept assignment and charges an excess charge, the N plan isn't going to pay that excess charge. You are going to get billed for that. Whereas the G plan is just going to pay that. You're not going to have to pay that. So I think that's why some people like go, well, you know, I mean, there was a news article today about how they're readjusting how providers are going to get paid and reimbursed by Medicare. And there's some good and there's some bad, much like anything. And so people who are going, I don't even want to deal with that. Let me get a plan G. I don't want to have to worry about access charge being an issue ever, and it's worth $25, $30, $40, whatever it is extra a month, to do that, that's what they'll do. Trevor Burrus, Jr.

SPEAKER_04 17:17

That's right. To have no surprises. These are what my clients tell me. Say, for that price difference, give me the plan G. Yeah. So I don't even have to worry about it.

SPEAKER_00 17:24

Trevor Burrus, Jr. But there are some people and in some states that there's not an access charge. There's eight of them, I think. Trevor Burrus, Jr.

SPEAKER_04 17:30

That's right. There are eight states that do not charge excess charges. Let's see, Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont. If you live in one of these states, there is a there are no excess charges in the state.

SPEAKER_00 17:48

But if you go across state lines, there could be. There could be. Trevor Burrus, Jr. But in these states, you know, as long as you're staying within your state line, it's illegal. There are no Medicare excess charges, but you know, per the state rules. And so a lot of people in those states will absolutely get a plan N, and we recommend that frequently. Another area that I think we, you know, you'll if you call in and there's some pretty big price disparity. Um not even just the excess charge, but you'll look in one state and the difference between a plan G and a plan N may be thirty dollars. That's not that much. $360 a year, you go to the the doctor a few times a year, you've almost made up that difference in copies. If you But in some areas it's sixty, seventy, eighty, hundred dollars a month difference. And so in those states, you're probably not going to go to the doctor five times a month, right? So what would be the point to get the plan G?

SPEAKER_04 18:43

That's where the plan N starts to look more desirable, and uh that's where the 15 percent of people typically choose it, is because they're seeing sixty, seventy dollars a month difference in premium. Yeah. Um and if you live in one of those eight states, then the copayers are the only difference. So it's even more desirable. That's right. But remember, when you pick one of these, pick it like you're gonna live with it for the rest of your life.

SPEAKER_00 19:03

Yeah.

SPEAKER_04 19:04

Um and uh although excess charges are rare, we have had a few clients get clobbered. Yeah. Um I think in ten years I've only had three of my own clients call me back to tell me it happened to me.

SPEAKER_00 19:16

Yeah, yeah.

SPEAKER_04 19:17

I saw an excess charge. But uh here in the company, I think recently there was a lady in Florida, she was getting infusions, I think, for rheumatoid arthritis, and she was getting them from the same doctor forever, but the doctor was out of town or on vacation or something, and they said we're gonna have so-and-so do your infusion. Oh. Wow. And that was one of the doctors that charges excess charges. I mean, again, fifteen percent of five hundred dollars is not a big deal. But if your infusion is a thirty thousand dollar medication and you get it from a doctor who bills an extra fifteen percent. Four grand or whatever? She's currently paying it. She called us, she told us about it. She said, It's my fault. I don't blame you.

SPEAKER_00 19:58

Yeah.

SPEAKER_04 19:58

She said, the first three years I had this plan. That's a crazy story. I called all the doctors ahead of time. I made sure they don't charge excess charges. I did that for three years, and not a single doctor ever charged excess. So I got lazy, I got complacent, I didn't check it.

SPEAKER_00 20:12

Yeah.

SPEAKER_04 20:12

And I got clobbered.

SPEAKER_00 20:13

Okay. That that's a that's a crazy story. Yeah. Yeah. Plus one for G plants. That's right. Because you you're not always going to think of everything. That's right. Really? I mean, when I go to the urgent care or wherever, which is pretty rare, but it's like, I don't even know if they take my insurance. I just plop the card down and hope for the best.

SPEAKER_04 20:31

I know what you mean. I know what you mean. And somebody who's hospitalized, you know, you can't look up the doctors before you walk in and hello, Mr.

SPEAKER_00 20:38

Anesthesiologist. I see you charge excess. Uh I would like not to be put under for this for this surgery.

SPEAKER_04 20:44

Right. Yeah. I mean, walk in and out, there might be a dozen doctors. Some of them will talk, some of them will just open your chart, look at it, and walk back out again. And one of them could be assessing excess charges. Just that. You just find out about it later. Yeah. So uh maybe plus one for plan G, but healthy people and people in those eight states for sure.

SPEAKER_00 21:02

Yeah, not to scare anyone from a plan N. Let's talk to Joseph in Oregon. Joseph, uh, welcome to Medicare School Daily. What questions you have for us? Um, my question is simple.

SPEAKER_02 21:14

Um I uh I am turning uh 65. I get on Medicare at 65, I get it for two months, and then I go the next year. I have to have been I have to like if I gotta get a dental plan, I get it for two months, and then I have to either keep that dental plan or get on a new one for the new year. Is that correct?

SPEAKER_04 21:38

No, Joseph, you're not necessarily gonna have to change everything right after getting on it. It's true that some parts of your Medicare will renew each year on January first, namely your drug coverage. Uh whatever drug plan we get you will only really be for November and December, and then we'll decide whether we want to change it for January or whether we're We don't. You can just let your drug coverage roll over to the new year, or you'll have the opportunity to change it. Now your Medicare A and B is going to be the same forever. You don't renew it or change it. Medicare A and B are going to be constant. If you get a Medicare supplement plan, that's not going to start over or change on January 1st. Only the drug coverage. And so yeah, we'll get you set up for Medicare A and B supplement drug plan, assuming that's the way you're going to go. And then as soon as your drug plan is active, you'll have uh five week five more weeks to look at 2027 drug plans with us, and we'll help you decide if you should stay or if you should change.

SPEAKER_02 22:39

And the next question would be um in my state, there was something about being on um Medicare, um being in an advantaged plan for one year, and if I didn't like it, I could switch to a supplement care supplement plan if I without underwriting if I wanted to. Is that correct as well?

SPEAKER_04 23:02

That's correct. Uh in the state of Oregon, you're allowed to have what's called a trial right. Trial right one is if you start with a Medicare Advantage plan right off the bat. Uh and then you're allowed to try that out for up to 12 months. And if you feel like you have made a mistake and you want to go but to original Medicare and a supplement plan, then you can, as long as you do it within those first 12 months, and as long as your Medicare A and B start at the same time, November 1st. Uh that's using, again, trial rate number one. Uh for the first six months of those 12 months, you're still in your open enrollment period to get a Medicare supplement plan. So it's really easy during the first six months. During those second six months, it's a different enrollment period and it becomes what we call guaranteed issue. That involves more legwork, more paperwork, and sometimes a little bit of back and forth with the insurance carriers. So it's not as easy, it's still possible. Uh but we recommend that you uh uh decide which kind of coverage you're gonna want and not spend too much time before you secure it.

SPEAKER_00 24:10

We've just seen too many people you know try to do this 12-month trial period and end up stuck on the advantage plan because they missed something. Um there's some logistical and this is in the second six months. So the first six months is easy. In the second six months, um you're coming in under this period called guaranteed issue. And what that means to an advan a supplement plan insurance company, right? So whatever carrier you're going to go try to get that Medicare supplement from, they're saying, hey, we are being forced to take this through some rule, right? Whether that's the 12-month rule or there's kind of a few other rules. And guess what? We can't ask them any health questions. And so this is an unknown risk to us. And so because we are being forced to take this person and we don't know if they're healthy or unhealthy or whatever it is, we are gonna make sure they dot every I, we're gonna make sure they cross every T, and we're gonna add some hoops to make them jump through. So what I mean by that Yeah, so what I mean by that is technically, yes, that second six months, you can do it. But there will be a time period where you have to disenroll from your Medicare Advantage plan, you have to get a termination notice from that Medicare Advantage plan that is mailed to you after the date that it cancels, and then that letter is then given to the Medicare supplement carrier to say, Hey, look, I have this special period. You're kind of waving this flag, I have this special period that you have to accept me by law, so accept me. And they're gonna ask you to fax the letter in, and then there's gonna be some hem-hawing around, and then they're going to approve it. That period, I have people that won't leave their house because they don't know if they have insurance, but that and eventually it'll go through, generally speaking. However, what happens if you're in month 10 and you have a car wreck, or you're in month 11, you're trying to do this, and you're undergoing cancer treatment, or you're incapacitated and your spouse doesn't or your kids don't know about this, that all this needs to happen, and all of a sudden you tick over 12 months in one day, and that's gone for forever. Okay? So I'm not trying to necessarily scare you. I'm just trying to say you're right. The first six months of starting is easy. That second six months is just a little bit riskier, and so we like people to know about that. Oregon's a little bit of a different state in terms of um there's this thing called the birthday rule. Have you heard of that? Yeah, but it's it was too confusing and I stopped paying attention. Yeah, basically it it it really simply it it means somebody in the state legislator, um you know, they they've they've gone through and they've made this rule that sounds good in theory, but ends up kind of hurting most people, but it helps some people. And what it says is in if you have a Medicare supplement like a plant G or you have a Medicare supplement plan N, on your birthday, you can move to a plan of lesser or or of equal or lesser benefits without any medical questions asked. That sounds good, right? You know, hey man, if they raise my premium, I can trip to another carrier. What that has done, though, is it's caused your Medicare supplement for everybody in the state, those prices to be about twice as high as any other state. Okay, so everyone why? Because the Medicare supplement care is like we are being forced to accept people and we don't know if they're healthy or not. We can't calculate our risk. And so what do they do? They raise the rates on everyone.

SPEAKER_02 27:43

I've been watching videos now for a while.

SPEAKER_00 27:46

Well, you're about ready to teach or teach then.

SPEAKER_02 27:51

So and I've watched from a bunch of different people, uh different companies.

SPEAKER_00 27:56

Like, yeah, you know, you better not be cheating, you better not be cheating on us, Joe. No, just kidding.

SPEAKER_02 28:03

Just kidding. I've gotten hundreds of calls from people I didn't ask for. Someone's trying to sell me insurance, and I go, no, no, no, no, I have someone. And then I I tell them they go, Who do you have? I said, Medicare school, and they were like, Oh, and then they go, Okay. And some people just hang up. They don't even say anything. Once they know you have someone, they'll just hang up on you and them.

SPEAKER_00 28:28

Yeah, well, a lot of a lot of those people calling you, you know, they're just trying to sell you a Medicare Advantage plan. They're they're not bad people, but that's all they're trained on, right? And so they don't really equipped to help you, like we'll help you enroll in Social Security, we'll help you do A and B. We'll help you with any any any appeals or anything, billings issues, claims issues, premium changes down the road, you lose your ID cards, like they're there to what we call in in this world, ink an app. Put get your signature on an app, and you'll never hear from them again. And so we really have tried to try to do things differently. Well, we'd love to help you when we can, Joe. We're gonna get to our next caller. If you've got any other questions, you call us back, okay? No problem. Hey, thanks a lot for listening to me. Yep, thank you. Yeah, bye-bye.

SPEAKER_04 29:17

All right, we've got Jack. Uh Jack, thanks for calling in. Uh, tell us your question, please.

SPEAKER_03 29:23

Hello, uh, good morning. Uh my name is Jack in Texas. I uh I work full-time, my wife works full-time. Uh I am on her insurance plan through her work, uh, high deductible plan where she's contributing to an HSA. I'm turning 65 in September. If I uh enroll in part A, the fact that she contributes to an HSA, uh, will she have to stop that? Because we both use the HSA for doctors' visits and medication.

SPEAKER_04 30:00

If you were to enroll in Medicare Part A, Jack, then she would only be able to make contributions uh for sort of her half of the household. All right. Uh there's a certain amount that she's able to contribute to now, and uh that'd be about cut in half if you were to go on Medicare Part A. So do you intend to stay on that high deductible plan for as long as she's working?

SPEAKER_03 30:24

Yes. Yes. Then So it cuts her in half uh because we file jointly too. Right. You know.

SPEAKER_04 30:34

Yeah. Um I would uh I would postpone the beginning of Medicare Part A uh for a couple of reasons.

SPEAKER_03 30:42

How do how do you make sure they don't automatically sign me up for part A?

SPEAKER_04 30:46

Are you drawing Social Security benefits at this time? No, absolutely not. Then you will not be enrolled in Medicare Part A or Part B automatically by anyone. All right. Only people who are drawing Social Security benefits in the months preceding their 65th birth month are automatically enrolled in any part of Medicare. So it won't happen for you. You're not on their radar. You'll just not take the steps to enroll in part A or Part B, and then it won't happen. All right.

SPEAKER_03 31:15

And then Okay, maybe they enroll you in part A automatically when you turn 65.

SPEAKER_00 31:22

Only if you are currently receiving a social security check.

SPEAKER_04 31:26

That's right. Now eventually you'll want to sign up for Medicare Part A when you're gonna be losing the coverage through the employer, uh, your wife's insurance. Yeah. Then you're gonna be signing up for Medicare Part A. It will help you do it, but when you do it, they will they will back it to that.

SPEAKER_03 31:43

How do you prove that uh this is a high deductible plan? How do I prove that that I had uh uh drug coverage, part D, covered? Um I guess you can get penalized.

SPEAKER_04 31:58

Yeah, no, you won't be penalized. Uh they'll ask for proof, you'll have a termination notice from the you know your wife's employer's insurance that says when it started and when it ended, and you'll provide that and that'll take care of the proof. There'll be no penalty. Same with part B. There'll be a form that's signed by the employer that says you recovered and how long and when it started and when it's ending, and then you can start part B at the end. No penalties. But the point I was gonna make is whenever we do eventually help you go on Medicare, they're gonna backdate the effective date of your Medicare part A by six months.

SPEAKER_03 32:31

And so Part A month six. Okay.

SPEAKER_00 32:35

Backdated by six months, right. And that six months begins on the date that you made the application. So let's say you enrolled in Medicare three months before you wanted it to start. They're gonna backdate the six months on that first month that you applied. So three months. So it's really nine months. So if you enrolled two months, do the application two months before you want it to start, then it's eight months. If you do it a month before, then it's seven months. Do you understand?

SPEAKER_03 33:04

Okay. I do. So I'm turning 67 uh in two years, two two Septembers from this September. Yep. I thought about starting all that the January of 2029. Taking Social Security and taking Medicare, uh, Medigap G.

SPEAKER_00 33:22

It's gonna line up perfectly for you. Then you're just gonna stop that full year. You're not gonna make HSA contributions on your behalf. Does that make sense? Uh 2028, then, correct? 2028, yep. And then you'll want to do your application, you know, to get everything started about 90 days in advance of September. So August, June, anytime after May 1st. Okay. So stop your contributions at the end of 2027, right? And then make application for Medicare. And you can even do the Social Security application. We'd love to help you do all of that together. Do all of that beginning in May. If you do those two things, call us, we'll handle the rest.

SPEAKER_03 34:06

Okay. And if I wanted to take a chunk of money out, uh they look back at two years. So if I did it 2029, are they looking at 2027 income?

SPEAKER_04 34:18

Yes, you're talking about Irma. Uh that's right. Yes. In 2029, they'll be looking at your 2027 income taxes. That's correct. They'll be looking at the month of the 2020.

SPEAKER_03 34:28

So it doesn't matter what yeah what month in 2029?

unknown 34:33

No.

SPEAKER_03 34:33

So that it so it does not. So it could be January.

SPEAKER_04 34:37

You could go on in January of 2029. For the entire year of 2029, the months that you're on Medicare, whether that's one month or six or all twelve, they'll have to be charging you for your Medicare monthly based on the household's modified adjusted gross income from two years before in 2027.

SPEAKER_03 34:57

2027. So if I wanted to take a chunk of money out, I should do it this year, 26.

SPEAKER_00 35:02

That's right. Yeah, you can do it this year, or you can do it next year, right? Because what you what's going to happen is there you you're gonna fill out a form called an SS 44. Okay, and that's basically to appeal this high income SERMA surcharge that we called ERMA, income related monthly adjustment amount. So you can use, and one of the reasons would be a work reduction or a work stoppage. So you're saying, hey, I retired or I went part-time, whatever it is. My income is now below the threshold, and you can use that for two years. So if you took out money this year, yeah, you could use it. If you took it out next year, you could use it again in 29. Okay.

SPEAKER_04 35:44

Very good point. You can appeal the earnings.

SPEAKER_03 35:49

When they add up our income, my wife's income plus my income plus money we take out of the 401k. Yep. Is it the adjusted gross income or the total before it's adjusted?

SPEAKER_04 36:01

It's the modified adjusted gross income. If you were looking at your form 1040, you'd look at line number 11, which is the adjusted gross income, the household, that's the amount you pay taxes on. Line 11, that's after deductions. And then add to it line 2A. And the sum total of those two lines is the household modified adjusted gross income. And that's what they'll try and charge you for, uh charge you based upon for your Medicare in that year. But then again, we'll help you do an appeal uh if it saves money and uh because of work stoppage or work reduction, as Josh was saying, and we'll be able to give them an estimate of what you think your household's modified adjusted gross income will be for 2029, and they'll go by that number.

SPEAKER_03 36:49

Well, wonderful. I will definitely call you guys. You're very, very knowledgeable and helpful.

SPEAKER_00 36:55

Good, good. Thanks. Love to do it. And there's no cost to work with us. When you call in, we're gonna compare. We'll help you do all the enrollment for Social Security Medicare, A and B, the ARMA appeal will help help facilitate all of that. Compare the different supplemental plan options, G versus N versus which carrier versus a Medicare Advantage plan. Get all your meds, help you figure out what the right drug plan is. Um dental revision will handle handle all that for you.

SPEAKER_03 37:23

I've been bombed with phone calls on Medicare stuff, and everybody's pushing advantage plans.

SPEAKER_00 37:29

You know why?

SPEAKER_03 37:29

Are they getting paid for them or what?

SPEAKER_00 37:32

Yeah, they get paid about twice as much.

SPEAKER_03 37:34

Commissions?

SPEAKER_00 37:35

Yeah.

SPEAKER_03 37:36

Oh, that's why.

SPEAKER_00 37:37

Commissions are, yeah, that's where that's where all you follow the money, right? So they're all and again, I always say they're not bad people. You know, they these big call centers, giant call centers, there's three or four of them. They hire thousands of people, they teach them about Medicare Advantage plans, and they bonus them if they get you into a Medicare Advantage plan and off the phone in 20 minutes. This is the business model.

SPEAKER_03 38:02

Yeah.

SPEAKER_00 38:02

Yeah. So there's I wanted to go with you guys. There's a handful of people like us out here, you know, I would say half a dozen or so that try to take a more educational approach. Um, we're not gonna blow up your phone. That's not our business model. We want people to want to work with us. So learn through all the content, the education we put out, and when it's time, give us a call. We'll be here. That's right.

SPEAKER_03 38:25

Well, thank you so much. I appreciate you answering my questions. Okay, thanks, Jack. Thanks. Thank you. I'll keep watching you.

SPEAKER_00 38:32

Take care. Bye-bye. See ya. Let's talk to Mike in Pennsylvania. Mike, welcome to Medicare School Daily. What questions do you have for us?

SPEAKER_01 38:43

I guess the first one I was calling you about is the new program I see that they're rolling at. It's called Bridge Program for uh some medications. From what I've read, is that it's a $50 copay. You do have to qualify for it, but uh it also doesn't apply to your Medicare deductible.

SPEAKER_00 39:03

Yes, that's correct. Are you on Medicare already or are you getting ready to start? I am not. There's a really helpful document that Medicare.gov puts out on this um Medicare GLP1, what they call the bridge program. And so there's four requirements that you have to meet in order to be eligible for this. So the first one is you have to have a drug plan. Okay? Now, what's interesting is the drug plan actually isn't funding this, like the billing isn't going through them, um, but you still have to have a drug plan. So when you start Medicare, you're going to get original Medicare A and B, which I want to put a pin. I want to make sure we talk about your enrollment timeline because if you're turning 65 in October, you got employer coverage, you want everything to start January 1st. Uh let's talk about that here in just a second. But I'm gonna I'm gonna keep going. So you have to have a drug plan, number one, you're going to anyway. Um you're not eligible, the second criteria is you're not eligible to receive a GLP 1 through your drug plan. So, in other words, like there's no legitimate way, right? You can't um the third one is you can't have, and this is where I think is gonna be an issue for you, you you cannot have type 2 diabetes, moderate to severe sleep apnea, or fatty liver disease, because those are current ways that Medicare will cover GLP1s. So if you have that, you are gonna have to get it filled through the normal drug plan, regular Medicare process. This is almost like a testing program that they're rolling out for about 18 months to see what usage and utilization looks like for people who don't have what they would consider a medical reason, but it's truly just for weight loss. Okay, so it's because I heard you say you have sleep apnea and that's how you're getting it currently. I am not sure that you will qualify. Okay. Now that doesn't mean you're still gonna be able to be able to get it. You're probably just not gonna be able to maybe get it for under this bridge program. Okay. So then the fourth criteria, again, you have to meet all four of these. So the fourth criteria is is related to BMI. Okay, so if you have a BMI of 35 or higher, then that qualifies you. If your BMI is between 30 and I guess 34.9, you also have to have certain types of heart failure or high blood pressure that's hard to control, or chronic kidney disease stage 3A or above. Do you have any of those? No. Okay. So yeah, so then there's even more. So if you go down BMI 27 or higher, you have to have prediabetes, you have to have had a heart attack, a stroke, or blocked arteries. So they kind of make it like I'm gonna say, like the skinnier you are, the more you have to have health problems in order to do this. But I don't think the bridge program is a thing for you because you have the sleep apnea. But that's not bad, that's not bad news. You can still get it through your drug plan. You're still gonna have a $2,100 cap. You're still pro you're actually probably gonna be able to, depending on which one you're on, you may end up getting it cheaper than that. Because some of these uh can be a little bit cheaper. So I don't think it's bad news. I just don't think the bridge program is for you.

SPEAKER_04 42:13

Did I hear you say that you were gonna work through the end of the year?

SPEAKER_01 42:16

That is the plan, unless they come for a rift for me, but until then, yeah, the plan is January 1st.

SPEAKER_04 42:24

So Okay. Well, it'd be real easy to put you on Medicare either in October, November, December, or January. Yeah, we can decide that. And then of course we'll help you decide between uh Medicare supplement plan and Medicare Advantage Plan. We have a process that we'll take you through. Uh step number one is usually helping a guy figure out which one of those two kinds of insurance he wants to put his name on, either a supplement or an advantage. And once he's got that figured out, step number two is gonna be talking about which supplement plan or which advantage plan. We'll guide you through that. And then finally, step number three is getting you signed up. We'll help you get enrolled into Medicare and your secondary coverage, have it start on time with no penalties and no problems. We're really good at that. And then finally, you're gonna keep our number and we'll be with you the whole time.

SPEAKER_01 43:12

I was doing uh again additional research there and I saw that the insurance companies do various different rates, like uh how it's rated community rated, issue by age related, or attained age related. Is there any way to look at a plan and find out how they came up with their rate or how they do their rating? Oh, yeah. They come up with you know pricing?

SPEAKER_04 43:38

Yeah, that information is at medicare.gov. Uh you can plug in your zip code at medicare.gov and you're gonna see the different carriers uh and their rating methods. But Pennsylvania is primarily an attained age state for Medicare supplement or Medigap plans. Uh that's really just one part of the bigger picture when it comes to anticipating and planning for future research.

SPEAKER_01 44:02

Yeah, I've been doing that too, I guess, with the stronger companies there. I mean, it does I've gone to a couple different sites where it's like yeah, within the last three years they raised the rates three, as opposed to some that are raised them by ten percent the rates.

SPEAKER_04 44:17

So when you choose a supplement plan, whether it's a G or an N, you want to choose it like you're picking it for a long time, maybe the rest of your life. You know, you might not get an opportunity to change your mind between plan G or plan N. And you also might not be able to change from one carrier to another. So we do want the lowest rate, but we want the lowest rate of the stable rate carriers. Alright, so it's an important decision. Um have you been thinking about whether you're gonna get plan G or plan N yet?

SPEAKER_01 44:49

I'm pretty sure that the N is what I'm looking at with the little copies that come with it, the emergency room or the doctor. I think it probably makes more sense. If I go with if I go with the supplemental, go with the N plan, I think.

SPEAKER_04 45:03

Is that because uh you don't go to the doctor all that often these days? I don't. Nope.

SPEAKER_00 45:09

Um It's quite a bit.

SPEAKER_01 45:17

Once a year.

SPEAKER_00 45:18

So there's some significant savings, I think, on you know, sixty, seventy dollars per month. You're probably not gonna make that up in a twenty dollar copay unless you see the doctor three or four times a month.

SPEAKER_04 45:31

That's right. Yeah, it's the price difference between the plan G and the plan N that usually helps my clients make up their mind which one they want. If it's say $20 or $25 difference per month, most p my clients choose for plan G. Yeah but when I see price differences in your area so closer to $60, $65 a month, that's enough room for three twenty dollar doctor's visits per month, $36 a year. You're a far cry from those days. So Plan N, I think, is right up your alley.

SPEAKER_01 45:59

My wife she has A active, but I did read that in Pennsylvania that she can, if for any reason we had to go on Medicare sooner, that they because she's on disability, that they will allow the plan to write her at 64 before she turns 65, but at a possible increased rate by doing so?

SPEAKER_04 46:22

It is more expensive when you're under 65 to have a Medicare supplement plan, and then all of a sudden less expensive to have that supplement plan at 65, but it wouldn't automatically go down in cost. You'd have to apply for the supplement plan again, a new one, to get the lower rate for her. But if she's going to be covered under your insurance through the end of the year, then I would wait to put her on Medicare Part B until she's coming off of your coverage. Could be December 1st, if you want, or it could be January 1st when she's no longer covered by the group plan and she'll have uh a better a better go of it.

SPEAKER_01 46:58

Well, if she had to go under that apply, reapply again, would she lose her underwriting the back of the No. You know, I know they don't do any underwriting first time you apply.

SPEAKER_04 47:11

As long as she's within six months of the start of six months of the start of Medicare Part B, uh there would be no medical underwriting, and that's gonna be the time to do it. But again, she could start part B December first because she wants to at 65, or it could be January first because she doesn't need it yet and she's covered under your insurance in December. But we'll want to get part B uh for her in either December or January. And then we're gonna want to get the supplement plan as long as again with within six months, uh which she'll want it right away. And so there won't be any underwriting for her uh either. Dylan will help you with her plan too. Uh but before you to look too deeply into these other carriers, Dylan's gonna tell you what carriers we've determined have been the stable rate carriers over the last fifteen years. Uh can't exactly predict the future. There's a certain amount of speculation, but when you look at past performance to determine future behavior, uh you've got the closest thing to the crystal ball. And so he'll tell you what carriers we have seen as stable based on listening to our clients over the last 15, 16 years. Okay. And um that information you get from him is coming directly from Marvin. So he'll help you figure out which carrier uh to get and to keep for yourself and your wife.

SPEAKER_01 48:34

Okay, and as far as the advantage, he'll discuss advantage plans too, because I was looking at advantage plans to begin with, but then with the max out-of-pocket and all that, and I was trying to do the math there and Cygna does about $275 billion in revenue every year.

SPEAKER_00 48:48

Uh obviously that's a lot. Uh Erie does about uh 500 times less than that, or about 600 million. So, I mean, that's not a small number, but it's not a big number in the insurance world. So I would just be careful about, you know, even if there's a $10 discount, or like, do you really want to go with an insurance company nobody's really ever heard of? Wouldn't it be great? All those people that are calling you, if you knew how to sniff out who was going to be somebody that could help you versus not, because when you turn 65, when it comes around to the annual enrollment period, you start getting hounded and barraged with phone calls. Personally, I think this is wrong and it shouldn't happen because most of these folks that are calling you, they've been trained to push Medicare Advantage plans down people's throats. So tomorrow, you're gonna learn how to sniff out those people, and we're gonna show you how you can know more than those people that are calling you and sniff out who is good and who is bad. Join us tomorrow. Uh, if you want to be a part of the show 833-824-2004, 11 a.m. to noon central time, every Monday to Thursday. We'll talk to you tomorrow.