Bogleheads® Chapter Series – Medicare with Lonnie Thibodeaux
00:00:00.000 | (upbeat music)
00:00:02.000 | - Welcome to the Bogleheads Chapter Series.
00:00:04.740 | This episode was hosted by
00:00:06.300 | the Pre and Early Retirement Life Stage Chapter
00:00:08.840 | and recorded on December 13th, 2023.
00:00:12.520 | The session features Lonnie Thibodeau
00:00:14.280 | reviewing Medicare basics, followed by a Q&A session.
00:00:18.160 | Bogleheads are investors who follow John Bogle's philosophy
00:00:20.860 | for attaining financial independence.
00:00:23.400 | This recording is for informational purposes only
00:00:25.820 | and should not be construed
00:00:26.900 | as personalized investment advice.
00:00:29.860 | Could you walk us through how you initially
00:00:32.220 | entered the business of Medicare insurance
00:00:34.680 | after having worked in aviation?
00:00:37.260 | What inspired you to pursue this field?
00:00:39.640 | And were there any specific experiences or individuals
00:00:43.400 | that played a significant role
00:00:45.320 | in guiding you along the way?
00:00:47.240 | - Well, first, thanks for having me back again.
00:00:50.480 | I'm honored to be here.
00:00:51.480 | Thanks for the question.
00:00:52.680 | Yeah, I'd spent about 17, 18 years
00:00:56.280 | in the corporate aviation business in a sales role
00:00:59.560 | of different capacities.
00:01:01.500 | And September 1, 2011 happened.
00:01:04.800 | I'd been working on a special project
00:01:06.800 | for the company that employed me.
00:01:08.320 | And that project included contacting people
00:01:10.920 | in countries like Japan, Australia, Europe, South America.
00:01:14.840 | We were starting to develop a market
00:01:17.260 | for some of the things that we did.
00:01:18.920 | And my boss came to me one day and said,
00:01:21.080 | "Hey, you and I need to get on the road."
00:01:23.280 | I said, "Where are we going?"
00:01:24.120 | He said, "Well, Japan, Australia, South America, Europe."
00:01:27.080 | And I said, "Bill, love you like a brother,
00:01:29.480 | knowing you a long time, but not going over there."
00:01:32.720 | So I came home that evening and I told my wife,
00:01:35.960 | "I need to find something else to do for a living."
00:01:38.920 | I was kind of tired of being a road warrior anyway.
00:01:41.040 | So she said, "What do you want to do?"
00:01:42.800 | I said, "You know, back very early in our married life,
00:01:46.440 | I'd been laid off from an aviation job.
00:01:48.480 | I was down in South Louisiana
00:01:49.840 | where the oil industry was collapsing.
00:01:52.200 | And I did insurance just on a whim for a couple of years
00:01:57.000 | just to pay the bills."
00:01:58.800 | And so I said, "You know, I don't think I gave it
00:02:01.640 | a fair shake at that time.
00:02:03.600 | So I'm going to try that again."
00:02:05.680 | So I got licensed in the state of Texas where I now live
00:02:08.400 | and started selling some things, health insurance primarily.
00:02:12.260 | Ended up meeting a gentleman who was a rep for a company
00:02:15.880 | who trained agents to sell their product.
00:02:17.920 | And he said, "Hey, I'm currently under consideration
00:02:22.560 | for a promotion.
00:02:23.440 | If I were to get that promotion,
00:02:24.760 | would you have interest in doing my job?"
00:02:26.160 | I said, "Certainly, give me a call if that happens."
00:02:28.320 | So three or four weeks later, he calls,
00:02:30.560 | interviewed for the job, took the job,
00:02:32.680 | and worked for that company for just about five years.
00:02:36.240 | And when a couple who owned this insurance agency
00:02:39.320 | was about ready to retire,
00:02:41.000 | and they approached me about purchasing their business.
00:02:44.080 | So that happened in March of 2007.
00:02:46.960 | And we've been doing this ever since.
00:02:49.080 | And I think my real interest in Medicare products
00:02:52.600 | was because as a kid,
00:02:55.040 | I spent a great deal of time with my grandparents.
00:02:57.240 | So I spoke old long before I was old.
00:03:02.040 | My wife has told me many times,
00:03:03.560 | she says, "You were old before your time."
00:03:05.380 | And I am guilty as charged.
00:03:07.080 | - Got it.
00:03:10.000 | Excellent, thanks for sharing that.
00:03:11.760 | I'll also add, Lonnie's kind enough to agree
00:03:15.200 | to a part two session,
00:03:17.800 | since it's unlikely that we'll get to all of the questions.
00:03:21.320 | So more to come on that,
00:03:22.720 | it may be in a month or two or three,
00:03:25.440 | and it'll be announced on the forum
00:03:27.400 | and other channels as we typically do.
00:03:29.720 | So again, Lonnie, thanks for that background.
00:03:32.520 | Next question, "Can you share with us
00:03:34.680 | what you enjoy most about your role
00:03:36.560 | in selling and recommending Medicare insurance products?
00:03:40.400 | Can you relate and experience
00:03:42.060 | where you feel your recommendations
00:03:43.960 | really help somebody avoid a mistake?"
00:03:46.840 | - Well, first of all, I just help,
00:03:50.840 | I like helping people solve the problems
00:03:53.120 | or answering the questions.
00:03:54.800 | In essence, finding the solution
00:03:56.520 | that fits their situation exactly.
00:03:58.500 | And as far as avoiding a mistake,
00:04:03.160 | I'm not sure this is a direct answer to your question,
00:04:05.640 | but I have to share an experience with you.
00:04:07.920 | This past July, I had a gentleman come in
00:04:10.520 | and I shared with him how Medicare works
00:04:13.900 | answered his questions,
00:04:15.480 | explained that there's two major ways
00:04:17.320 | to get his Medicare benefits,
00:04:19.460 | either through original Medicare with a supplement
00:04:21.700 | or Medicare Advantage plan.
00:04:24.200 | And after the presentation
00:04:25.640 | and answering all his questions,
00:04:26.880 | he looked and he said,
00:04:27.880 | "Well, I want a Medicare supplement plan.
00:04:29.600 | Why would anybody want Medicare Advantage?"
00:04:32.000 | And I said, "Great."
00:04:33.040 | So we got him enrolled.
00:04:34.720 | The very next day, I had a Denver gentleman,
00:04:37.120 | exact same situation, about to turn 65, enroll in Medicare,
00:04:40.820 | gave the same presentation, answered all his questions.
00:04:43.240 | And at the end of it, almost word for word,
00:04:45.960 | he said the same thing the prior gentleman said,
00:04:48.360 | "Well, I want Medicare Advantage.
00:04:50.880 | Why would anybody want Medicare supplement?"
00:04:53.080 | So my point being,
00:04:56.820 | we all have different wants, needs, priorities,
00:05:01.200 | and those kinds of things.
00:05:02.400 | And it's all about helping people get into the plan
00:05:06.020 | that fits their situation for them.
00:05:07.780 | - Okay, great, thank you.
00:05:12.840 | Next question.
00:05:14.080 | Can you tell us about the book "Medicare and You"
00:05:16.640 | that you recommended last year?
00:05:18.680 | And by the way, for the audience,
00:05:20.080 | a link to that PDF will be put in the chat.
00:05:23.640 | - Yeah, so "Medicare and You" is typically mailed
00:05:27.960 | to anybody who's on Medicare once a year,
00:05:30.600 | and it updates you with all the Medicare Part A,
00:05:33.840 | Part B deductibles, premiums, those kinds of things.
00:05:37.440 | And it is the Bible of Medicare.
00:05:40.720 | If you will read that book from cover to cover,
00:05:43.120 | it will do two things for you.
00:05:44.600 | It will give you a pretty clear understanding of Medicare,
00:05:47.520 | and it will probably cure insomnia.
00:05:49.360 | - Fantastic.
00:05:53.240 | With that, Miriam, do you want to start us
00:05:56.300 | with a question from the RSVP or chat?
00:05:59.140 | - Yes, actually, the first question is my question.
00:06:02.960 | And along with what Lonnie just said,
00:06:05.580 | Medicare Advantage, Medicare supplement,
00:06:07.760 | my question is, why would somebody wish traditional Medicare
00:06:12.760 | or original Medicare rather than the supplement
00:06:17.880 | or the Advantage plan?
00:06:20.080 | What is the advantage of, or what is the,
00:06:24.200 | why is original Medicare good for some people?
00:06:28.640 | - Okay. - What's the advantage?
00:06:30.280 | - Yep, great question.
00:06:31.760 | So with original Medicare,
00:06:33.700 | there are no networks of doctors or hospitals
00:06:37.320 | to be concerned with.
00:06:38.240 | You can go to any medical provider
00:06:40.360 | anywhere in the United States who accepts Medicare.
00:06:43.360 | And if you have a Medicare supplement plan along with that,
00:06:46.240 | then the same is true of your Medicare supplement plan.
00:06:49.600 | So for people who might travel a lot
00:06:51.520 | or people who want extreme flexibility
00:06:54.280 | in using the Mayo Clinic versus using a hospital in Houston
00:06:58.720 | versus using somebody in Florida,
00:07:01.240 | Medicare along with a supplement
00:07:02.720 | is probably the right answer for you.
00:07:06.560 | - That would be the primary reason for original Medicare
00:07:10.520 | or traditional Medicare.
00:07:11.880 | - Correct. - Right.
00:07:14.000 | The availability of doctors and networks and hospitals
00:07:17.240 | and that you can go to.
00:07:19.400 | - That's exactly right.
00:07:20.800 | - Okay, I might just mention
00:07:22.120 | that I do have traditional Medicare and the,
00:07:26.280 | which pays for 80%.
00:07:28.360 | And then the other 20% that we use came from our employer.
00:07:33.080 | So we have employer retiree insurance for the other 20%.
00:07:38.080 | - Very good.
00:07:41.680 | - Is that considered,
00:07:44.880 | so I just might point out that people should look
00:07:48.880 | for their employer retiree insurance
00:07:52.720 | that many employers may offer it.
00:07:54.800 | And for us, it was a good idea.
00:07:57.560 | Is it called traditional Medicare or original?
00:08:00.080 | What is the correct word there?
00:08:02.320 | - Well, thanks for the question.
00:08:04.280 | I oftentimes refer to it as traditional Medicare
00:08:07.840 | but it is technically correct to say original Medicare.
00:08:10.880 | - Thank you.
00:08:12.840 | Okay, Gorrie.
00:08:13.680 | - Great, thanks Miriam and Lonnie.
00:08:16.080 | Next question.
00:08:17.080 | Let's say I chose the wrong plans for my situation.
00:08:20.080 | When can I change?
00:08:21.640 | Say I'm not happy with the network provided
00:08:23.800 | in my Medicare Advantage plan.
00:08:25.800 | Let's say I'm healthy
00:08:27.280 | and chose an inexpensive Medicare Advantage
00:08:30.920 | and developed cancer.
00:08:32.840 | What are my options?
00:08:34.440 | What personal experiences can you mention about this?
00:08:37.640 | For example, the story about your client
00:08:40.040 | that had MA for many years and then developed cancer.
00:08:44.920 | - Yeah, so a great question.
00:08:47.440 | And I'll provide maybe a scenario.
00:08:51.000 | Let's say someone has turned 65 recently.
00:08:54.240 | They've enrolled in Medicare part A, part B,
00:08:56.760 | the first of the month that they turned 65
00:08:58.720 | and they've chosen a Medicare Advantage plan.
00:09:01.480 | So if you choose that route initially,
00:09:04.120 | then you have what's called a 12-month trial period.
00:09:06.880 | And what that means to you is,
00:09:08.480 | if at any time in that 12 months you decide,
00:09:11.400 | I've made a mistake in selecting a Medicare Advantage plan,
00:09:14.480 | I wish I'd chosen Medicare along with a supplement plan.
00:09:18.160 | Well, during the trial period,
00:09:19.600 | you can choose original Medicare
00:09:21.360 | along with a supplement plan
00:09:22.920 | and get what's called guaranteed issue.
00:09:25.400 | And you would be able to choose
00:09:27.720 | from a number of standardized Medicare supplement plans
00:09:31.960 | issued or offered by any company
00:09:34.600 | that offers them in the zip code that you reside in.
00:09:37.160 | Now, if on the other hand,
00:09:40.240 | you chose Medicare supplement
00:09:41.880 | when you first enrolled in Medicare
00:09:43.960 | and then subsequently decided,
00:09:45.560 | oh, I think I would rather have a Medicare Advantage plan,
00:09:48.680 | then in all likelihood,
00:09:51.120 | you will probably have to wait
00:09:52.280 | until the next annual enrollment period.
00:09:54.640 | And that enrollment period runs from October 15
00:09:57.080 | through December 7, every calendar year.
00:09:59.360 | Does that answer the question?
00:10:03.400 | - I believe so.
00:10:04.240 | And then the personal example?
00:10:06.480 | - Yeah, so we,
00:10:11.120 | my memory's foggy,
00:10:14.080 | but we've had a client or have a client
00:10:17.720 | who was enrolled in a Medicare supplement plan
00:10:22.240 | and the supplement plan premiums were getting really high.
00:10:27.120 | And she came to me during the enrollment period and said,
00:10:31.480 | I don't think I can afford to pay these premiums any longer.
00:10:34.840 | What are my options?
00:10:36.480 | So we talked about Medicare Advantage,
00:10:38.480 | the pros and the cons.
00:10:39.720 | And she said, well, are my doctors in network?
00:10:42.720 | So we confirmed that the doctors
00:10:44.080 | she wanted to see are indeed in network.
00:10:46.120 | But she was concerned then about the co-pays
00:10:49.520 | and potential out-of-pocket maximums.
00:10:52.040 | Well, it turns out in our area,
00:10:53.560 | we have a Medicare Advantage plan
00:10:56.960 | that has approximately $195 monthly premium,
00:11:01.200 | but the co-pays for all your medical care are zero.
00:11:05.920 | So it's a Medicare Advantage plan that does have a network,
00:11:08.600 | but from a coverage standpoint,
00:11:10.360 | it behaves more like a Medicare supplement plan.
00:11:13.160 | And the premium she's paying for that
00:11:14.880 | ended up being about half what she was paying
00:11:17.080 | on her Medicare supplement plan.
00:11:18.480 | So it turned out to be a great solution for her.
00:11:20.560 | She's been enrolled in that plan now about four years
00:11:23.440 | and at the last review
00:11:24.440 | during this most recent enrollment period,
00:11:27.040 | it still seems to be something that's working well for her.
00:11:30.760 | - Great, thank you.
00:11:31.920 | So the next question, and I'll add to it.
00:11:35.440 | So the first part is,
00:11:36.600 | what are the most asked questions by your clients?
00:11:39.240 | And I'll add to it, what do clients find most confusing?
00:11:42.840 | I know there's a tremendous volume of information,
00:11:45.280 | a lot of it's confusing.
00:11:47.000 | So if you can highlight what's most confusing
00:11:49.680 | and supplemental to that,
00:11:51.040 | what helps clarify most effectively
00:11:54.960 | those most confusing things?
00:11:56.960 | - Yeah, good question.
00:11:58.800 | So we've had a number of clients come in
00:12:02.160 | this past enrollment period
00:12:03.560 | and with a smirkish smile on their faces ask,
00:12:06.760 | am I getting all the benefits that I'm entitled to?
00:12:09.840 | And that's being driven by all the advertising
00:12:12.320 | for Medicare Advantage plans,
00:12:13.800 | because that's one of the taglines
00:12:15.240 | of one of the nationwide commercials, I think.
00:12:19.040 | So jokingly, that's it.
00:12:21.520 | What's one of the most confusing things,
00:12:25.200 | I think is the enrollment periods,
00:12:27.120 | because the annual enrollment period
00:12:29.320 | that I just talked about,
00:12:30.320 | that runs from October 15th through December 7th,
00:12:32.760 | applies to Medicare prescription drug plans
00:12:35.640 | and to Medicare Advantage plans,
00:12:37.320 | but it does not apply to Medicare supplement plans.
00:12:40.840 | In addition to that, we have another enrollment period
00:12:45.120 | we're about to approach,
00:12:47.360 | and it runs from January 1 to March the 31st.
00:12:51.280 | And that enrollment period
00:12:52.280 | is called the Medicare Advantage open enrollment period.
00:12:54.880 | And it only applies to people
00:12:56.440 | who are currently enrolled in a Medicare Advantage plan.
00:13:00.000 | But that enrollment period allows them to change
00:13:02.280 | from one Medicare Advantage plan to another,
00:13:04.680 | or allows them to go back to original Medicare,
00:13:09.240 | select a Medicare supplement plan,
00:13:11.160 | and then select a Medicare prescription drug plan.
00:13:14.640 | So the other thing we have are special enrollment periods.
00:13:20.000 | So if you moved out of a service area
00:13:22.120 | for the plan you're currently enrolled in,
00:13:23.760 | oftentimes that opens up a special enrollment period for you
00:13:27.760 | based on your particular situation.
00:13:29.680 | So just keeping the enrollment periods,
00:13:33.800 | I guess all straight,
00:13:35.160 | seems to be the most confusing thing for most people
00:13:37.200 | because there are a lot of moving parts, I think.
00:13:39.920 | - Got it, okay, that was helpful.
00:13:41.560 | Here's an interesting one.
00:13:42.720 | I just started kindergarten.
00:13:44.480 | Is it too early to start learning about Medicare?
00:13:47.800 | I made that up.
00:13:49.680 | Okay, next real question.
00:13:53.400 | I've had significant illnesses.
00:13:55.760 | Are there any preexisting conditions or limits
00:13:58.600 | on any of the plans you'll be discussing?
00:14:01.040 | - Okay, so for Medicare Advantage plans,
00:14:05.560 | they cannot eliminate coverage
00:14:08.280 | or charge you any higher premiums
00:14:10.000 | or fail to offer you coverage
00:14:12.760 | for any Medicare Advantage plan nationwide.
00:14:15.520 | On Medicare supplement plans,
00:14:17.240 | when you're in your Medicare supplement
00:14:19.040 | open enrollment period, and let me explain,
00:14:22.520 | that happens the first of the month that you turn 65,
00:14:26.000 | or let me back up.
00:14:27.600 | Technically it happens
00:14:28.760 | when you first enroll in Medicare Part B,
00:14:32.080 | and that gives you a six-month
00:14:33.680 | Medicare supplement open enrollment period.
00:14:36.320 | And that means that you can apply
00:14:37.760 | for any Medicare supplement plan
00:14:39.240 | that's offered in the zip code that you reside in.
00:14:42.280 | Now, there are some Medicare supplement plans
00:14:45.040 | that have what's called a preexisting condition clause.
00:14:48.400 | And what that means is,
00:14:49.800 | is that they won't cover a preexisting medical condition
00:14:53.960 | for the first six months you're covered in the plan
00:14:56.360 | unless you had creditable health insurance coverage
00:14:59.880 | prior to enrolling in that Medicare supplement plan.
00:15:02.760 | Now, most Medicare supplement plans
00:15:05.680 | have done away with that preexisting condition clause,
00:15:07.960 | but there are still some states,
00:15:09.360 | Texas being one of those,
00:15:11.440 | where companies can have that clause
00:15:14.040 | as a part of their contract.
00:15:15.520 | So just be sure you ask the question,
00:15:18.720 | especially if you don't currently have health insurance
00:15:21.200 | and you're enrolling in a Medicare supplement plan
00:15:22.880 | for the first time.
00:15:23.960 | And again, in summary, Medicare Advantage plans,
00:15:26.320 | that's never an issue.
00:15:27.600 | Supplement plans, it may or may not be.
00:15:29.600 | - Okay, thank you.
00:15:31.880 | So I'll ask another one,
00:15:33.240 | and then Miriam, after this one,
00:15:35.240 | I'll switch back to you for an RSVP
00:15:37.360 | or question from the chat.
00:15:39.480 | So Lonnie, tell us about who's eligible for Medicare,
00:15:42.920 | who isn't, when you can sign up,
00:15:45.560 | and when is it effective?
00:15:47.680 | - Okay, very good.
00:15:50.000 | So for people that are, we call it aging into Medicare,
00:15:53.480 | your Medicare will begin the first day of the month
00:15:55.640 | that you turn 65.
00:15:58.320 | And you can sign up or process that paperwork,
00:16:03.320 | if you will, up to 90 days in advance
00:16:05.440 | of your Medicare effective date.
00:16:07.400 | Oh, by the way, if your birthday
00:16:09.720 | is on the first day of the month
00:16:11.360 | and your Medicare is actually effective
00:16:13.080 | the first of the month prior to your birthday.
00:16:15.440 | Other people might get on Medicare due to a disability.
00:16:21.520 | So people that are qualified
00:16:23.280 | for social security disability benefits
00:16:26.040 | typically are eligible for Medicare 25 months
00:16:29.280 | after their social security disability benefits begin.
00:16:33.720 | And they are eligible to enroll in Medicare Part A
00:16:36.200 | and Part B, just like someone turning 65 would be as well.
00:16:39.880 | Now, the question for a lot of people,
00:16:42.240 | and we get asked this on a regular basis is,
00:16:44.720 | what if I'm still working or my spouse is still working,
00:16:47.840 | and we're getting health insurance benefits
00:16:49.800 | through mine or my spouse's employer?
00:16:53.720 | And for those people, you might want to delay enrollment
00:16:56.800 | in Medicare Part B.
00:16:58.440 | You will automatically be enrolled into Medicare Part A
00:17:01.560 | based on when you turn 65.
00:17:04.200 | But Medicare Part A for most people
00:17:05.840 | doesn't have a monthly premium.
00:17:07.360 | So there's no downside for you to be enrolled in Part A.
00:17:10.680 | If you have health insurance
00:17:13.280 | through yours or your spouse's employer,
00:17:15.240 | delaying enrollment in Medicare Part B
00:17:17.000 | simply means you won't be paying a premium for Part B
00:17:19.400 | until you actually enroll.
00:17:21.320 | Now, a lot of people get concerned
00:17:22.720 | about a late enrollment penalty
00:17:24.640 | for delaying enrollment in Medicare Part B.
00:17:27.360 | But as long as you're covered on a group health plan
00:17:29.880 | through you or your spouse,
00:17:30.920 | there will be no late enrollment penalty charge
00:17:32.960 | for deferring your enrollment in Medicare Part B.
00:17:36.000 | - Okay, thanks.
00:17:40.440 | Miriam?
00:17:42.040 | - Yes, Lonnie, it sounds like what is the best choice
00:17:45.920 | for an individual depends on where they live
00:17:49.520 | and what zip code they're in.
00:17:52.480 | And we do have a question on moving states.
00:17:56.760 | When you move states and you have your insurance
00:17:59.880 | and you need to choose a new Medicare Advantage
00:18:02.080 | or Medigap plan,
00:18:03.920 | can you do that?
00:18:07.840 | How do you do that?
00:18:09.200 | Is medical underwriting required?
00:18:12.160 | And then also, you haven't mentioned Medigap yet.
00:18:15.920 | And this question also involves Medigap.
00:18:18.040 | What is Medigap?
00:18:19.360 | And then, you know, moving states and medical underwriting.
00:18:24.360 | - Okay, well, Miriam, I'll try to remember
00:18:27.280 | all the things that make up that question.
00:18:29.480 | And if I forget any, just remind me at the end.
00:18:32.600 | All right, so the first thing I'd like to address is,
00:18:35.560 | is if I move from one state to another, what are my options?
00:18:40.560 | Well, if you're enrolled in a Medicare Advantage plan,
00:18:43.720 | then when you move to a new location,
00:18:46.480 | you will get the opportunity,
00:18:48.000 | no matter what time of the year,
00:18:49.240 | to enroll in a different Medicare Advantage plan
00:18:51.600 | in the state that you move to.
00:18:53.680 | If you choose, you can also enroll
00:18:55.920 | in a Medicare Supplement plan,
00:18:57.640 | and you can do that without any medical underwriting.
00:19:01.120 | Excuse me, meaning that you fill out the application
00:19:05.120 | and they must take you.
00:19:06.680 | Now, if you're enrolled in a Medicare Supplement plan
00:19:09.480 | and you move to a different state,
00:19:10.840 | in most cases, the vast majority of cases,
00:19:13.360 | you'll be able to keep the same Medicare Supplement plan
00:19:16.040 | you're enrolled in.
00:19:17.760 | A prime example, we have a couple who recently moved
00:19:21.000 | from Texas to Idaho, and they communicated with me
00:19:24.680 | during the process of the move,
00:19:26.600 | because they had exactly these kinds of questions.
00:19:29.600 | They're enrolled in a Medicare Supplement plan,
00:19:31.520 | and they will remain enrolled
00:19:33.240 | in that particular Medicare Supplement plan.
00:19:35.240 | Now, one thing that will happen is there will be
00:19:39.920 | an adjustment in the premium that they pay
00:19:42.440 | on that Medicare Supplement plan,
00:19:44.160 | because here in Texas, they were paying
00:19:48.520 | about $115, $118 a month each
00:19:51.120 | for their Medicare Supplement plan.
00:19:52.960 | Going to Idaho, it looks like they're gonna be paying
00:19:55.160 | about $160 to $165 a month each
00:19:58.000 | for their Medicare Supplement plan.
00:19:59.960 | The primary reason for that is the state of Idaho
00:20:02.840 | uses something called community rating,
00:20:05.440 | where a Medicare Supplement company,
00:20:09.520 | or let's say Plan G, which is the most popular out there,
00:20:13.240 | they have to charge everybody the same rate,
00:20:15.360 | regardless of whether they're 65 years of age
00:20:17.400 | or 95 years of age.
00:20:18.600 | That's community rating.
00:20:20.000 | And so for these people who are only 66, 67 years of age,
00:20:23.600 | it means an increased premium for them.
00:20:25.560 | Medicare Supplement versus Medigap.
00:20:30.080 | Most people in the industry refer
00:20:33.720 | to these Medicare plans that go along
00:20:36.640 | with the original Medicare as Medicare Supplement plans.
00:20:39.920 | When you talk to anybody that's part
00:20:41.560 | of the federal government or the Center for Medicare
00:20:43.640 | and Medicaid Services,
00:20:45.160 | they refer to those same plans as Medigap.
00:20:47.880 | So Medicare Supplement, Medigap,
00:20:50.880 | the same terms, just used interchangeably.
00:20:53.000 | - So that pays for the 20% that Medicare does not pay for?
00:20:59.080 | - That's exactly correct.
00:21:01.680 | - Okay.
00:21:03.160 | And one other thing, we have another question.
00:21:06.480 | It says, "If after initially enrolling in a Medigap plan,
00:21:12.200 | "like N, can you eventually switch to another plan like G,
00:21:17.200 | "if you later find it more suitable?
00:21:21.920 | "And what about the underwriting?"
00:21:24.360 | - Good question.
00:21:25.760 | So in the vast majority of states,
00:21:28.000 | if you wanna move from any Medicare Supplement plan
00:21:30.800 | to any other Medicare Supplement plan,
00:21:33.000 | even if it's the same letter designation,
00:21:35.120 | but with a different company,
00:21:36.720 | you're gonna have to submit an application
00:21:38.520 | and it will be subject to underwriting.
00:21:40.840 | Now, something I just learned recently
00:21:43.600 | is I'm licensed in the state of Oklahoma.
00:21:45.720 | We have 25 or 30 clients up there.
00:21:48.600 | And one of your Boglehead members, as a matter of fact,
00:21:51.560 | called me to get help with her mother
00:21:54.520 | who lives in the Tulsa, Oklahoma area.
00:21:57.120 | And she informed me that Oklahoma just this year
00:22:00.840 | passed a law that provides for a Medicare Supplement,
00:22:04.280 | Medigap, open enrollment period every year on your birthday.
00:22:10.040 | And it's a 60-day window that begins on your birthday.
00:22:12.800 | So thank you for the Boglehead member
00:22:15.120 | who informed me of that.
00:22:16.240 | I went and researched it, found that's absolutely the case.
00:22:19.400 | So I think that's something that's done
00:22:22.120 | in about seven or eight states across the country now.
00:22:25.400 | I think in general terms, that's probably an excellent idea.
00:22:29.800 | And I would kind of like to see that adopted
00:22:31.840 | by more states across the country.
00:22:33.560 | Does that answer your question, Harriet?
00:22:37.680 | - Yes, thank you.
00:22:38.800 | Corey?
00:22:40.040 | - Thank you.
00:22:41.240 | Next question.
00:22:42.280 | My partner or I may plan to work after age 65
00:22:46.440 | and will be covered by an employer plan.
00:22:49.520 | What do I have to do?
00:22:50.960 | What does COBRA affect?
00:22:52.920 | I'm sorry, how does COBRA affect this
00:22:55.080 | if my younger partner won't have insurance
00:22:57.280 | if I go on Medicare?
00:22:58.960 | - Great question.
00:23:01.080 | Yeah, so if one of you is aging into Medicare
00:23:05.360 | and you're the employee
00:23:06.920 | who the health insurance is coming through,
00:23:10.040 | one of the things to know is under normal situations,
00:23:13.920 | you have the option to exercise COBRA for 18 months.
00:23:17.760 | In a scenario like we've just described,
00:23:20.280 | that COBRA option is actually extended out to 36 months.
00:23:24.120 | So that helps a lot of people with an age gap
00:23:26.440 | between the two spouses.
00:23:27.880 | If that's not enough for you,
00:23:31.360 | then the other option is the older spouse
00:23:34.400 | go ahead and get on Medicare
00:23:35.800 | and the other spouse get an individual health plan
00:23:38.000 | through the Affordable Care Act, et cetera,
00:23:39.640 | and something like that.
00:23:41.720 | Was there another part to that question, Corey?
00:23:44.240 | - I think, I'll read it again.
00:23:46.240 | I think you covered it,
00:23:47.080 | but my partner or I may plan to work after age 65,
00:23:50.320 | will be covered by an employer plan.
00:23:52.760 | How does COBRA affect this
00:23:53.880 | if my younger partner won't have insurance
00:23:55.880 | if I go on Medicare?
00:23:57.440 | - Okay.
00:23:59.000 | Yeah, and the other thing to remember
00:24:00.280 | is just simply that if one of the spouses
00:24:04.840 | is already getting social security retirement benefits,
00:24:07.920 | then they may automatically,
00:24:09.320 | Medicare may automatically enroll that spouse
00:24:12.000 | in Medicare Part A and Medicare Part B.
00:24:15.240 | And if you're in a scenario
00:24:17.160 | where you don't want Medicare Part B,
00:24:19.720 | as soon as you get that card,
00:24:21.080 | just give them a call and let them know
00:24:22.720 | that you do not want to be enrolled
00:24:24.760 | and they will correct that and send you a new card.
00:24:27.640 | - Okay.
00:24:28.640 | Great to know.
00:24:29.840 | Next question.
00:24:30.920 | Let's say I'm a procrastinator.
00:24:32.920 | I was even going to put off asking this question.
00:24:36.280 | What happens if I don't sign up
00:24:38.880 | or don't do anything regarding Medicare?
00:24:42.440 | - All right.
00:24:43.280 | So if you're no longer employed
00:24:48.160 | or your spouse is no longer employed,
00:24:49.520 | you don't have group health insurance
00:24:51.280 | and you fail to enroll in Medicare Part B
00:24:55.880 | at the time that you're eligible to do that,
00:24:58.320 | then your next opportunity to enroll
00:25:00.120 | is going to be during something called
00:25:02.120 | the general enrollment period.
00:25:04.080 | And that happens from January 1
00:25:06.200 | through March 31 every year as well.
00:25:09.480 | And the effective date of your enrollment
00:25:11.240 | will be the first day of the month
00:25:12.880 | after the date that you enroll.
00:25:14.920 | Now, for every 12 months after you turn 65
00:25:19.920 | that you were eligible to be enrolled in Medicare
00:25:23.960 | and you did not enroll,
00:25:25.640 | when you subsequently do enroll in Medicare Part B,
00:25:27.960 | there's going to be a 10% penalty.
00:25:30.360 | So if you're 12 months to, I guess, 23 months
00:25:34.880 | past that enrollment date,
00:25:36.120 | it's a 10% penalty, 24 months, et cetera,
00:25:38.720 | it'll be a 20% penalty and on that road.
00:25:41.120 | And that penalty stays with you for as long as you live.
00:25:44.160 | So don't procrastinate.
00:25:46.240 | - Does it accrue interest?
00:25:48.240 | - It does not accrue interest.
00:25:49.560 | - Okay.
00:25:50.400 | - Wait, it's a penalty per month, per annual?
00:25:52.640 | - Well, it's...
00:25:56.360 | So right now the standard Medicare Part B premium
00:26:00.800 | is $174.70 a month.
00:26:03.760 | So somebody who is facing a 10% penalty
00:26:06.720 | would pay that plus $17.74.
00:26:11.440 | Does that answer your question, Miriam?
00:26:14.120 | - Forever.
00:26:15.320 | - Forever, that's right.
00:26:16.560 | - Okay.
00:26:19.080 | - Okay, so the next set of questions
00:26:23.160 | are divided into Parts A, B, and D.
00:26:27.440 | So we'll go through those three very separately
00:26:29.880 | so as to not overlap the content.
00:26:32.960 | And then following those three categories of questions,
00:26:36.640 | Miriam, we'll go back to you.
00:26:38.080 | So the first one, tell us about Part A Medicare,
00:26:42.640 | imprints costs, restrictions, coverage,
00:26:46.320 | with some examples of what would be covered
00:26:49.000 | under Part B versus not covered.
00:26:53.040 | Oh, this is...
00:26:54.120 | Okay, yeah.
00:26:54.960 | - I'm sorry, I didn't mean to cut you off.
00:26:57.240 | Is that the question?
00:26:58.520 | - Yeah, I just wanted to make sure
00:26:59.560 | the covered under Part B versus not covered is intentional.
00:27:03.240 | Did the question asker mean Part A?
00:27:05.960 | Tell us about Part A Medicare,
00:27:09.400 | costs, restrictions, coverage,
00:27:11.440 | with some examples of what would be covered under...
00:27:14.480 | Maybe it's Part A versus not covered.
00:27:16.680 | - Okay, I think I understand the gist of the question.
00:27:20.640 | So Medicare Part A is referred to as hospital insurance,
00:27:23.760 | and that's primarily what it is.
00:27:25.480 | And it comes into play when you've been admitted
00:27:27.600 | into a hospital as an inpatient.
00:27:30.160 | And I emphasize that because if you were in a hospital
00:27:33.520 | on an outpatient setting, day surgery, for instance,
00:27:36.040 | that's all gonna be covered by Part B of Medicare,
00:27:38.680 | not Part A.
00:27:40.400 | Part A also handles hospice,
00:27:42.240 | if you ever need that kind of service
00:27:43.760 | near end of life type thing.
00:27:45.080 | And it also handles skilled nursing care.
00:27:46.960 | So those are primarily the three things
00:27:48.640 | that Medicare Part A is responsible for covering.
00:27:51.880 | Skilled nursing care typically comes into play
00:27:54.280 | if you've been admitted into a hospital as an inpatient.
00:27:57.920 | And then you're, the way I describe it is
00:28:00.960 | you're not sick enough to stay in the hospital
00:28:02.520 | any longer, but you're not well enough
00:28:04.160 | or strong enough to go home and take care of yourself.
00:28:06.120 | So some certain number of days might be ordered
00:28:09.640 | by your doctor for skilled nursing care
00:28:11.240 | so that you can continue to be monitored by medical staff.
00:28:16.040 | That's Part A.
00:28:18.240 | Medicare Part B called medical insurance
00:28:21.880 | is basically everything else medical related.
00:28:24.160 | So that's your preventive care, treatments, diagnostics,
00:28:28.280 | lab work, x-rays, all those kinds of things.
00:28:31.160 | - Okay.
00:28:33.760 | So a follow-up question to the Part B part is,
00:28:37.360 | I've heard about Medicare Advantage programs
00:28:40.560 | and Medicare supplements.
00:28:41.760 | You touched on Medigap earlier,
00:28:43.240 | but I'm not sure about Medicare Advantage.
00:28:45.720 | How do those plans affect whether I need Part A
00:28:48.880 | and/or Part B?
00:28:50.720 | - Yeah, great question.
00:28:52.200 | So before anybody can enroll
00:28:54.600 | in either a Medicare supplement/Medigap plan
00:28:58.280 | or a Medicare Advantage plan,
00:29:00.240 | you must be enrolled in both Medicare Part A and Part B.
00:29:05.040 | The way I describe it is Medicare Part A and Part B
00:29:08.120 | serve as the foundation of your health insurance
00:29:11.200 | from the time that you turn 65 in general
00:29:13.920 | to the time that you pass away.
00:29:15.560 | And so for the vast majority of people,
00:29:19.800 | when you're either gonna get Medicare with a supplement plan
00:29:23.440 | or a Medicare Advantage plan.
00:29:25.240 | So sometimes people come into the office
00:29:28.720 | and they're concerned
00:29:29.560 | about this Medicare Part A hospital deductible
00:29:32.360 | that's what's called a per benefit period deductible.
00:29:36.320 | And in 2024, it's about $1,620.
00:29:40.280 | But if you have a Medicare supplement plan,
00:29:43.000 | you won't be responsible for that.
00:29:44.520 | So you don't have to worry about it.
00:29:47.160 | And if you have a Medicare Advantage plan,
00:29:49.600 | then the typical Medicare Part A,
00:29:52.280 | Medicare Part B deductibles and coinsurance
00:29:55.240 | don't apply to you either.
00:29:57.120 | What you need to concern yourself with
00:29:59.000 | is what does my Medicare Advantage plan prescribe
00:30:02.640 | that I will have co-pays for, co-insurance for
00:30:05.120 | as I use the plan and use other medical services.
00:30:07.640 | - Great, thank you.
00:30:10.080 | So we'll move to the Part D part.
00:30:11.760 | Tell us about Part D Medicare drug plans
00:30:14.200 | with some examples of what would be covered
00:30:16.600 | under Part D versus not covered.
00:30:19.600 | I currently take three different prescriptions
00:30:22.240 | and one is very expensive and no generic is available.
00:30:26.280 | How can I find out
00:30:27.440 | what my lowest out-of-pocket cost would be?
00:30:31.320 | - Okay, great question.
00:30:32.640 | So Medicare Part D, Medicare prescription drug plans,
00:30:36.600 | these are plans that are authorized by
00:30:39.040 | and meet requirements that Medicare prescribes
00:30:43.120 | for prescription drug coverage.
00:30:45.280 | And if you want to find which plan will provide
00:30:49.720 | the total lowest overall out-of-pocket cost for you,
00:30:52.240 | you can go to medicare.gov.
00:30:55.160 | You can input your prescription information
00:30:57.920 | and it will show you every prescription drug plan
00:31:01.520 | that's available to you based on the county
00:31:03.400 | that you reside in.
00:31:05.120 | And then it will default to sorting those plans
00:31:07.640 | with the sort being the lowest total out-of-pocket cost.
00:31:11.360 | And by that, I mean, it will add up
00:31:13.720 | what the annual premium is for the plan
00:31:16.320 | and any co-pays that you're responsible for.
00:31:19.040 | And oh, by the way, you can select the pharmacy
00:31:22.120 | or pharmacies that you might want to use in your local area
00:31:25.560 | and it will give you pricing for the prescriptions
00:31:29.240 | based on the drug plan selection and the pharmacy selection.
00:31:33.200 | In addition to that, a lot of these plans
00:31:35.080 | might have mail-order coverage available.
00:31:38.600 | And in a lot of cases, that can save you money.
00:31:41.760 | In some cases, it doesn't save you any money,
00:31:43.800 | but that tool at medicare.gov can tell you that as well.
00:31:47.600 | Now, I'm sorry, go ahead.
00:31:50.480 | -I just put into the chat a calculator
00:31:52.360 | that you previously mentioned.
00:31:54.320 | -Awesome. -Back to you.
00:31:56.640 | -One other thing that I will add is we have had some folks,
00:32:02.560 | well, who take sometimes relatively expensive drugs
00:32:05.680 | and can't find what they consider to be ample coverage
00:32:08.680 | in any Medicare prescription drug plan.
00:32:11.160 | So a couple of resources that we share with our clients
00:32:14.920 | is goodrx.com.
00:32:18.440 | It's just a discount program.
00:32:20.400 | They have a free version and they have a paid version.
00:32:23.440 | And they really can help sometimes with generic drugs
00:32:27.560 | that oftentimes would be considered tier-two drugs.
00:32:30.520 | So you might have a co-pay on a prescription drug plan
00:32:33.280 | and you might enjoy a lower co-pay
00:32:35.480 | using a discount program like goodrx.
00:32:39.120 | Another source, and this would be more
00:32:41.720 | for your more expensive brand-name drugs,
00:32:44.400 | is a website called costplusdrugs.com.
00:32:49.800 | Those of us who live here in Texas
00:32:51.480 | are very familiar with Mark Cuban.
00:32:53.240 | He's the billionaire that owns a majority stake
00:32:55.720 | in the Dallas Mavericks, and this is his company.
00:32:58.880 | And he started it out of frustration with drug pricing
00:33:01.600 | and how the industry works, and it's his hope
00:33:04.320 | that he's gonna help bring some solution to that.
00:33:08.040 | And then finally, we have some clients,
00:33:11.800 | in fact, I've had clients share this with me,
00:33:15.520 | that use Canadian pharmacies.
00:33:19.360 | And in certain cases, they found that those Canadian pharmacies
00:33:23.680 | can get them prescription drugs for less than the co-pay
00:33:27.320 | would be on a Medicare prescription drug plan.
00:33:29.200 | So all things that you can check out,
00:33:31.440 | especially if you're taking more expensive drugs.
00:33:34.600 | - Thank you, Lonnie, great resources to know about.
00:33:37.360 | Miriam?
00:33:38.360 | - Yes, along the Part D drug plans,
00:33:46.240 | we have a question about the coverage gap.
00:33:50.000 | - Right. - And whether or not,
00:33:51.440 | could you explain what the coverage gap is?
00:33:54.400 | And the question actually has to do with when you have,
00:34:00.360 | what can be included in determining the coverage gap?
00:34:05.440 | - Okay, it's a great question,
00:34:07.480 | and it's a bit of a complex answer, but I'll do my best.
00:34:11.480 | So when Medicare prescription drug plans
00:34:13.800 | first came out in 2006, one side of the political aisle said,
00:34:18.040 | we want all the coverage to be on the front end
00:34:20.040 | or the most comprehensive coverage.
00:34:21.760 | And the other side of the political aisle said,
00:34:23.400 | well, we want the most comprehensive part of the coverage
00:34:25.280 | to be on the back end.
00:34:26.720 | So it was literally designed by committee.
00:34:30.160 | And we got this thing where you had co-pays
00:34:33.120 | for most prescriptions up front,
00:34:34.720 | then you had this coverage gap in the middle,
00:34:36.880 | and then you had some more comprehensive coverage
00:34:38.840 | on the back end.
00:34:39.680 | When prescription plans for drug plans first came out,
00:34:45.000 | when you entered the coverage gap,
00:34:46.880 | you were paying 100% of the cost of the drug yourself.
00:34:50.320 | That has since been modified so that today,
00:34:53.000 | when you enter the coverage gap,
00:34:54.320 | you're paying 25% of the cost of the drug yourself.
00:34:58.280 | The 75% is provided by discount from the drug manufacturer
00:35:02.640 | and some coverage from your prescription drug plan.
00:35:05.480 | Now, what gets you into the coverage gap
00:35:07.440 | is how much you're spending on prescription drugs.
00:35:10.520 | The number changes a little bit each year
00:35:12.680 | to adjust for inflation, but I think in 2024,
00:35:16.400 | when you spent approximately $2,300, $2,400 on prescriptions
00:35:22.040 | and that includes the full cost of the drug,
00:35:24.120 | so that's what you paid in co-pays
00:35:25.840 | plus what the insurance company is paying,
00:35:28.120 | when that number in a calendar year reaches say 2,400 bucks,
00:35:33.120 | then you go from what they call the initial coverage level
00:35:36.440 | into the coverage gap.
00:35:37.600 | And at that point,
00:35:38.440 | you're paying 25% of the cost of the drug.
00:35:41.200 | Then to get moved from the coverage gap
00:35:44.800 | to an area they call catastrophic coverage
00:35:47.920 | is another even more complex calculation
00:35:50.440 | that includes a whole lot of things,
00:35:51.920 | but suffice it to say,
00:35:53.520 | any prescription drug plan that you're involved with
00:35:56.640 | will keep you informed as to how much you have to go
00:35:59.200 | before you get out of the coverage gap
00:36:01.440 | into catastrophic coverage.
00:36:03.120 | Once you move to catastrophic coverage,
00:36:04.880 | worst case scenario, you'll pay 5% of the retail costs
00:36:08.560 | and in many cases, you'll pay zero
00:36:11.040 | based on some calculations.
00:36:12.600 | - Okay, the question here is,
00:36:16.560 | if you fill a prescription that is not covered
00:36:20.320 | by your particular Part D plan,
00:36:23.800 | after making all the calculations
00:36:26.120 | that you have the right plan,
00:36:28.600 | is there any way for those costs to be included
00:36:32.680 | in your total costs for being out of the coverage gap?
00:36:37.240 | - All right, so give you a typical scenario
00:36:43.280 | where this might apply.
00:36:44.480 | Client comes in, they tell me what prescriptions they take
00:36:49.280 | and we advise them to enroll in a particular plan
00:36:53.600 | based on those prescriptions and the plan
00:36:55.320 | that'll provide the best coverage in our estimation
00:36:58.680 | using the medicare.gov tool.
00:37:00.520 | February, March, April, sometime during the next year,
00:37:03.720 | they get prescribed a new drug
00:37:05.640 | and that drug is not on the formulary
00:37:07.800 | for their particular prescription plan.
00:37:10.440 | And that typically creates anxiety.
00:37:14.040 | So one of the things that can oftentimes be done
00:37:16.560 | is if you will have your doctor or doctor's office
00:37:20.720 | write a letter to the prescription drug plan
00:37:22.800 | and ask for a formulary exception,
00:37:25.960 | then in most cases, those things get granted.
00:37:28.560 | Now, the exception might be
00:37:30.040 | that you're gonna have it covered at a tier three level,
00:37:32.440 | which means you're still gonna have substantial co-pay,
00:37:34.960 | but at least you have coverage for the drug.
00:37:37.920 | And I'm sorry, Miriam, was there a second part of that?
00:37:40.600 | - I think you answered the question.
00:37:44.360 | - Okay, very good.
00:37:46.000 | Lori, before we move on,
00:37:47.400 | I'm gonna ask two more questions
00:37:49.520 | based basically on this particular subject,
00:37:53.720 | but there is another question in the chat
00:37:55.800 | that we should approach later, okay?
00:38:00.080 | - Sure.
00:38:00.920 | - Okay, Lonnie, what about,
00:38:04.160 | we have a question on a disabled veteran.
00:38:06.760 | I like the idea of original Medicare,
00:38:09.520 | but for a disabled veteran who has healthcare
00:38:12.160 | through the VA, including dental, vision, and prescriptions,
00:38:16.920 | is it just money out the door
00:38:20.200 | or is the lower or no cost of an Advantage plan enough?
00:38:25.200 | - Okay, that's a difficult question to answer
00:38:32.200 | because it's gonna depend upon your particular situation.
00:38:35.520 | We have a number of clients who are former military people,
00:38:40.600 | some who have VA benefits,
00:38:42.120 | some who have TRICARE benefits.
00:38:46.720 | And I'm not an expert in the benefits
00:38:51.480 | that military folks get,
00:38:52.760 | but I do know that if you have TRICARE,
00:38:54.640 | it typically means that you were a career military,
00:38:57.400 | retired from the military,
00:38:58.680 | and you and your spouse enjoy this TRICARE benefit.
00:39:01.640 | So if you have the TRICARE benefit,
00:39:03.560 | then you probably don't need to worry about anything else
00:39:06.080 | because it will cover all of your medical costs
00:39:10.640 | with very minimal out-of-pocket costs to you.
00:39:15.040 | If, on the other hand, you have VA benefits,
00:39:17.240 | that can be a very different story.
00:39:18.760 | And a lot of the answer as to whether you need to worry
00:39:23.480 | about getting an Advantage plan will depend upon,
00:39:27.000 | do you have access to that VA care near where you live?
00:39:30.880 | Is the VA care near you satisfactory to you?
00:39:35.640 | We have some clients here who love the VA system
00:39:39.080 | here in the Dallas-Fort Worth area
00:39:40.400 | and wouldn't go anywhere else.
00:39:41.600 | And we have others that tell you,
00:39:43.400 | "I wouldn't go there, they'll kill you."
00:39:46.120 | So for some of those folks,
00:39:48.360 | we help them enroll in a Medicare Advantage plan
00:39:51.000 | so that they can go outside the VA system should they choose,
00:39:54.560 | go to a doctor that's in the network
00:39:56.280 | for that particular plan
00:39:57.400 | and still have pretty comprehensive coverage.
00:40:01.400 | And then they can choose to go inside the VA system
00:40:04.480 | when it suits them.
00:40:06.880 | -Okay, thank you.
00:40:08.120 | And then my last question is from the chat.
00:40:12.000 | If I have a Kaiser as a supplement plan,
00:40:15.480 | if I have Kaiser as a supplement plan
00:40:18.120 | and I move to an area where there is no Kaiser,
00:40:22.040 | what should I do?
00:40:24.800 | -Okay, so my understanding of Kaiser
00:40:28.320 | is it wouldn't be a supplement plan,
00:40:30.120 | it would be a Medicare Advantage plan.
00:40:32.560 | And if that's the case,
00:40:34.240 | if you move outside the service area for Kaiser,
00:40:37.080 | you're going to have to select a different Medicare plan,
00:40:39.600 | whether that's Medicare Supplement or Medicare Advantage.
00:40:42.960 | But with those kinds of plans,
00:40:44.440 | you have to live in their service area.
00:40:47.760 | -Thank you.
00:40:48.800 | Cory? -Miriam, you mentioned
00:40:50.320 | you had another one from the chat.
00:40:51.920 | Do you want to cover that now to make sure we get to it?
00:40:54.560 | -Sure. Ed asked a question.
00:40:58.720 | It is a long question, but he wanted, Lonnie,
00:41:01.720 | if he could speak to this.
00:41:03.840 | And apparently, Ed said that he negotiated in his job
00:41:15.840 | hundreds of managed-care contracts
00:41:19.240 | through 30 years in healthcare administration
00:41:22.800 | for the 17 cancer centers I managed.
00:41:26.760 | I escorted several Medicare Advantage insurers
00:41:30.440 | like Humana and WellCare, now Centene,
00:41:34.800 | out of my cancer centers for wanting to take reimbursements
00:41:40.280 | at less than Medicare traditional payment rates.
00:41:45.800 | If you can afford a supplement,
00:41:50.200 | I highly recommend enrolling and keeping it
00:41:52.720 | as long as you can afford it to keep great providers.
00:41:57.920 | And the first part of the question was,
00:42:00.520 | be aware that Medicare Advantage plans
00:42:03.800 | negotiate with providers for a reduced reimbursement rate.
00:42:08.920 | This is how they can offer perks such as gym memberships,
00:42:12.880 | Visa cards for groceries, dental, pet cares, et cetera,
00:42:17.640 | and this greatly reduces your provider network
00:42:20.400 | and quality of providers.
00:42:24.160 | And what's the question?
00:42:27.880 | -Can you speak to this?
00:42:30.000 | And I think the question actually is
00:42:35.280 | that if you can afford a supplement,
00:42:38.520 | he recommends enrolling and keeping it
00:42:41.160 | as long as you can afford it to keep your great providers.
00:42:45.720 | -Okay.
00:42:48.160 | So this is a discussion that comes up
00:42:51.280 | from at least 10 or 15 people
00:42:54.560 | every enrollment period in our office around the fall.
00:42:57.400 | So going back to, I think, a discussion we had previously,
00:43:04.240 | if having access to all the possible providers
00:43:08.760 | you could have access to is important to you,
00:43:10.960 | then there's no question that having original Medicare
00:43:14.280 | and a supplement plan is probably the right answer
00:43:16.920 | for you.
00:43:18.480 | And I would further tell you that if Medicare Advantage
00:43:21.520 | is something that you're interested in,
00:43:24.080 | the kind of Medicare Advantage plan you're going to find
00:43:27.080 | will be largely dictated by where you live.
00:43:31.360 | For instance, we're just outside the Dallas-Fort Worth area,
00:43:34.200 | large metropolitan area.
00:43:36.080 | There are a number of what I would consider
00:43:38.560 | to be very comprehensive Medicare Advantage plans
00:43:41.680 | who have very broad networks of hospitals,
00:43:45.760 | medical providers of all kinds, et cetera.
00:43:48.440 | But if you get into a more rural area,
00:43:50.760 | you're going to find that that's not necessarily the case.
00:43:53.680 | You'll find there's less competition.
00:43:55.360 | You'll find that there are smaller networks,
00:43:57.360 | and you will definitely find that your annual
00:43:59.800 | out-of-pocket maximums along with your co-pays
00:44:03.560 | for medical care are going to be higher
00:44:05.400 | than they will be in a more populated area.
00:44:08.920 | So I would say that it depends on,
00:44:12.200 | one, what's important to you,
00:44:13.760 | and, two, what options do you have in Medicare Advantage plans?
00:44:18.680 | And then maybe another consideration --
00:44:21.800 | well, definitely another consideration is,
00:44:23.680 | what's the premium you're going to pay for a supplement plan?
00:44:26.760 | Because that's always got to be a part of the equation.
00:44:29.360 | -Okay.
00:44:34.680 | Thank you.
00:44:37.040 | Next question, does Part A or Part B cover dental or eye care?
00:44:42.200 | How do I get dental or eye care?
00:44:44.920 | -All right, great question.
00:44:47.080 | Medicare Part A and Part B don't cover vision or dental
00:44:51.360 | or any other what Medicare Advantage plans
00:44:54.280 | call "extra benefits."
00:44:57.200 | Now, I'm going to say something
00:45:00.280 | that may be a little bit controversial.
00:45:03.520 | There are individual dental and vision plans
00:45:06.800 | available for purchase,
00:45:09.400 | but in my humble opinion, I'm not a big fan.
00:45:13.880 | At least here in Texas, Oklahoma, Arkansas,
00:45:16.880 | where we have a number of clients,
00:45:19.600 | I've researched a number of dental plans,
00:45:21.520 | and I just not found any that, in my estimation,
00:45:25.560 | deliver enough value to warrant paying a premium for those plans.
00:45:29.240 | So when people come to us and ask about dental coverage,
00:45:31.840 | I typically say, "Just go to your dentist,
00:45:34.000 | see if maybe they offer some kind of a discount program
00:45:37.080 | that you can purchase or a real insurance program
00:45:39.680 | you can purchase, but what I have to offer you
00:45:41.720 | is not going to provide great value."
00:45:45.080 | Dental, vision, over-the-counter benefits,
00:45:48.240 | those are the kinds of things that are offered
00:45:49.760 | along with Medicare Advantage plans,
00:45:51.680 | not Medicare Supplement plans, or Medicare Part A and Part B.
00:45:56.440 | -Okay, thanks.
00:45:58.480 | I'm going to slip in a question
00:46:00.040 | that relates to what Miriam asked earlier from the chat.
00:46:03.480 | You'll forgive me if it's insensitive,
00:46:05.000 | and you'll navigate, you know, the kind of political
00:46:08.800 | or controversial aspect of it,
00:46:10.400 | but I think it may resonate with a lot of the crowd,
00:46:13.480 | so I'm going to ask it.
00:46:14.760 | What's Medicare's general reputation
00:46:16.960 | for fairly and timely compensating physicians
00:46:20.600 | who accept Medicare?
00:46:22.280 | -In general, I don't know.
00:46:29.400 | I don't ever see that side of things.
00:46:32.600 | I don't hear complaints from the medical providers that I know,
00:46:37.080 | which is only a handful of people, about Medicare.
00:46:40.560 | Well, the complaint I hear is about the reimbursement rate.
00:46:44.520 | They're not crazy about that,
00:46:45.840 | but I don't hear them complain
00:46:47.440 | about the time it takes for Medicare to reimburse them.
00:46:51.600 | -Okay, good to know.
00:46:53.320 | Next question.
00:46:54.920 | Tell us about Part C Medicare plans
00:46:56.840 | with some examples of what would be covered
00:46:59.040 | under Part C versus not covered.
00:47:01.640 | -This area is confusing to me
00:47:03.160 | since I see a lot of commercials and ads
00:47:05.440 | saying they include things like dental, eye care,
00:47:08.960 | gym membership, over-the-counter drugs, et cetera.
00:47:12.400 | I really like my doctor and university teaching hospital
00:47:15.720 | that I used during employer health insurance.
00:47:18.800 | Can I continue to go to that doctor?
00:47:21.720 | What if I must go to an out-of-network hospital
00:47:25.280 | or doctor?
00:47:27.080 | -Okay.
00:47:28.640 | All good questions.
00:47:30.080 | So, first of all, Medicare Part C,
00:47:34.040 | a.k.a. Medicare Advantage plans,
00:47:36.480 | when you enroll in one of those plans,
00:47:37.960 | what it means is you're getting your Medicare Part A
00:47:40.760 | and Medicare Part B and Medicare Part D,
00:47:44.840 | prescription drug benefits, all from one plan.
00:47:49.160 | It's all combined together, much like health insurance
00:47:51.400 | you might get from an employer.
00:47:53.400 | Now, the question of whether you can continue
00:47:55.800 | to use your teaching hospital,
00:47:58.240 | you just need to check with the plan
00:48:00.360 | and see whether the hospital is in network for that plan
00:48:04.360 | and whether their associated clinics are
00:48:06.400 | and doctors that have admitting rights
00:48:08.320 | in the hospital are, et cetera.
00:48:12.000 | And as far as the extra benefits --
00:48:14.360 | Excuse me for a second.
00:48:15.960 | Most Medicare Advantage plans include those extra benefits,
00:48:23.760 | like vision, dental, a fitness benefit,
00:48:28.400 | oftentimes referred to as silver sneakers,
00:48:31.400 | an over-the-counter benefit,
00:48:33.160 | and a lot of them provide benefits
00:48:34.600 | for hearing aids, et cetera.
00:48:36.400 | And the way they can provide those benefits
00:48:38.560 | is for every county across the country,
00:48:41.400 | Medicare tells Medicare Advantage plans,
00:48:44.360 | "We're going to reimburse you X dollars per month
00:48:47.640 | for every member that you have enrolled."
00:48:50.000 | And so the health insurance company takes that number
00:48:53.080 | and determines that.
00:48:56.280 | We can design a plan with these Medicare Part A,
00:48:58.920 | Part B, and drug benefits
00:49:00.320 | in addition to these extra benefits
00:49:02.400 | for the money that Medicare is allowing for us
00:49:04.600 | for each member involved.
00:49:06.200 | And so they just try to get that as competitive as they can
00:49:09.480 | so they can get more membership
00:49:11.160 | versus other health insurance companies.
00:49:13.880 | -Okay. Next question's about Medigap.
00:49:16.280 | You may have covered it already.
00:49:17.680 | I'll ask it quickly to see if there's anything
00:49:19.680 | you want to add to it
00:49:21.120 | and then just to tee up what to expect
00:49:22.880 | for the rest of the hour as we're 7 minutes to 9.
00:49:26.720 | Miriam, I'll ask three quick questions
00:49:28.960 | that relate to Medicare Advantage
00:49:31.640 | and then switch it back to you
00:49:33.200 | if there's time for RSVP or chat.
00:49:35.720 | So this one that you may have covered already,
00:49:37.520 | "Tell us about Medigap supplemental plans.
00:49:40.840 | What are the gaps that I would have to pay for
00:49:43.240 | depending on what plan I choose?"
00:49:45.520 | And if you've answered it fully already, we can move on.
00:49:48.520 | -No, we'll get into that a little bit.
00:49:49.840 | So in most states, Medigap plans are standardized,
00:49:54.120 | and that means that they have a letter designation,
00:49:56.480 | A through N, and that letter designation
00:49:59.480 | tells you exactly what coverage you get.
00:50:01.520 | So whether you buy a plan from Humana, UnitedHealthcare,
00:50:04.440 | or any other health insurance company out there,
00:50:07.920 | the most popular plan sold today
00:50:09.840 | is Medicare Supplement Plan G or Medigap Plan G.
00:50:14.440 | With Medigap Plan G,
00:50:17.040 | the only out-of-pocket exposure you have
00:50:19.480 | is to satisfy the Medicare Part B annual deductible.
00:50:24.040 | And in 2024, that deductible amount will be $240.
00:50:27.840 | So once you've done that,
00:50:29.840 | no further out-of-pocket expenses with the Plan G.
00:50:32.920 | Now, another very popular plan
00:50:34.840 | is Medicare Supplement Plan N.
00:50:37.600 | And with the Plan N,
00:50:39.240 | your only out-of-pocket exposure, again,
00:50:40.960 | is that Medicare Part B annual deductible.
00:50:43.760 | And then there's a $20 copay for every doctor office visit
00:50:48.240 | and a $50 copay should you use a hospital emergency room.
00:50:52.080 | Now, one other thing to note is,
00:50:54.440 | with Medicare Supplement Plan N,
00:50:57.680 | it states that you're also subject
00:50:59.280 | to paying the Medicare Part B excess charges.
00:51:02.480 | We haven't talked about that yet, so let me address that.
00:51:07.280 | In the medical world, if a medical provider says,
00:51:10.560 | "I accept Medicare assignment,"
00:51:12.360 | that means that they're accepting the Medicare fee schedule.
00:51:15.680 | But a medical provider can choose to treat Medicare patients
00:51:19.400 | and not accept the Medicare fee schedule.
00:51:21.520 | And in that scenario, that provider can charge
00:51:24.240 | as much as 15% more than the Medicare fee schedule.
00:51:28.080 | And that's called the Medicare Part B excess charges.
00:51:31.800 | So if you have a supplement plan like Plan G
00:51:35.600 | and you go to a provider
00:51:36.840 | who charges those Medicare Part B excess charges,
00:51:39.760 | you're not responsible for paying those.
00:51:42.040 | But if you choose a Plan N,
00:51:44.120 | because it's got a lower premium
00:51:45.680 | and you use a provider who charges those excess charges,
00:51:48.760 | then you're subject to paying
00:51:49.800 | that extra 15% out of your pocket.
00:51:52.080 | Now, this, I think years ago,
00:51:55.440 | was a bigger issue than it is today.
00:51:58.160 | The last numbers I saw from Medicare,
00:52:00.600 | and I researched this about a year and a half ago,
00:52:03.160 | is that some 94, 95% of medical providers out there
00:52:07.600 | who treat Medicare patients
00:52:09.360 | do not charge Medicare Part B excess charges.
00:52:12.760 | So this would only come into play for very few people.
00:52:16.480 | - Okay.
00:52:19.120 | Next question relates to Medicare Advantage.
00:52:23.400 | What would happen if I picked neither a supplement
00:52:26.240 | nor a Medicare Advantage plan,
00:52:28.760 | and I contracted a disease or chronic illness
00:52:31.960 | that requires 20 days of hospital care,
00:52:34.840 | and then an ongoing outpatient treatment weekly
00:52:38.400 | with a list price of $5,000 per week for a year?
00:52:42.840 | What could that cost me?
00:52:45.360 | - Okay.
00:52:46.440 | So with Medicare Part A,
00:52:48.480 | if you're admitted into a hospital,
00:52:49.920 | you first have a Medicare Part A hospital deductible,
00:52:53.600 | and it's a per-benefit period deductible.
00:52:56.840 | And in 2024, that number's approximately $1,620.
00:53:01.840 | So your hospital bill for up to 60 days in the hospital
00:53:06.040 | is $1,620.
00:53:07.560 | And per-benefit period means
00:53:10.120 | that once you're admitted to the hospital,
00:53:12.320 | or I should say, once you're discharged from the hospital,
00:53:15.360 | that will count 60 calendar days.
00:53:17.640 | If you're readmitted into the hospital in that window,
00:53:20.560 | then you're considered to be in the same benefit period,
00:53:23.440 | and you would not be subject to paying
00:53:25.080 | the Part A hospital deductible again.
00:53:27.680 | But if you're discharged from a hospital
00:53:29.840 | and more than 60 days has passed
00:53:31.640 | and you're readmitted to the hospital,
00:53:33.600 | then you're subject to paying
00:53:34.600 | that hospital deductible again.
00:53:36.640 | Now, again, that covers you
00:53:38.440 | for up to 60 days in the hospital.
00:53:40.240 | If you're there beyond 60 days,
00:53:41.960 | then you have a daily copay
00:53:44.560 | beyond that Part A hospital deductible.
00:53:47.000 | And that information's somewhere in the document
00:53:50.840 | that I have provided, but I don't see it right now.
00:53:54.080 | Now, for Medicare Part B,
00:53:55.880 | so this is your medical coverage,
00:53:57.360 | so everything outside the hospital.
00:53:59.920 | And by the way, even if you're an inpatient in the hospital
00:54:03.560 | and you're there for surgery, as an example,
00:54:06.000 | the hospital bill is covered by Part A
00:54:08.520 | for what we just talked about.
00:54:10.760 | But if your surgeon is still gonna be covered by Part B,
00:54:15.240 | along with the anesthesiologist
00:54:16.880 | and other medical professionals
00:54:18.120 | that are involved in your care.
00:54:20.080 | So for Part B, you have an annual deductible.
00:54:23.160 | In 2024, that's $240.
00:54:25.800 | Once you satisfy that deductible,
00:54:27.720 | then you're subject to 20% coinsurance.
00:54:30.800 | And the risk for people is that 20% coinsurance
00:54:33.640 | doesn't have a cap on it.
00:54:35.360 | So God forbid, if you had a half million dollar Part B bill
00:54:39.040 | in the course of a year,
00:54:39.920 | then your 20% comes to $100,000.
00:54:42.720 | Does that answer your question?
00:54:45.640 | - I believe so.
00:54:47.360 | It reminds me of one of the,
00:54:49.320 | it was someone from the Fed or a treasury secretary said,
00:54:52.440 | "If that made sense to you, you've misunderstood me."
00:54:55.520 | (laughing)
00:54:57.840 | So two more, and then I realize we'll go past nine,
00:55:00.920 | but Lonnie was kind enough to say
00:55:02.360 | we can have him for longer.
00:55:04.120 | So I do wanna flip to Miriam,
00:55:06.440 | but I also wanna close out
00:55:08.680 | these few Medicare Advantage questions.
00:55:10.600 | So the next one is,
00:55:12.160 | I've heard stories about Medicare Advantage
00:55:14.520 | having pre-approvals, delaying approvals,
00:55:17.800 | arguing with doctors on treatment plans.
00:55:20.360 | I went through that with my bad employer insurance,
00:55:24.320 | and I don't wanna argue about issues like this.
00:55:27.240 | What do you recommend?
00:55:29.000 | - Okay.
00:55:30.040 | So I will tell you that with Medicare Part A, Part B,
00:55:35.040 | and a Medicare Supplement Plan,
00:55:37.520 | I have never heard of those kinds of things happening.
00:55:41.920 | Compare that to Medicare Advantage,
00:55:44.160 | and I will say that, again,
00:55:46.680 | I started doing this in 2007.
00:55:50.320 | And for all those years up until about 2021, 2022,
00:55:54.840 | we have had a number of people
00:55:58.720 | enroll in Medicare Advantage plans.
00:56:01.200 | And we might've had one that I know of
00:56:04.320 | that was faced with a situation
00:56:06.320 | where they were trying to get preauthorized
00:56:11.120 | for some kind of medical test or procedure,
00:56:13.200 | and the insurance company said no.
00:56:15.760 | Well, in 2023, I had three clients face that scenario.
00:56:20.200 | So this is becoming a little more prevalent.
00:56:24.400 | However, in all three of those situations
00:56:27.120 | that I'm aware of, understand that
00:56:31.280 | with every Medicare Advantage plan,
00:56:33.200 | you have an appeals process.
00:56:34.960 | And with every Medicare Advantage plan,
00:56:37.720 | you have something called a FAST appeal.
00:56:40.040 | And FAST appeal means they must provide you an answer
00:56:42.760 | within 48 hours.
00:56:44.360 | So let me take the liberty of a story.
00:56:48.880 | - And I'm sorry, is it 48 calendar hours?
00:56:52.080 | So if it's asked on a Friday,
00:56:53.600 | is it next business day, like Monday, or?
00:56:56.640 | - No, it's 48 hours.
00:56:58.200 | - So let's say someone asks late Friday night
00:57:02.080 | and the answer is due Sunday night?
00:57:04.200 | - Yep.
00:57:05.040 | - Okay. - Correct.
00:57:06.120 | I had a couple come in the annual enrollment period
00:57:10.600 | near the end of 2022.
00:57:12.920 | And they had both been on Medicare for three or four years,
00:57:15.920 | and they had only Medicare Part A and Part B
00:57:18.960 | and never worried about anything else.
00:57:20.400 | And that worked okay for them,
00:57:21.960 | but they were both a little concerned
00:57:24.200 | about what their financial exposure might be
00:57:26.120 | if they developed a medical condition.
00:57:28.120 | So they both enrolled in a Medicare Advantage plan.
00:57:31.320 | She's had no problems at all, so she's great.
00:57:34.680 | About March, April this year,
00:57:36.840 | I get a call from the husband and he says,
00:57:38.800 | "Hey, I've developed a back problem.
00:57:41.840 | "My doctor says I need an MRI
00:57:43.800 | "and potential preparation for a surgical procedure."
00:57:46.480 | And the health insurance company said,
00:57:48.560 | "No, you need to go do some physical therapy
00:57:50.480 | "or something else first before we go that route."
00:57:53.120 | And he said, "I'm in a lot of pain.
00:57:54.560 | "My doctor says that's a waste of time.
00:57:56.840 | "What can I do?"
00:57:58.240 | And I said, "You can file an appeal."
00:58:00.000 | And he says, "Well, how do I do that?"
00:58:01.440 | I said, "I'm gonna find the phone number for you
00:58:03.280 | "and I'll call you right back."
00:58:04.360 | So I found the number, gave it to him,
00:58:06.880 | and he texted me the very next day,
00:58:09.680 | I think by 11 o'clock, 11.30 in the morning,
00:58:12.840 | and said, "Thanks for the help.
00:58:14.040 | "I just received a text from the insurance company.
00:58:16.240 | "It's been approved.
00:58:17.080 | "We're going forward with the MRI in a couple of days."
00:58:20.160 | In every other scenario, the two others that I'm aware of,
00:58:23.880 | probably took just a little bit longer than that.
00:58:26.160 | But here's what I would say.
00:58:28.720 | Is it possible for those kinds of things to happen?
00:58:32.120 | Absolutely.
00:58:32.960 | But with every insurance company, Medicare dictates
00:58:37.440 | there must be an appeals process.
00:58:39.480 | And the first level of appeal is with the insurance company.
00:58:42.240 | The second level of appeal
00:58:43.360 | is even with the insurance company.
00:58:44.720 | But if it goes to a third level of appeal,
00:58:47.120 | then it's with a committee outside the insurance company.
00:58:51.560 | And I mean, in all the years I've done this,
00:58:55.480 | including those three,
00:58:56.480 | I think I've had maybe three others
00:58:58.720 | that had to file an appeal for something like that.
00:59:01.640 | And in every scenario at the first level of appeal,
00:59:06.480 | it was all approved and they got their stuff done
00:59:09.560 | as they wanted or needed to get done.
00:59:11.400 | - Okay, great.
00:59:13.920 | So last Medicare Advantage question for now.
00:59:17.080 | My doctor says I need to have my husband removed.
00:59:20.040 | Does Medicare Advantage cover that?
00:59:22.120 | I made that up.
00:59:25.040 | Okay.
00:59:25.880 | Who best fits a Medigap supplement plan?
00:59:29.400 | Who best fits a Medicare Advantage?
00:59:32.400 | - Oh, wow.
00:59:36.600 | Well, I guess first of all,
00:59:38.640 | if we may have covered this before,
00:59:41.360 | if it's absolutely imperative to you
00:59:43.680 | that you be able to see any doctor or any medical provider
00:59:46.600 | you wanna see anywhere in the country,
00:59:49.200 | then Medicare with a supplement plan is the obvious choice.
00:59:52.440 | Or if you're concerned about,
00:59:57.160 | well, I have treatments going on
01:00:00.160 | and if I had a Medicare Advantage plan,
01:00:02.160 | I might reach the annual out-of-pocket maximum,
01:00:04.760 | which might be three or $4,000 or more.
01:00:07.680 | And I don't wanna face that potential out-of-pocket maximum.
01:00:11.200 | Then in your scenario,
01:00:12.480 | then you'd probably be better off
01:00:14.320 | with a Medicare supplement plan as well.
01:00:16.920 | Conversely, we have people that walk in and say,
01:00:21.040 | hey, I've been on a Medicare supplement plan
01:00:23.040 | for fill in the blank, two years, 10 years, 20 years.
01:00:26.640 | I go to the doctor once a year.
01:00:29.200 | I go to the doctor once every 10 years,
01:00:31.120 | whether I need to or not.
01:00:32.520 | I'm paying all this premium.
01:00:33.840 | I don't see the value in it.
01:00:35.400 | Tell me about these Medicare Advantage plans.
01:00:38.400 | So a lot of the decision is driven by us trying to forecast
01:00:44.320 | how are you, where are you gonna be less out-of-pocket
01:00:47.440 | money-wise, okay?
01:00:48.960 | And if we find that that's gonna be
01:00:51.400 | with Medicare Advantage, we recommend that.
01:00:53.040 | If we find it's gonna be with Medicare supplement,
01:00:54.720 | we recommend that.
01:00:55.680 | And of course, we have a number of customers
01:00:58.600 | who come in and say, I want a supplement.
01:01:00.480 | Okay, we'll help you with a supplement.
01:01:02.040 | And conversely, some come in and say,
01:01:03.680 | I want a Medicare Advantage.
01:01:05.280 | So it's just all about finding
01:01:07.720 | what the right fit is for the person.
01:01:10.240 | - Okay, turn it over to Miriam for RSVP or chat questions.
01:01:14.640 | - Yes, Lonnie, you scared me.
01:01:17.280 | You scared me and I would suggest
01:01:20.240 | that if the procrastinator is here tonight,
01:01:22.920 | that they start to think about these medical decisions
01:01:27.920 | which plans, this is very difficult, complicated.
01:01:32.560 | And Lonnie, one question is,
01:01:34.600 | in the Medicare book you're talking about,
01:01:37.000 | and it is referenced here,
01:01:38.840 | are these answers to these questions also in that book?
01:01:44.480 | - Yeah, I would say if you read that book
01:01:48.360 | or if you have a question and go to that book,
01:01:51.680 | you can probably find answers
01:01:53.120 | to 95% of your questions about Medicare.
01:01:56.160 | It really is a comprehensive guide
01:01:57.880 | to the way the program works.
01:02:00.040 | - Okay, thank you.
01:02:01.480 | We have many questions.
01:02:03.200 | It's hard to, let me see.
01:02:05.360 | There is one related to, there's one on the HSA.
01:02:11.320 | Perhaps we could, let me ask that question
01:02:14.720 | since Rich has been waiting.
01:02:16.200 | I have some money in an HSA,
01:02:19.040 | which is a health savings account.
01:02:21.440 | Can I use this money to pay for Medicare Part B premiums
01:02:26.440 | and for the Supplement Plan G premiums?
01:02:30.080 | - Great question, and I'm glad I have the answer here
01:02:34.280 | on the document that I provided and it's in front of me.
01:02:37.360 | So first, you probably know this, but I'll mention it.
01:02:40.160 | You must stop making contributions
01:02:42.080 | into your health savings account
01:02:43.400 | because you're no longer gonna be enrolled
01:02:45.160 | in what's called a high-deductible health plan.
01:02:47.560 | You can use the funds out of your HSA account
01:02:52.720 | to pay for Medicare Part B, Part C,
01:02:56.960 | which is Medicare Advantage,
01:02:58.360 | if you're enrolled in that, or Part D premiums.
01:03:01.640 | You cannot use the HSA funds to pay for the Supplement Plan
01:03:06.880 | or the HSA funds to pay for Medicare Supplement
01:03:10.040 | or Medigap Plan premiums.
01:03:11.760 | I'm not sure why they wrote the law that way, but they did.
01:03:15.160 | And then of course, you can also use the funds to pay
01:03:17.640 | for any and all medical expenses that you might have,
01:03:22.640 | anything that the IRS deems medical expenses,
01:03:25.120 | just like you did before getting on Medicare.
01:03:27.360 | - Okay, thank you.
01:03:30.520 | The next question is following up on the Part D question,
01:03:34.200 | we're discussing buying your drugs
01:03:37.240 | through Wood Rx or Cost Plus,
01:03:40.880 | which could be a significant savings.
01:03:43.400 | Is there a way to add those costs to the calculation
01:03:47.880 | to move out of the coverage gap?
01:03:50.240 | - That's the last part again?
01:03:55.880 | - Can you use, is there a way to add those costs?
01:04:00.880 | I think what is meant is what you've paid
01:04:04.160 | to the Good Rx or the Cost Plus to the calculation
01:04:09.160 | to move out of the coverage gap.
01:04:12.800 | - Oh, sorry.
01:04:13.640 | No, there is no way to do that.
01:04:15.240 | If you're using one of the programs
01:04:17.280 | that we just talked about, then it's a drug,
01:04:19.760 | you're not using your Prescription Drug Plan
01:04:22.760 | to pay for those drugs
01:04:24.640 | and they will not be a part of that calculation.
01:04:27.720 | - Okay, thank you.
01:04:28.680 | Let me see.
01:04:31.320 | Let me do one more question here.
01:04:33.960 | "You may have covered this, but I want to confirm.
01:04:37.960 | "If I turn 65 and I'm still working,
01:04:42.160 | "I only need to sign up for Part A
01:04:46.240 | "and use my employer health benefits.
01:04:49.800 | "I only sign up," in other words, is it so,
01:04:52.400 | "that I only sign up for Part B and D
01:04:56.680 | "and get Medicare Advantage after I leave my employer?"
01:05:02.680 | - Yeah, so I'm glad you asked the question
01:05:04.640 | because what I didn't say is you have the option.
01:05:08.640 | So you're going to be automatically enrolled
01:05:11.600 | in Medicare Part A.
01:05:13.080 | You can defer enrollment without penalty
01:05:15.440 | in Medicare Part B and keep your employer's health plan.
01:05:19.280 | But you might work for an employer
01:05:21.720 | who charges a relatively high premium
01:05:24.480 | that's coming out of your paycheck
01:05:25.800 | to pay for that health plan.
01:05:27.520 | Financially speaking, it might be to your benefit
01:05:29.920 | to go ahead and enroll in Medicare Part B
01:05:32.320 | and then get either a supplement plan
01:05:34.040 | or Medicare Advantage plan.
01:05:35.720 | So you do what's in your best interest.
01:05:39.720 | The option is entirely up to you.
01:05:41.920 | And let me add one other thing to that discussion as well.
01:05:45.120 | I found this out the hard way.
01:05:46.800 | As long as you're on your employer's insurance
01:05:50.880 | and you delay enrollment in Medicare Part B,
01:05:53.320 | there will be no late enrollment penalty.
01:05:56.480 | However, I had a client come to me
01:05:59.720 | and he was offered a buyout package from his employer.
01:06:04.720 | And a part of the buyout package was
01:06:08.240 | that the employer paid for his and his spouse's
01:06:10.640 | health insurance for a period of a year.
01:06:13.200 | Well, right near the time that he was offered
01:06:16.720 | this buyout package, he turned 65,
01:06:18.800 | but didn't worry about enrolling in Medicare Part B
01:06:21.440 | because he had this health insurance from his employer.
01:06:25.200 | When he got ready to enroll in Medicare Part B,
01:06:27.600 | then Medicare charged him a 10% late enrollment penalty.
01:06:32.000 | Even though it was group health insurance,
01:06:34.240 | it was considered COBRA health insurance,
01:06:37.200 | not employer health insurance.
01:06:40.200 | And because he wasn't gainfully employed by the employer
01:06:43.760 | or his spouse wasn't employed by the employer
01:06:45.960 | providing the health insurance,
01:06:48.120 | it doesn't qualify for deferring
01:06:50.760 | that Medicare Part B late enrollment.
01:06:53.160 | So just be very careful of that.
01:06:55.440 | - They were not considered employed
01:06:57.040 | because it was a buyout package
01:06:59.480 | and they were no longer actually working.
01:07:01.680 | - That's correct.
01:07:03.120 | - Okay.
01:07:04.440 | I believe when I was working and I turned 65,
01:07:08.000 | I signed up for Part A, I did not sign up for Part B,
01:07:11.960 | but I did have to do something with Medicare.
01:07:14.320 | I had to like fill out a form or let them know
01:07:17.440 | that I was still working and I was on employer insurance.
01:07:21.960 | Therefore, hold off on the Part B,
01:07:24.560 | I'm putting it on the back burner.
01:07:26.720 | - Right.
01:07:28.160 | Yeah, you may indeed have to communicate that with them.
01:07:30.960 | - With Medicare?
01:07:33.480 | - Yes, correct.
01:07:34.520 | - Yes.
01:07:35.840 | And I believe that I have a friend that I worked with,
01:07:39.320 | who I worked with, who did not.
01:07:41.800 | And he then got into trouble with Medicare with that.
01:07:45.640 | He did not tell them.
01:07:49.720 | - Interesting.
01:07:50.560 | - Okay, Laurie, why not open for a raise hand?
01:07:56.400 | - Sure, yeah, we'll turn, yeah, great.
01:07:59.360 | Let's turn it over to the audience for live questions.
01:08:02.440 | Again, feel free to continue submitting questions
01:08:04.720 | to the chat, but if you'd like to ask a question
01:08:07.360 | to Lonnie verbally directly,
01:08:09.720 | please raise your hand with the hand raise function on Zoom.
01:08:15.520 | And absent that, I have some great questions
01:08:19.440 | to continue with that I'm sure will resonate
01:08:21.400 | with the audience.
01:08:22.240 | So absent audience questions, I'll proceed.
01:08:26.520 | Next question, I have a large 401(k)
01:08:29.280 | and other pre-tax savings accounts,
01:08:31.360 | and I expect a very large, around $200,000 RMD,
01:08:36.200 | required minimum distribution.
01:08:38.160 | As we say, a good problem to have.
01:08:40.840 | How does this affect my life?
01:08:43.080 | What is the most IRMA premium I could pay?
01:08:46.480 | - Great question.
01:08:48.520 | So for 2024, the highest Medicare Part B IRMA premium
01:08:54.920 | is $594 per month.
01:08:58.040 | If you're married, that would apply
01:08:59.680 | to both you and your spouse.
01:09:01.720 | And if you're subject to Medicare Part B IRMA,
01:09:05.600 | then you're also subject to Medicare Part D,
01:09:08.560 | as in dog IRMA.
01:09:10.160 | So if you have a standalone prescription drug plan,
01:09:13.360 | or if you're enrolled in a Medicare Advantage plan
01:09:15.640 | that includes prescription drug coverage,
01:09:18.680 | then you would be subject to that.
01:09:20.560 | And the highest Part D IRMA premium is $81 per month.
01:09:25.560 | So that means if you're enrolled
01:09:27.680 | in a Medicare prescription drug plan that has a premium,
01:09:30.200 | you're gonna pay the plan premium
01:09:31.600 | plus the $81 per month Part D IRMA.
01:09:37.520 | - Okay, thank you.
01:09:39.440 | Another great question.
01:09:40.680 | I plan on traveling to all the states in the U.S.
01:09:44.000 | during my retirement in an RV
01:09:46.480 | or spending significant time outside of the U.S.
01:09:50.640 | What considerations should I make?
01:09:53.600 | - Okay, so as far as Medicare coverage is concerned,
01:09:58.600 | it's in the U.S. only, not outside the U.S.
01:10:01.160 | So let me address that first.
01:10:03.520 | We have a number of countries in the U.S.
01:10:05.240 | who do travel internationally
01:10:06.760 | and you can purchase international health insurance coverage
01:10:10.640 | for, I'll say, very cheaply.
01:10:15.280 | If you're gonna be gone for two weeks, a month,
01:10:17.680 | you can get probably a million dollars worth
01:10:21.120 | of health coverage for you and a spouse
01:10:23.600 | for probably, I don't know, $120, $150
01:10:27.600 | for a two-week trip, let's say.
01:10:29.960 | And that's good for just most countries in the world.
01:10:33.080 | - And more specifically, does that mean
01:10:35.320 | you pay fully out-of-pocket
01:10:37.080 | and then expect a good percentage reimbursement?
01:10:40.120 | - Well, it depends on the company that you're dealing with,
01:10:44.080 | but in most cases, no.
01:10:45.600 | It will act pretty much like health insurance
01:10:47.200 | here in the United States
01:10:48.280 | where it might be 80/20 co-insurance
01:10:52.400 | and they'll charge you the 20%
01:10:55.440 | and then the insurance company handles the 80% of the cost.
01:11:00.640 | The insurance company handles the 80% on the back end.
01:11:04.480 | - So that means the medical provider abroad
01:11:06.760 | would accept that insurance if that's, okay.
01:11:10.320 | - Correct.
01:11:11.240 | Now, Medicare supplement plans
01:11:13.000 | do have limited international coverage.
01:11:15.480 | I think it's 25,000 or 50,000.
01:11:19.240 | I don't remember the number now.
01:11:20.320 | And many Medicare Advantage plans
01:11:22.080 | also have a similar level of international health coverage.
01:11:25.800 | And typically, that's 80/20 co-insurance as well,
01:11:29.720 | up to the maximum.
01:11:31.280 | Now, that doesn't sound like a lot of coverage
01:11:32.920 | for us here in the United States,
01:11:34.080 | but remember, in most foreign countries,
01:11:36.240 | the cost of healthcare is a small fraction
01:11:38.520 | of what it is here.
01:11:40.040 | In addition to that,
01:11:41.320 | check with the country that you're going to
01:11:44.400 | because, for instance,
01:11:45.400 | we've had clients travel to England,
01:11:47.600 | have had to use a hospital emergency room
01:11:50.040 | for an accident or something like that,
01:11:52.040 | didn't have any international coverage,
01:11:53.920 | and it turns out they didn't get charged anything anyway
01:11:56.280 | because it's a nationalized healthcare.
01:11:59.360 | I don't know if that would be true of everywhere,
01:12:02.240 | or, well, I know it wouldn't be true of everywhere,
01:12:04.280 | but I don't know if it would be true of everybody
01:12:05.880 | traveling to England,
01:12:06.760 | but that was their experience there.
01:12:09.200 | Now, as far as traveling around the country in an RV,
01:12:12.160 | if you have Medicare and a supplement plan,
01:12:14.680 | obviously no problem in finding somebody
01:12:17.240 | where you can use your recovery.
01:12:19.520 | If you have a Medicare Advantage plan,
01:12:22.200 | you always have access to a hospital emergency room
01:12:25.560 | or an urgent care center, regardless of network.
01:12:28.080 | Now, if you're gonna go somewhere outside of your home area
01:12:32.360 | and you're gonna stay there for a period of months,
01:12:36.480 | and you're gonna be on a Medicare Advantage plan,
01:12:38.400 | then you might consider heavily a PPO plan
01:12:40.920 | versus an HMO plan.
01:12:42.400 | The PPO plan so that you can use it
01:12:46.000 | without a network providers.
01:12:47.880 | And in addition to that,
01:12:49.760 | and I'll just use a couple of names,
01:12:52.080 | Humana and UnitedHealthcare
01:12:53.560 | both have national Medicare Advantage PPO networks.
01:12:57.720 | So for instance, we have clients here in Texas
01:12:59.760 | who are originally from Wisconsin.
01:13:01.720 | They spend the summer in Wisconsin.
01:13:03.520 | They have a Humana PPO plan
01:13:06.320 | and they can visit their doctor up in Wisconsin
01:13:08.280 | who is also an in-network provider
01:13:10.040 | and it's at their in-network copay.
01:13:12.200 | And because it's a PPO,
01:13:13.440 | they don't have to have a referral
01:13:14.720 | from the primary care physician here in Texas
01:13:16.520 | or anything like that.
01:13:17.600 | - Okay, great.
01:13:20.400 | So I'm personally curious if you can elaborate more
01:13:23.720 | on how to choose a good international plan
01:13:27.920 | and is there an equivalent of in-network,
01:13:30.760 | out of network when you're abroad?
01:13:32.840 | Do you benefit from searching
01:13:35.640 | who will accept this international plan?
01:13:38.800 | And if it's an emergency,
01:13:39.960 | maybe you're not equipped to take the time
01:13:44.960 | and resources that you would at home.
01:13:47.280 | - Yeah, so we represent basically one company that does that
01:13:51.240 | and it's a company called IM Global.
01:13:54.600 | And you can just go online and look them up.
01:13:57.000 | IM Global Health Insurance.
01:13:58.720 | And they specialize in international health insurance.
01:14:03.160 | And yes, they use a PPO system
01:14:06.280 | and they have network providers
01:14:07.760 | in most countries across the world.
01:14:11.080 | - Okay, and then would it be subject
01:14:13.240 | to pre-existing conditions, medical evaluation?
01:14:16.680 | How thorough is being accepted?
01:14:20.040 | - Yeah, good question.
01:14:21.000 | They have different products.
01:14:22.120 | Some of those are subject to pre-existing conditions
01:14:24.640 | but there are others that are not subject
01:14:26.200 | to pre-existing conditions.
01:14:28.120 | They just have a little bit more limited coverage.
01:14:31.120 | - Okay, great.
01:14:31.960 | Thank you.
01:14:32.800 | Switching back, checking in with the audience.
01:14:36.840 | I don't see raised hands, so I'll continue.
01:14:39.480 | Miriam, you let me know if we have chat questions.
01:14:42.920 | - Yes.
01:14:46.200 | - M, Hallie, would you like to ask your question
01:14:49.360 | or would you like me to ask it?
01:14:50.920 | - I can.
01:14:56.240 | - Okay, we have a raised hand, DeGore.
01:14:59.640 | - Okay, I heard M Hallie for a second,
01:15:04.840 | but then the audio-
01:15:05.880 | - Can you hear me now?
01:15:06.840 | - Yes, clearly.
01:15:07.680 | Thank you.
01:15:08.680 | - Hi, I hope this question isn't too specific.
01:15:10.880 | It's a great program.
01:15:11.960 | I appreciate y'all doing this.
01:15:14.840 | My sister just turned 65.
01:15:17.120 | She works for a large employer
01:15:18.760 | and her manager told her that she needed to sign up
01:15:23.160 | for Medicare Parts A and B,
01:15:25.320 | but she does have good health insurance.
01:15:27.840 | And she just had to have surgery and we got to talking
01:15:31.920 | and I said, are you sure you need to sign up for Medicare?
01:15:34.400 | Because if you've got good health insurance,
01:15:36.480 | you might not need to.
01:15:37.960 | I said, you ought to double check with HR and make sure.
01:15:41.880 | So she called HR and they said that,
01:15:44.880 | no, she didn't have to sign up for Medicare Part A and B.
01:15:48.120 | She is a low income earner.
01:15:52.480 | And so the $172 is somewhat difficult for her.
01:15:56.920 | So I thought maybe she ought to cancel the Part B,
01:16:01.080 | but I wasn't 100% sure if that was the right thing to do.
01:16:07.840 | And also I sort of feel that she was, I don't know,
01:16:12.000 | given misinformation and signed up
01:16:14.560 | for the Medicare by mistake.
01:16:16.280 | And does Medicare ever give refunds on premiums?
01:16:19.680 | - Great questions.
01:16:23.280 | So at this point, wow.
01:16:30.040 | Yes, so I would suggest going back to HR,
01:16:35.400 | let them know that she was advised by her manager
01:16:38.480 | to sign up for Medicare Part A and Part B
01:16:41.680 | and have them help her determine
01:16:45.000 | which is in her best interest,
01:16:46.360 | either to stay on the company plan or to get on Medicare
01:16:49.280 | and get a supplement plan or an advantage plan.
01:16:51.640 | Now, if she decides to stay on the company plan,
01:16:55.360 | she can contact technically
01:16:57.000 | the Social Security Administration
01:16:58.840 | and have them disenroll her for Medicare Part B.
01:17:03.600 | She'll have to provide the reason being
01:17:05.240 | that she's still on an employer's group health plan.
01:17:08.920 | But to my knowledge, they will not reimburse her
01:17:11.560 | for premiums that's already been charged
01:17:13.000 | for Medicare Part B.
01:17:14.080 | Now, I may be wrong about that.
01:17:16.480 | I just never heard of that being done before.
01:17:18.760 | - Yeah, that's what I thought I read on medicare.gov,
01:17:21.680 | but I just wanted to make sure.
01:17:23.240 | Now, right now she's on medical leave after surgery.
01:17:28.080 | And so that doesn't end until next month.
01:17:32.800 | And I guess there's a possibility
01:17:34.800 | that her job might've been filled
01:17:36.560 | while she's on medical leave.
01:17:38.000 | So if she canceled the Medicare Part B now,
01:17:43.120 | and then next month she finds out
01:17:45.040 | that she can't go back to work,
01:17:46.600 | would that be a big problem to sign back up for it?
01:17:49.080 | - No, it shouldn't because upon termination
01:17:54.160 | of her group health coverage,
01:17:55.520 | it will open up what's called a special enrollment period
01:17:58.640 | for her to get back on Medicare Part B.
01:18:01.040 | - Right, that was my understanding.
01:18:02.280 | But again, I don't wanna steer it wrong.
01:18:05.000 | - Right.
01:18:07.120 | - How long is that enrollment period,
01:18:09.080 | that special enrollment period for her to sign up?
01:18:12.040 | - How long is it?
01:18:15.480 | - Yes, is it like does it go from the point
01:18:18.520 | where she stopped working for how many months
01:18:23.360 | does she have to sign up?
01:18:25.040 | - Oh, good question.
01:18:25.960 | So it's not when she stops working,
01:18:29.200 | from the time her group health insurance coverage ends
01:18:33.280 | is 62 days.
01:18:34.600 | - Great.
01:18:39.880 | - Thank you so much.
01:18:41.400 | - Thank you.
01:18:42.240 | - So Miriam, do you wanna continue?
01:18:45.920 | I have other questions, but-
01:18:47.680 | - Well, I would say do we have any
01:18:49.120 | more raised hand questions?
01:18:51.040 | Anybody from the audience who would like to raise your hand
01:18:53.600 | and ask a question?
01:18:55.600 | - Jen.
01:18:56.760 | - Jen, Mary.
01:18:58.360 | Oh.
01:19:01.200 | - Hi, thank you so much for this forum.
01:19:04.360 | I just had a question.
01:19:06.480 | So if my parents are planning to live six months
01:19:10.520 | of the year in Florida and six months of the year
01:19:13.240 | in Virginia, and they currently have Kaiser
01:19:16.200 | as their supplement or their medical advantage plan,
01:19:21.200 | and there's no Kaiser in Florida,
01:19:25.680 | do they, so will they have to sign up
01:19:28.280 | for another supplemental plan for when they live in Florida
01:19:32.880 | and then use the Kaiser plan
01:19:37.000 | when they come back to Virginia?
01:19:39.000 | - Well, in general terms, no.
01:19:43.520 | They will need to decide on a plan
01:19:45.280 | and probably keep that plan no matter where they're staying.
01:19:49.520 | So, and the plan that they're eligible to enroll in
01:19:54.400 | is gonna be based on their permanent residence,
01:19:56.600 | at least the resident address that they have on file
01:19:59.320 | with the Social Security Administration and with Medicare.
01:20:02.200 | Now, do you know if their plan with Kaiser
01:20:07.000 | is an HMO or a PPO?
01:20:08.840 | - I think it's an HMO.
01:20:11.880 | - Okay.
01:20:14.200 | So if it's an HMO, then when they go to Florida,
01:20:18.600 | in all likelihood, their access to medical care
01:20:21.240 | is gonna be limited to either a hospital emergency room
01:20:24.880 | or an urgent care center.
01:20:26.680 | And that may be okay, I don't know,
01:20:30.120 | but they may also check with Kaiser
01:20:31.920 | and see if they have any PPO plans available,
01:20:35.440 | and they could switch over to a PPO plan,
01:20:37.240 | which would give them more flexibility
01:20:38.920 | when they're down in Florida.
01:20:41.120 | And by the way, we talked about this a little bit earlier,
01:20:44.160 | because they're on a Medicare Advantage plan
01:20:47.000 | beginning January 1 and going through March 31,
01:20:50.240 | there's an enrollment period
01:20:52.160 | called the Medicare Advantage open enrollment period.
01:20:54.920 | So they would have the opportunity to actually change
01:20:58.320 | in the first quarter of next year.
01:21:00.040 | - Okay. - Okay, Scott, great.
01:21:05.800 | Thank you so much.
01:21:06.640 | I'm sorry, one other quick question.
01:21:08.920 | If they decide to move to Florida permanently,
01:21:12.120 | then obviously, since Kaiser's not in Florida,
01:21:14.960 | they would just need to change their Medicare Advantage plan,
01:21:19.280 | like you said, to another Medicare Advantage plan
01:21:21.960 | that would potentially work in Florida.
01:21:25.320 | - That's absolutely correct.
01:21:26.480 | And of course, when they move,
01:21:28.760 | they would certainly get a special enrollment period
01:21:30.760 | to enroll in a Medicare Advantage plan in Florida,
01:21:33.400 | or if they chose, they would have
01:21:36.040 | what's called a guaranteed issue scenario
01:21:38.000 | into a Medicare supplement plan down there.
01:21:39.800 | So they'd have a lot of options available to them.
01:21:42.440 | - Okay, and if you move states,
01:21:44.560 | do you have to re-enroll in Medicare Part AB,
01:21:48.080 | or no, you just, that foundation just stays,
01:21:51.280 | and then you just change your address
01:21:53.000 | and re-enroll in a new Medicare Advantage, right?
01:21:56.880 | - Right, so Medicare Part A and Part B
01:21:59.480 | being a federal program, once you're enrolled,
01:22:02.400 | as long as you take no action with that,
01:22:04.200 | which you shouldn't, you just stay enrolled.
01:22:08.560 | Moving doesn't impact that at all.
01:22:10.760 | - Okay, thank you so much.
01:22:12.160 | - Sure.
01:22:13.560 | - Great.
01:22:14.640 | I saw a hand from Mary, but it's since disappeared.
01:22:17.440 | So I'll ask this question
01:22:18.720 | 'cause it dovetails with the prior.
01:22:21.600 | When can I change my Part A, Part B, Part D,
01:22:25.360 | or Medicaid Advantage, Medicare Advantage, or Medigap?
01:22:29.480 | - Okay, Medicare Part A, Part B,
01:22:33.200 | for the vast majority of people,
01:22:34.840 | once you're enrolled,
01:22:36.000 | you typically won't change those things.
01:22:37.800 | So that should not be an issue.
01:22:39.360 | If you enroll in a Medicare supplement/Medigap plan,
01:22:45.240 | in the vast majority of states,
01:22:46.720 | you can change those any time of year that you choose.
01:22:50.120 | Now, in most states,
01:22:51.800 | once you're outside of your Medicare supplement
01:22:54.120 | open enrollment period,
01:22:56.040 | there will be medical underwriting involved
01:22:57.800 | in changing from one supplement plan
01:22:59.520 | to another supplement plan.
01:23:01.400 | On your Medicare prescription drug plans,
01:23:05.280 | you'll get what's called an initial enrollment period
01:23:07.560 | when you first enroll in Medicare.
01:23:09.600 | After that, you get the opportunity
01:23:11.400 | to change plans every year,
01:23:13.080 | but only during the Medicare annual enrollment period,
01:23:16.400 | October 15th through December the 7th.
01:23:19.040 | And then Medicare Advantage, as we just said,
01:23:22.920 | same annual enrollment period,
01:23:24.720 | October 15th through December 7th.
01:23:26.560 | And then in addition to that,
01:23:28.000 | a Medicare Advantage open enrollment period,
01:23:30.800 | which runs from January 1 through March 31.
01:23:34.120 | Did I cover all the bases, Gloria?
01:23:36.280 | - So Part A, Part B, Part D,
01:23:38.440 | Medicare Advantage, or Medigap?
01:23:40.680 | - Okay, I think so.
01:23:42.040 | - Okay, great. - Thanks.
01:23:44.040 | - Mary, your hand was previously raised, but now-
01:23:48.440 | - I have your question here.
01:23:49.720 | - Okay, great.
01:23:50.720 | - In dealing with, she says,
01:23:52.400 | in dealing with a fairly complex medical care
01:23:55.240 | for a family member,
01:23:57.120 | I am often quoted Medicare rules for accessing care,
01:24:02.120 | such as cardiac rehab or skilled nursing facilities
01:24:07.320 | on the number of days and length of time.
01:24:11.040 | Is there a publication to actually read the rules?
01:24:15.240 | - Well, Medicare and you will address,
01:24:19.520 | certainly skilled nursing care.
01:24:21.280 | And I can just tell you that Medicare will allow
01:24:25.200 | up to a hundred days of skilled nursing care per year.
01:24:28.400 | And understand skilled nursing care,
01:24:31.440 | while it may happen in a setting like a nursing home,
01:24:34.320 | is not long-term nursing home care.
01:24:37.880 | Medicare doesn't cover any part of that.
01:24:40.640 | As far as cardiac rehab,
01:24:43.200 | I'm kind of at a loss on that one.
01:24:46.160 | That's not the kind of situation
01:24:48.280 | I normally get asked or address.
01:24:51.400 | And don't know that Medicare and you
01:24:52.840 | is gonna go into address that question.
01:24:56.360 | It may be something you'll just have to ask
01:24:58.000 | a medical provider about.
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