(upbeat music) - Welcome to the Bogleheads Chapter Series. This episode was hosted by the Pre and Early Retirement Life Stage Chapter and recorded on December 13th, 2023. The session features Lonnie Thibodeau reviewing Medicare basics, followed by a Q&A session. Bogleheads are investors who follow John Bogle's philosophy for attaining financial independence.

This recording is for informational purposes only and should not be construed as personalized investment advice. Could you walk us through how you initially entered the business of Medicare insurance after having worked in aviation? What inspired you to pursue this field? And were there any specific experiences or individuals that played a significant role in guiding you along the way?

- Well, first, thanks for having me back again. I'm honored to be here. Thanks for the question. Yeah, I'd spent about 17, 18 years in the corporate aviation business in a sales role of different capacities. And September 1, 2011 happened. I'd been working on a special project for the company that employed me.

And that project included contacting people in countries like Japan, Australia, Europe, South America. We were starting to develop a market for some of the things that we did. And my boss came to me one day and said, "Hey, you and I need to get on the road." I said, "Where are we going?" He said, "Well, Japan, Australia, South America, Europe." And I said, "Bill, love you like a brother, knowing you a long time, but not going over there." So I came home that evening and I told my wife, "I need to find something else to do for a living." I was kind of tired of being a road warrior anyway.

So she said, "What do you want to do?" I said, "You know, back very early in our married life, I'd been laid off from an aviation job. I was down in South Louisiana where the oil industry was collapsing. And I did insurance just on a whim for a couple of years just to pay the bills." And so I said, "You know, I don't think I gave it a fair shake at that time.

So I'm going to try that again." So I got licensed in the state of Texas where I now live and started selling some things, health insurance primarily. Ended up meeting a gentleman who was a rep for a company who trained agents to sell their product. And he said, "Hey, I'm currently under consideration for a promotion.

If I were to get that promotion, would you have interest in doing my job?" I said, "Certainly, give me a call if that happens." So three or four weeks later, he calls, interviewed for the job, took the job, and worked for that company for just about five years. And when a couple who owned this insurance agency was about ready to retire, and they approached me about purchasing their business.

So that happened in March of 2007. And we've been doing this ever since. And I think my real interest in Medicare products was because as a kid, I spent a great deal of time with my grandparents. So I spoke old long before I was old. My wife has told me many times, she says, "You were old before your time." And I am guilty as charged.

- Got it. Excellent, thanks for sharing that. I'll also add, Lonnie's kind enough to agree to a part two session, since it's unlikely that we'll get to all of the questions. So more to come on that, it may be in a month or two or three, and it'll be announced on the forum and other channels as we typically do.

So again, Lonnie, thanks for that background. Next question, "Can you share with us what you enjoy most about your role in selling and recommending Medicare insurance products? Can you relate and experience where you feel your recommendations really help somebody avoid a mistake?" - Well, first of all, I just help, I like helping people solve the problems or answering the questions.

In essence, finding the solution that fits their situation exactly. And as far as avoiding a mistake, I'm not sure this is a direct answer to your question, but I have to share an experience with you. This past July, I had a gentleman come in and I shared with him how Medicare works answered his questions, explained that there's two major ways to get his Medicare benefits, either through original Medicare with a supplement or Medicare Advantage plan.

And after the presentation and answering all his questions, he looked and he said, "Well, I want a Medicare supplement plan. Why would anybody want Medicare Advantage?" And I said, "Great." So we got him enrolled. The very next day, I had a Denver gentleman, exact same situation, about to turn 65, enroll in Medicare, gave the same presentation, answered all his questions.

And at the end of it, almost word for word, he said the same thing the prior gentleman said, "Well, I want Medicare Advantage. Why would anybody want Medicare supplement?" So my point being, we all have different wants, needs, priorities, and those kinds of things. And it's all about helping people get into the plan that fits their situation for them.

- Okay, great, thank you. Next question. Can you tell us about the book "Medicare and You" that you recommended last year? And by the way, for the audience, a link to that PDF will be put in the chat. - Yeah, so "Medicare and You" is typically mailed to anybody who's on Medicare once a year, and it updates you with all the Medicare Part A, Part B deductibles, premiums, those kinds of things.

And it is the Bible of Medicare. If you will read that book from cover to cover, it will do two things for you. It will give you a pretty clear understanding of Medicare, and it will probably cure insomnia. - Fantastic. With that, Miriam, do you want to start us with a question from the RSVP or chat?

- Yes, actually, the first question is my question. And along with what Lonnie just said, Medicare Advantage, Medicare supplement, my question is, why would somebody wish traditional Medicare or original Medicare rather than the supplement or the Advantage plan? What is the advantage of, or what is the, why is original Medicare good for some people?

- Okay. - What's the advantage? - Yep, great question. So with original Medicare, there are no networks of doctors or hospitals to be concerned with. You can go to any medical provider anywhere in the United States who accepts Medicare. And if you have a Medicare supplement plan along with that, then the same is true of your Medicare supplement plan.

So for people who might travel a lot or people who want extreme flexibility in using the Mayo Clinic versus using a hospital in Houston versus using somebody in Florida, Medicare along with a supplement is probably the right answer for you. - That would be the primary reason for original Medicare or traditional Medicare.

- Correct. - Right. The availability of doctors and networks and hospitals and that you can go to. - That's exactly right. - Okay, I might just mention that I do have traditional Medicare and the, which pays for 80%. And then the other 20% that we use came from our employer.

So we have employer retiree insurance for the other 20%. - Very good. - Is that considered, so I just might point out that people should look for their employer retiree insurance that many employers may offer it. And for us, it was a good idea. Is it called traditional Medicare or original?

What is the correct word there? - Well, thanks for the question. I oftentimes refer to it as traditional Medicare but it is technically correct to say original Medicare. - Thank you. Okay, Gorrie. - Great, thanks Miriam and Lonnie. Next question. Let's say I chose the wrong plans for my situation.

When can I change? Say I'm not happy with the network provided in my Medicare Advantage plan. Let's say I'm healthy and chose an inexpensive Medicare Advantage and developed cancer. What are my options? What personal experiences can you mention about this? For example, the story about your client that had MA for many years and then developed cancer.

- Yeah, so a great question. And I'll provide maybe a scenario. Let's say someone has turned 65 recently. They've enrolled in Medicare part A, part B, the first of the month that they turned 65 and they've chosen a Medicare Advantage plan. So if you choose that route initially, then you have what's called a 12-month trial period.

And what that means to you is, if at any time in that 12 months you decide, I've made a mistake in selecting a Medicare Advantage plan, I wish I'd chosen Medicare along with a supplement plan. Well, during the trial period, you can choose original Medicare along with a supplement plan and get what's called guaranteed issue.

And you would be able to choose from a number of standardized Medicare supplement plans issued or offered by any company that offers them in the zip code that you reside in. Now, if on the other hand, you chose Medicare supplement when you first enrolled in Medicare and then subsequently decided, oh, I think I would rather have a Medicare Advantage plan, then in all likelihood, you will probably have to wait until the next annual enrollment period.

And that enrollment period runs from October 15 through December 7, every calendar year. Does that answer the question? - I believe so. And then the personal example? - Yeah, so we, my memory's foggy, but we've had a client or have a client who was enrolled in a Medicare supplement plan and the supplement plan premiums were getting really high.

And she came to me during the enrollment period and said, I don't think I can afford to pay these premiums any longer. What are my options? So we talked about Medicare Advantage, the pros and the cons. And she said, well, are my doctors in network? So we confirmed that the doctors she wanted to see are indeed in network.

But she was concerned then about the co-pays and potential out-of-pocket maximums. Well, it turns out in our area, we have a Medicare Advantage plan that has approximately $195 monthly premium, but the co-pays for all your medical care are zero. So it's a Medicare Advantage plan that does have a network, but from a coverage standpoint, it behaves more like a Medicare supplement plan.

And the premium she's paying for that ended up being about half what she was paying on her Medicare supplement plan. So it turned out to be a great solution for her. She's been enrolled in that plan now about four years and at the last review during this most recent enrollment period, it still seems to be something that's working well for her.

- Great, thank you. So the next question, and I'll add to it. So the first part is, what are the most asked questions by your clients? And I'll add to it, what do clients find most confusing? I know there's a tremendous volume of information, a lot of it's confusing.

So if you can highlight what's most confusing and supplemental to that, what helps clarify most effectively those most confusing things? - Yeah, good question. So we've had a number of clients come in this past enrollment period and with a smirkish smile on their faces ask, am I getting all the benefits that I'm entitled to?

And that's being driven by all the advertising for Medicare Advantage plans, because that's one of the taglines of one of the nationwide commercials, I think. So jokingly, that's it. What's one of the most confusing things, I think is the enrollment periods, because the annual enrollment period that I just talked about, that runs from October 15th through December 7th, applies to Medicare prescription drug plans and to Medicare Advantage plans, but it does not apply to Medicare supplement plans.

In addition to that, we have another enrollment period we're about to approach, and it runs from January 1 to March the 31st. And that enrollment period is called the Medicare Advantage open enrollment period. And it only applies to people who are currently enrolled in a Medicare Advantage plan. But that enrollment period allows them to change from one Medicare Advantage plan to another, or allows them to go back to original Medicare, select a Medicare supplement plan, and then select a Medicare prescription drug plan.

So the other thing we have are special enrollment periods. So if you moved out of a service area for the plan you're currently enrolled in, oftentimes that opens up a special enrollment period for you based on your particular situation. So just keeping the enrollment periods, I guess all straight, seems to be the most confusing thing for most people because there are a lot of moving parts, I think.

- Got it, okay, that was helpful. Here's an interesting one. I just started kindergarten. Is it too early to start learning about Medicare? I made that up. Okay, next real question. I've had significant illnesses. Are there any preexisting conditions or limits on any of the plans you'll be discussing?

- Okay, so for Medicare Advantage plans, they cannot eliminate coverage or charge you any higher premiums or fail to offer you coverage for any Medicare Advantage plan nationwide. On Medicare supplement plans, when you're in your Medicare supplement open enrollment period, and let me explain, that happens the first of the month that you turn 65, or let me back up.

Technically it happens when you first enroll in Medicare Part B, and that gives you a six-month Medicare supplement open enrollment period. And that means that you can apply for any Medicare supplement plan that's offered in the zip code that you reside in. Now, there are some Medicare supplement plans that have what's called a preexisting condition clause.

And what that means is, is that they won't cover a preexisting medical condition for the first six months you're covered in the plan unless you had creditable health insurance coverage prior to enrolling in that Medicare supplement plan. Now, most Medicare supplement plans have done away with that preexisting condition clause, but there are still some states, Texas being one of those, where companies can have that clause as a part of their contract.

So just be sure you ask the question, especially if you don't currently have health insurance and you're enrolling in a Medicare supplement plan for the first time. And again, in summary, Medicare Advantage plans, that's never an issue. Supplement plans, it may or may not be. - Okay, thank you.

So I'll ask another one, and then Miriam, after this one, I'll switch back to you for an RSVP or question from the chat. So Lonnie, tell us about who's eligible for Medicare, who isn't, when you can sign up, and when is it effective? - Okay, very good. So for people that are, we call it aging into Medicare, your Medicare will begin the first day of the month that you turn 65.

And you can sign up or process that paperwork, if you will, up to 90 days in advance of your Medicare effective date. Oh, by the way, if your birthday is on the first day of the month and your Medicare is actually effective the first of the month prior to your birthday.

Other people might get on Medicare due to a disability. So people that are qualified for social security disability benefits typically are eligible for Medicare 25 months after their social security disability benefits begin. And they are eligible to enroll in Medicare Part A and Part B, just like someone turning 65 would be as well.

Now, the question for a lot of people, and we get asked this on a regular basis is, what if I'm still working or my spouse is still working, and we're getting health insurance benefits through mine or my spouse's employer? And for those people, you might want to delay enrollment in Medicare Part B.

You will automatically be enrolled into Medicare Part A based on when you turn 65. But Medicare Part A for most people doesn't have a monthly premium. So there's no downside for you to be enrolled in Part A. If you have health insurance through yours or your spouse's employer, delaying enrollment in Medicare Part B simply means you won't be paying a premium for Part B until you actually enroll.

Now, a lot of people get concerned about a late enrollment penalty for delaying enrollment in Medicare Part B. But as long as you're covered on a group health plan through you or your spouse, there will be no late enrollment penalty charge for deferring your enrollment in Medicare Part B.

- Okay, thanks. Miriam? - Yes, Lonnie, it sounds like what is the best choice for an individual depends on where they live and what zip code they're in. And we do have a question on moving states. When you move states and you have your insurance and you need to choose a new Medicare Advantage or Medigap plan, can you do that?

How do you do that? Is medical underwriting required? And then also, you haven't mentioned Medigap yet. And this question also involves Medigap. What is Medigap? And then, you know, moving states and medical underwriting. - Okay, well, Miriam, I'll try to remember all the things that make up that question.

And if I forget any, just remind me at the end. All right, so the first thing I'd like to address is, is if I move from one state to another, what are my options? Well, if you're enrolled in a Medicare Advantage plan, then when you move to a new location, you will get the opportunity, no matter what time of the year, to enroll in a different Medicare Advantage plan in the state that you move to.

If you choose, you can also enroll in a Medicare Supplement plan, and you can do that without any medical underwriting. Excuse me, meaning that you fill out the application and they must take you. Now, if you're enrolled in a Medicare Supplement plan and you move to a different state, in most cases, the vast majority of cases, you'll be able to keep the same Medicare Supplement plan you're enrolled in.

A prime example, we have a couple who recently moved from Texas to Idaho, and they communicated with me during the process of the move, because they had exactly these kinds of questions. They're enrolled in a Medicare Supplement plan, and they will remain enrolled in that particular Medicare Supplement plan.

Now, one thing that will happen is there will be an adjustment in the premium that they pay on that Medicare Supplement plan, because here in Texas, they were paying about $115, $118 a month each for their Medicare Supplement plan. Going to Idaho, it looks like they're gonna be paying about $160 to $165 a month each for their Medicare Supplement plan.

The primary reason for that is the state of Idaho uses something called community rating, where a Medicare Supplement company, or let's say Plan G, which is the most popular out there, they have to charge everybody the same rate, regardless of whether they're 65 years of age or 95 years of age.

That's community rating. And so for these people who are only 66, 67 years of age, it means an increased premium for them. Medicare Supplement versus Medigap. Most people in the industry refer to these Medicare plans that go along with the original Medicare as Medicare Supplement plans. When you talk to anybody that's part of the federal government or the Center for Medicare and Medicaid Services, they refer to those same plans as Medigap.

So Medicare Supplement, Medigap, the same terms, just used interchangeably. - So that pays for the 20% that Medicare does not pay for? - That's exactly correct. - Okay. And one other thing, we have another question. It says, "If after initially enrolling in a Medigap plan, "like N, can you eventually switch to another plan like G, "if you later find it more suitable?

"And what about the underwriting?" - Good question. So in the vast majority of states, if you wanna move from any Medicare Supplement plan to any other Medicare Supplement plan, even if it's the same letter designation, but with a different company, you're gonna have to submit an application and it will be subject to underwriting.

Now, something I just learned recently is I'm licensed in the state of Oklahoma. We have 25 or 30 clients up there. And one of your Boglehead members, as a matter of fact, called me to get help with her mother who lives in the Tulsa, Oklahoma area. And she informed me that Oklahoma just this year passed a law that provides for a Medicare Supplement, Medigap, open enrollment period every year on your birthday.

And it's a 60-day window that begins on your birthday. So thank you for the Boglehead member who informed me of that. I went and researched it, found that's absolutely the case. So I think that's something that's done in about seven or eight states across the country now. I think in general terms, that's probably an excellent idea.

And I would kind of like to see that adopted by more states across the country. Does that answer your question, Harriet? - Yes, thank you. Corey? - Thank you. Next question. My partner or I may plan to work after age 65 and will be covered by an employer plan.

What do I have to do? What does COBRA affect? I'm sorry, how does COBRA affect this if my younger partner won't have insurance if I go on Medicare? - Great question. Yeah, so if one of you is aging into Medicare and you're the employee who the health insurance is coming through, one of the things to know is under normal situations, you have the option to exercise COBRA for 18 months.

In a scenario like we've just described, that COBRA option is actually extended out to 36 months. So that helps a lot of people with an age gap between the two spouses. If that's not enough for you, then the other option is the older spouse go ahead and get on Medicare and the other spouse get an individual health plan through the Affordable Care Act, et cetera, and something like that.

Was there another part to that question, Corey? - I think, I'll read it again. I think you covered it, but my partner or I may plan to work after age 65, will be covered by an employer plan. How does COBRA affect this if my younger partner won't have insurance if I go on Medicare?

- Okay. Yeah, and the other thing to remember is just simply that if one of the spouses is already getting social security retirement benefits, then they may automatically, Medicare may automatically enroll that spouse in Medicare Part A and Medicare Part B. And if you're in a scenario where you don't want Medicare Part B, as soon as you get that card, just give them a call and let them know that you do not want to be enrolled and they will correct that and send you a new card.

- Okay. Great to know. Next question. Let's say I'm a procrastinator. I was even going to put off asking this question. What happens if I don't sign up or don't do anything regarding Medicare? - All right. So if you're no longer employed or your spouse is no longer employed, you don't have group health insurance and you fail to enroll in Medicare Part B at the time that you're eligible to do that, then your next opportunity to enroll is going to be during something called the general enrollment period.

And that happens from January 1 through March 31 every year as well. And the effective date of your enrollment will be the first day of the month after the date that you enroll. Now, for every 12 months after you turn 65 that you were eligible to be enrolled in Medicare and you did not enroll, when you subsequently do enroll in Medicare Part B, there's going to be a 10% penalty.

So if you're 12 months to, I guess, 23 months past that enrollment date, it's a 10% penalty, 24 months, et cetera, it'll be a 20% penalty and on that road. And that penalty stays with you for as long as you live. So don't procrastinate. - Does it accrue interest?

- It does not accrue interest. - Okay. - Wait, it's a penalty per month, per annual? - Well, it's... So right now the standard Medicare Part B premium is $174.70 a month. So somebody who is facing a 10% penalty would pay that plus $17.74. Does that answer your question, Miriam?

- Forever. - Forever, that's right. - Okay. - Okay, so the next set of questions are divided into Parts A, B, and D. So we'll go through those three very separately so as to not overlap the content. And then following those three categories of questions, Miriam, we'll go back to you.

So the first one, tell us about Part A Medicare, imprints costs, restrictions, coverage, with some examples of what would be covered under Part B versus not covered. Oh, this is... Okay, yeah. - I'm sorry, I didn't mean to cut you off. Is that the question? - Yeah, I just wanted to make sure the covered under Part B versus not covered is intentional.

Did the question asker mean Part A? Tell us about Part A Medicare, costs, restrictions, coverage, with some examples of what would be covered under... Maybe it's Part A versus not covered. - Okay, I think I understand the gist of the question. So Medicare Part A is referred to as hospital insurance, and that's primarily what it is.

And it comes into play when you've been admitted into a hospital as an inpatient. And I emphasize that because if you were in a hospital on an outpatient setting, day surgery, for instance, that's all gonna be covered by Part B of Medicare, not Part A. Part A also handles hospice, if you ever need that kind of service near end of life type thing.

And it also handles skilled nursing care. So those are primarily the three things that Medicare Part A is responsible for covering. Skilled nursing care typically comes into play if you've been admitted into a hospital as an inpatient. And then you're, the way I describe it is you're not sick enough to stay in the hospital any longer, but you're not well enough or strong enough to go home and take care of yourself.

So some certain number of days might be ordered by your doctor for skilled nursing care so that you can continue to be monitored by medical staff. That's Part A. Medicare Part B called medical insurance is basically everything else medical related. So that's your preventive care, treatments, diagnostics, lab work, x-rays, all those kinds of things.

- Okay. So a follow-up question to the Part B part is, I've heard about Medicare Advantage programs and Medicare supplements. You touched on Medigap earlier, but I'm not sure about Medicare Advantage. How do those plans affect whether I need Part A and/or Part B? - Yeah, great question. So before anybody can enroll in either a Medicare supplement/Medigap plan or a Medicare Advantage plan, you must be enrolled in both Medicare Part A and Part B.

The way I describe it is Medicare Part A and Part B serve as the foundation of your health insurance from the time that you turn 65 in general to the time that you pass away. And so for the vast majority of people, when you're either gonna get Medicare with a supplement plan or a Medicare Advantage plan.

So sometimes people come into the office and they're concerned about this Medicare Part A hospital deductible that's what's called a per benefit period deductible. And in 2024, it's about $1,620. But if you have a Medicare supplement plan, you won't be responsible for that. So you don't have to worry about it.

And if you have a Medicare Advantage plan, then the typical Medicare Part A, Medicare Part B deductibles and coinsurance don't apply to you either. What you need to concern yourself with is what does my Medicare Advantage plan prescribe that I will have co-pays for, co-insurance for as I use the plan and use other medical services.

- Great, thank you. So we'll move to the Part D part. Tell us about Part D Medicare drug plans with some examples of what would be covered under Part D versus not covered. I currently take three different prescriptions and one is very expensive and no generic is available. How can I find out what my lowest out-of-pocket cost would be?

- Okay, great question. So Medicare Part D, Medicare prescription drug plans, these are plans that are authorized by and meet requirements that Medicare prescribes for prescription drug coverage. And if you want to find which plan will provide the total lowest overall out-of-pocket cost for you, you can go to medicare.gov.

You can input your prescription information and it will show you every prescription drug plan that's available to you based on the county that you reside in. And then it will default to sorting those plans with the sort being the lowest total out-of-pocket cost. And by that, I mean, it will add up what the annual premium is for the plan and any co-pays that you're responsible for.

And oh, by the way, you can select the pharmacy or pharmacies that you might want to use in your local area and it will give you pricing for the prescriptions based on the drug plan selection and the pharmacy selection. In addition to that, a lot of these plans might have mail-order coverage available.

And in a lot of cases, that can save you money. In some cases, it doesn't save you any money, but that tool at medicare.gov can tell you that as well. Now, I'm sorry, go ahead. -I just put into the chat a calculator that you previously mentioned. -Awesome. -Back to you.

-One other thing that I will add is we have had some folks, well, who take sometimes relatively expensive drugs and can't find what they consider to be ample coverage in any Medicare prescription drug plan. So a couple of resources that we share with our clients is goodrx.com. It's just a discount program.

They have a free version and they have a paid version. And they really can help sometimes with generic drugs that oftentimes would be considered tier-two drugs. So you might have a co-pay on a prescription drug plan and you might enjoy a lower co-pay using a discount program like goodrx.

Another source, and this would be more for your more expensive brand-name drugs, is a website called costplusdrugs.com. Those of us who live here in Texas are very familiar with Mark Cuban. He's the billionaire that owns a majority stake in the Dallas Mavericks, and this is his company. And he started it out of frustration with drug pricing and how the industry works, and it's his hope that he's gonna help bring some solution to that.

And then finally, we have some clients, in fact, I've had clients share this with me, that use Canadian pharmacies. And in certain cases, they found that those Canadian pharmacies can get them prescription drugs for less than the co-pay would be on a Medicare prescription drug plan. So all things that you can check out, especially if you're taking more expensive drugs.

- Thank you, Lonnie, great resources to know about. Miriam? - Yes, along the Part D drug plans, we have a question about the coverage gap. - Right. - And whether or not, could you explain what the coverage gap is? And the question actually has to do with when you have, what can be included in determining the coverage gap?

- Okay, it's a great question, and it's a bit of a complex answer, but I'll do my best. So when Medicare prescription drug plans first came out in 2006, one side of the political aisle said, we want all the coverage to be on the front end or the most comprehensive coverage.

And the other side of the political aisle said, well, we want the most comprehensive part of the coverage to be on the back end. So it was literally designed by committee. And we got this thing where you had co-pays for most prescriptions up front, then you had this coverage gap in the middle, and then you had some more comprehensive coverage on the back end.

When prescription plans for drug plans first came out, when you entered the coverage gap, you were paying 100% of the cost of the drug yourself. That has since been modified so that today, when you enter the coverage gap, you're paying 25% of the cost of the drug yourself. The 75% is provided by discount from the drug manufacturer and some coverage from your prescription drug plan.

Now, what gets you into the coverage gap is how much you're spending on prescription drugs. The number changes a little bit each year to adjust for inflation, but I think in 2024, when you spent approximately $2,300, $2,400 on prescriptions and that includes the full cost of the drug, so that's what you paid in co-pays plus what the insurance company is paying, when that number in a calendar year reaches say 2,400 bucks, then you go from what they call the initial coverage level into the coverage gap.

And at that point, you're paying 25% of the cost of the drug. Then to get moved from the coverage gap to an area they call catastrophic coverage is another even more complex calculation that includes a whole lot of things, but suffice it to say, any prescription drug plan that you're involved with will keep you informed as to how much you have to go before you get out of the coverage gap into catastrophic coverage.

Once you move to catastrophic coverage, worst case scenario, you'll pay 5% of the retail costs and in many cases, you'll pay zero based on some calculations. - Okay, the question here is, if you fill a prescription that is not covered by your particular Part D plan, after making all the calculations that you have the right plan, is there any way for those costs to be included in your total costs for being out of the coverage gap?

- All right, so give you a typical scenario where this might apply. Client comes in, they tell me what prescriptions they take and we advise them to enroll in a particular plan based on those prescriptions and the plan that'll provide the best coverage in our estimation using the medicare.gov tool.

February, March, April, sometime during the next year, they get prescribed a new drug and that drug is not on the formulary for their particular prescription plan. And that typically creates anxiety. So one of the things that can oftentimes be done is if you will have your doctor or doctor's office write a letter to the prescription drug plan and ask for a formulary exception, then in most cases, those things get granted.

Now, the exception might be that you're gonna have it covered at a tier three level, which means you're still gonna have substantial co-pay, but at least you have coverage for the drug. And I'm sorry, Miriam, was there a second part of that? - I think you answered the question.

- Okay, very good. Lori, before we move on, I'm gonna ask two more questions based basically on this particular subject, but there is another question in the chat that we should approach later, okay? - Sure. - Okay, Lonnie, what about, we have a question on a disabled veteran. I like the idea of original Medicare, but for a disabled veteran who has healthcare through the VA, including dental, vision, and prescriptions, is it just money out the door or is the lower or no cost of an Advantage plan enough?

- Okay, that's a difficult question to answer because it's gonna depend upon your particular situation. We have a number of clients who are former military people, some who have VA benefits, some who have TRICARE benefits. And I'm not an expert in the benefits that military folks get, but I do know that if you have TRICARE, it typically means that you were a career military, retired from the military, and you and your spouse enjoy this TRICARE benefit.

So if you have the TRICARE benefit, then you probably don't need to worry about anything else because it will cover all of your medical costs with very minimal out-of-pocket costs to you. If, on the other hand, you have VA benefits, that can be a very different story. And a lot of the answer as to whether you need to worry about getting an Advantage plan will depend upon, do you have access to that VA care near where you live?

Is the VA care near you satisfactory to you? We have some clients here who love the VA system here in the Dallas-Fort Worth area and wouldn't go anywhere else. And we have others that tell you, "I wouldn't go there, they'll kill you." So for some of those folks, we help them enroll in a Medicare Advantage plan so that they can go outside the VA system should they choose, go to a doctor that's in the network for that particular plan and still have pretty comprehensive coverage.

And then they can choose to go inside the VA system when it suits them. -Okay, thank you. And then my last question is from the chat. If I have a Kaiser as a supplement plan, if I have Kaiser as a supplement plan and I move to an area where there is no Kaiser, what should I do?

-Okay, so my understanding of Kaiser is it wouldn't be a supplement plan, it would be a Medicare Advantage plan. And if that's the case, if you move outside the service area for Kaiser, you're going to have to select a different Medicare plan, whether that's Medicare Supplement or Medicare Advantage.

But with those kinds of plans, you have to live in their service area. -Thank you. Cory? -Miriam, you mentioned you had another one from the chat. Do you want to cover that now to make sure we get to it? -Sure. Ed asked a question. It is a long question, but he wanted, Lonnie, if he could speak to this.

And apparently, Ed said that he negotiated in his job hundreds of managed-care contracts through 30 years in healthcare administration for the 17 cancer centers I managed. I escorted several Medicare Advantage insurers like Humana and WellCare, now Centene, out of my cancer centers for wanting to take reimbursements at less than Medicare traditional payment rates.

If you can afford a supplement, I highly recommend enrolling and keeping it as long as you can afford it to keep great providers. And the first part of the question was, be aware that Medicare Advantage plans negotiate with providers for a reduced reimbursement rate. This is how they can offer perks such as gym memberships, Visa cards for groceries, dental, pet cares, et cetera, and this greatly reduces your provider network and quality of providers.

And what's the question? -Can you speak to this? And I think the question actually is that if you can afford a supplement, he recommends enrolling and keeping it as long as you can afford it to keep your great providers. -Okay. So this is a discussion that comes up from at least 10 or 15 people every enrollment period in our office around the fall.

So going back to, I think, a discussion we had previously, if having access to all the possible providers you could have access to is important to you, then there's no question that having original Medicare and a supplement plan is probably the right answer for you. And I would further tell you that if Medicare Advantage is something that you're interested in, the kind of Medicare Advantage plan you're going to find will be largely dictated by where you live.

For instance, we're just outside the Dallas-Fort Worth area, large metropolitan area. There are a number of what I would consider to be very comprehensive Medicare Advantage plans who have very broad networks of hospitals, medical providers of all kinds, et cetera. But if you get into a more rural area, you're going to find that that's not necessarily the case.

You'll find there's less competition. You'll find that there are smaller networks, and you will definitely find that your annual out-of-pocket maximums along with your co-pays for medical care are going to be higher than they will be in a more populated area. So I would say that it depends on, one, what's important to you, and, two, what options do you have in Medicare Advantage plans?

And then maybe another consideration -- well, definitely another consideration is, what's the premium you're going to pay for a supplement plan? Because that's always got to be a part of the equation. -Okay. Thank you. Next question, does Part A or Part B cover dental or eye care? How do I get dental or eye care?

-All right, great question. Medicare Part A and Part B don't cover vision or dental or any other what Medicare Advantage plans call "extra benefits." Now, I'm going to say something that may be a little bit controversial. There are individual dental and vision plans available for purchase, but in my humble opinion, I'm not a big fan.

At least here in Texas, Oklahoma, Arkansas, where we have a number of clients, I've researched a number of dental plans, and I just not found any that, in my estimation, deliver enough value to warrant paying a premium for those plans. So when people come to us and ask about dental coverage, I typically say, "Just go to your dentist, see if maybe they offer some kind of a discount program that you can purchase or a real insurance program you can purchase, but what I have to offer you is not going to provide great value." Dental, vision, over-the-counter benefits, those are the kinds of things that are offered along with Medicare Advantage plans, not Medicare Supplement plans, or Medicare Part A and Part B.

-Okay, thanks. I'm going to slip in a question that relates to what Miriam asked earlier from the chat. You'll forgive me if it's insensitive, and you'll navigate, you know, the kind of political or controversial aspect of it, but I think it may resonate with a lot of the crowd, so I'm going to ask it.

What's Medicare's general reputation for fairly and timely compensating physicians who accept Medicare? -In general, I don't know. I don't ever see that side of things. I don't hear complaints from the medical providers that I know, which is only a handful of people, about Medicare. Well, the complaint I hear is about the reimbursement rate.

They're not crazy about that, but I don't hear them complain about the time it takes for Medicare to reimburse them. -Okay, good to know. Next question. Tell us about Part C Medicare plans with some examples of what would be covered under Part C versus not covered. -This area is confusing to me since I see a lot of commercials and ads saying they include things like dental, eye care, gym membership, over-the-counter drugs, et cetera.

I really like my doctor and university teaching hospital that I used during employer health insurance. Can I continue to go to that doctor? What if I must go to an out-of-network hospital or doctor? -Okay. All good questions. So, first of all, Medicare Part C, a.k.a. Medicare Advantage plans, when you enroll in one of those plans, what it means is you're getting your Medicare Part A and Medicare Part B and Medicare Part D, prescription drug benefits, all from one plan.

It's all combined together, much like health insurance you might get from an employer. Now, the question of whether you can continue to use your teaching hospital, you just need to check with the plan and see whether the hospital is in network for that plan and whether their associated clinics are and doctors that have admitting rights in the hospital are, et cetera.

And as far as the extra benefits -- Excuse me for a second. Most Medicare Advantage plans include those extra benefits, like vision, dental, a fitness benefit, oftentimes referred to as silver sneakers, an over-the-counter benefit, and a lot of them provide benefits for hearing aids, et cetera. And the way they can provide those benefits is for every county across the country, Medicare tells Medicare Advantage plans, "We're going to reimburse you X dollars per month for every member that you have enrolled." And so the health insurance company takes that number and determines that.

We can design a plan with these Medicare Part A, Part B, and drug benefits in addition to these extra benefits for the money that Medicare is allowing for us for each member involved. And so they just try to get that as competitive as they can so they can get more membership versus other health insurance companies.

-Okay. Next question's about Medigap. You may have covered it already. I'll ask it quickly to see if there's anything you want to add to it and then just to tee up what to expect for the rest of the hour as we're 7 minutes to 9. Miriam, I'll ask three quick questions that relate to Medicare Advantage and then switch it back to you if there's time for RSVP or chat.

So this one that you may have covered already, "Tell us about Medigap supplemental plans. What are the gaps that I would have to pay for depending on what plan I choose?" And if you've answered it fully already, we can move on. -No, we'll get into that a little bit.

So in most states, Medigap plans are standardized, and that means that they have a letter designation, A through N, and that letter designation tells you exactly what coverage you get. So whether you buy a plan from Humana, UnitedHealthcare, or any other health insurance company out there, the most popular plan sold today is Medicare Supplement Plan G or Medigap Plan G.

With Medigap Plan G, the only out-of-pocket exposure you have is to satisfy the Medicare Part B annual deductible. And in 2024, that deductible amount will be $240. So once you've done that, no further out-of-pocket expenses with the Plan G. Now, another very popular plan is Medicare Supplement Plan N.

And with the Plan N, your only out-of-pocket exposure, again, is that Medicare Part B annual deductible. And then there's a $20 copay for every doctor office visit and a $50 copay should you use a hospital emergency room. Now, one other thing to note is, with Medicare Supplement Plan N, it states that you're also subject to paying the Medicare Part B excess charges.

We haven't talked about that yet, so let me address that. In the medical world, if a medical provider says, "I accept Medicare assignment," that means that they're accepting the Medicare fee schedule. But a medical provider can choose to treat Medicare patients and not accept the Medicare fee schedule. And in that scenario, that provider can charge as much as 15% more than the Medicare fee schedule.

And that's called the Medicare Part B excess charges. So if you have a supplement plan like Plan G and you go to a provider who charges those Medicare Part B excess charges, you're not responsible for paying those. But if you choose a Plan N, because it's got a lower premium and you use a provider who charges those excess charges, then you're subject to paying that extra 15% out of your pocket.

Now, this, I think years ago, was a bigger issue than it is today. The last numbers I saw from Medicare, and I researched this about a year and a half ago, is that some 94, 95% of medical providers out there who treat Medicare patients do not charge Medicare Part B excess charges.

So this would only come into play for very few people. - Okay. Next question relates to Medicare Advantage. What would happen if I picked neither a supplement nor a Medicare Advantage plan, and I contracted a disease or chronic illness that requires 20 days of hospital care, and then an ongoing outpatient treatment weekly with a list price of $5,000 per week for a year?

What could that cost me? - Okay. So with Medicare Part A, if you're admitted into a hospital, you first have a Medicare Part A hospital deductible, and it's a per-benefit period deductible. And in 2024, that number's approximately $1,620. So your hospital bill for up to 60 days in the hospital is $1,620.

And per-benefit period means that once you're admitted to the hospital, or I should say, once you're discharged from the hospital, that will count 60 calendar days. If you're readmitted into the hospital in that window, then you're considered to be in the same benefit period, and you would not be subject to paying the Part A hospital deductible again.

But if you're discharged from a hospital and more than 60 days has passed and you're readmitted to the hospital, then you're subject to paying that hospital deductible again. Now, again, that covers you for up to 60 days in the hospital. If you're there beyond 60 days, then you have a daily copay beyond that Part A hospital deductible.

And that information's somewhere in the document that I have provided, but I don't see it right now. Now, for Medicare Part B, so this is your medical coverage, so everything outside the hospital. And by the way, even if you're an inpatient in the hospital and you're there for surgery, as an example, the hospital bill is covered by Part A for what we just talked about.

But if your surgeon is still gonna be covered by Part B, along with the anesthesiologist and other medical professionals that are involved in your care. So for Part B, you have an annual deductible. In 2024, that's $240. Once you satisfy that deductible, then you're subject to 20% coinsurance. And the risk for people is that 20% coinsurance doesn't have a cap on it.

So God forbid, if you had a half million dollar Part B bill in the course of a year, then your 20% comes to $100,000. Does that answer your question? - I believe so. It reminds me of one of the, it was someone from the Fed or a treasury secretary said, "If that made sense to you, you've misunderstood me." (laughing) So two more, and then I realize we'll go past nine, but Lonnie was kind enough to say we can have him for longer.

So I do wanna flip to Miriam, but I also wanna close out these few Medicare Advantage questions. So the next one is, I've heard stories about Medicare Advantage having pre-approvals, delaying approvals, arguing with doctors on treatment plans. I went through that with my bad employer insurance, and I don't wanna argue about issues like this.

What do you recommend? - Okay. So I will tell you that with Medicare Part A, Part B, and a Medicare Supplement Plan, I have never heard of those kinds of things happening. Compare that to Medicare Advantage, and I will say that, again, I started doing this in 2007. And for all those years up until about 2021, 2022, we have had a number of people enroll in Medicare Advantage plans.

And we might've had one that I know of that was faced with a situation where they were trying to get preauthorized for some kind of medical test or procedure, and the insurance company said no. Well, in 2023, I had three clients face that scenario. So this is becoming a little more prevalent.

However, in all three of those situations that I'm aware of, understand that with every Medicare Advantage plan, you have an appeals process. And with every Medicare Advantage plan, you have something called a FAST appeal. And FAST appeal means they must provide you an answer within 48 hours. So let me take the liberty of a story.

- And I'm sorry, is it 48 calendar hours? So if it's asked on a Friday, is it next business day, like Monday, or? - No, it's 48 hours. - So let's say someone asks late Friday night and the answer is due Sunday night? - Yep. - Okay. - Correct.

I had a couple come in the annual enrollment period near the end of 2022. And they had both been on Medicare for three or four years, and they had only Medicare Part A and Part B and never worried about anything else. And that worked okay for them, but they were both a little concerned about what their financial exposure might be if they developed a medical condition.

So they both enrolled in a Medicare Advantage plan. She's had no problems at all, so she's great. About March, April this year, I get a call from the husband and he says, "Hey, I've developed a back problem. "My doctor says I need an MRI "and potential preparation for a surgical procedure." And the health insurance company said, "No, you need to go do some physical therapy "or something else first before we go that route." And he said, "I'm in a lot of pain.

"My doctor says that's a waste of time. "What can I do?" And I said, "You can file an appeal." And he says, "Well, how do I do that?" I said, "I'm gonna find the phone number for you "and I'll call you right back." So I found the number, gave it to him, and he texted me the very next day, I think by 11 o'clock, 11.30 in the morning, and said, "Thanks for the help.

"I just received a text from the insurance company. "It's been approved. "We're going forward with the MRI in a couple of days." In every other scenario, the two others that I'm aware of, probably took just a little bit longer than that. But here's what I would say. Is it possible for those kinds of things to happen?

Absolutely. But with every insurance company, Medicare dictates there must be an appeals process. And the first level of appeal is with the insurance company. The second level of appeal is even with the insurance company. But if it goes to a third level of appeal, then it's with a committee outside the insurance company.

And I mean, in all the years I've done this, including those three, I think I've had maybe three others that had to file an appeal for something like that. And in every scenario at the first level of appeal, it was all approved and they got their stuff done as they wanted or needed to get done.

- Okay, great. So last Medicare Advantage question for now. My doctor says I need to have my husband removed. Does Medicare Advantage cover that? I made that up. Okay. Who best fits a Medigap supplement plan? Who best fits a Medicare Advantage? - Oh, wow. Well, I guess first of all, if we may have covered this before, if it's absolutely imperative to you that you be able to see any doctor or any medical provider you wanna see anywhere in the country, then Medicare with a supplement plan is the obvious choice.

Or if you're concerned about, well, I have treatments going on and if I had a Medicare Advantage plan, I might reach the annual out-of-pocket maximum, which might be three or $4,000 or more. And I don't wanna face that potential out-of-pocket maximum. Then in your scenario, then you'd probably be better off with a Medicare supplement plan as well.

Conversely, we have people that walk in and say, hey, I've been on a Medicare supplement plan for fill in the blank, two years, 10 years, 20 years. I go to the doctor once a year. I go to the doctor once every 10 years, whether I need to or not.

I'm paying all this premium. I don't see the value in it. Tell me about these Medicare Advantage plans. So a lot of the decision is driven by us trying to forecast how are you, where are you gonna be less out-of-pocket money-wise, okay? And if we find that that's gonna be with Medicare Advantage, we recommend that.

If we find it's gonna be with Medicare supplement, we recommend that. And of course, we have a number of customers who come in and say, I want a supplement. Okay, we'll help you with a supplement. And conversely, some come in and say, I want a Medicare Advantage. So it's just all about finding what the right fit is for the person.

- Okay, turn it over to Miriam for RSVP or chat questions. - Yes, Lonnie, you scared me. You scared me and I would suggest that if the procrastinator is here tonight, that they start to think about these medical decisions which plans, this is very difficult, complicated. And Lonnie, one question is, in the Medicare book you're talking about, and it is referenced here, are these answers to these questions also in that book?

- Yeah, I would say if you read that book or if you have a question and go to that book, you can probably find answers to 95% of your questions about Medicare. It really is a comprehensive guide to the way the program works. - Okay, thank you. We have many questions.

It's hard to, let me see. There is one related to, there's one on the HSA. Perhaps we could, let me ask that question since Rich has been waiting. I have some money in an HSA, which is a health savings account. Can I use this money to pay for Medicare Part B premiums and for the Supplement Plan G premiums?

- Great question, and I'm glad I have the answer here on the document that I provided and it's in front of me. So first, you probably know this, but I'll mention it. You must stop making contributions into your health savings account because you're no longer gonna be enrolled in what's called a high-deductible health plan.

You can use the funds out of your HSA account to pay for Medicare Part B, Part C, which is Medicare Advantage, if you're enrolled in that, or Part D premiums. You cannot use the HSA funds to pay for the Supplement Plan or the HSA funds to pay for Medicare Supplement or Medigap Plan premiums.

I'm not sure why they wrote the law that way, but they did. And then of course, you can also use the funds to pay for any and all medical expenses that you might have, anything that the IRS deems medical expenses, just like you did before getting on Medicare. - Okay, thank you.

The next question is following up on the Part D question, we're discussing buying your drugs through Wood Rx or Cost Plus, which could be a significant savings. Is there a way to add those costs to the calculation to move out of the coverage gap? - That's the last part again?

- Can you use, is there a way to add those costs? I think what is meant is what you've paid to the Good Rx or the Cost Plus to the calculation to move out of the coverage gap. - Oh, sorry. No, there is no way to do that. If you're using one of the programs that we just talked about, then it's a drug, you're not using your Prescription Drug Plan to pay for those drugs and they will not be a part of that calculation.

- Okay, thank you. Let me see. Let me do one more question here. "You may have covered this, but I want to confirm. "If I turn 65 and I'm still working, "I only need to sign up for Part A "and use my employer health benefits. "I only sign up," in other words, is it so, "that I only sign up for Part B and D "and get Medicare Advantage after I leave my employer?" - Yeah, so I'm glad you asked the question because what I didn't say is you have the option.

So you're going to be automatically enrolled in Medicare Part A. You can defer enrollment without penalty in Medicare Part B and keep your employer's health plan. But you might work for an employer who charges a relatively high premium that's coming out of your paycheck to pay for that health plan.

Financially speaking, it might be to your benefit to go ahead and enroll in Medicare Part B and then get either a supplement plan or Medicare Advantage plan. So you do what's in your best interest. The option is entirely up to you. And let me add one other thing to that discussion as well.

I found this out the hard way. As long as you're on your employer's insurance and you delay enrollment in Medicare Part B, there will be no late enrollment penalty. However, I had a client come to me and he was offered a buyout package from his employer. And a part of the buyout package was that the employer paid for his and his spouse's health insurance for a period of a year.

Well, right near the time that he was offered this buyout package, he turned 65, but didn't worry about enrolling in Medicare Part B because he had this health insurance from his employer. When he got ready to enroll in Medicare Part B, then Medicare charged him a 10% late enrollment penalty.

Even though it was group health insurance, it was considered COBRA health insurance, not employer health insurance. And because he wasn't gainfully employed by the employer or his spouse wasn't employed by the employer providing the health insurance, it doesn't qualify for deferring that Medicare Part B late enrollment. So just be very careful of that.

- They were not considered employed because it was a buyout package and they were no longer actually working. - That's correct. - Okay. I believe when I was working and I turned 65, I signed up for Part A, I did not sign up for Part B, but I did have to do something with Medicare.

I had to like fill out a form or let them know that I was still working and I was on employer insurance. Therefore, hold off on the Part B, I'm putting it on the back burner. - Right. Yeah, you may indeed have to communicate that with them. - With Medicare?

- Yes, correct. - Yes. And I believe that I have a friend that I worked with, who I worked with, who did not. And he then got into trouble with Medicare with that. He did not tell them. - Interesting. - Okay, Laurie, why not open for a raise hand?

- Sure, yeah, we'll turn, yeah, great. Let's turn it over to the audience for live questions. Again, feel free to continue submitting questions to the chat, but if you'd like to ask a question to Lonnie verbally directly, please raise your hand with the hand raise function on Zoom. And absent that, I have some great questions to continue with that I'm sure will resonate with the audience.

So absent audience questions, I'll proceed. Next question, I have a large 401(k) and other pre-tax savings accounts, and I expect a very large, around $200,000 RMD, required minimum distribution. As we say, a good problem to have. How does this affect my life? What is the most IRMA premium I could pay?

- Great question. So for 2024, the highest Medicare Part B IRMA premium is $594 per month. If you're married, that would apply to both you and your spouse. And if you're subject to Medicare Part B IRMA, then you're also subject to Medicare Part D, as in dog IRMA. So if you have a standalone prescription drug plan, or if you're enrolled in a Medicare Advantage plan that includes prescription drug coverage, then you would be subject to that.

And the highest Part D IRMA premium is $81 per month. So that means if you're enrolled in a Medicare prescription drug plan that has a premium, you're gonna pay the plan premium plus the $81 per month Part D IRMA. - Okay, thank you. Another great question. I plan on traveling to all the states in the U.S.

during my retirement in an RV or spending significant time outside of the U.S. What considerations should I make? - Okay, so as far as Medicare coverage is concerned, it's in the U.S. only, not outside the U.S. So let me address that first. We have a number of countries in the U.S.

who do travel internationally and you can purchase international health insurance coverage for, I'll say, very cheaply. If you're gonna be gone for two weeks, a month, you can get probably a million dollars worth of health coverage for you and a spouse for probably, I don't know, $120, $150 for a two-week trip, let's say.

And that's good for just most countries in the world. - And more specifically, does that mean you pay fully out-of-pocket and then expect a good percentage reimbursement? - Well, it depends on the company that you're dealing with, but in most cases, no. It will act pretty much like health insurance here in the United States where it might be 80/20 co-insurance and they'll charge you the 20% and then the insurance company handles the 80% of the cost.

The insurance company handles the 80% on the back end. - So that means the medical provider abroad would accept that insurance if that's, okay. - Correct. Now, Medicare supplement plans do have limited international coverage. I think it's 25,000 or 50,000. I don't remember the number now. And many Medicare Advantage plans also have a similar level of international health coverage.

And typically, that's 80/20 co-insurance as well, up to the maximum. Now, that doesn't sound like a lot of coverage for us here in the United States, but remember, in most foreign countries, the cost of healthcare is a small fraction of what it is here. In addition to that, check with the country that you're going to because, for instance, we've had clients travel to England, have had to use a hospital emergency room for an accident or something like that, didn't have any international coverage, and it turns out they didn't get charged anything anyway because it's a nationalized healthcare.

I don't know if that would be true of everywhere, or, well, I know it wouldn't be true of everywhere, but I don't know if it would be true of everybody traveling to England, but that was their experience there. Now, as far as traveling around the country in an RV, if you have Medicare and a supplement plan, obviously no problem in finding somebody where you can use your recovery.

If you have a Medicare Advantage plan, you always have access to a hospital emergency room or an urgent care center, regardless of network. Now, if you're gonna go somewhere outside of your home area and you're gonna stay there for a period of months, and you're gonna be on a Medicare Advantage plan, then you might consider heavily a PPO plan versus an HMO plan.

The PPO plan so that you can use it without a network providers. And in addition to that, and I'll just use a couple of names, Humana and UnitedHealthcare both have national Medicare Advantage PPO networks. So for instance, we have clients here in Texas who are originally from Wisconsin. They spend the summer in Wisconsin.

They have a Humana PPO plan and they can visit their doctor up in Wisconsin who is also an in-network provider and it's at their in-network copay. And because it's a PPO, they don't have to have a referral from the primary care physician here in Texas or anything like that.

- Okay, great. So I'm personally curious if you can elaborate more on how to choose a good international plan and is there an equivalent of in-network, out of network when you're abroad? Do you benefit from searching who will accept this international plan? And if it's an emergency, maybe you're not equipped to take the time and resources that you would at home.

- Yeah, so we represent basically one company that does that and it's a company called IM Global. And you can just go online and look them up. IM Global Health Insurance. And they specialize in international health insurance. And yes, they use a PPO system and they have network providers in most countries across the world.

- Okay, and then would it be subject to pre-existing conditions, medical evaluation? How thorough is being accepted? - Yeah, good question. They have different products. Some of those are subject to pre-existing conditions but there are others that are not subject to pre-existing conditions. They just have a little bit more limited coverage.

- Okay, great. Thank you. Switching back, checking in with the audience. I don't see raised hands, so I'll continue. Miriam, you let me know if we have chat questions. - Yes. - M, Hallie, would you like to ask your question or would you like me to ask it? - I can.

- Okay, we have a raised hand, DeGore. - Okay, I heard M Hallie for a second, but then the audio- - Can you hear me now? - Yes, clearly. Thank you. - Hi, I hope this question isn't too specific. It's a great program. I appreciate y'all doing this. My sister just turned 65.

She works for a large employer and her manager told her that she needed to sign up for Medicare Parts A and B, but she does have good health insurance. And she just had to have surgery and we got to talking and I said, are you sure you need to sign up for Medicare?

Because if you've got good health insurance, you might not need to. I said, you ought to double check with HR and make sure. So she called HR and they said that, no, she didn't have to sign up for Medicare Part A and B. She is a low income earner.

And so the $172 is somewhat difficult for her. So I thought maybe she ought to cancel the Part B, but I wasn't 100% sure if that was the right thing to do. And also I sort of feel that she was, I don't know, given misinformation and signed up for the Medicare by mistake.

And does Medicare ever give refunds on premiums? - Great questions. So at this point, wow. Yes, so I would suggest going back to HR, let them know that she was advised by her manager to sign up for Medicare Part A and Part B and have them help her determine which is in her best interest, either to stay on the company plan or to get on Medicare and get a supplement plan or an advantage plan.

Now, if she decides to stay on the company plan, she can contact technically the Social Security Administration and have them disenroll her for Medicare Part B. She'll have to provide the reason being that she's still on an employer's group health plan. But to my knowledge, they will not reimburse her for premiums that's already been charged for Medicare Part B.

Now, I may be wrong about that. I just never heard of that being done before. - Yeah, that's what I thought I read on medicare.gov, but I just wanted to make sure. Now, right now she's on medical leave after surgery. And so that doesn't end until next month. And I guess there's a possibility that her job might've been filled while she's on medical leave.

So if she canceled the Medicare Part B now, and then next month she finds out that she can't go back to work, would that be a big problem to sign back up for it? - No, it shouldn't because upon termination of her group health coverage, it will open up what's called a special enrollment period for her to get back on Medicare Part B.

- Right, that was my understanding. But again, I don't wanna steer it wrong. - Right. - How long is that enrollment period, that special enrollment period for her to sign up? - How long is it? - Yes, is it like does it go from the point where she stopped working for how many months does she have to sign up?

- Oh, good question. So it's not when she stops working, from the time her group health insurance coverage ends is 62 days. - Great. - Thank you so much. - Thank you. - So Miriam, do you wanna continue? I have other questions, but- - Well, I would say do we have any more raised hand questions?

Anybody from the audience who would like to raise your hand and ask a question? - Jen. - Jen, Mary. Oh. - Hi, thank you so much for this forum. I just had a question. So if my parents are planning to live six months of the year in Florida and six months of the year in Virginia, and they currently have Kaiser as their supplement or their medical advantage plan, and there's no Kaiser in Florida, do they, so will they have to sign up for another supplemental plan for when they live in Florida and then use the Kaiser plan when they come back to Virginia?

- Well, in general terms, no. They will need to decide on a plan and probably keep that plan no matter where they're staying. So, and the plan that they're eligible to enroll in is gonna be based on their permanent residence, at least the resident address that they have on file with the Social Security Administration and with Medicare.

Now, do you know if their plan with Kaiser is an HMO or a PPO? - I think it's an HMO. - Okay. So if it's an HMO, then when they go to Florida, in all likelihood, their access to medical care is gonna be limited to either a hospital emergency room or an urgent care center.

And that may be okay, I don't know, but they may also check with Kaiser and see if they have any PPO plans available, and they could switch over to a PPO plan, which would give them more flexibility when they're down in Florida. And by the way, we talked about this a little bit earlier, because they're on a Medicare Advantage plan beginning January 1 and going through March 31, there's an enrollment period called the Medicare Advantage open enrollment period.

So they would have the opportunity to actually change in the first quarter of next year. - Okay. - Okay, Scott, great. Thank you so much. I'm sorry, one other quick question. If they decide to move to Florida permanently, then obviously, since Kaiser's not in Florida, they would just need to change their Medicare Advantage plan, like you said, to another Medicare Advantage plan that would potentially work in Florida.

- That's absolutely correct. And of course, when they move, they would certainly get a special enrollment period to enroll in a Medicare Advantage plan in Florida, or if they chose, they would have what's called a guaranteed issue scenario into a Medicare supplement plan down there. So they'd have a lot of options available to them.

- Okay, and if you move states, do you have to re-enroll in Medicare Part AB, or no, you just, that foundation just stays, and then you just change your address and re-enroll in a new Medicare Advantage, right? - Right, so Medicare Part A and Part B being a federal program, once you're enrolled, as long as you take no action with that, which you shouldn't, you just stay enrolled.

Moving doesn't impact that at all. - Okay, thank you so much. - Sure. - Great. I saw a hand from Mary, but it's since disappeared. So I'll ask this question 'cause it dovetails with the prior. When can I change my Part A, Part B, Part D, or Medicaid Advantage, Medicare Advantage, or Medigap?

- Okay, Medicare Part A, Part B, for the vast majority of people, once you're enrolled, you typically won't change those things. So that should not be an issue. If you enroll in a Medicare supplement/Medigap plan, in the vast majority of states, you can change those any time of year that you choose.

Now, in most states, once you're outside of your Medicare supplement open enrollment period, there will be medical underwriting involved in changing from one supplement plan to another supplement plan. On your Medicare prescription drug plans, you'll get what's called an initial enrollment period when you first enroll in Medicare. After that, you get the opportunity to change plans every year, but only during the Medicare annual enrollment period, October 15th through December the 7th.

And then Medicare Advantage, as we just said, same annual enrollment period, October 15th through December 7th. And then in addition to that, a Medicare Advantage open enrollment period, which runs from January 1 through March 31. Did I cover all the bases, Gloria? - So Part A, Part B, Part D, Medicare Advantage, or Medigap?

- Okay, I think so. - Okay, great. - Thanks. - Mary, your hand was previously raised, but now- - I have your question here. - Okay, great. - In dealing with, she says, in dealing with a fairly complex medical care for a family member, I am often quoted Medicare rules for accessing care, such as cardiac rehab or skilled nursing facilities on the number of days and length of time.

Is there a publication to actually read the rules? - Well, Medicare and you will address, certainly skilled nursing care. And I can just tell you that Medicare will allow up to a hundred days of skilled nursing care per year. And understand skilled nursing care, while it may happen in a setting like a nursing home, is not long-term nursing home care.

Medicare doesn't cover any part of that. As far as cardiac rehab, I'm kind of at a loss on that one. That's not the kind of situation I normally get asked or address. And don't know that Medicare and you is gonna go into address that question. It may be something you'll just have to ask a medical provider about.

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