For nearly 19 years, Medicare expert and co-founder of Boomer Benefits, Danielle K. Roberts, has been helping people make the most of their Medicare benefits. In this webinar for Pure Financial Advisors, Danielle explains:
- The basics of Medicare, Part A, Part B, Part C, and Part D
- Medicare and Social Security
- How to sign up for Medicare and the Medicare enrollment period
- Medicare premiums and cost-sharing
- Medicare and IRMAA, the income-related monthly adjustment amount
- Medigap and Medicare supplements
- The pros and cons and pitfalls of Medicare Advantage
Schedule a Free Financial Assessment with Pure Financial Advisors and learn how your decisions about Medicare, Social Security, taxes, and your investment portfolio impact your retirement plan:
Danielle also answers viewer questions, including:
- Is IRMAA qualification based on adjusted gross income per your tax form reported to the IRS?
- What is the benefit period for Medicare Part A? Is it a calendar year?
- If you move from one state to another, can your plan price change?
- Any advice regarding medical insurance options for someone who is retired at age 59?
- How do I time applying for Medicare so as not to have to pay for current healthcare premiums from work and Medicare premiums?
- Do spouses have to have the same selections for Medigap or Advantage?
- Can you change from Medigap to Advantage plan or the other way?
- How difficult is it to change from an Advantage plan during open enrollment to a regular Medicare program? What needs to be considered before a change such as this?
- I am a 64-year-old widow and receive my Social Security now. Later I will take my husband’s benefit. Am I automatically signed up for Medicare Part A and B? Can I see that on my Social Security online site?
- Does Social Security automatically adjust your Medicare B up or down according to your annual tax return?
Andi: Hello and welcome. My name is Andi Last from Pure Financial Advisors. Thank you all for joining us for this Medicare webinar with Danielle Roberts from Boomer Benefits.
Danielle: Hi there and thank you so much for that lovely introduction. I’m so happy to be with all of you today. I know how frustrating it is when you are turning 65 and you’ve got a stack of mail a foot high on your desk and kitchen table and you’ve got telemarketers calling you, and we’re going to help cut through all of that today and give you the straight facts. My agency Boomer Benefits helps baby boomers navigate Medicare across 49 states. We do business everywhere except for New York. And in today’s webinar, I’m going to walk you through some of the same things that we do for our own audiences at Boomer Benefits.
We’re going to talk about the parts of Medicare and what they cover. I will tell you when and how to enroll in those parts. I will talk to you about what kind of costs you can expect from Medicare, because Medicare is not free. I’m going to let you know about some major pitfalls to avoid. And then I’ll tell you some things that you might not be expecting to hear about what you can expect from Medicare on the back end of your coverage that will really help you down the line in dealing with your Medicare.
So you know who I am and why I’m qualified to speak with you on this topic, I am a founding partner at Boomer Benefits. I have been in the Medicare business for almost 19 years. I do webinars like this one for hundreds of financial advisor firms, cancer support groups, employer groups, and our own audiences every year. And in addition to educating consumers about Medicare, I also teach an 8 hour course to agents when they are trying to get certified in the state of Texas to be able to work with boomers like yourself. And there are a whole host of other things that I’m involved in, but I think the most important thing to remember is the history that we have with Medicare over the last 19 years has really enabled me to see what the problems are within Medicare and be able to pinpoint the pitfalls that we see people making time and time again as they enter Medicare. Because of that experience, I am frequently a Medicare expert on a number of news outlets. Our agency has over 16,000 5 star reviews for the type of service that we provide. It’s that back end service that my agents are providing after we set people up with their Medicare that really lets us identify where the problems happen and how to fix them. We’ve just become experts on that over time. I’m also the author of a bestselling book about Medicare, which you can find on Amazon for $10 or even less for the Kindle, about the Medicare mistakes that we see people making. We are coming up on 40,000 copies sold. So if you need a takeaway after today’s webinar, that’s a very inexpensive way to learn a little bit more.
So normally when we meet a new Medicare beneficiary, they’re afraid to pick up their phone and they don’t know which parts of the mail that they’re receiving that they should keep and which parts they should throw away. All of it is gobbledygook to them. And this is no wonder, because all your working life, you have had your benefits chosen for you by employers, for most people. Or maybe if you’re self employed, you choose your own health insurance through the ACA Healthcare Exchange. Now suddenly, you are thrust into a national health insurance program that has four parts and ten supplements and thousands of drug plan options, and things get a little dicey in terms of figuring this stuff out.
A couple of things I want to reassure you on. Number 1, you never need to invite a stranger into your home to teach you about Medicare anymore. Medicare business was done that way 20 years ago. I started out in that kind of business, but it’s no longer necessary to invite that kind of hard, in person pressure into your Medicare decisions. You will be able to learn everything you need to know on today’s webinar, and then I will give you great resources to go with from there to fill in the blanks. Also, no matter what your budget is, there are plans available to you. So if you have 0 to spend on a Medicare plan, or you have $200 a month to spend on a Medicare plan, I’m going to show you the spectrum available to you there. I’m also going to tell you about how to avoid penalties with some of the innocent mistakes that people make and how you can get back end free support with your Medicare for life so that you’re never alone in dealing with Medicare.
At my agency, I like to say that Medicare starts with the parts because if you dig into that stack of mail and you start looking at all these slick advertisements for Advantage plans and Part B drug plans, you’re really putting the cart before the horse. First, it’s really important for you to understand what are the benefits that you are entitled to from the federal government that have been provided to you based on your work history here in the United States. So we’ll start there with Original Medicare, which has 2 parts, Part A and B.
Medicare Part A, think of this like room and board in the hospital. It’s going to give you three square meals a day, doctors and nurses that come around to check on you. It will cover your inpatient medications in a semi private room. It will cover blood transfusions if you need to have one and it will also cover things like skilled nursing after a hospital stay that qualifies and hospice benefits if and when needed.
And then part B is the outpatient benefit. You and I think of this as doctors visits and lab work and preventive care. Of course, part B does provide those things, but it also covers things like outpatient surgeries, physical therapy, limited home health care, dialysis, chemotherapy, radiation, diagnostic imaging. Some of these things happen in buildings that are connected to a hospital complex. So people think they would fall under part A. But they actually fall under Part B. So, if you have been wondering: I’m super healthy, could I get away with just having Part A? The answer is no. Part B is really necessary if Medicare is your primary insurance and you’re no longer working, you don’t have access to any large employer health insurance, and Medicare is primary. You really need both A and B.
Now, those 2 parts together are parts that you sign up for through the Social Security Office or the Railroad Retirement Board. They are the only 2 parts that you will get from those sites. Part C and D, you will not get through Social Security because they’re optional and they came much later in the history of the Medicare program. These are Medicare Advantage, which we’re going to go over in great detail today. And we’ll also talk about your Part D drug plan. In my book, I explain that Part D is optional, sort of, because if you don’t sign up for Medicare Part D when you’re first eligible and you don’t have any other creditable drug coverage, either through an employer that you’re still working for, or maybe through the VA, then you start accumulating a penalty that gets larger with time for as long as you wait. Let’s say five years go by. Now you’re going to pay a 60% higher premium for Part D every month when you finally do sign up for it. So although it’s labeled voluntary, it is really important to enroll in it to prevent those penalties down the line.
The way that you enroll in Medicare Parts A and B is to do this during a 7 month window surrounding your birthday. This window starts 3 months before your 65th birthday, it goes through your birthday month and it runs for 3 months after for a total of 7 months. As long as you enroll in Medicare during that 7 month window, you’re not going to have to worry about any late enrollment penalties.
Now, some of you may still be working and you don’t intend to leave your employer health insurance until say, age 70 or 72 when you retire. And we’ll talk more about that in a few minutes and how you can delay without a penalty when you have employer creditable coverage from a large employer. But if you don’t have that and Medicare is going to be your primary insurance, this is your 7 month window during when you want to get signed up. And the easiest way to do that today is through the Social Security website, which is www.ssa.gov. It’s quick and easy; you don’t need an agent to help you. You can log onto there and get signed up for Medicare within just a few minutes. You can do the same thing at the Railroad Retirement Board if you retire from the railroad.
You can still go down in person to enroll in Medicare at the Social Security Office, but I don’t recommend it because they are so understaffed that we have seen that those applications take longer to get processed. So certainly online is the quickest. I also want to mention that if you started your Social Security benefits already, before you became eligible for Medicare at 65, maybe you started your Social Security at 62, you will be automatically enrolled in Medicare. Your card will just show up in the mailbox 1 to 2 months before you turn 65. That’s because if you’re already taking Social Security benefits, they assume you’re no longer working, you probably don’t have health insurance, and so they auto enroll you. Everyone else, including people who are waiting until their full retirement age to take Social Security, or people who delay until age 70 to get that largest benefit, You will enroll in that seven month window and it is your responsibility to do that during that window. Super important that we don’t miss it if you need those 2 parts of Medicare.
Now that we’ve talked about what the parts cover and how to enroll in them, I want to cover with you what it costs because this is always everyone’s second biggest worry is what is this stuff going to cost me? And people find it very confusing. I have an analogy that I’ve been using in our Boomer Benefits webinars for a number of years that will really help with how you understand the cost sharing, and that is this: If you think about your current health insurance that you have now or recently through your employer, someone is paying in a monthly premium to that insurance company for your insurance.Usually your employer is paying that premium and they pay a portion and then they deduct your portion out of your paycheck. This is just the same as if you were sending a premium check into Geico for your auto insurance. There is a premium check going into your health plan now to pay for that insurance, and Medicare has that too. Medicare has monthly premiums, just like insurance that you’ve had all your life with health insurance. And thinking about that same insurance, when you go to the doctor or the hospital, is everything 100% covered by your insurance company? Is it absolutely free for you? Well, of course not. In America, we’ve gotten very used to paying copays and coinsurance and deductibles as we seek medical care. And you will have those same types of costs with Medicare. So there are premiums and cost sharing, just like you’ve had all your working life on your employer plans.
Let’s talk now about what the premiums are. Medicare Part A, fortunately, for 99% of Medicare beneficiaries, will cost $0 when you sign up for it. We call that premium free, and the reason it costs $0 is because you have worked at least 40 quarters or 10 years in the United States during which you paid FICA taxes, which have gone to prepay your future Part A benefits. Even if you don’t have that work history but you’re married to someone who did, or you were married for 10 years to someone who did, or you had a late spouse that you were married to for nine months who had that work history, you get your part A for 0. And so the result is only about 1% of people pay for Part A. It is quite expensive though, it is $506 a month for those folks. And typically those are immigrants. They’ve been here 5 years, which means they’re eligible to enroll in Medicare, but they don’t have the work history or maybe they’re not married to someone who did. They end up paying quite a bit for Part A.
Part B has a premium for everyone unless you are in a very low income bracket, below the federal poverty level, and you get assistance for Medicaid. So around 95% of Medicare beneficiaries pay the standard base premium for Part B, which right now is $164.90. And this premium typically goes up a little bit each year. I expect it to go up anywhere from $10 to $15 here in 2024. We haven’t had that announcement yet from Medicare. Last year, it actually went down a little bit, so we’re all waiting to see what happens. But every year in late October, early November, Medicare will announce what that standard base premium is. There’s a small segment of people, 5 to 6% who actually pay more than this because they are considered high income earners. We know that in America, when you earn more, you get to pay more taxes. And in America, when you earn more, you get to pay higher Medicare premiums. So if you are someone that earned more than $97,000 as an individual, or $194,000 as a joint filer in 2021, they’re looking back 2 years, then you will have an adjusted premium.And in my industry, we call this meeting ugly Aunt Irma. She is the income related monthly adjustment amount, and no one wants to meet her. But unfortunately, if we’re in those higher income brackets, we do.
If you look at the second row here, you can see that someone who earned $100,000 in 2021 would pay $230.80 in 2023 for Medicare Part B. Likewise, let’s say you were a joint filer and as a household you earned $300,000. Then in 2023, each of you would pay $428.60 for your Medicare. Everyone’s an individual. Everyone will pay their own Part B premium, and this gets deducted out of your Social Security check before it ever even hits your bank account. If you’re not taking Social Security yet, then they are going to bill you quarterly for these premiums until such time that you do sign up for Social Security benefits.
Now, what about if 2 years ago you were still working and you were making considerably higher money than you do now? Well, the good news is that you don’t have to wait for the 2 years to catch up to you in order for that premium to get adjusted down. You can actually file a reconsideration request with Social Security. When someone is working with my team at Boomer Benefits, we walk you through all of this. The form is SSA-44. You can Google it and pull it right up. You will see on that form that there are some approved reasons why your income has changed, which Social Security might accept to lower your premium. And the most common one is work stoppage or retirement. So if you earn more then and now you don’t, you file the reconsideration reform, you give them documentation showing them that you retired and your new income is X, and they will usually adjust that down immediately for you.
The other thing I want to point out to you is that on that form, there’s only like 6 valid reasons. Your income has to have changed from work stoppage, marriage, divorce, death of a spouse, income changes, loss of a pension, or loss of an income producing property. If it’s not one of those reasons, then it’s kind of pointless to appeal. So we really need to be carefully thinking about what to do with our Medicare starting at age 63. Because if you take a big severance from your work at age 63, that’s going to inflate your Medicare premiums when you’re 65. Or if you sell a home and you have a big capital gain, that will also mean you pay higher premiums in 2 years when you turn 65. So if you knew that you needed to sell a property and you knew this early enough, you could do that at age 62 so that it doesn’t affect your Medicare premiums.
If you don’t do anything at all, no problem. Every single year, Social Security will get a new IRS tax file for the next income year. They will determine what your premium will be based on for that year, and they will send out a benefit determination letter to you, usually in December, saying, we’ve gotten the next most recent tax return, and here’s what you’re going to pay next year. So 2 years out, it would naturally fall. But if you have a qualifying reason, no need to wait for that. It’s a good idea to appeal.
Medicare Part D is a tricky little animal, and I have a whole webinar that takes an hour during which I explain Part D, and we won’t have time to do that kind of deep dive today. But if after the webinar you want to learn more about that, at the boomerbenefits.com website, you can watch an on demand version where I’m teaching about Part D.
I do want to give you some basics, though, in terms of premiums. Part D plans have certain parameters which they all must meet. There are certain classes of drugs which they must cover, anti cancer, anti seizure, antidepressant, and a few other fields. They also must cover at least 2 medications in every therapeutic class. But beyond those limits and guidelines, they can determine which other drugs they want to include. So they could include a whole bunch of inexpensive and generic drugs, and you might be able to get a very basic plan for less than $10 a month. And there might be a plan out there with a whole bunch of brand name drugs on it, and they’re going to charge a hefty premium for that.
The easiest way to determine which Part B drug plan is: We take a list of your medications, we punch it into a software that we have, it compares all the drug plans in your zip code and tells us exactly which drug plan is going to give you the lowest overall annual out of pocket cost. It’s not just the premium you want to be concerned about. It’s also what is the deductible on the plan and what is the copay that you’re going to spend for your specific medications on that specific plan. If we averaged everyone in America who has a standalone Part B drug plan, right now, around $31.50 is what they pay, but high income earners can pay more. So this $31.50 is a ballpark that we can use for the rest of this webinar in terms of forecasting what you might expect to spend once you get on Medicare. And then of course, you also have to deal with Irma on Part D.
So the way this works is, let’s say you sign up for a drug plan that has a $20 a month premium. You’re going to pay that $20 a month to whichever insurance company is offering the drug plan. On your application, you might mark that you want to pay that via bank draft or a coupon book or a monthly invoice. You’ll choose that when you apply. But then, if you’re in one of those higher income brackets, Social Security will also take a little piece of your Social Security check before it gets deposited into your account. So the thing that you really want to look at here is, people in these highest income brackets may pay $100 a month for an inexpensive plan because they’re paying this big Irma on top of that premium. And sometimes they’ll run into people like this that don’t take a lot of medications, or they take a few $4 medications at Walmart, and they’re not very excited to sign up for Part D and spend $100 a month when they’re not taking a lot of medications. But remember, if you don’t sign up, then later on when you do, you have that penalty that’s going to get added. Also, you can’t just sign up for Part D whenever you want. You have to enroll during a valid election period. Either that 7 month initial enrollment period for Medicare, or the annual election period that comes around every year in the fall.
Let’s say you don’t sign up during your initial enrollment period and now you need a medication starting in February. It’s an oral chemo med and it’s $8,000 a month. Well, you’re not going to be able to get into a drug plan until the following January. So you would spend that out of pocket for almost a full year. There’s quite a big risk to not enrolling in Part D. And that’s the most important thing that I wanted to impress upon you today.
We’ve talked about the premiums, now let’s talk about what you pay as you use your benefits. So you go into the hospital, you spend one night in the hospital as an inpatient. This kicks off a benefit period. You will pay a $1,600 deductible, and then there’s no other costs until day 61, which is pretty good. But on day 61, you start paying an expensive daily copay that doubles on day 91, and it runs out on day 150. So you pay all the costs for your hospital stay after the 150th day. You also pay for the first 3 pints of blood in a transfusion. And if after your hospital stay, they transfer you to skilled nursing, Medicare covers the first 20 days, but then they charge $200 a day for days 21 through 100 before skilled nursing runs out.
We can start to see why Medicare supplements were created in the first place by insurance companies. People who are in business to make profit and offering an insurance policy to folks are gonna know that a lot of people don’t want to pay a $1,600 deductible and an $800 a day copay at the hospital. So they created Medicare supplements to cover those deductibles, to cover the daily copays, to give you 365 days beyond day 150 in your in hospital coverage covered costs. And some Medicare supplements, depending on the one you choose, also cover that skilled nursing benefit. If you leave the hospital and you’re out of the hospital for 60 days or more, the benefit period closes. And let’s say you go back into the hospital in that same year after the benefit period closed. Well, now a new benefit period kicks off and you pay the $1,600 deductible again. So an even more important reason why we want to have these things covered by some sort of supplemental coverage.
On the Part B side, it’s a little simpler. It’s an annual deductible of $226. So on your first outpatient visit of the year, whether that’s to a doctor or lab facility or physical therapy or whatever you’ve got going on, you will pay a deductible and then Medicare pays 80% of the Part B expenses, and you pay the other 20% thereafter.
The problem is there’s no limit on the 20%. You will pay that 20% forever with no out of pocket stop loss like you have on plans under 65. And so this is where we read in the media about people going through medical bankruptcy when they end up needing something like a lifetime of dialysis or a long span of cancer treatment, and they’re paying 20%, because there’s no limit to that. And so we need to have something in place to cover these gaps that I’ve just shown you on these last 2 slides. One way that you can do that is if you’re still working when you turn 65. Let’s say that’s you, and you work for a large employer. A large employer is defined as any employer with 20 or more employees. So you have group health coverage from this large employer, whether that’s your employer or your spouse’s employer, doesn’t matter. The insurance is offered through a company that has more than 20 employees. In that scenario, your group coverage is primary and Medicare is actually secondary. So you could enroll in Part A since it costs $0, and that will coordinate with your group coverage and could reduce your spending in the event of an inpatient hospital stay. But you’re probably going to want to delay enrollment into Parts B and D because those have premiums that you pay every month and your group health coverage already has outpatient coverage and drug coverage. So you can delay those parts B and D with no penalty, and then you would just give us a call 1 to 2 months before you retire, and we would walk you through the process on the back end for adding part B and D when you’re well past 65, which is a little bit of a different application process. But we handle that for you and get you all taken care of so there’s no penalties.
Now, there’s one caveat here. If the employer coverage that you have is a high deductible health plan with an HSA and you are contributing into that health savings account every month or your employer is contributing to that, the IRS says you cannot contribute to an HSA if you have any other form of insurance active besides the employer health plan, and Medicare is a form of insurance. So in that scenario, I would recommend that you delay Parts A, B, and D. You’re going to delay all the parts of Medicare until you get ready to retire. But if you have just a standard PPO, you’re not contributing to an HSA, and it’s a large employer plan, then you would delay Parts B and D to save those premiums.
With small employers, the coverage is opposite. If the company has less than 20 employees, Medicare is primary. So if Medicare is primary, you want to go ahead and sign up for both A and B right when you turn 65, because that group coverage that is secondary is only going to be paying the 20%. Part B pays 80%. So let’s say you don’t sign up. Now you need an outpatient surgery. Guess who’s going to pay the 80% because you failed to sign up for Part B to pay it for you? You are going to pay that. So it can result in these big gaps in coverage, lots of uncovered bills. So for a small employer, Medicare is primary, sign up for Part A and B when you turn 65.
Likewise, COBRA is the same. COBRA is always secondary to Medicare. So, if you are on COBRA, you want to enroll in Medicare Parts A and B to pay as primary. So, pitfall #1 is people don’t know this and they make mistakes. What we often see is someone who worked for a small employer, but they asked their friend for advice and their friend who’s already on Medicare worked for a large employer. And they say, Oh yeah, you don’t need to sign up for Medicare. My agent told me I didn’t need to until I retire. Well, that was the case for them because they work for a large employer, but you don’t. And now you take that friend’s advice instead of consulting an agent who knows all the correct rules and you end up in a situation where you don’t have the coverage. And now, to add insult to injury, when you finally figured this out and you go to sign up for Part B, you’re going to get hit with a late penalty of 10% per year for every year that you should have been enrolled in Part B and you weren’t. And so, we want to make sure you avoid this pitfall.
And one last thing is if you have an ACA plan through the healthcare exchange, that is not creditable coverage for Medicare. So you need to leave it when you turn 65 and go on Medicare, even if Medicare is more expensive. Some people have very inexpensive ACA plans because they’re getting a subsidy from the federal government to help them with that cost, but that subsidy expires when you turn 65. You’re no longer eligible for that. And so if you keep taking it, they often don’t catch up with it right away, but we see it a lot where a year or 2 later they figure it out and now you get this bill in the mail asking you to pay back all the months of the subsidy that you took because you didn’t sign up for Medicare and you have the Part B late penalty. So if you have an ACA plan, leave that and go on Medicare at 65.
There’s one more thing I wanted to share with you about if you’re coming off employer coverage, and this is an example of why you should never do Medicare alone, you always want a very experienced Medicare agent to be helping you on the backend. This is an example of something that happens all the time. And when it does, people are completely befuddled about how to fix it. So, you switched over from your large employer coverage to Medicare. You’ve got your Medicare supplement all set up and you’re ready to go. You go to the doctor, you go to the lab, you have several tests done and you get all the bills in the mail because Medicare denied all of those claims. Well, what happened? How do you find out? Do you call Medicare? Do you call your insurance company? Do you call your doctor? Maybe you call the lab facility? Who do you call? Well, you’re not going to know because you signed up and you don’t have anyone supporting you on the backend, but we know from having done this for 19 years, exactly what happened.
We tell our clients, if you ever get a denied bill in the mail or any type of bill at all that you weren’t expecting, call us first. Because in this situation, what happens is the employer never notifies Medicare that they are no longer primary. They’re supposed to tell Medicare this, but we have at least a dozen of these every month where that doesn’t get transmitted. So when Medicare gets the bills, it denies all of them because it sees that they are paying as secondary. They don’t know that they’re primary yet. When this happens to one of our clients they bring it to us. We call Medicare. We know exactly which department to conference in to fix that. And we also reach out to all of your providers that send in bills that were denied and we have them resubmit those bills so that Medicare has a second chance to pay as primary. And this usually ends up in our clients paying nothing. But this is an example of the kind of hiccups that happen with Medicare on the back end. If you don’t have someone, a reputable agent supporting you that you can call and fix these things on the back end.
Now that we’ve talked about people who are still working, let’s talk about what you do in the private market. If Medicare is primary, how do you cover the gaps? Well, you’re going to have 2 routes that you can go with Medicare. Number one, you can enroll in a Medicare supplement that goes alongside your Medicare. This is also sometimes called a Medigap plan. Same thing, just 2 different terms. These have higher premiums upfront, but far less cost sharing, more predictable cost sharing on the backend. The other option is a Medicare Advantage plan also called Part C of Medicare. These have lower premiums up front, but higher and less predictable cost sharing on the back end because you’re going to pay co-pays, co insurance, and deductibles as you go. So you’ll spend a lot more in years where you have some health conditions and less in years that you don’t.
Let’s start with talking about Medicare supplements. These are private insurance plans offered by carriers to help cover the costs that Medicare leaves behind. The ones that I showed you, the $1,600 deductible, the daily co-pays, the 20%. In order to sign up for a Medicare supplement, you must first be enrolled in Medicare Parts A and B. So you have the $164.90 that you’re paying and then you’re going to be adding on the supplement. When people choose a Medicare supplement, almost always they choose a Medicare supplement for freedom of access. Because when you have a Medicare supplement, the only question that you need to ask your providers is, do you take Medicare? If the provider says yes, it doesn’t matter which Medigap plan or which insurance company that you sign up with, they all pay exactly like they’re supposed to. So this means with a Medigap plan from any insurance company, you can see over 1 million participating providers nationwide. You don’t have to pick a primary care doctor. You don’t have to get a referral to see a specialist. Medicare gets the bill. Medicare pays its share. Medicare then sends the remainder of the bill to the Medigap company instead of you. And the Medigap company pays your share. You only get a bill if there’s anything left over based on the Medigap plan that you chose. These are great if you travel, or snowbird, or live an RV lifestyle because you can see doctors anywhere across America.
There are 10 standardized plans to choose from and a whole bunch of insurance companies offer these plans. We work with all of those major name brand carriers: Etna, Humana, Blue Cross, Anthem, United Healthcare, Cigna, Mutual of Omaha, Manhattan Life. I could quote 10 other carriers. Companies like us at Boomer Benefits, we can compare them all and help you find the one that is the most cost effective. I’m going to give you a little pet peeve of mine about Medigap plans. I don’t know what Uncle Sam was thinking when they decided to name the Medigap plans with letters A, B, C, D, F, G, K, L, M, N, when we already have Medicare parts labeled A, B, C, D. This is endlessly confusing to beneficiaries. Just know that as agents, we are aware of this. So if you called in and you said, I wanted to get a quote for a Part G. Well, there’s no such thing as a Part G. It’s a Plan G. But we’re going to know what you meant.
The other thing is, Medicare supplement plans A, B, C, and D, less than 2% of people sign up for those 4 plans. And that’s because of all the Xs you see there. Most people don’t want a plan that doesn’t cover the $1,600 deductible or doesn’t cover the $200 a day skilled nursing. In fact, by and large, beneficiaries for decades have always chosen the plans with the most coverage. For a long time, plan F was the plan with the most coverage. And people who were eligible for Medicare on or before January 1st of 2020, they can still enroll in Plan F. You can see that it was popular because it covers 100% of everything. So go to the doctor, pay nothing, go to the hospital, pay nothing, chemotherapy, pay nothing. But there was some legislation passed in 2015 that changed that to where now, if you’re new to Medicare on or after January 1st of 2020, the most comprehensive plan that you can buy is a Plan G.
Now, Plan G, fortunately, is almost as good as Plan F. The only difference is that you will pay the first $226 out of pocket. That Part B deductible would be your responsibility. After that, Medicare gets a bill, Medicare pays 80%, your plan G pays the other 20%, and you pay nothing. So you essentially have a plan with a $226 deductible and 100% coinsurance after that.
Plan N is also popular. A lot of times it will have slightly lower premiums because you agree to take on some expenses such as doctor co-pays, ER co-pays, and access charges. So we will often have people calling in to Boomer Benefits and saying, “I live in Illinois and I’d like to get quotes for plan G and N in my area” and then our team is running those based on where you live.
Where you live really affects your Medigap premiums. Medigap insurance companies set their own rates. Agents like us, we can’t change them. So whether you get your quote through us or the insurance company, that quote is going to be exactly the same dollar amount. The insurance company bases the rate on your age, zip code, gender, tobacco use, and eligibility for household discounts. So those things all factor into what your medigap plan premium will be. Where you live also matters. Here in Texas and in the Midwest, rates are awfully low and very inexpensive. But in other areas, they can be twice as much because those areas either have expanded open enrollment rules, which we’ll discuss here shortly, or, such as in Florida, Connecticut, New York, the cost of healthcare is very expensive there. So you might pay twice as much for a plan in that area.
So if we put it all together, here’s how it looks. Now remember, we said Part A is a zero premium, Part B is $164.90 for most new enrollees, Part D, we’re using that ballpark average of $31.50. Let’s say that you take a few prescriptions. So on your Part D plan, you’re going to have maybe $50 out of pocket per month for drug copays. For some of you, it’ll be less. For some of you, it’ll be more. I’m just giving you a very generic example here. And then on your Medigap plan, if you were a female turning 65 here in the Dallas Fort Worth area, we would be able to run in a quote engine for you. And we might see plans running from say $100 to $120 a month from different insurance companies. So if we add that all up, it’s going to be around $350 for a Medigap Plan G in this area. And if you lived in Florida, it might be closer to $500 because the plans are more expensive there. So this is just an example of how you put all the parts together with the premiums to get an idea of what you would spend.
The other thing to know about Medigap plans is you have to qualify for them. And so in my book Chapter eight is called The Big Mistake, and the big mistake has to do with your one time, 6 month opportunity to get a Medigap plan with no health questions asked. When you first enroll in Medicare and you sign up for Part B, your Part B card comes in the mail, and it has an effective date. You have 6 months from that effective date to sign up for any Medigap plan offered in your zip code, and they have to approve you. If you apply after that, now you’re going to go through medical underwriting. You’re going to answer a whole page of health questions. The underwriter is going to look at all of your health history. They’re going to run your prescription history. They’ll look at two to five years. They’re going to look at your medical records to see if you have anything pending, any physical therapy, any doctor’s appointments, any surgeries. And they can turn you down for any of those things, for the risk that you bring.
There’s also something called a guaranteed issue. And this is something really not that you would be concerned about, but that my agents would know. There’s sometimes situations where someone enrolled in A & B a long time ago, and their open enrollment window is gone, but they have had creditable coverage afterward. That might either be secondary small employer coverage, or it could be something like Medicaid. Let’s take the Medicaid example. The person has Medicare and Medicaid is paying a secondary. And they’ve been on Medicare for 5 years, so their Part B, 6 month open enrollment window is long gone. But now they get married and their income changes and they lose Medicaid. Well, we’re going to know that loss of creditable coverage gives us 63 days to find them another Medigap plan with no health questions asked. Certain state rules apply and only certain plans are eligible for that. But the really important thing about what I’m explaining here is this.
Everyone confuses the 1 time, 6 month Medigap Open Enrollment window with the fall annual election period. The annual election period coming up from October 15th to December 7th has nothing to do with Medigap at all. So it is not a time where you get to just go sign up for a plan and magically get covered. That window of time is for changing Part D drug plans or Advantage plans only. So it has nothing to do with Medigap. And yet every year we have hundreds of people contact us trying to get into a Medigap plan during the annual election period, thinking they won’t have to answer health questions. So the analogy here is that you can’t go out and buy better homeowners insurance after the house is on fire. And the same applies to Medigap plans to keep them solvent so that they can pay the bills like they’re supposed to.
Now, there are some states where the enrollment rules are expanded. So, for example, if you live in New York or Connecticut, you can apply for a Medigap plan and be rubber stamp approved all year long. What happens there is adverse selection. Everyone waits to get coverage until they get sick, and that means the underwriters can’t underwrite out the sick people, so they have to raise the rates for everyone. So it might be great that you can get a plan after you get sick, but plans are really expensive because of that. And there are a few other states where there is something like a birthday rule or an anniversary rule where during a limited window of time each year, you can change from one Medigap plan to another of equal or lesser coverage without underwriting. We have a state page on our website for every state in the union. You go to boomerbenefits.com and click on your state and you’ll be able to see if you are in a state where that would apply.
Lastly, there’s a couple ways to apply for a Medigap plan and enroll in your coverage. You can call the insurance company and enroll in the plan directly. And let’s say they quote you $100 for that plan. You’re going to spend the $100 and that’s your premium. Now, if you call Boomer Benefits and work with one of my team and you asked for a quote for the same plan, we would quote you exactly the same premium and you pay that premium directly to the insurance company, not to us. The price and benefits of your policy are exactly the same, whether you enroll with a broker like Boomer Benefits so that you have ongoing lifetime claim support for all the hiccups on the backend, or if you enroll directly to the carrier and give up all of your help on the backend. We get paid by insurance companies a commission, whichever insurance company that you ultimately choose, we get paid by them. And so our service to you is actually free.
And look at all the things that you would give up if you didn’t enroll through us. First of all, if you call the insurance company, you’re just going to get one quote. They’re not going to quote you their competitor where it might be cheaper. They’re not going to tell you if their rate increases have been more than their competitors. When a billing issue happens and Medicare denies a bill, they’re not going to help you with it because when Medicare denies the claim, the insurance company offering your Medigap plan does not have to pay its 20%. So it’s not in their best interest to help you appeal and get something covered that should be covered. They don’t help you with your Part D every year. And when you get a bill in the mail and you don’t know where it came from or what it is, it’s not the call center at the insurance company’s job to fix that for you. It’s yours. Now, if you enrolled through us, we’re going to quote you all the carriers. We’re going to quote you all the rate increase trends. We’re going to help you identify a carrier that makes sense. We’ll help you with your Part D every year. If you get bills in the mail that you shouldn’t have had or Medicare denies your claim, we help you with appealing them and where to send them and how to fix them.
Since 2021, we have saved our clients almost $2 million in claims just from our clients calling in and saying, “Hey, Danielle, I remember on your webinar, you said not to pay this bill if I wasn’t expecting it. I got this bill and I don’t know if I owe this.” You’d be surprised how many people out there just pay that because they don’t know any better and they don’t have us to ask. And I just cringe thinking about it because they didn’t wait for Medicare to pay or they didn’t wait for the Medigap plan to pay. And you don’t even owe that bill, but you wouldn’t know that. And so lots of people just pay them and there must be millions or billions of dollars lost to that every year. I can’t even imagine. But you would never be on your own because of course we would always be fighting for you. I outline all of this to you to say that with Medicare, you’re going to be making some decisions up front. Whether you enroll at 65 or you enroll when you retire, whether you enroll in a Medigap plan or you enroll in a Medicare Advantage plan. But in all of those choices, you don’t have to do it alone.
So let’s wrap up Medicare supplements. All you ask your provider is, do you accept Medicare? The provider says yes. It doesn’t matter which insurance company you choose. You’re good to go. Medicare pays first, then the Medigap plan pays its share. There are 10 standardized plans for you to choose from. Plan G and N being the most popular, but we do get quote requests for the other plans. They’re guaranteed renewable, which means they can’t drop you for developing a new health condition. The benefits do not change annually like Advantage plans do. So if you are a “set it and forget it” person with your insurance, Medigap is maybe going to feel more comfortable to you. And then you just add on that standalone Part D drug plan to get the drug coverage.
Let’s talk about the other type of coverage. Medicare Advantage plans, also called Part C, are private insurance plans that deliver your A and B, and often Part D benefits, through a local, much smaller network of providers. So, this insurance company, it comes into the area, it contracts a bunch of doctors and hospitals, it creates a network, and it makes all of those providers offer discounted rates to members of the network. So, when this happens, you might have a network of say 2,000 or 5,000 providers in the area where you live, as opposed to Medicare and Medigap, you have access to 1 million providers nationwide. But think about this, we usually do get our health care close to home, so for most people, this isn’t a problem. A lot of people love that they don’t have to pay a separate Part D premium, 90% of Advantage plans have a built in Part D drug plan. The only thing to watch out for there is we need to make sure when you choose a plan that your doctors and hospitals are in the network, and does the built in Part D cover the medications that you take? Because you could pick a great inexpensive plan, but if it doesn’t cover your $600 Lantus® diabetes pen, that’s not going to help you very much.
With Advantage plans, many of them have what is called a zero premium. So there’s actually no cost beyond what you’re already paying for Part B, but you do still have to pay for Part B. You must be enrolled in A and B to enroll in a Medicare Advantage plan. Now, how could they offer a plan for a zero cost? Here’s why. When you enroll in an Advantage plan, you are no longer Medicare’s problem. Medicare shifts all of the risk to the Advantage company. So, Medicare pays the Advantage company over $1,000 a month for them to take your risk off of Medicare’s plate. So if that Advantage company can create a network with discounts and control your care and access to care and use of care for less than $12,000 a year, they are making money. These plans make billions because there are more healthy people than there are sick people.
Advantage plans often offer either an HMO or a PPO network. We’ve all been in HMOs before. These are the most restrictive. You’re going to choose a primary care doctor. You’re going to need a referral to see a specialist often. And you can’t often go outside the network unless there’s an emergency. PPO plans are more flexible. You can go outside the network. You’re just going to pay a lot more to see those providers and the provider has to be willing to build a plan. But there’s no health questions. Anyone can apply for an Advantage plan and get approved as long as it’s during a valid election period, like your 7 month initial enrollment period or the 7 week annual election period in the fall.
And because the Advantage plans make so much money for Medicare, they build in all these attractive extras to entice you to enroll in their plan and these things are pretty good. You can get some dental vision, hearing benefits. You can get gym memberships. A lot of them have a flex card and you can use the flex card to get $50 a quarter in vitamins and supplements for their over the counter catalog. They might install bathroom safety grab bars in your home or provide 2 days a month of adult daycare. The sky’s the limit on the stuff that these plans include and they’re all different, which makes it tough to compare them. Just remember those extras should be secondary in your mind. The most important thing is: is your doctor in the network, are your drugs in the formulary, and can you afford the expenses on the plan? Because you’re going to pay for things as you go, which I will show you here shortly.
Lastly, we all know that when you’re dealing with an HMO or PPO insurance company, and you’re going to go in for an expensive procedure, there’s going to be some prior authorizations that have to happen. So unlike with Medicare and Plan G, where you can pretty much just go ahead and get everything done, with an insurance company that’s in business to make a profit, they might say, “that sounds kind of expensive. We need your doctor to fill out some extra forms before we’re going to approve this.” And there’s been quite a bit of press about the algorithms that control these prior authorizations and how often they actually deny people the treatment that their doctor is recommending. So I’ll tell you a secret. At Boomer Benefits, I have a client service team of over 50 people. They are licensed agents and Medicare experts, and this group of people helps all of our current policyholders with the hiccups that happen on the back end. And one of those that we deal with a lot is prior authorizations. So a client will call in and say, “I had a mammogram and they found something and now I need a diagnostic mammogram and I’m panicking. I might have breast cancer, but it’s taken the insurance company 10 days and it’s still not approved. What should I do?” Well, we’re going to conference in the carrier, we’re going to do all the right things to get that thing moved along and if the algorithm denies it, we’re immediately going to help you appeal because 85% of the time those appeals are overturned. And we just know that from experience because I’ve built a team who are experts in helping these things move along, and that is roughly the percentage. So we know that even if a prior authorization isn’t approved, there’s a pretty good chance that if we appeal it, it will be approved. Now, if you don’t like this and this worries you, or you consider this a hassle, go with Medicare and Medigap because almost never do we have to run into any types of prior authorizations with them. This is more of a network thing.
With Advantage plans, there are some things that may be costly. They can charge you say $5 for a primary care doctor visit, $20 to see a specialist. Some might be $60 to see a specialist. They’re all different. They might say that on their plan, it’s $200 a day if you go to the hospital or $500 for the whole stay, but there are some things which many Advantage plans will charge you 20% for. No surprise, it’s usually for the most expensive things. So a lot of Advantage plans in their summary of benefits that we go over with you up front, we’ll show you what the costs are for everything. And we often see plans charging 20% for things like chemotherapy, cancer treatment, dialysis, durable medical equipment, and diagnostic imaging. There may be a few other things like that. And so because they can charge you that much, The federal government makes them put a maximum out of pocket limit on the plan. In 2023, that limit can be no higher than $8,300. So, if you’re going along and you have a really expensive year and you’re paying all this money out of pocket and it gets to that you have spent $8,300 out of pocket on Part A and B services, then you’re done for the year and the insurance company has to cover 100% of your cost after that, with your Part D costs being separate.
But, although $8,300 is the limit, they could charge less. So when someone calls in to us and they want an Advantage Plan, we’re looking for a plan that has their providers in the network, their drugs on the formulary, and can we find one with a $3,000 out of pocket limit? Because that’s going to be a lot better for our client than $8,300. Also, there are some states where Medicare Advantage is just hugely popular, like Florida, where those maximum out of pockets are really low. So it makes it really difficult for people in those states to even consider Medigap because the Advantage plans are just so inexpensive and rich in benefits. So a lot can depend on your state as well.
Now, if you are sitting at home on a Saturday and you’re cleaning your house and in the background there’s Medicare commercials and you hear the same aging sports star tell you about this amazing plan where everything’s free and we’re going to mail you checks in the mail every day and tomorrow morning after you sign up there’ll be a pink Cadillac in the driveway, you need to run for the hills. You should never ever enroll in an Advantage plan because a sports celebrity told you to on television. Those commercials are gimmicks. They will advertise a benefit that you could only get if you happen to live in this one county in Arkansas, and you were on Medicare and Medicaid because your income was so low. So 99% of the people that call that 1 800 number, what they are told is, “Oh, well, you don’t actually qualify for those benefits, but in your area, we have a really great plan with less benefits, and here’s why you should sign up for it,” and you get the hard sell, and you feel like you’ve wasted their time, and so you sign up for a plan, and then you go to see if you can see your doctor, and they’re not in the network, or you find out your medication is not covered. You’re locked into this plan now, and you’re in a lock in period. So please don’t ever enroll in an Advantage plan from a 1 800 commercial. That agent that helps you, the call center agent, you will never talk to that person again. So they have zero accountability to you if they make a mistake in enrolling you in your coverage.
Now, when we put our Medicare Advantage costs together, same thing. Part A is $0, Part B is $164.90 for most people, could be more with an IRMA, Part D is $0 because it’s included in 90% of Advantage plans. Let’s say you had the same drug copays as if you were at a Medigap plan and now also you’re going to be paying something that you wouldn’t pay on a Plan G. You would have doctor copays or lab copays. So let’s say you had a couple of medical visits that month and you paid $50 out of pocket. So you can see here that you’re spending less for the Advantage plan. You’re probably getting a bunch of built in benefits like dental vision, hearing, and gym memberships, and you’re not paying the separate amount for that Part D.
However, remember the costs are on the back end, and in a year of really poor health, you could possibly spend more on the Advantage plan than you might have if you had a Medigap plan. But how many months or years did you have the Advantage plan, in which you were saving the Medigap premiums? And so you can see it really depends on you and what you’re comfortable with. The choices are there for you to choose from, but there’s no one or the other that is better. Around 50% of people choose Medicare Advantage plans. That’s a pretty even split in America between Original Medicare and Medicare Advantage. So my tips, if you want an Advantage plan, just build a rainy day fund, put some money in an account that you never ever touch unless it’s in a medical emergency. Now you have a year with some bad health and you have more spending on your Advantage plan, no problem because you’ve got money set aside for that.
We like to stick to large carriers. Carriers that offer Advantage plans in every state because some of them have what’s called network reciprocity or a national network. So what that is, maybe you signed up for this plan in Fort Worth, Texas, but you’re going to be traveling to see your kids and grandkids for 3 months in Kansas, but the carrier that you bought your Advantage plan from also offers an Advantage plan in Kansas. And so you can actually see doctors in that network at in network prices instead of out of network prices, because it’s a large carrier that offers this network reciprocity or national network. So that’s why I like to really consider national plans instead of plans that are only offered in a few counties where you live. We always want to look for a plan with a low out of pocket maximum, and how and when you enroll matters. Please work with a Medicare expert, not with Joe Namath. It’s not my best advice.
And the last thing is remember, Advantage plans can change their benefits from year to year, unlike Medigap plans. So they can change the premium, the copay, the doctor network, the formulary of drugs that they offer, but everything they change, they have to mail to you in September a document. It’s actually a packet that arrives showing you what your benefits were in 2023 and what they’re going to be in 2024. So you can review them and decide whether you want to keep that plan and just let it automatically renew or if you need to give us a call and change because maybe they dropped one of your important medications. So that plan is not going to work for you next year. If you don’t review the packet, you sometimes get a really ugly surprise in January when it may be too late to make a change. So, that’s a lot on Medicare Advantage. If you want more please visit our website or our YouTube channel. I have a Medicare Advantage pros and cons video and a Medigap pros and cons video there that you can look at.
And so last slide here on pitfalls. Pitfall number three is just not understanding the difference. People don’t do the research ahead of time. And I’m going to point you to our website where we have a Medicare resources link and you can do more research. And with that, I will open it up for questions if we have time.
Andi: We do. I do obviously want to be respectful of our attendees’ time so we won’t spend a whole lot of time. We do have about 40 questions that have been asked and that some of them are related to how Medicare fits into your overall financial plan. Now is the time to schedule a free financial assessment with an experienced professional at Pure Financial Advisors. They’ll take a deep dive into your entire financial picture, including how Medicare costs fit into your overall plans for retirement. You’ll learn to protect yourself from market volatility, inflation, and rising health care costs. You’ll find out how to legally reduce taxes now and in the future, how to choose a retirement distribution plan that’s right for you and how to minimize your risk and maximize your return. This is a no cost, no obligation, one on one, comprehensive financial assessment, and it’s tailored specifically to you, your needs and your goals.
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Is Aunt Irma the income related monthly adjustment amount qualification based on adjusted gross income per your tax form reported to the IRS?
Danielle: Yeah. It’s going to be your modified adjusted household gross income, which for most people is that very bottom line number. I think it’s in line 11 of your tax return.
Andi: And what timeframe do they look at your wages 2 years before? Is it January to December of the 2 years before your birthday or is it from your birthday to the end of the year?
Danielle: It’s going to be a calendar year. So if you’re coming into Medicare in 2023, they’re going to be looking at 2021. And then also they do it every fall ongoing for the next year.
Andi: Okay. Are IRMA payments monthly or annual? Your chart does not say.
Danielle: Oh, good. This is a great question. Those are going to be monthly. So if you are already taking Social Security, you’ll see that Irma deducted from your check before it ever deposits into your bank account. But if you’re not taking Social Security yet and you’re paying your Part B premiums in a quarterly bill from Medicare, those Irma premiums will also be quarterly. If that’s a hardship, you can call Medicare and sign up for what’s called Medicare easy pay and you can give them a bank account and they can deduct that from you monthly if you find doing it quarterly all at once is a hardship for you.
Andi: Okay. And I’m hoping this question is going to make sense to you. How effective is Irma reconsideration request SSA-44 process for those that retired in 2022 for a 2024 Medicare claiming?
Danielle: Actually, when you have a retirement claim because your income changed because of what they call work stoppage, those often get approved. The only thing I want to remind people or that I don’t think I mentioned earlier is you don’t want to file your Irma appeal until you get the benefit determination letter from Social Security telling you that you have an Irma. Sometimes people want to get ahead of things and they already know there’s going to be an Irma. But if you send that form in before they’ve done the benefit determination, they have nothing to match it to. And so it goes into the black hole and you’ll never hear anything at all. So wait till you get the notice, then submit it. In the meantime, yes, you’re going to be paying that Irma while you’re waiting for them to process. It usually takes 2 to 4 weeks for them to process the Irma charges. But if they approve it, they will credit you with those premiums back on your account.
Andi: Okay, what is a benefit period? Is it a calendar year?
Danielle: The only time there’s a benefit period is with Medicare Part A. And if you spend one night in the hospital where you’re admitted as an inpatient, that starts the benefit period. And then the benefit period ends 60 days after you have been discharged from the hospital. So it is possible to have more than one benefit period in a calendar year.
Andi: If you move from one state to another, can your plan price change?
Danielle: With a Medigap plan, yes. So, you would notify your plan that you’re moving and they will calculate the rate for your new zip code and the rate just adjusts. If you’re moving, say, from Texas to Florida, that’s not going to be fun. But if you’re moving from Florida to Texas, you’d be really excited. On the Advantage plans, those typically are based on counties or statewide where you live. So if you move out of that state, you would actually have a window of time called a special election period to change to another plan in your new state.
Andi: Do you have any advice regarding medical insurance options for someone who is retiring at age 59?
Danielle: Yeah, your best bet is going to be the ACA plans. So you would go to healthcare.gov and you’ll enter your income information and it will give you all the plans available through the healthcare exchange and whether or not you get a subsidy and what the plans will cost you. And that is going to be the best insurance that you would be able to purchase until such time that you turn 65.
Andi: Is Boomer Benefits able to help a couple where one is eligible for Medicare and the other one needs to navigate the healthcare marketplace?
Danielle: Yeah, so we don’t actually help with the ACA plans. What happens is we’ll help the spouse that has Medicare and then we give the other spouse the information that they need and what to do when they get to the healthcare.gov website. Fortunately, that website is pretty easy to use. It’s very self explanatory. It walks people through the steps one by one. And if you have a general question about the ACA, most of the time my team knows enough to be able to answer those.
Andi: Excellent. How do I time applying for Medicare so as to not have to pay for current healthcare premium from work and the Medicare premium?
Danielle: So if it’s a large employer, you’re going to delay that Medicare Part B until such time that you retire. And then when you get ready to retire, you apply for Part B and you indicate what date you want that to start.
Andi: Perfect. Do spouses have the same selections for Medigap or Advantage?
Danielle: Yes. So when you have Medicare as your primary insurance, it’s always going to be you as an individual. So Medicare is your primary insurance and you’re going to have an option for you personally between medigap and Medicare Advantage and your spouse will have exactly the same options based on where you live. And it’s not unusual for one spouse to choose a medigap plan and a different spouse to choose a Medicare Advantage because they have different health needs.
Andi: Can you change from Medigap to Advantage or the other way? And then another question, how difficult is it to change from Advantage during open enrollment to regular Medicare?
Danielle: So remember with the Medigap plans, there’s a 6 month window and then it’s gone. So it’s very easy to start with Medigap and then later switch to an Advantage plan because Advantage plans don’t have any underwriting for them. So you could just wait till an annual election period. Drop your Medigap plan. Enroll in the Advantage plan. No health questions asked. Very easy to do. Going the other direction is more difficult because you might have been on your Advantage plan for several years. Now you’re starting to have health conditions and you’ve got bills coming and you think maybe I’d be better on a Medigap plan, but the health conditions that are causing a lot of bills to come in for Medicare Advantage might be the same health condition that will cause you to get denied if you try to go to a Medigap plan. So when we do have someone that wants to switch from Advantage to Medigap, there’s a very important order of events that we’ll walk you through. Which is apply for the Medigap plan first before we cancel the Advantage plan or enroll in Part D. Wait for the Medigap approval. Once we have the approval, then we disenroll you from Advantage and set up your Part D drug plan. Sometimes people do those out of order because they don’t know any better and then they find themselves with no coverage when the Medigap plan declines them.
Andi: Next question is, I am a 64 year old widow and receive my Social Security now. Later, I will take my husband’s. Am I automatically signed up for Medicare Part A and B? And can I see that on my Social Security online site?
Danielle: You probably can see it on the Social Security website, but you can also set up a mymedicare.gov account. A lot of people are not aware of this, but when you become eligible for Medicare, you can set up mymedicare.gov and it will show you inside that portal. And my understanding is that if you’re taking Social Security in any means, then you will have an automatic enrollment into Medicare Parts A and B.
Andi: Is there a Part D reconsideration request for those that retired in 2022? We already answered that, didn’t we?
Danielle: Yeah, the Irma appeal for Part B will affect your Part D as well.
Andi: What becomes of my wife’s coverage through my company retirement plan when I’m forced to join Medicare? She’s 16 months younger than I am.
Danielle: Yeah, so when you leave she would most likely be offered COBRA from your current employer. So you would have one option there if she wanted to pay for a COBRA, but COBRA can be quite expensive. So you would want to compare that with rates that she gets quoted on healthcare.gov for an individual plan and see which one is most cost effective.
Andi: Let’s just do one more question here and then, like I said, if you have any further questions, if your question does not get answered today, visit Danielle’s website at boomerbenefits.com. How does Boomer Benefits qualify insurance providers for highest quality Plan G administration and accessibility to preferred physicians?
Danielle: With Plan G, there’s no such thing as preferred physicians, because remember, Original Medicare and Medigap, you have access to all of the providers that have access to Medicare. So, any provider that accepts Medicare is going to be someone that you could see in your plan. You’re only going to be dealing with a network on the Advantage plan. So, we don’t actually need to do any of that when you have Original Medicare. And the carriers that we work with typically are going to be your big A rated carriers. There’s really no need for someone to get a plan from a C rated carrier when we have very competitive, great pricing from A rated carriers. And so we work with those and provide you the quotes and let you decide which plan you like best. And then remember, you don’t have to worry about the customer service the insurance company provides you because we’re going to be dealing with them, not you. You will get great service from my team and you won’t have to deal with the insurance companies call centers that sometimes may not be as friendly.
Andi: That is Danielle Roberts from boomerbenefits.com. Thank you to everybody who has attended today. And Danielle, thank you so much for your time. We really appreciate it.
Danielle: Of course, Andi, thanks for having me.
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