Robert Dow, owner of The Dow Agency, and Lisa Velasco, Medicare Manager at The Dow Agency, review the basics of Medicare including its parts, enrollment, and costs.
Outline
- 00:00 What is Medicare?
- 1:00 Who can get Medicare?
- 3:37 Medicare while still working
- 4:26 What does Medicare cover?
- 16:38 Standardized Medicare Supplement Plans
- 18:55 Medicare coverage choices
- 20:23 When can I enroll?
- 24:50 More resources
- 25:48 Q&A
- Is it true when you choose an Advantage Plan that you might not be able to go back to the standard Medicare? What are the parameters going from one thing to another?
- What’s the difference between a wellness visit and a doctor’s visit?
- How much overlap from a private plan to Medicare should you allow when you retire?
- Part D pays 20% that part A & D doesn’t. Is Part D just for prescription drugs?
- Who provides the Medigap coverage?
- Regarding the HSA, I have a job and working now, do I have to enroll in Medicare A but I still want to put money in my HSA. How does that work?
- If I plan to work until 70 years old, do I still need to apply by 65?
- What resources do you recommend for Parts G and N?
- What is underwriting in regards to Medicare?
- Do I have to get a physical to switch back to regular Medicare from an Advantage program?
- On Advantage, is it an option for Medigap or Supplement?
- When should I disenroll from Covered California?
Transcription:
(NOTE: Transcriptions are an approximation and may not be entirely correct)
Robert: So we’ll just start off very easily. What is Medicare?
Lisa: Medicare is a federal health insurance program for all of us, US citizens. it is funded in part by your taxes while you’re working, and it’s individual health insurance.
Robert: I have a question. Is Medicare free?
Lisa: Medicare is not free.
Robert: Okay, so let’s, let’s clear that in the air.
So one of the things that’s important to know is Medicare does carry a cost. A lot of it is funded by from your working dollars. So if you don’t mind scrolling down, in the beginning, Kathryn, it’s a lot of scrolling, but we’ll get there. but jumping ahead, the question I throw to Lisa is, who can get Medicare, who is eligible to get Medicare?
Lisa: US citizens and legal residents, you must live in the US for at least five years in a row, including the five years just before applying for Medicare.
Robert: Is there any requirements of age?
Lisa: You must be age 65 or older. Or if you’re younger than 65, you need to have a qualifying disability and anybody with any age of end stage renal disease or a LS qualifies for Medicare.
Robert: Good to know. Thank you. we’re not really going to dive into Medicaid, although they, there’s some alliteration between Medicare and Medicaid. We want to just kind of brush that with a broad stroke because of the clientele. If there’s Medicaid specific questions, again, we’re happy to help. But the good question to know or the answer to no is can you both have Medicare and Medicaid simultaneously?
Lisa: Yes.
Robert: so some people are eligible, meaning dual eligibility.
Lisa: Correct.
Robert: And they could, they can work together and are built to work together. and again, we can dive into that with a little bit more, Details. So if you don’t mind scrolling down. I just wanna pause on this question. do I need Medicare if I plan to work past age 65?
As many individuals who are on this call probably know what once was the retirement age, it seems to be moving back year and year. And as the cost of living continues to increase uncertainty of the market, many people are sort of planning on working past the age of 65. But there is some Medicare decisions you need to make prior to turning to 65.
So Elise, I’ll throw it to you. Do I need Medicare if I plan to work to page 65?
Lisa: so everybody’s options are different. it generally you can delay Medicare past age 65 without penalty, as long as your employer has 20 or more employees. And your employer health coverage is considered credible.
Robert: What is considered, what is credible mean?
Lisa: Credible is full coverage.
Robert: Full coverage.
Lisa: Yes.
Robert: so then to be clear, you need to enroll at age 65 if your employer has fewer than 20 employees. That includes self-employed, or your coverage is not serious, considered credible. considered not credible, would be like an Aflac, you know, something like that.
Right? You need to actually have insurance. many of us individuals are on our spouse’s insurance. So how does it play there?
Lisa: you, can delay it as well if your employer, your spouse’s employer still keeps you on the insurance to your 65. Sometimes they wanna push you away and push you towards Medicare.
So it just depends on the employer.
Robert: And this is one of those times where you have a conversation with your spouse. they’ll need to reach out to their HR director, controller, whomever it may be, and figure out what their plan details are. Some of their plans do force, remove at age 65. Yes. So if you do, or, you are planning on continuing to work.
how, what does that look like for Medicare and employed?
Lisa: your Medicare and your employer insurance can work together. if you take any part of Medicare, you’ll no longer be able to contribute to an HSA, which is a health savings account. Medicare will not cover anyone but you. So consider, and if you have any dependents or someone depending on you for health coverage.
Robert: So speaking as a, business owner, as you get older, your health insurance premium does increase. And so your employer is probably having a conversation with you saying your health insurance is getting X amount. Medicare is gonna be significantly less than that amount. and if there’s a contribution, if you’re, if they’re only paying 50% and 50% is coming out of your paycheck, there’s some financial decisions you need to make.
is it worth it for me to have this coverage? Now, this is gonna lead itself to the next, slide, and it’s really important. So many of us are so fearful of getting rid of a plan we feel comfortable with, especially if there’s health issues going on. And so we see, you know, employees maybe not retire because they don’t wanna get rid of the health insurance benefits, et cetera.
So the whole point of us wanting to connect with you today is just sort of give you a high level of what does Medicare cover. And Kathryn, if you don’t mind, keep going. and go ahead Lisa. What does Medicare cover?
Lisa: Medicare has two parts, A and B. A is your hospital insurance, and then B is the medical insurance.
Robert: So meaning part A going if anybody has to go to the hospital, the emergencies of the world, any inpatient care. And then B would be the health insurance we know going to the doctors, going to the checkups, et cetera. So if you don’t mind going to the next slide, Kathryn. So here’s a, in more in depth of Part A, the hospital coverage
Lisa: that includes your room, your meals.
in-care special units such as ICU, prescription drugs and medical supplies, lab tests, operating room, skilled nursing, some blood transfusions. it also covers hospice, part-time skilled care and rehabilitation services.
Robert: So a significant amount of your health insurance is covered by part A,
Lisa: yes,
Robert: which might give peace of mind.
However, keep in mind, this is only if you’re admitted to the hospital. So a couple fun facts about that, is. You’re premium free if you or spouse worked. So we said, is Medicare free? in this case, you’re premium free for just the part, a hospital part. Lisa, what if you have preexisting conditions?
Can you be denied?
Lisa: You can’t be denied
Robert: any preexisting conditions. You cannot be denied.
Lisa: Can’t be.
Robert: What if I have a house in Florida in Boca Raton and I have a house in Arizona? Can I use my coverage?
Lisa: Yes.
Robert: So you can use it nationwide. and then you must be admitted. That’s the important part in order for this to work is admitted, not emergency room admitted.
so if we can go down to the part B, so part A we understand hospital. Part B is the health insurance we’re more familiar with is the, what we’d call the everyday care, the medical insurance. what does Part B cover, Lisa?
Lisa: Part B is like you said, doctors, your annual visits, preventative care, x-rays, MRIs, CAT scans, some of your health programs like smoking, citation, obesity counseling, physical therapy, diabetes screenings, mental health, durable medical equipment.
Ambulatory surgery centers, telehealth, and I also wanna include that part A, like you said, has no premium, but Part B does have a, monthly premium. It typically starts off at $185, but it can be higher for some people depending on your income level.
Robert: So meaning the, if you. are at a certain income level based on last year’s taxes.
Is that how they calculate it? Yes. your monthly premium would be adjusted, considerably. Correct. but on this part B, can you be denied coverage for any preexisting conditions? Yeah. And can you also use this nationwide?
Lisa: Yes.
Robert: For any provider that accepts Medicare, and that’s an important distinction,
Lisa: right?
Robert: now this last part’s pretty important, a premium penalty for late enrollment. You do not sign up for part B at 65.
Lisa: Okay? So that’ll depend too, depending on if you, have credible coverage, you will not have a penalty. But if you do not have the actual, credible coverage, depending on how long you wait to enroll in your part B, Medicare.
Then there will be a penalty assessed depending on how long after you turn 65. That’s how they calculate it, depending on how many months.
Robert: So it’s, I can’t give
Lisa: you an exact number. Sorry.
Robert: Yeah. So the important part or takeaway there is, if you currently do not have health insurance and you are turning 65, the part B is a required.
Not required, but comes with a penalty if not enrolled. So if, so as we can scroll down to the next one, we talked about hospitalization. We talked about going to the doctor, that’s parts A and b. We have some holes. What does part A and B not cost or cover
Lisa: it? all the costs of your care. It doesn’t cover everything.
You will have out-of-pocket costs with no limits. it doesn’t cover your prescription drugs routine, dental, vision or hearing care, eyeglasses, contacts, long-term care. Excess charges for services by doctors who don’t accept Medicare and care received outside the US except for certain circumstances such as emergencies.
Robert: Emergencies. So the, big point here is, there are considerable amount of costs no different than your health insurance, out-of-pocket costs, deductibles, et cetera. So if we have part a’s hospital, part B is going to the doctor, just the general care, there’s gonna be a couple gaps. Can we get insurance for that to fill in those gaps?
Yes. And that’s where this next slide comes in. Where can I get more coverage? And you have two options there.
Lisa: Okay, so option one. Is a Medicare Part D plan, which is prescription drugs, and also you have to have a Medicare supplement with that. That’s the Medigap that fills in the 20% for you. Option two would be choosing a Medicare Advantage plan, which is more of the HMO sites.
So you’re in a, network that you need to stick with. the big difference between option one and option two is there is no network with Option one. You have the freedom to go to any doctor as long as the doctor accepts. Medicare and option two, you’re more in a network, so you need to use the in-network doctors,
Robert: which isn’t that big of a difference.
You know, back, maybe 10 years ago there was a lot more, PPO versus HMO in-network outta network conversations. As health insurance has changed throughout the last years, more individuals are on a network as well. But each option one or two, which we’ll take a deeper dive in, is all dependent on your specific case and your cashflow, et cetera, on what costs you really want to assume on the front end or on the back end.
So we’re gonna take a deep dive in that Medicare Advantage, part C. so Medicare part C. Advantage covers what,
Lisa: all the benefits of Part A except hospice care, which is still covered by your Part A, all the benefits of Part B. Most Medicare Advantage plans cover your prescription drugs as well.
they also offer additional benefits such as dental exams, cleanings, x-rays, your eye exams, hearing tests, and some of them offer fitness programs like Silver Sneakers.
Robert: You might, a lot of times you’ll see commercials, although compliance is really clamping down on this sort of some of the incentives to get somebody to go to C.
But a question I have is, can you get C alone or do you have to have part A and B?
Lisa: You have to have part A and B.
Robert: So you have to have the hospital plan, you have to have the wellness plan to get part C.
Lisa: Correct?
Robert: can you be denied coverage for this?
Lisa: You can’t be denied coverage
Robert: including preexisting conditions.
Lisa: Correct.
Robert: And, is there a network for this?
Lisa: Yes.
Robert: Okay. And the last one is, there a premium for this, meaning a monthly cost for this?
Lisa: So that depends on your zip code.
Robert: So zip code? what about income limits? Does it depend on your income limits or is it just zip code?
Lisa: Just zip code.
Robert: Okay. So now we’re, if we’re keeping a running total part A, no cost part B, cost based on income, part C based on zip code.
And if we scroll down, we’ll now, sorry, Kathryn, if you don’t mind, part D would be the other option. So this is the prescription drug coverage option that Lisa was just talking about.
Lisa: Yeah. So prescription drug plan coverage is gonna be what you have that works alongside your. Medigap plan. So it’s a standalone plan or a Medicare advantage plan And co I’m sorry, has it built into it
Robert: and so is, what sort of drugs are these the most commonly prescribed drugs?
Yes. That are part of this? Okay.
Lisa: Yes. Every insurance company has its own, formulary. what drugs that they cover.
Robert: So this is really important ’cause as we deal with, individuals that are getting to Medicare, certain prescription drugs seem to be the driving deciding factor on which plan it is, especially as if there isn’t a generic drug.
There’s a considerable amount of cost for these prescription drugs and one that, especially if it needs to be refill, refilled on a monthly basis or whatever the frequency is, it can drive your cost up. And that’s why, you know, having specific conversations. To your situation. We’re happy to have after the fact to figure out what the best plan for you.
and so if we don’t, if we can just keep one more down, if you don’t mind, Kathryn. you know, during the year you go through different coverage stages. but what we want to try and explain is, don’t worry about the graph so much here. But how much is your cost going to be for that plan year?
And you know, again, it’s hard to speak, but just generically on a high level, every dollar amount changes. It seems like this has the most change in the Medicare world. in terms of coverages, there’s, this is just an example of something, so what the annual deductible might be, and then you have your coverage amount, but that might not be the correct amount for what the actual cost is.
And so there could be a considerable cost on the backend. And those are conversations that we would have on a one-on-one basis as it relates to prescription drug only.
Lisa: Yes, during enrollment, I would definitely. Get a list of your prescription drugs and compare the pricing and out of pocket so you know, upfront before you enroll in a plan, how much your drugs will cost you monthly.
Robert: Yeah. And so then what happens, Lisa, if somebody has a new drug halfway through the year, can they change their plan halfway through the year?
Lisa: No, but I can definitely help you with your, with your out-of-pocket costs. I can help guide you. You know, and let you know upfront before you even have that drug, how much it’s gonna cost.
Robert: So then, for this part D coverage, do you need to be enrolled in Medicare part A and B to have it?
Lisa: Yes.
Robert: You must be enrolled. Is there a network?
Lisa: If you’re in the an advantage plan, then you have to use that network. If you’re using it as a standalone, then you don’t have a network.
Robert: Okay. Great. Good to know.
And then of course, as I said, coverage and costs vary by plan. but it is something that similar to part B, B as in boy, part D does have that premium penalty for a late enrollment if you don’t have the qualified coverage. Correct. So if you don’t mind scrolling down. So you might hear, you might have heard this is often in commercials about Medicare supplement insurance supplements, Medigap.
we’ll just kind of give you the broad strokes of what those supplements fill in the holes of.
Lisa: part a hospital co-insurance, skilled nursing facility care, co-insurance part b, co-insurance or copays, depending on what plan it is. Cost of blood, cost for 365 extra hospital days. Hospice co-insurance, part B deductible and part a deductible.
Robert: So on these supplements, we generally find individuals that are wanting to, are willing to pay a premium to avoid paying a large cost, right? so this is completely voluntary, but depending on your financial status and where you feel you want your dollars spent, this could be an option for you all.
Something that we can help into. So this is sort of considered the Cadillac, option, meaning I want to pay for a supplement to avoid having large. Expenses throughout the year, especially if you foresee that happening.
Lisa: and also having the freedom to, you know, not be a part of a network and being able to go to any doctor that accepts Medicare.
It’s a lot of freedom.
Robert: Yeah, that’s a good que that’s a good call out. Especially those that have multiple homes traveling right across state lines, et cetera. Yes. so if you can scroll down, this is where we usually lose people because we’ve thrown a at you, we’ve thrown B at you, we’ve thrown C at you, we’ve thrown D at you, we’ve thrown supplements, and now I just threw you with a whole bunch of other alphabet alphabetical letters.
But the reason why we wanna show you this is that. while the letters make complete sense to us, there is a variety amongst the different plans in terms of coverage. And while G G as in girl is one of the more frequent ones we do, just because of how rich a coverage it is, each plan is specific to you, your zip code, your financial status and everything.
And so we just want to be able to show you. all the various options because you do have to make a decision as it relates to Medicare, but you do have choices, and that’s kind of where you can lean on us to answer those for you, and then ultimately, help you make the best decision for yourself. I’m not gonna really dive into any of this, but just to show you, the variety there.
And we kind of brushed over all this, but again, nationwide coverage. and then one of the questions is, this gonna, could you be dropped from coverage on this? And supplement is guaranteed renewable as long as you pay your premium, and that plan still exists. And that’s the difference.
So they’re not going to kick you off, for medical issues? No. however, there are changes in the plans always. and these do carry a higher premium, you know, which sort of makes sense after you see all the costs that it carries. so as you, if you can go to the next, two slides. How much does Medicare cost?
we kind of try to simplify it as much as possible. but we have, you know, Medicare Advantage Part C, low to zero month premium. You do have a deductible. You have copay, part D does carry a monthly premium, deductible, copay, co-insurance, et cetera. Medicare supplement, same thing. Monthly premium deductible copays.
No co-insurance on that. but really what it leads you to is maybe more questions than you came, which is great. I now understand there’s this confusing world. How do we simplify it? and that’s ultimately what we’re here for. So how do you choose, if you don’t, if you don’t mind scrolling down, your role in original Medicare.
How do you do that, Lisa?
Lisa: you go onto ssa.gov,
Robert: which is Social Security Administration. You go on there individually. Can we do that for them?
Lisa: I can’t do it for you, but I can help you, walk you step by step over the phone.
Robert: Every, everybody has to go to ssa. Is there a service that does it for them?
Lisa: ssa.gov.
Robert: Everybody has to do it.
Lisa: Yes.
Robert: now I know my mother-in-law actually went to the social security office Yep. To try and do it. You could do that as well.
Lisa: Absolutely.
Robert: and then once done, how long does that take and what’s the waiting time?
Lisa: usually about two to three weeks. And then they’ll send you your Medicare card.
Robert: So two to three weeks you’ll get a Medicare card, at which point then what happens?
Lisa: Then you talk to me.
Robert: There you go. And at which point we will, you know, figure out your situation and decide, you know, obviously part A, part B, and then you have the option one or two. The option two being that Medicare Advantage plan.
You know that in-network that we discussed, or the option one that gives you that supplements and a little bit more freedom. What premium makes sense given your current financial situation or your future financial situation. You could see why we work closely with Pure Financial as it relates to your financial situation.
’cause we want it to be sustainable, although it can be changed year to year. We want something that’s consistent so you don’t have much turmoil and we go from there. so the next question is, okay, 65 is knocking down the door. When can I enroll? Lisa, when can I enroll?
Lisa: you automatically be enrolled if you’re already receiving social security or railroad retirement.
Robert: so 65, my birthday’s January 1st. Can I enroll
Lisa: if you’re turning 65
Robert: 3 months before, or three months after? Three months after,
Lisa: correct. So you have a total of seven months.
Robert: So seven months to do it. Yes. depending on if it’s you a loved one, we have a lot of individuals that sort of take care of the responsibility of their parents as they get older.
these are the conversations. Just remember three months, essentially 90 days before. and then if you enroll three months before, does Medicare start at age 65 or it
Lisa: starts the month of your birthday?
Robert: The month of your birthday. So if you enroll on the first day, three months before, you’re still waiting until your birthday?
Lisa: Yes.
Robert: and that’s important is especially if you’re continuing to stay employed and you’re wanting to switch to Medicare from your insurance, but we do. Always recommend to avoid early, as anybody can imagine, especially as we’re at the tail end of the year here. everything is slower and avoid gaps in coverage, late enrollments, et cetera.
And, and we, would recommend that. So then as it relates, if you can scroll down right there, what happens if you missed your initial enrollment period? oh. Whoops.
Lisa: You may enroll in part A, part B or both. you may choose to enroll in a Medicare Advantage plan or a prescription drug plan, which is part D and a late enrollment premium penalties may apply.
So again, depends on how late you are from enrolling. That will determine what the penalty will be.
Robert: and then to add a little bit more confusion, Kathryn, if you don’t mind scrolling down, Medicare supplement open enrollment period. how long does that process last?
Lisa: It lasts for six months, beginning with the month in which you are 65 or older and enrolled in both Medicare A and B.
Robert: So if you’re keeping track, you have three months for Medicare. Prior and three months after starts there. And then of course, in order to get into this, you have to already be enrolled in parts A and B to get those supplements.
Lisa: Yes. And also something to remember is when you’re in this enrollment period, then you do not have any medical underwriting for the Medicare supplement.
After the enrollment period is over, then they may over, they have the. Ability to underwrite you.
Robert: And that is a really important takeaway. Yes. Now you might say, Hey, you guys said no. there’s no enrollment or there’s no criteria in terms of, preexisting conditions. this is for supplements.
This is a little bit different. Now, there is a window that you can apply where it still pre-existing conditions doesn’t matter, but it’s gotta be taken advantage of.
Lisa: Yes.
Robert: and so then if you, don’t mind rolling down. anticipating any questions, what would those late premiums be? it’s essentially 10% of the part A premium for Medicare Part B.
Same thing, 10% for part B, you know, the doctors. And then the, penalty for the Part D, the prescription jugs is an additional 1%. so it’s not a ton of money, but it is significant enough to hopefully motivate everybody to jump ahead of this. so then the next question is, okay, I’m already on Medicare.
I like what you’re saying. I wish I would’ve known this before I signed up. When can I change my coverage? Now we can do it October 15th, we are in it. So the last three months of the year are essentially the open enrollment nationally for Medicare. And so this, these are the times you can make the changes needed.
And Lisa, when do those changes take effect?
January 1st. So of course, get ahead of it. October 1st. the carriers start releasing their plans. We know all of those changes that are happening. we can run that with you. and, a lot of times it’s just a soundboard. Does this look great for me?
And a lot of times we say, yes, it looks great. but if you there is any sort of turmoil and you’re already on it or you’re enrolling for the first time, now’s the time to add to it. and the Medicare Advantage and open enrollment period is, you know, the January to march as well. so then the next, question and the big one is, where can I go to help?
Right now, the government provides a ton of resources. This is no affiliation with us medicare.gov. You’re gonna see very familiar or similar conversation or information that we’ve shared here. There’s a phone number that you can call, however, there is a wait time for that. So just be aware. you can go to your social security office.
As we stated, there’s quite a bit of information. and if, and. And of course, if you don’t mind scrolling down, Kathryn, you’re gonna see, familiar faces. There’s Lisa’s information and my information, and we are here to help. You’ll notice that’s Lisa’s, direct line. She will take calls and texts if needed, and schedule a time.
We usually ask for about a 30 minute window per session just so that everybody can have enough time to say whatever they need and we can do the information before. We’re here to help. and that concludes our high level Medicare conversation. I know quite a few people were signed onto this call. Is there a bunch of questions that, you can see on there?
Kathryn: Is it true that once you select an advantage plan that you might not be able to go back to the standard Medicare, it might be due to your health changing while you’re on the Advantage plan? So what is the, parameters between going from one to the other?
Lisa: Just to be clear, the question is if you’re on an advantage plan and you wanna go back to original Medicare, just a and b and a Part D.
Can you, is that the question?
Kathryn: it’s, if you want to go, there’s a Medigap and Advantage. I think the question is, or even just, can they just go back to A and B? They don’t really specify. So maybe just talk about if I do take advantage. What happens if I decide I don’t want advantage and maybe I wanna go to Medigap?
Lisa: Oh, okay, I understand. So yes, you can. If you’re still within a window at that, that election period, you can go into a supplement. If you’re outside of the enrollment period, then they may underwrite you.
Kathryn: Okay. but yes,
Lisa: you can always, and you can always go from an a, an HMO, the Advantage plan to a supplement.
But again, you’re gonna get underwritten. Not that it’s a bad thing either,
Kathryn: pardon me.
Lisa: It’s not a bad thing either. If you get underwritten, sometimes people hear that and they get scared, but, they’re basically looking to see if you were in the hospital in the last two years.
Kathryn: Gotcha.
Lisa: Or if you were, not treated for something that was, prescribed to you or what is it?
when they give you a medical device and you didn’t do it, Hey, you have to take this test. You didn’t do it well then.
Kathryn: Yeah.
Lisa: Stuff like that.
Kathryn: and what is the difference between a wellness visit and a doctor’s visit?
Lisa: The same, actually wellness is like your annual exam.
Kathryn: Okay. And then, How much overlap from a private plan to Medicare should you allow when you retire?
Robert: How much overlap? From a private plan to Medicare should you allow, so if
Kathryn: I have private insurance and I’m getting ready to go onto Medicare.
Robert: So having both of them. Yeah, like do I make sure,
Kathryn: because you said it take, there’s a waiting period. Should I just make sure that my Medicare is actually.
Active before I cancel.
Robert: yeah, of course. And of course, members, there’s a, it’s age-based. So even though there’s an enrollment period, it’s whenever you turn 65. But yes, you know, what we, what you can essentially work with your employer if that’s where you’re getting your health insurance or your spouses.
Once Medicare’s official, you’re active, then you would show proof of coverage and the employer, yours or spouse or whomever would probably backdate it to, when the coverage started.
Kathryn: Gotcha. Oops, I just lost it. Okay. Then it’s, I think a slide showed 10 minutes ago said Part D pays 20% that part A and B doesn’t.
I thought Part D was only for prescription drugs.
Lisa: That’s correct. Part D is only for prescription drugs.
Kathryn: Okay. And then, who provides the Medigap coverage? The difference between Medicare Advantage and Medigap?
Lisa: So they’re all, it’s by private insurance companies.
Robert: So that’s the United, health Insurance, United Healthcare
Lisa: Blue Shield.
the, those are, they’re private insurance companies that do the Medigap. Okay.
Kathryn: and
Lisa: they also do Medicare. A lot of them do Medicare Advantage and supplement. They give you a choice. just depends on what carrier. I, don’t wanna be, carrier specific, but, a lot of them do both.
Kathryn: Gotcha.
And then, one of the slides it talked about that c and f are only available at first eligible, obviously it, that was before 2020. So in other words, does that mean that if we are not yet 65 and not yet on Medicare, we cannot, we can no longer take parts C and F correct? it’s, yes, correct. Okay.
Lisa: yes.
It’s only if you were 65 prior to 2020.
Kathryn: Now regarding the HSA. So if I have a job and I’m working now, do I have to enroll in Medicare A, but I still wanna put money into my HSA, so I’m not taking B. How does that work?
Lisa: You can still put money in your HSA if you’re gonna continue to work. I be, I’m like almost a hundred percent on that.
Kathryn: Okay. because I believe that once you have B, you’re not allowed to contribute anymore.
Lisa: Correct.
Kathryn: But so do you just have to be sure that you’re only enrolled in A and not B?
Lisa: Yes.
Kathryn: Okay. and so what if I work until 70? Do you still need to apply by 65
Lisa: for part A? But B can be postponed. Remember, as long as you have that credible coverage You won’t have any penalties incurred.
Kathryn: Okay. And let’s see. Anything that you can, do you recommend some people are asking for information about plans, G and n, do you recommend just going to, like, having an actual, conversation with you offline? Like how do you Yeah,
Robert: for sure.
Lisa: Absolutely. Yes.
Kathryn: also I see a
Robert: conversation there, Kathryn or somebody, asked about the donut hole and that’s still existing. wanted to provide a little bit of clarification. Yes, the donut hole no longer exists on a coverage gap with a huge out-of-pocket cost that no longer exists. that the name, still is out there.
We use that slide just as an example. however, within that donut hole, you still pay 25% of what used to be the gap from 2025 onward. So they eliminated the term in the phraseology, but they also, just adjusted it a little bit. So the donut hole that used to exist in years past changed in 2025.
Kathryn: Okay.
And a quick question, a couple people have asked, what is underwriting? What do you mean when you say, you know, that it, the
Lisa: underwritten means that they’re gonna take a look at your health, records.
Robert: No different than like a life insurance. They’ll, pull your medical records to, to make sure that, and there isn’t a strict guideline on what’s acceptable or not.
Kathryn: Okay. do I have to get a physical to switch back to regular Medicare from an Advantage program? And do they look at preexisting conditions?
Lisa: No.
Kathryn: Okay. I’ve read that once you pay $2,000 for an individual drug, you can get that drug for no cost. Is that true? Or do you know anything about that?
Lisa: I don’t.
I’ve never heard that. Something for drug specific. It’d be better to, talk to us directly, but I’ve never heard of that.
Kathryn: Okay. Sounds good. and then just another clarification, I don’t know if you actually answered this question or not, but. on Advantage, it’s an option between Medigap and Supplement, right?
If I choose supplement, it’s not a requirement to still enroll in Medigap. Is that correct? Did they say that? Right?
Lisa: So there’s two ways to go on Medicare member. Option one would be a Medicare supplement, but you also have the Part D. Those go together, right? And option two would be the HMO or an advantage plan.
Robert: Okay. And I wanna go back to that 2000 annual cap. Yeah. That is also something that changed in 2025. Again, don’t want to talk specifically, but yes, there was that cap that was added in 2025, and it sort of takes away the co-insurance and, allows you to make a smooth payment, which we could talk on an individual basis.
Kathryn: Okay. And then, when should I disenroll from Obamacare? cover or cover covered California. does that roll right in? Can you talk anything about that?
Lisa: So that would also be specific depending on when you’re 65, what month? So basically if you go three months before your 65th birthday, then you know you can enroll in your Medicare and it’ll start, let’s say for easy numbers, we’re in September, right?
So you’re 65 in December. So you would want your. Medicare to start in December and then your Obamacare would have to end, by the end of November, so that way the next day your, Medicare is active and ready to go. That’s why I recommend doing it three months before your birthday. I can help navigate through that.
That way it’s nice. Transition is easy for you, you don’t have nothing to worry about.
Kathryn: And then, someone’s asking, is there a charge for your services?
Lisa: There are no charges associated, with our services.
Kathryn: Excellent. And do you wanna explain why that is? Because Yes.
Lisa: because we get a commission directly from the insurance company for whatever plan we put you on.
So we cannot charge a fee ’cause we receive a commission.
Kathryn: Right. So anybody who needs information about Medicare, they don’t have to pay anybody for that information. They get the information because of our 1.45% that we’ve put in forever. Correct. Correct.
Robert: And,
that’s why we provided those free resources as well.
medicare.gov. you know, we’re brokers of course, and are here to be a resource, but there’s free resources everywhere. And we would just, be wary of anybody that would ever charge a fee because that would be,
Lisa: yeah, that’s illegal.
Kathryn: Exactly, yes. Okay.
Lisa: medicare.gov has a lot of, information on their website.
I actually use them daily.
Kathryn: Excellent. Excellent. let’s see. You guys have pretty much answered all the, can you, if your question
Robert: didn’t get answered, by all means, our email is hopefully, I, still don’t see you. You might wanna just throw it back up there, Kathryn. Yeah, we’re happy to, we’re happy to do that.
We also have a Calendly link that we will send you via email that you could just schedule time. we also, do you wanna put
Kathryn: it right there in the chat? If you wanna, ’cause you can add to the chat. If you wanna, just in the where it says webinar chat, I just put a guide for everybody. You guys have a Medicare checkup guide that we offer, but they’ll put in their email address and, Calendly link for anybody who wants to, have an, there you go.
Excellent.
Robert: And, and like I said, we’ll send out that link as well and happy to have any discussions with anybody. We also do face-to-face meetings, in-person meetings as well. happy to do that. we still do business or try to do business the old school way, so it’s nice to meet everybody virtually on Zoom. Love to put a face to the name as well.
Kathryn: If you have questions and specific questions, please reach out to one of us. But, reach out to your advisor if you’re part of the Pure Family. And you know, ask your advisor for help. And also reach out to Dow Agency for Lisa Marie or Rob and they will be able to take care of you and answer all your questions at no charge.
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