Robert Dow, owner of The Dow Agency, and Lisa Velasco, Medicare Manager at The Dow Agency, answer the top Medicare questions.
Outline
- 00:00 Intro
- 0:33 Top 10 Questions
- 0:58 What is Medicare?
- 1:40 Who can get Medicaid?
- 2:11 Can you have both Medicare and Medicaid?
- 2:42 Do I need Medicare if I plan to work past 65?
- 4:53 What does Medicare cover?
- 24:29 How much does Medicare cost?
- 26:07 How do I choose?
- 35:23 Question and Answer
Does Part A cover hospice?
Part B is fixed at $174/month, but the slide shows otherwise, which is it? And how about Medicare Advantage, is it the same price?
What’re the prices for Part C in San Diego?
Can you change Part C providers over time?
If I’m healthy at age 65, can I just get Parts A & B, then get C & D later in life?
How are hospital observational stays covered?
Does Medicare cover in home visits or rehab facilities outside of the hospital?
Discuss the issue with pre-authorizations for Medicare Advantage that might cause medication to be delayed or denied.
Can you elaborate on which plan covers dental coverage for PPO or HMO?
Are there any exceptions for penalties in late enrollment?
Can you define medical underwriting?
If I select HMO first, then want to switch to PPO, will there be under writing involved?
If I’m employed, I don’t need to enroll. Is this true?
How do you sign up if you’re a US citizen living out of the USA? Can you make the payments outside of the US?
If Medicare doesn’t cover when you’re outside the country, what are the best alternatives?
Do you have experience with TriCare?
How do you find out if there’s a specialty prescription needed for your plan?
Transcription:
Andi: Thank you all for joining us for this Medicare Basics webinar presented by Pure Financial Advisors. Your presenters for today’s Medicare webinar will be Rob Dow, owner of the Dow Agency, an industry leading and award winning insurance brokerage, and LisaMarie Velasco, the Medicare Manager at the Dow Agency. Lisa has over 20 years of Medicare experience and continues to work tirelessly to help her clients navigate the sometimes confusing Medicare world with patience and ease. Now in this webinar, LisaMarie and Rob will answer the top 10 questions about Medicare.
Rob: So assuming everybody can see this, I’m not going to go through this now, but these are the questions we’re going to be doing. Now consider this Medicare 101. We’re going to just give you a broad strokes of everything and then hopefully anticipate any questions that you might have. And answer those together. So I’m going to, the format’s going to be somewhat of an interview to Lisa, and we’re going to really lean on her 20 years plus of experience.
We’ll start off really basic. What is Medicare? So next slide, if you could, Andi. Lisa, what is Medicare?
Lisa: Medicare is health insurance for people who are 65 and older or permanently disabled.
Rob: Great. Is Medicare free?
Lisa: It is not free.
Rob: Does it cover your family?
Lisa: It does not cover your family.
Rob: Is Medicare the same thing as Social Security?
Lisa: Nope.
Rob: Okay, great. I’m glad we’re having this conversation. And one thing that we also hear often, is Medicare the same thing as Medicaid?
Lisa: They are totally different entities.
Rob: Now, we’re not going to talk a lot about Medicaid. We’re just going to address it because while they sound similar, they’re very different. So next slide if you could please, Andi. So who can get Medicare? So next slide. Lisa who can get Medicare?
Lisa: People who are 65 and are US citizens.
Rob: Okay, what if you are under age 65, can you get Medicare?
Lisa: You can get Medicare if you’ve been permanently disabled for two years.
Rob: Okay. So, if you’re 40 years old, can you get Medicare?
Lisa: Only if you’re permanently disabled.
Rob: If you’re 70 years old, can you get Medicare?
Lisa: Yes.
Rob: Great. So we’re hitting these on the broad strokes. So we’ll go ahead and to the next slide if we could, please. So now we used the term Medicaid. We see these on TV commercials. Generally, Medicaid is a health insurance for a lower income or lower earning family. But the question is asked, if you are on Medicaid, can you also get Medicare? Lisa: Yes. And we also have health plans that work with you if you have Medicare and Medicaid.
Rob: Great. So next question, please. Or next slide, please, Andi. I apologize. So, now, we hear, we are, the retirement age is getting pushed back, people are working longer than age 65, the stereotypical retirement age, do I need Medicare if I plan to work past 65? Andi, if you go to the next slide please. So, hey Lisa, I’m 68, I have two kids in college, I plan to work the next 4 years. Do I need Medicare?
Lisa: That’s something to definitely consider when you have children or spouses under your health plan. It depends on, you know, the cost that you’re paying for your employer compared to the cost of Medicare.
Rob: So essentially what you’re saying is, is if I have a group health plan that I am a part of currently, and I am currently staying on that plan and plan to stay on that plan until retirement, I don’t need to go on Medicare now. I would remain on that plan, correct?
Lisa: Yes. Correct.
Rob: So then the question that Lisa is saying is, if your family is also dependent on your health insurance through your employer and there’s contributions, whether it’s through, you know, a private group plan or any sort of association or union, these are the kind of questions that you need to start to be asking yourself of what is the next couple years look like from a health perspective, as well as a retirement perspective, so that if you don’t have a group health plan and you’re 65, do you need to get on Medicare? The question is-
Lisa: Yes.
Rob: -Yes. There you go. Next slide, please. So if you’re getting Medicare while still working, they can work together. It’s very, very rare. It’s not something that anybody does. It’s a really complex question, but we felt it important to talk about here because some groups have what is called an HSA. That’s a health savings account. There’s some tax ramifications of contribution there. So we work with those groups on those outlier cases. We just felt it important to bring that up just in case anybody out there is in that situation that we can, you know, tell you how to address it. Next slide. If you could, Andi. So this is really where we talk about the bulk of Medicare. What does it cover? And this is where it starts to get confusing. Thank you, Andi. So we’ll go ahead and say, what is Medicare? Parts A and B. Go ahead.
Lisa: Part A covers your hospital, visits and inpatient care. Part B covers your doctors and outpatient care.
Rob: Great. Next slide, please, Andi. So, Part A is hospital, you said?
Lisa: Yes.
Rob: So if I need to go to the emergency room, Part A of Medicare allows me to do that.
Lisa: Yes.
Rob: Is that the only thing that Part A allows me to do?
Lisa: Nope. There’s a lot of things that A covers. Some of the few would be hospital room and meals, skilled nursing services, hospice care.
Rob: And this stays with you forever?
Lisa: Yes. As long as you are on Medicare, correct.
Rob: Awesome. Andi, do you mind going to the next slide, please? So here’s a couple questions. I’m 65. I need to get on Medicare. What is part A going to cost me?
Lisa: It doesn’t cost you anything and you cannot be denied coverage.
Rob: So part A is free?
Lisa: Yes.
Rob: Great. Now you said denied coverage. So you mean if I have a preexisting condition and I am currently on a group plan through my employer, I’m a little nervous about losing that insurance. So no matter what my condition is, are you saying part A you cannot be denied?
Lisa: Correct.
Rob: Okay, great. That’s really good to know. I have a question. I’m in California now, but I want to retire to another state, due to retirement taxes, etc. Does Part A, is that only specific to California?
Lisa: No, Part A is nationwide.
Rob: So I could be in Arizona and I can use Part A?
Lisa: Yes.
Rob: I could be in Nevada and use Part A?
Lisa: Yes.
Rob: I could be in Florida and use Part A?
Lisa: Yes.
Rob: Doesn’t matter. Great. Next slide please, Andi. So then, now we said that was Part A hospitals. We understand that we can go to an actual brick and mortar facility. Part B is medical insurance. Explain what that is.
Lisa: So part B is going to cover your doctor visits, your wellness visits, preventative care, flu shots.
Rob: What about, you know, just screenings, oftentimes cholesterol, diabetes. Is this something that part B would cover?
Lisa: Yes.
Rob: Great. What about, some equipment if you know, knees need to be replaced or surgeries were to happen? Does Part B cover that?
Lisa: Absolutely. Durable medical equipment is covered.
Rob: Great. And then of course, you know, we’re concerned about costs. What about x rays, CAT scans, stuff like that?
Lisa: All covered under Part B.
Rob: That’s awesome. And then now as the world is moving towards a digital world, which we’re in now, what about telehealth?
Lisa: Yes.
Rob: Great. That’s good news. Next slide, please. Andi.
Andi: Actually, I just wanted to mention we had a question real quick. Somebody said, “What was the 60-day reserve in the previous slide?”
Lisa: The 60-day reserve lifetime. So this gets really into the weeds. We can talk about it. But essentially what it does is that it adds a 60-day staying in the hospital coverage for you. If you’re using that. So every health plan regardless of where you’re at has certain coverage in there. This provides a 60-day lifetime reserve if it were to extend to that.
Andi: Okay, I can see that we are getting a whole bunch of questions wrapped up. So let’s let’s- I’m just going to go ahead and keep them and we’ll answer them towards the end. But I wanted to get to that one since it said previous slide.
Rob: Of course. Thank you for doing that and I do understand that we’re kind of going quickly over this and we’re hitting it on a high level. The whole point is, is we want to be able to answer those questions at the end. So we’re just poking the bear and hopefully the questions will come.
Andi: Perfect.
Rob: So if we can, jump, two slides to the right, please. There you go. So part A, when we said it was hospitals that was at no cost. Lisa, does part B medical insurance have a cost?
Lisa: Yes. Part B has a premium of $174.
Rob: Does it matter where you live for that premium?
Lisa: No.
Rob: Is it based on gender for that premium?
Lisa: No.
Rob: You and I would be paying the exact same premium?
Lisa: Yes.
Rob: $174.
Lisa: Yes.
Rob: Now keep in mind, this number does increase every single year. Now, not every single year you get older has nothing to do with that. But the government will essentially say you need to charge X amount. So in order to get part A go into the hospitals, free. Part B, it’s a fixed amount annually, right now it’s $174. Again, same question, can you be denied coverage for preexisting conditions?
Lisa: No.
Rob: So when you’re making that decision to switch, a lot of times we have clients who have fear of switching something that they know they’re being covered on. There is no coverage that can be denied over here. In addition to, is this also nationwide if I’m moving out of state?
Lisa: Yes.
Rob: Great. Good to know. Next slide, please, Andi. Okay. So we just went over part A and part B, but we’re missing some coverage. We talked about going to the hospitals. We talked about doctor visits. We talked about x rays, but part A and B is not comprehensive coverage. We’re missing some. What is some coverages we’re missing?
Lisa: Prescription drugs, dental, vision.
Rob: Eyeglasses. These are the things that actually end up being a lot of out of pocket costs. You hear in the news all the time about rising prescription drugs costs. So if you have Part A and B, you have some gaps. And again, this is where we come in, where we can assist you with your needs according to whatever your health situation is. Next slide, please, Andi. So, if there’s gaps, we need a place to fill those gaps. Where can we get more coverage? Now, for all intents and purposes, we are going to call it Option 1, PPO. Everybody’s familiar with that. That means freedom. Choice, ability to do what you want to do. Option two, we’re going to call HMO, controlled cost, controlled networks. Both are available to you regardless of, of condition of medical condition or preexisting conditions. It all has to do with preference and cost. So if I’m on option one and I signed up for A and B, I know I need to a couple more gaps. What do I do Lisa?
Lisa: I just want to remind you too, Medicare when you just have part A and B. You have that coverage, but it still only covers you 80%. That is why we’re going to talk about option one and option two to come in and pick up that 20% for you so you don’t have that out of pocket unpredictable cost. Option one is, like Rob said, is going to be the PPO, the Medicare supplement. And while you have a Medicare supplement, it’s also required that you have a prescription drug plan. And that’s part D of Medicare. So that’s two things that work together, the supplement and the part D prescription drug plan. Now option two, like we said, is a Medicare Advantage, which is considered part C of Medicare. Now that has everything built in for you. So you’re going to have your A and B, and you’re going to have your prescription drug built into the, to the Medicare Advantage plan.
Rob: Awesome. Andi, next slide, please. So I’m intrigued. Let’s take a deep dive. Now, here’s what I want to tell everybody on the call. Where Medicare gets confusing is once we start throwing letters to you, A, B, C, D. I think it goes all the way, it could be the Z for all I know, we’re trying to simplify it. So I’m going to be using our terms, not the official terms, but just to help for clarity. So we are on part C. This is what we would relate to as an HMO plan that we’re all familiar with. So Lisa said it has A and B, you know, we have A and B. This fills in the gaps. Tell us how.
Lisa: It also has your prescription drug benefit built in as well. So, you have an American Medicare Advantage with everything built in working together. So you’re not having all these different moving parts and different premiums. Another thing we haven’t touched on is Medicare supplement and Medicare Advantage are different in pricing as well. So the more price effective is going to cost effective will be the Medicare Advantage plan.
Rob: So then oftentimes if anybody on this call is logging into Facebook or Google, you’re probably starting to be tagged, you know, from ads perspective on some of these additional coverages you see on the right-hand side of the Advantage, eye exams and hearing aids. These are the things that are all included in the Medicare Advantage. So the next question is, is what does it cost? And next slide, if we could, please. So the question I have, Lisa, is what is the average cost of a Medicare Advantage plan for somebody enrolling?
Lisa: Speaking of LA County and Orange County, the premiums are typically zero dollars.
Rob: So wait, zero dollars? How is that possible?
Lisa: Okay, that’s a good question. Your Part B premium that you’re paying, the $174, that money is allocated to the insurance company that you are with for a Medicare Advantage. So they pay, they pay it for you.
Rob: So this is really important to note. This is comprehensive coverage and HMO when you’re planning for your retirement. Controlled cost is great. I’ll give you a personal example. My mother-in-law, God bless her, is a widow. She is also a court reporter. Her health insurance, just for herself, was $850 a month. That was a significant expense. She had a calendar counting down the days till she could enroll in Medicare Advantage to decrease her cost. And then that money that was being allocated to the health insurance actually went towards more retirement. These are the kind of questions you need to be asking with your advisor. Thankfully, we’re in the right place that you can plan accordingly. But there’s a tradeoff. HMO plan has limitations. So we’re based in Southern California. Everybody knows Cedars or U. S. C. If God forbid an ailment happened and I enrolled into an Advantage plan and I needed to get X, Y or Z coverage, I can’t go to the doctor that I want to or the facility I want to because the HMO has limitations. You have to get a referral. So you have to be aware of that. There is a tradeoff there. So if that makes sense, we’ll go from there. Same thing can’t be denied coverage?
Lisa: No.
Rob: And there’s networks that we’re all very familiar with. It doesn’t mean it’s a smaller network than you’re on. So what we do is we say, who’s your doctor? We’ll say, Dr. Johnson, part of this network. We will find an Advantage carrier. The health carriers are the exact same ones that, you know, United Healthcare. They’re across the board and we will find you a network so that you can still have continuation of your doctor for those that like that. So if you could do the next slide, please. So now we’re switching gears. Okay, we’re going back to the PPO side, the freedom of choice. Let’s talk about this. What is Part D?
Lisa: Part D is your prescription drug coverage. So remember with the one we just spoke about, the Advantage Plan, it’s all built in together. Prescription drug plan stands alone, which has its own premium, and this is what will be working with your supplement.
Rob: So what would be the average cost of a prescription plan?
Lisa: Average cost right now is $100.
Rob: $100 a month. Okay, so then, if you can go to the next slide, Andi, it’ll kind of work there. So what this does is it does cover a majority of the drugs prescribed. Now that could be your generic drugs or name brand drugs. The one that we hear in the news all the time, Ozempic, some can cost up to $800 per prescription. What is the average cost of a diabetic drug or cholesterol drug?
Lisa: $300.
Rob: $300. So you can see how this cost could get very expensive, and this is going to be the major driver of your health insurance cost, and something that definitely needs to be planned according as you’re planning the next stage of your life. So, next slide if you could, please. Now we’re keeping, we’re keeping this on a high level, but because of what I just said and the expense that this is going to be for you, we really need to take a deep dive in this. And I’ll let Lisa describe this. This is essentially what your prescription drug coverage will amount to if you choose the PPO route in order to get coverage. So Lisa, explain this slide.
Lisa: Okay. So the prescription donut hole is what we’re going to go over. So how it works is if up to $5030 of total drug costs, once that amount is paid out of pocket by you. And that, that doesn’t mean coinsurance or a copay that includes the actual drug costs. Would it actually, you know, cost to the, to like the pharmacy. So once you hit $5030, that’s where it puts you in the donut hole. And it goes all the way up to $8000 of out of pocket costs. Once you’re at $8000, then you get out of the donut hole. And you’re in catastrophic coverage to the end of the year. Catastrophic coverage is basically your prescription drug is about $2.30 to the end of the year, depending on what type of drug it is. So it’s kind of scary. And this also does not only just apply to standalone Part D, this applies to your Medicare Advantage as well.
Rob: So that’s an important point. Regardless of the route you go, PPO or HMO, this is going to involve your cost for prescription drugs. Now, keep in mind, a majority of people never get to the coverage gap. So that doesn’t mean that if you’re 65, you’re going to be, you know, spending $8000. This is more for the extreme cases. But it is an important fact that we want to bring up because we’re partnering with Pure Financial and we’re trying to be conscientious of what the next 20 years look like. You’ve worked so hard to get here. We want to make sure that you’re prepared for what you’re facing from a medical perspective. So if you can go to the next slide, please. So part D prescription drugs, do I have to be enrolled in part A and part B?
Lisa: Yes.
Rob: So I can’t just go get Part D by myself?
Lisa: No.
Rob: Okay, so I’m speaking to any of the men on the call here. Men tend to be a little bit stubborn regardless of age, still refuse to go to the doctor, haven’t been to a hospital in 20 years, but maybe I’m on some cholesterol medicine. I want to just get Part D. That’s not possible.
Lisa: You have to have A or B or both.
Rob: Okay, great. And then is there a pharmacy network?
Lisa: There is a pharmacy network, depending on what company you go with, it has the network.
Rob: Okay, great. Good to know. So next slide, if we could, please. And truly on this webinar, we’re hoping to keep it simple. That’s it. Now, I understand we’re now talking Medicare, which is health insurance. We talked about Medicaid, which is still the same 4 letters. Now we’re going to bring up something else called Medigap and that’s where it gets kind of confusing. So we want to try and simplify it for you. But it’s all related under the Medicare supplement insurance. So what is Medigap?
Lisa: Medigap is the plan that will pick up your 20% that Medicare does not cover.
Rob: This is on a PPO?
Lisa: This is actually not nicer than a PPO, because Medigap, Medicare supplements, do not have a network that you have to stick with. Basically, if the doctor accepts Medicare, then your Medigap will pick up your 20% for you, which is really nice.
Rob: Would it be fair to call this the Cadillac of health plans?
Lisa: Yes, the Rolls Royce plan. So this is for those that want to pay a little bit extra. Remember that the Advantage is free. This is somebody that is wanting to pay for that freedom of care. They understand that. They don’t want any gaps filled and they’re okay to allocate some money towards that. Is that a right way to say it?
Lisa: Correct.
Rob: Okay. So if you can go to the next slide, Andi. Now this is where it gets a little confusing for people because now you’re starting to see a lot of letters. I don’t want you to focus on anything other than G. G as in gold. G in gold, as in gold, is reflective of what that Medigap plan is. And when you see 100%, that means insurance is paying 100%. So as you go down that column, you’re seeing 100% all the way, except for deductible, which is normal that no, there’s no plan that covers that deductible.
Lisa: It’s $240. I might want to add.
Rob: Is for the supplement plan.
Lisa: Yes. It’s your part B deductible. That’s the only thing that is not covered. And your part B deductible is $240 for the year.
Rob; $240. I think my deductible right now for my private health insurance is close to $5000. So it’s $240. Not large. Again, this is the Cadillac, the Rolls Royce of it all. And as you go down, everything is 100% except foreign travel emergency. That’s international travel. There’s a split on that. What is the average cost of this supplement plan, Lisa?
Lisa: Turning 65, you’re averaging about $140, $150. It goes by city, and your sex.
Rob: So, it’s not necessarily a crazy cost. It can’t compete to zero on the Advantage Plan, which a majority of people do. However, if you’re doing a running count, you have your, your Part D, the drug, we said that was just, we’ll call it $100 for the sake of it, we said the supplement is how much?
Lisa: About $140.
Rob: Okay, we’ll call it $150 for the sake of it, $250, and then you have the Medicare Part B, correct?
Lisa: Correct.
Rob: And that’s about $100. Let’s just call it $200.
Lisa: $174.
Rob: So, so you’re looking at about a $450 average cost to do this PPO route compared to just the $170 if you went the other route. Next slide, please, Andi. So, the big question is, is, ooh, I kind of like this coverage. Do I have to do A and B?
Lisa: You have to have A and B.
Rob: Okay, the big question I have is preexisting conditions. What happens?
Lisa: When you turn 65 or are new to Medicare on Part B, you have something called guaranteed acceptance. So they are not going to underwrite you at all. The only time you would be underwritten for a supplement is if you joined the HMO, the the Medicare Advantage plan first, and then a year later wanted to get the supplement. Then at that point they would underwrite you.
Rob: Is there a re-underwriting? So if I stayed on this plan for 6 years and God forbid I got cancer, can I continue this plan regardless of my health?
Lisa: Yes.
Rob: That’s really good to know. Is this also nationwide?
Lisa: Yes.
Rob: So Medicare is a nationwide regardless of the plan you choose.
Lisa: Absolutely.
Rob: Okay, next slide please, Andi. So again, how much does Medicare cost? Let’s go to the next slide if we could please. This is a really easy way to understand it. You Medicare Advantage Part C. It’s low cost. It is a low out of pocket. The sacrifice is freedom. Now it doesn’t mean the coverage is poor. It just means you lose the ability to choose. So these are the kinds of things that if you want to take a picture of this, For future reference, you should do that. This is a conversation you’d be having with your advisor saying, here’s my concerns with this. In addition to talking to a broker like ourselves who can walk you through this process.
Lisa: And another thing too, Medicare Advantage plans do have annual max out of pockets. So that’s also predictable, predictable out-of-pocket costs.
Rob: So for those that are unfamiliar with an out of pocket maximum, I’m going to give you an easy number. Let’s say your out-of-pocket maximum is $5000. Now, it’s much higher on these plans, but just for the sake of math. And let’s say, God forbid, I’m in the hospital and the bill is $30,000. Hypothetically, the most I would ever pay is that $5000. That’s my out-of-pocket maximum. So then if I went to the hospital again, and then I went again, and I went again and again, it doesn’t matter because my out-of-pocket max, the most I will pay is that $5000 or whatever that plan is. These are the things we’ll be telling you upon enrollment.
Lisa: They all, they all vary to the max out of pocket. Some are $800 a year, some are $2000 a year.
Rob: Thank you. Next slide, please, Andi. So how do I choose? if you can go to the next slide, please. We’re not going to make that decision for you on this webinar. We’re just trying to show you the two paths that you have to go. You either go option two, which is the Advantage plan, low cost HMO, or option one, which is, you know, the PPO essentially. Now there’s the original Medicare part A and part B. We would never encourage anybody to just do that. It would be a- it would be a misstep in our professional opinion. We, there is precedence for it, but certainly not something that we would encourage just because of what the financial risk of doing so could be on the prescription drug costs. So, if you want to take a picture of this, we have this internally as well, but this is a good slide to kind of keep it simple. Next slide, if we could. So when can I enroll? This is one of the more confusing parts of Medicare because right now, in addition to being ad targeted based on your age for all enrolled Medicare, etc., you hear about enrollment periods and when is enrollment periods. And truthfully, there’s quite a few of them and it can be kind of confusing. So, Lisa, I, I’m turning 65 in 3 months. What do I do?
Lisa: Three months before your birthday is ideal for you to start signing up for your Medicare. That gives us plenty of time to have the conversation of what avenue is more appropriate for you.
Rob: What happens if I, my wife kept telling me to do it and I didn’t do it and I’m a month past 65?
Lisa: You still have 3 months after your 65th birthday to enroll in Medicare part A and B.
Rob: What do you run the risk of by waiting so long?
Lisa: Well, I mean you don’t run a big risk, but you could eventually I mean you could forget and not enroll.
Rob: And just the stress of making a big decision, you know these things, we want to make sure we do it right because in a couple slides, we’re going to tell you about the enrollment period. And really you can’t change at any time, no different than your health insurance through your employer. There’s a certain enrollment period. So when you get locked in, you need to be locked in properly.
Lisa: And you also don’t want to have any gaps in your coverage as well. That’s a big thing that I come across. So if your coverage at work is going to end in September the 15th. You want Medicare to start the month of September. You don’t want it to start in October because then you’re going to have a gap in coverage.
Rob: So then how do so when it’s the initial enrollment period? Do I- what do I have to do? Do I have to fill out an application? What do I do?
Lisa: The easiest way to do it is to go to Medicare.gov and apply online. I’ve seen that that’s the quickest way to get it done.
Rob: Okay, great. So I go on Medicare.com to get it done. I also see that you can go to SocialSecurity.gov and you go through their Medicare portal, but again, this is not Social Security. This is completely different. You just go through their portal.
Lisa: Yes.
Rob: So the next slide, please, Andi. So we have a general enrollment period. What is this?
Lisa: That’s if you missed your your enrollment period to originally join Medicare.
Rob: So-
Lisa: They give you an additional-
Rob: – they give you a little window.
Lisa: Yes.
Rob: But there’s a really important bullet point I want you to look at at the very bottom, late enrollment penalties may apply. So yes, you are given a grace period but there is an expense charged in order- if you miss, which is essentially 10%, correct?
Lisa: Yes.
Rob: 10% every month and it accrues. So it’s something that, to create a little bit of urgency. So the next slide, please. So this is for the supplement open enrollment period. Now this would be the PPO part. When can we do this?
Lisa: Medicare supplement, you can enroll the same thing, 3 months before and 3 months after.
Rob: Gotcha. Now again, cannot stress- no medical underwriting if you enroll during this time. What happens if you don’t enroll in this time? And in four years after 65, you decide you want to supplement?
Lisa: Then you will have that big penalty.
Rob: And is there a medical enrollment required?
Lisa: No.
Rob: Okay, there is- and the important thing to do is, is that- or to note is, is that if you go during this grace period, there’s no questions asked. And that’s what that’s really vital to know. The next slide please. We talked about the penalties. Here’s the penalties to create urgency. We won’t talk too much about it, but it’s just know they exist. So we want to do it in the proper time, which is those 3 or 6 months. Next slide please, Andi. So when can I change my coverage? We I previously mentioned that. You can change the- next slide- you can change your coverage in essentially 3 weeks. October 15th for us in the Medicare industry is our busiest time. This is when anybody who has signed up is allowed to make the changes that they need to do. It often gets really busy during this time because people will just sign up for Medicare. And then things will start going a little bit south and they’ll realize, I wish I would have signed up for this, or I needed to do this. And so it’s during this very busy time, in addition to the holidays that we have to make the decisions for the health insurance for the next following year. So those are the kinds of things. Now keep in mind, you might be an Advantage with Blue Shield, for example, and you say, I don’t really like my network. I want to be with United. This is the time that you would make those changes. So it’s not necessarily going from HMO to PPO or what we’d call supplements to Advantage. It could be just across carriers, across plans, etc. If you called us in May and said, Hey, I really dislike my doctor. I do not like my network, we’ll say call us on October 15th and we’ll make that change. So it’s really important that we get those enough time to make the proper decisions to go accordingly.
Lisa: And one thing to remember during a EP. When you any changes you make in October, November, will still take place, your plan will be effective January 1.
Rob: Okay, so the next slide. Thank you. Oh, you can go to the next one. So this next one, the open enrollment period for Advantage. Now we’re saying October to December. They actually, they actually give you a 3-month grace period too, because similar to what we’ve seen with IRS filings and getting pushed back. There’s a little bit of grace period. We, we have to disclose that, but truly keep in mind, October to December. So then the next slide, where can I go for help? And you can click two, two from these, Andi. You can go to Medicare.gov. I mean, oh, sorry, go one up, Andi, or one back, I apologize. You can go to Medicare.gov. That is a third party independent resource for you to just get questions answered. There’s also 1 800 Medicare. Nobody’s going to try and sell you anything when you call these numbers. It is just for your information. In addition to Online resources, these are the ones that are provided with protection of you as the consumer. So then if you go to the next slide, regardless, though, you are going to need to work with a broker similar to us that specializes in Medicare that we can go through each question that you have. And we can pick the plan that’s perfect for you. So we are also here as a resource. We’re also here as a credibility check. If you’re saying hey, do you have just kind of a separate eyes? This is the direction that I’m going with with my broker on Medicare. Do you mind just affirming this is the right place? Yes, because we all know as as we get older in life our medical decisions are vital. And so we want to make sure we’re doing that. So that’s our kind of pledge to everybody on this call is we want to be an educational resource for you. And then also one, if you do need somebody to walk you through that process. So Lisa’s information’s right there. Again, we have a whole team that can do this in addition to bilingual if needed, so we’re happy to help you in any way. Andi, I’m scared of how many questions are coming through because these bubbles have been going crazy.
Andi: Well the good news is that I’ve actually been grouping them by topic. So hopefully we can crank crank through these pretty quickly. So first of all, I do want to mention that yes, this is being recorded. So some people asked about you know, they said you took- you said take some pictures of slides and then I moved the slides too quickly. So I didn’t get a chance. We’re actually going to send you out an email in the next few days when the replay of this is available so that you can watch it at your leisure. You can pause it. You can take screenshots. You can do whatever you need to do. And then, of course, you can always reach out to Rob and Lisa at the information that is shown so that they can answer your questions directly. But we’re going to try and get through as many of these as we can. So I’m going to stop sharing here for a second. So first of all, does Part A cover hospice?
Lisa: Yes.
Rob: Yes, loud and clear. Yes.
Andi: Okay. You said that part B is fixed at $174 a month, but the slide says it’s adjusted for income, which is it? And what about Medicare Advantage? Is it the same price? Had a couple of people ask us, is it $174 annually or monthly for plan B?
Lisa: It’s monthly and it can be adjusted for higher earners.
Rob: The threshold is $103,000 for an individual, $206,000 for a family. So if you exceed that, the price is slightly more expensive.
Lisa: Yes.
Andi: Okay. We have a number of attendees who are in San Diego County. You mentioned the costs for Part C in OC and LA. What about San Diego? Is it any different?
Rob: Slightly.
Lisa: Yeah, slightly. They have a small premium.
Andi: Okay. Can you change Part C providers over time?
Lisa: Can you, can we?
Rob: Yes. Yes. So through Advantage, if you’re going to do that, you can do that, but only during the open enrollment period. So if you’re, if you’re unhappy with your doctor, it doesn’t mean you’re stuck with them for life. But again, this is that open enrollment period.
Andi: If you are very healthy at age 65, is it possible just to sign up for Parts A and B and do C and D at a later point in life?
Lisa: You need, we wouldn’t recommend just having A and B. You’re leaving yourself open for that 20%, so you’re not protecting yourself. I mean, you need to have that extra protection with either a supplement or an Advantage plan that won’t cost you anything monthly.
Rob: Yes. We actually had a client that was healthy, was fit, was active, and had an aneurysm while surfing mid-year they were on the hook for medication, for neurological medication that exceeded $5000 a month. It’s those kinds of things where we want to be prepared. So in theory, yes, you can.
Lisa: And don’t forget, you still need to have that part D. Otherwise, you will get penalized through Social Security when you do decide to get Part D.
Rob: That 10%. So you can go years without it, when in fact you do need it, you’re going to have that late penalty in arrears.
Andi: Yes. I think this question might be similar. If I’m working at age 66, decide to retire at 67. Can I sign up for A and B and Advantage at 67, or do I have to make those choices right at age 65?
Lisa: 65, you need to enroll in A. B can be delayed.
Andi: How are observation hospital stays covered?
Lisa: Are observational-
Rob: So that that’s an out-of-pocket expense and it also varies per plan so good call out on the slide there. If you’re admitted it’s covered for observational. Then it starts going into a deductible situation at your cost with your out of pocket maximum coming into play.
Andi: Does Medicare cover in home nursing visits or rehab facilities outside of a hospital?
Lisa: Rehab, yes. Rehab, yes. And the first one that you asked for also depends on the plan that you’re on.
Rob: But yes, the answer is yes. We had a client that had hospice, but it was a hospice nurse that came to them twice a week. Because they couldn’t afford a facility, there’s all sorts of services, and it was completely covered by Medicare.
Andi: Okay, please discuss the issue with prior authorizations for Medicare Advantage. Often procedures or medications are delayed or denied.
Rob: Yeah, so I mean that that’s the medical world that we live in. It’s not specific to Advantage plans. It’s for us on the Medicare or medical world for all plans regardless of age and there. It doesn’t make it even more difficult based on Medicare. Unfortunately, that’s the system we live in. We’re here as brokers to help you expedite that. Give you a little bit of resources or direct contact to help escalate those situations. The big mistake that we see people do is while they’re watching Price is Right or wherever, you see these ads and it’s 1 800 SIGNUP FOR MEDICARE and you’re just calling a call center with no relationship or anything. That’s what we’re trying to get people away from doing.
Andi: Okay. Could you elaborate in which plans give dental coverage and if they are PPO or HMO?
Lisa: That also depends it’s a Medicare Advantages are the ones that offer the dental and depending if- something we didn’t mention with Medicare Advantage, depending on your county, then then there’s an option for PPO as well. In like an Advantage plan that has a PPO in it, too. So depending on which one you are on that would be the same for the dental so if you’re on a- if you’re on a Medicare Advantage, then the dental part will be HMO. And if you’re on the PPO, then it’ll be a PPO type of dental.
Andi: Are there any exceptions to the penalties for late enrollment in Medi- in the Medicare supplements?
Lisa: No.
Rob: No. It’s, it’s hard. It’s a hard question. No. You have to just fall with no. And I’ll give you a little wink, but no.
Andi: Okay. Can you please define medical underwriting?
Rob: Yeah, so medical underwriting is what we know it, whether you apply for a life insurance policy, a medical policy or whatnot. Some of the supplements, as you get later, can be denied with a medical condition. So they will pull your doctor records and see if that’s something you can apply for. Truthfully, what they’re trying to do is get an appropriate premium for the risk of the applicant. But if somebody is terminal, we have seen in the past that a carrier will not extend coverage on the supplemental side.
Andi: If I select PPO first but then decide to switch to HMO, will there be underwriting involved?
Lisa: No.
Andi: If I am employed, I don’t need to enroll, true?
Rob: True. I mean, if you’re employed and you’re on their health care plan, yes, that’s true. If you are not participating in their health care plan, then you need to enroll.
Lisa: Right.
Andi: How long is the gap between when I enroll via the .gov website and when the insurance actually takes effect?
Lisa: It’ll take effect the month of your 65th birthday. So if you enroll 3 months before, no matter what the month of your birthday is when the Medicare will start.
Rob: And, and just to build on that, Andi, I would say 90% of our clients are doing it 3 months before because they’re celebrating on their 65th birthday that all the money that they’ve paid into the Medicare, they finally get to reap some of those awards. So we rarely have people that wait after 65.
Andi: I had a number of people ask this question or related questions. How do you sign up for coverage when you’re a US citizen living outside of the USA?
Lisa: Do the website.
Andi: And does it matter where you live when you’re making the premium payments? Can you do that outside of the U S as well?
Lisa: Medicare goes based off of their address that is provided to Social Security. So whatever address Social Security has on file, that’s the address they’re going to use.
Andi: This one I guess is kind of related. If Medicare doesn’t provide coverage when you’re out of the country, what are the best alternatives for coverage?
Rob: Well, I’m sorry, go ahead.
Lisa: Well, they do cover you. They don’t, they don’t cover routine coverage. So they’re going to cover you if you have an accident and it’s an emergency. So you get the cold and then you don’t have coverage. But if you have a major accident or an emergency, then you have coverage. So you basically pay it up front. And then you show them the bill and they will reimburse you for your, for your out-of-pocket costs.
Rob: We have numerous clients that live internationally and are partaking in some of the universal healthcare options that those countries provide as well. Medicare is not there to supplement that. It is more for the traveling folk as opposed to the permanent residents.
Andi: Right. Do you have experience regarding TRICARE?
Rob: Yes.
Lisa: Military. Yeah. Military. Yes.
Rob: Give us, yeah.
Andi: Okay. As I have been asking you these questions, a bunch more have come through, so I’m just going to go through that list now, too.
Rob: We need to get suitable answers, so we’re ready with more thorough answers.
Andi: When I sign up for Medicare and then decide to go back to work with a job, I guess it’s what happens if I sign up for Medicare and then decide to go back to work with a job with insurance coverage.
Lisa: You keep your Medicare.
Rob: And truthfully, and the context with that is, a lot of business owner plans right into the, into their agreement on their healthcare that they will stop providing coverage for anybody over age 65. We should have mentioned this earlier too. When you’re evaluating your healthcare needs and you’re on a group plan and you have your family on your plan, and let’s say your spouse is turning 65, a lot of those group regulations through your employer also say your spouse can no longer be covered at age 65. The reason, it’s incredibly expensive. You know, the average premium for a 65-year-old is north of $1000 a month. Employers don’t really want to provide that coverage anymore. So they pretty much draw a hard line at age 65. Some, some unions extend upon that though.
Andi: Okay, enrollment periods and penalties. What if you are working past age 65 and are covered by work insurance? Also, do I not need to sign up for Plan G at the same time I plan up for B? I want to sign up for B when I retire but will be moving right after. Can I wait to sign up for G after I move, since coverage may differ in a different state?
Rob: Yeah, really good question. So I think there was two parts to that, though. It was, do I need to sign up for Plan B if I was working? Is that right?
Andi: Do I need to sign up for Plan G at the same time as I sign up for B is the first question.
Rob: Oh, well, depending if you want G, yes. If not, you’re going to have to wait until the next enrollment period to do so. And, and so yeah, that answers the question.
Andi: And then the other one was, they’re going to be moving right after, can I sign up for G after I move since coverage may differ in the different state?
Lisa: It’ll, it’ll follow you. The coverage follows you. It’s the same coverage.
Rob: It doesn’t matter what state you live in.
Andi: Okay, many healthcare organizations are not accepting Medicare Advantage due to them not paying. Any updates about that or should I plan to sign up for Medicare PPO and not MA? You’re taking a deep dive into the political underwings of health insurance. Lisa and I meet with doctors regularly and it’s a decision that they have as a business practice. If they want to accept Medicare, it’s a completely different revenue stream. It does come with its pain points because it’s a government-funded product for the most part. Now you might be saying I’m paying some premiums, but it’s a backed, government product. So. there is no updates other than every doctor we talk to kind of puts their hand on their head like this. And we just proceed the best way forward.
Lisa: And I don’t foresee doctors not accepting Medicare itself.
Rob: It’s too big of a- it’s too big
.
Lisa: Yeah, it’s too big. It’s the the supplement is that’s why you know It’s nice to have that freedom, but I can’t imagine the doctor not wanting to accept Medicare.
Andi: Somebody says, what is the total cost in theory?
Rob: That was the kind of number if you said, you know essentially $450 if you go the supplement route. And then a $170 assuming you’re under that high earner amount of you know, $203,000. That’s essentially what the cost is. And then of course, keep in mind, and individually reach out to us, you have the prescription cost. So I can’t tell you what your all in cost until we know truly what you need from a prescription standpoint. But the major driver of your health insurance moving forward is going to be that prescription drug cost.
Andi: If you have Social Security disability, can you get Medicare before age 65?
Lisa: Yes. That’s when you’re permanently disabled, right? Is that with SSDI? Yes. And you can get a supplement or an Advantage Plan, but, the Advantage Plans are a lot more affordable if you’re under 65. The, the, the supplements can be, like, very pricey. Let’s say if you’re 50 and you’re disabled, and you get a supplement, you’re looking near $800, $900 a month.
Andi: All right. I am still working and my husband is covered under my health insurance. I signed him up for Medicare A and B even though he doesn’t need the services yet. Should I have waited?
Rob: No, no, I like that decision. I’m, I, there’s, it really is preference. It has, that is an individual preference based on how much your employer was paying for your spouse, what that expense was coming out of your paycheck, if that was pre-tax. So, but on a surface level, I’d say, no, you didn’t make a mistake.
Andi; And actually I just see that she a few questions down She said there was an error in my question. I signed him up for Medicare a only not B. I’m still working. He’s covered under my insurance. When I retire, we will both sign up for A and B etc.
Lisa: That’s good.
Rob: Good job. Appreciate the context of all that.
Andi: To save money on part D can I use another cheaper plan outside of Medicare?
Lisa: Yes, they all the prescription drug plans are mainly their own, private insurance companies. You have a big selection of Part D’S prescription drug plans. I’m sorry.
Rob: But keep in mind, you know, the one that on average it’s $80 to $90 a month, so, not too significant of a cost.
Andi: If I’m 65, but I’m still working and have medical coverage. Do I need to sign up for part A now? I think we kind of covered that.
Rob: Yeah.
Andi: How much is dental coverage?
Lisa: If you have the Advantage plan, it’s built in there for you. So you just have copayments for whatever type of work you’re going to get done. With the supplements, you have to you can order a separate dental plan or you can use specific plans that give you dental discounts.
Rob: But keep in mind when you’re using those- so Advantage covered PPO, you know the supplement side that we’re referring to, when you go and get that dental plan, there’s a lot of wait periods for preexisting issues. So meaning if you need a root canal, you can’t just go get a dental supplement and be on day one, get that root canal. They usually make you wait about 12 months. So keep, keep that in mind.
Lisa: And the premiums you asked what they were. So I would say about $50 to $70, depending on the level of coverage that you’re looking for with dental.
Andi: I’ve got about 10 minutes left, so I’m going to keep, keep going. We’ve got a number of questions still. What do you recommend- this actually might podcast listeners. We have a number of people who listen to the Your Money, Your Wealth® podcast who are interested in retiring early. Somebody says, what do you recommend if you retire early before age 65?
Rob: As it relates to health insurance, the best way to go about it is contacting a local broker who knows the exchanges of the state you’re living in to get on an individual plan. We would always encourage you to do that. If you’re healthy, you can get a very high deductible. We often call it a catastrophic plan so that the expense is pretty low while you go through there. But yeah, that’s the recommendation. I’m really the only option.
Andi: Can you get the premium deducted from your Social Security check?
Lisa: Yes. The part B premium can be deducted from Social Security or you can pay it yourself.
Andi: Can I change from Advantage to Medigap and will there be a penalty?
Lisa: Yes, you can. and there’s not a penalty, but, you will be underwritten.
Andi: I’m on CalSTRS. So I won’t have Social Security. Do I still need to let them know my new retirement address? Does that tie in with Medicare?
Rob: No, but I would say yes.
Andi: Yeah, okay. I was told that there is a grace period for signing up for G after signing up for B. Is that not true?
Lisa: That’s not true.
Andi: Okay. Is the cost of Medicare tax deductible?
Rob: I’m, we’re not tax professionals.
Andi: And actually I will mention that at this point, while we’re on the topic, if you do have questions from this in terms of how your Medicare premiums fit into your overall financial plan, I’m gonna share our confirmation or our, our, contact information here so that you can get in touch with, one of the advisors at Pure Financial Advisors. Now, if you are already a client of Pure Financial Advisors and you have any questions about Medicare, your premiums, how all of that fits into your, your financial plan, you’ll want to contact your advisor directly. Otherwise, if you are not a client, now’s the time to schedule a free financial assessment with the experienced professionals at Pure Financial Advisors. They will take a deep dive into your entire financial picture, including how those Medicare costs fit into your overall plans for retirement. So I’m going to put a link in the chat so that you can ask us for that information and so that you can sign up for a free financial assessment if you have any questions related to your finances and Medicare.
Andi: Let’s keep going with questions. How do you find out if there is a specialty prescription covered by the prescription plan?
Lisa: That’s my job while I work for you, I will look up all your drugs and I will tell you up front how much your premium is for the plan and how much your out of pocket monthly drug cost will be. That’s what I do.
Andi: Can you confirm that there’s no penalty for not signing up at 65 provided that you have proof of creditable coverage until you sign up? And also, is this true for the Medigap plan charges?
Rob: Great. Two thumbs up.
Lisa: Yeah. That’s true.
Andi: All right. And this one I think is another one that would be one that would be for a Pure Financial Advisor. Is there a tax advantage to having your Medicare Part B deducted from your monthly Social Security payment instead of paying it out of pocket?
Rob: Yeah, I would talk to a Pure Financial Advisor. They know exactly what, how to answer that question.
Andi: Yep. And then I think all of the rest of these are probably questions that you will want to ask for an advisor at Pure. But maybe this one will help, can you explain the Medicare income limits and why they are based on two years before the filing year?
Lisa: Oh, you’re asking about the IRMAA?
Andi: I believe so, yes. The income related monthly adjustment amount.
Lisa: Oh, okay.
Rob: Yes, we could give our opinion, but again, contact somebody a Pure and they, they’ll be able to answer that with more authority than us.
Lisa: But they will adjust it. I do know that as- after that first year of being penalized, I do know that they go back and look again every year and they adjust it lower depending on your income, they lower it every year. If your income drops from that two years, they will lower it the next year.
Andi: Do all part C plans offer free gym membership?
Lisa: Most of ’em, yes.
Rob”Yeah, and also you a lot of people sign up through AARP. There’s all sorts of benefits there. Yeah.
Lisa: AARP. But they’re Medicare supplements. They also give a free membership if you did the supplement route.
Andi: Another question. I’ll take this one. Somebody says, what’s the difference between Pure Financial and Dow Agency? So Pure Financial Advisors is a financial planning firm. Dow Agency is who we have asked to actually present this Medicare webinar because they are the specialists on Medicare. So, Rob and Lisa here can help you with getting signed up for Medicare, for figuring out which plan makes the most sense for you. As Lisa said, for figuring out which drugs are covered under your plan, all of those type of details. In terms of how you pay your premiums, whether or not they are tax deductible, anything to do with the financial side of things, that’s where you’re going to want to contact one of the advisors at Pure Financial Advisors.
Rob: Right. We provide zero financial advice.
Andi: My birthday is January 12th. If I retire and sign up for coverage beginning July 1st, can I contribute to my HSA through December of the prior year? That’s another question for a Pure Financial Advisor. So I’ve posted that information in the chat. and I’m going to post Lisa and Rob’s contact information here again, so that if you have any questions related to Medicare, signing up for Medicare and determining which plan is the best for you, this is the contact information that you will want to use to be able to work out those details. If you have questions about the tax deductibility of it, contributing to your HSA, those types of details, use the information that’s in the chat to contact us here at Pure Financial Advisors. We got about 3 minutes left. If anybody has any questions or Rob and Lisa, if you have any final words that you would like to share with our audience, that would be great.
Rob: I would just close it out. I’m hoping that you’re leaving this with a little bit more information and knowledge than questions. If those questions did linger, our contact information is there. Lisa is giving her personal cell phone out. Feel free to text. We can schedule a time for us to connect via zoom in person, whichever you prefer. We try and keep it short and simple, but our whole goal is getting back to doing business the personal way. We’re not going to send you to a call center. This is who we are. We want, it was important for us to show our face and we cannot stress enough the, the quality of Pure Financial and as investments, we are here to just partner alongside you on your financial journey. And we’re just a small piece in that financial retirement journey to help with the Medicare costs, medical costs, and how we can fit in your overall retirement plan. So, if anything, we’re just a educational resource and hope to help you out.
Andi: All right. I’ve got two more questions that are specific to your, what it is, what, what services you can provide. Somebody asks, are there Medicare brokers like you in the state of Washington? I’m moving there in two years, so I need a medical insurance broker who is knowledgeable about Washington state. Can you provide that, that service?
Rob: Yeah, feel free to email us and we’re happy to make an introduction for you.
Andi: Fantastic. And then, do you also recommend a broker for private insurance for someone who isn’t yet 65?
Rob: Yeah, contact us and that’s something that we can handle as well.
Andi: Fantastic. Rob Dow and Lisa Velasco, thank you so much from the Dow Agency for sharing all of these great details and information. Like I said at the start, Medicare is so complicated and it’s really great to have experts who really understand and have the depth of experience and knowledge that you both do to share all of this. Again, if you have any more questions specific to Medicare, contact the Dow Agency at the information on screen. And I’m also going to put the information in the chat if you have questions about the financial side of how Medicare, works in your overall financial plan. Thank you all so much for joining us, and we will see you again soon.
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