Understanding Medicare is an important part of any retirement plan. In this webinar, Jeffrey Riego and Diane Gaswirth of UnitedHealthcare answer 10 common Medicare questions:

  1. What is Medicare? 
  2. Who can get Medicare? 
  3. Do I need Medicare if I plan to work past 65? 
  4. What does Medicare cover? 
  5. Where can I get more coverage?
  6. What does Medicare cost? 
  7. How do I choose Medicare coverage? 
  8. When can I enroll? 
  9. When can I change my coverage?
  10. How can I save money?

Jeff explains the A’s, B’s, C’s, and D’s of Medicare, coverage options, the Medicare open enrollment timelines, and financial penalties if enrollment is delayed, cost-saving tips, and much more. Download the slide presentation.

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Jeff and Diane also answer viewer questions, including:

How do you know if your health plan coverage under your employer is “creditable” so that you can delay?

If a 65+ person has retiree employer health coverage and also has both Medicare and Medicaid coverage – should they keep the retiree employer health plan?

I retired from the military and have Tricare. I will be getting Tricare for Life and Medicare. Should I get part C, Medicare advantage, and/or a Medicare supplemental plan?

While retired Federal Workers must take A & B, is it a fact that some advantage plans will pay my premium back to me?

My husband has Kaiser as a retired firefighter. I can get Kaiser’s Medicare advantage plan but isn’t that limited to states that have Kaiser?

I continue to work past age 65, I have employer coverage. I just signed up for Medicare part A, how do I know I qualified for the “special enrollment period”? It did not mention this.

“If you’re working beyond age 65 and you have creditable coverage, you may still want to apply for Part A.” Help me understand why.

I turn 65 this Dec. Assuming I enroll in Original Medicare plus chose a Supplemental Plan and a Part D plan before my birthday when do each of my plans become effective?

Does Medicare cover when traveling overseas on vacation?

Can you talk about family maximums? Any way around it?

I’m on Cobra and have an HSA from my past employer. Is there something that I should be aware of so that I don’t lose my funds in my HSA, and to avoid HSA fees and penalties?

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Is there an out-of-pocket maximum on Medigap plans?

What is the best way to decide between Medigap/Supplemental or Advantage?

Do you have examples of the costs of the supplement plans?

How does a contracted provider differ than a participating provider?

If I live in Riverside County, but all my doctors are in San Diego County then Medigap would be better for me than an Advantage plan, right? I don’t want to change doctors.

If I’m currently working and covered by an employer plan (as is my 70 year old husband) is there any reason for either of us to enroll in Medicare now?

If you have an Advantage plan that covers drugs do you need Part D?

The presentation included “that we should review our plan each year”. What is the best way to look at what is out there yearly?

My husband is in hospice for dementia. UHC won’t cover expenses for his diabetes.

I’ve heard that it’s better to enroll in a PPO type plan in case you get a serious illness, you won’t be able to later. Do you agree with that? Supplement Plan is more like PPO and Advantage plan is more like HMO?

What about cancer drugs?


Andi: Today’s presentation is going to be provided by Jeffrey Riego and Diane Gaswirth. Jeff is an independent agent who works directly with clients at no cost to educate them on Medicare and UnitedHealthcare’s products to help them find a plan that better fits their individual needs. And Diane Gaswirth oversees Sales and Retention for UnitedHealthcare in San Diego, and will be supporting Jeff today by answering questions during the presentation. So Jeff and Diane, thank you so much for taking the time to talk to us about Medicare today.

Jeff: Thanks for the introduction, Andi.

Andi: Absolutely.

Diane: Our pleasure.

Andi: All right, so shall we get started? Jeff, are you able to share your screen okay?

Jeff: Sure. Give me a second here. All right. Hello. My name is Jeffrey Riego. Thank you for the opportunity to talk to you today about the basics of Medicare. For many, Medicare is like a new language. It starts with learning words and then putting them into sentences. And then gradually you become more fluent. At United Healthcare, we try to simplify this process through our Medicare Made Clear program. We hope you’ll walk away today with some new vocabulary and a clear understanding of what Medicare is, how it works, and most importantly, how it can work for you. So these are the top 10 Medicare questions we hear from people around the country. First, we’ll define what Medicare is and who is eligible for it. Next, we’ll talk about Medicare if you plan to work past 65. Then we’ll look at the different Medicare coverage options and costs. After that, we’ll touch on how to choose coverage and explain the different enrollment periods. And last, we’ll talk about how you may be able to save money and where you can find more information. So let’s get started, guys. There are some common misperceptions about Medicare, so let’s go over a few basic facts about what Medicare is and what it’s not. Medicare is a health insurance for older and disabled Americans and currently serves more than 61.4 million people in the United States. It’s funded in part by federal payroll taxes paid by employees and employers, the taxes labeled FICA on your pay stubs. Medicare is individual insurance, which may be confusing to you if you’re used to getting coverage for yourself and your family. Medicare is not free. You have some costs to pay, which we’ll cover in a bit. Also, Medicare is not a family health plan. Each person must meet Medicare eligibility requirements as an individual. And finally, Medicare is different from Social Security. It’s also different for Medicaid, which is a health insurance for people with limited incomes and resources. We’ll talk about that next.

So what is Medicaid? Medicaid is a state government program that helps pay health care costs for individuals, families and children with limited incomes. Programs vary from state to state, but do follow federal guidelines for benefits. Eligibility varies also from state to state. However, Medicare and Medicaid can work together. In fact, some people can have both Medicare and Medicaid. These people are called dual eligibles. We’ll talk more about this later. So we said that Medicare is individual insurance, but who can actually get it? As you might guess, there are eligibility requirements for Medicare. First, Medicare is for US citizens and for legal residents living in the United States for at least the previous 5 years. You must also meet one of the following requirements, the age 65, younger than 65 with a qualifying disability and have received disability benefits for 24 months or any age with a diagnosis of end stage renal disease, or ALS. To the right, you’ll see what a Medicare card looks like. We mentioned the term dual eligibility. Let’s dive in in that a little more. People who are dual eligible can have both Medicare and Medicaid. And yes, the two programs can work together. If you have both Medicare and Medicaid, the two will work together and may cover most or all of your health care costs.

Additionally, dual eligible individuals may be eligible for special private Medicare plans. For example, people with Medicare and Medicaid can get some special coordinated care plan called dual special needs. So we’ve covered who can get Medicare. But before we look at what Medicare covers, let’s talk about a situation that I come across everyday, working past 65. If you plan to work past age 65, your Medicare decisions may be different. In fact, you may be able to delay Medicare enrollment altogether. This is generally an option for people who work for an employer with 20 or more employees and have employer health coverage that is considered credible by Medicare. Specifically, your plans prescription drug plan must be as good as or better than Medicare’s Part D. People who have health coverage from an employer with fewer than 20 employees must enroll at age 65, or they could face a late enrollment penalty. But what about if your health insurance is through a spouse? Well, in that case, you may be able to delay or you may still need to enroll at age 65, even if the spouse employer has 20 or more employees. This is because employers can have their own rules for covered dependents. Some employers require covered dependents of Medicare age, age 65, to enroll in Medicare in order to remain covered by the employer plan. You can ask the employer’s benefits administrator to learn more about your options. There are some important things to know about getting Medicare when you continue to work. First off, Medicare and your employer insurance can work together. Medicare will typically be secondary to your employer insurance until you leave your employer or lose that employer coverage, whatever happens first. Then Medicare will become primary. Second, if you take any part of Medicare, you will no longer be able to contribute to the Health Savings Account. And finally, Medicare will not cover your spouse or children. If you decide to take Medicare, you want to talk to your employer benefits administrator to understand what options they may offer. Let’s move on to what Medicare covers. First up is original Medicare, and it has two parts.

Part A is hospital insurance and Part B is medical insurance. Let’s look at each one of these, starting with Part A. So Part A hospital insurance covers services provided during an inpatient hospital stay. Most covered services are listed here. This includes your room, your meals, and nursing and other services. One important thing you may notice missing from this list is doctor services. That’s because doctor services are covered by Part B even when you’re in the hospital. Now, here are some additional important facts about Part A. Part A has a premium, but few people pay it. Remember the FICA payroll tax? It’s on your paychecks. If you or your spouse paid more than 10 years or more, or 10 years or more, you get Part A for free. You can’t be denied Part A coverage regardless of your health or financial status, and you’re covered at any hospital in the country. Finally, you need to know a few terms to understand Part A Benefits. Part A coverage and costs are based on benefit periods. A benefit period begins the day you are admitted to the hospital and ends after you’ve been out for 60 days in a row. Now, observation status. This is another important term. Part A covers hospital stays when you’re admitted in an inpatient, not if you’re there for observation, even if you stay overnight. Part B, however, would pay some of those costs. Now, lifetime reserve days. These are extra covered hospital days you can draw on if you are in a hospital longer than 90 days. The maximum length of days in a benefit period is 90 days. So you also get 60 lifetime reserve days that can be used only once, but they can be applied to different benefit periods. We’ll come back to these terms a little bit later. Now let’s look at Part B medical insurance. The main coverage services are listed here, including doctor visits, the test or exams your doctor might order, and other outpatient services. Also, we just discussed part B covers doctor services when you’re in the hospital as well. These are a couple of things to point out here. First, the annual medical wellness visit, which is covered 100%, is an opportunity to meet with your doctor to discuss your health status and goals, things that a regular visit may not provide time for. The second thing to point out is about medical equipment, also called durable medical equipment or DME. To be covered, the equipment needs to be medically necessary and prescribed by a doctor. It also needs to come from a supplier approved by Medicare. Now, here are some additional important facts about Part B. Part B has a monthly premium. If you’re receiving Social Security or railroad retirement benefits, the amount will be deducted from your check every single month. Just as with Part A, you can’t be denied Part B coverage regardless of your health or financial status, and you may see any provider in the country that accepts Medicare. Finally, Part B charges a premium penalty for late enrollment. Unless you qualify for a special election period, you won’t get a penalty. We’ll cover enrollment later in the presentation, but some people, including those who work past age 65, may delay Part B altogether without a penalty.

So we’ve gone over what Medicare- what original Medicare Part A and B covers. Now let’s look at what it doesn’t. Many people are surprised to learn that they will have out of pocket costs, which could be significant depending on individual healthcare needs. Further, there is no out of pocket maximum, no financial protection with original Medicare. Another possible surprise is that original Medicare does not cover prescription drugs. Other nonservices include routine dental, vision, and hearing, as well as corrective treatment, long term care such as nursing homes, custodial care which includes bathing, eating, dressing. These things may also be called activities of daily living and also care outside the United States, except for limited circumstances. The good news is that there are some options that may help with these noncovered items, so let’s explore those. Even from these simple examples, you can see the original Medicare doesn’t cover everything. The good news is that you have options for other coverage that can cover other things, like prescription drug coverage. On that note, we are now ready to talk about what Medicare Part C, Part D, and Medicare supplement insurance are. Now we’re going to see how Part C or Medicare Advantage, Part D, a Medicare supplement insurance, or Medicap, fit into the picture. You have two options for more coverage. Option one is to add Medicare supplement insurance and/or Part D prescription drug plan to original Medicare. Medicare supplement insurance will help pay some of the out-of-pocket cost not paid by Medicare A and B. Part D will cover prescription drugs. Now, option two is to choose a Medicare Advantage plan, also known as Part C. Most Medicare Advantage plans include drug coverage and additional benefits such as dental and vision. Part C is a Medicare Advantage plan. It’s an alternative to original Medicare and offers another way to get your Medicare Part A and Part B benefits plus more. You’ll also continue to pay your Part B premium directly to Medicare. Plans are offered regionally by private insurance carriers. Most plans also include other benefits like prescription drugs, dental, and vision. The most important thing is all your benefits are covered under one program. By law, Medicare Advantage plans must provide all the benefits that original Medicare does. So plans combine part A and part B coverage in one package. One exception is hospice care, which is covered by Part A, even when you have Medicare advantage. In that specific situation, a hospice steps fully forward and becomes primary for your Medicare. Most Medicare Advantage plans also include built in prescription drug coverage or Part D, which we’ll talk about next. Finally, Medicare Advantage plans may also offer additional benefits, including coverage for dental, vision or hearing care, as well as wellness and fitness programs. There are different types of Medicare Advantage plans. Most are coordinated care plans, where care is delivered through a provider network. You may get care outside the network, but you may pay more or even the full cost. Most coordinated care plans are HMO or PPO plans. PPO plans generally offer more coverage for out of network care than HMO plans do.

Special needs plans are designed specifically for people with certain health care needs, including those who are eligible for both Medicare and Medicaid, those who are living in nursing homes or who have certain chronic conditions such as diabetes. Point of service plans are sort of hybrid, with network care covered like HMOs and care outside the network covered for certain services. So a little bit more flexibility with those type of plans. Then we have private fee for service plans, typically offering more flexibility in choosing providers than other types of plans do. In general, you can get care from any Medicare approved provider who accepts the plan’s terms and conditions. And then we have Medicare Savings Account plans, which combine a high deductible health plan with a medical savings account. They generally offer more choice with more financial risk. Here are some additional things to know about Part C. You must be enrolled in Part A and B to be eligible for a Medicare Advantage plan. You must also live in the plan service area, and you can’t be denied coverage. It’s easy to get confused by this. The plan provides part A and part B coverage, but you still need to enroll in parts A and B. That’s the question. Importantly, unlike original Medicare, Medicare Advantage plan has an annual out of pocket maximum for Part A and B services covered by the plan. Once you pay this amount, the plan covers the entire cost for these services for the rest of the year. Now let’s move on to Part D, Prescription Drug Coverage. An easy way to think about the D is ‘D’ is for drugs. Remember, drugs are not covered by original Medicare except in select circumstances. You can get drug coverage in two ways. You can get it through a separate standalone Part D or through a Medicare Advantage plan as we just discussed. Each Part D plan or Medicare Advantage plan that includes drug coverage creates a list of specific drugs that will cover. That’s called a formulary. Each plan has its own list of covered drugs. Plans also cover all vaccines, like the shingle shots that aren’t covered by Part B. Part B covers things like flu and pneumonia shots.

Many Part D plan groups the drugs they cover into levels or tiers. Drugs in different tiers have different cost. The higher the tier, the higher the cost of the prescription. Now let’s take a minute to talk about the different Part D cost stages, especially the Part D coverage gap, commonly known as the donut hole, since this may be the most confusing for people. Now there are four Part D coverage stages. The stage you’re in determines the amount you pay when you fill a prescription. You begin in a deductible stage. If your plan has one where you would pay the full cost of your drugs, or in the initial coverage stage where you usually pay a copay. If your drug costs reached the limit for the initial coverage stage, then you would enter the coverage gap or the donut hole, where you would pay a greater share of the cost of drugs, typically 25% for generics and 25% for brand name drugs. Not everyone enters the coverage gap. If you do and your drug costs reach that limit, then you enter the catastrophic coverage stage and you pay reduced copays for the rest of the year. Then the cycle starts over in January. A few final points about Part D, you are eligible to join a Part D plan once you are enrolled in Part A, Part B, or both. Plans often have pharmacy networks that you need to use to get the plans pricing. Plans may vary a bit in terms of what specific drugs they cover and what your costs may be. And a final key point is that you could be charged a premium penalty if you are late enrolling in Part D unless you qualify for a special election period. Now we come to Medicare Supplement Insurance, or what is often called Medigap.

Medicare supplement insurance plans, which are also offered by private insurance companies, are different from the plans we’ve discussed so far. As the name says they supplement Medicare. Medicare supplement plans help to pay some of the out-of-pocket costs that come with Medicare, like deductibles and coinsurances. They can only be used with original Medicare and not with Medicare Advantage. You can only have one or the other. Plans are standardized by the federal government. There are 10 plans labeled with letters. It’s also important to note that Plans C and F are only available to individuals who are eligible for Part A or turned 65 before January 1, 2020. Here are some of the costs that Medicare supplement plans may help with and some that they may not. Medigap plans can help with Part A deductibles, original Medicare copays, coinsurance and provider excess charges, cost of transfusions and cost of foreign travel emergency. Except for foreign travel emergency coverage, Medigap plans don’t fill in for what Medicare doesn’t cover, such as prescription drugs or dental and vision care. So this table here may help you visualize the main point here is Medigap plans vary. There’s 10 different plans. They all cover different things. Now for some fast facts. You must be enrolled in both Part A and B to be eligible for a Medicare supplement insurance plan, and you may choose from the plans offered in your state. Also, there’s a set enrollment period where you can’t be denied or charged more for based on your health history. We’ll talk more about this in a minute when we cover enrollment. Medicare supplement insurance coverage is nationwide and goes with you wherever Medicare- or original Medicare does. Each plan sets its own premium. The amount can vary, even for the same coverage. In general though, the broader the coverage, the higher the premium. And finally, you must continue to pay the Part B premium to Medicare. So now let’s talk about Medicare cost. We’ll start with some definitions. Most people are familiar with premiums, deductibles and copays, which are defined here. Coinsurance may be less of a familiar term. It’s an amount you pay when the cost of a covered service is split with you. It is determined by percentage. For example, the cost of services is covered 80% and you pay the remaining 20%. Finally, if you choose a Medicare Advantage, Part D or Medicare supplement insurance plan, there are the costs you may pay for each. Costs will vary by plan and by provider.

Let’s start with Medicare Advantage or Part C plans. With Medicare Advantage, some plans have low to zero dollar premiums, some plans have deductibles and others do not. With Part D prescription drug plans, you may have a monthly premium, deductible, copay and coinsurance amounts. Part D plan costs will vary by plan and by provider. And finally, Medicare supplement insurance plans or Medigap plans may charge a monthly premium and also have high deductibles and copay amounts. So we have covered a lot. Hopefully you have a basic understanding of the different parts of Medicare, Medicare supplement insurance and the cost you could pay. Now what? Well, you get to put the different coverage options together to meet your needs, like this slide here. There are seven combinations. Now that we’ve covered the coverage options, let’s go back to the graphics we looked at earlier only as a one whole picture. Step one is to enroll in Medicare program. Again, original Medicare consists of Part A and B, and it’s provided by the federal government. Step two is where it gets interesting. Here you decide if you want more coverage than original Medicare provides. If you do, like we saw in the previous slide, you have two options. Option one, add plan to original Medicare. Or option two, choose a Medicare Advantage plan instead. You can get Part B coverage with either option. So the choice when looking at additional coverage is really between Medicare supplement insurance and Medicare Advantage. So let’s look closely at this. Let’s think about this choice in terms of coverage, costs and convenience. Coverage, provider choice is one of the main considerations between these coverage options. Medicare supplement insurance help pay for care from providers nationwide. Medicare Advantage plans generally have provider networks, and each serves as a set of geographic area. Cost, both options help manage costs, but in a very different way. With the Medigap plan, you pay higher premiums than with a Medicare Advantage plan, but other costs may be lower. With a Medicare Advantage plan, you pay copays, but the premiums may be low and you are protected by an out-of-pocket maximum. Convenience, many people who opt for a Medigap plan also buy a Part D. Again, prescriptions. With original Medicare, that’s three different plans. With Medicare plans, it’s usually just one. Now, once you decide on your coverage, you’re ready to enroll. So let’s explore the different enrollment periods. Most people first enroll in Medicare during their initial enrollment period, also known as IEP. The IEP is a 7-month long enrollment window. It includes your 65th birthday month, plus the 3 months before and the 3 months after. You are enrolled in Medicare Parts A and B automatically if you’re receiving Social Security. You’ll get your card in the mail. Otherwise, you need to sign up yourself online, on the phone, or at your Social Security office. During your initial enrollment period, you can also enroll in additional coverage, Medicare Advantage Part C, prescription drug plans Part D, or Medicare supplement insurance. A final note, you may refuse or delay Part B enrollment and just take the premium free Part A. This may be a good idea for people who have employer or other credible coverage, people that are continuing to work. It’s important to pay attention to the timing of enrollment to avoid late penalties. We’ll talk more about the penalties in a minute. If you miss your IEP, don’t panic. You have another chance to enroll, called the general election or enrolment period, known as GEP. The GEP is January 1 to March 31 every year. You can enroll in part A, part B or both. Late enrollment penalties may apply depending on your timing. Again, we’ll look into that in a minute. You must be enrolled in both Part A and B to be eligible for a Medicare supplement insurance plan. You are not subject to medical underwriting for 6 months after you enroll in Part B at age 65 or older. You can still apply for a Medicare supplement insurance plan after this time period, but you can be denied coverage or charged more based on your health history. We talked about working past 65 a bit earlier and how you may be able to delay. If you qualify, Medicare provides a special elect enrolment period for people who work and have employer coverage past age 65. You have 8 months to enroll in Part A. Not Part A, I’m sorry, it’s Part B, and Part A if you haven’t already. You may enroll in a Medicare Advantage or Part D prescription drug plan within the first two months. It’s important to pay attention to this timing. As what we mentioned, both Part B and Part D charge late enrollment penalties. The Part D enrollment deadline is especially important since it happens quickly and can sneak up on you. One more thing, make sure your employer provides you with proof of credible drug coverage. So we’ve mentioned penalties a number of times. Let’s take a closer look at them. So part A, part B and part D may charge late enrollment penalties. The Part A penalty doesn’t apply to many people, since most of us get Part A premium free. But for those who have to pay, the penalty is an additional 10% of the premium amount. The Part B penalty is an additional 10% of the premium for each 12 month period you could have had Part B but didn’t, unless you qualify for a special election period and you pay the penalty for as long as you have Part B. Now, the Part D penalty is an additional 1% of the current average plan premium for each month you’re late. You pay the penalty for as long as you have Part D as well. Long story short, hopefully you enroll on time and with no late enrollment penalties. Medicare is not a one and done decision. Things may change in your life, your health, your finances. So it’s important to review your coverage every year. You can change your coverage choices if you decide to during Medicare annual enrollment period, which is October 15 to December 7 every year, so the new coverage goes into effect on January 1. The kinds of changes you make here are listed. The Medicare Advantage Open enrollment period is specifically for Medicare Advantage plan members and runs from January 1 to March 31. You must be a member of Medicare Advantage plan on January 1 to be eligible for this enrolment period. During this time, you may switch to a different Medicare Advantage plan or drop a plan and go back to original Medicare Parts A and B. If you return to original Medicare, you may also enroll in a Part D plan until March 31. You may enroll in a Medicare supplement plan as well. You may only make one coverage change during this enrollment period. The next opportunity is the Fall annual enrollment period, unless you qualify for a special election period, which is October 15 through December 7. Okay, so this Medicare offers a special enrollment period for qualifying life events. Certain situations, like moving to a new home or healthcare coverage, or changes to your healthcare coverage, can qualify for a special enrollment period. In most cases, you have two months from the date of qualifying event to make coverage changes. Now, during a special enrollment period, you may switch or drop a Medicare Advantage or Part C or prescription drug plan Part D, but you can’t switch from original Medicare to Medicare Advantage plan. Now, we’ve talked about your Medicare coverage options, the cost you may have in enrolling. Now let’s talk about- a bit about ways to help save money. Medicare covers a range of preventive services, many at no additional cost to you. Learn what they are and take advantage of them. You may also be able to save money by choosing your provider from within your plan’s network if you have one. If not, make sure that your provider accepts Medicare assignment and won’t charge you beyond what Medicare will allow. Ask your doctor or pharmacist about ways to save. You may be able to switch to a generic or other low tiered drugs or get a better price by using a different pharmacy. And always, always, if you are in the hospital, ask whether you are inpatient or there for observation. It makes a difference on how your care is covered and how it may impact on your cost. If you need it and you qualify, you may be able to get help paying some health care costs. A good place to start is your state health insurance assistance program or SHIP office. S H I P. You can find that number at shiptocenter.org or by calling Medicare at the number shown. Now where can I go for help? We’re with you today because at United Healthcare we’re passionate about helping people have everything they need to make informed Medicare decisions. You can find us online and get regular updates by signing up for a newsletter and following us on social media. You can also find helpful information at Medicare.gov, the official government website for Medicare or you can call Medicare at the number listed here.

1-800-Medicare and our last slide. Thank you so much for your attention. We’ve covered a lot today and I can answer any questions you may have.

Andi: Diane has been doing a fantastic job of answering people’s questions on the back end but I want to make sure that we cover some of those on video as well so that we can get those for the people who watch the replay of this. So I’m going to just go through and Diane if you want to join us and you can help us answer these questions. Again, for the benefit of people watching the replay. I’ll start off with “How do you know if your health plan coverage under your employer is creditable so that you can delay?”

Diane: That’s one thing that they may direct that question to their HR department. They would be able to answer that. It basically has to be comparable to Medicare, equal or better than what Medicare provides.

Andi: “If a person is 65 plus and has a retiree employer healthcare coverage and they also have Medicare and Medicaid coverage, should they keep the retiree employer health plan?”

Jeff: Good question. So the Medicaid is something that’s separate, it’s through the state and that pays for any excess charges that your plan may not cover. So essentially that could be copays or coinsurances.
So it could actually work together for you.

Andi: “I retired with military and have TRICARE. In a few years I will be getting TRICARE for life and Medicare. Should I get Part C, Medicare Advantage and/or a Medicare supplemental plan?”

Jeff: Yes. Another good question. So since TRICARE for Life is already like a supplement to your Medicare. There’s only one type of plan that Tricare for Life members can enroll into. They’re called MA Only plans, Medicare Advantage plans without the Part D. So they’re specifically designed for people that have VA coverage or people that have another source of prescription drug coverage.

Andi: And then I think that also answers the question, “Do I need more than Medicare as my primary and Tricare for Life as my secondary?”

Jeff: Yeah, with just traditional Medicare and Tricare for Life, you don’t get a lot of the bells and whistles with Medicare. Primarily out of the country coverage, vision, hearing, possible dental plan, chiropractic coverage, acupuncture, gym membership, these are all things that you can add on through a Medicare Advantage plan that will work with your Medicare and TRICARE for Life.

Andi: “While retired federal workers must take A and B, is it a fact that some Advantage plans will pay my premium back to me?”

Jeff: Absolutely. Those are called rebate programs. There are several plans that will give you that buyback or give back is what they call it.

Andi: “My husband has Kaiser as a retired firefighter. I can get Kaiser’s Medicare Advantage plan, but isn’t that limited to states that have Kaiser?”

Jeff: That is correct. That’s one thing that you’ll want to investigate and do some research on because Kaiser is not a national plan. They’re in selected counties and selected states.

Andi: All right, let’s see, “One slide indicated if you are working beyond age 65 and you have creditable coverage, you may still want to apply for Part A. Help me understand why.”

Jeff: Because you’ve already paid into the payroll through your payroll taxes. At that point, once you work a number of 10 years or 40 quarters, Part A is given to you for free.

Andi: All right. “How do you coordinate ending HSA when signing up for Medicare, in order to avoid fees and penalties from the HAS?”

Diane: You want to talk to your HR benefits people for that.

Andi: Okay. Rhonda says, “Do you have examples of what the specific costs are?

Diane: Specific costs?

Andi: Rhonda, I think we need a little bit more specificity about which costs you’re referring to. Let’s see, “I turn 65 this December, assuming I enroll in original Medicare, plus choose a supplemental plan and Part D plan before my birthday, when do each of my plans become effective?”

Diane: On the first of your birthday month. So it’ll be December 1. So we’re actually in your what we call initial enrollment period at this time. And so this is the time that you can start enrolling to Medicare. Again, if you’re collecting Social Security now, you should have already received a card. If you’re not, you’ll have to go online or contact the Social Security office to enroll.

Andi: “Does Medicare cover when traveling overseas on vacation?”

Diane: No.

Andi: Good to know. I’m sorry, Diane, did you want to jump in there?

Diane: Yes, thanks. I was just going to say Medicare doesn’t, but Medicare Advantage plans do, and some Medicare supplement plans do as well.

Andi: Excellent. “Can you talk about family maximums? Is there any way around it?”

Jeff: Family maximums. Is that like- may be out of pocket maximums?

Diane: I was thinking or deductibles? It sounds like this would be a non-Medicare plan, on a non-Medicare plan.

Andi: All right. “When you buy a Medicare gap policy, do you have to stay with the same company? And if you went to change the company, what are the pros and cons?”

Diane: That’s a good question. So all of these plans like this are all standardized? All 10 of them. Now there’s a lot of different carriers that represent Medicare supplements. They have a totally different enrollment period from Medicare Advantage and Part D. So in this case, when you enroll into a Medicare supplement plan, you can change to a different Medicare supplement plan within your birthdate rule. Meaning 30 days before your birthday and 60 days after your birthday is your enrollment period where you can change. It’s a lot different- a lot different from the other components of Medicare.

Andi: Let’s see, “I’m on Cobra and have an HSA from my past employer. Is there something that I should be aware of so that I don’t lose the funds in my HSA?”

Diane: Well, you know, Jeff, I think the way I would address this question is you can’t have an HSA and an individual Medicare and keep it when you have an individual Medicare plan. So it might be something that you talk to Pure Financial about in terms of maybe how to roll that over into an IRA or do something else with it. Figure out your best option for your Medicare coverage, and then you can determine what to do with the HSA.

Andi: “Is there an out-of-pocket maximum on Medigap plans?”

Diane: No, no out of pocket maximum.

Andi: “What about premiums?”

Diane: They do have premiums, though, and each letter does cover an amount that Medicare doesn’t cover. So the plans typically that are more expensive a month would cover generally most of what Medicare doesn’t cover that you would have to pay. Right. Medicare Advantage plans, though, do have out of pocket maximums, so you know just how much you’re going to pay for all Medicare coverage services. So that’s kind of the nice part about Medicare Advantage plans. There’s more predictability and costs.

Andi: “What is the best way to decide between a Medigap and supplemental or Advantage?”

Jeff: That’s another really good question. That’s where I would have to actually sit and talk to you about your specific lifestyle, your health, if flexibility is something of importance, because the biggest Advantage supplements have is being able to go to any doctor, but that is at a cost.
These premiums are a lot higher than what Diane mentioned, the Medicare Advantage plans, which are essentially offered for $0 in most cases. So, yeah, grab my email and give me a ring and I can assess that for you.

Andi: And just to confirm, Jeff, is your email still Jeffrey.Riego@gmail.com?

Jeff: Yes.

Andi: I still have your contact information from last year. So I was going to put that in the chat.

Jeff: That’s it.

Andi: Okay, I’m going to put that in the chat right now for everyone. If you would like to contact Jeff for more information about Medicare plans and what works best for you, that is the place that you can contact him directly. And let’s see, we’ve got a couple of more questions. “Do you have an example of the costs of the supplement plans?”

Jeff: They range. It also ranges depending on your age. So these are the type of plans that have one common characteristic. The older you get, the more expensive these plans become. Now on top of the premium you pay, you also have to pay separately for Part D, which is another expense that you will have to consider every month. So you’ll be enrolling into 3 different plans, Medicare, a supplement and a Part D.

Andi: “What does a contracted provider differ than a participating provider?” I guess that’s, “how does a contracted provider differ from a participating provider?”

Jeff: Do you understand that question?

Diane: Yeah, I think it would be one in the same. So Medicare Advantage plans contract with participating providers to provide the medical services. So in exchange, the way it works is in exchange for agreeing to see doctors within a specific provider network, like Scripps Clinic for example, or Sharp Rees Steely, that’s when Medicare consumers receive all of the extra benefits that Jeff mentioned at very, very little cost out of pocket. That’s really how Medicare Advantage plans work. Whereas Medicare supplement plans do cost more, but they give people the freedom to see any doctor that’s contracted with Medicare.

Andi: And I do want to mention because a number of people have asked again, yes, we are going to be making both the recording and the slide deck available for you to watch and download on demand. You’ll want to keep an eye on your emails. We will be sending that out within the next couple of days. If you both can stick around, we’ve got a number of other questions to answer.

Diane: Sure.

Jeff: Of course.

Diane: Andi, I see that one about asking for different examples. The prices do range. I think if I can just state maybe a range. When you are 65 coming into a Medicare supplement plan, the cost can be anywhere from- and it depends on how comprehensive a plan you select too. So if you go with a more comprehensive plan that covers more services could be anywhere from $150 to $200 a month. Plus if you want to have coverage for your prescription drugs or Part D coverage, then you would need to add another plan to cover that and that could range anywhere from $10 dollars to $100 depending on your prescription drug needs. Compare that with what Jeff mentioned, which is a zero monthly plan premium for Medicare Advantage plans which cover hospital, medical, prescription drug costs, and more. It just depends on what you’re looking for and if the doctors you want to see are participate in the plans. So kind of just the basis of comparison there.

Andi: “If I live in Riverside County, but all of my doctors are in San Diego County, then Medicap would be a better plan for me than Advantage. Right? I don’t want to change doctors.”

Jeff: Yes, Medigap would be a better plan for you simply because Medicare Advantage plans are designed for a specific county. And so our plans here in San Diego County are different from those offered in Riverside County. You do have to be a resident of that county in order to enroll into the plans in the given county. So if you wanted to continue to see your doctors at San Diego, you would need to have a physical address here in San Diego to make that work.

Andi: All right, “Just double checking, if I’m currently working and covered by an employer plan, as is my 70-year old husband, is there any reason for either of us to enroll in Medicare now?”

Jeff: Currently working. No, actually- well, I can help you with this. Generally when people are still working, they don’t need to enroll to Medicare. However, if you want to compare the cost with staying on an employer plan, I have experienced that employer plans have generally gotten more expensive within time. They’re not the same cost as what they used to. So if you want to compare that with possibly getting off that plan and saving those premiums that he pays through his paychecks, I can put together how much it would cost for you if you were to utilize your Medicare.

Andi: Excellent. “Is the star rating for Medicare Advantage plans being discontinued?”

Jeff: No, not that I heard of. Right, Diane?

Diane: That’s right. It’s still in effect. Correct.

Andi: Okay. “If you have an Advantage plan that covers drugs, do you need Part D?”

Jeff: You only have one. So Medicare Advantage plans will typically have a Part D or not have one. And so you can’t have another Part D on top of that. It will actually delete whatever plan you’re on by enrolling into a Part D. Don’t do it. I have had some clients do that and they lose their coverage.

Diane: So if you have Part D coverage, you’re all set as long as your drugs are covered on the drug formulary. So that’s something to assess every year as well to make sure that there are no changes. And Jeff can help with that too.

Andi: “We live in two locations, San Diego and Kansas City. How does that impact using Advantage?”

Jeff: You’re a good example of a client I actually have that lives in New Mexico 6 months of the year and 6 months here in San Diego. It’s a little bit more effort on her end. However, it’s possible. All she does is she calls me a month prior to her move in back to San Diego and I relocate her plan to a San Diego plan and upon leaving back to New Mexico, I would re-enroll her back into a plan in New Mexico.

Andi: And then again, this is your opportunity to ask questions about Medicare. If you have anything that you want to get answered, now is the time to put that into the Q and A. We have another question. “The presentation included that we should review our plan each year. What is the best way to look at what is out there yearly?”

Jeff: That’s a good question. I think Medicare.gov would be a great way to kind of compare all the plans in your area, but also outreach to an agent like myself who is groomed to handle these things. At this time,
the next couple of months is my busiest time and that’s when all my clients or most of my clients, get in contact with me to reevaluate the present situation.

Diane: Yeah, it’s a time when all the plans make some changes. So it’s just a good opportunity to review what you have and make sure there’s no reason to make any changes. And if there is, as Jeff indicated, he can assist with that. So sometimes nice just to have that peace of mind that you are in the plan that you should be in, or if there is a need to make a change, that you have a way to accomplish that as well.

Andi: Jeff and Diane, is there anything else that you would like to share before we wrap this up today?

Jeff: Good. I’m good on my end. Oh, there’s another question.

Andi: Oh, OK. “My husband is on hospice for dementia. UHC won’t cover expenses for his diabetes.”

Diane: So I think, Carol, what we should probably do is just have you follow up with Jeff to take a look at what plan he’s on because we do have a plan specifically meant for people with chronic conditions such as diabetes, chronic heart failure, and cardiovascular diseases. And in fact, we participate in the Part D Insulin Savings program, which means that any insulin drugs that are part of the senior savings program, on that plan in particular, are covered at a zero cost, on all other plans at a $35 copay. So I think there must be something going on there that we’d like to dig into more. So yeah, if you don’t mind reaching out to Jeff, I think that would be great.

Jeff: Sure. Yeah. I have an open day today. I set a lot of time for this particular presentation. So if you guys would like to I’m reading another question here. “Should I reach out to Jeff?” Give me a ring. Andi, I believe put in my information there. If you like to talk right after this, give me a ring or shoot me an email.

Andi: Yep. Okay. And then let’s see. We’ve got another couple another question about living in two places. “I have original Medicare and a supplemental D and F. I am living in San Diego now and soon in going back and forth to Montana. Do I need to change anything?”

Jeff: Again, that supplement plan and Part D, it sounds like you’re using that to its full capacity. I mean, that is the type of plan that allows you to go back and forth as long as you’re okay with that premium. That’s something I’d like to reassess for you, see if that’s financially a sound decision for next year. But the type of plan you’re on, it’s a plan for your situation. Absolutely.

Diane: And the other thing, Andi if you just don’t mind me jumping in after Jeff-

Andi: Of course.

Diane: – is that I think a lot of times too, it depends on how long you’ll be out of the area that determines whether you should go the Medicare supplement route or the Medicare Advantage route. Generally anything after more than 90 days you probably want to look at a Medicare supplement plan. Anything less than that, you would be okay on a Medicare Advantage plan.

Andi: Okay. Let’s see. “I’ve heard that it’s better to enroll in a PPO type plan in the beginning in case you get a serious illness. You won’t be able to then enroll in a PPO type plan later. Do you agree with that?”

Jeff: I think what Rhonda is referring to is the supplement plan, right? Yes. So within the supplement plan, you are guaranteed as long as you enroll within the first 6 months of turning 65 or obtaining your Medicare Part B. After that 6-month window, insurance carriers can decline your enrollment based on your health records. However, with Medicare Advantage plans, you’re always able to go on Medicare Advantage plans, as long as you have Medicare A and B and live in the service county that you’re living in.

Diane: Right.

Andi: We got another question. “What question should I ask from Kaiser about it not being nationwide?”

Diane: And I think Chris is asking this from a question I answered previously. So it is true that, you know with Kaiser you need to see Kaiser doctors and go to Kaiser hospitals. I don’t know if Kaiser contracts with community physicians or hospitals in other locations, so that might be what you can explore. But as a general rule, if you’re a member with Kaiser, you would need to go to Kaiser facilities.

Andi: And then at this point we have one more question. We only have a few more minutes left. So if you do have any more questions that you would like to ask about Medicare, now is the time to put it into the Q and A. “What about cancer drugs?”

Jeff: Yes, cancer drugs can be obtained two ways. They can actually use the Part B of Medicare, which is the medical. Usually those are in circumstances where you need to get something intravenously, where they take you to an outpatient facility, or you can also use your Part D. Keep in mind that Part Ds also have formularies. So I’d have to look at what specific drug that is in order for the prescription to be covered by the Part D as in drugs.

Diane: Right. So Jeff has the ability to look up each drug individually to see how it would be covered either under part B or under Part D. And then I see Rhonda’s question about hearing that supplemental plans are more like PPO plans and I think we hear this question a lot. Just to clarify, Medicare supplement plans are true insurance plans, whereas PPO plans are actually a type of Medicare Advantage plan. So they are very different in that PPO plans still have provider networks so there’s InNetwork and out of network, so they work very differently. But the one common thing is that they allow members to go to the doctors they wish to go to. There’s an out of network component to a PPO plan as opposed to an HMO plan. But again, with a Medicare supplement plan there is no network. You can simply go to any doctor that’s contracted with Medicare and it’s portable. You go anywhere in the nation.

Andi: Excellent. I think we are just about to the point where we’ve gotten all the questions answered that we can in the time frame that we have allotted. If you have more questions, then go ahead and reach out to Jeff directly. His information is in the chat. To learn how decisions about Medicare costs, Social Security benefits, investments and taxes impact your overall retirement plan, we strongly encourage you to schedule a free financial assessment with one of the experienced professionals at Pure Financial Advisors. They are a fee-only fiduciary and there’s no cost and no obligation. Just click the link in the chat to schedule that assessment at a time and date convenient for you. And that is all we have time for today. Jeff and Diane, thank you so much for taking the time. We really, really appreciate it.

Jeff: Thanks for having us back, Andi.

Diane: We appreciate it, Andi. Thank you a lot.

Andi: Everybody have a great day. Thank you so much for joining us. We’ll talk to you again soon.

Jeff: Bye.

Diane: Bye.



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