Welcome, everyone, to Medicare, from A to D, Sarah Johnson. And this is a one hour class, like all of our webinars. It does provide classroom CPE credit.
There is no test required, but you do need to pay attention, and keep the presentation active on the main screen of your computer.
Along the way, we will have some attendance checks that you’ll need to respond to.
Those can come in 1 or 2 formats, you may see a poll pop up on your screen, in which case, you’ll just need to respond as quickly as possible, And then I will share the results with everyone, or I may ask you an open-ended question.
In that case, you’ll need to chime in the Question or chat box, on your GoToWebinar control panel.
I will read, what some of the responses, but I won’t share your name or do anything to embarrass you.
So please do be as honest as possible with your responses.
I think sometimes it does help to hear what others on the call are thinking.
You may, you know, here are some good questions as a result of that, or you may, you know, kinda just be able to compare yourself with the, with others in the markets. I think that is beneficial. If you have any questions along the way, you can also type those into the question or chat box.
However, though, sometimes get mixed up with the attendance check. So, if I don’t respond to you during the call, I will try to respond within 24 hours, or you can send me an e-mail, eric, at comedy …
dot com, or a text message.
If you want to write down my number, it is 8 1 7, 366-7536, so you can reach me. Either of those ways. If you do techs, please include your name, so I’ll know who I’m responding to.
You do probably see there on your screen, it says $5 fee.
Instead of comedy E, I actually did, last year, set up, a separate company, has had the Bright Idea, are running, you know, two to CE provider companies at a time, and it just confuse everyone.
So, what I’m doing, blending in the courses that we had approved under the other provider name, just into our, our CE offering this year.
So, on your CE certificate it, or if you go into …
Con, and you see your CE credits, this one will show up as $5, CE being the CE provider.
So, today, we’re going to be talking about Medicare Specifically, Parts A, B, C, and D of Medicare. It’s kind of a basics course or an intro course, for those of you who are unfamiliar with Medicare, for those of you.
Maybe already sell medicare related products.
Medicare Advantage plans Medicare part D plans or Medicare supplements.
You probably won’t learn a lot of new stuff in this course, but some time Hearing a basics course Gives you some ideas about ways that you can Explain some of these complex topics to your clients.
You know, they, they, even if you’re not a, you know, a newbie to Medicare, they very well might be, and, and so, learning how to dumb it down a little bit, Share it terms that they can understand, maybe beneficial.
We thought we’d be mine, my hope, for you, for the class.
So, let’s go ahead and dive into this.
We’re going to, we’re going to go in alphabetical order here, starting with Medicare Part A So, you know, we hear a lot about single payer system country.
The fact is, Medicare is a single payer system, four, seniors, pretty much. Basically, it’s a federal health insurance program for people aged 65 and older.
As well as people who have been on Social Security disability for at least 24 months and people with end stage renal disease, which is kidney failure, requiring dialysis.
So, um, especially for people over 65, no, Medicare is most people are signed up for Medicare.
Those who are still working might be on their company’s health plan, but the vast majority of people over age 65 are on Medicare.
That’s when we say if a single payer system is the reason you hear Medicare for all proposals, because those who would like to expand Medicare really are, would like to see a single payer system in this country recognize that we kind of already have it, for at least a portion of the population.
It’s been around for awhile since 1965.
It was signed into law by President Johnson.
And today, the majority of non working seniors age 65 and older are covered buy the program.
So, it’s funny to me that, you know, so many people on the insurance business and so many people just in general are kind of unaware of how Medicare works, given that most of us will probably have Medicare coverage. At some point in our lives.
You know, it’s something that is universal at least at a point in our lives and still people are fairly uneducated about, you know, all the different parts of it and how they work together.
So people are still uneducated, like I said, for an insurance program that’s been around for more than 50 years, and it covers more than 44 million people.
You would think that people would be very familiar with the program, that is not the case, too many seniors, as well as the younger people who often help them with their insurance decisions.
They don’t know much about Medicare. They don’t know how it works or what their options are.
But, as I said, that’s also true for agents who don’t specialize in medicare related products. So if you don’t sell medicare related products, you might be wondering, well, is this class worth my time?
I would say absolutely, because there are a lot of people that work past age 65, and have the option of being on the group plan.
Or, going with Medicare. They might ask you some questions about it.
You don’t wanna get too in the weeds with them, but you also no, don’t want to, don’t want to be obviously confused by the question.
I think that if, if, you know at least the basic, that can certainly be beneficial.
So, that’s what we’re gonna do in this class.
We’ll get you up to speed on how the different parts of Medicare.
So, there are, as I said, four parts to Medicare.
Part A is what they call hospital insurance, and Part B is what they call medical insurance.
Essentially, Part A covers your hospital facility costs, Part B covers most of the rest of the stuff that covers the doctors in the hospital, as well as all your outpatient.
Stop. There are a few other things covered under Part A, and I’ll show you those in just a moment.
But, um, but think of Part A, mainly as the facility charges in the hospital, or not in a skilled nursing facility, Part C of Medicare.
Not really a separate part. I mean, it’s called part C, But really, it’s an option where you can combine your Part A and B benefits and receive them through a private insurance company.
That’s called an Medicare Advantage Plan. Those plans usually also include Part E, which is a prescription drug plan.
So, those are the four parts of Medicare, Original, Medicare, as Part A, and B, That’s what’s been around.
Since 19 65, Part D, drug plan wasn’t added until, well, was signed into law in 2003, was actually added as an insurance benefit, 2006. So, it’s still relatively new.
And an advantage plans have been around for awhile, but they’re basically a way of receiving those Medicare benefits from a private insurance company rather than from the government.
We’re also going to discuss Medicare supplements or Medigap plans in this class.
They’re called Medigap, because they help to fill in some of the gaps or the holes in your original Medicare coverage.
So a lot of people, instead of going with an advantage plan, which is one option, they’ll stick with original Medicare and get a supplement to fill in the holes.
So we’re going to finish by talking about Medicare Supplement.
As I said, this is a one-on-one level course. It’s sort of an introductory class that’s meant to provide you with the basic information that you need about, a program that many of your clients will be eligible for, you know, sooner or later, right.
So, you will still have more to learn after this class, if you want to be able to properly advise clients, but at least you’ll have a fundamental understanding of the different moving parts. Here’s what we’re going to talk about.
In each segment.
We’re going to start off by talking about how you qualify for that type of coverage, what the cost looks like, what it covers, and what your cost sharing requirements would be as a Medicare beneficiary.
That’s what they call A, know, Medicare recipient. Instead of calling them a member, they’re a beneficiary.
And then, we’ll talk about how you actually sign up for the different parts of Medicare.
So, again, starting up, medical order will, will begin with Part A or your hospital insurance.
So, basically, anyone who is age 65 or who has been on Social Security disability for two years is eligible for Medicare Part A So, becoming eligible for Part A, is that the hard part? Getting on Social Security disability is the hard part, but once you’ve been on there for two years, then you can sign up for Medicare Part A.
If you turn 65 and you are already receiving Social Security benefits, then your enrollment in Part A is actually automatic.
They’re going to send you a card about three months before your 65th birthday. Those who are not receiving Social Security would need to apply for Part A if they want it. So, it’s not going to be an automatic enrollment for them.
It is possible to delay Part A If you’re maybe still working or you’re married to someone who’s working your own employer based health insurance and you want to continue on that, you can delay your part A coverage, if you want. Now, if you were working and you had a co-pay plan, there wouldn’t be a lot of reasons to delay Part A because there’s not a negative and in fact, it could actually help you because it might lower the deductable amount you would have if you had a hospital.
But if you were on, say, an HSA plan because Medicare A or B would disqualify you from HSA eligibility, you might decide that you want to postpone your part A.
So, you can continue to contribute to an HSA as well as take any employer contributions that the company makes to your HSA, but you can only do that. You can only delay Part A at age 65.
If you are not receiving Social Security, if you, when you turn 65, if you have qualify for what they call Premium Free Part A, which I’m going to talk about in just a moment, then you are allowed to postpone it without any penalty.
But if you are receiving Social Security, you can’t do that. The reason for that is Congress actually fed way back in 19 65.
That Part A, is mandatory for people who are receiving Social Security benefits. So the two programs kinda work together. And you can’t declined Part A and don’t receive Social Security. If you decided you wanted to postpone your part A, you’d actually have to stop your Social Security benefits and the way it will work. You actually have to pay back what you’ve already received.
So, most people aren’t going to want to do now if you are not receiving Social Security, and you want to postpone your part A, if you qualify for the Premium, free Part A, and think you could do that.
If not, you don’t qualify for premium free part A, and you delay it. You don’t sign up when you’re first eligible at a funny thing.
When you do, finally, you’re going to pay a 10% penalty, so 10% of your monthly premiums, and it’s going to continue for twice the number of years that you don’t lead you’re You’re part A So, if you’re basically, if you’d have to pay for part A, you should sign up at age 65, rather than postponing it.
So, what am I talking about with this premium, free stuff?
Well, basically, to qualify for Part A of Medicare, you need to qualify for premium free Part A, where there’s no cost to you.
You need to have worked for 10.
That means a quarter of a year, so the equivalent of 10 years, where you are contributing to the Medicare programs, You know, we, we pay for Medicare through our payroll taxes. We pay 1.4 or 5% of our and can’t be employer matches that if you’re self-employed, you pay 2.9% of your income to pay for part A during your working years.
So, when you turn age 65, if you have contributed to Medicare Part A for payroll 4, 10, or if you’re married to someone who did that, then you’re not going to pay for Part A at age 65. If you’re still working, you’re still gonna pay that 1.4 or 5% out of your paycheck that. That part is a way back.
You don’t have to pay an additional amount, for Part A.
Now, if you did not work for 10, then you actually would have to pay for Part A, the amount that you have to pay, $506 per month.
And that’s just for Part A, not for Part B Now, if you work between thirty and forty quarters, and it’s a reduced amount, is $278. But, it’s still, you know, it’s a lot of money for someone, on an extent.
And there’s an additional cost per Part E as well.
So, no, I remember, years ago, and I didn’t put it together until I was, so, I was working in selling Medicare Advantage Plans. And that’s how I got my start in, the insurance industry. But I remember my grant, Paul.
He had retired, and I remember he went back to work for a year and a half, or something like that, because he hadn’t worked enough contributing to the Medicare program two to qualify for that premium Free Part A, so he went back and worked for, for another.
Like I said, another year and a half or so to hear his 10, so that he would get that premium Free Part A.
As I said, the reason it’s premium free is because people contribute to Part A during their working Years 1.4 or 5% of their income, matched by their employer, so what is that Part A cover? What does that, 1.4 or 5% of your income for all those years get you?
Well, as I said at the beginning, it does cover inpatient hospital care, so think of that as the facility charges.
It also covers you in a skilled nursing facility that is basically a rehabilitation center where the the point is to make you better. So, you go home, so it’s not custodial care, skilled care, in a facility.
That could be in a nursing home. It could be a wing of a hospital.
It does cover hospice care.
That is for people who have a terminal illness, as well as home health care.
So, people that come and see you in your home, not for custodial purposes, but for skilled nursing, in your home, rather than in a facility following a hospital stay.
You do have some cost sharing requirements under Part A.
That’s part of the reason you need a Medigap plan or a Medicare Supplement or Separately Advantage plan because there are some holes in Medicare.
The first big hole is when you go into the hospital, you pay a deductible of $1600.
Now that doesn’t sound too bad, compared with the deductibles on some of the individual and group plans that we might sell. But that $6500 deductible is what they call a benefit period deductible. It’s not a calendar year deductible, so it can actually hit multiple times in a year.
So, if you go into the hospital, you’re treated, you’re released 60 days later, you need to go back into the hospital that would be a benefit period and you have a new $6500 deductable to pay.
Um, once you’ve been in the hospital for 60 days, you’re going to pay a co-payment.
And that co-payment is $400 per day for the next 30 days.
After day 90, you enter what’s called your lifetime reserve days.
What that means is basically you only have 60 days in your lifetime to use after day 90 in the hospitals to keep a running total of the number of days past day 90. You’ve been in the hospital during those 60 days, 91 to 150.
Your co-payment doubles to $800 per day. After day 150, you pay all of the costs.
Now, I know that, no, that’s not common, but it’s also not that uncommon, you know, there are definitely people who wind up in the hospital for several months, you know, and, and, uh, and in that case, you can run out of Medicare coverage after days, 150.
In a skilled nursing facility, you don’t have any costs for the first 20 days.
After that, you pay $200 per day up to Day 100.
And after that, you have no coverage at a skilled nursing facility.
You pay all of the, the costs.
So, um, all of those amounts that I said those are nice round numbers.
They do go up every year, this is the first year that I’ve actually seen nice, clean numbers like that.
For 2022 it was a 50 56 rather than a $6500 deductible in the hospitals at 389 versus a $400 co-payment.
After day 6778, after 90 days, And in the skilled nursing facility, 194 50, and more often than not, that’s what you see that they it’s something followed by 50 cents, you know, so they have to make it difficult to explain, right?
But I was so proud of good government this year, but says, not only did they make the deductibles and the out of pocket limits on HSAs, nice, clean numbers.
They did the exact same thing with, with Medicare Part A nice, clean numbers easy to explain to your clients as probably the only year that it will be like that.
Home health Care is covered, um, covered at no cost after a hospital stay for other things that are covered under or for other things you might need at home.
You know, like if you, if you need home health care, you very well might be durable medical equipment, like wheelchairs, walkers, hospital, beds, that sort of thing.
You pay 20% of the bill for that.
The Wiedemann is those fall under Medicare Part B So, somebody that decides to go home rather than being in a facility, you know, following a hospital stay there, they, they’re still going to probably have some cost sharing for the medical equipment. Even though the home care services home health care services are covered at no cost.
Hospice is also covered at no cost.
Now, you might pay up to $5 per prescription and other similar products for pain relief and symptom control while you’re at home.
If you need inpatient respite care, they didn’t pay 5% of the Medicare approved amount for that.
Might come through as a hospice nurse, takes a special type of person to do that, you know, to go around that visit with with people who are terminally ill all day but it’s very important job and my grandma had hospice care. So, I’m familiar with the program, you know, as a patient, but a family member of a patient, and they do a wonderful job. It’s a great service, and the fact that there is no cost sharing it does.
Let’s take a little bit of a burden off of the Family Editor, you know, at a very difficult.
So, we can someone sign up for Medicare Part A Well, the date that your coverage starts will depend on which month you sign up during your initial enrollment period.
So, if you sign up, when you are first eligible for Medicare Part A, then it’ll start on the first of a month.
But, but it’s going to vary depending on which month you sign up, and I’ll show you that in just a second.
If you qualify for premium, free part A, and you’re receiving social security, then your party’s gonna start automatically the first of the month, in which you turn 65.
Now, if your birthday is on the first of the month, the coverage will start before you turn 65, but if, let’s say your birthday is on the 15th of the month and on the first of that month, before you actually turn 65, that’s when you’re Part A We’ll start.
Here’s what I was talking about, if you sign up, if, let’s say, you don’t qualify for the premium, Free Part A where you’re also receiving Social Security.
So, you’re actually enrolling, physically enrolling in Part A either by calling Social Security, going online to SSA dot gov, or go into the Social Security office, sign up in any of those cases.
If you sign up before, the month that you turn 65, didn’t coverage will start the first of the month.
That you don’t do, turn 65.
If you sign up during that month during the month of your 65th birthday, the coverage will start the first of the next month.
If you wait a month, though.
Let’s say your birthday is in July if you wait till August, it’s not going to start September first. It’s going to start October first, so two months after.
Yes, sign up at, if you wait 2 or 3 months after you turn 65, then you’re going to be delayed three months.
So there is an incentive to go ahead and sign up when you’re eligible.
So do it for your 65th birthday because otherwise you’re going to have A waiting period there.
Now, what if you were one of those folks that decided to wait?
On Part A Maybe you’re still working, you do have an HSA qualified plan, Your employer is making a contribution, or you’re making contributions to your HSA, you know, maybe through payroll and and you want to be able to keep doing that The delay your Medicare Part A Well, that’s fine, you can do that.
You can sign up at any point later on, when you do sign up for Part A, for the Premium, Free Part A after age 65, They’re going to that date, your Medicare Part A coverage by up to six month.
So, basically, go back to six months, unless you turn 65 less than six months ago, So, so yeah, you delay.
You’re part A, and then you sign up the effective date.
Let’s say you, You wait and you sign up December the first, that’s the 12th month, they’re going to backdated to June first.
Um, no, backdate at six months, so that’s when your part A would take effect.
The coverage obviously can’t start earlier than the month that you turn 65.
Now, this is important, even if you don’t sell Medicare procs right, because if there is someone who is working past age 65 and they delay their part A so that they can stay on the group’s HSA, qualified plan, you might want to warn them.
If they, at some point, do go ahead and sign up for Part A that it is going to be backdated by six months, which will mean that they are actually eligible for the HSA for that six month period.
So, that way, they can plan ahead and stop making they’re contributions to the HSA, know, ahead of time.
Basically, you know, if you, if you lose your coverage on an HSA, leisure qualified coverage, or become ineligible, you’re eligible for Medicare.
Because you sign up for Medicare, then you have to prorate that HSA contribution based on the number of months. You actually have coverage during that year.
Knowing this rule allows people to plan ahead and contribute the appropriate amount not over control.
And that’s what this says.
So if you have an HSA and sign up after your 65th birthday to avoid a tax penalty, you and your employer should stop contributing to the HSA at least six months, before you apply for Medicare.
Um, if you’re Medicare Part A coverage overlaps, when you make contributions, you will have to pay a tax penalty.
So, important to either stop, or you’re gonna have to go back that money out of the account.
Now, another time that someone can sign up for Part A is during the general enrollment period, and so let’s say that you were not working.
You just delayed your Part A, you didn’t sign up at age 65, you weren’t receiving Social Security, benefits, are you are allowed to delay your Part A?
But if you weren’t working, you might sign up during the general enrollment period.
And if you do that, your coverage would start July the first.
So, signing up during the general enrollment period January through March, your coverage goes into effect July first.
There are some special situations as well, for instance.
No Times when, when someone might be able to sign up for part A and sign up for Part B during a special enrollment period, it’s only available for a limited time.
You’ll have a period of time to take advantage of that special enrollment period, And if you don’t take advantage of it, then then you have to wait till the next general enrollment period.
So, for instance, someone covered or a group plan, they can sign up at any time for part A while they’re covered under that group coverage.
Or they can wait until they retire and lose coverage, and they can sign up for part A All right.
So, real quick, looks like there was A question or a comment.
They were just kind of repeating some of the information about the, about the general enrollment period, so yeah, thank you for that.
OK, Medicare Part is what they call medical insurance.
It’s what they call medical insurance. Medicare Part B is going to cover all your doctor costs in or out of the hospital, as well as a lot of our other outpatient stuff. But before we get into what it covers, let’s talk about how you get it.
So basically, anyone age 65 or older on Social Security Disability can apply for Medicare Part B, but there is a monthly premium for Part B, It is not going to be premium free, like the way that the other.
Is not going to be premium free, Like, Part A, just real quick, let me, let me back up here.
Ah, they said that on the timeframes for 2023, that it actually for part A, it looks like it change.
So if you sign up during that general enrollment period between January first and March 31st, it looks like the coverage will start the month after you sign up.
So, if you don’t qualify for a special enrollment period, and you take advantage of the general enrollment period, it’s going to start a month after you sign up instead of July first. Events change wasn’t aware.
So thank you very much for, for confirming that. It looks like one other person did as well.
So, I’m going to hand over control to those folks, because they are definitely more up to speed than I am.
Just kidding. I’m going to, I’ll try to try to continue on here.
OK, so, four part P of Medicare.
Anyone, age 65 or older or on Social Security Disability can apply, but there is going to be a monthly premium. And how much you’re going to pay actually depends on what your income was two years ago.
That can be withheld from your Social Security Check or you can write a check directly to the government side if you’re receiving Social Security already.
Normally, you’re gonna pay out of your Social Security Check for Part B, But if you have not yet signed up for Social Security, and you sign up for Medicare, you can write a check to the government to pay for your Medicare Part B coverage. How much does it cost?
Well, as I said, it’s going to vary depending on what your income was two years ago.
Most people are going to pay B standard premium of $164, and 90% per month, that is down just a little bit, from 20 22 is about $170 last year.
The amount can and does change each year, for most years, anyway. You pay the premium? Eat at each month, even if you don’t get any Part B covered services. So yeah, you don’t, you don’t just pay for it, right. You don’t just pay for it with you, use it, you. You pay for it each month.
Here are the amounts that somebody might have to pay, four for Medicare.
So the standard premium for anybody making less than $97,000.
If they’re an individual filer, $494,000, their joint filers would pay that standard monthly premium of 164 90. But it’s not based on what the reason is. It’s based on your income two years ago.
So in 20 23, you would look back at the 2021 income, if that 2021 income was higher.
Between them $220,000 for an individual, or twice that amount. For a family. There is an income related monthly adjustment amount of 65 dollars and 90%. So that’s added to that standard monthly premium, to give you a new total monthly premium, up $230, and 80%. The next level up, between 123 and 150, 3000 for an individual Twice. That for a family egos at the $329.
And then 428 and 5, 2017 is out at $560 for people who make more than $500,000 a year or 750.
As joint filers, hard for me to feel, sorry for them, mainly because I’m envious by, it is a skill.
It’s a pretty good amount, and people will definitely complain to you.
But, the main point of this slide is if a client asks you, if an employee asks you, You know, how much is Medicare, Maybe they’re trying to compare their group and Medicare options, don’t just say, oh, it’s 6590 for Part B, Be sure to save it. It depends on their, their income.
Now, one important thing to know here is, and a lot of people don’t realize can feel that karma income related monthly adjustment amount determination If your income has changed.
So, if your income is significantly dropped since that time, two years ago, then you can appeal it and potentially have the premium lowered.
Oh, good. Good. Somebody just confirmed that as well.
They said recently, I’ve had several clients appeal the monthly amount that they’re being charged based on their 2021, and they show proof of what they’re making now on Social Security has been reducing the cost.
Yeah, so that is a valuable service you can form for your clients, you know, helping them, know, or at least, is, giving them the info on what they need to do to appeal that Irma determination that we just, when they based it on two years ago, is that the numbers that are going to write a meeting, in 20 23, People are just filing their 2022 taxes. But that’s not until April, and sometimes it’s October when they’re doing it.
So 2021 is the most recent filing date. Going into 2023.
You know, where they’re going to have information about what your income was. So, that’s the number they use two years ago. But, but, yeah, if your income is changed, they will, they will consider adjustment.
So, what does Part B covered?
We heard that Part A covers you in the hospital. It covers the facility charges and it covers home health care, skilled nursing facilities, and hospice, right?
Well, Part B is going to cover most of the other stuff. So, most of the services you receive outside the hospital, doctor visits.
Outpatient rehabilitation, outpatient, chemo, outpatient, radiation, dialysis, you know, durable medical equipment. Things like that are going to fall under Medicare Part.
All the doctors see in the hospital, though. They also charge under Medicare Part B, not Part A. And then preventive care as well. Medicare, especially with the Affordable Care Act. There was a little, bit, not a whole lot of preventive care and Medicare, prior to the Affordable Care Act, the ACA expanded the preventive care services that are available.
So there’s, there’s quite a bit of preventive care as well now that is covered under Medicare part B We just real quickly address a question that I know some of you might have, which is why would they design such a crazy system?
No, why separated into Part A and part B?
The reason is, back in 19 65, we didn’t really see too many, I mean, there were some comprehensive medical plans that group, the Docker coverage in the hospital coverage together.
In fact, those started hitting in the late 19 fifties, but before that, we had the Blue Cross. And Blue Shield system, right, wasn’t one company Blue Cross. Basically provided hospital coverage.
Blue Shield provided medical, or, I’m sorry, doctor coverage, basically, and so, what happened with Medicare was designed just a sort of based off of that old system, where you pay for the two parts of coverage separately. You would think that it would have evolved over the years, and they would have blended into the one, but they happen. And so people really need both parts of Medicare, but they pay for them.
They pay for them at different times.
So as I said, Part B is going to cover your outpatient charges, doctor, outpatient surgery, medical equipment labs, X-rays, chemo, radiation, dialysis, things like that, and all of the dockers at CU.
In the hospital, you also have cost sharing requirements Under Part B, They said they’re not as big as Part A, deductible isn’t as big as Part A, and it is a calendar year rather than a benefit period deductible, so you’re gonna pay upfront deductible 226 is what it is in 20 23. It was 233 last year, so, it actually went down, which is very rare.
But 226 is what you pay upfront.
After that though, you pay 20% of the bill and that 20% never ends.
Think about how big that is.
I mean, if would you sell a group or an individual health plan where you had a deductible and you had co-insurance, but there was no out of pocket maximum? I mean, most of us wouldn’t even consider that. Right.
But that’s the way Medicare works for, for your Docker charges.
So, if you had a really expensive circuit, all those Docker fees, you pay 20% of the bill never ends, right if you need it.
Maybe you’re getting outpatient dialysis or chemo or something like that.
The bill can be very high.
That 20% goes on forever. And that’s only if the doctor Excepts assignment.
If they accept what Medicare allows, as their total payment, they can actually charge up to 15% above the Medicare allowed amount. Now say they don’t accept assignment. I think the Medicare a lot of decreased by 5% or something, in that 50% is added to that.
But basically, that additional amount that a provider might charge, the member or the beneficiary would be responsible, would be responsible for.
So, when can you sign up for Part B?
Well, you can sign up, but before you turn 65, and the coverage is going to start the month, you turn 65, sign up the month. You turn 65 at all. The coverage will begin the next month.
And then there’s a delay, if you wait until after that, just like there is with Medicare, Part A For those who don’t sign up in their first eligible, they can sign up again during that general enrollment period January through March. I’m guessing with Medicare Part B, it’s the same way that the coverage now will go into effect the first of the next month rather than July first. For those who chimed in earlier, maybe you can confirm that for me.
Um, if you are waiting in signing up during the general enrollment period, there is a penalty, because you delayed enrollment. You’re going to pay a 10% penalty per year for each year, or you were eligible but not enrolled. And that penalty continues for the rest of your life.
So it is a big deal.
Somebody did confirm yes, so instead of going into effect July first, starting in 20 23, it’ll go into effect the first of the next month if you sign up during that general enrollment period.
If you have job based coverage from active employment, you can sign-up at any point for part B, or, during the eight months after you lose that job based coverage, you can sign up, and you’re not going to have that.
You don’t have to wait until that general enrollment period, but if you don’t sign up during that time, you have to wait till the general enrollment period, and you could end up paying a penalty.
Important point cobra does not count as active employment, so that means that you are going to need to it’s better not to take cobra if you are already eligible for Medicare. So you’re already age 65. You lose that job based coverage. Do you take cobra?
Then you, you know, it could last 18 months, potentially longer for attendance, and you could end up going through that.
Know that for eight months that you had to sign up for Part B, So you ended up paying a penalty because of?
So, Medicare Part C is what they call an advantage plan. Let’s go ahead and do an attendance check, since we haven’t done one, and we’ll make this nice and easy.
Do you sell Medicare Advantage plan? So, respond to the poll if you would.
Just a minute to answer.
Alright, so, my computer is good.
Looks like it is running a little bit slow, but let me go ahead and share that poll with you.
So most of you do not sell advantage plans.
And the reason I wanted to ask that is, we’re in a minute going to ask if you sell the other types of products, the Part D plans, and the supplements that will.
So, give it a moment on those, and we’ll, we’ll come back and ask that question.
Alright, so, Medicare Advantage plans.
Actually, the advantage plan is a private insurance plan that takes over for Medicare. So, when you sign up for an advantage plan, you don’t lose your, you don’t use your Medicare card in-state, you use the card from the insurance company that you sign up with. So, an Advantage plan is just a private insurance plans that is administering your Medicare benefits for you.
Advantage plans are gonna be similar to the job based or individual coverage that people under age 65 are used to.
So, basically, what advantage plan does is just going to cover everything that Medicare does. And then, Sam. And the, and then some part. That is what the advantage is.
There often extra benefits like dental invasion that are included with an advantage plan.
Also, and this is a really big benefit. An advantage plan taps the out of pocket spending that you would have annually.
So remember under Part B there is no cap on the 20% co-insurance but an advantage plan is going to have an out of pocket maximum and the fact that it does limit what your exposure is. That is a big advantage.
Sadie qualified for An Advantage Plan.
Well, you have to have Part A and B and Medicare and you have to keep paying for Part B So you don’t need to cancel it. Still have to have your Medicare.
It’s just, Medicare is paying that private insurance company to administer your benefits.
You may have an additional charge, usually it’s not very much if you have a charge at all.
Becky do have to keep paying for the Part B You do have to live in the plan, service area. There are not going to meeting medical questions that you have to answer, that’s a really nice thing with an advantage plan. It is guaranteed issue.
That’s just a cost.
It’s going to be way less than a Supplicant, we’re going to talk about supplements here in a minute, but usually zero dollars to $25 per month, premium, for most plans.
Again, you have to keep paying for Part B, so you can’t say it’s free, but, you can say a zero dollars premium, which it’s, it’s weird, you know, and people wonder why you phrase it that way, but that’s the reason, but you’re going to have more cost sharing them with a supplement. So, while it’s going to be a lower premium than a Medicare Supplement or Medigap plans, you’re going to have more caution. The reason for that is, you buy that supplement to fill in the holes in Medicare with an advantage plan. It’s going to have its own, holds its own cost sharing in the form of deductibles and co-insurance, or co-payments for some service.
So basically, Medicare Advantage is going to cover everything Medicare does, plus some additional benefits, like health plans for those under age 65.
Advantage Plans are going to have cost sharing in the form of upfront co-payments for lower cost services, like doctor visits and prescriptions. You’ll have a deductible and co-insurance for higher cost services in.
There will be any annual cap. There is a limit on how much you would have to pay.
Some of those additional perks, you hear about them on the TV, for people, like Walker and Joe, name it, and other other all celebrities. Things like dental and vision and hearing some advantage plans include gym. Membership.
Some will give you rights to the dock or some even provide some meals delivered at home, um, for you so there, there’s all sorts of extra perks with an advantage plan.
The problem with those perks, in my opinion, is, people get distracted by, you know, that that’s the reason people end up signing up. I am a firm believer that the main reason to sign up is because of the benefits you’re getting the health benefits you’re getting. So, people really need to compare the provider network: the deductible the out of pocket limit first.
Then let these perks be the tiebreaker if you’ve got two plans that are roughly tied that don’t sign up mainly because of the parks or else people can be lured into coverage that maybe isn’t the best for them.
So, when can a Medicare beneficiary sign up for it and manage plan?
Well, during the annual election period, or AEP, in the same way that we have an open enrollment period, the individual market that lasts from November, the first, now, three, January 15th, for Medicare, there is about a seven week window, tober 15 through December seven. The effective date is January, the first. People can also sign up during a special enrollment period. So if they lose job based coverage, that’s a common time to sign up for Medicare, and then also sign up for an advantage plans.
But also, if you move to a new area, no, that’s going to have new options available to you, that you can take advantage of a special enrollment window and sign up for an advantage plan.
There is a lock in period.
So when you enroll in an advantage plan, you’re generally locked in, and you cannot just enroll or change plans until the next open enrollment period.
There’s also something, or there is something called a Medicare Advantage.
Open enrollment period, it’s basically it’s during the first three months of the year, it does allow someone on an advantage plan to switch to another advantage plan one time, or to return to Original Medicare. So while there is a lock that we’re going to be, if you sign up for innovation and you’re going to be stuck in it Basically for the next calendar year, you do have a three month window at the beginning of the year, We could return to Original Medicare.
If you wanted to add, incidentally, if you have a Medicare Supplement, which we’re gonna talk about in just a moment, and you decide to sign that you drop that supplement for the first time to go to an advantage plan.
If it’s been less than a year, and you change your mind, you can go back to that supplement and get it back.
So, you know, basically, you’d be guaranteed issue for a supplement, and you’re not giving up that opportunity.
So, that’s advantage plans. Now, let’s talk about Medicare Part D plans. Same thing, I would really like to know who are cells, Medicare Part D? Now, remember, 83% of you said, No, only 17%, said, yes, you sell advantage plans, I think part is going to be lower than that. Let’s see what your responses are.
Alright. Most severe chime in, And let me go ahead and share the results here. So, it was a little bit lower. 14% of you say, yes, you sell part D plans, 86% say no reason, is, I think, you know, Part B does not pay, as well as an advantage plan. There’s a lot of options out there.
And in order to get paid for selling them, you know, broker dealers go through the certification, sell a part D plan.
And so I think that, you know, a lot of people, maybe they sell, it means plans and Part B is going to be incorporated in, or maybe they felt supplement.
And, you know, the Part B is just something they choose not to sell, you know, because it’s easy enough for people to sign up on their own.
Know, some Brokers might help with the Part D through the medicare dot gov website, but not, not, not actually be the agent would get paid on it.
The one challenge now, is, if you’re selling your manager Part D plan, you are supposed to record the phone calls, and so, that may cause even fewer people to sell those plans.
So, Medicare Part D is a prescription drug program, too.
Be eligible for it, you have to have Medicare Part A, or B, not, oh, you don’t have to have both to sign up for Part D, you have to live in the plan service area.
And every county in the nation is a service area for at least one, Part D plan. And a lot of places, there’s way more than that. The monthly average premium is just over $30.
It has not changed, should say change significantly in a number of years.
You can go to medicare dot gov and do a search for Medicare Part D drug plan. It’s pretty simple search tool. You put in your zip code type, in your prescriptions. It’s going to have all the dosage is available.
You select the right one and when you’re done adding plans, you can select the pharmacy or or more, and it’ll arrange your Part D plans, where it combines the premium and the expected out of pocket costs together and put them in order of price so that you can see which one is the best for you.
Then, if you decide to sign up, it’s a pretty simple application that you can do right there, online.
Obviously, if a broker is going to be involved, they’re gonna have a different way, You have to sign up for the part D, And it can actually, know, potentially, be a little more time intensive.
It is one thing I think the government does ride. The one thing I wish they would do is just let you enter your your, the broker name, you know, on the medicare dot gov tool.
And that would solve a lot of problems, But it is pretty pretty efficient system.
Now, under Part D, you are going to have some cost sharing.
All players are going to have formulary sets, you’re covered drug list, so they’re not gonna cover every single drug. Most plants are going to have an upfront deductible up to $505 in 20 23.
Some might have a lower deductible than that, um, but you’re not gonna see higher deductibles. Most plans have four tiered formularies. So three tiers of co-pays, one of co-insurance, but it’s going to vary.
Most plans are going to have a coverage gap or a doughnut hole followed by a catastrophic level of coverage but that.
that coverage gap has been reduced in recent years because of the Affordable Care Act it it closed it to where now you’re basically paying about 25% of the cost during the donut hole.
The Inflation Reduction Act also is making some changes to the Part D plan. So starting in 20 25, out of pocket costs will be capped at $2000.
Per beneficiary in 20 26, the government will begin negotiating with drug companies on drugs.
Medicare spends the most money on, so, changes to comes with Medicare Part D When can you sign up?
It’s the same time period as signing up for an advantage plan, December, October 15 through December seventh, for January first effective date.
You have the same special enrollment opportunities, lost a job based coverage or moving to a new area art samples, and you have a lock in period, just like with Medicare Advantage, you’re generally locked in and cannot enroll or change plans until the next Open Enrollment period. Medicare Part D plan can be included as part of a Medicare Advantage Plan. In that case, they’re called M a, P D, or Medicare Advantage Prescription Drug Plans. And those plans to be changed during that Medicare Advantage open enrollment period during the first three months of the year.
But if you just wanted to switch from one drug plan to another, you could not do that during the B, Medicare Advantage open enrollment period.
Now, if you don’t sign up for Medicare part D, when you’re first eligible, and you don’t have what they call creditable coverage, creditable coverage would be a plan like a job based plan that pays the same or better than the standard part D plan.
Then you’re going to pay a penalty, so if you don’t have that other creditable coverage, when you do sign up for part D, you do pay a penalty.
That penalty is 1% per month for every month that you are eligible but not enrolled in a part D plan, and you didn’t have that other creditable coverage. And like, the part B penalty, that part D penalty continues for the rest of your life. So, if you were to delay enrollment by five years, that would be 60 months, that would be a 60% penalty. That would continue for the rest of your life.
It is something you want to advise your clients on, especially if they are considering delaying Medicare So, they can stay on an HSA qualified plan.
It may be that the employer contribution to the HSA or the Tax Savings, they get contributing to the HSA more than makes up for this penalty, but you want them to at least know about it so they can factor it in. It is important to know that many higher deductible, for higher out of pocket HSA plans do not qualify as creditable coverage.
And so, you want to make sure that if they are delaying to stay on the HSA, that they know whether it’s creditable or not.
The employer is actually supposed to notify employees and dependents who are eligible for Medicare to let them know if they if the drug plan is creditable or not. And they’re supposed to do that each year before October 15th that a lot of employers don’t do that like they’re supposed to. Our last segment here is Medicare Supplements.
And so, time for a poll. And the question is, Do you sell Medicare Supplement?
So, remember about 17% Sold Advantage plans, about 14% sold Medicare Part D plans.
So, we’ll see if this number is any higher.
All right, most of you have chimed in, so let me go ahead and share the results with a little bit higher. At 21% of you said that you do sell Medicare supplements, supplements are a little bit easier. You don’t have to go through all those certifications.
Like you do, with A Medicare Part D plan or Medicare Advantage plan with the carriers and survey, they are a little bit easier, and you don’t have those same marketing requirements like recording the phone calls and that sort of thing.
So, a Medicare Supplement or a Medigap plan is?
Medicare Supplement or a Medicaid Medigap plan, is a private insurance plan that fills in some of the gaps in Original Medicare.
So, someone who has an advantage plan, they don’t need a supplement, right?
They’re choosing to have their receipt or Medicare benefits to a private insurance company, but if you have a regional Medicare, then you probably need something else. So, a supplement can be a good option, because it’s going to fill in some of those holes in Medicare.
With a Medicare Supplement, you’re not going to have a network like you do with an advantage plan.
You don’t need a PCP or referrals to see a specialist, pre authorization may still be required. It is a little bit easier through Medicare than it is through an advantage plan. Some things are going to be greenlighted with Medicare and with an advantage plan.
They may, they may tell you know, And that did happen with me when my My mom was on an advantage plan. We The doctors wanted her to go to an inpatient rehab facility.
Skilled nursing. But, But inpatient hospital, we inpatient rehab hospital, and they said Medicare would have said, Yes, Medicare Supplement would have been fine. The advantage to say no, we appealed it and lost. So, sometimes you can get, you know, that’ll be a little bit easier with a supplement. That’s one of the benefits of a supplement. one of the reasons that people will go to the other reason people like to supplement that.
You can get any provider that accepts Medicare.
You don’t, it’s not a network based product: Medicare does pay first and the supplement fills in the holes. Usually, there’s not a separate claim form that is required.
Basically Medicare will notify the supplement carrier about the claim and it happens seamlessly behind the scenes. Sometimes, you know, something I’ll fall through, and you may have to go back to the provider, say, yes.
When they send you a bill, say, I have a supplement, and they’ll build a supplement carrier, but normally, that happens automatically. There are 10 standardized plans, they have different letters assigned to them.
Plan F, You used to mean the most comprehensive supplement, it pretty much built all the holes in Medicare. Now, plan G is for anybody aging into Medicare.
After January 1, 2020, it fills in all the holes, except for the Part B deductible.
So, at this point, somebody turning 65 plan G is the most comprehensive plan that they can bought.
But by them being standardized, it means that the plan, so by one company is going to have the same benefits as a plan sold by another company.
To qualify, basically, these plans are guaranteed issue for the first six months after you sign up for part B, So, if you’re working, you delay your part B, when you sign up, for part B, you get a six month window to get a supplement.
After that, the supplement carrier could ask you medical questions, they could deny coverage sets.
It’s important to pick a good plan to begin with because many people end up staying with a supplement for a long time. So, you’re not going to just necessarily want the cheapest one at age 65. Or when you’re signing up you want one with a good history of reasonable rate increases over time instead of you know being lured in by a lower price, where they then increase the amount a lot here. So, with that, we are done, we’ve hit our our time limit. I appreciate everybody participating. I especially appreciate people who did correct me on a couple of items.
So, thank you very much for that, and I hope that, uh, Hope you all have a great day. Thanks.