Cities IG - 10-05-24

Episode Transcript

Speaker 1 (00:00):
Good morning and welcome to the show.

Speaker 2 (00:01):
This is Rob King, happy to be here with you today.
I want to do really give you a good update
on what's going on as we are now and to
the first stage of Medicare season as I call it.

Speaker 1 (00:14):
Now.

Speaker 2 (00:15):
We can't make changes until October fifteenth and through December seventh.

Speaker 1 (00:20):
But this year it's going to be an incredible year
of change.

Speaker 2 (00:23):
So if you work with an agent, or if you
haven't compared your stuff lately, you're really going to want
to do it this year because things are changing.

Speaker 1 (00:31):
Big time again.

Speaker 2 (00:35):
I highly recommend using an independent agent because they can
search and help you look at many different plans, whereas
if you call one of those eight hundred numbers, they
are just going to try to sell you on their plan.

Speaker 1 (00:47):
Again.

Speaker 2 (00:48):
You know, there's two different ways overall to put together
your Medicare package. You can have, you know, your Medicare
plus a Medicare supplement, you know, which was as a
plan letter. A lot of people have Plan after Plan G.

Speaker 1 (01:00):
There are some.

Speaker 2 (01:01):
Changes coming to those policies we'll touch on here in
a little bit. Big changes though this year are because
of the Inflation Reduction Act. They say that seniors or Medicare,
people will pay no more than two thousand dollars for
their medications, which can and can't be true depending on

(01:22):
if you have the right plan because of the formulas
and so forth. I'll touch on that later, but there's
a lot of changes going on, so let me just
stay right off the bat again. If you're on Medicare,
you need to get with your agent or you need
to do your research and make sure you have the
proper plans for twenty twenty five, because the Inflation Reduction

(01:43):
Act has made big changes on the drug programs and
the Medicare day inage program.

Speaker 1 (01:50):
So's kind of go through that a little bit.

Speaker 2 (01:53):
So far, all I've heard about the Medicare supplements and
I've only seen one rate sheet come out for.

Speaker 1 (02:00):
Company that's very popular. But I'm being told that.

Speaker 2 (02:05):
From what I've seen, is going forward, like twenty twenty
five and forward, they're no longer able to separate out
men and women. So again you might see that in
your rate adjustments or for new people coming in, it'll
just be one price for male or female.

Speaker 1 (02:21):
They can't break it off.

Speaker 2 (02:22):
Traditionally, females were lower, males were a little bit higher.
Costs I'm told because the ladies take better care themselves
in general health wise, live longer, so their premiums were
a little bit lower. Again, depends on if you're the
Iowa Illinois side. I will remind you that you can

(02:43):
change supplements any time of year you want, as long
as you're healthy enough to answer the health questions and
get accepted, you know, at their preferred rate or standard rate,
whatever's going to be best for you or what you qualify.
And then in Illinois there's a company that's always guaranteed accepted. Again,
as I go through our discussions to day, I'm not
really going to put names on different companies or whatever.

(03:07):
Just give you some overall big view examples of what
I see in the marketplace.

Speaker 1 (03:12):
FYI, this year.

Speaker 2 (03:14):
Twenty twenty four was the first year that there were
more people nationwide on Medicare advantage plans and there were
on supplements. So again, supplements had always been the leader
because they'd been around since the beginning of Medicare, and
Medicare advantage really just got popular ten twelve years ago

(03:35):
with their max out of pockets coming down and the
benefit packages.

Speaker 1 (03:40):
Being built up.

Speaker 2 (03:41):
So we'll go through and kind of talk about again
some of these other changes. So again medsops if you
get into twenty twenty five and you're on one and
it's just got a huge increase and you want to
do some shopping again, as long as you can qualify
health wise, or if you live in Illinois, you can
make a switch.

Speaker 1 (04:00):
Any time of the year.

Speaker 2 (04:01):
However, if you're on the Medicare supplement between October fifteen
and December seventh, and it's very important that you take
your drug list, either do it yourself or again go
to an agent that can help you run it through.
I use the medicare dot gov tool. You punch in
your zip code all your different medications, your pharmacies, because

(04:23):
they all might have their preferred, their standard, they're out
a network pharmacy, so it can make a big difference
where you're going and what you're paying for the different medication.
So make sure you put in all the choices that
you would use, not just the one that you currently use,
and then you can run your drug list. But the

(04:45):
standalone PDPs. Oh gosh, I guess about five years ago
there was a company that had the cheapest PDP program.
Drug program was twenty five dollars a month. Now, over
time those came down to our last year in Illin
there was a zero premium plan for people that really
didn't have you know, maybe a couple of generics, no

(05:06):
high cost medications, and then also one in the Iowa
side that was only fifty cents a month, very similar
plan there. Again not for people with more expensive medications,
because again they all have all drug programs are put
together with they may or may not have a deductible
to begin with.

Speaker 1 (05:26):
They will have their copay structures like this.

Speaker 2 (05:30):
Last year was real common Tier one, Tier two where
zero copay, Tier three might have been like forty seven dollars,
Tier four like one hundred dollars for a month, Tier
five like thirty three percent of the retail cost. Obviously,
the higher the tier and the more expense of the medications.
But again the Inflation Reduction Act has put in put

(05:52):
on all of these plans, Medicare Advantage and the PDPs
this year to where you will pay no more than
two thousand dollars. I'll pay no more than two thousand
dollars for their medications. Again, as long as all your
drugs are on the formulary. I've run some list where
a drug wasn't on the formulary and it was way
over two thousand dollars. So again, don't just assume your

(06:15):
plan is going to lock you in it under two thousand.
Make sure you check. You don't want to get stuck
in the wrong plan and then have to fight or
switch medications or whatever to get that cost down. Anyway,
so on both sides of the river this year, there
is a zero premium plan that's still available. Again, it's

(06:36):
not for people with more expensive medications, but if you
just have no drugs or maybe one or two just generics,
that would still be available to you, which is awesome. However,
I had a customer in the day that we were
just kind of playing around with stuff and they want
the female. The lady had a Eloquesce, which is a

(06:58):
Tier three medication, and boy, what a huge difference that
it's just that one medicine took took someone that just ted,
you know, the zero premium and they had really no
costs for their medications. That one medication kicked them up
between depending on which program to pick, fifteen to seventeen hundred.

Speaker 1 (07:17):
Dollars for the year.

Speaker 2 (07:19):
So again it's very very important and take a look
at that type of stuff and that we run those
medications and what pharmacy are going to pick them up
and make sure everything's on the proper formulary. When we
talked about Medicare advantage, like I said, this year was
the first year where people are Medicare advantage and we're
on actual supplements with the drug program. So it really

(07:44):
makes a big difference there too, because when I compared
her stuff on a Medicare advantage basis, there was one
company where it was going to be about five hundred
dollars costs for the year, and all the others were
at seventeen one hundred or a little bit higher. So again,
she's probably going to make a switch for twenty twenty

(08:06):
five to that new program just because the you know,
prescription drug or twelve hundred dollars difference right there, that's
a huge benefit to switch to that other company. And
it's a good company, well known company, and.

Speaker 1 (08:20):
With Medicare advantage.

Speaker 2 (08:21):
Over the last few years, what I had seen going
on was, you know, the max out of pockets were
coming down. The benefits, the goodie packages I call them,
you know, your dental vision over the counter, et cetera,
et cetera. All the goodies they put together to compete. Well,
all of the meetings that I went to this year,

(08:43):
all the different companies basically started off with the same thing.
Because of the Inplation Reduction Art, seniors next year will
pay no more than two thousand dollars for medications this
year because of the doughnut hole, the gap, and so forth,
a senior could have paid if they had really expensive medications,
up to eight thousand.

Speaker 1 (09:01):
Dollars out of their pocket.

Speaker 2 (09:05):
The way that they change that structure through Medicare is
that basically these insurance companies have to cover that difference
and cost. So every meeting that I went to, what
they said is due to the Inflation Reduction Act, all
the Medicare advantage programs for the most part are going
back and focusing on the just the basics of your

(09:29):
Medicare insurance, your healthcare coverages. So they're trying to keep
you know, the max out of pockets as low as
they can, because when they have to put so much
money or effort into one area, they have to take
it away from others.

Speaker 1 (09:42):
So like you know, the medical, the dental division, all that.

Speaker 2 (09:45):
It has to be overall package that they submit to
Medicare and then Medicare will approve it. So over the
last few years we had really seen the goodie packages growing.

Speaker 1 (09:57):
We had, you know, three hundred.

Speaker 2 (09:59):
And eighty five dollars for glasses, you know, two thousand
of dental.

Speaker 1 (10:05):
Oh what else.

Speaker 2 (10:06):
The type of thing there was last year they had
a plan for people didn't have any drugs, you could
get twelve hundred dollars back in like home exercise equipment,
golf clubs, bulleyball, green fees, all kinds of things that
designed to keep you healthy. And again, Medicare advantage programs
are designed to keep you healthy. That's how they are
able to keep their costs lower. But again a lot

(10:29):
of that has been tailed back. Of course, that twelve
hundred dollars deal with that one company's gone. They do
still have one that has a health benefit like that
for stuff, but you're only going to get ninety dollars
per quarter, and again you really only want to select
that one if you didn't have any drugs. Also, there

(10:51):
was a plan this last year twenty twenty four that
was popular with my snowbirds, if you will, because it
was a peep U which allows you to use you
know any doctor that will accept it, and it had
the same max in and out of network max out
of pocket and the cops were the same whether you

(11:13):
were in or out. So it was kind of like
an HMOs, you just the copas were the same no
matter where you were at. But it was when they
expanded PPO version they were also accepted at mail and
really a lot of my snowbirds liked that plan because, again,
if you're considering using an out of network facility, if

(11:36):
I can lock in your max out of pocket at
four thousand instead of ten thousand, again, we need to
focus on the medical part of it, not just the
goodie package. Now, again for people that are pretty healthy
and whatnot, I had a ton of them that were
going with the goodie package, and that one company that
had the best kind of overall goodie package had a

(11:56):
ton of my customers picked up over the last few years.
Part of the reason they were popular, even though they
weren't accepted at mail and it was an HMO, was
because they had the best overall goodie package. You got
one hundred and five over the counter, you know, like
sixteen hundred and eighty dental, but they're dental in their vision,
and the vision I think was like three eighty five.

(12:18):
They got total reimbursement, so it didn't matter if they
went in or out of network, they could get totally reimbursed. Well,
that changed now that company is using a dental network
just like a lot of the other companies, and that means,
you know, you need to do a little more research
if you were on that plan, to make sure your
dentist is in network, Otherwise you could have potential copase

(12:40):
as well. As you go for that, you're not going
to get fully reimbursed. You know, things like crowns and
implants may only be covered at a certain percentage. So
again it's important to take a look at that stuff
this year, especially so if you're on Medicare advantage. Wow,
what a change in the atmosphere there, because again they
had to pull back so much stuff for that. Again,

(13:07):
is Mayo a big deal because again some of the
HMOs are not accepted at Mayo, some are, some aren't,
So again you got to know which company has what's available.
I've you know, only visited with one or two people.
We're kind of looking at stuff. And again the benefit packages,

(13:28):
the goodie packages are all down, so it's it's.

Speaker 1 (13:31):
Really kind of more wide open this year.

Speaker 2 (13:35):
But it's very very important that you get out there
and you do do some research and make sure that
you've got the best plan moving forward for twenty twenty five. Again,
Medicare dot gov is a great tool. I recommend independent
independent agents because again they can chop around more than
just you know, their one plan. But that's really the big,

(13:58):
big extent all the changes for this year. Again, Iowa
and Illinois do have different rules, they have different programs.
Like myself, I am licensed to.

Speaker 1 (14:09):
Do that for you. Already starting to book up.

Speaker 2 (14:12):
I know my first week from October fifteenth is already
completely booked. That second week starting to get booked out.
So if you'd like to come in visit with me,
make sure you bring your medication less make sure you
know we'll talk about is mayo important, that kind of stuff.
You know, we can take a look at your supplements.
When it comes to supplements, I always license with what

(14:35):
I call the big Boy, the one everybody knows and loves.
It's more standard on both sides of the river. And
then I also try to have what I call the
low price leader for each state.

Speaker 1 (14:46):
Either Now, the thing.

Speaker 2 (14:48):
With Medicare supplements is typically if you're going to do
a supplement that's kind of a long term, you're not
really shopping.

Speaker 1 (14:55):
That every year.

Speaker 2 (14:58):
But basically the way that they work is by law,
they must pay eighty five cents of every dollar they
taken in premium back on expenses of the group the
people that are in their plan, you know in say
like Iowa or Illinois at the same age or whatnot.
And because of that, you can see these low price

(15:20):
leaders come into the market, you know, saving you at
thirty forty to fifty bucks a month, and you get
in with them when you first get into Medicare. When
you've got what I call a free ticket. You can
get into anybody's plan, no health questions, ask no pre
existing conditions. You got a seven month window to make
that choice, and the.

Speaker 1 (15:42):
Anytime you're outside of that.

Speaker 2 (15:44):
In Iowa, if you want to switch, you can, but
you have to answer health questions and you can be denied.
Now in Illinois, there's one company that has one product
that has guaranteed acceptance all the time. Because of that,
it's not their lowest price plan available, but it is
available and people over there can start with the low
price leader, and if their premiums get higher than that,

(16:07):
they can always drop back in no concerns about pre
existing conditions, whereas an Iowa you can't do that. Oh gosh,
what fifteen years ago, when I started in the business,
the low price leader on the Iowa side again was
forty to fifty dollars a month cheaper. But within two
years they had such big increases that they were more expensive,

(16:29):
and I had to go back out to all those
customers ask them the health questions. The majority were fine,
they were still healthy enough they could switch, but there
were a few that could not and they were just
stuck with the higher price supplements. There's also a lot
of other rules about if you're on a Medicare supplement
and you want to try Medicare advantage, you have twelve

(16:50):
month trial rights to where you can pick Medicare Advantage.
It would start Tanuary first, run through that whole year.
If for any reason during the year you wanted to
disenroll and get your supplement back, you're guaranteed to do
that for the following month. So again that first really
eleven months because you'd get it switched back, but you

(17:12):
get it switched back you're guaranteed to get your supplement back,
no health questions asked. And I did have a couple
of people that had, you know, they had Medicare supplements.
They started getting too expensive for the folks you know
eating in They go up every year, eating into their
budget more and more, and so they decided they wanted
to try it. I had I think two in my

(17:33):
career that then you know, developed cancer or a big
issue problem that did. Then I want to switch back
to the supplement during that middle year during their trial
rights period.

Speaker 1 (17:46):
Not the only time.

Speaker 2 (17:47):
You get special election period to do that. But that's
that's the main one. It's the first twelve months. The
other one is all Medicare advantage programs and drug programs
are approved by county, so if you ever move outside
of your county that you're currently in, you are able
to then look at where you're moving to see what's available,

(18:07):
and you either can pick someone else's Medicare advantage or
Medicare supplement.

Speaker 1 (18:12):
Again, no health questions act.

Speaker 2 (18:13):
Medicare advantage on a year basis, there's never any health
questions for them. They're always guaranteed acceptance, no pre existing
so you can change from one to another. Going to
be a lot of movement in the market this year,
just because again the Inflation Reduction Act has made some
big changes. There's still both great ways to provide your protection.

(18:36):
But again here Cities Insurance, we're always focused on making
sure that you get the best overall value based.

Speaker 1 (18:42):
On your needs.

Speaker 2 (18:44):
So again, if that's important to you, you want to
do a search, you want me to help you just
kind of review everything.

Speaker 1 (18:49):
Happy to do that, give us a call at five
six three three five nine eight five.

Speaker 2 (18:54):
Or it's going to be a busy medicare season, so
you don't get your ointments early.

Speaker 1 (19:00):
That gives you plenty of time to think about if
you're going to make a change or not, and just
make sure you get it done by December seventh. I
hope this information's helpful. I hope it's a good warning
to make sure that you get out and do chop
it around, make sure you got the right product, and
then we'll see all the changes that will come for
the following year in twenty twenty six. Again, this is

(19:22):
Rob Kane, happy to be here with you. Give us
a call five six three three five nineh eight five four.
Have a great weekend.