Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Good morning to all. Craig Shillig here and this is
Safe Money. I'm here every Saturday to talk with our
listeners about financial strategies we use to manage and protect
assets safely. I've been an insurance agent for over twenty
five years. During that time, I've learned a few insurance strategies,
like using annuities as safe money harbors, or using cash
(00:22):
value life insurance to supplement retirement income. Just a reminder,
you can call our office at five six three three
three two two two zero zero if you'd like to
schedule an individual meeting regarding your situation, or you can
email me at Craig at Craigshillig dot com. And that's
(00:43):
my name, cr Aig at cr AI G S C
h I L l ig dot com. October is still
a national financial planning month. Last week I talked about Medicare.
It's Medicare season and there's a lot of changes for
(01:05):
twenty twenty six. Today I want to talk about well
Mark's Blue Medicare Advantage Plan PPO. This is the hottest
Medicare advantage plan in Iowa for twenty twenty five. But
as you'll hear, they're having some benefit changes for twenty
twenty six, some good, some bad, and it does depend
(01:27):
if you use those plan benefits or not. Cope's coinsurance
and maximum out of pocket amounts are increasing in twenty
twenty six, and some of the fringe benefits like access
to silver sneakers and the OTC benefit known as over
the Counter Essentials monthly benefit is being eliminated. It's another
(01:52):
sign of the changing landscape within Medicare. Now, if you're
across the river and you're in Illinois, listener, this plan
doesn't work for you. However, understand there's a lot of
plan changes for twenty twenty six in the Medicare arena.
Benefits are being cut, prices are increasing on COPSE and
(02:14):
max out of pockets, and there's several service area reductions.
Let's talk about the Wellmark Blue Advantage PPO for this
twenty twenty five. In twenty twenty six, I'm going to
give you some of the changes that are on tap
(02:35):
for the upcoming year. So this year and next year,
this plan is a zero dollar COPE excuse me, zero
dollar monthly premium, which is very competitive in this area.
The max out of pocket amount for this year is
three seven hundred and fifty dollars now, because this is
(02:57):
the ppo you have both in and out of network coverage.
The out of network coverage amount would be fifty five
hundred dollars, but in twenty twenty six, that thirty seven
point fifty is going up to four one hundred and
fifty dollars. Now the out of network is going to
(03:19):
remain the same at fifty five hundred bucks. Primary care
office visits under this plan in network or going to
be a zero dollar cope in both years. That's pretty
standard across a lot of Medicare advantage plans their specialists
or they're out of network. Charge is going to be
(03:39):
across the board, just thirty five dollars. But remember out
of network's not going to pertain to anything locally here,
so Western Illinois, Eastern Central Iowa, that's still all going
to be a network. But if you were out of network,
you just pay a thirty five dollars cope to visit
a primary care physician. Specialist cope this year is forty
(04:03):
dollars per visit, but that forty dollars cope is going
to forty five and twenty twenty six now they're out
of network specialist cope is seventy, but remember out of
network's not really going to pertain anything locally. Here, hospitalizations
(04:23):
going up five bucks this year. If you're hospitalized for
up to six days, you pay three seventy five a
day for up to six days day seven through ninety,
you wouldn't pay anything in twenty twenty six. That three
seventy five is going up five bucks to three eighty
(04:44):
for a six day co payment. Then you'd pay nothing
days seven through ninety. Let's see, so this year one
of the reasons Wellmark's plan is very hot, it is
because they have no deductible on their drugs. There's no
(05:05):
drug deductible for twenty twenty five. That drug deductible is
going up to three hundred dollars in twenty twenty six
on tiers three through five, so you're gonna have to
pay a deductible for some of those drugs. Next year,
(05:28):
standard copeys are gonna be zero on tier one, five
dollars on tier two, and then you're gonna have co
insurance on tiers three, four and five. That's also a
change from the prior year. Let's see mail order, So
(05:48):
mail order used to be zero in both tiers one
and two, but mail order next year is gonna go
from zero on tier one, it'll be a five dollars
cope on tier two, and again you're gonna have co
insurance on tiers three, four and five, which is gonna
be different from a flat cope. Now, insulin, a lot
(06:13):
of that is captive thirty five a month. That's consistent
both this year and next year. That's a rule, so
that piece won't change that much. Let's see. Okay, so
we got that part. Let's move on to so max
(06:37):
out of pocket for this year's thirty seven to fifty.
Next year that's going up to forty one fifty or
fifty five hundred out of network. Now let's talk about
some of the different copays for some different medical charges.
(07:00):
Ambulance service this year on well Mark is three point
fifty co payment, that's whether it's ground or air, which
is still pretty competitive. But next year that amount is
going to go up to four forty for an ambulance cope,
whether it be ground or air. What that co payment
means is it doesn't matter if it's a ground ambulance
(07:21):
transportation or if it's a life flight. In Eastern Iowa,
we use med Force. You'll only pay up two four
to forty copey. That's it. The plan would pick up
the rest one hundred percent. Now, Rehab cardiac rehab services
this year is fifty dollars COPE, but that's going up
(07:42):
to sixty and twenty twenty six. Cairo practic services in
twenty twenty five is a fifty five dollars CO payment
if the Cairo is in the network. Now, Cairo coverage
under Medicare is new as of twenty nineteen. Now people
are going to argue, well, that was six years ago.
(08:03):
Craig Well understand that prior to twenty nineteen, chiropractic generally
wasn't covered at all, except maybe on group insurance for
the under sixty five crowd. Medicare didn't have it. Now
everybody locally here in the Quad Cities were used to
Palmer Chiropractic Clinic and having Palmer College here and getting
(08:25):
a routine adjustment. Well, those routine adjustments weren't covered by
Medicare until twenty nineteen. So not all chiropractors have signed
up for network contracts with big insurance companies. So this
is still kind of a dicey situation in the Medicare
system because not all chiropractors are on that. This year,
(08:49):
well Mark would pay if the chiros in their network,
you only pay a fifty five dollars copay. But guess
what in twenty twenty six, they're not going to cover that.
Maintenance visits will not be covered, and X rays will
not be covered. And part of that has to do
with lack of usage. A lot of members weren't using
(09:11):
that fit okay dental services. So dental under this plan
in twenty twenty five very competitive. They had an enhanced
preventative and comprehensive dental plan. They were covering up to
fifteen hundred dollars of dental services in and out of network.
(09:32):
But in twenty twenty six, you're going to have a
forty five dollars dental co payment and it's only going
to cover the macs combined in and out of network
coverage is only gonna be one thousand bucks. So to
determine that back about five hundred, which is equal to
(09:56):
most benefit plans that usually only cover one thousand dollars
for dental services. So that's kind of a big change
for twenty twenty six. Now, this plan at Wellmark still
is very competitive locally. But if you use the dental piece,
(10:17):
or for those that use medications, that deductible issue is
going to be a change the lack of dental and
then this plan is also losing silver sneakers in twenty
twenty six, which i'll talk about here in a little bit.
That may warrant you to want to switch plans. Okay,
(10:40):
so keep that in mind. Now, if you're diabetic, those
rules are about the same, none of that it's really changed.
You still have thirty five dollars caps. And if you
are a diabetic and you don't have this information, I
have a contact at Advanced Diabetes Supply AD and he's
(11:01):
very good at helping you get all those supplies you
need at or below generally what the cost you would
pay at the pharmacy. So he's pretty good about that.
You need information on that, call me. I'd be happy
to give it to you. DME Durable medical equipment. So
this year the plan covers twenty percent of the total
(11:23):
costs for items and supplies. Next year this plan is increasing.
They'll cover thirty percent of total covered Medicare covered items
and supplies. So that's actually better. But when we're talking
about the health fitness program known as Silver Sneakers Fitness program.
(11:45):
This year you have no co payment and you can
use that system. But next year Silver Sneakers is not
part of the Blue Medicare Advantage PPO plan at Wellmark. Okay,
So if you use Sneakers, I may have a better
back pocket idea for you via ETNA. When we're talking
(12:08):
about hearing services. This year, the plan it has a
forty dollars co payment and they do cover some hearing
aids if it fits your prescription. But in twenty twenty six,
that plans co payment is going up five dollars to
forty five dollars. You can still have a routine hearing exam,
(12:29):
but the audiologist does have to be in the network.
But they're not going to cover anything for hearing aid allowance.
So if you use that benefit this year, that's not
going to work in twenty twenty six. Home infusion therapy
that's remaining the same twenty percent of the total costs
(12:49):
for Medicare covered home infusion therapy immunizations. This year you
don't pay anything, and or next year it's just out
of network. You might have a thirty five percent co
insurance for some Part B vaccines. Let me see what
(13:13):
else do I got here? Okay, let's talk about hospitalization.
So to see this year the co payment for hospitalizations
three seventy five for six days. Twenty twenty six, that's
going up five bucks to three eighty upon discharge. This year,
(13:34):
they have a meal benefit. They would give you three
square meals per day from up to seven days. They're
not going to do that benefit in twenty twenty six.
Let's see diagnostic outpatient diagnostic tests and therapeutic services and supplies.
(13:55):
So this covers radiological services such as CTS, MRIs, MRAs
and pet scan. This year you have a two hundred
dollars copayment. Next year that's going to two ten. If
you're out of network, you have a three hundred dollars
co payment out of network. Next year'll be three point fifty.
(14:16):
All these copays are going up five or ten dollars
across the board. Outpatient hospital observations, so this year you
pay a three to fifty co payment. In twenty twenty six,
this is going up to three seventy five. It's going
up twenty five bucks. Outpatient hospital services, so minor surgical
(14:42):
service this year is a forty dollars co payment. Next
year will be forty five. Mental health is going up
five dollars from forty to forty five dollars co payment.
Outpatient rehab is also going up five dollars to forty five.
Substance abuse that'll also be a forty five dollars copay.
(15:05):
Outpatient surgery is going up one hundred bucks. This year,
you have a two hundred dollars co payment. Next year
that's going to be three hundred outpatient surgery including services
provided a hospital, outpatient facilities, and ambulatory surgical centers. This year,
(15:27):
the co payment for in network is four hundred dollars copayment.
Next year that's going to go up to five hundred.
Over the counter benefits. So this year this plan gives
you fifty dollars a quarter to use for certain non
prescription over the counter drugs and health related items. Benefits
(15:48):
are available each quarter. Any unused amounts do not roll
over a month to month. But there's going to be
no over the counter benefit in twenty twenty six. Let's
see so pedietary and specialists, so any ist, this year's
(16:15):
a forty dollars copey. Next year that I'll go up
five bucks to forty five. UH prosthetics and orthotic devices
and related supplies. This year you only pay twenty percent
co insurance. Next year that's going up to thirty that's
a ten percent increase. Skilled nursing, you pay zero dollars
(16:38):
a day for the first twenty days that standard. This
year you have a two fourteen co payments for days
twenty one to one hundred, But in twenty twenty six
that's going up four bucks to eighteen per day days
twenty one two one hundred. Then it will be two
thirty for UH. If you're out of network, two thirty
(17:02):
would be the twenty one to day. Let's see supervised
exercise therapy. This is the only cope that's actually going
down five bucks. Urgent Urgent care services is going up
five dollars to fifty five co payment. Vision care will
(17:24):
go up five dollars to forty five. Let's see the
maximum benefit allowance for eyeglasses or contacts this year is
one hundred bucks. They're cutting that in half. They'll only
cover fifty next year. And then, of course this plan
(17:45):
also has a worldwide emergency coverage benefit for travel outside
of the US that cope is going up five dollars
to a one hundred dollars CO payment. However, I would
caution you if you are going to take a trip
outside the US, I have a better back pocket idea,
and my plan pays for jet fuel that's known as
(18:06):
Geo Blue. If you know you're going to leave the
United States and you already bought your plane tickets, call
me and I can work up a quote for you
fairly quickly, and it's not that expensive. In a lot
of cases, if you're traveling outside the US, you'd pay
less money for that policy than you would to have
(18:28):
your bags checked at the airport. So drug deductible this year,
there's no deductible on this plan, which made it very
popular with a lot of my clients. There is going
to be a three hundred dollars deductible next year in
twenty twenty six. Let's see that's going to run on tears.
(18:58):
Let's see tiers three through five. That's where the deductible
will come in. And let's see what else do I
know here? So the tiering will be the same tiers
one and two, a generic Tier three is gonna be
your brand name. Tier four is non preferred drugs, and
(19:21):
then Tier five gets into your specialty. The big difference
next year is tiers three, four, and five is gonna
be co insurance is going to be a percentage amount.
It won't be a flat cope. So that's gonna go
twenty twenty five and twenty nine percent of the total
cost in this specialty tier. But please remember your cap
(19:44):
next year on drugs is twenty one hundred bucks. The
MP three plan will still be in play for twenty
twenty six. That's the Medicare Prescription Payment Plan. You can
participate in this. Now, remember this doesn't lower the cost
of your drugs. It just helps you space it out
on a monthly basis over the calendar year. Some of
(20:06):
my clients really like this for budgetary reasons. However, understand
also some of my clients don't like this because then
they're not really sure what their actual drug costs are
because it's divided by twelve or ten or five or
whatever month you decided to jump into that. So be
aware that's still there. That's not really it's a fifty
(20:34):
to fifty toss. Whether my clients like it or not.
It's new as of twenty twenty five. And some companies
are still getting used to it. But if you have
major drug costs, it can be beneficial from a budgetary standpoint.
(20:57):
But just remember twenty one hundred divided by twelve, you're
at one seventy five a month. So if you can't
afford one seventy five a month of drug costs due
to budget reasons, then maybe the MP three plan will
benefit you. But remember on the flip side, if you're
on some expensive drugs, you could hit twenty one hundred
(21:22):
in a month or two and then you're done for
the year. You've hit your cap, then the plan would
pick up the rest. I mean, you have no out
of pocket. Just remember a lot of people don't want
to spend twenty one hundred dollars on total drug costs,
and I get that, especially they don't want to do
it in one month. But some drugs that are on
(21:47):
Tier four or five, you can get to that number
fairly quickly. Now, not harping on the Wellmart plan again,
it's still the hottest plan available in the Quad Cities
this year. But the reduction of silver sneakers and the
drug deductible, in addition to cutting back on the dental
(22:08):
benefit and the reduction in the vision makes it a
little less competitive than some of the other plans out there.
I e ETNA is really stepped up to the plate
for twenty twenty six to say we're here. This is
both Iowa and Illinois, both both sides of the river,
so Clinton, Muscatines, Scott County, even Cedar County, Rock Island, Henry,
(22:36):
Mercer County. On the Illinois side, EDNA has really stepped
up to the plate to say we're here. We have
several plans to choose from. I think they have seven
plans on the Iowa side, maybe four or five on
the Illinois side between HMO and PPOs. So they're still
(22:56):
very competitive, but they're gonna be There's gonna be a
lot of switching between now and the end of first quarter.
In my upcoming meetings, I'm gonna talk about I'll talk
more about I'll talk about the AARP United Healthcare Supplement,
(23:23):
and then I'm also gonna talk about one or two
of the ATNA advantage plans. EDNA is really probably gonna
be popular for twenty twenty six. I think you're gonna
see a lot of people migrating too, that they're gonna
bleed purple and white instead of blue and white, or
white and blue if it's United Healthcare, So stay tuned
for that. Don't forget my monthly virtual meetings regarding Medicare
(23:47):
for two different companies every month are kind of on
hold right now. I probably will start doing an EDNA
program here in a couple months. I may even do
a United Healthcare Supplement virtual meeting here, maybe in November.
We'll see. But in one meeting, I cover Medicare supplement
(24:10):
plans with a standalone drug plan. The other meeting, I
normally talk about Medicare advantage plans, so EDNA may be
a part of that discussion. I'm still working on that.
There's been a lot of changes, so I don't have
future dates for those meetings at this time, but I
think i'll have a new company or two here in
(24:31):
a few weeks. You're welcome to call me. I'd be
happy to schedule an individual meeting with you at your
request via phone, video zoom, or in person. You can
call my office at five six three three three two
two two zero zero, and i'd be happy to schedule
(24:52):
an individual meeting at your request. You're also welcome to
email me at Craig at Craigshillig dot com. And that's
my name. C R a I G at c R
a I G s c h I L l i
G dot com. This is Craig Schillig with safe money,
Good morning to all. Craig Shillig here and this is
Safe Money. I'm here every Saturday to talk with our
listeners about financial strategies we use to manage and protect
assets safely. I've been an insurance agent for over twenty
five years. During that time, I've learned a few insurance strategies,
like using annuities as safe money harbors, or using cash
(00:22):
value life insurance to supplement retirement income. Just a reminder,
you can call our office at five six three three
three two two two zero zero if you'd like to
schedule an individual meeting regarding your situation, or you can
email me at Craig at Craigshillig dot com. And that's
(00:43):
my name, cr Aig at cr AI G S C
h I L l ig dot com. October is still
a national financial planning month. Last week I talked about Medicare.
It's Medicare season and there's a lot of changes for
(01:05):
twenty twenty six. Today I want to talk about well
Mark's Blue Medicare Advantage Plan PPO. This is the hottest
Medicare advantage plan in Iowa for twenty twenty five. But
as you'll hear, they're having some benefit changes for twenty
twenty six, some good, some bad, and it does depend
(01:27):
if you use those plan benefits or not. Cope's coinsurance
and maximum out of pocket amounts are increasing in twenty
twenty six, and some of the fringe benefits like access
to silver sneakers and the OTC benefit known as over
the Counter Essentials monthly benefit is being eliminated. It's another
(01:52):
sign of the changing landscape within Medicare. Now, if you're
across the river and you're in Illinois, listener, this plan
doesn't work for you. However, understand there's a lot of
plan changes for twenty twenty six in the Medicare arena.
Benefits are being cut, prices are increasing on COPSE and
(02:14):
max out of pockets, and there's several service area reductions.
Let's talk about the Wellmark Blue Advantage PPO for this
twenty twenty five. In twenty twenty six, I'm going to
give you some of the changes that are on tap
(02:35):
for the upcoming year. So this year and next year,
this plan is a zero dollar COPE excuse me, zero
dollar monthly premium, which is very competitive in this area.
The max out of pocket amount for this year is
three seven hundred and fifty dollars now, because this is
(02:57):
the ppo you have both in and out of network coverage.
The out of network coverage amount would be fifty five
hundred dollars, but in twenty twenty six, that thirty seven
point fifty is going up to four one hundred and
fifty dollars. Now the out of network is going to
(03:19):
remain the same at fifty five hundred bucks. Primary care
office visits under this plan in network or going to
be a zero dollar cope in both years. That's pretty
standard across a lot of Medicare advantage plans their specialists
or they're out of network. Charge is going to be
(03:39):
across the board, just thirty five dollars. But remember out
of network's not going to pertain to anything locally here,
so Western Illinois, Eastern Central Iowa, that's still all going
to be a network. But if you were out of network,
you just pay a thirty five dollars cope to visit
a primary care physician. Specialist cope this year is forty
(04:03):
dollars per visit, but that forty dollars cope is going
to forty five and twenty twenty six now they're out
of network specialist cope is seventy, but remember out of
network's not really going to pertain anything locally. Here, hospitalizations
(04:23):
going up five bucks this year. If you're hospitalized for
up to six days, you pay three seventy five a
day for up to six days day seven through ninety,
you wouldn't pay anything in twenty twenty six. That three
seventy five is going up five bucks to three eighty
(04:44):
for a six day co payment. Then you'd pay nothing
days seven through ninety. Let's see, so this year one
of the reasons Wellmark's plan is very hot, it is
because they have no deductible on their drugs. There's no
(05:05):
drug deductible for twenty twenty five. That drug deductible is
going up to three hundred dollars in twenty twenty six
on tiers three through five, so you're gonna have to
pay a deductible for some of those drugs. Next year,
(05:28):
standard copeys are gonna be zero on tier one, five
dollars on tier two, and then you're gonna have co
insurance on tiers three, four and five. That's also a
change from the prior year. Let's see mail order, So
(05:48):
mail order used to be zero in both tiers one
and two, but mail order next year is gonna go
from zero on tier one, it'll be a five dollars
cope on tier two, and again you're gonna have co
insurance on tiers three, four and five, which is gonna
be different from a flat cope. Now, insulin, a lot
(06:13):
of that is captive thirty five a month. That's consistent
both this year and next year. That's a rule, so
that piece won't change that much. Let's see. Okay, so
we got that part. Let's move on to so max
(06:37):
out of pocket for this year's thirty seven to fifty.
Next year that's going up to forty one fifty or
fifty five hundred out of network. Now let's talk about
some of the different copays for some different medical charges.
(07:00):
Ambulance service this year on well Mark is three point
fifty co payment, that's whether it's ground or air, which
is still pretty competitive. But next year that amount is
going to go up to four forty for an ambulance cope,
whether it be ground or air. What that co payment
means is it doesn't matter if it's a ground ambulance
(07:21):
transportation or if it's a life flight. In Eastern Iowa,
we use med Force. You'll only pay up two four
to forty copey. That's it. The plan would pick up
the rest one hundred percent. Now, Rehab cardiac rehab services
this year is fifty dollars COPE, but that's going up
(07:42):
to sixty and twenty twenty six. Cairo practic services in
twenty twenty five is a fifty five dollars CO payment
if the Cairo is in the network. Now, Cairo coverage
under Medicare is new as of twenty nineteen. Now people
are going to argue, well, that was six years ago.
(08:03):
Craig Well understand that prior to twenty nineteen, chiropractic generally
wasn't covered at all, except maybe on group insurance for
the under sixty five crowd. Medicare didn't have it. Now
everybody locally here in the Quad Cities were used to
Palmer Chiropractic Clinic and having Palmer College here and getting
(08:25):
a routine adjustment. Well, those routine adjustments weren't covered by
Medicare until twenty nineteen. So not all chiropractors have signed
up for network contracts with big insurance companies. So this
is still kind of a dicey situation in the Medicare
system because not all chiropractors are on that. This year,
(08:49):
well Mark would pay if the chiros in their network,
you only pay a fifty five dollars copay. But guess
what in twenty twenty six, they're not going to cover that.
Maintenance visits will not be covered, and X rays will
not be covered. And part of that has to do
with lack of usage. A lot of members weren't using
(09:11):
that fit okay dental services. So dental under this plan
in twenty twenty five very competitive. They had an enhanced
preventative and comprehensive dental plan. They were covering up to
fifteen hundred dollars of dental services in and out of network.
(09:32):
But in twenty twenty six, you're going to have a
forty five dollars dental co payment and it's only going
to cover the macs combined in and out of network
coverage is only gonna be one thousand bucks. So to
determine that back about five hundred, which is equal to
(09:56):
most benefit plans that usually only cover one thousand dollars
for dental services. So that's kind of a big change
for twenty twenty six. Now, this plan at Wellmark still
is very competitive locally. But if you use the dental piece,
(10:17):
or for those that use medications, that deductible issue is
going to be a change the lack of dental and
then this plan is also losing silver sneakers in twenty
twenty six, which i'll talk about here in a little bit.
That may warrant you to want to switch plans. Okay,
(10:40):
so keep that in mind. Now, if you're diabetic, those
rules are about the same, none of that it's really changed.
You still have thirty five dollars caps. And if you
are a diabetic and you don't have this information, I
have a contact at Advanced Diabetes Supply AD and he's
(11:01):
very good at helping you get all those supplies you
need at or below generally what the cost you would
pay at the pharmacy. So he's pretty good about that.
You need information on that, call me. I'd be happy
to give it to you. DME Durable medical equipment. So
this year the plan covers twenty percent of the total
(11:23):
costs for items and supplies. Next year this plan is increasing.
They'll cover thirty percent of total covered Medicare covered items
and supplies. So that's actually better. But when we're talking
about the health fitness program known as Silver Sneakers Fitness program.
(11:45):
This year you have no co payment and you can
use that system. But next year Silver Sneakers is not
part of the Blue Medicare Advantage PPO plan at Wellmark. Okay,
So if you use Sneakers, I may have a better
back pocket idea for you via ETNA. When we're talking
(12:08):
about hearing services. This year, the plan it has a
forty dollars co payment and they do cover some hearing
aids if it fits your prescription. But in twenty twenty six,
that plans co payment is going up five dollars to
forty five dollars. You can still have a routine hearing exam,
(12:29):
but the audiologist does have to be in the network.
But they're not going to cover anything for hearing aid allowance.
So if you use that benefit this year, that's not
going to work in twenty twenty six. Home infusion therapy
that's remaining the same twenty percent of the total costs
(12:49):
for Medicare covered home infusion therapy immunizations. This year you
don't pay anything, and or next year it's just out
of network. You might have a thirty five percent co
insurance for some Part B vaccines. Let me see what
(13:13):
else do I got here? Okay, let's talk about hospitalization.
So to see this year the co payment for hospitalizations
three seventy five for six days. Twenty twenty six, that's
going up five bucks to three eighty upon discharge. This year,
(13:34):
they have a meal benefit. They would give you three
square meals per day from up to seven days. They're
not going to do that benefit in twenty twenty six.
Let's see diagnostic outpatient diagnostic tests and therapeutic services and supplies.
(13:55):
So this covers radiological services such as CTS, MRIs, MRAs
and pet scan. This year you have a two hundred
dollars copayment. Next year that's going to two ten. If
you're out of network, you have a three hundred dollars
co payment out of network. Next year'll be three point fifty.
(14:16):
All these copays are going up five or ten dollars
across the board. Outpatient hospital observations, so this year you
pay a three to fifty co payment. In twenty twenty six,
this is going up to three seventy five. It's going
up twenty five bucks. Outpatient hospital services, so minor surgical
(14:42):
service this year is a forty dollars co payment. Next
year will be forty five. Mental health is going up
five dollars from forty to forty five dollars co payment.
Outpatient rehab is also going up five dollars to forty five.
Substance abuse that'll also be a forty five dollars copay.
(15:05):
Outpatient surgery is going up one hundred bucks. This year,
you have a two hundred dollars co payment. Next year
that's going to be three hundred outpatient surgery including services
provided a hospital, outpatient facilities, and ambulatory surgical centers. This year,
(15:27):
the co payment for in network is four hundred dollars copayment.
Next year that's going to go up to five hundred.
Over the counter benefits. So this year this plan gives
you fifty dollars a quarter to use for certain non
prescription over the counter drugs and health related items. Benefits
(15:48):
are available each quarter. Any unused amounts do not roll
over a month to month. But there's going to be
no over the counter benefit in twenty twenty six. Let's
see so pedietary and specialists, so any ist, this year's
(16:15):
a forty dollars copey. Next year that I'll go up
five bucks to forty five. UH prosthetics and orthotic devices
and related supplies. This year you only pay twenty percent
co insurance. Next year that's going up to thirty that's
a ten percent increase. Skilled nursing, you pay zero dollars
(16:38):
a day for the first twenty days that standard. This
year you have a two fourteen co payments for days
twenty one to one hundred, But in twenty twenty six
that's going up four bucks to eighteen per day days
twenty one two one hundred. Then it will be two
thirty for UH. If you're out of network, two thirty
(17:02):
would be the twenty one to day. Let's see supervised
exercise therapy. This is the only cope that's actually going
down five bucks. Urgent Urgent care services is going up
five dollars to fifty five co payment. Vision care will
(17:24):
go up five dollars to forty five. Let's see the
maximum benefit allowance for eyeglasses or contacts this year is
one hundred bucks. They're cutting that in half. They'll only
cover fifty next year. And then, of course this plan
(17:45):
also has a worldwide emergency coverage benefit for travel outside
of the US that cope is going up five dollars
to a one hundred dollars CO payment. However, I would
caution you if you are going to take a trip
outside the US, I have a better back pocket idea,
and my plan pays for jet fuel that's known as
(18:06):
Geo Blue. If you know you're going to leave the
United States and you already bought your plane tickets, call
me and I can work up a quote for you
fairly quickly, and it's not that expensive. In a lot
of cases, if you're traveling outside the US, you'd pay
less money for that policy than you would to have
(18:28):
your bags checked at the airport. So drug deductible this year,
there's no deductible on this plan, which made it very
popular with a lot of my clients. There is going
to be a three hundred dollars deductible next year in
twenty twenty six. Let's see that's going to run on tears.
(18:58):
Let's see tiers three through five. That's where the deductible
will come in. And let's see what else do I
know here? So the tiering will be the same tiers
one and two, a generic Tier three is gonna be
your brand name. Tier four is non preferred drugs, and
(19:21):
then Tier five gets into your specialty. The big difference
next year is tiers three, four, and five is gonna
be co insurance is going to be a percentage amount.
It won't be a flat cope. So that's gonna go
twenty twenty five and twenty nine percent of the total
cost in this specialty tier. But please remember your cap
(19:44):
next year on drugs is twenty one hundred bucks. The
MP three plan will still be in play for twenty
twenty six. That's the Medicare Prescription Payment Plan. You can
participate in this. Now, remember this doesn't lower the cost
of your drugs. It just helps you space it out
on a monthly basis over the calendar year. Some of
(20:06):
my clients really like this for budgetary reasons. However, understand
also some of my clients don't like this because then
they're not really sure what their actual drug costs are
because it's divided by twelve or ten or five or
whatever month you decided to jump into that. So be
aware that's still there. That's not really it's a fifty
(20:34):
to fifty toss. Whether my clients like it or not.
It's new as of twenty twenty five. And some companies
are still getting used to it. But if you have
major drug costs, it can be beneficial from a budgetary standpoint.
(20:57):
But just remember twenty one hundred divided by twelve, you're
at one seventy five a month. So if you can't
afford one seventy five a month of drug costs due
to budget reasons, then maybe the MP three plan will
benefit you. But remember on the flip side, if you're
on some expensive drugs, you could hit twenty one hundred
(21:22):
in a month or two and then you're done for
the year. You've hit your cap, then the plan would
pick up the rest. I mean, you have no out
of pocket. Just remember a lot of people don't want
to spend twenty one hundred dollars on total drug costs,
and I get that, especially they don't want to do
it in one month. But some drugs that are on
(21:47):
Tier four or five, you can get to that number
fairly quickly. Now, not harping on the Wellmart plan again,
it's still the hottest plan available in the Quad Cities
this year. But the reduction of silver sneakers and the
drug deductible, in addition to cutting back on the dental
(22:08):
benefit and the reduction in the vision makes it a
little less competitive than some of the other plans out there.
I e ETNA is really stepped up to the plate
for twenty twenty six to say we're here. This is
both Iowa and Illinois, both both sides of the river,
so Clinton, Muscatines, Scott County, even Cedar County, Rock Island, Henry,
(22:36):
Mercer County. On the Illinois side, EDNA has really stepped
up to the plate to say we're here. We have
several plans to choose from. I think they have seven
plans on the Iowa side, maybe four or five on
the Illinois side between HMO and PPOs. So they're still
(22:56):
very competitive, but they're gonna be There's gonna be a
lot of switching between now and the end of first quarter.
In my upcoming meetings, I'm gonna talk about I'll talk
more about I'll talk about the AARP United Healthcare Supplement,
(23:23):
and then I'm also gonna talk about one or two
of the ATNA advantage plans. EDNA is really probably gonna
be popular for twenty twenty six. I think you're gonna
see a lot of people migrating too, that they're gonna
bleed purple and white instead of blue and white, or
white and blue if it's United Healthcare, So stay tuned
for that. Don't forget my monthly virtual meetings regarding Medicare
(23:47):
for two different companies every month are kind of on
hold right now. I probably will start doing an EDNA
program here in a couple months. I may even do
a United Healthcare Supplement virtual meeting here, maybe in November.
We'll see. But in one meeting, I cover Medicare supplement
(24:10):
plans with a standalone drug plan. The other meeting, I
normally talk about Medicare advantage plans, so EDNA may be
a part of that discussion. I'm still working on that.
There's been a lot of changes, so I don't have
future dates for those meetings at this time, but I
think i'll have a new company or two here in
(24:31):
a few weeks. You're welcome to call me. I'd be
happy to schedule an individual meeting with you at your
request via phone, video zoom, or in person. You can
call my office at five six three three three two
two two zero zero, and i'd be happy to schedule
(24:52):
an individual meeting at your request. You're also welcome to
email me at Craig at Craigshillig dot com. And that's
my name. C R a I G at c R
a I G s c h I L l i
G dot com. This is Craig Schillig with safe money,
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
CrimeLess: Hillbilly Heist
It’s 1996 in rural North Carolina, and an oddball crew makes history when they pull off America’s third largest cash heist. But it’s all downhill from there. Join host Johnny Knoxville as he unspools a wild and woolly tale about a group of regular ‘ol folks who risked it all for a chance at a better life. CrimeLess: Hillbilly Heist answers the question: what would you do with 17.3 million dollars? The answer includes diamond rings, mansions, velvet Elvis paintings, plus a run for the border, murder-for-hire-plots, and FBI busts.