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. We talked to talk
with our listeners about financial strategies we used 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 is safe money harbors,
(00:24):
or using cash value life insurance to supplement your 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 appointment to discuss your individual situation,
or you can email me at Craig at Craigshillig dot com.
(00:47):
And that's my name, cr Ai G at cr Ai
G S c h I L l ig dot com.
Remember that October is National Financial Planning Month. Last week
I just stuck I discussed well Mark's Blue Medicare Advantage
(01:10):
PPO plan. Today I'd like to talk about ETNA and
some of the Medicare advantage plans that they have for
twenty twenty six. Also, remember that if you work with
a Medicare advisor, please give him or her an extra handshake.
Or a hug or both. Bring some cookies or a
(01:31):
pie to your appointment, buy them a coffee. Personally, I
like cupcakes or a fruit basket. CMS rules says we
can't charge a fee for services, so no cash, gift
cards or office fees are allowed. Just understand that most
insurance companies are not paying agent broker commissions in twenty
(01:54):
twenty six. No commissions on several Medicare advantage plans, prescription
drug plans, and many supplement plans. Companies are cutting their
commission amounts. And let me replete repeat that insurance companies
will not be paying agent broker commissions in twenty twenty six.
(02:15):
When you go to work right now, do you work
for no compensation when you were employed? If you're retired, now,
did you work for free? Out of the kindness of
your heart? Several insurance companies aren't going to be paying
commissions in twenty twenty six on prescription drug plans, Medicare
(02:37):
advantage plans, and so in a lot of cases, your
Medicare advisor isn't getting any compensation for helping you choose
a Medicare plan. For twenty twenty six, several standalone prescription
drug plans aren't paying commissions to agent brokers. And this
is on both sides of the river, folks, both Iowa
(02:59):
and Illinois. Several major supplement companies are cutting commissions by
two thirds or more. They want you to subscribe to
a one eight hundred number and not use a local
license agent. Now, I don't know what the correct answer is,
but I know that most sixty four and nine months
(03:20):
year olds have trouble understanding the Medicare system. The concept
that an eighty or eighty five year old will pick
up the phone and dial an eight hundred number and
feel good about that about that decision just doesn't sound
right to me. But when I say this, I sound biased. Now,
all of this doom and gloom isn't all bad. This
(03:43):
also presents an opportunity for those that are receiving a
SAR letter Service Area Reduction letter. If you get a SAR,
you can if you choose to move to a guaranteed
issue Medicare supplement plan. So keep that in mind. And
if you don't understand what I just said, give me
(04:03):
a call and we can talk about it. Now, let's
talk about ETNA and what they have available for Medicare
advantage plans. In twenty twenty six, they have five HMO
POS plans and three PPO plans in Iowa. On the
Illinois side, they have two HMO plans and four PPOs. Today,
(04:24):
i'll talk about one of their HMO pos, and if
I have time, I'll talk about one of their PPOs
here in Iowa. Now across the river, plans are a
little different from Iowa, but they're pretty close. I'll start
with the EDNA Medicare Signature HMO POS plan, and this
plan will compete very strongly with United Healthcare's current zero
(04:49):
dollar monthly premium plan. Depending on time, I'll then talk
about the EDNA Medicare Enhanced Extra PPO plan. I haven't
really timed this. We'll see how far this goes, and
if I can't get that far today, I'll just do
this on another show. So today, right now, I'm talking
(05:10):
about the aDNA Medicare Signature HMO POS plan for twenty
twenty six. This plan will have a zero dollar monthly premium.
There is a zero dollar deductible, and the max out
of pocket on this plan is only going to be
forty three hundred dollars for in network services in twenty
(05:33):
twenty six, you're gonna see a lot of plans. They're
gonna have a max out of pocket of more are
at five thousand dollars or more in twenty twenty six.
Cross are going up for four reasons. One, insurance company's
got to pay more for your drug costs. This year,
they're only paying twenty percent of the bill. Next year
(05:53):
they're going to be paying eighty percent of the bill.
Part of the triple be the big beautiful bill that's
also built into the pricing. Three is pasted claims experience.
A lot of us didn't get services during COVID, and
we started to go get to use goods and services
(06:16):
the last couple of years. Those are rolling in. Those
are the three major ones. So let me jump into
hospitalization under the ETNA plan, under the HMO the signature
HMO POS plan from ETNA, if you are hospitalized, you
(06:40):
would pay three hundred and ninety a day for up
to six days day seven. Going forward, you don't pay
any copay for that. But let's see three ninety at six,
you're looking at twenty three forty and forty bucks. And
(07:01):
the twenty three forty would come off of the forty
three hundred for your max out of pocket. The three
ninety cope is for both hospitalization observation services copay out
patient hospital or if you go to an ambulatory surgical center.
(07:22):
Now there's no copey if you go see your primary physician,
but you will have a thirty five dollars cope if
you go see a specialist. Preventive care is built in.
There's no copay for that. You can read the explanation
evidence that coverage EOC for all those covered services, but
those are the same as last year. ER. If you
(07:49):
go to the ER, you're gonna have a one thirty cope.
If you go to an urgent care center, the copay
for that is only fifty dollars, but ER in urgent
care UH is going to be one thirty. And your
ambulance of ambulance ride would be a three forty five cope.
(08:11):
That's for both ground or air diagnostic testing, so UH
diagnostic tests and procedures those are that's gonna be a
twenty dollars copey, but CT CAT scans and MRIs would
be a three hundred dollars cope. Outpatient X rays would
(08:34):
only be fifteen dollars cope. UH there's a you have
no copey for a hearing exam, but the ideologist does
have to be in the network. Now under EDNA, most
doctors at Mercy One, Genesis, Unity Point, and University of
Iowa hospitals and clinics are on their in network list.
(08:56):
If your doctor is not on the list, it may
be because they're a new doctor. And sometimes you will
find that the doctor physician is not on the list,
but the nurse practitioner is. So you just gotta take
a look see for that. Sometimes it's not under the name,
it could just be under the facility address. Let's see.
(09:21):
So there is a hearing aid benefit. You get an
annual benefit amount of twelve to fifty per year, but
understand that audiologist has to be in the network. So
dental services, this is a touchy one. Everybody wants free dental,
but nothing's free the year. There is a zero dollar
(09:43):
cope for covered dental services, but it's just basic. If
you're out of network, they would only pay fifty percent
of the covered amount. You do get an annual allowance
of nine hundred dollars for covered services. Edna's dental network
is a PPO network for the dental but the dentists
(10:06):
does have to be in the network, so take a
look see for that. Not all dentists or part of
the EDNA Dental network yet EDNA hasn't really pushed that
all that hard, but more dentists are signing up every day.
If your dentis is not in the network, they would
still pay the basic price and then they would just
(10:29):
balance bill you for the rest, so it's not an
all or nothing deal. There is a vision benefit, but
the I doctor must be in the network, and they do.
They have to be under the imed provider network. Let's
(10:49):
see skilled nursing facility. There's no copey for the first
twenty days. Days twenty one through one hundred would run
you two eighteen per day. Physical and speech therapy is
a specialist cope at thirty five. Occupational therapy is also
a thirty five dollars cope. Ambulance whether it be ground
(11:12):
or air, would run you at three forty five copey.
See Chemotherapy drugs has co insurance up to twenty percent.
Part B insulin is capped at a thirty five dollars cope,
and then other Part B drugs depending on which one
(11:35):
you're taking, runs a zero to twenty percent co insurance.
It does have a drug plan included. I will call
your attention to tiers one and two preferred Garinet generic
and generic drugs have a zero dollar copey on thirty
day preferred mail order system or on the one hundred
(11:59):
day preferred mail order system. That's a nice benefit for
all of our routine maintenance medications. And just like many companies,
they're also moving, Edna's moving to a co insurance amount
for tiers three, four and five. So Tier three preferred Brand,
(12:21):
Tier four non preferred drug, and Tier five Specialty are
all going to have co insurance in twenty twenty six.
Not of true Cope. Deductible for the drug plan on
this plan will be six point fifteen. That's the maximum
(12:42):
they can charge in twenty twenty six. But the deductible
only applies to brand new medication tiers three, four and five.
Under ETNA, they you like to use the CBS network,
but you can also go to HYV that would be preferred. Now,
if you're a Walgreens fanatic, I'm not saying you can't
(13:05):
use yet and a drug plan, but you will pay
standard pricing if you go to Walgreens under this plan
other covered benefits. They do have acupuncture, but the there
is a network for the acupuncture and that'd be a
thirty five dollars cope. Same with chiropractic. There's a chiropractic network.
(13:28):
If they're in the network, you'd only have a fifteen
dollars cope. Diabetes Diabetic Supplies then at the most you're
gonna pay twenty percent co insurance, but there's a lot
of caps on that. If you are diabetic, I would
encourage you to get a hold of me and I'll
refer you to my guy over at ADS Advanced Diabetes Supplies.
(13:52):
He can really help you with some of those costs
and items that you might need. There is a Silver
Sneakers membership under this plan for a zero dollar Copey.
Silver Sneakers has several participating fitness facilities and you can
even order an at home fitness kit one per year
(14:16):
if you want, let's see Durable Medical Equipment DME. You
would pay up to twenty percent co insurance for that.
There's also Substance Abuse Disorder Services, home care and support,
(14:37):
and medical Equipment ends supplies. This plan also has a
visitor travel program called Travel Advantage. It allows you to
remain in the plan from to twelve months. When you're
outside the plans service area. While traveling through the US,
you can see an EDNA Medicare participating provider and pay
(15:00):
in network cost Sure, not all providers participate in the
multi state network. In most cases, non urgent, non emergency
care you receive from an out of network provider will
not be covered. California is one of those states. It
also would be a not covered state. You would only
(15:21):
have coverage there if it was an emergency. And then
this plan also offers a twenty four hour nurse line
for a zero dollar copet that is the ETNA Medicare
signature hmopos for zero dollar monthly premium with a forty
(15:44):
three hundred max out of pocket in twenty twenty six,
that's probably going to be the most competitive HMO ATNA
plan that at provide. Now I'm going to switch over
to a very aggressive, little more expensive plan, but just
(16:07):
to give you a little food for thought, this is
the one of their PPO plans. And then remember on
the Iowa side, there's let's see one, two, they have
three PPOs and four Hmopos's not everybody qualifies for all
of them, but they have several. This one is the
(16:29):
ATNA Medicare Enhanced Extra PPO. Now, this plan has a
monthly plan premium of fifty seven dollars a month, so
this plan is not cheap. However, there is no plan
deductible and the max out of pocket on this plan
is forty five hundred, which is a lot lower than
(16:51):
most of the plans you are going to see next
year that are gonna be north of five thousand. Now,
because of the PPO you have in and out of
network coverage, the in network max out of pocket's forty
five hundred. The out of pocket excuse me, the out
of network combined service would be ten thousand dollars. Now,
remember locally Western Illinois, Central Illinois, Eastern Iowa, Central Iowa.
(17:19):
That's all going to be considered. In network, the hospitalization
under this plan would be three twenty five a day
for up to five days. Now, if you're out of network,
you would just pay forty percent co insurance. But in
network three twenty five at five days is only sixteen
(17:41):
twenty five. Sixteen twenty five would come off of the
forty five hundred dollars. Number three twenty five would be
the same for outpatient, and if you went to an
ambulatory surgical center under this plan, you'd only pay two
seventy five ECP visit is zero. Specialists would be thirty five.
(18:06):
Preventative is built in emergency copays one thirty. Urgent care
would only be fifty. Diagnostic, whether we're talking MRICAT or
CT scan would only be a two to fifty copey.
There is a hearing benefit, there is a dental benefit.
(18:28):
It's identical to the HMO plan. The vision plan is identical,
as is some of the mental health services. I will
call your attention to both the dental, chiropractic, hearing, and vision.
They do have their own networks. You have to check
(18:49):
the network for that. Skilled nursing is going to be
the same at two eighteen per day. Mental health services,
whether it's psychiatric, hospital, outpatient psychotherapy, it's going to be
a three to seventy hospital stay or a forty dollars
copey for any of those therapies. Ambulance, whether it's ground
(19:13):
or air, you'd only have a two to forty five cope.
The drug plan would still have zero dollar copes on
tiers one and two for thirty day preferred or one
hundred day mail order CBS and high ve are preferred
under this plan. This plan, because you pay fifty seven
(19:36):
a month, will give you fifty dollars a quarter to
buy over the counter items for your OTC wallet. If
you are a low income person, you can also get
an Extra Benefits card in twenty twenty five and there's
extra fringe benefits you can get there, but you must
(19:58):
qualify both meta and financially for that type of benefit. Acupuncture,
chiropractic diabetes, that's the same under this plan. You still
have Silver Sneakers, but you also have a DMR Direct
Member Reimbursement and allowance. The Direct Member Reimbursement benefit amount
(20:21):
is ninety dollars each quarter. The reimbursement period starts the
first day of January and it's every calendar quarter till
the end of the year. The ninety dollars does not
roll over. You can use that for fitness, gym memberships
at gyms that are not covered under Silver Sneakers, and
(20:44):
a few other items. Pedietry. Still in here. There is
a meal benefit durable medical equipments in their substance abuse
substance disorder coverage. The Visitor Traveler Program is still in
there and twenty four hour nurse line. I brought this
(21:06):
plan up just because this is a big I would
call this a very competitive PPO plan, but understand that
you have to pay six to eighty four a year
for this plan, but it does have some embedded fringe benefits.
There are some other HMOPOS plans under EDNA that I
(21:28):
haven't covered yet. The EDNA Medicare Signature PPO will be
very competitive for twenty twenty six with a zero dollar COPE.
They have an EDNA Medicare Elite PPO that's also to
zero dollar. However, that plan, and remember these are on
the Iowa side, that plan does have a deductible, so
(21:52):
that's not as enticing as some of these others. A
lot of people in this area are accustomed to a
zero dollars a monthly premium, and I get it. The
ETNA Medicare Signature PPO, which is a zero dollar premium,
the max out of pocket on that will be five grand,
(22:13):
not forty five hundred like the Enhanced Extra PPO that
I just talked about. So there are pros and cons
to these different plans. Everybody's situation is different. Meet with
your advisor and go over these plans. I know this
is confusing because I mean here with EDNA, you got
(22:36):
seven plans just on the IOA side to choose from,
and that's not counting what Illinois has, So check it out.
On the Illinois side, EDNA is very competitive, so is
Blue Cross of Illinois for twenty twenty six. But again,
pros and cons to all of these plans, and sometimes
(22:58):
depending on your medications, ed may not be the right
fit for you, but I don't know. We have to
look in either any case, double check your plan and
make sure that you're gonna have coverage for twenty twenty
six because if you do get a star letter, that's
that's going to affect you directly. That means you got
(23:19):
to do something by December seventh, So make sure you
take action on that. If you're under sixty five and
helping a parent, double check what plan they're on, because
if the plan is being reduced, they will get a
letter that states that effect. And if you're not sure,
give me a call. I can talk you through determining
(23:42):
which plans will be affected and which ones won't. But
there's a lot of changes for twenty twenty six in Medicare.
When we're talking about standalone drug plans. A lot of
those planned premiums are doubling or tripling, depending on the plan.
In Iowa value scripts going from zero to nine fifth.
There's a United Healthcare plan on the Illinois side that's
(24:04):
more than doubling. It's like forty two to ninety seven,
I believe, So just be cognizant of that. Don't forget
my monthly virtual meetings regarding Medicare for two different companies
every month are kind of on hold right now. But
in one meeting, I will generally cover Medicare supplements with
(24:25):
a standalone drug plan. The other meeting, I normally will
focus on Medicare Parts C known as mapds or Medicare
Advantage plans, and I'll cover the benefits of that platform.
Given all the changes, I don't have the future dates
for those meetings at this time, but I think i'll
(24:45):
have a new company sponsor here in a couple of weeks.
I may switch to just talking about supplements for a while.
In Iowa, you usually use United Healthcare, AARP or well Mark.
On the Illinois side, I like aar P, and I
Healthcare is very competitive. The Blue Cross of Illinois is
(25:06):
also competitive. Just in the supplement space. I'd be happy
to schedule an individual meeting at your request to discuss
your situation. You can call our office at five six
three three three two two two zero zero H, or
you can email me at Craig at Craigshillig dot com.
(25:30):
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. We talked to talk
with our listeners about financial strategies we used 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 is safe money harbors,
(00:24):
or using cash value life insurance to supplement your 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 appointment to discuss your individual situation,
or you can email me at Craig at Craigshillig dot com.
(00:47):
And that's my name, cr Ai G at cr Ai
G S c h I L l ig dot com.
Remember that October is National Financial Planning Month. Last week
I just stuck I discussed well Mark's Blue Medicare Advantage
(01:10):
PPO plan. Today I'd like to talk about ETNA and
some of the Medicare advantage plans that they have for
twenty twenty six. Also, remember that if you work with
a Medicare advisor, please give him or her an extra handshake.
Or a hug or both. Bring some cookies or a
(01:31):
pie to your appointment, buy them a coffee. Personally, I
like cupcakes or a fruit basket. CMS rules says we
can't charge a fee for services, so no cash, gift
cards or office fees are allowed. Just understand that most
insurance companies are not paying agent broker commissions in twenty
(01:54):
twenty six. No commissions on several Medicare advantage plans, prescription
drug plans, and many supplement plans. Companies are cutting their
commission amounts. And let me replete repeat that insurance companies
will not be paying agent broker commissions in twenty twenty six.
(02:15):
When you go to work right now, do you work
for no compensation when you were employed? If you're retired, now,
did you work for free? Out of the kindness of
your heart? Several insurance companies aren't going to be paying
commissions in twenty twenty six on prescription drug plans, Medicare
(02:37):
advantage plans, and so in a lot of cases, your
Medicare advisor isn't getting any compensation for helping you choose
a Medicare plan. For twenty twenty six, several standalone prescription
drug plans aren't paying commissions to agent brokers. And this
is on both sides of the river, folks, both Iowa
(02:59):
and Illinois. Several major supplement companies are cutting commissions by
two thirds or more. They want you to subscribe to
a one eight hundred number and not use a local
license agent. Now, I don't know what the correct answer is,
but I know that most sixty four and nine months
(03:20):
year olds have trouble understanding the Medicare system. The concept
that an eighty or eighty five year old will pick
up the phone and dial an eight hundred number and
feel good about that about that decision just doesn't sound
right to me. But when I say this, I sound biased. Now,
all of this doom and gloom isn't all bad. This
(03:43):
also presents an opportunity for those that are receiving a
SAR letter Service Area Reduction letter. If you get a SAR,
you can if you choose to move to a guaranteed
issue Medicare supplement plan. So keep that in mind. And
if you don't understand what I just said, give me
(04:03):
a call and we can talk about it. Now, let's
talk about ETNA and what they have available for Medicare
advantage plans. In twenty twenty six, they have five HMO
POS plans and three PPO plans in Iowa. On the
Illinois side, they have two HMO plans and four PPOs. Today,
(04:24):
i'll talk about one of their HMO pos, and if
I have time, I'll talk about one of their PPOs
here in Iowa. Now across the river, plans are a
little different from Iowa, but they're pretty close. I'll start
with the EDNA Medicare Signature HMO POS plan, and this
plan will compete very strongly with United Healthcare's current zero
(04:49):
dollar monthly premium plan. Depending on time, I'll then talk
about the EDNA Medicare Enhanced Extra PPO plan. I haven't
really timed this. We'll see how far this goes, and
if I can't get that far today, I'll just do
this on another show. So today, right now, I'm talking
(05:10):
about the aDNA Medicare Signature HMO POS plan for twenty
twenty six. This plan will have a zero dollar monthly premium.
There is a zero dollar deductible, and the max out
of pocket on this plan is only going to be
forty three hundred dollars for in network services in twenty
(05:33):
twenty six, you're gonna see a lot of plans. They're
gonna have a max out of pocket of more are
at five thousand dollars or more in twenty twenty six.
Cross are going up for four reasons. One, insurance company's
got to pay more for your drug costs. This year,
they're only paying twenty percent of the bill. Next year
(05:53):
they're going to be paying eighty percent of the bill.
Part of the triple be the big beautiful bill that's
also built into the pricing. Three is pasted claims experience.
A lot of us didn't get services during COVID, and
we started to go get to use goods and services
(06:16):
the last couple of years. Those are rolling in. Those
are the three major ones. So let me jump into
hospitalization under the ETNA plan, under the HMO the signature
HMO POS plan from ETNA, if you are hospitalized, you
(06:40):
would pay three hundred and ninety a day for up
to six days day seven. Going forward, you don't pay
any copay for that. But let's see three ninety at six,
you're looking at twenty three forty and forty bucks. And
(07:01):
the twenty three forty would come off of the forty
three hundred for your max out of pocket. The three
ninety cope is for both hospitalization observation services copay out
patient hospital or if you go to an ambulatory surgical center.
(07:22):
Now there's no copey if you go see your primary physician,
but you will have a thirty five dollars cope if
you go see a specialist. Preventive care is built in.
There's no copay for that. You can read the explanation
evidence that coverage EOC for all those covered services, but
those are the same as last year. ER. If you
(07:49):
go to the ER, you're gonna have a one thirty cope.
If you go to an urgent care center, the copay
for that is only fifty dollars, but ER in urgent
care UH is going to be one thirty. And your
ambulance of ambulance ride would be a three forty five cope.
(08:11):
That's for both ground or air diagnostic testing, so UH
diagnostic tests and procedures those are that's gonna be a
twenty dollars copey, but CT CAT scans and MRIs would
be a three hundred dollars cope. Outpatient X rays would
(08:34):
only be fifteen dollars cope. UH there's a you have
no copey for a hearing exam, but the ideologist does
have to be in the network. Now under EDNA, most
doctors at Mercy One, Genesis, Unity Point, and University of
Iowa hospitals and clinics are on their in network list.
(08:56):
If your doctor is not on the list, it may
be because they're a new doctor. And sometimes you will
find that the doctor physician is not on the list,
but the nurse practitioner is. So you just gotta take
a look see for that. Sometimes it's not under the name,
it could just be under the facility address. Let's see.
(09:21):
So there is a hearing aid benefit. You get an
annual benefit amount of twelve to fifty per year, but
understand that audiologist has to be in the network. So
dental services, this is a touchy one. Everybody wants free dental,
but nothing's free the year. There is a zero dollar
(09:43):
cope for covered dental services, but it's just basic. If
you're out of network, they would only pay fifty percent
of the covered amount. You do get an annual allowance
of nine hundred dollars for covered services. Edna's dental network
is a PPO network for the dental but the dentists
(10:06):
does have to be in the network, so take a
look see for that. Not all dentists or part of
the EDNA Dental network yet EDNA hasn't really pushed that
all that hard, but more dentists are signing up every day.
If your dentis is not in the network, they would
still pay the basic price and then they would just
(10:29):
balance bill you for the rest, so it's not an
all or nothing deal. There is a vision benefit, but
the I doctor must be in the network, and they do.
They have to be under the imed provider network. Let's
(10:49):
see skilled nursing facility. There's no copey for the first
twenty days. Days twenty one through one hundred would run
you two eighteen per day. Physical and speech therapy is
a specialist cope at thirty five. Occupational therapy is also
a thirty five dollars cope. Ambulance whether it be ground
(11:12):
or air, would run you at three forty five copey.
See Chemotherapy drugs has co insurance up to twenty percent.
Part B insulin is capped at a thirty five dollars cope,
and then other Part B drugs depending on which one
(11:35):
you're taking, runs a zero to twenty percent co insurance.
It does have a drug plan included. I will call
your attention to tiers one and two preferred Garinet generic
and generic drugs have a zero dollar copey on thirty
day preferred mail order system or on the one hundred
(11:59):
day preferred mail order system. That's a nice benefit for
all of our routine maintenance medications. And just like many companies,
they're also moving, Edna's moving to a co insurance amount
for tiers three, four and five. So Tier three preferred Brand,
(12:21):
Tier four non preferred drug, and Tier five Specialty are
all going to have co insurance in twenty twenty six.
Not of true Cope. Deductible for the drug plan on
this plan will be six point fifteen. That's the maximum
(12:42):
they can charge in twenty twenty six. But the deductible
only applies to brand new medication tiers three, four and five.
Under ETNA, they you like to use the CBS network,
but you can also go to HYV that would be preferred. Now,
if you're a Walgreens fanatic, I'm not saying you can't
(13:05):
use yet and a drug plan, but you will pay
standard pricing if you go to Walgreens under this plan
other covered benefits. They do have acupuncture, but the there
is a network for the acupuncture and that'd be a
thirty five dollars cope. Same with chiropractic. There's a chiropractic network.
(13:28):
If they're in the network, you'd only have a fifteen
dollars cope. Diabetes Diabetic Supplies then at the most you're
gonna pay twenty percent co insurance, but there's a lot
of caps on that. If you are diabetic, I would
encourage you to get a hold of me and I'll
refer you to my guy over at ADS Advanced Diabetes Supplies.
(13:52):
He can really help you with some of those costs
and items that you might need. There is a Silver
Sneakers membership under this plan for a zero dollar Copey.
Silver Sneakers has several participating fitness facilities and you can
even order an at home fitness kit one per year
(14:16):
if you want, let's see Durable Medical Equipment DME. You
would pay up to twenty percent co insurance for that.
There's also Substance Abuse Disorder Services, home care and support,
(14:37):
and medical Equipment ends supplies. This plan also has a
visitor travel program called Travel Advantage. It allows you to
remain in the plan from to twelve months. When you're
outside the plans service area. While traveling through the US,
you can see an EDNA Medicare participating provider and pay
(15:00):
in network cost Sure, not all providers participate in the
multi state network. In most cases, non urgent, non emergency
care you receive from an out of network provider will
not be covered. California is one of those states. It
also would be a not covered state. You would only
(15:21):
have coverage there if it was an emergency. And then
this plan also offers a twenty four hour nurse line
for a zero dollar copet that is the ETNA Medicare
signature hmopos for zero dollar monthly premium with a forty
(15:44):
three hundred max out of pocket in twenty twenty six,
that's probably going to be the most competitive HMO ATNA
plan that at provide. Now I'm going to switch over
to a very aggressive, little more expensive plan, but just
(16:07):
to give you a little food for thought, this is
the one of their PPO plans. And then remember on
the Iowa side, there's let's see one, two, they have
three PPOs and four Hmopos's not everybody qualifies for all
of them, but they have several. This one is the
(16:29):
ATNA Medicare Enhanced Extra PPO. Now, this plan has a
monthly plan premium of fifty seven dollars a month, so
this plan is not cheap. However, there is no plan
deductible and the max out of pocket on this plan
is forty five hundred, which is a lot lower than
(16:51):
most of the plans you are going to see next
year that are gonna be north of five thousand. Now,
because of the PPO you have in and out of
network coverage, the in network max out of pocket's forty
five hundred. The out of pocket excuse me, the out
of network combined service would be ten thousand dollars. Now,
remember locally Western Illinois, Central Illinois, Eastern Iowa, Central Iowa.
(17:19):
That's all going to be considered. In network, the hospitalization
under this plan would be three twenty five a day
for up to five days. Now, if you're out of network,
you would just pay forty percent co insurance. But in
network three twenty five at five days is only sixteen
(17:41):
twenty five. Sixteen twenty five would come off of the
forty five hundred dollars. Number three twenty five would be
the same for outpatient, and if you went to an
ambulatory surgical center under this plan, you'd only pay two
seventy five ECP visit is zero. Specialists would be thirty five.
(18:06):
Preventative is built in emergency copays one thirty. Urgent care
would only be fifty. Diagnostic, whether we're talking MRICAT or
CT scan would only be a two to fifty copey.
There is a hearing benefit, there is a dental benefit.
(18:28):
It's identical to the HMO plan. The vision plan is identical,
as is some of the mental health services. I will
call your attention to both the dental, chiropractic, hearing, and vision.
They do have their own networks. You have to check
(18:49):
the network for that. Skilled nursing is going to be
the same at two eighteen per day. Mental health services,
whether it's psychiatric, hospital, outpatient psychotherapy, it's going to be
a three to seventy hospital stay or a forty dollars
copey for any of those therapies. Ambulance, whether it's ground
(19:13):
or air, you'd only have a two to forty five cope.
The drug plan would still have zero dollar copes on
tiers one and two for thirty day preferred or one
hundred day mail order CBS and high ve are preferred
under this plan. This plan, because you pay fifty seven
(19:36):
a month, will give you fifty dollars a quarter to
buy over the counter items for your OTC wallet. If
you are a low income person, you can also get
an Extra Benefits card in twenty twenty five and there's
extra fringe benefits you can get there, but you must
(19:58):
qualify both meta and financially for that type of benefit. Acupuncture,
chiropractic diabetes, that's the same under this plan. You still
have Silver Sneakers, but you also have a DMR Direct
Member Reimbursement and allowance. The Direct Member Reimbursement benefit amount
(20:21):
is ninety dollars each quarter. The reimbursement period starts the
first day of January and it's every calendar quarter till
the end of the year. The ninety dollars does not
roll over. You can use that for fitness, gym memberships
at gyms that are not covered under Silver Sneakers, and
(20:44):
a few other items. Pedietry. Still in here. There is
a meal benefit durable medical equipments in their substance abuse
substance disorder coverage. The Visitor Traveler Program is still in
there and twenty four hour nurse line. I brought this
(21:06):
plan up just because this is a big I would
call this a very competitive PPO plan, but understand that
you have to pay six to eighty four a year
for this plan, but it does have some embedded fringe benefits.
There are some other HMOPOS plans under EDNA that I
(21:28):
haven't covered yet. The EDNA Medicare Signature PPO will be
very competitive for twenty twenty six with a zero dollar COPE.
They have an EDNA Medicare Elite PPO that's also to
zero dollar. However, that plan, and remember these are on
the Iowa side, that plan does have a deductible, so
(21:52):
that's not as enticing as some of these others. A
lot of people in this area are accustomed to a
zero dollars a monthly premium, and I get it. The
ETNA Medicare Signature PPO, which is a zero dollar premium,
the max out of pocket on that will be five grand,
(22:13):
not forty five hundred like the Enhanced Extra PPO that
I just talked about. So there are pros and cons
to these different plans. Everybody's situation is different. Meet with
your advisor and go over these plans. I know this
is confusing because I mean here with EDNA, you got
(22:36):
seven plans just on the IOA side to choose from,
and that's not counting what Illinois has, So check it out.
On the Illinois side, EDNA is very competitive, so is
Blue Cross of Illinois for twenty twenty six. But again,
pros and cons to all of these plans, and sometimes
(22:58):
depending on your medications, ed may not be the right
fit for you, but I don't know. We have to
look in either any case, double check your plan and
make sure that you're gonna have coverage for twenty twenty
six because if you do get a star letter, that's
that's going to affect you directly. That means you got
(23:19):
to do something by December seventh, So make sure you
take action on that. If you're under sixty five and
helping a parent, double check what plan they're on, because
if the plan is being reduced, they will get a
letter that states that effect. And if you're not sure,
give me a call. I can talk you through determining
(23:42):
which plans will be affected and which ones won't. But
there's a lot of changes for twenty twenty six in Medicare.
When we're talking about standalone drug plans. A lot of
those planned premiums are doubling or tripling, depending on the plan.
In Iowa value scripts going from zero to nine fifth.
There's a United Healthcare plan on the Illinois side that's
(24:04):
more than doubling. It's like forty two to ninety seven,
I believe, So just be cognizant of that. Don't forget
my monthly virtual meetings regarding Medicare for two different companies
every month are kind of on hold right now. But
in one meeting, I will generally cover Medicare supplements with
(24:25):
a standalone drug plan. The other meeting, I normally will
focus on Medicare Parts C known as mapds or Medicare
Advantage plans, and I'll cover the benefits of that platform.
Given all the changes, I don't have the future dates
for those meetings at this time, but I think i'll
(24:45):
have a new company sponsor here in a couple of weeks.
I may switch to just talking about supplements for a while.
In Iowa, you usually use United Healthcare, AARP or well Mark.
On the Illinois side, I like aar P, and I
Healthcare is very competitive. The Blue Cross of Illinois is
(25:06):
also competitive. Just in the supplement space. I'd be happy
to schedule an individual meeting at your request to discuss
your situation. You can call our office at five six
three three three two two two zero zero H, or
you can email me at Craig at Craigshillig dot com.
(25:30):
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.
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