Episode Transcript
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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
four years. During that time, I've learned a few insurance strategies,
like using annuities as safe money harbors, or using cash
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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
enroll into one of my virtual Medicare community meetings. I
do those via zoom. I give two every month, or
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you can email me at Craig at Craigshillig dot com
and that's my first name, Craigaig at cr aig scchi
lllig dot com. Today, I'd like to talk with you
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about the Medicare Open Enrollment Period also known as OEP
that's running rate now. It runs from January one to
March thirty. First, for those of you that missed your
December seventh enrollment deadline due to one reason or another,
or for those of you who think there's a better
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plan out there and you're not happy with your existing
Medicare advantage plan or they just didn't have time to
review with their advisor. If they should switch plans, now
would be the time to do that. If you live
in Iowa. There's a very popular well Mark Medicare PPO
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advantage plan out there that's very competitive against the other competitors. Now,
there's a couple nuances. It will depend on what your
current medications are as to if you're going to save
money on that plan. But if you'd like learn to
learn more about it, get my office a call. I'd
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be happy to help you with that. I have a
lot of clients that signed up for that plan for
twenty twenty five. Let's talk about Medicare Advantage plans also
known as Medicare Part C. Now. You still need to
have Medicare Part A Hospital and Part B medical in
order to get Part C Medicare advantage plans. Now Part
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B costs you one hundred and eighty five dollars monthly
premium for twenty twenty five. That's for most people unless
you're too successful. Two successful means your twenty twenty three
file joint tax return has gross income above two hundred
and twelve thousand dollars, or if you're a single filer,
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your income is above one hundred and six and that
goes by Maggie MAGI, which is known as modified adjust
to Gross income. A Medicare advantage plan has a doctor
hospital network. Some are HMOs known as a Health Maintenance organization,
or some are PPO networks known as Preferred provider organizations.
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Under this plan, you get your Medicare Part A hospital
and your Part B medical coverage from a Medicare advantage
plan not original Medicare. Medicare advantage plans, sometimes referred to
as Part C plans or MAPDE plans are offered by
private insurance companies like at United Healthcare, well Mark, just
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to name a few, that are approved by CMS. Known
as Medicare. Medicare advantage plans cover all Medicare services. The
rule is that Medicare advantage plans must offer equal to
or greater than coverage than what original Medicare would cover.
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In all types of mapdes, you're covered for all the
services that original Medicare covers, including emergency and urgent care,
except for hospice care in some care in qualifying clinical
research studies, however, hospice care and some costs for clinical
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research studies are covered by original Medicare even if you're
in an MapD plan. Medicare advantage plans may offer extra
coverage like basic vision, dental, hearing, health and wellness programs.
Most include Medicare prescription drug coverage known as Medicare Part D.
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In addition to your Part D premium, you may pay
a monthly premium for the Medicare Advantage plan. Medicare advantage
plans must follow Medicare rules. Medicare pays a fixed amount
for your care each month the companies offering the Medicare
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advantage plans. These companies must follow rules set by cms. However,
each Medicare advantage plan can charge different out of pocket
costs and have different rules for how you get services,
like whether you need a referral to see a specialist,
or if you have to go to certain doctors, facilities,
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or use suppliers that belong to the plan for non
emergency or non urgent care. These rules can change each
year based on the contract. The plan must notify you
about any changes before the start of the next enrollment year.
If you're already a Medicare advantage plan member. You may
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just enroll from your current plan and switch to a
different Medicare advantage plan only one time during OEP, or
you can go back to original Medicare during this timeframe again.
This period runs January first to the last day of March.
Who can participate People already enrolled in Medicare advantage plans
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as of January one? What kind of changes can you make?
You can switch to another Medicare advantage plan with or
without drug coverage. You can switch back to original Medicare,
and if needed, you can add a Medicare Part D plan.
If you have a Part D plan now, you could
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switch your drug plan for a first of the next
month effective date. Now remember you can only do this
one time. You get one chance to do this during OEP,
and your new plan then takes effect the first of
the following month based on if they've received an enrollment request.
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Can you change your Medicare advantage plan? After Medicare Advantage
Plan open enrollment, you can change your plan or enroll
in a new Medicare advantage plan during an SEP known
as a special enrollment period. These can happen due to
a qualifying life event such as losing your insurance due
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to moving to a new location outside your plans coverage area,
and you can and whether you may qualify for one
when you disenroll from a Medicare Advantage plan. You can
disenroll during the annual enrollment period, the open enrollment period,
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or during a special election period. If you have a
qualifying life event such as sell your house and move,
you become institutionalized, maybe you're going to retire, stuff of
that nature. What happens if you need to change plans
during a period, You cannot change plans. If you need
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to change a plan outside of the standard enrollment periods,
you may be able to do so if you qualify
for an SEP. Qualifying life events for these SEPs include
selling your house and moving. If the plan is not renewing,
if they've sent you a letter that says, effective such
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and such a date, we will no longer have this
plan available. You can also contact CMS directly if you
have more questions about that. Depending on the qualifying life event,
you have anywhere between thirty and sixty days in order
to make a plan change. How is the Medicare Advantage
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Open enrollment period different from the Medicare annual enrollment period
in the fall. The annual enrollment period is different in
several ways. First, it occurs in the fall between October
fifteenth and December seventh for coverage beginning January first. Secondly,
anyone eligible for Medicare can participate. Third, you can make
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as many changes to your plan and coverage as you
wish before December seventh. That's the big difference there. During
October fifteenth to December seventh, you can change as many
times as you want. During OEP you only get one change.
That's it. The Medicare Advantage Open Enrollment Period is an
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opportunity to change your coverage and choose the right plan
for you. If you're considering switching back to original Medicare,
you want to check out the rules on that because
if you leave a Medicare Advantage plan, then you are
going to have to sign up for drug coverage. Please
keep that in mind because you must have drug coverage
when you're on Medicare. Let's talk about some other frequently
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asked questions. What are the other enrollment periods for Medicare.
There's five Medicare enrollment periods in addition to the Medicare
Advantage Open enrollment period. There's the initial enrollment period that's
when you become you agent of Medicare turning sixty five.
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There's a general enrollment period. There's the annual enrollment period,
which we just ended on December seventh. There's a Medicare
Supplement Open enrollment period, and then there's also several SEPs
known as special enrollment periods throughout the year based on
a life event. Can you switch Medicare advantage plans at
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any time? Out Medicare advantage plans can only be switched
during the Medicare open enrollment period, during a special election period,
excuse me, a special enrollment period, during your initial election period,
and during the fall during the annual enrollment period Medicare
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special enrollment periods. If you need to sign up for
Medicare advantage plans outside of the usual Medicare enrollment periods,
an SEP a special election period could be the answer,
but understand you have to meet the criteria for that.
What is a SEP. A Medicare SCP offers an eligible
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member eligible Medicare member a chance to change your plan
outside of their initial coverage election period or the Medicare
annual election period known as AEP. How do you qualify
for a Medicare SEP. There are specific rules about who
may qualify for an SVP. Here are some common scenarios.
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If you've moved to a new home, you've changed your address.
If you're moving to another city and state where your
current Medicare plan isn't available, you more than likely will
qualify for an SVP. If you've recently been released from
jail incarceration and you're eligible for Medicare, you may qualify
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your Medicare advantage plan is no longer available from your
insurance company. Your insurance company is going to stop offering
a current plan in your area at the end of
that year or whatever period they're specifying. That's sometimes called
a non renewal or a termination of coverage event. How
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long is the special enrollment period? If you have add
health insurance through your job or your spouse's job, your
special enrollment period starts the first month after your initial
enrollment period ends, and then it ends eight months after
either your group coverage or your employment ends, whichever comes first.
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A late enrollment penalty may be applied if you wait
longer than sixty three days after your special enrollment period ends.
To enroll in a new plan. It's important to know
that COBRA isn't considered group health plan. Coverage. Signing up
for COBRA doesn't change when the special enrollment period ends.
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A Medicare special enrollment period is a period of time
to enroll or change a Medicare advantage plan outside of
your initial coverage election period or Medicare's annual election period
that's in the fun. There are various types of SEPs
that would allow you to enroll in a Medicare advantage
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plan outside of these time periods. Medicare advantage plans help
expand your Medicare coverage beyond original Medicare, often with extra benefits.
You can explore Medicare advantage plans in your area today.
If you want more information, please call my office. So
let's talk about some exceptional conditions for Medicare Special Enrollment
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periods cms. The Center for Medicare and Medicaid Services has
the legal authority to establish SEPs when a person or
group of people meet certain exceptional conditions. Some of these
conditions include individuals making a Medicare advantage enrollment request into
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or out of an employer sponsored Medicare advantage plan, Individuals
disenrolling from a Medicare advantage plan to enrollment in a
program of all inclusive care for elderly, also known as PACE.
Individuals who drop a Medicare Supplement insurance plan when they
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enrolled for the first time in a Medicare advantage plan
and are still in their twelve month trial right period.
Individuals enrolled in a special needs plan known as the
SNIP who are no longer eligible for SNIP because they
no longer meet the specific special needs status. Non US
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citizens who have become lawfully present in the US for
surprising benefits to Medicare advantage plans. Choosing a Medicare advantage
plan may be one of the most important decisions you'll
make as a mature adult, and it can be a
little intimidating. While original Medicare may seem safe and easy,
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you may find yourself missing out on some pretty valuable
options only available through Medicare advantage. Here's just four of them.
All the benefits of original Medicare. Medicare Advantage plans are
required by law to include all the benefits of Medicare
A and B hospital medical and prescription drug coverage, and
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one easy to use plan sometimes all in one card.
Most Medicare advantage plans also include prescription drug coverage. To
get the same coverage with the original Medicare, you normally
have to buy a separate prescription drug plan and also
pay a separate Medicare drug plan premium monthly, as well
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as in most cases a deductible as well coverage for
items original Medicare doesn't cover. Many Medicare advantage plans cover
items not covered by original Medicare is Part A and B,
things like routine dental vision and hearing care, prescription drug coverage,
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and in some areas, even fitness to memberships through the
Silver Sneakers program. The security of an annual maximum out
of pocket limit. One of the benefits of enrolling in
a Medicare advantage plan is that there are limits on
out of pockets spending each year. That amount varies from
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plan to plan. It can change each year based on
a contract. Pulling it all together, Let's face it, regardless
of your current health status, you can't predict what you
may need in the future. Knowing that there's an upper
limit to how much you'll have to spend each year
out of pocket may help you feel more confident about
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your Medicare advantage plan choice. So let's talk about a
few things that aren't covered by Medicare Part A and B.
It's important to know that Medicare doesn't cover everything. I
tell my clients all the time that Medicare only gives
you what you need. It may not give you what
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you want. If you want something, you can go out
and buy it, but Medicare may not provide that to
you with or add one hundred percent coverage. If you
need certain services that aren't covered by Medicare Part A
and B, you have to pay for them yourself, unless
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you have other insurance or state Medicaid to cover those costs.
You're in a Medicare advantage plan that covers those services.
Even if Medicare covers a service or item, you generally
have to pay deductibles, co insurance, and or co payments.
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And some of the items and services that Medicare doesn't
cover include long term care also known as custodial care.
That's a very important distinction. Long term care is only
paid by technically two items, one cash out of your pocket,
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or two you have some sort of long term care
insurance policy, or you have a long term care hybrid
insurance policy through a life insurance or an annuity contract.
Some other things that Medicare doesn't generally cover routine dental
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and eye care. I tell people all the time, eyes,
ears and teeth. That's I mean. Some in Medicare advantage
funds want basic coverage, but they're not going to cover everything.
So if you need new hearing aids, you're generally going
to have to pay for those. Now, some plans will
offer discounts on hearing aids, but remember they're not going
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to cover them on in full. And if your hearing's
really bad, the hearing aids that actually work are between
four and eight thousand dollars per year. That you know,
those can get expensive. Dnsures are generally not covered by Medicare.
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Cosmetic surgery is not covered. That's going to be a
cash out of pocket. Acupuncture is generally not covered. However,
some Medicare advantage plans do now cover acupuncture, but you're
subject to that network list hearing aids and fittings and
routine footcare. Now, pedietary care is built into most advantage plants,
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but you will probably have to spay pay a specialist
office copey in order to get that, especially diabetics for
routine toenail clippings and checkups, stuff of that nature. Going
back to what I mentioned before, there is a very
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popular Medicare advantage plan this year in Eastern Iowa for
Iowa residents. It's the Wellmark Blue Medicare Advantage PPO. And
I'll just throw out a few items here. They have
a very low max out of pocket for twenty twenty five.
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Their copays are generally equal to or lesser than some
of the best competitors out there. They are offering fifteen
hundred dollars annual maximum limit through the Delta Dental program.
So your dentist office has to accept Delta Dental insurance
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and there's no premium for that, but you can use
that up to fifteen hundred twenty twenty five. They're also
offering an over the counter benefit fifty dollars a quarter.
In addition to new this year for all you Medicare
advantage people, your maximum out of pocket on your drug
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costs stops at two thousand dollars. Last year that maximum
number was eight thousand, so again this year it's two thousand. Now.
Because of that, most plans are charging some sort of
drug deductible, whether it's a standalone plan or if it's
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on a Medicare Advantage plan chassis, they are charging a
deductible This year, the Well Marked Blue Medicare Advantage PPO
is not charging a drug deductible. Now, having said that,
in order to see if you qualify for that plan,
one of the issues is going to be what your
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current medications are, because if your medications on their formulary
costs you a lot more, it may not be worth
the switch because what you would save in copas an
out of pocket costs on the advantage side may get
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wiped out by the overall drug costs in a calendar year.
But if you give my office a call, I'll be
happy to check that I can see if it warrants
making a change. Again, this is a very popular plan
for twenty twenty five, and if it fits you, I'll
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tell you. And if it doesn't, I mean please understand.
We also represent other companies, United Healthcare, EDNA, just to
name a few. Now, well Mark's not across the river
in Illinois, so if you're across the river, that doesn't work.
But in some cases, the Blue Cross Blue Shield of
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Illinois has had some preditive Medicare advantage plans in the
twenty twenty five calendar year. So I'd be happy to
help you discuss that. There the only other item on here,
let's see Delta Donald. Yeah, but please call my office
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let me know if you're interested in doing that. Your
deadline's March thirty first, don't forget. I also give monthly
virtual meetings regarding Medicare for two different companies every month.
In one meeting, I cover Medicare supplement plans with a
standalone drug plan. That meeting is usually usually sponsored by
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well Mark, and I talk about their supplement plan and
I'll go through all parts of ABCND of Medicare. The
other meeting I do sponsored by United Healthcare, and I
talk about one of their Medicare advantage plans. I focus
solely on that with Medica parts C, but I will
cover the four parts of Medicare and I'll go into
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the nuances of what a Medicare advantage plan would mean
to you. You can call our office at five six
three three three two two two zero zero for the
zoom meeting codes and additional dates and times that I
would offer those meetings. It usually falls on the third
Tuesday or Thursday of the month. You're also welcome to
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email me at Craig at Craigshillig dot com and that's
c r ai G at c r a I G
S c h I L l I G dot com
and I'd be happy to send you the virtual zoom
link meeting codes. This is Craig Shilligg with safe money.