Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Good morning to all. On the fourth Saturday of October
twenty twenty four, Craig Schillig here, and this is Safe Money.
As a reminder, Halloween is less than a week away,
so get your costume and candy ready. We're here every
Saturday to talk with our listeners about financial strategies we
use to manage and protect assets safely. Now, I know
(00:21):
you're accustomed to hearing my father Dick do the talking.
I'm Craig Schillig, the son of Dick Schilig. I'm an
independent insurance broker here in Iowa, Illinois. I've been at
an insurance agent for over twenty four years. I've learned
a few insurance strategies during that time, like using annuities
as safe money harbors, or using cash value life insurance
(00:45):
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 that I do via zoom.
(01:07):
I give those throughout this month in October, and I'll
even do a couple dates in December. I'll give you
those dates a little bit later in the program. Today,
I'd like to discuss Medicare Parts C, known as Medicare
Advantage plans. What I can't finish or cover today. I'll
(01:28):
continue with this next week and I'll go line item
into some plan specifics and benefit highlights Part C. These
can be standard MA plans, or sometimes I'll have a
drug plan embedded with them, known as a Medicare Advantage
plan or sometimes called an MapD plan. That just means
(01:53):
it's a Medicare advantage plan with a built in drug coverage. Now,
some companies you probably heard of, our EDNA, Wellcare, well Mark,
United Healthcare, Blue Cross, Blue Shield of Illinois, just to
name a few. For twenty twenty five, there also will
(02:14):
be Health Alliance, Humana, Iowa Health, QC, Community Health, Mercy One,
and as well as well Point Health. My office represents
many of these companies and we can assist you as needed.
(02:35):
In Iowa, when we're talking about Medicare advantage plans, you
have forty nine plans to pick from across ten different companies.
If you're on the Illinois side of the river, there
are forty five different plans to choose from across eight
different companies. Now, when when we're talking about Medicare. Original
(02:59):
Medicare is health insurance provided by the federal government. It
has two parts, the Part A Hospital part and the
Part BE medical side of Medicare. Part A Hospital part.
This helps pay for hospital stays and in patient care.
You have a semi private room. All your interactions with doctors, nurses,
(03:22):
specialists could be surgical. You could be admitted to the ICU.
You could be in the recovery department, as well as
in patient physical therapy. Your cost for Part A is
generally zero dollar monthly premium as long as you work
ten years or contributed forty quarters of FIKA taxes. There
(03:46):
is a hospital deductible this year twenty twenty four of
sixteen thirty two. That's one thousand, six hundred and thirty
two dollars deductible per hospital admission. I don't have the
twenty twenty five amounts yet, and those are normally announced
in the coming weeks. Usually a client will tell our
(04:08):
office what those numbers are before I'm actually officially notified
by CMS. Part B of Medicare. This helps pay for
doctor and provider visits as well as outpatient care. It
could be a visit to the emergency room, but then
you go home. It could be an urgent care visit,
(04:30):
but generally under be you're going to go see your
primary physician. Maybe you go see a specialist. It could
be outpatient physical therapy or even outpatient surgery. Some knee, hip, shoulder, elbows,
or even wrist surgeries can be done pretty quickly these days.
(04:52):
Sometimes you can be released on the same day from
an outpatient surgical center on the given on the chance
that you respond well to the recovery process. Part B
costs for twenty twenty four is one hundred and seventy
four dollars and seventy cents of monthly premium, and there
is an annual deductible for twenty twenty four of two
(05:14):
hundred and forty dollars for the calendar year. Again, I
haven't been told what the twenty twenty five Part B
rates are yet, but those will be announced pretty soon.
Most people enroll for Medicare for the first time when
they turn sixty five. Be aware that original Medicare does
not cover everything. Certain things they don't cover, such as
(05:40):
prescription drugs that's covered under Part D that's Medicare das
in drug routine, dental vision, and hearing are also not
included in original Medicare rags. The red, white, and Blue
Medicare card has an eighty twenty rule. The Medicare card
(06:01):
will only cover eighty percent of Medicare covered services. That
means you're on the hook for the other twenty percent. Now,
most people don't sleep well at night having this twenty
percent hanging over their head. That's why most people generally
buy some additional coverage. Consider if you want additional coverage,
(06:23):
once you enroll in original Medicare, you can purchase an
insurance plan that other medical expenses are covered as well.
You have basically two options for this type of coverage.
Option one is known as original Medicare. This is sometimes
called the three card system. You carry three cards in
(06:44):
your purse or your wallet. You would have your Medicare card,
you'd have a supplement card also known as Medigap or
medsup insurance, and you would carry a prescription drug card
known as Medicare Part DAS and drug. This is a
(07:04):
standalone card that you purchase that you use to purchase
your prescription medications with. Whether you would go to a
local pharmacy counter like CVS, Walgreens, Hive, or You can
sometimes use one day mail order system through whatever provider
(07:25):
you've purchased that plan from. The drugs are shipped to
your mailbox for no shipping cost. Under the three card system,
you'd have a monthly premium amount for Medicare Part B,
the supplement would also have a monthly plan premium depending
on which supplement letter code you chosen, and the Part
(07:48):
D prescription drug card would also have a monthly planned premium.
Most drug plans also include a deductible and then you'd
have copase or co insurance to a cap per calendar year.
So that was option one. The second option is to
add Medicare Advantage Part C plan from a Medicare approved
(08:12):
private insurance company. This is sometimes called the one card system,
where you only carry one card in your purse or
your wallet, and you use the same card for both
medical and prescription drug purchases. These are sometimes referred to
as MA or MAAPD plans. MA just means Medicare Advantage
(08:35):
plan without a built in drug plan. Now some people
would buy these if they have a retiree benefit that
maybe pays for their medications, or certain federal employees or
veterans sometimes can get their prescriptions elsewhere and don't need
(08:55):
a fully embedded MAAPD plan refers to a Medicare advantage
plan that also includes prescription drug coverage. Now, these Medicare
Part C plans combine Part A, which is the hospital insurance,
and Part B, which is the medical insurance, all into
(09:18):
one polan. Usually they'll include Part D prescription drug coverage
as well. They also come with additional benefits that Original
Medicare usually doesn't cover. They include benefits not provided by
original Medicares, such as routine dental vision hearing coverage, as
(09:41):
well as built in fitness gym memberships, monthly allowances for
non prescription items from your medicine cabinet like neo sporn,
band aids, Q tips, coughs for a bug spray or sunblock,
just to name a few. Some plans will allow you
(10:04):
to use Walmart dot com, and others have the ability
to purchase items from the local high V pharmacy, maybe
Walgreens or CVS. It just depends on the company plan.
So let's talk about eligibility, enrollment time periods Medicare eligibility.
(10:24):
To be eligible for Original Medicare, you must be a
US citizen or legal resident and you must meet one.
And you must meet one of these requirements. You must
be aged sixty five years age or older, or you're
younger than age sixty five with a qualifying disability, any
(10:50):
age with a diagnosis of end stage renal disease or
als known as anotrophphobic lateral sclerosis. Legal residents must live
in the US for at least five years in a row,
(11:10):
including the five years just before applying for Medicare. Some
questions that come up when can I enroll in Original
Medicare for the first time. You can get started with
Original Medicare during what's known as the Medicare IEP, which
is known as the initial enrollment period. For most this
(11:32):
is around age sixty five. Your initial enrollment period is
a seven month window around your sixty fifth birthday month,
so that's the month of your birthday, the three months
before your sixty fifth birthday, and the three months following
your sixty fifth birthday. If your birthday is on the
(11:54):
first of the month, then your IEP is determined as
though you were born learn the month prior. During this time,
you can enroll in Original Medicare Parts A and B.
You could enroll in Medicare Parts C Advantage Plan and
A Part D without any type of penalty. You also
(12:17):
have six months to be guaranteed coverage and a Medicare
Supplement insurance plan known as METAGAP or medsub coverage starting
the first month you are age sixty five or older
and enrolled in both Medicare Parts A and B. Please note,
you must be automatically enrolled in Medicare Part A and
(12:37):
B if you are receiving Social Security or Railroad Board
retirement benefits. Another question that comes up, what if I
miss my initial enrollment period. If you miss your initial
enrollment period, Original Medicare offers another change to get coverage.
(13:00):
This is known as the GOEP General Enrollment Period. The
GOEP runs from January one to March thirty first each year.
During this time, you can enroll in Medicare Parts A
and B. If you enroll in original Medicare during the GOEP,
(13:20):
you may also be able to add Medicare Advantage Part
C plan or a Medicare Prescription Part D plan between
April one and June thirtieth of the same year. Additionally,
once you are enrolled in both original Medicare Part A
and B, you can apply for a Medicare Supplement insurance plan. Now,
(13:44):
keep in mind, missing your initial enrollment period can be costly.
Medicare Part A, Part B, and Part D is in
drug may charge you a premium penalty if you miss
your initial enrollment dates unless you qualify for a Medicare
(14:07):
special enrollment period. What is my enrollment schedule? If I'm
eligible due to a disability? Your seven month initial election
period includes the month you receive your twenty fifth disability check,
so you have to be on SSDI for at least
(14:28):
twenty four months. It would also include the three months
before in the three months after that twenty fifth disability check.
When can you enroll or make changes to a Medicare
Advantage Part C or Prescription Drug Part D plan. If
you've enrolled in original Medicare Part A and Part B,
(14:51):
you may be eligible to enroll and or to make
changes to a Medicare Advantage Part C plan or standalone
prescription drug Part D plan during the following enrollment periods.
One of the enrollment periods is the period we're going
through right now, known as the Annual Enrollment Period, sometimes
(15:11):
called the AEP. The dates for that are running right
now from October fifteenth and they end on December seventh.
During the annual enrollment period, you can add, drop, or
switch your Medicare coverage. There's an OEP Medicare Advantage Open
(15:32):
Enrollment period which runs the first quarter of the year.
That's January first until March thirty first. If you're already
in a Medicare Advantage plan, you may disenroll from your
current plan. You either switch to a different Medicare Advantage
plan you only get one time only, so you only
(15:53):
get one switch, or you can go back to Medicare
during this time period. There's also what's known as SEPs.
These are special enrollment periods. Depending on certain circumstances, you
may be able to enroll in a Medicare plan outside
of the initial enrollment period or the annual enrollment period
(16:17):
time frames. Some ways you may qualify for a special
enrollment period are if you retire and lose your employer
provided coverage, if you sell your house and move out
of the planned service area. For example, you live in
Davenport and you move to Southern Texas. Once you've established
(16:40):
new residency in that city or town, you can apply
for coverage within that area. Plans are based on the
county and zipkoe that you reside in. If you qualify
for extra help during Medicare, for example, you qualify for
state you qualify for a state Medicaid plan. Have you
(17:05):
been diagnosed with certain qualifying chronic health conditions. There's some heart, lung,
and other chronic conditions that may give you benefits to
qualify for once you've been diagnosed by a physician. Here's
a question. What's more important to you a lower monthly
(17:26):
premium and pay for cares you need it, access to
your current doctors, additional benefits not covered by original Medicare,
or how about a plan that works with your veterans benefits.
Medicare advantage plans combine Medicare Parts A, Part B, and
usually Part D coverage into one plan. With some plans,
(17:51):
members choose from a network of doctors, hospitals, and other
providers to get care. Plans may offer extras like dental
basic dental. Some will have comprehensive dental, vision, hearing benefits,
fitness club memberships, and much more. But I'm talking about
(18:16):
Medicare Supplement insurance plans, also known as medic gap or
med subs. These plans help pay for some out of
pocket costs not paid by original Medicare Parts A and B.
Medicare supplement plans allow you to go to any doctor
hospital that accepts the red, White and Blue Medicare card
(18:39):
without any referral needed under med subs or supplement plans.
You would have a higher monthly premium in an exchange
for low or in some cases, no costs when you
need care, and you would have nationwide access to any
provider who accepts the original, Red, White and Blue Medicare card.
(19:04):
What about adding drug coverage? Medicare prescription drug plans, known
as the standard Part D plan, offer prescription drug coverage,
which helps pay for some Medicare coverage prescription drugs. This
plan may be used along with original Medicare, or you
can pair it with a Medicare supplement plan coverage to
(19:28):
supplement that benefits you already received from Medicaid. So if
you're on state Medicaid, there's sometimes called dual special needs plans.
Dual special needs plans, also known as what they refer
to as dual snips, are for people who have both
Medicare and a Medicaid card. A dual plan will help
(19:52):
you coordinate care for complex medical needs. You may get
extra benefits and features not provided by either Medicare or Medicaid,
and in most cases, these plans can be had for
a zero dollar monthly premium For members that qualify for
extra help or low income subsidy known as l S
(20:18):
special coverage for certain chronic conditions, such as diabetes or
some cardiovascular disorders, These are called chronic special needs plans.
Chronic special needs plans known as ce snips are for
people who have a qualifying chronic health condition. This plan
(20:42):
has extra services and programs designed to help you better
manage your chronic condition. So let's talk about some important
Medicare advantage information. Here's some things to get to know
and or be aware of under Medicare advantage plans. Medicare
(21:03):
advantage plans must cover all the services that original Medicare
covers and may offer some additional benefits. Adding a Medicare
advantage plan may affect current coverage, So understand that if
you have existing or employer provided coverage and plan to
(21:25):
work past age sixty five, you do need to check
and see how a Medicare advantage plan would effect and
or a cancel current existing coverage. Medicare advantage offers the
same protections as original Medicare. Even though Medicare advantage plans
are provided by private insurance companies, you still have the
(21:48):
same rights and protections as you would with original Medicare.
A Medicare supplement insurance plan also known as MEDA gap
are also called MEDS policies, is not a Medicare advantage plan.
Please remember this. Sometimes you guys commingle the two when
(22:11):
I talk to you on the phone. Medicare supplement plans
are health insurance policies and our secondary to original Medicare.
Medicare advantage plans comply combine original Medicare Part A and
Part B, and usually Part D into one single plan.
(22:34):
Please remember that you need to be enrolled in one
plan or the other. That be A you have a
supplement and a drug plan, or you have a Medicare
advantage plan. You're not allowed to be enrolled in both.
You cannot have double coverage. That's that's a no no.
(22:55):
Here's some steps you can take to protect yourself. You
must continue to pay your Part B premiums. If you're
drawn Social Security now, then this amount is automatically deducted
from your monthly Social Security check. If you're delaying your
Social Security draw to a later date in the future,
(23:18):
you can choose to pay. You can choose. You can
choose to pay CMS directly via EFT out of your
checking account, or you can be quarterly invoice billed from
Medicare directly. Medicare gives your Part B premium to a
(23:39):
Medicare advantage planning company to help you pay for your
additional coverage. Important thing to remember. If you qualify for
state Medicaid, your state may pay your part B premium
on your behalf. You may qualify for financial assistance, and
there's some referrals I can give you if you think
you fall into that category. Remember if you're new on
(24:05):
Medicare and you'd like to change your plan or you'd
need your part G plan looked at for twenty twenty five,
you have until December seventh to do so. There's several
changes occurring in twenty twenty five. Please remember I give
monthly virtual meetings for two different companies every month. I
(24:26):
do one on Medicare supplements and I do another one
on standalone drug plans. A few of my next virtual
meeting dates are going to be. I'll do one on Monday,
October twenty eighth, I'm doing one on Wednesday, October thirtieth,
and I will do one on Friday, November first. You
(24:47):
can call my office at five six three three three
two two two zero zero for the zoom meeting codes
and additional dates and times. You're also welcome to email
me at c R a I G at c R
a I G s c h I L l I
(25:10):
G dot com. I can then send you the virtual
zoom link meeting codes. This is Craig Schillig with Safe Money.