Safe Money - 11-02-24

Episode Transcript

Speaker 1 (00:00):
Good morning to all. On the first Saturday of November,
Craig Schillig 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. This is
my fourth show. I've been an insurance agent for over
twenty four years. During that time, I've learned a few

(00:22):
insurance strategies like using annuities as safe money harbors, are
using cash 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

(00:42):
like to enroll into one of my virtual Medicare community
meetings that I do via Zoom. I'll give some of
those throughout the month of November and in December, or
you can email me at craigat Craigshillig dot com and
I'd be happy to send you the Zoom codes. Today,

(01:05):
I'm going to continue my discussion about Medicare Parts C
known as Medicare advantage plans. I'm going to pick up
where I left off last week when we're talking about
Medicare advantage plans. There's some items you need to keep
in mind. You want to take some steps to protect yourself.
You must continue to pay your Medicare Part B premiums.

(01:28):
If you're drawing Social Security now, this amount is automatically
deducted from your monthly Social Security check. If you're delaying
your Social Security draw to a later date, you can
choose to pay CMS directly via monthly EFT out of
your checking account, or you can be quarterly invoice billed

(01:50):
from CMS. Everyone asked me, how can Medicare Part C
plans only charge a zero to in some cases, maybe
fifty dollars a month of premium and continue to make
money and be profitable. Medicare, sometimes referred to as CMS,

(02:12):
gives your Part B premium to your Medicare advantage plan
company to help pay for your additional coverage. I've heard
in the past that CMS sends a kicker monetary amount
with the standard Part B premium to that insurance company.
This in turn helps that insurance company to remain profitable

(02:32):
and operating. If you're on an advantage plan, then you
aren't on the CMS claims roles, so there's an incentive
for the government to keep these Medicare advantage Medicare advantage
plan companies profitable. Some important things to remember. If you
qualify for state Medicaid, your state may pay your Part

(02:56):
B monthly premium on your behalf. You may qualify for
financial assistance depending on your financial situation. You may qualify
for help paying for Part D plan premiums or Part
D prescription drug premiums through a low income subsidy or

(03:17):
also known as extra help now. If you have Medicaid now,
you get extra help. If you are late enrolling in
Part D, then you must pay a late enrollment penalty.
This is an additional amount charged by Medicare that will
be added to your Part D premium if you didn't

(03:38):
enroll in prescription drug coverage when initially eligible for Medicare
and you didn't have credible drug coverage, or you didn't
enroll in the prescription drug coverage within sixty three days
of losing your credible drug coverage. To avoid this and
roll on your prescription drug coverage right when you are

(04:00):
initially eligible for Medicare, if you qualify for extra help,
this rule does not apply to you. Some things to
remember moving forward or moving forward, it may be better
to use network providers. Use of network healthcare and pharmacy
providers is typically required in most advantage plans. Using providers

(04:24):
outside of the network may cost you a little bit more.
Remember in an emergency, however, you can use any provider
you'd like. I tell all my clients you need to
keep your member ID card handy. You must present your
member ID card, not your red, white and blue original
Medicare card when receiving covered medical services and prescription drug purchases.

(04:52):
If your plan has a built in prescription drug coverage,
you do have a built in safety net. Your annual
plans out of pocket maximum insures you'll never pay more
than a certain amount in a given plan year for
covered medical services. However, there are costs that do not
count towards the out of pocket maximum, such as monthly

(05:16):
premium payments. Drug costs, whether it be a drug premium,
deductible or drug cope. Drugs are always separate from medical
costs and the cost of extra services that a plan
may offer, such as routine dental vision and hearing. Let's

(05:37):
talk about some additional resources. In addition to a financial
license insurance agent, here's some other resources that may be helpful.
UHC has a website. The website address is Medicaremadeclear dot com.
This is an educational program website from United Healthcare. It's

(06:01):
designed to help you learn all you need to know
about Medicare so you can make informed decisions about your
health and Medicare coverage. There's Medicare dot gov. There's SSA
dot gov. You can also go to specifically SSA dot
gov slash Medicare slash Part D extra Help. Extra Help

(06:27):
is a Medicare program to help people with limited income
and resources to pay for Medicare drug coverage, Part D premiums, deductibles,
co insurance, and other related costs. There's the Administration on Aging.

(06:47):
That address is Eldercare dot act dot gov. This this
place will help. It helps you in finding local and
community based organizations that serve older adults and their caregivers
in your area. SHIP, which is known as State Help

(07:11):
Health Insurance Assistance Program, SHIP offers free counseling and can
help with questions about choosing a health plan that can
help with pain for prescription drugs under the State Pharmaceutical
Assistance Program, and they'll talk to you about your rights
and protections under Medicare. Just remember that SHIP is a

(07:32):
volunteer organization and they cannot give advice. A license insurance
agent can help you take the next steps Today. Licensed
insurance agents are trained to provide personalized support, answers, and
advice that can help you choose a plan with confidence.
An agent can help you look up current doctors, specialists,

(07:55):
hospital and clinics to see if they're part of the
provider new work you're looking at. Agents can check your
prescription medications to make sure you're covered and help you
understand your possible drug costs for the plan year. Please
understand that an agent cannot predict the future. That can

(08:16):
only go by what medications you're taking now. If a
new drug is prescribed during the new plan year, then
your overall costs can and may change. Plan your enrollment
and renewal schedule. With some plans, your coverage remains the
same and automatically renews so long as you stay current

(08:38):
with your monthly premium payments. Determine if a financial need
or specific medical condition can make you eligible for a
special needs plan, or if you're a veteran. Some Medicare
advantage plans are created for their specific situation. Generally, most

(09:00):
guides are full of important information, including a summary of benefits,
specific plan information as well as details about enrollment procedures,
benefit information, Medicare star ratings, multiple language interpreter services, contact information,

(09:23):
and new for this year, there'll be QR codes so
you can look at your information directly from your smartphone.
So let's get into the nuts and bolts and an
advantage plan today. I'll cover one plan from United Healthcare
UHC as seven plans in Scott County for twenty twenty five.

(09:44):
Four of them are for the general public, the other
three requires certain qualifications in order to enroll. The four
plans range in monthly premium price from a zero monthly
plan premium to there is a plan that costs forty
six dollars a month for twenty twenty five. Now, what

(10:06):
are the differences between the plans? Every plan has a
monthly plan premium, an annual out of pocket maximum, a
price list of services with a flat copay or coinsurance
to what we sometimes refer to as the mop moop
that's the maximum out of pocket or sometimes we call

(10:28):
it the cap CAAP per contract calendar year. Once you
reach your annual out of pocket maximum in a calendar year,
the plan picks up the rest of the medical charges
for the remainder of that plan year. The only thing
that's not included in that amount is drugs. Drug costs

(10:49):
are separate any drug costs or drug costs or what
most of my clients complain to me about generally every
year because the costs are usually too high. Whether it's
a zero dollar monthly premium or a forty six dollars
premium plan, all plans will have plan benefits that have

(11:13):
a primary care provider, visit a specialist, visit in patient
hospital care, emergency care. And understand that the copas are
coinsurance is different from plan to plan. The plan I
want to cover today is the AARP Medicare Advantage from UHC.

(11:35):
It's known as the Iowa Triple zero four PPO Plan.
This plan is available in Clinton, Scott, Muscatine Counties in
Iowa and Henry, Mercer and Rock Island County in Illinois. Now,
don't let the AARP logos scare you. United Healthcare is
writing a very large check every year to AARP for

(11:59):
the sole purpose using their logo. AARP is not an
insurance company. United Healthcare is the insurance company for this plan. Also,
you do not need to be a member of AARP
in order to get enrolled into this plan. I'll cover
as much as I can today, and then I'll continue
this into the next show. If you want provider choice

(12:23):
plus reliable benefits and extras, you can count on this plan.
You can count on. This plan has access to out
of network care, predictable out of pocket medical and prescription
drug costs, Plus they have basic dental over the counter essentials.
There's a vision benefit, and fitness gym memberships are included.

(12:48):
There's no annual deductible. The annual out of pocket maximum
for this plan is forty one hundred in network for
twenty twenty five. The plan also has an out of
network option with a sixty two hundred max out of
pocket combined in and out of network for the calendar year. Now, locally,

(13:10):
I want you just to focus on the in network area. Genesis,
Mercy One, Unity Point, University of Iowa hospitals and clinics
are all considered in network under this plan as well
as you can also go to Mayo as an inpatient
if you're across the river. Peoria is also considered in network.

(13:31):
For citizens in Illinois, every copay or co insurance charge
is counted against the annual out of pocket maximum. Once
you've hit this number in a calendar year, you don't
pay anything additional for the remainder of that calendar year.
If you visit your primary care provider are sometimes referred
to as a PCP, there's a zero dollar copay both

(13:55):
in and out of network. If you go see a specialist,
the cope is going to be forty five dollars if
you're in network and out of network specialist visit would
be eighty dollars. If you were to become hospitalized under
this plan, there's a four to forty copey per day
for days one through five that's of inpatient hospital care.

(14:21):
Then it's a zero dollar cope for day six going beyond.
That's per hospital admission, so twenty two hundred are taking
five times The four to forty per day charge would
then be applied to the maximum out of pocket of
the forty one hundred dollars, meaning you would only have

(14:42):
nineteen hundred remaining for the calendar year. If you'd happen
to be at an out of network hospital facility, there's
a forty percent co insurance per sday for unlimited days.
And remember the out of network annual out of pocket
maximum or the most you would pay in a year
for covered medical care, would be sixty two hundred under

(15:04):
the out of pocket maximum amount. If you were to
go to an emergency room, there's a one forty per
visit cope. If you're admitted to the hospital the same day,
that cope would be waived and you just pay the
hospital daily cope. The plan also offers virtual visits with

(15:24):
a zero dollar cope to talk with a network telehealth
provider online three either live audio or video. You can
do this via FaceTime or a zoom call. There's built
in preventative services. There's a zero cope for both in
and out of network. Under preventative Skilled Nursing Facility care,

(15:48):
you would pay a zero dollar cope per day for
days one through twenty. Then it would be two hundred
and three dollars per copey per day for twenty one
for day's two only one through one hundred. Another benefit
of a Medicare advantage plan you can go to skilled
nursing if you wish after just a one day hospital stay.

(16:12):
Under original Medicare, if you were to have a supplement,
you need to have a three day hospital stay before
you can go to skilled nursing, so that's kind of
a something to keep in mind. That's kind of a
fringe benefit of Advantage plans. Outpatient hospital including outpatient surgery
is a four to forty copay or forty percent coinsurance

(16:36):
if you're out of network. The plan does have outpatient
mental health. There's group therapy and individual therapy with a
five dollars copay both in and out of network. There's
also a virtual mental health visit with a zero dollar copay.
You can talk with a network telehealth provider online through

(16:57):
audio and video or again via FA time or a
zoom call. If you're diabetic diapetes monitoring supplies, theres no
copay for covered brands, and it'd be fifty percent coinsurance.
If you were using an out of network pharmacut diagnostic

(17:17):
radiological services such as MRIs CT scans, that would be
a two to fifty copey both in and out of network.
If you're getting a diagnostic test and procedure that's non radiological,
you would have a fifty dollars cope both in and
out of network. Lab services for twenty twenty five, there's

(17:40):
no copey for that. Outpatient X rays you'd have a
twenty five dollars in network cope or thirty five out
of network copey for X rays ambulance, whether it be
by ground er air, your cope is only two ninety.
If you've ever seen a life flight bill from like

(18:03):
med Force, I've seen bills for twenty to thirty thousand
dollars for trips from Davenport to Iowa City. Emergency care
would be a one forty copey. Urgent care services are
much lower than an er visit. Those would only be
a sixty five dollars copey. There's a routine physical. You'd

(18:27):
have a zero copey for your annual medical Medicare physical
one per year. There's a routine eye exam which also
carries a zero dollar copey one per year. You do
need to check the network to see if your eyed
doctor or ophthalmologist is in the network. Routine eyewear is

(18:48):
included for a zero dollar copey. The plan will pay
up to two hundred dollars every two years towards the
purchase of one pair of frames with a zero dollar
cope for standard lenses and a forty to one fifty
copay for other covered lenses or contact lenses, fittings and

(19:11):
evaluations may be an additional costs through network providers. Home
delivered eyewar is also available through select select network providers
on select products only. There's also a built in dental
preventative program. There's a zero dollar cope for exams, cleanings,

(19:34):
X rays, and fluoride. There's a built in hearing benefit.
You can get a routine exam with a zero dollar
cope one per year, or it'd be an eighty dollar
cope one per year for an out of network hearing exam.
There's a hearing aid benefit built into the program. Under

(19:55):
this benefit, you can pay, depending on the type of
hearing aid, a cope between ninety nine and eight twenty
nine for OTC hearing aids. There's a one ninety nine
to twelve fifty cope for prescription hearing aids. You can
purchase up to two hearing aids every year through network providers.

(20:17):
This includes hearing aids delivered directly to you, but that
only covers select products. There's a built in fitness gym membership.
Under this, you pay a zero dollar cope which includes
free gym memberships, online fitness classes, and there's also built
in memory activities, footcare. There's a routine exam, but you

(20:42):
do have to pay the specialist cope of forty five
or eighty, and you can go up to six times
per year. Over the counter essentials. United Healthcare will give
you a twenty five dollars credit every quarter to buy
covered over the counts from Walmart dot Com or the

(21:04):
Healthy Benefits app. United Healthcare will even give you rewards
for certain items that they want you to do with
your U card. They'll give you fifteen dollars if you
go in for your annual physical or your wellness visit.
You can get ten dollars each month just for getting

(21:25):
getting to move and do it counting your steps, ten
dollars to connect with others, or five dollars just if
you get your flu shot. There's also a built in
meal benefit if you upon hospital discharge from a one
day hospital stay, there's a zero dollar cope for twenty

(21:48):
eight home delivered meals immediately after your inpatient visit, or
if you had a skilled nursing facility stay, a couple
of good things for twenty twenty five. The coverage gap
or the donut hole has been eliminated and your out
of pocket maximum cost is lower than ever. That means

(22:08):
you're protected more from high drug costs. In twenty twenty five,
I'll get into some of the prescription drug plans. I'll
review some of that from the last meeting, but I'll
get into more on that in a second. Remember, if
you're now on Medicare and you would like to change
your choice of Medicare Party plans or Medicare Advantage plans

(22:32):
for twenty twenty five, you have until Saturday, December seventh
to do so. If you want to make a change,
this is the time to do it during this period
right now. Just a reminder. I give monthly virtual meetings
to two different on two different companies every month. In
one meeting, I cover the Medicare Supplement plan with a

(22:54):
standalone drug plan. That meeting is usually sponsored by well Mark.
The other meeting that I'll talk about My next one
is going to be on Tuesday, November nineteenth, that covers
well Mark UHC. I use there the sponsor for several
my virtual meetings. This month. I'll focus strictly on Medicare

(23:17):
Parts C and Medicare Advantage Plans, and I'll cover the
benefits of those platforms a few of my next United
Healthcare virtual meeting dates are Tuesday November fifth, Thursday November seventh,
and Thursday November twenty first. That'll cover the dates for
this month. You can call our office at five six

(23:40):
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 Craig at Craigshilig dot com
and that's cr Aig at c R a I G

(24:03):
S c h I L l I G dot com.
I can send you the virtual zoom link and that
I'll have my meeting codes on it. This is Craig
Schillick with Safe Money.