September 26, 2025 • 10 mins
“Hey Mike, open enrollment is coming up. Anything we should know?” Discover what to watch for in Medicare and healthcare plans so you don’t get stuck with surprise gaps in coverage.
Text your questions to 913-363-1234.
Request Your Wealth Analysis by going to www.retireontime.com
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Mike (00:00):
The advantage plans might come with all these new bells
(00:02):
and whistles and like, oh, youcan get a free Apple Watch or
you can get a gym membershippaid for, and like all these and
that might seem nice. Yeah. Butif you need your doctors, there
are things that may not becovered. Welcome to How to
Retire On Time, a show thatanswers your retirement
questions. We're here to movepast that oversimplified advice
that you've heard hundreds oftimes.
(00:23):
Instead, we want to dive intothe nitty gritty because the
truth is, there's no such thingas a perfect investment product
or strategy. Nothing doeseverything well, so let's dive
into the details and figure outwhat's right for you. Now, text
your questions to (913)363-1234, and we'll feature them
on the show. Remember, the showis not financial advice. Do your
research.
(00:43):
Alright, David. Let's dive in.What do we got today?
David (00:47):
Hey, Mike. Open enrollment is coming up.
Anything we should know? Yeah.Yeah.
And and so what are theyreferring to here?
Mike (00:55):
Holy cow. Open enrollment. That's gotta be Medicare.
David (00:57):
Yes.
Mike (00:58):
Well, I mean, it's probably Medicare. It's
Affordable Care Act.
David (01:01):
Both are coming up.
Mike (01:02):
Yeah. You're a company, are you gonna be, you know,
switching insurance? That'sright. It's there's a the end of
the year is a really now, like,CPAs have their busy season.
Yeah.
The health care season is uponus to be very, very busy. Yeah.
So because this show is aboutretirement, let's talk about how
or the the Medicare bit Yeah.More specifically. I mean,
(01:25):
Affordable Care Act, re reviewit.
Is it the right plan? Should youswitch things? It is changing a
lot. Funding's being shiftedaround a lot. Insurance
companies are taking ondifferent risks.
They've had to deal with certainthings as well. So there's a lot
shifting right now, and what wasthe right plan for you isn't
necessarily an indicator that itis still the right plan for you.
(01:48):
Insurance is not an investment.It is the transference of risk.
So in your plan, which risks areyou taking and which risks are
you receiving help?
There is no max out of pocketfor all medical costs. It is a
max out of pocket or a highdeductible plan with a roof on
(02:09):
qualified situations, qualifiedexpenses, qualified procedures,
qualified fill in the blank.
David (02:15):
Yeah. Do we know what those are? Like, what are the
what's is there a list ofapproved procedures or
Mike (02:20):
Well, let me let me give you an example. So my wife and I
had our daughter who was born,what was it, five months ago.
David (02:27):
Yeah.
Mike (02:28):
Okay. In this year particular, in particular, we
had a high deductible plan thatwas really cheap. Why? I'm
healthy. My wife's healthy.
My son is healthy. We don'treally go to see the doctor
often. Yeah. Okay? I mean, I Isee my annual checkup, say hi to
the doctor, he asked me a bunchof questions, checks my my blood
(02:49):
pressure and all that fine.
And then I pay an additional$500 to this place called
functionhealth.com. They runhundreds of tests, so I see even
more on my health as well. We dothings a little bit
unconventionally. Okay? So wehave very cheap health
insurance.
I am paying thousands of dollarsless a month and have been for
(03:14):
years Mhmm. For for for cheaperhealth insurance. That's my
situation. Yeah. So when mydaughter was born, I had an
option.
We I mean, the company, we couldhave shifted our health
insurance as a collectively todo something different and pay
thousands of dollars more, or wecould just keep things as they
are. Everyone seems to be happy.I mean, I don't know. I'm not
(03:35):
gonna ask you if wanna have morekids or not, that's
inappropriate on on the show.But but we we when we when our
daughter was born, we paidcompletely out of pocket for the
whole thing.
David (03:48):
Oh, wow.
Mike (03:49):
Every penny. Oh. And you might think that's ridiculous.
Well, let's do the
David (03:55):
Let's shift your perspective. Yeah. Yeah.
Mike (03:57):
Let's say I pay $1,500 a month less in insurance because
I have a simpler version ofinsurance. Right. And I paid
$20,000 for one time. We knew wewe were gonna have this child.
We had planned on it, andthere's a five year kind of
threshold of what would becovered.
(04:18):
Okay? What's, you know, what'sbetter? I saved money Yeah. In
this situation. And you couldsay, well, maybe you could have
manipulated what Well, whenyou're going through
underwriting and things likethat, they're asking if you're
pregnant or not, there's a lotof things, and it's complicated.
So we stuck with our plan, wepay less a month, we saved money
(04:39):
for it, we paid out of pocket,and overall, we actually kept
more money. People will say,Well, that's an incomplete
understanding of how healthinsurance works. I'll say, No.
People try to game the system onhealth insurance to to get more
out of it. It's like, no.
That that's not how it works.
David (04:53):
Mhmm.
Mike (04:54):
Insurance is pulling people together, hedging against
risks, you're paying for theseservices, but the insurance
company has to make more moneyoverall.
David (05:01):
Right.
Mike (05:02):
They have to make more than they spend on these
payments, on the claims and soon. So the reason why I bring
that up is when you get intoMedicare, a lot of people will
think, I'm gonna save money onAdvantage Plans. Mhmm. That
might be true if you don'treally need your doctors. But if
you need your doctors, there arethings that may not be covered.
David (05:20):
Tell us why I'm aware
Mike (05:20):
of that.
David (05:21):
Tell us why you would save more with Advantage over
others.
Mike (05:24):
I mean, we're all paying the same I'm not on Medicare.
Medicare people are paying, youknow, part a is free, part b is
you're paying the same amount. Iforget what it's gonna be this
next year.
David (05:34):
It was a 185 in 2025.
Mike (05:37):
Yeah. So whatever it's gonna be next year
David (05:39):
Yeah.
Mike (05:41):
The advantage plans might come with all these new bells
and whistles and like, oh, youcan get a free Apple Watch or
you can get a gym membershippaid for and like all these and
that might seem nice. Yeah. Whatthey've done is they've taken
money from the government tocreate an insurance policy for
you based on what they haveallocated for Medicare, and they
have basically put together aplan
David (06:03):
Mhmm.
Mike (06:03):
An advantage plan, where you're not really paying much
for it. Maybe you pay a littlebit extra, maybe not. But
they've structured it in a wayso that it still makes financial
sense for them, and you'repicking a plan that works for
your specific situation. But ifyou step outside of that, then
you're paying an arm and a legfor it. Whereas traditional
Medicare might be more just youpay apart for whatever you use.
(06:24):
So do you see how it gets kindof more nuanced? And then the
gap plans, the supplementalplans, you're getting kind of
your core risk, transference ofrisk or your core coverage, plus
additional coverage that coversthe gap of what's going on. So
people need to understand thatthis is much probably more
complicated than they realizewhen they go and say, well,
(06:45):
what's good plan? Well, what'sthe cheapest plan I can have?
Because it's all kind of thesame anyway.
I'm gonna get a good deal. It'snot like you're comparing the
cost of eggs at Sprouts or WholeFoods or Hen House or Fred
Meyer's Safeway or whatever thegrocery store is. What's
Albertsons. Albertsons. Kroger.
David (07:05):
Let's list them all.
Mike (07:06):
You're not comparing the price of eggs You're paying for
a certain plan with certainrisks that you are or not are
not taking. So when you havethat kind of mindset, you might
slow down and start to ask morequestions, which is good. But
the other part, this is whatgets my goat, and we'll end on
this.
David (07:23):
Okay.
Mike (07:24):
Is when an insurance company doesn't really want to
maintain a plan, how do they fixit? They can't really just
cancel a plan.
David (07:32):
No, there's a contract. They have to go to the end of
the year, right? They have tohas all CMS, right? They have
all the
Mike (07:38):
There's all sorts of regulations So around one of the
ways that they will helpalleviate their financial
burdens on maybe a situationthey don't want to maintain but
kind of have to is by cuttingcommissions.
David (07:50):
Uh-huh. For who who gets the commission?
Mike (07:52):
If you cut Medicare commissions, Medicare insurance
agents may, and they're supposedto do what's right for you Yeah.
Yeah. Yeah. But they may find anequivalent plan that's close
enough that still pays them acommission, but not not keeps
your current plan. And maybeyour current plan was the better
plan for you, but it doesn't paythem.
(08:13):
I mean, just the filth of of howyou can cut commissions of a
plan to help try and get peopleoff of it, that's such a a
backdoor deal. And so how That'sso sketchy.
David (08:25):
The the the Medicare beneficiary, I mean, how are
they to know all of this? How dothey know if they're being sort
of guided in a differentdirection that may not be in
their best interest?
Mike (08:36):
I mean, you ask the uncomfortable question. Well,
why shouldn't I stay on theother plan? Does that plan pay
you or not? And hopefully,they're honest. Sometimes
they're not.
I mean and I'll say it this way.David, you're the director of
our health care. Yeah. Medicareand Affordable Care Act and all
that. Is your pay structurebuilt at all around the
(08:58):
commissions you we make onMedicare?
David (09:00):
Thankfully not.
Mike (09:01):
Yeah.
David (09:01):
Yeah. No. I can truly say that anything that I would
recommend to somebody is it'sbecause it's matched to them
perfectly with no otherconsideration.
Mike (09:09):
It's not what we're focused on. We're a membership
model or a one time model, flatfee advisory practice. So when
someone comes to you and theyschedule that meeting for
Medicare or Affordable Care Act,and you click that button that
says we want to see all plans,not just the plans that pay a
commission
David (09:23):
Mhmm.
Mike (09:23):
It's a different conversation. And it's not a
conversation that's happeningtoday. So I highly recommend
that you if you if you wannawork with your Medicare person,
fine, but probe themaggressively. Yeah. Are you
giving me all the plans or justthe ones that pay a commission?
David (09:42):
Yeah. Ask the question. See how they react.
Mike (09:44):
Yeah. And if you're uncomfortable having that, then
just ignore them, ghost them,and find someone else. Schedule
a meeting with us at that pointif you wanna have that
conversation. I mean, do what'sright for you, but just be aware
that there are some thingshappening in the back end that
could affect your health caredecisions moving forward. That's
(10:06):
all the time we've got fortoday's show.
If you enjoyed the show,consider telling a friend,
leaving a rating, and mostimportantly, that you are
subscribed to it so that youdon't miss a thing. For more
resources, including a copy ofmy book, on demand courses, and
so much more, just go towww.retireontime.com. If you
want help putting yourretirement plan together, go to
retireontime.com and click thebutton that says get started.
(10:28):
But seriously, from all of ushere at Kedrick Wealth, we wanna
thank you for spending yourtime, your most precious asset
with us today. We'll see you inthe next episode.
The advantage plans might come with all these new bells
(00:02):
and whistles and like, oh, youcan get a free Apple Watch or
you can get a gym membershippaid for, and like all these and
that might seem nice. Yeah. Butif you need your doctors, there
are things that may not becovered. Welcome to How to
Retire On Time, a show thatanswers your retirement
questions. We're here to movepast that oversimplified advice
that you've heard hundreds oftimes.
(00:23):
Instead, we want to dive intothe nitty gritty because the
truth is, there's no such thingas a perfect investment product
or strategy. Nothing doeseverything well, so let's dive
into the details and figure outwhat's right for you. Now, text
your questions to (913)363-1234, and we'll feature them
on the show. Remember, the showis not financial advice. Do your
research.
(00:43):
Alright, David. Let's dive in.What do we got today?
David (00:47):
Hey, Mike. Open enrollment is coming up.
Anything we should know? Yeah.Yeah.
And and so what are theyreferring to here?
Mike (00:55):
Holy cow. Open enrollment. That's gotta be Medicare.
David (00:57):
Yes.
Mike (00:58):
Well, I mean, it's probably Medicare. It's
Affordable Care Act.
David (01:01):
Both are coming up.
Mike (01:02):
Yeah. You're a company, are you gonna be, you know,
switching insurance? That'sright. It's there's a the end of
the year is a really now, like,CPAs have their busy season.
Yeah.
The health care season is uponus to be very, very busy. Yeah.
So because this show is aboutretirement, let's talk about how
or the the Medicare bit Yeah.More specifically. I mean,
(01:25):
Affordable Care Act, re reviewit.
Is it the right plan? Should youswitch things? It is changing a
lot. Funding's being shiftedaround a lot. Insurance
companies are taking ondifferent risks.
They've had to deal with certainthings as well. So there's a lot
shifting right now, and what wasthe right plan for you isn't
necessarily an indicator that itis still the right plan for you.
(01:48):
Insurance is not an investment.It is the transference of risk.
So in your plan, which risks areyou taking and which risks are
you receiving help?
There is no max out of pocketfor all medical costs. It is a
max out of pocket or a highdeductible plan with a roof on
(02:09):
qualified situations, qualifiedexpenses, qualified procedures,
qualified fill in the blank.
David (02:15):
Yeah. Do we know what those are? Like, what are the
what's is there a list ofapproved procedures or
Mike (02:20):
Well, let me let me give you an example. So my wife and I
had our daughter who was born,what was it, five months ago.
David (02:27):
Yeah.
Mike (02:28):
Okay. In this year particular, in particular, we
had a high deductible plan thatwas really cheap. Why? I'm
healthy. My wife's healthy.
My son is healthy. We don'treally go to see the doctor
often. Yeah. Okay? I mean, I Isee my annual checkup, say hi to
the doctor, he asked me a bunchof questions, checks my my blood
(02:49):
pressure and all that fine.
And then I pay an additional$500 to this place called
functionhealth.com. They runhundreds of tests, so I see even
more on my health as well. We dothings a little bit
unconventionally. Okay? So wehave very cheap health
insurance.
I am paying thousands of dollarsless a month and have been for
(03:14):
years Mhmm. For for for cheaperhealth insurance. That's my
situation. Yeah. So when mydaughter was born, I had an
option.
We I mean, the company, we couldhave shifted our health
insurance as a collectively todo something different and pay
thousands of dollars more, or wecould just keep things as they
are. Everyone seems to be happy.I mean, I don't know. I'm not
(03:35):
gonna ask you if wanna have morekids or not, that's
inappropriate on on the show.But but we we when we when our
daughter was born, we paidcompletely out of pocket for the
whole thing.
David (03:48):
Oh, wow.
Mike (03:49):
Every penny. Oh. And you might think that's ridiculous.
Well, let's do the
David (03:55):
Let's shift your perspective. Yeah. Yeah.
Mike (03:57):
Let's say I pay $1,500 a month less in insurance because
I have a simpler version ofinsurance. Right. And I paid
$20,000 for one time. We knew wewe were gonna have this child.
We had planned on it, andthere's a five year kind of
threshold of what would becovered.
(04:18):
Okay? What's, you know, what'sbetter? I saved money Yeah. In
this situation. And you couldsay, well, maybe you could have
manipulated what Well, whenyou're going through
underwriting and things likethat, they're asking if you're
pregnant or not, there's a lotof things, and it's complicated.
So we stuck with our plan, wepay less a month, we saved money
(04:39):
for it, we paid out of pocket,and overall, we actually kept
more money. People will say,Well, that's an incomplete
understanding of how healthinsurance works. I'll say, No.
People try to game the system onhealth insurance to to get more
out of it. It's like, no.
That that's not how it works.
David (04:53):
Mhmm.
Mike (04:54):
Insurance is pulling people together, hedging against
risks, you're paying for theseservices, but the insurance
company has to make more moneyoverall.
David (05:01):
Right.
Mike (05:02):
They have to make more than they spend on these
payments, on the claims and soon. So the reason why I bring
that up is when you get intoMedicare, a lot of people will
think, I'm gonna save money onAdvantage Plans. Mhmm. That
might be true if you don'treally need your doctors. But if
you need your doctors, there arethings that may not be covered.
David (05:20):
Tell us why I'm aware
Mike (05:20):
of that.
David (05:21):
Tell us why you would save more with Advantage over
others.
Mike (05:24):
I mean, we're all paying the same I'm not on Medicare.
Medicare people are paying, youknow, part a is free, part b is
you're paying the same amount. Iforget what it's gonna be this
next year.
David (05:34):
It was a 185 in 2025.
Mike (05:37):
Yeah. So whatever it's gonna be next year
David (05:39):
Yeah.
Mike (05:41):
The advantage plans might come with all these new bells
and whistles and like, oh, youcan get a free Apple Watch or
you can get a gym membershippaid for and like all these and
that might seem nice. Yeah. Whatthey've done is they've taken
money from the government tocreate an insurance policy for
you based on what they haveallocated for Medicare, and they
have basically put together aplan
David (06:03):
Mhmm.
Mike (06:03):
An advantage plan, where you're not really paying much
for it. Maybe you pay a littlebit extra, maybe not. But
they've structured it in a wayso that it still makes financial
sense for them, and you'repicking a plan that works for
your specific situation. But ifyou step outside of that, then
you're paying an arm and a legfor it. Whereas traditional
Medicare might be more just youpay apart for whatever you use.
(06:24):
So do you see how it gets kindof more nuanced? And then the
gap plans, the supplementalplans, you're getting kind of
your core risk, transference ofrisk or your core coverage, plus
additional coverage that coversthe gap of what's going on. So
people need to understand thatthis is much probably more
complicated than they realizewhen they go and say, well,
(06:45):
what's good plan? Well, what'sthe cheapest plan I can have?
Because it's all kind of thesame anyway.
I'm gonna get a good deal. It'snot like you're comparing the
cost of eggs at Sprouts or WholeFoods or Hen House or Fred
Meyer's Safeway or whatever thegrocery store is. What's
Albertsons. Albertsons. Kroger.
David (07:05):
Let's list them all.
Mike (07:06):
You're not comparing the price of eggs You're paying for
a certain plan with certainrisks that you are or not are
not taking. So when you havethat kind of mindset, you might
slow down and start to ask morequestions, which is good. But
the other part, this is whatgets my goat, and we'll end on
this.
David (07:23):
Okay.
Mike (07:24):
Is when an insurance company doesn't really want to
maintain a plan, how do they fixit? They can't really just
cancel a plan.
David (07:32):
No, there's a contract. They have to go to the end of
the year, right? They have tohas all CMS, right? They have
all the
Mike (07:38):
There's all sorts of regulations So around one of the
ways that they will helpalleviate their financial
burdens on maybe a situationthey don't want to maintain but
kind of have to is by cuttingcommissions.
David (07:50):
Uh-huh. For who who gets the commission?
Mike (07:52):
If you cut Medicare commissions, Medicare insurance
agents may, and they're supposedto do what's right for you Yeah.
Yeah. Yeah. But they may find anequivalent plan that's close
enough that still pays them acommission, but not not keeps
your current plan. And maybeyour current plan was the better
plan for you, but it doesn't paythem.
(08:13):
I mean, just the filth of of howyou can cut commissions of a
plan to help try and get peopleoff of it, that's such a a
backdoor deal. And so how That'sso sketchy.
David (08:25):
The the the Medicare beneficiary, I mean, how are
they to know all of this? How dothey know if they're being sort
of guided in a differentdirection that may not be in
their best interest?
Mike (08:36):
I mean, you ask the uncomfortable question. Well,
why shouldn't I stay on theother plan? Does that plan pay
you or not? And hopefully,they're honest. Sometimes
they're not.
I mean and I'll say it this way.David, you're the director of
our health care. Yeah. Medicareand Affordable Care Act and all
that. Is your pay structurebuilt at all around the
(08:58):
commissions you we make onMedicare?
David (09:00):
Thankfully not.
Mike (09:01):
Yeah.
David (09:01):
Yeah. No. I can truly say that anything that I would
recommend to somebody is it'sbecause it's matched to them
perfectly with no otherconsideration.
Mike (09:09):
It's not what we're focused on. We're a membership
model or a one time model, flatfee advisory practice. So when
someone comes to you and theyschedule that meeting for
Medicare or Affordable Care Act,and you click that button that
says we want to see all plans,not just the plans that pay a
commission
David (09:23):
Mhmm.
Mike (09:23):
It's a different conversation. And it's not a
conversation that's happeningtoday. So I highly recommend
that you if you if you wannawork with your Medicare person,
fine, but probe themaggressively. Yeah. Are you
giving me all the plans or justthe ones that pay a commission?
David (09:42):
Yeah. Ask the question. See how they react.
Mike (09:44):
Yeah. And if you're uncomfortable having that, then
just ignore them, ghost them,and find someone else. Schedule
a meeting with us at that pointif you wanna have that
conversation. I mean, do what'sright for you, but just be aware
that there are some thingshappening in the back end that
could affect your health caredecisions moving forward. That's
(10:06):
all the time we've got fortoday's show.
If you enjoyed the show,consider telling a friend,
leaving a rating, and mostimportantly, that you are
subscribed to it so that youdon't miss a thing. For more
resources, including a copy ofmy book, on demand courses, and
so much more, just go towww.retireontime.com. If you
want help putting yourretirement plan together, go to
retireontime.com and click thebutton that says get started.
(10:28):
But seriously, from all of ushere at Kedrick Wealth, we wanna
thank you for spending yourtime, your most precious asset
with us today. We'll see you inthe next episode.
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