Medicare 360 09 29 25

Episode Transcript

Speaker 1 (00:01):
Welcome to Medicare three sixty, where the world of Medicare
is simplified and you are empowered to make informed healthcare choices.
With over two decades of experience and insurance and financial
solutions with host licensed insurance agents Jennifer Lee, you are
guided through the ins and outs of Medicare, whether you

(00:22):
are nearing retirement, navigating your options, or just curious about
what's available. Everything you need to know is covered. Tune
in for knowledgeable insights, tips and answers to your Medicare
questions so you can take charge of your health and
your future. And now Medicare three sixty.

Speaker 2 (00:44):
Welcome to today's Medicare three sixty show. I'm your host,
Jennifer Lee, and today we are going to deep dive
on the Medicare New Handbook. We're almost done and I
will go over the new updates for Medicare Care and
New Handbook twenty twenty six, So let's get started. We

(01:05):
are at page one two of the Medicare and New
Handbook for twenty twenty five, so let's get to it.
Premium the periodic payment to Medicare, an insurance company or
healthcare plan for healthcare, prescription drug coverage, so keep in
mind your Medicare Part B premiums are going to be

(01:28):
sent to Social Security. If you do have any premiums
to your insurance company, it could either be sent to them,
mailed to them autodeduct. Sometimes you get autodeduct from Social
Security as well. Preventive services healthcare to prevent illnesses, to
detect illness at an early stage when treatment is likely

(01:53):
to work best. For example, preventive services include PAP tests,
flu shots, and screening mammograms. Definitely, preventive services is good
to do, and typically they're at zero costs because of
course we want you to be healthy and see any
red flags or just take precautions. In your health primary

(02:18):
care doctor the doctor you go to first for the
most health problems. They may talk with other doctors and
healthcare providers about your care and refer you to them.
So remember usually in an HM plan, you'll have to
see your primary care physician to get a referral from
your doctor, so keep in mind when that happens. Typically,

(02:42):
depending on the medical group, they could have that on
file for the whole year, so you don't have to
worry about going to your doctor. They could get that
approval for several weeks, months, or the whole year. Referral
a written order from your primary care doctor for you
to visit a specialist or get certain medical services. Without

(03:03):
a referral, your plan may not pay for services from
a specialist, so keep that in mind. Sometimes you routinly
see your specialists you think it's already approved or authorized
by your doctor, and if it wasn't, you may be
liable or at costs for those services. Just make sure

(03:25):
it has been approved and so forth. Just make sure
you're not paying out of your pocket on that to
keep that in mind. Service area an area you must
live in for the plan to accept you as a member.
For plans that limit which doctors and hospitals you may use,
it's also generally the area where you could get routine,
non emergency services. Plans can and in some cases, must,

(03:49):
disenroll you if you move outside their service area, so
keep in mind. In most Medicare advantage plans will all
end your drug plan. It is based on county and
zip code. Sometimes it's based on zipcode because you might
be living in a different county and so forth, and
even for a Medicare supplemented plan, it is based on

(04:10):
zip code. But if you do move sometimes you could
still keep your plan. Skilled nursing facility a nursing facility
with the staff and equipment to give skilled nursing care
and in most cases skilled rehabilitative services and other related
health services. Skilled nursing facilities. Sometimes if you are at
the hospital you can't quite go home, you could get

(04:33):
a referral to go to a skilled nursing facility for
more care like rehab before, so you could get well
before you go home. Skilled nursing facility care so skilled
nursing care and therapy services provided on a daily basis
in a skilled nursing facility. Examples of skilled nursing facility

(04:54):
care include physical therapy or intravenous injections that can only
be given by a physical therapists are registered nurse. Okay,
we are on page one twenty three some non discrimination notice.
I won't go through that. You can just read that
yourself accessible communications information on that. If you do want

(05:16):
Medicare and New Handbook and other languages, you could definitely
call for that as well. So guys, we are done right,
So this is awesome. We finished the Medicare and New Handbook.
Just in time for the new twenty twenty six Medicare
updates that I would love to go over with you guys.

(05:40):
So you are well informed, so let us get to that. Okay,
let us see just one second. Okay, I know we've
been going through the Medicure New Handbook this whole year,

(06:03):
but the Medicare and New Handbook for twenty twenty six
just came out. This is what it looks like. Uh,
if you are new to Medicare, you probably want to
read this, or if not, just listen to this radio
show and we cover most or all of this. Right.
So you should have already got your official guide from

(06:26):
CMS mail to you all Medicare households every fall. Okay,
so it does include your summary of benefits, your rights,
your protections, and your options. So the biggest thing I
would say is the Part D as well. That was
a big thing last year the prescription drug changes. So

(06:47):
the out of pocket cap for prescription drugs under Part
D is increasing from around two thousand and twenty five
twenty twenty five to twenty one one hundred and twenty
twenty six. The maximum deductible for Part D plans will
go up to pay to six hundred and fifteen dollars
for twenty twenty six. I would say keep in mind

(07:10):
the formulaities do change, the tier levels change the amount
that you're paying, and the deductibles may change. So definitely
look at that because you do not want to be
surprised with larger cost to your drugs. Insulin cost cap
does remain in place, no more than thirty five dollars

(07:33):
per month, no deductible for the insulin, which is great.
Adult vaccines those recommended by ACIP continue to be covered
under Part D with no cost sharing. That is also good.
Medicare Advantage and supplemental benefits, so changes in what special
supplement benefits for the chronically ill SSBCI may include non

(07:57):
health related items being narrowed. The focus is more on
benefits that directly improve or maintain health function. Some plans
Medicare Advantage or standalone Part D may may no longer
be offered in certain areas. Beneficiaries should check whether their
plans are continuing. So this is definitely a big thing.

(08:21):
I highly recommend you've look at your mail. Right open
your mail because there are changes cost, some premium changes,
so Part B premium is projected. Okay, This is a projection.
This is not set in stone to increase to something
like maybe two hundred and six dollars and fifty cents

(08:42):
per month in twenty twenty six. Deductibles for Part B
are also rising. More to come on that once it
comes out. Er month income related monthly adjustment amounts. Search
charges for higher income beneficiaries will also increase, so keep
that in mind as well. So there are new and
enhanced benefits, digital tools and preventive care. So there are

(09:06):
more tools for managing Medicare benefits online, managing your prescriptions,
viewing Medicare Summary Notice MSNs, getting the handbook digitally. So
remember there is the ANOC, which is the annual notice
of changes that you should get with your plan if
it's a Medicare advantage or a drug plan that sells

(09:27):
you the differences from twenty twenty five to twenty twenty six. Okay,
Expanding preventive services for example updates and cancer screening screenings,
possibly expanded coverage for colorectal screening via newer methods. So
what are your enrollment periods, rights and protection? So a

(09:49):
reminder annual open enrollment for Medicare include Medicare advantage and
Part D is October fifteenth through December seventh for changes
effect in twenty twenty six, so January first, twenty twenty six.
When a plan is discontinued, beneficiaries have special enrollment or

(10:09):
guaranteed rights to choose another plan. Beneficiaries have rights and protections, appeals, quality,
oversite member resources ascribed in the handbook. So please keep
in mind that if you do get calls from randomly
overseas telemarketers call centers, is actually illegal and uncompliant and

(10:33):
they're not following the rules if you didn't request to
get called. Okay, So I know you may be getting
calls now, right, they are not compliant. They are those
people calling you for Medicare. It's it's not compliant. They're

(10:55):
not supposed to do that. So I would just hang
up on them because and put them on your do
not call lists because they are not following the rules. Okay. However,
from October first to October fourteenth, you can go over
your plans with your agents, but you can't make changes

(11:18):
till October fifteen, Okay, so keep that in mind as well.
What to do now so your action steps definitely review
your current plan. What prescriptions you have, what premiums, deductible
costs will look like under plan in twenty twenty six.

(11:41):
You want to compare your alternative plans, especially if you
anticipate higher drug costs or your plan is changing or
going away. Consider whether you're affected by IRMA and whether
any financial planning might help. Use digital tools, go online,
get the handbook, switch to electronic notices. Are also just
consult on a trusted source just like ourselves medicure three sixty.

(12:07):
Feel free to give us a call and so that
it is in a nutshell, so what I have seen.
Obviously we can't talk about specific plans, but to kind
of give you a synopsis thing things. Well, your health

(12:30):
plan may change. There are health insurance companies that are
more stable and you won't see a lot of changes.
But then you will also have insurance companies that have
a little bit of instability. And reason being is because

(12:52):
the Inflation Reduction Act of twenty twenty five. Remember how
they capped the drugs to two thousand dollars, which is
a great thing and eliminated the donut hole. But this
really affected the insurance companies because now they're more on
the hook on on the drug cost, right, sounds great

(13:16):
for seniors, sounds great. For those that were in that
donut hole, we're paying six to eight thousand dollars in
their drug coverage is very expensive. But for some that
weren't taking prescription drugs, benefits have been decreasing. They're getting

(13:38):
more strict. If you have a chronic condition, you definitely
need to actually you actually definitely need to. Oh my gosh,
a lots of frame of thoughts. Yeah, So for those

(14:00):
that's don't have that much drugs, weren't paying that much,
benefits have been decreasing. The insurance companies are more strict
on the chronic conditions and verifying that you have chronic
conditions to actually get more benefits in your plan. So

(14:23):
let's here's some questions that listeners definitely have been asking.
So I do want to bring that up. What happens
if I reached the twenty one hundred cap for the
party in the middle of the year, Well, you don't
have to pay anymore, right, because the most you would
pay in your drugs is twenty one hundred, which is awesome.

(14:47):
I take insulin. How does the thirty five cap work exactly?
Any restrictions? So yeah, your Insulince thirty five bucks. Just
make sure it's in that like preferred list and just
make sure that it's covered by your insurance company. If
my plan is discontinued, how do I know what to

(15:08):
switch and when? So this is a big thing. There
are plans that are terminating, so definitely look into your
different plan options. I would definitely look at companies that
are more stable or here for the long run, because

(15:29):
there are companies that midyear just filed for bankruptcy and
terminated their plans. The nice thing is that if your
plan is discontinued, you do have guaranteed issue to get
on a Medicare supplement if you choose to do that,
because Medicare supplements do have underwriting and you may not qualify.
So this is a way to get into that. But

(15:51):
not to fret. If your plan is getting to discontinued,
contact us a trusted insurance agent to go over your
changes and what options you have. Okay, So for higher
income people, what is IRMA and how it is calculated?
How to reduce it? So IRMA is based on your

(16:14):
income related monthly adjustment from two years ago, so in
twenty twenty six, they will look at your adjusted gross
income for twenty twenty four. If you were a widow
sold your home, we could get you that exception while
not promising you, but we will help you apply for

(16:35):
that appeal with Social Security. If it's just maybe through
a layoff of four to one k a distribution inheritance,
you can still file an appeal, but it's going to
be a little bit tougher to get that appeal. How
do the digital tills work? Can I really get everything
online and skip paper mailings? Yeah, we're getting into that

(16:56):
digital age. I mean, I'm a paper person too. I
love the paper, like it's just the feel reading it,
signing things and so forth. But we are in that
digital age. You definitely could go on Medicare dot Go
to look at your plant options, but of course sometimes
when you're reading something and talking to a licensed independent

(17:16):
insurance agent, it is very different because we know the
ins and outs, we know the vendors of these plants,
we know what's going on in the industry, versus just
reading it on the computer right or on paper. So
that is in a nutshell on the Medicare and you handbook. Yeah, so, like,

(17:45):
let me just recap again, is that you should have
got the Medicare new Handbook in the mail for twenty
twenty six, and they are changes, right. The biggest thing
with that would be your deductibles might change, the bar
by premium might change, which didn't come out yet, the

(18:08):
prescription drug deductible change. The max out of pocket on
your prescription drugs change, right, So that's the twenty one
hundred for Part D deductible for Part D six fifteen,
and then the insulin cap is still thirty five dollars
per month. So the biggest thing on your prescription drugs

(18:30):
is that making sure that your drugs are covered and
if you're going to pay for something or if it's
going to increase in cost, some carriers do have a percentage.
Some carriers do have like a percentage of meaning like
the co insurance on that or just a copay which
is a flat amount of thee So just keep that

(18:50):
in mind. So for the medicure advantage plans, there could
be revisions on there, especially for those with special benefits,
people with chronic illness. And then just some of the
nice to have perks, especially the ones that aren't directly

(19:11):
health related, might no longer be offered under like the
chronically ill benefit category, so you do want to check
your plan for these offerings. Some insurance insurance are pulling
out of certain areas or stopping certain plans, so your
options will definitely maybe be different in twenty twenty six

(19:32):
and in twenty twenty five. Like kind of the surpriser
to me, some insurance companies are removing their fitness benefits
I benefits right, So those are the things to definitely
look at, so start budgeting. In regards to the part

(19:54):
be expected premium, they say it is going to definitely
go up. We don't know yet until it comes up
on that, and then the IRMA surcharges will go up
as well. So these changes can't affect your monthly budget significantly.
So there are some good stuff too, like the preventive

(20:17):
screenings and better digital access, managing your prescription drugs, your
Medicare summary notices, getting that handbook. So I would really
recommend doing the preventive services like cancer screenings. Getting it
early with these can help catch issues sooner, So don't

(20:40):
forget October first to October fourteen. You could talk. You
could talk to a licensed insurance agent. The plans will
come out for those that are antsier want to get
it over with to review their benefits. Yes, reviews could
happen on October first, and then October fifteenth to December

(21:04):
seventh is when you can make a change and enroll
in a different plan to change your coverage. Switch plans
and definitely if your plan is discontinued, usually do get
that special enrollment period. So remember the handbook does walk
you through your rights including appeals, denials, getting making complaints,

(21:28):
so things like that. So, well, what should you do today?
I would definitely check your medication list against your current
and potential plans, like get your medication list going. Also,
when you're talking to a licensed insurance agent, you do

(21:50):
need a scope of appointment completed, meaning it basically says
that you are okay to talk about these medicare plans
and saw drug plan, So you are giving that agent
permission to talk to you about it. So typically there
is a forty eight hour waiting period. If you do
talk to someone, you need to wait twenty four hours

(22:15):
forty eight hours sorry, once you sign that to talk
to that person, So keep that in mind. If you
don't get that, that agent's really not compliant. Okay, So
the bottom line is twenty twenty six does bring some

(22:36):
cost increases, but also some protections, especially around prescription drugs, insulin,
and vaccines. So if you plan now, you definitely could
avoid surprises and get the coverage that works best for you.
So remember, talk to a licensed insurance agent. Sign the

(23:03):
scope of appointment that basically states you are allowing permission
to go over the plans. Get all your prescription drugs done,
if you want to change your primary doctor, keep them,
all your specialists, and just any type of benefits you need.

(23:27):
Typically seniors really want dental, so there are still good
dental plans within these plans, so keep that in mind.
But I really recommend that you do go over your
plan because you just don't want to have any surprises
next year if something particular that you actually use on

(23:50):
a daily or monthly basis is going to be gone.
So that's my big thing for you guys. Look forward
to our next Yes show to go over. Other things
are just maybe deep dive in regards to what to

(24:10):
do what to look for this annual upcoming enrollment period.
Once again, my name is Jennifer Ley. You're a Medicare
three sixty show host. I'll look forward to next time.
You have a great day.

Speaker 1 (24:26):
Thank you for joining the program Medicare three sixty. Hope
you found today's episode insightful and empowering. Remember understanding your
Medicare options is key to making the right choices for
your health and financial well being. If you have questions
or topics you would like covered in future episodes of
Medicare three sixty, don't hesitate to reach out and speak

(24:49):
with our licensed insurance agent Until next time, Stay informed
and take charge of your healthcare journey. This has been
Medicare three sixty, your trust, the source for all things Medicare.
Take care