Episode Transcript
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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 over the Medicare
New Handbook. We left off on page sixty four, Section
four Medicare Advantage Plans and other Options. So what should
(01:05):
I know about Medicare advantage plans. To join a Medicare
advantage plan, you must have Part A and B, live
in the plans service area, be a US citizen or
lawfully present in the US. So let me just clarify
that for you be a US citizen or lawfully present
(01:28):
in the US. Keep in mind that you do have
to be lawfully present, meaning like a Green cardholder or
immigrant that's been here for at least five years. Okay,
So a lot of the times I've noticed, if you
are an immigrant, you're not going to get your part A.
(01:48):
If you are on Medicaid medical you might be able
to get it something that we could definitely help you
out on that and go walk you step by step. Okay,
So joining and leaving you could join a Medicare advantage
plan even if you have a pre existing condition. You
(02:09):
could join or drop a Medicare advantage plan only at
certain times during the year. Go to page seventy one
to seventy two. Each year, Medicare advantage plans can choose
to leave Medicare or make changes in coverage, cost, service area,
and more. If the plan decides to stop participating in Medicare,
(02:31):
you'll have to join another Medicare advantage plan or return
to original Medicare. Go to page ninety eight. Medicare advantage
plans must follow certain rules when giving you information about
how to join their plan. Go to pages one oh
five to one oh six for more information about these
(02:51):
rules and how to protect your personal information. So that's
the biggest thing people ask me is, oh, do I
have to qualify? No, you do not have to qualify
medically to get on a Medicare under advantage plan. There's
(03:12):
no underwriting involved. If you have a pre existing condition,
you're still going to be accepted. Of course, it has
to be during the special enrollment periods or one of
the enroment periods to get on a Medicared advantage plan,
something very different from Medicare supplement, which does require underwriting.
(03:34):
But since we're talking about Medicare advantage today, I'm not
going to go over that. But just know that there
is no underwriting depending on your health conditions when it
comes to a Medicare advantage plan. What if I have
end stage renal disease that's called ESRD. And if you
(03:58):
have ESRD, you can choose either original Medicare or a
Medicare advantage plan when deciding on how to get Medicare coverage.
If you're only eligible for Medicare because you have ESRD
and you get a kidney transplant, your Medicare benefits will
(04:18):
end thirty six months after the transplant. Go to page
fifty two for more information about continuing coverage for immunosuppressive drugs.
So let's say that again. If you do have ESRD,
you choose either original Medicare or a Medicare advantage plan
when deciding how to get Medicare coverage. If you're only
(04:39):
eligible for Medicare because you have ESRD and a kidney transplant,
your Medicare benefits and thirty six months after the transplant,
so keep that in mind. This is typically for people
that are below sixty five and have ESRD, right, you're
going to have to get off Medicare already six months
(05:00):
after the transplant. But if you're ready above sixty five
or like have sc I for more than twenty four months,
you are eligible for Medicare as well Medicare Drug Coverage
Part D. Most Medicare advantaged plans include Medicare Drug Coverage
Part D, and certain types of plans that don't include
(05:23):
Medicare drug coverage, like Medical Savings Account plans and some
private fee for service plans. You could join a separate
Medicare drug plan. However, if you join a Health Maintenance
Organization plan which is HMO or Prefer Provider Organization PPO,
which doesn't cover drugs, you can't join a Medicare separate
(05:48):
Medicare drug plan. In this case, you'll either need to
use other prescription drug coverage you have, like employer or
re tire coverage, or go without drug coverage. Decide not
to get Medicare drug coverage when you're first eligible and
your other drug coverage is incredible prescription drug coverage, you
(06:09):
may have to pay a late improvement penalty pages eighty
three to eighty five if you join Part D plan later. Okay,
that was a handful. Let me kind of go over
that with you. So for Medicare Drug Coverage Part D,
most Medicare advantaged plans do have the D covered, some
(06:33):
like a few don't have it. So if it's just
at Medicare Advantage m A, there's no drug plan on that.
And then if it's Medicare Advantage Prescription Drug Plan m APD,
then there is a drug plan included on that. So
things to know. On your original Medicare Part A and
(06:55):
B card, there is no D, but you do definitely
have to have drug coverage, right. If you don't have
drug coverage through a credible prescription drug coverage plan, you
will be penalized one percent for every single year that
you weren't on one and that you had to be. Okay,
(07:16):
So credible drug coverage could be your via drug coverage,
a group health insurance plan that has drug coverage, Okay,
So keep that in mind. I know some people are like, well,
why do I have to pay for drug coverage if
I'm not taking any prescription drugs? Right, that's something for
(07:37):
a supplemental plan. But because you will be penalized, some
people tell me, you know what, it's still going to
cost me more. So I just work with that. But
just keep in mind, maybe when you're in your eighties
or your nineties, something catastrophic happens you need a really
expensive drug. Still might be worth it to get a
(07:58):
drug plan, even though you will get penalized for that
every month, one percent for every month that you weren't
on it and had to be. Just so keep that
in mind. I've had an incident where I met a lady.
She did not have a drug plan because she said
I don't need one. So whoever consulted with her did
(08:23):
not consult with her because that person was an order taker, right,
didn't give her a drug plan because she didn't want one. Well,
did you tell her that she was going to get
penalized for every month that she wasn't going to have
one one percent No, So keep that in mind, guys,
things that you know, we could go back and forth on,
(08:45):
especially if you do have like an income related monthly
adjustment things like that, that everyone's situation is very different,
So that's something that we could definitely talk about. Okay,
what if I have other coverage? Okay, talk to your employer,
union and other benefits administrator about their roles before you
(09:07):
join a Medicare advantage plan. In some cases, joining a
Medicare advantaged plan, it might cause you to lose your
employer union coverage for yourself, your spouse, and your dependence,
and you may not be able to get it back.
In other cases, if you join a Medicare advantage plan,
you may still be able to use your employer union
coverage along with the Medicare advantage plan you join. Your
(09:28):
employer union may also offer a Medicare advantage retiring plan
that they sponsor. You can only be in one Medicare
advantage plan at a time, so yes, I've seen this happen.
Where you're still on your employer's plan, you also get
a Medicare advantage plan. This it's going to just depend
(09:49):
on the employer how they coordinate those benefits and so forth.
But my biggest thing is wasting money. So if your
coverages are the same, not equal, or just be whatever
it may be, keep in mind, if you're paying on
your group plan a premium and you're playing on Medicare
(10:13):
advantage premium and costs, it's two coverages that may be
overlapping and you might not need. So those are the
things that I rather you not pay more than you
have to, right so we definitely will review that for you,
help you either get off of your group plan or
(10:34):
get on just Medicare or vice versa, or whatever fits
your needs at that time. I always do tell those
that are still working to consult with your HR or
benefits administrator to see what type of options they have.
If you're still working, if you're gonna get on Medicare,
(10:58):
and then what we do is we come pay your
costs on your group plan versus Medicare advantage or just
getting on Medicare original Medicare and see which would best
benefit you. And this will depend on your premiums, your copays,
(11:19):
your co insurance, your deductibles, your network, your doctors, your specialists,
your hospitals, your prescription drugs, and just any other extra
benefits that you may be paying on your group plan,
like vision and dental, et cetera. To see which would
be better for you. If that makes sense, Okay, so
(11:42):
let us go to page sixty five. What if I
have a Medicare supplement insurance medagap important? If you already
have a meta gap in joining a Medicare advantage plan,
you may want to drop medicap. Keep in mind, if
you drop metagap to join a Medicare advantage plan, you
(12:04):
may not be able to get your medigap policy back,
depending on your state's metagap enrollment rule in your situation.
For more details about dropping your medicap policy, visit Medicare
dot gov, slash health dash, drug, dash plan, slash, meta gaps,
slash ready, slash two, slash buy slash change policies. You
(12:28):
can't buy medagap while you're in a Medicare advantage plan
unless you're switching to it back to original Medicare. You
can't use metagap to pay your Medicare advantage plan co payments.
Deductibilson premiums. Okay, So keep in mind you cannot have
a Medicare advantage plan and a Medicare supplement at medicgap plan. Right.
(12:50):
If you do atend to drop your Medicare supplemental plan,
please cancel it when your Medicare advantage is effective, just
because you're paying for something that you don't need to pay,
So keep that in mind. It doesn't automatically cancel out.
(13:12):
So keep that in mind. If you are paying a
premium on your Medicare supplement plan and go to Medicare
advantage okay, So what do I pay? You're at a
pocket cost in a Medicare advantaged plan depend on whether
(13:32):
the plan charges a monthly premium. Some Medicared advantaged plans
have a zero dollar premium, but you may still have
to pay the Part B premium. If you join a
plan that charges a premium, you pay this in addition
to the Part BE A premium and the Part A
(13:52):
premium if you don't have premium Part A. Whether the
plan pays any of your monthly Part B premiums. Some
Medicare advantaged plans will help pay all or part of
your Part B premium. This is sometimes called a Medicare
(14:13):
Part B premium reduction. So how does this work, because
a lot of people do ask about it. How what
works is you have the Part B premium that you
are paying to Social Security for your Medicare. Be it
for twenty twenty five, it's one hundred and eighty five dollars.
It could go up or down every single year, or
(14:35):
it could also change bitpending on your income two years prior.
So for twenty twenty five, they are looking at twenty
twenty three. If your income is at a certain threshold
above the standard income limits, you will be paying a
searcharge or more for your Medicare, So keep that in mind.
(14:56):
Of course, if you're on Medicaid and medical you may
not be paying a premium as well. Okay, so then
these plans they are a zero cost and they say,
mister client, missus client, we would love for you to
be on our plan. What we will do is we
will provide you some give back or like a rebate
(15:20):
back to your Medicare Part B premium. So let's just
say it's a full amount at one eighty five, one
fifty fifty dollars, sixty dollars, just depending on what that
plan is offering for that year. So if you are
receiving Social Security, the standard Part B premium of one
eighty five for the year will be deducted. But then
(15:44):
the insurance company says social Security, this person is on
a plan that gives money back, so we are giving
x money back. So let's just say you're paying one
eighty five, the plan is one fifty back, so es centrally,
you're paying thirty five dollars back. So you might not
(16:08):
see it big because like if you're receiving your Social Security,
they deduct the Part B premium, then they're going to
put it back. And then let's just say you are
not getting Social Security. When you get a bill, and
typically your bills are quarterly, then the insurance company gives
that back, so then that's the amount you pay. So
(16:29):
keep in mind that once you enroll in one of
these type of plans, it could take up to ninety
days for the insurance company to know how to find
Social Security and Social Security to act to put that
money back, So keep that in mind. It will be
pro raded based on the effective date on the plan.
(16:50):
So that's a big common question that I typically get
in regards to the rebate plans. Also keep in mind
you don't get something for no thing, right. So these
plans typically they could have higher maximum out of pockets
your moop, they could have higher coinsurance, deductibles, codepayse okay,
(17:13):
keep that in mind. Sometimes the network or the medical
groups or the doctors are limited, so keep that in mind.
And sometimes some benefits that are standard on other plans
that insurance company offers is less gone not available, so
(17:34):
also keep that in mind. So of course, you don't
get something for nothing, right. When clients feel like they're
not using the health plan, they don't go to the doctor,
they don't go to specialists, they don't need all the
extra benefits, right, then they say, maybe I'll try it
(17:54):
for this year because I don't foresee using my coverage. Right.
And of course, on a Medicare advantage plan, you are
able to move and switch Medicare advantage plans once a
year on annual enrollment period. Of course, there's open enrollment
period from January to March that if you do want
(18:15):
to make a change, you could reach out to us.
And then also those special enrollment periods, so keep those
in minds. I know that it's a lot to grasp,
but you could definitely get the hang of it once
you're on Medicare. You know, your first year, second third,
and then it does definitely get better. Okay, let us
(18:37):
move on. What do I pay? Whether the plan has
a yearly deductible or any additional deductibles for search and services,
the amount you pay for each visit or service like
your co payment or your coinsurance. Medicare advantage plans can't
charge more than an original Medicare for search and services
(18:57):
like chemotherapy, dialysis in days two, anyone to one hundred
of skilled nursing facility care. So that I've seen like
the twenty percent, I've seen a copay the skilled nursing facilities.
I've seen them at zero, but I've seen them a
couple hundred per day, So kind of just depends. But no,
there is a maximum out of pocket costs for these
(19:19):
Medicare advantage plans. Type of healthcare services you may need
and how often you get them, Whether you get services
from a network provider or provider that doesn't contract with
the plan, if you go to a doctor or other
healthcare provider, facility, or supplier that doesn't belong to the
(19:41):
plans network for non emergency or non urgent care services.
Your plan may not cover your services, or your cost
could be higher whether you go to a doctor or
supplier who accepts assignment. If you're in a preferred provider
organization plan, private Fee for Service plan, or Medical Savings
(20:02):
Account MSA plan and you go out of network, put
a page is fifty nine to sixty for more information
about assignment. Okay, what do I pay? Whether the plan
offers extra benefits in addition to the original Medicare benefits,
and if you need to pay extra to get them.
So remember with these plan with the extra benefits, the
(20:26):
vendors may be different from the insurance company, which kind
of gets confusing for the insured or the patient. That's
why you have us to go over that with you.
Of course you could call the insurance company, but sometimes
they don't know what they're saying doing a new employee,
(20:47):
or they're not really advocating for you. You know, we've
seen accountless times when they don't even know the benefit
and we have to push them or tell them or
remind them that no, the client does get these benefits. Okay,
the plans yearly limit on your out of pocket costs
for all Part A and BE covered services. Once you
(21:11):
reach this limit, you'll pay nothing for Part A and
B covered services. So this is the awesome part about it.
There are limits to out of pocket costs, which is
called MOOP maximum out of pocket costs. So this is
really good because in the something catastrophic happens, then you
(21:33):
have a max out of pocket for those that are
on a budget. I mean, these max out of pockets
could be so low if that's what you really want.
I mean some are higher. So it kind of just depends.
But if you look at the copays and coinsurance, sometimes
it doesn't even seem like you're going to ever hit
that unless you definitely, you know, do skilled nursing or
(21:58):
things like that. Depending on the plant, of course, HMOs
and PPOs have different maximum out of pockets. Your PPOs
tend to have more out of pocket and deductibles copase
cultures because you have the ability to go in or
out a network without those approvals like HMO does. Okay,
(22:21):
so what else, Whether you have Medicaid or get help
from your state through a Medicare savings program, go to
pages ninety one to ninety two. So that's the biggest
thing too. Sometimes clients they change their plan, they forgot
get to tell their specialists or provider to run the
(22:42):
approvals to get those referrals from the specialists, and sometimes
they are definitely caught up with getting a bill because
of not being approved. We do also help with that.
We could see if we could retro or go back
to the doctors and figure out how we get get
(23:06):
it approved, so will be covered things like that that
you know sometimes a agent will not do for you,
but with Medicare Premiere three sixty, we definitely help you
with that. So to learn more about costs and a
specific Medicare advantage plan, contact the plan or visit Medicare
(23:27):
dot gov slash plans slash compare. Okay, So on that note,
we do want to end on that is every single
county is going to have different plans, different insurance companies. Right,
(23:53):
So sometimes if you do have a friend, relative, family
member that lives out of state or just even in
a different county, what may pertain to them, what they're
unhappy about that or satisfied or happy with that about
that may not apply to you because geogeographically, Medicare advantage
(24:15):
plans are based on county. Right, every county is going
to be different. Every county is going to have different plans,
different objectives, just different vendors, different doctors, different medical groups.
So not all plans are created equal or vendors. That's
why it is really good to talk to a licensed
(24:37):
independent insurance agent like me to help you go through that.
So I am going to stop for today. Enjoyed this
Medicare advantage synopsis, summary, and we will continue next week.
You have a wonderful day, right.
Speaker 1 (25:00):
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
(25:22):
with our licensed insurance agent Until next time, Stay informed
and take charge of your healthcare journey. This has been
Medicare three sixty, your trusted source for all things Medicare.
Take care
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 over the Medicare
New Handbook. We left off on page sixty four, Section
four Medicare Advantage Plans and other Options. So what should
(01:05):
I know about Medicare advantage plans. To join a Medicare
advantage plan, you must have Part A and B, live
in the plans service area, be a US citizen or
lawfully present in the US. So let me just clarify
that for you be a US citizen or lawfully present
(01:28):
in the US. Keep in mind that you do have
to be lawfully present, meaning like a Green cardholder or
immigrant that's been here for at least five years. Okay,
So a lot of the times I've noticed, if you
are an immigrant, you're not going to get your part A.
(01:48):
If you are on Medicaid medical you might be able
to get it something that we could definitely help you
out on that and go walk you step by step. Okay,
So joining and leaving you could join a Medicare advantage
plan even if you have a pre existing condition. You
(02:09):
could join or drop a Medicare advantage plan only at
certain times during the year. Go to page seventy one
to seventy two. Each year, Medicare advantage plans can choose
to leave Medicare or make changes in coverage, cost, service area,
and more. If the plan decides to stop participating in Medicare,
(02:31):
you'll have to join another Medicare advantage plan or return
to original Medicare. Go to page ninety eight. Medicare advantage
plans must follow certain rules when giving you information about
how to join their plan. Go to pages one oh
five to one oh six for more information about these
(02:51):
rules and how to protect your personal information. So that's
the biggest thing people ask me is, oh, do I
have to qualify? No, you do not have to qualify
medically to get on a Medicare under advantage plan. There's
(03:12):
no underwriting involved. If you have a pre existing condition,
you're still going to be accepted. Of course, it has
to be during the special enrollment periods or one of
the enroment periods to get on a Medicared advantage plan,
something very different from Medicare supplement, which does require underwriting.
(03:34):
But since we're talking about Medicare advantage today, I'm not
going to go over that. But just know that there
is no underwriting depending on your health conditions when it
comes to a Medicare advantage plan. What if I have
end stage renal disease that's called ESRD. And if you
(03:58):
have ESRD, you can choose either original Medicare or a
Medicare advantage plan when deciding on how to get Medicare coverage.
If you're only eligible for Medicare because you have ESRD
and you get a kidney transplant, your Medicare benefits will
(04:18):
end thirty six months after the transplant. Go to page
fifty two for more information about continuing coverage for immunosuppressive drugs.
So let's say that again. If you do have ESRD,
you choose either original Medicare or a Medicare advantage plan
when deciding how to get Medicare coverage. If you're only
(04:39):
eligible for Medicare because you have ESRD and a kidney transplant,
your Medicare benefits and thirty six months after the transplant,
so keep that in mind. This is typically for people
that are below sixty five and have ESRD, right, you're
going to have to get off Medicare already six months
(05:00):
after the transplant. But if you're ready above sixty five
or like have sc I for more than twenty four months,
you are eligible for Medicare as well Medicare Drug Coverage
Part D. Most Medicare advantaged plans include Medicare Drug Coverage
Part D, and certain types of plans that don't include
(05:23):
Medicare drug coverage, like Medical Savings Account plans and some
private fee for service plans. You could join a separate
Medicare drug plan. However, if you join a Health Maintenance
Organization plan which is HMO or Prefer Provider Organization PPO,
which doesn't cover drugs, you can't join a Medicare separate
(05:48):
Medicare drug plan. In this case, you'll either need to
use other prescription drug coverage you have, like employer or
re tire coverage, or go without drug coverage. Decide not
to get Medicare drug coverage when you're first eligible and
your other drug coverage is incredible prescription drug coverage, you
(06:09):
may have to pay a late improvement penalty pages eighty
three to eighty five if you join Part D plan later. Okay,
that was a handful. Let me kind of go over
that with you. So for Medicare Drug Coverage Part D,
most Medicare advantaged plans do have the D covered, some
(06:33):
like a few don't have it. So if it's just
at Medicare Advantage m A, there's no drug plan on that.
And then if it's Medicare Advantage Prescription Drug Plan m APD,
then there is a drug plan included on that. So
things to know. On your original Medicare Part A and
(06:55):
B card, there is no D, but you do definitely
have to have drug coverage, right. If you don't have
drug coverage through a credible prescription drug coverage plan, you
will be penalized one percent for every single year that
you weren't on one and that you had to be. Okay,
(07:16):
So credible drug coverage could be your via drug coverage,
a group health insurance plan that has drug coverage, Okay,
So keep that in mind. I know some people are like, well,
why do I have to pay for drug coverage if
I'm not taking any prescription drugs? Right, that's something for
(07:37):
a supplemental plan. But because you will be penalized, some
people tell me, you know what, it's still going to
cost me more. So I just work with that. But
just keep in mind, maybe when you're in your eighties
or your nineties, something catastrophic happens you need a really
expensive drug. Still might be worth it to get a
(07:58):
drug plan, even though you will get penalized for that
every month, one percent for every month that you weren't
on it and had to be. Just so keep that
in mind. I've had an incident where I met a lady.
She did not have a drug plan because she said
I don't need one. So whoever consulted with her did
(08:23):
not consult with her because that person was an order taker, right,
didn't give her a drug plan because she didn't want one. Well,
did you tell her that she was going to get
penalized for every month that she wasn't going to have
one one percent No, So keep that in mind, guys,
things that you know, we could go back and forth on,
(08:45):
especially if you do have like an income related monthly
adjustment things like that, that everyone's situation is very different,
So that's something that we could definitely talk about. Okay,
what if I have other coverage? Okay, talk to your employer,
union and other benefits administrator about their roles before you
(09:07):
join a Medicare advantage plan. In some cases, joining a
Medicare advantaged plan, it might cause you to lose your
employer union coverage for yourself, your spouse, and your dependence,
and you may not be able to get it back.
In other cases, if you join a Medicare advantage plan,
you may still be able to use your employer union
coverage along with the Medicare advantage plan you join. Your
(09:28):
employer union may also offer a Medicare advantage retiring plan
that they sponsor. You can only be in one Medicare
advantage plan at a time, so yes, I've seen this happen.
Where you're still on your employer's plan, you also get
a Medicare advantage plan. This it's going to just depend
(09:49):
on the employer how they coordinate those benefits and so forth.
But my biggest thing is wasting money. So if your
coverages are the same, not equal, or just be whatever
it may be, keep in mind, if you're paying on
your group plan a premium and you're playing on Medicare
(10:13):
advantage premium and costs, it's two coverages that may be
overlapping and you might not need. So those are the
things that I rather you not pay more than you
have to, right so we definitely will review that for you,
help you either get off of your group plan or
(10:34):
get on just Medicare or vice versa, or whatever fits
your needs at that time. I always do tell those
that are still working to consult with your HR or
benefits administrator to see what type of options they have.
If you're still working, if you're gonna get on Medicare,
(10:58):
and then what we do is we come pay your
costs on your group plan versus Medicare advantage or just
getting on Medicare original Medicare and see which would best
benefit you. And this will depend on your premiums, your copays,
(11:19):
your co insurance, your deductibles, your network, your doctors, your specialists,
your hospitals, your prescription drugs, and just any other extra
benefits that you may be paying on your group plan,
like vision and dental, et cetera. To see which would
be better for you. If that makes sense, Okay, so
(11:42):
let us go to page sixty five. What if I
have a Medicare supplement insurance medagap important? If you already
have a meta gap in joining a Medicare advantage plan,
you may want to drop medicap. Keep in mind, if
you drop metagap to join a Medicare advantage plan, you
(12:04):
may not be able to get your medigap policy back,
depending on your state's metagap enrollment rule in your situation.
For more details about dropping your medicap policy, visit Medicare
dot gov, slash health dash, drug, dash plan, slash, meta gaps,
slash ready, slash two, slash buy slash change policies. You
(12:28):
can't buy medagap while you're in a Medicare advantage plan
unless you're switching to it back to original Medicare. You
can't use metagap to pay your Medicare advantage plan co payments.
Deductibilson premiums. Okay, So keep in mind you cannot have
a Medicare advantage plan and a Medicare supplement at medicgap plan. Right.
(12:50):
If you do atend to drop your Medicare supplemental plan,
please cancel it when your Medicare advantage is effective, just
because you're paying for something that you don't need to pay,
So keep that in mind. It doesn't automatically cancel out.
(13:12):
So keep that in mind. If you are paying a
premium on your Medicare supplement plan and go to Medicare
advantage okay, So what do I pay? You're at a
pocket cost in a Medicare advantaged plan depend on whether
(13:32):
the plan charges a monthly premium. Some Medicared advantaged plans
have a zero dollar premium, but you may still have
to pay the Part B premium. If you join a
plan that charges a premium, you pay this in addition
to the Part BE A premium and the Part A
(13:52):
premium if you don't have premium Part A. Whether the
plan pays any of your monthly Part B premiums. Some
Medicare advantaged plans will help pay all or part of
your Part B premium. This is sometimes called a Medicare
(14:13):
Part B premium reduction. So how does this work, because
a lot of people do ask about it. How what
works is you have the Part B premium that you
are paying to Social Security for your Medicare. Be it
for twenty twenty five, it's one hundred and eighty five dollars.
It could go up or down every single year, or
(14:35):
it could also change bitpending on your income two years prior.
So for twenty twenty five, they are looking at twenty
twenty three. If your income is at a certain threshold
above the standard income limits, you will be paying a
searcharge or more for your Medicare, So keep that in mind.
(14:56):
Of course, if you're on Medicaid and medical you may
not be paying a premium as well. Okay, so then
these plans they are a zero cost and they say,
mister client, missus client, we would love for you to
be on our plan. What we will do is we
will provide you some give back or like a rebate
(15:20):
back to your Medicare Part B premium. So let's just
say it's a full amount at one eighty five, one
fifty fifty dollars, sixty dollars, just depending on what that
plan is offering for that year. So if you are
receiving Social Security, the standard Part B premium of one
eighty five for the year will be deducted. But then
(15:44):
the insurance company says social Security, this person is on
a plan that gives money back, so we are giving
x money back. So let's just say you're paying one
eighty five, the plan is one fifty back, so es centrally,
you're paying thirty five dollars back. So you might not
(16:08):
see it big because like if you're receiving your Social Security,
they deduct the Part B premium, then they're going to
put it back. And then let's just say you are
not getting Social Security. When you get a bill, and
typically your bills are quarterly, then the insurance company gives
that back, so then that's the amount you pay. So
(16:29):
keep in mind that once you enroll in one of
these type of plans, it could take up to ninety
days for the insurance company to know how to find
Social Security and Social Security to act to put that
money back, So keep that in mind. It will be
pro raded based on the effective date on the plan.
(16:50):
So that's a big common question that I typically get
in regards to the rebate plans. Also keep in mind
you don't get something for no thing, right. So these
plans typically they could have higher maximum out of pockets
your moop, they could have higher coinsurance, deductibles, codepayse okay,
(17:13):
keep that in mind. Sometimes the network or the medical
groups or the doctors are limited, so keep that in mind.
And sometimes some benefits that are standard on other plans
that insurance company offers is less gone not available, so
(17:34):
also keep that in mind. So of course, you don't
get something for nothing, right. When clients feel like they're
not using the health plan, they don't go to the doctor,
they don't go to specialists, they don't need all the
extra benefits, right, then they say, maybe I'll try it
(17:54):
for this year because I don't foresee using my coverage. Right.
And of course, on a Medicare advantage plan, you are
able to move and switch Medicare advantage plans once a
year on annual enrollment period. Of course, there's open enrollment
period from January to March that if you do want
(18:15):
to make a change, you could reach out to us.
And then also those special enrollment periods, so keep those
in minds. I know that it's a lot to grasp,
but you could definitely get the hang of it once
you're on Medicare. You know, your first year, second third,
and then it does definitely get better. Okay, let us
(18:37):
move on. What do I pay? Whether the plan has
a yearly deductible or any additional deductibles for search and services,
the amount you pay for each visit or service like
your co payment or your coinsurance. Medicare advantage plans can't
charge more than an original Medicare for search and services
(18:57):
like chemotherapy, dialysis in days two, anyone to one hundred
of skilled nursing facility care. So that I've seen like
the twenty percent, I've seen a copay the skilled nursing facilities.
I've seen them at zero, but I've seen them a
couple hundred per day, So kind of just depends. But no,
there is a maximum out of pocket costs for these
(19:19):
Medicare advantage plans. Type of healthcare services you may need
and how often you get them, Whether you get services
from a network provider or provider that doesn't contract with
the plan, if you go to a doctor or other
healthcare provider, facility, or supplier that doesn't belong to the
(19:41):
plans network for non emergency or non urgent care services.
Your plan may not cover your services, or your cost
could be higher whether you go to a doctor or
supplier who accepts assignment. If you're in a preferred provider
organization plan, private Fee for Service plan, or Medical Savings
(20:02):
Account MSA plan and you go out of network, put
a page is fifty nine to sixty for more information
about assignment. Okay, what do I pay? Whether the plan
offers extra benefits in addition to the original Medicare benefits,
and if you need to pay extra to get them.
So remember with these plan with the extra benefits, the
(20:26):
vendors may be different from the insurance company, which kind
of gets confusing for the insured or the patient. That's
why you have us to go over that with you.
Of course you could call the insurance company, but sometimes
they don't know what they're saying doing a new employee,
(20:47):
or they're not really advocating for you. You know, we've
seen accountless times when they don't even know the benefit
and we have to push them or tell them or
remind them that no, the client does get these benefits. Okay,
the plans yearly limit on your out of pocket costs
for all Part A and BE covered services. Once you
(21:11):
reach this limit, you'll pay nothing for Part A and
B covered services. So this is the awesome part about it.
There are limits to out of pocket costs, which is
called MOOP maximum out of pocket costs. So this is
really good because in the something catastrophic happens, then you
(21:33):
have a max out of pocket for those that are
on a budget. I mean, these max out of pockets
could be so low if that's what you really want.
I mean some are higher. So it kind of just depends.
But if you look at the copays and coinsurance, sometimes
it doesn't even seem like you're going to ever hit
that unless you definitely, you know, do skilled nursing or
(21:58):
things like that. Depending on the plant, of course, HMOs
and PPOs have different maximum out of pockets. Your PPOs
tend to have more out of pocket and deductibles copase
cultures because you have the ability to go in or
out a network without those approvals like HMO does. Okay,
(22:21):
so what else, Whether you have Medicaid or get help
from your state through a Medicare savings program, go to
pages ninety one to ninety two. So that's the biggest
thing too. Sometimes clients they change their plan, they forgot
get to tell their specialists or provider to run the
(22:42):
approvals to get those referrals from the specialists, and sometimes
they are definitely caught up with getting a bill because
of not being approved. We do also help with that.
We could see if we could retro or go back
to the doctors and figure out how we get get
(23:06):
it approved, so will be covered things like that that
you know sometimes a agent will not do for you,
but with Medicare Premiere three sixty, we definitely help you
with that. So to learn more about costs and a
specific Medicare advantage plan, contact the plan or visit Medicare
(23:27):
dot gov slash plans slash compare. Okay, So on that note,
we do want to end on that is every single
county is going to have different plans, different insurance companies. Right,
(23:53):
So sometimes if you do have a friend, relative, family
member that lives out of state or just even in
a different county, what may pertain to them, what they're
unhappy about that or satisfied or happy with that about
that may not apply to you because geogeographically, Medicare advantage
(24:15):
plans are based on county. Right, every county is going
to be different. Every county is going to have different plans,
different objectives, just different vendors, different doctors, different medical groups.
So not all plans are created equal or vendors. That's
why it is really good to talk to a licensed
(24:37):
independent insurance agent like me to help you go through that.
So I am going to stop for today. Enjoyed this
Medicare advantage synopsis, summary, and we will continue next week.
You have a wonderful day, right.
Speaker 1 (25:00):
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
(25:22):
with our licensed insurance agent Until next time, Stay informed
and take charge of your healthcare journey. This has been
Medicare three sixty, your trusted source for all things Medicare.
Take care
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