The Danger Behind Using A Medicare Advantage “Trial Right”

[00:00:03]When you start Medicare, a lot of people think every year you're going to be able to switch back and forth. So, your decision at the beginning maybe isn't super important because next year you can just switch it and change it if you want. That is generally speaking not the case other than in a handful of states, the decision that you make could be a lifelong decision. Now, there's this thing that we've all heard of, maybe you haven't, but it's called the trial right, and it relates to Medicare Advantage plans, cuz generally people who start with a Medicare supplement plan, like a plan G or a plan N, they love that, and they don't want to change it, right? If you go with an advantage plan, that starts getting into the world where, hey, I want to know I have optionality to get back to a supplement plan. Unfortunately, generally speaking, you are going to have to medically qualify to do that. Except there's this little thing called a trial, right? So, you're going to learn about what a trial ride is and how you can use that or maybe why you shouldn't plan on using that for your future. Welcome to Medicare School Daily. My name is Josh Music. I'm here in the studio with Justin Cohen. Justin's worked with us for many years now. He's one of our Medicare guides. When you call into medicarechool.com, you're going to be talking to folks just like Justin who are able to walk you through your scenario and help you understand what your best options are so that you can get enrolled in coverage without any hiccups, without any gaps, without any penalties, without any delays in coverage. I encourage you to call in if you want to be a part of the show. Uh we'd love to talk to you. Phone number is 833824204.

[00:01:29]833824204.

[00:01:31]We're here Monday to Thursday, 11:00 a.m. to noon central time, every single day, Monday to Thursday. And we would love to talk to you. You should not go on Medicare and make a mistake. You should not go on Social Security and make a mistake because there are resources here uh that can help you do that. So, please don't make a mistake.

[00:01:47]Call into the show if you have a question. If you want help to get your personal situation, compare all your options, advantage plans, supplemental plans, drug plans, dental, vision, hearing, whatever it is, you can talk to one of our agents live. 800782-6676.

[00:02:02]800782-6676.

[00:02:06]Justin, let's talk about trial rights and Medicare Advantage plans.

[00:02:10]>> Well, uh, trial ride gives you the opportunity to try a Medicare Advantage plan, to try it out, to take it for a spin, a test drive to see if you like it. Uh Medicare Advantage plans are attractive because they have 0 monthly premiums and generally include ancillary benefits such as dental and vision and maybe an allowance for over-the-counter supplies. But I think somebody realizes that those Medicare Advantage plans are not necessarily going to be the best kind of coverage you can get, but maybe you want to take a stab at it. So, Trial Ride gives people an opportunity to start with a Medicare Advantage plan when they first go on Medicare and have 12 full months to try it out to see if they like it and still have the uh the emergency cord there to be able to be pulled to go back to original Medicare and get a Medicare supplement plan with no medical underwriting. There's really two trial rights. Trial right one is when your Medicare A and B and an advantage plan all start on the same day. Generally speaking, the first of the month in which you turn 65. People who retire and go on Medicare after 65 don't get a trial right one because of the way the rules are written. But uh people who can get trial right one start Medicare A and B and an advantage plan on the same day can have that advantage plan in effect for up to 12 months and decide that they don't like it anymore.

[00:03:26]Uh really it's easy to get out of an advantage plan and go onto a supplement plan for those first 6 months. That's during your open enrollment for a Medicare supplement plan. uh and um with that there's no paperwork. There's no extra leg work. It's very easy. But if you're going to use a trial right in the second six months of those 12, then it gets a little bit tricky because you have to first cancel the Medicare Advantage plan, receive a termination notice in the mail and then apply for the Medicare supplement plan guaranteed issue. You have 63 days to do all of this. So, it kind of all has to go right. You have to be on top of it and it doesn't work if you get hospitalized or go out of commission for some reason.

[00:04:03]Uh that's trial right one. Uh trial right two is when you start Medicare and you get a supplement plan right from the beginning. Uh if at that point uh you decide later that you want to try a Medicare Advantage plan and you've never had one before, then you can go on a Medicare Advantage plan for up to 12 months, decide you don't like it, and then pull that card and go back to original Medicare. With Trial Right 2, you can only go back to the original supplement plan you had with the original carrier. same plan, same carrier, unless they've stopped selling that and then you can pick a different one. With trial right one, at the end of those five months, 6 months, eight months, but at the most, I'd like to say 11 months just to be safe, uh you'll be able to pick any metagap plan from any metagap carrier available in your area.

[00:04:50]Generally speaking, we want you to understand the differences between supplement plans and advantage plans right from the get-go so you make the right choice from the start and don't need to count on trial right, which uh works most of the time, but not always.

[00:05:05]>> Yeah, I think if your plan is to like try to game the system to save a little premium, you're making a mistake. Trial, right, is it's for like the people that like, oh, I got an advantage plan cuz no one told me about a Medicare supplement plan. No one explained the differences and that's what I really want. And so it's an opportunity for you to kind of recover yourself. But we'll talk to folks who are like, "Hey man, I'll go on a Medicare Advantage plan for 12 months, switch over if something happens." Well, the truth of the matter is those insurance company know they know that people will switch over when something happens and so they know they are going to be on the hook. They're going to lose their shirt when you come over. Um, again, the first 6 months of your trial, right? not a big deal. Trial right one.

[00:05:49]The second 6 months is when they're going to make you start jumping through hoops to prove that you really are eligible for this and they're going to try to get you not to be able to use it and throw some throw some blocks in your way. My recommendation is don't plan on using it. Don't try to outsmart the system. It's not worth the stress. It's not worth the risk that something could go wrong because we see people mess this up frequently. So, choose your coverage, understand it, and just get back to enjoying life. like stop trying to game game insurance for goodness sakes. So anyway, let's talk to Kenneth in Georgia.

[00:06:24]Kenneth, welcome to Medicare School Daily. What question you have for us?

[00:06:29]>> Yes. Uh I wanted to know uh I'm I'm uh I've reached my uh full retirement age uh of uh 66 years and 10 months I think.

[00:06:45]Um, and uh, I'm looking to retire this year, >> but I wanted to know uh, how far in advance uh, of my retirement do I need to sign up for the Social Security and Medicare?

[00:07:04]>> Good question, Kenneth. So, uh, you can sign up for Medicare up to 3 months in advance of the month you needed to start. If you're doing social security at the same time, that changes that to four months in advance. So, let's say you were going to be retiring in, I don't know, September, and you would lose your health insurance at the end of that calendar month, meaning on October 1st, if you didn't take Medicare, you'd find yourself without coverage. So, 10 October, count back three months, 987.

[00:07:35]July is the earliest you could apply for Medicare only, but you could do it in June if you wanted to apply for Medicare uh and Social Security at the same time.

[00:07:46]Uh now, are you already enrolled in Medicare Part A?

[00:07:52]>> I am not.

[00:07:52]>> You're not?

[00:07:54]>> Okay, then I'm going to change that a little bit actually. Uh you can sign up for Medicare Part A any old time you want to. Are you contributing to a health savings account, an HSA right now?

[00:08:05]Yes, I am.

[00:08:06]>> You are. Then you want to stop that about 6 months in advance. Uh, in fact, more like seven months, 8 months. You might want to stop contributing to the HSA. Here's why. If we get together and you want Medicare in October, we're going to sign up for it at the very latest in September. Right? You do it 3 months in advance if you can, but you can do it the month before if you need to. And when you sign up for Medicare Part A in September, they're going to backdate it by 6 months. 876543.

[00:08:36]Meaning, if you're still contributing to a health savings account right now, you'll find yourself with an overlap between contributions and the backdated Medicare Part A effective date. Now, it's usually not a big deal, but if you got your taxes audited, then you would owe taxes on those contributions and a 6% penalty. So might go ahead and tell your employer you need to stop contributing to the HSA right away, but then contact us say 3 months beforehand and we'll help you sign up for Medicare Part B can be done 3 months in advance and the Social Security can be done four months in advance. So, if that answers your question, >> and if you want somebody to walk through this with you, hold your hand through this whole process. Doesn't cost anything. We'd be happy to do it. Uh, you got your pen and paper?

[00:09:27]>> I do.

[00:09:28]>> Okay. Our phone number, you can call, talk to someone, schedule an appointment for, you know, 3 months before you need everything to start. phone number is 8007826676 8007826676.

[00:09:45]Everyone who works here, have you have you watched my dad Marvin at all on YouTube or anything?

[00:09:50]>> Yes.

[00:09:50]>> So, every everyone who works here, whoever you're going to talk to has been trained by him. You're not going to get routed to the other side of the world, right? Somebody who doesn't understand what's going on here in Medicare. You're going to talk to someone. We're in Kansas City. Uh, just call in, no cost.

[00:10:06]We'll show you your options. We'll help you enroll, hold your hand through that process, do all the tricky government paperwork, fill out the forms, do all the stuff, so you can literally make your transition to Medicare with ease and confidence knowing you made the right choices. Okay, >> since you've already reached your full retirement age, Kenneth, you can go ahead and start Social Security any old time you want to. You know, you don't have to wait until you retire to do that. In fact, that's the significance of full retirement age is there's no longer an income test. There's no longer a limit to the amount of money you can make from a job because it won't affect your social security benefits any longer. Now, maybe you want to talk to a financial adviser before you make the permanent decision of starting Social Security. It should really be a part of a larger picture with your whole financial future and plan. Uh but um yeah, there's nothing stopping you from starting Social Security any old time.

[00:10:54]>> Okay. Okay. Thank you.

[00:10:57]>> Thank you so much. Have a great day.

[00:10:59]Call us if we can.

[00:11:00]>> All right. You too. Take care. Bye-bye.

[00:11:01]>> All right.

[00:11:04]Okay, let's talk to John uh in Wisconsin. John, welcome to Medicare School Daily. Thank you for waiting.

[00:11:09]We've had uh some call long callers.

[00:11:12]Understand you got a question about Irma. Go ahead.

[00:11:15]>> Sure enough, Josh. Good morning. Thank you for taking my call. I appreciate it.

[00:11:18]>> Of course.

[00:11:18]>> And I just want to start out by thanking you and thanking Marvin for your outstanding work uh for all of us out here and and looking to get onto Medicare.

[00:11:28]>> Well, it's important. I appreciate it.

[00:11:30]Thank you.

[00:11:31]>> Yeah. Sure enough, your team uh agent named Steve, I can't remember his last name, but he uh he got us on the greatest uh um policy on the way forward. So, we're we're we're very very happy.

[00:11:44]>> Excellent.

[00:11:44]>> Thank you.

[00:11:46]>> Yeah. So, my question is uh I'm I'm confused a little bit about Irma. I understand uh that it's that the uh the the value of your income is a factor off AGI and I think it's line 11. Is that correct?

[00:12:01]uh um >> modified um adjusted gross income MAGI.

[00:12:07]Uh John, to clarify, that's that's your >> that's your AGI plus line 2A tax exempt interest.

[00:12:14]>> No, 2A. I'm sorry. I apologize. Um so, hypothetically, if our income doubles or let me let me back up. I understand that it's it's referred after two years back.

[00:12:26]Uh the IRS looks at or Medicare looks two years back. I understand that.

[00:12:31]>> But if I hypothetically if our income doubles this, let's say next year, so my Irma um would go into effect much higher and then if the income goes back down to what it would be this year, does does the government does Medicare automatically reduce the Irma back to what it was or do I have to call in and request that? So it it depends a little bit. So are you are you going back to work and then stopping work or what's the change for the fluctuation in income?

[00:13:07]>> No, I just retired last year at 1231.

[00:13:11]But I'm thinking about, you know, if I have luck and have good investments or if I take capital gains, um would that for the one year?

[00:13:22]>> Yeah. So >> that's going to drive the ear out.

[00:13:24]>> Yeah. So the time to do that would be this year or next year if you just retired at the end of last year, right?

[00:13:30]Because you can use that lifechanging event that you retired and say, "Hey, I don't make that much money anymore, right? So what's going to happen? Let's say you did all that this year in 2026."

[00:13:41]You're actually not going to find out about that until 2028 cuz they're always going to go back two years. And so at that point, you're going to say, "Hey, look, I retired." you know, and so you can use that life-changing event twice, and they don't care if the money came from work. They don't care if the money came from this, that, or the other. They just care that you had a life-changing event. So, I would do that as soon as possible from an Irma perspective.

[00:14:06]Obviously, that's just one piece of any equation, you know, taking gains or all of this stuff. So, but I would just be very you can use you can use that for the future. Um, but if you're saying, you know, 5 years from now you do it, you're not going to have you're not going to have a life-changing event.

[00:14:23]You're not going to have any reason to appeal it.

[00:14:26]>> Oh, so did you say you have two chances to appeal?

[00:14:30]>> Yeah, you can use the same life-changing event twice.

[00:14:35]>> Oh, >> but they need to be back to back and as soon as possible from when it happened.

[00:14:39]Like you can't you can go back now and do it, right? But if you're if you were 5 years ago, they're not going to do it.

[00:14:45]It needs to be like around that time.

[00:14:48]>> Okay. So, would there be any chance that the government would track your income and just it would it would just follow your income every year? If it went up, it went up.

[00:14:59]>> No.

[00:14:59]>> And then went down, it went down.

[00:15:01]>> The only thing they're going to track Well, they they do track it, right? But in December of every year, they look at it and say, "Hey, two years ago, did this guy make over the threshold?" if they did, they're going to send out an Irma award letter saying, "Hey, you got to pay us more."

[00:15:16]>> So, they are tracking it and it will fall off automatically.

[00:15:20]Um, but it's always going to be based upon two years back. So, what you're trying to do is trying to say, "Hey, they're going to look at 2026. They're going to see it's elevated. So, I need to appeal it." They're not going to automatically know that now you make less. If you get that award letter and you make less and you have a valid life-changing event, then you it's on you to take care of that. Would you add anything?

[00:15:42]>> Okay. I'm I'm 99% clear on this. I guess it's it's never going to be where the government will automatically follow your income.

[00:15:52]If it if it if you go into a higher Irma category, you're kind of stuck there unless you have one or two chances to reduce it. That's it. No, I I think I can talk on that now. I I follow John.

[00:16:05]So, you're saying first of all, they do look back every year. Every single year, they're looking at your tax returns from two years ago. They this year in 2026, they're looking at 2024.

[00:16:15]>> Next year in 2027, they'll be looking at 2025.

[00:16:19]>> And so, your question is if the income doubles because we >> decide to take money out of investment or we win the lottery or sell our house and and we it's we get make more than the amount you can write off, right? For a married couple, you can run off like $500,000, but uh the rest of it will end up on your tax form, your 1040, and two years after that, they will send you the letter telling you that they're going to charge you extra. But it'll only be for that calendar year.

[00:16:46]>> And then the next calendar year, they'll look back and they say, "Oh, well, he didn't have a big year the next year, so we're not charging him an Irma." That will happen every year like that. John, >> now I'm 100% clear and I appreciate that. I was worried cuz I I was confused. I I thought I heard it from your team or read it maybe that it was not the case. So, >> it does not lock in it. It resets every year.

[00:17:11]>> Fantastic. Wonderful. Josh, thank you again for your time. Uh good work and your time this morning. I appreciate it.

[00:17:17]>> Thanks. Yes. Bye.

[00:17:20]>> Okay, let's talk to Debbie in Indiana.

[00:17:22]Debbie, welcome to Medicare School Daily. What questions do you have for us?

[00:17:25]>> Hi.

[00:17:26]>> Hi.

[00:17:26]>> Hi, Josh.

[00:17:27]>> Hi.

[00:17:29]Great to be with you. Um, I love you and your God. I watch you all the time.

[00:17:34]>> Well, pre-minent educators.

[00:17:36]>> We appreciate that.

[00:17:37]>> You >> I used your agents when I needed Medicare, which was just this past year.

[00:17:43]So, my question today is on Irma's.

[00:17:45]>> Okay.

[00:17:48]>> So, I retired in 2025 and Medicare started in 2026.

[00:17:54]I was fortunate enough to have a really good job and in 2024 my Medicare premium uh for 2026 was based on that wage. I was above the lowest Irma threshold. So I'm obviously paying the Irma premium now and I know I can apply for an appeal >> for that due to my change to retirement.

[00:18:16]However, there's a couple other things that have come into play that I'm not sure how to handle. Um, I know that I will be above that base limit again in 2025 and 2026 income year look backs because I received two lumpsum amounts uh as K1s, >> okay, >> from my mom's estate when she passed.

[00:18:41]>> Okay. So when I combine those amounts with my now social security and a small annuity that I'm receiving monthly, those K1s are going to put me above the Irma limits of approximately $108,000 until 2027.

[00:19:02]So, I don't know if I should file that Irma waiver now uh even with my K1 income or does the appeal process consider that retirement life change but then disregards the K1 income that has come in for that one or two times.

[00:19:22]>> Okay. So, uh when they're looking at this uh number one, this is confusing. I understand that. uh when they are when they look at this, they don't care where the income comes from.

[00:19:33]>> They don't, you know, you could have income from a thousand different sources. They don't care. The only thing they care about is if you've had a life-changing event, right? So, >> but for you, it sounds like this is going to continue a little bit, right?

[00:19:48]So, you had high what was your income in 24?

[00:19:53]In 2024 from my salary it was $119,000.

[00:19:58]>> 119. So you're in the first Irma brack are you are you filing single or married or >> single?

[00:20:05]>> Okay. So you were in the first Irma bracket. So you've got an Irma probably of 80ome dollars this year. Does that sound about right?

[00:20:13]>> No, I was actually bumped up into the next the next I'm not at the lowest amount.

[00:20:21]>> Okay. Okay. My premium is like $120 something dollars.

[00:20:26]>> Okay. Well, the so the way it work Oh, maybe that's part B and part D or something the the on the chart. So, and you know, you can always Google SSA4.

[00:20:35]So, if you're single between 109, so this is for 2026 between 109 and $137,000.

[00:20:43]Um, if you're between 109 and 137, you have a part B as in boy the uh the medical side Irma of8120 $8120 and you've got a drug plan Irma of $1,450. So together those are just under $100 extra. Okay.

[00:21:01]>> Yeah.

[00:21:01]>> The next one up goes to if you're at 137 to 171 then your part B Irma is 20290. you're actually paying double the part B premium amount of the standard, right?

[00:21:13]And then there's about a $37 Irma. So, I just the 120 number kind of threw me off cuz I don't know where that would be coming from. Um, but maybe it's a mixture of some other things. So, at any rate, uh you're at you're you're at uh you're going to be paying that. So, that was 2024, you're at 119. At 2025, how much did you make? Have you filed your taxes yet?

[00:21:36]>> 2025.

[00:21:38]Um, yes. And I Let me look. I should have had this prepared. I'm so sorry.

[00:21:46]>> Good.

[00:21:47]>> Sounds like we would appeal for 27 and 28.

[00:21:50]>> Yeah, >> that's that's what I was wondering. If can I appeal at a point in the future when I don't have that K1 income?

[00:21:58]>> Yeah. Will 2020?

[00:22:00]>> Yeah.

[00:22:01]>> Will 2027 be elevated or will it be kind of back to base?

[00:22:08]when I below below the 109.

[00:22:10]>> Yeah. The the numbers are confusing because um 20 26 was for 2025 taxes.

[00:22:19]Sure. Right.

[00:22:20]>> And 2024 income. Yeah.

[00:22:23]>> So in 2027 it will be based on my 2025 tax return.

[00:22:30]>> And and will you be below 109 and 27 do you think?

[00:22:37]in my when I file my 2027 taxes in 2028.

[00:22:41]>> No, I'm just saying for will your 2027 income be below 109,000, do you think?

[00:22:47]Okay, so then here's the deal. We can we can cut through we can cut through all this extra stuff and just say there's really no point there's really no point to appeal this year. Okay, they're not if you're going to stay in the same bracket, what's there's no reason to do it. You can use that appeal I think two times. So, I would recommend in 2027, let you probably December of this year, you're going to get a letter. It's going to say, "Hey, you owe this Irma, this extra amount. You're going to fill out SSA 44. That's the form." And you're going to say, "Hey, I've retired." And then you can put in the amount of money that you're going to take in 2020 that you're going to probably make in 2027.

[00:23:23]As long as it's below 109, they'll drop that Irma. Okay? So, and then in 2028, they're going to look back at 2026. So, in December of next year, you're going to get another letter saying, "Hey, in 2026, you made over the limit." And you're going to use that SSA4 again cuz you can use it twice. Say, "Hey, I've retired. Here's what my income is going to be in 2028." So, I would just say I I would not worry about too much other than the next time you get the letter and the time after that, you're going to say, "I retired and here's the money I make now." And as long as it's below the 109, they'll drop it. But you're not going to be able to get around that Irma this year.

[00:23:59]>> Yeah. So when I say I make now, that's what they look at, not >> necessarily my tax return, what I'm going to be making now.

[00:24:08]>> Yeah, it can get confusing. You're just going to say I retired. Here's the date I retired. Here's what I make this year in 2027. And then you're going to do it again for 2028.

[00:24:17]>> And you can actually do both those at the same time, Debbie, at the in December of this year when you get the letter about Irma announcing it for the year 2027. The that's when you'll fill out the SSA4 for yourself. And you can do step two for 2027 and use step three for 2028. Take care of both of them at the same form and uh send that into social security. That should take care of that. But wait till >> Oh wow.

[00:24:38]>> Wait till the 2027 Irma announcement comes before you do this, >> which will generally be December this year.

[00:24:43]>> Yeah.

[00:24:45]>> Yeah. Fabulous. And then how long does it normally take to hear from them?

[00:24:49]>> Three to five weeks.

[00:24:52]>> Okay.

[00:24:53]>> Great.

[00:24:54]>> Sounds good. Okay, Debbie, >> you guys are awesome.

[00:24:55]>> Call us if you need anything. Thanks.

[00:24:58]Thank you. Bye.

[00:24:59]>> Bye-bye.

[00:25:01]>> Okay, let's talk to Jeff in Indiana.

[00:25:04]Jeff, welcome to Medicare School Daily.

[00:25:06]Understand you've got an appointment maybe coming up and you got some questions.

[00:25:12]>> Yes, I do. I'm sorry. Who is this Marvin?

[00:25:14]>> This is Josh.

[00:25:16]>> Josh. Hi, Josh.

[00:25:17]>> You drew you drew the short straw today.

[00:25:19]>> Tom Cruz's uh cousin Evan on too. I was just watching your video recorded last Thursday.

[00:25:26]>> Yeah. Yeah. Yeah. So, the Yeah, that we've got Justin Cohen here today. Yes, sir. Two of us. My dad's in uh My dad is in India. He is I was texting him yesterday. He said it's 2 a.m. I still can't get used to the time zone, but he's back, I think, in a couple of days.

[00:25:40]So, >> I understand. Thank you for your patience. I'll cut to the chase here. Uh it it shouldn't be this hard into the disclaimer. I just turned 70 two weeks ago. I filed for Social Security. I got all the delayed retire credits so that when I go first, my wife will enjoy uh that additional money. Uh she and I are both uh filed social security, but we're both working full-time for a uh a a place that uh that gives you uh pays for your uh insurance premium when you're full-time people. So, I have not filed for B nor, but I'm getting ready with your education to sign up both she and I for that starting July or excuse me, January 1st of 2027.

[00:26:28]>> Time to pull the trigger. Sounds good.

[00:26:29]Okay.

[00:26:30]>> It and a lot of this stuff is stuff that I picked up from you and your dad. So, I don't want to show off because I've I have heard this and retained it, but uh just about the time I think I know what I need to know, bam, something comes up.

[00:26:44]And my question this morning that I told to the lady who uh question who uh answered the phone which is very good at her job by the way >> was according to the ratings of the supplemental programs uh the attained the issued and the community. Uh I live in a northern Indiana and I understand that Indiana has the birthday rule that I can within x amount of days I think 30 days before and 30 days after uh just go out shopping for a another plan in which I'm assume that's what I'm planning on going to just based on price. Uh here I had this community thing beat in my head that states that you you it just takes a group of people together and the premium does not go up because of your age. Uh it may cost a little bit more now but I'm in it for the value. I'm lucky enough to have the resources to pay for these as long as it's not too exorbitant and I just want some education on a is Indiana truly a birthday state and b if it is is it true that I should just in June on my birthday just go shopping for uh prices alone and not worry about the attained issued in the community ratings.

[00:28:03]>> That's right, Jeff. Uh, this is Justin.

[00:28:05]Tom Cruz is my cousin.

[00:28:07]>> Hi, Justin.

[00:28:08]>> Yeah. Uh, yeah. So, Indiana, I believe, is a is a birthday rule state. And so, I wouldn't worry too much about the issue age or attained age or community rating.

[00:28:19]Get yourself a plan N for basically the lowest rate you can find, knowing that if you're going to stay in Indiana as an Indiana resident, then you should be able to use that birthday rule if the rate changes drastically uh going forward. uh we'll help you get set up.

[00:28:34]Cory will uh with a good carrier, but really you're just looking for that lowest rate you can find. Then again, using the birthday rule to change carriers isn't the most fun thing that we've helped our clients do. And so if it's just a few dollars difference, uh get it from a large national stable rate carrier while you're at it. And then this won't be an annual bit of homework that you have to come back to over and over again.

[00:28:59]>> Certainly. And uh uh I I have also come to the information that if I sign up or or sign up now somehow uh for something to take effect on January 1st that I can freeze those rates which we will be good on the day that I want it to take effect January 1st of 2027. Is that true?

[00:29:20]>> Typically yes. Uh but I have seen a carrier's rate change even after the signature date. So go ahead and get it done. uh and if the rate's going to change, we'll certainly let you know and talk about that. Uh but usually it will not. Usually you lock that in.

[00:29:36]>> Yeah. And rate increases for supplement plans generally don't happen on January 1st. U most carriers either they take them, they go into effect at your birthday, right? Or the policy anniversary. Or it happens between March and June. So it's kind of weird.

[00:29:52]Everyone thinks it's going to start January 1st and there's going to be new 2027 rates and it doesn't really work like that.

[00:29:59]>> I'm 70 now, my wife is 67. Like I said, we have both filed and are receiving Social Security benefits, but at at those ages to lock in a price with Corey in September when I have a scheduled appointment to uh contact him and to talk to him at lengths would be the appropriate thing to do.

[00:30:20]>> Yes.

[00:30:22]100%. Yeah.

[00:30:23]>> Great.

[00:30:24]Okay. If if you don't mind, I've got another question about uh part D.

[00:30:28]>> Go for it. Sure.

[00:30:30]>> Part D. Uh for myself, cut right to it.

[00:30:33]I'm taking a medication called Skyrizzy and having my login screen set up and credentials set up. I went in to do what I've been told to do and it pops up four, five, six different insurance programs, but all of them state that I'm going to be paying $58,000 between now and the end of the year and trying to find out which one of these has the you know where what is their formularies where are their formularies listed at on this on this uh uh medic on this Medicare government website. you know, I'm scared to death that that I'm just gonna not be able to take this medication because it'll take me into bankruptcy.

[00:31:16]>> So, uh, at medicare.gov, uh, when you look at each drug plan, each one will have a link that says, you know, to visit the plan website, that's where you could go if you wanted to find the formulary. But if medicare.gov is showing you that that medication will have you spending 58,000, then you already know it's not on the formulary.

[00:31:35]Skyzy is on the formulary.

[00:31:37]>> Uhhuh. All the ones that they listed for me all state it's going to be over 58 $60,000. So I guess I got to come to terms unless they change their minds between now and January 1st that this medication is going to be off limits for me. I need to find something else.

[00:31:53]>> Well, you're going to have one of us helping to make sure that there is not a drug plan offered in your county that already has the Skyrizzy on the formulary. If it's not on the formulary, it can be added.

[00:32:05]>> Uh a doctor can fill out a form. what's called a formulary exception. Uh the doctor that prescribed you this guy Rzzy would fill this out for you and submit it to your drug plan and typically they're going to cover it.

[00:32:16]>> Can I ask you a question or two?

[00:32:18]>> Uh yes sir.

[00:32:19]>> Are you in Leaport County?

[00:32:23]>> Yes, I am in Leaport County. My zip code is a Stark County.

[00:32:29]>> And then the what is the dosage of the Skyrizzy that you're take? Uh uh I'm currently taking a subcutaneous injection once every three months.

[00:32:43]>> Okay. So I just put in Let me see what Let me just cuz I I mean I see Skyrizzy on the formulary.

[00:32:49]>> So the one that it does the So 150 mgram 150 mg auto injector. Does that sound right?

[00:32:56]>> Or 180 or 360.

[00:32:58]>> Yes sir.

[00:32:59]>> Okay. So, um I mean I see that it's on a lot of lot of formularies. So, you know, it says it's going to cap out at $2,100, which is the max, right, that you'd have to spend. Next year, it'll probably go up to 2,200.

[00:33:12]>> 24,400 next year. Okay.

[00:33:14]>> But, yeah, I show that it's on it's on a lot of plans. So, I think I think you >> What do I need to do? Refresh my my uh Medicare Medicare program because I go through the login process and all that.

[00:33:28]I think it's just a sign you have to work with us.

[00:33:32]>> Well, no this thing in September.

[00:33:36]>> Yeah. I don't know. I just, you know, I just typed in your zip code, typed in Skyrizzy, the 150 mgram, clicked next, or I chose CVS as the pharmacy and I clicked next and it all popped up.

[00:33:45]>> One of my choices, too.

[00:33:47]>> Yeah.

[00:33:47]>> Great.

[00:33:48]>> Mhm. If you choose a pharmacy that's not >> If you choose the wrong pharmacy that's out of the network with the plan that that doesn't work with Medicare drug plans, then it will tell you that it's not going to be covered at all.

[00:34:00]I just chose the big ones. I chose Walgreens. I chose CVS and I chose uh Walmart.

[00:34:06]>> Yeah, I've got a just trying to >> Humanana plan zero premium has it covered. Ware $8 premium has it covered.

[00:34:12]Uh two welfare plans another human plan.

[00:34:15]silver script.

[00:34:16]>> So, it's going to sleep a little better tonight.

[00:34:18]>> I'm going to sleep a little better tonight.

[00:34:20]>> Good. Yeah.

[00:34:22]>> So, it's it's going to cost you $2,400 over the course of next year. And if you were to just fill it at the pharmacy in January, you'd probably spend that $2,400 all upfront, or at least the pharmacist had asked you for it. So, when you're enrolled in your drug plan, they're going to send you some information about the M3P, the Medicare prescription payment program. and you want to call the insurance carrier and tell them you want to use that program.

[00:34:46]So, they'll take that 2400 and chop it up into 12 mostly equal payments, not exactly equal. And then you're spending about $200 a month to have this medication.

[00:34:56]>> Thank you, Justin. You just figured out my next question.

[00:34:59]>> Uhhuh.

[00:35:01]>> That's why Justin >> I have another one, too. As long as I have you, too, if you don't mind.

[00:35:05]>> Yes, sir.

[00:35:08]>> Like I said, I'm old. I'm six. I'm 70.

[00:35:10]I'm in my ways. Uh uh the there's a little scary situation in my mind with jumping to uh having uh Medicare school over the phone and internet take care of my insurance needs instead of a guy that I can just walk into his office here two miles from my house and strangle him if things are going wrong. How do I get over this scared feeling that I'm jumping into somebody that I only see on TV or talk to on the phone or communicate via uh texting instead of somebody that I've been with for 60 years of my life?

[00:35:48]>> Well, I keep my desk in the back corner of the building, so anybody trying to jump over it and strangle me has a hard time getting there. Uh but >> Oh, no. If things go well, I would bring in a bottle of Crown Bo Crown Oil, too.

[00:36:00]Oh, yeah. Well, >> you better be close to the front.

[00:36:02]>> It's been it's been years since anybody tried to strangle me. But, um, >> no, Jeff, generally speaking, whatever insurance agency you get your coverage through, that's who you're going to be able to lean on, right? Or at least that's the only person or agency that you have any reasonable expectation to be able to lean on in the future when there's a problem or if there's trouble.

[00:36:23]And so whether you go local or whether you go through us, uh make sure that you trust the people and their reputation for customer care. Uh generally speaking, the only difference between us and that guy down the street is I can't reach out and shake your hand. But um >> the other guy, you know, the guy down the street, it sounds if you've known him for 60 years, he might be headed toward Medicare himself and wanting to wrap up shop. So I don't know.

[00:36:47]Obviously, we love to be here. We're here.

[00:36:49]>> He's older than I am and he's been he's older than I am. he's been recommending me go to an advantage plan. So, that was a a notch in the bad side. You know, that was a con instead of a pro. So, yeah, I'm just getting over the the the fact of and and it's much less money not to go through him. So, those are leading me quite heavily towards a Medicare school program. and and uh depending upon uh uh what kind of uh sense I get for Corey when I get him on the phone will determine whether or not I'm signing up both my wife and myself for that on that day when I get Corey on the phone.

[00:37:25]>> Well, we'll tell Corey to be on his best behavior.

[00:37:30]>> You'll like working with Corey. He's very He takes his time. He doesn't rush people. He's actually been in insurance for over 20 years. So, you're you'll have a great experience for sure.

[00:37:40]>> Good deal. Thank you. Okay, >> I've got a last one if you don't.

[00:37:43]>> Okay. Yeah, we got we got two or three callers lined up. One more. Let's go.

[00:37:47]>> Okay, one more. This has got to do with uh uh federal taxes on social security.

[00:37:52]I've got a little uh downloaded piece of information from finance buff once again on the internet that you plug in your social security and what you're going to make outside of social security. and being with I I got a wife who who we got through business school, the University of Indiana with a 3.98 GPA. I don't even have to tell her what I want to do with finances. I got to prove it. So, this finance buff says you put in $70,000 worth of of social security income, which luckily she she and I together will be into starting when we both uh uh have a full year of social security next year. uh we can add and this thing says this calculator says that we can make up to an additional $20,000 on top of the $70,000 worth social security and still pay no federal tax. Now I'm trying to to suggest to my wife heavily not to worry about this that this is going to happen but like I said she's a prove it to me.

[00:38:53]I got the I got the bachelor of science and business so prove it to me. Any suggestions on that sir?

[00:39:02]I will typically defer to a tax specialist when it comes to these questions. I'm not qualified to give that advice. The the the okay >> the formula to determine how much you you pay in taxes on your social security and what percentage of your social security benefits are taxable or not taxable is a very complicated one.

[00:39:20]Marvin's done multiple videos on this.

[00:39:22]I've watched them. Uh I still go online and use a calculator when I want to answer these questions.

[00:39:28]>> Great. Okay. Hey, I appreciate your time, gentlemen.

[00:39:31]>> Take care, Jeff.

[00:39:33]>> All right. Bye. Bye.

[00:39:33]>> Bye.

[00:39:36]>> Let's talk to Adam in Maryland.

[00:39:41]Adam, welcome to >> Hi there.

[00:39:43]>> Welcome to Medicare School Daily. What questions you have for us?

[00:39:47]>> So, the question I have, so I'm starting a little early. I am uh a little bit before the time that I have to pick uh pick Medicare stuff. I'm 60, but I'm, you know, on the internet you see all sorts of information and I can't tell what's real and what's not real. And so I'm trying to figure out the differences between Medicare and Medicare supplement, I think it is, and Medicare advantage. And when do I need to and when do I need to pick a plan even if I'm covered under I'm currently currently covered under my employer's insurance but and I hope that for some time but I understand I think I heard somewhere have a picket and then you can defer and I have a small window to do that and I'm trying to get a little bit smarter about all this stuff because it's all a foreign language to me right now.

[00:40:33]>> Did Adam did you say that you are 60 years old?

[00:40:37]>> I am 60. Yes sir. And uh but I know but time goes pretty quick. I think I have to pick something by the time I'm 65 and I tend to try to look at the information and kind of I don't try to make a snap decision. So this is me starting a little early I guess. I come I think I come across one of your sites and I said, "Oh, that's interesting. I'm you know and then you start you know the internet just kind of bombards you and it's like I just need to figure out some ground truth is what I'm trying to do right now. like can I wait till I'm can I when do I have to pick something? Do I have to pick something? And and you hear these I mean I know there I've heard of advantage plans and Medicare Medicare supplement and I I know very little about either of them and but I also want to be prepared for kind of the future.

[00:41:24]So, one of the other questions I have is if I pick a plan or a style of plan, can I switch back and forth at some point like when you have open enrollment or are you locked in? If I pick advantage, are you always with advantage and you know those types of things?

[00:41:39]>> Well, it's better to be early than late.

[00:41:42]Uh, Adam, if you're planning this far ahead, that's great. Uh, you'll have it all figured out by the time you're going on Medicare. Most people can't go on Medicare until they're 65 years old. And so most people start looking for this stuff about 64.

[00:41:55]>> And so the fact that you started looking is the reason that you're getting bombarded. Uh you can use an incognito tab on a browser if you don't want it selling you out uh and uh generating a bunch of phone calls.

[00:42:07]>> But um so you've got a couple questions.

[00:42:10]Differences between supplement plans and advantage plans was one of them. And then can I switch between those during the annual enrollment period going forward? Those are your questions.

[00:42:19]>> Those are the two primary questions.

[00:42:20]Yes, sir.

[00:42:21]>> Okay. Well, there's lots of time to make that decision. Again, it's probably a few years out, but we can uh give you a little bit of Medicare 101 and briefly talk about the differences there. So, um now you're also employed and so you have insurance through your job. I believe you told me that. Is that right?

[00:42:40]>> That is correct.

[00:42:40]>> So, you might not even have to be going on Medicare at 65 if you're still working, >> possibly. still have health insurance and it's a large employer with at least 20 employees. It might be even farther into the future when you're making this decision.

[00:42:54]>> We're we're a pretty large employer.

[00:42:55]We're north of 30,000. So I we we check that box. But do I still have to make a selection and then defer it when I'm like 65. That's right.

[00:43:03]>> I I think I heard there's a small window and if you miss the window, you get added fees or every every month or every every month you're late after that. uh you have a so you still have to do some there's some actions that you have to do I understand and I'm not depend I'm not sure that anyone's going to remind you to do them >> which is my concern >> you're you're going to be fine there's and if you think about it it makes sense the government would prefer that you stay on that employer plan forever till you're 150 years old and they never have to cover you so they're not going to penalize you and you don't have to do anything as long as you have employer provided coverage right through a employer. So there's nothing you have to do at 65. There's no box you have to check. The only exception would be if you are already receiving a social security check, which I doubt will be your situation.

[00:43:52]>> If you already receive a social security check, they will autoenroll you because they assume you're retired, but you're not going to.

[00:43:58]>> I'm not Yeah, I'm not receiving any social security.

[00:44:02]>> Well, then you'll not be automatically enrolled. You won't have to do anything.

[00:44:07]I've heard people say, "Don't I have to register but decline?" Something like that. No, there's nothing that you'll need to do.

[00:44:14]>> Okay. That's right. And that's what I've heard. Like I've heard you register and decline. And that's where I'm like and I don't know where I heard it actually and I heard it in passing. And it's like that's a little fat. I mean a little factor that's like oh I better run that to ground because that's you know cuz what I heard is it's like 3 months before your 65th birthday and 3 months after and you have this little window.

[00:44:33]Mhm.

[00:44:33]>> Um and it wasn't clear what that window actually was, but I also remember hearing that and there was something online where they said if you miss the window then you get penalized or you have an added >> and all that all that all that is true if you don't have coverage from a large employer, right? Okay.

[00:44:52]>> But you do so you're fine.

[00:44:53]>> Yeah. Okay. Fair fair enough. So I'm fine. Good. So I don't need to do anything until I leave work basically.

[00:45:01]>> That's right.

[00:45:03]All right. Um, okay. That's that that's good. So, what are the large and I don't know if you can tell me this, what are the large brushstroke differences between Medicare Medicare supplement, which I think is kind of the original or the OG and then recently, I don't know what recent really means. There's these advantage plans. And the advantage plans I've seen, I've seen a couple of them online that say, you know, zero co-ay, zero money, zero this, and zero that.

[00:45:30]And I was like, zero doesn't make sense to me cuz someone's got to make I mean they got to collect fees somewhere along the way. But my big concern is that you know I I compare in my head advantage to like an HMO and then Medicare uh traditional Medicare more like a PO.

[00:45:48]So I can go anywhere as long as they accept the insurance with a PO versus an HMO. I can only stay in their network.

[00:45:55]And if I have, you know, if I'm 75 or 80 and I have a catastrophic diagnosis, you know, and then my the the place that has the cure is outside the network, then what do I do? That type of that's kind of the formula. That's kind of the kind of my question.

[00:46:12]>> Yes. Uh well, I think that you're right.

[00:46:15]Original Medicare is sort of like the ultimate PO because you can use any doctor in the entire country and Medicare Advantage plans will feel more like an HMO that's more restrictive on where you can go. That's just the beginning of it though. Um I would say it like this. So uh Medicare is health insurance from the federal government instead of from your job, right? It's not from a private health insurance company.

[00:46:38]>> And so it's different. Many people would tell you better in three main ways. The first we just talked about the network part. Original Medicare does not have a network. All right. Uh to my knowledge, every hospital in the country accepts original Medicare because if they don't, they don't get any federal funding.

[00:46:55]>> So that makes sense.

[00:46:57]>> And about 98% of all doctors in the country accept original Medicare. So that first part thing we like is no networks. The second thing we like about Medicare is no referrals. You don't even have to have a primary care physician on Medicare, much less need their permission to see a different doctor.

[00:47:14]So, no referrals is the second thing.

[00:47:16]And then the third thing that separates this from what you're used to is uh original Medicare requires no pre-authorizations.

[00:47:23]All right? Aside from some uh very obscure things having to do with Parkinson's disease, original Medicare does not require pre-authorization. And as soon as your doctor is convinced that a test or a procedure is medically necessary for you, then it's approved.

[00:47:39]So these are the three things >> that >> So it's approved. But can they can they can they approve it and then decide later not to cover something?

[00:47:49]>> No. No, that's not I've run into that with I I guess they call private insurance or my employer insurance. um where um we've had you know my wife had a diagnosis and we tried to have some things were covered and then they said oh no we're not covering that now we have to go through this ownorous appeal process which is brutal >> um and not always you know and and so that's so they don't I mean once they say once a doctor says a medical it's and this is my word medically necessary and it's within the within in the structure of of um Medicare, you're you're you're kind of good.

[00:48:32]>> That's right. Again, we're talking about things that separate Medicare from what you're used to. You're used to private health insurance carriers. And with original Medicare, uh once some a doctor thinks it's medically necessary, it's FDA approved, then get on the table, buddy, because you can get your test done. All right? We don't really have to worry about them coming back later and saying, "You know what? We decided no."

[00:48:55]So, original Medicare is considered to be very good health insurance because again, no networks, no referrals, and no pre-authorizations.

[00:49:04]So, it's good, but it's just a good start because at the end of the day, Medicare is only going to cover 80% of your medical bills. Adam, 80% of a doctor, of an ambulance, of a surgery, of an emergency room. It's the 20% left over that we're worried about. So, that's why we get either a Medicare supplement plan or a Medicare Advantage plan. It's to either cover that leftover 20% or otherwise get you out from underneath it. Now, a Medicare supplement plan is uh what we call option number one. Some people will tell you that this is the Cadillac option where not only do you pay for original Medicare A and B, which is right now a couple hundred a month, but you're going to pay additionally a monthly premium for your Medicare supplement plan. That in Maryland might be another couple hundred per month. And now you're up to 400. And then you need a drug plan and those can cost a little bit.

[00:49:57]>> Is that income based as well on top? I mean >> no it's not the Medicare supplement plan is not income based just Medicare B and D. So anyway not to lose sight of what we're saying get original Medicare because you like it because it's good because it lets you go to anywhere with no pre-authorizations. And then you buy a supplement plan to cover the leftover 20% to cover the gaps. They call it a meta gap because it covers the gaps.

[00:50:21]Now, this is maybe $400 a month, maybe more than that. By the time you've added drug coverage and dental coverage, and so not everybody feels like they can afford a Cadillac. So, there's an option number two, which is a Medicare advantage plan. All right? which is a replacement of your original Medicare with a managed care program either an HMO or a PO Adam from a private health insurance carrier that will have networks that will have pre-authorizations and that will have out-of- pocket co-pays when you go to use it. Right? If you're not paying $400 a month or 200 extra for a supplement plan, you're paying zero for a Medicare Advantage plan most of the time. You're not paying upfront with this one. You're paying as you go. So, just think about eventually, are you going to be willing to pay extra to supplement the Medicare to enjoy having no network restrictions, no referrals, no pre-authorizations? Oh, and by the way, pretty much no out-of- pocket costs when you get sick because you're paying upfront for a Medicare supplement plan. Or will you not want to park a Cadillac in your driveway and you'd rather have something less expensive on a monthly basis, which is a Medicare Advantage plan. doesn't quite work everywhere. And it can deny your procedures and your services. But at least it's only a couple hundred a month instead of twice that. So, it's early, but that's what you can be thinking about in the meantime. Uh we'll want to talk to you when you're either turning 65 or when you're a few months out from retirement. Then we'll give you a refresher >> in case you don't remember.

[00:51:51]>> That's a good Yeah, that's good. I mean the the um I mean right now I'm I'm in a what do you I'm in a high deductible um health plan. So I'm used to I mean I have to satisfy my deductible before I get anything covered at 100%. And I was I I went through the ringer a couple weeks ago on some something small where I was just looking for pricing transparency.

[00:52:14]They couldn't give it to me. So I said this this is quasi elective. I'm going to wait till I know what my cost is because I've been burned before by private insurance in the past where they said they've covered something and then it turns out they didn't. You've already done the procedure so now you're on the hook. You're on the hook to pay for it.

[00:52:31]So, I mean Medicare. So, it's Medicare uh original Medicare Medicare and then that covers um and then there's a drug piece to it and then and then there's the GA and then there's Medicare GAP and that's kind of the kind of the Cadillac and then the other one could be anything from you know whatever is just a Cadillac to like a to like a um a Yugo or something. I'm dating myself of course.

[00:52:56]>> Oh, it'd probably be a Chevy. I mean it's not a jalapy. They're not garbage.

[00:53:00]They're not terrible. They're just they're just not they're just not a Cadillac. Oh, and by the way, your other question right now you have a high deductible health plan because you're reasonably healthy. And yeah, you went through something you weren't quite sure it was going to cost, but generally speaking, you got that high deductible health plan because you know next year you can change it. You can go to a low deductible plan the year after that >> or the year after that.

[00:53:20]>> But once you go on Medicare and when you make this decision, you need to make it like you're going to get stuck with that decision. All right? It's not easy to change between these two.

[00:53:31]in the future. The >> other question I had.

[00:53:33]>> Uhhuh. That's right. So when we're helping you go on Medicare again a few years into the future, we'll make sure you understand that once you start down one of these paths, you may not be able to backtrack and go the other way. So very important to determine which one of these you want because you can be making a lifetime decision, >> right? and I tend to be around for a long time and that you know you have a monthly I assume you have a monthly cost just like everything else and you know you make the wrong decision you could be out you know I've seen some of your videos online where you kind of go in and run some numbers and the numbers right now mostly because I'm working don't look too terrible even the Medicare numbers don't look terrible but again once you don't have that income coming in then it come then it gets a little bit more real I suppose as well but that's um but this This is good information for me. You I mean I didn't realize I could wait and you know I'm a you know 65 is almost around the corner.

[00:54:28]If I'm still employed by my employer I can wait. I don't have to do anything at all which is nice to know.

[00:54:33]>> Um >> cuz you know and then you know I can reach back to you all in a couple of years and you guys can reach back to me as well.

[00:54:42]>> Please reach out to us. We love to um uh just you know go to medicarechool.com.

[00:54:48]We've got a lot of education on there.

[00:54:50]There's a workshop on there. It's about an hour long called the Medicare Essentials Workshop. You know, you sound like somebody who likes to be prepared.

[00:54:57]I would check that out. Just keep watching stuff on the YouTube channel.

[00:55:00]We got to bounce to our next caller, but it was really nice talking with you.

[00:55:04]Thanks so much.

[00:55:05]>> Thank you. Have a good day. Thank you very much.

[00:55:07]>> You too.

[00:55:08]>> Bye-bye.

[00:55:10]>> When you retire, you may move. Whether that's at the beginning because it's time to get south or maybe it's just something happens in life, you want to be closer to your kids. Well, what happens to Medicare whenever you retire?

[00:55:22]That's a big question a lot of people have and you may have. Join us tomorrow.

[00:55:25]You're going to learn what happens to all the different Medicare plans when you move from state to state or across the country.