Why Medicare’s 20% Coinsurance Is So Dangerous… And What To Do About It

Added: 2026-05-12

[00:00:03]If you're retiring uh soon or maybe you've already retired and it's time to start living off your investments and go on Medicare, uh there are a few mistakes that we see people make uh pretty consistently. The first two years are the times that most people will make the biggest mistake mistakes that affect their retirement. Uh so today you're going to learn about what those big mistakes are so that you can live not only for a couple years but your whole entire retirement and make it very very comfortable. I'm joined in the studio today by uh the gentleman that leads our financial planning team here at medicarechool.com. His name is Eric.

[00:00:43]Welcome. Glad to have you here.

[00:00:46]>> Great to be here.

[00:00:46]>> Yeah. So you guys are going to get to learn a little bit from somebody who's been doing this for the last 30 years and uh you'll learn a lot. I am confident. If you want to be a part of today's show, if you have a question for us, call in. We'd love love love to chat with you. It's your opportunity to really get your questions answered in a non sales environment. We're obviously not going to sell you anything on a live stream, but it's your opportunity to call in, get your questions answered.

[00:01:13]Medicare is confusing, social security is confusing, retirement planning is confusing, income planning, taxes, all of these things are difficult. And when you uh retire, you got to make sure that you do it right. So that's what we're here for. You've come to the right place. Thank you uh for being with us.

[00:01:32]So Eric, please share with me, share with all of us just about what happens in the first two years that can really derail a retirement.

[00:01:41]>> Yeah, let's let's talk a little bit about that exciting two years, right?

[00:01:44]Big decisions to be made. Imagine that uh first day of retirement. you a lot of people I think they kind of echo the sentiments of Dr. King when they say free at last, free at last, right? They put in all this time, their career's behind them, and now they got this whole bright future ahead of them. There's a lot of things that are going through people's minds at that time. They're thinking not only about social security and Medicare, they're thinking about if they possibly have a pension, 401k, what do we what do they do with all this? But really truly deep down inside, they're thinking about bucket list.

[00:02:18]>> Yeah, there you go.

[00:02:19]>> That's right. And and uh there's statistics to back it up. So, they have a list of things that they want to do that they've kind of been putting off because they've been working their whole life and now they have time and they have money. And usually when you add those two together, it equals spending.

[00:02:35]>> Yeah. Yeah. It's true.

[00:02:36]>> Yeah. Yeah. And uh the bucket list items, you know, it can be anything from house repairs to a new car. RV travel is a big one right now. A lot of lot of people driving around buying RVs, driving expensive, too. They are expensive. They are expensive. Yeah.

[00:02:53]Yeah. But they love them. They love them. And it's a great way to see the highways and the byways of the United States in particular. But uh visit family, all these types of things that they they've been put on this bucket list. So if you think about that first day that you're retired and you're looking out at this bucket list, you got to think what's this going to cost, right? Yeah. And where does this money come from?

[00:03:20]>> Yeah. to to pay for it. Am I going to pull this out of savings? Am I going to pull it out of 401k? There's all these different options.

[00:03:26]>> The tax implications, all these things.

[00:03:28]>> Absolutely. What are the tax implications? So, let's talk about that statistically a little bit.

[00:03:32]>> Okay.

[00:03:32]>> Yeah. So, let me throw some numbers around this. So, I've read various numbers on this and it's about 77% of Americans when they go to retire, they experience this thing called the freedom surge. Okay.

[00:03:47]>> Okay. Freedom surge.

[00:03:48]>> I never heard of that.

[00:03:49]>> Yeah. That's the freedom surge. So that's that time plus spending and the bucket list and that's that's what they're doing. A and it makes perfect sense because you're young enough, you're healthy enough to do all these things. You've been saving up to do these things, so you might as well do them. And we never want to dissuade anybody from enjoying retirement. That's that's what we want to do is just make sure that they don't make mistakes that have long-term ramifications.

[00:04:16]>> Sure.

[00:04:16]>> Yeah. Right.

[00:04:17]>> Absolutely. So uh you mentioned taxes obviously that's a big one right tax implications of the freedom surge uh what we generally see is the freedom surge uh lasts about 2 years >> okay >> and then uh there it just sort of settles down >> like oh this is new this is I'm used to this I've gone everywhere I need to go I've had enough fancy meals or whatever it is >> no that's what it is right and and now I got what's next yeah there you go >> yeah and they and and retirement really if we look at it I know that a lot a lot of planners will go out there and they'll uh take a 4% withdrawal rate over time >> right yeah common rule 4% rule >> very common right but actually when we look at spending uh what we see is it's more shaped like a smile as opposed to a line >> okay >> you get spending up front and spending at the end the big expenses and then it kind of normalizes out in the middle >> so yeah so we really want to be careful with that spending up front so that we can do that spend spending at the end.

[00:05:17]>> Well, the spending at the end isn't any fun. Probably >> it's not as fun. Not as fun. Not as fun.

[00:05:22]>> But I guess the opposite of that is making your kids or the state take care of that.

[00:05:27]>> Yes.

[00:05:27]>> So, you want to be able to have control of of all of that spectrum.

[00:05:31]>> Absolutely. Yeah. Take control. Don't leave it over to the IRS to take control. Uh we our kind of our mantras is we want you to live the life that you want to live and that you deserve to live. uh I want you to never run out of money and never have to adjust your uh cost of living or your lifestyle downward. Right? That's that's that's those are the those are the two big solves.

[00:05:52]>> So I had an experience with this. Okay.

[00:05:54]>> Uh not too long ago. This is one of the things that we always want to keep our eye on is taxes, right?

[00:06:01]>> And I always think of it as a little bit like March Madness. So when March Madness rolls around, all of a sudden you have all these shows on ESPN and stuff and they're called brackettology and everyone's putting their brackets together. Well, we for us that's a year- round game because it's tax brackettologology. Okay. Yeah. So, we're keeping our eyes on those tax brackets.

[00:06:18]>> So, uh what his situation was he and his wife just retired.

[00:06:24]>> They had uh a combined income of about 75,000 uh with and that was all the benefits and pension and and everything that they were drawing.

[00:06:35]>> And I had them sketch out the next two years. So, let let's talk about this freedom surge and see what this looks like. And for them, they had just a series of a lot of little things. And they didn't think it was going to be much. It's $1,000 that they thought for the gutters and, you know, house repairs, this trip here and there. But when we when we penciled it out, it was about 20ome,000 almost $30,000.

[00:07:01]A >> and uh so the big question is is where is that coming from, right? And also what's the most taxefficient way that we can we can get that >> right >> because that's we're playing the game of brackettology 75 and just this is not uh um with deductions this is just gross income. They go from a 12% federal tax bracket just federal not state >> and that bumps them up to a 22% tax bracket.

[00:07:28]>> So that's a that's an additional $10,000 that that they're going to be paying just in federal taxes on on that. So that's a big jump. That's a big jump. So uh now just to cut to the chase on the solution here is what we were able to do was uh take the money out but spread it out over two tax years.

[00:07:48]>> Sure. Yeah.

[00:07:49]>> Yeah. So divide it up.

[00:07:51]>> Yeah.

[00:07:51]>> Yeah. Absolutely.

[00:07:52]>> Cut that tax bill down.

[00:07:54]>> Now if the freedom surge lasts longer than two years, obviously there's a little more planning. Is there I mean I I think I kind of know the answer but maybe speak to like the kind of the softwares that you are utilizing to help people do this planning because it is important. Why not save the money >> on the taxes?

[00:08:10]>> Yeah.

[00:08:10]>> Yeah.

[00:08:11]>> Yeah. Like uh so we we use a lot of different softwares, right? And part of the reason for that is uh we want to be really accurate. We we we really want to uh stress test and make sure we're getting it right, not only on the tax side, but also on the savings side. So there's this uh one software that we use and it's it's relatively common a Monte Carlo simulation and what that allows us to do is to stress test their plan thousands and thousands and thousands of times with all these different scenarios and helps us come up with a number and uh based on that number we know the probability of them never having to decrease their style uh style of living and and never running out of money. Now for us a and I think a lot of people we're always looking at 90% plus in probability. We ne we're never going to go below that. So yeah, important to stress test and that's a big piece of the software that we're looking at.

[00:09:06]>> But like so if I'm retiring, I know, hey, there's all these things I need to I'm going to spend. Maybe I want to take the kids on vacation. I don't know what it is. So, do you have the ability to to kind of map that all out, put that all in, and it says, "Hey, here's exactly the buckets to pull from because a lot of people, you know, if you're listening, you you you may have like a, you know, a 401k, you may have some savings somewhere, and you maybe have like, you know, obviously social security and social security taxation comes into this as well because if you're taking an extra dollar out of your so out of maybe something that like an IRA or something that can put you up and even having more of your social security be taxed. like all these things work together and of course if it's too much then you could have a Medicare tax on top of it. So there's all these different taxes. So I feel like it's important um that you have an actual written plan with like okay here's how I see the first two years 3 years four years going and how you know how best we can reduce some of our or you know fund some of these things in a very taxefficient manner. Um and I mean I think the first time I helped somebody with this was 12 years ago. So, we've been doing it for a while. Um, >> but it it's just very important uh that you guys take advantage and if you don't have someone that you're working with, you can work with Eric and his team on mapping how retirement goes.

[00:10:24]>> No, you're absolutely right. Yeah. Yeah.

[00:10:26]No, that's a perfect example and and that's exactly what we do and especially during those first two years, the freedom surge, right? We want to map that out and really look at it from the tax standpoint like I I was just talking about a little bit ago, but then also where's that money coming from? What's the most tax efficient way we can do that? But the other thing is, and you touched on this uh when you talked about social security is social security is an interesting uh uh vehicle because there's no givebacks on it, right?

[00:10:54]>> Yeah. Once you once you start that social security after that first year, you're locked in locked into that benefit. And so we would not only want to look at social security now and your benefit, but but do we possibly delay?

[00:11:09]>> Yeah.

[00:11:10]>> Or um how does this impact you later, >> right?

[00:11:14]>> And like you tied in, how does this in impact you know your Medicare?

[00:11:18]>> Yeah. Yeah. So all those factors and and we it it can it sounds >> it's really hard to figure that out alone.

[00:11:25]>> I know that's why we how it's hard to sit down and map that out. It's Yeah.

[00:11:29]Yeah. There's a benefit.

[00:11:33]>> Okay, we got Susan from Delaware. Susan, welcome to Medicare School Daily. Are you there?

[00:11:40]>> Yes, I am.

[00:11:40]>> Hi. What are your questions?

[00:11:43]>> Hi. Uh, my name is Susan and I had started my retirement um in July of 2025.

[00:11:51]Now, I did sign up when the enrollment in July and then I did sign up for the enrollment period. I guess what's that?

[00:11:58]October, November.

[00:12:00]>> Okay.

[00:12:00]>> Do I have to sign up again in July since I started in July?

[00:12:05]>> Okay. Okay. Let me ask you just a couple of questions. So, you you signed up for Medicare last July. Is that correct?

[00:12:14]>> Well, actually, I retired July 20, 2005.

[00:12:18]So, I went to because I signed up with the A plan for the hospitalization >> and then I started my B plan in July.

[00:12:26]>> Okay. And then 25.

[00:12:27]>> Oh. of 2025. So, you're kind of wondering like do you need to switch plans or anything?

[00:12:33]>> Yeah, because I did sign up in the enrollment period.

[00:12:36]>> Sure.

[00:12:37]>> You know, in October or November.

[00:12:39]>> Can you tell me what plans you have?

[00:12:40]>> July. And >> I have um I have AARP for my supplement.

[00:12:46]>> Okay.

[00:12:47]>> So, United Healthcare and then I have I had to change my prescription um in in January. I had to change it to the PO plan. Well, wellare.

[00:12:59]>> WCare. Yeah. Pretty common. Very common.

[00:13:01]Probably the most common plan in the country. Your supplement plan.

[00:13:03]>> It has.

[00:13:05]>> Yeah. Yeah. Understood. Yeah. Do you have a do you have a plan G or do you have a plan N?

[00:13:11]>> Uh G.

[00:13:12]>> Plan G.

[00:13:13]>> Girl.

[00:13:13]>> Okay. Yeah. As in girl. Okay. Awesome.

[00:13:15]So, yeah. So, that plan uh there's nothing that you have you actually don't ever have to change that plan G ever.

[00:13:22]that plan is yours for as long as you want to keep it. They can't cancel it on you. They can't change the benefits on you. Uh the only thing they're going to do is they're going to raise the premium probably every year, right? And I'm sure you've kind of experienced a little bit of that. The last couple of years, the last three years, they've been the most interesting years in terms of price increases for a long time. So, United Healthcare uh for about 20 20 years they had about a 2.9% rate increase every year. That's like below inflation, right? It's very very low. Then postcoid there's been a lot of medical inflation.

[00:13:58]There's been a lot of overuse of plans and there's been a lot of fraud that has been introduced into Medicare. And so what's been happening is we've seen those supplement plans start to go up um a little bit faster. And so you've maybe experienced that. So, you can move you can move off of that plan into another plan, but you would have to medically qualify.

[00:14:19]>> Um, but there there's never anything you have to do with that plan. It can be yours for as long as you want it. Okay.

[00:14:26]>> All right. Cuz I know that it is going up to $22.90 come July.

[00:14:32]>> July.

[00:14:33]>> I'm getting my my notice in May.

[00:14:35]>> Yeah. How's your health? What's What's kind of the What's kind of the >> It's not too bad. I mean, I I was diagnosed with MS. I have uh poor bone structure, so I'm working on that. So, I go see a specialist for my bones. And um I have diabetes.

[00:14:50]>> Have you had any fractures?

[00:14:53]>> Uh actually, no. I did have a uh I um I did fracture my shoulder because of the dog yanked me and took me to the ground.

[00:15:03]That was two years ago.

[00:15:04]>> Okay.

[00:15:05]>> So, that was before I retired, but yeah.

[00:15:08]So, Yeah, it might be a little bit it might be a little bit difficult to switch, but here's what I would tell you. Um, we're expecting we're hoping we're expecting this to be the last year where there's kind of these bigger price increases and then we think it'll hopefully normalize um out, you know, to kind of go back to that trend that they were on for a long time. And I do want you to know you're not alone in terms of, you know, United Healthcare is not the only carrier that's had to take those increases. It's been every carrier. So, you're probably not going to be able to save a whole lot of money by moving. Um, and the other thing, do you use the Do you use the gym membership that it's still part of the the UHC supplement plan?

[00:15:49]>> I don't Well, you know what? It turns out that the YMCA does not. They're in the network, but they don't give a discount. I just signed up with the YMCA.

[00:16:01]>> Okay, gotcha.

[00:16:02]>> So, I found out they're in the network, but they don't give a discount. I said, "Well, what are they in the network for?

[00:16:07]penalty.

[00:16:07]>> Yeah. Yeah. What does that even mean?

[00:16:09]Yeah, that's that's interesting.

[00:16:10]>> Yeah, that's what I said. What does that mean? Yeah.

[00:16:13]>> Um I think you gave us >> $65, but >> you're not alone. All the premiums are going up. And if you're healthy, uh don't have any the the multi the MS with a fracture in the last two years is probably going to be very difficult for you to switch plans. So, I think probably just stick tight with where you are for now. Um, as far as your drug plan, October 1st or October 15th, rather, that's the beginning of annual enrollment period. It sounds like you've kind of figured out how to navigate switching those plans. Did you use medicare.gov for that?

[00:16:45]>> Um, I use Medicare School actually.

[00:16:47]>> Okay. Okay. Okay. Sounds good. Well, that's I mean, that's our company, so yeah. Uh, well, >> yeah, I know.

[00:16:53]>> Yeah. Well, thank you. Okay. What other questions you have, Susan? Anything?

[00:16:59]That's that's really all I have. Thank you so much.

[00:17:01]>> Okay. Well, hey, you take care.

[00:17:04]>> You too.

[00:17:05]>> Bye-bye.

[00:17:07]>> Okay. We've got another caller here.

[00:17:09]Let's go to uh let's see. We've got Raju in California. Raju, can you hear me?

[00:17:15]>> Yes. Uh the question is about uh Medicare and HSA. Okay. So, I'm 66. My wife is 64.

[00:17:22]>> Okay.

[00:17:22]>> This year, my wife, she lost a coverage in March. um retroactively we came to know about it in April of this year. So she can be added on to my insurance.

[00:17:37]>> Okay, good. And do you have Medicare Part A?

[00:17:41]>> No, I have not I had asked you guys and I have not taken you don't want to do that.

[00:17:47]>> Further, you want to you want to stop any Medicare contributions about 9 months. Pardon me. You want to stop any HSA contributions about 9 months before you're going to go on Medicare. So, are you clear on that?

[00:18:03]>> Isn't No, isn't it 6 months?

[00:18:06]>> Well, here's here's why. So, and I said about So, whenever you apply for Medicare, um you they are going to backdate your part A date 6 months because you're over 65.

[00:18:18]>> Got it? So if you if you retire and if you apply for Medicare, >> you know, you most people do it about 90 days in advance. So that's why I said if you do it 90 days in advance, they're going to take that application date back the clock up 6 months. So that's where I got to 9 months. But if you do it 60 days in advance and it' be 8 months. If you do it, you know, 30 days in advance, we're kind of getting down to the wire.

[00:18:39]Now you're at, you know, 6, seven months. So it it's not from they're going to backdate it 6 months from the date of application is my point.

[00:18:47]>> Okay. Yes.

[00:18:48]>> And you can do that as early as 90 days.

[00:18:50]>> Yeah. I I was not aware of the 9 months because of the application date. Okay.

[00:18:55]That's very good. Uh >> yeah, good to know. Good to know for sure. So, okay. So, I think I have an understanding. So, then where is what's your question?

[00:19:02]>> So, in June I'm going to start contributing to a family plan HSA.

[00:19:08]>> Okay.

[00:19:09]>> Because she's she's going to be on my plan.

[00:19:11]>> Okay.

[00:19:12]>> As well. So now the problem is would I get a full 8750 plus,000 catchup for me and a,000 catchup for her to be done or will it be pro rata? That is my first question.

[00:19:27]>> Okay. So you so I I believe that the um the max so if we look at the family max for 2026 is 8,750.

[00:19:41]Uh >> get it. Okay. And then I believe only one I think the only I I think the $1,000 ketchup can only be used for one spouse. No. Okay. No. Both eligible.

[00:19:54]You're both over 65. Both. Yeah. So 107 10750 is your max for the year.

[00:20:03]>> Right. But uh is it proa because see first uh five months I'm individual.

[00:20:09]>> Yeah. No, I don't believe so. Next >> I don't believe so. The second part of the question is if I have to contribute whatever the amount whether pro data or otherwise >> sure >> uh I'm going to I'm planning to contribute in the first 3 months of starting June.

[00:20:24]>> So she's going to apply 3 months before that. Right. Okay. Means December also will be counted.

[00:20:30]>> This is only if you're over 65 do they backdate anything.

[00:20:35]>> If she's just turning 65 in October, she can contribute all the way up until September.

[00:20:41]Does that make sense? They're not going to back they're not going to backdate anything. You can apply for Medicare part part A and B up to 90 days in advance of when you want it to start.

[00:20:52]Okay? They're going to take that application date and they're going to back the clock up 6 months and that's when your part A is going to be and you can't have contributed um from that a date on to an HSA.

[00:21:06]>> Okay.

[00:21:06]>> Yeah.

[00:21:07]>> Okay. I think you answered all my questions. Thank you.

[00:21:10]>> Okay. Hey, thank you, Raju. Take care.

[00:21:12]>> Yeah. Thank you, Phil. Yeah. Bye-bye.

[00:21:16]>> Uh let's talk to Terara from California.

[00:21:19]Terasa, can you hear me?

[00:21:22]>> Yes.

[00:21:23]>> Hi. I understand you have a question about uh maybe switching supplement plans. Is that right?

[00:21:29]>> Yes.

[00:21:29]>> Okay. Go ahead.

[00:21:32]>> Well, um I have a a high deductible G.

[00:21:38]>> Okay.

[00:21:40]But I wanted to um I wanted to upgrade to a regular G. Yes, >> I have a agent who involved me well thankfully you know when I after retirement but he said that he said that my supposedly cuz I'm now 60 I'm I'm turning 67 >> okay >> and I retired at 66 from the postal service.

[00:22:18]>> Okay.

[00:22:18]>> And then um >> I enrolled to well thinking about the benefits of of uh enrolling into Medicare Part B versus the PHB. So I dropped my PHB and enrolled in Medicare B.

[00:22:40]>> Okay. and then enrolled in he enrolled me into a high deductible G. He said that >> my my B date is when I turn 65.

[00:22:55]>> Yeah. So you >> after listening to you guys?

[00:22:58]>> Yeah.

[00:23:00]>> Okay. After listening to you guys, you know my B date should be the date I go to the B.

[00:23:10]>> Okay. Correct.

[00:23:10]>> Do you have a red, white, and blue Medicare card?

[00:23:13]>> Yes, I do.

[00:23:14]>> Okay. What is the Do does it have an coverage A or, you know, a part A and a part B coverage start date?

[00:23:22]>> Uh, yes, it does. Okay.

[00:23:24]>> Part A is 512024.

[00:23:27]>> Part A and B is 512024.

[00:23:31]>> No, part A is 51204.

[00:23:36]Uh, part B is 1212025.

[00:23:39]Okay. So, what are your So, then what's your question? Do you >> I mean, because that I mean that's locked. That is what it is. We're not going to change that.

[00:23:53]>> All right. But, uh, can I move to far to plan regular G?

[00:24:01]>> Yep. Yes. Without going. Yeah. Yeah. So, let's let's talk about this. So, you're in California, correct?

[00:24:09]Right.

[00:24:09]>> Okay. So, California has what they call a birthday rule and it allows you um to be able to move supplement plans without underwriting. However, there's a catch.

[00:24:20]You have to go to a plan that has equal or lesser benefits. Okay? So, the most common application of that is people who go from a plan G to a plan G. Or maybe they go from a high deductible G to a high deductible G. Or maybe they go from a plan N to a plan N. kind of lateral moves from one carrier to the next. They can do that without medical underwriting. They can also go down in coverage. So, meaning moving from a plan G to a plan N, that would be kind of down in coverage. Moving from a plan F, which is like, you know, most people can't get a plan F, but moving from plan F down to a G or an N, that's kind of a downgrade of coverage. So, they can do that without medical underwriting. But to move up in coverage requires medical underwriting. So to move from an N up to a G or to move from a high deductible up to a N or a high deductible up to a G requires medical underwriting. Okay. So that you need to know that. The second part of your question is I think you're actually pretty lucky and I'm glad you called in. So because your B date is 121, you have 6 months from that date, you have you're in this period called a metagap, which is another word for Medicare supplement, metagap OEP, which stands for open enrollment period. So from 6 months of your part B date, which was 121 for 6 months, so until the end of this month of May, you can actually go ahead and get your G plan. No medical underwriting. How does that sound?

[00:25:52]>> Oh, okay. Great. Great. Great.

[00:25:56]>> That's good. Okay. So, um >> I know. No, I'm I'm happy to hear that.

[00:26:00]>> Yeah. No, that's very good. So, um if you want, can I give you our office number and then you can call in.

[00:26:06]>> I got it.

[00:26:07]>> Oh, you got 800 7826676.

[00:26:10]>> That's correct. Y.

[00:26:12]>> Yeah. So, call in and then just tell them, "Hey, I'm in my last month of my metagap OEP. I need to get a plan G. I'm in California. Can you get me to someone who can quote me all the different options? Cool.

[00:26:25]>> All right.

[00:26:26]>> And they can do that today or tomorrow or whenever. Okay. Terita, take care.

[00:26:32]>> Thank you.

[00:26:33]>> Byebye.

[00:26:34]>> Thank you.

[00:26:37]>> Okay, let's get to another caller. We've got uh Lisa uh Lisa in Ohio. Welcome to Medicare School Daily.

[00:26:45]>> Yeah.

[00:26:46]>> Hi there. I understand you've got part A. You're still working and you kind of want to talk about a drug plan maybe without part B. Is that correct?

[00:26:55]>> Correct.

[00:26:55]>> Okay. Maybe get us up to speed.

[00:26:57]>> Okay. Uh so you're still working, you have part A and you want to get a drug plan but don't have part B. Do you have credable drug coverage through your employer?

[00:27:07]>> I do.

[00:27:08]>> Okay. And can you >> do now? The re >> Yeah. Go ahead.

[00:27:11]>> The reason why I'm looking at this is is please understand I work in healthcare.

[00:27:16]>> Okay. I'm a financial analyst. I get I work in reimbursement. So, I get the Medicare updates. I'm looking at the Medicare GLP1 bridge >> that starts July 1.

[00:27:28]>> Okay.

[00:27:28]>> That's why I'm I'm asking this question.

[00:27:31]>> Okay. So, to get a drug plan, you have to be eligible for part or you have to be on part A, which it sounds like you have. That I think the consideration would be like coordination of coverage and who's going to pay first. I I don't know that I've ever had anyone ask me.

[00:27:46]The answer is yeah, you can get it. I just don't know how it's going to like necessarily work. I don't think I've ever heard of anyone who has a drug plan and an employer drug plan.

[00:27:57]>> Um but that GLP that makes a lot of sense. I bet we're going to start getting more questions about this.

[00:28:04]>> Um >> I just I've just got the update from Medicare this this morning. So I'm looking at this and I'm like, "Oh, wait a minute."

[00:28:13]>> Oh, no. Oh, I mean that's a if it's, you know, going to be is it $50 is I think that's what it is. If that's going to be a thing, I I bet that's going to be it.

[00:28:21]>> Yeah.

[00:28:21]>> So, um yeah. Yeah, I think you can take it. I think the coordination of that will be something interesting. Do me a favor.

[00:28:30]We've got your number obviously saying.

[00:28:32]Let me do a little bit of research and then uh I here's what I will do in the next couple of episodes. We'll talk about this. Um, and you can call back in if you want, but give me give me a moment to just cuz I feel like we're going to get this question a lot and how are those going to coordinate? So, let me do some research. I just don't want to tell you um the the wrong thing here, but you are correct and that you can um you can get a drug plan as long as you have part A. You don't have to have part B.

[00:29:02]>> So, >> okay. I mean, I you know, my employ like I said, I work in healthcare. My employer has a plan through Anthem, but we're self-insured. We don't cover this stuff.

[00:29:13]>> Yeah.

[00:29:13]>> You know, we've got a very limited formulary, so this isn't even covered.

[00:29:18]It's not even Don't even question it.

[00:29:20]>> Oh, you mean like the GL the GLP1 stuff, >> right?

[00:29:24]>> Yeah. Well, >> they don't Yeah, they don't cover this stuff.

[00:29:27]>> And it is It is expensive. So, um >> Yeah.

[00:29:31]>> Yeah. I Let let me uh Yeah. And here's the other thing that I would probably do. I would want to in some of this I I wouldn't actually be able to tell you. I think it would be worth you. So you guys self-insure. Who's the benefits like administrator? Like do you know who kind of like manages I can't remember what they call that TPA?

[00:29:50]>> True scripts. I believe it's I think it's true scripts.

[00:29:53]>> Okay. I would I would >> wrong but I think it's true skips >> cuz you're kind of going to have double coverage more or less. I mean you're not going to try to probably you know run it through it. I would chat with whoever is like the TPA for your self-funded plan and ask them if I do this is my coverage going to be changed on your end, >> you know, from that that that insurance carrier's perspective. So, it might may not be like, "Yeah, you can do it, but then they're going to say, oh, but we're going to drop you or we're going to make it so you can't get any meds through us or something." You should have find that out, >> right?

[00:30:31]>> Okay.

[00:30:32]>> Okay. So they won't they wouldn't be primary then they would be fall into the secondary.

[00:30:39]>> Yeah, I gotcha. Okay.

[00:30:40]>> Yeah. So I would I would just talk to them. I think that's probably the best thing. Um you can do it. Yeah. But how what is that going to mess up your employer coverage in any way? Okay.

[00:30:52]>> Right. Right.

[00:30:55]Well, I've been considering just dropping my coverage anyway because I need a hip replacement.

[00:31:00]>> Oh, are you eligible for Medicare? my deduct.

[00:31:02]>> Oh, obviously you are. You have you have a So, you're 66. Well, let's talk about that.

[00:31:07]>> Yeah, I'm 66.

[00:31:08]>> Let's talk about that. Um, so, uh, you are in Ohio. Let me just like run a scenario for you if I can. Do you have for on your employer coverage, how much do you how much do you pay for that?

[00:31:23]>> Uh, I would say roughly $50 a month.

[00:31:26]>> Oh, so it's No, no, no. $100 a month.

[00:31:28]$50 a pay period. A pay period.

[00:31:30]>> About $100 a month. Okay, sounds good.

[00:31:32]And you are born in February of 1960.

[00:31:37]>> Correct.

[00:31:38]>> Okay. And then are you living with anyone over the age of 50 in your household?

[00:31:45]>> No, it's just me.

[00:31:46]>> Okay, sounds good. And are you in Miami or Montgomery County?

[00:31:51]>> Montgomery.

[00:31:52]>> Montgomery. Okay, let me just look up something.

[00:31:54]>> I know. If I if I go to if I go two blocks, I'd be in Miami County, not Montgomery County. There you go. Okay.

[00:32:02]So, you can get golly, you can get So, Medicare, let's talk to Medicare. So, part A is free, right? You know that you have that, right?

[00:32:11]>> Um, part B is 20290. Let's call it $200.

[00:32:15]Okay. So, it's basically $200. If you were to get Do you know the differences between like plan G and plan N?

[00:32:23]>> Yeah. Yeah.

[00:32:24]>> Okay. So there are there's there's a you can get a plan G for about $140 and you can get a plan N for about $105 110. Um so there's about a $30 price difference there. So but let's just say you're going to go with a plan G. We're going to call it 140. So you're at you're at 340 right on Medicare. Do you know your deductible on your current plan?

[00:32:51]I believe it's I god I don't even remember right now.

[00:32:55]It's either 6,000 or 10,000.

[00:32:57]>> Okay. But it's pretty high, right? And you need to get this hip replacement, right? So let's say it's let's say it's six grand and I bet it may be six grand deductible with a $10,000 max out of pocket.

[00:33:09]>> I mean, it could be something like that.

[00:33:10]I don't know. But a lot of times there's a deductible and then you pay a co insurance, meaning you're going to pay a percentage of the bills up to that maximum out of pocket. Um, so you're paying $100 a month, but you've got between $6 and $10,000 that this is going to cost you. Whereas if you go with Medicare, do you take any other meds?

[00:33:31]>> It's only going to cost me the >> um I take I've got high blood pressure.

[00:33:36]I take three uh high blood pressure meds, amloopene, leinopril, and hydrochloroioide.

[00:33:43]>> Okay. Well, those are all those are all very cheap.

[00:33:46]>> Couple dollar. Yeah, those are couple dollar a month.

[00:33:49]>> Yeah.

[00:33:50]>> So, yeah, nothing major.

[00:33:51]>> I'm just going to check and see. Uh I'm going to put those into uh well, here I'm just going to see what drug plan.

[00:33:58]Yeah. So, there's several plans that are maybe a drug plan is going to cost you between zero and 10 bucks a month. So, let's just call it 10 bucks a month.

[00:34:05]Okay.

[00:34:06]>> So, we've got 200 for part B, 140 for a G plan, and $10 for a drug plan. You're at 350. That's what it's going to cost you. So, it's going to cost you an extra $250 a month, but if you go to Medicare, but you're going to have a $283 deductible after you meet that. It's 100% coverage. See, it does cuz after this hip replacement, what are you going to have to do?

[00:34:28]>> Rehab, >> a bunch of a bunch of rehab, right? So, then you're going to be paying a co-ay or whatever it is. You know, the surgery's going to be expensive and then there's all of that, too. So, you could switch. I mean, if I were in your shoes and then also just kind of considering this GLP1 thing, um, it might be a good idea to go ahead and take a look at that. Yes, your premium is going to go up a little bit, but your total exposure, you know, meaning what you're going to have to come out of pocket if something goes bad or if you get this surgery goes way down, >> right?

[00:35:06]>> You kind of tracking with that?

[00:35:09]>> Yeah, I do. I I know what you're saying.

[00:35:11]I mean, I've followed you guys long enough that I've been kind of, you know, I've been bantering this around back and forth going, "Okay, wait a minute." It's like, you know, the doctor's like, "I can give you another shot in three months, but I I'm right in the middle of gardening season." So, it's like, you know, hip replacement's not going to happen until after the garden's over with.

[00:35:29]>> There you go. Well, >> I'll I'll hobble around for another, you know, three, six months, you know.

[00:35:36]>> Sure. Okay. Well, let me >> It won't happen till the end of the year. So, >> let me share one other thing with you.

[00:35:41]So, have you worked at this same employer since you became eligible for Medicare and went on part A?

[00:35:47]>> You've worked Yes. Okay. So, whenever you do >> I've been there for what, eight years now?

[00:35:53]>> Okay. Okay. That's good. So, whenever you do start Medicare uh part B, whenever you want it to start about 90 days before, you can work with us. You know, we'd love to walk your walk you through this, hold your hand, show your options, fill out the paperwork, all of that stuff. Um, but you are going to there's going to be a document. Yep.

[00:36:11]L564 and then 40B. L564 goes to the employer. That with the 40B goes to the social security office and that gets you enrolled into part B. The good news is is you already have a Medicare number.

[00:36:23]So, it's going to process quickly.

[00:36:25]They're going to add part B. Um, and then you can apply for your drug plan.

[00:36:29]You can apply for your supplement plan.

[00:36:31]Really about 90 days before is that perfect window. And again, we walk your we hold your hand through that. Um, but sounds like you've got a little bit of a plan. I mean, maybe this is just a go on Medicare in 2027 plan, >> you know.

[00:36:44]>> Okay. Well, I was, you know, I'm looking at this, you know, this GLP bridge. It's only July 26 through December of 27.

[00:36:55]>> Oh, getting the GLP.

[00:36:58]>> Yeah.

[00:36:59]>> Yeah. So, you want to start for a limited period.

[00:37:02]>> If you want to go to Medicare and get your GLPS and get your hip replacement done this year, I mean, you can start it. You know, we could start Medicare as soon as June >> um first and get everything set up. So, you're you've got options for sure.

[00:37:18]>> So, at least on the part D side, I probably should talk to >> talk to your employer.

[00:37:23]>> Uh the Yeah, talk to the employer and the prescription. I believe it's True Scripts. It may be somebody else, but it used to be True Scripts a few years ago.

[00:37:34]Um, so I'll talk to them, see if there's any or who's going to be paying what first, who's in who's in the first, you know.

[00:37:44]>> Yeah. And make sure it's not going to mess up your mess up that plan in any way.

[00:37:49]>> That's what you want to be careful of.

[00:37:51]>> Okay.

[00:37:52]And then if you decide it's just better to go on Medicare, >> just I mean we can do it quickly. You can get everything in place. And you already have a Medicare number. That's what really makes it go quick.

[00:38:03]>> So >> easier. Yeah. Okay.

[00:38:06]>> Okay.

[00:38:07]>> Super.

[00:38:07]>> Lisa, do you have our office number if you need to call back in to talk to someone? Do you have our office number?

[00:38:12]>> 800 number?

[00:38:12]>> Yep.

[00:38:13]>> Yes. Your 800 number? Yes, I got it.

[00:38:15]>> Sounds good. Okay. Thank you, Lisa.

[00:38:18]>> Thank you.

[00:38:19]>> Take care. Bye. Bye.

[00:38:20]>> Bye.

[00:38:22]Okay. Uh, let's get to another caller.

[00:38:24]Panita in California. I feel like everyone's calling from California.

[00:38:28]Panita, are you there?

[00:38:30]>> Yes. Hello. I'm here.

[00:38:32]>> Hi. Welcome to Medicare School Daily.

[00:38:34]What's your questions?

[00:38:36]>> Thank you. Um, pleased to be here. So, I turned 65 later this year and I'm a breast cancer survivor and also have some autoimmune uh disease.

[00:38:47]>> Okay. So my question is in looking at uh what what is the best plan for my needs?

[00:38:53]Medicare original or Medicare Advantage?

[00:38:58]>> Sure. Uh I mean with what you've described so far for me it's going to be a very easy go with a supplemental plan if it fits your budget, right? I mean at the end of the day you are going to have a lot more access to providers. you're not going to have an insurance company saying, "Ah, we're not going to approve that service." Autoimmune diseases can be very, very tricky. You know, all the infusions and the flare-ups and things that happen um that kind of are unexpected and you're trying to get this provider to accept it or get approved.

[00:39:30]It can be very, very difficult sometimes when it comes to advantage plans because now you have a network, you've got pre-authorizations, you've got all that sort of stuff. So, a supplemental plan 10 times out of 10 as long as it fits your budget. Okay.

[00:39:46]>> And that's that's the original.

[00:39:48]>> That's original Medicare with a Medicare supplement. Yes. A metagap Medicare supplement. Those are both the same thing.

[00:39:54]>> Yep. So, then from there, you've got, you know, do I decide between a G plan and an N plan? And so, um, yeah, let me do this. Do you want me to run some just low just let me run a quick quote on what that is and then you can just that way you got it in your mind. Obviously you're not signing up right now for it but I can just at least give you a ballpark.

[00:40:15]>> Um and then your process are you on social security right now?

[00:40:20]>> Uh yes I am.

[00:40:22]>> Okay. So you are actually going to be receiving your Medicare card shortly. So So you're going to get that card mailed because you're on social security already. It'll show up in your mailbox.

[00:40:31]And when you get that, that's really kind of your green means go. It's time to figure out what coverage is going to make sense. Do you live with anyone over 50 in your house?

[00:40:43]>> Yes, my husband.

[00:40:45]>> Okay. Uh, is he on Medicare yet?

[00:40:49]>> Yes.

[00:40:50]>> Okay. Do you know what carrier he's with? Does he have a supplement plan?

[00:40:55]>> Uh, no. He has Advantage.

[00:40:57]>> Okay. Okay. Sounds good. So you kind of know how that works a little bit. So plan G probably in your neck of the woods for your age around $190.

[00:41:09]Plan N is about $40 cheaper. 150 155 and the rates may change a little bit between now and then. Let's just call it 150.

[00:41:21]So given everything >> what is the difference between these plans?

[00:41:25]>> Yeah. Yeah. Yeah. So, uh, a plan G. So, so let me start. So, for years there was something called a plan F. And a plan F was a full coverage plan. Meaning that once you paid your Medicare premium part, you know, B, and you had your plan F, it was 100% coverage. It didn't matter if you had cancer, you had a 16 car pile up, and you got, I mean, like everything went wrong in a year and you had a million dollars worth of bills, it was a full coverage plan, okay? They never have to pay anything other than your monthly premium. Okay. So, the next plan that became very popular because that was phased out back in 2020 for most people. Um, so the next plan down is called a G. And the G is almost like an F plan except you have a small deductible. A deductible is what you have to pay before the plan kicks in and pays anything, right? And so that deductible for 2026 is $283.

[00:42:20]So once you pay that $283, it's 100% coverage after that.

[00:42:26]>> Okay, so that kind of makes sense.

[00:42:29]>> So the next plan down is called a plan N. Okay, and these plans G is still the most popular. Um, but the next plan down, you know, in terms of coverage, and the next plan that's the most popular is a plan N. And so the differences, there's a couple differences. The first one is is you are going to when you go to the doctor, you're going to have a co-pay. Okay? So, you're going to have that that same $283 deductible, right? But you'll also um once you've met that, anytime you go see a doctor, there's a $20 up to a $20 co-pay.

[00:43:02]>> Okay?

[00:43:03]>> Secondly, if you go to the emergency room, there's a $50 co-pay.

[00:43:09]>> Okay? And then the third difference between a plan G and a plan N is that on a plan G there uh so there's this concept called Medicare assignment.

[00:43:19]Okay. And what Medicare assignment is and that's that's when a doctor and this this only relates to physicians. That's when a doctor says yes Medicare whatever you want to reimburse me that the assigned amount I'm going to accept that is payment in full. 95% of doctors accept what Medicare says they're going to pay as payment in full. There's about 5% of doctors who say that's not enough and so they can charge what's called an excess charge. And so a plan that can be up to 15% above, okay, the amount. So in that scenario, so let's say you add a $100 bill, a medic doctor that accepts assignment says, "Okay, I'll accept the $100, right? That's payment of full." A doctor that doesn't accept assignment, they can charge up to 15% more. The G plan pays that 15%. The N plan does not.

[00:44:10]>> What about international travel?

[00:44:12]>> Let's say you're gonna go to Brazil.

[00:44:14]Okay, you you're you're in Brazil.

[00:44:16]You're at Carnival and something happens and you go to the doctor's office or the hospital or the clinic or whatever it is and you pull out your red, white, and blue Medicare card, they aren't going to have any idea what that is. Yeah. It's like, okay, cool. That's a nice piece of colorful paper. They don't know what to do with that. So, whatever it happens is going to be on you to pay. Okay. Now, a Medicare just doesn't cover outside the country and you know like whatever the Virgin Islands and Guam and the the the territories. Um so, outside of the country, it's on you to pay. Now, a Medicare supplement plan, uh the way it works is they will reimburse you for up to $50,000 of expenses lifetime.

[00:45:01]So, if you had a $10,000 bill, first you're going to have a $250 international deductible and then it becomes an 8020 plan and they will spend I guess up to $2,000 in that case, right? Because it's going to be 8020 and over the life if you did it a lot of times, you know, if you you could use up to $50,000. So, what we tell people, you're traveling internationally, let's not rely on Medicare. Let's get travel health insurance. budget in budget it into the cost of your trip $2 $300, right? If you're gone for 10 days or whatever it is, and you will uh sleep much better every day.

[00:45:40]>> Got it. And then what about dental and vision on plan G?

[00:45:46]>> So, uh first off, Medicare, original Medicare, um along with your supplement plan has really good vision coverage, right? The only thing it really doesn't cover is your I need to go in get my annual eye exam and get new glasses and lenses, right? It's not preventive. It's not It doesn't cover that. But anything medically, glaucoma, I mean, just anything anything that's medically necessary, they're going to cover. Well, okay.

[00:46:13]>> Okay.

[00:46:14]>> Dental is not really like that. Dental, you're going to need to get something on your own uh that has some coverage. And we've got a lot of different options for that. I would budget $30 to $50 a month.

[00:46:29]It depends on how bad your teeth are or you know what what you expect to happen.

[00:46:34]You know, I need some crowns and all that sort of stuff. But it is important if you're coming off of dental coverage, which I'm assuming you have with your employer >> right now.

[00:46:45]>> Uh well, I'm not employed.

[00:46:47]>> Okay. Do you have dental coverage then?

[00:46:49]I'm sorry.

[00:46:49]>> I buy it privately. Yes. Yes, I do. I buy it. Oh, well then you already know how this works. Okay. Yeah. So, then you can probably just keep that if you like it.

[00:46:57]>> Yeah. If you just buy buy it privately.

[00:46:59]Yeah. Just there's not it's you're not going to get something that's like this is for Medicare. It's a it's a private dental plan.

[00:47:06]>> Um just like I I could buy the same plan like it's not there's nothing Medicare related.

[00:47:12]>> Thank you, sir.

[00:47:12]>> Okay. Well, hey, take care.

[00:47:14]>> Thank you.

[00:47:15]>> Bye-bye.

[00:47:17]>> My dad's going to be uh back with us uh tomorrow.

[00:47:22]and we will be talking about the topic is the ending the debate on plan G versus N. So he's going to go and get all the nitty-gritty details about how do you decide between plan G and N because it can be confusing.

[00:47:35]If you are retiring uh need to go on Medicare, maybe you are turning 65 and need to go on Medicare, we would love to help you. Uh our office is located in Kansas City, Missouri. So when you call in, you're going to talk to someone that's been trained personally by my dad and myself. Um, and you'll be able to talk through your situations, your medications, your doctors, your budget, your health situation, all of these things to make sure that the plan that you get is the plan that is right for you. And our promise here is this.

[00:48:04]Whenever you become a client of ours, you are not just another number, somebody that just fades off. And you can actually call in. You have a dedicated client care manager that knows your situation, knows your history, and is there for when life changes. So, if you move across town or across the country, if you uh lose your ID cards, if you have a billings issue or a claims issue, uh and you need assistance, we are going to be here for you. You don't have to call some faceless 800 number, be connected to someone on the other side of the world that doesn't speak your language. You can call us right here and we would be honored to help. If you need help uh with your financial planning, some of these things we talked about today about taxes, about planning, what's the right way to spend through um some or you know fund a retirement uh in a taxefficient manner that doesn't uh put you largely at risk. Uh here at Medicare.com, we do have a financial planning division led by Eric and he and his team would be honored to take a look, give you a second opinion on what you're doing to make sure that you can retire and maintain what he always says is like we want to make sure you don't run out of money and we want to make sure that you don't have to change your lifestyle cuz we all get accustomed to how we live, right? And the last thing we want to do is run out of money and then be forced to change our lifestyle.

[00:49:17]So, thank you for joining me today. Uh we would love to help you guys. We'll talk to you tomorrow.