Ready For Retirement
Ready For Retirement
Everything You Need to Know About Medicare: Q&A with a Medicare Expert
Drew Shockley of MOVE Health Partners joins James to address questions about Medicare. He overviews the Medicare system, explains Parts A, B, C, and D, and breaks down what Medicare does and doesn’t cover, who is covered, and when/why you might want alternative coverage.
Questions Answered:
I’m 65, still working and qualify for Medicare, but I have health coverage through my employer. What should I do?
Does Medicare provide good, reliable coverage?
Timestamps:
0:00 - Medicare overview
5:28 - About enrollment
9:49 - Part C, Advantage vs traditional
16:26 - Switching plans
19:26 - Plans F, G, etc.
22:56 - Plan D
26:11 - Dental and vision
28:25 - Fear about coverage
33:09 - Denied coverage?
35:19 - What Medicare doesn’t cover
37:24 - Other options
39:08 - MOVE Health Partners
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One of the things I hear most often from people thinking about retirement is what am I going to do for health insurance and navigating health insurance options, especially at different ages in retirement? It can feel like an insanely complicated maze, but it really doesn't have to. So today we're going to kick off a little mini-series all about health insurance in retirement. Part one, so today's episode we're going to talk about health insurance options for people over age 65, or 65 and over. In other words, we'll cover everything you need to know about Medicare. Next week we'll be talking about insurance options before age 65, for those of you retiring before Medicare age, and then part three of this so two weeks from now, we'll be talking about strategic planning opportunities for how your insurance coverage best fits into your overall plan.
Speaker 1:This is another episode of Ready for Retirement. I'm your host, james Canole, and I'm here to teach you how to get the most out of life with your money. And now on to the episode. Joining me today we have Drew Shockley. Drew is a certified Medicare insurance planner. He's a co-founder of Move Health Partners, which is one of the nation's premier health insurance firms dedicated to working with forward-thinking advisors and retirees all over the US. Drew, thanks for joining me. Glad to be here. James, thanks so much, absolutely Well, this is one of the maybe the most confusing pieces of retirement of what am I going to do, or maybe not the most confusing, but at least the most overwhelming.
Speaker 1:You're approaching 65. You're no doubt getting letters, mailings, just all these these things telling you here's what you should be doing, and it can be quite overwhelming. So, to start, I would love if you could unpack just what is medicare. We hear these a, b, c, d, l, m, n, o, p's. If you could walk through that and who it's designed for, that'd be a great place to start, and then we'll go from there would love to and, uh, you, you are correct.
Speaker 2:I mean if, uh, you know, I mean if you're an American, one of the millions of people that are approaching age 65, it's amazing, somehow everybody finds your phone number and your address and they send you every piece of mail, literature and you get every ad fed on every social media platform ever about Medicare. And it's hard to navigate, especially for most people, because half of the US population has health insurance through their employer. And if you're out there listening and you've always had health insurance through your employer for 20, 30, 40 years, this is the first time that you're having to kind of navigate a transition away and it's confusing and it's complex and sure, there, you know, know, there are a lot of different options, but there are also some really important things that you want to avoid too, and so that's our goal today. We're gonna try to keep a high level and walk you through that and give you what you need to know to make that next step confidently.
Speaker 2:When we talk about Medicare, james, there there are many parts to it. The two main parts of Medicare are part a in Part B. Part Part A is an Apple. It's actually for hospital insurance as long as you work for 10 years or 40 quarters, then you qualify for Medicare Part A and it has no premium cost to it. So working for 10 years, 40 quarters and paying into it, you get Medicare Part A. That's the hospital benefit. Medicare Part B, as in boy, is the medical part. That's where doctors, outpatients, specialists, testing labs, things like that. They all fall under Medicare Part B. At the time of this recording, the cost for Medicare Part B is about $174 a month for most husbands and wives that are making less than $100,000 a year. But you could actually end up spending a lot more for that too if you have some income-related adjustments.
Speaker 2:But the two main parts of Medicare A and B A is for hospital, b is for doctors and outpatients. A lot of people hear about Medicare Part C. That's actually a separate private insurance plan called a Medicare Advantage, which we're gonna talk a little bit more about later. That kind of combines your hospital and doctor into one plan and you get it through a private insurance company. And then Part D is really really easy to understand. Part D is in drug prescription drug. Part D is for prescription medications and you have insurance companies that offer Part D plans. Medicare itself doesn't offer any help for retail prescriptions that you get at a pharmacy. So that's a brief explanation of A, b, c and D. Hopefully that makes sense.
Speaker 1:James, yeah, it does, and I think what if that person so some detailed follow-ups on that? So say, I'm 65, but my spouse has stayed home and she raised the kids and she doesn't have 40 quarters of work, what does Medicare Part?
Speaker 2:A look like for her? That's a great question. So that happens actually often. You know, especially with this generation there were a lot of spouses who stayed at home and did not work and pay into the program. As long as you're married to someone that paid in for 10 years or 40 quarters and that qualifying spouse is 62 years old, then that spouse that is 65 at that age would qualify for Medicare A premium free and qualify to enroll in Medicare Part B with their standard monthly premium. So that actually comes up a lot and we see that and we help people navigate through that situation. So if you didn't work, as long as you're married to someone that's worked 10 years or 40 quarters and they're at the minimum age of 62, then you can enroll in Medicare when you become eligible at 65.
Speaker 1:Yeah, great. I think a lot of people who have listened to this podcast for some time they'll hear we'll talk about ERMA surcharges, and planning points to, if you're doing things like Roth conversions or things with your portfolio, how do you avoid ERMA surcharges as possible? That's the part B and part D premiums that you were talking about, and then A. You're not technically paying a premium, as you mentioned, but you did pay for it over the course of your working career through that. Okay. So, drew, this also kind of corresponds. You don't have to be on Medicare and Social Security. They're not the same thing, but they kind of coincide in terms of a similar age when you're eligible for both. Do you have to enroll in Social Security to be eligible for Medicare?
Speaker 2:You don't have to be in Social Security to be eligible for Medicare. You don't have to be in Social Security to be eligible for Medicare. In fact, a lot of people do end up deferring it. A lot of people in today's age. They're continuing to work and you know they may still have a job and a salary and they're working for a company, but they're 65 years old and they want to leverage Medicare A and B. You can do that. You can enroll in Medicare Part A and Medicare Part B and then you can choose all of your other options along with that. But you can defer your Social Security income to a later time. So you know Social Security and Medicare are two different things but they do collaborate and kind of coincide in most cases If you are under 65 and you are on disability, you've been injured, hurt or you're no longer able to work.
Speaker 2:If you're on Social Security and you have been for 24 months, then you would become eligible for Medicare at an earlier age. I've watched this over the past 19 years that I've been working with people on the Medicare side. It is not uncommon for someone to be hurt or injured or not able to do their job and qualify for Social Security and after a 24-month period then you would qualify to utilize Medicare Part A and Medicare Part B and have to make a choice after that. So you can defer Social Security at a later time if you're 65 or older and you don't have to be on both to utilize Medicare.
Speaker 1:Now what about those individuals or those couples that they've turned 65, but they still have insurance benefits through their workplace? Is there anything they need to do with Medicare at age 65, with any of the parts, or is that something they fully defer until they switch over?
Speaker 2:65 that are qualifying for Medicare and they're getting all the literature and notice you know notices in the mail and all of that and they're trying to decide should I utilize Medicare for myself or for my spouse. I'd say generally in most cases you should talk to a professional about that. You should actually review your options to see if you should make that transition. Most of the time, even if you're working at a large employer that has really great benefits, you might be better off to move into Medicare A and B and actually look at your additional options alongside of that, as opposed to staying on a company plan. A lot of times the costs go up for a company employer-sponsored plan when you're over that Medicare age and sometimes, depending upon the size of the company, they could require you to enroll in Medicare A and B. So it's something that you should definitely check into if you're approaching that age and you should talk to a professional and do some research to determine whether you should use it or defer it to a later date.
Speaker 1:So definitely a planning thing. It's not a universal. You have to use it after 65 or you should use it, but it just depends upon what your other options are. Is there any part of Medicare that you just automatically are covered by, or is everything need to be an intentional act that you're enrolling in?
Speaker 2:If you've worked 10 years or 40 quarters, you automatically become eligible for Medicare Part A at 65. And most people can be automatically enrolled. However, not everyone is automatically enrolled. But if you've worked 10 years or 40 quarters, medicare Part A is the hospital portion and you qualify that premium-free. If you're still working and you plan to continue working and you have benefits through your job and that company does not require you to enroll in Medicare, you may decide to defer Medicare Part B, which is the medical part, that's the doctor and outpatient-rays, you know, labs, things like that. You may decide to defer Medicare Part B. However you should. You know, you should review that We've found in many, many, many cases that if someone is 65 or older and they're eligible for Medicare A and B, a lot of times they find their cost being significantly lower and their out-of-pocket risk and exposure for being on Medicare and a plan that works alongside of Medicare being significantly lower than what they see through their employer plan.
Speaker 2:So, it's not a you know it's not a uniform decision. You know you should review your options if you are eligible or if your spouse is becoming eligible. If your spouse is 65, but you're going to continue to work, it might be a really great idea to peel them off, put them onto Medicare A and B and then choose a plan that works alongside of Medicare to put them in a better spot than through your employer plan.
Speaker 1:Yeah, got it, let's go to. So you mentioned part C. Let's talk about Medicare Advantage versus the original Medicare plus traditional Medicare, supplement and drug plan. A lot of conversation around this. Can you just explain what the difference is here, what the deal here is and kind of what the debate is all about?
Speaker 2:Sure this is. You know this is definitely a big debate. You know we get asked the question all the time hey, what's the right option? What's the better option? Should I go Medicare Advantage or should I go traditional Medicare supplement? And it really just depends on your situation. You know, medicare the actual Medicare program, started in 1965. Neither you or I were here, but they put that program together and that's the federal, you know, healthcare program that provides coverage for hospital, doctor, etc.
Speaker 2:In 2006, the federal government actually came out with something called a Medicare Advantage Plan. Up until that point you just could enroll in Medicare A and B and Medicare was always your primary. And then you went out and bought a supplement through an insurance company and that insurance company would serve as the secondary coverage. But starting in 2006, we had the development of the Medicare Advantage Program. And the Medicare Advantage Program is a collaboration between insurance companies and the federal government. And so if you choose a Medicare Advantage plan, what most people don't realize is that you're enrolling in a plan with an insurance company and they're becoming your primary insurance. So pick a number, you know, pick a name of any major insurance company that you know If they offer a Medicare Advantage plan and you choose that they're becoming your primary insurance. They're taking over for Medicare. Now they have a contract for them. You know, with them you still have to be enrolled in Medicare A and B. But it doesn't work like that. When you go to the doctor, you don't give them your card for Medicare, you give them your Medicare Advantage card, and so the biggest difference between a Medicare Advantage and a traditional Medicare supplement is that with a Medicare Advantage, you're choosing an insurance company to be your primary and with a Medicare supplement, you're choosing to allow Medicare to be your primary and then the supplement plan to come in as a secondary coverage.
Speaker 2:There's no right or wrong answer. It depends on the situation. If you look at the state, there's a lot of data out there. We love the Kaiser Family Foundation, kfforg. They're a nonprofit organization that provides a lot of healthcare data and statistics. You can go there and you can look at the different percentages of people that are on Medicare Advantage and Medicare Supplement, dependent upon state. Some states have had pretty high adoption of Medicare Advantage and the plans are well developed there and the networks of doctors and hospitals are well developed. In other states we've had a much lower adoption rate. So both options are worth considering, but they do work very different.
Speaker 1:Yeah, as you're looking at it, which is right for people and I know that's a hard thing to say because there's so much to depend on or so much does depend upon but is there one that covers more, or one that you say tends to be the right option for more people?
Speaker 2:Yeah, option for more people. Yeah, that's you know. When we're talking about Medicare Advantage and Medicare Supplement, they're really two different vehicles for getting to the same destination. With a traditional Medicare Supplement, generally you pay more per month. So you'd be on Medicare A and B, paying your standard premium there, and then a Medicare Supplement, depending upon your age and your state, could range anywhere from maybe $1,200 a year up to maybe $2,500 a year, depending upon your age and your state that you live in.
Speaker 2:And with that option, you know, medicare is your primary, the supplement plan is your secondary, kind of when you lay your head down at night, you don't really have to worry about out-of-pocket cost or exposure. You're not paying. When you go to the doctor, you're not paying co-pays or doing cost share or anything like that. If you go to the hospital you're not having these large out-of-pocket bills. That's what most people have enjoyed as their option through an employer and through traditional Medicare supplement for many years. The difference in a Medicare Advantage plan is that with a Medicare Advantage plan, costs are a little bit lower and in some places Medicare Advantage plans have no monthly premium. As long as you're enrolled in Medicare A and B, you're choosing that.
Speaker 2:Having labs, going to the hospital, you know, going into, you know, rehab or any type of facility, having an MRI, cat scan.
Speaker 2:You're paying out-of-pocket, you're paying as you go and most Medicare Advantage plans depending upon the state, you could have an out-of-pocket risk or exposure on an annual basis between $3,000 and $6,000, and in some cases more. So it's really kind of dependent upon the type of person that you have. If the type of client that you're working with, if you're more apt to spend a little bit more to have that comfort when you lay your head down at night, you don't have these potential big medical bills, you know, laying out over the top of your head, then you might need to go with a traditional Medicare supplement option If you want to, you know, take the Medicare Advantage route. You could save money on an annual basis from premiums and cost, but you may risk a higher exposure if you were to get sick or utilize that plan on an ongoing basis. So it's really the tale of risk and that really depended upon the person. So there's no right or wrong answer. It's dependent upon the appetite of the client and the type of personality they are similar to investing.
Speaker 1:Yeah, out of curiosity, drew, assume you turn 65 next month. Where do you choose in?
Speaker 2:That's a great question. I love that question actually because a lot of times clients ask that want to know you know what are you going to do. It helps them, you know, with a lot of comfort. Obviously I'm not 65 today I am approaching it here in quite a while, but I'm not 65 today. But if I would be, I would choose the traditional Medicare supplement option. The traditional Medicare supplement option utilizes Medicare as your primary vehicle for hospital and doctor coverage and then you choose an insurance company to be that secondary and so that gives me the comfort at night. You know I can spend a little bit more on an annual basis from a premium perspective, but if I'm having to utilize it I'm not paying out of pocket. I'm not second guessing if I'm going to go get a second opinion or if I want to have another procedure or testing labs, whatever I'm going to go, do it because I have the comfort of knowing that I have a Medicare and a Medicare supplement, you know, backing it up.
Speaker 1:Now, what about those people that? Because it can seem like a daunting decision, what do I do? There's people on both sides saying it's better. What if, for example, someone were to get started with but they later want to switch over to that Medicare supplement type plan? Is that something people can do?
Speaker 2:There are a lot of nuances when changing from a Medicare Advantage to a Medicare supplement plan. You truly only have one opportunity to enroll in a Medicare supplement plan without being asked any questions. I think everyone is familiar with underwriting. What insurance companies do from an underwriting perspective they ask you questions and determine if you're eligible or not. Well, with a traditional Medicare supplement, if you are enrolling into Medicare A and B or you're turning 65, in most cases you can enroll in a traditional Medicare supplement with no questions asked. You kind of have this open enrollment or this guaranteed issue period where they don't ask any questions. If you're outside of that, if you're 68 or you're 69 or you're 70 or 75 and you've been on a Medicare Advantage for a while and you're like, hey, I think I want to switch back to a traditional Medicare supplement, you can do that. However, the insurance company may be able to put you through an underwriting process. They may be able to put you through an application and determine whether you're eligible for a traditional Medicare supplement or not, based on your medical history. So my advice to those of you listening if you're approaching 65, make sure you're speaking with somebody that you trust and that you know a professional that can help you navigate the differences between a traditional Medicare supplement and a Medicare Advantage and determine what's right for you. Because when you turn 65, you may only have that one shot to enroll without any questions asked, and if you want to change later away from a Medicare Advantage, you may not be able to do so.
Speaker 2:But don't you know, don't hear me wrong Medicare Advantage plans are. You know they are. There are a ton of options when it comes to Medicare Advantage and you can switch freely from a Medicare Advantage plan to another Medicare Advantage plan in the annual enrollment period. Medicare has a time period every year between October the 15th and December the 7th, and if you're on a Medicare Advantage plan and you have other Medicare Advantage plans available in your area, you can speak to an agent and you can switch for that next plan year. So you know, at the time of this recording it's 2024. You know we you have this fall open enrollment season coming up to pick a plan for 2025. Go through it, check your doctors, check your prescriptions. You know, check your hospitals. Networks change, things like that can change and you may need to make a move to a different Medicare Advantage plan.
Speaker 1:So it's going to depend upon the person, obviously. I think it sounds like your preference, at least for Drew, if Drew was going through this as an individual, not just as a consultant would be towards that traditional supplement plan as opposed to Advantage. Can we jump into that more? Can you give a brief explanation of what that plan might look like or some examples of that?
Speaker 2:explanation of what that plan might look like or some examples of that Sure. So, to keep with the theme of letters, traditional Medicare supplements actually utilize letters as well. You've heard maybe over the years if you've ever helped your parents or anybody else that has walked through this. A very common Medicare supplement plan is Plan F. As in Frank, plan F was a great plan. It had all the bells and whistles. It paid all of the Medicare hospital deductibles, all the doctor deductibles, and literally, with Medicare as your primary and Plan F as your secondary, you could have no out-of-pocket for Medicare-covered expenses.
Speaker 2:But today, for most people that are becoming eligible for Medicare after 2020, the most popular and most common traditional Medicare supplement is Plan G. As in George, we love Plan G. Plan G is good, g for good. Plan G is awesome. It provides a lot of the bells and whistles that Medicare supplement Plan F did, with the exception of one. You would just have to pay your Part B deductible, which is a very minimal amount. That's the doctor side. After that, we love traditional Medicare Supplement Plan G. Again, in most cases, if you're 65 years old, you can get Medicare Supplement Plan G for around $100 a month Right now. If you're turning 65, in some states it's a little bit more and if you're older than 65, it's going to's. You know it's going to be a little bit more than that based on age. But we love traditional Medicare supplement plans. They've been around forever.
Speaker 2:Medicare has the primary, you know, as the primary coverage. That Medicare supplement plan is just your secondary. So when you're going out and utilizing doctors and hospitals you just have to be concerned hey, do you take Medicare? You just have to ask that question and you will find predominantly almost every place across the country is going to say yes. You know, we have such a large percentage of our population on Medicare. If you're in any type of medical practice where you're seeing people in you know 60s and 70s and 80s, you're seeing a lot of Medicare patients.
Speaker 2:99% of people that are coming through your door have Medicare. And so you know, with people that have traditional Medicare supplements we don't really run into issues with you know doctors or hospitals or you know, really billing issues or anything like that, because those plans were designed to collaborate exactly with Medicare. So there are a number of carriers across the country you can consider. You know, really depend upon your state, but the plan options are the same from carrier to carrier. So plan G is plan G. It doesn't matter whether you're with insurance agent. You know insurance company number one or insurance company number two, plan G is plan G. That's a great question.
Speaker 1:I know Plan G is very popular and quite a number of people end up with Plan G. Who is it not right for?
Speaker 2:Well, assuming that you are eligible to enroll in Plan G, that would be the recommendation that I would have for a lot of people. My mom turned 65 about five years ago and I enrolled her into Medicare supplement plan G with an insurance company that there was. There was a great fit for her. Some people may not be eligible for plan G. Some people may be on a Medicare Advantage plan. They may have developed, you know, a condition or something like that that would prevent them from enrolling into a traditional Medicare supplement. However, if you're turning 65, everyone that's listening and approaching 65 should consider traditional Medicare supplement. However, if you're turning 65, everyone that's listening and approaching 65 should consider traditional Medicare supplement plan G and compare that to. You know another Medicare Advantage option that you may look at compared to a traditional Medicare supplement.
Speaker 1:Got it, let's go. You mentioned plan D and this one's maybe the easiest to remember. This covers prescription drugs. What if someone listening doesn't take prescriptions? Should they still enroll in a drug plan, and how do those plans work?
Speaker 2:A lot of questions when it comes to Medicare Part D, as in drugs. So just to recap, medicare itself doesn't really provide much benefit for retail prescription medications. So think about this If you're going to a pharmacy to pick them up, you should enroll in a Medicare Part D prescription drug plan. Medicare does provide coverage for prescriptions if you're in an inpatient facility and there are some prescriptions and immunizations and types of treatment that are covered under Medicare Part B. But when you're talking about like a regular retail medication that you might take on a monthly basis, when you're talking about like a regular retail medication that you might take on a monthly basis, you know Medicare itself may not provide any benefits for that. So if you do take medications, you should enroll in a Medicare Part D drug plan, and if you don't take medications, we recommend that you enroll in a Medicare Part D drug plan. And there's a couple reasons why you would want to do that.
Speaker 2:First of all, you only have certain windows when you can actually apply for and enroll in a Medicare Part D drug plan. You can do it three months before you turn 65, the month of, and you can do it three months after. If you miss that window, then you have to wait till the annual enrollment period, which is that October the 15th, through December, the 7th window. If you miss that for that upcoming annual year plan year, then you would not be eligible to enroll in a drug plan at any time throughout that year. You may miss that window unless you qualify for a special enrollment period or some other things that could change, but most people would miss that window and you would be without drug coverage for an entire year.
Speaker 2:If you do go without drug coverage and you want to enroll in a prescription drug plan later, you could be subject to a penalty. The federal government or Medicare program has installed a penalty for people that do not enroll in a prescription plan and wait until a later date, and that's another reason why you would want to enroll in a drug plan today. You don't want to be in that window and need drug coverage and then you don't want to be subject to the penalty later on. And how?
Speaker 1:costly? Is it the Part D part of Medicare?
Speaker 2:Most Medicare prescription drug plans have a very minimal cost. You can find plans throughout the country that can be less than $20 a month in many, many cases. The penalty is something that, can you know, can increase over the years. It's going to be 1% for every month that you were eligible for a drug plan and not enrolled. So if someone went, you know one, two, three years, 36% penalty on top of the average drug plan cost, and then that penalty would stick with that person for the entirety of their life. It doesn't go away. So you know, drug plans are very inexpensive. Most cases you can find one for less than 20 bucks a month in every state. So you should consider a drug plan at all times when you become eligible and try not to go without. So you're in a window, not necessarily just for the penalty but for a fact that if you need prescription medications, you're not having to pay those out of pocket by yourself.
Speaker 1:Yeah, Off topic a little bit, but where does dental vision, the kind of those types of coverages people have through their employer typically and then they go into Medicare? To what extent is that something that Medicare also helps with?
Speaker 2:Sure. So if you go back to earlier in the video, we were talking about Medicare Part A, that's hospital Medicare. Part B is doctor Medicare. Part C is the Medicare Advantage plan and then Medicare Part D are prescription drug plans. So C comes through insurance companies and D comes through insurance companies as well. So Medicare itself doesn't provide any benefits for going to get your teeth cleaned or going to have a cavity filled. There are some medical situations where there could be some help there, but the vast majority of cases Medicare does not help in any way.
Speaker 2:Shape or form for dental coverage. Same when it comes to vision. Really, I mean, if you're going surgically to repair some cataracts or some other things like that medically that you have going on with your eyes, then that will be a part of the Medicare Part A or Part B. But if you're just going for a regular eye exam, then you're going to be on your own for that.
Speaker 2:So many people that we work with and that I've watched over the past almost 20 years, they would purchase separate insurance plans when it comes to dental and vision if that helped them, if they were in need of those types of you know products and there are a ton of options through insurance companies that you know that are, you know, very high quality, very good, give you access to doctor. You know good eye doctor networks and good dental networks and things like that. So you should consider that you know with a professional you know and make sure that you know you don't leave yourself in a gap there where you don't have coverage that you're used to, and that's entirely separate from Medicare.
Speaker 1:That's not part of any Part C, part D, anything else like that, even through insurance companies.
Speaker 2:You can find some Medicare Advantage plans that's the Part C again. Those are through, you know, insurance companies. There are many Medicare Advantage plans that provide some benefits for dental and many Medicare Advantage plans that provide some benefits for vision. However, it's not a part of just the traditional original Medicare program Part A and Part B. So if that's what you, if you're on Medicare A and B and you're not a part of a Medicare Advantage program and you want dental and vision coverage, you'll need to purchase that separately.
Speaker 1:Yeah, Okay, very good. There's a lot of myths, misconceptions, misunderstandings about Medicare. I think the biggest one, the biggest thing people want to know is will Medicare actually provide the coverage I need? How often are you seeing people really aren't getting the coverage that they're hoping to get when they're involved?
Speaker 2:Yeah, it's rare, james. I think there's a general fear about approaching Medicare, especially for the millions of Americans that have had coverage through their job. They're like, hey, I've had coverage through my employer and I had this, I had a baby or I had a heart attack or I had a stroke or I had all these, these things and my employer plan was great, it helped me, it paid for my hospital bills, et cetera. You know, am I going to? Is that going to happen when I go to Medicare? And I think there's just a general fear when they're approaching that.
Speaker 2:You know Medicare federal government program been around since 1965, covering millions and millions and millions of Americans. There aren't really any like gotchas that I can tell you about here. You know any type of, you know any type of condition that you can think of will likely be covered by the Medicare program and will also be helped. You know, if you're in a traditional Medicare supplement plan, you know we've had some situations where people you know were doing kind of exploratory back surgeries that were not approved, you know, by the federal government and doing you know where. These places said, hey, we don't take Medicare and they're not a part of you know, we're not a part of the Medicare network, etc. And that's because they were doing procedures that were not, you know, approved. They were exploratory kind of test trial type stuff approved. They were exploratory kind of test trial type stuff. When it comes to you know the things that you would be concerned about. You know the cancers, the heart attacks, the strokes, you know the injuries, accidents, those types of things I could tell you you confidently should trust the Medicare program and know that it's going to provide you with those things.
Speaker 2:Now, a lot of people that we see that are transitioning into Medicare. You know they're, you know, concerned about you know, doctors and hospitals. I would say if you are choosing a Medicare Advantage plan, you need to be really cautious about this, because every Medicare Advantage plan remember the Part C, medicare Advantage plans do have their own specific doctor networks from insurance company to insurance company. So if you choose a Medicare Advantage, you're no longer utilizing Medicare as your primary. So you don't go to the doctor and say, hey, do you take Medicare that is off the table? You take your Medicare card, you put it in a drawer, you don't even use it. You use your Medicare Advantage plan and that carrier will determine the doctors and hospitals that you can go to, just like you have had through your employer plan for many, many years.
Speaker 1:When people, as you've said, there are millions and millions of people in Medicare, there are naturally going to be some of those millions and millions of people that have had bad experiences. Is that due to choosing the wrong plan from the get-go? Is that due to some random one-off thing that does happen that maybe isn't super common? Is that due to something entirely different?
Speaker 2:I think that a lot of the concerns that you see these days have to do with people that are enrolling in Medicare Advantage plans and don't understand what they're enrolling into.
Speaker 2:If you're again, if you're enrolling in a Medicare Advantage plan, you're choosing to receive all of your benefits through that insurance company. So you have to make sure that you're going to a doctor. That's within that plan. A lot of Medicare Advantage plans are HMO plans so you have to stay specifically in that network and if you go outside of that network they're not going to provide any coverage to you. So, people you know, a lot of the situations that we see are when people enroll in Medicare Advantage plans. They don't understand what they're getting into and then they see well, I can't go to this doctor or that doctor, that doctor, or I can't go to this hospital. Or you know, they told me I had a limit to the number of things that I could do this, this and this. So a lot of those things you know again can be attributed to just just, you know, a lot of clients enrolling into a plan that they don't fully understand.
Speaker 2:This is one of the reasons why I prefer the traditional Medicare supplement route with you know traditional Medicare, supplement Medicare being primary networks, you know are less of an issue. You have a supplement plan that just kind of comes right alongside it. You're not paying, you know a lot of co-pays or bills out of pocket. You're not having this pay-as-you-go type mentality and that's why I would prefer the traditional option. For a lot of people, especially in that mid to higher net worth, you know situation, you know it just puts them in a spot where when they lay their head down at night, you know they're not worried about you know this. You know multiple bills and managing this whole process coming from, you know, coming from providers when they're utilizing coverage. But that's a great question.
Speaker 1:You mentioned. I know that okay, if you start on an advantage plan, there may be some underwriting. There will be some underwriting requirements if you later want to switch over to a traditional Medicare plan. Can you ever be just straight up kicked off of a plan or denied coverage because of some condition that shows up?
Speaker 2:No, so Medicare itself doesn't kick people off unless you don't pay your premiums, that's it. So if you're drawing Social Security, then your Medicare premium should be automatically deducted from Social Security. That's not always the case, but if you're drawing Social Security income, I would recommend just making sure that your Medicare premium is automatically deducted out of your Social Security Part B, specifically Part B and D, which of those would be deducted?
Speaker 2:You can do both, but the most common is Medicare Part B, that's the doctor and outpatient procedures. You know, if you get a drug plan through an insurance company, uh, you can choose to have that part D plan deducted from your social security as well, um, however, uh, it's not as common as as Medicare part B, as in boy, um, so you know, recommend doing that. So Medicare is not going to kick you off. You get sick? Uh, you know, they're only going to kick you off if you stop paying your premiums. Um, and same thing when it comes to you know, when it comes to insurance companies, they're not going to kick you off for getting sick.
Speaker 2:It's just a matter of you making sure to keep your insurance premiums up. So I recommend, you know, talking to you know, if you have a, you know an adult child. You know a son or a daughter, you know that's younger than you. Make sure that they're aware if something were to happen to you, if you were to get sick or something were to occur, that they know what you need to pay. Or even just you know, talk to your financial advisor, making sure that they're aware so that they can communicate it to you when you're doing those types of plannings, especially when you get into your later years, you know, just make sure that you keep those premiums paid because, as you mentioned earlier and as we've talked about in the video, many people can get into a spot where you know they may not have the same options to supplement their Medicare at 75 that they do at 65. You just have this window where you have an important decision to make and you should review that with a professional and making sure that you're choosing the right one for your situation.
Speaker 1:Yeah, Now as we start to wrap up, is there anything Medicare does not cover that anyone listening should be concerned about.
Speaker 2:Yeah, we talked earlier in the video about, you know, dental and vision and those types of things. Those are a lot of common. You know situations that people come up with to say, hey, well, what's Medicare going to do? Can I get my teeth cleaned? Well, that's not going to be a part of the Medicare program, right? So part A is hospital, part B is doctor. The biggest one that we hear from James is talking about, you know, really long-term care and those types of expenses.
Speaker 2:Medicare does have some benefits If you're hurt or injured or you've got a qualifying, you know, hospital stay prior to and you're moving in to, you know, to a facility. Medicare has some limitations when it comes there. So a lot of people you know will have up to 20 days in a skilled nursing facility and if you have a Medicare, medicare supplement plan, you can have up to 100 days in a skilled nursing facility period. You know people get to that 101st day and all of a sudden the bills are, you know, $200, $300, $400 a month for the facility or a day, excuse me, $200, $300, $400 a day for the facility, and you know people are caught off guard by that. So make sure you've got a plan in place. Make sure that you know your financial advisor understands what this is, your risk, your exposure, and make sure your kids understand that as well if you're getting into that situation.
Speaker 2:Very happened to my grandfather. I was a teenager at the time and I didn't understand it, but now, looking back in that situation, I know what happens. You know when that type of situation occurs. So skilled care, you know, in-home care, those types of things just be ready and be able and be prepared to make plans and arrangements for that.
Speaker 1:We've discussed this whole concept of Medicare obviously is okay. You turn 65, you become eligible, unless, of course, you've been disabled for a certain number of time and then you're eligible earlier. Setting aside the fact that, obviously, if you continue to work past 65, you can still stay on your employer's coverage if it makes sense to do so in terms of coverage and cost, Is there any option for those that aren't covered by their employer and they're over 65? Are there options outside of Medicare that should be considered?
Speaker 2:The options are very limited. We deal with this situation often because many times there are people that move to the US that were, say, non-us citizens. They haven't worked for 10 years or 40 quarters to qualify for Medicare and the options are limited. Most insurance companies don't offer plans for people over 65 that are not eligible for Medicare. It's really really limited for Medicare, you know, it's really really limited.
Speaker 2:So if you maybe you're watching this and maybe you're not, you know, not living in the US today, but you want to come to the US and you're trying to figure out about Medicare, you can actually buy into the Medicare program. So you know, most people you know worked for 10 years or 40 quarters or they're married to someone that worked for 10 years or 40 quarters over their working life and they qualify for Medicare at 65 or earlier if they're heard or disabled. But if you didn't have that and you didn't pay in, you know, maybe you know just moved here, you know you can buy into the Medicare program and then that would give you the ability to purchase a Medicare supplement or to also enroll in a Medicare Advantage plan to help those types of things. But as far as alternatives outside of it after 65,. If you're not working, they're very, very limited.
Speaker 1:A whole bunch. Okay, very good, we covered a good amount. We'll start to wrap just for the sake of time. I think there's only so much Medicare people can handle at once. But, drew, for those people that are looking for more information, how can they learn more about you?
Speaker 2:How can they learn more about Move Health Partners? Can you speak to that? Absolutely so. Move Health Partners is one of the nation's premier, you know, health insurance and Medicare agencies. We have a team of people here, licensed agents, licensed in most states across the country that can help you analyze, compare contrast and actually complete the enrollment, and we can do that with every major insurance company in most states. You know you can find us, movehealthpartnerscom. You can find all of our information there.
Speaker 2:We, you know, have a team that is dedicated to working with people in this situation. We're going to talk more, I think, in some of your later episodes. We're going to talk about, you know, if you're not eligible for Medicare yet, what should you do and we're going to talk about that and how to do some planning. You can retire and you can leave an employer plan and find your own insurance and it might be more affordable than what you think, and our team does that as well. So I think we're super unique when it comes to that and you know we have. You know we have people that you know have had health insurance with their employer forever and they didn't even know that they could purchase insurance on their own and leave and make it affordable, and they didn't know how to transition to Medicare, and so our team is doing that every single day and we love just celebrating those wins and getting people to the spot that they want to be in to, you know, in their next phase of life.
Speaker 1:Yeah, well, drew, I appreciate you making the time and, just as a teaser for that next week's episode, yeah, we are going to be talking about what are your options if you retire before 65. And what? What strikes me is so many people say I cannot retire yet because where? What will I do for health insurance? And yes, it's going to be a cost, yes, it's something that you need to have, but I think it's far more daunting and far more out of reach in people's minds than it actually is in reality. So, starting to come up with just an overview, like we did today, but for free, medicare options, stay tuned. If you're listening for next week's episode, we'll do that same thing. So, drew, thank you very much for your time. We're going to include a link to your website resources in the show notes for today's episode, but just appreciate you coming on and helping to educate us all about Medicare.
Speaker 2:Absolutely Glad to be here. Thanks a lot, all right.
Speaker 1:Take care everyone, hey everyone. It's me again for the disclaimer. Please be smart about this. Before doing anything, please be sure to consult with your tax planner or financial planner. Nothing in this podcast should be construed as investment, tax, legal or other financial advice. It is for informational purposes only. Thank you for listening to another episode of the Ready for Retirement podcast. If you want to see how Root Financial can help you implement the techniques I discussed in this podcast, then go to rootfinancialpartnerscom and click start here, where you can schedule a call with one of our advisors. We work with clients all over the country and we love the opportunity to speak with you about your goals and how we might be able to help. And please remember, nothing we discuss in this podcast is intended to serve as advice. You should always consult a financial, legal or tax professional who's familiar with your unique circumstances before making any financial decisions. We'll see you next time.
