Changes in Medicare Coming Transcript

Speaker 1  00:00

No need to lose sleep over planning your Medicare coverage. Lisa Lauro and the team at Secure Money Health want you to get the best, most customized service when planning your Medicare coverage. In fact, Lisa wants to share her new book with you, The Ultimate Medicare Book. It’ll help you choose the right plan, understand your benefits and avoid common pitfalls. Go to mymedicarebook.com. That’s mymedicarebook.com. It’s time to secure all your health care needs, and we will really simplify the process. Welcome to Secure Health with Lisa Lauro.

 

Steve Sedahl  00:46

Hey, welcome in, everybody. This is Secure Money Health Radio. It’s where Medicare matters, with Lisa Lauro. Lisa, of course, she’s president of Secure Money Health; works in conjunction with Secure Money Advisors and the good folks at Secure Money Advisors, Brian Quaranta, just talking about the big guy himself. Yeah, We’ll get to see him again, soon, yeah, hopefully he’s a busy dude. Anyway. Hi, Lisa, how are you?

 

Lisa Lauro  01:07

I am well, how are you doing this morning?

 

Steve Sedahl  01:10

Very, very well. Feels like summer, huh? Yeah, got sone thunder and lightning. And, you know.

 

Lisa Lauro  01:15

Yes, yes, it’s going up to 84 here today, which we’re thrilled about. And we’ve had some, some, some storms come through, but yesterday was a nice day as well. So I’m, I’m hopeful.

 

Steve Sedahl  01:29

Me too. I’m feeling good. So Medicare, you know, this is this constant changing world in Medicare, as you’re well aware, and so, we went through and found there’s some changes coming up next year, and some of them significant, some of them not really significant, but we thought it would be worth mentioning.

 

Lisa Lauro  01:47

Yeah, absolutely. I think, you know, the more up to date we are with everything, the better off we all are, because we need to know what’s coming, right?

 

Steve Sedahl  01:55

Yes, of course. So, with Part D, that’s our, you know, there’s an increase, a slight increase in Part D out of pocket cap. What does that mean? What? That doesn’t seem to be that big…

 

Lisa Lauro  02:05

So Part D? It doesn’t seem like too big of a deal, right? So Part D is your prescription drug plan, and for 2025 as part of the Inflation Reduction Act, all medications are capped at $2,000 so long as they’re on the formulary. Okay? And so, so, so when, when choosing a prescription drug plan, you want to be sure that you obviously choose a plan, that all of your drugs are on the formulary and covered, so that you can, if need be, if you have some that are expensive, they’re going to be capped at 2,000 and so what this means here, and what’s changing for next year is that now, instead of the cap being at 2,000 it’s now at 2,100 so folks are going to have to spend an extra $100 on medications to Meet that $2,100 cap.

 

Steve Sedahl  03:00

Well, I’ll tell you what that that’s, that still isn’t that much. And I know, in my own experience, that $2,000 cap. So what? We’re mid-May, and I am about out of it, and I don’t take that many meds.

 

Lisa Lauro  03:12

Wow, yeah, yeah. So that’s, that’s just it. I mean, you know, for some folks that are just on generics, they might think to themselves, my goodness, $2,000 that’s a lot of money, but there are some very, very costly medications out there that some folks hit that 2,000 and in February, you know, sure, sure. And then, you know, they’re done for the year, so long as, like, they’re on the formulary. Yeah.

 

Steve Sedahl  03:40

Yeah, absolutely. All right, so that’s the for next year. Medicare drug price negotiations begin. This is exciting.

 

Lisa Lauro  03:48

This, this is actually very exciting, because, you know, and this is the perfect segue to the next question, right? Because, because here, you know, talking about that cap. Now there are so many very expensive medications, especially the ones that a lot of folks are taking now for diabetes and weight loss, those GLP 1s and things like that. And so with these, there are 10 selected drugs that are going to be reduced in cost because they are on this list, and Medicare now is able to negotiate the prices for these drugs, which is going to result in significant savings for many, many folks. And there’s one like Januvia. There’s folks that are on Januvia. They’re, they’re saying that that price now is roughly 500 and almost $30 which make may go down to roughly, you know, 113 115 for next year, for a 40 day’s supply.

 

Steve Sedahl  04:53

Holy… That’s a huge difference!

 

Lisa Lauro  04:57

It’s a huge difference. So even though it’s still $100 a month for that prescription, it’s a whole lot better than 500 Oh, gosh. I mean, that’s… so we are going to see these reductions. And they’re, they’re saying that these, this cost savings could be, you know, up to one and a half billion in out of pocket costs. Savings for 2026, for folks that are on Medicare.

 

Steve Sedahl  05:22

That are on Medicare. Wow. I mean, that’s pretty significant. That’s pretty cool. It is. Do you see, do you see this, the negotiation of drug prices? Do you see that evolving and just sort of ongoing?

 

Lisa Lauro  05:33

Yes, I’m hopeful that. And I think for there’s another list that might be released thereafter. So once these kind of get negotiated, there might be some others for maybe the next year, again, it’s going to, it’s going to determine how the new administration handles this. Because a lot of this was set by this, this entire plan of Inflation Reduction Act has been rolled, rolling out since, I believe, 2022 and so since we are now with a new administration, it’ll be interesting to see what they keep and what they tweak, change or completely get rid of. But sure, these negotiations, I believe, are going to stay for 2026 and so again, that significant savings for many folks is, is amazing.

 

Steve Sedahl  06:22

Well, and again, for folks that are listening, you know, you are certainly well experienced in Medicare. And folks, if you want to come in, sit down with Lisa, that’s what you do. I mean, people can come in, sit down, and if they’re working with Secure Money Advisors, that’s great. They don’t have to be; they can just if, if you’re concerned about Medicare, if it’s time come in, have the conversation and really get an understanding of what you’re doing, because it’s all about education, right?

 

Lisa Lauro  06:49

It is. It is. And honestly, Steve, with the annual enrollment period coming up in October, I mean, it sounds far away, but it’ll be here before we know it. It’s, it’s, it’s very important for folks to take a look at their medications every single year and never assume that the prescriptions that you’re on now are going to be covered the same way for next year. But, and I’ve mentioned this on the show before, we’ve got this software that we use, and once we put in all your prescription drug information and dosage amounts, it will narrow down your search and recommend plans, prescription drug plans that are, that are right for you based on those specific prescriptions. So,

 

Steve Sedahl  07:34

Sure. And one of the things we’re talking about changes coming up next year, the $35 monthly cap on insulin that that just continues. That’s been there for a bit.

 

Lisa Lauro  07:43

Yes, so that was rolled out in 2023 and that is going to stay. So that’s great news for those folks that are diabetic. Insulin caps are going to be capped at $35 and can remain that way going forward.

 

Steve Sedahl  07:58

And that’s no matter what your deductible is.

 

Lisa Lauro  08:02

That’s correct. Yes, regardless of your, if you’ve met your deductible or not, you are going to be capped.

 

Steve Sedahl  08:11

Fair enough. What? Let’s talk about this – increased payments to Medicare Advantage plans. Lot of us are on Advantage plans. What do we need to know? And how does this affect us? Or will it?

 

Lisa Lauro  08:20

Yeah, you know, and that one I wasn’t 100% clear on, because I’m wondering here, if it’s a 5% increase in payments from the federal government, does that mean that they are going to increase what they’re giving towards these plans at 5% or is that a 5% cost increase to the actual beneficiaries? And so I was looking to see…

 

Steve Sedahl  08:48

I think it sounds like it’s the former than the latter, at least the way I read it, yeah,

 

Lisa Lauro  08:53

Because I was, I was, I was interested in seeing how, you know, how does that relate to us? Is that a 5% increase to the beneficiary, or are they going to give an additional 5% as, like, a subsidy, so that the benefits can be a little more robust?

 

Steve Sedahl  09:11

Yeah? Well, I like that. I like that version.

 

Lisa Lauro  09:14

I like my version too!

 

Steve Sedahl  09:16

Yeah. Well, we’ll just stay on top of it. I’ll count on you to… As this thing develops, we’ll kind of get a handle on it,

 

Lisa Lauro  09:21

I think so, I think that’s something that we’re going to have to revisit as more information is put out. But I I’m hopeful that it is the latter as well.

 

Steve Sedahl  09:30

Yes, of course. And so, this again, we’re talking about stricter rules for supplemental benefits in in plans, in MA plans, Medicare Advantage plans,

 

Lisa Lauro  09:41

Yes, and so there are a lot of there are plans that are for specifically for chronically ill folks. There are Advantage plans that are geared specifically for those. But there are items and services that don’t significantly benefit health outcomes. And so, for those they will be kind of discontinued or not allowed, and the list that I found for this, so the examples that were given were alcohol, tobacco, non-healthy food, life insurance, which I thought was, was interesting. And so, it basically in the final rule, the CMS adopted the non-exhaustive list of non-primary health related items or services that do not meet the standards or having a reasonable expectation of improving or maintaining the health or overall function of the enrollee. And so that’s what it was based on.

 

Steve Sedahl  10:40

All right, I like that. Automatic enrollment in Medicare Prescription payment plan in 2026 – what does that mean?

 

Lisa Lauro  10:49

Yes, so, so what that means is, this year, in 2025 they began this payment plan for prescription drugs. So it seems like the focus has been on a lot, a lot on prescription drugs as of lately, because one: their cap, you know, they’ve been capping the insulin, so that’s kind of a cost reduction. They capped medications this year, 2000 as we mentioned just earlier, and then, to help with the cost, they’ve now put in place a prescription payment plan. And so, the way this works is, if you are currently on the prescription payment plan, if you opt in for it this past January, then it’ll just automatically renew.

 

Steve Sedahl  11:40

We got one more change, zero cost sharing for adult vaccines. Now this is nothing new, but it’s just continuing.

 

Lisa Lauro  11:47

That’s right, that’s right. So as of now, there is a list of vaccines, and most of them are covered 100% for adult vaccines. Okay, yeah, I think the pneumonia vaccine is one that is not, no, not pneumonia, sorry, shingles, I think is one that’s not on the list. A lot of folks have said that they had to pay for their shingles, but, but all the other, all the others are mostly on the on the list, which is wonderful.

 

Steve Sedahl  12:23

Fair enough. All right, but we have run out of time in this segment, Lisa. Let’s remind folks come on in 724-293-6653, is the number 724-293-6653, let’s take a quick break. We’ll come right back. We will continue with Secure Money Health, where Medicare matters, with Lisa Lauro coming up right after this.

We’re back on Secure Money Health Radio where Medicare matters. Lisa Lauro is here. Lisa’s been helping folks with Medicare. You’ve been helping at Secure Money Advisors for a while, but you come to us as a teacher, that’s your that’s your background, that’s what brought you here, right?

 

Lisa Lauro  13:05

That’s correct, yes, yes, I love teaching in any capacity, you know? So, so while I’m not in the classroom, so to speak, anymore, I still feel though, as though I’m teaching, whether I’m in a seminar, or here we are on radio and, you know, educating folks on Medicare. And then finally, here in the office, sure, that’s my favorite. Is sitting, you know, across from somebody, and really being able to explain and jot down notes and use diagrams and things like that,

 

Steve Sedahl  13:40

Sure. And then, of course, when they come in and see they you’re going to give them your book, The Ultimate Medicare Book, Simplifying Medicare So You Can Make Confident and Informed Decisions. That’s the book you wrote, and you’re happy to give that out to folks when they come in.

 

Lisa Lauro  13:53

Absolutely, yes, yes, it’s a complimentary copy. So, if that’s something that interests you, you have the URL for us. It’s uh…

 

Steve Sedahl  14:00

Oh, I do medicaresimpleguide.com

 

Lisa Lauro  14:04

medicaresimpleguide.com. Yes.

 

Steve Sedahl  14:07

And so if you go to that website, you don’t even… Lisa will just send it to you, right? Yes, ask for it, and we’ll send it to you.

 

Lisa Lauro  14:04

Yep, we’ll send it right out, yep.

 

Steve Sedahl  14:40

All right, fair enough. Let’s jump in here. We’ve got, so we got a lot of great questions. And so these are just sort of general knowledge things, but I’m sure you get these questions a lot, can I use Medicare? Can I use Medicare to cover medical care while traveling abroad? Now, we’ve talked about this before, but it’s worth talking about again, as we get into travel season.

 

Lisa Lauro  14:33

You’re right. We are entering travel season and folks will need this information, so some good nuggets here for that, Medicare does not generally cover medical care outside of the United States, but there are some exceptions. So, I’ll go through some of these bullet points here. The first one is that emergency care in Canada – so if you’re traveling directly between Alaska and another US state, then you’ll be covered.

 

Steve Sedahl  15:03

Okay, so you can stop in Canada and take care of yourself.

 

Lisa Lauro  15:07

Emergency hospital stays, if a foreign hospital is closer than a US one. So, then you can, you can use the foreign abroad hospital there. This is an interesting one. This one always seems to get me, but it’s cruise ships and medical care. If you’re on a cruise ship and you’re within six hours of a US port, then you can get the care that you need.

 

Steve Sedahl  15:35

So is that, I mean, I know six hours, I mean that to me would take in most of the Caribbean cruises, you know, that’s still going to be within six hours of a US port, generally speaking.

 

Lisa Lauro  15:45

Yes, generally, most of them, for, for the Virgin Islands, you know, are within that, yeah, sure. I mean, Aruba is pretty far, I don’t, you know that’s not, not, you know, so that would be foreign.

 

Steve Sedahl 16:00

But again, it’s worth checking out. Yes, yes, okay, fair enough. What else so cruise ships? That’s always a question I get, and I’m not even a Medicare guy. Yeah, exactly. Medigap plans, where are we?

 

Lisa Lauro  16:13

Yeah, Medigap plans, C, D, F, G, M and N provide limited foreign emergency coverage. So typically emergency coverage is covered at 80% on those most of those plans, especially I know for G and N, it’s 80% covered, and you have, but the key here is that you have a limited $50,000 lifetime maximum. Okay, so, you know, 50,000 doesn’t get you too far if you’re having to, if you’re sick, but I think the idea, if you do get sick and you’re abroad is to basically stabilize you and get you home so that we can do, you know, basically finish your care here.

 

Steve Sedahl  17:00

All right, here’s another one. Does Medicare cover… oh, wait a minute, we didn’t – so Medicare Advantage plans. We didn’t mention that.

 

Lisa Lauro  17:08

Yeah, so some Medicare Advantage plans offer limited international coverage, and I would say the, most of them are contracted to deal with emergency situations and urgent cares, right. When you are abroad. So,

 

Steve Sedahl  17:23

And that’s in my situation, I have an Advantage plan. That’s exactly what it is. It’s urgent care first, and emergency room as a secondary,

 

Lisa Lauro  17:32

Right, right. Yeah. I mean, if it’s not, I usually tell folks, if it’s not, truly an emergency, and there’s an urgent care that you can seek out that’s close by, that’s probably going to be your better option, because you don’t want them to turn around and say, well, this wasn’t really an emergency situation, you know? So, so if it’s not an emergency and it’s just like a cold or something, and you go to urgent care, you’d probably be better off,

 

Steve Sedahl  17:56

Fair enough. Here we go. Does Medicare cover acupuncture, chiropractic or alternative therapies?

 

Lisa Lauro  18:04

Yes, and I think we had a show on this recently too, but it is, it is something to discuss. It’s important. Acupuncture, Medicare does cover up to 20 visits per year for chronic, chronic lower back pain. And as far as chiropractic, it does cover spine manipulation for subluxations, but not routine adjustments or X-rays. And usually when you do see a chiropractor, initially for the first time, they will want to do some X-rays. So that would probably be out of pocket to you, but if you do have some subluxations that need to be fixed, those would be covered, okay. And then alternative therapies, treatments like massage therapy, naturopathy and homeopathy, those are not covered, okay, all right, so those would be your expense.

 

Steve Sedahl  18:55

Sure. And well, that makes sense as well, I guess. And then, can I delay Medicare if I have COBRA TRICARE or VA benefits?

 

Lisa Lauro  19:04

So, COBRA is one that most people are surprised about, but you, COBRA is not considered credible coverage. Okay?

 

Steve Sedahl  19:14

I’ve so, I’ve found that so hard to believe. That’s surprising.

 

Lisa Lauro  19:18

Yes, so, so if you here’s kind of how I think of COBRA. COBRA is a nice thing to use when you’re trying to bridge the gap from 64 to 65 right? Let’s say you retire at 64 you have just a couple of months to bridge that gap where you’re going to need health insurance, and then you’re going to turn 65 so then you go on to Medicare. That works well, and COBRA can be quite expensive. So sometimes, just using the Pennie Health Marketplace plan that we have here in PA is, is, you know, it’s, it’s, it’s good to price both out and see what’s going to be most cost effective for you, sure. All right, but. Yeah, but what happens with COBRA is, once you turn 65 it’s no longer, it’s not considered credible coverage. So, in those cases, you need to sign up for Part B to not get a penalty. And most of what I read recently because I just had somebody in my office that wanted to extend – they, their employer was going to pay for their COBRA for till, till the for the rest of this year. And so, I was looking to see, you know if that would be allowed, and you have from the time your employee coverage ends until, you have about eight months to pick a plan. But everything that I read said they recommend that you do your Part B sooner than later to avoid penalties. Sure, so I really think you’re kind of rolling the dice with that one. I would probably just opt for Part B and, I don’t know that’s, that’s just kind of how I feel about it.

 

Steve Sedahl  21:05

Sure, well, no, I think that makes perfect sense. So, what is TRICARE? And that’s, that’s new to me.

 

Lisa Lauro  21:10

TRICARE is for veterans. Oh, okay, all right, yeah, so it’s a veteran plan, but you do have to have A and B for, to have TRICARE, okay? And then Medicare is the primary payer, and then TRICARE picks up as secondary.

 

Steve Sedahl  21:27

All right, so that’s for veterans, and so, and then, what about, there’s a couple other veterans’ notes here, VA benefits?

 

Lisa Lauro  21:34

There’s TRICARE, and then there’s VA. So there’s, there’s two separate, two different things. They’re two different things. You can have both VA and Medicare, but the VA benefits only cover care at VA facilities. If you want care outside of the VA you’ll need Medicare, so you have to, Yeah. And then there are for folks that that have the VA benefits. There are Medicare Advantage plans that are geared specifically for veterans, which are especially those folks that are getting their prescription drug coverage at the VA. They pick up their medications there. Then those, they’re called MA-only plans, and those are really nice for veterans, there’s a lot of nice benefits, because I don’t think it’s one, it’s either dental or vision that the VA doesn’t offer. I can never remember which one, but I think it’s dental that they don’t offer, and vision they do and so those MA-only plans can fill that gap, sure, of coverage. Well, that’s a good coverage.

 

Steve Sedahl  22:33

Folks, if you want to know some more, it’s 724-293-6653, that’s the number you can call. 724-293-6653. Can I get Medicare if I never worked?

 

Lisa Lauro  22:44

Yes, but you may have to pay for your Part A. So generally speaking, Part A is premium free, but if you haven’t worked, and that premium free is based on that you worked for 10 years or 40 quarters of your lifetime. So, if, if that, if you don’t have those 40 quarters, then you’re gonna pay for your Part A and it could be really costly, like if you have anywhere from 31 to 39 quarters, I believe it is, is $285 a month, and less than 30 quarters is 505.

 

Steve Sedahl  23:22

Wow. That’s a big chunk.

 

Lisa Lauro  23:24

Yeah, so that’s a lot. That’s a lot.

 

Steve Sedahl  23:27

Yeah, exactly. All right, this is so Medicaid, that’s the, certainly in the headlines a lot these days. Can I have both Medicare and Medicaid? Two very different things?

 

Lisa Lauro  23:37

Yes, and people confuse them all the time. So Medicaid is based on your income, and it’s if you are a lower income individual, then and you qualify for Medicaid, you can have both Medicare and Medicaid. And there are specific plans, Advantage plans out there that you can get. And the one that has Medicare/Medicaid is called a Dual Special Needs plan. And that dual, that’s what they’re referring to, Medicare/Medicaid, okay, so, so those are, those are really nice, nice plans.

 

Steve Sedahl  24:15

And again, that so it is there. And so again, it’s a Medicaid is, again based on income. Medicare is everybody,

 

Lisa Lauro  24:25

That’s right. Medicare is everyone who is 65 or older, and then the Medicaid is based on your income.

 

Steve Sedahl  24:32

Okay, all right. Well, we need to wrap it up. This is, what a fun show, what a fast paced show! Yeah, give us a call, folks, 724-293-6653, or visit the website medica, medicaresimpleguide.com and we are going to do this again next week. Lisa, always a pleasure.

 

Lisa Lauro  24:48

Always a pleasure. Have a good one.

 

Speaker 2  25:03

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Outro  26:57

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