Enrollment Options, Comparisons with Employer Insurance, and the Implications of Medicare Premiums Transcript

Steve Sedahl  00:00

Hey, welcome in everyone. This is Secure Money Health Radio, it’s where Medicare Matters. Lisa Lauro’s here. My name is Steve Sedahl. We’ve got a big show planned for you here today. We’re going to kick it off right after this.

 

Speaker 1  00:11

It’s time to secure all your healthcare needs, and we will really simplify the process. Welcome to Secure Health with Lisa Lauro.

 

Steve Sedahl  00:24

Hey, welcome in, everyone. This is a Secure Money Health Radio. It is where Medicare matters. And Lisa Lauro is to make sure, is here to make sure that does happen. Hey, Lisa, how’s it going?

 

Lisa Lauro  00:33

I’m good. How are you today?

 

Steve Sedahl  00:35

Very, very well. This is always a fun show for me to do. Just, there’s just so many things about Medicare that that I know, I think, for if you’re not anywhere near Medicare, you probably don’t care. But if you’re, I mean, I’m thinking, if you’re over 50, you’re thinking about Medicare,

 

Lisa Lauro  00:51

Yeah, as you’re edging up on 60, I would say you’re starting to consider, you know what, what you’re going to do, if you’re going to get ready to retire, coming up, if not. And so, there’s a lot of different, there’s a lot of choices to make.

 

Steve Sedahl  01:04

Right, Oh yeah, it’s like, I got a, I got a friend of mine who’s 60… 63, and he’s counting the months.

 

Lisa Lauro  01:12

There’s, there are a lot of folks I meet with that are, have, you know, they’ve got their own little personal countdown, that is for sure. So, you know, lots to think about, lots to discuss, and hopefully with this show, we can provide some clarity for some folks today.

 

Steve Sedahl  01:29

Absolutely. And of course, if you want to know a little bit more about Medicare, actually a lot more, I invite you to visit medicaresimpleguide.com sign up and get Lisa’s book, and it’s called The Ultimate Medicare Book. It’s yours free by visiting that website. Just do that, and Lisa will send you the book.

 

Lisa Lauro  01:46

Yeah, absolutely; happy to send it complimentary copy, right to your house, perfect.

 

Steve Sedahl 01:51

And you know, no cost, no. You know, no shipping, nothing. You’re just going to send it to them. All right. I like it. Let’s jump in. We got some questions here that have come in over the last couple of weeks. Here’s somebody saying, I turned 65 in three months, but I’m still working. Have insurance through my employer. Do I need to sign up for Medicare now? Or can I wait?

 

Lisa Lauro  02:12

That is a great question, and one that we actually hear quite often. So, you know, if you’re still working and your employer has 20 or more employees, then you can delay enrolling in your Part B, which Part B is the medical piece to Original Medicare, without facing a penalty, so long as your group insurance that you have is considered credible coverage. Now, what, if you’re considering to do that, you may want to sign up for Part A only because Part A, so long as you work for 10 years or 40 quarters, is, has no, it’s called it’s premium free. So many people choose to do that when they turn 65 but, you know, I want people to consider Medicare options when they’re turning 65 because the group insurance, and many people are surprised to find this out, isn’t always your best option. In fact, in most cases, Medicare is the more cost-effective way to go, and that surprises a lot of folks.

 

Steve Sedahl 03:22

No kidding. Yeah, I can see why.

 

Lisa Lauro  03:24

yeah, so, so I definitely think it would behoove you to sit with someone and make a cost comparison. Go over what it’s going to cost to stay on your group insurance, what it’s going to cost to come off and it’s not just about premiums, either, you know. Take into consideration what the benefits are offering, because with group insurance, typically there are higher deductibles that you have to meet, especially if you’re on a family plan. So, it could be $3,000 deductible. And with that, you know, you’re not going to really get into your using your health plan, because you’re going to be busy, should you get sick, paying off these deductibles? So, you know, when people confuse deductibles with max out of pocket all the time? Oh, yeah, that’s like to think about. It is confusing. And what I like to think about is, is with car insurance. That’s, is my analogy that I use. You know, if you were to get into a car accident, God forbid, right? But if you were, you have a deductible on your car, and they’re not going to fix your car until you’ve met that deductible. And the same thing applies with health insurance. So with your group insurance, you have a high deductible of maybe $3,000 for a family they’re not going to, the insurance company is not going to start paying your claims until you’ve met that deductible. And on the Medicare side, the deductibles are much, much less, like a fraction of the cost, if any. So big thing to consider, don’t, just, you, stay on the employer coverage, because it’s something that’s comfortable for you. Do your due diligence, meet with somebody and see what options are available and make some comparisons.

 

Steve Sedahl  05:11

Are you willing to help us out and do that?

 

Lisa Lauro  05:13

100%. Would love to sit with folks. In fact, that’s what I do. I sit with you. We go over it, we make a comparison. You bring your summary benefits, and I will be 100% honest with you, if your group insurance is the way to go, then I will tell you: You know what? Come see me in a few years. I’d love to help you stay where you are, but if not, let’s get you in the most cost-effective plan with the best coverage we can find for you.

 

Steve Sedahl  05:36

Sounds great, folks. If that sounds good to you, give us a call right now. 724-242-6828, 724-242-6828, and that’s a new number, but again, it’s a, still a seamless process, absolutely. So as we, as we look at this, you talk about comparing this and you know, again, your employer plan, you know, I wonder, I wonder, how many people actually know what they’re paying for, for their insurance from their employer plan?

 

Lisa Lauro  06:04

You’d be surprised how many folks don’t even know what their insurance is! They’re like, you don’t even know what it is like. I don’t, I don’t know what, what it’s called. I have to look at my card. And so, yeah, it’s, it’s, it’s, you know, oftentimes when we get paid, we get paid. You know, if you’re a salaried employee, you get paid the same amount. I remember when I was a teacher, I never even opened it up. Shame on me, right? I just was the same amount. So, what am I going to open it for; what’s the difference, yeah, as long as it hits my bank account, you know, I should have probably looked a little closely, you know, at my, at my paycheck, but because it’s automatically coming out of your, out of your pay. Oftentimes, you are so right, Steve, people don’t know how much they’re paying for it, and so always look at that stuff, you know.

 

Steve Sedahl  06:50

Well and again, your comparison, then you have it here on that. You did a comparison. So, if it was costing you 300 bucks through your employer, well, part B $174.70, I mean,

 

Lisa Lauro  06:58

Yeah, actually it’s $185 this year. I think $185 Yeah, yeah, yeah.

 

Steve Sedahl 07:02

But $185 versus $300 still, right? And I don’t think $300 is unreasonable to say that’s what you’re paying with your employer,

 

Lisa Lauro  07:10

Right, right.

 

Steve Sedahl  07:13

Yeah, all right. So again, so it’s okay to delay Medicare, if it makes sense. I mean, and there are rules around it,

 

Lisa Lauro  07:21

Right? Absolutely, all right.

 

Steve Sedahl  07:26

So, here’s somebody that was shocked to see my Medicare premium over $200 I thought it was $185 bucks. What happened lately? So, what happened?

 

Lisa Lauro  07:36

Yes, so you know, this is another great question, because a lot of people think Medicare is free, and it’s not free. Okay, you know, so the standard rate, when, when, when taking into account the Part B premium, the government looks at your modified adjusted gross income, and they it’s a two year look back. It’s not the average of the last two years. It’s literally whatever’s on two years ago. So here we are today, 2025 they’re looking at your 2023 taxes. And while most people fall into the standard rate, which means if you file your taxes individually, and your modified adjusted gross income is 106,000 or less, then you fall in the standard range. And if you file jointly, and your adjusted gross income is 212,000 or left, you’re in that 185 standard rate. However, there is a whole chart, and if you are in a higher tax bracket, you’re going to get what’s called an IRMAA tax on top of your 185 and IRMAA stands for Income Related Monthly Adjustment Amount. So, the government will hit you with a tax penalty, and you will pay more for your Part B than others, because you’re in a higher tax bracket. Now,

 

Steve Sedahl  09:11

Well and again, yeah, essentially, it’s a means tested way of coming up with that amount,

 

Lisa Lauro  09:18

Right, right. So, so what happens here is, if you feel as though you know your income has dropped due to retirement or another life-changing event, and you feel as if this is incorrect information, then for sure, you want to file a appeal. And there is a form on the Social Security Administration’s website that you can get and it’s the form that you’re going to want to appeal with, is SSA-44, 44, so and you can request a reduction in your premium Part B premium with this appeal.

 

Steve Sedahl  10:00

Have you seen that be successful?

 

Lisa Lauro  10:02

I have I have. The application itself is several pages, but they there are many different qualifying events, life events, that perhaps you might fit into that scenario. And it’s definitely worth a try.

 

Steve Sedahl 10:23

Sure, 724-242-6828, is the number. Say we got one, it’s time for one more before we take a break. My, my neighbor says, my, my neighbor says Medigap is the best. My cousin swears by Medicare Advantage. How do I know what’s right for me? This is a discussion you have every day. I’m guessing.

 

Lisa Lauro  10:39

It is, it is; you cannot imagine. And you know what? When people are talking to others, they’re doing their due diligence. You know, they’re getting a, they’re getting a kind of pulse of what’s going on and what people are interested in, in and, you know, their friends, their neighbors, their cousins. But you really have to take the advice that they give you with a grain of salt. Okay? Because what’s that phrase? What’s good for the goose isn’t always good for the gander kind of thing. Not always. Yeah, no, it’s not. And here is why. Okay, you know, there are many different factors we have to look at you as a case-by-case basis, in terms of your medications, your prescriptions, whether you’re going to be a snowbird and travel a lot or live somewhere. What is your budget? Not everybody has the same budget, right? And then finally, what is your health history? So you know, while your neighbor’s plan might be the best thing since sliced bread for them, it may not be the best thing for you, because if none of your doctors are covered on their plan, then that’s not good for you, right? If you’re going to go snowbird somewhere, and they’re on an Advantage plan and they’re, you know, it’s more of a regional plan that plans not good for you. So, and if you have different prescriptions, and your prescriptions aren’t covered. Again, that plan is not good for you, right? So, these are things that you have to take into consideration. It’s very important to do your due diligence and really sit with somebody and come up with a plan that’s best for you, because what’s good for your husband or your wife isn’t going to be good for you too. So, you can, oftentimes, I have to put spouses on different plans because of that information.

 

Steve Sedahl 12:25

That’s what I was just going to ask you, if spouses are on different plans. And obviously they are. I guess that makes sense.

 

Lisa Lauro  12:31

Yeah. I mean, we have to, we have to find the plan that’s right for you, and so for the first time, probably in your life, where you’re able to actually pick a plan that’s for you, and you only because it’s the best one for you. And I am so happy to sit with folks and help them do that. So give us a call. 724-242-6828, I know you have to go to a break soon, right Steve?

 

Steve Sedahl 12:55

Yes, we do. And again, yeah, just remind folks to come on in, sit down with Lisa and get that, get your Medicare mapped out. Visit simple securemoneyhealth.com if you’d like to learn more. securemoneyhealth.com we’re going to take a quick break. We’ll continue the conversation.

Welcome back, everybody. This is Secure Money Health Radio. It’s where Medicare matters. Lisa Lauro is here. Lisa’s president of Secure Money Health works in conjunction with Secure Money Advisors, the good folks over there, Brian Quaranta, who I had a chance to talk to this weekend. It’s always fun to reconnect with him, and again, it’s a great service that, that really Secure Money Advisors creating this, this, this Medicare sort of envelope for people. It’s really quite nice, and it’s very unusual.

 

Lisa Lauro  13:47

And I don’t know if we’ve ever even talked about that. Like, if I can, I’ll just give a little background as to how I came to be here, because it all sort of made sense. You know, Brian and the crew over at Secure Money Advisors for 15-20, years, had been helping people to retire and coming up with retirement plans and things like that. And what he realized was, that there was a missing piece to the puzzle, and that was the health care aspect of it, because that goes hand in hand with retirement, doesn’t it? And so, Brian realized this, and he said, you know, we really need to bring somebody on full time that can help with the health insurance piece of retiring, right? So he brought me on just about four years ago, and together, we formed the company Secure Money Health. And now, while we are putting retirement plans together for folks, we, they can walk across the street here, just across the parking lot, and come see me, and we could talk about the health benefits that are offered for folks turning 65 and then I also was able to get my credentials in the Pennie Health Marketplace plan, which is the Affordable Care Act, plans that are offered for folks that are under 65, because you couldn’t imagine how many people I ran into that the spouse was turning 65 but the other one was still under 65 and maybe had two, three years to go before they were going to be ready for Medicare. So, I’m able to now help both family members with their health care, and it’s been such a blessing. Now, you don’t have to be a client of Secure Money Advisors to come and see me. Okay? But it is – it has been a great thing that we offer this service for the folks over at Secure Money Advisors as well, so that this way it’s just kind of all in house, and it makes sense.

 

Steve Sedahl 15:50

Yeah it’s very nice. And you come to this industry, you know, sort of naturally; you’re a teacher. You spent a lot of years, 20 plus years teaching. So again, you put that skill to work here, because that’s what you’re doing. And Brian and the team at Secure Money Advisors, they’re very passionate about the teaching, the education, and that’s where you come from.

 

Lisa Lauro  16:08

Yeah. I mean, as part of that teaching, Brian wrote himself – he wrote a book, and that’s about retirement planning, Right Track Your Retirement. And then he encouraged me to write a book, and my book is The Ultimate Medicare Book. And, and I think, you know, as I feel like, as natural teachers, you know Brian, Brian doesn’t have a teaching background, so per se, but he is an amazing teacher when it comes to the financial advising and, and so both books are available. If anyone is interested, you can medicaresimpleguide.com,

 

Steve Sedahl  16:44

Sure and again, and folks, if you want to get a head start, here’s a number. It’s 724-242-6828, go ahead. Give us a call. Lisa’s got some time on her calendar. She’d love to sit down with you. Let’s jump back in. We’ve got another scenario where someone is asking, my prescription used to cost five bucks. Now it’s fifty. What happened? Good question. What happens?

 

Lisa Lauro  17:09

Yes, I feel like, if I’m preaching at all, this is one of the things I preach about all the time.

 

Steve Sedahl  17:15

Okay, good, let’s have it!

 

Lisa Lauro  17:16

Which is, do not assume from year to year that your prescriptions are going to be covered the same way. Now, you know, there’s two different scenarios here that I want to touch base on. If you are on a Medicare Advantage plan, then most likely, your prescriptions are embedded into the plan, right? And you have the ability to change that plan between October 15 and December 7 every single year. And if you have a standalone, if you’re on a Medigap Plan, this would also apply to you, because most likely you have a standalone prescription drug plan, and that too can be changed during that same annual enrollment period. So, for whichever direction you decided to go with your Medicare, you do need to every single year, between October 15 and December 7, sit and go over your medications and do not assume that they’re going to be covered. Because these prescription drug plans, they can change the formulary mid-year, if they wanted to.

 

Steve Sedahl  18:22

Oh my gosh, would that affect you?

 

Lisa Lauro  18:25

And it could affect you. So they can, they could take a drug completely off their formulary, which is their list, or they can re-tier it, and so, so you have a formula, you have a list, and then you have tiers of medications, one to five, one being your least expensive generics, all the way to five being your specialty meds. And so, you know, now they are required to send you a letter. So, should that happen, you should get a letter in the mail. But with all the junk mail you get nowadays, I mean, everybody gets it, you know, it’s very possible that you can, you can overlook something like that. And so, during the annual enrollment period, that’s your time to sit and go over; now here at the office, one of the things that I, I pride, we pride ourselves on, is this amazing software that we use. It is so helpful. We will get a list of your prescriptions. We’ll load that in with dosage, amount and everything. And the software takes all the guesswork out, because there are many different prescription drug plans to consider and, but they’re not created they’re not all created equal because they all cover and have different formularies and different tiers. So based on your specific information, this software will tell us exactly what is recommended for you, so that we can pick the right plan for you year over year. So, you know, do not assume that when your medication is covered this year, it’s going to be covered the exact same way next year.

 

Steve Sedahl  19:56

Wow. Good to know. 724-242-6828 is the number to call. Here’s a question about veterans and Medicare. He’s asking, “I get all my care through the VA. Do I even need Medicare?”

 

Lisa Lauro  20:11

Great question. Yeah. So that is a great question. I do see from time to time some veterans, and you know, while the VA provides excellent benefits, it’s important to understand that the VA coverage and Medicare do not work together. They which means they do not coordinate their benefits. Okay? So if you wanted to go outside of the VA system, even in an emergency situation, you know, you’ll need Medicare to avoid big out of pocket costs. So sometimes we might be in a in a place where we can’t go see a VA, a doctor, or get to a facility, and so, that’s where it’s really nice for veterans to pair their VA benefits with a Medicare Advantage plan. Now, for those folks that have, get all their medications at the VA there are specific advantage plans that are for veterans, and they’re called MA-only plans, and some of the benefits that people like with these plans that come with these plans is often they are very low premiums. Most, many of the plans have a zero premium, so it’s not costing them any additional money to have this MA Medicare Advantage plan, and they offer extra benefits. Sometimes that the that the VA doesn’t cover. So, you know? So like some veterans can get their dental or vision at the VA, and others can’t, and I think it’s based on how much time they put in, or what have you, that’s my understanding. So some of the extra benefits that they may want to have or consider having with this Advantage plan are dental benefits, vision hearing aids, over the counter allowances, which is a lump sum of money for you to use at the things that you would get at a pharmacy; not your prescriptions, but think of the things on the shelves, pain relievers, vitamins, stomach medicine, allergy medicine, cold and flu. The other thing is gym memberships. There’s programs. Each of these Advantage plans have some type of fitness program. And then finally, a lot of them do offer transportation. So, if, if a veteran, you know, no longer drives, they will be able to organize a ride for you to get to and from your doctor’s appointment. And then the last thing that’s important to notice is that, you know these  MA-only plans, they will include emergency coverage anywhere in the US, so emergency and urgent care. So, if you are a veteran and you’re traveling and you’re unable to get to a VA facility, then you can use the emergency services or urgent care.

 

Steve Sedahl  23:08

That’s good. That’s good to know. Again, well, and there are a lot of veterans. I mean, I know in your area there’s a lot of vets that are there, and so it’s important to know.

 

Lisa Lauro  23:18

Right. Yes, just know what, what’s available to you, right?

 

Steve Sedahl  23:22

Absolutely. 724-242-6828, the number we’ll dig into. One more caller says, I’m on Medicare, but my husband is only 63 still needs insurance. Can he get coverage through my Medicare?

 

Lisa Lauro  23:37

Yeah. So unfortunately, Medicare doesn’t offer family coverage. So, in this particular case, your husband would need to get insurance separately, and that would be either through Pennie Health Marketplace plan here in PA sometimes you can tack on COBRA with your work. So COBRA, you can tack on COBRA under 65 it’s okay to do that until you turn 65 and the only thing is, I would say COBRA is also very expensive. So you would want to do a cost analysis, whether it’s the Pennie Health Marketplace or COBRA, whichever one is going to be, you know, in your best interest, but, but once you turn 65 the interesting thing to note here is, a lot of people don’t realize this is that COBRA is not considered credible coverage, so when you turn 65 oh, no kidding, yeah, you do need to sign up for your Part B, because It’s not considered credible coverage. And the and to avoid a Part B penalty and defer your Medicare, you have to have credible coverage. So if it’s COBRA,

 

Steve Sedahl 24:50

So just COBRA in general is not covered, not considered credible.

 

Lisa Lauro  24:54

COBRA is not considered credible coverage once you’ve turned 65 It’s okay. It’s okay to tack it on from 63 to 65 or 62 to 65 but once you’ve hit 65 you’re required to get on to Medicare unless you have credible coverage. And COBRA is not on the list of credible coverages.

 

Steve Sedahl  25:13

Good to know. That’s a great way to end the show, Lisa, let’s remind folks to give us a call. 724-242-6828. 724-242-6828, and remember visit medicaresimpleguide.com to get your free copy.

 

25:26

That sounds great. Thank you so much, Steve. Hope you all enjoy your Saturday.

 

Speaker 2  25:30

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Outro  27:27

Coach P Radio.