Joanne: Are you getting closer to Medicare eligibility, and you're starting to get overwhelmed by the numerous options that you have, as well as when to time everything to avoid mistakes? Well, in today's episode, we will give you the five keys to having a stress-free transition to Medicare. 

Cameron: But before we start, my name is Cameron Giardini, and together with my cohost, Joanne Giardini Russell, we operate Giardini Medicare, an independent insurance agency based out of Southeast Michigan.

Although we are based in Michigan, we work virtually over the phone to directly help consumers in about 13 states to find the right Medicare coverage for them. If we do not work in your state, we will connect you with another trusted independent agent that will be able to help you find the right coverage that you want.

And even if you choose not to work with us, we know the information in today's episode will help you with a successful and stress-free transition to Medicare. And in addition to this episode, I want to point out that we now have a free online course you can register for. It is at gmedcourse.com. And it combines every resource we've ever used regarding Medicare, so make sure to check it out. So with that out of the way, we'll give an overview of today's episode. We will talk again about the five keys to a stress-free or less stressful transition to Medicare.

So key number one is understanding your Medicare options early. And then, in key two, we will talk about understanding the different parts of Medicare. We will then talk about the differences between Medicare Advantage and Medicare supplement plans. We will talk then about the costs associated with Medicare and wrap things up by discussing some misunderstood Medicare topics.

So although Medicare is available to those under 65 for various reasons, such as Social Security, and disability entitlement, for the sake of this episode, we just want to point out that we will only really be talking about the transition to Medicare. With the assumption that it's due to you turning 65 and being eligible for Medicare due to actually being age 65 or older, although a lot of the concepts will apply to both.

Okay, so Joanne, start us off with key number one.

Joanne: I will do that, but I do want to revisit one thing, the course that Cameron mentioned in the beginning. If you go to our course, I can actually guarantee that that's one of your biggest things to have that stress-free transition to Medicare, because even though we're going through some of this, the course will take you there.

So I'm just going to give a little plug for the course. It's been fabulous. But the key, uh, It's key number zero. Key number zero, right? Start there with zero. Exactly. And I'll talk about number one. The key number one step is to understand what to learn or when to learn about Medicare options. Now, we always recommend using an independent broker like ourselves or another broker to compare your Medicare options since we contract with dozens of insurance companies to make coverage comparisons much easier for you than trying to contact each insurance company directly.

I mean, that's a pain. If you want 10 quotes, you're going to call 10 insurance companies. Always please remember that our services are free and they cost you nothing extra. You will pay the same price as you do going directly to an insurance carrier. You save nothing. You actually hurt yourself instead of working with a broker like us.

One thing to consider, and this is always a huge thing we talk about, and it sounds a little silly, but the question should be, do you even need Medicare? And this question should always be in the back of your mind when you start that Medicare transition journey, whether or not you need Medicare is going to depend on whether you have active employer coverage through yourself or a spouse, and does that employer have 20 or over employees, it's going to depend on do you have marketplace coverage, there's a whole bunch of questions that you need to ask or learn the answers to.

But do you even need Medicare is a really big question that people just don't spend enough time thinking over or talking to an agent about then consider your timing? Of course, you can start viewing Medicare options whenever you would like, but generally, we don't recommend going to seminars and getting really stressed out over all your options too many years ahead of time.

We do have some people that show up eight years ahead of Medicare eligibility, which is likely too much time because Medicare coverage, really can change every year. In some years, the changes have been pretty drastic. Nick. An example, this year is a 35 per-month cap on insulin, and a couple of years ago, we never would have thought that that could have happened.

 That just shows you how quickly things can change. 12 months, this is just a tip for one year, 12 months before you're turning 65. At that point, start getting familiar with the different Medicare topics, the terminology, the general costs, the coverage types, and even the enrollment windows. But don't get too caught up or focus too much on the exact plans and exact coverage that you're going to be enrolling into.

But it's a really good time to just start familiarizing yourself with Medicare Advantage versus Medigap coverage. Then six months before you're turning 65, then start getting a little more drilled down. Start to learn the specific costs and the coverage options with Medicare Advantage or Medigap plans.

And this is the time to start diving more into quotes for the coverages so then you can start deciding exactly which coverage you'll want to enroll in the near future. And remember that for some Medigap companies, you can't even enroll in the coverage six months before you turn 65. 

Cameron: Yeah, I think the key takeaway here, as Joanne said, is just don't worry too much about exact details years ahead of time.

If you're coming up to Medicare eligibility, say two years from now, don't sit there and think, I'm going to get this plan with this company at this price, because One of those variables is very likely to change, whether it's the company, the price, whatever it might be, something's going to change from now until you're eligible in the next couple of years.

But of course, within that year, do everything you can to learn about your Medicare options. And just to go along with the critical timing notes and to continue with what Joanne was saying when it comes to Medicare Advantage and Part D, the prescription drug plans, the coverage changes every year on January 1st.

So new details for these plans were. Kind of coming up on it again. It is almost the fall. It's crazy to think, but the new plan details, aren't released to the public until October 1st. So keep that in mind if you are eligible for Medicare towards the end of the calendar year. This happens pretty often if somebody is coming up.

To eligibility in December. And you say in January, what are my options going to be? I know, December, we can already tell you exactly that coverage, but what is it going to look like for 2024?

Well. We don't even know yet. And we can't even tell you, even if we do know, until October 1st. It's not that you're penalized if you're turning 65 or transitioning toward the end of the year, but keep in mind that the timelines can get a little funky there. So where do you go to learn about Medicare?

There's always the Medicare and You Handbook or the official Medicare.gov website. They're good sources when it comes to general Medicare knowledge, but they are not going to provide everything you need to know about specific coverages like Medicare supplements and Medicare Advantage plans.

So there are more ways than ever, thankfully, to learn about Medicare options. You can go to social media. You can do this by going to YouTube, you know, podcasts, obviously, if you're listening to this, you're probably already listening to other social media sources. You can even do Tik Tok. That is what Joanne loves to do.

Uh, there are. A lot of bad, uh, there's a lot of bad advice on Tik Tok, but hey, try it out. Yeah. Yeah. I know we're biased, but just be careful. So now there are also websites. Of course, you can go to the official websites that are done by the government, whether it's social security or Medicare, and even brokers have really good websites out there.

So if there's a national firm similar to us that has good information. Feel free to, to read their website. And then, of course, we have that free online course that is pretty much brand new, just came out a couple of months ago, and you can go to that at gmedcourse.com. Now, of course, as I already mentioned with anything on social media.

Even what we're telling you, make sure to verify what you're hearing with official Medicare sources when possible, and ask questions to a broker, whether it's us or somebody else, to confirm what you're hearing, be very careful. You know, don't listen to the story of friends while you're having dinners or cocktails.

Unless you were the one directly involved in picking their plan and understanding precisely what they pay and how they use it, just take everything with a grain of salt. Friends love to tell you the best part of things, right? Without telling you any of the downsides. No one wants to say, Hey, I screwed up by getting this coverage, but just keep that in mind and then use that opportunity too.

Come up with questions. So if your friend tells you something, say, okay, I'll note that down. And then just take that to a broker or a professional that can help you weed through some of the questions you have from people you hear. So, Key 1 was probably the longest, but we'll talk next about how to understand the different parts of Medicare, which Joanne will start with.

Joanne: Alright, so often you just hear the blanket term of Medicare, right, as you're approaching age 65, but it only gets more confusing when you start looking at all the options and learning about the alphabet soup of Medicare, Part A, B, C, and D, as well as all those different Medigap plan letters. But what do they cover, and which parts do you actually need?

We'll go into more specifics about what each part of Medicare covers in our Medicare 101 episode, but here's a brief overview of that. So part A and part B, are the two parts that make up what is considered original Medicare, or traditional Medicare. Part A is often referred to as hospital insurance.

And it provides coverage for services like inpatient hospital stays, skilled nursing, home health care, and hospice. Part B, on the other hand, is often referred to as medical insurance, and it provides coverage for most doctor and outpatient services. There is Part C. Contrary to popular belief and what it sounds like, Part C is not part of original Medicare.

But instead, Part C is just another term that refers to Medicare Advantage plans, and these are provided by private insurance companies and they provide a private Alternative to Original Medicare, which is Part A and Part B. So just remember there, Part C is not something you're automatically going to have there's also Part D. Now, just like with Part C, Part D coverage is also not a part of Original Medicare. Remember, that's only A and B, and instead, it's an additional prescription drug coverage. And this coverage is also provided by private insurance companies that are contracted with Medicare.

There's also Medigap. Original Medicare does not cover 100% of your costs for... the covered services. So Medigap plans are purchased by consumers, and you purchase them from a private insurance company as secondary coverage to Medicare. And then that's going to fill in most of the financial gaps that are left by original Medicare.

Now it's really important to understand, as I mentioned earlier, you're not going to have all of these things together. So you're not going to have A, B, C, D, and Medigap. Generally speaking, you'll have either original Medicare Part A and Part B with a Medigap plan and with a Part D prescription plan, or you're going to be enrolling into a Medicare Advantage plan as an alternative to those coverages.

Cameron: Exactly. Yep. So, just understanding the different parts of Medicare is crucial, and along with understanding how they work and what they do, you have to understand when you can first enroll in these different parts of Medicare. So again, for most consumers, your first chance to enroll in Medicare coverage will be your initial enrollment period, which is also shortened to your IEP.

This enrollment period applies to original Medicare Part A and Part B, and it also applies to Medicare Advantage plans and Part D prescription drug coverage. Not everyone is going to have to use their IEP. So if you plan on delaying Medicare due to having something like active employer coverage, tune into our other episodes for what you might want to do after age 65.

Now your IEP. It's a seven-month enrollment window, and it occurs during the three months before the month you turn 65. It also includes the month you turn 65, and it includes the three months following the month you turn 65. However, just to make things complicated, I'm not sure why, but if you were born on the first day of the month, your IEP, actually occurs one month earlier.

So let's break this down with a quick example. If your birthday is August 19th, Your IEP would be from May through November. But if your birthday is August 1st, your IEP would be pushed forward a month. So it would be April through October. It starts a month early. It also ends a month early. On another note, don't think you can get a head start on Medicare coverage by applying during the first month of your IEP.

Yes, you can get everything in place and have it ready to go, but your coverage won't start sooner. So if you apply for Medicare during the three months before you turn 65, your Medicare coverage it's still going to begin the first day of the month you turn 65 in most circumstances. And just an added note here when it comes to Medigap enrollment, the most crucial enrollment period when it comes to these plans is your Medigap open enrollment period.

This period lasts for six months, and it begins when you are 65 or older and enrolled in Medicare Part B for the first time. During this enrollment period, you can enroll in any Medigap plan that you're eligible for without health questions and without being denied for having preexisting conditions. So super important to understand the timing of all those different coverages.

And then this brings us to key number three, which is probably our favorite, or at least most talked about, and Joanne can. Talk all about it.  

Joanne: The most talked about, and we did a customer client survey a few years ago. And if you remember Cameron, 62% of people at that time said this was the hardest thing for them to discern and understand and choose between Medicare Advantage and Medigap.

And you have to, to choose well; you have to understand them. Choosing between those two types of plans, Medicare Advantage plans and a Medicare Supplement plan, it is one of the most important decisions you're going to make when it comes to Medicare. So it's important to thoroughly understand both of these options and really how they work.

Of course, you don't technically need to enroll in either of these coverages, but the vast majority of Medicare enrollees will choose to do so. Even if you think you're dead set on one option versus the other, it's always a good idea to take the time to seriously consider both and get the exact costs and the coverage quotes for each option on your specific geographic location and your health needs.

So as Cameron mentioned, don't listen to the opinions of your friends, family, Friday night cocktails, and things like that. Don't listen to those opinions until you've seen the numbers and then really. Thought it through to how it would work with your world, your life, your budget, and things like that.

And this is often where a broker can help because we can point out things we've seen with the thousands of people we've walked through this exercise. Now, Medicare Advantage plans, and Medigap plans are entirely different ways of having Medicare coverage. We do have other episodes and videos that are devoted to the detailed Differences between these two options and who they might be right for.

But for now, we're just gonna do a brief overview of the two so you know how to go and what to look for when you're looking for those videos and such. Medicare Advantage. So Medicare Advantage plans, again, remember these are also referred to as Part C. These are private alternatives. to Original Medicare, and they bundle all of the benefits from Part A and B and typically your Part D, which is drugs, and they bundle that into one package.

Now, these are managed care programs and private insurance companies offer them, and they typically are going to come in the form of an HMO or a PPO. They will often require the use of specific networks of providers and hospitals, and they may require you to have prior authorization before you get certain medical procedures performed.

Okay? So Medicare Advantage plans must follow set rules by Medicare, and they must cover the same services covered by Original Medicare, but you always remember getting those services delivered to you differently if you enroll in a Medicare Advantage plan. Now, a Medicare Supplement, which is also considered or called Medigap, is sold by private insurance companies, and these are designed to fill most or all of the financial gaps that are left by Original Medicare, which again is Part A and Part B.

These Medigap plans they're going to provide secondary coverage to Original Medicare. So Original Medicare is going to remain primary, and it's going to allow the beneficiary, which is the consumer, purchasing a Medigap plan. It's going to allow them to see any provider that accepts Original Medicare anywhere in the country for any Medicare-approved procedure.

Then you should buy a Part D plan, which is a drug plan, and you can buy that in addition to Medigap, which will handle the prescription drug coverage for you. 

Cameron (2): Yeah, exactly. It's all about understanding the differences between Medigap and Medicare Advantage. Just to highlight it one more time, again, these are very, very different ways to get your Medicare coverage.

They're certainly not the same. You won't have both together. And I would say no matter your situation, just take the time to look at both options. We think that's super important. So we've talked more about coverages when it comes to Medicare, but key number four is understanding the cost of Medicare.

It is impossible to make a transition to Medicare without knowing what Medicare might cost you. Or at least it's impossible to make a proper transition without doing so. Even if you plan on delaying Medicare, it can be worth understanding the cost of Medicare. So you can at least plan for the future.

So some original Medicare costs know that most people will be eligible for Part A of Medicare with no monthly premium. And when I say most, it's 99%, so it really is most. However, Part B comes with a base premium of $164.90 per month. Now, Medicare Advantage plans, the Kaiser Family Foundation reports that the average Medicare Advantage plan monthly premium is 18 per month in 2023.

However, they also found in 2022, 69% of Medicare Advantage enrollees paid 0 per month for their plan. Next, you have the Medigap and Part D options that Joanne talked about. So, Medigap plan premiums are highly, highly dependent on where you live, but as an example for Plan G for somebody that is 65 years old in Michigan, it might range from 100 to 140 per month for a competitive plan.

Part D, the prescription coverage, is an extra expense in addition to Medigap coverage, and CMS has reported that in 2023, the average Part D premium is 31 dollars and 50 cents per month. Still, Part D premiums can range from single to triple digits per month. And it's important to know that with Medicare Advantage and Medigap coverage, you will still be responsible for paying your monthly Part B premium.

So there are possible ways to get assistance with Medicare premiums. It's essential to see if you are eligible for financial assistance through state or federal programs to help with Medicare costs. Some of these can be a low-income subsidy or extra help. It's a federal program that can help with prescription drug costs.

And then there are also Medicare Savings Programs. These are provided or administered by the states, and they can provide assistance for Part B premiums and other out-of-pocket costs. Just know that both of these programs are typically going to be based on your income and your asset levels. So they are not designed for everybody.

They are there for those that have the financial need to get assistance with their Medicare costs. Now on the opposite end of the spectrum, some people say, "I pay more than $164.90/month for my Part B."

And that is possible. So it is also essential to know that if your income is higher, you might pay more for some of your Medicare coverage due to the income-related monthly adjustment amount, which is known as Irma. We have discussed this in much more detail in other episodes, especially our Irma episode. Still, generally speaking, you may have to pay more for your Medicare if you're modified, adjusted gross income as an individual is $97,000 or more, or $194,000 or higher if you file a joint tax return and just keep in mind, IRMA will take into account your income from 2 years ago, and it only impacts part B of Medicare and part D. And that also includes if you get a Medicare advantage plan, that includes that part D prescription drug coverage. So again, if you think IRMAA might impact you, just check out our other podcast episode.

And last but not least, Joanne can talk about key number five. 

Joanne: Alright, the last thing to make this more stress-free for you all is understanding some of these lesser-known Medicare scenarios. So there's going to be a whole smorgasbord here. But up to this point in the episode, we've covered the most common keys to ensuring a stress-free transition to Medicare.

But the last key is being aware of some slightly less common scenarios that might impact you when you become eligible for Medicare. One of the first ones we see, and it's a huge one, is Medicare and COBRA. And our recent podcast episode was all about this. It's a serious thing that happens to many people, but many people are unaware of this.

But if so, if you're approaching Medicare eligibility, it's crucial to understand how Medicare and COBRA interact. COBRA is secondary coverage to Medicare once you're entitled to Medicare. So it's very likely you will need both Part A and Part B of Medicare in place. as primary coverage if you keep COBRA coverage.

COBRA involves work and leaving employer coverage. So again, please go back to our podcast episode all about that for a lot more detail. But we see that hurts Medicare beneficiaries, and they had no idea. Another thing that we see often is Medicare and HSAs, which is a health savings account.

So if you are enrolled in Any part of Medicare, either Part A or Part B, you can no longer contribute to a health savings account. Also, your employer or anyone else cannot contribute to that account either. So if this might impact you, please make sure you listen to the full episode about Medicare and HSAs, and there's also a good YouTube video all about Medicare and the HSAs.

Medicare and marketplace coverage. So most people are happy to leave their marketplace or ACA marketplace insurance when they become eligible for Medicare unless they get a federal subsidy. But those people may not be as eager to make the switch. Unfortunately, you have to make the switch, and it's essential to understand that if you're eligible for the premium.

Free Part A coverage with Medicare. You're no longer able to be eligible for that marketplace subsidy. And that means that help that you have been getting paying those premiums will dissipate. And if you don't go to Medicare, don't think you're getting away with this because we see people impacted at their tax return time when those subsidies are pulled back, and they're stunned.

Alright, so don't delay that. Let's talk about delaying Medicare based on your employer size. So delaying some or all of your Medicare coverage past age 65 may be possible, depending on if you'll continue to have active employer health insurance. The other key thing that some people gloss over is that you'll want to ensure that the employer providing the insurance to you has more than 20 employees.

So that your employer coverage will remain primary to Medicare past age 65, so again, if your employer has over 20 employees, this goes for a spouse's insurance. If you're on active worker coverage, you can stay on that if your employer has over 20 employees. If it's 20 or under employees, you need to get Medicare in most situations.

Lastly, if you're covering a younger spouse with your group health insurance, make sure that you consider how your Medicare enrollment and the choices that you're going to make will impact their coverage and their cost. That's important to kind of factor here.

Cameron: Yeah, everything is super important to consider, as you can tell.

So approaching Medicare eligibility can seem daunting, but we know that there are vital things you can remember during your transition to Medicare to make sure you aren't making any mistakes. You are getting the right coverage for you with as little hassle and stress as possible. As always, please leave us a review on your podcast app and subscribe so you can listen to future episodes.

You can also find more Medicare content from us by going to YouTube and searching Giardini Medicare. You can also search Giardini Medicare on TikTok. And lastly, you can visit our new free online course@gmedcourse.com, which is gmedcourse.com. Thanks for listening, and have a great day.