Joanne: We often hear that one of the most frustrating things when it comes to Medicare is where to find answers to many of the common questions that people have. So to help solve that, in this episode, we will answer several questions that have recently been asked by our podcast and our TikTok audience.

So you can get some of those answers to the Medicare questions that you might have as well. 

Cameron: But, before we start, my name is Cameron Giardini, and together with my co-host Joanne Giardini Russell, we operate Giardini Medicare, which is an independent insurance agency based out of Southeast Michigan. Now, although we are based in Michigan, we do work virtually over the phone to directly help consumers in about 13 States find the right Medicare coverage for them.

If we do not work in your state, we will connect you with another trusted independent agent who will be able to help you find the coverage you want. And last but not least, we now have a free online course that you can have access to. You can do this by going to gmedcourse.com and there you will find hundreds of Medicare topics, pretty much everything we could think about when it comes to Medicare all in one place.

So a brief overview, like with all Medicare content we produce, our goal is to give you as much useful information as possible from the comfort of your home without giving out personal information, which is often pretty hard to do when you're transitioning to Medicare. We really couldn't make these episodes without you being our listeners, so if you have any specific questions that you want us to cover in a future episode, please, please send us an email to info at gmedicareteam.com

And then we will do our best to feature one of those questions as well as the answer on our next Q&A episode. So, let's dive into question number one. Question number one is, Am I guaranteed enrollment into a Medigap plan when I get my Medicare Part B? No matter my age over 65? So there are a couple of different ways to ask this question, but what the listener is wondering is, do they have access to their Medigap Open Enrollment Period if they apply for Medicare Part B after age 65?

So as a reminder, your Medigap Open Enrollment Period lasts for 6 months, and it begins the first day of the month when you're both 65 or older. and enrolled in Medicare Part B for the first time. I can't emphasize that enough, but again, it's both 65 or older and enrolled in Part B for the first time.

Now during this enrollment period, the reason it's so special is because you can enroll in any Medigap plan that you're eligible for in your zip code regardless of your current health status and pre-existing conditions. So if you're wondering why someone might have delayed their Medicare Part B and even be asking this question in the first place past age 65, We will discuss this in more detail in other episodes, but just know typically this occurs if you are covered by active employer group health coverage from an employer with 20 or more employees, and you want to continue that coverage past age 65.

Just wanted to mention that in case any of you are wondering that. Now with that being said, the answer to the original question is yes. If you delay your Part B of Medicare past age 65, You will still have access to your individual 6-month Medigap Open Enrollment period when you do later enroll in Part B for the first time.

For example, let's say you delayed your Part B past age 65 due to having active employer coverage. And then at age 70, you retire in July, and you want your Part B to begin August 1st. Now, in this case, your Medigap Open Enrollment Period will last for 6 months, from August until January of the following year.

And you could use that period to enroll in any Medigap plan that you're eligible for. The reason we bring up this topic is that it is super important not to enroll in your Part B of Medicare if you don't need to if you're continuing working with larger coverage and you think the costs benefit you to just stay with that employer coverage.

We've talked about it in a lot of episodes, but if you just randomly start Part B just because you think you have to at age 65 and you don't have to in your situation, you can run into issues, or you potentially will. where you no longer have access to that Medigap Open Enrollment period. You may still have other guaranteed issue rights, but they will be more limited compared to Open Enrollment, so it's really important to take a step back.

When you're turning 65 talk with a broker to figure out if you need Medicare and when you need it to avoid mistakes like this when it comes to Medigap Open Enrollment. And can we just do 

Joanne: one more time, Cameron, because this is such a common, common, common question. Specify that it is age 65 and older and enrolled in your Part B coverage. Okay, that's the truth. 

Cameron: It's not just happened because you turned 65. Both of those situations have to be true. Now, as a little bonus answer for those of you who might be enrolled in Medicare before age 65, which might be due to disability or conditions like ALS or end-stage renal disease, If this is the case for you, you will still have access to your Medigap open enrollment period when you turn 65, just like anybody else that is turning 65 and enrolling in Medicare Part B for the first time.

Joanne: Let's move to question number two. So what happens with my HSA plan with my current employer coverage? If I continue to work beyond age 65, so as a quick reminder, an HSA stands for a health savings account, a health savings account is a specific tax advantage savings account for those people who are enrolled in a HSA eligible.

High deductible health insurance plan. Also, don't forget to listen to other episodes that we have specifically about Medicare and HSAs. So, if you enroll in any part of Medicare, you then become ineligible to make contributions to your HSA at that time. A lot of people aren't aware of that. But what happens if you delay both Part A and Part B of Medicare due to your having active employer coverage from an employer with more than 20 employees and you go past age 65?

Contrary to popular belief, if you are not collecting Social Security retirement benefits in this situation, you can likely delay both. Part A and Part B. Again, most people do not understand this, but you can defer both Part A and Part B of Medicare. In this case, you can continue to contribute to your HSA just like you were doing before you turned 65, as long as you will still be enrolled in that HSA-eligible plan.

The reason you can do this is that although you are 65 and eligible for Medicare, you don't enroll in any parts of Medicare. You are still eligible to make those HSA contributions. Medicare is not technically a high-deductible plan, so remember, you have to be enrolled in that high-deductible plan at the workplace, and then you can still make those contributions, but you cannot enroll in Part A or B of Medicare.

And then, down the road, just keep this in mind, when you do finally go and apply for Medicare Part A, Your Part A effective date will be, in effect, retroactively six months from the month that you technically apply for Medicare. This gets confusing, but for example, if you are 68 years old and you're applying for Medicare A and B, In September of 2024, your part, an effective date when you get your card, is gonna be rolling back and go back to March 1st, 2024.

So that means that you will want to prorate and adjust your HSA contributions for 2024 based on the fact that you would be only eligible for HSA contributions during the first two months of the calendar year, January and February, because again. That Part A effective date starts on March 1st, which would make you ineligible for the HSA contributions.

Again, it gets pretty confusing, so please go to our YouTube episode about Medicare and HSAs or our podcast episode about Medicare and HSAs. 

Cameron: Exactly. Just like everything in this episode, it's just to answer these specific listener questions. We, of course, have more information on every topic in this in more detail, probably somewhere else in another episode.

Question number three, is there a supplement plan that can keep me from getting in the donut hole so quickly? And what they're talking about is the Part D donut hole. And they say I usually reach it by March due to taking a medication called Moonjaro. So what is the donut hole in the first place? Well, the donut hole is a commonly used term for the Medicare prescription drug coverage gap.

This is a phase of prescription drug coverage where during 2024, You are responsible for 25 percent of the full cost of your medications. This can end up being hundreds or even thousands of dollars depending on the cost of your medication. The donut hole does apply to both Part D plans and Medicare Advantage plans with prescription drug coverage.

So don't think you can avoid it by choosing one over the other. So when it comes to whether or not you will reach the donut hole in 2024, this will depend on the full retail cost of your prescriptions. Once the total retail price of the medications that you are getting covered by your plan or getting filled using your plan reaches $5,030, you reach the initial coverage limit, and that is what makes you enter the coverage gap or the donut hole.

So for example, a common Part D plan, a prescription drug plan in Michigan, has Monjaro with an estimated retail price of $900 per month for a one-month supply. Now, this does not mean that you will pay out of pocket $900 every time you fill the Mounjaro, but $900 each month is being counted towards that $5,030 limit.

regardless of what you're paying at the pharmacy. So this means you would likely reach that donut hole or that initial coverage limit halfway through the year. Now avoiding the donut hole with expensive medications would require you to try to find a cheaper alternative source of your medication outside of your current prescription drug coverage.

The only way to avoid it, again, is if your total medication costs don't reach that $5,030 limit. So, some ways to do this, you use GoodRx or other online coupons, although those aren't that great for a lot of the expensive, common medications. You could also look at LIS, which is Low Income Subsidy, also known as ExtraHelp.

You could look for assistance from the drug manufacturer, this is an option we like. We use a website often called needymeds.org, you can always check there. Or you can even use medications from Canadian pharmacies. However, sometimes it might simply just make sense to use your Part D plan and reach the donut hole, so it's always important to consult with a broker to talk about all of these costs.

So, unfortunately, to answer the original question, there's not an actual supplemental policy to help. With these prescription costs, you don't get in the donut hole. It's about avoiding spending money using your drug plan It's not really adding something to your drug plan, but luckily the donut hole will no longer exist in 2025 and there will also be a $2,000 cap on covered prescriptions beginning next year. So hopefully this helps you and the particular person asking this question. It's the best no more donut hole yeah, hopefully, everything else falls into place as well, but One good thing to hope for we shall see 

Joanne: we shall see question number four is there another part B?

Enrollment options after age 65, if I'm not leaving employer coverage So leaving active employer coverage group insurance, can allow you to enroll into Medicare Part B after your age of 65 years old using what is known as a special enrollment period or a SEP. Now, this enrollment period can be used while you're still covered by your active employer coverage and if your employment ends or your employer-provided medical coverage ends.

You then have eight months from that month, whichever comes first, to sign up for Medicare Part B using this special enrollment period. But what if you're not leaving employer coverage, like our listener here is asking? So, a couple of other options, you may be able to use your initial enrollment period or your IEP, but this ends three months after the month you turn 65 years old, so this is only going to be applied to you if you're just barely over age 65.

Otherwise, after those three months are gone, your IEP will end, and then it won't occur again. So this just leaves two main options for then going to get Part B coverage after you've turned 65 years old, and you are not leaving employer coverage. So what are the two options? Well, Option number one is the General Enrollment Period, and this is called the GEP.

This enrollment period occurs every year from January 1st to March 31st, and it allows a person to enroll in Part B if you're eligible for it, regardless of what other coverage you have or may have had. Just know that having to use the GEP to enroll into Part B, may result in a lifetime Part B penalty for you, and it's typically the enrollment period of last resort.

Another option, option number two, is Up until recently, the only Part B special enrollment period was if you were leaving employer coverage, as we mentioned. But as of 2023, there are now some new SEPs that may be available and worth at least looking into if necessary. These possible special enrollment periods may be available for individuals who are impacted by an emergency or a natural disaster.

Group health plan or employer misrepresentation, which is an interesting one. If you've been terminated from Medicaid eligibility, you've been maybe formally incarcerated as an individual. And finally, there's another SEP that is called Other Exceptional Conditions. So, that leaves a lot of room for interpretation.

But, and we haven't seen that much yet, have we, Cam? 

Cameron: I have not seen somebody use it, but hey, it's an option, so. It's an option. I just know about it. Yeah, and again, just so everyone knows, just to be clear, the main option for most people when you are applying for Medicare after age 65 is leaving active employer coverage, so hopefully that is the option you'll be able to default to.

So question five is pretty interesting, I think at least. It's why people push Medicare Advantage plans to those under age 65. And first, it's important to mention why some people might even be eligible for Medicare before age 65, while many are not. So, you may be eligible for Medicare before age 65 if you have been receiving Railroad Retirement Board or Social Security Disability Benefits for 24 months.

Or you might be eligible if you are diagnosed with ALS, which is Lou Gehrig's disease, or it's Amyotrophic Lateral Sclerosis, or you might have End Stage Renal Disease, which is ESRD. And there are other criteria with certain ones of these, but those are the general guidelines for why you might have Medicare under age 65.

Now, if you are eligible for Medicare before age 65, and you start to look at Medicare Advantage or Medicare Supplement options, you might quickly realize, just like this person who asked the question, that most brokers, will be encouraging you to enroll in a Medicare Advantage plan. And we often do the same thing.

It's not pressuring people, but we do often gravitate towards Medicare Advantage in this scenario. Now you might think this is because of bias or greed, but in reality, it simply comes down to affordability. The large pricing difference between Medicare Advantage and Medigap plans for those under 65 is what makes a lot of people choose the Medicare Advantage side.

So for example, in Michigan, a Medigap Plan G, which is normally about $130 per month for someone age 65 or older, That could be up to $500 per month instead for somebody under 65. And that's the same plan with the same benefits. However, Medicare Advantage plans, don't change based on age.

So a $0 per month Medicare Advantage plan would be the same price for somebody who's over or under age 65 on Medicare. So the math changes when we're looking at when you're eligible for Medicare. However, with that being said, make sure to talk to a broker that is licensed in your state since Medigap prices, can vary drastically for those under 65.

from one state to the other. Companies in states like Pennsylvania, Kansas, and, more recently, Virginia, are offering Medigap plans at a similar price to those over age 65. Finally, remember that despite Medigap plans potentially being much more expensive for those under 65, If you can qualify for a plan, you can still enroll in a Medigap plan if you'd like to.

It just has to come down to whether or not you truly want to pay those higher premiums and you can afford to do so. Question number six

Joanne: If I have a Medigap plan F and I can't pass medical underwriting, can I at least change to plan G or N with the current company that I have? So, again, remember that after your six-month Medigap Open Enrollment period when you first start your Part B coverage and you are age 65 or older, in most circumstances you'll have to go through medical underwriting and answer health questions to be able to change to a new Medigap plan.

Based on the answers to the health questions and the preexisting conditions you might have, you may be approved or you might even be denied to change your Medigap coverage. So underwriting is even going to apply when it does come to changing Medigap plan letters, like Plan F to a Plan G, with the very same insurance company that you already have.

Some companies may make exceptions to this once in a while, so it's always good to ask, but I would say you really should not expect them to allow the change if you can't pass medical underwriting. So the answer to our listener's question is likely going to be a no. Now, there are just about a dozen states where changing Medigap plans may be possible regardless of your health due to unique rules called birthday rules or anniversary rules and even year-round open enrollment or guarantee issue rules.

We're going to link to a list of these states in the show notes for the episode, but also make sure to connect with an independent broker that's licensed in that particular state so you can learn about those specific options. But generally speaking, it's always best to think of your initial Medigap choice as your long-term coverage for years to come.

Make sure you choose a plan letter that you're going to be happy with for many, many years. Also, we typically don't recommend Plan F when it is possible to enroll in other plan options like Plan G or Plan N our listener was wondering about. 

Cameron: Now last but not least, Question 7. Do we always have to rush to make plan changes in the fall?

And this is a really good question because we are just coming off of that time. So the Fall Annual Election Period, or AEP, is certainly the most popular time to look at plan options. But it is also the most hectic as many of you are aware. In our opinion, this time of year it's overhyped by advertisers and even brokers, since, as you will see, this is not the only chance you have to make plan changes.

So when it comes to Medicare supplements or Medigap plans, if you can qualify for a new Medigap plan based on your health, You can make the switch from one Medigap plan to another any day of the year, any time. Also, the fall annual election period, typically doesn't allow you to change Medigap plans with no health questions, so there's no benefit to changing in the fall.

Overall, the fall period has very little to do with changing Medigap plans, and it might even be the worst time to do so since that is when most companies are swamped with other people making plan changes. So if possible, we would always suggest looking at different Medigap options from one to another outside of the fall or really before the fall craziness begins.

Now when it comes to Medicare Advantage plans, despite the frenzy during the annual election period, there is another Medicare Advantage enrollment period right after AEP, and this is called the Medicare Advantage Open Enrollment Period, It's pretty confusing, but based on the name, because a lot of times open enrollment is used a lot in Medicare.

This period, it allows you to also make a plan change to your Medicare Advantage plan. This occurs from January through March of each year. Now also, during the year, dozens of special enrollment periods may be available to change from one Medicare Advantage plan to another, or from Medicare Advantage to Original Medicare.

I'm not saying these are guaranteed to be available, but they are always there to consider and at least to look at if you are in a position where you find yourself wanting to make a plan change. Now these can include if you have Medicaid or low-income subsidy, if you move out of your planned service area, even if there is a declared disaster in your area, and more that we will link to.

Now when it comes to Part D, This is actually one of the times where, generally speaking, the fall annual election period is actually most important for checking your Part D coverage. This is the only set enrollment period of each year where you can change from one Part D plan to another.

However, you may also be able to change your Part D coverage throughout the year if you qualify for special enrollment periods like the ones we just talked about with Medicare Advantage. And we will link to those. But when it comes to the fall annual election period, our tip is to start early. Plan details for the upcoming year, they are released on October 1st, and you have until December 7th.

So you have close to two and a half months to decide if you want to make a plan change. And you can also think about what plan you may want to change to. So start thinking about what you're looking for regarding new coverage even before the fall. Think about it in August and late summer, that way you're not rushing to make these plan changes towards the end of the year as that December 7th deadline approaches.

So overall, finding the answers to your specific Medicare questions can often seem like a daunting task, but hopefully, this episode has helped you see that you aren't alone. We know we say this often, but it is really important to connect with an independent broker that you can trust to go over your specific situation and questions when it comes to Medicare.

As always, please leave us a review on your podcast app and subscribe so you can listen to future episodes. You can always find more Medicare content from us by going to YouTube or TikTok and searching Giardini Medicare. Last but not least, if you want to give us any feedback or send us any questions for future episodes, please email us at info at gmedicareteam.com. But thank you and have a great day.

​