Getting Your Edge: How to Rightsize your Home and Life.
Life Happens to Everyone! These events can force changes in how and where you live. How you react and manage those events is what matters. Join Judy Gratton and Dennis Day, two agents with over 22 years combined experience in real estate, as they provide you insights into managing the twists and turns life throws at you, so you can land on your feet and in the right place. Whether you need to downsize from the forever home, upsize to handle a growing family, or moving an aging parent into a safer setting, the “Rightsizing” Podcast will share the information you need to “rightsize” your home and life. Using their personal experiences and interviews with experts in a variety of fields, like: financial planning, estate sales, or living abroad, our hosts will dish out the information and advice that will help you take on life’s challenges informed and prepared. For more information about the Edge Group Real Estate Team and the Freebies click here: https://edgegrouprealestateservices.com/
Getting Your Edge: How to Rightsize your Home and Life.
Medicare 2025
As we tackle the complexities of Medicare Advantage plans, Kevin Anderson shares why partnering with a Medicare broker can be a game-changer in finding the right plan without additional charges. We'll discuss the open enrollment period, potential pitfalls like scams, and the critical importance of reviewing your plan annually. Learn how companies like UnitedHealthcare are navigating financial constraints by adjusting benefits and explore why connecting with reputable professionals is essential for safeguarding your healthcare choices. Empower yourself with the knowledge to avoid unexpected challenges and make confident decisions about your healthcare needs.
Welcome back everyone. This is Dennis Day. With Getting your Edge Out of Right Signs, your home and life podcast, We've got a very informative show about Medicare. Before I get going, I want to introduce our co-host, Judy Gratton.
Speaker 2:Hi Dennis.
Speaker 1:Hi, jay. Our guest is Kevin Anderson. Has been working Medicare for the past 12 years, enrolled over 800 people. Kevin has a sets you apart from a regular Medicare agent, much more informative and helpful than the 1-800 numbers, kevin, that's for sure. Why, kevin? What's the difference between you and other brokers?
Speaker 3:One of the key things this year instead of being an adaptive agent for one company, we found it necessary to become brokers. I'm appointed with five companies in your area. I can write 38 plans. I'm not a captive, so we have the freedom to find the perfect plan. Most common thing I hear is I want the same plan you gave my best friend and I said there's about a one in 25 chance it happened. But let me ask you some questions. We want the best plan for him, but it wasn't the same as his friend. Being a broker gives us the freedom to find the best plan. Make sure networks are appropriate for the individual, and that's why I'm good at what I do.
Speaker 2:Kevin has been our broker for two years, I think, or is it three. This year everything changed. I had Kevin up before. It's important for people to understand the changes this year and how it could affect Mentioned me, Kevin People who want to change plan. I want the. When they saw what was, they didn't want it. That was me.
Speaker 3:No, you weren't alone. I had a couple of those today.
Speaker 1:What are the key changes from 2024 to 2025 in Medicare and how will they impact seniors?
Speaker 3:It is every advantage plan drug plan will choose to exist December 31st why plans are being dissolved because of changes in Medicare. Many people won't be aware until January 1st that they've reverted back to simple A and B Medicare without a supplement or Advantage plan. Several companies have left this. Many counties in Washington, well-known companies leaving permanently, starting in January. Let's see if I can do it in a nutshell without making two-hour Medicare seminars.
Speaker 2:Okay.
Speaker 3:Because of companies' counties, the big void. At least two companies have come into Washington for the first time. Other states, not only Washington, but in every single county they're the only Medicare companies in every county Brings challenges to establishing networks. Here is big in Oregon, but this is their first time in Washington. It's a scary thing. Big company leaving in Washington. 69,000 people will wake up January 1st without a plan if they didn't do anything. Those blooms and people can't enroll in a plan. It's unfortunate, but I'll touch on more of this as we go.
Speaker 2:Why were there changes in Medicare happened and what are the goals intended to be achieved by these changes?
Speaker 3:Judy, that's a good question and gets to the heart of the matter. The big news is that the donut hole will cease to exist starting in January. Congress has been working on shrinking the donut hole to help seniors. Congress has been working on shrinking the donor role to help seniors In 2022, president Biden's son in the inflation reduction and eliminating the role Huge.
Speaker 3:My wife and I both do Medicare and we've had people with drug lists who paid $28,000 a year. It's a record in the low twenty thousand dollars. Once you and the plan paid five thousand, not counting premium, you under the donut hole, the twenty five percent on a typical tier three, the free, the copayment might be 45 bucks. All of a sudden they're four and five hundred in the donut hole hoping to get out next year once they've reached $2,000 in deductibles or co-pays the rest of the year. I applaud President Biden. Another change is payment plan for prescriptions Starting in January.
Speaker 3:Folks that spend $24,000 a year in drugs, that's $10,000 a month. After January. The drugs will be free after that. Right, not very many of us can spend $10,000 in one month. Right, we're on fixed budgets. Seniors have downsized. They've moved into. You guys know all about that more than I do. They're on a set budget that doesn't grow unless you count little raises in their social security. They're on a set budget. It doesn't grow unless you count little raises in their social security. They're on a fixed budget. How do you pay the $2,000? Medicare says starting next year. What we'll do is we know you won't have drug payments after this. We'll divide it into 12 months. They won't discount it, so insert a $2,000 in January. I don't know what $2,000 divided by 12 is. Judy's super good at math when she has a calculator in her hand. When she has a calculator in her hand.
Speaker 2:Ah, okay, yes, I do, right here. It's called my phone. I'll look.
Speaker 3:It's going to be like $105 in January and each month, I'm guessing, but that's better than $2,000. And that's brand new and that's from the inflation reduction net. So those are good things. Now, one of the results of that is that drugs that $166.66.
Speaker 2:There you go.
Speaker 3:Well, it's $8.44. The whole thing is geared towards helping seniors lower the cost of their medication, and so that's a great thing. Would you like to know how the premiums and deducted and co-pays will change?
Speaker 1:Absolutely. I've been waiting all day for this.
Speaker 3:Medicare allows drug plans standalone drug plans or embedded in advantage plans. They allow a $590 deductible. That's the max. Now companies can go with less, but most of the drug plans are $500. If we're talking in the $37 to $48 range a month or premium for a drug plan, they're going to have to pay the whole $590. Now, many companies that have Advantage plans with the drug plan, they're going to have to pay the whole $590.
Speaker 3:Now, many companies that have Advantage plans with the drug plan built in, they said 90% of prescriptions are generic. Tiers 1 and 2, they're fine. Tiers. Tiers 1 and 2 are generic. We won't apply a deductible to that. We'll just apply a deductible for tiers 3 and up. That's a huge help, right. And they might say a deductible for two years. Three and up. That's a huge help, right. And they might say, depending on the plan and depending on the company, instead of $590, we're only going to charge $150 deductible. So that's another good thing. It's making money on lemonade, because it isn't such a great thing that people have to pay the deductible where they never had to do that before.
Speaker 3:If you want a standalone drug plan without a deductible, the cheapest one that I know is $83 a month and I haven't enrolled a single person in it. Now many people have been mapped over to that by their companies because of the plan that they had that went away. The company is going to automatically put them in another drug plan. But the reason I don't like it $83 a month, remember. Premiums don't count towards your $2,000. So you get rid of the $590 deductible. You start just paying co-pays on your medications but you don't get credit for that $83 or more a month. You don't get a thousand dollar credit towards a $2,000 max. It doesn't make any sense in my way of thinking. Now, in the past it was important because you paid $100 a month or $110 a month for a premium for a drug plan, but then you had reasonable co-pays.
Speaker 3:Now my own drug plan I'm not on an Advantage plan. There aren't Advantage plans. In the county that is now my permanent residence Most overall as a general term, there's no advantage plans. So I have a standalone drug plan. Mine, if I kept that one, went up tenfold for January and included a $590 deductible. It went from $3.70 a month. Very few people know about that drug plan but I have a great agent. My wife put me on that plan and instead of $3.70 a month premium they want you to pay $37 a month next year. That's tenfold Now. The other big change is many plans I won't say a majority of them, but pretty close to at least half the plans now will have a medical deductible. That's brand new news to me. I haven't seen that before in the state of Washington. So before your zero copay for your physician visit, you've got to meet a $175 deductible or whatever the deductible is. Unfortunately, the biggest company doesn't do that. They don't have a medical deductible. So those are some of the changes that we're going to see.
Speaker 2:That could be really expensive if you're not careful.
Speaker 3:It is and we'll get it to the end on what people can do if they've made a mistake or they don't know how to. For instance, today is Wednesday, medicare opener annual enrollment, and Saturday at midnight. We're down to the last three days Thursday, friday, saturday and in years past we've had appointments showing up at houses on December 7th at 11 pm. Back then Jen had to do the whole list. The case is one at a time. I forgot the question, just to remind you. Jen had to do the whole list. The question is one at a time. I forgot the question. I have just to remind you I have attention deficit disorder, so I go down rabbit trails and sometimes I don't make it back.
Speaker 2:I think you have earned that. It sounds like over the last few weeks trying to help people understand what the best choice is for them, and I really Kevin sat down with us with three different plans and explained the three that he saw for our particular needs, and then we made a decision based on that, but it took a lot of work. One of the things that I know has changed dramatically is dental, which I'm very much a stickler about dental, and so Kevin had to go hunting to find something that worked for us with dental.
Speaker 3:There's another challenge that doesn't affect very many people in your audience, but people that have Medicare and Medicaid. That whole arena and that's outside the scope of this webinar that little arena is changing dramatically. Companies, that one, one company has eight dual plans where before they just had two, an hmo and a ppo, now they have eight. Now we have to determine eligibility or and, and then there's an integrated issue that's going to come up in the next few years, where the company that gives the dual plans has to be integrated with Medicaid and a contract with Medicaid so that they only get billed once. Doctors don't have to spend, send part of the bill to one place and then the other part to Medicaid, so there's a same one. Thank you, judy, for the compliment. I appreciate it.
Speaker 2:Well, I'm very serious about that and that's why I wanted to have you back on, so hopefully people hear this Now. You mentioned something briefly about if they don't have an open enrollment period, but isn't there a period in the first part of the year where they can still make a change?
Speaker 3:Yes, it's fair. Just a few years ago it's called open enrollment period. People call the one we're in right now open, but it's annual enrollment period that goes through December 7th. A-e-p, o and B you're right, judy starts January 1st and goes to the end of March. It's only for people with Advantage plans and I'm glad Medicare started this a few years back.
Speaker 3:If you have an Advantage plan that you don't like, or you signed on to one because you watched the TV commercial or whatever and you signed out it's not what you were hoping for. In January and February and March you can change to any other Advantage plan guarantee issue, no waiting periods, no pre-existing conditions and you can get the plan that's best for you. Now that's really important in the companies that stayed. The companies that stayed have sent back. In the first week in October they sent annual notification of change letters to everyone and it said here's your plan for 2024. Here's the plan we're putting you in for 2025.
Speaker 3:If we're talking about UnitedHealthcare, that's 20 new Advantage plans, 20 that they have for this year. And so a computer decided you're on this certain PPO, we're going to put you on this other PPO, yeah, and your premium is going to jump to $46. It doesn't come with any dental anymore or it might include just cleaning, something like that and people go, oh okay. And then I've been called so many times just even today again and I called and activated my new car and I didn't have to come and see you. Should I cancel my appointment? No, you shouldn't. Let's have the appointment and let's see if that's the best plan for you, and in a very short order we find out it's not.
Speaker 3:But that's perfect. For those whose companies stayed Not like regions that left you have nothing right. But if that company stayed, whether it's Humana or UnitedHealthcare I won't mention a couple of the others. It's just better not to mention a couple others. I don't want to disparage anybody, but for those that stayed, they mapped over their client base to a new plan. Some companies called it frost blocked them over, so they won't be without coverage and during OEB we can change you. So that brings a lot of hope.
Speaker 2:One point I want to make because I don't think people understand this but your services don't cost them anything.
Speaker 3:No, and I had 10 appointments today and twice I was asked this question. Judy just made a statement about how much do we owe you? I just spent two hours with this. Do I have to pay you? No, and it doesn't matter if I enrolled you a premium of zero, a plan that costs nothing, or if I enrolled you in an F plan supplement that costs $330. It doesn't matter, I get paid the same. The companies pay us and the companies have that money because Medicare pays them to administer the plan. So now it's free and everyone should utilize an agent or a broker. It's very helpful and they don't make more money recommending certain plans.
Speaker 2:So, going back to why did all these changes like loss of dental and different things why?
Speaker 3:Okay, simply, your drugs this year are free after you pay $8,000. Next year they're free after $2,000. Companies have a $6,000 gap. Right Now everyone makes it into the normal, but lots more people are going to make the $2,000. So how do they build a plan? They have a certain amount of money for Medicare that they have to give back 85% in benefits. They're allowed 15% for expenses and employees and profit ROI. So they have to make up $6,000. Now some companies just stripped bare bones the medical Instead of $25 for a specialist, maybe it's $65, for example, right Instead of $1,000 for dental. One company has $250. And not only is it $250 for dental, it's your total for dental and vision. So they stripped down to make up that $6,000 hole. Now I don't mean to just talk about one plan, but the only company that illustrates what I'm trying to say the best is UnitedHealthcare, with 20 new plans. So they built a plan with certain kinds of frosting on the cake. The cake is the same size. Medicare is Medicare. Here's the cake. Maybe I want less cake and more frosting. Maybe I just want a bite of cake in the middle and lots of frosting.
Speaker 3:Being the auxiliary benefits or alter therapies, like some people are into naturopath and the acupuncture. Some people really enjoy chiropractor. Those are alternative therapies. There's only three plans in your county that includes those things, but then they might not have over-the-counter, they might not have glasses. Some don't even have dental at all or they might only do cleanings. And offer a dental say $54 a month, we'll give you $1,500. Offer a dental, say $54 a month, we'll give you $1,500. So pay $600 a year, we'll give you $1,500. Dental which he's alluding to is one plan has $2,500 of dental and it also has $50 of over-the-counter. That's fantastic, but not all plans have that. And some people have dentures. People our age, a lot of us, don't have our own teeth. People with dentures don't need dental coverage. They get a realignment of their dentures every five years, whatever it is. So why let the plant have dental? Let me use that money, that $6,000 hole. Let's use that money for something else.
Speaker 2:And that's what you did with us. You asked us, we gave you a list of our doctors, we did all the different things and then you were able to show us the plans that best suited our needs. And I just it's. I think it's really important for people to consider speaking to you or someone like you to do this, to make sure that. Because you said now, were people notified if regents leaves, did they notify people they were going to be gone or they just don't have anything come january 1st surprise?
Speaker 3:people without agents regents oh, regents, I'm sorry I took my hair is up okay no, they received an annual notification of change.
Speaker 3:That's required. The problem is most of them that I've seen are like little pamphlets made out of brown tissue paper. They look like a refrigerator warranty or something that comes in the box. People get that and go I don't want to read all that and they throw it out. So they're unaware that the change is coming, unless a friend has told them, and I've had a lot of people go. My friend says I'm losing my plan. Yeah, you got a letter about it. No, I never got a letter. Yeah, you did you just didn't read it.
Speaker 2:I think Jim is the one who read about our plan changing, and that's when we picked up the phone. Poor Kevin.
Speaker 3:Sounds like some of these's the College of Integration Reduction Act. There's a 1.9% max that's tied into that. It's one of the things I didn't like about it, so I won't name a company. There was one company that did $300 million a quarter, I think it was, and they were operating on less than 1% profit, and when the new contracts came out that they signed, they could see the writing on the wall that they barely survived profitability. Many companies lost hundreds of thousands a quarter this year. They're going to lose their next year. So rather than do that?
Speaker 1:they just what steps. If somebody's unclear where they stand right now, what would you suggest they do?
Speaker 3:There are a few people less than 1% that are really good at research and really good with computers. A big majority of people our age Medicare age. They're a different generation. They like their flip phone. They don't know about smartphones. They don't know about computers very well. They can do Facebook usually, but sending a picture and a text is hard. But if someone is good at studying, I recommend Medicaregov.
Speaker 3:Now Medicaregov is greatly flawed. There are several plans that we are appointed to do that people have to qualify for, that aren't even listed in there, and then many of the benefits are erroneously represented. Medicaregov but it'll get your feet wet and so I suggest to people to do an hour worth of study. Start with Medicaregov and plug in your zip code, plug in your doctors and then play around in there, see which providers cover your doctors and then also your prescriptions. You should put your formulary in there, see which providers cover your doctors and then also your prescriptions. You should put your formulary in there and then talk to a broker or a Medicare agent, enrollment agent and then you'll have some knowledge. Then your questions will be what's the difference between HMO and PPO? Before you maybe didn't even know they existed. Your questions will be smarter.
Speaker 2:Go ahead. No, go ahead, you finish, because my question is different.
Speaker 1:Oh, I'm done.
Speaker 2:Are there people they should avoid? They could call you. I hear a lot of advertisement on the radio and television and whatnot for number. You mentioned that you represent how many companies? Now, if they're only one you're only going to get what that one has to offer, correct?
Speaker 3:Correct. Yeah, and their incentives. It's then the captive agents with commission and the salary. Yeah, they're going to push for that. What was the first part you were doing?
Speaker 2:Anybody, any other? I know you can't really name names. We have any questions for if they want to talk to an agent to help, because I have, I could do it, but I don't want to. I read enough contracts.
Speaker 1:Kevin, let me ask you if they lose their coverage because they didn't do anything with this annual enrollment period and January 1st comes along, are they going to be penalized because they aren't enrolled in anything at that?
Speaker 3:time. As long as they enroll in a new plan within 63 days of their plan leaving, that will open up a window for them. But meanwhile, if they don't realize it until too late in January and it's into February, their new plan won't start until March. So they're still at that 63-day window that starts March 1st. So they won't have penalties. I think that's what you're alluding to, right, the 1% penalty per month. They won't have penalties for two months without adequate coverage.
Speaker 3:That could be really scary without adequate coverage that could be really scary. The hospital part A the most I've seen someone have to pay was $90,000. Your first day in the hospital you gotta whip out 1600. And part B all the doctors and tests. You gotta pay 20% of that. I've had two clients in the same year, same hospital. One was in the hospital for three months, one was four months. One paid $800,000. One paid $1 million. That's how much the bills were, not what they paid Advantage clients.
Speaker 3:Most of them have a built-in safety net. It's called maximum out of pocket. Once you hit that it kicks in. So you don't have to pay the millions. But you still may have to pay five or six up to $9,000 of that. But no, they'll just be without coverage until they can bring coverage and they'll be motivated.
Speaker 3:But the TV, all of them. I called and I put it in my zip code to see what I would be blessed with. Right, what those companies? Those are national commercials, many of them, and they've taken a small county in Kansas that has a certain thing on a plan that no one else in the country has. So unless you have that zip code you don't get that and they're listing all those things on the TV. The other thing too if you call, it's always a recorded call. They'll say is this Dennis Day? Yes, you just said yes, they delete this question. Is this Dennis Day? Yes, you just said yes, they delete this question. And now they've got you saying yes and they can sign you up on the phone without a signature on whatever plan they want. Seniors should never be talking to salespeople on the phone, especially not Medicare. Many scams.
Speaker 1:That's pretty scary. So long, Kevin. If people suddenly wake up on January 1st and find out I'm not covered, how do they get a hold of you?
Speaker 3:360-355-6560 or Medicare10 at gmailcom. So I'm happy to talk to anybody on the phone. Judy said we don't charge anything and if we can't get it fixed before midnight on Saturday, well, I'll give you instructions on what we can do for January with your plan. But I will stay up all night long If people call and say that they're losing their plan. Those are the ones I want to talk to, especially to make sure they don't go a couple months with just basic traditional A and B.
Speaker 1:Yeah, thank you for this fantastic information, kevin. This is really helpful and I don't think a lot of people really know this is happening.
Speaker 3:Yeah, but you think about it, judy, you're on Medicare, don't you get a bunch of stuff in the mail? Don't you get phone calls and like it hits you, yeah, for you, I'm terrible.
Speaker 2:I see it says UnitedHealthcare and they want to have someone come to my house and I don't want them to come to my house, so I just don't answer.
Speaker 3:I'm a little different because I have the capabilities of recording phone calls. The last one I ended up getting Nicole when it was her third Medicare. I said a chief caretaker charge a recorded call with someone's and here's his agent number. We'll access that recording because he didn't tell me if I picked humana's honor program. Yeah, they're gonna give me back on my social security, that's awesome, but there's no drug plan built in because I'm supposed to get my drugs through va and he never told me that. He never mentioned, mentioned it. If people from out of state get complaints and people in state, you only get so many in a Medicare Yanks, yanks your license.
Speaker 1:You can't do it anymore. Can you operate in other states, sell plants there, oregon, washington, oregon that's an anonymous, they might call you, but I'm not sure you have room to help them.
Speaker 2:Are there people you could recommend in other states?
Speaker 3:Yeah, there was a group of eight of us that are all over the place now that helped Unite Healthcare I don't remember what it was 15 years ago or whatever it was come to Cowlitz County and those are solid men, good ethics and morals. They're just like me, never do anything illegal and so, yeah, I have people in other states I can refer to Good.
Speaker 1:Thank you Kevin.
Speaker 2:That is a lot of valuable information.
Speaker 3:Just send me an email, MedicareChev at gmailcom and your phone number. That gives me permission to call you.
Speaker 1:Thank you again, Kevin. This has been very helpful and we'll probably see you again next year.
Speaker 3:And to correct Judy, this is my third time on your podcast, right, is that?
Speaker 2:right, yeah All right. Thank you.
Speaker 1:Good night, you guys.
Speaker 3:You're both awesome. Bye.
Speaker 1:See you later. That's it for this episode of Getting your Edge how to Right Size your Home Life podcast. We're here to help. If you need to get a hold of Kevin, we can help you with that. If you need information about selling your home, buying a home or just general information on downsizing, we've got it all. Thanks again. See you later. Bye-bye.
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