Hello, welcome to Boomer Banter.

So imagine this.

Your 65th birthday is around the corner and the mailbox is overflowing with glossy brochures promising the perfect Medicare plan.

You're hearing terms like Medicare Advantage, Medicare supplements, Part D, maybe even irmaa.

But it feels like a foreign language.

And you think, how hard can this be?

I've had insurance all my life through my employers, so it can't be that hard.

I'll just pick a plan.

And then a friend casually mentions to you that their Medicare Advantage plan didn't cover a critical procedure that they had.

And you start to wonder, well, what if I need to know more?

And you don't know really what to ask or who to ask?

And even if you've been enrolled for a while in Medicare, things change.

You know, you get that big book if you have an Advantage plan, do you look at it?

There's too much, right?

So you don't know what to do and if you should make a change.

And you know what?

You're not alone.

Medicare decisions can be overwhelming.

There are so many plans, all kinds of fine print, unexpected costs that catch even the most prepared people off guard.

And every year you have the opportunity to reevaluate your coverage and change it or update it.

So today we are going to dive into this Medicare maze and we're going to try to tackle everything that you didn't know to ask, but that maybe you should.

So we're going to try to understand the pros and cons of different kinds of plans and how to avoid costly pitfalls.

Hopefully this episode will give you the tools you need to make informed choices without the stress.

So let's get started.

Welcome to Boomer Banter where we have real talk about aging well.

My name is Wendy Greene and I am your host.

And our guest today is Tim Hanbury.

He is a registered health underwriter with more than 30 years of experience in the health insurance business.

He was a sales manager for Blue Cross and Blue Shield of South Carolina and a VP of Sales for Cigna Healthcare.

His expertise includes individual health, group health and Medicare insurance.

He has been an independent insurance agent since 2001 and has helped thousands of individuals navigate the insurance marketplace, specializing in helping individuals with their choices for Medicare coverage.

That's why we are going to talk to Tim today.

He is our Medicare guru.

Today and each week, I publish the Real Talk About Aging well newsletter.

Each edition contains nuggets that you can learn from and implement, hopefully easily in your life or feel inspired by, so you can sign up to receive this this newsletter by going to Bitbit ly Navigate Aging.

Hope to see you there.

So join me in welcoming Tim Hanbury to Boomer Banter.

Hello, Tim.

Hi.

Thank you for having me.

I appreciate being here.

Well, we are glad to have you and look forward to learning a lot from you.

So let's start with the basics.

Tell me about original Medicare and what it covers.

Okay, well, original Medicare, it's also called traditional Medicare.

It's what it started in 1966 as, contains two parts and they identify with letters, which can be confusing at times.

But it's part A and part B of Medicare and it's roughly broken out where part A is the hospital side of the equation.

So the facility charges the nursing services, those types of things.

The physicians are not included in that as far as their compensation.

So.

So that goes under part B of Medicare, which is the outpatient side, but includes the physicians in and out of the hospital and that would be used more often as the outpatient.

So it's doctor visits, it's X rays, it's testing labs, et cetera, all those things that you would normally do when you go see the doctor.

And if you happen to be as an inpatient in the hospital, then it's covered under part A.

Part B would be the outpatient side or if you're in the hospital under observation, and we'll talk about that a little bit later too.

So.

Okay.

And so there's no cost for part A, is that right?

There's no cost if you've worked and, or have credit for working 40 quarters and paying Medicare taxes.

If you don't meet that requirement, you can purchase part A, but it's relatively expensive if you've only had 30 credit quarters or less.

It's $585 for Part A.

If you're between the seven and a half years to 10 years, which is what the 40 quarters are, you're at 218, I believe, dollars for a part A premium.

So it's a little bit expensive if you're not eligible for that.

So that.

Yeah, right.

Most of us wouldn't pay for part A, but then the Part B we are, we pay for.

But that comes out of our Social Security, is that right?

If you're taking Social Security, I would always recommend that you do that because you don't want to forget it.

If you don't make your payments, they will term you after a period of usually 90 days.

And it's, it's a bit of work to get it turned back on.

So you, you want to set it up under your Social Security benefit if you have that.

If not, they'll bill you quarterly.

And many times when you get that bill, the first time, it may not be completely accurate.

Don't worry, they'll catch up on the second bill.

I bet they will.

Well, you know, they'll bill for three or four, sometimes five months and say it's a quarterly payment and you're looking at that going, wait a minute.

But it's just the way it fell.

Okay.

When they get to it.

So, all right, so we have part A and part B.

And are there other costs like CO payments and things like that?

Well, yeah, with part A and B.

Well, part B there.

Well, a couple of things.

One, there are potential penalties if you don't sign up in the proper time frames and that scares people a bit.

But it's actually pretty easy to get around from a standpoint of making sure that you have other coverage somewhere, usually with an employer.

And same thing for part B also, which is the drugs.

Excuse me, part D, which is a drug benefit.

D for drugs.

So that can come and surprise people a little bit.

But when you look at that $185 for Part B of Medicare, that premium cost, what they call a standard premium that everybody would pay, the 185 can increase if you're considered a higher income individual.

And that's where we get into.

It's called the income related monthly adjustment amount.

I can't make that up.

Yeah, say that fast three times.

Right.

They affectionately call it irmaa.

And depending on where you fall in.

So if you're filing taxes as a single person or if you're married filing separately, for example, the threshold for that surcharge starts at 106,000 of adjusted gross income.

And that's from two years ago.

If they don't have your taxes from two years ago, they'll look at three years ago.

So that's where that starts there, which I think is relatively low for a single person.

And if you're married filing jointly, it's double that, it's 212,000.

So there are five different brackets.

And if you're a very high income earner, you can be looking at potentially over 600 and almost $30 a month for part B only.

So it, it does have some teeth there.

And they can, we can't appeal this if it comes to it.

So if your income, and what I see a lot of times is people will either get some kind of severance pay or something like that, or they Were just had a very good job and then two years ago they were making a lot of money and they retired this year.

So they're not making that money.

We can appeal that based upon a work stoppage or a work reduction to get that eliminated.

You don't have to pay it for the year and, you know, get beat up with that and then have a lower the next year.

They will automatically redetermine that every December.

So if your income was higher or lower, they'll.

They'll adjust and either reduce this, the surcharge or eliminate it.

So there are ways to look at it, but you want to, you don't want to be surprised by that because that numbers quite a bit.

Yeah.

So if that does happen, you know that there's an appeal process that's possible and you might want to talk to a Medicare specialist like Tim to get help with that appeal process.

It's actually pretty easy.

But if you don't know about it, you don't know about it.

That's right.

Okay, so you mentioned the Part D plan and what should we look for with that?

And that is something, whether we have original Medicare or not, we would want to add on, Is that right?

Yeah.

Part D came into play in 2006, new program under George Bush.

And it's been wonderful in the sense that it does provide coverage for prescription drugs.

It's been probably the most complicated part of Medicare in the way that they had it structured this year starting in 2025 from a law that was passed in 22.

They've changed the benefit quite a bit, so they've taken out some of the levels that were there.

So what you have basically now is a $2,000 cap on what you can spend on your medications.

And that sounds like a lot of money, and of course it is.

But you know, when you have 500 to $1,000 medications, it's pretty easy to get there.

And if they're on tv, I kiddingly say, yeah, you're going to get there.

Right.

You got to pay for the advertising.

Yes, somebody is.

That's for sure.

So that cap is a good thing.

But what it also did it under the Affordable.

Excuse me, under the Inflation Reduction act, which the law was passed through.

It also reduced the amount that the federal government subsidizes for these plans.

So this year wasn't as bad.

There was a, what they call a demonstration program where they tried to soften the increase on some of these drug benefits by giving a little bit more money back to the insurance companies.

But next year, I Don't believe that will come into play.

So what happened was they reduced the amount that they pay.

So you'll see this change come with Advantage plans where you have some in order to offset the cost of the prescriptions, they're going to take benefits away from other areas.

So instead of having maybe 1,500 in a dental program, you may only have preventative dental or copay.

Goes up a bit with Medicare supplement plans or what's called Medigap plans are the same thing that confuses people at times.

You have a standalone part D drug plan, and this year there's 13 of them.

They have premiums that range from 0 to $151 a month, depending on your medications.

So if you have a number of expensive medications, you're looking probably more likely at a plan that's 80 or $90.

I don't, I've never put anybody in $151 plan yet because it didn't make sense.

And if you're just on generics now, that zero premium plan is fabulous.

But I don't think we'll see that again next year.

So we'll see.

I hope so because that helps, folks.

But yeah, yeah, with the Part D, overall, it's a good thing.

It's just you want to make sure that every year you're looking at that because if you have a standalone part D drug plan, just because it's covered this year, it doesn't mean it will be next year.

With Advantage plans, they send you that big book that you talked about in the beginning.

That's your annual notice of change, and it will indicate what medications have changed as far as CO payments and things like that.

But honestly, most folks don't spend the time on that.

And I can understand that, too.

Yes.

No, that is not my preferred reading for sure.

So, so let's, you've mentioned the Advantage and the supplements.

What is the difference between those two?

And why would I choose one over the other?

Well, again, very personal choices.

That's part of what I spend my day doing is to try to find, you know, what are you exactly looking for in your coverage and what your needs are.

When it comes to the easiest way that I try to explain it is the two plans are kind of opposite.

So a Medicare supplement plan or a Medigap plan will have a premium, and that premium can vary by state very widely.

But in South Carolina, the, what we call the richest plan, the plan that has the least cost to use, called the Plan G.

And I wish they didn't use the letter to identify it, but they do.

So it's a plan, not a part, but a plan G.

That plan will have $257 this year in cost to use for covered Medicare services.

So if it's covered by Medicare, the most you can spend is $257, but you'd have a premium that runs.

Ladies are a little bit less money, but about 130, maybe $140 a month.

So relatively reasonable.

And what that does is it coordinates with Medicare itself.

So part A and B will pay first, and then they'll send information over to the insurance company of your choice.

And there's literally dozens of them.

That's why your mailbox is as full as it is.

And they will.

Then the insurance company of your choice pays.

There are some deductibles and such, but it's basically paying the 20% that Medicare doesn't.

So, okay.

The problem with Medicare is it's 8020 unlimited, so you want to have some kind of coverage there to put a cap on it.

So with a supplemental plan, you have a very low cost to use, but a higher cost to own it.

With an Advantage plan, it's kind of the opposite.

You have typically no cost to own it because the federal government pays the insurance companies.

So you have a zero premium in many cases.

But the cost to use it is kind of.

I try to relate it to an employer's plan because it's very similar.

You'll have all these different services, and then there'll be a CO payment.

The difference between an Advantage plan and employer's plan is typically there's no deductibles under an Advantage plan, or if there are, there are minor deductibles, $95 for drug benefit or something.

And what they have, though, is a maximum out of pocket, which is an accumulation of those CO payments.

So if you're in the hospital overnight, for example, you may have a CO payment of $330 for up to 5 days.

Depends on the plan.

It varies by planning.

But once you get to that maximum out of pocket, then you don't pay anything for the rest of the year.

And that's where they look like an employer's plan to me.

Because right now in South Carolina, for what we call PPO plan, where you can go outside the network of providers if you so choose, you're looking at a low of about 5,900 as a maximum and a high of about 9,350.

And now you would have to have a number of medical Services to reach that.

Okay, it wouldn't be just for a few doctor visits, but you certainly can.

So if you look at it, the cost to own it and the cost to use it are dramatically different between the two options.

So an advantage plan, very low cost to own it, but a higher cost to use a supplement.

Higher cost to own it, but a very small cost to use it.

So it's really just kind of dependent upon what you're looking at.

The advantage plans tend to be a little more complicated because they're tied into networks of physicians where supplement plans are based upon Medicare assignment, which is the contract with the federal government, not with an individual insurance company.

So advantage plans are a little bit more work.

We look at your doctors, make sure they're covered.

We look at your medications to see who's got the lowest cost out of those.

And there's roughly in South Carolina, on average, in the cosmopolitan areas, you might say of Columbia and Greenville and Charleston, about 38 to 42 plans available.

In the advantage realm, from a standpoint of Medicare supplement plans, there's probably closer to 50 companies that offer.

So the other thing I think about with the advantage plan is that you get your eye, eyes and dental coverage, which also has a co pay, but unless you're really sick, it seems to me that that would be a better way to go just personally than a supplement where you now have to buy your own dental and vision.

Yeah, those are called supplemental benefits.

And.

And while I like those benefits, I wish they weren't.

People focus on them, I think a little too much.

But having said that, because of the federal government's reimbursement, they're able to provide typically a dental benefit, which is probably the most popular, followed by vision.

There typically are hearing benefits there.

They could be, they'll pay up to $1,250 an ear or they'll pay a co payment for a single hearing aid.

You'd have two of them kind of thing.

There was also things like an over the counter wallet is what they call it, where you can get, you know, $105 every quarter to go to your local pharmacy to buy wellness items.

That's one of the areas that I saw them pull back a little bit because of the drug benefit.

This year I saw less of that.

Now it's the thing that just to keep in mind to folks have a long enough memory like I do, in the sense that, you know, Joe Namath get all the benefits you're entitled to ads, they were really talking about folks who are what we call dual eligible, meaning that they have Medicare and Medicaid.

And in those cases, I like, this year, there's one plan that has $279 per month for somebody who's dual eligible for free healthy food, or they can use it for rent assistance or utilities, things like that.

So those things are nice to have.

Certainly.

I don't know how long they're going to continue to fund those items as Medicare, you know, evolves.

But it's good to have them.

I can understand why people, if you're in good health, an advantage plan certainly makes, I think, a lot of sense.

So there's, there's the caveat, right?

If you're in good health.

So if you're, if you know that something's coming, or if you have a family history of something and you've been in the advantage plan because it's been more, more economical for you, can you switch to a supplemental plan?

You can switch at the end of the year, but you have to go through medical underwriting, which means that you have to answer health questions.

Now, it's kind of not as bad as it sounds, really, but if you've had anything major, you had a heart attack in the last five years, you have a pacemaker, you have, you know, a knee that needs to be replaced that hasn't been yet, diabetes with complications, those types of things, the insurance company could do one of three things.

They can accept you at the quoted rates, they can increase those premiums, or they can decline to cover you.

So if you have major conditions, you're not going to get into a supplemental plan, typically.

And that's the tough part, because if I'm in good health and I'm not paying anything and it's all working great, well, what do I want to go spend money for?

Right.

It again, it's not that.

It just depends on the person and where they want to put their money.

I have people that have businesses and can certainly afford, you know, the premiums that take an advantage plan because they can afford the out of pocket.

And the one gentleman I'm thinking of in particular, he said, tim, I'm in business.

I've been paying for employee benefits for years, and I just don't want to pay anymore.

So I'm gonna get one for myself that doesn't cost me anything.

Yeah, but there's other folks, too, that, you know, I've got medical conditions that indicate that I want, you know, better coverage.

And at 65, or when you first come on Medicare, and that could be after 65, long as you have other coverage, you have a six month window to sign up for any supplemental plan you want without proof of insurability so you don't have to answer any health questions.

So that's the key.

Within that first six months you could technically switch, but you know, if you, you kind of want to make a decision up front, I think in some ways, but you can switch down the road too.

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okay, so let, let's talk about this three day rule regarding hospital stays.

You mentioned it briefly in the beginning.

Yeah, Some of the gotchas of Medicare and this happens a little more often when you're a readmit.

Okay.

Under Medicare, the way that they look at this and it, and I don't want to be overly complicated, but if you're readmitted within 60 days, okay, that means you don't have to pay or the insurance company of your choice doesn't have to pay the part a deductible which is $1676 this year.

So in those situations, because of the way they're compensated, many times you'll see people or the hospital systems will put you in as observation instead of inpatient.

And it's no different.

You have the same band on your wrist.

It feels exactly the same.

If you don't ask anybody, you wouldn't know the difference.

But if you don't, if you're there listed as observation and not inpatient, you won't be able to go, if you need to, to a skilled nursing facility or a rehab hospital.

On Medicare you have what I call it the three midnight rule.

Because you have to be in the hospital as an inpatient for three midnights in order to qualify for that service, the special, the rehab hospital or the nursing home.

And without that, there's considerable costs per day on that.

The first 20 days are free, but after that you're looking at, I believe it's $214 a day for days up to 21 through 100.

And keep in mind that they, Medicare only pays for up to 100 days in that.

So if you're in there longer than that, it's problematic.

Okay.

So the three day rule applies if you're going to rehab or skilled nursing.

Correct.

But if, if, if you're just going home, if you've been it, your coverage will still cover your stay, whether you're under observation or inpatient.

Yeah.

Just keep in mind that Medicare does cover home care, but they're looking for, they're not custodial in nature.

Meaning that if you just need somebody to help you get out of bed and you know, get dressed and all that, they're not going to cover that.

You have to be improving.

So it's recuperative care that they'll pay for.

So if you're coming out of a surgery and you need help for, you know, two or three week period, that's where that comes in the play.

And there's no cost for that under Medicare.

So.

Okay, all right, I didn't know that.

So that's good.

Yeah, no, it's, it's, it's like all things insurance.

It's, it's, it's got a exception to everything.

So.

Yeah.

So what if, what if your Medicare claim is denied?

Can you, can you challenge that?

You can.

What I see most times and there's a difference between the two options.

Okay.

If you talk about difference between supplements and advantage, a supplemental plan gets paid by Medicare.

Okay.

So you go there, they look at the claim.

It's technically called fee for service medicine.

So if the provider or whoever's doing the billing frankly provides the necessary information under Medicare guidelines, they're going to get paid a fee for their service and that's fine.

And in that case, if you get a no, they're not paying it for, for some reason.

Usually it's my experience is the provider didn't give enough information or need, they needed something else and should resubmit with additional information.

But that's not always the case.

There are certain timings on things.

Quick example, I had a woman with an $8,300 test and what I think happened there is it got denied by Medicare and of course she was very concerned.

But in talking to the hospital system they're saying, well, it was needed, but Medicare said no.

And I think it was a timing issue.

There's, you know, between these two tests, they wanted a two year period or something like that.

Now there is also a thing called an advanced beneficiary Notice what they call an abn.

And all it is is a financial responsibility letter that's under Medicare's format that they're supposed to provide to you, saying, hey, before we have this test, if Medicare doesn't cover it, you know, you need to.

If you want this test done, you need to sign it saying you'll take responsibility for the cost.

Well, in this case, they didn't do that.

And I think that's a high bar for providers, to be honest with you.

But they didn't provide it, so we were able to get that written off under a Medicare supplement plan.

So she didn't have to pay the $8,300.

But, you know, I don't want to see providers not get paid for services either.

It's.

It's just you.

You have to be aware of certain guidelines.

And that's true with Medicare also.

Now, with an Advantage plan, Medicare is not paying the claim.

Okay.

Medicare is supervisory only.

So the insurance company of your choice is the one that is doing the evaluation on that claim.

And in that case, that's called managed care, which is what we have under 65 also.

And you do run into potential hassles at some times.

Quick example, I've got a bad back.

So, you know, I've got the Affordable Care act because I'm just.

I'm three months away from 65.

You know, I needed an MRI and no Timuni physical therapy.

And of course I wish physical therapy would help, but it's not.

And so about two weeks later, I got my mri.

The provider went back and forth with Blue Cross and got it done.

So those kinds of things can happen with an Advantage plan, too.

There's a lot of talk about that out on YouTube and things like that.

I think the truth is always in the middle.

Do I think it's terrible all the time?

Of course not.

But can it be a time?

Sure.

So you're trying to walk that fence of making sure that you don't have a procedure that's unnecessary because you don't want it any more than the insurance company wants to pay for it.

But you also want to make sure you're getting what you need, too, so that you're diagnosed properly.

So it's a lot harder than it sounds, I think.

Yeah.

So what I think I hear you saying is that with an Advantage Plan, you don't get to just go straight to the MRI you're in.

The insurance company determines what the protocol is to a certain degree.

They have more control than you may think they do just because Providers, you know, they have to get paid too.

So if they're going to provide a service and not get paid, they, they have to pre authorize is what it is.

A prior authorization is what they call it.

And so Medicare supplement is more open with that because it's paid directly.

Okay.

It's far easier for the most part as a physician, you know, if you have someone with a supplemental plan, they can pretty much do what they want to do in the time frame they want, as long as they understand some of the limitations of that.

And I'm sure they do after, you know, dealing with things for a number.

Yeah.

Okay, so say you're still employed, you know, because a lot of us are still employed into our 60s and 70s.

Do you have to apply for Medicare?

Is there a penalty to stay on your employer plan?

How does that work?

Well, penalties, and that's what scares people a lot of times, and understandably so, because they are permanent.

Long as you have other creditable coverage, meaning as good as Medicare and your employer's plan is typically what people will stay on their employer plan after age 65.

As long as you have the other coverage, you're fine.

You won't get into a penalty.

It's when you don't have credible coverage.

And there's different timelines for this.

When you come off of an employer plan after the age of 65, you have an eight month window to sign up under what's called a special enrollment period to sign up for part B of Medicare.

Let's say you just have part A because it was free, so you use that as secondary coverage to your employer plan.

Now you're going to go to Medicare for full coverage, so you get part B.

In addition, you have eight months to do that.

Now, I don't see people taking eight months to do it.

You want to dovetail this so that you have no break in coverage.

So you get ahead of it a couple months.

And if you have part A already, it's very simple.

There's two forms you fill out, one by your employer and one by you.

And you send that to Social Security, not Medicare, but Social Security Administration, and they'll enroll you into Medicare Part B.

And you need A and B together to have full coverage and get an advantage plan or a supplemental plan of your choice.

Okay.

So you can choose to stay on your employer plan, but you might want to look and see.

Sometimes the cost of your employer plan is more than your Medicare plan.

No doubt about.

I always tell folks at 65 you can do either direction.

It's really kind of a math problem at that point.

You know, what's it going to cost me under Medicare versus what it's going to cost me under my employer's plan?

So it's.

You have great deal of flexibility under Medicare, even though it doesn't seem that way because it's within all this jargon, because they have a different way of saying things.

There's no doubt about it.

So where would you get slapped with a fine or a penalty if you were still on your employer plan?

And, and you can see this.

You don't see it as often, but people that take COBRA coverage, I can continue with my employer's plan.

That's true, you can.

Now, it's going to be fairly expensive because the cost of all this, you're paying the full amount under Cobra, they can also add 2% to it also for administration.

But if you do that and you go a full 18 months at 65, you now just earned yourself a penalty under Part D of Medicare for 18 months because you didn't have.

Well, that's.

Forgive me, it's under Part B where you're going to run it.

You could have credible coverage under cobra, but it's not.

You're going to have it simply because they don't consider COBRA coverage to be credible coverage, even though it was when you were an employee.

It's the same plan, but you don't have that employer employee relationship.

So therefore, for.

They're not looking at it as credible coverage.

So you'd have a 10% lifetime penalty on your part B, and you would have, in that case, 18 months at.

It's a relatively small penalty, but it can move over time.

It's called the national base beneficiary number, which, believe it or not, that's what they call it.

You know too many of these acronyms, too.

Oh, God.

Yeah, I know.

And what they're doing is they're taking the national average of a pen, a drug card, and that's this year.

It's 36.78 and multiplying it by the number of months and then multiplying it by 1%.

So you're paying basically 36 right now, currently almost 37 cents a month times the number of months, and it's permanent.

And if that number goes up, so does your penalty.

Okay, so don't wait those 18 months and don't wait to sign up even.

So as I understand it, though, even if you're employed, you still need to sign up for part A, is that right?

You probably should in most cases, however, not every case.

And the reason is if you contribute to a high deductible health plan at work, and that's a plan basically with nothing but a deductible and then 100% coverage after that, no CO pays that's compliant with what's called a health savings account, which you would set up at either a local bank or your employer will set it up through companies that just do that.

And what that allows you to do is, well, I forget what this year's number is, but it's, I think it's $4,350 per person that you can put into a health savings account and take that directly off of your earned income.

So it's, there's a tax advantage for doing that.

But if you're on any part of Medicare, including, including part A, you're going to get a surprise in about nine months when you get that letter from the IRS saying, sorry, we've disallowed your deduction because you're on part A and here's the tax you owe based on ordinary income.

And they can also put a 6% excise tax on it, which is the penalty tax, basically.

So that's a gotcha that you don't want to do.

Yeah.

So there's, there's.

What other gotchas?

What are the gotchas should we know about?

Well, in South Carolina, one thing that I have seen is Medicare becomes primary if you're on an employer plan with less than 20 full time employees or full time equivalent employees.

So if you have two part time people working 20 hours, that's one full time.

So if you're in a smaller company that offers benefits and you say, well, everything's been Great, I'm turning 65, I don't need that Medicare stuff.

If you're under 20 employees, that's a problem because now the group insurance is going to pay the 20% and you're going to have Medicare pay the 80%.

But you didn't sign up for it, so you're paying the 80% and that's quite a shock to folks.

So please, if you're on a small employer's plan out there, you don't want to, at 65, not really take Medicare for the most part, I think it makes sense to just go to Medicare at that point.

Now if you're on a large company, that's fine because your group plan will be primary and Medicare would be secondary.

So you don't have to have secondary coverage if you don't want.

So okay, all right, talk to me about travel.

Like if I go overseas, can I use Medicare if I get sick over there?

Not outside the territories or Puerto Rico.

It's United States only.

Now, a Medicare supplement plan, they're required to have foreign travel benefit there, which is a insurance plan taken out by the carrier of your choice that has a $250 deductible.

It then pays 80% of the bills, up to 50,000 in total costs if you were to get there on an advantage plan.

That's one of the objections initially they had going back a number of years.

So they now have typically 250 thousand dollars in foreign travel coverage, which is actually quite good.

One thing that I see in foreign travel that is kind of a risk is air ambulance.

I had a gentleman fly from the Bahamas, he got injured to Charleston and it was $79,000.

And that's what the insurance company paid, believe it or not.

So because the bill was higher than that.

So, yeah, you, you know, depending on your situation, you may want to take additional travel insurance.

It's not expensive.

There's any number of.

Just Google it on any browser and it will come up with numerous options.

Yeah, but if I'm, if I'm going like I'm hoping to go to Spain this year, so if I do that, I would just bring my insurance card that I have and hospital or doctor or whatever there should be able to use that.

Yeah, you'll have coverage.

But my experience with this is whatever you do, make sure you save every piece of paper.

Everything they give you, you may have to pay out of pocket and then get reimbursed.

The good news, for the most part, Europe, South America, things like that.

The cost for hospitalization is not nearly what it is here.

So typically it isn't that bad.

You're probably not going to go full blown there anyways.

You just want to get stabilized and get back to the United States.

So having that out of pocket, you know, can be troublesome.

But as long as you keep everything so you can prove you know what you paid for and so forth and then just have the currency conversion sometimes, which is also part of it.

But you know, it's, you have good coverage under Advantage plan and you have some coverage.

The only risk I think on a supplement would be the air ambulance.

I can't imagine what it would cost to fly from Europe or Spain to the United States.

My goodness.

Well, I'm not, I'm not planning on needing any of that, but it's, it's good to know Right.

So, okay, so here we are, New year, new administration, new arguments about Medicare and coverage.

And are there any anything that you know as of today that we need to be aware of as far as changes to Medicare that could be coming?

Well, the one thing, and given the timing right now in the first quarter, I just want to mention something to you.

You know, people say, Tim, we, we, you know, we see all those ads on TV in the fall and we understand that, but why are they still on tv?

Well, they're there because, well, this year, two reasons.

But the main reason is in the first quarter of the year if you're on an Advantage program you can make, it's called a Medicare Advantage open enrollment period where you can make a one time change in the first quarter of the year to any other Advantage plan that you so choose.

Now I can give you the situation here and it's unfortunate, but this happens though.

A local hospital system here with one of the insurance companies is talking about breaking the contract for February 1st.

So I have to act on that.

So I move seven, eight people from the plan that in question to a different plan so they could still go to that hospital system in their document.

And this one happened, I think it was just last week, Thursday, they came to a conclusion where they are accepting that insurance company.

So did I have to switch them?

Technically, no, they'd have been fine.

But you don't know that.

So yeah, that's, you know what happens.

And, and I think some of that, that came out about five years ago, right.

In the height of some of those call center advertisements.

You know, you had some unscrupulous people and just some.

But that would say, oh yeah, your drugs are covered and they weren't or your doctors are covered and they're not.

And this way you can make a one time change when you found that out.

Yeah.

And that is happening.

I, you keep seeing that in the news with the hospitals pulling.

Yeah.

And again, a lot of that I think is just hardball negotiations like it was in this case.

But you know, you, that's why I typically when I go to folks with Advantage plans is I want to put them in a PPO plan, meaning they can go outside the network of doctors.

PPO stands for preferred provider organization.

But that means you can go outside the network of doctors without permission from the health plan.

And that's typically used if you're going out of state, to be honest with you.

But in this case, if you wanted to, in the company in question, the co payment for a physician out of the network is $10 more than it is in the network.

So now the doctor has to agree to accept that.

But you can still typically go see them.

Yeah.

So yeah, it's, it's a little more work with an advantage plan each year too because it changes.

There's so much to know and it makes, it makes people like me, makes my head spin.

You seem to know it from memory.

You wrote the book.

You wrote the book, the Medicare Blueprint.

There you go, guys.

Yep, yep.

And I, I went through it.

There's a lot.

And you can find it on Tim's website, medicareblueprint.com where you can actually download it.

Is that right, Tim?

You can download an electronic version of that.

You know, when it comes to websites, everybody's got the same stuff.

The, the one thing that I would say to folks as my proof statement, I guess is we have, and my business partner Jason and I have about 1700 testimonials on our website.

The nice part about it is our clients to almost all of them will give us permission to use their full name.

So it's not Mary T.

It's, you know, Mary train them, that kind of stuff.

So to me that adds credibility to it.

I don't know.

How do you know an agent is good?

You know, we all say the same things and you know, we got the best service, you know.

Well, your experience counts for a lot as well.

You wrote the book.

Yeah.

And your knowledge that you shared with us here has been very helpful.

So I do appreciate that and I.

I hope I didn't confuse more than.

Help, you know, see it, you know, and that's why we need to talk to people like you because it does get confusing for so many of us that aren't living it, breathing it every day.

So yeah, thank you, thank you for that.

I also want to remind people to use the link bitbit ly navigate aging to get bite sized information each week in the newsletter that will help you age well.

All kinds of good stuff in there.

I also.

This is my last week of recommending the Fit strong Women Over 50 podcast which is part of the Becoming Ellie group E L L I where you can find them on their website, becoming ellie.com they are a wonderful resource for health and nutrition and wellness as we are aging.

So check out the becoming ellie.com and then in February we're going to be switching from our financial focus to relationships and our first episode in February will be on relationships with ourselves when going through a loss.

I'll be talking with grief counselor Carrie Lewis.

Who shares her personal journey of his devastating loss and how she now helps others rebuild their lives after significant changes.

Whether it's the loss of a loved one, physical ability as we age, or other major life transitions, this episode I know is going to inspire you to embrace healing and rediscover purpose.

Just a reminder to check out Greenwood Capital for sponsoring this podcast.

We thank them and they are an independent registered advisory firm providing wealth management, investment solutions and financial planning for clients in 23 states.

Thank you Tim and thank you everybody who listened today and joined in and whoever is going to be listening in the future.

We look forward to having you as part of our Boomer Banter community.

Thank you for having me.

It was a pleasure.

Thank you.