Avoiding Medicare Mistakes in Retirement Video from Savant Wealth Management

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Good afternoon. Welcome to today’s Savant live webinar. Today we are discussing avoiding Medicare mistakes.  my name is Joel Kundick. I’m a financial adviser in Savant’s Vienna, Virginia office.  We are a national firm with 45 offices in 20 states helping all our clients across the country with their major financial decisions. So today I’m pleased to welcome special guest Margo Steinlage. Margo is co-owner, broker and president of Steinlage Insurance. She’s a great resource. She has a large knowledge base on this subject. And let me say right now, we want your questions all of you. So, depending on how things go, I don’t know exactly how time is going to work out, but if you don’t get a question answered today, and I’ll remind you this at the end, you’re going to get a survey link at the end and make sure you post your question there. We want to make sure everyone’s questions get answered. So, welcome to Mar to Margo. Thank you for joining us today. Thank you, Joel. Thank you, Savant, for having me. And thank you all for tuning in. Hopefully you have a notebook, a cup of coffee, and a glass of water because we’re going to rip through all of the Medicare and the changes that are happening in the Medicare market. I’ll sprinkle in a little bit of ACA updates for anybody who may have a younger spouse or maybe you’re looking for early retirement options. But a little bit about myself again, I’m Margo Steinlage, born and bred in the Midwest. I’m a Missouri native. I also live here on the East Coast. But here at Steinlage, we offer holistic planning in all 50 states. So, whether you’re in Florida, California, you’re in Oregon, you’re tuning in, wherever you’re located, we can help when it comes to Medicare and ACA guidance, and it’s complimentary. There’s no cost to you for using our team services. So, whether you need COBRA or ACA comparisons, or maybe you’re 64, 63 and a half, just trying to sniff out what’s coming down the pipeline with Medicare and you’re looking for strategy. give us a call, shoot me an email, and we can help you. Whether it’s with that pre-enrollment support or once you are moved into Medicare, we’re there to help on the back end, too, with billing discrepancies, you misplaced your card, you need your free review in the fall, we’re here at all stages of the enrollment process. Today, we’re going to jump in with three big parts of the presentation. We’re going to look at who is eligible for Medicare and really pull back the curtain on what’s required upon turning 65. Do you have to take Medicare or is Medicare optional? can you delay Medicare at age 65 or when you are eligible for disability? next we’re going to look at the different moving parts and plans of Medicare. Many of you have heard of Medicare A, B, Part D, Part C, supplement, Medigap. How do all of these terms play into the big overarching Medicare red, white, and blue card? What’s good, what’s bad, what’s right for you may be different than your neighbor. Lastly, we’re going to look at regulation changes. We’re going to look at IRMAAA, income related monthly adjusted amount. For any of you who are in high earning status, stay tuned. IRMAAA will be very important to address and keep on your radar as you do move into Medicare eligibility. So, let’s jump right in with who is eligible for Medicare. So, you’re probably tuning into this webinar because you’re approaching Medicare eligibility, whether that’s at age 65 or maybe you’re hitting your 24th month of disability. and you’re automatically qualifying for Medicare even though you’re not 65. or maybe you delayed Medicare because you stayed on your large employer’s group health plan and now you’re planning to retire. Medicare is available to anyone who is hitting one of these kinds of benchmarks. So, most of you fall into the turning 65 bucket where you can enroll in Medicare in a three-month window before your 65th birth month and a three-month window after your 65th birth month. So, my birthday is June 29th. I can sign up for Medicare in March, April or May for a June 1st effective date. Or I can delay a little bit and sign up in July, August or September for a first of the following month effective date. So, we have this seven-month sweet spot to enroll in Medicare as you approach your 65th birthday. For most of us, we need to do something at age 65. We have to sign up for Medicare to avoid lifelong penalties and gaps in health insurance or gaps in health insurance. So that’s the general rule. Something has to be done. You need to enroll in Medicare upon turning 65. However, like most rules, there’s exceptions to the general rule. And an exception here is if you or your spouse plan to work beyond age 65 and you have coverage or employer sponsored group health coverage through that employer, then Medicare is optional if the employer is a large employer. And what that means is if there’s 20 or more full or part-time employees at that place of business, then they are deemed a large employer, and the large employer plan can continue and you can stay on that large employer plan and delay enrollment in Medicare A and or B. And then once you’re ready to come off either voluntarily or upon retirement, when you’re ready to come off that large employer’s group health plan and move into Medicare and fully retire, then you create a special enrollment period to sign up for Medicare without any penalties or gaps along with picking up a supplement, or a drug plan, or a part C advantage plan. So, we have this window that hey, something has to be decided. You either have to take Medicare because you’re on a small employer plan, fewer than 20 employees. You got to sign up for Medicare at 65. You’re on ACA, you need to sign up for at age 65. You’re on COBRA or retiree health insurance; you need to sign up for Medicare at 65. or we can delay Medicare because there is this large employer benefit at play. As soon as you or your spouse become retired or no longer an active employee on that large employer plan, you need to shift over to Medicare. COBRA is not deemed active coverage. And as soon as COBRA goes into force, Medicare is the required primary payer. So, you can see gaps in your health insurance if you delay Medicare and maybe your employer says, “Hey, we’ll give you 18 months of subsidized COBRA.” Yay. That’s amazing. Thank you, employer. Thank you, boss. But I still need to sign up for Medicare because Medicare is the primary payer, not COBRA. You would have a gap in your health insurance there. Another thing to watch out for, I’m just going to go a little bit in the weeds here because this will impact many of you who do delay Medicare at 65 to stay on that competitively priced large employer plan. Maybe you have a spouse, a younger spouse or children on that employer plan that you want to keep covered. or maybe you’re contributing to an HSA, a health savings account, and you want to reap the benefit of maxing that HSA out, whether it’s for you individually or for the family. So, in these instances, when you have a high-deductible HSA qualified large employer plan and you’re staying on that employer plan for the foreseeable future beyond age 65, you need to delay both part A and part B of Medicare so that you can continue contributing into the HSA. IRS and Medicare, Social Security do not allow you to contribute into an HSA when there’s any part of Medicare at play. So, if you enroll in the free part A benefit and you are still maxing out your HSA, that’s a no. You’re going to get hit with an excess tax. So be cautious when you have HSA and Medicare at play. Be aware that we need to time HSA contributions in those scenarios. Further, just a little bit, hang with me, a little bit further on this pathway. If and when you delay Medicare to stay on the large group and you’re maxing out your HSA each year and now let’s say you want to retire at age 68 or 69 or 70, and you say, “Hey, Margo. Hey team Steinlage, I’m ready to retire January 1 of 2026. What do I need to do with regards to signing up for Medicare timing my HSA and getting over into Medicare and off my large employer group health plan? We can start your Medicare enrollment process 90 days out of your desired kind of transition date. So here we would submit your paperwork in October to transition over fully into Medicare for January 1. As soon as we submit that paperwork, Medicare will have a six-month retroactive look back on your part A hospital benefit. And I say this again, I’m in the weeds here, but I mention this because we have to time your HSA contributions with that six-month retroactive look back effective date taken into consideration. So here we submit in October for January one effective date. We’re going to see your part A go into effect April 1st. So, we can contribute January, February, March or 1/4 of the allowed HSA amount for 2025 in this hypothetical example. This right here, this HSA issue is I see it often. Okay, so I mention it in every single presentation I do because many of you will be told by HR, hey, you can get the free part A. Well, no, you can’t if you’re contributing to the HSA. Also, if you’re collecting social security, this is sneaky. If you’re collecting social security, Medicare, you’re automatically enrolled in Medicare as soon as you start collecting Social Security, you can send your Medicare card back to Social Security and say, “Hey, I don’t want Medicare Part B. I’m delaying it to stay on my large group plan, but you can’t term, or you can’t cancel out the part A free hospital benefit. Part A and Social Security are married. You can’t separate those two. You can sign up for A and B and delay social security, but as soon as you take social security, part A will come into play. So, if you’re, you know, 69, 70 and you say, “Hey, I’m ready to take Social Security and there’s still an HSA at play.” We’ve got to be aware of the part A look back. This right here is like the first 20 minutes of our conversation with most clients is just figuring out what kind of group coverage do you have? We have an intake form that every client, if you’re one of our clients tuning in, hello. every client fills out our intake form and we’re pretty aggressive. We want your doctors. We want your prescriptions. We want to know about your whole family dynamic. Who’s going to be impacted or affected by your decision to move to Medicare? What’s your modified AGI? If you’re making above 212,000, you’re a high earner and Medicare is going to be expensive for you. It may not be the best decision to move to Medicare at 65 depending on your circumstance knowing that we can delay it if there’s a large employer plan at play. So, lots of variables to consider. There is no one-size fits-all recommendation. My goal with this educational event is for you to hear it a few times. Watch this on repeat. It’ll be recorded and sent out to you by team savant. but watch this a few times. This is a foreign language. Most of us for, you know, our working careers, we’ve received three, four, maybe five plan options from our employer and then all of a sudden we’re expected to understand this foreign language at 65 and move fully into Medicare with a hundred different plan options. So, it can be stressful. You’re not alone in thinking this is a stressful transition. We work with doctors, engineers, a lot of people get kind of stumble through this process and our goal here is to make it as streamlined and easy as possible for you. Okay, more on HSAs. Some of you may have a nice pot of HSA money at play if you funded it over the last few years. Kudos to you. You can use those HSA funds for your IRMAA, the income surcharge premiums. You can use them for the standard part B premium. We’ll discuss all of this. You can use it for drug costs, your co-pays at point-of-sale pharmacy or Mark Cuban or Good RX. You can use it for dental. Dental, as many of you are aware, my dental plan maxes out at 1,500. Dental gets expensive as we get older. If you have 20 grand worth of dental, you know, use those HSA funds if you have a nice pot. the only thing that is not medically qualified are your Medigap Medicare supplement premiums, your ACA premiums, and if you are a younger spouse and the HSA is in your name, okay? You can’t pay use your HSA funds to pay for your older spouse’s premiums on Medicare. That’s a no. Don’t ask me why. IRS has this in its code. It’s there. My job is just to make you aware of it. So, the HSAs, , usually you can get, right now, I don’t, it’s like 9500. Don’t quote me on that. I’d have to have the sheet right in front of me. It’s about 9,500 a family if you’re over the age of 55. So, there’s a thousand catchup in there. So, it’s quite a bit of money at play. and a lot of you will delay Medicare to stay on that large employer plan and max out the HSA. Okay, so I keep tossing out part A, part B, supplement, drug plan, advantage. What the heck are these moving parts? What does all of this mean? And if this is your first educational like Medicare 101 event, I’m glad I’m the one who is introducing you to the topic, but again, it can be overwhelming. So, I’m going to try to break it down into bite-sized pieces here and hopefully we can create some clarity. So, when you are ready to move into Medicare, whether you have to at age 65 or you’re ready to come off that large employer plan and it’s go time. We’re signing up for part A and part B, the two moving parts of original Medicare. So, when you’re fully in Medicare, you’ve signed up for the free part A benefit, which for most of us is zero premium. If you and or you can piggy piggyback on your spouse’s work history, if either of you or you individually have accumulated 40 quarters, which equates to 10 years of work history, then you reap this part A hospital benefit at zero premium. If you have fewer than 40 quarter, then it’s prorated and you’re paying anywhere between 200 and 500 a month for part A. Rarely do I see somebody pay for the part A benefit, one a year maybe, if that. Part B is going to have a standard set premium that Medicare announces. They just announced the 2026 premium here for part B, but right now for 2025 it’s $185 a month per person to get into Medicare. Next year it’s going to go up to $26.50. That was just announced this week. So, to get in the door with Medicare, you have to pay and Medicare Part B premiums are adjusted based on your modified AGI. So, anyone who is a high earning individual, you will see a income related search charge on top of this 185 base premium. If you are low income and you qualify for your state Medicaid program, then Medicaid can come in and assist in paying for that part B premium. So, when you talk to your neighbor Betty or Suzanne who has zero pre premium, she says she’s paying nothing for her Medicare, she may have Medicaid and it’s picking up the cost. and your next door neighbor is paying 700 a month just for Medicare. He may be making a million dollars and have the highest IRMAA slapped on that part B premium, the 185. About 90 to 95% of us will pay the 185 per month. The other 5 to 10% will see IRMAA. With your red, white, and blue card, when you sign up, if you’re collecting social security, that 185 per month drafts automatically out of a social security check. If you are not collecting social security, then Medicare will bill you quarterly and you can set up autopay, and we assist with this process. So, we can have it draft out of a checking account or maybe an HSA account and then once you collect social security, it turns into a social security deduction. Another little pro tip, you can reimburse yourself if you’re collecting social security. If we have some older clients on here, if you’re collecting social security and your Medicare is drafting out of social security and you have this bucket of HSA funds, you can reimburse yourself for those social security deductions by using your HSA funds so, once you’re in Medicare, you have your red, white, and blue card, you’re walking around with your VIP card, and you go into the hospital, you have a set hospital deductible. And this year it’s $1,600. Next year it’s $1,700 and change. Okay? So, this is a per 60-day occurrence. You go in the hospital in January and then again in June, you’re paying another $1,600 deductible. Medicare Part B is kind of the umbrella. Outpatient surgery, ER visits, doctor visits, colonoscopy, X-rays, MRIs, all of that is going to fall under the Medicare Part B component. and you have a very small annual deductible which is $257 a year. Next year it’s going up to 2.88. Once you meet that annual deductible and that resets January 1st each year, once you meet that annual deductible, then Medicare covers 80% of the claim. You are responsible for the remaining 20%. There’s no cap or ceiling on that 20% exposure. So, here you’ll also see that the red, white, and blue card that you get when you’re fully in Medicare does not include prescription drugs. It doesn’t include dental or vision. It doesn’t include long-term care. Medicare is just acute care needs. Okay? So, there are gaps in Medicare. So the takeaway here, you will pay for Medicare. Medicare is not free and for some of us it’s going to be quite expensive as I’ll show you with IRMAA and there’s gaps in Medicare coverage. How do we fill those gaps in Medicare coverage? Now I know I have some federal retirees on here and I do not work with federal retirees. My it’s outside of my agency scope. Stick with me for the full hour. You’ll learn a lot. But for federal retirees, I’m just going to put this plug in. There are people out there that work specifically with federal retirees. They usually charge a fee for service to give you federal retiree, like Medicare coordination coverage, advice. For the rest of us who are non-federal or non-military, the rest of us really have two pathways to fill the gaps in Medicare. We can either set up a Medicare supplement, also known as Medigap plan with a standalone drug plan. Okay, that’s the left side of the screen here. That’s kind of one pathway, one option. Option two is you can set up a Medicare Advantage plan, also known as part C. Some of you may have a third option with like a retiree plan at play. If you have a retiree plan, we will compare that retiree plan to these alternative options to see what’s the best fit for you. Okay. With regards to choosing whatever you choose, anticipate paying that part B premium plus any IRMAA if we can’t appeal it. anticipate this as kind of being your base premium, your expected premium regardless of how you choose to fill the gaps in Medicare. Okay, that part B premium plus any IRMAA is your base. And then we need to decide which route or which pathway do we select. If you are a client who says or an individual who says, “Hey Margo, hey team Steinlage, I want flexible coverage. I have kids in different states. I have a second home or I just want to travel with my friends or my spouse and I don’t want to have somebody dictating my care and you know requiring pre-authorization or you know requiring me to use a network then this level of coverage Medicare supplement and drug is going to give you the most flexible opportunity of seeking care nationally here when you choose to go with Medicare, original Medicare, your red, white, and blue card, and you add a supplement, Medigap plan, Medicare is your primary payer. And what that means is you can go to any provider nationwide that accepts Medicare. And another pro tip is accepting Medicare patients, new to Medicare patients. So, I always tell our clients, if you are new to Medicare, or approaching Medicare age, go check in with your doctor. Reinitiate a conversation or treatment with your primary care because some doctors are saying, “Hey, you haven’t seen us in three or four years. You’re no longer an active patient and you’re now on Medicare. Sorry, we’re not taking new Medicare patients at this time because Medicare doesn’t reimburse these doctors a whole lot. So, the doctors want to save some space for private payers, group plans, , specifically. So, if you are moving to Medicare, keep that in mind. Go call your doctor, see them real quick so that you are an active patient. Most doctors that I’ve seen, it’s like 24 months. If you haven’t seen them, you’re no longer an active patient. So, when you choose this level of coverage, you can go seek care at all of the big hospitals. Mayo Clinic, John’s Hopkins, my St. Louis native, , Mercy, and BJC. You can go seek treatment at these hospitals. You will never say, “Hey, do you take my supplement with, you know, United Healthcare, Humana, or Etna?” You would say, “Do you take Medicare? Medicare is my primary. Here’s my Medicare card.” Medicare sends the claim to excuse me, the provider bills Medicare. Medicare processes its claim and then sends the residual to your supplement. So here, your supplement plans, if you were a little bit older and you’re grandfathered on the plan F, that plan F supplement picks up all the gaps in Medicare. It covers the Part A deductible, the $1600 per 60-day occurrence. It covers that part B medical annual small deductible, the 257 per year, plus it covers the 20% over here. Anyone who’s over the age of 65 as of year 2020, we have access to plan G, which would be the ne next most competitive and robust level of supplement coverage that you can get. The plan G is identical to F. The only difference is that you have a part B deductible that you’re responsible for. So very small, $257. Plan N is kind of the most economical plan. You’ll have the $257 deductible plus $20 co-pays and $50 co-pays at the ER. So, $20 provider co-pays, $50 ER co-pays. And we have to verify that your doctors take Medicare, opt into Medicare, and accept assignments, which means they are billing per Medicare’s approved amount. If they are not assigned, then those non those Medicare non-assigned providers can balance bill or excess bill up to 15% in most states. So you would be responsible for that part B excess 15% charge with a plan N. The plan G covers that excess charge. Okay. In addition to lining up some type of supplemental coverage FGN or maybe you want to go high-deductible G, you also need a standalone Part D drug plan. Even if you’re on no meds, our recommendation is to set up a Part D drug plan so that you’re protected and you’re avoiding this late enrollment penalty. So here, Part D generally in most markets, we see it range between about 0 to $150 a month. If you’re on some of these carriers right now, you’re seeing your in your annual notice of change come in and your drug plan premium just doubled. I’ll explain why here in a little bit, but the drug plan market is volatile. Over the last six weeks we have sent all of our current clients our intake forms so that we can get up-to-date medications and doctors so we can make sure once you move into Medicare, our job’s not done. We have to do a review to make sure you’re in optimal coverage every single year because there’s so much volatility in this market. So don’t my advice here, another pro tip, don’t sit on your coverage. Review it specifically the drug benefit because that’s where the changes take place each year your medications change your spouse’s meds change or the plan design is changing for next year your Eliquis just went from a tier three to a tier four and instead of paying $47 co-pays you’re paying $150 co-pays here the benefit is that with this level of coverage is that it’s flexible. You don’t get a ton of bills coming in the mail. There’s no real restriction. There’s no third-party company dictating your care. The negative is everything’s alert. We got to add a supplement. We got to add a dental. We got to add a drug plan. And that can get expensive. Okay. So about 45% of the market will go supplemental. A lot of my clients because I work with a lot of financial advisors tend to lean heavy towards the supplement. With that being said, the alternative option here where 55% of the general market will land is called Medicare Advantage plans. And these are also known as part C. All right. This is where you see Joe Nameoth on the TV. If you watch ESPN, like I do with my husband way too often throughout the week, I see these 1 800 call Medicare free, free, free, free, and then disclaimer at the bottom, but only if you have Medicaid. So here, buyer beware is my recommendation. This product has a great benefit. It’s affordable on the front end. You’re not paying monthly premiums in most markets for this zero premium advantage plan, whether it’s an HMO or a PO. but on the flip side, when you start using care, you may bump into network restrictions or pre-approvals or pre-authorizations or denials, and those can be very frustrating as a consumer. but if you are fairly healthy and you’re using routine doing your routine care, you know, one or two visits a year, you don’t have any chronic care needs, these advantage plans can be very affordable, but again, when you’re healthy at 65, this looks very attractive. You get free dental, you know,  $3,000 worth of dental, $400 worth of vision. drug coverage baked in at no additional premium. So, it’s very affordable on the front end, but as you start using care, you are paying for all of those services rendered. And if you become unhealthy or high risk or just a high user of services, these plans can become frustrating. Okay, there are some additional riders that we can add to these advantage plans to keep your out-of-pocket maximums low. There’s hospital riders like with AFLAC. We’ve all heard of AFLAC where for 2030 bucks a month, we can add kind of pieces to the Medicare Advantage puzzle that fill the gaps. So instead of having a $2,100 co-pay for a hospital stay, these indemnity plans can come in and fill those gaps for you that are left with the advantage market. but I would say the biggest drawback because all we hear are the advantages to Medicare Advantage, free dental, free awesome perks. the drawback to these plans is that you can get stuck in an advantage market. if you become high health risk and let me explain that a little bit further. So if you’re like hey Margo hey team Steinlage I know I want to go advantage. I’m going to say, “Okay, let’s go over all the pros and cons just so you’re aware and then let’s find an optimal plan for you with your doctor’s, dentists, and medications covered.” And we’re going to review that every year. And let’s say five years later now you’re in skilled care and you can’t find a good skilled care because none are in network. Or five years later, which is actually happening this year, we had about 20 huge hospital networks that went to battle with the advantage carriers. So, John’s Hopkins and C had a huge battle and they were unable to find a agreement. So, this year, mid-year, C dropped John’s Hopkins from their network. Oh, shoot. I chose my advantage plan because it had all my John’s Hopkins doctors in network. What am I supposed to do now?  UAB in Alabama went to battle with C. UAB and C agreed, but we don’t know how for how long or what those terms are. Anthem, Mercy, all battling. Okay, so there’s 20 hospitals right now that are pushing these advantage plans to lower their rates and reimburse them more. With that being said, that can be frustrating to you as a consumer if you’re in this advantage market. So if at some point you’re using care frequently, you’re getting preauthorizations, restrictions, or your doctors drop and you try to move over to this supplement pathway for more flexible freedom that right now in most states, most markets, you are required to answer health underwriting questions and get pre-approved to move into the supplement. So, if you’re healthy, they’ll take you. If you’re too high of a health risk, you’re on three blood pressure meds, you have afib, you have PT coming up, you’re on Tramadol, whatever your health risk is, they can deny you. The supplements can deny you because you’re outside of your new to Medicare kind of freebie enrollment period. And when you try to move from advantage over to the supplement, you can get locked out of the supplement. And now you’re left kind of treading water in the advantage plan market. And you can go HMO to PO, Anthem to C to Humana to Etna to Essence to TUS. You know, there’s a lot of regional carriers that you can choose from, but you’re at the whim of those plan designs each and every year. You’re not guaranteed the coverage that you got at 65 at age 75. One year there was a Arizona Sigma plan last year that had like 25 grand of dental. It was a marketing ploy, but this year, you know, it’s going to be gone. So, watch out. Don’t just go for the Medicare Advantage plans for the bells and whistles because those bells and whistles can be stripped mid-year or end of the year. Okay, so again, we’re trying to match each client with your goals, your financial goals, your travel goals, and your doctor and prescription needs. Right? So again, there’s no one-size fits-all approach. This education is critical so that you are getting optimal coverage day one and you’re planning for the long term as well. you’re not just thinking shortsighted for hey I’m healthy right now because you’re going to hold on to this policy until hopefully you know you live beyond the average age of what is it like 87 now so hopefully you’re living into your right 90s you’re working with my kids we are a third generation family business so I can say you’re working with my kids it’ll be the fourth generation okay I’m going to keep moving along there’s a lot of great information on our website if you want more details or just shoot me an email if you have specific questions. I know Joel, you’re probably looking at some of those questions saying, “Okay.” So, the Inflation Reduction Act is a really awesome benefit and in regulation that came in and got rid of that archaic donut hole. I hated explaining the donut hole. I actually loved it because it was so dense, but I don’t have to do it anymore because the donut hole doesn’t exist. So, if any of you are older and you’ve had you’ve hit the donut hole and you had crazy cost on your medicines, right now this year, because of the inflation reduction act in 2022, everyone on some type of Medicare plan has a $2,000 worst-case cap on their prescription needs. So, the goal here to hit that $2,000 cap every time you fill your medicines at Harris Teeter or Pebbly Weave, what is it? Then I forget Piggly Wiggly. Schnucks in the Midwest, there’s all Deerberg. Safeway. If you’re filling your medicines at these retail shops or through mail order and the medicines are on your drug plans formulary, whether you’re getting drug coverage through that Medicare Advantage pathway or you’re opting for supplement and drug standalone drug, you have a drug design benefit and you’re filling medicines that are on that drug designs formulary. Okay? Everything on the formulary when and if you fill it goes towards that $2,000 cap. Okay, you may pay a co-ay or a fixed coinsurance, but the key is to be matched with a plan that has your drugs on the formulary and has optimal pricing on those medicines. Once you come out of pocket two grand, whether it’s some type of combination of deductible, co-pays, and co- insurance throughout the year for all of your meds being filled, once you filled the $2,000 bucket, now your drug plan pays 100%. for the rest of the year on those medicines. So if you were hitting the donut hole on your Eliquis, your Ozempic, your Jardian in years past, your inhalers, now this looks amazing. Two grand and you’re done. The drug plan’s picking it up. On the flip side, these drug plans are saying, “Oh my goodness, we’re hemorrhaging here.” You know, we are paying my dad’s on Nurtec. It’s like a $16,000 migraine medicine. He’s on a zero premium ware plan and he pays two grand and then ware is paying the rest. So these drug plans are saying hey we have got to modify our design. We’re increasing premiums for 2026 and we’re slimming up formularies. And the tricky part here, this is why we’re really pushy with our clients in August through this week, saying, “Hey, complete our intake form because you’ll get this annual notice of change document each year once you’re on Medicare.” And your plan will just auto renew if you do nothing, which is cool. But as soon as you get that annual notice of change document, the plan won’t tell you if your drugs are covered. it’ll just say go online and access the formulary. And most of us don’t. We just look at the premium. So, we like to just check to make sure that your premium didn’t get jacked up 40% and b your medicines are covered for next year at the most competitive price. Okay. Also, anyone who is staying on the large group plan because they have awesome large employer coverage or their spouse has large employer coverage, you’re still working, you’re delaying Medicare. Make sure that drug benefit under the large employer plan stays creditable coverage. You’ll get a letter or your HR staff should be able to give you notice, a letter that says, “Hey, your large employer plan meets the minimum requirements of Medicare now that you’re 65. You can delay Medicare, but you got to maintain creditable group coverage. So, we need that letter in case it’s ever needed later to show proof that, hey, Medicare, I delayed Medicare at 65. I stayed on large employer coverage and it was creditable for those three years that I delayed Medicare. We are getting a few clients who are receiving creditable coverage letters that say, “Hey, creditable coverage is going away for next year. You need to move over to Medicare drug.” And that can have pretty nasty implications if you do get that letter. So, feel free to reach out, shoot me an email, but just I like to put that on everybody’s radar. Do your due diligence. okay, IRMAA, I know I promised more on the income related monthly adjusted amount. It’s a mouthful. it’s not fun to see these prices so, what Medicare is doing and using when you decide to move into Medicare, whether it’s at 65 because it’s required or if you can delay Medicare until a later date, come off that large employer plan. Now, once you move into Medicare, Medicare is setting your Medicare premiums for the current year that you’re in based on your prior two-year modified AGI. So, for anyone who is turning 65 from now until the end of the year, Medicare will use your 2023 household modified AGI. They’ll get that information from IRS automatically and they will use the 2023 tax return modified AGI figure to set 2025 rates. Then in 2026, you’ll see an update automatically by Medicare to your IRMAA and your premium owed based on the 2024 information they received from IRS. 2027 will get 2025’s tax return. That happens automatically in the background. You don’t have to proactively reach out. And you can see here on this chart if you I’m going to go down to the second column bottom row. So right here 750,000. If you are making great money, you’re working and you plan to continue working. You can see here that Medicare the 185 is your base, the 443 is your part B IRMAA. They also slap on a part D drug IRMAA on whatever drug plan you pick. if it’s a standalone or built into the Medicare Advantage. So, just to get in the door, if you were to opt into Medicare at 65 and come off that large employer plan, it would be $715 per person if you’re a joint filing couple. If you’re making above 500,000 as a single filer, it’s $715 to just get your Medicare and force plus a supplement plus a drug plan or your advantage plan. So here, what Medicare doesn’t know, let’s say  you have to take Medicare at 65 or you’re coming off that large employer plan and you want to take Medicare at 70. What Medicare doesn’t know is that, hey, my income’s dropping because I’m retiring or I got a divorce from a high earning spouse or I had an unfortunate passing of my high earning spouse. If you have a life event that creates a substantial drop in your modified AGI, we can tell Medicare by filing a request for reconsideration. this SSA44 form down at the bottom here. We can file this form and tell Medicare, don’t use my 2023 tax return. I retired in 2024 or 2025, therefore use my 2025 modified anticipated income. Or if you’re moving into Medicare for 2026, you’ll tell Medicare, don’t use my 24 tax return information. use my anticipated 2026 modified AGI. and this is where we like to loop in Savant. We bring in the advisor because they have a really good awareness as to what that anticipated figure will be with passive income, alternative income sources. So, we’re not just looking at the standard part B premium 185. Medicare is cheap. Medicare can be expensive and we may need to go an extra level or two to get that IRMAA reduced. Now, if you are selling a house in Florida, a vacation home, and you live in Michigan full-time, and it creates a huge capital gain, you’re going to have a high modified AGI and you got to ride it out for a year. If you’re doing a, you know, minimum distribution, you got to ride that out two years later when Medicare catches up with your high income. but again, everything resets based on that prior to your tax return. You’re never stuck with IRMAA unless you make really good money into retirement. Then that IRMAA will hang around because we can’t appeal it. It’s not linked to work or, you know, a high-earning income. Mostly, I feel like we’re doing IRMAA daily, three or four times a day with clients. So, this is a pretty safe space to talk to me about and my team. If you have IRMAA questions, let me know. But again, we do webinars for our clients every year just to keep this IRMAA present and remind you all to do your IRMAA appeals if it is there. Usually, it takes one or two years to do the IRMAA appeals and then Medicare’s caught up with that lower anticipated income. Again, we lean on Savant for a lot of assistance with this. So, once you are on Medicare or maybe you’re already on Medicare, we review your coverage, specifically that drug plan or advantage plan from October 15th to December 7th. That’s the annual enrollment period where we can change or make a modification to your coverage. if you’re on a Medicare Advantage plan January through March or maybe you got swooned into enrolling in a Medicare Advantage plan and you didn’t really want to or you’re in the wrong one. January through March is what I call the oopsy period where you can redo what you did. You signed up for Humana, your doctors only take C. Whatever the scenario is, we can make a fix to the boo boo. I have four kids, so I can say boo boo. So, Medicare supplements, I got to keep it light. This is a dense topic. So, Medicare supplement plans. Most states require underwriting still. So again, when you’re turning 65 or you’re coming off that large employer plan after age 65 and you’re becoming new to Medicare, it’s your first time moving into Medicare at 65 or at a later date. It creates a special election window to move into a supplement with no health questions. You’re guaranteed issue. After that six-month window is up, anytime you want to rate shop your plan, in most states, you have to answer underwriting health questions to go from supplement G to supplement G, supplement G to N, N. You there there’s an underwriting undertone at play. Okay, with that being said, there are a handful of states and more coming. Ohio just announced a bill. It hasn’t been approved. Virginia, Maryland, California, Missouri, Illinois. There’s a handful of states that allow for seamless movement on your anniversary or your birthday. So again, June 29th birthday have a cancer. I could, if I were on Medicare, I could shop my supplement G to supplement G for a July 1 effective date in in these states that allow for seamless movement. Okay, so this is kind of a consumer protection and I think it’s a good law. it protects you from being like a small carrier that, you know, has a 200% rate increase, which is not unheard of. I would say the average right now when I first started doing this it was about a 3 to 6% rate increase average nationally on supplement plans and now it’s at like 10 to 12%. So anticipate again that’s a negative to the supplement is your premiums go up but you have awesome coverage. The advantage plans are cheap, affordable on the front end, but there’s a lot of strings attached to your care, and there’s no right-size fits-all approach to this. Okay. Also, let me just check my time here. Okay. Give me like two minutes. Some of you have early retirees. Maybe your spouse is younger, getting kicked off your group plan, or you guys are, you know, 50, 55, flirting with early retirement. The ACA market is in turbulence right now. We are waiting for the administration to either definitively say, “Hey, the Biden era subsidy extension is actually expiring at the end of the year or we’re waiting for a bill to be approved that will say, hey, we’ll extend for one more year the enhanced subsidy.” So with that being said, if you are looking at strategy to compare COBRA early retirement options, November is when we will have a good idea as to what’s what 2026 will look like. Because there’s no certainty with these enhanced subsidies being extended, most carriers, the national average is between 16 and 18% that we are seeing for next year’s ACA premiums on and off exchange. These plans are just increasing. Your group plans are also increasing. The home market’s increasing which is unfortunate but so be aware that there will be more expenses involved with ACA coverage next year for most of us. Also, if you are on Etna and you have an individual ETNA plan on or off exchange and you are under age 65 and it’s not through an employer, Etna is completely removing itself from the ACA market next year. won’t be available. If you do nothing, you should be automatically enrolled in like the closest level plan, but that doesn’t guarantee your doctors are covered in that, you know, C or Sigma or Am Better network. Okay. so being proactive to do this review is key. And then also my HSA lovers out there, all bronze plans under the ACA are going to be HSA qualified. So to cope with these high premium expectations, maybe looking at the ACA bronze plan over a silver plan if you’re losing subsidy is going to be key to keeping your cost low and getting the tax perk of being able to max out your HSA for yourself or the family. Again, I can’t give blanket advice here. I can just give you some strategy nuggets and then we have a one-to-one conversation with me or my team to really dissect your specifics. But starting this process sooner than later for the Medicare piece is key. ACA. Again, we don’t have enough information and we won’t until November to start that strategy session. That’s all I got for you. I tried to keep it in under an hour. Again, I’m a third generation Medicare guru and ACA guru. I could talk about this stuff all day and I do. So, feel free to email me privately your questions. I know Joel is Let me pull up the questions. Yeah. No, I’ve tracked a few here for you, Mark. Start with a few. Okay. Yeah. I mean, number one, I think this is probably good as a first one. what is the ideal time for someone to be thinking about this Medicare decision or getting in contact with someone for help? Yeah, I would say starting it sooner rather than later is key. and like 6 to 12 months out from your 65th birthday is the sweet spot. Sometimes we talk to clients 18 months out if you know it just helps settle your mind. This is a lot of anxiety is created when somebody is approaching Medicare age. We’ll always talk to you. It’s our busy season coming up. So, you know, if it is an 18-month window, reach out in January or reach out now and we’ll schedule something in January. If you’re in that two to six month window, now is the time to be reaching out to us so that we can Okay. start the timeline, right? How about for part D, is the $590 deductible included in the $2,000 out-of-pocket maximum? It sure is. Yep. So, if your plan, so $615 is the most for 2026 that a drug plan can charge in deductible. Some may only have like a hundred or 200 or $300 deductible. Whatever your deductible is at for this year or next year. It all goes towards that $2,000 benchmark. Okay, good. Here’s another one.  Today, neither my spouse nor I have credible coverage, insurance coverage. If I go on Medicare and later she changes jobs and it offers creditable coverage, can I go off Medicare and onto her plan? You bet. As long as it’s a large employer plan. So, you can come on Medicare, you lose creditable coverage, you don’t have access to large employer coverage anymore. Whatever the scenario is, you can move into Medicare and let’s say you go back to work or your spouse goes back to work and picks up large employer benefit and it is creditable. You can delay Medicare, opt out, terminate it, turn this up, turn the drug, and go back on the group plan, and then recreate that enrollment period into Medicare at a later date again without any penalties. I will say there’s usually a two-month delay to requesting a stop to the part Benefit. So, heads up there. Okay, how about exceptions? What does Medicare have exceptions for covering insulin? My wife is suddenly getting charged when she picks up long after the annual co-pay has been paid. text me. I need more info. Specific medicine plan. What plan are you on? I need more info. I saw a few questions that came throughout. I did try and respond as possible where you have a very specific fact that it’s a real good question to just pose directly to Margaret. And I will say, Joel, so if anybody’s on Medicare just wanting eyes on their coverage, shoot me an email. Give me a day or two. I get we had 860 people register for this which is amazing but give me a day or two to work through the emails after this but if you need a review we have an  like new to Steinlage Medicare already on Medicare intake form where we’ll collect all of that critical information and set up a phone call next Wednesday like the first few weeks in October so we can walk through recommendations here. How about are all AC plan plans HSA eligible? Bronze. Yes, bronze. Bronze. Okay. Yep. Someone asked, can you repeat the COBRA information about counting not counting as active insurance if you’re losing coverage before you’re Medicare eligible? When you are on COBRA, COBRA will typically float to the secondary payer many times, most often. So, you need to pick up Medicare to avoid a gap in your health insurance. So, if you’re 65 and you’re already on COBRA or you’re after age 65 and you’re looking at COBRA, Medicare needs to be the primary payer. So, we need to look at enrolling in Medicare. Okay, I think I know the answer to this one is, but it’s a good one. How far into the past can an IRMAA appeal be filed? I retired in December of 22, but I continued paying a higher part B premium through 2023. Can I get money back later? Yeah, that’s what I was afraid of. Yeah, usually it’s a year out like the tax filing year. I’d have to go back to my little cheat sheet to it’s plan to do it the year you retire or at least by April the following year. Okay. But all right. We are about out of time here. So, I’m going to say those who are not able to get your questions answered. I did say there will be a survey that comes to you at the end. Feel free to pose it on the survey. We’ll try and get back to you or don’t hesitate to reach out directly to Margo through her firm Steinlageinsurance.com.  If you have additional Medicare questions you can go to savantwealth.com and search Medicare. We have all kinds of blogs and other information there.  You’re also welcome if you have broader questions than just the Medicare channel that we’ve been talking about today.  Here at Savant Wealth, we are here, like I said, for your major financial decisions and we’d be happy to have a complimentary consultation with you on that. So, thank you everyone for your time. And thank you Margo for being with us. Have a wonderful day everyone. Bye everybody. Thanks.

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