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0:00your questions in when we get to the end. Then I can stay as long as you need me to. Uh we usually
0:04do 30 minutes or so of questions just to make sure you get all of the information that you need. And
0:10when we do that, you will be able to um sometimes you'll have a question that gets answered by
0:16Lauren who is my colleague who's in the webinar with us today. she may send you a direct answer
0:21to some of those questions and then of course I'm going to take them live for anything that
0:25I think that um some of you will ask more than once. So that's the plan for today. Okay. Well,
0:34let's move into the information here. Um can somebody give me a verbal in the chat? Just
0:39let me know. Can you hear me? Okay. I have a couple people saying they can't hear. Um okay,
0:44awesome. Good to go. Thanks guys. I appreciate that. All right. So this webinar is for people
0:50who are eligible for Medicare, either already on Medicare or becoming eligible for Medicare
0:56in the near future. We're going to cover some of the real basics today. And then um it will be for
1:02people whose Medicare is their primary coverage. So, if you have some other form of insurance like
1:09retirey insurance from your employer or tryare for life or federal employee health benefits,
1:15we will not be covering um how that how those work today. We're going to be talking about the options
1:22in the private market, but you can still gather a lot of information about the basics of Medicare by
1:27sitting through this webinar. You can also visit our website where I have a courtesy video that I
1:33did record for those of you that have Triricare or federal employee health benefits. It sort of
1:38explains a little bit about those benefits so that you can go then back to um your benefits person
1:44at whatever organization that coverage comes from and ask any questions that you need to.
1:51What we're going to cover today is the parts of Medicare. I'm going to explain to you what they
1:56cover and what they don't. I'll teach you how and when to enroll in Medicare. We're going to
2:01talk about what Medicare costs because it is certainly not free. And then we will go over
2:06the major pitfalls to avoid. I have a few that I have worked into today's webinar. And as we go,
2:12I will certainly fill you in on how you can get free lifetime support with Medicare so that you
2:17are never alone in dealing with Medicare um now or in the future. So, just to give you a little
2:23information about me, I am an insurance agent. and I've been in this business for 20 years.
2:28My brother and I own Boomer Benefits, which is an agency that helps people navigate their entry into
2:33Medicare nationwide. Um, I have been around long enough that I'm a frequent guest expert on all
2:40types of media. So, you may have come across me in one of those outlets. And I'm also the author of
2:46the best-selling book, 10 Costly Medicare Mistakes You Can't Afford to Make, which is a book that we
2:53put together after years and years of helping people with Medicare. My service team manager
2:58and I went through and just determined what are the questions um the types of mistakes that people
3:04make that we see people make the same mistakes year after year. And then we wrote a book about it
3:09so that people can avoid um that h that happening to them. And uh we will give away a couple of free
3:16copies of that book later in the webinar today. So if you haven't read it, stay tuned and maybe you
3:21can be a lucky winner today. So Boomer Benefits helps people in 49 states. We do business in every
3:27state except for New York. We have 20 years of experience in the Medicare industry and we have
3:33more than a 100,000 policy holders. So we are a large agency. I have 200 employees that work for
3:40me in our Fort Worth headquarters, but we are all licensed in all of the different states,
3:46so we can help people in any state. We have over a million followers on social media. You're welcome
3:51to check us out on any of those channels. And we also are a Forbes Finance Council member and I
3:58also have a social security certificate. So, uh, if you have a couple of Social Security questions,
4:04sometimes I can answer the basics and then I have a real expert that I refer people to if they need
4:09a deeper help with Social Security. Boomer Benefits has over 30,000 five-star reviews
4:15for our service and helping people with Medicare, which is a completely free service to you. Doesn't
4:20cost any money at all. We'll talk about how that can be as we go through the webinar today. And we
4:25have sort of old school customer service where you're going to call in and get a live person
4:29on the phone and not be put through a phone tree. So when I meet people that are new to Medicare,
4:35typically they are overwhelmed because maybe 6 months to a year before your 65th birthday,
4:41you start getting a stack of mail and you open your mailbox and every day there's more,
4:46right? And usually what I find is that people have a sack of mail a foot high on their desk or
4:51kitchen table and they're not sure what they need to keep, what they should throw away,
4:55what is an ad, and what's really Medicare. And sometimes they don't make any decisions at all
5:00because that snack mail is so overwhelming. Now, you probably have also been getting a lot of
5:05telemarketing calls. I know that those happen that they're not supposed to do that. Boomer
5:10Benefits never does those type of uh cold calls like that. We work only with people who reach out
5:15to us for help. But I know that the telemarketing can also be quite stressful. So I'm going to help
5:20you today. So at the end of the webinar, you'll be able to throw out most of that stack of mail.
5:24You're going to know what is what. So there are two things that people with Medicare really need.
5:31And today you have probably come here knowing that you need help with the first one, which is
5:38learning about Medicare and selecting the right coverage for you. You may have questions like
5:43what should I enroll in? How is it going to cover me? What will it cost? How uh can I decide which
5:49type of Medicare insurance is the best coverage for me? And then when I enroll in that coverage,
5:53how it will work. Probably everyone came to the webinar today knowing they need help with that.
5:59But there's a second part that you may not know yet that you will absolutely need and that is
6:04how will you get support for Medicare issues that arise once your coverage is in force.
6:10In your old employer insurance, you could have called your benefits department and gotten help
6:14with things. You don't have that once you're on Medicare. So, you will have things crop up like
6:20you'll get a bill for a procedure that should have been covered and you're not sure who to call. Do
6:24you call Medicare? Do you call your insurance company? Do you call uh the lab facility that
6:29did the procedure? You call your doctor. People are usually unsure of how to solve these things.
6:35Sometimes you'll have a claim that gets denied and you'll want to know how do you write an effective
6:38appeal. There will sometimes be medications that are maybe not covered by your drug plan and
6:44you need to know the next steps so that you can determine how to get get that covered. Maybe it's
6:49an appeal or a drug exception and you don't even know those terms yet. But this is probably an even
6:55more important piece that you need in the overall picture. And as we go through the webinar today,
7:01I'm going to show you how you will be able to easily get both. The good news today is you don't
7:06have to invite a stranger out to your home or kitchen table. You will you will find today as we
7:11go through the webinar that you're going to come out of this with a lot more information and you're
7:15going to feel pretty solid. There are also quality Medicare plans for people at any budget. So, we're
7:21going to show you the range of options today. And then you can always get free support with
7:26um avoiding mistakes and penalties on the back end of your insurance. And you can get that through
7:32enrolling through a broker like us at Boomer Benefits, which we will give you some information
7:36on as we go. So, I like to say at Boomer Benefits that Medicare starts with the parts because if you
7:42don't first understand how the benefits work that you have worked all your lifetime for the benefits
7:49provided by the federal government, it's really hard to determine what you need to add to that
7:54coverage to fill in the gaps. So, we're going to start by going over the parts of Medicare
7:59and showing you what they cover. Medicare Part A is your inpatient hospital services. And I want
8:05you to think of this like room and board in the hospital. Three square meals a day, maybe some
8:11yummy strawberry jell-o at the end of the night, right? Real exciting. You're going to have doctors
8:15and nurses that come around to check on you. There will be medications related to your stay that are
8:20given to you. Sometimes you need skilled nursing or wound care while you're in the hospital,
8:25and sometimes you need it for a while after you leave the hospital. Medicare Part A covers all
8:31of those things. It also covers blood transfusion and hospice benefits. So that is Medicare part A.
8:38But sometimes you may have things that happen on a hospital campus that actually get build under part
8:46B, which is your outpatient insurance. So this could be something like doctor visits, lab work,
8:53preventive care. Part B covers all of those things, but it also covers things like outpatient
8:59surgeries, physical therapy, limited home health care, dialysis, chemotherapy, radiation, ambulance
9:06rides, MRIs, and CT scans. And because you have them done at a hospital campus doesn't mean that
9:13they fall under part A. They only fall under part A if they're part of an admitted overnight stay.
9:19So health care services that you receive when they are not part of an admission to a hospital
9:24are going to fall under Medicare Part B. So if you have been thinking, hey, I'm a really
9:31healthy person. Could I get away with just having part A? The answer is no. If Medicare is going to
9:36be your primary insurance, it's really necessary to have both. And when you put these two together,
9:42these two together are called original Medicare or traditional Medicare. and they are the foundation
9:50of all of the benefits that you will have going forward. Now, these two parts are the only parts
9:57that you get directly from the federal government. So, they're the only parts that you will sign up
10:04for through the Social Security website. And that is because the other two parts of Medicare, parts
10:10C and D, came much later in the history of the program and they are optional. So part C is the
10:17Medicare Advantage program. This is a way that you can get your Medicare benefits through a private
10:22insurance company in your local area that operates a network. We'll talk about that extensively
10:27today. And then part D is the voluntary drug program. And the voluntary drug program is
10:34voluntary because some people may have other forms of coverage like VA benefits for drugs or Indian
10:40tribal benefits for drugs. But really, everyone else that doesn't have that type of credable
10:45coverage, other drug coverage, Part D is a very necessary part, even though they say that it's
10:51voluntary. So, the way that you enroll in Medicare is during a seven-month window surrounding your
10:5865th birthday. You will only do this part once in your lifetime. You only have to enroll in Medicare
11:04once. You don't have to reenroll in parts A and B every year. Your window to enroll is specific to
11:10you. It starts 3 months before your 65th birthday. It goes through the birthday month and then it
11:15runs for 3 months after. And as long as you enroll within that seven-month window, you're not going
11:20to be hit with any late penalties. Now, some people can delay enrollment into certain parts
11:25with no penalty if they have employer insurance from a large company. And we'll talk about that
11:31today as well. When you enroll, really, for the most part, people don't go down in person to sign
11:39up anymore. And in fact, that is the the longest and least efficient way to enroll. You're dealing
11:45with paper and it takes longer for everything to get to you. So, the quickest way to enroll today
11:50is to go to the Social Security website, which is what most of you will do if we have any Railroad
11:56retirees. They're going to go to the Railroad Retirement Board website. And you can enroll in
12:00Medicare in just a couple of minutes online during that seven-month window that is specific to you.
12:06Now, some people will be automatically enrolled in Medicare, and that applies only to anyone that
12:14starts their Social Security benefits prior to turning 65. So, give me a shout in the chat if you
12:21are un if you are turning 65 and you're already on Social Security, say I am or me or Social Security
12:28and let me know. Yes, we have quite a few people. So, all of you that started Social Security at 62
12:35or 63, your Medicare card is just going to show up in the mailbox one to two months before you
12:41turn 65. And if you don't want the coverage, you actually have to decline it with Social Security.
12:47Everyone else who may be delaying their social security benefits until their full retirement age
12:52or until age 70 to get that maximum benefit check. Those folks, which is the majority,
12:58have to initiate their own enrollment into Medicare in that seven-month window. So,
13:03it will be your responsibility to make sure you get it done within that time frame. If you end
13:09up working with Boomer Benefits, we will walk you through all of these things, make sure you
13:13don't miss any of your deadlines. But in terms of going to the website and applying for Medicare,
13:18your agent doesn't need to do that for you. You will do it on your end through your own portal
13:22for Social Security and it takes just a couple of minutes. It's actually very easy to enroll in.
13:27Now, you'll notice that I didn't mention anything about long-term care, and that is because Medicare
13:34doesn't cover that. So, if you live in an assisted living facility or nursing home and you are sick
13:41enough that they send you to the hospital, part A is still going to cover your hospital benefits.
13:45Or if you need to see a doctor, maybe a doctor that comes out to your facility or, you know,
13:50a family member picks you up and takes you to the doctor, part B is still going to cover your
13:54doctor visits, but it doesn't pay for the rent to live in assisted living or a nursing home. So,
13:59you need to find another source for that. either it could be long-term care insurance. Um perhaps
14:05your financial adviser that you work with has programs. There are certain types of
14:09life insurance with a long-term care acceleration rider. There are ways that you can plan for that.
14:14But just know that Medicare is not going to be um covering that. So you do need to have a
14:20separate plan for that. All right. So let's talk now about what is Medicare going to cost you.
14:26I would say every year we probably meet maybe 10 to 15 people who are completely surprised to
14:33find out that Medicare costs anything at all. They have gone their whole working life thinking that
14:37Medicare will be fully paid for. And of course, it isn't. And people get confused about how the costs
14:43work. So, I'm going to boil this down for you and make it pretty simple by explaining to you that
14:48the costs that you incur with Medicare are the same types of costs that you have incurred on any
14:54health insurance you've ever had in your lifetime. Think about your current insurance. Maybe you have
15:00it through an employer. Maybe it's through the Affordable Care Act healthcare exchange. You have
15:05a premium that you pay to the insurance company in exchange for the coverage itself. If you're
15:11getting it through an employer, they're paying the premium, but they deduct your portion out of your
15:15payroll check. So, we've been paying premiums for health insurance all of our working lives, and we
15:21will pay premiums for health insurance once we are on Medicare as well. The other type of costs that
15:27you have incurred all your life are co-pays and co- insurance and deductibles. So, if you think
15:33about your current insurance, when you go to the doctor, is it free? For most people, no. There's
15:38usually a doctor co-pay. If you have an expensive procedure like an MRI or you have a hospital stay,
15:44you may have a deductible of a,000 or 1,500 or I've seen many group plans where it's a $5,000
15:50deductible. And so this is called cost sharing. It's money that you spend at the time that you
15:56seek health care services. You've been having cost sharing your whole working life. And Medicare
16:03has cost sharing, too. So let's talk about the premiums first. If you have worked 40 quarters
16:10in the US during your lifetime, when you turn 65 and enroll in Medicare, Part A will cost you
16:17zero. It's premium free. And back in the 60s when Medicare was first rolled out, there were a lot of
16:25people who didn't have this work history because we had a lot of homemakers back then. And so
16:30you can even get Medicare Part A for zero if you are married to someone that has 10 years of work
16:36history or 40 quarters of work. You could even get it through an expouse. If you're still single and
16:43you were married to that spouse for 10 years or more and they're eligible for social security,
16:48you can draw premium free part A on an expouse and even a late spouse. So most people when they turn
16:5565 will pay zero for part A. We do sometimes meet immigrants who've been here for five years which
17:00qualifies them for Medicare but often they don't have the work history and their spouse immigrated
17:04with them and those people will pay over $500 a month for part A. So hopefully most people here
17:10are in the premium free bucket and I think because of this this is why people sometimes think that
17:15all of Medicare will be free because this one part they call it free but really it's not free. You
17:20paid into that system your whole working life to prepay your future hospital benefit. Now, on the
17:28part B side, everyone pays a monthly premium to Medicare itself. And in 2026, the standard base
17:36premium that most people will pay is $22.90 a month. I would say 92% of people pay $ 202.90
17:47or less. The or less category is sometimes people have an income that is so close to the federal
17:53poverty level that they apply through their state for Medicaid, which is financial assistance from
17:59the federal and state government with the cost of healthcare. If you have Medicaid, you could have
18:04that coordinate with Medicare, and that would often take care of the part B premium for you.
18:09But most people don't qualify for that. It's a small subset of the Medicare population. And then
18:16on the other end of the spectrum, about 6 to 7% of people pay more for part B. And this is based
18:23on your income. So the way this works is in 2026, let's say that you're turning 65 in March of 2026.
18:36When you enroll in in Medicare and you get your Medicare ID card in the mail, shortly after that,
18:44you will receive something called a benefits determination letter from Medicare. And it
18:50will say, "Hey, we took a look at your income from 2 years ago, what you earned in 2024,
18:57and based on that income, we have deemed you a high wage earner. And so here is what you will
19:04pay for Medicare Part B. And you can see here that if you had someone that was a single filer who
19:10earned 110,000 back in 2024, their letter would say they're going to pay 28410 for Medicare Part
19:17B. And this gets deducted right out of your Social Security check before it ever even hits your bank
19:22account. If you're not taking Social Security yet, they'll bill you for Part B quarterly. Now,
19:28likewise, you might have a married couple. Let's say we have a married couple who earned 450,000 as
19:34joint income. They would get two letters, one for each of them, telling them that they each will pay
19:40$64,920 for Medicare. So, you can see that if you come into Medicare expecting to pay 202
19:49because you didn't know about the income related monthly adjustment amount or Irma, that could be
19:53a nasty surprise. And so, we do want to plan for this potentially. And thinking of this,
19:59decisions you make with your money when you are 62 and 63 can affect your I'm sorry 63 and 64
20:07can affect your Medicare premiums when you're 65 and 66. So if you cash in a big IRA or 401k
20:15and it inflates your income for that year, you may end up with an Irma. You might sell
20:20some property like a vacation home and you have a large capital gain. That can also do it. Now,
20:25some of you will say, "But wait a second, I earn less now because two years ago, I was working or
20:30I had higher income." Well, in that case, you can appeal it. And so, at Boomer Benefits,
20:35we help people with the form. We help them with the documentation. If they need to appeal that
20:39we give them all the support they need to appeal this, but in order to appeal, you have to have
20:44one of the reasons on the form. There's a form that comes from Social Security. You can actually
20:49Google this form. The form name is SSA-44. and it will tell you that valid reasons for an appeal are
20:57retirement or going from full-time to part-time or if your income changed due to marriage, divorce,
21:03death of a spouse, or sale of an income producing property. And so they're going to look at your
21:08tax return and look at your modified adjusted gross income, which includes all income, wages,
21:14dividends, capital gains, IRA distributions, tax exempt interest income, and social security
21:19benefits. And typically you will find this by looking at that tax return line 11 and
21:26adding line 2A. And then this would tell you if you're potentially going to have an Irma. Now,
21:31you can't appeal this until you actually get the benefit determination letter from Social
21:36Security. But if you do, you have an opportunity if you've got one of those qualifying reasons to
21:41appeal that at which point they would adjust that down if they approved the appeal instead
21:46of you having to wait the two years for that uh lower income to catch up to you.
21:53We're going to talk about advantage plans in a little bit and I'll discuss their premiums when
21:57we get there. But before we leave the premiums for Medicare itself, I want to talk about part D. So,
22:03if you end up staying with original Medicare and you add on a Medicare supplement or a metagap
22:08plan, you will also need a standalone Part D drug plan. And drug plans, when they enroll you as a
22:16member, they get paid by Medicare to take you on as a client. So, they can set their premiums
22:25wherever they like. They could even have a zero premium, meaning they're not charging you anything
22:30extra beyond what Medicare is already paying them for your enrollment. But they could also have a
22:36formulary with a ton of brand names and they're very proud of their formulary and they can charge
22:40much higher. There are plans out there that are over $200 a month for part D. But if we averaged
22:46everyone in America, the average premium that people will expect to pay in 2026 is around $35.
22:52So, this is a number that we're going to use as a ballpark projection in some of the examples
22:58that I'm going to show you today. When it comes to Part D, we have a whole program at Boomer Benefits
23:04where you actually come into a webinar with me and I show you step by step how to determine which
23:10Part D plan is right for you. And so, we have full support for anything that you're going to
23:15do with Part D if you end up enrolling in that standalone program. One other thing is that if
23:23you get sent an Irma letter for part B, you also will have an income related monthly adjustment
23:28amount for part D. So let's say that we found you a drug plan and that drug plan had a premium of
23:35$10 a month and you enroll in that drug plan and you pay $10 a month to the insurance company. If
23:41you're in a high income bracket, they will also deduct a little extra out of your social security
23:47check and that is how you pay the part D Irma. So you can see that depending on your income,
23:52you may see anywhere from $14.50 to as much as $91 being deducted for that Irma. So
24:00um very important to know that when you're working with us, we will absolutely advise you and help
24:04you with your best chance for appealing this. But sometimes people can't appeal it. they just owe it
24:09because they are high income. And so what we might run into sometimes are people that don't take
24:14any medications or they take two little generics that are a dollar at Walmart, but they're in the
24:19highest bracket and they're sure not excited about spending $91 plus out of pocket when they don't
24:25take medications. But remember, we never know when we are going to get sick. And Part D covers
24:31some very expensive medications such as oral chemotherapy medications. So, if you don't enroll
24:37in Part D when you're first eligible, there are two strikes against you. One is a late penalty.
24:44If you don't have some other form of credable coverage, like you're still working and you have
24:48employer coverage or you've got VA benefits, then you start accumulating a penalty that grows every
24:54single month cumulatively for as long as you fail to enroll. And then when you finally do enroll,
25:00you pay a higher premium for the rest of your life because you've got to pay this penalty
25:03every single month. More importantly, you can only enroll in Medicare during valid election periods,
25:09like your initial seven-month window into Medicare or the annual election period in the fall. So,
25:15in my book, I give an example of someone, a client of ours that skipped the drug plan every year
25:21and ended up one year with cancer and she spent $20,000 in four months to pay for an oral chemo
25:28because she skipped a drug plan that would have cost her $10 a month. So, I can't make you enroll
25:34in Part D, but I can tell you that running without Part D coverage is a serious risk because she had
25:40to wait all the way until the next election period for us to get her into a drug plan. So,
25:45failing to enroll in Part D means you don't have coverage for things like amunosuppressants and
25:51um anti-depressants and anti-seizure medications and chemo medicines which are very expensive. So,
25:57it is risky to go without it. All right, those are the premiums. Now,
26:03let's talk about the cost sharing part. If you had just original Medicare and nothing else,
26:08what would you come out of pocket when you are at the hospital or a doctor's office? Well, if you
26:13spend the night in the hospital, there's going to be a deductible out of your pocket of $1,736. And
26:19you won't pay anything else unless you are unlucky enough to still be in the hospital on day 61.
26:25At that point, you start paying an expensive daily co-pay that doubles on day 91. On day 150,
26:31all of your benefits run out. So now you pay 100% of your hospital costs. You also pay for
26:38the first three pints of blood in a transfusion. And if you go into skilled nursing facility after
26:44a qualifying hospital stay, Medicare pays 100% for only the first 20 days. If you're in there longer,
26:52you pay over $200 a day. So, a lot of times people will say, you know, it's probably pretty rare,
26:58right, that people are in the hospital for 61 days. And that is actually true except from the
27:03pandemic. Then we had tons of people that got into these heavy heavy co-pays because they were in the
27:09hospital longer. We never know when something like that is going to happen. Also, if you were
27:13to leave the hospital 60 days after you leave, your discharge date, the benefit period for part
27:19A closes. Now, if you go back in the hospital 2 days later, you pay the deductible again. So,
27:25part A's deductible and co-pays are for this benefit period, right? It starts with each benefit
27:30period. And so, if you timed it really poorly, you could end up paying this several times a year. So,
27:35we want to make sure that we put coverage in place to pay for the deductible, to pay for the daily
27:43co-pays, to give you a year of coverage beyond day 150. And some plans will also cover that skilled
27:49nursing piece. And wouldn't you know, back in 1965, as soon as Medicare rolled out Part A and B,
27:55insurance companies like Mutual of Omaha came onto the scene and created metag gap plans,
28:02also called Medicare supplements. And what they supplement is this. They step in to pay
28:07these pieces that Medicare does not when you have hospital stay. On the part B side, your outpatient
28:15insurance, you upon your first outpatient visit of the year, whether that's a doctor visit or
28:21a lab work or a physical therapy that you had pending, if it is a part B healthcare service,
28:26when Medicare gets the bill, they will shortay the provider by $283 and the provider will then bill
28:33you and you pay the first $283 in Part B spending each year. So that is your deductible. Now, let's
28:41talk about a deductible for a minute. Everyone has deductibles on their homeowner's insurance and
28:47their auto insurance, right? Let's say you're in a car wreck and you have a $500 deductible, but your
28:53car repair is going to cost 3,000. You have to go into Caliber Collision or wherever you're at,
28:59and pay the $500 first, your deductible, before the insurance company steps in to pay the other
29:062500. And this works exactly the same way. You pay the first $283 in charges. Once you have met that,
29:15now for the rest of the year, all of your part B spending, all of your outpatient care, Medicare
29:20pays 80% and you pay the other 20%. Unfortunately, unlike insurance that you've had all your working
29:27life where there's a stop-loss, Medicare doesn't have that. So you will pay that 20% forever which
29:33can be a staggering amount of money in the event of a lifetime need for dialysis or oxygen or
29:41uh chemotherapy or radiation. And so this 20% is definitely um the most important piece that
29:47we want to get covered with any type of coverage that we put in place. So how do we cover the gaps?
29:54Well, some of you are still working. In fact, um, let me just launch a poll here real quick
30:00because I'm interested to see. Uh, I want to know, will you be retiring at 65? You will put either I
30:07am retiring at 65 or I plan to work past 65. And if you've already retired, you can tell me which
30:12one of those you did. So, you should see that poll there on the right hand side and you can drop your
30:17answers in and it'll be interesting to see because we have so many people today that are still
30:23working. Yes. Interesting. Okay, so currently we've got about 43% of you that have responded.
30:31Let's see if we can give it just another minute. I'm curious to see where this ends up.
30:38Okay, so 40% of people plan to work past age 65. 16% of you are retiring at 65 and the rest
30:47are already retired and on Medicare. So, that's a pretty big uh percentage of people that work
30:53past 65. And that's not uncommon today because our jobs are are not sedentary. Uh I'm sorry,
31:00they're more sedentary than they were back in the 60s where most jobs required you to get up and
31:05move around a lot, right? We have the age of the internet has changed everything. So, one way you
31:10can cover the gaps is by having your employer insurance coordinate with your Medicare. So,
31:14if you work for a large employer or your spouse does and the employer has more than 20 employees,
31:20that group coverage is primary and Medicare is secondary. So, in that scenario, if we're working
31:25with you, we would tell you to enroll in part A because part A costs zero and it will coordinate
31:29with your employer coverage. It could reduce your spending in the event of a hospital stay, but
31:34you're going to delay enrollment into parts B and D because why would you want to pay those premiums
31:38when your employer coverage already has outpatient benefits and drug benefits? The only caveat to
31:43that is if that large employer insurance is a high deductible health plan and you are contributing to
31:48an HSA because of that high deductible, then in that scenario, you want to also delay part
31:53A because the IRS won't let you keep contributing into that HSA if you have Medicare part A active.
32:00So in this scenario, you could work past 65 with part A and then one to two months before
32:06you get ready to retire, you would call Boomer Benefits and we would help you apply for part
32:10B on the back end. There's special forms for that. There's an application for part B and there's also
32:15an employer form that has to be verified. We walk you through all of that so that you get everything
32:19into social security as it should be and you don't end up with any unnecessary late penalties because
32:24you you completed the paperwork incorrectly. But here's the another thing. If you work for a small
32:31employer, Medicare is primary. So now you for sure want to sign up for A and B right when you turn 65
32:38because otherwise if you go to have a knee surgery and you didn't sign up for part B to pay the 80%
32:44you will pay the 80%. So we see this all the time. These people get uh these massive medical bills
32:50because of uh running into they didn't know that they should have enrolled in Medicare. You may
32:56also potentially end up with a late penalty. And so it's really important if you work for a small
33:01employer to sign up. Now, if you have retirey insurance through an employer or you have COBRA,
33:07Medicare is also primary. So, if you keep your employer insurance, but you're no longer actively
33:12working, you need to sign up for A and B because Medicare is primary and the COBRA is secondary.
33:18And so, it's important to know that so that you have everything in place to coordinate so that
33:22you don't have any surprise bills. So, pitfall number one, people just don't know this. So, small
33:28employer people, they will think they can skip Medicare for now because they're still working
33:32and they end up uh running into unexpected medical bills. Also, some of you may have plans through
33:38the healthcare exchange and you have a subsidy that's making it really cheap, maybe cheaper
33:41than Medicare, but those plans are not creditable for Medicare. So, you need to leave them when you
33:47turn 65 and you enroll in Medicare um to avoid any late penalties later on. You also are no longer
33:54eligible for whatever subsidy you are getting on your healthcare exchange plan once you turn 65.
34:00So if you miss the enrollment and they catch up to that, which eventually they will, you have to
34:04pay all that subsidy back. And so we need to leave that coverage and go on to Medicare when you turn
34:0965. So one example that I want to give you about some of the backend issues that people run into is
34:16this one. So, a client switched off of employer insurance and came through Boomer Benefits and
34:22enrolled in uh all of his plans with us and he had a bunch of doctor visits and some lab work
34:28and immediately Medicare denied all of his bills. Can you imagine if that were you and you're new
34:34to Medicare? What do you do? Who do you call? Do you call Medicare itself? Do you call the doctor's
34:39office? Do you call the lab facility? You're going to be lost wondering what happened. Well, what
34:43happened and the reason it's important to have a broker like us because we deal with this all
34:48the time is the employer failed to notify Medicare that this person retired. So Medicare thinks it's
34:54still paying secondary and it denies all of the claims. Well, if that happened to you, you would
35:00have to fix it all on your own. You would have to call each of those providers. You would have
35:04to explain what happened. You would have to get them to rebuild after Medicare fixed everything.
35:09Well, if you were working with us, we have a whole service team that handles all of that for you. So,
35:14in this case, we we faxed in the denial notice. We advocated for him with Medicare until we resolved
35:19that. And then we contacted all of the providers and we had them rebuild Medicare and in the end,
35:25he owed nothing. But a lot of hassle, right? Things that happen on the back end of Medicare
35:30that are no fault of your own that you will have no idea how to solve. And this is how you solve
35:36them by working with a company like ours which is a completely free service and we provide all of
35:41that service on the back end to you with anything that happens to go wrong. We also get posts like
35:48this one all the time in our Facebook group for Medicare beneficiaries and this person went in
35:52for the annual wellness visit and got build for it. Well, that's supposed to be a zero charge,
35:58but this this person Philip went and had his and he's perplexed as to why he had to pay for it. And
36:04you can see here we answered, hey, this happens all the time. Should have been covered at 100%.
36:09If you enrolled through Boomer benefits, give us a call. We will handle fixing this for you. Those
36:14are the kind of things that can just happen with any type of Medicare uh coordination of benefit
36:19that you may sometimes need help in getting fixed. Okay, moving back to original Medicare as your
36:26primary. Let's say you're no longer working. Well, now you're going to need some coverage to fill in
36:31those gaps that I showed you a few slides back. So, your options are either a metag gap plan,
36:38which is also called the Medicare supplement. Same thing, just two different terms. These have higher
36:43premiums upfront, rate increases every year, but far less cost sharing on the back end. Or you can
36:52enroll in an advantage plan, which is called part C of Medicare. These have lower premiums
36:58because you agree to get your care from a limited network of providers, but you will have higher
37:03cost sharing on the back end because you're going to pay for things as you go. So, in some years,
37:08you might save money when you don't have a lot of health care going on, but in a year with a lot
37:12of healthare, you might spend considerably more than what you would have had you had a Medicare
37:16supplement. So, part of what you need to determine is which one is really the right coverage for you.
37:24with a Medicare supplement. This is a private insurance plan that helps to cover the costs
37:30that Medicare leaves behind. It steps in to pay those deductibles, co-pays, and co- insurance
37:36that I showed you a few slides back. You must be enrolled in part A and B first and then you add
37:42the Medicare supplement. Most people who choose a Medicare supplement do so because of the freedom
37:49of access. When you have a metagap plan, you can see any provider in the nation that accepts
37:55Medicare. There's over one million providers that do. So Medicare is going to get the claim,
38:01it will pay its share, and then instead of sending you the bill for your deductibles,
38:05co-pays, and co- insurance, they send that bill to your Medigap company who steps in to pay
38:09that for you. That is how it works. So you don't have to choose a primary care doctor. You don't
38:15need a referral to a specialist. You can use this anywhere. If you snowbird or have an RV lifestyle,
38:21you can use it all across the nation. And that is the primary reason that people pay more for
38:26a Medicare supplement. The people that choose Medicare supplements, the primary reason they
38:30tell us that they do is they want to be able to go wherever, including the Mayo Clinic, right? So,
38:34the Mayo Clinic does not accept Medicare Advantage plans. And if they want the option to go there
38:39if and when they have a condition where the best specialist in the world is there, then a Medicare
38:44supplement allows them that freedom of access. Now, there are 10 standardized Medicare supplement
38:50plans and each of them has a separate set of benefits. So, you can get one with a little bit
38:54of benefits or one with a lot of benefits. And a whole bunch of insurance companies offer them. So,
38:59at Boomer Benefits, we work with every major carrier that you could think of. And this
39:03would be carriers like uh Mutual of Omaha, United Healthcare, Blue Cross, Anthem, Sigma, Humanana,
39:11Etna, Bankers Life, Manhattan Life. There's a bunch of them. We have quoting software. we
39:16can quote all of them for you and your zip code and be able to tell you exactly which one gives
39:21you the lowest um and most competitive premium. So, when we look at the 10 standardized plans,
39:27unfortunately, Medicare labeled them plan ABCD FG KLM. I will never understand why they didn't use
39:35Roman numerals because it's endlessly confusing for new Medicare beneficiaries to have parts A, B,
39:41C, and D and then you add plans A, B, C, D, F, G, K, L, N. The missing letters are plans that have
39:48been discontinued. And in recent years, both plan C and plan F are being phased out. So, it won't be
39:55long before we really have eight options instead of 10. And very few people sign up for Medigap
40:02plan A, B, C, or D because look at all the X's there. Most people who have a Medigap plan, they
40:07want their hospital deductible to be covered. And most people want to know if they go in a skilled
40:11nursing facility to recover from a stroke or a major surgery, they don't want to pay $217 a day.
40:18They want that covered. And so very few people enroll in these columns with the X's, I think less
40:24than 2%. The two most popular plans today are plan G and plan N. And when you look at plan G, look
40:30at everything in that column that is covered at 100%. So the only thing you come out of pocket is
40:37that $283 deductible. Well, then for the rest of the year, Medicare pays 80%. Your plan G pays the
40:43other 20%, you don't even have a doctor co-pay. It is the most comprehensive coverage that you
40:47can buy. It's considered the Cadillac plan, but it's also then the most expensive plan, right? And
40:52we'll talk about premiums here in just a minute. We also get a lot of people asking about plan N,
40:59which has slightly fewer benefits than plan G. On that plan, you get a little bit lower premium,
41:05but you're going to pick up a doctor co-pay of up to $20. There's an emergency room co-ay up to
41:09$50 and there's something called excess charges which you may run into occasionally that result
41:14in some small uh balance bills. So we have a lot of people asking us to quote those two. We also
41:20will have people call in and ask us for a part G. Well, they're confusing parts of Medicare and
41:26plan. So there's no such animal as a part G, but of course we're going to know what you meant and
41:31we will talk to you about the plans that you're interested in and we can provide quotes for those.
41:36Now, on these plans, you will notice that in plans K, L, and N, there is sort of a percentage that is
41:43covered. So, you might have part of the deductible covered. There is also a high deductible version
41:47of plan G where you pay the first, I think it's almost $3,000 out of pocket now um before it kicks
41:54in. So, if you are a consumer-driven health care person and you're willing to pay a little bit for
41:59a lower premium, if you're willing to take on some part of your cost, you can always ask for
42:03quotes for those plans. I will say though that the plans that are less popular, fewer of the carriers
42:08offer them. So insurance companies based on state law, they can decide whether they want to offer
42:14all of these plans or just one of them. They don't have to offer every plan in every state.
42:21So when it comes to what you're going to pay for metagap plans, the first thing to know is that
42:26the Medicare insurance company sets the rate. and a broker or an insurance agency like us at
42:32Boomer Benefit. All we do is quote the rate that already exists. We can't add to the rate. We don't
42:38inflate the rate. You don't pay anything more to work with a broker. the insurance company.
42:44What they're going to base your quote on is the age of your application, your zip code,
42:50your gender, whether or not you use tobacco, and any eligibility for household discounts
42:56if you and your spouse are applying for the same carrier, which sometimes they offer that. What's
43:03really going to affect your rate too is where you live. So in the Midwest and even here in Texas,
43:07we have pretty reasonable metagap premiums. But in some states, the cost of health care is a lot
43:13higher or there may be expanded open enrollment rules that drive the rates up. So for example,
43:19Florida and New York in particular have very high premiums, much more than you would pay if you were
43:24in the Midwest or in Texas. They're basing that on the cost of healthcare in that local area.
43:30So, if you were to call a carrier and get a quote for you and then you called Boomer
43:35Benefits and got a quote for the same carrier, those two numbers would match. Think about this
43:40like an auto insurance broker. I don't know if you guys use a broker, but I have an auto
43:44insurance lady that I use. And every year when I get my rate increase for my auto and homeowners,
43:49I call her. I tell her, "Hey, I got my rate increased." And she goes out and shops it for me,
43:53right? And then she comes back to me and she says, "I have these five other companies that you
43:58could consider and here's what they're charging." Well, you know, maybe I'm going to switch to one
44:02of those plans because it saves me some money. I don't pay her anything. She gets paid a commission
44:07by the insurance company for whichever company I ultimately choose. I pay the same rate whether I
44:13go through her or directly with the insurance company. The difference is if I get an auto
44:18wreck and I enroll direct with the insurance company, I'm dealing with everything myself.
44:23But I wouldn't do that. I have a broker because if I get into wreck, I want to call my broker and
44:27I want them to deal with all of the paperwork. And a Medicare broker is exactly the same way.
44:32We don't charge anything for helping you, but we are there to handle all the things
44:36on the back end. And the way that we get paid is a commission from the insurance company that you
44:40ultimately choose. So let's take a plan G sample quote since plan G is the most popular one. Your
44:47foundation is Medicare itself. You have a zero premium for part A. you have $ 202.90 for part B,
44:53could be more if you're in a high income bracket and you owe an Irma. We're going to ballpark Part
44:59D at $35, but we might find a plan in your state that is $0 or $5. We we won't know until we know
45:06what medications you take, and we'll show you how to enter those into medicare.gov and pick exactly
45:11the right plan for you. So, I'm just using the 35 as a ballpark average. And then you add on the
45:18plan G. So for a female turning 65 in Dallas Fort Worth, non-smoker, she's going to pay the quotes
45:25are going to start around 120 a month. For a male, it would be closer to 150. If you were in New York
45:30or Florida, it would be at least twice that. But here, the way that I put this together for
45:35my taxes example, she's going to pay around 358 a month, and she has a plan with a $283 deductible
45:42and a 100% coverage. She doesn't even have a doctor co-pay. So, to put that in perspective,
45:47I have a $3,500 deductible on my health plan. I pay $600 a month for it. And after I meet the
45:54deductible, I still have to pay another 20%. So, I think that this coverage is fabulous and I can't
46:00wait to sign up for it when I turn 65 because it's way cheaper than what I spend. But many people,
46:06including some of you, maybe have come from employer or corporate where your employer covered
46:12most of that cost. And so you have maybe been paying $50 a paycheck for your insurance. And this
46:17may seem insurmountable to you, might be more than you can afford. And that is why Medicare Advantage
46:22plans were created as part of the balanced budget act of 1997 to roll out an alternative to give
46:29people cheaper premiums. But the part they give up is then having to work with the network instead of
46:33having that nationwide access. And we're going to show you those in detail here in just a moment.
46:39Now, you do have to qualify for a metagap plan. So, these two slides are really important. These
46:45next couple slides in my book, it's called The Big Mistake, Chapter 8, and I do a much deeper
46:49dive here, but I'm going to show you the overview here. Everyone who gets Medicare has a one-time,
46:58one chance opportunity to enroll in a metagap plan with no health questions asked. They can't
47:05underwrite you. They cannot turn you down for health conditions. And that window starts whenever
47:10you first enroll in Medicare. So whether you do that at 65 or maybe you keep working for a large
47:16employer and you don't sign up for part B until age 70, it starts when you sign up for part B.
47:21You have six months to apply for any metagap plan in your zip code. No health questions asked. They
47:26cannot turn you down for health reasons. When that six-month window is gone, it's gone forever. Now,
47:32if you go to apply for a plan or you want to switch from one plan to another,
47:36there'll be a whole page of health questions. They're going to look at your records. They're
47:40going to look at your medical records. is going to look at your prescription records and they
47:44can determine whether they accept you or decline you. So, really important to know this because if
47:50you want a Medigap plan and you're coming into Medicare with some serious health conditions
47:54or maybe even not serious but just chronic, something that is treatable but not curable,
47:58this might be something like rheumatoid arthritis, right? Well, if you have something like that, this
48:04six-month window is going to be your one time to get into a metagap plan because later that would
48:10probably be something that most carriers would decline you for. Okay? And what is super important
48:16to understand about this window is that it has nothing to do with any other annual election
48:22period with Medicare. It is a one-time window specific to you and your Part B effective date.
48:29So be aware that if you go a different route right out of the gate with Medicare, you can't
48:35just later change back to original Medicare and get a metag gap plan with no underwriting in
48:40most states. So pitfall number two is that people confuse the annual election period in the fall,
48:48October 15th to December 7th, with the metagap open enrollment window when in fact the annual
48:54election period has nothing to do with metagap at all. It is not a ticket to join a metagap plan
49:02with no health underwriting. It is for changing your Part D drug plan or your advantage plan if
49:09you have one. Those two types of insurance, part D and advantage plans have no health questions ever.
49:15So, they limit you to an election period each year when you have to get enrolled. Medigap plans,
49:21they're not changing their benefits on you each year and they require underwriting. So,
49:25you can apply for a metagap plan any old time. You can shop at any time you want. You don't have to
49:30do it in any certain window, but the only time that you're going to get to do it in most cases
49:35is going to be in that original six-month window. Now, sometimes we'll have people that have some
49:41other form of coverage. Maybe they worked for a small employer. So, Medicare A and B have
49:46been in place for a long time and their six-month window is long gone, but they maintained credible
49:50secondary employer insurance. Those people will give it be given a smaller shorter window around
49:5663 days when they can enroll in certain metagap plans, not all of them with no health questions.
50:03So there are some variances here. But the big thing I want to get across is the annual election
50:08period is not a time of year when you can sign up for a metagap plan and get to skip the health
50:12questions. It has nothing to do with metagap at all. Now, the reason is you can't go out and buy
50:19better homeowners insurance after the house is on fire. And the federal government understands this,
50:24and most states understand that, too. And they apply this rule to Medigap so that everybody
50:28doesn't wait to sign up when they get sick. There are a few states, however, that have
50:33state rules where you can apply um year round and you can wait until you get sick and it drives the
50:41rates of those rates just skyhigh. So, the states with exceptions, there are four states that have
50:47year-round open enrollment, meaning you can apply anytime and there's never any health questions.
50:52New York, Massachusetts, Connecticut, and Vermont. The downside to this is those are going to be some
50:56of the most expensive states because if people wait until they get sick to get the coverage,
51:01and they can't underwrite out the sick people, they have to raise the rate on every single person
51:05in the plan every year. And these states will have much higher premiums usually than in other places.
51:11And then in some states there's something like a birthday rule or an anniversary rule which says
51:16if you already have a metagap plan, not Medicare advantage, but metagap and you want to shop that
51:22plan once a year, we will let you shop it within a limited window around your birthday or your
51:27policy anniversary. And during that window, they cannot underwrite you for health questions. So
51:32you can shop it with your broker here at Boomer Benefits once a year and we can help you move to
51:36keep that premium lower. The downside to states with the birthday rule is once they implement a
51:41birthday rule, within one to two years, all the rates in that state go up 30%. So, it's nice that
51:47you'd be able to change, but you're paying more than you would in a state that doesn't have the
51:51birthday rule. And this is confusing stuff, right? We've got all these different election periods and
51:56states that have differences. And that is just another reason you want to work with a very
52:00experienced broker like us who understands all of this and can give you the guidance you need
52:04in not only enrolling in your plan upfront but maintaining it from year to year because metagap
52:10plans have rate increases every year just like auto or homeowners insurance. Healthcare has
52:16insane inflation. So once a year you're going to get a rate increase of probably 10 to 20%.
52:22So when you go the metagap route, you have to ask yourself, can I afford it now at the beginning
52:28quote? And can I still afford it uh if I were to get a rate increase every year from now until
52:33whenever at 15 20% per year? And if you can't, then maybe a Medicare Advantage plan is a more
52:40comfortable option for you. So you can enroll in a Medigap plan directly with the insurance
52:45company or through a broker like us. You would pay exactly whatever quote the carrier has. you pay
52:50the carrier's rate whether you enroll through us or directly with the carrier. The difference is if
52:55you go directly to an insurance company, they're not going to quote you their competitor down the
53:00road that has a better rate for you. And if you get a denial, they're certainly not going to help
53:05you with an appeal because when Medicare denies covering a claim, Medigap doesn't have to pay its
53:11share either. So if Medicare denies paying the 80%, the Medigap plan also does not have to pay
53:18the 20%. Medigap only pays its share when Medicare approves the claim. So if you call them to try to
53:24appeal something, they have no motivation to help you appeal a denial because then they have to pay
53:29out money. They're an insurance company that is in business to make a profit. They don't help
53:33you with part D. You'd have to figure that out on your own. And they're not going to help you with
53:37billing issues when they happen on the back end, what are very, very common. You can enroll in that
53:43same plan through Boomer Benefits and pay the same price. and we're going to show you every carrier
53:47in your area and what they cost. We absolutely have a program to help you with party every year.
53:52When appeals happen, you call our service team. We have a claims team that writes great appeals.
53:56Will help you with all the documentation. And when I train our clients correctly and they remember to
54:03call us when they get a bill in the mail before they pay it, a lot of times you don't actually
54:09owe that bill. It's that somebody miscoded something. There are 70,000 Medicare billing codes
54:15and someone made an error and that's why you got a bill. Our clients call us and my claims team goes
54:20to work on it and you only pay it if we find out you actually owe it. And since October of 2021,
54:26if we added up all the bills that we've saved our clients, we actually I need to update the slide.
54:30We just crossed the $6 million market mark. So it it scares me to think about people out there
54:35who get these bills and probably just pay them thinking they owe them when a lot of times they
54:39don't. And somebody made a coding error. This is why you don't want to ever be on your own with
54:44Medicare. You can work with us and our service is 100% free to you and we'll be on your side
54:48forever. Here's an example where a current client wrote in a review saying boomer benefits sounded
54:55too good to be true. But when we were being build for over $1,000, even after Trella tried calling
55:02the hospital several times to fix it herself, she didn't. But when she called us, we fixed it. And
55:07she says like magic, the bill disappeared. That is the value of a very experienced claims team um
55:14that only a large brokerage like us can provide. I can tell you when I was a small local agent 20
55:19years ago, we did not provide this service. There was no way it this takes 85 full-time people on my
55:25team to provide this service and it is far beyond what you can get from any local broker out broker
55:32out there because we work so hard to build it. So Medicare supplement, you only ask your doctor,
55:37do you accept Medicare? If the doctor says yes, then any metagap plan will work for you in any any
55:43state where you purchase it. Medicare pays first, then the metagap plan pays its share. The plans
55:48are standardized, meaning there's 10 to choose from. They're guaranteed renewable. They can't
55:52drop you for developing a new health condition. And the benefits don't change from year to year
55:57like advantage plans do. So these plans require less homework from you. And then of course,
56:02you're just going to add on that standalone Part D drug plan to be your pharmacy card.
56:08Now, let's talk about the other option. Part C of Medicare is called the Medicare Advantage Program.
56:14Let me turn the space mirror down. It's roasting me right now. It's been cold in Texas the last
56:19couple mornings. So, a Medicare Advantage plan is when an insurance company comes into a local area
56:26and they may contract 2,000 5,000 providers and form a network and all those providers agree to
56:33treat the plan's members at a discounted rate. Does this sound familiar? Well, it is because
56:38you've had HMOs and PPOs your whole working life. And when you enroll in a Medicare Advantage plan,
56:44most advantage plans include a built-in part D drug plan. So, there's no separate premium for
56:50part D. And when you enroll in an advantage plan, Medicare pays the advantage plan buu bucks to take
56:57on you as a client. Now, you are the Medicare Advantage plan's problem. No matter how sick or
57:02healthy you are, you're not Medicare's problem. It's the advantage plan's responsibility to pay
57:07for your health care services. So if they make say 12 to$15,000 per year per person that signs
57:14up for their advantage plan, they have a heavy incentive to compete for your business. And one
57:19of the ways that they do that is by offering really low premiums. So in most urban areas,
57:24you can find advantage plans that have a zero premium. And this means you're not paying anything
57:29beyond what you're already paying for part B. But you must stay in Medicare A and B. You still have
57:35to pay for part B 20290 plus whatever Irma before you can add on an advantage plan. If you enrolled
57:43in an advantage plan and then canceled your part B, the advantage plan would immediately cancel and
57:48now you'd run without outpatient coverage until the next general enrollment period, which is
57:51a disaster that I have seen a number of people make and I do warn about it in the book. Okay.
57:58What I like about webinars like this one is I can get the most important ones out in front of you so
58:03that even if you don't have the means to purchase the book, I can tell you about some of the biggest
58:07ones and you're going to get those here today. So, if you found a zero premium advantage plan,
58:12that's nice because you're not paying for the plan and you're not paying for that separate
58:15part D. And then what you're going to do is access a network. Most advantage plans, not all,
58:20but most advantage are either an HMO or a PO. The HMO plans are by far the most popular. I think I
58:27saw a statistic uh from the Kaiser Family Foundation that seven and 10 beneficiaries
58:32on an advantage plan choose the HMO. And that's because HMOs typically have the lowest premiums,
58:37the lowest doctor co-pays. Uh they have a lot of extras built in. They are usually
58:42more attractive in benefits because they have a little more control over you, right? You're
58:46going to choose a primary care doctor. You need to get a referral to see a specialist. And a lot of
58:51people are used to that from having been in HMOs during their working years. So, we see many many
58:55people choose the Medicare HMOs. The PO plans uh offer a little more flexibility, but if you go
59:03outside the network, number one, you're going to pay much more to see a doctor outside the network,
59:07and you have to ask the doctor outside the network if they're willing to build a plan. So,
59:12for example, the med the Mayo Clinic would say, "Nope, not taking it." So, the PO only works in
59:18flexibility if the provider you see is willing to build a plan. and PO plans are starting to be
59:24phased out. Some of you that mentioned that you're on Medicare and you're here for a refresher,
59:28uh you may know that there was a lot of media coverage that two million people got dropped
59:32from their advantage plan um during the fall of 2025 election period. And most of the plans that
59:39they did away with were PPOs. And that is no fun to be on a plan that's working great for
59:44you and then get a letter from your carrier that the plan is closing and you need to go
59:47find new coverage. That can really be a problem if you have a bunch of specialists already set
59:51up and everything's working on your current plan. Nobody likes that happening. I'm very concerned
59:56um that we are watching the beginning of the end of the PO Medicare Advantage plans um just based
1:00:02on what happened with that so many of those plans exiting. Obviously, HMOs are more profitable for
1:00:08the insurance company because they control what you can do a little bit more. And so I think
1:00:13um we will start to see PPOs either cost more or kind of go away over time. But there's no
1:00:19health questions on an advantage plan. Anyone can enroll in one during a valid election period like
1:00:23your initial enrollment period for Medicare or the annual election period in the fall. And of
1:00:29course they want your business. So not only do they try to offer you a low premium, but they
1:00:33build in these extra things that you can't get um with original Medicare and Medigap. This might be
1:00:41some dental, vision, and hearing coverage. It might be a free gym membership, things like
1:00:45that. They're all going to be a little different. You should never choose your health benefits that
1:00:51are going to treat you for major illnesses based on a dental benefit. But if you found a plan that
1:00:56worked for you and it happened to have some dental benefits built in, of course, that's nice. And I
1:01:00think it's one of the reasons that these plans are so popular. So, um, important to know that that,
1:01:08um, these plans when they have those little extras built in, those are a yearby-year benefit and
1:01:13they can change from year to year. So, you want to make sure to make use of them. If you join a plan,
1:01:17make sure that you use those benefits as they can change from year to year. Now, when you have a
1:01:22plan with a network, there are going to be things like prior authorizations. If you're going in for
1:01:26an expensive surgery, your doctor's going to have to file some paperwork and get it approved ahead
1:01:30of time. And that's just normal with any type of network plan. If you had a denial, you would need
1:01:36to write an appeal. This is another reason why you would want to have an agent so that you could
1:01:40certainly enroll um or you could certainly apply a an appeal. You would apply for an appeal with the
1:01:46carrier and we would help you with the language on that and what documentation to submit. And so
1:01:51with advantage plans, you have the lower premiums, but on the back end, instead of everything being
1:01:56covered like on a plan G, you're going to pay as you go. So, you may have um let's say you
1:02:03called our office and you were working with Tina on my team and you determined that you wanted an
1:02:08advantage plan. She's going to get a list of all the providers that you see and a list of all the
1:02:13medications that you take if you're willing to give that to us. And then we're going to go out
1:02:17and look at all the advantage plans in your area and try to find the plans that have your
1:02:21providers in the network, the drugs you take on the formulary for the built-in part D. And then we
1:02:27want to look for the plan of of course that cost you the lowest out of pocket. And they'll all be
1:02:31a little different, but we go over the summary of benefits with you. And it might say this plan
1:02:36has a zero premium. When you go to the primary care doctor, it's a $10 co-pay. When you see a
1:02:40specialist, it's 30. If you have lab work, it's 50. A lot of times hospital stays will be several
1:02:46hundred. It might be $300 a day or something like 500 for the whole stay. And so there are
1:02:53some back-end expenses for hospital. And then some things they can charge you up to 20%. So of course
1:03:00the things that they charge 20% on are the most expensive things usually dialysis, chemotherapy,
1:03:06radiation, oxygen, and durable medical equipment. Well, 20% of a chemotherapy is going to be a lot
1:03:12of money. So Medicare makes advantage plans have a cap to protect you. This is called your maximum
1:03:18out-ofpocket limit. So every time you're spending money at the doctor, at the lab, at the hospital,
1:03:24at your wherever you're getting treated, they're tallying what you spend. And the maximum that the
1:03:30limit can be in a year is $9,250 in network and $13,900 out of network. Well, listen, for people
1:03:39on a fixed income, that's still a lot of money out of pocket that you could potentially pay in a
1:03:44major health scenario. But these plans all compete with each other. So often we can find a plan with
1:03:53a $6,000 limit, right? So my team is going to be looking for the one that has your doctors in
1:03:58the network, your drugs on the formulary, and the lowest maximum out of pocket that we can find for
1:04:03you because the lower the better. I will also tell you the drug spending on the built-in part D does
1:04:08not count toward this limit. It is additional. So in years where you're really healthy,
1:04:14this zero premium plan may save you a lot of money, but there may be a year where you have a
1:04:19lot of health care going on and you're going to spend more out of pocket because you're paying
1:04:24for services as you go. So it's really important to have a rainy day fund set aside with a little
1:04:30bit of money so that you have some money in a year like that that you can access. Maybe it's
1:04:35money left over in an HSA that you had while you were still working. Maybe it is just an account
1:04:41where you put some money. Maybe you decided, you know, I'm going to do the advantage plan, but I'm
1:04:45going to take the money that I would have spent on the Medigap plan. I'm just going to put it every
1:04:48month into this little bank account. So sometime I need it, it's there. So with an advantage plan,
1:04:54part A is zero. Part B is 20290. Part D is zero if it's included in the plan. Around 97% of advantage
1:05:02plans have a built-in part D. So you can see as opposed to 380 something in our example for
1:05:08Medigap, you've got around 20290 here for Medicare Advantage. That's the basic cost, not including
1:05:17the co-pays that you're going to spend as you go. So there is this potential for a lot of back-end
1:05:22spending. That's why you want to have the rainy day fund. We want to look for a plan with a low
1:05:26out-of-pocket maximum. And how and when you enroll matters. Please promise me if you don't work with
1:05:33Boomer benefits, never enroll in an advantage plan based on a TV commercial. Those commercials are
1:05:39gimmicks. They will advertise plan benefits that you can only get if you had Medicare and Medicaid,
1:05:45meaning you're getting federal or state assistance with the cost of your healthare because your
1:05:49income is so close to the poverty level. So, an ordinary person calls in, they will tell you,
1:05:55"You don't qualify for the benefits that they just advertised, and they will hard sell you on another
1:06:00plan that doesn't have nearly as many benefits as were advertised." I have seen this happen more and
1:06:06more times than I can even count. And now you get enrolled in something and they didn't check to see
1:06:10if your doctor was in the network, one of your drugs isn't covered, and it's costing you $400
1:06:14at the pharmacy. You never want to enroll in that way where you're calling a call center in some
1:06:19company in the Middle East or something and you're talking to a person that you'll never get back to
1:06:26again and they're not going to have your best interest at heart and they're not going to make
1:06:30sure that you get a plan with the things that fit you because you'll never be able to reach them.
1:06:34There's no accountability. So, you need to work with a broker. I also like national plans. I like
1:06:40the big big carriers that offer plans in all 50 states because if you're traveling to Tennessee,
1:06:47but you've got a plan in Texas, I can call the plan in Tennessee when you're traveling there and
1:06:52you're sick and you need to see a doctor and I can ask them for network reciprocity, meaning, hey,
1:06:58uh my clients out of the home network, but they have that same plan in Texas. Can we see a doctor
1:07:03at the in network rate while they're visiting Tennessee? So these national uh the big plans that
1:07:08have um plans in all 50 states, they started to have these national networks and I like that for
1:07:13our clients when they are doing travel. The other thing that we usually find works well for people
1:07:19that go on an advantage plan, people are are nervous to enroll in this cheaper coverage because
1:07:24of the potential for the back-end spending. So, the way that you can shore up the benefits in an
1:07:29advantage plan, you can add on a very inexpensive lumpsum cancer policy that pays you cash benefits
1:07:37so that when you're spending 20% on your advantage plan for radiation or chemotherapy, you have cash
1:07:43money coming into you from this indemnity uh cancer policy that you bought. The other one
1:07:48that we see pay out all the time is a hospital indemnity because you will pay hundreds of dollars
1:07:53potentially out of pocket on an advantage plan. If you have a hospital stay, you can add a small
1:07:59hospital policy that is inexpensive that pays you cash when you're in the hospital. And so that's
1:08:03a way that you can make the benefits a little richer. And even when you do that, you still will
1:08:08spend less over five years than you would with a metagap plan. So which one is the right one? Well,
1:08:15I can only tell you that it's up to you. There are many, many people who will gladly spend more
1:08:21for the freedom of access and not worrying about bills in the mail on the back end. And there are
1:08:26many people who are maybe don't want to pay for a lot of healthcare coverage. Maybe they're healthy
1:08:32or they can't afford to pay for a metagap plan and they're perfectly happy with an advantage plan.
1:08:37And so there's no right or wrong here. About 54% of people enroll in a Medicare advantage plan and
1:08:42then the rest are in either Medicare or Medicare with a metagap plan. At Boomer Benefits, I would
1:08:48say maybe 75% of our clients choose Medigap and the other 25% choose Medicare Advantage. And
1:08:55that's usually because I my team and I, we explain it like this and we're telling you the pros and
1:09:00cons, right? And so I think when we explain all of that, sometimes people do lean a little bit
1:09:06toward the metagap coverage. Keep in mind if you start with metagap and after a few years of rate
1:09:11increases it gets too expensive, it's easy to change over to an advantage plan at the next
1:09:16election period because the advantage plans don't have any health questions and so sometimes people
1:09:20do if the costs get too high for them. So with an advantage plan, it's a private insurance company
1:09:25offering a network in your area. You have lower premiums because you agree to treat with that
1:09:30network. You're going to have co-pays and things on the backends, but the part D is included. Now
1:09:34advantage plans change their benefits every year. They are going to send you an annual notice of
1:09:39change in the mail in September. And if you don't like what's changing, then you have the upcoming
1:09:44annual election period starting on October 15th, which you can change away from that advantage plan
1:09:49to a different advantage plan or back to original Medicare. You could just keep in mind um advantage
1:09:56plans work really differently than metagap plans. So you need to research these carefully, learn the
1:10:01differences, and enroll with a trusted agent so that you don't enroll in something that you don't
1:10:05know how it works. Okay. So, in a moment, guys, we are going to start taking some questions. But
1:10:10before I do that, I want to point you to some resources for yourself. So, there's a menu bar
1:10:16at the top of the boomerbenefits.com website. And if you click on or hover on that blue bar,
1:10:21you will find a section called Medicare resources, which links to a ton of we also
1:10:26work with your doctor office and help you decide which one is right for you, plan N. And uh that is

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