Maximizing Your Medicare: Essential Tips for Open Enrollment 2024 with Expert Emily Gang

Welcome to another edition of the what's Next Retirement Podcast with Craig Weir. Life is full of transitions that have a financial impact now and in your future. When finances are affected, there are always questions to ask and choices to make. As an independent certified financial planner for well over 30 years, Craig has helped Americans make decisions that give them their best financial futures. The experiences with so many clients has given him a unique perspective to help with with what's next for you as you navigate the unknowns of your own life. What's next? Answers to the retirement issues on your mind.

Hey everybody, it's Craig Weir. Welcome back to podcast. We got another exciting episode. I hope at least exciting we'll have some good information. Anyway, I know that the guest I have is always exciting to talk to, so you'll have to pardon the host for me being a little bit boring, but Emily will elevate all ships, so to speak. So this is another episode of what's Next in Retirement. And today we're going to really focus on the open enrollment period for Medicare that's going on right now. And that's Emily's specialty. She is a pro in that. And you know, there's this window every year that you're already in Medicare and have a supplement. You understand that you got this window that you got to decide, am I sticking with the horse I started on or am I switching horses? We're going to talk about that. So that's why, that's why it's important right now. But for those of you that are kind of listening to this, after December 7th, it's still germane information. It's still going to be really valuable to you to kind of understand, gosh, what are my choices and what's going to happen when this comes up again and what do I need to do, who do I need to talk to, all those kinds of things. So as a disclaimer that I always like to put out there just so that people understand where we're coming from is this if this happens to be one of your first podcasts of ours that you're listening to? We're Q3 advisors. We only do tax consulting and financial planning work. We don't sell any insurance products or any medical supplement products. We don't manage clients money. I'm here to try to help you get the right questions answered and to direct you to people that I believe can help you with those. So Emily Gang is officially the Medicare coach all over the Internet. So welcome back to the show, Emily. Appreciate you being.

Thanks for having me. Yeah, Me, Craig.

Yeah. So you're. You're kind of busy right now, right? You're.

It is. It is busy. Yeah. Which is fun. It's always fun to kind of reconnect with clients because we get them set up when they first join Medicare, which is kind of the most important time because of how Medicare's guarantee issuance rules work. We can't just switch everything every year.

Yeah.

But during this time, we can change their Part D as well as their Medicare Advantage plans.

Yeah. So that's kind of where we want to go is what, what do. What do people need to know right now? Let's kind of make this kind of an update on what's going on in the supplement world for 2024 open enrollment. It probably changes every single year, but what are some of the things that you are seeing right now?

Yeah. So if you've already heard other podcasts, we have a process to help people make a decision whether, which paths they go down for Medicare. But most of our clients go down the original Medicare route because they want to see more for. For doctors. They want to pay a slightly higher premium for lower overall costs. All those things. Right. And so most of our clients right now, we're reviewing their Medicare Part D drug coverage. And so, you know, there's some pretty big changes happening to these plans in 2025. The one that's getting kind of the most attention is getting rid of what's called the donut hole. And it's really just a change in copay. But. But the reality is, like, I keep getting asked about the. About the donut hole going away. That's really the biggest impact, to be honest. What the biggest impact is that we're seeing is this $2,000 cap on medication co pays. And so we're seeing a lot of changes. I think as of this morning, over 60% of our clients are changing Part D plans, and the average savings is $2,100. And so it's a lot of money. Right. It's a lot of people changing plans. So.

So hold on just a minute. Let me make sure that everybody understands what you just said. Yeah. For the guy who's sitting there and, oh, I got a Medicare plan. It's good. It's going to renew, whatever. What you're saying is that 60% of your clients are changing horses and they're saving on average, 2,100 bucks.

Yes.

Right. So, Mr. And Mrs. Jones, listening in on this. If. If you're not evaluating your options, you're leaving money on the table. Okay. I just want to make sure people got that. Let me also say this. I. I neglected to disclose on the front end of this. Also, Emily and I have a different relationship other than she's just a guest on the podcast. Right. So several months ago, I connected with Emily. I saw one of her social media ads, and like many of you may have seen, we'll see hopefully in the future of hers, I clicked the button, I had the console, and I ultimately, my wife and I hired Emily and her team to come in and just say, okay, based on your health, based on the things that are important to you, based on around your healthcare and your doctor accessibility, the zip code you live in, all those kinds of things. You tell me, Emily, what plans should I get? And give me a list of the companies that are the best for me to go with. And we did that. We are. We were just thrilled with the service, excited about what's there. And as I understand it, Emily, next year about this time, you're going to be knocking on my email saying, hey, Craig, we need to talk.

Exactly.

Yeah. So Emily is not just a guest, she's somebody. I've been through this process, and that's why I have guests like her on. On this is I want you guys to be able to be connected to people that I know that I trust. I know they're going to give you a good deal. So. All right, so go ahead then. I just wanted people to understand we got a different relationship.

Yeah, yeah. No, I appreciate that.

Yeah.

And so. And again, you're. You don't take a ton of medication, so. So yours a little bit different, but we've even seen people with no meds changing. Like, there's states like New York and California where the lowest. So first off, Medicare has a rule that everyone must have a creditable prescription drug plan or they'll be penalized. And so, like, we all have to, like, kind of play in this game. And in the past, a lot of states had a premium plan as, as high as $3. Right. So it'd be a really cheap plan to just check that government box. But in places like New York and California, that cheapest plan is now like $30 or more. And so now they're ticking. Right? Because. And then I'm also like, why are. Why are New York and California getting, like, what's going on in those two states is driving. Because everywhere else, we can get $0, $3, $5 plans. And so it makes it a little bit interesting, too. We're playing with the dynamics of the premiums but also meeting the Medicare rules and what, what are the trade offs? And so we're saying I don't care if you take no medications or 25 medications. We're seeing changes across the board. We're seeing some people like Silverscript, like really increase their. With this two grand cap, it's hard for a lot of people to justify being in that plan. So my point is like there's a lot of chat about Medicare prescription drug coverage. The chat seems around the donut hole. But the big thing really is a 2000 cap. You know, it's interesting though because every year we always hear the rules and then you get to like see the practicality of it. And while the 2000 cap sounds great, we're seeing that more medications are either one, having higher co pays to probably make up for that capacity or two are just not covered at all. And so we're doing a lot more combinations of using a Medicare Part D drug plan with, with coupons, whether it be GoodRx single care cost plus. And so we're really trying to play the game of what's that best combination when people have higher medication costs. And it can make a big, it can make a big difference at a client today who just saved a thousand dollars by us using coupons and switching overall plans. And so it's a fun game that we get to play right. Play right now and mainly around, around part D. Yeah.

So the $2,000 cap is a cap that insurance companies are putting on the amount that they're going to pay out for prescription meds.

The government had said that you, Craig, will not pay more than $2,000 in medication co pays during a calendar year of approved medications. So we still have to have it as approved medication. Like if it's not on the formulary, it doesn't count towards your two grand. But if it's an approved medication, there's a $2,000 co pay cap for your medications.

So what are you seeing in premiums in terms of renewals? What do you see generally happening with premiums for folks everywhere?

They're up, they're down, they're everywhere. There's no common theme.

Okay.

Yeah.

And we just had the cost of living adjustment announced for Social Security. So have they announced the Medicare Part B increase?

So as we are filming this on what day is today? November 5th. We have not received the part B premium. So today's election day. We don't have part B premiums or the, the irmaa, the high income penalty thresholds either. I am guessing that they're going to go up a bit more than what people probably want to see. And I'll be curious to see where it ends up. But I'd guess in the next few days or weeks we'll be seeing that number, that number released.

So you're not expecting just a casual inflation number. You're expecting some sort of a big.

Bump based on the timing of this. Because COLA and Medicare used to be more closely announced and it's not this year.

I see.

Makes me think that something might be happening in the background. That's just my speculation, but I think that there could be reasons why they're holding off on announcing it.

We just need to keep an eye out on it. Yeah, just keep an eye out, watch for it, see what's going on. So you know, what else, Is there anything else out there that we need to know about before we just kind of surrender to? I'll just keep my plan and put my head in the sand.

I think Medicare Advantage is another big one. You know, people, our clients on Medicare Advantage are seeing changes in most cases. I have a client who is at MD Anderson in Houston and his Medicare Advantage plan is being dropped mid year by MD Anderson, which is not great. So he has a bit of a unique case. So we'll have some options in a little bit. But I think that we're, we're just seeing a lot of doctors changing the plans that they're accepting. When it comes to Medicare Advantage. We're also seeing again, and it's not abnormal, but we're seeing a lot of people like our clients who were enrolling in a part D plan with XYZ Company and then XYZ company calls them back to, to sell them over to Medicare Advantage. And so I think it's just important that we're all aware of the pros and the cons of Medicare Advantage and at least make an informed decision. Because once you leave your Medicare supplement in most states and go to Advantage, you're not guaranteed to reverse it. And so it's, it's important to be thoughtful about long term implications of going to Medicare Advantage as well.

Yeah, I was talking to my mother a couple weeks ago and she just kind of threw in to the conversation that she just recently switched to a Medicare Advantage plan. So she's in Oklahoma, she has horrible health. She'll get pneumonia a couple times a year. She's had 22 major surgeries, her back is a mess, she's pris all through her. I was like, mom, we could have at least talked about this. Right. Because if, for anything my understanding is that if that Advantage plan decides they're no longer going to do business where she lives now she probably is going to have to health qualify to go back into some other plan. Is that a true statement or not?

You can easily go between different Medicare Advantage plans but in order to go back into the supplement the Medigap plan, the plan G, the high deductible G, the N are kind of the most.

Common ones like what we're in, those.

Are in require medical underwriting. So so I, I talked to a woman today who is a family friend of ours and she's like but I'd really like to have dental and vision and I just for, for us I'd say I love, I would never let my parents be on Medicare Advantage for what they want just cause I think that the, the networks can be hard for some people. Luckily my parents can afford a premium so like we're fortunate in that way. And, and even that free dental and that free gym and that free hearing doesn't make up for that substantially higher maximum out costs that you get on Advantage versus regular Medicare with any, with any type of supplement plan. And so I think but, but Craig, it sounds great right? Like they, they do a great job selling it. They're, they know how to market it. And I think it is the right thing for some people but, but not for most. I'll just say that.

Yeah. And, and we have, we have clients that they have their Advantage plan and they love it but they also evaluated were they really going to use the benefits. Is it really worth the premium to them? So I don't want listener to, I don't, I don't want hate mail coming in that we're against Advantage plans. What Emily's really saying and what I'm saying is really evaluate whether the benefits are worth is the juice worth the squeeze too?

And for, and for some people it's the right decision. Absolutely.

Sure.

But it's that's we have our process right. Which I mentioned earlier. There's a process to figure out which one's the right but which plan's the right best. Which plan is best for you. And it's not usually just around free gym, free dental, free meal, free ride, $0 premium.

And you know I was, I was very, I had somebody ask me why, why would you, why would you hire a consultant to come in and to evaluate this stuff? I mean all the information's available. Well sure it's available but a. It's my first Rodeo B, do I want to spend all that time? And C, even if I spend all the time, will I know that I got it right versus somebody like you and your team? I mean, this is all you do. And we were able to very quickly come to this. You were able to very quickly come to a conclusion of what was really going to be best for Pam and I to make work. Well, is there anything else that we need to know before we move on to kind of action steps? Is there any other big things that you know about what's going on right now?

I think the other thing next year, one of the big changes with Medicare is that telehealth is going to not really be approved for most services. That's kind of a change that people are not loving.

Wow.

But other than that, services are pretty similar between 2024 and 2025 when it comes to Medicare supplement, also called Medigap. Again, we're not guaranteed to change those every year. And so people don't usually change that once they're already on Medicare. They're kind of going to be in that, that plan for a while, unless you have a, you're in a state with unique rules. I think overall supplement plans for at least the companies who we recommend have had a pretty stable increase. It has been higher in the last two years and say in the last five or 10 years. I think Covid is kind of one of those main drivers of increased premiums, but nothing crazy for the, for those companies. I know we have some concerns about some Cigna sold their supplement business and we have some concerns about how their customer service is going. But overall, you said Cigna supplement plans are pretty normal overall just because of how they're, how they work. Right. They have to work alongside Medicare Part A and B. And so they don't have the, they don't have the free will or the options, the impact they have on say a part D or even a Medicare Advantage plan. They're along for the rides. Medigap plans are along for the ride with Medicare Part A and B. So those are kind of the big things.

So sitting here today on election day, as we record this, we've got basically a month. What are some what would you recommend or some action steps for somebody listening to this before December 7th of 2024, what are a few things that if they're sitting here and they just are like, well, gee, I hadn't even thought about making changes. Give them two or three bullet points. What are the things they can do with this? What would you suggest that they do. If they were your sister, your brother, your aunt, your uncle, what would you tell them to do?

So first off, if you're not on Medicare, this does not apply to you at all. So people will be nervous and they'll say, I see this deadline, I'm going to be on Medicare next year. What do I do? This is not for you. This is only for people who are currently on Medicare. And so I would say whether you're on part D, if you're on part D, go through your current plan, what's the premium going to be next year? What are your co pays and really calculate that cost. Medicare.gov has a tool that you can use to have some insights. It's not always accurate, but it's a good, at least like kind of litmus test as to what's happening. But look to see, like what's your plan going to be next year? Is your pharmacy in network or out of network? Those are big changes that can impact what you pay for your medication costs. And by looking for those things, you can find a better plan for the upcoming year. Now, if you're on Medicare Advantage, look at all of it. I want you. I'm seeing a lot of doctors changes in terms of networks. I'm seeing premium changes, copay changes, out of pocket changes. Just look to see at the overall changes. The big thing we're looking at again is doctors, total costs, medications out of pockets, premiums, things like that. And to make sure they're not gonna be any big surprises next year. So definitely review it. Advantage, you can review again at the beginning of the year. So, so the real hard deadline is, is part D. But I think it's just good to just do all the reviews now and so you don't have to worry about it in, in, in the new year.

You know, one of the things that you coached me through too was that different providers come and go into different areas. And so one of the things that you strongly recommended to Pam and I was let's pick somebody that has shown it has demonstrated a to the market that we live in so that they don't just rush in. You and I were talking before we started this. There's a company that came in and they started undercutting all kinds of prices to get market share. And now, now they're jacking prices way up, pulling out the different markets and stuff. So that's maybe another thing I'd add in is find out from somebody like Emily, is the company I have, are they really, are they really one of the big carriers in the area that I'm in, or because if they're not, then there is a risk that at some point you're going to be kind of less holding the bag on, on making a change anyway or accepting a huge change to the coverage that you have. Yep.

Yeah. And it's. I guess it goes to that point, Greg, it's so important to get Medicare right the first time. I think what I see is that people are like, I'm healthy. I've picked my health insurance my whole life. It's been great. I'm good. And, and those people don't fully understand all the implications. And, and they come back to me a year later, two years later, five years later, whatever it is, and they're like, will you fix this? And I'm like, I can't fix it right there. That, that ship is sailed. It's like it just goes back to, there are tweaks that we can make, but the. Some of the big changes are such around Medigap plans, they can't be changed later. And so it's important in most states, it cannot be changed later. And so it's important to be very thoughtful when you first join Medicare so that you have that right plan to protect your retirement savings. Because I've seen costly mistakes being made.

Well, as I've said a few times, my wife and I are a huge fan of what you do and appreciate the work that you did for us and what we're going to continue to do over years to come. And for those of you listening in or watching the podcast, we've got another podcast that is actually the meeting that Emily and I had where she went through her discovery and recommendations of what we needed to do in our own Medicare. So if it's something you'd like to kind of listen into that conversation to see why would somebody really fit in and add value to you, then that'd be a great one. And even if it's not so much that you make the decision to connect with Emily, you'll learn something from that. The question she asked us like today, the insights that she brings to it, I think is valuable for you. And if 60% of her clients are making a change and they're saving an average of 2,100, seems to me that's probably a really good thing to do. And so in the show notes, we'll put a link to where you connect with Emily. You can get with one of her team mates and they can help you figure out what's a good best step best next step for you. So make sure you check out the show notes and you know the call is free. If you're seriously want to determine whether or not you're in the best plan or there's a better plan for you, that's what they do is they help you with that and they can explain how their consulting service works and all that kind of stuff. We try to get into all that stuff today. But seriously, check out the show notes. Go listen to the other podcasts. I think, I think I get into some of the pricing stuff that you got out there, but it's very reasonable for the work that you guys put into it. Any final comments before we wrap this one up?

I always say Medicare can be great if you know how the rules work and you do what's right for you. So be thoughtful and take, take care of your Medicare decision.

Sounds great. So that's what's next for retirement, right? You gotta, you gotta think about this information the very first time you sign up for Medicare months in advance and then every year make a decision, evaluate like what she just said, make sure that you get what's best for you. All right, so another exciting episode. A lot of great information. Emily, thanks again for joining me and for just dispelling all this wisdom from the ages on us for Medicare.

All right, thanks for having me, Craig.

Take care, guys.

Investment advisory services offered through Q3 Advisors. This presentation is for educational and informational purposes only and is not intended to be individualized financial, tax or investment advice.