Sage Insurance Advisors LLC, specializes in Medicare plans and represents insurance companies offering Medicare supplements, Medicare Advantage Plans, and Part D prescription drug plans.

Serving Northeast Indiana from 4233 East State Boulevard in Fort Wayne and online at SageInsuranceAdvisors.com.

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>> Well it's that time of the year again we have to start thinking about Medicare and if you want to make any changes and do you understand the changes that already have been made for twenty twenty four seems weird to talk about twenty twenty four already but it is that time of the year and of course as always this time of the year we have Greg McDonald with us who is an expert in insurance and he just knows about everything there is to know about Medicare and about the new changes and about insurance.

>> So if you have questions and I know a lot of you probably do I do give us a call here at (969) 27 twenty and Greg will address your question and give you some answers.

And I will tell you by the way, this is a two part show Greg will be with us tonight live here so you can give us a call and he will be here next Wednesday night same time same place seven 30 on Wednesday.

So if you think about something during this next week, jot it down and call us next week if you don't have the time to do it tonight.

OK, here he is the man Greg MacDonald.

>> That's a big buildup.

You better come through.

I was going to say with that kind of build up wow.

I wish I was as good as what you said.

Well, just pretend for the day there what I can do.

Greg, let's start out really simple and talk about the difference between Medicare and Medicaid and I know that you've mentioned before so frustrating that the names Medicaid and Medicare are so close when they're really quite opposite.

>> Well, keep in mind Medicaid aid rate aid means it's help and this is a state program to help people that have lower incomes provide for health care.

>> Yeah, Medicare is a national program federal and so this is for people that are 65 older or have had disabilities to the point where they are getting Social Security disability payments or I mean if they are getting them early because that's the issue.

>> You know, it doesn't matter how old you are as long as as you're able.

>> I mean if you qualify yeah.

That yeah you can have that at any time.

>> I don't know.

This is kind of a strange question maybe but what percentage of people would you say are on Medicaid or getting some sort of again the word aid ID any idea like as opposed to Medicare.

>> Oh wow is yeah I'm not impossible to measure but and some people have both oh you can have you can have both so people that have lower incomes can have both Medicare or they automatically at 65 will get Medicare.

>> Yes.

OK yes.

And so or they can be on disability.

>> Oh that's true.

I mean for things so you can have they call it's called dual eligibles Medicare Medicaid OK and for dual eligibles you generally are getting some type of assistance both federal and state and with that they have special programs for Medicare Medicaid people.

>> OK, All right.

>> Well we'll forget about percentages but just to know that I just want to just prove that I did know everything you shouldn't have said that you should have said nobody knows.

>> Nobody knows.

It's never been measured.

OK, well that was not a fair question really.

We have so many more things that we want to talk about.

So that's an explanation of what the differences between Medicare and Medicaid.

But tonight we want to really focus on Medicare because it's the time people need to start looking at the changes that have been made her 20 24.

>> We don't get to choose the changes those are chosen for us by the federal government and the insurance companies that they they put forth the plans.

>> They present it to the Centers for Medicare, Medicaid or Medicare Services excuse me and they are approved by that.

But the plans run this all by through Medicare plans are approved and and presented to the public in October and then we have this time period between October 15th and December 7th to choose a plan if you have one.

>> Now this is an opportunity to change to a different plan.

OK, say the dates again this is October 15th or 15th through December 7th which is why Greg is here tonight and next week because we want to give you all the information that we can possibly so that that will help in the decision you have to make here in the next few weeks.

>> OK, we have an example of the new Medicare book which many of you have probably already received in the mail Medicare and you for twenty twenty four .

So Greg, in this book a lot of work has already been done.

>> Like you said, insurance companies come out with their new plans.

>> The federal government decides if they want to make changes and all that has to be done to even publish this book.

>> Correct.

OK, so they put out they kind of summarize things.

Yeah.

And so generally the first part of that book is just talking about Medicare in general and some of the ins and outs of Part B, part A enrollment periods what's covered , what isn't and then there's a section on Medicare Advantage plans and drug plans and they have a quick synopsis of the plan details on that.

But it's just to give you a quick idea of what's out there.

Yeah, I certainly wouldn't make a selection based on what is in that book if you are interested then you need to call either your ship counselor or you call it insurance agent to be able to get more information on what those plans do you think?

>> Are you saying that it's just such a small version of what's really happening?

>> It's just it's just bullet points.

OK, think of it as bullet points, OK?

All right.

And I will say that although it looks like a thick healthy book there again a lot of it may not apply to you at all.

So you can look at the index at the beginning and look up then the part that you want to know about and I'll tell you what page numbers to look on.

>> So some of it and we don't expect everybody to read all about obviously hey, we have a phone call from Gloria.

>> Let's find out what she has to say here.

She says this I'm confused about the differences between supplemental insurance and Medicare Advantage plans could you explain the difference that can be confusing?

>> It can be and with all the commercials that are out there and they're going to be running so you're going to be running solid now and your friends telling you what you should do and you shouldn't do so an easy way of looking at this is Medicare works in conjunction with Medicare supplements.

So when you have a claim it goes directly to Medicare.

Medicare pays the claim it notifies your Medicare supplement insurance and the supplement pays what you normally would have to pay.

Now there's different 10 different supplement plans so how they pay is a little different.

But the idea is they're paying what you normally would have to pay in advance of this.

You can go to any doctor you want because there are no networks you don't have any prior authorizations you need to worry about if your doctor approves this and Medicare does it, you're good to go and you can use it anywhere in the country.

A Medicare Advantage plan is similar to what you had with group insurance or individual insurance before you turn 65.

>> The claims go directly to an insurance company and they pay the claims.

But you are going to have to pay a copay for most services.

So if you go into the hospital you'll pay a daily copay to see a specialist.

You'll see a copy a test copay.

Well, with a supplement you're paying a premium and you're not really paying much on the back end for services with an advantage plan you pay very little premium.

>> It could be zero and a package everything together.

>> So you have medical prescription coverage and extras such as dental vision.

Hearing Medicare supplements does not have drug coverage so you have to have a separate drug plan and when it comes to these extra benefits they don't have those either.

So it's kind of like Medicare supplement you pay now so you're not paying later for medical services advantage plan.

You're not paying anything unless you need something which is better depends on your situation.

>> They both work.

It's what are you most comfortable with?

>> You say what are you most comfortable with?

How do you make that analysis?

How do you decide for you personally what's the best what what parameters?

Well again it rather looks at what are you used to a lot of times it's it's what did your parents have yeah.

What what are you used to most of you know for us particularly in our age group, our parents have Medicare supplements and people with or helping their parents know how they work advantage plans that are a little different now.

They've been out since 2006 and they've been around for a while now.

>> But the the thing to keep in mind is they're both going to work and if you having a lot of medical issues generally I'd suggest a supplement because you have an idea how much you're going to pay on a monthly basis and you don't have to worry about OK, can I get done what it needs to be done?

Am I going to have any programs done?

If you're healthy and you rarely go to the doctor advantage plans were great, OK because you're not charged unless something unless you go from something happens and even if you have some minor things going on, your advantage plan still work well OK, I've had people who who've had the opportunity to move from an advantage plan to a supplement and have some serious health issues and they're happy with the advantage plan.

>> So no, I just want to stay where I am so it really comes down to an individual preference and you can't Greg, because we have this time frame where you can make some changes their enrollment or whatever you can't change your mind midstream.

I mean once you make a decision you're locked into that until next year in October .

>> Yeah.

And that's that's something that when you say locked in some people have are confused about that because I get calls saying once I make a decision I'm I'm done.

No, every year you have an opportunity to change.

Keep in mind that when you turn 65 you can enroll in a Medicare supplement without any health questions.

>> OK, OK.

If you go to a supplement after that I mean changing from one supplement to another the insurance company will ask you health questions and they can say no.

>> OK, OK so if you have a lot of different health problems you may have to stick with a supplement once you originally sign up for one.

>> OK, yeah Medicare Advantage doesn't ask any health questions so it's very easy to move back and forth between them.

>> OK, and keep in mind too that Medicare Advantage has what they call a trial period.

>> Everyone is allowed a twelve month trial, OK?

And so one trial.

>> One one time.

One time OK, so if you had a Medicare separate and you want to try an advantage plan because you've heard all these things about advantage you can try up for up to one year mid-year.an get off of it- >> So let's just say you have a supplement, OK?

It's getting expensive and you sort of try advantage so you can try it.

You start January let's say in May you're going I don't like it.

>> I'm spending money.

>> I don't I don't I don't like the way this works.

You can call you can have go right back to the supplement that you're on.

>> No questions asked.

OK ok. All right OK let's talk about some of the changes then that are in this Medicare book for twenty twenty four .

>> Anything major or just kind of run of the mill the rituals the big changes coming up for this year kind of goes on on the drug it plans OK OK so the the Inflation Reduction Act that was signed a couple of years ago this year we had it had some influence on Medicare and some some significant changes in there.

>> The big one for this year was that they capped insulin prices at thirty five dollars.

>> Yeah, that was a big convert.

That was a big comp and that's through I mean for the the drug plans have a deductible.

The initial phase is coverage gap.

Well they they capped that at thirty five dollars all the way through it.

>> OK so that was a big deal this year.

The big thing is they are eliminating what's called the catastrophic phase now for people who take a lot of drugs and expensive drugs, this was a phase that when you go through the coverage gap there was another phase on top of it and at that point people would be paying five percent of the cost the drug well that's a significant reduction.

But if it's an expensive drug, five percent is still of three thousand dollars or whatever and still significant.

Well, that stage has gone away totally for next year.

>> The effect should be that people are taking expensive drugs should see that they max out between thirty two hundred to thirty five hundred dollars that that's all they should have to pay for the year or the year for the prescriptions.

>> Yeah.

So that's a significant that's that is significantly over.

>> Drugs are so expensive sometimes and you know the prices aren't going down and if it's either this is my perception but if you see them advertised on TV or in magazines or whatever a lot you're also paying for the marketing.

>> Well and there's going to be a repercussion to this because next year when it comes to this they're actually going to cap how much you could spend the year for prescriptions at two thousand dollars.

OK, OK, great for the consumer but the insurance company is saying oh I don't have to pay for this so what's going to happen to prescription drug plans?

Well you can expect premiums going up and I'm seeing it already.

>> So this year in Allen County we have thirty eight drug plans for twenty twenty four .

>> Thirty of them are fifty dollars or more a month and premium.

>> All right.

So you say fifty plans is that what you said?

I said thirty eight thirty eight but thirty of those plans the premiums are going to be fifty dollars and arranging from fifty dollars to over hundred dollars per month.

OK big difference big difference now we have eight plans and kind of went the other way.

>> In fact we have one plan that just decided we're not going to charge anything so it's the first time that's happened.

>> We have a zero premium drug plan but keep in mind if you have a zero premium drug plan, what are the is the company going after it's going after those people that aren't taking any drugs are taking inexpensive generic drugs.

So if you fall in that category it's fantastic.

Right, because you can get a drug plan ,pay for it and have very low cost on your drugs.

>> But if you're having more expensive drugs, that plan isn't going to work so much because you end up spending more than what you could for a higher priced plan.

>> Wow.

So thirty eight plans.

How do you begin to decide which one is right for you?

>> Well we have calculators and so what agents do is we go in and we will put in all your prescription drugs and it will run how each company tears the drug and it tears what their pricing structure is.

>> What weight here do they cover the drug at all?

>> Some companies don't cover all the drugs and it could be a different tier and a different company.

>> Absolutely.

Which for example that's the prime example a client that I worked with today, Guardians, which is a diabetic drug and it's a fairly expensive drug I see that advertised.

Yeah.

So one of the companies decided to tear it as a Tier six which is a specialty tier but they're really putting it a generic price so it's acting as a loss leader to get people into their plan.

>> I see.

So these are these are some of the things that make it very difficult for the average consumer to determine OK, I see a plan that's cost zero.

That's that's a good way to go.

Not necessarily the plan that maybe a hundred dollars a month may be less expensive overall for you because of how it treats your drug.

So you have to be aware boy, how do you how can you decide some of those whether or not there's a generic or not?

>> Will the insurance company tell you or do you need to call like Jardins or whatever?

>> No medication.

Those are things the agents can help with because we see what is there a generic alternative OK to it and so then you have the option of OK, we can do this or not with the pharmacy be able to give you that information also.

OK, so you could ask I mean if you if you get charged a lot for a particular prescription you can ask is there a generic again asking your insurance agent or at the pharmacy or the company in another thing just as we're talking about drug plans to be aware of the prices are different at different pharmacies because the drug plans have networks who so they have preferred pharmacies, they have standard pharmacies and they have pharmacies out of network.

So for example, I'll take one silver script is the largest drug plan company in the country.

Silver script.

Silver script OK standalone drug plan.

>> That company is owned by CVS also it's going to be so if you take that plan to Walgreens it's not going to work so you just have to be aware of OK, what plans work with pharmacies you may want to work with?

>> How can I get that information?

>> You'll have to check with the plans themselves.

OK, who's it or you can check with the pharmacy but yeah yeah OK we have another question this time it's from Ava Aiba.

>> Thank you for watching us tonight here on LIFE Ahead she said Is there anything I can do to prepare for Medicare in my years leading up to the age of sixty five?

>> That really good question Ava and I imagine a lot of you watching her in that same situation right in the in the idea at this point Ava is to look into what Medicare looks like, how it operates and then look at the plans themselves.

What's the difference between a Medicare supplement, a Medicare Advantage plan?

What's my costs going to be on each one of those programs and you can get some preliminary information to give an idea what it's going to cost you if you work for an employer and you have a group health plan and you're going to continue to work, it may be a situation where you don't have to worry about Medicare at all as long as you're on a group health plan and your company has twenty more employees then you don't have to worry about it.

You can work as long as you want without Medicare and then when you transition off into retirement then you can call Social Security and only Medicare and start at that point.

>> OK, all right OK.

I hope that's helped you out.

And again as we go through the next several minutes you have an opportunity to call Greg here with your questions or next Wednesday night again at seven thirty I have another question.

Yeah, OK, let's talk about the DAP everybody talks about the Medicare gap.

>> What is it and how do you get around OK so Medicare came up with this grid and it's been like forever right?

I tell you I like my favorite line on this one is I think a bunch of actuaries went out on the town and came up.

>> But anyway, what I remember is some plans have deductibles.

Some don't when they might have a deductible for brand names add up and no deductibles for generics.

So it's just it just depends on the plan.

>> The deductible standard deductible for twenty four is five hundred and forty five dollars and at that point you start paying co-pays for your prescriptions but you might let's say you have a generic and it's costing zero.

>> Yeah but there's still a cost to that drug right.

>> Or you have a brand name drug and you're paying forty five dollars for it but the actual cost for the drug is three hundred that 300 the actual cost is adding up every time you buy it right OK and once the aggregate retail cost next year reaches five thousand thirty five dollars then you go into what they call the coverage gap or donut hole.

>> Now that's a misnomer now because there's no catastrophic phase.

So once you go in there you're kind of you're then your transition from regular copay let's say it's forty five dollars for brand name drugs now you're going to pay twenty five percent of the actual cost of the drug.

>> Well that may be a little less than you're paying but more likely it's going to be more so and so you pay that twenty five percent until you reach what they call the true out-of-pocket costs which next year is going to be eight thousand dollars and that's the formula for that is the full cost of the drugs and the coverage gap plus what you paid before you got in the coverage gap and I've had told us eight thousand dollars then at that point you max out it's way too confusing.

>> It's crazy.

It's really hard.

That's why you need somebody to help explain like we're asking Greg to do Greg, I want to talk about the coverage gap again next week, you know, because a lot of people do want to know that we only have a couple of minutes here left on the show tonight.

What best advice can you give people as they're heading toward this October 15th decision time get if you're on a plan and you take prescriptions, review them.

I've had people come in and we're looking at plans that they had this year.

Yeah, And if they keep it compared to plans they could have their spending five hundred a thousand dollars more because of formulary changes within the plan.

So please review your drugs with your agent to see if it's still a good fit because there's some you know if you're not yeah.

You get surprised now advantage plans have an open enrollment period after the first year they'd have the first three months.

>> So if you need to make a change you can OK but if you're on a drug plan you don't have that option so you want to make sure that you make any changes necessary before December 7th.

>> So you're good for the following year.

So complicated and can change every year.

>> It is it can change every year.

But one thing well let's talk about next week, OK?

There is a couple significant changes with two of the advantage plan companies.

>> All right.

So that's a teaser for next week if if you want to find out what are some of the changes that are coming up in a couple of major ones and if it's your company yeah.

Yeah.

So tune in next week and we'll talk about it.

OK, and again our questions next week can be about Medicare, about you know how this affects your drug coverage and about any of the new changes that we have in store for us here on twenty twenty for meanwhile, Greg MacDonald, always appreciate you coming to share your insights with us every year at this time.

>> Thank you, Greg.

And you did live up to my expectations.

It's all good for the rest of you do have a good night.

>> Stay safe and stay healthy and we'll see you right here next Wednesday night at seven thirty.

Good night Sage Insurance Advisors LLC, specializes in Medicare plans and represents insurance companies offering Medicare supplements, Medicare Advantage Plans, and Part D prescription drug plans.

Serving Northeast Indiana from 4233 East State Boulevard in Fort Wayne and online at SageInsuranceAdvisors.com.