it's like I had died.

>> That's our show right here on PBS Fort Wayne every Wednesday night at seven thirty.

I love the show and remember the title is LIFE Ahead because what we do here is try to give you information and education to help you with choices and decisions that you have to make in your LIFE Ahead.

>> Thus the name of the show well tonight is no exception.

It's that time of the year again when we have to start thinking about Medicare.

>> Are there changes?

Well, we'll find out what's going to happen here in twenty twenty three and we're even going to discuss some new legislative changes that might interest you as well.

>> And should you consider getting an advantage plan or a supplement?

A lot of things to talk about and our guest this evening is with us every year for a couple of times no exception this year.

>> Please meet Greg McDonald.

He's no stranger to us here on Life who wrote like the had you've been doing this several years now with me I was trying to think how many years it's been it must be approaching ten at this point.

>> It really yeah it's been a while.

Oh man.

But the years are shorter every time they do it's a couple of months ago when I sat down and talked about this when Greg walked into the station this evening it's like oh there you are.

>> Didn't I just see you?

Yeah, that's right.

Well I will tell you that Greg is just full of knowledge he has how many years of experience now in the insurance business?

>> Twenty twenty one is when I started over twenty years.

>> Oh wow.

Over twenty years so twenty excuse me 2001 I'm more than more than a year 2001 2001.

>> OK so what that means is you have the opportunity to ask the expert in the field of insurance some questions and that's what we do here on life Head you can call us we have phone service in the control room.

>> They will answer your phone calls and if you would like to talk on the air with us, that's great.

And if Greg has any questions back right there on the phone, if you're not comfortable doing that, our phone screener will take your question, type it up and send it out here to the studio for me here on the teleprompter and I'll ask you, Greg OK, number is (969) 27 twenty .

>> Please give us a call here in the next half hour.

But I want to just get started here Greg Medicare and you twenty twenty three it seems like I just got the twenty twenty two .

>> The first thing that we want to talk about if there are significant changes that might affect everybody that's watching this evening.

>> Greg, I know there are some new legislation.

Let's discuss that.

Well, to answer your first question OK, no big changes, no big chance.

So so is if you have a Medicare Advantage plan or a supplement, there is no huge changes going on.

>> In fact, in most plans there's you know, most companies even your company OK, most companies there haven't been any dramatic changes now there have been some and you need to to look at these options.

>> But in general if you have a plan if you're doing advantage plan particularly and you have a plan and you like it generally you're going to be fine with it for this upcoming year.

>> The only reason it would be different is if your prescriptions have changed or the company's formulary has changed and in that case yeah, you might need to make a switch but in general you're probably good when you're say if the company's formula has changed you mean like drugs are classified into different categories or is that what they call them?

>> Well, every every drug plan or advantage plan has what they call a formulary which is the formulary of Larry, which is a list of drugs that they cover and each plan is required to cover at least two drugs for every major health condition.

>> OK, OK.

But those those drugs can change.

>> They can add if I had a drug drop a drug they can change the tiering of a drug which is the pricing structure every year.

>> So it's worth looking at.

>> It is I get that I mean that happened to me once up a particular prescription that I've been on for years move to a different tier.

>> Right.

And was like four times more expensive and fortunately we discovered that after the first delivery.

>> So then the doctor just rewrote the same thing only in the tier one category and doubled the amount or something like that to help me help me out.

>> So those kind of things you should look at?

Well, absolutely.

In fact it's interesting because at times they might have a drug that's a combination drug like two drugs in one pill and they will tier that far more expensive than if you just took the two drugs separately.

>> Exactly that thing.

Yeah, So those are the things you'd have to look at.

>> Yeah.

And doctors generally tend to try to help you out the best that they can.

>> OK Medicare Ammu twenty twenty three and the first important things are usually right here on the first couple of pages in fact the first says what's new and important let's talk about covid updates.

That's obviously been a big topic here in the last couple of years.

>> What kind of things are covered by covid?

How long will they be?

>> What do we need to know?

Well, vaccines are covered .

Yes, OK, vaccines and booster's are now covered .

>> In fact one of the changes that has occurred here in in fact in recent legislation is on vaccines.

>> If the vaccine is recommended by ASEP now try to remember what ASEP is.

But anyway, it's it's the federal bureau go with that look at immunizations whether if it's a recommend did vaccine there's no charge for any of the plans going forward.

>> For example, shingles shingles is always been a prescription that people have to had paid for in twenty twenty three that will there'll be no copay for a single shot Exel and it's really a must do it is definitely a must do as I'm looking here in the book about covid it's as Medicare covers several test items and services related to cope .

>> So if you're getting additional special treatment or something that would be covered , well sure it's going to be it's covered those vaccinations are no charge any medical services are going to follow whatever the copay structures are gone with that plan.

>> OK and I think this is kind of interesting coverage could change when the public health emergency ends.

>> Well, we're not quite sure when that's going to be knows when that is exactly.

Exactly.

OK, that's you know the main thing about Koban right now to it to be comfortable to know that you can go get your vaccines, you can go get your boosters and those will be covered .

>> Yeah, OK, what about timing to sign up for Medicare?

>> What's important about that and when should one do that?

>> Right.

So we're coming up on October 15th which is the beginning of annual enrollment period and then it goes through December 7th.

OK, so that's when the any type of plan if it's an advantage plan or prescription plan, this is the time to enroll.

OK, OK now for advantage plans only there is a little bit of a backup if you want to call it enrollment period that starts from January one and goes to the end of March that if you're on an advantage plan and for some reason it isn't working for you and you don't like it and you want to get out of it, you can you can go to a different advantage plan or you can disenroll from that advantage plan pick up a drug plan and go on original Medicare or go on a Medicare supplement.

Yeah, So you have that option now if you have a prescription plan you can't change during that period.

>> It's only during the a.m. this is for advantage plans only right now.

>> I'm going to back up just a little bit, Greg.

There may be some people that are not familiar with advantage plans or supplements and in it it can be a very confusing thing.

>> What's the difference in how do you decide if you're going to get something in addition to Medicare?

>> How do you decide which should be?

That's a big question.

It is it is particularly when you first start out what's going to be the platform that you go to because there's really you can look at it there's two different paths you can go down if you want to remain on original Medicare.

>> The down side with it is there's no cost containment with it.

In other words, you have deductibles and co-pays with the original Medicare but there's no out-of-pocket max, for example.

>> That's where Medicare supplement comes in and it will fill in the gaps.

>> A lot of people called Medigap.

They'll fill in the gaps of original Medicare.

You pay for that type of of a plan but it's nice in the sense that you pay a premium and you have you don't have much copayments or payments at all on the back end of it for example, the most popular Medicare supplement plan is Plan G g g. >> I never hear anybody G is angry that or make it easier for you to remember Reagan Greg it makes it simple to remember so if you have a plan gee you're only responsible for the part B deductible that was two hundred and thirty three dollars this year.

It's actually going down next year it's going two hundred and twenty six dollars good.

>> Once that's paid you really are good you can go anywhere you want as long as the doctor provider accepts Medicare it's good anywhere in the country.

The downside of it is you do have a premium and you do have to have a separate drug plan because supplements do not cover prescription drugs.

Now the alternative path our Medicare Advantage plans that is a plan that is administered by an insurance company claims go to that insurance company instead of going to Medicare and it's administered much like a group health plan, an individual health plan that you might have prior to Medicare.

>> The difference is you really don't have deductibles in these plans.

You're just having co-pays for services rendered advantages here as you have very low premiums.

Prescriptions are included in most of the plans and they have some ancillary benefits that Medicare doesn't cover such as a preventative dental vision hearing most of these plans have gym memberships so there's added bonuses to it to some of them and right now advantage plans they predict nationwide 50 percent of the population on Medicare will be on advantage plan into this year.

>> Yeah, that's pretty interesting.

>> That percentage is actually higher in our area.

Oh, why do you think that is there we get sick a lot more in the Midwest.

>> Yeah, I think it's because we're more educated about I think so I think we are we look at the plan benefits.

>> Yeah.

And we're kind of an area that we like just to pay for what we need and that's kind of what an advantage plan is.

>> Right is commercial says you pay for what you need with an advantage plan with the supplement you're paying up front so you don't have much payment on the back end.

>> Got it.

Well, we have a phone call already as I knew we would everybody loves and Greg's on and has an insurance question.

Jody called in and she said Are there any new changes in the affordability of certain drugs with Medicare this year?

>> How would you answer that, Greg, when it comes to insulin ,insulin, insulin, diabetic insulin next year the top amount that that you can pay for insulin is thirty five dollars if your plan covers that particular insulin now plans are not required to cover every product and I find when it comes to insulin there's tends to be two Bajour types.

>> There's no Vilborg and Humalog.

Those are medications.

>> Those are insulin.

So two different ones by two different companies.

OK, most companies don't cover both they'll cover one or the other.

>> So and I've seen companies cover one one year and then move to the other the next.

>> OK so you need to pay attention to aware of that OK but the nice thing is that if it's on the formulary for insulin it's only thirty five dollars now for other drugs Jody it just depends.

I mean companies can do what they want with a prescription how they can tear it and price it.

However however they want to and so it just depends on the drug and how popular it is and if that company thinks that they can get some inroads by using that as a loss leader, would they have that sort of information on on websites for that and for your insurance company or not?

>> A list of drugs and the tears and everything.

>> Every company will have a formulary list for every plan and just because it's a company for example, let's just say it's United Health Care because there's the they're the largest it may cover it drug with one plan and not in another.

So I think you can't just say that one company cover something.

>> You have to look at each specific plan.

How many plans would each like say United Health or or Anthem Blue Cross like how many different plans might they have ?

>> Is that unlimited?

Oh they can have when it comes to advantage plans they can have several many of these companies four or five yeah.

>> Or six advantage plans usually the number of prescription plans they're limited three so they'll have two or three prescription plans but advantage plans they can have several am I correct in the booklet that you get in the mail toward the end of the year with your from your insurance company that you have an advantage plan with and I haven't gotten mine yet but should be coming hopefully any day doesn't then have a list of the drugs that each of those plans.

>> No what are you going to how do I know that did I go to the website you'll have to go to the website or ask for a formulary because companies will provide you a formula.

What Sandy's referring to is the annual notice of change that's yeah.

>> Which is sent out in September if you have an advantage plan so I'm sorry I do not know.

>> Yeah but yeah she should have received that OK but that lists all the changes from what you had this year.

>> What's going into next year but it doesn't necessarily have the formulary in it so you either have to go to the website or request it.

>> Well I'll have to say that I endorse what you're talking about Greg because things can can change and I made a change in my plan now that I stayed with the same company but I changed to a different plan one year because just there were different different medications or different lifestyle changes and I found out I was paying a lot of money for things I didn't even need anymore.

So I changed to a different plan.

>> So it was worth reading that booklet and finding out what worked for me or what didn't work for me.

Right.

I bet you helped Jody a lot there with that answer.

OK, let's talk about legislation Inflation Reduction Act.

Is that the correct term?

>> I'm wrong.

No you're not wrong.

That's all it is called the inflation reduction OK in that had some good things and it actually Jody this this pertains to your question as well.

It does legislate on prescription drug cost maximums moving forward not so much for twenty twenty three but in twenty twenty four it effectively legislates out the catastrophic phase of the drug plans.

>> Now just as a reminder most drug plans have a deductible and then they go into it and they call the initial phase which you're paying a copay for a price but they're actually adding up the full retail price of it and in twenty twenty three when that retail price exceeds four thousand six hundred and sixty dollars, you go into what they call the coverage gap or a donut hole the donut hole and people get stuck on that.

>> Yeah you get the well the price structure changes OK and so for most brand name drugs you're going to be paying twenty five percent of the cost of the drug.

Now that doesn't include insulin anymore if it's on an insulin program but twenty five percent of the cost for brand name drugs it might be less for generics depending upon the plan.

>> Now next year if you exceed or what they call the true out of pocket cost which is a combination of what you paid and the total cost the drug in their formulary if you exceed seventy six hundred dollars you go into what they call the catastrophic phase where you're paying five percent of the cost of the drug or a copay whichever is is greater in twenty twenty four that actually goes away.

>> So if you reach the catastrophic phase you're done, you're capped out and the plan will pay 100 percent after that.

>> That's very good news for people who take a lot of drugs.

>> Yeah.

And there's going to be reductions of what you pay out of pocket in twenty twenty five as well.

We won't go there at this point but yes there are some cost containment coming and so it if it works the way that they're they're suggesting it would work next year excuse me in twenty twenty four you camp out around thirty two hundred dollars for out-of-pocket costs for your drugs which is really good news for people who take a lot of prescriptions.

>> Yeah good news for sure.

OK here's what I want to talk about just for a minute.

Let's talk about some things that are not covered by an A and B most people will choose to get part and B in Medicare, correct?

>> Yes.

You want to have both.

OK, that's an opinion, right?

Yeah.

You want to balance it because a is is what you get just from working OK?

You work 40 quarters you get part A free three you've paid for it.

>> Yeah paid for by it's not so many years before you pay nothing is ever free part B you do have a premium for it moving forward once you get on to Medicare and sign up for B but you want B because that includes your doctors, your outpatient facilities, the E.R.

A is hospitals and skilled nursing.

>> OK, so you want both OK so if you're new at signing up for Medicare make sure that you say yes I do want to pay that little bit of extra and get part B right.

>> Actually Part B went down.

Did I say that earlier?

>> Oh yeah.

This is this is the first time I think that I've seen in your Membrey that I well yeah I think it is that where it actually for most people it was one hundred and seventy dollars and ten cents this year it's going to go down one hundred and sixty four dollars and not be so.

>> Yes and with good news and what's really interesting about it is with a Social Security increase I've never seen B go down on Social Security go up so that's really a unique situation like stocks and bonds.

>> There you go.

There you go.

This is a strange world we're living in now I kind of want to review some of the things that are not covered by Part A or part B so that if you're looking for a supplement or an advantage plan some things you might want to consider.

>> OK, most dental care dental not covered .

>> Medicare does not cover dental unless it's usually a result of disease.

>> Oh I see if it's part of whatever the result of cancer or other disease or something like that.

>> Yeah they'll they'll do some then but generally routine normal stuff that we do know eye exams not cover not routine not routine dentures not not covered long term care not covered .

Wow.

Cosmetic surgery not covered that's OK. >> Who needs that anyway.

Right right.

Massage therapy.

>> No never know.

OK how about routine physical exams.

>> No well see the thing is and as you as you're bringing these this up when you first come into Medicare you do get a welcome to Medicare visit which is a routine physical.

>> Yeah.

After that it's a wellness check which is primarily they're going to doctor's going to talk to you, take your blood pressure, listen to your heart and and ask a lot of questions, get a lot of medical hideousness.

>> Yes.

And symptoms but for example OK as a guy usually a routine physical has a prostate exam.

>> We always enjoy that but so long as I like mammograms mammograms a wellness check doesn't include that.

>> OK, a routine physical does now one of the pluses with advantage plans a lot of the things that you just mentioned they do cover it so routine dental vision hearing those are covered annual physical those are covered with those plans.

>> So that's one of the major draws.

Yeah, for sure.

A couple more things here that are not covered .

We just want to mention hearing aids and exams for fitting them.

>> Not a plan not covered Concierto hair for medication retain based medicine boutique medicine that's not covered either with Medicare or Advantage plans at this point.

>> OK, OK.

Some of the things that you know, hearing advantage plans do cover when it comes to consider now they're not so that is going to be there's some real advantages with that type of medical care but it's not covered by Medicare.

>> All right.

Covered items or services you get from an opt out doctor what do you call an opt out doctor?

>> That's someone who does not accept Medicare assignment.

Oh, I see.

OK, right.

So in most particularly in our area most doctors accept Medicare assignment because let's face it, most doctors are affiliated with the hospital systems.

>> There are some that are not and they do have the option whether they accept Medicare or not.

>> Now if you have a doctor who does not accept Medicare but agrees to treat you Medicare will still pay them and but they're allowed to charge you 15 percent additional to what Medicare pays.

>> I see.

And a plan G supplement actually covers that now the other supplements do not but plan G actually pick up that additional fifteen plan G Gregg plan.

>> Um you know we said that Medicare doesn't cover eye exams but I did read that if you've had cataract surgery Medicare will pay for the new glasses or new contacts, correct?

>> Well, they cover cataract surgery.

Yeah.

They cover the surgery and then buy a new pair of glasses because your prescription has changed, correct?

No, I thought I read that it's I thought I we're going to check on this in there's a possibility I can be wrong here.

OK, but from what I'm remembering no now you as I said OK advantage plans generally have glasses change but no they typically don't.

>> Usually the idea of the cataract surgeries to clear the vision is not to correct it.

>> Now one difference here is Medicare.

As I said, Medicare will pay for lenses that will clear the vision because you change can't because there's cloudy OK, they have lenses now that she can put in your eyes which are corrective ICU.

>> So if I were to have cataract surgery I could get lenses that I no longer would need to wear glasses.

>> I see.

I think OK now Medicare will pay for the surgery.

Yes.

It will not pay for those lenses because there's a greater cost to those that so you can you can pay the extra dish extra Medicare will cover the procedure but they're not going to cover the lens.

>> OK, and we're going to clarify that even more next week because guess who's going to be back again?

>> You're going to hold me accountable to that one, aren't you?

Well, I don't know.

We'll see then and we'll do a lot of homework here with our new Medicare book.

>> And again, I want to invite you to join us next Wednesday night at Seven Thirty.

Greg MacDonald is going to be right here to answer insurance questions.

So make sure you got that down on your calendar or put in your smartphone so that you're with us next Wednesday night at seven thirty.

>> Meanwhile, I hope you all have a safe and a very healthy evening and weekend and Greg, I'll see you next Wednesday.

>> You sure will.

All right.

Good night, everyone.