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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>> Good evening.

Welcome to PBS Fort Wayne.

The name of our show is LIFE Ahead.

Now let me tell you why every week here on LIFE Ahead we have a different topic and different guests but we try to come up with topics that might apply to you in decisions you have to make for your LIFE Ahead if you will.

>> And tonight, all of you, we're going to have to deal with this subject.

We're going to be talking about health insurance and who's not talking about that right now or hearing about it on TV.

So we're going to dig into that a little more completely tonight with Greg MacDonald.

>> Greg, thank you for being here.

Oh, my pleasure.

He's a familiar face to you because Greg comes this time of the year you've been coming every year for a number of years.

>> He's been over 10 years old .

>> Yes.

Oh, you don't look any older.

He's still 10 years ago.

>> Bless you.

And Greg, by the way, just to give you a little heads up, we're going to welcome any phone calls you have about health insurance and he's going to be back next week.

That's the good thing.

>> We always do this in two parts because there's so much information that you want to know or need to know.

Greg, I'm going to start out by pointing out that this is the new Medicare book for 20 26.

>> Most of you if you're on Medicare have probably already gotten out in the mail.

>> If you have it, should they go online or call?

It's available.

It's available online.

>> If you go to Medicare dot gov you can get a PDF copy of it or you.

Oh, OK.

OK.

All right.

And on page two of that which is actually just the inside cover it lists kind of a little quick little summary of the changes for twenty twenty six and we always talk about this time of the year if you want to make changes to your insurance plan change plans change companies whenever you have a certain amount of time you can do that without some penalties.

>> Tell us about that Craig and the dates.

OK, so this is the time of year where it's called the Medicare.

>> Well, it's an open enrollment yeah.

>> Enrollment period.

It begins at PILFERER 15th and goes to October December 7th and this is the time that you can change Medicare Advantage plans and prescription drug plans and so advantage plans you have a little leeway because there's also a period at the at the beginning of the year that you can change if you need to drug plans.

>> It's imperative because if you don't change now the drug plan that you select will be your drug plan for next year.

>> OK, ok OK.

So there are enough changes that a lot of you might want to consider making some changes.

>> I made some changes two or three years ago.

Mm hmm.

Actually after we had had a conversation and same company I just changed to a different plan and saved two or three hundred dollars a year.

>> I had to give one thing but it wasn't a priority.

So that's OK.

Yeah.

And the thing is happening this year that is really making a difference for folks is the Inflation Reduction Act is really starting to kick in to the Medicare Advantage companies and what that means is they're having to pick up more of the cost.

>> For one thing they're picking up the life insurance company insurance company.

>> They're picking up the lion's share of the drug costs and they're not getting paid as much.

Yeah, and so they're really looking at OK, how can they save costs because they're in it to make money.

>> Right.

And so they're not only looking at their plans, they're looking at areas in which they've been profitable and and where they haven't been and so inner in northern Indiana for example, we have plans that are no longer going to be in certain counties.

>> Oh, OK.

We're changing some of them.

Can you tell us that now or have you been.

>> It varies with companies.

OK, OK we're seeing some of the benefits being cut back the ancillary over the counter benefits.

A lot of those are now gone and most of these plans are even seeing some of the gym memberships have been cut back.

>> The dental benefits have been cut.

That dental vision and some of the things that were nice co-pays have gone up the maximum out of pocket for many of these plans have gone up as well.

>> So there's a lot of different changes that are happening in the advantage plans that if you have one you certainly want to take a look at to make sure that it's still going to work for you and particularly if you're out around if you're not in Allen County.

Yeah, they have like I said, some of these plans I'll pick out one Aetna which was operating in Adams and Noble counties.

They're not going to be operating in there.

>> Yeah, I see that Adams Wells and Noble and Wells here can't get that anymore.

So get if you have that and you live in those counties you only need to select something else.

>> Exactly.

OK and then we have well we have some companies that no longer work with Parkview so Anthem which is a big one.

>> Yeah.

Anthem is has Parkview in Network with every plan except Medicare Advantage.

>> Oh really.

So coming and the beginning of next year and they've announced the they've cut off negotiations so next year oh that's a big battle involving a lot of Parkview will not work together and Parkview is not taking any out of network plans really.

So if you if you go to Parkview and you have Medicare Advantage, the three companies that you'll have to work with will be Aetna, Humana and United Health Care.

Everybody else we ought to network with them.

>> That's really something that everybody should know because that will be a huge number of people that will be involved in that and we're talking any of the Parkview not just, you know, our Illinois Road and State Street and correct.

>> So yeah, I see we have a slide up here so that's what we're talking about.

We have fewer ancillary benefits.

We have some companies adding medical deductibles.

They're not big.

They're like one hundred to two hundred fifty dollars and that just is for if you're going to the hospital if you have served half or surgery or just surgery, it's not the routine stuff.

>> It's major stuff.

But yes.

And another thing that you'll notice on the slide is coinsurance for brand name drugs instead co-pays.

So if you have for example, I saw one example which is a popular drug right.

OSX retail price is like around a thousand dollars a month.

>> So if you have a 20 percent coinsurance for example, that's actually a low coinsurance for many of these plans.

Yeah, So you're still paying two hundred dollars whether other plans where it is a copay like 45.

So those are things that you want to investigate during this period of time just to make sure that your plans are going to be a good fit for you and there's lots of options for that.

>> Well, you know, looking at the drugs are what are normal for you is really important because some of them again are getting into two hundred four hundred dollars a month and that's worth changing your plan if you need well you need to check it because there's two things at play.

One thing is is the plan's formulary in the formulary is the list of drugs that they cover and if it's not on the formulary, the insurance companies aren't going to pay anything for it.

>> And the other thing is the tears and the tears are the pricing structure within the plan.

And sometimes when you look at this from year to year a drug will either go out the formulary, you might have a new one come in or it could change tiers.

So what you were paying for it for this year may be totally different for next.

So that's why it's really important for you to check to make sure that your drugs are going to work well within the plan you the tier can change as well.

>> Yes.

Correct.

Correct.

OK, I remember again several years ago but trying to be efficient and frugal or whatever I had a prescription that moved from tier two to tier one and nearly doubled and you know I was getting pretty expensive and I talked to the doctor about it and he said Oh that's no problem.

>> I will give you a prescription that will fit in tier two .

>> That's the same thing basically and we'll just double it for the amount of time and you know, doubling that we're still much cheaper than going with tier one.

>> Well, just you've got a little backwards Tier one is usually the least expensive.

>> Oh OK.

That's Tier one two three, four and five on the part so tier one and tier two .

>> So the generic drugs three and four are the brand and five got specialties.

>> Greg, is it still correct that insulin which was cut back to thirty five dollars a month is that staying?

>> Yes.

So it's going to be one thing it's not subject to any prescription deductibles which by the way the deductible for this year is 650 dollars, OK?

And most the plans are up close to that if it's not six fifteen it's yes close.

>> So once that deductible is met and then then we're going to whatever that copays coinsurance is right.

>> So I forget where I was going with this is when we were talking about the tiers and whether or not insulin was OK insulin.

>> Thank you.

I just that's fine and you can change my question.

>> Very good.

So insulin it's thirty five dollars or twenty five percent whichever is least expensive OK and it's not subject to any deductibles OK so so that doesn't count and does not it does not count ok does not count OK all right now Greg we're looking at a list of the prescriptions or medications now these are ones that are going to be going down or so what happened is the they've created a program that negotiates so many drugs a year who does who negotiate government negotiates with the pharma, with the pharmacy agencies and so they they negotiate they they select the ones that they want to negotiate with and these are the most popular drugs that they want to work with.

>> And you saw the list that and there's some you know Eliquis is a Realto Januvia Jardins farse all are very popular drugs and they're expensive drugs.

>> Again I have to say they brought these things down.

I'm concerned about Javier.

>> I mean I swear if I see that commercial one more toljan like the Gengel on one.

>> Yeah.

I could do the dance I think to what are some of these numbers I'm just not familiar with?

>> Well, Eliquis and Xarelto tend to be cholesterol type medications and Jardins Januvia or diabetes.

Oh OK then we have Parseghian Chesterville in Rubick Solera Novela which is a insulin.

>> Oh ok so yeah these are thirty five that'll say thirty five but what happens there's there's a little bit of variance that they can use depending on and keep in mind that a company doesn't need to cover a particular and so you'll find that a lot with Noval organ Humalog usually a company covers one or the other and they yeah but they don't cover both.

>> OK all right that's making sense.

So drug costs are important to look at when you make a decision of whether or not you want to change your plan.

>> Is that correct?

Will that be in the Medicare book or how am I going to know you're not I'm not you're not because the Medicare book will give you some of the give you the thousand foot view of what the plan has.

I mean I'll give you the some co-pays.

Yeah.

It'll you know, the max out of pocket what some of the ancillary benefits are.

But when it comes to the drugs no they can't get into that and so that's why you need to examine it when I do my discussions with a client yeah.

The first thing I look at is what the drug drugs are, what they what they what they are taking, what the cost of that would be and then take that out there and OK, which plan best aligns with Yeah.

>> That say what's a good fit and that's number one then we look at OK where the doctors are the network this year because just because the doctors in network this year doesn't mean it's going to be in the network next year.

So those are things that you have to continue to look at on an annual basis just to make sure your plans are a good fit.

>> I'm going to back up for a minute.

You talked about checking about your physicians since you mentioned Parkview won't be in there.

Does that mean any of the doctors will not be either correct.

And the thing that that's making it difficult is that most of these plans have if it's a PPO for example in a PPO is a preferred provider organization that allows a person to go in and out of the network.

>> If you go out of the network, the insurance company will still pay but you're going to have a higher higher deductible, higher share of the cost.

>> Oh OK.

OK, part of you has said that you're not going to take out your network plans so even if you're for example it says all right if you see a specialist it costs forty five dollars in network and cost seventy dollars how to network if you're going to it's not going to do any good because they're not going to accept it.

>> Got it so truly if you were if you deal with a few doctors you're going to have to move if you want Medicare Advantage you're going to have to go to those three companies.

>> Same again.

Say again.

That's that part of you will be taken.

>> It'll be Aetna, Humana and United Health Care.

OK, all right.

What about are you health becoming so popular nowadays in Fort Wayne ?

>> Well are you health is that is a different hospital or a different medical system.

OK, so and we used to have you health plan and that is no longer available.

I actually purchased by Anthem so yeah that was purchased by Anthem.

So everyone that had a IU health plan they'll be transitioned to an anthem plan for next year.

>> So if you have Anthem you're already covered with then yes OK yes you don't need to make any change.

No no that's fine.

>> And the same with doctors as well as for the hospital.

Right.

So you just want to double check just to make sure but those those three are the ones that have have Parkview OK so without without being advertised there you go.

>> And and those three also have Lutheran and IU so they have all three hospitals within their network.

Well I mean those are the questions we have for you tonight Greg.

>> I know I you're probably limited in what you can say because maybe some of the decisions aren't me.

>> Will anything changes for you as an agent?

>> Well, it becomes very complicated because just trying to fit things in, you know that that becomes more interesting because it's a puzzle piece.

>> Yeah, it really is and everybody's different.

So I had a couple today.

What works for the wife doesn't work for the husband and so we're looking at two different plans and that's often confusing particularly for people who have been on group health plans where everybody in the families insured with Medicare it's individual periods.

>> Oh always.

Oh you don't have an option if you're a couple that doesn't matter.

You cannot be on the same but you can have the same plan but it's an in it to individual plans with the same company.

>> Got it.

OK well what are the other things Greg in addition to looking at the drug costs should you look for when you're deciding on a plan?

>> I mean or you well here as an agent somebody do like ask you know, do you have any serious illnesses or well we we are not supposed to as agents.

>> Oh we're not supposed to ask for personal health information.

>> OK, however if you decide to share with us that we can that's OK.

>> We can help use our expertize to guide you in making proper decisions.

>> So if somebody has a lot of physical problems and might be looking ahead at a lot surgeries or something or therapies, those are things that are important in your decision and so particularly as you're aging into Medicare, you want to let your agent know just what your situation is and don't be shy about telling them we're we have to very much watch to make sure we care for the personal information and that doesn't go anywhere.

So yeah, we're very confidential with that anonymous right.

>> But just like you share with your doctor what's going on with you, you should share with your agent particularly if there's some kind of medical expenses or procedure coming up because that can make a decision between Medicare Advantage and Medicare supplements and we can we can get into that.

>> In fact we talking a little bit there's a lot going on in Medicare supplements to that we can get into.

>> But I think we will really dig deep into that next week.

>> But just just so you know, there's a lot of things happen in the Medicare supplement area too.

>> Well, just an overall question and again we're going to look at that more specifically next week.

>> How does one decide whether they should get an advantage plan or a supplement?

What's the difference the big difference between the two with a Medicare supplement Medicare is the primary payer a requirement with what?

>> With Medicare supplement.

OK, so Medicare itself pays the claim and then your supplement kicks in with the most of what you would have to pay.

Oh, without it OK.

And so with the advantage the claim goes to insurance companies first for well it does go to Medicare at all.

>> Oh and all at all it goes to the insurance companies and they pay the claim when it comes to the cost share depending upon which Medicare supplement you have typically you have more cost share with advantage which means you're going to pay more for a particular service than you would with with the supplement .

However, then you start weighing the cost benefit analysis of OK, which is going to be the least costly for you and oftentimes when you have a lot of physical issues OK or you have a chronic condition Parkinson's for example, sometimes I just recommend that that a supplement would be the way to go because there's no networks.

Oh OK.

So you can go wherever you don't have and by the way, since we're talking about this part this part of you anthem thing, if you have a Medicare supplement it doesn't these networks make no difference so you can have an anthem supplement and go to Parkview.

>> There's no problem at all.

Oh OK.

So the company its only advantage plan.

Yeah it's only the advantage plans the company of your Medicare supplement makes no difference so what somebody might want to change from a or an advantage plan to a supplement if they want to stay with Sakia.

>> Yeah they can do that.

Oh the OK the thing that that you have to realize is when you have a Medicare supplement and you go to that you do have to answer questions also there's underwriting with that and if the insurance company can say yes or no.

>> Oh I see.

So those are the things that you have to approve a test or a surgical procedure.

>> Nothing just to just to be admitted into the plan itself.

I say when you first come to Medicare they don't ask any health questions so it's guaranteed issue.

You're good to go.

>> But when you change in the future and by the way you can always change I mean you can go back every year you have you have an opportunity.

>> You can go get some supplements to advantage the back and forth.

I mean that you can do that as long as you can answer health questions to the satisfaction of the company that you're applying to.

>> I see.

OK, how does that differ from year to year or once you've answered the questions are you done or do you have to?

>> Oh no, no, no, no, no.

As long as you if you once you have answered the questions and you have a policy they're not going to ask you the questions again.

OK, OK.

And your policy premium is not going to go up just because you had cancer this year.

OK, they're not going if you look at it and your rates went up it isn't because I had a lot of services they can't do that.

It's all based upon what is happening and what they call your block of business.

>> OK, well Greg, we're almost out of time for for this show.

>> But one quick question with a quick answer if you can do get again without going into specifics.

>> I mean everybody's singing on TV all the time right now, all of the federal and government issues over health care.

>> Yeah, Is this going to affect what we choose to do now though?

>> Well, everything just until next year, right.

>> Every year is going to be different to what you I mean what's going to happen?

I mean everything is fixed for four twenty six ok ok.

But let me ask you one warning to people out there because I know you're getting phone calls, OK?

If you get a phone call from somebody other than your agent or the company that you're dealing with hang up because one it's illegal for agents to call you without their permission.

>> OK, OK.

And so if you're getting these solicitations a lot of times are coming from offshore call centers which they have an Asian accent.

>> Some of them don't even have an Asian accent.

OK, but yeah, just hang up on them because they shouldn't be it's illegal for them to call you and certainly don't switch plans with somebody you don't know because on the phone because I've had people call in and they call up and they said well they said I had this and I I can get all these.

>> Don't you know I'm glad you mentioned that, Greg, because a lot of times we don't really know or or keep it tuned in warned about complicated things for us personally and if somebody sounds like they're an authority on the phone, you might believe them and say oh well I didn't realize that OK, changed me to such and such and well I'll pay that extra sixty dollars a month.

>> Well in a lot of times it's not what you are doing a lot is they use what they call dual eligible plans.

These are people who have Medicare Medicaid OK and the plans are extremely rich and they I mean you can have all these ancillary benefits and you can go into the hospital and all this and it didn't cost you anything.

>> I mean sounds great.

>> Everybody would want the plan.

The problem is you have to be qualified due to low incomes status and so a lot of times these folks will call and use a bait and switch.

>> They'll tell you about all these things, you know, wow, I want that.

And then there is this but let me show you what else we can do.

>> Hey, guess what?

We're out of time right now.

Don't forget Grace is going to be here next Wednesday night at seven thirty.

Jot down your questions that you've been thinking about here on this show and you can ask him next week again Wednesday night at seven thirty.

>> Meanwhile, have a great night tonight.

Thank you, Greg.

You're welcome.

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.