On this episode of Medicare Moments with Toni King, Toni answers a question from Carol, a married 70-year-old whose husband is undergoing treatment for cancer while she is in good health. Their Medicare problem? Carol’s Medicare Supplement Plan F premium increased by 20 percent! Now Carol and her husband aren’t sure if they can afford the plan and don’t know how to make a change. Listen now to hear Toni’s advice!
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Hi there, this is Toni King. Thank you for listening to today’s Medicare Moments podcast. I took the Medicare and You handbook and put it into “people terms”, so that America can understand and personalize their Medicare for themselves. Today we are talking about why the Medicare supplements are getting premium increases, just going out of control. People are getting confused if you can change or when you can change Medicare supplements, and people get very confused on that. With Medicare, it’s what you don’t know that will hurt you. So let’s just go down the maze of Medicare together, and I’m going to introduce you guys to Jim. And Jim is helping me today. Aren’t you, Jim?
I am. Thanks, Toni. It’s really great to be here, and you helped me with my Medicare when I needed it. And I know, folks that are listening, Toni can help you with whatever your question might be. So it’s really great to join you.
Well, thank you. I appreciate it.
Well, Toni, today we have a question from Carol, and this is what Carol writes: “We have received a twenty percent increase for our Plan F Medicare supplement that will go into effect soon. I’m a seventy-year-old female in good health, but my husband is undergoing cancer treatment. Also, his cardiologist has advised him that he may need a pacemaker. Now, my friends have advised me that we will have to wait until Medicare’s annual enrollment to change from our current Medicare supplement plans. I’m concerned that with the Medicare supplement increase, we may not be able to afford those premiums. So what should I do? Would a Medicare Advantage Plan be a good option to change to, with my husband’s cancer issues?” That’s Carol from Tampa. How can you help her, Toni?
I appreciate this question, Jim. This one is very important. People ask their friends for help, and sometimes their friends just lead them down the wrong path. And that’s one of the things that has happened with Carol. So she was given inaccurate information, and America needs to understand this. The people that are listening need to understand that Carol does not—now, listen, listen to me on this one, Jim. She does not have to wait until Medicare’s annual enrollment period to change her Medicare supplement insurance plan. It has nothing to do with Medicare’s annual enrollment period. Carol was given inaccurate information, because Medicare’s annual enrollment period is only for changing your Medicare advantage plan or your Medicare Part D prescription drug plan. And people get very confused on that. How does that sound, Jim?
I think that sounds good, and now Carol will be on the right track as she tries to make the right plans and move forward.
That’s right, and she’s got to do it for herself and for her husband. One thing that people need to realize is that in 2015, Congress passed a law, and it’s called the “Medicare Access and Chip Reauthorization Act” or MACRA. That helped the docs fix proposals. They were losing doctors. Doctors are getting out of Medicare, and this helped the doctors, so that they would stay in Medicare. But also, Medicare supplements Plan F and Plan C had changes. There’s two parts to Medicare. Remember, Jim, when we did the consultation? There’s two parts. There’s Medicare Part A, which is your inpatient hospital stay, and there’s Medicare Part B, which takes care of all of your medical. So, if your Medicare Part A started prior to January 1st, 2020, you can enroll in Plan F. You can keep Plan F what however that works. But if your Medicare Part A started after January 1st, 2020— which mine did, and I think yours did also—we can’t enroll in Plan F. We can enroll in Plan G and the rest of the plans. So, you know, that—that’s why she’s getting the increase. Because people after January 1st, 2020 cannot enroll in Plan F. And they’re just raising the rates, because they know that they have a group, have a lot of people in it, that have health issues. And I just want to tell people, “If you are getting rate increases and you need to change, you can do it at any time.” How does that sound?
That sounds good. We’re gonna take a short break, and we’ll be right back. Welcome back to Medicare Moments with Toni King. We’re talking about Plan F. Toni, let’s continue along that line.
Doesn’t it get confusing, Jim?
Can you imagine there are over 60,000,000 people on Medicare right now? 10,000 turning sixty-five every day? The amount of mail and phone calls that people are getting is just ridiculous. If you have had your Part B, that’s why Part B we, we treat it like gold. If you have had your Part B longer than six months, to change Medicare supplement insurance plan, you have to answer health questions. You have to do the underwriting, a complete underwriting situation. And that is what’s going to happen with Carol. Both her and her husband are going to have to go through complete underwriting to change their Medicare supplement. If she has good health issues, then she can change her Medicare supplement insurance plan. But with her husband having cancer, or she knows that he has to do a pacemaker, that may be an issue. What do you think?
So, when you go through this underwriting, you ask a whole array of health questions about yourself, and you might not make it through.
That’s right. Some people think they don’t have health issues, and they find out that the situation is not what the insurance companies want. So Carol’s options are—she can change from Plan F to Plan G for both her and a husband, if they can answer the health questions. If they can’t answer the health questions, then from October 15th through December 7th, is the time for them to enroll in a Medicare Advantage Plan. That’s one thing they can do. You have an HMO and you have PPOs. Those are the main Medicare Advantage Plans that people can enroll in,and it would start January 1st. What I would advise Carol to do—and I would advise anybody out there—if you’re contemplating changing from a Medicare supplement to a Medicare Advantage Plan, who do you think you want to talk to about this?
I think we want to talk to you about this, Toni.
Well, you can talk to me. I mean, you can email us, but the most important person that you need to talk to is your doctor, because you want to make sure that all of those doctors that you’re using are in the network. You’ve got a network with the Medicare Advantage Plan. You want to make sure that they’re all in the network and they’re accepting the plan that you’re thinking of moving to. What if they don’t?
If they don’t, then you’re going to have to make a hard decision, especially if you’ve been with your doctor for a long time.
That’s right, and people don’t understand that. And lot of people think that a Medicare Advantage PPO Plan—because you can go in network, you can go out of network—and they think it’s like a Medicare supplement. But they need to look at what the costs are. The costs sometimes can be 11,000 dollars out of network. It depends on what’s happening in your area or your zip code.
Now, when you say 11,000 dollars, you mean deductible.
That’s the total amount out-of-pocket—total out-of-pocket. I guess I’m getting a little tongue-tied. It makes me nervous.
It’s okay, because that’s a lot of money. And it can have that kind of an effect on someone, because if you’re going to be spending that much money, you need to know upfront, so there are no surprises at the end. Expert advice is important.
That’s correct. And if that agent is not going to tell you, then you need to go online. You can go and look at Medicare.gov and look at that plan and see everything that’s available for it.
What’s your experience online like that, Toni? Is it easy for the common person to navigate that? I don’t think it’s that easy, is it?
It’s not that hard. Your Medicare.gov probably has the best website out of all the government websites that I’ve seen. If I can navigate it, I mean—I guarantee you somebody else we can show them how to do it. It’s not that hard. So why don’t we go over what is a Medicare Plan G and Plan N? Those would be her two options to go for for Medicare supplement. It would help her, so she would know what the cost are. What do you think, Jim?
I think that’s great. So let’s start with Plan G and see where that goes.
Okay, well, Medicare Plan G is slowly but surely taking the place of Plan F. Because pretty soon, there’ll be no one that can enroll in Plan F, because there’s a time limit. But Medicare Plan G offers lower rates, and it has the same benefits as Plan F—except it does not pick up the Part B deductible. That’s not covered. So that changes a little bit every year. So you’re gonna have to pick up the Part B deductible, which, for this year, is two hundred and thirty-three dollars. So that’s your out-of-pocket.
For the entire calendar?
For the entire calendar year. And we’ve only got a few months left. Next year, they have not released those numbers for next year. And then you’ve got Plan N, which is a different type of Medicare supplement plan. It’s kind of close to a Plan G, but it does have more out-of-pocket. They got this as close to a Medicare Advantage Plan as they could get, because it has a copay. Okay, you have a little more out-of-pocket. There’s a twenty dollar copay when you go to the doctor, and there’s a fifty dollar copay for emergency room. You do have to pick up the Part B deductible. It’s not paid for. But it does not pick up what’s called “excess charges.” So if your doctor says, “I want the excess or an MRI or a cat scan.” Or someone that you’re having some kind of surgery, wants the excess that Medicare is going to charge or that they’re gonna pay for—Plan N does not pick it up. Plan G does, so you got to look at all of that.
So again—it’s kind of back to what you said. Plan G is a great plan to take advantage of, if you can.
If you can! And you want to look at the premiums. Let’s see what you can save yourself—what, what what out-of-pocket you’re gonna have. So, you know, what we tell everyone when they come in the office or whenever we’re doing a Zoom consultation—because I can talk to somebody from Alaska now. You know, Alaska is part of the United States. Yeah—Medicare covers anyone that’s in the fifty states and the District of Columbia and whatever is out there that’s part of the United States. Different little areas that are part of the United States, so it covers them. They have Medicare Part A, Medicare Part B. And one thing that we like to tell people, that if you’re making a change to your medical care supplement, don’t cancel your policy until you get approved. And I wouldn’t wait a month or two trying the new plan out to make sure you like it. Also, if you’re thinking about changing from a Medicare supplement to a Medicare Advantage Plan, please try that Advantage Plan out for a couple of months before you decide to go back to original Medicare with the supplement. Because, if you’ve got some kind of health issue, you are in big trouble.
So you can keep it. Don’t cancel, is what you’re saying. Try something new, run it in parallel for about two months, and make a decision.
A lot of people would not think about doing that.
Because they think, “Oh, I can go back to that plan. I can do whatever.” And if they’ve had heart issues or cancer, they may not get back into that plan. So, you know, you’ve got to personalize your Medicare. You’ve got to personalize everything. And all of this can be found our Medicare Survival Guide: Advanced Edition. Right now, it’s available on my website ToniSays.com. That’s ToniSays.com. But after about October 10th, SeniorResource.com will be carrying that book. Yeah—and you know that Jim.
I do, I do. And folks should go to SeniorResource.com. And your podcasts are resident there—are anywhere where you get podcasts—and a lot of great information about Medicare that you provide in your articles are there.
And that’s what we want to do, is thank everybody who is listening to the Medicare Moments podcast. If you have any questions about personalizing your Medicare just for you, making it especially for you, visit www.SeniorResource.com. It’s SeniorResource.com.
It’s a great place for all senior resources.
And you’re there!
And I’m there. That’s my new home. You know? So that’s where the Toni Says Medicare articles can be read. We just want to tell everybody to have a great day. I want to thank you Jim for being here with me, helping me along because it’s awful nice to have somebody to talk to.
That’s a privilege to be here, Toni, and thank you for having me. And, folks remember—that’s SeniorResource.com, for everything you need to know about Medicare. And look for Toni’s articles through there, and our podcasts are there, as well.
And we appreciate it. Have a great day, and God bless America.
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Originally published October 13, 2022
Bob Carlson, America's leading retirement expert, reveals the big secret the IRS won't tell you.