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I had a couple in my office this week and he was just signing up for Medicare. She’s under 65 and they were saying, “Oh my goodness, we have gotten a couple of trees in paperwork, and all of it is hard to understand and all of it is difficult.” Well, my purpose in giving you for the next 32 hours an extended course. Just kidding, okay. I’m going to give you in just the next few minutes an overview of Medicare, so you have a general understanding of the A, Bs and Cs, and I even added a D for Medicare. Now, on this podcast, I’ve got one slide to show you. Okay? Here it is. You ready? This is a 2023 Medicare overview. The very first thing I want to look at is just in this box, because Medicare A and B, if you’re 65, you know that you’re going to get a Medicare card that has either A or A and B on it.
Now, if you do need to go on to Medicare right at 65, you need the A and B. If you are still working and you have coverage at work, you do not need A and B at 65. You just need to pick up A, unless your HR department has some kind of agreement with Medicare and they require you to go ahead and pick up part B. And you say, “What are you talking about?” A and B. Medicare part A. This is called original Medicare. Medicare Part A covers hospitals. Now, it covers a little bit more than that, but if I did an all-encompassing word, it covers hospitals and it costs nothing if you qualify for Medicare. Medicare Part B covers doctors, and you might hear the term DME, durable medical equipment, and it covers those. And it costs you, then this is the reason if you’ve got a company plan and you’re over 65, you don’t necessarily need to sign up for Part B unless your company requires you to do so, so you can get by with just part A.
“Well, I’ve been told that I’ll pay a penalty.” Not if you have qualified coverage. You have substantial coverage through your work. Then, when you decide to stop working at 67 or 68 or whenever you decide to stop working, and you go off of that company plan, that’s when you need to pick up Part B because it costs you, in 2023, it costs you, if you’re in $178,000 or less range, $164 and 90 cents a month, and they’ll start taking that and they’ll start charging you that. That is original Medicare, and I want you to see two numbers here, A and B. A lot of people come in and they mistakenly say, “I signed up for Medicare. I’m done.” “Really, what do you have?” “I have part A and part B.” You have 80% of the coverage if you have original Medicare. Now, there’s two other things that are out there, and almost a hundred percent of the people go one or the other of these ways, and the way that you should go is individual to you.
Now, let me explain what I’m talking about. If you go here and you get a Medicare Supplement, now some people call it a Medigap policy because it covers the gap. You say over here is 80%, the Medicare Supplement basically covers most of the other 20%, minus a few deductibles and some donut holes, and that’s actually what they call them. I’m not talking about what you get at the bakery. That’s actually what they call them. Donut holes. It’s going to cover the other 20%. Now, Medicare Supplements cover any doctor in any state in the United States, any pharmacy that takes Medicare, any doctor that takes Medicare, any hospital that takes Medicare. I use the illustration to my clients. If you’re in Bangor, Maine and you see a clinic and they take Medicare and you want something for a cold or something that you want, an antibiotic for something, you can go in there and Medicare will take care of it if you have a Medicare Supplement.
Also, since it will cover any doctor that takes Medicare, any hospital, any pharmacy, a lot of people I tell, if you’ve got ologists, now, what I mean by that is if you’ve got a cardiologist and you’ve got a rheumatologist and you’ve got a lot of doctors and you’ve had a lot of issues, and sometimes when I’m talking to people and I’m presenting the ABCs and Ds of Medicare, they immediately say, “That’s what I need because we travel. That’s what I need because I can’t live without my cardiologist.” Now, that is a Medicare gap or a Medicare Supplement. Some people have said it’s like a PPO. It’s not really a PPO, but it’s like a PPO in that you can go to any doctor pretty much anywhere that’s going to cost you depending on the plan you get, and there are different letters for the different plans you need to work through with whomever you’re talking to.
You can talk to us because we do both Supplements and Advantage, but you can talk to them. It’s $125 to $167 when you’re about 65, and if you get a Medigap Medicare Supplement, you’re going to have to drop down and get a D , a prescription drug plant, and those start at around $40. $40. So for each one of you, if you’re married, for you, if you’re single, you’re going to have to pay a 164.90 for part B. You’re going to have to pay, if you go this direction, 125 to 167 a month for the Medicare Supplement and $40 and up for the prescription drug plan, and then you’ve got your coverage at about 100%. It’s very excellent coverage. Now, if you don’t know the price of medical coverage, you’re thinking that’s a lot. I mean, if I add all of that together, I’m 330 to $400, but if you’re buying medical coverage at age 63 and you’re getting a decent plan, you’re probably paying, on the market, about $800 a month for it, so it’s going to be a reduction in cost.
Now, let me show you how I can really reduce your cost. If you want to go this direction, to cover the other 20%. This is Medicare Advantage. And you always hear this in the fall. Because from October the 15th to December 7th, you can sign up for Medicare Advantage and JJ’s on there, and Joe Name is on there, and Magnum P.I. was even on there, and they’re saying, buy my Medicare Advantage, and they probably don’t have any idea what they’re promoting because they’re just getting paid to do the commercial. But what it is, it is an HMO. It is through a company. With this, your coverage is basically dictated by Medicare with this as the 20% supplement. That’s why they call it a Supplement. With this, you turn your Medicare coverage over to a company and it’s like an HMO, and in that HMO you have to go to those doctors that are in that family of doctors that your doctor is a part of.
Now, if you’re in Bangor, Maine, and you have an emergency, they’ll help. But if you’re in Bangor, Maine, and you want to go get an antibiotic, they won’t necessarily cover that because you’re out of the range of the HMO. Why do people take that? Because the cost is zero in most cases. It costs nothing to cover the other 20%. And recently, a couple of years ago, I went through a period where I had a couple of surgeries. I had all kinds of specialists I had to go to. They all found out that I was fine. I was just mean. That was the only problem with me. And all of that cost me $85 for an ambulance ride when I fell and broke my nose in Nashville, Tennessee. All of the doctors were covered, all the surgeries were covered. I paid not one penny because I was in an HMO coverage with a company. That also includes the drug plan.
So a lot of people, if your doctor, here’s the question; does your doctor take the Medicare Advantage? And it’s the HMO plan. And if your doctor takes that plan, and if you’ve got a specialist, I call it running the gauntlet. If all of your doctors are on the same family of plans, many people see Medicare Advantage as a viable option.
So you need to talk to somebody, but don’t talk to a normal insurance agent. 80% of the normal insurance agents can’t sell the Medicare Advantage, which costs nothing. So they’ll say, “Oh, you got to get a Supplement. That’s the only thing you need is a Supplement.” Because they’re going to make money off of over here. You may be able to get by and be happy because you might say, like a lot of people, “Well, if I went to a specialist, I would go to the specialist that my doctor referred me to and he’s going to refer, she’s going to refer within their same family.”
So, very important that you talk to somebody that does both options of Medicare in addition to original Medicare. Lot of information. Go back and watch this podcast. Listen to this podcast again, and go over it again until you get it down. Or you can call us at (714) 421-4288. We’ll do our best to help you in any way we possibly can. Thanks for listening. You need to understand Medicare. You can also contact us at email@example.com. Make sure you understand the issues that are involved in Medicare.