In this Episode of the Secure Your Retirement Podcast, Radon and Murs discuss the critical aspects of the Medicare Annual Enrollment Period (AEP) with Medicare Specialist, Shawn Southard. As we dive into Medicare AEP 2024, they explore why reviewing your current plan is crucial and how it may impact your healthcare costs, coverage, and provider networks. Whether you're already enrolled in Medicare or preparing to enroll, knowing the key changes and updates for 2025 is essential to make informed decisions. Shawn provides actionable Medicare enrollment tips that could save you money and ensure you have the right coverage for your needs.

Listen in to learn about the important factors to consider during Medicare AEP 2025, including the upcoming changes in prescription drug coverage, plan premiums, and benefits. Shawn also sheds light on how to evaluate your maximum out-of-pocket costs and the importance of checking provider networks and extra benefits offered by Medicare Advantage plans. Don’t miss out on these essential retirement planning insights to secure your healthcare in retirement.

In this episode, find out:

·      Why you need to review your current Medicare coverage annually.

·      How changes in premiums, co-pays, and maximum out-of-pocket costs can affect you.

·      The importance of evaluating extra benefits like dental, vision, and fitness programs.

·      How to ensure your providers are in-network for the upcoming year.

·      Key changes in prescription drug coverage and what they mean for you in 2025.

Tweetable Quotes:

·      "What worked for you last year may not be the best fit for next year. It’s essential to review your Medicare plan annually." — Shawn Southard

·      "Medicare AEP is the time to reassess, compare, and make sure your coverage is still serving you in the best way possible." — Radon Stancil

Resources:

If you are in or nearing retirement and you want to gain clarity on what questions you should be asking, learn what the biggest retirement myths are, and identify what you can do to achieve peace of mind for your retirement, get started today by requesting our complimentary video course, Four Steps to Secure Your Retirement!

To access the course, simply visit POMWealth.net/podcast.

Medicare open enrollment. What do you need to know? Well, today we've got a person who is an expert in Medicare, Shawn Southard. He's going to walk you through five reasons why you need to meet with a Medicare person in open enrollment. So make sure you listen all the way through.

To learn more about how to secure your retirement and all the different elements you need to know, please subscribe to our channel and hit the bell so you'll be notified when we release episodes every Monday. We have helped hundreds of our clients gain clarity and get on the path to a great retirement. Now it's your turn. Let's dive in.

Welcome to Secure Your Retirement podcast. Today we're talking Medicare and there's no way that Merc and I could talk Medicare by ourselves as good as anywhere close to as we could if we didn't have our specialists with us. Shawn Southard. So Shawn, thank you for coming on and helping us with this complicated topic of Medicare. We appreciate it very much.

Yeah, same here. Hey guys, it's great to be here. Thanks.

Excellent. So Medicare, every year has this time in which people are able to do open enrollment. So could you just real quickly, Shawn before we get in, because the real theme here is five reasons why you should meet with a Medicare agent during open enrollment. Could you just give us a real quick overview of what open enrollment means?

Sure. Every year Medicare has a window of eight weeks. It starts on October 15th and runs through December 7th. The same dates every year, and it's a time period in which all Medicare beneficiaries, everybody who's enrolled in Medicare can make changes to their Medicare structures if they need to or if they want to. So it's a very big time, obviously for Medicare beneficiaries, and it's going to be a very critical time for many people if they do need to make changes.

So we are in that enrollment period right now, and hence the reason for this entire podcast is well, we're in it. You may be on Medicare, you may be turning 65 this year. But as we are in Medicare open enrollment, there's things that Shawn thinks and I would think most Medicare agents would think you need to check on and review. So we've got five we're going to walk through here. The first being review your current coverage. So Shawn, tell us why that's important and why that needs to be done every year, even if you're already on a plan.

Sure. Well, every year, Medicare, the carriers, the insurance companies that work with Medicare to create Medicare Advantage plans and prescription drug plans known as Part D, standalone Part D plans are allowed to and do change their plans for a number of reasons. So even though you're in a plan, and it may have been in the plan with the same company for a couple of years, you may notice that it changed. There's some aspects of it that has changed from this year going into next year. And same with the Part D drug plans. So they don't necessarily always stay the same from year to year. So it is important that you do look at that. Now, the plans are required on the Medicare Advantage plans. They're required to send out what's known as an annual notice of change, known as anoc for short. Medicare loves acronyms, so A NOC, and that is a comparison tool that'll allow you if your plan has changes to look side by side, this is what the plan offered this current year, and this is what it's going to be doing for next year. So you can look at it side by side and go right down through all the changes. So it's very important that when you get that document that you actually look at it and don't throw it away. And of course when you're going to be meeting with your agent that you should bring that with you so they can also see it. So bottom line is what worked for you last year may not be the best fit or may not work for you in the upcoming year. So you definitely should review your coverages.

Excellent. So now obviously we know with Medicare there are different things that we have to, I don't know, buy or pay for sometimes. And so when it comes to this idea of what this is costing me, why would this be an issue that would want to consider?

Sure. So another reason to meet with an agent during this time period is you should definitely evaluate your costs that are going to be impacting you for the upcoming year, especially for Medicare Advantage folks that are enrolled in those plans. Sometimes from year to year you'll see the plan plans will have premiums. Maybe the plan that you're in right now has a zero premium, and then for next year your plan changed. They're going to be charging $15 a month or $40 a month. Okay, so now it's no longer going to be free if you stay in that plan. So it's important that you look at all the plans that are going to be available to you and look at what those premiums are going to be for the upcoming year. A lot of times copayments amounts change and co-insurance amounts change. Some years you may have a zero copay for certain things, or you may have a $25 copay to go see a primary care physician, and then next year they're going to charge $35 to go see a primary care physician.

So your cost to go see the doctor went up $10 per visit or co-insurance has changed. They may have went from a flat rate, maybe for a surgery it was going to cost $600 for you to pay, and then all of a sudden now they're going to 10% or 15% of the cost of the surgery that you're going to be responsible. And then maximum out of pockets change in 2025, the maximum out of pocket is going to be right around $9,400. Medicare Advantage carriers are going to be allowed to if they want to have a maximum amount of pocket limit of $9,400 in their plans. So you definitely need to be looking out for that. I do find over the years that that's one thing that many many care beneficiaries on me Advantage plans overlook is the maximum out of pocket they would be responsible for. So definitely very critical to look at those cost components within your plans. And then for the Part D, real quickly, with all the changes that are coming in 2025, premiums are going up. So that's something to definitely look at this year if you are enrolled in a part D standalone plan.

And so cost is always a big factor in a lot of people as Medicare selection process and decision-making process. But what is important with cost is what types of value you're getting for that. And a lot of these plans have things outside of just medical. So can you talk a little bit about some of the things someone may need to evaluate outside of medical during this annual enrollment period as well?

Absolutely. So a lot of these Medicare Advantage plans, if you are in and those that are in 'em know what I'm talking about. Original Medicare does not offer some things that we feel that they should and that we were used to all of our lives until we got into Medicare, such as preventive dental, getting your teeth cleaned and that once a year, x-ray that they do for your mouth and your gums going to get our vision checked, our eyes examined and so forth, and help with contacts and frames and lenses and then hearing exams and so forth. So a lot of Medicare Advantage plans do offer those services inside their plans, but from year to year that can change. They may offer vision and then the next year they're not going to offer vision, for example. And that is happening this year where some plans are scaling back and taking away some of those extra benefits as they say.

So if you're not paying attention, you're not reviewing and you're not getting together with an agent to go over that, you may find out the hard way to come next year in January, that service that you're used to having is gone. So it's important that you review that and make sure it's still going to be in there if that's important to you. And of course, fitness programs, a lot of them offer United Healthcares is called Renew Active. They have a very robust gym network out there that people can utilize. There's Silver Sneakers where you can go to different gyms and participate in those silver sneaker workout programs and so forth. So it's important to know that are they still going to be there, still going to be part of your plan, or you have to switch over to somebody else to keep those benefits. And for those that are on Medigap plans, I don't mean to leave you out there because I do know that there's plenty of folks that are listening to this that are on med supplements or Medigap plans do know that many, many carriers that offer Medigap coverage also offer as part of it.

They're not really allowed to talk about it upfront until you get into the Medigap plan. But they do have discounts. They don't actually have the plan itself. They don't have a vision plan, but they have discounts. They have many vendors that they participate with to give you discounts on dental and vision and hearing exams and hearing aids and so forth. And they do have gym membership networks as well. So it's important to make sure you're assessing that and making sure that those are still going to be there for you in the ways that you want them in need them in the new year.

Excellent. So now why should we do this next point that we're going to discuss here? Point number four, check provider networks.

Yeah, so checking provider networks is very critical to the whole process, especially for those on Medicare Advantage plans. Those on Medigap plans or med supplement plans, their health insurance comes from original Medicare and original Medicare is part A and B, hospital and medical coverage. There are no networks in original Medicare, original Medicare is not an HMO or PPO plan. They just need to be concerned about does the doctor or provider take Medicare? Does the hospital take Medicare? Unfortunately, over 99% of providers and hospitals in the United States do take Medicare. So that's all they need to be concerned about. Those on Medicare Advantage plans, on the other hand, are in these private plans that work in conjunction with Medicare, but a lot of people don't realize that when they enroll in those plans, Medicare Advantage, their healthcare is coming from that specific plan, not from original Medicare.

So in that way, they need to make sure that next year the providers that they use and the providers that they need to see, are they going to be accepting that plan? Because Medicare Advantage plans are network plans, they are HMOs, they are PPOs, they are hmo, pss point of service plans. So not all providers take the plans and then providers can come in and out of those networks. So it's important that you're reviewing that and especially if you have something coming up or you're going to need to have a procedure or a surgery performed, you definitely need to make sure that they're going to be in the network and they're still taking your plan.

And then for our final one on this list, I know we've done a previous podcast with you, Shawn, around the changes coming to Medicare and some of the changes in the drug coverage. So number five here on our list is review prescription drug coverage. Let's talk about why that's so important right now.

Yeah, this is a burning topic. I've been meeting with people last week, meeting with lots more people this coming week and the remaining six weeks of this annual enrollment period for Medicare. The biggest change, well, there's two changes, really the two biggest changes, one on the front end, one on the back end with prescription drug plans for Medicare. First of all, the maximum out of pocket has dropped from 8,000 down to $2,000. So once a person in 2025 has come out of pocket for $2,000 for their prescription drugs, they're going to be in catastrophic coverage, which means that they'll pay $0 for their prescription drugs for the remainder of the calendar year. This year and previous years, it was $8,000. So that's going to be wonderful for so many Medicare beneficiaries out there that are on prescription drugs, especially brand name drugs that don't have generics right now.

However, on the backend, the change that's really impacting everything is the way it's been written into law is that now drug plan providers, the actual companies that provide drug plans, prescription drug plans for Medicare beneficiaries are going to have to pay 60% of the cost of the drugs when people are in catastrophic. Right now, they only pay 20%, they're going to have to pay 60%. So these companies are, because obviously they're very smart, they have actuaries and figure all this out, and they said, Hey, in order to get the profitability that we want and that we need, we're going to have to take in more premium on the front end to offset these backend costs that we're going to be paying for all these beneficiaries and catastrophic coverage. So what we're noticing is that a lot of the drug plans premiums have shot up. So anywhere from 10% to 17, a couple of cases I've seen about a 22 to 24% premium increase from last year to this coming year.

So that is something to definitely be aware of and be reviewing. Even with the change, though, ironically, the plan that you are in right now may still be the best plan for next year, but it's important that you take the time to review it for sure. And then of course the formularies have changed a little bit. Formularies are the drug menu, what drugs are covered and how they're covered and what tier they're on. The different tiering systems, those have changed a little bit. So depending upon what drugs you take, you may notice next year that you're paying more copays. Your tier, your drug may have gone up a tier or two from the previous year. So it's important that we're reviewing these drug plans and that you're taking the time to make sure that what you have is going to be the best for 2025.

Excellent. Well, Shawn, as always, you always give us what we need to understand and make it super easy to understand when it comes to something that it can be complicated. So could you just take a moment and let people know if they wanted to have a review and meet with someone in particularly you, how that would work, and then also how they can reach out to you?

Absolutely. My motto is always keep it simple. Kiss. My grandfather always told me, keep it simple, Shawn. Always trying to keep it simple. So a meeting with me, just a couple of things, it would bring you some personalized service. I've noticed for many people that I've worked with so far, they don't even remember who helped them get into Medicare and everything. It's been a while. So that's telling me that those people that they first work with aren't keeping in touch with 'em and they've lost connections. So luckily I haven't seen any cases where people, they're not in a bad situation, they're actually in good situation. So at least those initial people have directed 'em in the right way, which is good. But with me, you're going to get that personalized service. I follow up and keep in touch with my clients and the people that I work with.

And of course, there's no cost to meet with me. It doesn't cost you any money. I don't charge any fees. And if you were to do these things on your own or go to carriers direct, it's the same. The premiums are different. Everything is the same coming through me except you get that personalized service working with me. And the best way to reach me, you can obviously go to our website here for peace, peace of mind wealth management. You can call the office at 919-787-8866 Or you can email me at my email address. It's Shawn with S-H-A-W-N@pomwealth.net, and I will definitely get in touch with you as soon as I can and get you scheduled to come in and see me.

Alright. Excellent. Thank you very much, Shawn. We appreciate it. Thank

You guys. Always a pleasure.

And just so everyone's clear, it's Shawn@POMwealth.net and you can reach him here at the office. As he said. We hope this has been beneficial. We'll talk to you again next week. We hope this video has given you some confidence and clarity as you plan for a worry-free life in retirement. But what else do you need? We have created a complimentary video course called Three Keys to Secure Your Retirement. This video walks you through Step-by-step, what you need to do to get ready for retirement. You can also check out our podcast called Secure Your Retirement. You can subscribe below

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