Medicare’s Game-Changing Updates: What You Can’t Afford to Miss Webinar

Welcome, everyone. Thank you so much for joining today’s webinar with Mercer Advisors, Medicare’s game changing updates and what you can’t afford to miss.

Navigating Medicare can be an incredibly daunting task, but you are not alone. Whether you are approaching retirement age, already utilizing Medicare, or maybe helping some loved ones make informed decisions about their Medicare, understanding your options are crucial.

And with Medicare’s enrollment period starting next week, it’s important to understand key changes being introduced.

And today, Mercer Advisors is cohosting this webinar, Medicare’s game changing updates and what you can’t afford to miss, with Chapter, a free concierge service for Mercer Advisors clients. Chapter is an independent Medicare adviser who provides unbiased holistic health care guidance to our clients.

My name is Laura Combs, and I’m an executive managing director at Mercer Advisors. I’m joined today by Josh DeForest, an executive managing director at Mercer Advisors, along with Ari Parker, who is the cofounder of our Medicare partner chapter. And Ari is one of Medicare’s leading experts, and he has helped thousands of Americans sign up for Medicare by breaking it into simple bite sized pieces.

Ari’s work has been featured in the New York Times, Forbes, CNBC, MarketWatch. I could go on. And, really, Ari is a graduate of Harvard, Stanford Law School and is trains and leads the chapter team of over thirty licensed Medicare advisers.

He lives in Phoenix with his wife, two dogs, and a little one along the way, and you’ll be hearing from him shortly.

Today, we are gonna be talking all things Medicare. And as many of you know, this can be incredibly confusing, and it’s our hope today that you find clarity and walk away with a new sense of understanding.

And when we think about today, we’ve got a number of individuals on the the webinar, some panelists to help answer your questions live. If you’ve joined one of these events before, you know we get a lot of questions, so we wanna make sure this is time well spent, and we’re answering what’s important to you. So I would encourage you to utilize the q and a feature on your webinar screen to submit your questions because we have a number of Medicare advisers who are going to be on the line answering those questions kind of behind the scenes directly to you in the chat as well as live during our q and a session at the end of our time.

As part of our relationship, again, if you’ve joined these events before, you know, we have done these in the past, and so we’re very excited to have you join again today. You have access. If you want to grab your phone, you can get a free copy of Ari’s book, which he’s talked about before. We’re gonna be hearing more about that today.

His book is not that complicated. So this is your chance. Grab your cell phone. Take a picture of that QR code so that you can have this for for your reading pleasure, in in the future.

And we’ll also have this QR code again at the end of our time today.

So take advantage. Grab a copy of that, and, I’m gonna hand things over to Josh DeForest to go through our agenda.

Excellent. Well, welcome everybody. Ari, thank you for being here. It’s great to, do this with you again.

We’re gonna spend some time talking today really about, Medicare basics. What are some of the things that you need to know to be able to make an informed decision about Medicare for you?

I think it’s really important then to understand what are your options and how do you choose a Medigap plan or Medicare Advantage plan. What are the right choices for you? I’m already seeing some of the questions come in around this already.

And then importantly, what do you need to do as we head into open enrollment? Laura mentioned it starts next week. So, Ari, as we kick things off here, can you kind of take us through that three legged stool, the basics of Medicare, and how people should be thinking about their options?

Absolutely. And first, let me say thank you so much for having me, Josh and Laura. I love presenting with you. And of all the presentations I give, this is the one that I look forward to the most. So with that, let’s talk about how to break down Medicare. You can picture Medicare as a three legged stool. You need all three legs in order to have comprehensive coverage.

The first leg of the stool is hospital.

The second leg of the stool is everything outside the hospital. And then the final leg of the stool is drug coverage.

Hospital, outpatient, drug coverage. You need all three legs of the stool to have comprehensive insurance. Let’s break these components down a little further.

Leg one, which is called Medicare Part A, is your inpatient insurance. This covers you when you’re at the hospital. It means you have a wristband. If you don’t get a wristband when you go to the hospital, then you’re being held for observation and Medicare doesn’t cover observation. So you wanna make sure if you’re hospitalized that you get a wristband.

Medicare Part A also covers inpatient mental health care, skilled nursing facility care, home health care, but this is very limited. Can’t be too much, can’t be too little. It’s a Goldilocks scenario. And finally, it also covers hospice care.

Then there’s Medicare part b. Part b is your outpatient coverage.

This covers visits to your primary, visits to specialists. It also covers lab work, x rays, MRIs, CT scans, a panoply of services, including durable medical equipment like a continuous glucose monitor or a or a walker.

And Medicare Part B is really comprehensive. It is excellent insurance.

Now you might be wondering, this all sounds great. How is it paid for? Well, Part A is paid through yours or your spouse’s federal payroll tax. If you or your spouse have paid federal payroll tax for ten or more years, that applies to almost everyone at this webinar, then you have paid the monthly charge for Part A.

There is still a deductible. It’s over sixteen hundred dollars per hospitalization, but we’ll talk about how to cover that a little later on. Then there’s Part B. There’s a monthly charge for Part B that’s collected by the government, and it is approximately a hundred and seventy five dollars per month each.

So if you and your spouse are both on Medicare Part b, then you owe approximately a hundred and seventy five dollars per month for Medicare Part b. If you’re a high earner, you’re going to owe more for Part b. We’ll talk about high earners a little later on. It’s something that chapter can help you appeal if you’re subject to the two high earner taxes on your Medicare.

But you should know there’s a monthly charge for Part B collected directly by the government.

Now let’s talk about what Medicare doesn’t cover. And by the way, original Medicare refers to Part a and Part b. That’s why it’s printed on your red, white, and blue card. It takes less than five minutes in order to activate your Medicare. There we have simple one page instructions that help you activate your Medicare using your online Social Security account. It takes less than five minutes if you do it online, and it takes a lot less time than if you try calling the Social Security Administration call center.

So there’s two big ticket items that original Medicare doesn’t cover. The first is that under original Medicare, there’s no maximum out of pocket on your costs. For example, my mom has been on Medicare for several years. Last summer, she got a knee replacement, which is a forty thousand dollar procedure in the Chicagoland area.

My mom would have owed eight thousand dollars for her knee had she not had some type of additional coverage.

Then the following month, she slipped and broke her elbow. She would have owed twenty percent for everything related to her elbow as well. So her out of pocket exposure for last year would have been well over ten k had she not had some type of additional coverage.

The second big ticket item that original Medicare doesn’t cover is long term care insurance. Long term care is also called nursing care, around the clock care, twenty four seven care, custodial care. These are all synonymous terms for long term care. There’s no coverage under original Medicare for long term care.

Now long term care is defined by the activities of daily living, such as eating, bathing, dressing, toileting, even cognitive decline is considered an aspect of long term care. There have been proposals to add long term care to Medicare. They haven’t made it out of committee. It would simply bankrupt the country in order to ensure for long term care.

The best time to have a discussion around long term care insurance is in your late forties or your fifties. You can reach out to your Mercer adviser in order to have that discussion. By the time you reach Medicare eligibility, the premiums are typically too expensive even if you could get insured for long term care. So I just wanted to flag that here.

Now with that, let’s talk about the third leg of the stool, which is drug coverage, part d, d as in drugs. Now even if you don’t take any prescriptions, it is important for you to get the third leg of the stool. The reason why is because there’s a lifetime late enrollment penalty if you delay signing up for Part D. So you definitely don’t want to deal with that lifetime late enrollment penalty, so it’s important to sign up for Part D when you’re first eligible.

The other reason to sign up for Part d is so that you have coverage for your prescriptions. And now there’s only two ways to get insured for Part d. It has to come from a private insurance company, unlike Part a and Part b, which come directly from the government. So Part d is technically voluntary.

It comes from a private insurance company. Don’t worry. We’ll talk about how you can get it. There’s only two ways.

And it’s important for you to obtain so that you avoid a lifetime late enrollment penalty. The only exception here is if you have creditable part d coverage. That means coverage at least as good as what part d would offer. If you say, jeez, I wonder if my drug coverage through my employer is at least as good as what Medicare part d would cover.

Guess what? Your benefit coordinator at your employer is legally required to tell you. So just reach out to your benefit coordinator if you’re curious if your drug benefit is at least as good as what Medicare Part d would cover. That’s the only exception for people who want to delay getting Part d.

Ari, thanks for walking through kind of the the overview of Medicare. I know for people attending today that have joined these webinars before, this might be a bit of an overview. But for some people that are new, really important to lay the foundation for, for Medicare. I I’ve seen it in the questions, Ari.

They’re already coming in. You know, this is a today’s call is really focusing on some of the changes that we’re seeing headed into twenty twenty five. And so wanna just spend the next little bit of time talking about, you know, how listeners, how attendees today you know, how can we think about these upcoming changes to part d specifically and how they can how they might be affecting our our clients and listeners today. There’s a lot of changes, and so I know I know the audience interest is high.

I’m seeing it in the chat, so thank you all for putting that in. Let’s jump into some of the the changes really affecting specifically Part d.

Absolutely. There are three exciting improvements on the horizon for Part d. They all kick in January first. In order to action them, you need to review your coverage before December seventh. December seventh is the deadline to take advantage of these upcoming improvements to Medicare Part d. So let’s talk about what those exciting changes are. The first is that there’s going to be a maximum out of pocket on your prescription benefit.

Previously from two thousand six to twenty twenty three, there had been no maximum out of pocket on drug costs. I’m going to show you just how expensive that was for older aged Americans on the next slide. You should know that for the very first time as of January first, there’s a maximum out of pocket and it’s only two thousand dollars The key here is to review your drug coverage before December seventh in order to action this change. The second exciting improvement is that there’s no more doughnut hole. The doughnut hole is actually being eliminated.

That is a big change. Previously in the doughnut hole, if someone was on an expensive medication, they owed twenty five percent coinsurance while they were in the doughnut. Your responsibility in that stage has now been zero zeroed out. Excuse me.

The third improvement is that there’s going to be smoothing applied on expensive prescriptions.

So in previously, when someone was on an expensive prescription, they might have owed thousands of dollars in January or February for their medications when they went to pick them up at the pharmacy. That’s no longer the case. Instead, drug insurance companies are going to be required to smooth out your costs over the course of the year, So you’ll only owe a couple hundred dollars per month if you’re on an expensive prescription rather than several thousand dollars upfront.

So let’s take a look at how this will affect your drug costs.

So remember from two thousand and six, which was the start of the Part D program, to twenty twenty three, there was no maximum out of pocket on your prescription costs. So if someone was on an expensive brand name medication or a specialty medication, for example, one that fights the metabolic pathways of cancer, they could have owed well well above ten thousand dollars for their prescriptions over the course of the year.

For this year, that number was actually capped at approximately thirty three hundred dollars. And now beginning January first, there’s more good news on the way. The maximum out of pocket is going to be two thousand dollars for the upcoming year. Again, in order to action this change, you need to review your drug coverage before December seventh. In order to be subject to that maximum out of pocket, all of your prescriptions need to be covered by the plan of your choosing, and that’s something that you can review with an independent unbiased advisory. I think I know a good one, and it’s entirely complimentary to you.

Excellent, Ari. So we think about, you know, what Medicare does cover, what it doesn’t cover. There’s sort of this big gap of twenty percent, of of expenses that are not covered that you have to really think about, and and how do we make sure that that doesn’t affect our clients. Can you talk through how do we think about those decisions around, you know, what do we do on the twenty percent that Medicare doesn’t cover?

Yeah. It’s it’s a great point. If you just have original Medicare, that is if you just have Part a and Part b, then you only have eightytwenty coinsurance.

Remember, in exchange for giving that Part B premium to the government, the government picks up eighty percent of your medical costs and you owe the other twenty percent out of pocket. So last year for my mom, that would have meant she would have owed well over ten ks because she would have owed eight thousand dollars for her knee replacement and well over two ks for her elbow. So you need some type of additional coverage in order to cover the twenty percent of medical costs that you otherwise owe under Medicare. What’s more is you know that just having Part A and Part B doesn’t give you Part D.

And further, it doesn’t cover dental, vision or hearing. So when the clients of Mercer Advisors realize this, it kickstarts the conversation around what type of additional coverage should they use. And here we have a framework that we apply when meeting with the clients of Mercer Advisors. We call it the three Ps, and I write about this in my short book on Medicare.

It’s not that complicated.

The three P framework is your providers. Who are the doctors that you see? Who are the doctors you would want to see if you developed a chronic condition? The second p is your prescriptions.

What drugs do you take? Brand name or generics? What pharmacy do you like to go to? A national chain like CVS or Walgreens or the mom and pop drugstore down the street?

Is mail order acceptable? And then the final p is your priorities. What’s important to you? Do you winter in Florida or Arizona?

Do you have a second home near your grandchildren? Do you plan to travel internationally?

All of these questions will also factor into finding the right coverage for you. And I have good news. There are only two ways to achieve comprehensive coverage. There’s only two ways. Now across these two different options, there are over twenty four thousand plans nationwide, and our advisers sort through them at the touch of their fingertips.

But I want you to know that broadly, there’s only two options.

Option one is to keep original Medicare and add a Medicare supplement plan, which is also known as Medigap.

If you choose Medigap, and I like calling it Medigap because it pictures what it does, This retains the flexibility of original Medicare. It’s networkless.

So the vast majority of Mercer adviser clients choose option one. If you go Medigap, then you just need to add a stand alone prescription drug plan, and we want to review your stand alone prescription drug plan before December seventh so that you can action those exciting changes to Medicare part d.

The second option is to replace original Medicare with what you see advertised on television.

These plans are Medicare Advantage plans. They’re also called all in one plans or part c plans. Those are all synonymous terms. What these plans do is replace the benefits of original Medicare through a private insurance company. The private insurance company is now on the hook for administering your Medicare.

What people like about these about this type of coverage is that it’s typically lower cost than option one. Though you still owe your part b premium to the government, many of these plans have a zero dollar premium. What people like a lot less about option two is that it’s managed care. It’s subject to HMO or PPO restrictions.

And if you choose an HMO, then you can’t see out of network doctors. If you choose a PPO, you’re still very limited. You can go to out of network doctors, but they have to accept the plan’s terms and conditions at the time of service. Otherwise, you’re on the hook for a hundred percent. So there are massive trade offs to option two, and that’s the type of education we provide in a one on one consult with the clients of Mercer Advisors.

Ari, I think that’s a that’s a really good point.

And having worked with hundreds of clients thinking through what their choices are, what their options are, you are right that after being educated, most people do end up choosing option one. But can you dive a little bit deeper as to just you know, even though it’s a little bit more expensive, why do people go with option one compared to option two as you just described it?

Yep. So why do the clients of Mercer advisers tend to choose option one, and the split might be as high as ninety ten in terms of the preference for option one? The reason the clients of Mercer advisers tend to choose Medigap is because they appreciate not having to worry about whether their doctor is in network or out of network. It is better than a PPO.

The only question, if you retain the flexibility of original Medicare, is whether your doctor or institution accepts Medicare. And guess what? Almost every doctor and institution do. You name it.

The Mayo Clinic, they accept your Medigap plan. What do they not accept? Mayo Clinic doesn’t accept Medicare Advantage. The Cleveland Clinic, MD Anderson.

MD Anderson is probably the nation’s leading cancer research institute. Sloan Kettering. I could keep going on and on. The point is that there’s no network restrictions if you choose option one.

Additionally, what the clients of Mercer advisors tend to The reason they tend to like option one is because they appreciate not having any bills or co pays to deal with. The only question is on option one is whether you’ve met your Part B annual deductible, which is two hundred and forty dollars for this year. If you compare that to my deductible here at chapter, my deductible is six thousand dollars I can’t wait to be on Medicare. I have to pay the first six thousand dollars in hospital or medical expenses for my wife and I before we see a dollar of benefit.

That is not the case if you go option one. Instead, your deductible is only two hundred and forty dollars The final thing that clients appreciate about option one is that it’s designed to last a lifetime. Your benefits don’t change year over year. It is standardized under federal law.

So I have a saying the way that I train our team here is marry your Medigap, date your drug plan. The Medigap plan that you choose is probably going to be the plan for the long haul, and you’re making a thirty to thirty five year purchasing decision. It’s not just your health today. It’s also your health into your seventies, eighties, and beyond because actuarial tables suggest you have a fifty fifty shot at living to a hundred if you’re turning sixty five today.

So it is really important to consider this as a thirty to thirty five year purchasing decision. If you go option one, then the only thing you need to review each fall is your standalone prescription drug plan.

So with that, let me talk about a specific Medigap plan letter type that you might have heard of, and each plan letter type is standardized under federal law.

Now you might be wondering, well, then what am I really reviewing if I’m choosing plan G, for example, medigap plan letter G, which is the most comprehensive option for someone who recently turned sixty five. Well, there’s still a lot of competition, even though the hospital and medical benefits are standardized. The insurance companies charge varying premiums. And again, because you’re making a long haul decision, we want to optimize that choice when you first start Medicare. So we’d be more than happy to help you shop your Medigap plan in order to make sure that you’re on the optimal one based on your three P’s. So what is Medigap Plan letter G? Under Medigap Plan letter G, which is the most comprehensive plan for someone who recently turned sixty five, You have no network restrictions.

You don’t need anyone’s permission in order to see a specialist. You don’t have any additional bills or co pays once you hit the annual deductible, which is two forty dollars for this year. It works nationwide, so there’s no problem with wintering in Florida, Arizona, or somewhere else. And finally, it includes eighty percent international coverage.

So this really came in handy for a client who was vacationing in France this summer. They were hospitalized with a heart condition outside Paris for several weeks, and they racked up thirty thousand dollars in costs. Because they were on Medigap plan letter g, they received eighty percent reimbursement for their hospitalization, so it didn’t ruin their trip. And this is something our Medicare or excuse me, our member advocate team helped them get reimbursement for.

Alright. Thanks for walking through option one, which which, like you said, will probably apply to the majority of listeners today. But I’m guessing with option one, there’s an option two here. So let’s talk about option two. And I think this is the one that that people are probably gonna see and hear a lot about. I think I saw somewhere with with the twenty twenty five changes, there’s gonna be close to ten thousand commercials running about option two. So, Ari, walk us through option two and what people need to understand to make a decision about their Medicare coverage.

Yeah. That’s exactly right. There are over excuse me. There are nearly ten thousand commercials per day playing about option two.

You could pick your favorite ex NFL quarterback pitching these plans. Joe Namath, Fran Tarkington, you name it. The plans that they’re talking about are Medicare Advantage plans, which is option two. And it’s one or the other.

You can’t choose both. So it’s either option one or option two. You can’t have both. So what are Joe Namath and Fran Tarkington talking about?

They are talking about a replacement for original Medicare administered through a private insurance company. These plans are subject to the insurance company’s restrictions. In other words, it’s managed care. Here is where we get into the world of prior authorization, waiting periods, and, of course, network restrictions.

So what clients like about these plans, what tends to be tempting about them, the benefits that are advertised on television, are dental and vision, sometimes hearing as well. But there’s the fine print, and the fine print is that there’s massive trade offs to your hospital and medical benefits, which simply isn’t going to work for many of the clients of Mercer Advisors because, again, you don’t want any restrictions on your health care when you really need it. So that puts a button in option two. Now option two has its use case. If you’re primarily living off social security, then option two could work well.

If you’re in excellent health and you think that your health will continue into the future, then option two can work really well as can also work really well. But, again, it’s important to understand the downsides if you’re going with option two. We do search all plans. And again, if you’re interested in option two, we can certainly help you, but we want to make you aware of the trade offs.

Alright.

So with that, let me talk about I keep mentioning this period that you have to review your coverage before December seventh. Who does that period apply to? Well, this period applies to your stand alone prescription drug plan if you’re on option one. And if you went option two, then it certainly applies to your Medicare Advantage plan.

This period does not apply to your Medigap plan. So the Medicare annual enrollment period, which is from October fifteenth to December seventh, applies to your stand alone prescription drug plan, or it applies to your Medicare Advantage plan. And you can use this period to come off your Medicare Advantage plan and choose a Medigap plan and a stand alone prescription drug plan that would begin January first. There are some restrictions that apply here.

Or you can use it to review your stand alone prescription drug plan, which is especially important for this year, again, because the maximum out of pocket cap that’s going into effect on Medicare part d.

Alright. We’re gonna get to, some of the many questions that have been coming in, and the team is furiously answering them.

But one of the questions that we get all the time around this time of year is, you know, I like my current plan.

Should I still think about making changes? Like, what should somebody be thinking about during this annual enrollment period, and should they be consider making any changes to their plan that they have today?

Yeah. Let’s talk about it. So some of the people who are attending this presentation, and there are so many of you. There are nearly a thousand attendees, which is fabulous.

Let’s sort this. So it depends on what your situation is. If you’re turning sixty five, then you are not subject to the Medicare annual enrollment period. Instead, you’re going to be starting Medicare, and that is your opportunity to choose coverage for the first time. So you should know that the best time if you’re turning sixty five to have a consultation with the chapter team is three to six months before your sixty fifth birthday. Now what if you’re past age sixty five and you’re on yours or your spouse’s work provided coverage?

Then we can help you do an apples to apples comparison between what you would get if you were to come off your work provided coverage and start Medicare instead. For some of you, Medicare is actually going to be a better deal than remaining on your work provided coverage, or if you’re nearing retirement, then it’s time for us to help you activate your Medicare and then choose either option one or option two. The final bucket of clients who are on this call are those who are already on Medicare. If you’re already on Medicare, then the time to review your coverage is between October fifteenth and December seventh.

You can use that time, if you’re on option one, to review your stand alone prescription drug plan or if you’re on option two, to review your Medicare Advantage plan. So let me talk specifically to those who are already on Medicare. Here is your checklist for the period from October fifteenth to December seventh. First, last week, you should have received your annual notice of change.

This will describe how your plan is changing, if at all, for the upcoming year, and it will do a comparison, a side by side, between what you receive this year and what you’ll be receiving for next year. Then number two, you should step back and reflect on your three p’s.

What are your three p’s for the upcoming year? Perhaps they’re different than in previous years. And then finally, you should schedule your free Medicare consultation with the chapter team, and we’re going to have the QR code. Please scan that QR code, and that will offer you an appointment to review your coverage for the upcoming year.

So this is our three step checklist for those who are already on Medicare. Now it’s important to adjust or reconfirm your coverage every year, even if you’re happy with it, it. Because what’s changing year over year are, first, the regulations. Again, the maximum out of pocket on Medicare part d is beginning January first, and we don’t want you to miss out on that.

Just by taking fifteen minutes to meet with a senior Medicare adviser on our dedicated Mercer advisers team, we can help you save on average eleven hundred dollars and the savings could be even more significant this year. Now if you’re on option two, what’s changing about your coverage could be the physician networks. The networks can change year, midyear even on a Medicare Advantage plan. The benefits might be changing on your Medicare Advantage plan And also, the costs associated with your plan might be changing as well.

So, again, it’s really important to review it. And finally, I should note there’s competition here. So that’s why it’s so important to search every insurance company in every plan wherever you live in order to find the optimal plan based on your three piece.

Ari, thanks for going through kind of how to think about reviewing that. I know, I can probably speak for my a lot of people on the call. I love a good checklist. So being able to have that checklist of of what we’re looking at to make sure that we’ve got the best coverage that’s gonna meet people’s needs and hopefully save them a little bit of money. Great great option.

Wanna move now into a time where of q and a. We get a lot of questions. I’m seeing close to a hundred questions that have come in so far. So everyone continue to put your questions in.

We’re gonna spend the next portion of the webinar really answering some frequently asked questions. We’ve done these a a number of times, and we get similar themes. So we’ll highlight some of the frequently asked questions. But, again, want to make sure this is time well spent for each of you.

And and like Josh mentioned a minute ago, I’ll say it again. Continue to put those questions in the q and a. We will be answering those live. The the Medicare advisers are answering those behind the scenes for all of you.

So thank you to the many of you that have put those questions in.

Really wanting to make sure that we’re walking through that. So let’s jump into the first one. I’ve seen this a little bit in the in the information already today.

Talk a little bit, Ari. If I have a preexisting condition, you know, thinking about many people who might have a preexisting condition, can I be denied for a Medigap plan? Talk to us about this.

This is a fantastic question.

In forty six states, the answer is yes if you’re outside your Medigap open enrollment period. Your Medigap open enrollment period is the six months after you start your Medicare Part b. So your Medigap open enrollment period is your golden opportunity to elect option one. If you’re outside that six month period, then in forty six states, you might be subject to questions about your health history unless you have a guaranteed issue right, which are few and far between. So the four states that are the exception and offer year round guaranteed issue are all along the Eastern Atlantic seaboard, and they are New York, Connecticut, Massachusetts, and Maine. So if you don’t live in New York, Connecticut, Massachusetts, or Maine, and you know that you want to choose option one, then the best time to do it is in your Medigap open enrollment period, which is the six months after you start Medicare Part b.

Let’s move on to the second frequently asked question, which happens for a lot of our clients. Somebody who is past age sixty five, the age where you can first enroll in Medicare, but still planning to work for a little while longer. I’ve had a lot of clients who really love what they do. They work past age sixty five.

Do the the common question is, do they still need to enroll in part b?

Yeah. The answer is no so long as yours or your spouse’s employer has at least twenty employees.

The critical threshold is twenty employees. If you or your spouse work for an employer with nineteen or fewer employees, or if you’re self employed, then you need to start Medicare by way of turning sixty five. Otherwise, you might be subject to a part b late enrollment penalty. The other thing people mention here is, well, my company is going to pay for Cobra.

Do I still need to enroll in Medicare Part B? The answer is yes, because Cobra is considered secondary to Medicare. Medicare is designed to be primary. So even if you’re planning to go on COBRA, you still have to activate your Medicare part b so you have primary insurance.

This is one of the key Medicare mistakes we help clients avoid.

Okay. This is this is really good. I I saw a lot of questions about that, so I’m glad we we covered that, Ari. The next one comes up a lot when we are doing planning. So as Josh and I meet with clients throughout the year, especially headed into the year end, we’re generally doing a lot of tax planning with our clients, and this is something that I’m sitting with families and talking about right now, kind of a year end tax planning. How can we lower our clients’ tax bills or take advantage of maybe current tax laws, maybe realize some gains, for example?

Let’s talk about Irma. I’ve seen this question in the chat quite a bit. There’s a lot of questions. I know I saw James, an adviser answering questions on here.

Walk us through the what is the income related monthly adjusted amount, and who does it apply to?

Yeah. We love talking to clients about IRMAA. The government loves its acronyms. IRMAA is one of them.

IRMAA refers to the income related monthly adjustment amount. This applies to high earners based on your tax return from two years ago. So it’s a two year look back. For twenty twenty four, the government is looking at your twenty twenty two tax return to assess whether you’re a high earner.

For next year, the government is going to be looking at your twenty twenty three tax return. So what is the government looking at? They’re looking at your modified adjusted gross income. And these I earner surcharges, and there’s actually two, apply to your Part B and your Part D.

So even if you went Medicare Advantage, you would still be subject to IRMAA because remember the government collects these directly.

Charges. So this applies to someone who files solo and earns more than one hundred and three thousand dollars modified adjusted gross, or it applies to someone who files jointly and earns more than two hundred and six thousand dollars modified adjusted gross. And don’t worry, we’re actually going to share this one pager if you fill out the survey, if we’re going to send it along with the book. Now the government is updating these numbers for twenty twenty five. They haven’t been officially published yet, but it’s a good proxy to use the twenty twenty four IRRMA fact sheet in order to determine whether this would apply to you.

Exciting news here. This is appealable, and it’s something that we help the clients of Mercer Advisors save thousands of thousands of dollars on. If you have had a life changing circumstance, if you have had a life changing event, then you can actually appeal your IRMAA. And it’s a simple two page form.

All that you need is a life changing event. Now what qualifies as a life changing event? The top two are work stoppage or work reduction. Unfortunately, the third most common is divorce.

Now if you had a really good year in the stock market, for example, that does not count as a life changing event. But if you have had one of the eight that would qualify, and again, the top two are work stoppage or work reduction, then instead you would ask the government to use a more recent year. So instead of using your twenty two return, you would ask the government to look at your twenty twenty three return or your forecasted income for twenty twenty four.

And, again, this is something that we help you appeal, and it can save thousands of dollars for each of you. So a couple who wins their IRMAA appeal can save close to twelve thousand dollars per year in what they would have owed for surcharge for, the Medicare high earner tax.

I think that’s such a cool piece to focus on, Ari, because I know that as as Josh and I meet with clients, this is always something on people’s mind. And and I’ve seen your team walk, some of my clients through this process, and it’s just absolutely amazing to to partner with all of you. And I think while people are continuing to put questions in, one that I get a lot that I wanna just address right now is, you know, we’ve we’ve talked about how Mercer partners with chapter and it provides this service to our clients as a complimentary service. There’s no cost.

One thing that I’m seeing in the chat, Ari, and just wanna hear straight from you and the team is how does chapter make money if it’s a if it’s a a free service? You know, how how how do you guys make money? I’ve I’ve seen this question a lot. Josh, I know you’re seeing it come in too.

So just wanna address that for the the attendees today.

Yeah, all this sounds great, right? How do you get paid? Remember, we’re entirely complementary to you. There is no charge to work with chapter. Now chapter earns revenue from insurance companies, and it doesn’t matter which company you choose. We search every insurance company and every plan nationwide.

All that matters to our advisers is making the single best fitting recommendation based on your three p’s, based on your providers, your prescriptions, and your priorities. That’s the only thing that matters to our advisors. So our advisors incentives are entirely aligned with the clients of Mercer advisors. We act in your best interest.

Ari, that’s a really good point. For years and years before we started using chapter, I would have to find somebody. Once it was in Durango, Colorado, it was so hard to find a person who could help our clients in a specific location, and it’s great that you guys can search all those different locations, especially as our clients move around the country potentially.

We had this question come in a couple of times, which is, is Medicare ceasing to cover telehealth in January? There seem to be some, a couple of different questions that came in around that topic. Can you just talk and address, you know, what Medicare does around telehealth?

Yeah. So during the during the pandemic, there was a suspension of the telehealth regulations, and it was actually covered phenomenally by Medicare.

The final regulations are actually in flux around telehealth.

It will vary, depending on how the regulations shake out. So I would defer on whether they actually will be as generous in reimbursing for telehealth services for twenty twenty five. Because telehealth has become so popular, I would actually be surprised that those regulations go into effect, but we’ll see.

Alright. Can you just walk through the three p’s one more time? I know you I’ve said it a couple times, but I I saw a few more questions just on the three p’s. If you wanna just highlight that again for the listeners today.

Absolutely. The three p’s are your providers, who are the doctors that you see, who are the doctors you would want to see if you developed a chronic condition, let’s say. The second p, your prescriptions. What medications do you take, brand name or generic?

What dosages? That will affect price as well. And, of course, what pharmacy do you like to go to? And then the final p are your priorities.

What’s important to you? Do you love to travel? Are you planning to travel internationally? Do you have grandchildren on the way in a different state?

Do you winter in Florida or Arizona? All of that will affect will affect whether option one or option two is right for you as well. And, again, chapter is nationwide. We know all the rules state by state, and we help lots of clients who live in Hawaii and Alaska too.

We had this question come in a couple of times. You covered plan g, and some people were asking for some comparisons. A lot of people were on plan f. You mentioned how plan g was so comprehensive. Could you just give a brief kind of reason why we’re talking about plan g and not plan f like we used to?

Yeah. So plan g is the replacement for plan f. So if you turned sixty five prior to January first twenty twenty, then the most comprehensive for you coverage for you would have been Medigap plan letter f.

Now for someone who turns sixty five after January first twenty twenty, the most comprehensive plan letter type is Plan g. There is only one difference between Plan F and Plan G, and that is as follows. Plan F covers the Part B annual deductible, which is two forty dollars for this year. Plan G does not. That is the only difference between the two types of coverage. That is the only difference between Plan f and Plan g. Plan f covers the part b annual deductible.

Plan g does not. With that said, if you’re on Plan f and you’re in good health, you might be able to save hundreds, if not a one thousand dollars in premium by switching to plan g. The only question is whether the premiums you pay for are more than two forty dollars. So we can actually dollarize the savings. And if you’re in good health, then it might be worth shopping your plan f, and you can shop it at any time, actually. Remember, you’re not subject to the Medicare annual enrollment period.

Great. Sorry. And another question that I I saw come in a few times, especially as it relates to the updates that you highlighted today. You know, you talked about the the two thousand dollar, you know, max out of pocket. There’s some questions around, you know, do we think that that will, you know, be indefinite? Will that be for a fixed number of years? You know, you may not have the answer, but how should people be thinking about that two thousand dollar max piece?

I don’t have a crystal ball. It’s definitely going into effect for twenty twenty five.

So it’s really important to review your drug plan or your Medicare Advantage Plan before December seventh in order to take advantage of that two thousand dollar maximum out of pocket on your prescription cost. It is definitely going into effect on January first. And, again, in a fifteen minute review, what we’ll make sure of is that the plan of your choosing covers all of your prescriptions. Because if there’s a prescription that that plan leaves out, then it’s probably not the right one for you, because it will not those drugs will not be subject to the maximum out of pocket if they’re not covered by the plan that you choose. So it is crucial in order to action the two thousand dollar maximum out of pocket to review your drug coverage before December seventh.

Ari, another question that came in, was around you you just you talked about option one and option two earlier. And then the the next question was, well, what if I wanna change between option one and option two or from option two to option one? How should people think about making a change between those two?

Yeah. It’s it’s pretty rare to see someone go from option one that is Medigap to option two because of all the trade offs that you would have to accept. We see it, but it’s quite uncommon. And it’s something that we would really caution you against because of the trade offs inherent to option two. It’s managed care administered through a private insurance company and it would reduce your flexibility.

It is quite common to see the clients of Mercer advisors go from option two to option one. That is they leave their Medicare Advantage plan and instead elect Medigap and a stand alone prescription drug plan. If you want to do that, then the time to do it is before December seventh.

Awesome. Well, we’ve answered, goodness, north of a hundred questions here, approaching two hundred live, and and the advisers, again, I can see are still typing behind the scenes. So thank you to all of you who submitted your questions for our q and a session. I wanna thank you, Josh, for for cohosting, and thank you, Ari, for your time today along with the entire chapter team.

We have covered a lot today, a lot of different things, a lot of different topics from whether you are enrolling for the first time or you’re reviewing your coverage or how to appeal your your IRMAA status, a lot of different things, some great takeaways for our listeners today on really how to compare and weigh the cost of benefits and cost of these different varieties of plans. So, for those of you who have worked with us for a long time, you know that at Mercer Advisors, we really take a comprehensive holistic view on financial planning and truly believe that this Medicare component is an incredibly important piece of your overall financial plan.

If you are interested in connecting with chapter further for the one on one consultation that Ari highlighted, I would encourage you to take action. Scan the QR code that you see here on the screen today. It’s not that complicated. If you don’t have a smartphone today, I would encourage you to reach out to your wealth adviser here at Mercer Advisors, and they can get you connected with chapter four, a copy of Ari’s book as well as a one on one consultation.

Again, chapter’s chapter’s team provides this high touch service throughout the year. I know, even some of my family members have met with the chapter team regularly to review even following that initial consultation, and it’s just been an incredible value add. So, again, wanna thank you all for joining. Thank you again, Ari, and the entire team. And on behalf of Mercer Advisors and Chapter, we thank you all for joining and hope you have a wonderful rest of your day. Thanks so much.