Navigating Medicare: Your Guide to Open Enrollment Success

Good morning. Thank you guys for joining for this really great conversation. We’re excited to spend the next hour or so with you really diving into this idea of navigating Medicare, and in particular, what to think about as we head into open enrollment.

My name is Josh DeForest. I’m an Executive Managing Director here at Mercer Advisors, and I’ve been here at Mercer for, a little over fifteen years. Most of that time has been served as being an advisor and serving clients. And today, especially, my focus is really on making sure that all of our clients have an amazing experience here with Mercer Advisors.

And to to kind of set some context, our mission here is to really make sure that we can create the best context possible for you as clients to have a family office experience. What that means is to be able to have all of your financial questions answered as it relates to taxes, estate planning, insurance, investments, all in the context of your financial plan. And and our mission, what we’re really trying to do here is to try to make sure that you have expert resources at the ready to answer the important questions in a timely way. And that really brings us into this conversation, as we’re talking about, Medicare.

Before we jump in there really quickly, some of you guys may have seen that for the second year in a row, Barron’s ranked Mercer Advisors as the number one registered investment advisor in the industry. And a lot of that is because of our ability to bring all of these services to bear. We believe in trying to amplify our clients, financial lives, to help to simplify their financial lives, and really help everybody make the simple little decisions consistently correctly.

Because we believe that when you do the little things right, it adds up into real impact, in the end.

So, as a as a final note of housekeeping here, tomorrow, this recording of this webinar will be posted on mercer advisors dot com. And so if you wanna share this with somebody, you’ll get a copy of this in your email, but it will also be posted, on our sharing knowledge page on mercer advisors dot com. It’s also a great way if anything that we talk about today sparks an interest and you wanna have a further conversation, you can go to mercer advisors dot com and start that conversation if, you know, you’re not one of our existing, Mercer Advisors clients.

So, without further ado, I’m gonna take us into our conversation and introduce to you, our speaker today, Ari Parker.

Ari is the Co-founder of Chapter. He is a senior Medicare advisor. He’s also a Stanford trained attorney and the author of the book, It’s Not That Complicated, which really focuses on how to simplify the Medicare decision making process. Ari lives here in Phoenix where I reside as well with his wife, his two dogs, and young daughter. And so with that, Ari, welcome back to our seventh edition of, our Medicare conversations.

Thank you so much for having me, Josh. It’s great to join you.

Yeah. It’s so good to be here. We’re excited to have this conversation. Before we begin too, I wanna just note one thing.

Because this is a webinar format, you won’t be able to verbally ask questions here, but we’d highly encourage you to kinda look towards the bottom, use the q and a feature. We have people in the background who are ready to answer these questions. As a note, if it’s personal to you or it relates to, like, your personal situation, we’d encourage you to have a more in-depth discussion and we’ll have some links on how to be able to do that. But especially if you have a question about something that Ari says, or the topic at hand today, especially in a more general nature, they will be here and ready to answer all of your questions.

Just use that q and a feature, that you see here at the bottom. So with that, let’s take us into our agenda.

To set some context, we have two of these conversations each year. In May, Ari and I talked about the sort of Medicare one zero one, And we’re actually gonna spend the first part of today’s conversation reviewing some of those basics just to kind of set the framework, set the groundwork, so that we all know what we’re talking about in using the same terms.

In the second part of today’s conversation, we’re going to really shift into what we’re headed into in the next almost two weeks, which is open enrollment and what are the decisions and what are the frameworks that you should be thinking about as you have this opportunity to potentially make a change. What does it mean for you and how to make those decisions? And so that’s really what we’ll spend our time on today. So first, we’ll cover Medicare one zero one, then we’ll talk about, like, what is the difference between Medigap and Medicare Advantage, and then sort of this third bullet point here is, know, really what should you be thinking about as we head into, open enrollment. And so, Ari, just to kick things off, can you walk us through the basic components of Medicare and help us understand some of that terminology?

Absolutely. And before I do that, let me say that three in four seniors don’t understand what Medicare covers and what it doesn’t. By virtue of attending this presentation, you’re going to know more than ninety nine percent of people on Medicare, and I want to thank everyone who’s here. So with that, let’s talk about the key components of Medicare. You can picture Medicare as a three legged stool, three parts to Medicare, and you need all three legs of the stool.

The first leg is hospital coverage. What happens to you when you’re inpatient?

The second leg of the stool is your outpatient coverage. That’s services outside the hospital. And then the third leg of the stool is your drug coverage. Now each of these legs corresponds to a part.

Your hospital insurance, that’s Medicare Part A. Outpatient coverage, Part B. And finally, drug coverage, Part D. D as in drugs.

Let me unpack these legs of the stool a little further.

Medicare part a covers you when you’re inpatient at the hospital. It means you have a wristband.

It also provides coverage when you’re receiving inpatient mental health care, skilled nursing facility care, home health care, though this is a Goldilocks scenario, can’t be too much, can’t be too little, and finally, hospice care, which is an official diagnosis.

You might be wondering, this sounds great, how is it paid for? It’s paid for through your federal payroll taxes. If you or your spouse has paid federal payroll taxes for ten years or more, then Medicare Part A is premium free. There’s no monthly charge for Medicare Part A.

There is a deductible for each hospitalization and it’s substantial, so we’re going to talk about how to cover that a little later on. Then there’s Part b, the second leg of the stool. Part b is your outpatient coverage. This is visits to your primary, visits to specialists, lab work, x rays, MRI, CT scans, even durable medical equipment, like a heart monitor, a continuous glucose monitor, a wheelchair, or a walker is billed to Medicare Part B.

Now there’s a monthly charge for Part B. The standard premium for Part B is one hundred and eighty five dollars per month. So if you and your spouse are both on Medicare, then you owe a hundred eighty five dollars each per month, and Uncle Sam will collect this directly.

Now, if you’re a high earner, you’re going to pay more for Medicare part b. There’s a wealth tax, and we’ll talk about that a little later on.

In terms of oh, I’m sorry, Josh?

Yep. So so this is great. This cover is sort of like, you know, what, what Medicare does cover. There’s also this big section, almost twenty percent that it doesn’t cover. Can you talk about that a little bit more?

Yes. So in exchange for that a hundred eighty five dollars per month you pay to the government, you get eighty twenty coinsurance.

Government pays eighty percent, you owe twenty percent out of pocket. My mom lives in the Chicagoland area. She needed a knee replacement last summer. It’s a fifty thousand dollars procedure.

My mom would have owed ten thousand dollars out of pocket for her knee had she not had some type of additional coverage. The very next month, she slipped and broke her elbow, she would have owed twenty percent for everything related to the elbow as well. So there’s no financial limit on your twenty percent exposure. It’s uncapped.

The second big ticket item that original Medicare doesn’t cover is long term care. Long term care is defined by the activities of daily living, such as eating, bathing, dressing, even cognitive decline goes to long term care. Long term care is known under synonyms, twenty fourseven care, around the clock care, nursing care, custodial care.

That is all considered long term care, and as things stand today, there is no coverage under original Medicare for long term care. So I just wanted to footnote that here, the best time to have a conversation around long term care is in your late forties or your fifties. By the time you reach Medicare eligibility at sixty five, it’s oftentimes too expensive to insure for long term care.

Alright. I think that’s a really good point, and it really kind of highlights this overlap between health and wealth. And this is really the idea of making integrated financial decisions. I I believe that every person needs to have a plan for what to do with long term care.

Not that every person needs long term care insurance to be that plan, but planning for what happens when and if you need that is really a critical component. And we’ll talk about what to do about that, you know, part that Medicare does not cover in a second. But to kind of stay on this idea of, like, the three legged stool, and we’ve even seen some questions already coming in the chat about this. Can you talk a little bit about part d and what to think about there and maybe what some of the changes are that are coming up?

Part d is your drug benefit. And what surprises people is that Medicare Part a and Part b come from the government. That’s referred to as original Medicare. But Part d, you have to purchase through a private insurance company.

And there’s a penalty if you enroll late in Medicare Part D. So even if you don’t take any prescriptions at all, it’s important to consider getting Medicare Part D, so you have all three legs of the stool. So Part D, that’s your drug benefit. That’s for prescriptions.

And the reason to get it is so that you have prescription insurance throughout the year, because even if you don’t take prescriptions today, what if your doctor adds one next month or suggests that you start taking one? And then also, if you sign up for Part D coverage, you avoid the lifetime late enrollment penalty. And this lifetime late enrollment penalty is a headache, and it keeps compounding for as long as you delay signing up for Medicare Part D. The only people who have an exception here are those who receive drug coverage at least as good as what they would have received from Medicare Part D.

So there’s two ways to get a standalone prescription drug plan. We’re going to talk about them as we get into the discussion around additional coverage, but just know that Medicare Part D doesn’t come from the government. You have to purchase it from a private insurance company in order to avoid that lifetime late enrollment penalty.

Now, Josh mentioned that there are changes coming to Medicare Part D, and they’re very significant, and they go into effect January first. So in order to action these changes, you need to review your coverage starting October fifteenth and do it no later than December seventh.

So first, there’s going to be a maximum annual out of pocket cap on Medicare Part d. This is really significant.

Previously, between two thousand six and twenty twenty three, there was no maximum annual out of pocket on your drug costs. So someone who was on an expensive brand name or specialty medication to fight cancer’s metabolic pathways, they easily could have owed ten thousand dollars to fifteen thousand dollars for their medications.

That’s no longer the case. Now, there’s a maximum annual out of pocket on Medicare Part D, and that max is twenty one hundred dollars for the upcoming year. In order to action this change though, all of your drugs must be covered under the plan that you choose. If one of the drugs isn’t covered, then that medication isn’t subject to the maximum annual out of pocket cap.

The second change that’s on the way for twenty twenty six is that insurance companies are automatically going to apply smoothing to your drug costs. Previously, if you were on an expensive medication, you could have owed thousands of dollars in January or February when you went to fill the prescription at the pharmacy.

Now, there’s going to be smoothing applied. So even if you’re on a very expensive medication, as long as it’s covered under the Part D plan of your choosing or the Medicare Advantage plan, then they’re going to smooth that amount. So you’re going to owe a little less than two hundred dollars per month. It’s way better than forking over thousands of dollars to the pharmacist at the beginning of the year.

The final change that’s coming and by the way, there are many, many changes. I’m just mentioning three here. The final change that I’m going to mention here is that Medicare is negotiating ten prescriptions on your behalf for the upcoming year. These are ten of the most expensive prescriptions. And if you’re on one of those medications, it really you really should notice significant cost savings come January.

Again, in order to action these improvements to part d, review your coverage between October fifteenth and December seventh. That’s your time to take advantage of these improvements.

Excellent. So we kind of talked earlier about how Medicare covers most but not all of what the, expenses could be. So can you talk to us a little bit more about, how people go about covering that twenty percent gap so that they don’t have to pay for that all out of pocket?

That’s absolutely right. So remember, original Medicare leaves you exposed to twenty percent uncapped on your medical expenses. Remember my mom’s knee replacement.

And it also doesn’t cover prescriptions. Prescriptions you have to get through a private insurance company. What’s more, original Medicare doesn’t cover dental, vision, or hearing. So when clients realize that there are these gaps under original Medicare and that they don’t actually have comprehensive insurance, that’s what motivates the conversation around what type of additional coverage to choose. So that way you have comprehensive coverage.

This is, I think, where it gets really complicated seeming for most people. You get all of these things in the mail. There’s all of these, you know, commercials on television from famous people, and the terminology starts to get kind of wonky. I think this is where most people get lost. Can you start to kind of walk us through how well, there’s a lot of stuff flying around and, you know, the alphabet soup that goes out there.

What actually are we talking about here with the couple of options that people have?

There are two ways to achieve comprehensive coverage.

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

If you go this route, the only other thing you would need to add is a standalone prescription drug plan. So you have all three legs of the stool.

The second option is what you see advertised on television. These are Medicare Advantage plans. And as as you mentioned, Josh, you could pick your favorite Medicare Advantage spokesperson, Joe Namath, Jimmy Walker, William Shatner. They’re talking about a replacement for original Medicare administered by a private insurance company and subject to the private insurance company’s terms and conditions.

So here’s where we’re in the world of managed care. We have network restrictions. So all your doctors need to be covered by the plan that you’re choosing. Otherwise, you’re going to owe a lot more at the time of service.

Now what people like about Medicare Advantage is that it oftentimes includes prescription drug coverage, and it can come with additional goodies like dental, vision, and hearing. What people like a lot less is that it’s less flexible coverage, and it’s also less comprehensive coverage. It’s pay as you go insurance.

And these are mutually exclusive. It’s one or the op one or the other. You can’t have both option one or option two. You can’t have both option one and option two. And also, regardless of whether you choose option one or option two, you still owe the part b premium to Uncle Sam of a hundred eighty five dollars per month for part b.

So there’s a couple of, like, key things that people have to think about. You you’ve called them the three p’s when we’ve talked about them before and, like, how to really think about getting a little bit more granular on this decision. Can you talk about that?

The three p’s are the framework that we use for helping you evaluate your coverage in a one on one consultation with our team. And there’s no charge to use chapter. It is entirely complimentary to you. And if you’d like to sign up for a consult with us, we’d be delighted to serve you. And you can just drop your question in the chat and we can share the link. And we’ll also have a QR code at the end that will offer you a one on one consultation.

The three p framework that we will discuss with you in a forty five minute consultation is, first, your providers. Who are the doctors that you want to see for the upcoming year? What doctors would you want to go to if you developed a chronic condition?

The second p, your prescriptions. What medications do you take? Brand name or generic? What pharmacy do you like to go to? A national chain or a mom and pop drugstore?

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

Do your grandchildren live in a different state? Do you own an RV and love being on the road? Do you plan to travel internationally?

All of this will factor in to helping you decide between option one or option two, and then narrowing down to the single best fitting plan based on your needs.

So it’s it’s no wonder why we’ve already gotten some questions in the chat about plan f or plan g. You know, can you just talk about, like, why, you know, really at the end of the day and in my experience as an advisor, most of the clients who I’ve worked with after hearing all of the information and and thinking about their options, understanding how it fits inside of a financial plan, end up going with option one where they get this supplemental or Medigap coverage. Can you just talk about a little bit more about, like, why that’s the case?

Absolutely. And as you mentioned, yes. Most clients choose option one. Most Mercer Advisors clients choose option one, the vast majority, in fact.

Here’s why. First, they appreciate not having to worry about whether their doctor is in or out of network. Original Medicare is networkless, and over ninety three percent of doctors accept it nationwide. In fact, the only ones who don’t tend to be pediatricians.

The second reason clients of Mercer Advisors tend to choose option one is they appreciate the freedom to see any specialist they want nationwide. If you want to go to the Mayo Clinic in Rochester or Scottsdale, that’s no problem if you have Medicare Supplement. The same thing goes for the Cleveland Clinic, MD Anderson, Sloan Kettering, you name it. I know we have attendees who live all over the country, so I just wanted to mention those institutions specifically.

There are no HMO like features under Medigap because original Medicare is networkless. And remember, Medigap covers the gap. It covers the twenty percent you’d otherwise owe out of pocket.

The other reason that clients of Mercer advisors tend to choose Medicare supplement is what Josh mentioned. They appreciate the cost certainty.

Let me help you picture just how significant this is. Your Part b annual deductible for this calendar year is two hundred and fifty seven dollars Under certain Medigap plan letter types, and some have been thrown out already, and I’m going to go unpack them further in the next slide, your maximum out of pocket would also be two hundred and fifty seven dollars for this year. If you compare that to my work provided insurance, my wife, daughter, and I have a six thousand dollar deductible. Meaning, we don’t see a dollar of benefit until we hit six thousand dollars Under original Medicare, your Part b annual deductible is two hundred fifty seven dollars for this year. And under certain Medigap plan letter types, it caps your maximum annual out of pocket for this year at two hundred fifty seven dollars as well.

So that is significant cost certainty.

And the final thing that I’ll mention is Medigap is designed to last a lifetime. If you’re turning sixty five today and you choose Medicare Supplement, then your benefits won’t change year over year. So you’re making a thirty to thirty five year purchasing decision. That’s how long actuarial tables suggest you have.

Indeed, if you’re sixty five today, you have a fiftyfifty shot of living to one hundred. So as your health needs change in your eighties and nineties, you’re probably going to want to be on Medicare supplement because it’s the most flexible and comprehensive type of coverage. So marry your Medigap, date your drug plan. That’s the way we train our team here at chapter. The time to marry your Medigap is when you first start Medicare. The time to date your drug plan is every fall.

So you you talked about that and, you know, in my experience, a lot of our clients have either historically chosen plan f. Now especially they’re choosing plan g. You know, let’s dive into that a little bit deeper and and kind of give some of those details you were talking about.

Let’s have some fun. So each Medigap plan letter type is standardized under federal law. Plan f is standardized under federal law. Plan g is standardized under federal law. Plan n is standardized under federal law. Meaning that each Medicare Supplement insurer must cover the same hospital and medical benefits.

So what they’re really competing on is price, and not just the upfront price, but the price over the long haul because you’re making a thirty to thirty five year purchasing decision, and they’re also competing on creditworthiness.

So here’s what Medigap Plan G must cover under federal law. First, there’s no network restrictions. Your network is the same as original Medicare, and almost every doctor nationwide accepts original Medicare, and that goes for every institution as well.

Second, there’s no referral required for a specialist visit. You don’t need anyone’s permission in order to get a second opinion.

Third, there’s no additional bills or co pays under Medigap Plan g once you hit your Part b annual deductible, which is two hundred and fifty seven dollars for this year. The coverage works nationwide, so if you live in Texas and you want to get a second opinion in Arizona or California, it’s no problem. Or if you were visiting your grandchildren and you wanna see a specialist in one of those states, it’s no issue.

And finally, Medigap Plan G includes eighty percent international coverage when you travel abroad. And this really helped a client who was vacationing in Paris over the summer. This was written about in the Wall Street Journal. They actually suffered a heart condition, and they needed to be hospitalized for almost two weeks.

Our member advocate team was able to help them get eighty percent reimbursement on their almost thirty k hospital stay. So it didn’t ruin their trip. We helped them get twenty four thousand dollars in reimbursement. Now, the eighty percent international coverage benefit is subject to a couple limitations.

First, it’s only for the first sixty days that you’re outside the United States, and second, it’s subject to a lifetime maximum of fifty thousand dollars but that goes a long way even in Western Europe. Those countries have a lot less expensive health care than here in the United States.

Ari, I’m laughing, a little bit because there’s a there’s a comment in the in the question that, from a hospital administrator that says they refer to Medicare Advantage, in their group and, you know, in their private practice as, Medicare disadvantage, which might lead us into our next conversation. So if we just talked about and this is true of the clients who I’ve served as well, even before we worked with chapter, but especially now that we do. If if if all that’s true, if it’s better flexibility, it’s better coverage, etcetera, why do so many people end up going with option two Medicare Advantage and, you know, all the things that people see on TV?

Yep.

Option two is Medicare Advantage, and you might see these plans advertised as all in one coverage or Medicare Part C. It’s all referring to the same thing, Medicare Advantage. And this is a replacement for original Medicare administered by a private insurance company and subject to that insurance company’s terms and conditions. And there’s usually hundreds of pages of terms and conditions.

So here’s why people tend to here’s why people may choose Medicare Advantage. First, they want to take a bet on their health. They’re in very good health, and they don’t anticipate their health changing.

Two, they don’t go to the doctor very often.

Three, they’re tempted by the additional benefits that are advertised by the plan. For example, dental, vision, or hearing. And these benefits vary county by county across the United States. So even an advertisement you might see promising you, for example, a substantial dental benefit might not be available in your specific county.

So these plans vary county by county across the United States. The important things are that to remember is that this is managed care. So this is where we’re in the world of HMOs or PPOs, unlike original Medicare, which is networkless. The other thing to remember is this is pay as you go insurance.

When you go to the doctor, you’re going to either owe co pays or coinsurance, and these can really stack up when you need care.

So it can ultimately be more expensive in the long run.

The final thing that I wanna mention here is that you’re time restricted as to when you can get Medicare Supplement. In forty six states, you have a one time window in order to choose Medigap without any questions about your health history. And that is the six months after you start Medicare Part b. So if you’re watching this and you know you want option one, then the best time to sign up is when you first start Medicare.

This will get into our next section. There’s a question actually that came in, the chat that said, you know, marry your Medigap plan, question mark. But what if the price increases of that plan?

And so, this I think will get into really this next section, which is, okay, we’re heading into open enrollment.

What are the various things that we should be thinking about as we head into this next period that begins on October fifteenth where we have the option to make changes?

Yep. The Medicare annual enrollment period is less than three weeks away. Starting October fifteenth is the time for you to review your coverage for the upcoming year. During this time, if you’ve been on a Medicare Advantage Plan, you can use the annual enrollment period to switch to original Medicare.

And in forty six states, you may have to answer questions about your health history. In four states, you have year round guaranteed issue to sign up for Medicare supplement. The four states that have year round guaranteed issue are New York, Connecticut, Massachusetts, and Maine. So if you’re along the Northern Atlantic Seaboard, good news, you can switch from Medicare Advantage to Medicare Supplement without any questions about your health history.

If you live in one of the other forty six states, you may have to answer seven to ten questions about your recent health history. But it’s not as scary as a life insurance exam, for example. There’s not someone who comes and takes your vitals and draws your labs. It’s just seven to ten questions about your recent health history, and those question those questions vary insurance company by insurance company.

What else can you do during the Medicare annual enrollment period? Well, it’s also the time for you to review your drug coverage. So even if you’re perfectly happy with your Medicare supplement plan and you’re happy with the price that you’re paying, it’s the time for you to review your drug coverage for the upcoming year, especially so you take so you take advantage of those upcoming regulatory changes that Josh and I spoke about earlier. So this is the time, Medicare annual enrollment period, it’s the time for you to review your drug plan. Or if you’re on Medicare Advantage, it’s the time for you to shop your Medicare Advantage plan because the Medicare Advantage plans change every year, and I’m going to talk about that more in a little bit.

So I yeah. I think this is this is the next piece is, you know, you like your plan, but, like, what we should do? Should I continue to think about this? You know? Do I need to do anything?

Walk us through that.

Yep. You should adjust or reconfirm your coverage every year. And it’s really important to work with an independent unbiased advisory that can go through your three p’s. They can go through your providers, your prescriptions, and your priorities for the upcoming year. And I wish you could do this easily through medicare dot gov. Bad news, you really can’t. Instead, it’s important to work with an independent unbiased advisory that can help you compare and evaluate all your options.

What’s changing every year are your pre are the premium and costs associated with the plan if you’re on Medicare Advantage, and that’s also true for your stand alone prescription drug plan.

What’s also changing are the benefits if you’re on Medicare Advantage. And finally, under Medicare Advantage, the physician networks are changing as well. They can even change midyear, in fact, which is a huge surprise to many. Under Medicare Advantage, your network can change midyear.

So here is your checklist to prepare for the upcoming annual enrollment period, which begins October fifteenth. First, at the end of last week or perhaps earlier this week, you should have received your annual notice of change. This will describe how your plan will operate for the upcoming year.

Two, write out your three P’s.

And we’re going to offer a copy of my short book on Medicare. It has a worksheet at the beginning that encourages you to write out your three p’s. And we’re going to offer a complimentary copy of it by virtue of you attending this presentation. So the second step to prepare for the annual enrollment period is to write out your three p’s. And then third and finally, reach out to your Mercer advisor in order to schedule your free Medicare consultation.

So I think this is a good summary. So just to sort of like cover here. We’ve kind of talked about the basics and some of the, language used around Medicare. We’ve talked about what’s changing, also what to do about open enrollment.

So what should our clients be thinking about next? What types of areas should people be taking action in? Because I’ve seen a lot of these questions coming in around, you know, when do I initially sign up? How do I think about open enrollment?

I think you have a good summary here on the next slide.

How do we think about this, like, when to take action?

Yep. Three buckets. First, those who are turning sixty five. If you have a birth a nineteen sixty birthday or if you are turning sixty five in the first half of nineteen sixty one, now is the time to meet with us and to discuss your three p’s. So we can help you decide between option one or option two, and so we can help you activate your original Medicare.

It takes less than five minutes if you do it through your online Social Security account portal. It’s fast, safe, and secure, and it’s way better than calling the Social Security Administration’s call center, where you’ll wait on hold for over ninety minutes and they won’t help you sign up for Medicare. So we would love to help you activate your Medicare and then to discuss your three p’s. The second bucket of clients, those who are past age sixty five and are retiring.

If you’re retiring or your spouse is retiring before the end of the year, now is the time for us to help you get your health coverage in order, so that way you have continuity of health insurance when your work provided coverage ends. If you’re delaying until after you retire, I have bad news to report. COBRA isn’t creditable for the purpose of delaying Medicare. COBRA is only secondary to Medicare.

This is one of the biggest mistakes we see clients make, and we will help you avoid it if you reach out for a consultation.

Then the final bucket of, the the the final bucket of attendees, those who are already on Medicare, a lot of this presentation has been geared towards you. Remember your checklist, review your annual notice of change if you’re already on Medicare, write out your three p’s, and then schedule your review so that we can make sure you’re on the best fitting coverage for twenty twenty six.

Excellent. So in this next section, we actually asked all of you for questions that you had ahead of time. We sort of collated some of them, and you’ve asked you’ve you you all have asked a bunch of questions, but we wanted to get to some of the most frequently asked questions that we kind of heard in advance of this. And so, you know, Ari, really the first one that we have is around this idea of, you know, my prescription hasn’t changed. You know, should I still review my coverage in three weeks when I have the opportunity to?

Yes. Absolutely. Because even if your prescriptions haven’t changed, the way your plan covers those prescriptions may have changed. Changed. And we wanna make sure that you take advantage of the new changes that are coming to Medicare Part d for twenty twenty six. In order to action those changes, you need to review your coverage during the annual enrollment period.

And then the next one that came through was, you know, can I use the annual enrollment period to switch to a Medigap or a Medicare supplemental plan? I saw I even saw that question come in a few times as we were, going through the presentation today.

The answer is yes. In forty six states, you may have to answer questions about your health your health history, and it’s just seven to ten questions about your recent health history. And then if you’re insurable, you get to switch from your Medicare Advantage plan to a Medicare Supplement plan and also sign up for a standalone prescription drug plan. So the annual enrollment period is the time that you can switch from Medicare Advantage to Medicare Supplement.

Excellent. And I actually saw this question come in the chat several times too. So it’s around this idea of, you know, I’m past age sixty five, but I’m gonna keep working. And I might work another two or three years, so maybe I’ll be sixty seven or sixty eight when I’m done working and actually retire. Do I need to enroll in Medicare part b now, and how do I think about, you know, working past age sixty five?

The only people who have an exception to delay starting Medicare are those who work for a large employer.

So if you or your spouse work for a large employer, that means twenty employees or more, rule of twenty, then you have an exception to delay starting Medicare. So as long as the questioner works for a large employee or employer or their spouse works for a large employer, they do not need to enroll in Medicare part b until they or their spouse are ready to retire.

Excellent. And then this next question that we’re gonna talk about, and I again, I saw several of these come in, so I’m glad that we actually put these in the in the front, which is there’s this idea you talked about this earlier. There’s the base premiums that you pay for Medicare.

Then we have this idea called IRMAA, and we wanna talk a little bit about that. But before we do, I think this is really one of those examples where engaging with an expert in the arena like chapter for Medicare is really important, but also understanding how that affects your tax picture, how that may have changed over time, integrating all of these decisions into a comprehensive financial plan is something that is really, really important. And so I wanna kind of talk about this idea of marrying tax planning and also, you know, doing things like Roth conversions or, you know, tax loss harvesting in a portfolio, etcetera. But then thinking about how that has an impact on how much you actually pay for Medicare. So can you talk a little bit about how to think about that?

Absolutely.

The standard part b premium for this year is one hundred and eighty five dollars per month. If you’re a high earner, you are going to pay more. You’re going to pay more in two ways. You’re going to pay more on Medicare part b, and you’re also going to pay a surcharge on Medicare part d.

These surcharges are referred to as the income related monthly adjustment amount, or as the government lovingly calls it, IRMAA. That’s their acronym for it. Don’t ask me why, but that’s their acronym, IRMAA. So you are subject to IRMA based on a two year look back.

So for this year, the government is looking at your tax return from two years ago. And for next year, the government is going to be looking at your twenty twenty four tax return. And the numbers for next year haven’t been published yet. So these are the numbers that you should be looking at based on your twenty twenty three return.

So if you are a solo filer and you earn more than a hundred and six thousand dollars modified adjusted gross income, or if you’re a joint filer and you earn more than two hundred and twelve thousand dollars modified adjusted gross income, then you are subject to those two surcharges, one on Medicare Part B and one on Medicare Part D. And if your spouse is also on Medicare, then they are also subject to those surcharges.

This is something that’s appealable. We help clients of Mercer Advisors appeal their IRMAA all the time, and we are very successful at helping you knock down your IRMAA. All we request that the government do is look at a more recent year because they’re looking at stale information from two years ago. So if you’ve had a life changing event, then we can help you appeal your IRMAA. And there’s eight life changing events that the Social Security Administration spells out. The two most common are work stoppage or work reduction, and sadly, the third most common is divorce. But if you have one of these eight life changing exceptions, we can help you appeal your IRMAA and instead request that the government look at a more recent tax year, either twenty twenty four or your anticipated income for twenty twenty five.

Ari, a question came in. Can you clarify for the IRMAA addition? Is that per month or or on what basis is that?

Correct. These are per month surcharges. Yes. It it is really significant. So we help clients appeal their IRMA, and it can save ten to twelve thousand dollars per couple if they have a life changing event that substantially knocked down their income.

Yeah. This can be really important. It’s it’s not a thing that you can do all the time, but especially if you have these big events that already talked about. It can be really important.

It can save you hundreds, if not potentially thousands of dollars per year if if it applies. And so it’s one of those things that, I would recommend, you know, if you have a question about it, ask it. We can set up a consultation with chapter. If you’re a Mercer advisor’s client, I highly recommend that you engage with your advisor on this topic because there’s a lot of modeling of tax returns that we can do so that we can really plan for years in the future.

But really understanding, like, where we can have impact here is is gonna be really, important.

So, I’ll I’ll note a couple of things here. We, have the team behind the scenes has already answered ninety questions, and we still have forty two that we have not answered yet. So we’re gonna get through some of these actually as we go through this. But, before we do, there’s a couple of things that I would just note here. If you want a copy of Ari’s book, you can get out your phone and open up the camera app and look and click on this QR code. It will take you to a web page that will allow you to engage with chapter but importantly sign up and receive a copy of the book.

In the chat, I’ve also put links to merceradvisors dot com if you want to start a conversation with Mercer advisors. I’ve also put a link to how to engage with chapter as well if you have Medicare specific conversation or questions rather. And I’d encourage you to do both. This is really the way that we can really integrate really good decisions here. So, we’ll leave this up. But, Ari, I’ll ask you a couple of questions that I saw come through.

One question that we get every single time, but, and I know I love to ask it and you love to answer it is, you mentioned earlier that it’s it’s free to work with chapter. I think we’re all conditioned to believe that nothing in life is free. So obviously, chapter is not a non profit organization. How do you make money? Why does it still make sense to use Chapter in this context? And like, why not do it on their own?

Yes. Absolutely. And people are welcome to do it on their own. You can certainly use medicare dot gov as a resource.

And you’re welcome to also get a second opinion from us. So even if you’re a long ways away on your research, we would love to help you evaluate your options. Now the way that chapter earns revenue is from insurance companies, and it doesn’t matter which insurance company you choose. In fact, our advisors are blinded as to which plans chapter earns revenue from and which ones we don’t.

So all that our platform is evaluating, which is what our advisors use to sort through your three p’s, are your providers, your prescriptions, and your priorities. And then our advisors discuss a short list of plans with you for your consideration and help you end to end by completing the paperwork. And then we provide ongoing year round concierge support through our member advocate team, which is your first line of defense for any questions that come up. Instead of calling the insurance company, you call chapter, and we get to the bottom of the issue.

Ari, the question came up. We talked about plan g. I think some people had some questions. What, what is the difference between plan f, plan g? Should people think about switching between the two? I saw that question come up a couple of times as well.

Plan g and plan f are identical with one difference.

Plan f covers the part b annual deductible, which is two hundred and fifty seven dollars for this year, whereas Plan g does not. So the only difference between Plan f and Plan g for this year is the two hundred fifty seven dollar Part b annual deductible. So if you would save more than two hundred fifty seven dollars in premiums, then you should consider switching from Plan F to Plan G. And many, many people save thousands of dollars on their premium by switching from Plan F to Plan G, even taking that Part b annual deductible into account. So it’s a good call out, Josh. If you’re on Plan f, the replacement for Plan f is Plan g, and the only difference is the Part b annual deductible. Yeah.

Yeah. It’s a good point. Plan f is sort of what we used to be in the past. Plan g is really the way forward, and that’s a really important thing to to consider here.

A a question came in. Somebody missed it. Can you cover what are the three p’s again? I think that would actually be a good review here.

Oh, I love that question. The three p’s are your providers. Who are the doctors that you see? Who are the doctors you’d want to see if you developed a chronic condition?

What institutions would you want to go to? For example, MD Anderson, which is probably the nation’s leading cancer research institute, or the Mayo Clinic.

Second, your prescriptions. What medications do you take? Brand name or generic? What pharmacy do you like to go to?

And then the third p, your priorities. What’s important to you? How are you planning to spend your golden years? Are you planning to visit your grandchildren often?

Are you planning to winter in a different state? Do you have plans to travel internationally? All of this factors into what coverage is right for you in deciding between Medigap versus Medicare Advantage.

Excellent. And there’s a question that actually I’ll answer, which was, you know, as we think about IRMA, if you actually wanna go to that, that page, it was sort of what is what is included when we’re talking about income here. For the most part, they call this this modified adjusted gross income, MAGI.

Interestingly enough, there’s about five different ways that you can define it. And the simplest thing that I would say is in the way that we always help clients with this is we actually take your tax return, look at it, make adjustments for what’s happened in year before you go and file your twenty twenty five return so that we can actually do the math right. But for the most part, most of the things that you think of, capital gains, dividends, you know, if you have a w two income, etcetera, are included here. This is actually why it’s important to do tax planning in advance because if you do a Roth conversion, that counts towards this. If you realize capital gains, that counts towards this. But the reverse is true. If you can loss harvest and things like that, it can all have an impact here.

But the answer is it’s you know, our Ari’s book is called It’s Not That Complicated. Unfortunately, it’s the IRS, so it actually is that complicated.

And, but we can help really simplify a lot of that because we have a really good analysis tool that can give you a lot of clarity on exactly your situation, and what that means for you.

So, I I like this question. Ari, can you talk about how chapter is different from other Medicare enrollment services?

We’re different in dozens of ways. The best way to experience it is to have a one on one consultation with one of our advisors so you can feel it for yourself. But here are some ways in which we’re different. First, we built a platform that has every insurance company and every plan nationwide.

And there’s over twenty four thousand plans across the United States, and they vary county by county depending on where you live. So here in Maricopa County, there are over two fifty different options for me to choose from. And that is on Medicare supplement, there’s over seventy options. On Medicare Advantage, there’s well over fifty options.

And then there’s the standalone prescription drug plan to talk about if I choose Medicare supplement. So that’s number one. We built a platform that has all the information at the touch of our adviser’s fingertips. It’s sortable based on your three p’s, your providers, your prescriptions, and your priorities.

Second, we blind our advisers as to which plans chapter earns revenue from and which ones we don’t. This creates a fiduciary like standard to you. We our North Star is we will always act in your best interest. Our advisers are blinded as to which plans we earn revenue from, and moreover, they are only compensated on making the best fitting recommendation to you.

The third thing that I wanna mention here as a clear differentiator is our ongoing concierge support. You are not just supported by the Medicare advisor that you speak with, you’re also supported by our member advocate team. They will fight to the end of the earth for you, whether that’s a misplaced ID card, a question about a claims invoice. Those are written in hieroglyphics.

They will help decipher it, and they’ll call the insurance coordinator at your physician’s office in order to help you lower a bill. And moreover, what if you’re at the pharmacy and you receive a ridiculous quote for a co pay? We will call the insurance company on your behalf to try to get that co pay knocked down. There might be an issue in the way that the pharmacist is invoicing it.

Those are all examples of the types of support that you will receive from our member advocate team day in and day out.

So I think we have time for two more questions. But before I ask you them, I wanna note just a couple of things just because, even though the team has now answered forty more questions since we started doing q and a, we still have forty unanswered questions at this point in time. A couple of things that are important here. If you go to the chat, you’ll find the link on how you can ask your questions directly with chapter, especially if it’s specific to Medicare. So I highly encourage you to go to the chat, copy down the link.

If if the question is more related to your tax and your overall financial plan, the link is there also for mercer advisors dot com. If you’re not a client, we’d love to begin to engage with you on that. If you are, I’d highly recommend that you reach out to your advisor. They, your Mercer advisor, can also put you in touch with chapter, as well.

So I just wanna note that just in case we don’t get to your questions. And then the last piece is we are taking a note of this, and so we will try to do our best to do as much follow-up as we can, even after we’re done because I think we could be here for two more hours, answering all the questions. And, as much as Ari and I would like to do that, I don’t know that all of you want to stay on here for two more hours. So, the question here is, how do you when you think about plan g, how do you go about evaluating, you know, insurance company a who offers plan g and insurance company b?

How do you go about comparing which one is better and making the right recommendation there?

Our advisers have this pricing information at the touch of their fingertips. It’s not just a question of the initial price. It’s also a question of the twenty year sum of premium index, which is taking your age and adding five years, ten years, fifteen years, twenty years, and seeing, based on today’s pricing information, how a carrier would charge you.

So it’s not just a question of today’s rates. It’s also a question of how an insurance company historically has raised rates and how they would price you based on the existing information.

Additionally, we take their creditworthiness into account. So for example, are they an a plus rated carrier, a minus? Are they lower rated? That’s something we want to discuss with you as well.

We also want to discuss the way a carrier adjusts their pricing. So there’s issue age rating, there’s attained age rating, and there’s community age rating. And we want to discuss those variations with you because that will also affect and restrain how a carrier can ultimately increase your premium over time because you’re making a thirty to thirty five year purchasing decision. So we really want to go get into the weeds, get into the details of how you’re of setting expectations around how an insurance company may raise prices over time.

Because, of course, they all get inflation, and we don’t know what inflation will be tomorrow.

And then the last question here, if you go back two slides to the Irma one, was just a clarification. So so just to be clear, as you step up into these higher levels of premiums, it actually affects your part b premium as well as your part d premium as well.

So with that, Ari, if you wanna go to the the last slide, one last chance to, use the QR code and get a copy of the book. And and I’ll answer one last question that sort of came through that that people have had, which is, you know, can Mercer Advisors help with these other areas related to insurance in my financial life? Because chapter helps specifically as it relates to Medicare, but we our job as fiduciaries, our job as a family office is to address all of the areas of financial need. Whether that’s, you know, long term care insurance, life insurance, you know, all of the different ways that you may need help. But importantly, we do that in the construct of a financial plan. We start with the financial planning process, we evaluate impacts on taxes, goals, where are you trying to get to, what is your investment plan and your income, and all of those things help us to make decisions as fiduciaries.

The last thing that I’ll just note here is that our job at Mercer Advisors is to make sure that we bring the best to bear for every single one of our clients, and we are legally obligated to act in our best interest. That’s why we’ve partnered with chapter. It’s why we partnered with other firms in different capacities. And I I really hope that today you’ve gained a greater understanding both of how health and wealth intersect with each other.

Hopefully, you’ve gotten some of your very specific questions answered about what to do with your Medicare coverage in in, to be specific. But also, if you have more broad questions, if you wanna explore any of these topics further, if your Mercer Advisors client have said this, reach out to your Mercer Advisor. We would love to engage with you on this. Your advisor can put you in touch with chapter as well.

But if you’re not, we’d love to have a conversation with you about this and many other things too, and we can do that through mercer advisors dot com and really begin that conversation. So, Ari, thank you so much for your time today. This is a really great discussion. I think we got a lot out of it, and, we really appreciate your time today.

Thank you.

Thank you so much for having me, Josh.