Whether you are under 65 and shopping for plans outside of your employer—or as a self-employed business owner—or you’re retired and looking to better understand Medicare, this webinar will help you make sense of your options.
We cover:
Why working with an agent is at no cost to you
The differences between Bronze, Silver, Gold, and HSA plans
Marketplace vs. off-Marketplace options and how tax credits work
Medicare basics, including Parts A & B and the two main paths: Medigap vs. Advantage plans
Ancillary coverage such as dental, vision, travel, and final expense plans
You may be surprised to learn that the advice of a knowledgeable agent can be invaluable—and working with one never costs more than going it alone.
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Thank you for joining us. With me today is Paul Minor. He is an expert in all things health insurance, and we brought him back for, I believe this is his third annual appearance because he's done such a great job. So he's our local go-to guy for anything health insurance related. As you can imagine, we get a lot of health insurance questions. It impacts a lot of things. It impacts taxes. It impacts retirement spending. So he's going to walk through a lot of the nuances today. This is going to be recorded. If anybody would like a copy, we're happy to share it with you. You can share it with a friend or family, and if they have questions, they are welcome to reach out. We both offer a complimentary consultation if they would like. As always, you have down here at the bottom the chat or the raise hand. If you want to raise your hand and we can unmute you for a question, or easiest way is just to talk into the chat, and then at the end of the presentation, which will be roughly 20 minutes, Paul will take questions then. So with that, Paul, go ahead. All right. Fantastic. So glad to be here and with you today, and so I'm going to go over all the information. Thank you for that introduction. We'll just jump right into the slide. But why use an agent? There we go. You can just call an insurance company, for example, and work it that way. But just like you do with finances, having someone to go to, having someone in between that can answer questions, that can compare multiple insurance companies at the same time and multiple insurances and they're actually on your side because they want what's good for you. And there's no cost, which is great. That's my love language right there. If it's $0, that's it. And it's the same plan, the same price to you using an agent. Plus, I provide ongoing support as you continue on year after year. Even if you're like, "Hey, I want to do some of the research my own", well, year after year, that kind of fades and you're like, "Hey, I want someone else to keep up with all these industry trends." So with that and the expertise, I've always felt like maybe a better question would be, why not use an agent because of that? Now, I see the slide deck up here, but I'm not sure on changing... There we go. Yeah. Yeah, I can advance if you want to tell me- Yes.. whenever you want me to go to the next one, and I can- Sorry about that. No problem. It could be my technical error as well. Let's move on to the next slide. When it starts individual under 65 plans. Perfect. Obviously, I'm talking fast. We're getting there. So when it comes to the under 65 plans, they like to group them according to metals, and it kind of makes sense. So we have the bronze plans. Bronze plans would have the lowest premium and the highest deductible. And oftentimes, if you're doing a plan and you're paying for it yourself, the bronze may actually be the best for you because if the premium gets a lot higher, then you're just paying in premiums what you could be paying for your co-pays when you go get something done. So that's just something we take a look at. But at any rate, the silver plans would have a medium type premium and a lower deductible, or what I would call a medium deductible. And then the gold plans would have a high premium and low deductible. So if you want some coverage right away, then you're going to be paying that higher premium but you will hit the co-pays or co-shares very quickly. And then the HSAs, and I'm going to say something else about this also, but HSA plans as in and of themselves will have a low premium. You will pay full price until you meet the deductible, and then you'll pay lower after that. Now, HSAs are super helpful, too, because you can get tax deductions for when you put money into your HSA. So you can put it in tax-free, it can grow tax-free, you can invest it as well, it carries over from year to year. And then when you spend it on qualified health, then you will spend it tax-free also. And in the marketplace plans, both on and off, if they're exactly the same as the marketplace plans, for the bronze, they also qualify for HAS plans. So that could be a big thing, especially if your income is higher, having that tax advantage is a really big deal. All right. We'll move on to the next one. We'll look at marketplace plans, whether you go on marketplace or off marketplace. On marketplace is great because they can get you tax credits in real time if you qualify. Now, to get those tax credits, if you have a family of two and it's adjusted for whether you have one in the family, four in the family, whatever, but family of two seems to be the most common. You have a husband or wife, maybe you're retiring early. You're 61, 62, you need a few years before you get to Medicare. If you make, and realistically, this is gross income. There's only a couple of things that you can actually deduct in terms of marketplace income. But if you make 84,600 or less, then you can get some serious savings on the marketplace. If you make more than that, you're not going to get savings on the marketplace. So it is based on income for the current year. They don't care what you made last year. They care what you made during the year that you need insurance. And so if you can structure it, or maybe you wind up making a larger withdrawal from your 401K or something like that the year prior, or the year you have marketplace insurance, maybe you're able to pull a little bit from your Roth IRA so that that doesn't show up as income. Because it's only the current year. But some of these tax credits are really large. It depends on where you live. They can be different. But for an example, we've got clients this year in northern Michigan, not the UP, but the northern mitten, that get a $2,000 a month tax credit. That's huge. So it can be very beneficial if you qualify for that. Also, one thing to note as you look at plans, the under 65 plans are primarily HMOs, but you can get referred out to specialists say at University of Michigan or something like that. But the better the network, the higher the premium. And when we are dollar for dollar paying for it out of our wallets, then most people, they want to kind of get a network that works for them without having to pay for excess network. So I would say choose this path if you're eligible for tax credits, because this is the only thing that is going to give you the tax credits. However, let's say you are going to make more than that, clearly. So then there's probably no point to go onto the marketplace. You can go off marketplace. Off marketplace would be the full price version of the same plans. The better the network, the higher the premium, same as before. The same plans as the marketplace. Some companies might offer one or two slightly different ones, but they're basically the same thing. The off marketplace does have a simpler enrollment with no tax forms to have to deal with later on. So if you're not going to get a tax credit, you might as well go off marketplace. So I would say choose this path if you have a high income. And then we have another off marketplace offering. And so I've kind of brought this into the portfolio fairly recently, but there are plans that are medically underwritten. And so this is the deal. If they're a little bit better plans, they are going to have a PPO network, which is a better network, and they have an average of 20% less than off marketplace plans. But because they're medically underwritten, that's why they can give a little better plan at a lower price. But that also means that you have to be in this pretty niche area of being healthy and being a little bit older. I don't find this actually has a great savings for younger couples, but it can be especially good savings for people that are, say, upper 50s, early 60s. They're not going to go on the marketplace and they're healthy. We can see some serious savings here. I mean, 20%. If you can save a couple hundred bucks a month, that's huge. Absolutely huge. So this is especially good for healthy older people I'm going to take a look and we're going to think outside the box also in some other areas. What if you own your own business, for example? So a lot of times we go straight to group coverage, and that's fine, that's not a problem at all. But I have several clients, for example, farmer, lawn care people, small business owners, and they can set their own salary because they assign what they're paid, and they can run a lot of their expenses through the business. And so if you can assign yourself that lower income, then you can get tax credits and maybe the marketplace would work better for you than, say, a group policy. Here's another thing. If you're an employer, and I have several people in this category, and where they pay for their employees' premiums because they're great owners and they want to make sure they're taken care of and that kind of stuff. But then they age into Medicare, and you're like, "Wow, we can pay $700 or $1,000 a month to cover their premium if they stay with the group policy, or we can pay them a stipend, basically not to take the group coverage, but it was going to pay for their Medicare coverage." And so they can get a Medicare plan at a much lower cost, and it works well for the employee and it works well for the employer. So some of those types of cost-saving measures can be really helpful, and that's what I help do. And then here's another thing as far as group insurance goes. So the better the plan stats, the more expensive it is, and that makes sense. We know that in every area. Price generally reflects network and ease of use as well. And so generally speaking, you're going to pay more for a plan that has a larger network and more for a plan that is easier to use. Discount plans, you may, for example, have to do certain things at certain hospitals, but certain other things at different hospitals. And if price is the biggest factor, then fantastic. That's something that you can do. Just something to keep in mind. It's sometimes helpful to get a quote from other carriers just to see how you compare. Going less expensive doesn't necessarily mean that you're going to get a worse plan, but you can see how you rack up in terms of what's out there and what you're paying. All right. We'll hop into Medicare now. And Medicare, a government program, helps with medical costs, and so that's super helpful. There are some things, and I'll lead with this, that Medicare does not cover. Dental care is one of them, which is really getting expensive. Vision, in terms of an eye exam and glasses, anything medically dealing with the eyes. Like you get cataract surgery, that's going to fall under medical. But hearing aids, hearing exams, that can be a big expense, too. I've talked with several people that have spent $6,000 on hearing aids. Probably great hearing aids, but it hurts the wallet, doesn't it? Weight loss medications. This is a big deal. Medicare's not going to cover them. They'll only cover, say, Ozempic and Wegovy if you get them because of diabetes, and they're used to control that. However, there is a new trial program that offers, if you're on Medicare, it will offer the GLP-1s. They have a few set ones in there, Wegovy is one of them, for $50 a month. It happens outside of your prescription drug plan. But if it's only used for weight loss, they have this trial program that's going to run at least another year, and that may be something that's helpful. You set that up with your doctor, and he can enter you in that program. You have to be a certain weight or have certain things going on, but that has been a big help to a lot of people. Also, Medicare is not going to cover medical costs outside the US. So, it has some limitations, but we also have insurance to deal with those things. So let's talk about what Medicare does cover. Part A, $0 a month. If you've worked 40 quarters in your life or your spouse has, you'll pay zero. So it's fantastic. Hospitalization, it's going to cover. It's going to cover skilled nursing for the first 20 days, and then you're going to have a hefty copay after that. It's going to cover hospice care. There is a $1,736 deductible. That's 2026 data. They have not finalized 2027 yet. This deductible will actually reset if you've been out of the hospital for 60 days. So just an interesting thing to note. And then you also have Part B. Part B, $202.90 a month. That's 2026. And that would be if a single person makes $109,000 or less, or a couple making double that. If you make more, they charge you more for the same thing, and you get into what's called an IRMAA, an income-related monthly adjustment amount. So you have the privilege of paying more for the exact same product. That's just the way it works. So if Part A covers the things when you think of admission type things, then Part B is going to cover the things outside of that admission. So we think of doctor visits, we think of diagnostic tests, outpatient care, preventive care, durable medical equipment, these types of things. Part B covers 80% and has a $283 yearly deductible. It'll go up just a little bit next year, but again, we don't have those figures yet. Now, the one thing with Part B, that sounds pretty good. That's a low deductible. Your portion's only 20%, but there is no max out-of-pocket on Part B. So if you have some major things, that might add up pretty quickly. All right. So once you get Part A and B, you have two different paths that you can take. There's not a right path and a wrong path, but there is a path that will suit your needs better than the other, and that's what we try to identify. What works specifically for you? Medicare Supplement with a Medigap, also known as a Medigap plan. Great network. Anyone in the United States that takes Medicare takes your supplement. So super easy. You pay upfront in terms of premiums, and then when you use it, you have a $283 deductible, and then you have $0 copays for all of your medical for the rest of the year. Super easy to use. You would need to add a prescription drug plan with that. Big variance on these costs. This year, anywhere from zero to 110 a month. I'm expecting those to probably the minimum to go up to maybe around 10 or 15 a month. But so if you have low cost use, you can still get a low cost plan. Take a look at all of the factors together, determine what's best for you. And then maybe you want a dental plan to go with that, or dental/vision, dental/vision/hearing plan, something like that. That can range. I put 30 to 80 a month. Realistically, it could be anywhere from 20 to 200 a month, depending on what you wanted and what your needs were. But that's a typical range to pick that up. And then the other path is the Advantage Plan. The Advantage Plan is also known as Part C. These have strong networks. We're going to see this, like with some of the big carriers, you're going to see Bronson, Beacon, Spectrum, Beaumont, Trinity, Coral Health, University of Michigan, Sparrow, Henry Ford in-network. So you have very large networks to work with. Not as good as the Medicare Supplement, but very strong. So $0 a month for the most popular plans, and many of them have a zero or low deductible. You might be talking somewhere between $250 and $500 deductible. And then you would pay copays when you use it. This would be similar to a group policy in terms of how you do that with the copays. But oftentimes, depending on the level of insurance you have, oftentimes they're much more favorable. They would include a prescription drug plan as well, and they would include some form of vision, dental, hearing, possibly an over-the-counter benefit or gym membership, too. And so I've kind of dubbed them the all-in-one plans. And again, these are going to work very much like a group policy in how they're administered. So, here's some notes on drug plans for 2027. There is a $2,400 max out-of-pocket for drugs that are on the formulary for your drug plan. This year was $2,100. It goes up every single year, but at least there's a limit. I have some people on $100,000 a year drugs, and so having that $2,400 limit is a huge deal for them. There will be up to a $700 deductible on drug plans next year. Most people won't face that deductible because it usually is not applied to generics. But if you have a heavier hitting drug, you may have to meet that deductible first. They also have the M3P, which is a Medicare prescription payment plan, and if you have especially high upfront costs, maybe you have one of those really expensive drugs and you're going to hit the $2,400 very quickly. You can smooth those payments out by spreading them through the year if you sign up for the prescription payment plan. And again, there's no best path, but there is a path that benefits your particular needs, and that's what we want to find. All right, so let's go over a few questions that are pretty common. Should I sign up for Medicare when I turn 65? I met with three people yesterday in the same boat, wondering, do I stay on my group plan? Do I not? Whatever. Well, not necessarily. Here are some qualifiers. First of all, with Part A, most people, yes, because it doesn't cost anything and it can limit your hospitalization cost. However, if you sign up for Part A, you can no longer contribute to an HSA. So if you're keeping your group policy and you want to still contribute to your HSA, you don't necessarily want to sign up for Part A. Now, one of the things about signing up for Part A, let's say, because most people will, is that it does not trigger special election period, and it may help you, and it doesn't cost anything. So most people do want to get that. Do you need to sign up for Part B? Well, you have to know, is your group plan considered to be creditable coverage by Medicare? And if it is, you don't have to while you're still on the group plan. Many group plans around here are creditable, so you can decide, is moving to Medicare going to be good for me, or is staying on the group plan good for me? And that will help you decide, because when you sign up for Part B and you're 65, that triggers an enrollment period. It's the open enrollment period for Medicare supplement. And so signing up for Part B is a big deal, because if you sign up for Part B and stay on your group plan, you'll no longer have that special election period if you move to a Medicare plan later on. So that's why it's great to talk to an insurance agent and kind of figure that out before you do that. All right. Here's the next question. What if my income drops after I retire? Medicare looks at your modified adjusted gross income from two years ago. So maybe you had a breakout year and you had all this income, but now you're retiring in January. Your income is going to be much less. So instead of taking this penalty, even though, according to them, you deserve it because your income from two years ago was much higher, you can fill out a form, it's an SSA-44, that says, "Hey, yes, I made that income then, but now I'm not working and my income is much less." And they can lower what you're paying for Part B. This can be a big deal, and for some people, it can make a shift of $200, $300 a month. And do you know what? When it's your money, every dollar counts. So I can certainly help with that. I've pointed a lot of people in that direction or even helped them fill out the form. Here's another question I get. When can I see 2027 plan information, and when can I sign up? So for Medicare, October 1st, the first day you can see. I can't even talk about 2027 plans until October 1st. When can you sign up? October 15th through December 7th or whenever you leave group insurance. So that's a nice wide open time. A lot of times, renewing with group insurance, you might have a week or so to do it. This gives you a good bit of time to get that done. If you're under 65, typically speaking, November 1st, sometimes sooner, but you'll definitely see it by November 1st. And you can sign up November 1st through December 15th or whenever you leave your group insurance if you want a January start date. They do give a one-month extension that you can actually have a plan start in February. So here's another one. My Medicare supplement premium went up a lot. Ooh, we saw some big increases, average of close to 25% this year, 20% to 25%. You can shop for a better deal any time of the year. So you have to answer some medical questions, and if you are considered healthy, absolutely, you can get the exact same plan, different carrier, for a much lower price, and that's a big deal. I helped, oh, close to 40 people or so just within the last 12 months sign up with the same supplement, different carrier, much lower price. And some people cut the amount of premium they were paying in half. So I can send you a sample of questions, and if you're thinking, "Hey, this is a good possibility," what I like to do is apply several weeks ahead of time so that you know for sure whether you can get a new plan or not. Never cancel your old policy until you're sure you can get a new policy. Here's another one. When can I refer a friend to Doss Financial? Well, anytime. So Doss Financial does not have a special election period, so absolutely refer them today. All right. Ancillary plans. We'll take a quick look at this. If you want to pay a monthly premium and avoid spikes in cost, there's a plan out there for you in almost any area. But hospital indemnity is a big one as we see these hospitalization copays increase. You basically get cash for each day that you're hospitalized, and so again, if you want a small monthly premium to smooth out those hospital bills, that's a great thing. And here's what I'd like to point out. They have some differences in how they do this, but 64 and a half until 70, guaranteed issue. Doesn't matter how sick you are, doesn't matter if you're dealing with a ton of things, you can get a guaranteed issue. Cancer diagnosis plans, heart attack plans, stroke plans, lump sum of money if an event happens so you're not worried about the finances as you deal with this. And again, monthly premium to see you through a major event. Then there's dental plans we've already talked about, but sometimes you can get an overlaying dental plan with your current dental coverage, and if that's worth it to you, that's something we can take a look at. Long-term care. This is a big deal. You can spend all of your stuff and move to Medicaid, but your choice of places to go is much more limited that way. Average cost of a nursing home, $10,000. So I kind of consider this more of an asset protection as well. Short-term home health care. Hey, maybe you can recover at home instead of a facility if you have something that's going to pay for home health care. Or travel plans. You're leaving the US, man, this will give you great security in knowing that you're going to have coverage. Or even just a final expense plan. Some people, maybe they don't want to go with a full life insurance route, but they want enough to be able to cover their funeral costs. And lots more, whatever. So I work with a bunch of different companies because I want to be able to give you choices, and so boom, there's some of them right there. I think I've even added another one since that slide. But anyway, that's just because I want to be able to give you choices. All right. So what is your situation? One of the best ways to contact me, because especially if you're in the Medicare realm, I can't contact you first. Medicare protects you by saying that an agent has to have your permission before they talk to you about Medicare. So I have a QR code, and if you advance, I think I put the titles on the next, maybe one more, and then I think it's the next. There we go. So left-hand side, the under 65 survey. The right-hand side, the Medicare survey. And what this does is it pulls up a ... survey you can enter your information in, and it is encrypted from end to end. It goes directly to me, and then I'm notified when it's completed, and then I can reach out to you and say, "Hey, look, these are some exact things that might fit your situation." So if that's helpful, hey, you can scan that in and send me the survey. And then if we move on to the next one, I'm going to give you those same things if you want to type it in, for example. Those are the surveys at the bottom. They're, again, secured, but if you just type in retireflow.com/paul, or for the under 65, retireflow.com/paul-minor, that gets to the same thing. Or if you just want to call me or send me an email, maybe you just have a quick question or something like that, I'm certainly happy to help in any way that I can. All right. It looks like I talked a little bit more than 20 minutes. Sorry about that. But if anyone has any questions, now's a great time for them. Great job, Paul. I took a few notes, so while we wait for volunteers. You mentioned a lot of those ancillary plans, some of the supplements and things. If people sign up for those, do those get deducted from their Social Security like everything else, or is that sort of a separate payment? Great question. And primarily, almost exclusively, no, they can't come out of Social Security. Anything dealing with an advantage plan or a prescription drug plan can. Supplements and ancillary products cannot. Most of the time cannot, I'll say it that way. And we were talking offline yesterday in preparation for this, but you said something in here that I thought was really important, and you can correct me, but you mentioned that sometimes if somebody has had the same supplement with the same company for several years, that rate, they may think, "Oh, well, this is just the deal." They should still go and meet with someone like yourself and shop that rate because that rate may creep up and the exact same plan with the same network and same benefit could be substantially lower just right through another carrier. Yes. This is exactly right, and that's the biggest thing. So I'll throw a little shade on the cable companies, but this is what happens, right? The new customer deal. I know. Yeah. Because I just moved, and so now I have this rate with the cable company, whatever they are. I'm not going to mention any names. And I'm paying a great price, and then eventually that price starts going up and up. And then I see this TV ad and they're like, "Hey, you can have a price down here." And so I'm like, "I want that price." They're like, "No, you're an existing client." Right? So they kind of reward disloyalty, and supplements are kind of similar in that. I'll give you an example. So I have a lady that I'm meeting with, I forget when she's coming. I think in a week or two. Anyway, she's paying $561 a month for her Plan G. But a comparable Plan G with another carrier is going to be 220 bucks. That's huge. If you can pass medical underwriting, exact same coverage, far better price. That's amazing. And when I look at carriers, I'm not strictly interested in price. And this is what I mean by that. If you have a carrier that is going to get you hooked in, know you can't pass medical underwriting, and raise those rates through the roof, I'm not interested in that. I'm interested in price if they are still going to be reasonable or have shown a track record of reasonableness over the years, or aren't likely to get your book and then sell it to someone else also. At any rate, but that's why I do all the work kind of behind the scenes for this. You can get such a better deal. That's great. Right. Well, I don't think we had any additional questions. But Paul, as always, great stuff. Thank you for your time and expertise and for your-- I don't know that I know anyone more passionate about health insurance, which is why you're kind of the tip of the spear, buddy. We appreciate you. I'm sure this is going to be watched by many, and you've given information that will connect everyone else with questions. So with that, we'll let everybody get to their days, Paul. Thank you again, as always. We're here for you, your family, and friends. Paul is as well. Have a great day, and be well. All right, thanks. Take care.