We do love it when someone refers a family member or friend to us. Sometimes the question is, “How can we introduce them to you?” Well, there are multiple ways but a very easy way is to simply forward them a link to this webpage.
Here are this week’s items:
Portfolio Update: Murs and I have recorded our portfolio update for October 28, 2024
Medicare AEP in Retirement – 5 Things You Need to Know
Radon and Murs discuss the critical aspects of the Medicare Annual Enrollment Period (AEP) with Medicare Specialist, Shawn Southard. As we dive into Medicare AEP 2024, they explore why reviewing your current plan is crucial and how it may impact your healthcare costs, coverage, and provider networks. Shawn provides actionable Medicare enrollment tips that could save you money and ensure you have the right coverage for your needs.
Medicare AEP in Retirement – 5 Things You Need to Know
Medicare Annual Enrollment Period (AEP, October 15 to December 7, is one of the most critical times of the year for anyone who is eligible for Medicare. With the constantly evolving healthcare landscape, it’s crucial to understand your options and make informed decisions that align with your health and financial needs. Whether you’re already on Medicare or you’re about to turn 65 and eligible for the first time, the AEP offers a window of opportunity to review and adjust your healthcare coverage for the coming year….
Medicare Annual Enrollment Period (AEP, October 15 to December 7, is one of the most critical times of the year for anyone who is eligible for Medicare. With the constantly evolving healthcare landscape, it’s crucial to understand your options and make informed decisions that align with your health and financial needs. Whether you’re already on Medicare or you’re about to turn 65 and eligible for the first time, the AEP offers a window of opportunity to review and adjust your healthcare coverage for the coming year.
But here’s the challenge: with all the choices, costs, and changes, how do you make sure you’re in the right plan? Are you prepared for potential Medicare plan changes in 2024, or aware of how your prescription drug coverage may be impacted? This blog will walk you through five essential tips you need to know during the Medicare AEP for 2025 so you can confidently choose the plan that’s best for you.
1. Review Your Current Coverage
Even if you feel comfortable with your current Medicare plan, it’s good practice to review it every year during AEP. Why? Medicare Advantage plans and prescription drug plans, also known as Part D plans, can change yearly. The insurance providers that offer these plans often update aspects such as premiums, copayments, coverage limits, and even provider networks.
In other words, you may have chosen a plan that was best for you in 2023 based on the options available. However, different options in 2024 may be even better, and how would you know without a yearly review? Insurance companies send out an “Annual Notice of Change” (ANOC) before AEP starts. This document will allow you to compare side-by-side what your plan currently offers and what will change in the following year. Be sure to review it carefully and bring it with you if you meet with a Medicare specialist. Making small adjustments could save you hundreds or even thousands of dollars over time.
2. Evaluate Your Costs
When it comes to Medicare, cost is often the determining factor in selecting a plan. However, the lowest-cost plan may not always provide the coverage you need. Medicare Advantage plans often come with varying premiums, deductibles, copays, and coinsurance amounts. Even plans that previously had a zero premium may introduce new costs in 2025.
For instance, in some cases, a $0 premium plan may start charging $15 or more monthly. Copayments for routine visits to primary care physicians could rise from $25 to $35, or the maximum out-of-pocket (MOOP) for 2025 could increase. This MOOP is the most you’ll have to pay for covered healthcare services within a year, and in 2025, the maximum out-of-pocket for Medicare Advantage plans is set at $9,400, significantly impacting those who may need extensive care.
If you are on a Medicare Part D drug plan, pay close attention to changes in the plan’s cost structure. Premiums may rise, or the tier system used for prescription drugs could shift, leading to higher out-of-pocket costs for your medications. Regularly reviewing and comparing plans can help ensure you’re getting the best value without sacrificing essential coverage.
3. Consider Added Benefits Beyond Medical
Medicare is not just about hospital and doctor visits—it also involves other valuable services such as dental, vision, hearing, and even fitness memberships. These additional benefits are often found in Medicare Advantage plans, but they can change yearly as well.
Some plans may scale back or eliminate certain benefits altogether. For example, a plan that included dental or vision coverage in 2024 may no longer offer those benefits in 2025. In some areas, Medicare Advantage plans include wellness programs like SilverSneakers, which offers gym memberships and fitness programs specifically for seniors. If these types of benefits are important to you, make sure they are still available in your chosen plan for the upcoming year. If not, you may want to switch to a plan that better meets your needs.
For those with Medigap (Medicare Supplement) plans, discounts on services like dental, vision, or hearing might not be part of the policy but can often be included as additional perks. This is why reviewing the fine print is essential during AEP.
4. Check Provider Networks
If you’re enrolled in a Medicare Advantage plan, your coverage is typically limited to a specific provider network. These plans often operate as Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs). Unlike Original Medicare, where you can visit any doctor or hospital that accepts Medicare, Medicare Advantage plans can limit your choices to specific healthcare providers.
Because these networks can change from year to year, it’s essential to confirm that your doctors and hospitals will continue to be in-network for the coming year. If a major provider leaves your plan’s network, you could end up paying significantly more out of pocket or being forced to switch doctors. Make sure to check that your preferred providers, especially if you have upcoming surgeries or treatments planned, will still be covered under your plan in 2025.
5. Review Prescription Drug Coverage
Medicare Part D plans, which cover prescription drugs, also change from year to year. In 2025, there are significant changes that will impact many Medicare beneficiaries. The maximum out-of-pocket (MOOP) for prescription drug coverage will drop significantly from $8,000 to $2,000. Once you reach this MOOP, you will pay $0 for covered prescriptions for the rest of the year, which is a massive benefit for those on expensive, brand-name medications without generic alternatives.
However, this reduction in out-of-pocket costs comes at a price for insurance companies, which will now be responsible for a larger share of prescription drug costs under the catastrophic coverage phase. As a result, premiums for Part D plans are expected to rise, in some cases by as much as 24%. This means that even if you’ve been happy with your current plan, you need to compare the new premiums and check whether your medications will still be covered at the same tier.
Additionally, drug formularies—the list of drugs covered by a plan—can change each year. If a drug you rely on moves to a higher tier, it could increase your out-of-pocket costs. Taking the time to compare plans and ensuring your medications are covered is crucial to avoid surprises at the pharmacy in 2025.
The Importance of Working With a Medicare Specialist
Navigating the complexities of Medicare can be overwhelming. Working with a Medicare specialist can make the process significantly easier. A specialist can guide you through the Medicare enrollment periods explained and ensure that you choose the right plan that fits your medical and financial needs.
At Peace of Mind Wealth Management, our team, including our Medicare Specialist Shawn Southard, is available to help you understand your options and ensure you are prepared for the upcoming year. Whether you’re a current client or new to us, you can schedule a complimentary phone call with Shawn or one of our advisors to review your Medicare plan and make sure it’s the best fit for you in 2025.
Schedule your complimentary call with us and learn more about “Medicare AEP 2025: 5 Things You Need to Know.” Remember, Medicare Annual Enrollment Period (AEP) is October 15th to December 7th.
By taking the time to review your coverage during the Medicare AEP, you can ensure that you’re getting the best value for your healthcare needs while securing your retirement plans and peace of mind.
We do love it when someone refers a family member or friend to us. Sometimes the question is, “How can we introduce them to you?” Well, there are multiple ways but a very easy way is to simply forward them a link to this webpage.
Here are this week’s items:
Portfolio Update: Murs and I have recorded our portfolio update for May 20, 2024
Turning 65 in Retirement – What To Do for Medicare
Radon, Murs, and Shawn discuss Medicare planning for people nearing the age of 65. Shawn explains the timelines and eligibility criteria for the Initial Enrollment Period (IEP), Special Enrollment Period (SEP), and General Enrollment Period (GEP).
Turning 65 in Retirement – What To Do for Medicare
If you’re ready for Medicare and turning 65, there are a lot of complex topics that you must think about. In our latest episode of Secure Your Retirement, we had our very own Shawn Southard back on the show to help folks reaching the age of 65.We’re going to walk you through the entire process…
If you’re ready for Medicare and turning 65, there are a lot of complex topics that you must think about. In our latest episode of Secure Your Retirement, we had our very own Shawn Southard back on the show to help folks reaching the age of 65.
You’ll be able to go on Medicare at 65, but it’s overwhelming looking through plans and options.
We’re going to walk you through the entire process to help you start to understand Medicare, how it fits into your retirement planning, and the steps you can take to make the whole process easier on you.
What is the Initial Enrollment Period (IEP)?
IEP has a seven-month window, starting three months before turning 65, where you can enroll in a Medicare plan. You can apply for Part A, which is for in-patient care and Part B, which is for doctor visits and outpatient care.
Special Enrollment Period (SEP)
An SEP is becoming more common as more people are working past the age of 65. While you’re still working, you’ll forget about Medicare when turning 65 and remain on your health insurance plan until you retire.
Once you do retire, the IEP is likely to go by, so you’ll fall within the SEP.
You can fall into the SEP for a few reasons, but the most common is that you worked past your IEP and now need coverage because you’re off your group insurance plan.
Note: You have eight months from the time you retire to enroll in a plan within the SEP, or you will face penalties.
General Enrollment Period (GEP)
Imagine that you go to Cancun in your mind and aren’t paying attention to the IEP or SEP. You can still get into Medicare during the GEP, which is January 1st – March 31st each year. You can enroll in Parts A and B at this time.
Medicare also changed the rules a bit, and if you sign up in January, you’ll begin receiving your benefits on February 1st, not July 1st, which used to be the case.
Depending on when your IEP and SEP passed and your situation, you may receive a late enrollment penalty. Shawn works with folks to help navigate these situations on an individual basis.
Scenario: Still Working, turning 65, and Still Enrolled with My Employer’s Plan
If you’re approaching 65 and plan on working a few more years, you need to make sure that your company plan has 20 or more people actually enrolled in the plan. It’s not enough for 20 people to be working at the company – they need to be enrolled in the health plan.
In this case, Medicare will provide an exception and won’t need to do anything with Medicare.
Employees of employers with a health plan that has 19 enrollees or less will need to enroll with Medicare, even if they plan on continuing working past 65.
Scenario: Retired But with Health Coverage
In some cases, a person will retire before 65 and still receive benefits from their employer. For example, state employees of North Carolina can still receive their benefits until 65, but these benefits are considered secondary when you hit 65.
You will need to enroll in Part A and B of Medicare at 65, even if you want to keep your former employer’s health insurance.
Scenario: I’m Still Working, Approaching 65, But I Receive Social Security Retirement Benefits Already
If you’ve been receiving Social Security or Railroad retirement benefits for at least four months before you reach 65, you’ll automatically be enrolled in Medicare Part A and B when you hit 65.
You will want to send the coverage back to Medicare when you receive your Medicare card.
Why?
Medigap plans have no medical underwriting for the first six months of your Medicare coverage, and you’ll pass by the six-month period because of the automatic enrollment. Even if your coverage starts for one day, the time for Medigap plans will start ticking down.
How Do You Enroll in Medicare?
If you’re reading this and thinking, “I need to enroll,” you have a few ways to do this. An easy way to enroll is to:
You can also go down to any Social Security Administration office and enroll in Medicare in person.
For many people, the ideal solution is to go through the online portal.
What Forms and Documents Do I Need for This to Go Smoothly?
You should have a few things available:
Social Security number
W-2s
Proof of citizenship (Birth certificate, passport, etc.)
CMS Form (if you work past 65)
Shawn can help you obtain all of the forms you need when you work with him.
Penalties for Missing the Enrollment Period
If you miss the enrollment period, you will be penalized. Penalties cannot be undone, so they’re monthly, lifetime mistakes. For example, if you miss Part B coverage, you’ll pay 10% on top of the premium for every 12 months that you miss it.
You’ll be paying 10% more monthly for the rest of your life.
Let’s say that you didn’t enroll until 60 months after your enrollment period. This means that you’ll be paying an additional 50% on top of your premiums forever.
The Part D (for drug plans) late enrollment penalty is 1% for every month that you weren’t enrolled in one for the rest of your life. Shawn knows a client that didn’t enroll in a prescription drug plan at 65 because he didn’t need medication at the time. When he turned 70, he needed medication, and he now pays a 60% penalty on top of the normal plan price.
Anyone listening to this will want to avoid being penalized because it will impact you for the rest of your life.
You can handle Medicare on your own, but if you work with Peace of Mind Wealth Management to secure your retirement, Shawn is our Healthcare Professional Specializing in Medicare and is available to help all our clients.
Working With Shawn Using the K.I.S.S. Acronym
Shawn follows the Keep it Simple Shawn mindset, and he aims to provide a calm approach throughout the process. He will work with you wherever you are in the Medicare process, discuss your goals, and help you find the coverage and plan that is best for you.
He uses a flowchart to show people the:
Foundations of Medicare
Options of Medicare
You’ll also learn about Medicare plans, Medigap, payments, Income-related Monthly Adjustment Amount (IRMAA) and other aspects of Medicare. Shawn will also hop on calls with your employer to make the process as seamless as possible.
If you do want to talk to Shawn about Medicare and begin working with him, feel free to reach him at our office at (919) 787-8866 or email him at shawn@pomwealth.net.
We do love it when someone refers a family member or friend to us. Sometimes the question is, “How can we introduce them to you?” Well, there are multiple ways but a very easy way is to simply forward them a link to this webpage.
Here are this week’s items:
Portfolio Update: Murs and I have recorded our portfolio update for January 8, 2024
Understanding Medicare Advantage Open Enrollment in Retirement
In this Episode of the Secure Your Retirement Podcast, Radon and Murs have our in-house Medicare specialist, Shawn Southard, discuss the Medicare Advantage open enrollment. With an education background and a servant’s heart, Shawn is passionate about helping people find the right Medicare plans. Listen in to learn about the benefits of a Medicare Advantage plan and the reasons for the Medicare Advantage open enrollment period.
Understanding Medicare Advantage Open Enrollment in Retirement
Medicare is such an important part of your life as you age and secure your retirement, but it’s often overlooked in retirement planning. You may have to pay IRMAA surcharges and really need to begin planning to get the most out of your benefits. We’re happy to have had Shawn Southard on our podcast this past week to discuss Medicare Advantage Open and what it means for our listeners and clients.
Medicare is such an important part of your life as you age and secure your retirement, but it’s often overlooked in retirement planning. You may have to pay IRMAA surcharges and really need to begin planning to get the most out of your benefits.
We’re happy to have had Shawn Southard on our podcast this past week to discuss Medicare Advantage Open and what it means for our listeners and clients. Shawn works in-house for us and will be helping all our clients with their Medicare needs.
Throughout the year, there are a lot of Medicare-related things that pop up that we really need to focus on.
Note: Every month, we plan on having Shawn on the show to discuss questions that our listeners may have.
Medicare Open Enrollment Period
Medicare has quite a few enrollment periods that are easy to overlook. You can enroll when:
You turn 65 years old
You’re working past 65, retire and leave your health plan.
Annually, from October 15 – December 7 (this is when 95% of beneficiaries make changes to their plans)
January 1 – March 31st for Medicare Advantage policyholders, who can change plans or disenroll if they wish.
Medicare Advantage Open enrollment is what anyone reading this blog or who watched our episode will need to think about in January until the end of March.
What is a Medicare Advantage Plan?
Medicare Advantage plans, at a very high level, are often organized into parts by letters. But before we go into that, original Medicare is broken into:
Part A: Hospital coverage
Part B: Medical coverage
Part D: Prescription Drug coverage, optional but will incur lifetime penalty if not enrolled when eligible.
Part C is the Medicare Advantage plan. Medicare Advantage helps round out your Medicare. These are private plans that go through the insurance companies and are approved by Medicare. Each plan must offer the same Part A and B coverage as your original Medicare plan, but it is a private plan.
The Advantage plan offers additional benefits, such as:
Preventative Dental
Preventative Vision
Hearing Exams
An Advantage plan may also combine your prescription coverage into the plan, but you’ll need to review each plan to learn more about the coverage offered.
Why Join a Medicare Advantage Plan Over Original Medicare?
A lot of you may be thinking, “Why would I switch from original Medicare to an Advantage plan?” One of the main reasons to make the switch is that original Medicare is only for things that are deemed medically necessary.
Medicare Advantage plans add in coverage for:
Annual physical exams
Dental cleanings
Eye exams
Hearing exams
Original Medicare plus a Medigap plan is an option, but this option comes with a premium that ranges from $130 – $150 per month.
Medicare Advantage has many great plans that have $0 premiums.
For a retiree, an Advantage plan often makes a lot of sense because they’re on a fixed income.
Why Someone May Not Choose a Medicare Advantage Plan
Advantage plans seem very advantageous, but they’re also not for everyone. A downside of Medicare Advantage is that they are network plans:
Health Maintenance Organizations (HMOs), smaller network
You’ll need to go to someone in your network if you have an Advantage Plan. Original Medicare doesn’t have networks, so it’s easier for you to travel. You don’t need to worry about the provider being in network as long as they accept Medicare.
Medicare Advantage HMO requires you to stay in network. A PPO does have out-of-network options, but you may pay more for the services.
You need to consider the following when choosing a Medicare path (Original Medicare/Medigap or MedAdvantage):
Health
Lifestyle
Budget
Medicare is complex, and it’s easy to make a costly mistake along the way because of the amount of misinformation that exists. It is in your best interest to consult with a Medicare specialist before making any changes to your plan.
Why Someone May Want to Switch Medicare Advantage Plans
Since we’re in the enrollment period where someone can switch Medicare Advantage plans, the question arises: why would you switch plans?
Often, a person wants to switch Advantage plans because:
Doctors that they have been going to are no longer in their network, so they switch to a plan that allows them to retain the same doctor that they know and trust.
They plan to move and the new service area does not have their providers in network.
Shawn helps our clients choose the right plan for their medical needs and lifestyles. He has a strong educational background as a high school teacher and corporate trainer. In fact, his background as an educator is why he joined our team. He aims to educate each client, based on their individual needs, to find the best Medicare path.
Shawn needs to know your health/medical conditions, any prescription drugs you are taking, and your lifestyle (such as traveling) to help you select the right type of Medicare plan for you.
Medicare is complex – especially if it’s not something you work with every day.
If you want to have an in-depth discussion about your Medicare situation and ensure that you’re on the right pathway, feel free to reach out to Shawn.