Speaker 1: 1:13

All right, welcome back to the Make the Most of your Money podcast. I'm your host, colin Page. I'm joined today by my co-host, taylor Stewart. How are you, taylor?

Speaker 2: 1:22

I'm lovely, I'm so proud of you for taking this intro. This is great.

Speaker 1: 1:26

Yeah, I'm doing my best Taylor impression as I take over the captain's chair today. So today we're diving into a topic that's super important for anyone approaching retirement or supporting a loved one who is, and that's Medicare. So understanding Medicare can be confusing with all the parts, the deadlines, choices to make, and that's why we are thrilled to be joined by Margo Steinlogge, who is a lawyer and seasoned expert and an independent insurance broker from Steinlogge Insurance. Margo, welcome.

Speaker 3: 2:11

Thank you so much, guys. This is an honor to be on my second ever podcast it's a big deal. This is a big one usually I have a powerpoint and an audience, so I don't know who's on the other line here. Yeah, I feel like my husband has primed and prepped me for this by making me listen to Joe Rogan.

Speaker 2: 2:36

Oh gosh, yeah, we're going to get weird Crazy podcast, so thank you for having me.

Speaker 1: 2:44

Well as, by way of intro, you are a lawyer by training. You are an insurance broker, like I said, from Steinlage Insurance, and that's a family-owned Medicare insurance brokerage based in Missouri and Charlottesville, Virginia, where I am, which is how we know each other and you guys have been helping folks navigate Medicare and health care options since 1950, it says on your website yeah, yeah, since 1950, it says on your website.

Speaker 3: 3:21

Yeah, my grandfather started a general insurance agency Medicare wasn't around in the 50s and then in the 70s, 80s and 90s my dad really directed the agency towards health insurance in general and at one point had about 600 independent agents underneath him and I realized he really liked working with the individual client. So in the 90s and early 2000s really tailored our services towards the individual client as opposed to growing with independent agent relationships. So yeah, I'm the third generation. I always tell clients I was born with a Medicare card. It's all I know. And I drive people bonkers because I'm very passionate about health insurance and Medicare and ACA.

Speaker 3: 4:13

So my poor husband and my kids. I'm hopeful one of my four kids will will be the fourth generation, but we shall see.

Speaker 1: 4:22

Yeah, I mean, I know we're here to talk about Medicare, but I also am curious what it's like working in a family business with with your two brothers. Uh, they're not on the podcast today so you can say you can say whatever you want, but going to be the fifth.

Speaker 3: 4:36

I don't want to incriminate myself, um no, I love working with my family.

Speaker 3: 4:41

I have a twin brother who is not in the business. He's a physician's assistant, um, but yeah, I love working with my brothers. I talk to them all the time they're in Missouri. I'm here on the east coast, um, it's it. I feel like most family businesses have just a ugly underbelly, an ugly side to them, but I feel like here at Steinluggy we all get along and appreciate the strengths that each of us bring to the table. Both of my brothers are bald, so it's funny when clients call my assistants will be like do you want the one with hair or the bald one?

Speaker 2: 5:21

That's good.

Speaker 3: 5:25

Yeah, so we keep it light and fun. I mean, it's a complex topic. It's easy to get in the weeds, so we try to keep it as just clear and concise and less confusing for those who are approaching their 65th birthday.

Speaker 1: 5:42

It's a lot to take in. Yeah, well, let's get into it. I mean, I know it's a big topic, but can you give us kind of a high level overview of how Medicare works, who it covers, what it doesn't cover? Yeah, take it from there.

Speaker 3: 6:01

Yeah, yeah. So typically somebody is coming to Steinloggie to talk to myself or my team, I would say, as early as a year out, 18 months out from their 65th birthday, and most of my referrals that are coming to me are from wealth managers, financial advisors. They're sitting with their clients talking about the retirement plan and the next chapter for their clients, and usually my name pops up. If you're an early retiree, talking about COBRA and ACA, pre-65 coverage, that's where we come into play. And then also, you know, now the 64 year old is talking about Medicare. So as soon as we get connected with a client, we're kind of pulling out who's their preferred providers? What's their family dynamic? Is there a younger spouse at play who may need COBRA or ACA? Are there children on the group health plan that are 20, 25? Is the person working past 65? Are they looking to retire at 65? So before I even jump into the nitty gritty nuts and bolts Medicare alphabet soup you know we've all heard that term jump into the nitty gritty nuts and bolts Medicare alphabet soup We've all heard that term I'm looking at. Is Medicare even required at 65? You know more of a high level. You know what's the foundation that the client is coming from, then we're looking at the size of the employer, if that individual is working past age 65. Is Medicare required? Is it optional or is it the inventory? Are there any penalties that like they want to stay on the group plan? And again, without getting too technical and in the weeds, the general rule that I tell clients is that you have to take Medicare at age 65, okay, to avoid life penalties, gaps in your health insurance. It's required unless that client or their spouse is working with a large employer. So large employer means 20 or more employees at their place of business. You know, if I'm working for Boeing, there's many employees at Boeing Then when I turn 65, I have the option to move to Medicare or I can stay on my Boeing group insurance plan or my large employer's group health plan and delay Medicare. So right out of the gate we're just trying to figure out if Medicare makes sense or if it doesn't.

Speaker 3: 8:43

Generally, somebody has to take Medicare unless they have access through active employment through a large employer, which means 20 or more employees. Then Medicare is optional. Does it make sense to move to Medicare if it's optional or stay on that group health plan and continue staying covered under the group health plan until that client's ready to retire. Then you know, 12 months or two years or five years down the road, at age 70, now that client comes back to me and says, hey, I'm ready to retire. What do I need to do with regards to Medicare? Now I create a special election window to come off the group health plan health plan.

Speaker 3: 9:24

Is there an HSA component? This is kind of a red flag that I always see is an over-contribution into an HSA high deductible health plan. So if somebody is delaying Medicare at 35, right, and they have access to a high deductible health plan and they're maxing out their HSA contributions, then typically that individual will want to delay both A and B in Medicare because the IRS doesn't allow you to contribute into the HSA if you have the free Part, a benefit.

Speaker 1: 10:12

Yeah, so you just mentioned Part A. I mean, a lot of our listeners are younger and may have heard of you know that there's Part A, Part B, Part C and D, what? What are those main parts of Medicare and what do each of those cover?

Speaker 3: 10:30

Yeah, yeah. So as soon as a individual says hey, I'm ready to move into Medicare, it's required at 65, or that individual is retiring after age 65, coming off the large group plan, they're going to enroll in original Medicare, which consists of two moving parts the Part A hospital benefit and Part B medical benefit. So I always say you know, you look at a red, white and blue card, you'll see Part A benefit, part B benefit, part A hospital, part B medical. If a client goes into the hospital, is admitted as an inpatient for a week with COVID or the flu or, you know, had a heart attack, all of those bills are flowing under the Part A hospital benefit of their Original Medicare red, white and blue card. If they go in for an MRI, they go in for a doctor's office visit, blood work, x-ray that's all going to fall under the Part B medical coding of original Medicare. So when somebody signs up for Medicare they can elect Part A and or Part.

Speaker 1: 11:41

B and Part A, the hospital coverage. That's the part that's free or that you've paid into your whole life through your paycheck. That's included. Anybody at age 65 qualifies for that and can take it for no cost. Essentially, Part. B is a little different. How do you pay for Part B?

Speaker 3: 12:08

Yeah, so Part A, as you said, is free for most of us. I will get some clients who, for most of us, I will get some clients who maybe were a stay at home parent or, you know, moved here 15 years ago from France and they don't have the work credit. If, if an individual has not worked and paid the FICA taxes, it's it's 40 quarters or 10 years worth of work, it's 40 quarters or 10 years worth of recovery. If you don't have that credit allowance, then Medicare Part A will cost you some money Most of us though very rarely do I find somebody paying for the Part A hospital benefit.

Speaker 3: 12:54

Part B, you'll have a standard rate it's $185 this year per person per month. And if a client is collecting Social Security, that will get drafted automatically out of the Social Security benefit as soon as that individual signs up. Or they'll set it up for auto pay out of a checking account and they call it Medicare easy auto pay out of a checking account and they call it Medicare easy. One tricky thing, but I always put on advisors radars and I'm sure it's on your radars. You guys see this If you have a high earning client let's just say you have a couple who is has a modified AGI that's above 2212,000.

Speaker 3: 13:37

And that figure fluctuates each year. If they have a high modified AGI as a joint filing couple or as a single filer, then Medicare will cost much more. It's not $185 per month, it's going to be $300, 405, all the way up to $700 per month per person. So again, that initial conversation, that onboarding, that collecting of information that we do is really trying to find out how much is Medicare going to cost you. Is it even required? And when you do move into Medicare, you know, can we reduce that that high cost. It's called IRMA. It's not IRMA.

Speaker 1: 14:21

I can never get the acronym straight Income related Medicare adjustment. I don't know what that is. There's two A's.

Speaker 3: 14:32

I don't want to get too technical.

Speaker 1: 14:34

It's IRMA, that's all you need to know Irma is just the Irma, it's your charge for a tax, depending on who you're talking to.

Speaker 2: 14:41

I think that's a good thing to just highlight. So part A is really good Base case for most folks. Part A is free. Part B is going to cost something and it is means tested and so the more you make, the more it can cost, and that's something we don't need to get into it now, but just from a financial planning perspective, to be considering structuring your income certain ways, and there's about a two year delay too. So, like your 2025 premiums are going to be based on your 2023 tax return.

Speaker 3: 15:08

So just some good things to be aware of that.

Speaker 2: 15:10

We can.

Speaker 3: 15:11

Yeah, in most cases, taylor, we can appeal that Like. A lot of people are unfamiliar with this space, but if that individual is retiring, you know, in 2025, they say, hey, taylor, hey Colin, I want to retire and move into Medicare. We can tell Medicare, we can fast track this and say, hey, don't look at my prior two-year tax return from 2023. Track this and say, hey, don't look at my prior two-year tax return from 2023. I was killing it. I was making a ton of money. Now I'm in retirement, I am going to have a lower income in 2025 and definitely a lower income in 2024.

Speaker 3: 15:49

Use that anticipated modified AGI for 2025 and 2026, excuse me, 2026, instead of 2023 and 2024. So we help the clients appeal that IRMA surcharge and it can be substantial. You know, if a joint filing couple made 700 grand, 800 grand in 23, and now they're making 200 grand just on passive investments in 25, 200 grand just on passive investments in 25, you're saving, you know, 500 bucks a person per month. That's six grand types too. That's 12 grand. Where can you go spend that money elsewhere?

Speaker 3: 16:26

So it's and then another thing we do, which I'll, I'll, you know, talk up Steinloggy all day, but we are constantly reminding our clients in the fall that, hey, heads up, this IRMA is going to come back in the upcoming year. Make sure you appeal a second time because of that two-year look back, they'll see the IRMA in 2026 as well and they'll have to do another appeal. So just keeping it on their radar, making sure clients know what the heck's going on, what IRMA means, what these documents, these determination letters coming from social security mean, it can be overwhelming.

Speaker 2: 17:07

What's the success rate with those appeals?

Speaker 3: 17:10

Hi, yeah, I mean some clients will say, oh, I sold my home, I moved from Virginia to Florida or Texas, california to Texas. Like in those circumstances, if it's a non-qualified life event that is creating a higher modified AGI, like a distribution, a home sale, that creates a high modified AGI, those we can't appeal. But if it's linked to retirement, work reduction, work stoppage, a divorce from a high earning spouse, death of a high earning spouse, those are all instances that will have a successful and the wonky thing is it can take two weeks for Medicare to process that, which is amazing, or I've seen it take six to nine months. So part of our job is just keeping track of where documents are in the process, especially when they're sent to medicare or irs. You know we, we are telling clients right now if you're turning 65 in 2025, start the medicare enrollment process sooner rather than later.

Speaker 3: 18:24

Because of all of this shake up that's happening in social security and CMS, hhs, the offices in the last two years, the social security offices in the last two years have been crazy, like from a processing speed standpoint slow. Now it's even slower. Some social security offices I would say most are closing their doors to walk-ins you have to call. As a client, you have to call and make an appointment. They're scheduling six weeks, 12 weeks out. So if you are a senior or you have parents who are in Medicare or looking to get in Medicare, don't wait until the midnight hour. You can be very frustrated and it can be a very high anxiety moment just waiting for CMS to process a form and maybe backdate it but maybe screw it up because these social security reps are new hires, they're not experts. You know Medicare? We joke in our office. You can call Medicare and get five different answers to a question. It's sad, it's frustrating from the broker perspective and the client perspective right now it's very frustrating.

Speaker 1: 19:42

So when I was kind of learning how Medicare works and doing the CFP coursework, the way it was explained to me was that Medicare is kind of like Swiss cheese in terms of what it covers. It covers a lot, but there are holes in it, and so and people are often like confused about what what is covered under Medicare and what isn't covered what are, what are some of the bigger holes that that you know, maybe traditional health care, health insurance would cover but Medicare may not cover fully, or yeah?

Speaker 3: 20:20

Yeah, yeah, I love the analogy. We're pretty dairy-free in my family so I love going to the restaurant and ordering like the biggest burger with cheese on it, because I don't get it at the house Very free. So, yeah, the easiest way to explain that is Medicare covers 80% without getting in the weeds, because I love to get in the weeds, but Medicare covers 20% or, excuse me, 80%. You have a gap and this is for acute care. Okay, you go into the hospital, you're in there for five weeks. This isn't covering Medicare, doesn't cover long-term care or assisted care. So we're looking at kind of a acute care level. You're getting 80% coverage with any doctor nationwide that takes original Medicare, which is a high majority, a large majority of doctors you know like 95, 97% of doctors nationwide take original Medicare.

Speaker 3: 21:27

So to fill that 20% gap, most of our clients coming off of, you know, wealth manager referrals and financial advisor referrals most tend to go with a Medicare supplement policy, to go with a Medicare supplement policy or also known as Medigap. Those are interchangeable terms and this Medicare supplement Medigap policy this is where you hear like supplement plan G or the old school plan F or plan N. Those are all different supplemental policies Medicare supplements Medigapsaps that come in to fill the remaining 20. So medicare original medicare red, white and blue card covers 80 any doctor nationwide. All of the claims are sent from provider to medicare and then medicare sends the residual 20 to that medicare supplement, also known as Medigap.

Speaker 1: 22:26

So that's an important difference when folks are coming from an employer-based health plan where they've got the concept of a deductible and then maybe they have some coinsurance but there's a maximum out-of-pocket that they'll pay with that plan, maximum out of pocket that they'll pay with that plan. So once they hit that maximum out of pocket, like everything else, that year is basically covered. That's not the case with original Medicare. You know Medicare will cover 80% but you're always going to have that 20% that you need to cover and there's no limit to how much that could be. So imagine, you know, a major health event or a cancer treatment that could get very expensive very quickly because there's no cap yeah, I mean I, with the increase in autoimmune diseases right now.

Speaker 3: 23:18

Uh, infusions are a perfect example where things can get costly very quickly. You, you know, we all think about chemo and cancer, but like just infusion treatments. So that cap, that supplemental plan, regardless of the carrier. You know that individual goes UnitedHealthcare, aarp, anthem, blue Cross, humana, aetna, there's so many carriers out there. They all play by the same rules and again, once the provider submits the claim to Medicare, medicare sends it to that supplemental plan. It's really easy, seamless coverage. I would say. The hardest thing here and you touched on, like the group plan option where you have the deductible, the max out of pocket, which is what, like you and I have right, the hardest part here is just the overwhelming amount of options that a senior is looking at when they move into Medicare. For so many years most of those seniors have been spoon fed three, maybe four different HMO or PPO options that their employer has offered them when they move into Medicare. There's 40 drug plans. There's, you know, a hundred different advantage plans with 10 different carriers. There's 15 different supplements. There's 15 different supplements, supplement Gs. There's 15 different supplement Ns.

Speaker 3: 24:46

How do I compile this into a, you know, bite-size approach and get rid of all the noise and really isolate what I want, what I need and the direction. Do I go advantage? Do I go supplemental? Because the initial decision that your clients will make, our clients will make, will most likely have long-term consequences and that's kind of where I come to the table is through education, because of these initial decisions. If you're willy-nilly just saying I want zero premium, Margo, I'm healthy, I run, I'm vegan, I'm on this longevity cycle, whatever the excuses or level of that client's health, that's not guaranteed at age 70 or 75 or 80. And now if they went cheap, medicare Advantage, zero premium, with all the free little bells and whistles that you saw Joe Namath mention. Have you guys seen the Joe Namath commercials and the small guys talking about Medicare?

Speaker 2: 25:51

I actually saw the Joe Namath one. Yes, actually, hold on. Can we stop for a second? Because you've introduced the term Advantage plans. Let's establish what that is and how it's different from everything we were talking about before. Before was like original Medicare, part A, part B, and then there's a gap the supplement. So explain what advantages and how it's different from everything we've talked about.

Speaker 3: 26:11

Yeah. So so when somebody is turning 65 and like going through this education process and trying to just get armed with with what the heck is Medicare, and trying to just get armed with what the heck is Medicare, there's really two different pathways that the senior and the client can look at. They have pathway one which is Medicare with a supplement and a drug plan and that gives them total freedom to go to any doctor that takes Medicare. And they have that 80-20 payer situation Medicare covers 80%, supplement pays 20%. And they have that 80-20 payer situation Medicare coverage, 80%, supplement, pays 20%. Then they're adding a standalone Part D drug plan. Okay, this is like Cadillac Mercedes, I'd want to drive a Porsche. So Porsche 100, okay, really, I have my eye on like a 1960s Land Rover. We can drink right Very cool.

Speaker 1: 27:04

Anyway like a 1960s Land Rover. We can dream right.

Speaker 3: 27:05

Very cool Anyway so this is the Land Rover, the Porsche coverage that if a client wants total flexibility, they're going to go this route 100% of the time. The pathway two option for a client is called Medicare Advantage, and this is heavily fueled by advertisements, call centers, the Joe Namath infomercials that you see when you're watching ESPN. There's a ton of money poured into the Medicare Advantage market. When somebody signs up for a Medicare Advantage plan, typically it's zero premium, so that individual is paying the standard Part B rate, the 185 that we talked about. Maybe they have IRMA that they can't appeal. Plus, they sign up for that pathway too. Medicare Advantage, zero premium. These are HMO or PPO plans, okay. So as soon as a client signs up for a Medicare Advantage plan, they no longer use their red, white and blue Medicare card. It gets put in a drawer, gets forgotten about and now there's zero premium, hmo or PPO, with Devoted or Essence or Blue Cross or Humana.

Speaker 3: 28:20

All the players play in this Medicare Advantage space. That becomes their managed care, their gatekeeper, their dictator. They have to go to network doctors. If they go out of network and they're in an HMO, they're on the hook for the bill. If it's not an emergency, they need pre-authorization. This CEO of UnitedHealthcare was murdered and the concern was all around pre-authorizations, which happens on the group coverage, happens on the Medicare Advantage side as well.

Speaker 3: 29:06

Consumers, you know circumstance If you're getting pre-authorization and you're a high user of care and you're limited to your network, you're going to say, hey, this is for the birds, I want that Medicare and supplement pathway to get more flexible coverage. But you really don't realize that you are in this kind of networked, restricted policy until you get sick and you're in skilled care you need the pre-authorizations and you have those frustrations and the push, pull and the red tape with your Advantage plan. So on the face these Advantage plans look amazing, ok, they sound great, they have all kinds of free perks. But when that consumer, that client, is ready to actually start using the care, and now they're 75 or 80 years old and they don't want to deal with pre-authorizations or bills stacking up on their desk and they say, hey, margo, I want to drop my zero premium, cheap coverage and go back over to that Medicare supplement, medigap pathway, most of the time that client is locked out of kind of jumping ship Okay, captain, jumping ship over to Medicare supplement because of underwriting.

Speaker 3: 30:17

So when a senior, when somebody's 64 and they're signing up for Medicare and it's going to take effect on the first of their birth month month when they turn 65, or if they're delaying Medicare. You know they're staying on their large group plan and they're ready to come off that group plan. So either of those circumstances either they're new to Medicare at 65 or they're coming into Medicare after age 65 off that group plan. Now when they sign up for Medicare it triggers a like unique six month window that allows that individual to sign up with any supplement plan. There's no restriction in movement, there's no underwriting, there's no pre-screening or pre-existing limitation.

Speaker 3: 31:06

Okay, but if they go zero premium, medicare Advantage Part C, which is the same term as Medicare Advantage if they go that cheaper, more economical pathway, and now three years or 10 years later they are saying, hey, this is frustrating care. Now when they move to the supplement Medigap plan, they're going to get flagged with their health. Are you a high health risk? Do you have a stent? Do you have a fib? Are you taking tramadol? Now they're locked out of this supplemental plan because if they are high health risk, that supplement plan can deny them access to the supplement product because they're one of the medicare window one of the ways it was explained I've heard it explained is medicare supplements or medigap.

Speaker 1: 32:01

Though there those plans, the, the Plan F, Plan G, there's some other letters in there. The parameters of those plans are standardized and so there can be multiple different carriers offering a Plan F or Plan well, not Plan F anymore. Plan G is kind of the new gold standard. They all have to cover the same things and have the same terms. They may differ on price and compete in different locations, but the plans are not standardized.

Speaker 1: 32:41

Insurance companies are free to kind of turn various dials and knobs and attach bells and whistles to it. You know, to manage the cost of, you may not be paying premium out of pocket, but Medicare is sending the money that you would have been paying in for Part B and you had paid in for Part A over to this Medicare Advantage company who gets to design the plan and the policy. And it's not standardized and they can change it One year to the next. And I've heard of like individuals just being totally unaware that they had one plan that they signed up for and that plan either got way more expensive because the insurance company wanted to change some things or that the coverage actually changed year over year.

Speaker 3: 33:43

Yeah, yeah, I mean, colin, you'd be shocked by how many clients are like, oh, I want the free dental. Well, that's just the shiny object to entice enrollment and next year it's going to be gone. And now you're left with a watered down policy here in Virginia between 2024 and 2025. One plan specifically that was like the best Medicare advantage I can't even say best per CMS codes. It was like the most popular Medicare advantage in central Virginia. All of their plans in Virginia went from like a $3,000 maximum out of pocket exposure, which is pretty low. You know, if you're on a budget, this plan looks great.

Speaker 3: 34:26

Not everybody can afford a supplement, unfortunately. So if that person chose this product in 2024, in 2025, that max out of packet went from $3,000 to $9,300. So you just picked up $7,000 worth of exposure under the pretense of I want free dental, because there was $1,500 worth of exposure, under the pretense of I want free dental because there was $1,500 worth of dental. So it is a buyer beware situation. I always tell clients you are not setting and forgetting your insurance. You lose if you don't review this every year. I would say again, I don't have the exact, like Kaiser Family Foundation numbers here, but I would say of my clients, 20% are needing some type of change every year.

Speaker 3: 35:16

And we are super like, squeaky in October, november, like, hey, clients, give us your drugs, your doctors. The average in that space is, like I would say, 80, maybe 85% of the population doesn't even review their coverage. So 15% is the norm. You know, you just set it up at 65 and hope for the best. I don't want to deal with this again, but it's prudent to shop this. Whether you're on expensive medications, your doctor's change, you're on an advantage plan, your supplement has crept up.

Speaker 3: 35:52

You know the new one thing that we've seen just some like market changes from 24 to 2025, the new norm, kind of post COVID, the new norm for supplemental premium increases. It used to be about 3% to 5% per year For the last 36 months. We've seen an average of about 10% to 15% across the board on supplemental products with all carriers. So these double-digit rate increases, most of our clients can absorb that. So, as we're kind of planning with your clients, what does the future of Medicare hold? Well, anticipate higher rate increases, more utilization.

Speaker 3: 36:37

As the policyholders are aging, you can anticipate higher rate adjustments, higher rate adjustments post COVID specifically. So Medicare increases about 5% per year. And then, on the supplement, the new average is about 10 to 15%. Again, most of us can absorb that. But if you have clients who are kind of on the fence like hey, you know 500 bucks for my health insurance and I'm on a fixed income, we are seeing more of our supplemental clients not all, not even the majority more jump ship over to that advantage product because of affordability of the Medicare plus supplement plus drug plan Plus, I got to add my dental and vision a la carte that can stack up. So the negative to supplemental in this 80 20 product stack is that it becomes expensive for for certain individuals that can't absorb those high costs okay, so once you're honest good, I was gonna say so once you're on a supplement plan, that the the coverages don't change.

Speaker 1: 37:47

I mean, the plan is standardized, but your premiums may increase with rising health care costs. They increase insurers increase the premiums on everyone and I think we can only expect there's going to be more of that. What were you going to say, taylor?

Speaker 2: 38:02

Yeah, just to clarify, because switching if you're on a supplement, you can switch between supplements fairly easily. Is that correct? It's a great question Because I'm hearing two things like one other part because, like, it's not easy to go from advantage to a supplement, right? So I just wanted to clarify when you're saying make sure you shop it every year, but you can't switch, can we clarify what is easy to switch and what is hard to switch?

Speaker 3: 38:27

it every year, but you can't switch can we clarify what, what is easy to switch and what is hard to switch? Okay, so you have the two pathways right supplement and drug or medicare advantage. Anytime you're going from the cheaper zero premium to try to climb up to that porsche, that cadillac pathway with the supplement, that's difficult. Health questions come into. But if you're on the zero premium Medicare Advantage plan we can go HMO to PPO, carrier to carrier very easily. Now let's focus on the supplemental pathway.

Speaker 3: 38:58

In most states it's difficult to go from UnitedHealthcare to Humana supplement, go from united healthcare to humana supplement, humana to aetna. So your initial decision with your supplement is probably one that you're going to set for for a while. Where we come in and shop is on the drug plan portion. That's where there's a little more volatility. Your medications change, your clients medications change, the market, product gets stale In a few states and the trend is to follow this rule in a few states. Right now there's about 15 states that allow for a birthday rule or an anniversary rule where you can come in and shop your supplement product on your birthday or the policy effective date and go from United Healthcare to Blue Cross, blue Cross to Humana supplement G to N and vice versa with no underwriting. That is a new trend that is picking up steam. Utah and Virginia just passed their birthday rules for 2025 and Maryland passed it in 2023. Rhode Island is talking about getting a birthday rule and there's a few other states that are.

Speaker 3: 40:15

This is like in the you know pipeline to get approved through legislation For other states. You know Florida. You can't go from United healthcare to mutual, mutual to Cigna, like you can't shop your supplement unless you're healthy, which we all say we're healthy. But if you are a high health risk you're going to get flagged and denied and you're stuck in that initial supplemental plan decision, initial supplemental plan decision. So if you go supplemental, it's easy to move to that cheap advantage plan product down the road if your finances change. But you're getting hit with 10 or 15% rate increase each year.

Speaker 3: 41:01

And now UHC. I say UHC a lot because they're like the behemoth in the market. Uhc increases 20%, 30% in some states and you're like, oh my gosh, I just took a $50 increase. Is there any other options? In most states I'm going to say, yeah, we can change, but you have to go through medical underwriting. These supplement carriers are kind of removed from that aca regulation that requires uh or or eliminates the allowance of pre-existing health questions. So supplements outside of that six month new to medicare supplements can in most states require underwriting.

Speaker 2: 41:49

So not easy to switch supplements, easy to go from supplement to Advantage, not easy to go from Advantage to supplement and easy to switch amongst Advantage plans. Is that right? This?

Speaker 3: 42:03

is why I have a full-time job. Yeah, no, I get it, that's a lot.

Speaker 2: 42:07

What happens if you move states? What if I move from Virginia to Texas?

Speaker 3: 42:11

So if you have a Cigna plan in Virginia and you're moving to Texas, they offer products in Texas.

Speaker 2: 42:19

I'm just curious because you're saying some states let you change the birthday rule and some don't. I'm just wondering can you game it at all? Could you move somewhere to?

Speaker 3: 42:25

switch you can if you're in, you're in um DC, who doesn't have a a birthday rule allowance and you're like shoot my supplements through the roof, I'm gonna move to Virginia, who has a birthday, or Maryland yes, you can gain the system Now. You're in a state that allows fluid movement um and flexibility.

Speaker 1: 42:47

And.

Speaker 3: 42:48

I haven't. You know. My clients are hitting like 75, 78, just based on the length of time I've been doing this. I haven't seen the need to get that creative because most are in a competitive supplement from day one. We try to not put.

Speaker 2: 43:04

Yeah, I mean, something probably went wrong if you're having to move just for a Medicare reason.

Speaker 3: 43:07

But I was just, I was just curious, curious like what happens if you do so but on that advantage product, if somebody went with a zero premium advantage plan and now is like, oh my gosh, this product is ruthless. If they move states and that advantage plan is not available in the new state, it creates a guaranteed enrollment allowance to get into any supplement without underwriting. So that can get really nice for older clients who mom is getting sick, they're in New York or you know Vermont and they need to move to Virginia. Whatever the scenario is, typically we can get them into a supplement and better coverage if the parent made a unwise decision when they first got in. Yeah, it's education, education, education. In this space, because it's noisy, I hate to say a lot of agents are slimy, but they are. They're quick, like hand mouth permission. I got to make a buck. Quick, quick, quick numbers, volume. And we lose sight of what's important with the senior. And educating that senior before they even need to make a decision is key here.

Speaker 1: 44:22

Yeah, that's an important thing to talk about too, because I mean you're making these decisions maybe at originally at 65. But you know you may be, your healthcare issues may not be coming till your mid 80s and you may not have the same, you know, cognitive abilities or capacity to deal with you know these. What is a complex market, and so we've all heard about aggressive marketing or misleading sales tactics and sadly they target tend to be these older folks who may not hear zero premium or see an ad and get talked into changing plans. I'm curious what protections are there for, you know, consumers who have these kinds of issues?

Speaker 3: 45:15

Not many. I mean you can make a complaint to the insurance state insurance department, you can make a complaint to CMS, but not I think you got to fend for yourself. If you have an aging parent who is in a memory care, just keep an eye, have somebody watching out for their coverage, get their Medicare login so that you can monitor what type of product they're enrolled in each month. Each year I have the worst situation I've seen. It's disgusting, but I have an advisor's parent who was in memory care and they got switched about 28 different times throughout the year for this Medicare Advantage product and so every month we had like a whole process where every month I'd shoot the advisor an email and just say, hey, log into your mom's Medicaregov account to see if there's any fraudulent movement. Mom picked up the phone and said, yeah, I want the next best, I want free dental. And she does that constantly throughout the month. And these online teleworkers are just moving mom from plan X to Y to Z and back to X to Y to Z every month. So there's some protections that came out with this Inflation Reduction Act and CMS. That limits how much movement can happen throughout the year. But again, the carriers it's all self-governed, so the carriers are the ones who are going to flag that bad behavior.

Speaker 3: 46:47

There's talk about the Medicare Advantage space and enrollment to limit it, to have like term limits on Advantage plan enrollments to get more back to the like level of care that most of us need. So instead of being able to change your Advantage plan every year or five times a year, once you enroll in a product, you're in that product for two, three, four years so that you build a relationship with the provider and you have a certain value of care. That's happening. That is proposed. I don't know if it'll actually get passed, but that is a way to avoid this predatory movement that we are seeing in the advantage plan space, specifically because there's a ton of money kind of hanging out in the background with Medicare paying advantage plans, advantage plans paying commissions. How do you limit that incentive of the money and the movement? So they proposed the three-year term.

Speaker 2: 47:53

So we'll see, yeah, why shouldn't somebody work with a broker? Unlike the life insurance space, if you go through an agent or you buy it yourself, it's the same price. So is that the same for you, for your space?

Speaker 3: 48:05

So, like you're not saving any money by doing it yourself, you're just, yeah, that's nobody should do that I think the key there and one of the reasons we, like Steinlegg, has become kind of popular amongst the advisor and wealth management relationships and industry is because, like relationships and industry is because, like once, you find that trusted relationship and you know that the, the senior, is the, you know, focus of of everything. That's the drive behind what we're doing. Now. The senior is not paying for for our service. It's the same price, as you said, for supplemental, for drug, for advantage, and we're there when things are getting rocky and there's hiccups, there's hurdles.

Speaker 3: 48:54

We are the agent on the file. I have a whole customer support team where client has a billing snafu. Provider refuses X, y and Z service. The carrier is creating a pre-authorization. We're going through an appeal process. I don't know who will do that for free for a client, but a good broker. So you can pay $500 or $300 an hour for some consultant to sit on the call with you. But again, I think the key there is finding a really good relationship with a broker that is trusted, because we provide a lot of value at a free service.

Speaker 2: 49:35

What makes a bad broker? What should people look out for? I'm also curious and you may not want to answer this, but is your compensation different based on certain plans? So what should people be looking out for? Compensation different based on certain plans, like, so, like, yeah, what should people be looking out for?

Speaker 3: 49:48

Yeah, you always want to find an independent broker, Like you never want to work with somebody who's just pushing one, two, maybe three products and it takes a lot of time for us to go out Like I'm pretty like ruthless with my contracts with all of these carriers. Like I want everything under the sun. I will be able to show everything. But that means a ton of work for me and my team to do recertifications, trainings, Like the month of August is research for us. So find a broker who has a large portfolio so that you are getting access to everything. You're not just being, you know, razzled and dazzled with the three products that I want to everything. You're not just being, you know, razzled and dazzled with the three products that I want to write. Also, find somebody who has a team that does the customer support on the backend, because that's really where the value comes in.

Speaker 3: 50:39

When you're working with a 1-800 customer service rep in Bangladesh and you can barely hear them or speak with them, it's a very frustrating experience. That's where a broker who has the support on the back end the pre-enrollment support, the enrollment support and the post-enrollment support is key. And not everybody handles enrollment, especially post-enrollment support. It's hey, I'm out of the equation. This is beyond my scope. Call the insurance company directly, and usually that's where clients get stuck in the transfer from Humana's customer support over to their billing department and then an hour later my call's dropped. Let me me call back, so it can be a very frustrating experience and usually a good broker will have a tour.

Speaker 2: 51:34

They're coming running there's the siren going by, lost you for a second. Um can people work with you directly or do they have to go through an advisor?

Speaker 3: 51:45

uh, so, yes, yes, you can go directly to me. You can find me online, you can shoot me an email or you can work through your advisor if they have a good relationship. Usually it's just an email with the advisor and myself. It's to open that conversation and dialogue. We are licensed in all 50 states, so wherever your advisor is, wherever you live, we are typically able to assist and kind of do a deep dive assessment of your needs. So I always welcome just shoot me an email that's usually the easiest way to connect with me and my scheduling team comes in, my consulting team comes in and we're kind of doing that high level analysis of the current health insurance situation and circumstance for each client.

Speaker 3: 52:35

And it's not just a quick 30 minute or one hour phone call Like this is multiple conversations to get to that desired Medicare transition point, whether it's in three months, six months or six years. We are constantly communicating and peeing with clients. So I would also say that's something to be on the lookout for. If you're talking to a broker and they're trying to move you through this process, sign, sign, sign. We don't even sign somebody up until we have verified that you have your Medicare ID number, your card. Like we don't want to leave a client hanging out in no man's land. And CMS and social securities. You know, call, log to say, hey, I'm waiting for my Medicare ID number. Like we want to make sure every piece of the puzzle is in place by the time they turn 65 or they retire off the group plan.

Speaker 1: 53:31

Yeah, I mean one thing I really appreciate. I know one of the last clients I referred to, steinlage, who was retiring early so he wasn't going straight to Medicare. He was looking you all were going to help him compare Affordable Care Act plans and we got on the call and it turned out that, you know, what you guys could offer from the Affordable Care Act exchange wasn't going to be as good a coverage or price as his COBRA policy. And so you know the recommendation was stick with Cobra and we'll reach out to you in 18 months about getting on an exchange plan. Then. And I think that's definitely the hallmark of a good broker and one who's operating with you know the client's best interest in mind.

Speaker 3: 54:24

Yeah, yeah, I mean, some of the funnest advice I can give is don't do anything, you don't need me yet. Like call us in two years or when you're ready to retire. And most clients want us to like ping them every year to just say, hey, what's the situation? But we're with retirement goals. But that's where I really like partnering with you all and the advisors is like when we're doing these IRMA appeals. I need help to help the client estimate their modified AGI and you guys have a much better assessment. And like let's bring in your CPA, let's bring in the squad here so that we all can help you save money, make sure we're not running afoul of any IRS regulations, any CMS regulations, and ride into the Medicare sunset with accuracy. So it's good to have a team dynamic.

Speaker 3: 55:22

I bring in children adult children into the conversation when there's a parent that's a little feeble or uncertain as to their next decision. Transparency is key. It's a noisy market. So, yeah, well, that's great. You had a great experience. I think you worked with my teammate, angela on that specifically yeah.

Speaker 1: 55:47

That's right yeah.

Speaker 3: 55:48

Crack a hard wet Pips.

Speaker 1: 55:52

Oh well, I mean, there's so much more we could talk about. This is such a big area and rapidly changing and, yeah, we'd love to have you back. But if someone wants to get in contact with you, your email address is margo at steinlageinsurancecom.

Speaker 2: 56:13

Go ahead and spell that one.

Speaker 1: 56:15

Yeah, s-t-e-i-n-l-a-g-e insurance.

Speaker 3: 56:22

Dot com yes.

Speaker 1: 56:23

Dot com.

Speaker 3: 56:25

I always tell clients who butcher my last name I'm like it's okay, I'm like Madonna or Margo without a T too, that's one that can get misspelled too. Yes, or a UX if you're French and fancy.

Speaker 2: 56:43

Cool.

Speaker 3: 56:44

Yeah, this has been awesome, I think yeah.

Speaker 2: 56:46

I think we've fun to do another one with the other 80% of the questions we didn't get to. So this is awesome. Yeah, I think the biggest takeaway for me is like there's just so much to it. It doesn't cost you any extra to the client, like why would you not work with a broker? And obviously we think you all are a great option. You're in all 50 states, so start there. But yeah, this is awesome.

Speaker 3: 57:11

Learned a lot, cool. Well, thank you guys for having me and thank you for anybody watching or listening. I mean, it's out in the internet, I don't know who's watching it.

Speaker 2: 57:23

Well, thanks again.

Speaker 3: 57:25

Yeah, thank you guys, take care.

Speaker 2: 57:27

Thanks, margo, see you next time.