Avoid These Medicare Traps & Hidden Rules! (Advantage vs. Medigap)

Kai, are you serious? Your mom can't do what? She most likely won't be able to switch from her Medicare Advantage plan back to a Medigap supplement plan. Okay, so wait. You're telling me that she can't change her Advantage plan back to Original Medicare and a Medigap supplement plan? Well, I didn't say that she cannot go back to Original Medicare. That she can do. It's just that most likely she cannot go back to a Medigap supplement plan, and that Medigap company will most likely deny her application. I thought people could change their plans every year during this Medicare open enrollment period. Nope. Medigap supplement plans have a one-time-only open enrollment, whereas Medicare Advantage plans you can switch twice a year. Okay, this is exactly why our clients always say I'm so confused. We end up having the same conversation every year during open enrollment. Well, to add to the confusion, Medigap plans come with a list of guaranteed issue rights that my mom would need to qualify for, or she would have to answer health questions in order to be accepted by the plan. So if your mom is likely unable to go back to a Medigap plan, does she regret her decision? No, not at all. In fact, we created a new video where we explain the decisions our two moms made over 15 years ago, and why neither of them regrets their original choice. And we'll show you the video shortly, and you can also click in the description below. And whether you're new to Medicare or already enrolled, navigating the rules can be more challenging than managing tax regulations. In my 20 years of working with Medicare, I can't recall a single client who has been able to keep all these rules straight. Would you agree, Kai? Absolutely. There's so much contradiction and confusion between all the different open enrollment rules between Original Medicare, Medicare Advantage, Medigap supplement plans, and your Part D drug plan, too. Even many agents and sometimes even customer service with Medicare has gotten rules wrong. And this is why we made this video and this chart to clarify the contradictions and confusion of the most common open enrollment periods and how they apply to you. Hi, I'm Kai. And I'm Ann. And our goal is to help you retire healthy and wealthy. And here's Gracie, our retirement puppy. And you'll see a picture of her pop up whenever there's a key point for you to write down and remember. I'm sure many of you have noticed in our other social security videos, our hybrid pension annuity videos, those topics can be quite confusing, while Medicare can often feel even more overwhelming. Wouldn't you agree, Ann? Yes, absolutely. That's due to the seemingly endless and confusing rules surrounding it. However, we'll break down the most common rules using this chart, which you can download from the description below. All our information comes from Medicare.gov, the Medicare & You handbook, and a booklet titled Choosing a Medigap Policy. And feel free to refer to these government publications for more detailed information. Yeah, right. I'm sure most of you are not going to do that. That's like reading the IRS handbook. Well, that's true. So let's use this chart instead. I think it'd be much easier. Now, if you're still unsure about the differences between original Medicare, Medicare Advantage, and a Medicare supplement MediCap plan, check out this video by clicking the card up here or the link in the description below. We'll also have a video available at the end as well. You can be confident that all our agents are personally trained and vetted by us, so you'll never have to deal with a pushy sales environment. Or the vibe of the newbie that don't know what they're talking about type of vibe. Exactly. And keep in mind, whether you go through Medicare, the insurance company, or us, the price remains the same. We get paid by the insurance companies and not by you. Kind many people get the three and six months rule confused. That's true. So let's start with the first open enrollment called IEP, or your initial election period for each plan. Your original Medicare, Medicare Advantage, and standalone Part D all have the same rule, three months before or after your 65th birth month. However, this three months before or after rule that Ann just mentioned does not apply to MediCap supplement plan. Those plans have a one time only, one time only, six months open enrollment. And that's when you're new to Part B or you're turning 65. So your 65th birth month. So just to clarify, it's either option, meaning you could be over 65. But if you're new to Medicare, you have six months from your Part B effective date, not Part A, right? Correct. All right. Well, that rule isn't too complicated, but the annual enrollment period, AEP, is where things start to get confusing. Ready? So if your mom missed the initial six months from Part B open enrollment for a MediCap, then can't she just wait until AEP, the annual enrollment period, October 15th to December 7th? No, not for MediCap. Then what's the AEP then? Well, during this period, my mom can go from a Medicare Advantage plan back to original Medicare, and she can also switch to as many Medicare Advantage plans as she wants during this period. With the last application submitted by December 7th, that plan will go into effect January 1st of the next year. But what about changing to a MediCap? No, during this annual enrollment period, my mom will need to answer either health questions or have a guarantee issued right. These health questions can vary by carrier, and if she answers yes to even just one question, the carrier will most likely deny her application. And in some states, there are no medical underwriting, meaning the MediCap company is required to accept her back. And we can leave a list in the description below as well. Kai, can your mom change her Medicare Advantage plan to a supplement MediCap plan during the MAOEP, or the Medicare Advantage open enrollment period that starts from January 1st to March 31st? No, again, MediCap only has a one-time-only open enrollment period that's six months from the 65th birth month or from the Part B effective date, and that's it. So what can she do during the January 1st to March 31st MAOEP period? Well, my mom can disenroll from her Medicare Advantage plan and go back to original Medicare with or without a drug plan, just that she may not have a MediCap plan. She can also change one time during this period to a different Medicare Advantage plan with or without a drug plan. Of course, if she does not choose a drug plan during this time, she will get a penalty later on when she does want to add a drug plan back. Another reminder for our viewers, during the MAOEP period, you cannot join a Medicare Advantage plan. You can only make changes to an existing one. Additionally, you cannot change or enroll in a standalone Part D plan during this time as well. That's very true. Now, Kai, is your mom really restricted in switching from her Medicare Advantage plan to a supplement MediCap plan? Couldn't she look into a special enrollment period, like a trial write, that might allow her to make those changes? That's a great question. Our chart indicates that there are always a special election period or SEP for Original Medicare, Medicare Advantage, drug plans, and the same applies to Medicare supplement MediCap plans, such as when transitioning off an employer plan and even if it's a Medicare Advantage plan. However, since my mom is on an individual Medicare Advantage plan, not an employer-sponsored one, she will need her Medicare Advantage plan to meet one of the following conditions. For example, it must stop providing coverage in her area. She has to move outside her plan's coverage area, her plan's premium or co-pays must increase by 15% or more, or if her plan or providers terminate their contract with each other. These are the most common qualifying events for the special enrollment period, but these are technically called guaranteed issued rights. Kai, if your mom doesn't want to qualify to go back to a MediCap supplement plan under those other special events that you just mentioned, can she qualify to go back under the trial write rule? No, it's too late. These two trial writes only last for 12 months each. Either 12 months from the time she was eligible for Part A and enrolled in a Medicare Advantage plan, or 12 months from the first time she dropped a MediCap supplement plan and enrolled in a Medicare Advantage plan. With all these confusing rules and changes, be sure to subscribe if you haven't already so you'll be the first to know about any future Medicare rules changes. Lastly, Kai, wouldn't you agree that one of the biggest reasons people hesitate to purchase a Medicare supplement MediCap plan is the cost savings? Yes and no. And I mean, really, when you think about people that have a pension or a hybrid pension, cost really isn't much of an issue. They typically choose a MediCap plan from our experience. However, today, most people don't have a pension. That's the problem. And most people don't even know about hybrid pensions. This is the number one reason why millions opt for a Medicare Advantage plan, even if they prefer MediCap plan. That's why we created a video on this topic and the top three concerns for retirees, which you can find in the description below. That's true. Even our clients with a million dollars in their 401k often consider or seriously re-evaluate Medicare Advantage plans due to the absence of their pensions. Now here are the videos as promised. And click up here if you want to watch our brand new video on why our moms made the decisions and how they have never regretted their Medicare choices. If you're interested in learning more about the top concerns for retirees and how to incorporate a hybrid pension to afford the best Medicare plan, click this playlist down here.