What Are My Medicare Options?

Hi everyone. I'd like to welcome everyone to our McCabe & Associates education podcast series. Today I am delighted to have a special guest with us Lauren Bigum Steel. She is from Boomer Benefits and Boomer Benefits is a firm that works with clients on Medicare and everything there needs to be known about Medicare. So Lauren, welcome to our podcast series. So thankful that you are here with us today.

Happy to help.

Great. Lauren, if you would, just give us a little background about the Boomer Benefits story, history services, stuff like that, if you would.

Yeah. So, Boomer Benefits was started by a brother and sister here in Fort Worth, Texas. They're originally from Michigan, but Dave and Danielle Con. We've been in business for over 20 years and they are still the owners of our company and they come into the office all the time and they're still very involved. Which is great. We have over 200 employees. So we've grown quite a bit. When I first started here a little over six years ago, we had roughly 40 people. And so to see over 200 now has been quite, you know, an awesome opportunity for growth.

And the biggest thing that kind of keeps us standing apart from other brokerages throughout the country that sell Medicare is our client service team. So that was the main thing that when Dave and Danielle started this was they wanted someone to be there for their clients when they called. Instead of having them call, you know, Medicare or 1-800 number or something, they really just wanted that personalized experience, which is what we ended up growing into. We have almost 100 people on our client service team and they just kind of help prevent you having to do a lot of the work for Medicare for yourself.

So once you sign up with our sales team, you work with our client service team and they are really the backbone. And if you have claims, if you get a doctor's bill, if you have if you're moving during the enrollment periods, anything like that, instead of having to call, you know, Medicare or call your insurance carrier or try to figure it out on your own, you just reach out to us. We're all here in the same office located in Fort Worth, Texas, but we help clients all over the country. And yeah, that is pretty much our little spiel.

So, it was interesting. I came across a CNBC episode I think first with Danielle is where I became known about Boomer benefits and then there was another educational seminar that I attended where she spoke as well. So that intrigued me. I went into the Boomer benefits website. You talk about information. I mean there's some tremendous videos and fact sheets on Medicare. Very easy website to maneuver through. I thought it was great. Laura, how does, you know, Boomer Benefits work with investment firms like McCabe & Associates?

Yeah. So, we love working with, you know, investors and adviserss throughout the country. So, we like to pair you with people here in our office who are, you know, our tenure employees. So, that way you always have someone to refer your clients to. And then our which would be Gabe. He was one of the people that we had referred over to him so or referred over to you guys. He is an awesome person to help out with, but he is someone that would be able to help your clients kind of go over all of Medicare.

You know, do a full Medicare 101 like you had mentioned with our resources. There's just so much misinformation out there on Medicare that, you know, I feel like everywhere you turn if you Excuse me. I feel like everywhere you turn or you search something and now you're getting AI answers and stuff. So, not everything is always correct and we like to really just make sure that we are here to make sure you're getting the correct information. So, whether that be online or with one of our agents and even if you feel like pretty confident with your Medicare knowledge, we still want to go over that with you just to double check and make sure that you know, have all of the different parts and plans and all of that down.

So, they would kind of go over all of that with you and then enroll you into the plan that you know you see fit for yourself. Our agents do not work off of commission, which is really different from other brokerages. They are paid, our company is paid to commission by the carrier whenever you enroll, but our agents are paid a flat fee for enrolling someone into a plan. So you won't feel like you're being pushed into a certain plan that you're not, you know, wanting to be in necessarily or feel like you're, you know, going a different route than you originally wanted to.

They're really just looking out for the best interest of you, their client. Instead of what is going to be best for their, you know, wallet.

So really a true fiduciary standard as far as what they're looking to match for medical benefits for clients, right?

Yeah. They're really looking at what is going to be best for you financially, healthwise, if you travel, like all these different things. If you go the Medigap route, we want to make sure that, you know, you find a plan that is stable and has rates that you can afford. If you go the Medicare Advantage route, you know, make sure that you are on u a plan that covers your medications, your doctors, all of those different services. And that's what our agent. So very simple you know just a few questions with as it pertains to Medicare you know what is Medicare what is metagap what is Medicaid so Medicare is the you know federally run insurance program for people 65 and older also if you're on disability for 24 months you do qualify for Medicare as well Medicaid is a federal program for people with low income so they're a little bit different.

A lot more people that are younger or you know families and all that qualify for Medicaid due to the income aspect while everyone over 65 qualifies for Medicare. And then a metag gap plan is a secondary insurance to Medicare. So they work together. Medicare covers 80% of your medical services and that leaves 20% open for you to pay on. So, Medig gap plans cover that 20%.

Got it. And I think we're at a timely call for this discussion obviously because we're in an open enrollment period now for Medicare enrollies. You know the different parts of Medicare. So obviously when you turn 65 and again correct me if I'm wrong but age 65 you enroll for Medicare. Part A is is basically the initial part. Is that correct? And if you can explain you know part A and what that would cover. Yeah. So, part A is your hospital insurance. That is a lot of your inpatient care, skilled nursing facilities, hospice, and that something we always say is to think of that as just your room and board for a hospital.

So, it covers, you know, your stay, your meals while you're in the hospital, all of that. Part B is your outpatient coverage. So that is your doctor's visits, your lab work, anything you know that you go to the doctor for, that's your part B coverage. And part A is what you are paying into during your taxes during your working years. So a lot of people will turn 65 and say, "I thought Medicare was free. I've been paying into it for forever." Well, you are paying into part A.

So that is your free part. If you don't qualify for part A due to you or your spouse's working history, it's about like it ranges from like $300 to $500 a month for part A, but most people do qualify for preart A. And then part B, the standard cost is $185 a month and that is also based on your income. So, part B and part C, which we can get into, those are based on your income of how you file your taxes and so your premiums may vary.

Got it. And part C, that that's where Medicare Advantage would come in. Am I correct on that?

Yeah.

So, part C is your advantage, which kind of is also referred to as a Medicare replacement.

So instead of being covered by Medicare at your 80%, you're now covered by a carrier. So, Etna, Humanana, however, United Healthcare. Those work a lot like your current coverage that you would have, you know, working or using the healthcare.gov because they're HMO and PO plans. So those kind of work that way, but the premiums are much lower on those plans.

Got it. And the same goes for part D as well, which is your prescription drug plan. Is that correct?

Yeah. So, it covers all of your outpatient medications. So, anything that you're picking up at the pharmacy and again those range in pricing and but the good thing about part D is there is now a cap on the price of medications. So, in 2025 it was a $2,000 cap on your covered medications, which is a huge decrease in price from 2024 when it was an $8,000 plus out of pocket. In 2025 they made the inflation reduction act which brought it down to $2,000 out of pocket and in 2026 it's 2100. So that is the most anyone will pay for their medications out of pocket at the pharmacy.

Got it. And I know you know Boomer Benefits is is call it agnostic when it comes to picking and providing providers, right? You know truly an open architecture source for you know Medicare Advantage plans and also part D prescription drug plans. Is that correct?

Correct. Yeah. So, we really just look at what is in your area. What is, you know, the most cost effective. We're represented with the most top rated carriers. So, we're really just looking at what is going to cover you at the time that you're enrolling.

And I know I mentioned I believe I mentioned, but you know, we have clients that are not only doiciled in Illinois, but you know, spread across the country, too. So, Boomer Benefits can definitely help with clients that are spread out throughout the United States. Is that correct?

Yeah. So, just whenever you reach out to us or if you wanted to look into anything, we just go based off of the address that you have with Social Security. So, whenever they ask, whenever like the main state that you give, that we like run quotes and things in is the state that Social Security has your address in. So, if you're a snowbird, that's totally fine. We just run everything off of where your like permanent, you know, your most frequently residence is.

Got it. I know I mentioned that we are in open enrollment period now but you know when am I eligible to enroll not me personally but when are people eligible to enroll into Medicare? What are the deadlines? You know what are the penalties if you miss a deadline or anything like that? Maybe you can touch on that topic for a moment.

Sure. So for eligibility you can enroll when you are 65 like I mentioned or if you've been on disability for 24 months and there's no penalty. So, if you decide to continue working, which most people are, they're working past 65. If you continue to work and you have creditable insurance, which means having over 20 employees, you don't have to enroll into Medicare. You can continue just the coverage with your employer. You're totally welcome to go to Medicare, but a lot of people carry spouses or maybe children or something still, so they choose to just keep their employer insurance.

I will say most people do enroll into part A with the turn 65 because it's free and that's your extra health hospital insurance, but you won't want to do that if you have a high deductible plan because you're contributing to an HSA plan. So, that is the biggest really part is that if you have an HSA plan that you are contributing to, you'll want to skip all parts of enrolling in Medicare until you choose to retire. HSAs are seen as another form of health insurance, so you can't have part A with another form of health insurance. They which makes sense.

And then I'm sorry. I know we're talking about the you know obviously the different parts and then you know Medicare Advantage plans. I actually went through you know helping my mother out when she filed for Medicare and then you know looking at all obviously the supplemental side of it. But not only you know obviously the parts but like the traditional Medicare of plan GH and forgive me because I know there's probably nine of them. But maybe you can touch on the difference between like you know obviously if you get a supplemental through Medicare true Medicare supplemental plans versus out going outside of that.

What are the two big differences there? The biggest difference is that on a Medicare Advantage plan, you have a network. So on the Medicare Advantage plans, you have a PO or an HMO network that you have to stay within for your providers.

Okay?

On a Medicare supplement plan or a Medigap plan, you have access to see anyone who accepts Medicare. So, if you travel and you know, are an RVER and you're going to visit your grand grandkids or whatever, you can see anyone from here to, you know, the other side of the country if they take Medicare. If you're on a Medicare Advantage plan, your network is a little bit more limited. We've seen where they only are networks in your county. So, you know, or county or like surrounding counties, you may not have a ton of coverage outside of that.

So, if you do fall you know and need help or something and that's not like complete emergency care you may not have coverage while you're you know in a different state. They are getting more networks. We're seeing Medicare Advantage plans become more robust because we're seeing so many people move to them. So, you know, they are growing networks as we progress. But

Sure, that's like kind of like the main difference between them is that one has, you know, the network restrictions and one has a little bit more open access.

Another thing is that Medicare Advantage plans cover things that Medicare supplement plans don't. So Medicare was my next question offer. Yeah. So Medicare Advantage plans can offer gym memberships. They can offer dental coverage, you know, for implants or cleanings and all of that. They can offer hearing aid assistance or dental care and all of those different things. Where on a Medicare supplement or Medigap plan, those are not covered. You would have to get a standalone plan outside of that, which is, you know, $40 or $50 a month, while on a Medicare Advantage plan, they're covered.

So, it's just kind of, you know, a little bit of a different coverage. Medicare Advantage plans have out of network cost or not, sorry, they have max out of pocket cost. That's the word I was looking for. So they, you know, if you're on an HMO plan, you could pay, you know, $4,000 out of pocket max for, you know, your entire year of coverage.

That's hospital stays, all of those things. On a PO plan, you could have a max out of pocket of over $10,000. So, it just kind of varies. And then on a Medicare supplement plan, you have a lot lower out of pocket. With Medicare, your premiums are just higher. So, they have

So, the advantage plans kind of sound like our are, you know, most common to, you know, workplace benefits, right? When you go into open enrollment and you choose which plan either PO HMO whether you're in network out of network it to me it sounds very similar to that you know versus the true Medicare parts I'm sorry the plans of those parts are obviously a little bit more robust as far as you know what they cover maybe a little bit less inexpensive but you know obviously limited to you know dental vision that maybe those advantage plans would pick up is that correct Yeah.

So, they work a lot like your health plan that you would have under 65 with those extra benefits and everything and you know, we all have out of pocket, you know, deductibles and all of that. So, sure, a lot of people are used to how Medicare Advantage plans work. It is just up to you on how you want to use your coverage. So, got it. It could either be paying a higher premium but having less out-of- pocket or services which would be on a Medicare supplement plan or paying less for your premium, having extra benefits but having a little bit more out of pocket if you have to go to the hospital or you're having services completed.

And I don't know if you know this and I'm not going to hold you any number, but when most people decide to pick which side of that do they want, you know, versus Medicare supplement or a advantage plan, do you know typically which side people lean most to or is it all dependent on their own personal situation?

Very dependent. But from what we've seen, I think the math from 2024 was 51% of people of Medicare beneficiaries are on Medicare Advantage plans. That is just where we're at. Premiums for Medigap plans are increasing and so some people are just not able to afford the price of those. If they are, they're keeping them and that's great. But we have seen a lot of people move to Medicare Advantage plans due to the cost of just the rising rates on Medigap plans.

Sure. And for like you know how does it affect high income earners? I know you mentioned and I know there is a breakdown as far as income of what you know increases of premium will go to on Medicare plans you know for high income earners they will pay more obviously for income growing annually. Is that correct?

Correct. Yeah. So for part B and for part D, so part B like boy and part D like drug, there is something called the IRMAA, which is the income related monthly adjustment amount. And it kind of depends on how you file your taxes, whether you file them jointly or single. So anywhere from in 2025, that is the only rates we have right now. Anything over $16,000 single or 212 joint you're paying over the $185 amount. So that could range anywhere from you know $249 to $628 I believe.

So that is how much your part B premium is. And on a Medicare Advantage plan you still pay your part B premium even though you no longer really like on Medicare. You still pay for the part B premium.

Sure.

And then for part D for your drug plan, that also has the IRMAA and that ranges anywhere from like an additional So you have your price for your part D plan which ranges in 2026 the ranges are like $0 to like $130. So it's up to you like you know whichever plan you choose but you pay an additional like $13 all the way up to like $85. And that is also on the Medicare Advantage part two. If your plan has a drug plan on it, you would pay that IRMAA for part B as well. Part

Sure. And we've been having those conversations with our clients, too, as well as, you know, obviously, you know, clients that are in the retirement years, income distributions. We're very cognizant as far as, you know, what clients are taking with income distributions from their investment accounts and ultimately how that can affect their premiums for Medicare. Yeah. And they look back two years at your income. So, in 2026, they'll be looking at your 2024 tax returns. And you can file something called an SS44 appeal form.

Okay?

And that is basically just how you can appeal your premiums down. Whether that is you know, you retired in 2025, so you're like in 2026, I'm not making as much, right? If you sold a property. There's all these different reasons that you can file for that appeal and that will help drop your premium down. If you're at that top level, it may not drop it all the way down to the standard amount, but it would at least drop you down, you know, to a lower amount than, you know, paying that $630 a month.

Oh, sure.

But there that form is available and, if you work with one of our agents, we can teach you how to like fill that out and get that all sent into Social Security.

Yeah, that's fantastic. Because like I said that has happened to a few clients that have retired coming off of you know a relatively higher income and then you know obviously they get first year Medicare premiums and it's like wait a minute I'm not making that income anymore. You know how can I adjust that? So yeah thank you for bringing that up and explaining that. That's very helpful. Yeah, and that's a huge thing to think of if you are still working. When you're looking at your cost comparison between your current employer insurance versus going on Medicare, it is really huge to look at if you would have an IRMAA.

Because there's, you know, if you're like, oh, Medicare is going to be so much cheaper because it's 185 a month plus, you know, anything else.

It could be a lot different if it's, you know, $658, right?

Exactly. Talk to us about, you know, Medicare and long-term care. Obviously, you know, we talk to our clients about long-term care planning and those needs, but you know, obviously Medicare does not cover that. Is that correct?

Right. Yeah. So, Medicare doesn't cover any long-term care. They do cover, you know, like I mentioned, hospice and skilled nursing, which is if you have surgery or something and you're needing a few extra days to recover, they'll pay for that in a skilled nursing facility. But as far as long-term care, there is no coverage on that.

Got it. Got it. Well, I know that we want to always keep our podcast under about a half hour, which we're basically right there and this information has been incredible. Thank you so much for, you know, sharing, Boomer Benefits story with us and going through, you know, the ins and outs briefly of Medicare and how Boomer benefits can help. I do want to share with our clients and, you know, we do have information I know Lauren you mentioned about Gabe. Gabe has been a dedicated Medicare expert.

He's assigned to our office for our clients. I do have his contact information here which we will definitely you know let our clients know that you know these services are available. Obviously this is in addition to you know what Gabe services can compare and what he does and how he can work with our clients. So I just want to make that known and like I said your website has been tremendous a tremendous resource. I actually did take for myself the Medicare 101 quiz. Happy to say I did pass it.

But it, the resources on the website are fantastic. So, I just want to say thank you for that. There's countless videos, I believe, that Danielle is posting on your website, which basically walk people from the early stages of Medicare to folks that are on Medicare looking to switch plans possibly, when to do that. So I know the resources are great. Anything else that you want to add before we wrap up the podcast?

I don't think so. But like you had mentioned with the resources, we have calculators on there. So, if you want to look at your IRMAA and see, you know, how much you'd be paying, there is an IRMAA calculator on there. If you ever wanted to just see about, you know, if you may have a penalty, which you more than likely wouldn't, but if you would, there's penalty calculators, there's everything on there, our YouTube channel, any social media you will find us. And yeah, we're just happy to be a resource for you and you know, help you get all of your Medicare situated.

Fantastic. Lauren, thank you so much for your time today. Really appreciate it. And then you know, our clients we will direct you to how to get in contact with Gabe at Boomer Benefits should there be any questions or needs for Medicare planning. So, thank you so much for your time today. Really appreciate it.

Of course. Yeah, no problem. Thank you.

This transcript was generated from the episode audio and may contain errors.