 My name is Michelle Maher and I'm coordinator for plug-in at the Robbins Library series targeted to 50 plus adults. We do monthly programming from now that we're kind of past the pandemic. Doing back to monthly programming, we were doing every three weeks during the pandemic. But now we're back to monthly programming from September through June. We offer programs, so the programs are run the gamut. We'll be showing a film before the end of the year about how Midwestern state is dealing with climate change. A farm is successfully dealing with all of that, and I felt it was especially timely given what this country is going through with the drought. Also, if you are interested in learning about programs, you can find out about it in a number of ways. You can sign up for the Robbins Library general email list, and then you'll find out about all the programs that the library offers. If you would like to only learn about plug-in events, there is a plug-in mailing list. If you go to the Robbins Library's front page, scroll down to the bottom. You can sign up for the plug-in at the Robbins, and I sent out usually two emails a month. One to let you know what the program is going to be, and then one closer to the event as a reminder. The only one who uses that email list is me. If you want to get the general Robbins Library email list, you need to sign up for that. We also have someone here from the Friends, and the Friends has a mailing list too. You can find a whole host of email lists there. All of the friends' events and the plug-in events are in the general library. The email list goes out once a month. If you just fill out one of these forms for me and leave it on the table, I will add you to... This is your permission for me to add you to the list. I would like to introduce Ben Thornton. This is our 11th season of plug-in, and our palindrome year. Ben has been presenting every other year, and we took a little break during the pandemic, to talk about Medicare. He is a licensed insurance broker, and he also is a financial consultant. His company is called Unicorn Consulting, and Ben will tell you that every year when he does this, he updates, and it has to be vetted by the federal government. So everything that Ben is telling you has been vetted by Medicare. And this program is not only for those of you who are about to become eligible for Medicare, it's also for those of you who are of that age who are enrolled in Medicare, because every year there's an open enrollment program period, which started on October 15th and goes to the end of the year, correct? December 7th. December 7th, sorry. And you get to choose every year if you want to stay with the Medicare plan that you have, or if you want to go to Medicare Advantage, and Ben will explain all of that to you. So without further ado, Ben. Thank you, Michelle. It's always great to be here. So as she was saying, my name is Ben Thornton. I've been a Medicare broker for 10 years now. Been doing this program for eight years, and it's always been a great program. I'm going to be going over a little bit of the history of Medicare, and then talk about the different parts, and finally go over the specifics for the coming year. After that, there'll be time for questions. Do want to hold questions till the end, though, because there might be something later on that answers your question before you get to it. So I am living in air and working now from home for this. I moved out there in 2017. Before that, I actually lived in the Colonial Village condos. I'm a registered investment advisor, licensed in Massachusetts. Health and life insurance licensed in several states. Series 65 licensed, and I've been helping people with Medicare since 2006. So this is my 17th season of helping people. So Medicare started July 30, 1965, when President Johnson signed into law the bill that created Parts A and Part B. In the 1980s, Medicare supplement plans, which are also known as Medigap plans, were introduced. Those helped cover the expenses that Part A and Part B do not cover. In the 90s, those supplements were standardized. Before that, insurance companies could do whatever they wanted with the plans. In the 90s, the government standardized the plans. That's where you're going to get the Plan A, Plan B, Plan C that people talk about. Or in Massachusetts, it's slightly different, which I'll get to in just a second. In 1997, Medicare Part C, which is Medicare Advantage plans, were introduced. And finally, in 2006, Medicare Part D was introduced, which finally gave people access to prescription drug plans without being in a Medicare Advantage plan. To qualify for Medicare Part A and B, you are automatically qualified if you are a U.S. citizen. Age 65, have lived in the U.S. for five years, and have 40 Medicare credits. You also automatically qualify if you have end-stage renal disease. If you have been collecting Social Security disability insurance for 24 months. So that's SSDI, not SSI. So there is a slight difference between those two, so only one of those actually qualifies for it. Or if you are disabled due to Lou Gehrig's disease. If you don't qualify automatically, you can still sign in if you pay a monthly premium for your Part A insurance. Coverage will begin, in most cases, the first day of the month that you turn 65. The exception to that is if your birthday is on the first day of the month, it actually starts on the first day of the month before your birthday. So if you're born on April 1st, coverage starts on March 1st of that year. So for Medicare Part A, Medicare Part A is hospital coverage. That's any inpatient care. These numbers are accurate for 2023. So at the beginning of a hospital stay, if you're in the hospital for 60 days, you're responsible for the first $1,600 of expenses for the hospital stay. And then the Medicare Part A will cover the rest. So the Part A benefit period starts when you enter the hospital as being admitted as an inpatient. And it ends when you have not received inpatient hospital care or skilled nursing facility for 60 days in a row. So if you go into the hospital, then come out and you go see your doctor and the doctor's like, nope, you need to be back in the hospital. That still counts as one stay. If you go home, though, or get better, have to go in for another reason. That's a new benefit period so that deductible starts over. After 60 days in the hospital, you're responsible for $400 per day from day 61 to 90. And then you're responsible for 800 days after day 90. If you're in the after day 90, there are 60 days total. So if you're in the hospital, 95 days, that takes five days off of your lifetime. That does not replenish. The rest of this does. So if you're in the hospital, then for another 100 days, you'd use up another 10 days of the reserve period. But the first 90 days would still be covered as before. Medicare Part A also covers 190 days of inpatient psychiatric care. That does not replenish. So that's 190 days over the lifetime. There are other benefits per Part A. In Part A, they cover the blood transfusions. You're responsible for the charge for the first three pints after that Medicare Part A pays for it. They cover home health care. They cover skilled nursing facility. For the first 20 days, you're responsible for the cost. Medicare Part A does not pay for it. From days 21 to 100, you pay $200 per day. The insurance covers the rest. After 100 days, then I'm sorry. They cover the costs for the first 20 days. You're responsible for $200 a day from days 21 to 100. And then you're responsible for all costs after day 100. Sorry, I got that confused for a second. But they cover everything for the first 20 days. Medicare Part A will cover the first 20 days of skilled nursing facility. From days 21 to 100, you pay $200 per day, and they pay the rest. And then after 100 days, you're responsible for the payments. They also cover hospice care. Medicare Part B covers outpatient care. That's your doctor's visits. That's the any labs that you have, any outpatient procedures, X-rays, MRIs. And that Medicare Part B is not covered completely. Or you have to pay, sorry, Medicare Part B. You have to pay $164 per month for individuals making up to $85,000 per year. Medicare Part A, you don't have a premium at all. This is the premium for Part B. If you don't enroll in Medicare Part B, when you first are eligible for it, then you get penalized 10% for every 12 months you are eligible, but don't sign up. This does not imply, this does not apply if you have group coverage through an employer. So if you're getting coverage from an employer because you're still working and you're 68, 69, you don't have to worry about that late enrollment penalty. It's only if you're not getting creditable coverage through an employer. However, Cobra coverage does not count. It does not weigh the penalty. So if you leave work and sign up for Cobra, that penalty will start to apply for it. So if you're not working and you're qualified for Medicare, don't go on Cobra. You'd want to sign up for Medicare Part B instead. In 2023, Medicare Part B has a $226 deductible. So you're responsible for the first $226 for the year, for office visits, labs, et cetera. Then you're responsible for 20% of any cost after that. That's per year. That's not per benefit period. That's the difference between Part A and Part B. Part B benefits include office visits, labs, X-rays, diagnostic imaging like CAT scans, some preventative care. So preventative colonoscopy mammograms are covered at no charge. Annual wellness visit, so that's once a year. You'll go to the doctor's office. They'll check to see how you're doing to make sure that everything's up to date. That's covered completely. Outpatient surgery is covered under Part B. Chemotherapy is covered under Part B. Durable medical equipment, so diabetic supplies, hospital beds, anything that you would get at a durable medical supply store is covered. Some medications are covered through Part B. Part B also covers ambulance, and it covers some additional benefits, but those are not as commonly used. What's not covered? Most dental care is not covered. Dental care that's caused by an infection or something else that's medical is covered, but routine dental care is not. Routine eye exams are not covered by Part B. Densures, cosmetic surgery, acupuncture, hearing aids, long-term care, and most medications are not covered by Medicare Part B. So as I was saying, should you enroll in Medicare as soon as possible? If you qualify for Medicare Part A with no premium, meaning that you have the 40 quarters of work that you've been a citizen for five years, or that you have one of the other conditions, you should enroll as soon as you're eligible. There's no charge to you for it, and it will work with your employer coverage. If you have insurance through a credible employer plan, you may wish to postpone Part B, and you may want to postpone Part A if you have to pay a premium for it, because sometimes the benefits from your employer will be better, and so there's no reason to pay the extra premium. Again, each situation is different, so you would want to look into it to see whether the coverage is credible and whether or not the Medicare would be of assistance to you to apply for Medicare A and B. If you're collecting Social Security or railroad retiree benefits, you will automatically be signed up for Medicare A and B when you turn 65. If you are disabled, you will automatically be signed up for Medicare A and B 25 months after SSDI begins, so 24 months of disability, you qualify for it the 25th month, it starts automatically. If you are not collecting Social Security benefits, you will not be automatically enrolled. You will have a seven month open enrollment period beginning three months before your 65th birthday, the month of your 65th birthday, and three months after the month of your 65th birthday to sign up with no penalty. After that is when that Part B penalty starts to kick in. If you don't enroll at that time, you can sign up for Medicare Part A with no premium. You can sign up anytime. You'll just contact Social Security. Let them know that you want to sign up for it and you'll be able to sign up for it for the next month. You may sign up for Medicare Part B and Part A if you need to pay a premium between January 1st and March 31st of each year. Coverage for those would begin July 1st of that year. If you are working and you're receiving insurance benefits through your employer, you can apply for Medicare Part A and B at any time while you're still working and for up to eight months after the employment or the coverage ends without a penalty. So when you're thinking of retiring, you can start looking into the plan and you still have eight months after you lose that employer coverage to sign up without any penalty. If you sign up for COBRA, that doesn't count. The penalty will still apply. How to sign up? Applications go through Social Security Office. You can go online to ssa.gov. You can also apply by phone or you can apply at the local office for Arlington, that's 10 Fawcett Street in Cambridge. So as I said, when you turn 65, if you're collecting Social Security or Railroad Retirement Benefits, you will automatically be signed up for Part A and Part B. Sometimes you don't want Part B because even though you're getting Social Security benefits, you're still working and you still get an employer through a spouse or something like that. Then if you do not want it, you can sign the back of the Medicare card that they give you, mail it back to the address provided, and they will send you a new card with just the Part A coverage so you don't have to pay for the Part B premium if you don't need it. If you are collecting Part A and you want to add on Part B later, you cannot do it through the website currently. The best way of doing it is to call Social Security Office or to go to the office. For that in general, the Social Security offices are always busy at the beginning of the month, so I always recommend going after the 10th of the month or setting up an appointment because they're just a little bit less busy a little bit later in the month. So Medicare Part A and Part B are very good. They have all those coverages. There are a few limitations to the plan however. The first major limitation is there's no out-of-pocket maximum. So if you have $100,000 in procedures and things, you're responsible for 20,000, 20% of it. There's no maximum. The amount just keeps going up. They pay 80%, you pay 20%. It also does not cover prescriptions. There are two ways to handle those issues. First is a Medicare Supplement and Prescription Drug Plan or a Medigap Plan and Prescription Drugs, which is Part D, or Medicare Advantage Plan, which is Part C. Both work for different situations, which one is best for you is what we're beginning to now. Medicare Supplements are offered by third-party companies, are not offered by Medicare, and prices vary by the different companies. In Massachusetts, earlier I said that in the 90s, the government standardized all of the supplement plans and you have the letter plans, the Part A, or the Plan A, Plan B, Plan F, Plan G. Three states, Massachusetts, Minnesota and Wisconsin, standardized their coverage before the government standardized it. We get to keep our standardized plans that we had before that. So our plans are not going to be a Plan F or a Plan G or a Plan N, like you'll hear from any of your friends in other states. We have three different plans right now. And that's going to be on the next slide. The Medicare Supplements, to qualify for it, you must have Medicare A and B. It is secondary to A and B. So when you go to your doctor's office, you'll be giving them your Medicare card and your supplement card. They'll bill the Medicare first. Medicare will pay their portion. The bill will go automatically to your supplement. They'll pay their portion, and then the doctor's office will send you the bill for the remainder. It covers some or all of the costs left over after Medicare pays. In 2020, there was a big change nationwide with Medicare Supplements. As part of the Affordable Care Act, anyone who became eligible for Medicare after January 1, 2020 cannot choose a plan that has first dollar coverage. Before that, there were plans, Plan F in Massachusetts that was Supplement 1 that covered everything from your Part B deductible on. So that first $226, they covered everything. So you had no out-of-pocket cost for anything that was covered by Medicare A or B. If you qualify, if you become eligible for Medicare after January 1, 2020, they no longer allow that. The best you can get is a plan that has that $226 deductible for Part B. Everything else is covered. So in Massachusetts, there are currently two options available. These were the standardized options before. And the first one is the core plan. It covers everything that Part A and Part B leaves over except the deductibles. So it doesn't cover that $1,600 deductible per hospital stay. And it doesn't cover the $226 Part B premium. But it covers the 20% after the Part B premium. It covers day 60 and on for Part A. Supplement 1 covers everything. That was the one before 2020. If you were eligible for Medicare before 2020, it covers all the deductibles. So it covers that $1,600 and that $226. Supplement 1A is what Massachusetts came up with as the option instead of Supplement 1, which covers everything still from Part A. It just doesn't cover that $226. So in Massachusetts, there are a variety of plans, as I said, from different companies. The supplement core plans range from $114 to $205 per month. Some of the more expensive ones have some additional benefits besides just the basic benefits. It does not cover the Part A deductible. It doesn't cover the Part B deductible. And it does not cover the skilled nursing facility charges from days 20 to 100. It does add an additional 60 days of inpatient psychiatric hospitalization. So it's to have 190 days per lifetime. It's 250 days per lifetime. Supplement 1 in 2023 is going to be between $207 and $331 per month. These prices are on top of your Part B premium, that $160 premium for Part B. It covers all the Part A and B deductibles and the skilled nursing facility fees. It covers 80% of emergency medical expenses during foreign travel within the first 90 days of travel. Some of the core plans also have that benefit, but that's not one that they're required to have. And it includes an additional 120 days for inpatient psychiatric care. Supplement 1A is between $185 and $322 per month, depending on the plan. And that one is going to be the same as Part Supplement 1. And that covers everything the core covers, covers the Part A and the skilled nursing facility, the emergency medical expenses, the 120 additional days. It does not cover the $226 for Part B deductible. So when do you sign up for a supplement? In Massachusetts, you can sign up for a supplement anytime starting two months before your Medicare Part A and B become effective. It will become effective on the same date as your Medicare Part B effective date or the first of the month after you sign up. So there is no open enrollment period. You can sign up for this anytime during the year. There's no penalty for signing up late. You can sign up anytime. You can sign up when you're 75 and decide you want a supplement. You can sign up for it at that time. This is in Massachusetts and other states. There are restrictions to this. Some other states require underwriting to sign up for a supplement plan. Massachusetts does not have underwriting for supplements. They do have an incentive for you to sign up when you first become eligible, though. They reduce your price by up to 15% for the first three years depending on the plan if you sign up when you first become eligible. That's how they encourage people to sign up early is by giving you that reduced premium for the first few years that you're on the plan. But even with the supplements, you're not being covered for your prescriptions. So that's where the prescription D plan came in originally. In Massachusetts, in Arlington in 2023, it's separated by county. So different counties will have different plans. But in Arlington in 2023, there are 24 different prescription drug plans available. They're available through nine different companies. You do not need to pick the same plan as you have for your supplement. You could have Blue Cross for your supplement and Tufts for your Part D plan where you can have AARP and well care. It does not matter. The two companies, it's more important to find the one that fits your needs than to stick with a company. The price range for the plans range from $6.80 per month to $126.60 per month. The more expensive plans are going to have more beneficial coverage for higher cost medications in general. But this is something that's going to be very specific for what medications you're on. And it's something that is a large part of what I do is I will go get a list of medications that one of my clients is on, run it through all the different plans, find out what plan is going to give them the best price for the year between the premium, the cost of the medications, everything, and help them sign up for that plan so that they have the best, most cost effective one for themselves. You can do it yourself. You can go to Medicare.gov, find a plan. You put in your medication information, the drug names, the strengths, how often you take it, what pharmacies you use, and it will come up with a comparison of all the different plans. You can break it down by company, by premium, by out-of-pocket expenses. So which plan is the best? It really does depend on which pharmacy you use and what medications you're on. Some plans have low premiums, but if you're paying a lot more for your medication, you're going to be paying more out-of-pocket for the year than a plan that costs more each month, but has cheaper medications. Some are very specific about which pharmacy you use, so if you have one pharmacy that you love the pharmacist, you've been with them for years and you want to stick with them, you want to have a plan that covers that pharmacy. When to sign up for Medicare Part D? So for Medicare Part D, you have to be enrolled in Part A or Part B. You do not have to have both. So if you just have Part A and you need a prescription drug plan, you can pick that up. The initial enrollment period is during the same time period that you sign up for your Medicare Part B. And then the annual enrollment period is between October 15th and December 7th each year, which we're just starting now. You can enroll or switch plans for coverage beginning January 1st of the next year. So if you're just signing up for Medicare, you can enroll at the same time that you're signing up for Part B. If you don't sign up during that time, you can only sign up for a prescription drug plan between October 15th and December 7th for coverage that begins on January 1st of the next year. And then once you have a plan, each year you can change it to a different plan. So if your medications have changed or even if they haven't changed, it's a good idea to go through the plans because sometimes each plan will change how much they cover a certain medication for the next year. And so it's good to check each year which plans are going to be the best for your current medications. But what if I don't take any medications? Why should I sign up for a plan? You should still sign up for a plan if you're not taking medication because you may need medications later in the year and you won't be able to get them. And also there is a penalty for enrolling late. The late enrollment penalty for Part D is 1% of the national average per month you were eligible but not enrolled in a prescription drug plan. So if you sign up 30 months after you become eligible for it, you would pay additional 30% of the national average which for 2023 is $32.74. So you'd be paying additional $9.80 per month for your plan when you pick it up for the rest of your life. And that penalty does change each year based off of the national average. So if the national average goes up you're going to be paying more penalty each year because of that percentage. So like I said, there's a plan that's $6.80 per month. If you don't sign up and you sign up a few years later you're going to be paying more than that in penalty. There are also some special enrollment periods other than the annual enrollment period where you can sign up for a prescription drug plan. If you move out of the area that your current prescription drug plan is in, you can sign up in a new plan. If you lose other credible coverage, for instance if you lose your employer coverage you can sign up for a prescription drug plan at that time. You don't have to wait for the open enrollment period. If you live in a nursing home you can change your prescription drug plan at any time. If you have mass health, if you're dual eligible meaning you have both mass health and Medicare then you qualify for a special enrollment period as well and you can change prescription drug plans throughout the year. If you qualify for extra help, there's different state programs that you can qualify for that would reduce your premiums. Those also give you additional opportunities to change your prescription plan if you need to. And if you're trying to switch to a plan that is a five star plan. Each year all the plans get a star rating from Medicare. It's based off of surveys of the customers, of the providers, and they give rating on a scale of one to five stars. If a plan has a five star rating then you can change to that plan at any time. That's one of the benefits of getting that highest rating. For Medicare Advantage, this is the other option. Supplements as I said are over $100, could be over $300 per month so those can be pretty expensive. Medicare Advantage plan is also offered through third party companies. It's not offered through Medicare. It's offered by Blue Cross, offered by Tost, offered by Harvard Pilgrim. Prices vary by company and by plan. You have to be enrolled in part A and part B. But what it does is instead of having the Medicare card that you billed first and then the supplement, it combines everything into the same sort of plan that most of us are used to through work where everything is covered by one card. So it covers the doctor's office, covers your hospital stay, covers medications, all with just the one card that you would give to whoever. Most include prescription drugs. Not all of them do. So if you're signing up for Medicare Advantage plan, you want to see if it's an MA plan or an MAPD plan. So if it's just an MA plan, it does not have drug coverage. If you sign up for a Medicare Advantage plan that does not have drug coverage, you cannot sign up for an additional drug plan on top of it. You have to sign up for a prescription drug plan with the Medicare Advantage. Some people get prescription benefits through like the VA. And in those cases, sometimes it does make sense for them to get the Medicare Advantage plan and keep their prescriptions through the VA, which is why they offer plans like that. But for most people, getting an MAPD plan is going to be beneficial because, again, that prescription drug plan penalty will apply if you don't have a plan that has a prescription drug coverage. In 2023 in Arlington, there are 38 MAPD plans and 7 MA plans offered by nine companies. They range in premium for each month of no charge, no additional charge per month to $258 per month. You're still going to be paying your Part B premium, so it's not that you're not going to be paying anything for your plan. You'll still be paying that Part B premium of $164 per month, but you don't pay any additional money to the Medicare Advantage plan. Some Medicare Advantage plans do have network coverage, so you have to go to a doctor in network just like with the commercial plans where you have an HMO and you have to go to a specific set of doctors. Medicare Advantage has that same restriction. Which plan is best? Again, it really depends on your need. The first thing you want to check is make sure the doctors you want to keep are on the plan. You want to check the prescription coverage. You want to check the costs for different procedures. If you know that you have a lot of specialists, you might want one that has a cheaper copay for specialists. When to enroll? For Medicare Advantage, again, like the prescription drug plan, you can enroll in the same time as you enroll in your Part B or during the annual enrollment period between October 15th and December 7th. And that, again, each year you can pick a plan during that time to start January 1st or switch plans to start January 1st of the following year. Also, there are special enrollment periods for these. If you move out of the plan service area, if you have mass health, if you qualify for extra help, live in a nursing home or another institution, or if the plan is a five-star plan, you can change to that plan at any time during the year. Disenrollment period. Medicare Advantage has something called disenrollment period as well. If you just enrolled in the Medicare Advantage plan sometime between October 15th and December 7th of this year and you get it started for January 1st, and this is the first time you're enrolled in it, you may decide, I really didn't want to do that. I want to just go back to plain Medicare. You're able to do that and switch to another Part C plan or to just get prescription drug plan and go back to regular Medicare. You can switch to another plan during the annual enrollment period at the next year. You can disenroll from January 1st to February 14th and go back to Medicare. If you disenroll, you would go back to Medicare and you can pick up a prescription drug plan at that point for the new year, but you cannot enroll in a different Medicare Advantage plan. So, here's the main comparison between those two different options. The Supplement Part D route or the Medicare Advantage route. Supplement and Part D, you can see any doctor that takes Medicare. There's no network. You can go to any doctor in the country that takes Medicare. They will take your supplement as well. I've had a lot of instances where I've gone to, I've had clients call me and say, my doctor says they don't take this supplement. They do. Even if it's a plan that that doctor doesn't take, like there's a Fallon plan which is mostly in Central Massachusetts. But if it's a Fallon supplement, then your doctor takes it even if they don't take the Fallon Medicare Advantage plan or the Fallon Regular plans. There's more flexibility with prescription plans. You don't have to pick the prescription plan that's part of the Medicare Advantage plan. You can pick any plan that's available even from a different company. And you can enroll in the supplement at any time during the year. And it will start on the first day of the next month. Medicare Advantage plans are usually cheaper than the supplements. As I said, there's plans that have no additional charge per year versus $115 for the cheapest supplement. One card takes everything. You don't have to keep two or three cards around to make sure that you have all your benefits. It's just one card. Show what you're done. May also include value-added services. There are programs like Silver Sneakers that some Medicare Advantage plans have, which gives you discounts for gym memberships. They also sometimes include vision coverage or hearing aid coverage that the Medicare does not cover is that supplements may not cover. Low-income assistance. There are various sources that help pay if you need it for Medicare Part B premiums, Part A and B deductibles, co-pays and co-insurances, Part D premiums, or Part D co-pays. To see if you qualify for those, the best thing to do is contact the Social Security Administration. They can help you determine your eligibility. It's not something that I can do. I can help you contact Social Security for it, but I can't say, yes, you qualify for this. It's something that Social Security is the one that would make the determination. Mass Health. If you qualify for Mass Health as well, and there are different qualifications for Mass Health once you turn 65 than before 65, so if you qualify for Mass Health after you're 65 and after you have Medicare, you are called Dual Eligible, and you can sign up for different plans that are called Senior Care Option Plans or SCOs. Again, most of the different companies have those, and you'd be able to sign up for those at any time during the year. Prescription Advantage is another state program that helps pay prescription costs. So if you're having trouble paying for your prescriptions, you can contact Prescription Advantage and see if they can help you with your medication costs. There's also medication coupons and programs for the different medications. You'd want to go to the company websites. Not all of them work with Medicare, so you want to make sure that if it is one that you make sure they know that you're on Medicare, so they can tell you, yes, this discount plan works with Medicare or not. There are, here are some important phone numbers. 1-800-AGE-INFO is Massachusetts Executive Office of Elder Affairs. They have Elder Service Agency. Prescription Advantage is option two on there. The SHINE program is a great program. They can also help you, they can give you options, or they can run some of the figures for you and give you options. They cannot help you sign up for Medicare plans, which is one of the main differences between what they do and what I do is I can actually help you enroll in the plan. They can just say, here's your information and then you have to actually go and do it. Option four, if you need to report anything, option five for all other matters for the Elder Affairs Services. Mass health phone number, senior care options, as I said, if you qualify for both Medicare and Medicaid, you can call that number and see if there's a senior care option plan that works well for you. Medicare Advocacy Project offers free legal advice and representation. Mass College of Pharmacy and Health Services has an outreach program that will help with prescription drug information and referrals. And then I've listed the Social Security phone number once again because that is the most important number when you're trying to sign up for Medicare. Does anyone have any questions? Yes. So a credit for Medicare Part A is one quarter of paying Medicare taxes. So if you've worked for 10 years, and you've paid Medicare taxes through your payroll for 10 years, that is the 40 credits. Each quarter of a year is one credit. You have up to three months after the month of your birthday to sign up for Part B and a prescription drug plan or a Medicare Advantage plan or anything because this would be your initial enrollment period. So is that three months before your birthday month, your birthday month, and then three months after? Part A, if you're collecting Social Security, you would... Okay, so then that's the same thing. If you're employed, that's another thing on top of that because for that you can sign up for Part A and Part B any time while you're employed or for up to eight months after the employee, after you've dropped the coverage from your employer. It depends on the plan and how your company is set up. You would want to talk to the HR department or the medical benefits for that to see if they will... Because in some cases if you have under 20 employees is what it usually is. There's under 20, there's 20 to 50, and there's 20 to 100 and more of the three categories. If it's under 20, then they don't have to cover you so you would want to sign up for Medicare because you would be being dropped from their coverage from turning 65. Okay, so let's say I want to sign up for A and B in December 31st. Right, if you want to start January 1st you would need to sign up before the end of December. You could sign up December 31st because of your eligibility case. You could sign up till December 31st because that's your birthday month and you're just turning 65. So you don't have to worry about that annual enrollment period this year. Next year if you wanted to switch plans you'd have to worry about the October 15th to December 7th window. Yes? Can you explain how the plan stayed in three years and then wanted to disenroll? Am I going to be effective? No, because to have a Medicare Advantage Plan you have to be enrolled in Part B. If the Medicare Advantage Plan has a prescription drug coverage, if it's an MAPD plan, then you have a prescription drug plan and so there won't be a penalty. If it's just a Medicare Advantage Plan without prescription coverage, then you will be assigned that penalty for not having the prescription drug coverage. So all in there? Yes, because you have to have Part B to get a Medicare Advantage Plan. Yes? Yes. They will automatically come out of your Social Security check for the Part B premiums. If you do not collect Social Security and you're signed up for Part B, what they'll do is they'll bill you for three months at a time. So they'll bill you quarterly for the insurance. And it's based off of eligibility year and not year that you signed up for it. So if you're eligible, as of January 1, 2020, but you delayed it for a few years, you can still sign up for a supplement one plan. It does not have to be a 1A plan. Yes? No. In Massachusetts they do not. Again, that's something that other states, if you live in New Hampshire, they do have age ranges. Other states will have things like that. Massachusetts, it's a standardized premium for each plan. Currently, yes. Correct, because you wouldn't be in the network for that plan. At the time now, you do not need to do anything. When you do sign up for Part A and Part B eventually, because as I said, you can still sign up for Part A now if you qualify from the 10 years of paying Medicare to 40 quarters. But when you go to sign up for Part B, they will probably send you a letter. Usually they'll send you a letter saying, please send us verification that you've had credible insurance for this period of time. And then you would send that to your HR department. They would send that information onto Medicare. It's standard. Most HR departments do it all the time, so they'll know exactly what they're doing. You do not have to sign up for Part A. The benefits is you'll have Part A is for hospital coverage. So normally with your benefits from your employer, you will have cost for your hospital stay. The Medicare Part A plan would work with that and it can possibly reduce your out-of-pocket costs. And if you have the 40 quarters, then you're not going to be paying anything for it. So you're getting additional benefits at no additional cost. Yes, every year you have that option. You can change plans during that open enrollment period, or between January 1st and February 14th, you can disenroll from the Medicare Advantage Plan, although that's only the first year that you're signed up for it. So if you... You don't have that disenrollment period. No, during your open enrollment period from October 15th to December 7th. The best way of doing that if you want to switch is to pick up a prescription drug plan. By picking up a prescription drug plan, you will automatically be unenrolled from that Medicare Advantage Plan with the prescription drug because you can only have one prescription drug plan at a time. Yes, unless you're in one of the few circumstances where you're getting prescription coverage elsewhere and you're not going to need prescription plans. Mm-hmm. None. Yes. I have a question. What is unicorn consulting if somebody had... Are you available? So unicorn consulting is my company. I am the owner. And it's both Medicare and also group and individual health care. It's also financial advising and such. Each of the different areas have different structures. As far as this goes with Medicare Advantage or prescription drug plans or supplements, there is no cost to anyone here for it. If I enroll you in a plan, the insurance company will pay me a commission for signing you up with their plan. But there is no charge to anyone to use my services. On the first page is my phone number and my e-mail address. You can contact me at any time. I am happy to help out with any issues, no matter how complicated. And as I said, for anything Medicare related, there is no charge to any of you. You have a website? I do. It's unicornconsulting.us. I need to update it more than I do. But I do have a website. Thank you. Yes. For the Medicare Advantage plan, how restrictive do you... It's really pretty much the same as your current networks, although some doctors' offices will cover a commercial plan. But not the Medicare version of it. Like I know some doctors' offices will cover a Harvard program for commercial members. Do not cover the Harvard program HMO. So you do want to check to make sure that it's the same or that your doctors take that coverage. But it doesn't tend to be much more restrictive. Right. And it's a variety of things. The insurance company's website is usually the most up-to-date. You can also contact your doctor and ask them. They will usually know. Sometimes they do get confused. So because, again, because we can take Harvard program but not the Medicare Harvard program. So the best place is usually the insurance company website. They will have the provider networks that they have. But the providers also usually know... Not necessarily the providers but the staff at the office know which plans they are accepting. Yes. Yes, you can only sign up for a supplement or a Medicare Advantage plan. You cannot sign up for both. Correct. At the top I put down the price range of the premiums for that plan. And then there's the $226 premium Part B deductible that you're due for the year as well. But you said there's no... 1A has a Part B deductible but it does cover the Part A deductible. We are self-employed. Does the company or they don't? So if you're getting self-employment insurance directly through a company, that would be a more complicated situation. There's really a lot that would depend on it. Depending on the size of the company and things like that. But in general, probably be in the best interest to sign up for Medicare and the secondary, either a Medicare Advantage or a supplement to go with it and not do the self-employment. Again, it's going to be very much an individual situation. Excuse me. I'm going to ask everything again. The gentleman with the pressure over there was the 1A covering the Part A deductible. Yes. Which deductible? The $1,600? The $1,600 deductible. The core plan does not cover that $1,600 deductible. The 1A plan does cover the $1,600 deductible. The 1 covers the Part B deductible but the 1A does not cover the Part B deductible. Part A is free if you meet the qualifications. Correct. Because that's what you've been paying your payroll taxes for this entire time. That's the one that the government keeps complaining is going to go and solve it. But you've already paid those premiums your entire working career. Out of all the parts, which ones are tied to states? In other words, if I move out of state, what's impacted by that? So, Met, if you move out of state, you can keep your Medicare supplement or you can switch to a Medicare supplement in the new state. Your Medicare Advantage plan or your prescription drug plan is tied to really your county. So, if you move counties, then you're going to get different prescription drug plans and different Medicare Advantage plans that you might qualify for. Do you have to change it or do you have to live in the state where you're getting, where you used to enrolls? Yes, because what will happen is if you move out of state and you contact Medicare to let them know that you've moved so that you get all of your benefits in the new place, they will contact Medicare Advantage to let them know as well and because you're not in their region anymore, you will be automatically disenrolled from it. But you get that on-back opportunity to enroll in the new place. What was the other one besides Medicare Advantage? The prescription drug plan. What is the donut impact in terms of when you pay and when you don't pay for the full dates and the prescription drug? Ben, could you repeat the question, please? Yes, sorry. So, that question was about the donut hole and the different parts of the prescription drug plans. So, I don't have those numbers with me right now. The way it works, there are several different parts to a prescription drug plan. The first part is usually there's a deductible that you're responsible for before the prescription plan kicks in. Then they'll start their amount and you pay co-pays up to about $4,500. At which point you reach what's called the donut hole where the insurance company reduces the amount that they pay. It's not that they don't pay anything anymore, like it used to be. They do pay a percentage, but your prices are reduced by a percentage up to about $7,500 out of your pocket. At which point you reach catastrophic coverage and then it goes down to about $5 to $10 for prescription from then on for the rest of the year and that starts over again on January 1st of next year. Each year? Each year, the different periods start over again. There's a question back here. Yes? This is probably supplementary. During open enrollments, if you have a supplementary, you can change to an advantage plan. Yes, but you would want to contact the supplementary and let them know that you're up to get a Medicare advantage plan and I'd enroll for myself. Ben, do you find that many people are going with the Medicare advantage plans? Yes. Again, it really depends on their needs. What I find in general is people that are a little bit more prone to being in the hospital will pick a supplement plan, especially a supplement 1 or 1A plan because that will cover the Part A deductible for the hospital stay and that will be more beneficial and will achieve them over time, but it really depends on how much people are paid each month and how likely they think they are to use a lot of benefits or some people just want to have just the extra protection and they'll go with the supplement as well. The advantage covers things like physiotherapy which supplements 1 or 1A wouldn't cover. Is that right? Some of those types of benefits? Could you read me the question? You were asking if Medicare Part A has additional benefits that the supplement might not. It does depend again on the supplement and the prescription and the Medicare advantage plan. Medicare advantage plans are more likely to have things like the silver sneakers or cover some acupuncture. Supplements in general just have to cover whatever Medicare covers. So if Medicare doesn't cover acupuncture, the supplement doesn't have to cover that either because it's only being a secondary to the Medicare plan. Some of the plans do choose to have additional benefits like some have some hearing coverage, vision coverage and such, but again that's not required and Medicare advantage plans I've found can be a little bit more likely to have those things. Thank you very much, Ben. It was really very helpful. Thank you.