In other words, there are times when people get on an advantage plan
and they can never get off of those plans.
Welcome to Medicare School Daily,
where we help you understand Medicare, save money,
avoid making Medicare mistakes,
and above all else,
get the most out of your Medicare benefits
when people decide to go into Medicare.
They have two different ways
in which their Medicare benefits can be used.
One, way is to use an advantage plan.
The other way is to use a supplemental plan.
And during this brief video, I want to talk about advantage
plans and specifically about one aspect
of the Advantage plan, and that has to do with
what is called the 12 month trial period.
Now, I'm gonna explain that in detail here.
In just a couple of minutes, but let's first talk about this question.
Why do people choose Advantage plans?
In other words why would half of all people today
choose Advantage versus supplemental plan?
Well, number one,
because Advantage plans are going to
typically have a very low or no monthly premium.
Now, when someone has an Advantage plan,
they have to certainly pay their Part B premium.
This year,
that's $170.10 a month comes out of your Social Security check
where they bill that quarterly.
But we have to have to pay for our Medicare B.
But many areas of the country have plans where there is
plans that have no premium
or if it does have a premium it is very, very low.
In other words, it doesn't cost very much to
for you to be on that advantage plan In other
words that insurance companies that charge you a premium.
The reason for that is because you have co-pays instead of premiums.
Okay.
So they pay very low premiums, but also people choose them
because of all the perks that come along in other words
these are these add on benefits with advantage plans
that do not come with supplemental plans.
And first off, those perks include a dental plan.
Typically about 1000 dollars worth of coverage
for dental could
be basic services and some other comprehensive services.
You'll have vision benefits above and beyond original Medicare,
typically one eye exam and a credit towards eyewear.
And then most of the plans are going to give you, come kind of
a hearing aid option.
Now you can't just get any hearing aid you want, but they have a series of
hearing aids that they will cover
certain network providers that will cover those.
And you'll have a very reasonable co-pay for some hearing aids.
So that's a benefit. That's why people choose them.
They also choose them because most of the plans today
give you an over-the-counter benefit, which is basically a card
allow you go online or maybe into a catalog and maybe
35 or $50 every quarter you can go on and get things
you typically pick up at a drugstore
that would just be over-the-counter type items,
maybe some supplements or Band-Aids or Tylenol
or aspirin or those kinds of things.
And that's a perk they offer.
And then also gym membership.
Most people have an advantage plan allows them to go to
certain facilities
and maybe a community center or curves or maybe a YMCA or someplace
that takes the plan
and you can have a free membership to that particular ship.
So those are perks available.
And then lastly,
some of the areas of the country
have what's called a Part B reduction.
Now, I will tell you that few people really qualify
for Part B reductions
because they're not either available
or because your scenario would not allow you to do so.
But when someone gets a Part B reduction,
which is really best for veterans,
retired military, retired federal government
and certain ZIP codes around the country,
what they do is they
they give you a credit back towards your Part B premium.
So right now everyone's paying $170.10 a month for their Part
B, so if that advantage plan gives you a credit, they may credit
your your Social Security check at $30 or $50
And so instead of charging the full amount for your Part B
premium, $170.10, it may be $120.10 or 150 and $0.10 so they give you
a credit towards that part B that's called a part B reduction.
And again, not everyone can get that,
but it is a perk that is available to some people in certain areas.
All right. So that's why people choose that now.
What people often though, are not told are some of their
potential problems.
Doesn't make Advantage plans bad,
But these are things that you have to know about that
a lot of agents simply don't discuss. Number one.
Every advantage
plan is going to have a network of providers, doctors
and hospitals, pharmacies that take the plan.
Certainly not everyone is going to take every plan,
but there will be a network of providers,
whether it's an HMO or a PPO, providers
that allow you to, you know, go to their hospital
or certain doctors that will allow that.
Now, there are some doctors don't take any advantage plans.
Some take all, some take maybe the PPO, not the HMO.
But again, it's a
it's a provider a voluntary choice where they're going to participate
in the network.
And the reason we're seeing this as a potential problem
is because certainly not every doctor takes Advantage plans.
So you have to make sure
that the providers that you want to go to the doctor
or the hospital, different places where you get your care
that they're going to be in that network.
So that can be a problem because you're going to have
limited choices of providers secondly, pre certification.
So when someone's on an advantage plan,
what happens if they need certain health care services?
Basically, about 70% of all health care services, MRI's, CAT scan,
skilled nursing stays, a hospital stay, outpatient surgery,
those kinds of things are going to have to be a preapproved
or pre certified by the insurance company.
Which means that the doctor says you need a hip replacement.
Well, the insurance company, the Advantage plan has to approve
that sometimes they do and sometimes they don't.
Sometimes they may
say therapy is enough for you or we're going to pay for a rod
only not a full hip,
but that you, given that insurance company
through the advantage plan, the right to have the final say so.
it's not your doctor, it's not you
that make the final decisions in comparison to that.
When someone gets a supplemental plan,
they don't have pre certifications, Medicare and your doctor
make all those final decisions all right.
So that is a potential problem because sometimes those services
are denied or delayed.
And then thirdly, and this has to do with the trial period.
and I'll close with this and that is the permanency
In other words, there's times
when people get on an advantage plan
and they can never get off of those plans.
All right.
And so sometimes people would like to get off,
but their health has changed they've been on it too long,
and now they're going to have to medically qualify to do that.
So that is an issue with advantage plan.
So let's talk about how this trial period works.
That will be our third question, who gets a trial period?
Well, frankly, folks in most states and again,
there are exceptions, but in most states around the country,
your trial period begins when you enrolled into Medicare A.
And so you can see here
we have John Smith and Jane
Smith and John Smith decided to start Medicare at 65
and his Medicare card will look just like this, hopefully
you can see it but it's saying that part A and part B both
began January one 2022 and if that's a situation
where both A and B match up and he went on the advantage
plan during that first year he would have a trial period.
And what that simply means is any time
any reason during that 12 month trial period
if he wants to get off the advantage plan
and pick up a supplemental plan
and a drug plan he can do so no underwriting required.
So in his scenario he did have a trial period.
He started Medicare at 65 he started with an advantage plan.
He would have 12 months to switch and during that 12 month period
he would not have to go through underwriting to make that switch.
But Jane, on the other hand, she decides to work longer,
but she goes ahead and rolls into Medicare A
only for one year and then she retires and picks up
Medicare B a year later.
In this scenario, in most states, Jane will not have a trial period
because the trial period only last 12 months tied to the A date.
And so her trial period already has terminated.
by the time she goes on Medicare so day one on her advantage plan,
if that's what she chose
because she started 1-1-2023 day one in order to get off
of her advantage plan and go to a supplemental plan.
Now she has to qualify.
So he has a trial period.
She does not.
So it's based upon when you start your Medicare
and what plan that you decide to start with.
All right. So that's the trial period.
So what happens after the trial period?
So let's say that someone doesn't have one or they did have
one and didn't exercise the right to return to original Medicare.
So they stayed on their advantage plan 12 months
and one day or longer, three years, five years or seven years.
And now they would like to get off the plan.
Well, the switching rules now apply.
So you just can't do anything you want when you want to do it.
Now you have to live with some rules.
So what happens if someone's on Advantage plan
and they would like to switch to another Advantage plan?
They can do that two different times of the year.
So I can switch
advantage to the advantage October 15th to December 7th
with the policy effective date of January one the next year.
So October 15th, December 7th,
my new policy goes effective January one on that Advantage plan
or the first three months of the year.
I can switch advantage to advantage.
So if I make that decision in January, I can switch.
My new policy goes effective February,
I switch in February, it'll go effective in March,
I switch in March, it will go effective April.
Then after that,
there's no other opportunity to switch advantage to advantage
until the next year's Medicare open enrollment period.
Again, there's no underwriting required
if that plan's in your area, you like it, you can have the plan.
But what happens if the trial period is over?
We're gone
beyond the 12 months or we didn't have a trial period at all.
Then if I'm gonna get on my Advatnage plan now,
I want to move to a supplemental plan.
Now I'm going to have to medically qualify to make that switch.
Many times people think they can just switch
because Medicare has this open enrollment and that is not true.
Folks, if you don't have a trial period
either initially or ever
now, you're
going to have to medically qualify to get a supplemental plan,
which means we're going to have to ask you 25 or 30 health questions.
We're going to check all your medications, what you're taking now
and what you've taken for the last 24 months.
And then we're going get a statement from your doctor
which means there could be some health conditions
that would keep you from making this switch,
because now that supplemental plan has every right,
that company has every right to say,
No, we're not going to prove your policy,
and then you can stay on that advantage plan
then for the rest of your life.
So to make the switch,
you don't have to be ready
to run a marathon, but you do have to be generally healthy
things like rheumatoid arthritis, and you'll not make the switch.
If you have
A-fib in your medical records, you're not going to get to switch
if you're under any kind of treatment right now.
You're not going to get to make the switch
if you're taking certain medications, opioids or
certain things that are
indicating a very serious health condition
you're not going to make the switch if you're an insulin
dependent diabetic that has retinopathy or neuropathy,
you're not going to be able to make the switch.
So there are certain health conditions
that would keep you on that advantage.
Plan for the rest of your life.
No, it doesn't mean that you have bad insurance.
It just simply means
you still have to live with networks
for the rest of your life and you have to
live with pre certifications the rest of your life.
Because you cannot
medically qualify to pick up that supplemental plan.
All right.
So the 12 month trial period does exist and not everyone gets it.
This depends on when they go on Medicare and what they start with.
But those who do,
if they don't take action within that 12 month
trial period, then they are going to have to medical
medically qualify to switch those that don't have a trial period.
Day one on the advantage plan if they ever want
to get off of it again,
then you have to medically qualify to make the switch.
And so hopefully their health will allow that.
If it doesn't, then they will have to stay in the advantage system
Hey, thanks so much for watching the video,
and I do hope that it was helpful.
Now if you feel like
you need to learn more about Medicare
to make sure you're making the right Medicare decision,
really the best way and the easiest way to do
that is to go to MedicareSchool.com.
That's MedicareSchool.com,
and you'll be given the opportunity to be able
to click on Get the Free Workshop.
We call that the essentials workshop
and I do all the teaching.
And there you'll learn all the ins and outs of Medicare
to make sure that you have an accurate
and thorough understanding of how Medicare works.
The second thing you can do
is click where it says, talk to a Medicare guide,
and there
you can actually set up a time
where you can discuss your situation
with a Medicare guide.
They'll explain all your options
and actually even walk you
through the enrollment process as well,
if that's what you need to do.
And so go to MedicareSchool.com,
watch the workshop or talk to a Medicare guide.
It would be our privilege to assist you further.