Medicare Insurance Market Disruption

Um Welcome to Finishing Well, brought to you by CardinalGuide.com with certified financial planner Hans Scheil, best-selling author and financial planner, helping families finish well for over 40 years. On Finishing Well, we'll examine both biblical and practical knowledge to assist families in finishing well, including discussions on managing Social Security, Medicare, IRAs, long-term care, life insurance, investments, and taxes.

Now, let's get started with Finishing Well. Welcome to Finishing Well with certified financial planner Hans Scheil. And today's show, Medicare Insurance Market. Disruption, if you haven't heard about it all yet. Boy, you're gonna, because we go into the October season of open enrollment for Medicare, there's going to be a whole lot of discussion about your Part D plan, your drug plan, and what's going on with that, especially premiums going up and changes in coverages and deductibles and all those things.

And so it's a perfect time from my perspective to look at James chapter 1, verses 2 through 5. You may be familiar with these. It says, my brethren, count it all joy when you fall into various trials, knowing that the testing of your faith produces patience. But let patience have its perfect work, that you may be perfect. And complete, lacking nothing.

If any of you lacks wisdom, let him ask of God who gives to all liberally and without reproach, and it will be given to him. And as I've had a chance to review what you guys are going to hear about today and think about it, what at first seems like a trial, undoubtedly, ends up to have all sorts of interesting ways that I think it's going to improve our lives, certainly give us better insurance. But again, give us an opportunity to ask for wisdom and then thank God that he comes with it. I mean, he really does. As I think you're going to find out through the show today, I'm so glad you're listening because I think you need this information if you're on Medicare or soon to be there.

Hans? Yeah.

So Medicare insurance market disruption. And so As many of you know, I sold my first Medicare supplement policy. in 1976. It was almost 50 years ago. And so I've been part of Medicare.

And watching it. For word. fifty of its sixty years. Um And, you know, th this is about as mixed up and all different directions as I've ever seen it.

So and There's there's a lot of things at work here, but When you get right down to what's the current problem, And the problem is, is that Congress, when they passed the Inflation Reduction Act. They wanted to throw something in there for the seniors. That was in 2022. By the way. that they passed this.

Maybe it was twenty twenty three. But they passed this new law that was really about inflation. It wasn't about Medicare. but they threw in Medicare prescription drugs and they said Okay, we're going to make sure that any senior who's on Part D of Medicare is going to have a maximum out-of-pocket, cash out of pocket. of $2,000.

I'm talking deductibles, co-payments. anything, so that's the most that they can pay out of pocket. And it's wonderful. Everybody was applauding it. And they said, by the way, it doesn't start until 2025.

So people kind of forgot about it, except those of us in the Medicare insurance business. And we knew it was coming. And so at the beginning of this year, 2025. If you're on Medicare Part D, you now have much better coverage than you had in twenty twenty four. But they had left out one important thing when they passed this bill is they didn't throw up didn't put up the money For this wonderful new coverage that they're deeming to everybody.

And so What happened is, is in the summer of twenty twenty four, six months before this went into effect for All the people on Medicare, which includes you and me, Robbie. Um the insurance companies The big ones that work in the Medicare business, that do the Medicare Advantage plans and the drug plans. It's met with Medicare. than the federal government. And Centers for Medicare Service, and they said the insurance companies put their bids out, and they say, this is how much we're going to have to charge.

For drug coverage, for all these consumers Part D or included in the you know this this is the premium And it was big time. It was over $100 a month. that they were all asking for. And then the government threw up. They just said, no, you're not going to get that much.

And then You know, it wasn't a very good first meeting. And then they Um separated for a little bit and you know remembering 2024 was an election year So they all of a sudden came up with some money to kick the can down the road a little bit.

So I don't give you all this politics behind it, but The long and the short of it is we got a little bit of the premium increase. at the beginning of 2025 Um Some companies just ate it.

So you didn't really feel it.

So you got the benefits, but you didn't get... The charge.

Well, now we're entering into a new year, 2026, and the Medicare open annual enrollment season is going. Yeah.

Um just get ready and fasten your seatbelt because there's going to be some changes coming up. Yeah, and I can assure you. The good news is is Is that medicare.gov has updated their stuff as I found out in the video? They did a video right along these same lines, the same title, Medicare Market Disruption. If you go to cardinalguide.com.

And You know, to me that this really is a a a Helpful tool that Medicare has done for us in such a time as this, right? Oh, it is.

So It's just, I think it's awesome that you found that getting ready to record the show with me. And so. For those of you listening, if you're on Medicare, and you don't have a Medicare.gov account, Go and open one.

Okay, it's pretty easy to do. You go to Medicare.gov. and you just get a user ID and a sign-on. You got to have your Medicare number and plug in some stuff. And then once you get in there, you're going to see all your claims over the last year.

I mean, you can go in and look up. When you went to the doctor or the hospital or the surgeon, or and you're also going to see all your medicines if you're on Part D. All your prescriptions, it was just amazing when I first looked at it. I didn't realize they already know what drugs I'm taking. And of course they do, because I'm on a Medicare Part D.

Yeah, I was blown away. I was, 'cause it there it showed up The plan that I'm on, the welcare plan, and it showed all my different. You know, their coverages, my drugs, I'm like, man, this thing is unbelievable. And so as we look forward to this new annual enrollment, we've got information we really never had before.

Well, you do. Once you get the account set up, Then you can go in there and you can say find plans or shop plans just for Part D plans. Yeah.

If you're on a standalone Part D and you can It already knows the drugs you're taking, and so you can just shop. And it'll run your drugs against every single plan that's available. and it'll tell you the best plane for you to be on and it'll even accept your application online.

So And guess who that bypasses, Robbie? Yeah.

Yeah.

I'm guessing Hans. That's what I'm yeah. I mean, so you're thinking, well, why are you promoting this, Hans? Uh because In the past, we told you, call us, we'll do all that stuff for you, and we'll still do that. I mean, if you.

Want our help. Going through this stuff and sorting it out. And many of you, once you go on Medicare.gov, you're still going to need our help because you're not going to understand all of it. But The reality is is they're going to be cutting us out Of this, anyhow, over time. Eventually, you're not going to go through an agent to buy a Medicare Advantage plan or a Part D standalone.

Yeah.

Um we make our living by just providing the consulting around Medicare. The end. We'll keep right on helping people. We just won't get paid by the insurance companies to do it. But we make our income in other ways and other things that people buy from us.

So I'm not too worried about that. for right now but that's one of the ways that the insurance companies have cut costs is they've they've just cut us out of the equation.

So What I'm wanting to do on the radio here is just Teach you How to get into your own account and go in and do your comparisons and then You can call your agent. You can call us. We have agents just standing by and we'll help you with this stuff. regardless of whether we get paid to do it or not. Yeah, and and The basic idea here, unfortunately, or fortunately, depending on how you look at it, the fortunate end of it is.

Like, we have better insurance now on Medicare from a standpoint of drugs than we've ever had in 2025. You know, you would not have an out-of-pocket more than $2,000. And that's absolutely huge for somebody who's got horrible, you know, if you're on chemotherapy.

Some drugs are crazy expensive. And what they did to protect seniors is true. I mean, you can't have a greater out-of-pocket than $2,000. And so I have that in my own family, and I've seen it this year. And I'm like, oh my gosh, this is extremely helpful.

But. You know, when you have better insurance, there are additional costs, but I don't think those are going to be just as nearly a big a deal as the coverage that you're going to receive if you have this problem. Yeah, and that 2000 and 2026 is going to 2100.

So they made a provision in the law that it can get adjusted. upward each year, but that's just $100. And I too have experienced that myself. I'm on a couple of fairly expensive drugs and I went through May paying a lot of money every time I went to the pharmacy. In the drive-through, handed him my credit card.

And then all of a sudden in May, I reached the 2,000 bucks out of pocket and I haven't paid a dime since then. picking up all the different prescriptions I'm taking.

So there's an upside to this. Here's the thing with your Part D plan that I want you to know for this year is There's more than just your premium that you pay.

Some of you are paying zero. And that's going to go up a little bit. Uh maybe a lot.

Some of you are paying 20 bucks a month. That might go to 50 or 60. But that's not the whole problem. The problem is also each drug plant has its own formulary. and they can make changes to the formula, which drugs are covered and which tier they're on.

You really need to do the research or have somebody do it for you year to year. to make sure that you've got what you think you are. Yeah.

And we stand ready to help you with that. I'm telling you, the first place to start, though, is at Medicare.gov and get you a user ID and password. This would be a good time to remind you that this show is brought to you by Cardinal Guide, CardinalGuide.com. And if you go to CardinalGuide.com, they have a real easy menu. It's the Seven Worries tabs.

And today's tab would be under Medicare. And I'm telling you, if there was a video worth watching on this, it's today's video, which is Medicare Insurance Market Disruption. It's right there under the Seven Worries tab, Medicare. You can watch it. They have.

unbelievable show notes. And then all sorts of details that we can't get to in the show today. If this is of interest to you. Even Tom takes you through the screen to show you Hans's plan and how they get to, you know, where the drug coverages are and all those kinds of things. Extremely helpful.

All there at cardinalguide.com, as well as Hans's contact information and Tom's when you get to that point, or you know, Hans's book, The Complete Cardinal Guide to Planning for and Living in Retirement, as well as that workbook. It's all there at cardinalguide.com.

So, we'll be back with a whole lot more on Medicare Insurance Market. Disruption. We'll be right back. Investment advisory services offered through Brookstrone Capital Management LLC, abbreviated BCM. a registered investment advisor.

BCM and Cardinal Advisors are independent of each other. Insurance products and services are not offered through BCM, but are offered and sold through individually licensed and appointed agents. Cardinal Advisors is not affiliated with or endorsed by the Social Security Administration or any other government agency.

Well, welcome back to Finishing Well with Certified Financial Planner Hans Scheil and today's show: Medicare Insurance Market Disruption.

So, especially on the Part D plan, is what we're talking about today.

So, Hans. Let's bring us up to date. Yeah, so in the video, we went over just setting up the whole thing. I mean, you've got really five. There's stakeholders.

That's what they all the MBAs like to call the stuff when you're in meetings with them. Got the federal government, the federal law. the Centers for Medicare Services. They're the people that provide Medicare to us from the government. and you got the drug companies.

who everybody likes to villainize the drug companies and say, oh, they're awful and But these are the people that are inventing Uh these drugs That are saving people's lives and extending their lives, and so we always got to remember that and. We all think they charge too much, but they're a player and I certainly don't want them to go away. You got the hospitals and doctors. And they're a little bit like politicians. Everybody loves their own doctor.

but they think the group of doctors as a whole are bad. And the same thing with hospitals, but The reality is we need them and they provide and save a lot of lives, but they're a whole constituency. And then you've got the large Medicare insurance companies Um you know like united healthcare and humana and etna and cigna as the big players Blue Cross in in this stuff that offer the Medicare Advantage and the Medicare Supplement Insurance. And then you've got the people like me that are insurance agents. And we're kind of thrown in the bucket with these call centers Around the country that are selling this stuff.

So you got all these. players going on And this is a one big political football, and I'm telling you, it's all getting disrupted.

So Why should you care about that?

Well, I don't know. If you're a consumer, you know, what a lot of people tell me is: look, Just tell me what it's going to cost me and how it's going to affect me. And so that's what I'm going to do right now. Yeah.

Yeah, really. Let's get to it. Let's get to it. You know, what you have is original Medicare, Part A and Part B. and you pay money for Part B.

You pay if most folks are paying $186 a month. And they take it out of your Social Security check if you're getting one. Um If you're a high income person, You pay this thing called Irma. And your 186 is way more. But that's actually paying for your Heart B coverage.

Pian. Part A is hospital, Part B is doctor and outpatient. It's not good enough by itself. You got big deductibles and co-payments. A lot of people buy a Medicare supplement.

like a plan g And many of you listening have that with us. you look to us for that. We still get paid to sell that. and we're very much in that business. and that's not administered by the federal government.

Yeah, and it's a It's a very good deal to have original Medicare and then pay a premium to have a supplemental plan. that's going to fill in the gaps of Medicare.

So Many people forego the supplemental coverage and they take their original Medicare and they outsource it to a private insurance company. like Humana, United Healthcare, Cigna. Yeah, um Blue Cross and they buy one of these Medicare Advantage plants. And so You've now left Original Medicare. You're getting your Medicare from a private insurance company.

The government. is sending them a check every month. Two. provide your Medicare to you. Yeah.

Many people do this because a lot of these things have a zero premium. I mean they don't have to pay really anything, the government sends them enough money to pay for the whole thing. And that's fairly attractive to a number of people. Um And you still pay the $186 a month and you still pay Irma if you're a high-income person. They throw in a gym membership and few other things Uh that are extras.

And then the what's most importantly, what we've been talking about is they throw in a Part D plan. often for no cost. And that's where the disruption is happening. And so If you're on a Medicare Part C or a Medicare advantage. You're really going to need to look at your coverage and you're going to need to read a letter.

You're going to get a letter from them. called the Annual Notice of Change Letter. Yeah.

It's going to tell you in several pages. Like what's changing in your Medicare plan. Um Don't know if you can pick out of there the changes, but you're going to need somebody like me to help you with it. um just cut to the chase and figure out what You know, how is my plan changing? And then how is this changes to Part D?

affecting it.

So And that's kind of the landscape. If you're on a standalone Part D plan, You've probably already gotten the letter. that you maybe haven't read or you have read it. And it you know, it's telling you about a possible premium increase. It's also telling you that they might change the formulary or the the way they pay on certain drugs.

It's so. Trust this is just something you need to pay attention to this stuff this year. Yeah, I would say. Yeah.

But I I You know, again, I'm based on the way they've adjusted the. Um Medicare site, I'm going to feel a lot better. You know, again, when you dig into something to where you try to understand it, I know that when I do it that war you know, and study and I'll go, Okay, well, I know I'm on the best plan and I know that that that You know, I'm getting this taken care of. But on top of that, I know that if there's something catastrophic that happens to me, the maximum out of pocket is 2,000. That's the best news I could think of.

Yeah.

And they really gave you something there. They just didn't put up the money. The government didn't put up the money to pay for it. It's like giving away a government benefit without Without putting up the money. And so they, I don't know who they thought was going to pay for it, but the large insurance companies are just saying we're not paying for it.

I mean, we we we we're going to charge the consumer If we can't get it out of you, the government.

So you either pay us more or we're going to charge the consumer. And we're right kind of in the middle of a phase-in period.

So Yeah, like I said, I don't want to start saying exactly what's going to happen to your Part D plan. for your drug plan. But you need to pay attention. You need to read your mail. And then if you if you don't already have one of these Medicare.gov accounts that shows your particular Medicare account.

I'd advise you to open one. It's not really that difficult. And you can go in there and you can see everything that's gone on. Throughout the year, with your Medicare, they even know down to every drug that you've taken. If it's covered by Part D, it's on there.

And then that's already entered, so you can go in and shop plans for next year. And they already have your information. It's it's pretty easy to just Do it yourself. And then if you can't make sense of that, Um Cause or get in touch with us. Write into us and I'll certainly have somebody take care of you.

Yeah, absolutely. And I I you know, again, the b Like in my own family, you know, one of us has a Medicare supplement, you know, Reginald Medicare with Medicare supplement.

So I have a standalone. Part D plan. But uh another member of my family has Medicare advantage. And so in her case, you know, essentially I'm gonna have go on Medicare.gov and s and shop overall Medicare Advantage plans because You know, all that adjusts medications and all that stuff too.

So it's a little different process depending on what form of Medicare you have, right?

Well, it is. And that's going to be more complicated than shopping your Part D plan. Um a little harder to decipher. But still very doable. and it's going to make a recommendation.

It's going to want to know who your doctors are or who her doctors are. that she's seeing and what hospitals she'd go to and it kind of gets into all that and it does the computer does the shopping for you so I don't want to deter you from that. I'm just saying that's where we're going to get even more complicated. Yeah.

We stand ready to help any of you folks that are our listeners. We'll walk you through this. Um And if you're not on Medicare Advantage, if you're on original Medicare and a supplement, This might be the year we'll shop your Medicare supplement coverage. Yeah.

You really need to come to us to do that, and we represent a whole list of companies. That's really all about the price you're paying.

So if you want to knock a few bucks off of your your Medicare supplement policy or plan G or Plan N or plan F. we can possibly do that for you as well. Yeah, maybe save those dollars to go towards your new pay what you're going to pay on your Part D, depending on the situation, right? Yeah.

Sure.

So Um, I don't want to alarm everybody, I want to put you to ease. I mean. Basically, the part D, the drug coverage, is costing you more. this year. and they're either taking it directly from you On a Part D plan.

Or maybe they've decided to bite the bullet. another year And not make as much profit.

Some of these companies. They've not you know i'm thinking they're not going to go up as much as they probably would have just because of the shock value. But sooner or later. This Part D coverage has to go up. Because it's paying a lot more out.

Um But that's really the biggest change going on. But the other thing that they do and and And I think that's part of the reason we got to be careful, and we really got to shop, they may not change your. Premium, but they may severely change what they cover and the different tiers on what they cover. Which, you know, I I'm sure if you've Used your drug plan a lot, you know. You know, it could be 20, it could be 100, you know.

Um based on the way they have their tiers, right? Sure.

And they can change those from year to year.

So you need to do your homework. or you're checking. You know, and you just do this year. We'll be glad to help anybody that needs us to take a look at it. Start on Medicare.gov.

I mean, go there. You need one of those accounts anyhow, because Once you start having claims on your Medicare, You'll find it. You you go in there, if you've claimed on your Medicare this year, which you can go in there. Once you open that account, it's all in there.

So if you ever Wondered about one of your claims or what's going on, it's right there under your account on Medicare.gov. Pretty easy to check. Yeah, that's wonderful.

Well Again, a lot of great information, and we want to remind you that this show is brought to you by Cardinal Guide. But there again at cardinalguide.com, you're going to find. A wonderful video on this very, you know, if you feel confused, whatever, you may want to go watch the video, which again is Medicare Insurance Market Disruption. It's right there under the seven worries tabs of one name, Medicare. Easy enough.

You go there, it's got show notes, it's got. Like all the stuff that from Medicare.gov, their pamphlet that they hand out to you as well, it's right there at cardinalguy.com under the Medicare tab. And again, as always, Hans's book, The Complete Cardinal Guide to Planning for and Living in Retirement. There's, believe me, that's when I found it out. I needed a Medicare, Medicare.dov account years ago.

It's always recommended we get that. And then, of course, Hans's. Contact information as well as Tom. It's right there at cardinalguy.com. Uh Amazing show, Hans.

I'm so glad that you guys stay on top of this stuff. Thank you, and God bless you. God bless. The opinions expressed by Hans Scheil and guests on this show are their own and do not reflect the opinions of this radio station. All statements and opinions expressed are based upon information considered reliable, although it should not be relied upon as such.

Any statements or opinions are subject to change without notice. Investments involve risk and unless otherwise stated are not guaranteed. Past performance cannot be used as an indicator to determine future results. Any strategies mentioned may not be suitable for everyone. Information expressed does not take into account your specific situation or objectives and is not intended as recommendations appropriate for you.

Before acting on any information mentioned, please consult with a qualified tax or investment advisor to determine if it's suitable for your specific situation. Finishing Well is designed to provide accurate and authoritative information with regard to the subject covered. Investment advisory services offered through Brookstrone Capital Management LLC, abbreviated BCM, a registered investment advisor. BCM and Cardinal Advisor Are independent of each other. Insurance products and services are not offered through BCM, but are offered and sold through individually licensed and appointed agents.

Cardinal Advisors is not affiliated with or endorsed by the Social Security Administration or any other government agency.

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