Richard Chan

Thanks, Robert.

Thanks for having me.

Excited to be here.

Yeah, no problem.

So Medicare is the federal health insurance program for people who are over the age of 65 in the US.

And so for most people, it is a mandatory transition that has to happen at some point in their life, either at 65 or if they're working past 65 when they retire.

Yeah, that's right.

There's a lot of things that people aren't aware of.

There's something called late enrollment penalties.

And so generally, if you miss your window to sign up and you don't have any other sort of coverage, there are penalties up to 10% of your premium for every single year.

You could have had Medicare, but you didn't.

And they are lifelong.

So once you sign up, they last forever.

Yeah.

So, Medicare as a program generally will cover what they consider, in quotes, medically necessary services.

So, that would be things like going to the doctor, if you get into an accident, going to the hospital.

But it won't cover things like routine dental, routine vision, at least not in the basic program.

That's not what the Medicare program was designed for.

When you think about Medicaid, it's really for critical services or necessary services.

And there are now some really private plans that I think you were inferring earlier that do cover some of these routine dental and routine vision and other services that maybe the traditional program doesn't cover.

That's correct.

Medicare doesn't cover long-term care.

And in many cases, it doesn't really cover assisted living or any of the costs associated with that.

Yeah, the first is Medicare is not free.

I think a lot of people understand that there's an amount taken out each month that supports the Medicare program.

But when you turn 65, there is a premium that you need to pay unless you have low-income assistance.

For some high income earners, depending on your bracket, it's as much as three times the standard rate for someone who is on Medicare.

So that's important.

Number two is that there are very specific enrollment windows.

So you don't want to miss them.

As soon as you're about six months out of 65, whether you are intending to stay on your work insurance or not.

You should proactively approach that decision around whether you are going to go into Medicare or not, really because there are situations where maybe your work plan isn't considered as good as Medicare's, and so therefore you would still incur penalties for staying on that work plan.

Yep, exactly right.

It's based on your income from two years ago.

Yeah, so that's a good question.

The answer is somewhat.

So Medicare itself is a mandatory program, so it is funded by existing laws, which generally means that they don't require an annual vote through Congress to continue operating.

Having said that, generally what that means is only critical services are continued, and so I think the expectation is about 50% of the staff at Medicare would be furloughed during this period.

So as it relates to how it impacts...

people who are making a decision, you can still select a plan, you can still switch.

But if you try and call directly into the Medicare or the government services, obviously it's going to take longer for them to get back to you.

Or if you're signing up, turning 65 during these couple of months, it may take longer for you to get registered and get your red, white and blue card.

Yeah, exactly.

So a couple of things are happening depending on the type of Medicare plan you're in.

There is the Medicare Advantage market, which is typically the most common private plan that most people are in.

A lot of fluctuations in terms of carriers changing benefits.

There's people leaving markets or reducing the types of plans that are available.

So we're expecting some of our customers to see notices that may tell them that their plan is at renewing for 2026 or that there's significant changes to the benefits that they're having.

Really does a lot of the insurers are trying to grapple with how to stay profitable.

That's one.

And then for people who are on traditional Medicare, typically they may buy something called a Medicare supplement plan.

Even in that market, we're seeing not uncommon double-digit hikes in terms of percentage increases for premiums as well.

So all in all, a decent amount of change, which warrants people making sure that they're looking at their benefits and seeing that it covers what they need for 2026.

Yeah.

The first and very most important one is review your annual notice of change.

That's a document that comes to you in September that talks about, hey, what's happening for the next year for your plan.

It may be the one that says your plan isn't renewing.

With that, obviously, review and check if any of the key benefits that you care about changing.

In addition to that, it's important to look and see if your providers are still working with the plan in the upcoming year.

There are a lot of changes to networks.

particularly over the last 18 months, there's probably been about 30 health systems that have dropped different plans across the country.

Once you've done that, the next best step is really reach out to your agent, broker, or your state health insurance program, someone like Coverite.

We can help you navigate what are the different benefits for 2026, go through maybe what works for you, and then select a plan that maybe makes sense for what you need.

But all in all, in short, make sure to read

what's changing, make sure to get ahead of it and talk to someone if you're not sure if there's something better or there's something that's missing.

Yeah, the SHIB programs are mostly volunteers.

They're not necessarily licensed, but they're capable of kind of understanding the basics of Medicare.

And that's obviously different to agents and brokers like ourselves who are appointed with each of the carriers and licensed to sell those.

So we go through certification and licensing.

And that's different to Medicare.gov, which also you're calling it the federal government hotline, which again, as I mentioned earlier, it's going to be hard to reach them probably over the coming weeks given the shutdown.

Exactly.

Yeah, there's a lot of ins and outs as it relates to drug costs, how the drugs work.

Maybe you've got special drugs and how to get approvals for those.

And so generally, with people who are licensed to understand how each of the insurance companies work, if you need those sorts of approvals, that's definitely a great channel to go through.

Thanks a lot, Robert.