We're your Michigan-based "Transition to Medicare Team" We help people decide if they need/want Medicare coverage and help them through every step of the process. We enroll people into their Medicare products and help them through the entire crazy process! (We're compensated by product enrollments, just like your home or auto insurance person)
Our sole focus is Medicare and nothing else.
No worry that you'll be SOLD other products or pestered by mailers and annoying phone calls. We're not a call center, we know our stuff and we're here to guide and help. Contact us at info@gmedicareteam.com or 248-871-7756 with any and all questions (oh, and that's free by the way! No service to sign up for or consulting fees to ask a question)
Your videos are very informative...however just one suggestion: maybe try speaking in a more natural way. Its easier to listen that way :) (no offense)
I'm genuinely curious... What does "in a more natural way" mean? In recent videos I have do less cuts, but other than that, I don't know what else to change to make it more natural
It seems to me a 10-year look-ahead is appropriate here: Two options presented to me in Iowa have a G premium $37/mo higher than a N. Applying your recently observed plan increases for both, in 10 years the difference widens to $98/mo. But the $20 office co-pay remains the same, unless legislation changes it! For me the choice is clear - and thanks for the explanation!
you are amazing! thank you. this means i need to look closer, so many things to look at and i'm sure i missed that. love this website! and you! thanks again, kathy
What about changing if you move to a non birthday/no medical underwriting to change state if you have a medigap plan that is nation wide (eg AARP/United Healthcare)? Does moving to another state allow to change without medical underwriting or because they offer plans in all states you have to keep the plan you have in the new state? I have G and in some states AAPR/UNC now offers 2 versions of G. One with "extras" (the original one they offered) and in my state as of June 2023, a G without the "extras" that for me is $70 cheaper. I likely fail medical underwriting so I can't just switch. Also these medical forms for underwriting when they ask if you have experienced X in the last Y years do they mean new diagnosis within Y years (so a diagnosis older than that isn't an issue) or does that mean if you have ever been diagnosed with X even if not treated for it currently. Or if you have been diagnosed with X more than Y years ago but are currently taking meds for it. For example I have had 3 cancer diagnoses, but no treatment since 2011 (although one is an incurable blood cancer) , but I have an annual follow up where I am still in remission. So how do you answer the cancer diagnosis question? Not been treated nor newly diagnosed in the last Y years, but am followed but still in remission... Thanks
@@GiardiniMedicare Thank you. I am trying to figure out how to go from AARP/UHC G with "extra free benefits" to their new G they offer without them. So technically I'd still have G just a "different" extras (or lack there of) G with the same parent company (UHC). The no benefits one is about $70/mo cheaper which means, of course, they lied and these extras weren't free for the last 5 years (for me anyway) with their new (as of June 2024 in my state) plan without them is much less. It seems to me that would mean I have a guaranteed rights situation (eg they lied) however UHC claims since a different subsidiary does the new G therefore they have nothing to do with each other even though the parent company is the same. UHC claims that (but wouldn't let me go up the chain to see if the first line person knew what they were talking about). I might be stuck temporarily moving to a state (eg move, move back after staying there for whatever length of time is required) with both G's and the birthday rule or equivalent. Sigh.
@@kidsandliz It's definitely an unfortunate situation, but whoever you have talked to at UHC is correct that they don't have to give you GI even to switch from one Plan G to another with the same company. Are you sure you wouldn't be able to pass underwriting with a different Medigap company? That seems like the logical next step
@@GiardiniMedicare I haven't looked yet. In this state they are the only ones with a community rated risk pool and I was thinking about premium rates when I am much older when I originally chose a company (and also didn't choose F since, in effect, that would have had no younger people in it either which would eventually drive costs up faster; I have been on medicare since October 2018). My biggest problem is a cancer with no cure but a long life span (one of the indolent blood cancers) that requires an annual check which UHC said would cause me to always fail medical underwriting even though I haven't been treated since 2011 (not to mention other chronic conditions that are on some of the lists you posted, although some I haven't received/been told to have treatment for.). Which companies (if you feel comfortable posting that here - I live in MS so can't use your company or I would have called to make an appointment) have the most lenient standards for medical underwriting? I appreciate you answering my questions.
@@kidsandliz The ongoing cancer diagnosis really does complicate things like you said... UHC tends to have fairly lenient underwriting, and I would have to agree with them that your ability to pass underwriting with another carrier is going to be limited. Overall, your logic for choosing UHC in the beginning was sound, so don't beat yourself up about the decision now! I know it doesn't help with cost savings, but at least you have a Medigap plan currently regardless of the price you could pay with other plans. Although we don't work in Mississipi, if you use this link, you can at least connect with someone we know who does: gmedicareteam.com/map/ They may not have a solution, but maybe they will know something we don't... Just keep in mind that right now during AEP everyone is swamped, so I would recommend checking with them after this enrollment period since you can change Medigap at any time of the year.
It applies to both. But there are Medicare Advantage plans without prescription coverage, so the plan would have to of course have prescription coverage included
@@GiardiniMedicare So, I guess my question was, does the 2000 cap apply to people that have no Part D coverage? If all they have is Medicare Part A and Part B, but no part d, does the cap still apply?
Mr giardini. Question...plan D , DO TIER COSTS VARY FROM STATE TO STATE. MEDICAREs website doesn't show the tiers and the formulary. I.e. Utah ... rosuvastatin 20mg Medicare shows 0.00 However WELLCARE shows tier 3 And when i called WELLCARE he said it was tier 1. For 2025. Thank you Kathy
Tier costs can vary from state to state, even with the same company. For example, Tier 4 could be 45% in one state and 47% in another. However, the medications in each tier shouldn't really change from state to state. For the Rosuvastatin, you might be looking at different Wellcare plans. It is a Tier 1 with one of their Part D plans, but it is a Tier 3 with a different Wellcare Part D plan.
Thank you, this info made me reconsider choosing a $0 premium, and investigate another plan, in Ohio, using Medicare's Plan Finder. I plugged in my 7 drugs, (2) tier 3, (1) tier 2, and (4) tier 1, all are in the formularies. The result was a choice between a plan with $0 annual premium, and $2000 annual drug costs, reached in June, and a plan with $1,070 annual premium, and $868 annual drug costs, reached in August. So, oop of $2,000 vs $1938. BUT, then I wondered what if another unanticipated drug was added in 2025. I picked a tier 3, added it to the plans, and the new comparison became $2,000 vs $2,096. Plus, every single drug's 'price' changed. I do not understand how, if the 'secret handshake' additional amount that get's calculated into an enhanced plan's $2,000 limit is not very clearly identified, then how can I know both what plan is financially best for my drug cocktail, and what my potential actual exposure could be for all presciptions. I contacted our SHIP, and they clearly have no knowledge of this aspect. Very puzzled.
I turn 65 in May 2025, so I'm starting my research now (and thanks -- your videos have been extremely helpful!) That said, can I set up a login and account on Medicare.gov so I can list my prescriptions and location to compare plans before I have a Medicare card?
I followed your link to download CY2025 Landscape files. Opening these files to see if certain plans were basic or enhanced in Michigan I don't see any PDP plans listed for the county I am in. It only looks to show MAPD and SNP plans. It is a large county in the Detroit area. I cannot find the plans that I am checking on Medicare.gov.
Is Medicare.gov 100% accurate? Because I'm looking on sunfire and it says my clients Rx are 3 of 5 covered and Medicare.gov says 5 of 5 covered. Which one should I go by?
Very good info! I consider myself as well informed about Medicare plans, but had NO idea about the basic vs enhanced plan distinction! And I find it a little bizarre that the Medicare.gov site gives no info/help about that! Thanks for explaining it all!
Talk about _______CANCER ______ medications Tier 5 SPECIALTY - medications that can only be gotten from a specialty pharmacy Levatinib (Lenvima), a tyronsine kinase inhibitor used in conjunction with pembrolizumab (Keytruda) for metastatic endometrial cancer A 30-day supply of Lenvima lists at $21,500. In 2024, I paid a copay of $3,310.89. I have the WellCare Value Plan, $0.50 per month. I am now in the Catastrophic Drug Coverage In 2025, if I keep WellCare, it will be $0 monthly, and I would pay a $595 deductible and $2,000 cap for the Tier 5 medication?
Cameron, I REALLY like your videos but on this one, if PlanFinder ranks the total MOOP (premium + 12 mos copays) for you, why bother confusing the issue with labels like Basic, Standard and Enhanced? I think it makes folks believe they can't trust PlanFinder and should overinsure to get better value. What am I missing? You say in the description "Whether you’re on a standalone Part D plan or a Medicare Advantage plan, understanding this new cap is key to managing your drug costs". But wouldn't your understanding of how to use PlanFinder and Interpreting it properly really be the key for most beneficiaries? BTW THAT video was the best PF procedural video I've EVER watched. (But I couldn't find how to create you Medicare Account you said was in the description) Thank you.
You are correct that the best thing to do is still just plug the medications into plan finder and choose the option with the lowest overall costs (provided pharmacies and other factors work for the individual), but understanding how the cap is calculated is still important in my opinion. We have already talked to many people who mistakenly wanted to go with a plan simply because it showed them spending "$2,000" on the plan finder tool, not realizing that others plans showing lower OOP costs still had them reaching the $2,000 cap. Overall, your perspective is helpful, so thanks for the comment! Also, it looks like I forgot to add the link for creating a Medicare.gov account so I will go back and add that link to the description. Good catch!
Minolta cameras used to have a slogan: "Only from the mind of Minolta." I think Part D needs a similar slogan: "Only from the mind of politicians and lobbyists." Minolta tried to merge its way out of financial trouble, but ultimately was bought out by Sony. Unfortunately, there'll be no savior coming to our rescue to "buy out" this Part D mess.
Thanks for this very detailed explanation of how the Troop is calculated for 2025. I've been thinking about how to optimize the plan usage by adjusting frequency of medication refilling. Given the examples you showed how much could this potentially save by prioritizing tier 3 meds in the early part of the year by filling every 21 days? Here's my logic. For a one month supply of a medication you are allowed to refill after 21 days, for Tier 3 and above medications the contribution of the standard benefit amount is significant. Therefore would it be better to fill tier 3 and above medications every 21 days in the early part of the year to reach the $2,000 cap as soon as possible. Tier 1 & 2 meds would be filled as needed. Once you see medications being filled at zero dollars you can now fill Tier 1 and Tier 2 meds every 21 days to build up a "stash" which can be drawn down starting in January 2026 when you would not fill any tier 1 & 2 meds until your stash was depleted. Tier 3 meds would be filled as needed until the end of 2025 and then starting in 2026 you'd fill every 21 days again.
@@hippiegirl5167 My wife is on Humira. Its about 6,000 a month. We applied for Patient assistance so that the manufacturer can carry the cost. A good agent will assist you with the patient assistance working with the doctors to make sure everything is done appropriately.
Very good video. I went to Medicare.gov and was confused on all the information and numbers. This is by far the best explanation for Medicare drug plans. Thank you.
question. i take a pain medication. its a generic at no cost. my doctor prescribes 60 a month. i take 30 a month and fill it every other month. plugging the drugs into the medicare calculator if i get 60 for one month every month its zero. if i get 30 a month every month its zero. if i get 60 as needed (i check off every other month) it costs $518 for the year....... why? i called the company and the rep had no clue. he told me it a zero cost generic so dont worry about it. i worry about everything.
Hard to say without knowing the exact medication and plan, but typically, with pain meds and controlled substances, there are "dispensing limits" where the medication can't be filled at more than a 30-day supply. So, when you put it in Medicare.gov as technically a two-month supply, it goes above the dispensing limit and instead shows you the full cash price, which is higher. Like the rep at the company, I don't see any issue as long as you get it filled as a 30-day supply in the real world.
Did you try checking at the website for the drug plan? I've seen comments recently from people on a few of these "part D" videos saying that the numbers that the Medicare calculator comes up with don't match the numbers from the actual drug plan website. I'd definitely "worry" about it, and check directly with the drug plan.
ok so i went to medicare.gov to see what it say for me. WTH?! levothyroxine isn't covered anymore? every drug plan says this. so then it says the year cost for that drug is $1782.12. that is for levothyroxine 75mg 90day supply. so i divided that total by 4 since i get it 4 times a year... and that came to $445.53 a pop? am i doing this right? it use to be covered and I paid $0. are they trying to push us to advantage plans that have drug coverage? no thank you! those screwed my sister in law
i just went back to it and changed it from the generic brand to the name brand (levothyroxine to synthroid ) and the price was cheaper for the name brand??????? what is going on? am i doing something wrong?
went back and tried again. something is wrong at Medicare.gov. Now it is covered. went back a 4th time and it is not covered. ok crazy day...... will try again tomorrow. sigh oh wait it is the dosage that is affecting it? why would a higher dosage of levothryroxine not be covered? but the higher dosage of synthroid is but i still have to pay a high cost?
@@brin3m Try a difference browser to see if that makes a difference. Firefox has issues with medicare.gov due to an issue with browser cookies, so I would use the Chrome browser until I solved that issue.
I really appreciate how honest you are about commissions and explains why it was harder to find a policy. With a well funded HSA, HDG was the way to go for me but many tried to steer me away from it. Being in WA state, I can switch to another medigap plan without a penalty.
I’ve watched many similar videos on the Medicare supplement. Your videos are the best in terms of content and presentation. Unfortunately I can’t take you as my agent because my company has engaged another firm and tied our hands with $$$ that can only be paid if we use the assigned“agency “😅😢😂
We have definitely seen that before where companies force you to use a specific third party! Either way, I'm glad you were able to get some value from the videos, and I'm sure you will still get excellent coverage
@@GiardiniMedicare I suspect there is some kickback going on. Their assigned “realtor” was not the best in my experience. Still I hope you can get that kind of deal with the cooperate sponsor. Their employees would get the best service.
@@dalaiyang1588 Assuming it is the same company I am thinking of, we have also heard the service is not great... But you can't deny the money they give you to use them
I learn great information from your videos, however, you constantly move your arms and hands like a conductor leading a symphony orchestra. This excessive movement is distracting and might make viewers like myself have to limit viewing time.
@GiardiniMedicare my Italian aunt flails wildly when she speaks. It's like that with all her Italian relatives also. Hand movements for them are like an intricate form of sign language combined with the verbal parts.
Very good advice. While it's possible to choose a plan that covers some of your meds and use discount cards for uncovered meds and save money overall, you run the risk that the drug prices and the discount program can't change during the year. You are then on the hook for whatever it costs without any financial limit. Better to pay a few bucks extra to make sure all your meds are "covered" even if you plan to buy using discount programs during the year. My wife could have saved $400 in 2025 by choosing a $25 Part D plan vs a $98 Part D plan, however the more expensive plan covers 12 out of 12 of her meds. She is also changing meds a lot right now as her docs are trying to improve her therapy which isn't ideal. She may find herself on 2 or 3 different meds. Better to have the more expensive plan that gives us the flexibility to choose alternative meds come 2025 as needs arise.
@@ninastump7616 I hadn't heard this before but it looks like you might be onto something!! I asked Chat GPT about this. This is what ChatGPT says "There is no widespread indication that prescription discount cards, like those offered through GoodRx and other similar programs, will be entirely discontinued. However, there are significant disruptions in the industry, such as the recent announcement by Change Healthcare, a major processor for these discount cards. Change Healthcare has been terminating its processing services for many discount card companies as of early 2024. This decision could impact the ability of some prescription discount card companies to continue operating, particularly those reliant on Change Healthcare for processing claims . This change does not mean all prescription discount card programs will vanish but could lead to fewer options or shifts in how certain discount cards operate. The industry might see transitions as companies look for new processors to continue offering their services . It's important for users of such cards to stay informed about potential changes with their specific discount card provider, as these shifts could affect where and how savings can be accessed." Thank You for alerting me to the possibility of discount cards going bye bye. This would be blow to Seniors because we can't take advantage of manufacturer discount cards for expensive meds. About the change at Change Healthcare. Change Healthcare is owned by Optum ( a major PBM). Optum are owned by United Healthcare. Optum offer their own Rx Discount Card through AARP. It's not very good in terms of pricing. This sounds like anti competitive behavior. I'd be surprised if this action doesn't get congressional attention especially after the Change Healthcare hack which has attracted much congressional criticism.
It maybe overly complex, and more expensive in the long run, however ultimately it resolves the problem of folks that are on Tier 4/5 meds having to pay $8,000 or more each year, not by choice, just because they have a medical condition that they did not choose or cause. Benefits are enhanced under the IRA rules, but the politicians severely underestimated the financial cost of providing the better benefits.
But isn't it difficult to move from Advantage to Medicare with a gap plan, especially as you get older. Isn't there a rigorous review process to make that change?
It's not difficult or rigorous, but it does come down to your health and pre-existing conditions. We talk about it in much more detail in this video: ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-tfVYpougjWM.htmlsi=eRhicZ8sb5XhmVZf
So with an "enhanced" plan it seems that I should get prescriptions for as many $0 copay drugs as I can, whether I need them or not! Each one has in effect a NEGATIVE cost, since it gets me closer to the $2000 cap. Have I got that right?? What am I missing??
@@garyolsen3741 That's different. What is or is not covered depends upon the formulary of the plan. That has nothing to do with if it is enhanced or basic. There maybe an enhanced plan that does not cover your tier 5 med. Each plan has a seperate formulary, even if the plans are from the same company.
@@JeanPierreWhite Yes, I understand. I have a great plan. Why are you trolling me here? I’m good, thanks. My point is that the $2000 Cap works for me with my enhanced plan.
@@garyolsen3741 Unfortunate you consider my comments as trolling. My interactions with others in response to my or their posts here have been good. Have a nice day.
What's the deal of I'm still working. Am I going to get penalized if I don't get a plan D now? Not ready to get medicare part B yet. Please answer me. I can't get an answer.
As I understand it, as long as you have employer insurance you may delay plan D. BUT when you decide to get plan D you will have to provide proof that you had coverage.i think your employer has to do this. I'd recommend calling Medicare and be sure of the regulations. Or There are brokers on RU-vid who explain it. 'How to delay Medicare without penalties'
Ask your employer if your current employer prescription coverage is "creditable" for Medicare Part D. If it is, you won't be penalized. If it is not "creditable" then you would need Part D now to avoid a penalty. No one can give an exact answer since it's up to your specific employer covergae. However, if you do end up needing Part D, you only need Part A to also get Part D.
@@8aNda1d One thing to be aware of is as of 2025 beacsue of the $2,000 cap many employer plans that are creditable in 2024 will NOT be creditable in 2025 because the employer plan due to the increased level of benefits on part d plans in 2025. To the OP. Make an appointment with an agent to figure this out.
Is it reasonable to get a higher premium plan (enhanced?) in order to have access to a larger formulary? If so, is there a simple way to get the number of medications in a plan's formulary? This question is based on my limited research of plans for my wife and I. We each tend to get one or two expensive drugs. Many of the part d plans in our area of Ohio are dropping such pricey drugs and increasing the deductable for the rest. Thanks for a better explanation of the true OOP!
I would say it is somewhat reasonable, depending on how much more you would have to pay for the enhanced plan. Overall, we still recommend choosing the plan with the lowest overall costs based on the prescriptions you expect to take during the upcoming year. To try and find more of a breakdown for how many medications are covered by a plan's formulary, usually Q1 Medicare has the best search tool we have found: q1medicare.com/PartD-BrowseMedicarePartDPlanFormulary.php
@@GiardiniMedicare Yes, I had found that site. It actually can tell you the exact number of drugs in a formulary (I located it through a Google search), but that feature was apparently not working a few days ago probably due to updates being processed. It can do it at the current time. Thank you very much.
This is the first explanation I have seen of the $2,000 cap, which provided this information. Thank you! The Medicare tool kept showing me plans and numbers that didn't make sense to me. Now I understand why. Only the government would take what should be a simple thing, and turn it into a convoluted mess. The current rules are a mess, and the new for 2025 simplified rules are still a mess. From the people that brought you the tax code, we present prescription plan rules.
In my case, even though I'm on Medicare, I'm also still working as a self employed person. So I get a tax deduction for paying Part D insurance premiums, but no tax deduction for paying prescription costs. So I figure that tax savings/no tax savings into my total yearly cost.
All my working life my employer provided insurance had the option to deny surgeries if they considered them "not medically necessary". Apparently screaming headaches due to a pinched nerve in my skull... for 30 years... is "not medically necessary". No more. I will not go with any advantage plan, I don't care what the cost is.
Yes. This possibility is exactly why I went with traditional Medicare and Supplements vs "Medicare Advantage". I had enough of Insurance companies saying you can only see certain doctors in certain areas, and refusing to pay for medical service until your tried all of their alternatives. With Traditional Medicare the conversation on the best treatment is between you and your doctor only and pays for what you and your doctor decide is best. And not what is cost effective for the Medicare Advantage insurance company stock price.
@@JBoy340a What really bugs me about my issue: They give me opiates for the pain... and then send me letters telling me I should try to get off them! After denying the surgery that would fix it!
Unfortunately traditional medicare will only pay for treatments that are medically necessary. What they do pay for is without pre approvals but they can and do deny payment for treatments and tests. I've had two things denied by traditional medicare in my first year. It happens.
