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Welcome to Healthcare Redefined: Advocating for Aging Adults and Their Families, where we empower families to navigate the complexities of aging and healthcare. Presented by Your Nurse Advocate Consulting, we share real stories, expert advice, and practical tools to help you and your loved ones confidently navigate aging with dignity.
We explore topics like creating collaborative care plans, demystifying Medicare, handling healthcare crises, and preparing for the future. Join us as we transform uncertainty into understanding.
Pam Dunwald: [00:00:00] Hi, welcome to Healthcare Redefined: Advocating for Aging Adults and Their Families. This is episode three. This is Pam with Your Nurse Advocate Consulting. Today's episode Medicare Ready, Getting Ready for Medicare Annual Enrollment, will walk you through how to prepare, what to review, and the key things you need to know before making decisions about your coverage. So let's make Medicare season less stressful together.
Pam Dunwald: [00:00:26] Welcome, everybody. This is Pam from Your Nurse Advocate Consulting. We are having a special Tuesday Tips that we're recording beginning of the week here. And we are so super excited. We have Wendi Schoonover. She is owner of Integrity Insurance Group. And she's going to talk to us today about everything Medicare. We're getting ready for open enrollment. And we don't know how long this will go, but hopefully we'll get some good questions answered for you. And with Wendi, I'm just going to kind of interview her, ask some questions and and ask her for her expertise. This is a lot of questions come up, a lot of people don't understand the different options for Medicare coverage. So we're going to dive into all of those. So, Wendi, welcome and take just a couple of minutes too, to just explain how you got started and what exactly you do.
Wendi Schoonover: [00:01:13] Excellent. Thank you, Pam. I appreciate it. My name is Wendi Schoonover. I started Integrity Insurance Group in the summer of 2018. It became official in February of 2019, but I've been in the insurance industry since 2002, and I was on the claims side before, and hated it, to be honest with you. And got recruited into the production side of things and started my own agency, just really to have a sense of a little bit more of an advocacy and educational approach to the clientele and give agents an opportunity to have someplace that's, I don't know, supportive and fun to work in and be productive so we can help people.
Pam Dunwald: [00:01:52] Awesome. So let's go ahead. We are in the very beginning process of planning for open enrollment. So when it starts, first of all, tell us what those dates are and what is open enrollment?
Wendi Schoonover: [00:02:04] So, there's actually, open enrollment is actually in the spring. So this is where things get real dicey and real fun, and real confusing with regard to Medicare. So what we're approaching currently is called the annual enrollment period or annual election period. It's from October 15th through December 7th. You can actually meet with a broker and talk about plans for 2026 as early as October 1st, but enrollments can't happen until October 15th, and whatever plan you choose would take effect January 1st.
Pam Dunwald: [00:02:33] Okay, perfect. Thanks for clarifying.
Wendi Schoonover: [00:02:35] Yeah, it's a lot.
Pam Dunwald: [00:02:37] So, then what is the spring open enrollment? What is that? What does that mean?
Wendi Schoonover: [00:02:42] So, it's ridiculous. So during the annual enrollment period, you can make, let's say you're on a Medicare Advantage plan. You can make as many changes to your Medicare Advantage plan or to your standalone drug plan as you want to, whatever the last change you make is, that's the one that will take effect January 1st. Okay. You can also move from an original Medicare and a supplement to an Advantage plan, from an Advantage plan, back to original Medicare and a Medicare supplement during that annual enrollment period. January 1st through March 31st is actually the open enrollment period. At that point, let's say you made a change during the annual enrollment period. You slept on it, Santa came, you woke up, and you're like, oh my gosh, I've made a mistake, or I don't want to do this, or I have another question, you can make one more change during that time frame, and it will actually take effect in the month following the month you make the change. So if you, on January 2nd, call me back and say, would they have made a mistake? I want to go to this plan X, Y, or Z. We make that change anytime in January. It's effective February 1st. February would be March, and then March would be April 1st.
Pam Dunwald: [00:03:53] Gotcha. That's a lot. But it's nice to know that you do have that little, that little bit of that look back, you know, an opportunity to change your mind. So let's start. Let's start from the beginning. So, as our seniors, what are the requirements when you turn 60, or what's the requirements for starting out initially with Medicare?
Wendi Schoonover: [00:04:12] So the truth is that there's no real requirement. I'll give you a couple of different examples. If a person is already taking Social Security, they will automatically get enrolled into parts A and B, and if they don't take any action to choose their own part D, which is their drug coverage, Medicare will actually enroll them into a drug plan for them, and that may or may not be what they want, but you know that can happen. But a lot of people, you know, are working past 65, so they may not want to take Medicare just yet. So they want to opt out for some time. Other people are not taking Social Security just yet because they're postponing it. Because they get more money later, right? And so, they still want to take Medicare, in which case you actually do have to take the initiative to enroll into Medicare under that circumstance, which you can do online at socialsecurity.gov or ssa.gov. You can do it over the phone, you know, may the Lord be with you if you call Social Security and do it that way. And you can also make an appointment with the Social Security office near them and enroll that way.
Pam Dunwald: [00:05:22] Gotcha. So, bottom line is, if you're already collecting Social Security when you turn 65, no worries, they're going to enroll you in A and B, and if you don't choose a drug plan, they'll do it for you. But if you're still working, you're not collecting Social Security, and you turn 65 and you want the Medicare benefits, you have to actively enroll yourself.
Wendi Schoonover: [00:05:43] Correct. And keep in mind, too, for those not working, it's probably the easiest way to explain it, if parts A and B only give us about 80% of our health care coverage. So the whole point of what's called the Medigap, or a Medicare supplement, or a Medicare Advantage plan, or Advantage prescription drug plan, is to put a lid on that 20% gap. The gap in Medicare doesn't have a limit to it. So that 20% could be 20% of $1,000, but it could be 20% of a couple of million dollars. So that's important to keep in mind as well.
Pam Dunwald: [00:06:16] That's a really good point. So where I'd like to take it from here is for those aging adults that feel like, you know, just the Medicare Part A and B, and they would, you know, get a drug plan. I mean, why, you know, what is their coverage look like compared if they were to look at adding or going to a Medicare Advantage plan or Medigap plan?
Wendi Schoonover: [00:06:35] Oh, that's great, it's loaded. But that's a great question. So, the first part of it would be we're going to do the example of somebody says, I don't want to take anything. Can Medicare just be my coverage? So essentially, there's parts to Medicare, right? So I've got part A. Part A is my hospitalization, some skilled nursing, and some home health. Part A is the part of Medicare I don't have a premium for. As long as I've worked my 40 quarters, I won't pay, you know, to have part A, but it does come with a per-occurrence deductible. In 2025, that amount is $1,676 per occurrence. So if I have a hospitalization in January, and then I have another occurrence in March, and maybe another one a couple of more times a year, every single time I have the obligation of that $1,676, right? Then my part B, that does come with a premium. That premium is based on income, but it also has a deductible. That part B deductible is actually an annual deductible, and it's only $257 for 2025. So, but that's the part that we use more than anything else. That is doctor's bills, that's not just for primary care, that is any specialist you might see, a surgeon, anesthesiologist, which are my personal favorite, any of those guys are going to be billed under part B. Durable medical equipment, some skilled nursing, some home health.
Pam Dunwald: [00:08:02] And what about things like therapy? Like if they go to a physical therapist, outpatient.
Wendi Schoonover: [00:08:06] Physical, that's going to be a part B as well. So it's outpatient services. It would also fall under part B. Thank you for that, because I did leave that one out. So and that that part of Medicare has the 20% gap, and there's no limit to it. Right. So I have the freedom of going wherever Medicare is accepted. But my coinsurance is 20% of all of that of part B. And there's no max on the part A per-occurrence deductible either. So then I get my part D coverage. That part, you know, is kind of negligible. That's going to take care of itself. But the bigger risk is in your part A and B gap of that 20%. So you can, but you know you're just going to get a lot of medical bills if you get really sick, you know? And every single time you go to the doctor, you'll get nickel-and-dimed, and there's just no limit. There's not, like, a max out of pocket that you would reach to where Medicare would say, okay, thanks. You know, it just doesn't matter, and it doesn't start over. It doesn't like reset every year or anything like that. It just keeps going.
Pam Dunwald: [00:09:05] Gotcha. Thanks for that. So what before we move on, what is included now people talk about your annual Medicare exam. What does that mean? What do they pay for that?
Wendi Schoonover: [00:09:16] Annual, like the wellness exam, is what you're talking about?
Pam Dunwald: [00:09:19] Yes.
Wendi Schoonover: [00:09:21] Well, the client shouldn't pay for that. The client, if you've got a supplement or a Medicare Advantage prescription drug plan, those plans actually get paid for you to do it. You shouldn't be paying for that.
Pam Dunwald: [00:09:31] Right. But if you have the Medicare just A and B.
Wendi Schoonover: [00:09:34] Then you wouldn't probably. I mean, you could just say, I'm not going to do that. Why would you do that? Right. Yeah. I mean, you would have to pay 20% of that visit if you chose to do it. But if I'm a person who's winging it, I'm probably not going to go to the doctor unless it is an emergency or I feel like it is absolutely necessary. So I don't know that I would do that under those circumstances. I guess it'd be up to the person.
Pam Dunwald: [00:09:58] Gotcha. So let's move into, so we've got a couple of other choices, if we want more coverage than just straight Medicare. Mhm. We have the Medicare Advantage plans, and we have the Medigap plan. So let's start with the, which one would you, which makes more sense to start with?
Wendi Schoonover: [00:10:16] So for me, for me personally, I mean, this is going to be a controversial answer, but I would if it were me and I was going on Medicare today, I would choose probably an HMO, Medicare Advantage prescription drug plan. And the reason that I would choose that is because I'm going to get the same coverage that I get with A and B, that they're required to do that. The hang ups with Medicare Advantage plan that a lot of people have are prior authorizations. But as we discussed prior to launching this recording, prior authorizations are coming to original Medicare. They exist already. They are likely going to increase in the very near future. So now I'm dealing with a relatively similar set of circumstances with regard to my treatment. And HMO, a lot of people like freak out about HMOs, but all HMOs is it says, hey, you got to play in our sandbox in order for you to get coverage. If it is elective, if it's primary care, if it's a hospital stay. If it's an emergency, I'm covered worldwide, even better than original Medicare, believe it or not, if I'm on an Advantage plan. So but an HMO specifically is going to have lower co-pays and much lower max out-of-pocket costs for me to meet. So if it were me and I found a max out of pocket, let's say that was $3,900 a year.
Wendi Schoonover: [00:11:33] And, you know, I'm relatively healthy. I'm probably not going to want to pay a premium to an insurance company when I don't know that I'm necessarily going to use that. But I'm also not sick. I'm also not somebody that takes a lot of medications. I'm also not somebody who you know... So I think that's a very personal decision. But, you know, in some cases, even if I had a tier 3, 4, or 5 medication, an Advantage plan might cover that better than a standalone drug plan would. So to me, it comes down to a financial decision. Some of it is preference, right? Like some of it is like I'm willing to pay. Some people tell me that, like, I don't care that it's a high premium. I don't care that my co-pays are higher on my standalone drug plan. I just want the comfort of being able to go wherever I want. Okay. You know, then that's totally, I totally get that. But to me, all insurance is a transfer of risk, and I want to transfer as much risk to the insurance company as I can without having to pay a premium in order to get that, if I can help it.
Pam Dunwald: [00:12:38] Great. Great way to explain that. That was excellent.
Wendi Schoonover: [00:12:42] Thank you.
Pam Dunwald: [00:12:42] So, before I get into comparing both of them, could you just tell us a little bit about what the Medigap is and why there's such a difference in cost and like, or what people might recognize as a supplement plan?
Wendi Schoonover: [00:12:57] Sure. And sometimes people get them confused. Many people will tell me they're on a supplement and they're not. A true supplement is called Medigap or a Medicare supplement plan, and they are letter plans. So the parts of Medicare are all letters, and the plans with Medicare supplements are all letters just to keep us on our toes. Right? And so the cost for a Medicare supplement depends on what letter plan you choose, for one. So a Plan G is the most comprehensive one available on the market today. But it's also going to depend on my gender and whether or not I use tobacco. And some companies, they will actually charge me a little bit more depending upon my list of medications, even though the first time I get on one, I'm in my open enrollment period, and they can't deny me, they can still look at my list of medications and think I'm a little bit of a higher risk than the average person, so I'm going to charge this person a little bit more premium. So it's very, it varies, and then it varies also from company to company. So they're easy to understand because a Plan G is a Plan G is a Plan G, whether it's a Mutual of Omaha, Aetna, Cigna, Humana, or whomever, because they're federally standardized. Excuse me, but the premiums will vary vastly from company to company. And then again, who's applying? You know, females are always going to be less expensive because we're smarter and more attractive. Just kidding, guys. But females tend to live longer. So those companies know they're going to get our premiums for a longer period of time. So typically, we don't get charged as much. And then I don't remember the second part of your question.
Pam Dunwald: [00:14:34] Well, just the second part is the finance. So why is an Advantage plan, the premiums less a month than the Medigap plan?
Wendi Schoonover: [00:14:43] Oh, that is, I mean, that is a great question. So the end of the private companies set their own rates. So think of a Medicare supplement like you're getting auto insurance. So I might get the exact same liability coverage at State Farm that I get at Farmers. But Farmers is probably going to be significantly more expensive. And I'm not getting anything else more than the coverage that I bought. Right? And supplements are exactly that way. Medicare Advantage plans are a totally different animal, so they actually want to attract clientele because Medicare, the whole reason they exist, let me back up a step here, the whole reason that Medicare Advantage plans came into existence in the first place: Congress invented them. But the reason was because Medicare was in a kind of a chokehold with regard to paying all these premiums. So there's this one perspective of, man, you don't give me 100% of my coverage, Medicare? What's up? I paid into you. What's the deal? Right? But the other perspective is there are a bazillion people on Medicare. We are living much longer, right, than we were 20 or 30 years ago. And so the cost of those claims are just astronomical. So in an effort to give number one Medicare beneficiaries an option, but also take the heat off of original Medicare a little bit, in the government, was these advantage plans. And so what happens with those is that Medicare says, Hey guys, if you'll pay these claims for us, United Health Care, Humana, Cigna, whomever, we will pay you a flat fee for every enrollee that you have in your book. So they're going to have lower premiums and lower, you know, I shouldn't say lower co-pays because some of those other ones don't come with co-pays, but they're going to have lower premiums because they're trying to attract us to them.
Wendi Schoonover: [00:16:39] But the other part of it is that Medicare is paying them to do that. So anything that they can do to incentivize people to enroll in them, like combo, pay the higher tiered drugs better, right? Give us dental vision and hearing, you know, anything like that, and give us a zero premium, or I've got there's one plan I can think of now that's only $24, but has a $4,000 annual dental benefit. That's unheard of. You know. So. Yeah. So it's like, you know, a lot of people don't like them because of the prior authorizations and things of that nature. But the truth is they work super similarly to an employer-sponsored plan. So if you, and maybe you didn't like that either, you know, to be fair, but people who are retiring, it is a very smooth transition for them because Medicare Advantage plans don't come with deductibles. So all those deductibles we talked about with original Medicare, it's actually covered for you. You just, you pay co-pays as you see specialists. Maybe a physician, if you choose a PPO or, excuse me, primary care, if you choose a PPO, a flat co-pay for any testing, hospital stays, and then you've got a max out of pocket where that contract says, no matter what happens to you in this calendar year, you're not paying more than whatever that number is. You know, if that, does that answer your question? Did I go too much? Okay. Okay. I mean, I tend to do that, so.
Pam Dunwald: [00:18:06] Oh no. That's great. And so leading that. So now that we have a little bit of background on both is, are there times, you know, when you, as you talk with your clients, what are some considerations people need to look at when determining which one would be best for them? Like one of the scenarios for us being in Wisconsin, we have a lot of snowbirds. So they question whether or not a Medicare Advantage plan would benefit them if they're spending 3 or 4 months in another state. So or if they travel internationally. I mean, are there what do they need to consider when they're looking at which plan would be best suited for them?
Wendi Schoonover: [00:18:49] Absolutely. It took me a minute to process the term snowbirds, and I was like, Oh, I gotcha. No, that's I'm like, I'm over here in Oklahoma. I mean, we get a lot of snow, but probably nothing like Wisconsin. So what I usually tell people is if you choose a national company, so I'll use United Health Care as an example. Excuse me. They have what's called a national HMO. So let's say you're a person that's like I want to do an HMO because I want to protect myself, and I don't want to pay a high, you know, co-pays or whatever, as long as wherever you are going to stay for those several months a year is in-network with the plan that you choose, zero issues. You could also consider a PPO. A PPO is going to give you out-of-network coverage. You just pay a higher copay, or you know, for that freedom. You may want to do a supplement in that example. People oftentimes, the two things that I get that people are concerned about are travel and emergencies specifically, which, because I always tell people they'll be like, well, I'm traveling, and I'm like, okay, well, if you're traveling, are you going to go get your toenail taken off? Like, probably not. You're probably going to wait till you come back home, right, to go to your primary care and say, Hey, I want this ingrown toenail taken off or whatever it is.
Wendi Schoonover: [00:20:08] So if it's a non-emergent issue, the likelihood of you seeking care where you're staying is pretty low. So it leaves emergencies, right? So emergencies on a Medicare Advantage plan are going to be covered. And internationally, I believe they're covered at 80%. I'll need to fact-check that, but I believe they're covered at 80, or no Medicare supplements cover you at 80%. But I think yeah, Medicare Advantage plans, worldwide emergency room coverage, or emergency coverage. So there's that. I mean, I don't, I try to, I stay pretty neutral. You know what I mean? Like my job in my opinion, isn't necessarily to encourage one or the other. I can tell you what I would do in similar circumstances, but I'm not going to say you should do this or you should do that, because at the end of the day, what you really want from any kind of insurance is peace of mind, you know? So if it gives a person better sleep at night because they chose a Medicare supplement and they're paying a little bit more for it than maybe they might like, then by all means, you know, do that. I wouldn't discourage that at all.
Pam Dunwald: [00:21:11] So as we approach this enrollment period.
Wendi Schoonover: [00:21:19] Annual, annual.
Pam Dunwald: [00:21:21] Enrollment period.
Wendi Schoonover: [00:21:23] I'm sorry.
Pam Dunwald: [00:21:24] So as we're approaching that, what would you recommend, Wendi, that people do to get prepared? Is there things that they should do before they meet with their advisor? Or if they say they want to come and meet with you, what do you tell clients or prospective clients? How do you get prepared to make those choices?
Wendi Schoonover: [00:21:43] Sure. I think that there's two things. One, we have to have what's called a scope of appointment. A scope of appointment is a required document from the Centers for Medicare and Medicaid Services, and we have to have it. It's a newer rule. We have to have it 48 hours before meeting with you. Now, if you called me and said, by God, you know, or if we didn't have time for the 48 hours or something, that's a little bit different, but you gotta have that. The other thing is things change. In the last 12 months, if your doctors have you, you want to get an updated list of your physicians and an updated list of your medications. One thing that happens pretty frequently is that we make decisions one fall based on that year and what medications we're taking, and then suddenly these doctors are like, Oh no, you need to take this and this. And it could make a big difference in what individual drug plan you may, you know, you may choose or Medicare Advantage plan. And keep in mind, on the supplemental side, a lot of people want to skip the annual enrollment period. They're like, well, I'm just fine. I can change this anytime I want. So why would I come in? It's for your drug plan. Their Medicare is making some additional adjustments for 2026.
Wendi Schoonover: [00:22:59] They haven't come out, you know, and confirmed, you know, what those changes are with regard to deductibles on the part D specifically. But when anytime Medicare makes changes, so this most recent year our part D deductible went up, and so did some of the premiums. Right. Or the individual companies will say, okay, well, we're not going to pay quite as much on this or that, you know. So there's just a ton of things to consider. So I always say like, if you can book an appointment early, because if you're working with somebody who's been doing this longer than a couple of months, they're probably going to get pretty busy pretty quickly because a lot of people wait till the last minute, you know. So book early and then get your scope of appointment on file so you don't have to worry about that, and then bring in, or if you can call beforehand and give your broker a week or so to call in and say, here's my new list of medications, then that would be an ideal circumstance. We want to make recommendations or show you what your options are based on real-life information. One of the things that drives me nuts this time of year is that we all get those spam calls all year long, but this time of year, they are on turbo, and those guys don't care what medications you're taking, who your new specialist is that you just got referred to.
Wendi Schoonover: [00:24:20] They're just going to throw people into a plan because they want the commission for it. And you may never, you may never talk to them again, so those are the three, like be very, very vigilant this time of year on your phone. Don't answer it if you don't know the number; they can leave a message. Do not give your Medicare information over the phone. I know I'm going off on a soapbox, but it's very dangerous. They have AI auto dialers now that will call these folks. And they'll say, Hey, is this PM? Well, hey, PM, are you on Medicare A and B? And they sound real. And you might say, well, yes, because you are. And this person might say, Oh, you might qualify for extra grocery money. Well, that sounds fantastic. I want more grocery money. You know what I mean? So okay. And before you know it, you're talking to an agent who's switching a plan, and you may or may not even know that's what they're doing. So be very... So scope of appointment, you know, updated doctor's list, specialists included, updated medication lists. And by God, don't give your Medicare card information over the phone.
Pam Dunwald: [00:25:21] Awesome. Great advice. And the phone calls. Yes.
Wendi Schoonover: [00:25:25] Oh my God.
Pam Dunwald: [00:25:26] It's terrible.
Wendi Schoonover: [00:25:27] I've answered a few for fun for my clients. Yeah, it gets pretty fun because I know what to ask them. And they, I get hung up on a lot because they are like, wait a second. Oh, they're talking about a little bit.
Pam Dunwald: [00:25:39] I've got three, I've written down as we were talking, just three last questions, and the first one I'll ask has to kind of do with those, you know, those spam calls or whatever we want to call them around this time of year. But I know, and even on the TV. So what should people know when they're constantly being inundated with $0 zero premium? What what do we need to share with our viewers on that?
Wendi Schoonover: [00:26:04] That is all. If somebody's telling you that something has a zero premium option, or if Joe Namath or Jimmy Carter or whatever his name is from Dynomite, whatever his name...
Pam Dunwald: [00:26:14] Oh, Jimmy Walker.
Wendi Schoonover: [00:26:16] Walker! I said Jimmy Carter. That's a different, that's a different vibe. But they are all advertising Advantage plans. 1,000%. And so it and I don't personally think there's, you know, Advantage plans are bad. They get a bad reputation for a number of reasons. But if it's a zero-premium, if there's an over-the-counter benefit, it is an Advantage plan. Those things are not an option with a Medicare supplement.
Pam Dunwald: [00:26:41] All right. So on those zero when they advertise that, so when they're advertising zero premiums, is that tied to income at all?
Wendi Schoonover: [00:26:49] No, it's actually not. As a matter of fact, there are a ton of Medicare Advantage prescription drug plans that are available to folks with zero premiums. There are special Medicare Advantage plans for folks who qualify for low-income subsidy and Medicaid, but that is a totally separate deal.
Pam Dunwald: [00:27:06] So that would be like that, and we're not going to get into it, but that would be like the dual plan.
Wendi Schoonover: [00:27:10] Dual Complete. Yes, ma'am. Um huh.
Pam Dunwald: [00:27:12] Okay. Alright. So for people out there that are listening, just because you might not think you wouldn't qualify financially for a zero payment, that doesn't mean that you might not. I mean, you could. Correct?
Wendi Schoonover: [00:27:24] You will. I mean, it's just another option. So I mean, there, I can't think of, most of my Advantage plan clients have either a zero premium or they've got that $24 one that, you know, it's fantastic because of the dental coverage. It's not a matter of, you know, you don't have to qualify for it. It's just a matter of, like when I meet with somebody for the first time, whether they're new to Medicare or, you know, if they're, well, usually if they're new to Medicare or during this time of year, especially, I will put side by side. Here's what it would look like if you did a Medicare supplement like you're doing now in an individual drug plan with your specific information. And here's what it would look like on a zero-premium Medicare Advantage plan, maybe a $19 one. And so if you're working with somebody that works on both sides of those options, they should be able to share with you what all of your best options would be so that you can make an informed decision.
Pam Dunwald: [00:28:22] Perfect, perfect. All right. My next question was as we were talking about drugs. So could you explain a little bit? And I believe that it's going to go into 2026. What is that $2,000 cap on medications?
Wendi Schoonover: [00:28:34] It's gone up a little bit. It's actually a result of the Inflation Reduction Act that the Biden administration put into law. So prior to 2025, there was no cap on your medication out of pocket. That is the reason that that donut hole, if you remember, used to exist. So people that were on expensive medications, like they might meet their deductible in January and then pay co-pays. And then they have they have to pay a percentage for a few months. And then it went back down, which is an obnoxiously complicated scheme anyway. But what that law did was it said, hey, we're going to get rid of the donut hole because that's bananas. And then we're going to put a cap on your max out of pocket for the year. It still might mean that you meet your deductible early on in the year, but it wouldn't, throughout the 12-month period for 2025, you would not pay more than $2,000 out of your own pocket. Not that that's not a significant amount of money, but there was no cap prior to that. I think next year it's going up a tiny bit. I haven't gotten confirmation on what they have. I don't know that they've officially released that, but not astronomically so.
Pam Dunwald: [00:29:43] Okay, awesome. And then for some insurance plans, is it true that you can take that $2000 and spread it out over the year and make monthly payments on that if your medications will go over that $2000?
Wendi Schoonover: [00:29:56] So yes and no. So what it actually is, is that what a lot of my clients will do is they'll pick a part D plan that's a little bit, got a little bit of a higher premium, but that's what they're doing. They're working out their deductible, and they're spreading it out over 12 months. There are actually what are called zero-premium prescription drug plans, also. If you're on one of those plans and you have expensive medications, Mounjaro comes to mind, Eliquis comes to mind, you are going to meet your deductible early in that year, and you're going to max that out. And it's, and you don't have any leeway really under those circumstances to spread it out. But what you can do is get a different prescription drug plan that would spread that out for you, if that makes sense. So yeah, and co-pays are a little bit less, but your premiums are higher. So yeah. Yeah.
Pam Dunwald: [00:30:50] Yeah. The reason why I bring that up is, I do have a client, she has a Humana drug plan. And she was able to, she's on some expensive COPD inhalers and things like that.
Wendi Schoonover: [00:31:03] Oh my god, yeah.
Pam Dunwald: [00:31:04] Yeah. So she was able to, she was going to I think, by May or June, reach that $2000. And so they did allow her. Now she's just paying monthly. So they stopped billing her per, you know, prescription, get them picked up, and she just gets a bill in the mail every month now for her.
Wendi Schoonover: [00:31:28] You're max out of pocket or your co-pays. So that might, I wonder if that was something that the pharmacy worked out with her, maybe, or maybe Humana.
Pam Dunwald: [00:31:37] So this was Humana because I worked on it with her. Yeah.
Wendi Schoonover: [00:31:39] That's awesome. Yeah, yeah. That's fantastic. I mean, I usually, I mean, I usually just show them, you know, like this, based on your meds, like, this is what this is going to look like, you know. And a lot of folks will opt into the higher premium because then they're not paying so much out of pocket. And then it you know, like I said, spreads it out.
Pam Dunwald: [00:31:58] To kind of even it out.
Wendi Schoonover: [00:31:59] Right, right.
Pam Dunwald: [00:32:00] Then I think my last question is, as we talked a little bit about this offline, but there's talk about if you could explain this, that some people are frightened to try or go on a Medicare Advantage plan because they're told that if they have a chronic disease or chronic illness, that they can't go back to a supplement. So could you kind of talk about that a little bit?
Wendi Schoonover: [00:32:24] Sure. And, you know, it's, we're human. Right? So fear typically drives our decisions. And a lot of folks will tell me, well, what if I get cancer? And I always say, well, what if you didn't? You know, I mean, it's a valid question, but there's two parts to it. So if, let's say you choose a Medicare Advantage plan and nothing happens, you know, 3, 5, 6 years in, and then you get a diagnosis, it would be difficult to prove medical underwriting to go back to a Medicare supplement in full transparency. However, if it is the first time, so let's say you hadn't tried a supplement before and you just went straight Medicare Advantage to start out, it's the first time you've tried a Medicare Advantage plan, and then you're going back. You can actually do, under those circumstances, you can go back to original Medicare and a supplement with no medical underwriting. Here is the thing that I would love for us to think about, though. And I'll give you, like a real-life example. My mother, and I am not going to tell you her age in case she sees this, but she was on, she was on a Medicare supplement for years. Decades. She's never gotten a chronic illness or anything, but she got to the point where she was paying somewhere in the neighborhood of, I want to say, around 320 some odd dollars on her Medicare supplement.
Wendi Schoonover: [00:33:44] So I was like, look, mom, let's think about this from a financial perspective, right? You are paying 320 whatever dollars a month, whether you use this plan or not. I found her a Medicare Advantage prescription drug plan with a max out-of-pocket of $3,900 a year. So when we think about, like, I'm not saying choose the Medicare Advantage plan and wing it altogether, I'm saying you've got to have some perspective. Those Medicare supplements might start out at $100 a month. But you, if you continue to renew, especially with the same company, and you know, it's all based on our age, it's just going to get more and more and more and more expensive. And at some point it's like, okay, am I going to just continue to pay this insurance company however much 3 or $4000 a year, versus I'm going to... I guess what I'm getting at is under the circumstances of getting a chronic illness like cancer, a horrible diagnosis like that, we're going to pay one way or the other. You know, I mean, there's just not, your Medicare supplement is not going to stay at 100 or $120 a month. You know what I mean? Now, for people who can withstand that, great. But there ar I mean, people that I deal with are living, you know, month to month on just Social Security.
Wendi Schoonover: [00:35:05] And at what point do you say this isn't making financial sense anymore, just based on the math alone. So I think that's important to consider. You know, the other thing is, too, when if you choose a zero premium plan, and you would have been paying $120 a month for your supplement, the financially frugal idea would be, and I'm not saying I would be able to do this, but would be to put that $120 bucks back, save it, right? So that if you needed a copay or you needed to max it out, you would have that. But, those are, it's just... The unfortunate thing is that there's no one decision that we can make that is going to always be 100% perfect. And the longer we live, the higher the likelihood is that we're going to get something down the road. And it just really comes down to affordability for one thing, preference for another. And then the other part of it is just like, who do you, I mean, do you what, what really are we trying to do? You know what I mean? Like, at some point, something's gotta give financially, I guess, is what I'm kind of getting at in a roundabout way. So it was a lot, probably I go off on soap boxes on this stuff, man.
Pam Dunwald: [00:36:23] No, it's all great information. And I think the more people hear, and you know, that they need to understand, it's like anything else. You know, I'm a nurse. If you were to grab your chest and fall on the ground, I know exactly what to do. Financial planner, I'm not an insurance advisor. So that's a different animal for me. So, in wrapping up, Wendi, is there anything that I didn't ask you that you feel is important to share about this annual enrollment period?
Wendi Schoonover: [00:36:50] Ah. That's funny. I don't necessarily know about that specifically, but I do have kind of a final thought to share. So this is kind of two-layered. Number one, a lot of people have seen things that I've shared on social media, and they'll say things like, Well, you're just selling this. I'm like, well, somebody sold you your house for one thing. But the other part of that is like, I'm not really ever in a position where I feel like I'm trying to sell one thing or another. Advantage plan, drug plan, supplement. My job, in my opinion, is to share information based on your circumstances and guide you through how they work, what they will cost, what your financial responsibility is. The decision is up to my client. I do think that Medicare Advantage plans, because of these robo dialers and because of other agents set up in Walmart, that's the other thing to be wary of, or, you know, just different vendor fairs that you go to. There are a lot of people who get into this business because they want to make money, not necessarily because they want to care for people. I think there's a big distinction between being a salesperson who is an agent versus a broker who is an advocate.
Wendi Schoonover: [00:38:07] And I think finding somebody that you kind of get that feeling from is super important, so that, you know, that person isn't saying, hey, you should do this because they make more money. Although that is a point of contention with Medicare Advantage plans a lot of times. People will be like, well you make more commission off of it? And the truth is, that's actually very subjective. We get a percentage of the first year's premium on the Medicare supplement side, and then we get a flat amount from the company we do an enrollment to for the Medicare Advantage plan side and the drug plan side, because those are managed through Medicare. Right? So I think we got to get out of that mindset of being afraid of them because you think, oh, this agent's just trying to make a dollar. I don't miss it. I don't miss any meals. I can stand up and show you that. But I'm not like that. And I think there are some very, very good advocate-driven brokers in this industry. It's just a matter of knowing who they are and don't do business through those telemarketer phone jobs. They're not there for you. They are there to put money in their pockets. So just food for thought on that.
Pam Dunwald: [00:39:19] No, I appreciate you taking your time. And I know that if anyone that's listening or we share this video with, I know depending on the state, you may or may not be able to help them, but I know you can point them in the right direction. And I know you've been able to help those of us in Wisconsin.
Wendi Schoonover: [00:39:36] So I got Wisconsin, Colorado, Delaware, Oklahoma. I'm still waiting on Arkansas, Texas, and Kansas that I applied for. But I also I work with what's called an independent marketing organization that has agents nationwide. So don't be afraid to reach out to me. I might be able to point you in that direction for sure.
Pam Dunwald: [00:39:52] Awesome. So in the description of the video and we'll have the replay on our YouTube channel as well as I'll be sharing it. So I'll make sure that I, Wendi, have all your information, but just to share what would be the best way for people to reach out to you if they would like to talk to you about the Medicare?
Wendi Schoonover: [00:40:09] Oh, sure. The office line is (918) 600-2133. I do have an admin assistant who helps me answer the phone. And then it also has a way for you to leave a voicemail in case I'm doing a Zoom interview or if I'm on, you know, just with a client. We also have a website. It's IIG, which stands for Integrity Insurance Group, it's IIGTulsa, because that's where we're located, dot com. There's a contact form you can fill out there. You can also follow me on TikTok. My handle is when W E N I N T U L S A. So it's WenInTulsa. So if you're on TikTok, you can follow me there. I just share factual information about Medicare, Medicaid, Social Security, and annuities, and life insurance.
Pam Dunwald: [00:40:54] Awesome. Well, Wendi, thank you so much. This is, you know, we try and help, you know, our clients as much as possible. We know this is a big, a big deal at this time of year, but we wanted to hear from the expert and get some expert insights on all of these things.
Wendi Schoonover: [00:41:10] I appreciate you having me on. This is like I feel, I don't know, maybe it'll go viral, and you and I will be on Good Morning America. We don't know.
Pam Dunwald: [00:41:19] Yeah, this has been great because I think, you know, with being an advocate and you advocating for what you do.
Wendi Schoonover: [00:41:25] Sure.
Pam Dunwald: [00:41:26] It's important that we share with everyone that there are people out there that really care about making sure that you have the education that you need to make an informed decision. And that's what sounds like we're both all about. So yes, that being said, we're going to go ahead and wrap this up. I'll have all the information again for Wendi. Reach out, and we will talk to everybody soon at another Tuesday Tips. Take care now.
Wendi Schoonover: [00:41:46] Thank you so much. Thanks, Pam.
Pam Dunwald: [00:41:48] Alrighty. Bye bye.