The $14,000 mistake retirees make during open enrollment

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The choices you make have implications. They fit within a wide range of issues that someone thinks about when they consider retirement, and one of these has the, has to do with the flexibility to change.

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You’ve probably heard the basics about Medicare Part A, Part B, enrollment at 65, but today we’re pulling back the curtain on what the brochures don’t tell you.We’re calling this episode Medicare’s dirty little secrets, the coverage gaps, the hidden costs, the enrollment pitfalls that could cost you thousands. Joining me are three experts who have seen it all Marsha Mantel, author of Creating your Medicare recipe, JO, author of Maximize your Medicare, and Fred Ricardi, the head of Medicare Rights Center. Together they have helped countless retirees navigate the Medicare maze, and today we’re going to help you. So let’s decode this together.Jay, I, I want to start with you. The first secret that, uh, folks need to know about is what I’ll call the commission conflict. And here’s what I understand to be true, that Asians tend to earn 3 times more selling Medicare Advantage plans than they do a Mediga plan. Tell us what we need to know.

1:13 spk_0

Thanks for having me, Bob. So yes, in part, that is true.That is the bottom line is when someone is new to Medicare, their first year, that the compensation level that is allowed by carriers and states, the CMS, is higher for Medicare Advantage.After the first year, or if you change plans or you repeat your membership in a Medicare Advantage plan, then you get a lower rate that continues on for an extended for as long as you are a member.Under meta gap, a very different structure, which is the states have mandated rates which are set by the state, the carriers adopt up to that limit.And from there, you are paid on a repetitive basis. Again, these are all decided, determined by the individual state of your residence for a specified time, one which the producer, the agents do not control.But yes, that is the case for this first year upon entry into Medicare,

2:25 spk_1

right? And from a consumer’s perspective, from a beneficiary’s perspective, uh, do either of, do any of you view the commissions as a potential conflict?

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Generally, and thanks for having me here, Bob. Generally this is one of the biggest secrets in Medicare is people who are enrolling in a Medicare Advantage plan have no idea that an individual is potentially going to be earning a commission year after year. I tend to think about it like earning royalties. Maybe you write a TV script and then the TV show errors and errors and then you keep receiving royalties. Beneficiaries have no idea about that.

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Yeah, Marsha, I’m sure you have something to add.

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I do, Bob. Um, not only do they have no idea, but the consumer doesn’t know to even ask about this. So they’re really, it, it, I want to be clear here too. I’m a big fan of the brokers and the agents. I think we need more really good brokers and agents out there helping people navigate this Medicare maze, but people have no idea what to ask or how any of this works, and often they are.I mean, Medicare Advantage plans are not necessarily bad, but they’re not necessarily ideal for an individual either, and they’re not presented with two equal choices many times. And I go back to, well, what would anyone do if you’re in a situation where you could sell health insurance or any product and get $700 or sell another similar product for $200.What would you do? It’s not the brokers setting these fees. It’s the insurers and the laws that allow this highly unbiased situation, yet they don’t tell theconsumer,

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right? And in some cases some of the insurers aren’t paying a commission at all, in which case the consumer beneficiary may or may not be presented with that option. Is that fair to say?

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I think that’s, I think that’s fair to say.

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Yeah,

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so for

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2026. How so, Marsha?

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Well, it’s just more prevalent this year withThe insurance industry being under.Profit losses or concerns of profit losses or revenue.Loss, you know, the revenues being lost, the insurers are looking for ways to move whole cohorts of retirees into the plans that are much more profitable. So they stop paying commissions on certain products in their line or shutter them entirely.And that leaves a smaller pool for the brokers to present.

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Yeah, Fred, you were going to say something. Well, and

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Bob, I think one of the best kept secrets is something called the state health insurance programs. These are known as ships, and what they do, they’re run in every state. They’re funded by the federal government, and they provide people independent counseling on their Medicare options. There’s no commissions involved.And so that is a resource available for folks so they don’t solely have to rely on brokers to learn about what plan might be the best fit for them.

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Yeah. Jay, when you and I have talked about this topic, one of the things that you mentioned was you could certainly pay attention to what your agent is telling you in terms of their recommendations, but the, the, the onus is on you to go to the Medicare’s plan compare and look at all your options and compare the ones that you’re being presented by the agent to the also to the ones that are being presented on Plan Compare. Is that fair?

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Yeah, I mean, I think the very, I think to avoid wrongdoing, I tell people in my newsletter two very simple things. Number one, ask for the agent’s NPN.Which is the unique identifier number for the person. You cannot get around it. I have one. It is included everywhere, so you can check to make sure the authority of that person. And regarding Medicare.gov’s plan compare.It takes extra legwork for me, which we’re happy to do, which is simply provide the entire list.Without any filtering system, meaning that in a particular county there are going to be 50 plans, let’s just say, we can simply show them all, and that is something that I’m not sure cause I can’t speak for other producers, but that’s something that, you know, we are absolutely happy to share with consumers.

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So we’re trying to uncomplicate the, uh, complicated. Uh, we’re trying to pull back the curtain on some of these secrets. I want to turn to another secret, Fred, which is, um, the problem that someone has when they’re trying to switch from Medicare Advantage to a Medigap if they initially enrolled in the Medicare Advantage as opposed to original Medicare and Medi gap. There are some things that people need to know about that.

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Yeah, it is that happens to be one of our most common questions that we get on our national helpline. So we run a helpline for Medicare beneficiaries and their family members, and people call us and they are confused because they’ve maybe they enrolled in Medicare Advantage plan when they first learned about Medicare enrollment and sometimes you don’t learn about enrolling into Medicare until you receive some marketing material in the mail.And we’ll have a call from someone and they’ll say, I need to get out of this plan. My providers left the network and I feel like, what are my options? And that’s where we don’t necessarily always have good news to share with someone because sometimes depending on where you live, that once you enroll into a Medicare Advantage plan and you’ve been enrolled in that plan,You can always switch back to original Medicare during follow up and enrollment, but you may not be able to pick up a supplement, a supplement plan or a Medi gap. That’s what pays secondary to original Medicare, the 20% co-insurance, the hospital deductible, etc. And so, um, there are some options for some folks.But that is pretty surprising to people that they learn that they have kind of made an initial decision that has a lifetime consequence. Yeah,

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so I want to take a short break and when we come back, we’re going to riff a little bit more about things like the special enrollment period and other things that they need to know about switching from MA to Meta gap. So don’t go away.Welcome back to Decoding Retirement. We’re talking about Medicare’s dirty little secrets with an expert panel of guests who are here to help you uncomplicate the complicated. Um, we were just talking about the challenge that people have when they’re in a Medicare Advantage plan and then they try to move into a meta gap plan and the hurdles that they face. Um, Fred, thank you for that explanation. I’m curious, Marsha, uh, any reaction? Any, any helpful tips for our folks?

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Well, I’m in the same boat as Fred and Jay. It is one of the biggest questions. So one of the things I try toShare with people is in states that are not Massachusetts, Connecticut, Maine, or New York, which have this continuous open enrollment, so options to move between these plan types. If you’re in the other 46 states, you’re generally making a 30 year decision.Except now there’s this birthday rule thing.Which is further complicating the complicated. So to give you an example, I I looked at two of the states that have these birthday rules, and what this birthday rule generally does, it allows some Medicare folks to switch their meta gaps. So maybe you’re in a plan G, but it’s gettingToo expensive and you’d really just prefer a plan A. Well, you can’t even do that. So birthday rules in Colorado say you have a 60 day window starting your birthday to switch a meta gap down to one with lesser benefits or an equal one without underwriting.At the same company or a different company.But in contrast, in Illinois, they also have a birthday rule, but it’s only 45 days long, not 60, and it’s only for those who are between the ages of 65 and 75, and you can only change within the same insurer.So we have this, you know, 50 state rules and regulations for insurance, and that means 50 sets of rules. And what your cousin does in Colorado is not what you can do in Illinois, further complicating this whole switch between plantypes.

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Yeah, so I guess, well, I know there’s lots of other issues around these, these rules. Jay, you and I have talked about this a lot over the years. Tell us what we need to know from your perspective.

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Well, there are certainly options for people when they learn that they’ve chosen something that is suboptimal, which is, for example, there is the trial right, which means that people first enter into Medicare.When they turn 65, they discover during this first year that something isn’t exactly right, doesn’t quite fit their situation, that they prefer meta gap. There are certain other situations when this can occur.There’s no doubt the crazy people, uh, well, I’m only speaking for myself, Marsha is totally rational, you know, write books about these nuances, right? I mean, in other words, I try to tell people that this is an exercise which is chess. This is not just 8 by 8 squares. OK, the pieces move like checkers, the choices you make have implications.They fit within a wide range of issues that someone thinks about when they consider retirement, and one of these has the has to do with the flexibility to change, so changing from Medi gap to Medicare Advantage, unrestricted, changing from Medicare Advantage to Medi gap restricted. This explains candidly.Just using your common sense that people would understand that these would not exist at the same price. Just this one aspect alone. And just from a common sense point of view, somehow when money, insurance.Health care gets thrown into the mix. People’s, you know, lose their sense of common sense. They they they forget their common sense, butTrying to communicate to that public, you know, can be complicated.

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But you knowwhat, Bob, one thing I want to point out is we do get phone calls from people who want to leave their plans and they can’t. Maybe they’re outside of an enrollment period.There are still options if someone’s had a health service denied, they have the rights to appeal. One dirty little secret is very few people appeal a health plan denial. It’s lower than 20%. It’s around 12% or so. But guess how many people win the appeal upon the second determination? I’mhappy to

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roughly all of them, theydon’t.

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Roughly roughly 50%. So we always encourage people to appeal any denial from a Medicare Advantage plan or a Part D plan because they’re likely to win that appeal by just submitting it. So we want more people knowing about these rights because theyexist. Yeah.

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So speaking of rights, I understand that if, uh, Medicare Advantage plan is canceled, you received your annual notice of change and you learn that your plan is canceled, uh, you do have a right then to maybe go into a Mega plan. Is that correct?

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Yeah, there are some, there are some rare occasions where someone will have some guaranteed issue into, into a meta gap plan. And so for example, one important point is some people who were enrolled in a retiree plan, they may lose that option. It’s no longer available to them. Somebody in that situation would, would have that option also to somebody who’s working longer might have guaranteed issue to a supplement meta gap plan. So it’s important toExplore all these special enrollment periods, but to Marsha’s earlier point, this is complicated and it’s complex. And so those initial decisions are super important.

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Yeah, it’s complicated and if anyone hasn’t, uh, watched or listened to us so far, they’re learning how complicated it can be. Mars, I want to turn to another, uh, secret, uh, we call it the hidden cost reality.Which is that when someone signs up for a Medicare Advantage plan, you may have a $0 monthly premium, but you may also have some other costs that you’re not anticipating, especially if you’re unhealthy.

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Yeah, you know, thanks for bringing that one up, Bob. This is one of my big beefs. You know, when we hear heavily, heavily advertised products out there that, and they’re clear, kind of, and that they say it’s zero monthly premiums. You can get a Medicare Advantage, HMO health maintenance organization style plan, an in-network plan for $0 a month in most places, even some of the PPOs, so they’re different flavors of Medicare Advantage.Yes, 0 monthly premiums. What people here is free.And that’s not how much these Medicare Advantage plans cost. They you are nickeled and dimed for everything you use in the health care system. Then once you have a Medicare Advantage plan, you’re paying, it’s $20 here and $40 there and I’m $175 for something.So it doesn’t necessarily seem onerous, though it’s a surprise. What’s hard is when you are older and sicker.And you require a fairly healthy amount of health care services, you can reach these upper maximums that are never talked about. And that dirty little secret part is it’s, yeah, maybe a zero monthly premium, but it will cost you on a risk exposure $9300 if you’re in network for 2026 and about what is the number $13,900 if you’re in and out of network.So my question to, you know, audiences when I speak to them about Medicare Advantage and Medi Gap and such.How much do you have sitting kind of aside in your little healthcare bucket? So if you’re the one who gets a cancer diagnosis or you’re the one who gets a chronic disease that requires very costly injections to, you know, frankly, to stay alive, do you have $14,000 sitting over on the shelf? And they’re aghast. It’s like, no, no, it’s free.It’s notfree.

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All right, we’re gonna take another short break and when we come back, I want to talk a little bit about that math equation that needs to happen, which is how much I pay for Meta gap versus what my maximum out of pocket exposure might be. So don’t go away.Welcome back to Decoding Retirement. We’re talking about Medicare’s dirty little secrets and hoping to uncomplicate the complicated and provide you with some actual advice during open enrollment, uh, period. Um, Marsha, we were just talking about, uh, the hidden cost reality. Uh, one of the things that people sometimes need to do, and Jay, I’ll turn this question over to you, is this notion of if I were to compare my meta gap premiums, maybe $200 a month versus the maximum out of pocket.The math seems to favor one over the other, at least if you’re, uh, unhealthy, maybe less so if you’re not, uh, if you’re, if you’re healthy, maybe it’s not the biggest problem. But take us through the, the math that you do when you’re thinking about this, this equation.

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Well, I think, first of all, people should understand that the price of insurance is probability based in probability. So,Right from the beginning, yes, you can understand that people are surprised, for example, there’s co-insurance, there’s co-pay involved when they have Medicare Advantage. That all said, let’s remember that.20 million depending on on the number of people that were the data source, live on Social Security alone.So you have a practical reality of whether or not the guidance that you provide is also, I mean, I always tell people, yes, I want to have security that insurance provides. I didn’t say donate, and this is the practical reality in the world that we have.And so now the question directly that you asked Bob is yes.You live in a location which is very competitive with respect to Meta gap. 12 months at $150 200 dollars a month for Meta gap is reasonable within a range. It’s a wide range, but a range.So you’re talking about $2400 with 100% certainty.And then comparing it to the possible cost that you will encounter in overall costs on Medicare advantage.And when you’re 65, then that number is smaller because the premium is lower.When you’re 80, you live in South Beach, now your Medi Gap premium has 400+ easily.Now the math becomes more complicated for sure because now we have an out in and out of pocket maximum under Medicare Advantage and depending on the plan, certain plans, the carriers, they understand the math, they have full control and very good data. They’re competing on every single feature, every single detail inside of a Medicare Advantage plan for sure.

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Yeah, and I think, I think that’s the crux of it. We really are in an affordability crisis for older adults and so we have folks living 50% of people on Medicare are living on less than $35,000 a year. They’re spending anywhere from 10 to 15% of their income on healthcare costs. People really are caught in a bind on how to afford it. So you do a quick back of the envelope.And you tell someone, hey, just out of pocket, your premiums are going to cost $5000 a year for your Part B premium, your Part D premium for your Medi gap. For some folks, it’s just not affordable. And so that’s when they also start to look at Medicare Advantage because on the surface, to Marsha’s earlier point, that zero premium is very attractive, but you have to look underneath the hood for all of the other costs associated with these decisions.

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Yeah, and we’re living in a world now where co-pays are increasing.Hospitals are requiring payment before insurance kicks in and a whole bunch of other things associated with Medicare Advantage, uh, more dirty little secrets to uncover. Um, I, I want to go to another thing that I’ve written about, which is, um, in the latest Medicare trustees report, they noted that Part B premiums for next year are going to rise 11% and that they’re projecting these increases to go.Upwards of 7 to 10% per annum up to like 2033. Uh, Marsha, you have lots to say about this, I know.

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I do, and I’m, I’m, you know, on the edge of my chair like Brett and Jay and you waiting to know for sure, are we going to be hit with that $206 per month premium, the jump from $185 per person per month this year for Medicare Part B all the way up to 206. Um, we’re really concerned about such a gigantic jump, and Fred, exactly what you and Jay were saying earlier, this affordability crisis, itIt happens before we even get to Medi Gap or Medicare Advantage because everyone has to pay for their Part B. Now there are some extra help programs that can maybe help with that, you know, we’re concerned about the, the Medicare clawbacks, Medicaid clawbacks rather coming for those who are also eligible for Medicaid, um, which often helps with these costs, butI mean, you start out the year with $206 coming out of your Social Security check, and that’s where insurance starts for retirees. So this is really a situation that’s escalating quickly and it’s not like we have a one-time jump, this one time 11% jump, but that trustee’s report also shows that for the next 10 years the increases will be will be between 7 and 10% per year.Well, if we get inflation back down to the 2.5 or 2% general inflation, that’s what your Social Security benefit will go up. But your Medicare Part B premiums going up 789. It’s not an equation that is sustainable for many, many folks in this country.

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Yeah. Jay, how should beneficiaries plan for these increased potentially increased Part B premiums?

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Well, certainly planning, of course, on all the other elements is certainly a good idea.We’ve talked a lot about different accounts, for example, and HSA, other ways to plan for possibly larger costs in the future. This also goes all the way back to investment strategy, for example, excuse me, the idea of something linked to inflation, meaning that you’re gonna wanna have this and all goes even to the timing of Social Security.Social Security as a reminder, has a cola, which has the increase that uh Marsha mentioned, and then also being able to delay, if possible, if possible, will also increase the amount of monthly benefit that someone is going to receive. But no, there’s no question until we have answers to.Pushed down, in other words, to stop the rise of systematic health care costs, we’re going to continue to have this struggle. I don’t think that there’s any way around that until you had a fundamental change in the way that healthcare costs are determined in the UnitedStates.

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Yeah. Uh, I’m afraid we have to take another short break and when we come back, I want to talk about some new trends that are happening in the network, so don’t go away.Welcome back to Decoding Retirement. We’re here trying to do our best to reveal Medicare’s dirty little secrets and then provide you with some actual advice to help you figure out what to do that would be in your best interest. Uh, one of the new dirty little secrets is what we might refer to as network disruptions. Uh, Jay, there’s a number of breaking issues that, uh, where we’re looking at major hospital systems, dropping Medicare Advantage plans, uh, midstream. What do we need to know about that little secret?

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This is probably just now coming into the headlines. The reality is is that this is not new, meaning thatAll the, if you’re involved or if you are a Medicare Advantage plan member, I’ve written and we’ve spoke about this at length, that for me, the number one.The thing to check is to check the participation of networks. It is unsettling and difficult to understand that the different provider and the different plans, they’re negotiating their payments on different schedules.And so Murphy’s law can have this situation where you are scheduled to go to a particular hospital for whatever reason, and at that very same time, and of course, that combination gets a lot of headlines. That said, this is one of these base case understandings of the way that Medicare Advantage works, and the reality is this is something that has always been the case, and something which has existed, for example, if in your employer plan.If you are covered by your employer, you’ve faced this in the past as well.There are a number of measures and of course Fred and Marsha will be able to comment as well about what to do when this happens, but this is an inherentOne of these rules, one of these conditions that people should consider right from the beginning when they’re considering Medicare Advantage versus Mediap for

27:05 spk_1

sure. Yeah. So Fred, let’s go to what consumers beneficiaries should do, right? We want to give them some actual advice here.

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Yeah, every year we receive calls from beneficiaries who are frightened because they’ve learned that a provider or a whole entire health system might be leaving a plant’s network.And then we also received calls from beneficiaries that thought a provider was a network and maybe they were never a network. And I guess one secret is, is there the plan provider directories for Medicare Advantage plans, they are riddled with errors and CMS is aware of this andto give credit to CMS this year, they are going to put more information about providers on Medicare’s Planiner, and they’ve acknowledged that plans are not necessarily keeping all of this information up to date. So if someone enrolls in plan.And that provider is indeed not in network, then they will have a special enrollment period if they made that decision through Medicare Plan Finder. So my advice to folks out there that are using the Planinder or if you’re like me and you’re helping people use the Plan Finder, make sure you keep good notes because if that provider is not a network, then that person should have a special enrollment period to leave that plan next year.

28:16 spk_1

Yeah, Marsha, you have something to say about that?

28:19 spk_3

Yes, well, and I love that the Planfinders adding this and acknowledging that theyThat there are mistakes kind of to tie the two, Jay and Fred, your comments together, you know, some specifics here. I live in the Boston area and was shocked to see that our biggest health care system, as General Brigham, just announced that they’re no longer allowing primary care physicians to accept Blue Cross and UnitedHealthcare’s PPOs and HMOs, so Medicare Advantage, they’re taking a slice out.Well, one of the things with Medicare Advantage plans, the HMOs, you have to have a PCP. So those PCPs though won’t be paid under either of those plan types for 2026. I can imagine that is making people in the mass general system, you know, kind of freak out. The other big news is that Vermont is losing two of their three providers for HMOs, Blue Cross and UnitedHealthcare.Both have pulled out entirely. Two plans left last year, leaving 3 Medicare Advantage plans. Two of the three have now left for 2026, leaving only Humana. So again, we’ve got this population and they can sort of frame it under, well, you know, the rural counties may be in a situation where they’re losing some plans. Well, Vermont’s a whole state, you know, and I was just shocked to see that the other day.And Humana’s only offering their their Medicare Advantage plans in some of the counties, so not across the whole state. So these folks are just waking up to an absolute scramble. And that again, you know, Bob, you’ve heard me say it a million times, we cannot be putting this. It’s just, it’s sinful to put this kind of burden on our 80 and 90 year olds. It’s tough enough at 65, you know, but this is just not OK.Yeah.

30:14 spk_1

So we have a lot more questions to get to, a lot more dirty little secrets and not enough time to get to all of them. So we’re gonna do a quick round robin, OK. So let’s start here. The Part D secret, Fred, which is, if you don’t sign up for Part D in a timely fashion, you’re going to

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pay, you’re gonna end up with a late enrollment penalty, and it’s gonna be 1% of the base premium for every month that you did it in a.but I want to point out we just encountered somebody in this exact situation. They didn’t need prescription drugs and eventually they needed an expensive injectable. They were eligible for something that Marsha mentioned earlier called extra help that lowers the cost of your prescription drugs. There’s income limits, there’s an asset test, but in your state there’s also something called the me.Care savings program. It will pay your Part B premium, that $185 a month, and it will lower the cost of your drugs and allow you to enroll into Part D and eliminate that penalty. All right,

31:06 spk_1

Jay, one for you, uh, many beneficiaries may be reading about how plans are now testing prior authorization requirements. What do we need to know about that?

31:16 spk_0

Well, relates to the point that I made before, which is we have a systematic healthcare cost issue. And so it should not necessarily be surprising that original Medicare itself is imposing some type of way to push down the total cost, including prior authorizations, that’s entirely possible.Medicare Advantage plans are used to this, because they, the carrier, ultimately determines the level of service and has to meet minimum requirements according to original Medicare. Medi gap carriers have no leeway, meaning that if original Medicare covers that particular service, Medi-gap will cover the balance as specified by the Medi gap plan.But yes, I would expect this type of thing. We’ve had, there are prior authorizations in a limited scope, but now we have possibly a wider set of prior authorizations in the future.

32:17 spk_1

Yeah. So, Marsha, there are a couple of other secrets I want to get to, one of which is, uh, we’ve learned recently that the Justice Department is investigating some insurers over practices. What have beneficiaries need to know about that investigation?

32:32 spk_3

Oh gosh, Bob, I think the administration’s doing a whole lot of things, um.Just keep on top of the information. If you are in a plan.Read the documents. Read that annual notice of change. No one likes to read it. Read it anyway, you know, call your brokers, call your agents, use the ship reps, right? I think you mentioned the ship reps earlier, the state health insurance assistance programs. They are no charge to any beneficiaries and you getGreat information from them, but you need an appointment right away. Um, Medicare Rights Center, you know, to mention, I love your, your shop, Fred. Uh, there’s great information available out there in English. So you, you, we all need to just be, as I got, we’re in consumer-driven healthcare.So we’ve got to get on the bus and we cannot sit in the back. We are not looking out the window. We got to drive that bus whether you’re 75, 85, or 95. And if you don’t want to do it, get someone on board with you to help you. It’s there’s no shame in asking for help. This stuff is wildly complicated.Yeah.

33:40 spk_1

So we have to take one more break and when we come back, we’ll talk about some of the secrets that we haven’t got to yet. So don’t go away.Welcome back to Decoding Retirement. Today we’re exploring Medicare’s dirty little secrets with an expert panel of guests. Um, Marsha, you were talking about the need to get information about your plan, and, uh, Jay and I, uh, Jay, you and I in the past have talked about whether folks should actually go to places like Reddit to get information. What, what say you?

34:18 spk_0

Well, I, I, I troll on Reddit, because I’m interested to hear what the nature of the questions, the degree of information right and wrong that I can read from everyday users. We have our own client base, we’re hearing their feedback as well. The issue here for me is that the quality of answers varies all over the map.That some are actually very accurate. Maybe even I have hijacked their exact diction.That all said, that doesn’t mean that everyone is on the same page and using the same language.AndWhen I talk about health insurance, I try to remind people health insurance is not health care. Health insurance is a legal contract and so diction, the actual words super important.So when we have 20 different opinions using 20 different phrases, it’s really difficult, challenging for the reader, the uninformed but curious reader, to keep it all straight. So that is what I would say. I’m not saying that any particular person that is posting there as far as their answers is.Blanket right or blanket wrong, I wouldn’t go to that extreme, but you need tobe careful.

35:42 spk_1

Yeah, so when I think about going to get information, uh, two things. One is you mentioned that I think that you’re using AI to build tools to analyze the CMS Medicare documents. And, uh, in preparation for this interview today, I actually went on AI to say, what are some Medicare’s dirty little secrets and I produced a document for all you to review.And the interesting thing was, from my perspective, AI got a lot wrong, right? Every question on the document was, are you sure that’s right? Are you sure that’s right? Are you sure that’s right? So my first thought is I shouldn’t trust AI for Medicare information, at least not yet.

36:15 spk_2

Yeah, I, I think there’s a lot of things we can’t trust AI for just yet, but I, this is what I want to point out. The Medicare Rights Center, we’ve been around for over 35 years. We’re transforming the information we provide. We have a website.Called Medicare Interactive.org that is trustworthy information. It is fact-based. It is fact checked and I want to let people know that it is made for beneficiaries. It’s made for consumers. The information is simple and straightforward. But to Mars’s earlier point, older people, they may not be online, that’s why we have a helpline. I want to make sure I get this out here. It’s.1-800-333-4114. People can call us with a question, a simple question. So there’s online resources, but be careful where you’re getting information because you may not realize you’re getting your information from a brokerage firm, from a plan. I’m not saying it’s bad information, but oh, but more and more, it’s, it’s unclear who’s providing this information. Yeah,

37:19 spk_1

Marsha, I know you love AI.

37:23 spk_3

It was no surprise to hear you say you did something on AI that I called Chatty Cathy. I’m also not surprised that let’s say the information was less thanPerhaps, yeah, I’m, I’m a big skeptic. I think it will grow up and, you know, become a teenager and then an adult at some point, but right now that it’s fun for us to play with those of us who know what the law is and how the insurers work and how all these many, many pieces to the puzzle get put together. It’s not OK for the average consumer. It’s it’s like doing the Reddit feed, Jay, you know, like, oh, I’m just gonna read all these comments, I’m gonna pick the one I like the best.It’s not for me,

38:05 spk_1

Bob. So Jay, um, Fred just mentioned an 800 number to call at the Medicare Rights Center. A lot of times people say, oh, call the Medicare 800 number and talk to a rep there. And my understanding is that the folks might give you information but not necessarily advice. Is that fair to say?

38:22 spk_0

Yes, that’s fair to say that in order to impart actual guidance, actual advice, we need to have a license provisions from the different carriers andThe AI tools, if, if I didn’t circle back there.One way is to, for example, under my book’s website, it is populated only the knowledge base is a very specific limited set, meaning that the answers only come from a particular source. We’re gonna see those types of tools, uh, and as most things when you talk about development of the speed of technology or advancement.The progress is faster than what we would, um, you know, otherwise expect. I would expect those types of developments to happen rapidly, uh, in the very, very near future. But yes, when you get advice, for example, we can’t, my phone phone calls are recorded.So if there’s any dispute, misunderstanding, for example, there’s a disclaimer to say these aren’t the only plans. In other words, the CMS has safeguards, guardrails to protect the consumer.

39:39 spk_1

Yeah. So in the time we have left, uh, are there any little secrets, dirty little secrets that we haven’t got to Fred, I’ll go start with you.

39:45 spk_2

Well, I just want to point out as to an earlier point I made, that people are surprised when they’re turning 65 and they don’t know anything about Medicare, and that’s because people are not getting an official notice from the federal government. So we need to see Congress step up, pass a law, make sure that people who are approaching Medicare eligibility learn about it because those initial decisions are so important. Yeah.

40:10 spk_1

Marsha, any other secrets that we haven’t touched on?

40:13 spk_3

Let me think, Bob. Yes, one that really surprises folks also with this transition period, Fred, you don’t sign up for Medicare on Medicare’s website, which would be intuitive. You sign up on Social Security’s website, not intuitive, but that is where you sign up. And if you have started Social Security early.You automatically get your magic Medicare package. Welcome to Medicare, 3 months about 3 months before your birthday, your 65th birthday. You didn’t even know you signed up for Medicare. So there are just so many points of confusion in this transition period, and we don’t start nearly early enough to educate people about what they’re getting into.

40:54 spk_1

Yeah. Jay, how about you? Any uh dirty little secrets we didn’t get to?

40:58 spk_0

Well, related to what the point, the very lessons then Marsha pointed out that preparing early vital, meaning that people do not understand that, for example, your Medicare Part B premium can be higher than the base rate because of something called IRA, which is related to your level of modified adjusted gross income, which itself is a is a slight variant of what you file on your income tax return.These are the types of matters to just to give people the idea about the many interactive layers when it comes to retirement planning, of which Medicare is a very important part.

41:39 spk_1

Yeah, just to add on to that, Jay, you and I have talked in the past a lot about how this health insurance question is not a uh discrete item, right? It’s part of a much larger issue. It’s part of your financial plan. It’s part of your retirement plan.And that you need to understand how uh pulling this part of the uh thread on the sweater affects the whole sweater, right?

42:00 spk_0

Absolutely, and I want to point out that this is for me the starting point, which is that for our financial planning clients, I’m first asking about this person’s health.And the reason is the entire duration weighted average, you know, the bond, the bond geeks would call a weighted average life, meaning your anticipated amount of time that which you’re creating a financial plan is linked to your health. We’ve talked about the cost of accessing the care, the coverage given that, and from there the ripple effects are many complicated.But certainly our conversation here hopefully has helped towards that and to see how all the piecesfit.

42:45 spk_1

Yeah, I, I, I just want to make mention that in the past we’ve had Sudupto Banerjee on this show from T. Rowe Price.Where he talked about managing healthcare costs on an annual basis and maybe disregarding the fact that sometimes you may see reports from a mutual fund company or even a research company saying that you need to have $200 300 dollars, $400,000 set aside to pay for healthcare costs in retirement.And uh, while that may be the case uh on a gross basis, it’s not the case on an annual basis, and people need to be aware that they can control their health care costs. I know they’re unaffordable. I know it can be overwhelming, but you can make these costs affordable in retirement if you sort of think ahead. Is that, is that fair to say?

43:28 spk_0

I definitely think so. I don’t all right. I think for some folks, yeah, I, I overeat a lot. That doesn’t mean I need $10 million in my bank account for food, right? In other words, that we are paying this on an annual basis, planning on annual basis.Oh, as long as you understand these nuances that we have discussed at some length about the ability to adjust your plan, meaning from Medicare Advantage and Medica, these are considerations for sure.

43:57 spk_1

Well, Jay, like you, I’m in the small frequent meal plan too, so I, I get this overeating thing. Um, if there’s one takeaway from today’s conversation, it’s this Medicare is not automatic, and it’s definitely not simple.The decisions you make or don’t make can follow you for years and cost you tens of thousands of dollars. A huge thank you to Marsha, Fred, and Jay for sharing their hard won insights. If today’s episode made you realize you need to take action, don’t wait. Check the show notes for resources and links to our guests work. And until next time, keep decoding retirement, keep planning.And remember, the best retirement decisions are the informed ones. And don’t forget you can listen to Decoding Retirement on all your favorite podcast platforms.

44:49 spk_4

This content was not intended to be financial advice and should not be used as a substitute for professional financial services.