Health Insurance Seminar by John Klimchak - Part 6

So wait this is, so say you're rated 600, whatever dollars because you had income, that's your premium for the rest of your life.

Unless you challenge it.

Until the income goes down because the premium is gonna be based on your tax return from two years.

But you have to challenge it, they don't do it automatically.

I agree.

Don't they continue to look at it?

If your compensation goes up or down but if it goes up it can go up.

That's right of course.

So, is it automatic or you have to submit paperwork to have it?

They say it's automatic but.

Let's take a look at the dynamic here, who's gonna be the guy that's paying $630 a month? It's gonna be the owner of the company, the high income wage earners.

And who's not gonna be who's gonna be paying, 185 probably the workers.

So if you're an employer, you're paying for everybody. So then you take a look at it, cause let's keep some numbers in mind.

We have say let's do with the employees first, you have $185, hypothetically $200. The cost of healthcare depending upon where you wanna go.

So lets assume he even up let's say bronze, so we have a bronze plan that has a single premium under small group it says Anthem Blue Cross Blue Shield Bronze Blue access on top.

That's what we're gonna look at, so this bronze plan with Anthem Blue Cross Blue Shield. This is a small group rate. This is an actual regular rate jobs.

So any small group that goes with this particular plan has a good number but this plan has a 5,250 dollar deductible if you're single.

After the deductible is to fifty fifty split, the insurance carrier pays 50%, the member pays 50%, until there's a total out of pocket of 8,000. After 8 thousand dollars everything's covered at 100%.

That's what this plan is. The cost to the insurance company for this plan, the single premium is 1059. Hypothetically, let's take a look at this as opposed to Medicare.

So under Medicare we know Part A hospital is free, Part B has to be paid for. So let's assume it's a lower wage earner, low wage earner of course is gonna be about $185.

Then to Sherry's point, the employee has to either has one of two choices, they can get a Medicare supplement plan or they can go to any Medicare doctor they wanna go to and then they have to buy a prescription plan right something like that a good plan is gonna be roughly three hundred and twenty six dollars for Plan G.

Basically what that saysyou pay a 250 dollar deductible after that everything's covered 100% so you're paying a 250 dollar deductible versus a 5,000 dollar deductible here alright the cost of that plan is gonna be roughly 326 dollars.

So you have 326.

A year?

A month.

326 plus 180 so far and then you have to get a drug plan so you got 180 plus 326 and then you have to get an RX plan that's gonna be roughly about $115 so at the end of the day that's 10, 11, 12 that's $620 all in going with the Medicare supplement comprehensive coverage now for those lower income employees they could also go into what's known as Medicare Part C which is managed care.

So what the difference is rather than we'll call it the government managing the healthcare we got any Medicare doctor you want to go to and you have freedom to go wherever you want to go.

The government says to the insurance companies United Healthcare and we're gonna give you a chunk of money and you manage the care for the employees and then what will happen the premium for those plans the premium for those plans are gonna be next to nothing it could be zero it could be free you know at the end of the year you see all of these commercials Joe name and son there you know we're gonna give you you know money if you would roll in these plans.

Let's see like the United Healthcare benefit and the

But you're limited on your doctor, you can't go to your own doctors or the ones you want.

That's right.

Listen and if I'm sick and I got cancer, I wanna make sure that I can go wherever I wanna go.

Absolutely.

I don't want somebody telling me cause they manage as of life care and they say nothing we can do.

Not only that she's 100% right not only that under the managed care plans with the insurance companies managing the care who's holding the money you think they want to give it up?

No of course not

So what do you think is gonna happen, somebody's gonna try to get some type of procedure, what do you see?

Deny.

Then what happens now most people get oh this is the worst insurance company and you know maybe part of it's true but not all of it but then all of a sudden what you have to do and we see this on the commercial small group side also not to the extent of the medical advantage but the doctors have to provide to the insurance company the medical necessity of why the procedure has to be done and why some lower cost alternative treatments made important you see that more so with the Medicare Part C's and you see that a lot with the drugs especially drugs on virtually any plan.

They're saying, the insurance companies saying to the doctor, why are you prescribing this expensive drug when there are three or four other drugs that are less costly why aren't you prescribing those and the doctor has to come back for the benefit of the of the patient and say well you know what we've tried those and the patient has an adverse reaction that's why this particular drug needs to be approved and they have to go back and forth and get that approval that's what happens but that's what happens with Medicare Part C Medicare Advantage plans.

I can't say they're the worst but to Sherry's point quality of care you want the choice to go wherever you want to go.

The point that i wanted to share is now with Medicare not Medicare supplement with a Medicare self ones you have the freedom to go into with a good drug plan and under the drug plans. Medicare drug plans there's a maximum out of pocket of $2,000 per year for the prescription plans which is a big deal because of your point we've had clients that own businesses and they might have a small group plan available to them and they might have cancer and some of these drugs can cost $15,000. Thank you.

And prior to 2015 the member would have to pay 5% of that number 5% of the big number is a big number and under their small group health plan with United Healthcare they may have been a 75 dollar copay. Premium was more expensive as we saw right here but when you do the math they may have been better off staying under Oxford or the group health plan that's supposed to go on Medicare with the 5% copay that would that existed prior to January 1st, 2025.

But getting to the point so now when you take a look at the math if a group has less than 20 employees Medicare is gonna be primary anyway they're gonna have to enroll in Part B anyway so irrespective if they're gonna be under a group plan or Medicare supplement and drug plan we've just learned you know what if you gotta pay for Part B anyway whether the owner or not better off getting Medicare supplement with a drug plan than being under the group plan, agree? that's for those groups that are 2 to 19 however if you're 20 or more and then you're the executive paying the $600 and then you do the math so you got 600 plus 320 is 900 so me let's say it cost 11 hundred dollars now can we go to the platinum plan more likely they're not and if you're executive you're probably gonna be under a platinum plan.