Enrollment Periods for Medicare with Special Guest Ryan Dawson, Dawson Insurance Group

0:00 This program is designed to provide general information with regards to the subject matters covered. This information is given with the understanding that neither the hosts, guests, sponsors, or station are engaged in rendering any specific and personal medical, financial, legal, counseling, professional service, or any advice. You should seek the services. Of competent professionals before applying or trying any suggested ideas. Attention to individuals, families and caregivers. It's Medicare Hour and More with Peter right here on k FORHD Radio. This is the podcast for all types of insurance solutions while specializing in Medicare because we Medicare.

0:47 Here's your host, Peter R. Joseph Hey, Southern California and West Coast. Good morning, Good morning, good morning, and glad to see you guys here. This is our second show. Excited to be here with you guys. I want to stay happy Saint Patrick's Day as well as you could see. I am wearing green for the festivities. So hey, glad you could join us. Obviously, we are live on a couple of places, our Facebook business page Joseph Insurance Broker, LLC. You can always drop comments and we will comment back as soon as we can. We are also on our YouTube channel, medicare Minute with Peter, so look for that channel. We will be broadcasting live on there as well. So before we get into our topic for this morning, we are going to kind of just summarize what's going on out in the world of sports.

1:43 I'm a big sports fan, if you guys don't know, a huge Lakers fan, huge Dodgers fan, and huge Rams fan. Live an hour south of Los Angeles. That's where our brokerage is situated, and so hopefully you guys are catching that World Baseball Classic. It's been pretty exciting stuff, very controversial play this last Sunday night. The US did win, but that last strike looked like a ball to me, unfortunately, but hey, we will take the win. And now it looks like it's going between US, the US and Venezuela tonight at five o'clock PM Pacific time, So hopefully you guys can catch that exciting stuff. And Lakers are on a great wedding streak, so I'm excited about that as well.

2:31 They are in third place in the West, so hopefully they can continue that trend as well. All right, and I just want to just send a little prayer to all our troops that are being sent out for this conflict in the Mid East. Hopefully we'll be coming to an end soon, I hope and pray and then for the safety of our soldiers. So our thoughts and prayers are with you guys, all right. So today we are going to have another special guest, one of my agents, Ryan Dawson, who's one of my agents for probably the past i'd say about maybe seven eight months. He came on board, lives out in Texas, just moved out to Idaho.

3:15 He's on the border of Idaho in the state of Washington, and he will be our special guest today. His insurance group is called Dawson Insurance Group. He's been doing this for quite a while. He's been the insurance pace for quite a while, but now he's devoting his time and specializing in medicare and health insurance as well as small business group benefits. We'll be talking to him getting to know a little bit more about who he is as a person and why he has entered into this industry. So I'm excited to bring him on in about ten minutes. So the topic for today though is we you know, last week we talked about Medicare one on one. We broke down the different letters ab, C and D, and we dove really into A B and D. We're gonna talk about see a little bit more today. We also though, we'll be talking today about Medicare enrollment periods. That's really important, especially we're going to look at common scenario guides for you guys to just be well aware of, especially if you're turning sixty five, or you are collecting Social Security, or you're leaving your employer and you're retiring at a later age. So we were going to look at all those different scenarios. We don't want to confuse you, guys.

4:37 We want to make sure that everything is clear cut. So let's kind of dive into the different periods for you guys. Again, if you have any questions, comments, please drop them down in the chat. If you're on our YouTube channel, please subscribe, but we'd love to have you subscribe to our channel for the latest information in the insurance space. All right, So, so our first period is called the initial enrollment period, and so who applies to is individuals turning sixty five and becoming eligible for Medicare. Now there's a seventh month window. When you do come into turning sixty five, you can apply for Medicare three months prior to your sixty fifth birthday, and then your birthday month, and then three months after your sixty fifth birthday.

5:27 So that's that seven month window. There's no penalty when you sign up within those seven months. I always tell my clients are prospects to sign up as soon as that window opened. So the reason being is Social Security, if you don't know, is so understaffed right now. They don't have a lot of folks they're helping, and so it takes a while for the enrollment process to happen. It takes a longer time to get your red, blue and white Medicare card mailed out to you could take six to eight weeks, and so we want to make sure that you guys are ready to rock and roll when it's your sixty fifth birthday, you have your Medicare ID in hand and we can get you started on your Medicare journey. So that is the seven month window. Again, it's called the initial enrollment period. Our second enrollment period is the general enrollment period. So who that applies to.

6:21 It applies to individuals who miss their initial enrollment period and don't qualify for a special enrollment period. A lot of times, you know, we have clients who just they don't know about these enrollment windows. A lot of them are so arbitrary, right, I mean, it's it just doesn't make sense sometimes, and it's like, you know, why can't we just sign up for Medicare when we want to? Unfortunately that's the way the government has things set up. So we want to be careful and not pass those deadlines because you will get a penalty for life. For Part B it's ten percent per year, and for Part D it's about thirty two cents per month, but you pay that penalty for the lifetime until you pass away.

7:05 So you want to avoid those penalties at all costs, all right, So for general ROMAN period, the timing is January first through March thirty first each year. Coverage starts the first day of the month after enrollment. So here's the scenario examples that would happen with that case. For person forgot to enroll in Part B at age sixty five, that happens a lot person had no qualifying coverage and must enroll late. So we're going to talk about that scenario that tends to confuse folks quite a bit. And then the possible late enrollment penalties for Part B and party. So let's say you missed the window. Now you're paying a penalty. Well, now you're allowed to enroll into Medicare.

7:49 Even though you have that penalty, it gives you that special time to actually enroll into Medicare at that point. So the scenario where you have no qualifying coverage, it mustn't relate. A lot of folks don't realize. And we talked about this a little bit last week. If you are retiring a lot of times your employer is going to offer you what's called cobra coverage. Well, unfortunately, cobra coverage is not credible coverage with Medicare or CMS or centers for Medicare and Medicaid, And so folks think it's credible coverage and then they find out the hard way it's not, and then when they sign up for Medicare they're hit by that penalty. They're upset they didn't realize.

8:33 And so I'm glad if you are a current client and you're listening in that you hear this, and you hear this, well, Cobra coverage is not credible coverage. So if you're offered Cobra coverage, yeah, you can stay on it for a few months, but you have eight months after you retire to get onto Medicare without a penalty. So, like I said, you can stay on cover for a few months, but after that, I would highly recommend you jump on and enroll into Medicare Part B, so you don't get that enrollment all right, I'm sorry that penalty charge, all right. And then here's the big enrollment period that everyone hears about in commercials. It's the annual Enrollment period called AEP. That's how all my agents refer to it.

9:19 AP is October fifteenth through December seventh, and this is a big period where you can actually enroll into Medicare Part B. You can actually change no, no, no, sorry, you can't enroll into Medica PARBENT. You're already on Medicare for this period of time, and for that you're going to actually be able to switch Medicare advantage plans. A lot of times, benefits change every year, and so you want to make sure that you're on the best plan for you. You always want to be with an agent like myself or my colleague Ryan to review your plan and make sure that your benefits are still the same or have gone up. If they've gone down or your costs have gone up, that's the time to review and maybe, you know, possibly move over to a different carrier for your Medicare advantage plan. So that's the time to do that is the October fifteenth through December seventh is switching Medicare advantage plans.

10:21 There is you can move from original Medicare to a Medicare advantage So if you're just on original Medicare, which is Part A, B and then Part D for your prescriptions, you can move to a Part C plan, which is Medicare advantage. You can also drop your Medicare advantage and return to original Medicare. So that's a way that you can do that as well. And then you can also change your Part D prescription drug plans during this time. So especially with your Part D, if you're on just a Part D plan, those premiums fluctuate pretty crazy every year. This last year are the premiums for a lot of the carriers shot up dramatically, and the reason being is, you know, we'll talk about this later, but they went into this area where they decreased the cost of all prescriptions. Well, that was going to affect the premiums in one way or another, and that's what happened, and the premium started shooting that on the party plans. So let's stop there with the special enrollment periods. I want to welcome Ryan Dawson.

11:32 Like I said earlier, Ryan Dawson is one of my agents, just moved from Texas. He's out on the border of Idaho and the state of Washington, and he has such a heart for seniors. He's been in the insurance space for quite a long time. We're going to get to know him a little bit of why he's doing what he's doing, and hopefully maybe a little bit more about his personal life as well. Ryan, Hey, buddy, we're excited to have you on. Can you hear me? Yeah? Yeah, I can hear you? Can hear me? Yep? Yep? Awesome. Well, we're excited to have you on our show. So we're going to ask you quite a few questions just to get to know you and have our audience get to know you. Right, Okay, great, Yeah, thanks for having me on.

12:14 Yeah, Well, welcome to our show. So just, you know, before we get into the nitty gritty of any medicare questions, we ask you just tell the listeners a little bit about yourself, where you're from, how you got into this industry. Yeah, yeah, absolutely, So again, my name is Ryan Dawson with Dawson Insurance Group. I've been in the insurance industry since twenty eighteen, so it's been. Been a little while. Definitely came a long way. I started in Los Angeles actually working for a call center. It was actually really good experience for me. I actually believe all agents, if you're just getting into the industry, I think everybody should work for under like an agency model and work there. Like started out as a fronter.

13:03 The only thing I knew about insurance was that I was on my mom's plan. You know, let's see here. So yeah, I quickly moved up the ranks, went from fronter to a licensed agent to a sales manager. At the height of it, I think I was managing about twenty agents on the sales floor. And then that also we also had a customer service department and then a verification department, so I helped manage all three departments. Then that brought me to Texas. So I was moved to Texas to help open up another office down there and did a lot more operational stuff. So that's when I kind of started learning more about like carrier contracting. I had no idea what that process entailed. It's actually quite confusing and tedious, and you you get into a lot of that when you jump into medicare as well. So luckily I had a little bit of experience, uh, dealing with like the carriers and all.

14:10 Of that, so that during my like. My timeline or like my experience as an agent, I was actually researching medicare quite a bit. I'm actually very bullish on medicare. I know that, you know, the overall outlook is a little negative right now, but there's going to be so many people to help, and uh, you know, the boomers are are retiring, and you know, they have no idea what's going on, of course, because it's it's extremely confusing. But yeah, that that that's a little just a little bit of my story. I'm really excited to jump into medicare.

14:56 Awesome, awesome, Well, what made you decide to special just in medicare. I know you were in all fields of insurance but obviously you've kind of, you know, transitioned and decided to really focus in on this. What made you do that? Well? It's actually kind of funny because when I was an agent, one of my managers was like, you do really good with seniors. Like I seem to like actually get along really well, and I'm able to build rapport really well with seniors. I don't know why. I mean, everybody kind of like some people do really good with like men, or some people do really good with women or. Whatever the case. So I always just been able to get along with seniors, I guess, so I get a lot more And that's like one thing I noticed right away is like I get a lot more fulfillment when I help somebody with their Medicare plan than the other products that we offered, like ACA. I feel like it's a lot more relationship based.

16:00 And then just getting into the community too. I mean that that's something that I think is like huge, is being able to get like actually in front of people so you can be you know, I want to be known as like the local insurance guy pretty much. Yeah, for sure for sure. And then where you stationed that right now? Currently? So I moved to like Pacific Northwest. So I'm gonna be doing the majority of my business in Spokane, Washington, but I live in in Post Falls, Idaho, Idaho. Like Coutney County is uh, there's actually no Medicare advantage plans available out here. There's there's dual plans, so there's a lot of d snips available. United's big Molina, of course, is really big, so that you know this market. I was just in a meeting with United. They said, there's Coutney County is one of the one of the one of their bullish markets that they have for for United specifically, So I'm gonna be you know, targeting that market a lot.

17:05 Awesome awesome, Yeah, all right, Well what do you do outside of work? What do you enjoy doing when you're not doing medicare? Yeah? Yeah, So you know, twenty twenty five was a really big year for me. I got married, had a baby. Yeah yeah, got married to my high school sweetheart. We've you know, she followed me down to California and then to Texas and h yeah, we we had our son in July. He came a month early. You know, it's been it's been very, very very rewarding. You know seeing him grow up. It's our first kid together. Other than that, you know, I'm really into sports. I played sports growing up, and we enjoy eating out. I'm the I'm the big sucker for a nice steak dinner.

18:04 What sport do you follow closely? Mostly just football, I used to you know, I know that you like the Lakers in baseball. I'm a big. Rams fan though, too, are you NFL or college? Yeah? NFL? I mean I really like playing fantasy football, so I mostly just just play fantasy football and watch. That awesome awesome. Well, what's what's been the most rewarding thing for you helping people on medicare? Obviously you said you've got a knack for talking with seniors, which is awesome. We definitely need a lot more people like you in the industry. So what's what's the most rewarding thing? And do you have any stories or do you have any specifics of anything that's happened lately with your clients?

18:54 Yeah? Sure, Yeah, there's actually a guy that I helped out recently. I talked to him a few months ago. Because right now I'm doing the majority of my business, or the majority of my business is done through Facebook, right now, and I'm targeting the turning sixty five market. So I talked to a guy, you know, a couple of months ago doesn't turn sixty five until June. So he had remembered me because in our first conversation, you know, when I first talked to somebody, I want to kind of even though they're not I can't help them right away. I try to have a long and memorable conversation. So what I'll do is I'll kind of just you know, introduce myself, learn a little bit more about their situation, and so I kind of stay in that part of this of the conversation for a very long for as long as possible, so I'll get like their doctors, all their doctors information, their prescriptions, ask them what else is important to them. So while we were discussing the prescriptions, he had mentioned he's been dealing with a condition that's really affected his quality of life. And I got the name of the medication. It's a brand new medication. The full price of the medication is like thirty thousand dollars a year, and he yeah, yeah, so it's just outrageous and he was able to like get on it initially.

20:24 I think they or maybe had him on like a trial period, or maybe they gave him some samples or something. And then Medicaid. He's in California, so medical like wouldn't cover it. There was just something weird. So then I helped him apply for like a manufacturer's So we went on the manufacturer's website and this was all done on the first call. He was of course, the person has to be willing to be helped as well, and so he went on the manufacturer's website. We filled out the application right there, and then I never heard from him after that, and then randomly he just called me and as we were talking, he was like super excited because he got that medication for free. They paid for his medication for I think like eighteen months worth of that medication they gave to him for free.

21:13 Wow, So you really pulled through for this guy. That's awesome. Yeah, yeah, yeah, absolutely. And and you know, I've helped quite a few people, like you know, I'm running into scenarios where like people don't have enough work credits for free part A. So you know, you and I talked about that scenario a few times, so you know, I've ran into that quite a bit. I've gotten a few people, you know, QMB status so that they can get that free party because a lot of people don't know this that you know, you know, you need to work for at least ten years of your life to qualify for free Part A. If you don't have that, then that premium is going to be like north of six hundred dollars I've seen, yeah.

21:57 For sure, And we talked about that our first episode and so you know, you guys definitely pay attention to that. But yeah, we do have scenarios where people don't have their part as. It is a lot of work on our part to get that thing going, but obviously there are ways around it. And so don't don't fret if you're in that situation where you don't have Part A or Part B that you're on like Medicaid, you know there are ways that that will pay for it. So yeah, no, I appreciate you bringing up that scenario. That's really important. Yeah, yeah, absolutely. So let me ask you this, what do you think is the biggest misunderstanding that people hear about medicare when they turn sixty five?

22:46 The biggest misunderstanding is that it's completely free. Yep, you know, you. Yeah, had many conversations where you know, the beneficiaries ranting about you know, and I get it. You know that you you see that getting taken out of your taxes every year. I think it's called FIKA FICA taxes. You know, so you pay into your whole entire life and then you all of a sudden you find out that you know, you have a part B premium. So yeah, unfortunately, that's just the way that the industry is set up, and it's way out of my pay grade, you know.

23:31 But yeah, yeah, well, I mean and the other well, the other thing I was going to say too, is you know, just jumping on that bandwagon. There is even different pro rated fees, like if you're making more than a certain amount of money gross, or if you're married and you're making them out over I think it's like one ninety is it one ninety right now? I think it's like, yeah, one eighty nine or one somewhere. People. I mean, I deal with clients all the time who get frustrated, like what I thought it was only like two hundred dollars a month. You know, I'm now I'm paying like four hundred dollars a month. What's going on there, and unfortunately that's just the way things are set up. So it's called IERMA. So we do walk you through all that. There is a chart that we give you, guys, so that you can see where exactly you've landed how much you be paying per month. But yeah, now I appreciate your Ryan bringing that up. What so, tell folks what happens when people miss their enrollment window because that's what we're talking about today. So if they miss their enrollment window with medicare what happens.

24:39 So they're going to be essentially penalized for the rest of their life. You know, you're going to have a Part D penal one percent for every month that you could have had it, and then you have a Part B penalty as well. I've I haven't really encountered that scenario, and I I know it does come up, like in some of the forms that I'm in, I see agents posting that and it it does surprise me that some people do get penalized because there's just so much information out there, there's so many agents reaching out to people. But yeah, I guess it could. I guess the main scenario that it could happen with is if you're on an employer plan and you push out your Medicare enrollment, you just need to make sure that your employer has twenty or more employees for that to be considered qualifying coverage. But I don't know what's like a scenario that you encounter a lot with with that.

25:40 Uh, usually the biggest, the biggest one lately has been Cobra. So yeah, we talked about that a little bit today and last week. But and I'm dealing with some clients who miss their window because they thought Cobra was credible coverage and then they find out it's not, and then they end up paying that penalty. So, you know, we want to make sure you guys are well aware that if you retire, you know a lot of times the insurance that you continue on is not really the same insurance. It's called Cobra. You want to make sure that any of the paperwork that you sign and you get in the mail, if it says Cobra anywhere on your health card are on your paperwork, then it is indeed Cobra, and that is not credible coverage. You do have eight months after you retire to get onto a medicure plan.

26:29 But if you're on COBRA longer than eight months, you're going to hit that unfortunately penalty. So I've had some clients really frustrated they're fighting back and forth, especially like if you're in a situation where you retire and then you go back to work. We've had that situation happen, So they're on COBRA for you know, several months, and then they're back on their employer health insurance plan. Social Security, unfortunately, is a confusing place in terms of people try to help you sort through all that, and so sometimes it's good to have an agent like myself or Ryan to advocate for you and try to walk you through all that.

27:09 But yeah, those are the scenarios I always run into, unfortunately. I mean it's it's happened probably, i'd say a number of times in the last six months, so I don't you haven't run into that yet. I ran into a couple who were and it just doesn't seem believable to me, but they are on an ACA plan and they were both over the age of sixty five. But I wasn't able to do too much of a deep dive on it. But that I haven't really ran into that scenario yet. But yeah, that's why it's obviously important to you know, get on it early, get with an agent early on, and do that analysis.

27:54 Yeah, I mean, and I even saw a situation where because I do you know, we do, both of us do ACA, and so I've had clients where they're about to turn sixty five. Cover California is normally supposed to kick you off when he's turned sixty five. We've had situations where they haven't, which is just weird. I don't know if there's a glitch in the system or what's going on, and so they miss their win and they end up double paying. They're paying for their ACA plans still while they're on Medicare. So we've had that situation happen to Yeah. So so a couple other things, Ryan, What what do you hope to achieve in the next year for your business? What do you have some goals in mind?

28:40 Yeah, yeah, I mean, I think the main goal right now is to obviously acquire as many members as possible. So right now, like since I moved back, I haven't really had a chance to go into the community yet, but right now I'm focusing on getting that going. So I have a seminar. I'm doing a seminar April ninth. Nice, So yeah, that's that's going to be because the whole reason why, the main reason why I got in the business is because I want to do like in person sales.

29:20 So that's that's kind of that's like my main goal right now. I want to achieve that and then just go from there. Where is that going to be taking place? Have you had a location set yet? Yeah? So it's going to be the Golden Corral on Division Street and Spokane on April ninth at six pm. Awesome. Awesome. Well, and if you guys are watching, all of Ryan's information is on the banner scrolling across the screen on the bottom that's his direct number and his insurance group. So I encourage you guys if you're out in that area, definitely reach out to Ryan. He's the command. He will definitely help you out. He has a heart for it and he will set you on the right path. So, Ran, thank you so much for coming on our show. Is there anything else that you'd want to tell in terms of messaging to agents that are listening in if they're struggling, Is there any key things that they should know about.

30:21 Yeah, yeah, definitely. I mean I see I see it all the time online. That just the overall frustration with a you know, agents, they're they're feeling very frustrated. This business, especially if you're going independent, is you have to look at it as a business and it's. All going to fall on you. So you need to be very very proactive when it comes to like learning the products. Learning you know, you know, learning the products is one thing, but I think the main factor is like how are you going to obtain members?

31:03 So you need to have a you need to become an expert at that. I think before you go independent, don't go independent and then just and then say you're going to figure it out from there, because you're going to fail very quickly. And it's extremely expensive too to acquire a member and then to keep the member. So the main thing I'd say is is finding a mentor and hopefully you could work for like an agency where you have like a salary and you're just learning the products. I think that's what helped me out a lot, and I just I became I became very proactive on you know, learning the industry before I went independent, so you know, I actually bought a Christian Brindle's book before I knew it, knew.

31:57 About you guys. Yeah, yeah, So actually read his book before I even met you or Christian or anybody. So you know, that was just one of many books that I read before getting into the industry. Awesome, Awesome, I'll probably send a couple other books your way, by the way, I bet he's written another one about setting up a successful agency. Are you ever thinking about like bringing on I mean, you have alsosly obviously learned quite a bit in this industry. Ryan's very plugged in with a lot of peers and colleagues that are high up, and so have you thought about Ryan, like bringing on some people that you can mensor yourself.

32:38 Yeah, I mean, if anyone wants to provide the funding for it. I mean I've done it before. You know, I've ran a sales office with with you know, I think we at the height again I mentioned it earlier. I think we had like twenty agents at one time, so I you know, I instituted some brand new retention techniques, like on our retention side, uh, increase the the I fix the processes in our verification department. So I know, like all the different departments and what it takes to build a successful sales floor with the recruiting and things like that and training new agents. But the main I think the main factor is just when you bring on a new agent, you know it's going to take them at like at least six months to fully grasp everything.

33:29 But yeah, that's that's definitely something I would be open to. Just right now, I feel like I'm not ready, but unless just financially, but yeah, if somebody ever wanted to open an office in a Pacific Northwest. I'm also hopefully. You guys are are listening in and hearing that. So one of our sponsors is Christian Brindle and Everything Senior Insurance, so I'm sure he's listening in as well. But Ryan, thank you so much for your time. Is there a website that people can look up your information as well? Yeah, yeah, Dawson Insurancegroup dot com perfect Perfect And then yeah, my phone number is five zero nine two zero nine nine one eight one and you can reach me by a call, text, you can message through my website.

34:19 Awesome. Well, Ryan, thank you so much for being on our show. We appreciate your time and I hope that the first seminar goes really well for you. April ninth, Is that the date? Yep, yep, April ninth. Awesome? All right, Well you guys, if you're out in Idaho or state of Washington, please look Ryan up. Thanks again, Ryan, We appreciate your time. Take care of Thank you, Thank you, Peter, welcome. All right, that was a great interview. I love Ryan to death. He's he's been a great agent of ours for the last seven eight months and he's done some great work. And as you can see, he's got a great heart for seniors, has a great skill set in that department. So I love the fact that he's on our team and doing great things. All right. So we do quite a bit of things in our community, and we want to show you just this little commercial break about what we do. I think it's important for our business to be seen as a business that impacts the community in positive ways. You know, business sales and all that secondary to us, because we did so well in these last year and a half. My kids are part of a local elementary school here in Chino Hills, and so I wanted to partner up with them and be

35:50 more involved with my kids' lives and make an impact on their school, and I felt like this was a good way of doing that. So we specialize in Medicare and health insurance, and then the big one lately has been small business group benefits. So a lot of small businesses. Are looking to retain their employees and the best way to do that is to offer health benefits to their employees, and so we do that. So I was actually in a nonprofit sector for about twenty two years and we just decided to transition out just because of politics and moving around a lot, and so I wanted a little bit more stable position, and so went into the insurance business for a little bit and was a captive agent with New York Life, and then decided to create my own business because I saw a need for seniors needing help with the Medicare process because it's so confusing, and so I felt like my skill set really transferred well because I've got such a servant's heart, I've got a calling to really help people, and so it was a natural fit for.

36:45 Me, all right. So thinking local as a local support system that helps with schools and small businesses, we have been involved with them in the past years. We also like to give back to our small businesses. I'm part of the Chino Valley Chamber of Commerce here locally, and we're an ambassador. We also, you know, give back to our schools as much as we can. Like I said in our first show, I've got two kids, eleven year old that goes to elementary school out here as well as my daughter who's fifteen and goes to local high school.

37:29 So we want to make sure that we support the community as well, that we are involved, and that we're not just doing business, but we're actually giving back as well. So that's what that little commercial is all about. All right. So you know, we don't have a lot of time, but we do have about ten minutes, and so I do want to continue on with our enrollment periods that we were talking about. So we did cover a couple of enrollment periods. We covered the initial enrollment period. We covered AEP which is annual in rolla period where you could switch your Medicare advantage plan or drop it and go to original Medicare. And then our general enrollment period where if you've missed that window, you're able to sign back from that January through March thirty. First date. So let's talk about a few other scenarios or special enrollment periods that happen. So one is called SEP Special Enrollment period.

38:25 There's a lot of different scenarios that can happen in that regard. If you lose your employer group coverage after retirement, that opens up a door for you to sign onto Medicare if you're moving out of the Medicare Advantage service area, so if you're moving not zip codes, but you have to move counties. So if you're moving counties or states, then that also opens you up for a open enrollment period to get onto a Medicare plan if you're gaining or losing Medicaid, So for lower income folks, if you're using in if you end up getting onto Medicaid or you lose that benefit, that also opens up the door for Medicare. If you qualify for Extra help or low income Subsidy. That is something we'll talk about in the coming weeks, but that actually allows you to reduce your costs on your prescription drug plan. So even if you don't qualify for medical or Medicaid, you can actually get on a low income subsidy plan to reduce those prescription costs.

39:30 So you know, again we'll talk about that in the next few weeks. And then if you're leaving or entering a skilled nursing facility, that also opens the door for a open enrollment for Medicare. So those are the special enrollment period scenarios. The next thing is employer coverage after sixty five scenario, and we talked about this with Ryan a little bit where we've run into situations where clients are confused or don't know when to actually get onto Medicare, your employer has to have more than twenty full time employees. If you're a smaller business with less than that, then you have no choice. When you turn sixty five, you have to get onto Medicare. But if you're with an employer that has more than twenty full time employees, then you actually are able to stay on the employer plan.

40:19 And it's important to come alongside an agent like myself to look at your numbers and see if it makes sense for you to stay on that employer health plan. Some companies, you know, I run into clients who say, well, my company pays for everything, I don't pay for any of the premium for my health benefits. That's not necessarily true, and so we want to look at your paycheck and see if there's actually money coming out for health premiums, and we'll see how much you're actually paying out per month and see if it makes sense to switch over to Medicare to cut down those costs. So you may delay Part B without penalty. Remember, you have an eight month window after retire to get onto Medicare safely without any penalties. If you're on Cobra. Again, I will continue repeating this. Cobra is not eligible coverage with Medicare, so you want to make sure that you're on a plan before that eight month window ends. Now here's the other confusing part. You have eight months to get onto Medicare Parts A and B, but for Part D prescription drug plans that is sixty three days without a penalty. So you can see how confusing it can get because you got two different enrollment periods and it doesn't line It should line up in my opinion, but it doesn't, and so people will wait towards the end of that eight month window, they'll sign up and then they're like, wait a minute, I just got hit with a Part D penalty.

41:50 What's that about. Well, it's because you missed that sixty three day window, and the Part D penalty is not as steep as the Part B penalty. Like I said, it's it's a few cents maybe thirty cents a month. But you don't want to pay a penalty if you don't have to. So what I usually do with clients that are retiring is I at least get them right away on a Part D plan so they are within that sixty three day window and are able to get on safely, and then we'll look at different Medicare advantage plans down the road. But you want to get on a Part D plan right away. Again, that's a sixty three day window. Now, some employer retiring plans require enrolling in Medicare Part A and B. That's another place where you come alongside an agent to see if your employer actually requires you to be in Part A and B.

42:40 We've had situations where the employer didn't know that and they end up going to a hospital for something serious while their insurance that they have where their employer doesn't want to pay and ends up Medicare being the primary and they say, well, you're on Medicare. Are you're supposed to be on Medicare, and that Medicare is supposed to be paying for this, not our insurance plan. So you want to make sure you know what's going on with your employer and the rules that coincide with that employer. Retireing plan does become secondary payer to Medicare, so keep that in mind. And then failure to enroll in Medicare could result in loss of retire coverage. So we don't want that scenario to happen to you. Let's make sure we get ahead of the game before you're actually retiring, to see all the ins and outs in that we dot our eyes across our t's all right, and then moving scenarios. You know, someone moves again. We talked about this as a special Roman period. But if you move out of the Medicare or advantage plan service area, if you move to a new state with different plan option, this trip typically triggers a special rollment period. You know.

43:51 The other thing that happens too, is that plans will leave the market, and if that happens, that opens a special roment period for you as well. Medical networks change that opens a door as well. But if you find out that your plan is ending or terminating, you know, reach out to an agent so we can get you on the right path for that, okay, and then you know, Ryan basically did mention this briefly, the dual eligible DECENTI for sure, that's what decent means. It's dual eligible. What that means is that you're both on Medicare and Medicaid, all right. And then in California it's called medical so individual with both Medicare and Medicaid, they can actually change plans, especially if you're on full Medicaid. You can change plans once every month, that is the new rule. But you have to change onto what's called a fully integrated dual plan.

44:53 So not all carriers have that. And again it's it's good to get with an agent to help you decipher plans out there on the market are actually fully integrated plans, all right. So when you are on full Medicare and Medicaid, again that allows you to change. Now, you don't want to have to change every month, obviously, you want to be with a plan that works for you, and it would just be a nightmare if you have to change your plans every month. So there is you know, that opportunity for you. But you know, if you're on the right plan, there's no reason for you to change every month. And then there's institutional special needs scenarios. So if you are in a nursing home, assisted living facility, long term care facilities, they may switch Medicare advantage or part plans monthly.

45:48 So if you're in any of those institutional special needs scenarios, just know that you're able to change your plan monthly. The next one is what's called a five star special rollment period that allows you to go onto a plan if you're on a Medicare advantage plan per SE that's got four stars. So all these plans that you're on, they're actually rated by a CMS from one star, which is the worst, to five stars, which is the best. And if there is a five star plan in your area or county, you're actually allowed to get onto that five star plan automatically if your star if your plan is less than five stars, so just keep that in mind. Again, an agent is the best person to talk to to see if those plans exist in your area, so you're able to switch around for that. The last you know, we'll talk about more of this next week since we're starting to run out of time here, but The last scenario is the late enrollment penalty scenario. There's a ten percent increase again for each twelve month period that someone delays without credible coverage. You're allowed to sign onto Medicare if you hit that penalty, and then party penalty is one percent of national based beneficiary premium for each month without credible drug coverage. So, as you see, Part D is not as steep as we said. Part B is the one that's steep. That's ten percent per year for

47:20 the life time. So you want to make sure if you're getting penalized, get onto medicare as quickly as possible. Talk to an agency or an agent that can get you on the right foot in for that. So we cover quite a bit of information. I know, I hope I didn't bore you guys. That's why we bring on guests. We want to in commercials to make this a little bit more livelier. Medicare can be tedious and there's just a lot of information to decipher and process. But we want to make this as easy as possible for you guys, and that's why we've created this show. We'll be talking about other things in Medicare obviously in the coming weeks. But again, if you have any questions, drop some comments on our Facebook page or on our YouTube page. We will respond back to those. You can also call us at nine O nine two one seven two six three zero.

48:12 We are on live at nine am Pacific time every Tuesday, so please watch us on the different channels. You can also see us on kfour HD Radio KFOURHD dot com. You can also download an app to your smartphone that is free for you and listen to us on there as well. So to our listeners, just remember Medicare decisions are important and the right guidance can make a big difference. You're listening to Medicare Hour and More with Peter, where we want to make an impact in our community and we medicare. Thanks for listening. Tune into Medicare Hour and More with Peter every Tuesday at nine am Pacific time right here on KFOHD Radio at KFOREHD dot for more real life stories from experts who medicare about you and protecting your health, your finances, and your future. See you next week.