Episode 231: All About Medicare with Joanne Giardini-Russell

Medicare can seem like a mystery. Whether you are nearing the age to sign up or your parents have questions you’re trying to help them answer, this episode is dedicated to demystifying all the options.

Melissa Joy and Joanne Giardini-Russell, Owner of Giardini Medicare, talk about what your healthcare can look like in retirement. Understanding Medicare and making informed decisions about enrollment and coverage options isn’t easy. 

Listen and learn about the potential costs associated with Medicare and the need for proper planning. Joanne shares her expertise and provides resources for anyone approaching Medicare age. 

Medicare decisions are not the same for everyone. You need personalized advice and guidance in navigating the complex world of Medicare... especially during the open enrollment period for Medicare, where changes can be made to Medicare Advantage and drug plans. 

Understanding the rules and timing of Medicare enrollment has the potential to impact your HSA and IRMA charges. Get informed so you can make the best decisions about your health and money.

Listen and Learn:

• The difference between Medicare, Medicare Advantage and Medigap plans 
• Ways to make informed decisions about cost and coverage to select the right plan for you during retirement 
• The rules and timing of Medicare enrollment, as well as the potential impact on HSAs and IRMA charges

Resources: 

• Learn more about Joanne on her Website 
• Connect with Joanne on LinkedIn
• Follow Joanne on YouTube 
• Listen to Joanne’s Podcast
• Additional Information about Medicare 

Links are being provided for information purposes only. The information herein is general and educational in nature and should not be considered legal or tax advice. Tax laws and regulations are complex and subject to change, which can materially impact investment results. Pearl Planning cannot guarantee that the information herein is accurate, complete, or timely. Pearl Planning makes no warranties with regard to such information or results obtained by its use and disclaims any liability arising out of your use of, or any tax position taken in reliance on, such information. Consult an attorney or tax professional regarding your specific situation. Please note, changes in tax laws or regulations may occur at any time and could substantially impact your situation. Pearl Planning financial advisors do not render advice on tax matters. You should discuss any tax matters with the appropriate professional.

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Transcript

Melissa Joy (00:01.341)

Do you understand what healthcare looks like in retirement? If you're like me and you're learning all the time, instead of fully understanding, then you want somebody in your back pocket like Joanne Giardini-Russell. Joanne is an expert on Medicare and she is also the owner of a firm that helps, she's an insurance agent for people that need to sign up and enroll for Medicare and her company is Giardini Medicare.

Joanne, welcome to the podcast.

Joanne Giardini-Russell (00:31.342)

Thank you. Good to be here.

Melissa Joy (00:33.437)

Well, you're an old friend of the podcast. We've been talking to each other. You were like there on day one, I feel like, when I started Pearl Planning. So thanks for being a friend of the pod and a friend of the firm. And I'm often letting people know, hey, you should talk to Joanne when it comes to Medicare conversations. Yes. And her team. Yes. Joanne's team, just like Pearl Planning, Joanne and the team.

Melissa Joy (01:03.037)

Your team is ready to talk and you are kind of the education, you're the leader and the force in education. We're gonna talk about some of that today. And I, full disclosure, we do do a little business with each other. You're a client of Pearl Planning. I always disclose conflicts of interest. So just FYI for all the peeps, but.

Joanne Giardini-Russell (01:18.486)

Absolutely.

You're not old enough to be our client though. You're not old enough to be my client. So there you go. Full disclosure.

Melissa Joy (01:26.333)

Well, and I was thinking, I hadn't been sending waves of people to you recently, because a lot of the people we work with are just like the listeners on the podcast. We start working with you when you're in the thick of it, in the middle of your accumulation years. And so many of our clients are in their 40s and 50s. We can talk about why you need to familiarize yourself with what's coming down the pathway today. Because I think the first portion of our conversation should be like, what should you know and understand if you're somebody like me? Retirement looks a little more real than it used to, but still, it's another 15, 20 years until I'm Medicare age.

Joanne Giardini-Russell (02:05.39)

That's funny because it makes me think back to when we started Medicare in terms of a business, because I'd been in financial spaces or insurance essentially my whole life and then never Medicare. And the reason I really didn't do Medicare was because I had no reason to know about it. I had parents that are healthy and are still healthy, knock on wood, very healthy. So it's like I wasn't in the thick of trying to figure out their stuff. So it's like what I had no comprehension of what Medicare was really. That's what probably your audience is in there. You know, some of them are like that now. And then all of a sudden…

Melissa Joy (02:38.141)

I mean, I'll be honest, like for some years, I didn't really, I'd have to like stop myself and think Medicaid, Medicare, like Medicaid is for people with less money or no money and Medicare is what your middle-class parents get. Yeah, your insurance.

Joanne Giardini-Russell (02:53.486)

Right. Insurance, well, it’s your insurance plan exactly. And that's what is funny because we can tell who is healthy when they start asking those questions at 65. Like, I'm ready for my Medicaid. Like, no, you're ready for your Medicare. So we've all kind of been there, but until you really have that reason to dive in, you don't really understand and have a full appreciation for how just crazy it is, how expensive it can be, things like that. I was sharing with you prior to this that I go on, I peek on the Reddit forums and that's a youth, a young kind of platform.

And we see lots of, “Hey, I'm helping my parent now at 65. I can't figure this stuff. What do I do?” So there is a lot of that. And just at your 40s and 50s, you just kind of got to understand that it's health insurance. It's health insurance for when you turn 65, but there's people on disability that have Medicare and things like that. You don't need to understand a ton of it until you're ready to kind of enter into the arena to figure it out. But I would say, in planning mode, it's important to understand that it's not free. A lot of people get to our stage where it's like, it's not, my gosh, it's not free and it is not free.

Melissa Joy (04:01.501)

Right. Or I've heard, I picked the good plan, the one that has no costs, things like that.

Joanne Giardini-Russell (04:05.326)

Good luck with that. Exactly. And so no cost, no premium per month doesn't mean no cost, right? So that's those types of marketing gizmos and things like that. But even recently, even just three, four years ago, I would say we were telling financial folks like, okay, you can probably maybe factor in 4-to-5,000 a year for healthcare. Well, I'm looking at, now it's like seven per person because it's almost comfortable because...

Joanne Giardini-Russell (04:35.214)

you've got dental expenses, you've got like even my own world. I think of myself where I got, I had two crowns last year. And in my brain, a crown is about $500 each, like dentist and you're like, yeah, 1200 each, right? So that was a big surprise. And, you know, so all those things have to go into you guys adjusting your budgeting every year as you go into that, even if you're 10, 15 years out, right? But you very likely could have a parent that is now saying, hey, can you kind of help me with this? Because this stuff is kind of crazy, this Medicare stuff. So that's important.

Melissa Joy (05:09.917)

Well, and things can change because if you get involved at maybe the point in time where, I mean, in many cases, it's the point in time where mom and dad aren't able to take care of themselves as much. And so you're getting involved and you're like, my gosh, you know, mom and dad were like, I chose the plan where I don't have to pay any premium when I'm healthy. Well, then you're stuck with less choices perhaps for providers and things like that. And still there are costs.

Joanne Giardini-Russell (05:34.606)

Right. Right. And so what we tell the kids sometimes is, and I say kids, you know, being a 50 year old, but if mom and dad have big costs that they didn't anticipate and they chose the wrong plan and they're stuck, guess who's going to inherit those costs, right? So sometimes you're better off chipping in with siblings even to make sure your parents have good stuff in place.

Melissa Joy (05:40.573)

Yeah.

Joanne Giardini-Russell (05:56.91)

because you're right, you're getting the phone calls. You're getting that skilled nursing facility calling you saying, hey, you know what, they gotta get out of here. If their insurance doesn't cover past day five, pick your mom up. And then you're trying to work and have your kids and do all different things. And then you're stuck with picking mom up in the middle of the day. And what are you gonna do when you can't lift or whatever? So a lot of that does come down to insurance selection and people don't realize it until there's a big issue. And that's not one of the things.

Melissa Joy (06:22.237)

Okay, so I hear one big takeaway right now, which is if you're listening and you're seeing which generation you're thinking about mom or dad who are approaching age 65, because we're gonna talk in a moment about how age 65 is when you make some decisions that may or may not be reversible, but some pretty big decisions when it comes to Medicare, then talking to someone credible who has the background and the knowledge like yourself, Joanne.

who gets compensated by the insurance decision. You're not doing this as a nonprofit, but there's no differences in cost if you go to Joanne versus going direct to the website. Then that would be helpful because you're going to get no... I mean, you're talking to the people that are calling saying, hey, mom just got kicked out of the facility. What the heck do I do? Things like that. You have that knowledge and it's constantly changing. So that's one.

The second is that if you're planning to retire early, there's gonna be this step down from private insurance that tends to cost more. We'll cover that in another episode. Into the Medicare world, but still in my financial planning assumptions, I'm assuming that each person in the family who's retired is paying six or $7 ,000 a year with a cost of living adjustment that's higher than our standard cost of living adjustment. And you're not just gonna get away with, like even if you pick a plan that says it has dental.

That's very like it's about like having dental insurance through work. Like you still get out the checkbook and write big checks. And so you just need to be familiar with that write off.

Joanne Giardini-Russell (07:58.254)

Absolutely. Absolutely. That's where the surprises come into play. And then if you've got those years when you retire at 60 or 62, you're throwing in, you know, you've got ACA coverage you've got, which is different than what we do, because we don't work very specialized and focused only in Medicare. So we have referral partners for under 65. But that's even a big cost. We get lots of emails from, hey, I'm turning 62. Can I get Medicare now? No, you can't. You got a three year gap. So what am I going to do? Well, you don't have a whole bunch of options. And it can be expensive. So.

Joanne Giardini-Russell (08:28.078)

all those costs leading up to it and then making your decisions when you kind of get on the doorstep. Or you might be the opposite person who are like, you know what, my insurance at work is really good. I'm going to work till I'm 70 just because it's worth doing it that way and I enjoy working. So you deal with all those retirement kind of stories. We are just that little, and I wouldn't say little, but that, that healthcare piece of called Medicare basically. But there's nothing perfect. There's no, and this is what makes it so hard is there's just, there's no one way to do Medicare.

Melissa Joy (08:39.037)

Yeah.

Joanne Giardini-Russell (08:58.99)

They're just, there's 20, 30, 40 things you have to consider. And that's why it's funny in talking about platforms and things I do, Tik Tok, Tik Tok teaching every single day. I've got a video on Tik Tok over 75,000 people listen to me blab about Medicare, which just cracks me up and tons of seniors. But, you know, but people will just put in this little sound bite of I'm turning 65 in November. What should I do?

Melissa Joy (08:59.069)

Right.

Melissa Joy (09:23.645)

I need to know a little more information, just like your retirement. Like there's no one number, like if you have a million dollars, you can retire. Like there are more inputs with good advice.

Joanne Giardini-Russell (09:28.43)

Right, yes, exactly. Exactly, there's 20 other questions I have to get to. So we've created this, based on that actually we created a website, doineedmedicare .com. That's it, doineedmedicare .com. You go there, you click the green button and there's a form that you fill out and answer a bunch of our questions.

Melissa Joy (09:42.365)

I love it.

Joanne Giardini-Russell (09:49.646)

The form comes in to me and I spend my nights, you know, my husband watches TV, I respond to my emails, but I basically tell them what they should be doing. Because it's a lot of, I'm not planning on retiring, I'm doing an HSA, blah, blah, blah. But I can dissect and diagnose with a lot of information, but I can't just take somebody's, you know, hey, I'm turning 65, what should I do? And answer them. So there's a lot that goes into it, for sure. Just exactly like your world, just different product, if you will.

Melissa Joy (10:09.789)

Yeah.

Melissa Joy (10:16.221)

Well, first of all, what I'm hearing there and we'll make sure to include this in show notes is go to TikTok if you want. I do not say this often. Hopefully my 15 year old is not listening, but good advice on TikTok if you listen to Joanne's advice in particular. You guys also have a strong presence on YouTube where you're explaining common topics. Something that comes up for my high earning people who are retiring is Irma, which is, you know, you have to pay.

Joanne Giardini-Russell (10:42.67)

Yes.

Melissa Joy (10:45.853)

additional costs. It's basically a tax for someone when it comes to Medicare if you're at a certain income level. And that can be variable year to year. Something a planner may be able to impact. So when people get close to 65, when are they going to when do they really need to like get off of the TikTok and get onto your website to schedule an introductory call?

Joanne Giardini-Russell (10:54.414)

Right? For being successful. Yes. Yes.

Joanne Giardini-Russell (11:11.246)

Yep. When they're about a year out, we suggest the TikTok, the YouTube, our podcast channel, our, we have a course even that people can enroll in for free and they can go through all the modules. They can do all sorts of things to familiarize themselves with the concepts, right? Cause you've got your product concepts of Medicare Advantage and Medigap. So just even understanding what those two words sort of mean is helpful. That's why I kind of like the TikTok where it's just a couple of minutes a day. It just kind of gets ingrained in people's heads.

And people come through that and just say, my gosh, I felt prepared because I kind of heard you talk about it for a year and a half. But really three to four months ahead of someone's target date, meaning if someone's going to they could be 68 years old. Well, let's talk about 65 first because when you're coming into age 65, every single person that turns 65 has to make some decision with Medicare. It doesn't mean you have to enroll. And people are shocked by that. But everybody does not have to enroll at 65.

Melissa Joy (11:45.309)

Right.

Joanne Giardini-Russell (12:07.95)

They need to know if they should or shouldn't. So that's why that whole “do I need Medicare” becomes a super important just question because people just don't pay attention to that. And you've got.

Melissa Joy (12:18.045)

And like one of the considerations would be, are you working and how many employees are at your employer, correct?

Joanne Giardini-Russell (12:21.39)

Yes. Exactly, exactly. Are you on COBRA? Did you leave? I have a 70 year old yesterday who told me he's going to take COBRA. I said, you can't without Medicare. He had no clue. So we have to just, and they don't know that. And they think, well, it's the same insurance. So we have to explain all that. But that whole question, and we've harped on this for years of “do I need Medicare” is really the most important question because so many people go into it and they,

Melissa Joy (12:32.317)

Not a good choice. There's a lot of them. Because I've listened to you, I know.

Joanne Giardini-Russell (12:51.374)

overpay, they buy things they shouldn't be buying. But think about the industry. The industry is full of call centers and agents. And, you know, I was at, I was on a quick vacation weekend and happened to be in a resort with a large, large, large call center. Won't name the call center, but they, they, their business comes from every person that like, if you use GoodRx as a consumer, GoodRx takes your data, your name, address, phone number, they sell it to this call center and they have a relationship.

And this call center, they get on the phone and all they do is call people. That's right. They don't, all they care about is your turn to 65. They don't really, if you're working, they don't even ask those questions. And then.

Melissa Joy (13:31.805)

a sales process. It's not a consultation process.

Joanne Giardini-Russell (13:34.5)

It's a total sale. And I was talking to some people that work there because you could see on their shirts where they were from. And I'm like, that's interesting. So, for sure, for sure, for sure. It was a huge conference at 150 people. It was their awards dinners. Absolutely, absolutely. I'm not saying we don't, but it's just kind of felt slimer because it was a big call center, right? And so.

Melissa Joy (13:42.653)

And are they being wined and dined for this weekend? Yeah.

Melissa Joy (13:49.885)

I mean, we've both been to those in the past. Yeah.

Melissa Joy (13:58.237)

it's definitely slimier when we're looking at somebody else on the on the booze cruise, right?

Joanne Giardini-Russell (14:02.446)

So I'm laughing and talking to this person and she's telling me how they just focus on education and training and all this kind of stuff. And I said, well, what do you do when somebody wants Medigap and you're in a regional blah, blah, blah? And she said, well, we don't sell Medicare supplements. And I didn't know that. I said, what do you mean? She's like, we just do Medicare Advantage. So, okay, so you're pushing education, but you're just limiting your product choices. And I said, is it just because of contracting? She goes, no, it takes our agents too long to understand and learn it.

Melissa Joy (14:30.525)

Is there a difference in what you get paid if you sell Medicare Advantage versus Medigap Plans? Which one pays more?

Joanne Giardini-Russell (14:34.638)

There is, there is, there is. Well, if you're just looking at the first year, Medicare Advantage pays $600 roughly and Medigap is about 400 roughly. But long -term, if I had somebody to truly stay with a Medicare, they balance out. They're not as skewed as what people kind of act like they are. It's just that where Medicare Advantage could be very short -sighted. It's not when you're a call center because again, it's just churn and burn.

Melissa Joy (14:53.725)

Mm -hmm.

Yeah.

Joanne Giardini-Russell (15:04.206)

So remember that as your turn is 65, they're not asking all the other questions. They're not caring about if your spouse is employed or what are you paying for your insurance at work. It's just, you're a sale, right? And they're paying for sales.

Melissa Joy (15:15.517)

Yeah, there's exactly one lane they want to put you in. And the consult is, here's why you want to be in that lane. But there's only one outcome.

Joanne Giardini-Russell (15:20.59)

completely and fast.

Yeah, it's just, yeah, it's a quick sale. And that's what she was basically saying is, well, we don't want to take the time to train our salespeople to do Medicare supplements. We're talking both and we don't want to sway people. We want them to make a good decision for the long term because we do it selfishly because you know what? Then they're not going to come back to us complaining. So we don't get a lot of complaints because they knew what they bought.

Melissa Joy (15:47.421)

Well, you're talking to people after year one, right?

Joanne Giardini-Russell (15:50.222)

Yeah, we have a relationship, they can email us all that kind of stuff, they can have a service team, but yeah, it's a big, big difference. So again, figure out what your target, first figure out at 65, do you need Medicare? If you do, if you don't, how about if you don't, ignore everybody else. Hang up on call center people, literally hang up, tear up the mail that comes in the mailbox. Then you get a connector to somebody that you want to work with, doesn't have to be us, just find somebody that's reputable in the Medicare space.

We're not licensed in all states. We do have partnerships with people that can help in every state, but we're not for everybody either, right? We're very tech, we're very videos, we're very electronic signatures, things like that. Not everybody. Right, right, right. Exactly, so some people don't like that and that's okay. So we might, we're not for everybody too. But just find that connected person that you kind of can have a relationship with going forward.

Melissa Joy (16:30.461)

You're not coming into an office to sign up for things. You are going to be using digital onboarding.

Joanne Giardini-Russell (16:46.19)

Because at the time you need it, now if you're 68 and retiring, well now I need to fire up my Medicare or we're having layoffs right now. We're seeing people like, “my God, I just lost my job. May 31st, I just found out I'm done.” Okay, well, let's get you going. So you want that where you can just jump in fast. And so that's why it's important to defer Medicare at 65 potentially, and then be ready for it in that situation, right? So everybody's different. So it's just, you know, you have to know who to call when you need it, but.

Melissa Joy (16:55.613)

Yeah.

Melissa Joy (17:07.357)

in that situation. Yeah.

Joanne Giardini-Russell (17:15.63)

More traditionally, you're having people planning their retirement. So then they're saying, well, I'm going to retire the end of December, 2024. What do I need to do? Well, in that case, it's three months before you're retiring. Or let's say you're three months before you're 65. That's generally the time where you can book a consultation and say, OK, I'm three months away. I'm ready to go. I'm serious. And then you start your path. And everybody's different, too. Whether you're turning 65, you might be collecting social security. So you automatically get enrolled. You might have to be proactive and go on the computer.

You know, you might have just left all these different situations, but that's where we'll help you. We were the kind of like the Sherpa people that interpret the whole Medicare stuff that's on Medicare.gov for people. I laugh because there's a really good fact sheet. It's 15 pages. I love it. It's very laid out where are you a small employer? Is it HSA? Or you can go through all the steps, but nobody wants to read it. Nobody out there wants to read it. So we're just kind of like the humans that interpret that document for you and walk you through it. That's it.

Melissa Joy (18:10.109)

Yes. I mean, that's the job of a good consultant. I consider that the job of a good financial planner is to take what is a cornucopia of options and narrow them down to those that apply for each person. And that's what keeps our job interesting, right? Because not everybody is the same, even though there is. We could both have built our businesses to be that mold of like one size fits all. This is what I'm planning to sell. And whoever.

Joanne Giardini-Russell (18:24.11)

Yep.

Melissa Joy (18:37.469)

Whoever I can squeeze into that box, that's what I'm going to do. It's just not quite as fulfilling as the complexity of navigating a changing world and where you are getting to know the people and then seeing what fits.

Joanne Giardini-Russell (18:54.158)

Yep. Yep. And it's easy. It becomes easy for us when you know your craft, right? And you know what you're doing. So you spend 24 -7 with Medicare after years and years and years, you know what you're doing. So that's our team of people. So that is kind of fun. And it is all unique. And again, we could be helping the kids. We could be helping the parents. Here's who we can't help, though. I'll tell you like real clearly who we cannot help. We can't help that 80 -year -old who did things wrong. We can't help them when it's a crisis. So that phone call of like, hey,

Melissa Joy (18:59.325)

Yes.

Joanne Giardini-Russell (19:22.702)

My mom's in a skilled nursing and she just got kicked out. We have no clue who her agent is. She signed up 25, who knows? That's not a fit. We can't fix problems. So our whole business is really built on preventing the problems, just like yours is for preventing running out of money, right? Or if you want to be doing things, well, maybe you got to work two more years, whatever yours is. Ours is along the lines of, you know, we want to prevent, you know, if you're going to be in a skilled nursing, what situation, what plan do you want? You know?

.. to be paying for things at the time because sometimes there are no do-overs with Medicare. So that is unusual with our world too. Sometimes they can be really limiting. So we can't fix. So if someone's hearing this thinking we can just fix mom because she has a problem, don't call because we can't. So.

Melissa Joy (19:54.461)

Right.

Melissa Joy (20:06.237)

Well, let's talk about, I wanna pause. We're still in that range of early retirement or maybe not retired 65 -ish. I wanna talk about a couple things. First of all, just familiarize me, and I know this is like an unfair question, but Medicare Advantage versus Medigap plans. Can you give me some context of what the differences are without devoting a whole episode to it?

Joanne Giardini-Russell (20:32.814)

Yes, yes. So quite, quite simply, if somebody listening has a Medicare new handbook, you can actually get it online, but you go to page 10. I love page 10 simplicity because it's basically telling you that when you sign up for Medicare, so when we talk Medicare, that's the federal government. So that is the government piece because there's two components. There's part A and part B, but that's the government. That is just every single person that goes to Medicare insurance ultimately is going to get A and B with the government.

Melissa Joy (20:59.965)

Mm -hmm.

Joanne Giardini-Russell (21:00.014)

and that's what's going to cost you and based on income and all those things, we figure out what your pricing is going to be. But that's your base with the federal government. Then we, as agents, we come along and then we give you one of two products because Medicare is only going to pay 80%. So therefore we want to get you to a 100 % payment. So what we have to do is we have to give you either a Medigap policy or a Medicare Advantage plan. And they're very, very different. They're apples and oranges.

So Medigap is quite simply like it sounds. It covers the gaps left over from original Medicare. So somebody that has an 80 % coverage policy, we're going to give them a Medigap policy. Now it's going to come with a premium. Let's say it's $140 a month. They're going to pay $140 a month every single month, even if they're healthy, just like your car insurance. You pay for your car insurance every month, even though you're not crashing your car every month, right? So it's the same concept. So you pay it all the time.

Melissa Joy (21:54.301)

Right.

Joanne Giardini-Russell (21:58.254)

And you have to buy a drug plan that goes with it. And you don't get all the bells and whistles that you see with Medicare Advantage. And having a Medigap policy plus a drug plan, what it does is you're really just buying your freedom. That's how I look at it. You're paying $140 a month for your freedom to go to any doctor in the country that takes Medicare. You don't have networks. You don't have restrictions. All you have is a $240 deductible. That's it. So.

Melissa Joy (22:22.141)

So if you've been choosing like the PPO option in your employer health insurance where you are like, I don't want in network, out of network. If I want a specialist, I want to go to it. It's not apples to apples completely, but this would be more similar to that in terms of options than here's your network and you're going to stay in it. Is that the case?

Joanne Giardini-Russell (22:43.374)

It's funny because people say that. They're like, I have Blue Cross, the Cadillac, it's the best PPO on the planet. I want to duplicate that. No, Medigap is like a PPO on steroids. It's not even, not remote because I can be in Michigan, I can be in Florida, I can be in South Dakota. I can go to any doctor that takes Medicare in the country. That's it. Nothing. So think of your PPO.

Melissa Joy (23:05.373)

Sounds good to me. I'm not selling it, but in many cases that's attractive.

Joanne Giardini-Russell (23:10.286)

It's the easy button. It is honestly the easy button. You have to be able to afford it and you have to want to afford it. So the people that are just like, well, I'm not, I'm not paying a dime for my insurance because there's a zero. I'm healthy. Yes, I'm very healthy. There's a zero premium thing, a flyer that just came in the mail. Why would I pay for any insurance when I'm super healthy? That's Medicare Advantage. So this is a flip side. It is an alternative to what you can choose. So if you enroll in a Medicare Advantage plan,

Melissa Joy (23:20.477)

Because I'm healthy, that's the next thing that always comes out.

Joanne Giardini-Russell (23:38.222)

Yes, on the surface, 70 % of the plans have zero premium. That just means you don't give the company 140 bucks, you give them zero every month. However, you land in the hospital for two nights, you're probably going to fork up $600. And that's two nights, right? If it's five nights, it's roughly $300 a night. If you have cataract surgery, you might pay $250. If you might go to a specialist, you might pay 50. So think of your PPO at work that's similar to that one. And that's...

You can pay out a PPO, you can get an HMO, whatever. So you typically have a max out of pocket, roughly $5,000, and then extra benefits. And this is where people get kind of trapped into these things like, well, I want that dental. And then you're right, you find out that it just covers some cleanings, but it's still a value for some people. And not everybody can afford Medigap necessarily. So, you know, it is a good fit for some people. The problem becomes when again, you've got two choices. So again, think back to that call center I talked about a few minutes ago.

Melissa Joy (24:20.413)

Mm -hmm.

Joanne Giardini-Russell (24:33.454)

If that call center doesn't tell you that Medigap exists and maybe you had health issues, maybe you're the type that even if you're healthy, you would appreciate knowing you have an option of really good insurance, they didn't offer it to you. So that's, to me, the worst part of that.

Melissa Joy (24:48.573)

Well, that's because after, at age 65 or when you need to enroll, if you continue to work and it was appropriate to not make your election earlier, then there's one point in time where you don't have underwriting. Is that correct?

Joanne Giardini-Russell (24:59.374)

Mm -hmm.

Joanne Giardini-Russell (25:06.734)

Right. So that's what's key. It's like you come in again at that healthy 65 year old, people don't in our world necessarily always are not always healthy. My healthy client called me out of the blue a few weeks ago and says he has 11 sessions of radiation coming up because he has a rare cancer. He was healthy last week before that as far as he knew. So we see it every day. So when people tell us, well, I'm healthy, I just don't even pay attention, right? We just totally disregard that because you can't pinpoint when you're going to need a stent or have something go wrong.

Melissa Joy (25:35.517)

It's not a prediction for, it's not just your current self that you need to say you're healthy or that, and you, like we all know we don't have a crystal ball. You're talking about hopefully decades of your health that you need to make a decision about at that point in time.

Joanne Giardini-Russell (25:50.83)

Right, you tell me when your health is gonna change and I'll tell you exactly what policy to buy when. Exactly, so it does get a little comical. We're not trying to poke fun at that, but it does get a little silly and nobody wants to think of themselves as ill, but you're totally right in that when you first start Medicare at age 65 plus, whenever you do, it could be 60 to 70 starting it. When you start that Part B coverage with Medicare, you get this window of six months.

Melissa Joy (25:54.845)

Same, tell me when you're gonna die, I'll tell you exactly how much money you can spend.

Joanne Giardini-Russell (26:18.702)

in order to where you can change and you can pick any policy you want, any plan you want. You can have cancer and get the best Medigap plan out there. We don't have to ask you a health question, nothing related to your health. This surprises people a lot because everyone comes in with saying, well, that's not right. The ACA protects you from the Affordable Care Act. It's protection from pre-existing conditions. So you're lying. I can buy whatever I want and no, you can't. So the ACA does not extend to Medicare years, which...

Melissa Joy (26:36.989)

Yeah.

Melissa Joy (26:47.005)

That's your private health insurance prior to Medicare years.

Joanne Giardini-Russell (26:50.702)

So that's why people that have cancers and we can buy ACA coverage, we can go to group plans. There is no problems with pre-existing conditions. The problem starts with Medicare. So it's starting at a time when it's your age 65 plus, which is when you're more likely to have an issue, right? And people come in not understanding that if they take a Medicare Advantage plan for the first four years while they're healthy, and then something happens, then they come, they call us in the fall, just because it's the open enrollment time in their mind, they think that this is the time where they can just go get anything they want.

Melissa Joy (27:05.405)

Mm -hmm.

Joanne Giardini-Russell (27:20.654)

And they're very, very surprised. If they're ill and they cannot get a Medigap plan in the fall, they're yelling at us because that's not fair and the ACA protected. It doesn't matter what you're saying is fair or not fair, this is the way it works. So there's a lot of rules in timing things with Medicare. So those are the things that are most important for people to understand for sure. And that's why you need that education upfront before you go into the system just to understand a lot of the rules. We're here to...

We'll dive into the rules more, but we do, like the YouTubes and the TikTok, we're always kind of focusing on these massively important rules that people just don't seem to understand. So it's.

Melissa Joy (27:55.677)

Well, you've got a great system to kind of pre -educate before their convert, or you may have an initial discussion and say, go watch this video, we'll have a follow-up call, but you do try to get into the weeds. Whereas, it could be just as easy to have a 20 minute call where you're eligible to sign up for this and this is the product we sell and then it's done.

Joanne Giardini-Russell (28:08.782)

We do.

Joanne Giardini-Russell (28:21.198)

Yeah, we get a lot of we get more of you know, I came from YouTube, I've already seen the videos, I know exactly what I want. And then that's a wonderful phone call because they are educated. And that's where it makes it very nice because they know what they bought. They're not tricked. They're you know, we're there then to guide them with other issues, right? Now it's time to look at your plan. Let's do this. We communicate with all those things. And it works fantastically. And again, not for everybody. You know, some, I’ve had some people say like, “Well, I don't want to watch a video. I want to talk to a human.” That's fine. So we have phone calls too.

But, you know, we do repeat ourselves 8,000 times a day with the same topics because it's the same questions. Do I need to get Medicare? Well, blah, blah, blah, blah, blah. So we just put in a video. So it's fun.

Melissa Joy (29:04.349)

Well, let's go ahead to talking about what this quote unquote open enrollment period is, which not everybody needs to change or enroll. And then I've got a couple like asterisk topics I want to revert back to ARMA and HSAs. So we're releasing this episode in summer. In the fall, there will be a time period where many of us choose our employer benefits, but also.

Joanne Giardini-Russell (29:20.494)

Mm -hmm.

Melissa Joy (29:31.389)

Medicare people have a window where some may be able to make changes. Tell me about what people need to be familiar with this year when it comes to open enrollment. This is for people who have already started to use Medicare.

Joanne Giardini-Russell (29:44.974)

This is people, this is not for people that are still working and have elected to defer it. So number one, just know, right, if you're 64, that doesn't apply to you. If you're turning 65 after the enrollment time is over, this doesn't apply to you. So yeah, so it's an important time zone, October 15th to December 7th. The only thing it really means to people is those people with a drug plan, a standalone drug plan or a Medicare Advantage plan, those are the two products that are changed during that.

Melissa Joy (29:49.981)

Right, or pre-65.

Joanne Giardini-Russell (30:14.158)

That's how simple the time period is. So it's designed to be that window where you can make a change. That's it. If you have a Medigap plan and you want to make a change in October or April, you can do it any time of the year. So just ignore that piece. But it's only for Medicare Advantage and only for drug plans. The important part of this is that your information related to your particular plan, which is just like Melissa said, is that you have to be in the system for having this time period apply to you.

So if you're on a Medicare Advantage plan, if you're on a prescription drug plan, in September, the companies are legally required to give you your information by September 30th, the end of the month, they are to have an annual notice of change delivered to your doorstep, to your mailbox, to your email, whatever method you chose. In that annual notice of change is exactly what it says. It's the notice of change. This is what your plan is going to change. You need to look at that paper, because right now we have plan premiums …

that are under a dollar for drug plans this year. When you get it in September, I can almost guarantee it's not gonna say under a dollar still. It could say $26, it could say $96. We have no idea. We don't find that out until October 1st. You're gonna find out. What you need to do then is look at the document. So many people don't look. And then if you don't look and all you're thinking in your head is like, it worked fine this year. My plan works fine. They just ignore everything.

All of a sudden in January, if your plan changed from 50 cents to $96, you're paying $96 a year for the entire year of 2025.

Melissa Joy (31:49.021)

Now why is this change coming?

Joanne Giardini-Russell (31:51.758)

Every year it changes. So every year, this is just a change every single year. So people just don't pay attention to their mail. It's also, the reason they give you the document is so that you have the chance to change your plan if you want to. It's that simple. So Medicare Advantage, if your plan, your dental is $2,000 this year, maybe they're cutting it to $1,200 next year. Okay, this is your opportunity to go find a different plan, because this is your window to do so. So that's simply what it is. Now this year going into 2025,

we're going to see a lot of differences probably in Medicare Advantage and probably in prescription drugs. Nothing is finalized, but next year there's a $2,000 cap on prescription medications. Well, in the past, people have spent eight to $10,000 potentially if they're a high drug consumer. They've paid a lot of money. Well, next year it's going to be $2,000. The insurance companies are going to be shifted to them having to pay 60 % of that cost. They don't like that.

They're going to change some things. Okay, they're going to get a little more federal funding from the government, all the things that we've read so far and learned. But there's a lot of doom, the sky is falling out there with lots of agents and agencies. You know, everything's going to either like you can't buy a prescription drug plan next year, or it's going to go to $100. We don't know. Nobody, I will just say this is May, we're recording in May, nobody knows what's going to happen. And we won't know until October, but that's why it's going to be an extra critical year ..

for you all to pay attention because things are going to change. We've seen now Medicare insurance for the last five years or so has been, there was a Wall Street Journal the other day, has the Medicare bubble burst. And there has been a bubble of Medicare, meaning for stockholders. They've made a ton of money with some pretty pricey stocks over the past five years. Stockholders still want appreciation in the stock.

but you've got usage, the utilization on Medicare Advantage plans has gone through the roof. So now people are really using their plans because now it ended up COVID, post COVID demand, all sorts of things are kind of, you know, causing issues for the companies. And now they're losing money in some cases. So the stockholders don't like that, right? So you're being squished here where we've already had one company come out and say mid-year, we're taking away these four benefits, which is very unusual.

Joanne Giardini-Russell (34:09.486)

So we're gonna see more of that going into the fall is my guess, right? 2025.

Melissa Joy (34:12.445)

So it's not doom and gloom, but it is door open. There will be change. Some people may actually have lower costs because they were big users of pharmaceuticals, and the government is capping how much you are required to pay. But then that means that likely healthier people are cost sharing because the bottom line still needs to be met for these for -profit companies that are in the Medicare space.

Joanne Giardini-Russell (34:38.926)

Yeah. So it's not doom and gloom. It's like, okay, have the benefits been too rich for five years? This one company literally was paying for park passes, national park passes for seniors as a benefit. I looked at the plan last year, like, my gosh, you could get your Peloton bike reimbursed. You could do all sorts of crazy things, which you could stretch it and say it was related to healthcare. I'm actually liking the fact that it's going to change to some degree because I'm hoping there'll be a shift away from …

all of the crazy benefits that you see on TV. We'll pay your gas, we'll pay your rent, we'll pay your, you know, it's like at the end of the day, this is healthcare. Like maybe check to see if your doctor takes the plan. Might be a little more important than can you get the national park pass paid for by your insurance plan? We all want free stuff, right? But it really got a little out of control. So that's the positive, I think, when it kind of comes back to center line maybe a little bit. So we'll see. But this year again,

is just going to be more change than in the past. And that's why people should really just look at their annual notice of change in September. And you're right, some change will be very good. The people spending 10 grand are thrilled to have 2,000, right? But we'll see. It's just gonna be a lot of change, but that is your chance to do things over. It's your do-over in the fall.

Melissa Joy (35:54.237)

Change is constant and you know that I think that just like with a financial plan where we tell we focus on retirement and say, hey, here's what it looks like. That's not the last time we're going to run the numbers. And the same goes. That's what the if you were in a plan that has that open enrollment period, this is why it pays to have somebody that isn't just thinking about you the day they put you in the plan, but also during those renewal periods, communication effectively to many people about, hey, please open your statement, things like that.

Joanne Giardini-Russell (36:24.526)

Easy, it's easy, communication.

Melissa Joy (36:26.125)

So if we can circle back to the two asterisk topics that I have, first of all, I alluded to Irma. That is something that, like, let's say you work for yourself. And in that case, I think Joanne, you'd likely enroll in Medicare at age 65 if you were self-employed only and without a spouse, with a large employer. And then, but you're making a lot of money and you're on Medicare. You may...

Or if you're in your RMD periods where you have to take money out of your IRAs, you may be in a circumstance where you get an extra bill on your tax, like while your premiums go higher. And I call it a tax for people that make more money. So I'm thinking for some of those people, especially the ones working, there may be some optionality. Like I actually for one self -employed individual.

Joanne Giardini-Russell (37:08.558)

That'd be too. Mm -hmm, it is.

Melissa Joy (37:20.957)

we're thinking about, should we have a solo 401k instead of a sub IRA? Because that may be able to lower things. Although I'm also thinking about, well, would that put it higher in RMD years? So it's not always black and white. But that is something where it may pay for you to be very careful and have a very tax aware investment game plan. And I think sometimes people either miss that or sometimes if somebody made half a million dollars a year and then they're bemoaning the, you know.

Joanne Giardini-Russell (37:32.142)

Right. Right.

Melissa Joy (37:50.877)

$5,000 extra premiums, I'm like, it's not that huge for the half a million that you made, but people do not like those Irma charges. They do not like to be charged more for Medicare than their friends.

Joanne Giardini-Russell (38:01.198)

And I laugh, it's like, well, then I'll take that million dollars, just donate it to me. You take the right off and your Irma will go away and I'll have the million dollars, right? So it's so funny. You know, they don't want that either. So yeah, nobody, right. They want what their friend has. And I get it, it's the same product and you're just paying three or four times more potentially. You just are. It is.

Melissa Joy (38:08.541)

Yeah, okay.

Melissa Joy (38:14.877)

Right.

Melissa Joy (38:25.661)

That's frustrating, but you do want somebody that's tuned in. So if you are asking your financial advisor who really just opens your accounts and like sends you money when you want it, but doesn't tell you, here's how much you can spend or here's the right account to take money from, et cetera. If they're not tuned into the IRMA, they may be compounding the problem versus trying to mitigate the problem. And I don't love that because they often are paid the same amount or more than we are for less advice.

Joanne Giardini-Russell (38:45.614)

Yeah. Yeah.

Joanne Giardini-Russell (38:51.758)

I couldn't agree more because I would say there's a lot of financial planners out there that they don't discuss Irma. They don't even talk about the concept when you're 63, 64, because maybe that's when you should be doing Roth conversions. So many things that I'm glad are in your hands versus ours because people start asking us, should I do a Roth conversion? That's not my land. But I can tell you horror stories about people that...

took an extra, literally, I think a woman was like, she took an extra $400 out of a, an IRA one year because the financial person told her to, it bumped her. She was, you know, in the lowest bracket and bumped her up to the next one. And she only took a thousand, like she took very little out. So everything, she actually, like it costs her more to take the thousand dollars out because the Irma implication and the tax and it just, she was so angry at that advisor because it was never discussed.

Melissa Joy (39:37.917)

Yeah.

Joanne Giardini-Russell (39:46.734)

Absolutely, it should be planned. It's a part of that tax planning conversation.

Melissa Joy (39:51.453)

Yeah, I upload people's tax returns and my software tells me last year, here were you were for the Irma  zone. Like even if you're 64, like if you were when you turned 65 and then I can do some scenario analysis and I'm not replacing the CPA in this conversation, but usually with a dialed in CPA and a firm that's thinking about it from our perspective, we can give you, I would at least like a heads up if you're heading into it. And sometimes there's ways to mitigate.

Joanne Giardini-Russell (40:16.078)

Yes.

Melissa Joy (40:18.685)

So the other thing is we're huge proponents of HSAs. We have an upcoming episode that's all about HSAs too, but HSAs and Medicare is my understanding because you have educated me. Do not mix. Tell me more.

Joanne Giardini-Russell (40:18.702)

Definitely.

Joanne Giardini-Russell (40:30.702)

They do not mix. Best place to start is we have a really good HSA video on YouTube. And it's not too long, but it goes through all the scenarios because it gets complex with, you know, if you've got somebody on Medicare and another spouse that's not on Medicare, it comes down to who's putting money into the HSA fund, what you can do, what you can't do. But just know that as you approach age 65, you cannot do part A, you cannot do part B if...

You want to remain on that employer plan. You have a compatible plan to do the HSA, number one. But number two, you cannot be putting money into the HSA if that is you, if you enroll in part A. So all of those people that hear that, again, your friends are saying, well, you gotta get part A, you gotta do this, you gotta do that. If you're listening to them, and then all of a sudden you find out that, well, I have an HSA, your friend might not have an HSA. So they're telling you the wrong thing to do, and you signed up for free, because it's free, free part A.

You've just hurt your HSA potential because you can have an excise tax. You can have penalties for putting it in there, things like that. So we just give you the rules. We can't, you know, counseling is to, you know, I've been putting it in for three years after the fact. That's a different story because you're talking amended tax returns. You're talking about doing a whole bunch of things. So just know that, yes, if you're putting money into an HSA, you're remaining working, just do not get part A, do not get part B. The second piece of it, though, is that in...

It's a dumb rule, but when you go to apply, let's say you're 68 now and you've been funding that HSA. When you go to apply in May of whatever year that is, your part A, when they print it on your card, on your Medicare card, is going to show up as November 1st of last year, which means your HSA contribution should have stopped last October 31st. So it gets kind of squirrely for sure. All of that is in the video, but also realize too that nobody else, we get a lot of people saying, well, my employer puts the money in the HSA.

That's okay, right? Like, no, nobody can put money in the HSA if you are enrolling in part A or part B of Medicare. So I would say just, I love my HSA too. I love, love, love my HSA. So it's like, I don't want to turn 65 because I have to go to Medicare. So it's like, I just keep cramming as much as I can and don't spend it. I'm sure you tell people not to spend it either. Let it ride, invest it all. Yes. Yeah. So I love it. But just, again,

Melissa Joy (42:44.669)

Yes, invest it. Yeah.

Joanne Giardini-Russell (42:52.686)

Just know it's a big consideration. So that's one of our flags. So on our, do I need Medicare? You know, if someone says, yes, I'm putting my HSA in, no, I'm not getting Social Security. I'm going to work, you know, I'm not retiring either. That's the person we're telling them like, okay, don't do this. You got to understand the rollback of six months. You got to watch this video. And we give them a bunch of tools to just kind of prep themselves. So, you know, it's, it gets squirrely and all we can do is give you the rules, but, it does get confusing because again,

Well, my husband's on the HSA. Can he do this? Can I do a non-impact? There's a lot to it, actually. Yeah, my idea. You got it. Exactly.

Melissa Joy (43:27.581)

might need some professional advice to avoid something unexpected. Well, Joanne, your wealth of knowledge, as usual, I learned new things. I appreciate all of the conversation and we will make sure that our show notes are chock full of the resources you've mentioned. Do look for Joanne on social, how can they find you?

Joanne Giardini-Russell (43:50.382)

The TikTok, it's under GIARDINI MEDICARE. Everything we do is GRDNMEDICARE. We have the course. We can list that in your show notes. That's a free course. You just have to put an email in it. We don't spam. We don't have time to chase people down to sell them stuff. Believe me, we don't.

Melissa Joy (44:01.349)

Turns out that good advice leads to good business, right? Like you...

Joanne Giardini-Russell (44:06.254)

Exactly. We're too busy. It's so funny. People are like, I don't want to give an email. It's like, my gosh, we don't have time for that. So in the podcast, we have a podcast that is exclusively just my son and I talking Medicare topics every two weeks. We've got new episodes. So those are our main ways to catch us, but everything is really under G I A-R -D I-N -I Medicare. And the hardest part of that is spelling it, G -I -A -R -D -I -N -I.

Melissa Joy (44:31.389)

Well, you've been a loyal guest of the podcast. Keep it coming. Thank you, Joanne, for our annual conversation and have a great afternoon.

Joanne Giardini-Russell (44:34.894)

Thanks for the you too. Thanks much.