In this episode of The Agent of Wealth Podcast, host Marc Bautis is joined by Ryan George, founder of Part ABC, a national Medicare brokerage. Ryan shares why he believes Medicare should be taught, not sold, and breaks down some of the most important decisions individuals face as they approach age 65.
From understanding enrollment timelines and comparing Medicare Advantage and Medigap plans to navigating prescription drug coverage and planning for retirement before Medicare eligibility, Ryan provides practical insights to help listeners better understand their options.
In this episode, you will learn:
- Why Medicare decisions should be based on your individual health, finances, location and personal preferences — not someone else’s experience.
- How the Initial Enrollment Period works and why understanding key deadlines is critical to avoiding potential late enrollment penalties.
- The differences between Medicare Advantage and Medigap plans and how to determine which type of coverage may better fit your needs.
- Why reviewing your Medicare coverage over time is important as your health, prescriptions, location and plan benefits change.
- What options are available for individuals who retire before age 65 and need health insurance before becoming eligible for Medicare.
- And more!
Tune in for a practical introduction to navigating the Medicare landscape, understanding your coverage options and preparing for one of retirement’s most important healthcare decisions.
Resources:
needpartabc.com | needpartabc.com/listen | Follow Ryan George on LinkedIn | Bautis Financial: 8 Hillside Ave, Suite LL1 Montclair, New Jersey 07042 (862) 205-5000 | Schedule an Introductory Call
Disclosure: The transcript below has been edited for clarity and content. It is not a direct transcription of the full episode, which can be listened to above.
Welcome back to The Agent of Wealth Podcast, this is your host Marc Bautis. Today, I am joined by a special guest, Ryan George.
Ryan is the founder of Part ABC, a national Medicare brokerage, and brings a unique perspective to the world of Medicare after spending 12 years in estate planning.
His philosophy is simple: Medicare should be taught, not sold. Through Part ABC, Ryan helps people approaching 65 and their families better understand their coverage options and avoid costly mistakes.
Ryan, welcome to the show.
Thanks for having me, Marc. I appreciate it.
My pleasure. Before we get into Medicare itself, you spent 12 years working in estate planning. What led you to make the transition into the Medicare space, and what did you see that made you want to build Part ABC?
Good question. So, yeah, for the first 12 years or so, I was on the financial advising and estate planning side. My former partner went to law school with my dad, so that’s kind of how I got introduced to that world.
I didn’t love it. I was fortunate that I did well at it due to my partner, but ultimately, I didn’t love it. So, I was actually going to get out of finance and insurance altogether.
This opportunity kind of sprung on me through a father-and-son duo, and they explained everything to me. This might not make sense to the vast majority of the country, but Giant Eagle, which was one of the top 10 privately held grocery store chains in the United States, had their corporate contract with us. They’ve since been bought by Kroger. So that’s kind of what brought me into this.
And then, once I saw, “Oh, we’re just educating people because we’re brokers and we have access to everything,” versus on the estate planning side, where I really looked at it as, “Hey, I’m an enemy until I’m not,” I realized it was a much different environment.
On the Medicare side, it’s like we’re all on the same page. So it’s a much different take, and it’s a much different world and niche than anything I was ever a part of before.
So, expanding on that education piece and the idea that Medicare should be taught, not sold, what exactly do you mean by that? And why do you think so many people approach Medicare decisions without really understanding their options?
Yeah, great question. And we get it a lot.
The biggest thing is that people aren’t used to Medicare. They’re used to health insurance, but they’re not used to Medicare. So, when people turn 65, they listen to their friends, relatives, neighbors and coworkers, but everything is ZIP code-specific. It can be gender-specific. There are so many things that play a factor into it.
So, we almost have to kind of unwind people’s brains from what they think they know.
A lot of people will also do research, especially on Facebook, and they’ll see negative things about a particular plan or company. And that might be true for that specific person, but if you’re reading it and that person is in Iowa and you’re in New Jersey, it doesn’t pertain to you. It’s entirely different.
So, the education piece is really us walking everybody through what everything is and how it works. But there’s no right or wrong answer.
And as a broker, you get the same—it’s not a commission, it’s called an enrollment fee—you get the same whether it’s Company A or Company B, or whether it’s a $0 premium or a $300 premium. It’s all the same to the brokerage.
So, all we’re really there to do, and we say this all the time, is guide you and educate you. But if you’re loyal to one insurance company and they’re more expensive than the insurance company we’re recommending, we’ll certainly put you in that plan. We’re just telling you that you’re probably better off over here. But if this is the company you really want to go with, then by all means, go ahead.
How does that work? You mentioned you call it an enrollment fee, not a commission. Is that paid by Medicare, or is that—
It is an enrollment fee.
Oh, thank you. The enrollment fee. Who actually pays that?
The enrollment fee is paid by the insurance company. So it’s the same whether you, Marc, call the 1-800 number or contact my brokerage and speak with a licensed broker or speak to me. It’s all the same.
It’s paid for by the insurance company, and that’s how we get compensated. But if you just call the 1-800 number, then the insurance company obviously doesn’t have to pay that out. But you also don’t have a go-to person when you need somebody or have questions because now you’re just dealing with a call center.
And is that enrollment fee regulated between insurance companies? Or can Insurance Company A say, “Oh, we’re going to give you $1,000,” and Insurance Company B says, “Oh, the enrollment fee for us is $10,000”?
No. So it’s all federally regulated. It’s the same whether it’s Insurance Company A all the way through Z, and it’s the same no matter what the premium is.
So that’s kind of the one biggest thing that we try to get across to people. As long as you talk to a broker who has access to the vast majority, if not all, of the plans in your area, and they recommend that you go with a certain company, it’s probably for your best interest.
At the end of the day, again, if they have access to all the plans in your area, then you don’t have anything to worry about in terms of being sold something versus actually getting into what is best for you.
When should someone figure out this Medicare maze? Obviously, they’re approaching 65. Do they do it when they’re 64? Do they figure it out once they turn 65? When is the best time to go through this, talk to someone like you and figure out what their options are and what the best option for them is?
Again, with it being federally regulated, there are a couple of nuances there. So, to answer your question, I would say it depends on your relationship status. Are you married? Is your spouse younger or older? Will they still need insurance? Will you both be going to Medicare?
Those are all things to think about. But to answer your question in a general sense, per person, there’s what’s known as your Initial Enrollment Period, or IEP. That is three months before the month of your 65th birthday, the month of your 65th birthday and the three months following the month of your 65th birthday.
So they give you seven months to get onto what’s known as Original Medicare, Part A and Part B.
However, if you’re working, or your spouse is working, and there are 20 or more employees at the company, then you have what’s known as qualifying coverage and can choose to stay on the group insurance. They’re not legally allowed to boot you off.
And we always tell people it comes down to which one’s cheaper and which one’s better. We’ll tell people all day, every day, “Hey, it’s better for you to stay on the group insurance until you retire.”
Then, for the Medicare aspect, we’ll also get people who are older and retiring, so we have to transition their spouse—and possibly their kids, if they’re under 26—to an Affordable Care Act plan, go on the marketplace and go from there.
What are some of the mistakes you see people make when they’re approaching that seven-month window they have to make that decision, or even with the decision itself?
Yeah, so the biggest mistake people make is not knowing the timelines.
That seven-month window is a true window because you can get penalized, and it is a lifelong penalty per month. Some people think that’s kind of a sales tactic. It’s not.
Again, there are some rules and guidelines, but you need to know your specific deadlines. So, if you’re still working but your employer has 20 or more employees, you’re good.
However, if you own a business and only have 19 or fewer employees, even though you administer the group insurance plan and all of that, you have to go to Medicare.
COBRA is not qualifying coverage. ACA is not qualifying coverage. So there are some nuances to it.
But if we’re talking about one specific person, that seven-month window is really what it is. And if you’re talking in terms of, “Hey, I’m going to retire at 65,” then you have three months before, the month of your 65th birthday, excuse me, and the three months following.
I know one of the decisions someone has to make is whether they take a Medicare Advantage plan or Medigap coverage. How do you help people make that decision and determine which route to go?
Yeah, so that’s the biggest thing that we do all day, every day. It really does depend on health, finances and location.
We’re in Western PA, basically Pittsburgh. We’re the number one Medicare network in the country, and I say that because we have the most options at our disposal. On the Advantage plan side, we have 150-some options to choose from. Not that we go through all of those with everybody, but we sit down and talk with people, and we have a program where we can put in your prescriptions in real time. We can put your doctors in, and we’ll be able to tell you exactly what you’re looking at.
This program can actually tell you which plan is most suitable for you. Legally, we’re not allowed to say “best,” so it’ll tell us which one is most suitable for you and rate the different options.
So that’s a nice thing. But yeah, there’s no right or wrong answer. And going back to the enrollment fee aspect, whether it’s a Medicare Advantage plan or a supplement plan, it’s all the same to us.
So we’re kind of like, “Hey, what is most important to you?”
We run across a lot of people who have health issues and don’t care. They’re just like, “Hey, when I go to the doctor, I know I’m going to get a bill, but I don’t want a premium.”
We have other people who say, “Hey, I’ll pay the monthly premium, whatever it is, every month. I just don’t want to get a huge doctor bill when I do go and have some services rendered.”
So that’s a big thing. We have spouses where one is on an Advantage plan and the other is on a supplement plan. We have spouses on different supplement plans or different Advantage plans.
So it’s really just going through, again, your health situation, your finances, your marital status and all of those things. Then we can kind of narrow it down from there.
Kind of going back to the enrollment fee, for you, it’s no different no matter what insurance company or type of plan someone chooses. Are there Medicare agents or insurance agents out there who are compensated for pushing a specific plan or insurance company? And how can the consumer know, “I’m dealing with this type of person,” or, “I’m talking to this type of person?”
Yeah, great question. We get that all the time. That’s probably one of the biggest questions we get in terms of compensation and stuff.
To answer that, you’ll know, obviously, if you call the 1-800 number for a specific insurance company, they’re only going to give you the options that they sell. So that’s the first thing.
If you deal with a broker, they’re going to have access to all the plans. But if you’re talking regionally, like we have two big carriers here, which are Highmark, Blue Cross Blue Shield, and then UPMC, they do not give those contracts out to anybody who’s not in the area.
So if you’re calling a big call center and they’re located even in Ohio, they’re not going to have access to those two. They won’t be able to say, “Hey, we have access to UPMC or Highmark,” or whatever the case is.
Yeah, that’s the biggest thing: just taking people through it and making sure they understand that if you call the insurance company, they’re only going to offer the plans that they have.
If you call a call center, they will offer you the national plans, which, again, are ZIP code-specific. So they can be great, but if you’re in a super-concentrated area like we are, you might not have access to some of those bigger players. It really ranges throughout the country.
What happens when someone makes that initial decision when they turn 65? They’re on Medicare, maybe they have some kind of plan with different parts. Inevitably, things are going to change, whether that’s in their health or in the plan itself.
Is it something that, year to year, they have to go and evaluate all of this? Or is it like, “Oh, wait a couple of years”? How should they approach that? And how can you help someone make the decision that, “Yeah, you went on this plan a year ago, but things have changed and this plan is probably better for you”?
Yes. So what we do is send out letters every year from our office to all of our clients saying, “Hey, these are the general things that are changing universally in Medicare in terms of Part A, Part B, deductibles changing and things like that.”
Obviously, with all the clients we have, we can’t send something specifically tailored to everyone. So we say, “Hey, set up a time to talk to your broker, and we’ll go through all of the options.”
But every year, there’s what’s known as the Annual Enrollment Period, which is actually coming up October 15th through December 7th. Every year, people have the opportunity—mainly if you’re in an Advantage plan; it’s a little different for supplement plans—to go from Carrier A to Carrier B or back to Carrier A.
So we get you on what is the best plan for you at the time, but it’s not something where we say, “Hey, you’re stuck in this plan. You have to stay on this plan.”
Again, people move, health changes, finances change, and that’s a big thing. People, unfortunately, can go into skilled nursing, assisted living or nursing homes, and that changes and plays a huge role in the factors we consider.
So it really just depends, but this is a lifetime thing for us. There is that enrollment fee, like I was saying, but obviously, we service everything for the life of the insurance policy. While we do that, we can get renewals. And again, the renewals are exactly the same regardless.
So there is a quote-unquote incentive, if you will, to be there. But our number one thing is that the real work starts after we enroll you.
I can sit here and explain Part A, B, C and D to you, Marc, and you’ll know everything at a trivial level in five minutes. But if you move, things change or what have you, that’s when the nitty-gritty starts.
It’s not right when you enroll. It’s after you’ve been in the plan and start to see, “Okay, this copay is different. They’re changing the plan. They’re taking some of my benefits away.”
So we go through that every year, and everybody has access to us throughout the year as well. We can help with claims, billing and all that stuff.
I know one of the parts that people have a little bit of confusion around is Part D and prescription drugs because that’s one of the things that changes as well. Maybe certain drugs are covered one year but not the next year. Maybe they need a new prescription for a different type of drug. How does that go into the initial planning and then also as things change?
Yeah, so that’s a huge thing. The one thing that’s nice about Part D, prescription drug coverage, is that it is universal for everybody. So whether you’re on a supplement or an Advantage plan, it doesn’t matter. It’s all the same.
A few years ago, there used to be what’s known as the donut hole. Some people might have heard of that. That’s no longer a thing anymore.
So in 2026, $2,100 is the maximum out-of-pocket that you can spend. That is per person because, again, with Medicare plans, you can’t have a family plan or anything like that for Medicare.
So it’s $2,100 per person, and that is the maximum for 2026. In 2027, that number is going up $300 to $2,400.
So that program I mentioned a little bit ago, we put everybody’s prescriptions in there, and then we can say, “Okay, this is what you’re looking at. This is what you’re looking at.”
My wife happens to be a board-certified toxicology pharmacist, so that helps. If I need anything specific, I can ask her about things to do and whatnot. She’s now back with CVS, so that helps when I have specific questions about prescription drugs.
But in walking people through it, we have something called CleverRx, which is very similar to GoodRx. We partnered with them, and it’s free to all of our clients. It’s a coupon code.
Another company that we partnered with is the Canadian Med Store. They’re out of Jacksonville, but they are partners with Canadian drugstores, and they will ship those drugs to your house.
So those are just some added-value things that we do for clients. But the biggest thing is saying, “Okay, if you’re going on this plan, this is what you’re looking at for this medication.”
By and large, it is pretty much the same universally when it comes to what one medication costs versus another. And again, you have that $2,100 out-of-pocket maximum.
So we’re just trying to make sure that if there is a specific carrier that covers a particular drug a little bit cheaper than another one, that’s the one we ultimately want to go with.
And to go off your question earlier, that’s the biggest thing: we say, “What’s most important to you?” And if it is prescription drugs, then yeah, let’s tackle that first.
I want to talk a little bit about someone who, let’s say, is looking for early retirement. And by early retirement, I mean prior to age 65 when they would go onto Medicare.
Let’s say they want to stop working at 60. How does that work from age 60 to 65? What are their options, and how does that transition into Medicare?
How that would work is, if you’re married and the husband and wife both retire—or one retires—and they have group insurance, let’s say using your example, at age 60, they would have to, obviously, if they were offered COBRA, either ride that out or go through the marketplace and get individual health insurance.
Which we do as well. We do all things health insurance—group and individual—and then Medicare is the main one we market.
But that is the process somebody would need to go through. If they are no longer offered COBRA and they’re no longer offered group health insurance, then they would have to go through the marketplace.
Each state is different, so it does depend. In Pennsylvania, we have what’s known as Pennie—P-E-N-N-I-E—which is our marketplace. But every state is different, and some states use the national marketplace.
Those marketplaces can guide you to what plans are available in your area. Some people, depending on household size, income and age, can qualify for a tax credit. That tax credit can go directly toward the premium every month, and then you just pay whatever is above and beyond that tax credit.
And that’s what you would have to stay on until you turn 65, or until your spouse turns 65. Then one of you would come off and go to Medicare, while whoever is younger would stay on the other coverage.
Is COBRA the same plan that, let’s say, that person had while they were on group insurance, just that they’re covering both sides of it? They’re covering what they were paying plus whatever the employer was subsidizing? Or is it different?
No, so it’s pretty much the same thing. There is a 2% service charge added onto it. We administer some of our larger group COBRA plans, and there is that 2% added on.
Personally, of all of my personal clients, I’ve only had one where it made sense for them to stay on COBRA simply because the cost was so exorbitant. In that situation, the client sold to a private equity firm and they had a deal. That was the only reason why.
By and large, COBRA is way more expensive. However, a lot of people feel more comfortable with it, so they want to ride it out. And again, that’s entirely up to the client and their family and what they want to do. We’re happy to walk people through that.
But yeah, it is the employer cost, the employee cost and then that 2% added on top.
And when you say more expensive or that it doesn’t make sense, you’re comparing that to going on the marketplace or one of the plans there?
Yeah, just simply because of what the premium ends up being. A lot of people don’t realize, even if they’re the owner of the company or in HR or whatever, they don’t particularly realize how costly their insurance is and what the company is actually paying in terms of 70%, 80%, whatever that may be.
They were just paying the 30% or the 20%. So even if it seems expensive, there’s still another 70% or 80% on top of that, and then with COBRA, there’s that extra 2%.
I guess there’s a thought out there from people that—and you kind of alluded to it—they’re comfortable with COBRA because it’s the plan they know. Is there an apples-to-apples comparison? Can they get a very similar, close-to-the-same type of plan on the marketplace? Or is there always going to be a lowering of benefits that you get on the marketplace?
That, again, will depend on where you live. Here in Western PA, where our headquarters is in Pittsburgh, you have two options on the marketplace: Highmark and UPMC.
Now, if you’re in Allegheny County, which is right where the city of Pittsburgh is, there’s like six pages of plans to choose from between those two. So you have a lot of options.
But I always joke: bad weather, good Medicare here, not so good under 65, however.
So it truly is state-specific and ZIP code-specific, but you can get apples-to-apples coverage. We’ve seen it with some of our clients in New York. I have a client who just moved to Texas from Pittsburgh, and hers is very apples-to-apples.
But yeah, it just depends on where that client is living or going to be moving to.
Yeah, makes sense. All right, so I guess the one thing—or what’s the best piece of advice you can give someone approaching 65 so that they avoid some of those lifetime penalties and optimize their Medicare experience?
Yeah, so the number one thing—and this is an agency-specific thing that we really crusade simply because I don’t want to see anybody get hit with a penalty, even if it’s a dollar. I don’t want you to have to pay an extra $12 a year for life just because you happened to miss something.
When you are eligible for Medicare—so that’s your Initial Enrollment Period, the IEP, three months before the month of your 65th birthday, the month of your 65th birthday and the three months following—even if you’re staying on your spouse’s plan or your group plan, at least get Part A of Original Medicare.
The reason why you want to get Part A is because then you will be in the Social Security system, because it does go through Social Security and CMS, which is the Centers for Medicare & Medicaid Services.
So as long as, when you’re about to turn 65, during that time period, you go and get Original Medicare Part A only, you will then get that red, white and blue card in the mail.
It’ll have a Part A effective date on it. But the most important thing is it’ll have your MBI number, which is your Medicare Beneficiary Identifier number. That number is attached to you in Medicare, so that’s the number you’ll use to enroll in any private insurance plan—Advantage, supplement or whatever.
The reason why we say at least get onto Part A is because Part A is known as hospitalization. It’s quote-unquote free because of all the years that you’ve been working and paying into FICA taxes. So you’re not going to have to pay for Part A.
Part B does have a premium. So if you have qualifying coverage, you don’t want to start that Part B because you’re going to owe it.
So we just tell people, “Hey, get at least Part A so that when you go to retire, even if it’s five years from now and you’re 70, you can say, ‘To hell with work, I’m quitting on Monday.'”
Then you can just contact Social Security and say, “I want my Part B to start.”
Where people get tripped up is if they miss the enrollment window completely, or all they get is Original Medicare and only a Part D plan for prescription drugs. It’s very, very, very few and far between as to why you would want that.
But if you do do that, there are some people who miss the prescription drug portion, and they ultimately will get hit with another penalty for not having qualifying coverage for Part D prescription drugs.
So we tell everybody, just enroll in Part A. And if you have any questions, reach out to a brokerage so they can walk you through it and guide you.
We do seminars all throughout PA, really. At those seminars, we’ll get people who are 60 and we’ll get people all the way up to 85—which was somebody at our most recent one—and they’re just there to learn. We just kind of walk them through that process.
But yeah, that’s the number one thing you’ve got to be on the lookout for: those late penalties.
But if there’s one thing I can crusade, it’s just this: when you’re approaching your 65th birthday, get on that Part A because it’s free and you have 90% of the process done.
Oh, got it. That makes sense.
All right, Ryan, that’s all of the questions I have for you today. Thank you for sharing your expertise with our audience. This was a really informative discussion.
Before we close, where can listeners go to learn more about you or get in touch with you directly?
Yeah, absolutely. You can go to our website, needpartabc.com. If it’s in regard to this podcast specifically, we have needpartabc.com/listen.
And yeah, you can schedule a consult with any of us. We’re happy to help.
For me, all I have is LinkedIn, so you can find me on there. But yeah, I’m always happy to talk and guide people in whatever way we can. Those are the best places to find us.
Great, we will include all of that information in the resources section of the show notes. Thanks again, Ryan, and thank you to everyone who tuned into today’s episode.
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