By Senior Benefits, Inc.
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Nick and Zach are back to give us some more essential information about the more commonly purchased products for Medicare beneficiaries. They break down everything that you’ll need to know by category and product. As a result, they have a very handy guide to what you’ll need.
They discuss products in dental, vision, and hearing, and what is available there. Importantly, they discuss cancer coverage and what’s applicable there. They also break down life insurance opportunities and address any potential questions that arise there. Check out their conversation for the full scoop!
Show Notes
Links Referenced:
For this episode of Seniors Living Healthy, Zach and Nick break down medicare supplements and coverage. They distinguish some of the differences between the plans, and what you can expect with the type of care they provide.
Zach and Nick kick things off by discussing medicare supplements. As the name indicates, they supplement your medicare as a secondary policy to your primary. Zach and Nick shine some much-needed light on the subject. They also cover the gap from the last episode and discuss Medicare Advantage i.e. “Part C.” They break down how it works, and what you need to know. They close with the Pros and Cons of each topic so that you can make the best decision to fit your needs.
Show Notes
Links Referenced
Show Notes
Links Referenced:
Transcript
Announcer: Welcome to our fireside chat with Seniors Living Healthy, the podcast that helps prepare and educate you as you enter and live out your golden years. With over 10 years of experience, Nick and Zach are experts in the senior market and are here to help you live a healthy, full life. And now fireside with your hosts, Nick Keene, and Zach Haire.
Nick: Hello, and welcome to season two of Seniors Living Healthy, episode one. I’m Nick. And I have Zach, our co-host with us.
Zach: Hey, folks.
Nick: And for episode one of season two, we want to cover parts A, B, and D of Medicare, and the changes for 2022. So Zach, let’s jump right in.
Zach: Sounds good. So, kind of start off there from the top, Part A, just like in the alphabet, starting out with the first letter there, you know, that is our hospitalization, sir. You know, Nick, what are some common things that Part A covers?
Nick: Yeah, so Part A kicks in when individuals are admitted to the hospital. It’s worth mentioning, Zach, that they’re admitted because we are seeing more commonly that people are being put in the hospital under observation. And that is actually covered under Part B. So, very simply, anytime someone is admitted to the hospital, not under observation, Part A kicks in.
Zach: Got you. So, let’s say, you know, I’m getting ready to turn 65 in a few months. I’m still working things like that, how do I get Part A? What do I have to do to qualify for it?
Nick: Great question, Zach. We do get this question quite frequently. So, the most common way to qualify for Medicare is those individuals that have worked 40 quarters or ten years and paid into Medicare via payroll taxes, right? Those individuals get Medicare the month of their 65th birthday.
Zach: Got you. So, no matter what, they’re going to get Part A. I know you said you paid into it while you’re working. Is there any additional costs added to that?
Nick: Right. So, great question there, Zach, and worth mentioning here as well. For those individuals that qualify traditionally for Medicare, they worked 40 quarters, ten years, and paid in, Part A is premium-free, think of it as prepaid. But also you have those individuals that may qualify based on their spouse’s, right? Their spouses may have worked 40 quarters or ten years, they also qualify for Medicare Part A the month of their 65th birthday.
Then the third situation, there is a cost. And those individuals that don’t have a spouse that qualifies for Medicare they can draw off of and don’t have the credits themselves, depending on how much they have worked and paid in, Part A can be purchased.
Zach: Yeah. So, you do still have the ability to get Part A, if you don’t ‘qualify’, you can always pay for that and pick it up.
Nick: Absolutely.
Zach: So, we know that in most cases, there’s no additional premium; you’ve paid into it as you were working. Are there any other, you know, common costs associated with using Part A, whether it be a deductible, whether it be you know, skilled facility care, things such as that?
Nick: Absolutely. So, yeah. So, basically with Part A, the way it works is it’s designed with what we call a Medicare period of care, right? So, when those individuals that have Part A are admitted to the hospital, they are immediately responsible for a $1,556 deductible in the year 2022 that covers their first 60 days in their period of care, right? So, for those individuals, they go in, they pay that $1556 deductible, they’re covered for the first 60 days, right?
But it’s worth mentioning that if they go beyond day 60 they do have additional cost, right? And that period of care doesn’t end until they go a continuous 60 days without accessing care under Part A. So, assuming their period of care extends, day 61 through 90, those individuals are going to be responsible for $389 a day that they’re in the hospital, and day 91 and beyond using those 60 lifetime reserve days, they’re going to be responsible for $778 a day. You know, and the other thing to touch on here, Zach, that you mentioned is skilled facility care, right? So, we’ve seen a major transition in our market over the last five to ten years.
You can recall when we were little, people had extended stays in the hospital, you know, people were in their one, two, four, six months. That doesn’t happen really anymore, right? What we’re seeing, the trend is individuals are being admitted to the hospital, they’re being stabilized, and they’re being shipped off to skilled facility care centers, right? And you know, whether that’s for a hip replacement or a knee replacement, they fell and they broke something, speech, occupational therapy, whatever it may be, these individuals are staying at the skilled facility care centers for extended periods of time, not in the hospital. So, to qualify for Medicare to cover skilled facility care, they have to be in the hospital for at least three days and be admitted to the skilled facility care center within 30 days of being discharged. If those criteria are met, Medicare will cover day 1 through 20, one hundred percent, and then day 21 through 100, the individual is responsible for $194.50 per day.
Zach: Got you there. So, you know, once someone is on Part A [everything 00:05:16], is there any limits where they can go, networks, anything like that?
Nick: Yeah, one of the beauties of Medicare, Zach, and you know, we tell clients this all the time is Medicare’s a nationwide program, right? California, North Carolina, Michigan, to Florida, and everywhere in between. They can access care, right? And that’s one of the great things about Medicare is almost all facilities, almost all doctor’s office accept Medicare. So, they have no restrictions, they can go just about anywhere they want.
Zach: Got you. So, kind of wrapping up Part A there is, anyone can get that as long as you’ve worked 40 quarters or your spouse has worked 40 quarters. You’re able to get that the month you turn 65, the first day of the month.
Nick: Absolutely.
Zach: And no matter whether you’re continuing working or what you’ve got Part A?
Nick: Yep.
Zach: And with Part A alone, there was a $1,556 deductible on that they’d be responsible for but then, you know, it does help you in the skilled facility care things such as that, along with your 60-day continuous window of care. And again, no network so you can go wherever you want to go if you’ve got that Part A; pretty much every hospital, I’d say, in America takes Medicare.
Nick: Absolutely, Zach. And just to wrap up on Part A, you know, one of the things that people need to remember is Part A is just hospital admittance insurance. Most of your typical services that are everyday needs are happe...
Some of the highlights of the show include:
Quotes
“Part A is paid in typically via payroll contributions, 10 years or 40 quarters, and there is no premium. With Part B there is a standard premium and in the year 2021, that premium is $148.50 per month.” — Nick
“Part B is elective. So, whereas Part A is automatic, there are plenty of individuals that are still working when they turn 65. They may have insurance through their retirement, through their union; that's considered credible coverage, so it's certainly elective.” — Nick
“The important thing to remember folks is prescription drug plans all have to meet a minimum benefit that Medicare determines, okay? And what that means is they have to cover at least two drugs in every therapeutic class. However, some drug plans may cover different drugs in those therapeutic classes. So it's important that you reach out to a professional.” — Nick
“A lot of times with an Advantage Plan, you're looking at paying less than the front end where you might possibly with copays and deductibles on the back end see a bill.” — Zach
“I recently turned 60. So, a lot of what I'll talk to you about is really based on my own experiences. I'm going through this in real-time.” — Ty Wooldridge
“My background was in actuarial science, and I can tell you that the time value of money is an important ally when you're retiring. If you just took $50 a week, and you invest in that, even at a really low rate, like 4% which, as an average rate for 40 years, which is fairly low, you have a quarter-million dollars by the time you're 40 years out.” — Ty Wooldridge
Transcript
Announcer: Welcome to our fireside chat with Seniors Living Healthy, the podcast that helps prepare and educate you as you enter and live out your golden years. With over 10 years of experience, Nick and Zach are experts in the senior market and are here to help you live a healthy, full life. And now fireside with your hosts, Nick Keene, and Zach Haire.
Zach: Hello, and welcome back to episode six of season one of Seniors Living Healthy. I'm joined here as always with Nick.
Nick: Hello, folks.
Zach: So, this episode, we're going to wrap up what we've covered the first five episodes this season, touch base over what we have talked about, do a little refresher, review course. And then we're going to look into what next season is going to bring, and that's where our guest, Ty Wooldridge, President of Aetna Senior Supplements, will come in. We interview him, kind of looking forward to financial security once you do retire. So, as we just jump in here, we're going to talk about the parts of Medicare and the different things out there that can fill in those gaps in Medicare. Nick's going to run through those for us.
I'll ask him some questions, he'll just review them real quick to make sure everybody's up to speed if you're just now joining us, you’ll know we've touched on the last five episodes. So, Nick, as you know, we've been discussing the parts of Medicare this past season.
Nick: Sure.
Zach: So, real quick, let's start out with Part A of Medicare, give the listeners a run-through on that.
Nick: Yeah, so I want to start out real quick with the Part A and Part B, Zach, about who qualifies, when they qualify, and when they get it. So, individuals that have worked 40 quarters or 10 years and paid into Medicare, [unintelligible 00:01:45] payroll taxes mainly, qualify for Medicare, including any dependents and or spouses of those individuals. And other individuals, whether it be through disability, in limited circumstances regardless of age, or end-stage renal disease, or ALS can qualify as well, Zach. So, back to Part A, your question. Part A is hospitalization.
Anytime an individual is admitted to the hospital, they are covered under Part A and a couple things to remember under Part A is there is a period of care: that is 60 days, and that is covered with a $14058 deductible in the year 2021. So, beyond that, there are additional day costs, day 61 through 90 in the period of care $371, and then 91 through 150, they're responsible for approximately $742 per day. The other thing that we're seeing more in this market as it regards to Part A, Zach, is skilled facility care. I know you and I talk with clients about this quite frequently. But skilled facility care comes in a lot when people have to go to rehabilitation facilities, whether it's following a stroke or some sort of debilitative condition.
And if they are in the hospital for three or more days, and released, and admitted to a skilled facility within 30 days, Medicare will pay day 1 through 20, and then they're responsible for day 21 through 100 at approximately $185 per day. And that pretty much rounds out Part A, Zach.
Zach: Great. So, real quick on Part A, circling back there talking about the days in the hospital, the window of care, we know it's a 60-day window of care. Kind of, explain how that resets, how that works.
Nick: So, a period of care ends when an individual goes 60 days without care in the hospital or surrounding arena. So, not to be confused with the first 60 days period of care that's covered under the Part A deductible, but also beyond that going 60 days without additional care.
Zach: Great, perfect. So, rolling in there. Next part is our Part B of Medicare, which is a lot more in play than Part A does.
Nick: Absolutely. So, Part A is paid in typically via payroll contributions, 10 years or 40 quarters, and there is no premium. With Part B there is a standard premium and in the year 2021, that premium is $148.50 per month. There is something called IRMAA, Zach, that can allow people to either pay less for their premium or more, depending on their income.
Your Part B is elective. So, whereas Part A is automatic, there are plenty of individuals that are still working when they turn 65. They may have insurance through their retirement, through their union; that's considered credible coverage, so it's certainly elective. Reach out to us, reach out to someone to answer your questions about what may work or what may not work in that regard. But if someone does elect to take Part B, they can expect to pay a premium typically. And Medicare Part B has an 80/20 coinsurance: Medicare pays 80% of all outpatient claims, and the insured is responsible for the remaining 20% after a $203 outpatient deductible.
Zach: So, a little trivia question for you, Nick. We get asked this all the time: Part A or Part B; which one pays for the shingles shot?
Nick: Shingles. That...
Some of the highlights of the show include:
Quotes
“President Johnson is the one that signed Medicare into law, and that was done in 1965. And soon after that, a multitude of companies brought out Medicare type Supplement Plans. they were going to cover what Medicare didn’t, but they could add bells and whistles and different things that way.” — Danny
“That's what makes Medicare Supplements a great deal for people because it leaves them in control of what they want to do as far as their healthcare is concerned.” — Danny
“Medicare Supplemental policies are secondary to Medicare, meaning Medicare is still their primary, meaning it's a nationwide program, they can go anywhere that accepts Medicare. And they're also standardized. So, the coverage from one company to another is identical from plan to plan.” — Nick
“You can only buy Advantage plans at certain times of the year with the annual enrollment period, whereas you can buy a Supplement any time of the year.” — Zach
“If you're in a Medicare Advantage Plan and your doctor drops out of it, there's nothing you can do until the open enrollment period.” — Danny
“Medicare has evolved, coverages have been added, things have changed, and the same is true with the Part D. It's been evolving where it gets better and better as time goes on.” — Danny
“Since the plans are standardized, we had the capability to find the same benefit package, the same coverage with another provider saving them a ton of money.” — Nick
Links
Transcript
Announcer: Welcome to our fireside chat with Seniors Living Healthy, the podcast that helps prepare and educate you as you enter and live out your golden years. With over 10 years of experience, Nick and Zach are experts in the senior market and are here to help you live a healthy, full life. And now fireside with your hosts, Nick Keene, and Zach Haire.
Zach: Welcome back to episode five of season one of Seniors Living Healthy. I'm your host, Zach, and with me as always, is Nick.
Nick: Hello, folks.
Zach: Also, we're pleased to be joined this week by Danny Haire, owner of Financial Services, Inc.
Danny: Hi. How are y'all today?
Nick: Doing well, sir. Thanks for joining.
Zach: Thanks for jumping on here with us, Danny. So, he has been in the business for over 40 years, and can even remember back when Medicare Supplement Plans first came out. Danny, real quick, do you kind of want to just give us a quick historical rundown of Medicare Supplements, where they came from, who brought them out, that type of thing.
Danny: Well, of course, President Johnson is the one that signed Medicare into law, and that was done in 1965. And soon after that, a multitude of companies brought out Medicare type Supplement Plans. The difference from those plans compared to today is there were no government standardized plans. Companies pretty much got to put together whatever they wanted to do. I mean, of course, they were going to cover what Medicare didn’t, but they could add bells and whistles and different things that way.
And then as time went on, of course, the government standardized these plans. So, that was pretty much, I think, in the ’80s, when that happened, that these plans become standardized and everybody was selling the same thing, and there could not be any deviation from those.
Zach: Gotcha. So, as we did discuss last episode, Medicare's got those gaps in it, and so there are plans out there to fill those gaps. As we talked about last episode, those Medicare Advantage Plans. So, this episode we're going to look at Medicare Supplements, and also, kind of similar to our last episode, instead of doing a product review, being this whole episode on a product, we're just going to kind of lump our interview portion in with our product review, just because it's going to flow so well together.
Nick: So, Danny, quick question for you tell us why Medicare Supplement Plans benefit our clients?
Danny: Zachary said earlier I've been in the business for well over 40 years. So, having seen changes and seeing what these plans can do for people in filling in the gaps, I just think it gives—anything that gives you control of your healthcare, in my thinking, is the best for you. You can go to any doctor, any time, any place. You're not in networks, you're not having to get pre-approvals or referrals. So, to me, that's what makes Medicare Supplements a great deal for people because it leaves them in control of what they want to do as far as their healthcare is concerned.
Nick: Sure. Couldn't agree more. A couple things to point out also, Zach, that come to mind is Medicare Supplemental policies are secondary to Medicare, meaning Medicare is still their primary, meaning it's a nationwide program, they can go anywhere that accepts Medicare. And as you mentioned earlier, Danny, they're also standardized. So, the coverage from one company to another is identical from plan to plan.
And more importantly, we get asked quite frequently, can these plans be canceled based on a year of high claims, or claims level? And the answer is simply no. The only way a person's Medicare Supplement Plan can be canceled is due to non-payment; it's what's called guaranteed renewability. Zach?
Zach: Kind of going back, touching on a few of those points, you know, going through Medicare Supplements, as we talked about in the last episode—Advantage plans as well—you can only buy those certain times of the year with the annual enrollment period, whereas a Supplement, you can buy those any time of the year. As long as you can enter the health questions and qualify there. So, kind of on that note there, Danny, what are some pros to that capability to be able to purchase a MedSup and not—as you said, gives you the freedom. If you want to go a little more into that?
Danny: Well, the freedom, to me, is the most important thing. Being of Medicare age myself, and having the flexibility if I want to change a plan, go from one plan to another, or g...
Some of the highlights of the show include:
Quotes
“There are two options, really, when it comes out there to filling in gaps in your Medicare: Medicare Supplements andMedicare Advantage Plans.” — Zach
“The HMO plans are primary care physician-based. Their networks are typically county-based or sometimes multi-county based, but they're for individuals that don't do a lot of traveling. They do have set copays on a lot of services, and they typically are relatively inexpensive.” — Nick
“And then the PPOs: there is no requirement for a referral on a PPO. They typically are going to have larger networks, regional, or in some cases, national networks.” — Nick
“The only thing that a Medicare Advantage Plan has to do is offer benefits equivalent to original Parts A and B of Medicare.” — Nick
“It's important to note that Medicare Advantage Plans wrap up and replace Part A and B, but also incorporate Part D of Medicare in the same type of plan. So, unlike Medicare, and a supplement and a stand-alone drug plan, it's all in one card.” — Nick
“Medicare Advantage Plans give you additional benefits that original Medicare does not cover. It basically Medicare Advantage Plan will pick up, like, deductibles, and coinsurance, things of that nature traditional Medicare does not cover.” — Tausha
“Medicare Advantage over traditional Medicare has a stopgap in place that caps the amount of spending that you would do each year, which is called a max out of pocket.” — Tausha
Links
Transcript
Announcer: Welcome to our fireside chat with Seniors Living Healthy, the podcast that helps prepare and educate you as you enter and live out your golden years. With over 10 years of experience, Nick and Zach are experts in the senior market and are here to help you live a healthy, full life. And now fireside with your hosts, Nick Keene, and Zach Haire.
Zach: Hello, and welcome back to another episode of Seniors Living Healthy. As always, I'm your host, Zach, and beside me is Nick.
Nick: Hello, folks.
Zach: You guys, this episode we're going to look into the different options to fill in those gaps that Medicare covers where we've talked about in the previous episodes, with Part A being your hospitalization, and Part B being your outpatient. There are two different options out there. One of them is Medicare Supplements, which we're going to touch on next episode, where this episode we're going to focus on Medicare Advantage. You may see him also called MAPD or Part C of Medicare. Especially with Annual Enrollment Period coming up, you're going to see a lot of TV advertisements, radio advertisements, billboards, things in your mail, all of that stuff, in regards to that.
So, guys, as always, usually do a product review in our episodes, but since this whole episode is on a product, we're just going to jump right into it and just cover the whole product as a whole. And then, as always, we'll go into our interview, our confession section, and then wrap up the episode. So, now that we've talked about A and B has all these gaps, this episode—and we're going to spill over into next episode—we're going to talk about what covers those gaps that Medicare doesn’t. Some different options, everything out there for you. So, Nick, give me a quick rundown just to refresh everybody, what some of those gaps are?
Nick: Sure, absolutely, Zach. So, the main two parts of Medicare Part A and Part B. As you alluded to, Part A is the hospitalization, Part B is the outpatient. So, some of the major gaps under Part A of Medicare are, Medicare Part A has a $1408 deductible per 60-day benefit period. And then also beyond that, for individuals that required skilled facility care beyond hospital stays, Medicare covers all but $176 day 21 through 100, with Medicare paying 100 percent, day 1 through 20 provided that an individual is in the hospital three days or more and admitted to that facility within 30 days. Then as far as Part B, Zach, as you know, Part B of Medicare has an 80/20 coinsurance. The clients are responsible for the remaining 20 percent that Medicare does not pay, as well as a annual deductible of $198 per year.
Zach: Great, Nick. So, now we're caught up with the different gaps and everything out there. There are two options, really, when it comes out there to filling in gaps in your Medicare. One of them is Medicare Supplements; we're going to spend next episode talking about this one. So, this episode, we're going to talk about Medicare Advantage Plans. You may see that also referred to as Part C, or MAPD. That's a couple of different lingo we use in our industry. You'll see it, especially with Annual Enrollment Period coming up. So, you're going to see a lot of advertisements, billboards, radio ads, things like that for those products. And so, Medicare Advantage Plan, lack of better terms, it replaces A and B of Medicare.
Nick: Absolutely. Yep.
Zach: So, Nick, looking out there, there are several different types of MAPDs, you want to run through those real quick, maybe touch on the two main ones that are out there, and we'll go from there.
Nick: Sure, absolutely. So, there's a number of different types of Medicare Advantage Plans that are offered on the market, Zach, but the few that are the most common are going to be the HMO, which stands for Health Maintenance Organization, the PPO, which is a Preferred Provider Organization, and then SNP plans: Special Needs Plans. Those plans are specified for specific portions of the population, whether that be dual-eligible Medicare beneficiaries, institutionalized Medicare beneficiaries or Medicare beneficiaries with chronic conditions.
But back to the main two, the HMO plans are primary care physician based. What that means, Zach, is the beneficiary's care is all handled directly through their primary care physician, and any doctors or specialists within that network or outside, are only available to the client with a referral from that primary care physician. And their networks are typically county-based or s...
Some of the highlights of the show include:
Quotes
“These drug plans are regulated by the government and Medicare, and there's only certain election periods throughout the year that people can make changes or elect different coverage, so we get complaints about these plans non-stop throughout the year.” — Nick
“Your Tier 1 drugs are typically going to be the most inexpensive in most cases. Lots of drug plans offer these drugs free of cost. Tier 2 are going to be preferred generics in a lot of cases or non-preferred generics that are a little more expensive but still relatively inexpensive; Tier 3 are going to be your brand name drugs, and Tier 4 are going to be your specialty drugs, like cancer drugs.” — Nick
“You're going to pay the full cost of your prescriptions until you get through the deductible phase of your prescription drug plan.” — Nick
“The reason the doughnut hole can be such a bear is for people that have higher, more expensive medications, their cost-sharing within this period goes up pretty substantially.” — Nick
“We're going to be able to tell you when to expect to hit that doughnut hole, or if you're going to hit it at all, or when you hit that catastrophic phase moving forward there.” — Zach
“We always try to make sure when we're running PDPs for our clients, you know, making sure—a lot of them like those little local drugstores; we try to get them to at least check the big chains out there in case they do travel.” — Zach
“The key is always to choose a preferred pharmacy for lower drug costs. That's always the key.” — Tausha
“CVS is now allowing patrons to use PayPal, which I think is pretty cool. And then possibly in the future, they might be able to use Venmo as well.” — Tausha
“I just really wanted to just highlight the support that CVS Aetna has given around COVID-19. We waived all COVID related copayments, and I think what's probably stands out the most for me is that we opened multiple COVID-19 testing sites throughout the United States where we kind of had those hotspots. And CVS acted quickly and implemented those hotspots to help with testing.” — Tausha
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Transcript
Announcer: Welcome to our fireside chat with Seniors Living Healthy, the podcast that helps prepare and educate you as you enter and live out your golden years. With over 10 years of experience, Nick and Zach are experts in the senior market and are here to help you live a healthy, full life. And now fireside with your hosts, Nick Keene and Zach Haire.
Zach: Hello, and welcome to episode three of our inaugural season of Seniors Living Healthy. I'm your host Zach, and here with me, as always, is Nick.
Nick: Hey, folks.
Zach: So, this month's episode, we're going to talk about Part D of Medicare, which is your prescription coverage. Nick, what is our number one complaint?
Nick: Prescription drug plans, no doubt, Zach. For whatever reason, these drug plans are regulated by the government and Medicare, and there's only certain election periods throughout the year that people can make changes or elect different coverage, so we get complaints about these plans non-stop throughout the year.
Zach: That's right. With our hands being so tied, it's really, really hard. We can't tell the future. So, we can't see what people are going to be doing, taking prescription-wise down the road; really, all we can do is what's working for them there in October when those annual enrollment period comes. So, I know we've touched there briefly on enrollment period but, Nick, what are the two most common times people can enroll in drug coverage?
Nick: So, the two most common times people can make changes to their prescription drug coverage is going to be their initial enrollment period when they first become eligible for Medicare, which is a three-month window both before and after their eligibility, and then also the annual enrollment period, which is that period from October 15th, through December 7th each year, that they're allowed to make changes to that coverage.
Zach: Great. Yep, definitely. Yeah, those are our two most common times. There are a couple of different scenarios out there. If you guys want to subscribe to our newsletter, that’s something we'll, kind of, touch in that, here in the next couple days we'll be getting out to you guys, to see the different options you may have out there enrollment-wise. So, Nick, when we were working with people looking at things, what should our clients keep in mind when we're working with them to select a drug plan? Because like I said, we can't tell the future?
Nick: Sure, absolutely. So, Zach, what we try to do is find the best drug plan and drug coverage for our clients at the time. Not only that, but we want to make sure people newly eligible to Medicare know about the downfalls of not selecting drug coverage, whether that's being penalized for not having credible coverage through Medicare prescription drug coverage, group insurance, or retirement benefits, whether that is someone who is not taking prescriptions and just thinks they don't need it, we want to make sure they're not getting penalized. We also want to make sure that folks have the best drug coverage for them. So, it's our job to ask questions to make sure that we're informed, that we take care of our clients.
Zach: Definitely, yeah. Trying to put the client there first is always want to make sure we get what works best for them. So, moving forward there, looking at the different parts of the prescription plan, the first thing we want to cover there are the tiers. Prescriptions are broken down into various tiers, that kind of breaks them down into cost, types of prescription, things like that. Nick, you want to touch on those real quick, what the different tiers are, and what that means.
Nick: Yeah, absolutely. So, Zach, the way the tier system works, and by the way, Medicare is who is dictating what prescriptions are in what different types of tiers based on their cost. So, your Tier 1 drugs are typically going to be the most inexpensive in most cases. Lots of drug plans offer these drugs free of cost. Tier 2 are going to be preferred generics in a lot of cases or no...
Some of the highlights of the show include:
Quotes
“Think of Part B as covering everything outside of being admitted to the hospital. Medicare has no referrals. Lab work, physical therapy, CAT scans, MRIs, ambulance rides, emergency room visits if not admitted to the hospital, and homecare in a limited basis, are all covered under Part B.” — Nick
“Medicare Part B has an 80/20 coinsurance, meaning Medicare pays the first 80% and you're responsible for the remaining 20%. The coinsurance takes effect after you have paid an annual deductible of $198 per year. Once the deductible is paid in full, you're responsible for 20% of all remaining charges.” — Nick
“Part B of Medicare pays for diabetic testing supplies. Insulin, pills, diabetic medications are covered under Medicare Part D, but the testing supplies themselves, folks, are covered under Medicare Part B.” — Nick
“Medicare is actually a pretty favorable insurance when it comes to chiropractic coverage. Typically, the only thing that is not covered within Medicare is examinations and/or X-rays if those are taken.” — Dr. Sara
“The cool part is we are removing that pressure, and putting those bones back in the proper place. It allows your brain and your body to connect and actually function optimally, and as that happens, for one, a person gets out of discomfort while at the same time that means that the organ system is also thriving and starting to optimally function.” — Dr. Sara
“The goal of our podcast is helping people prepare for retirement, whether that be 65, 70, 75 whenever that is.” — Zach
“If you get up into retirement age, and you have all the money in the world, and you want to travel, you want to do all the things you want to do, yet you don't have your health, what do you have?” — Dr. Sara
“I call it a Build-A-Bear plan, just because it is a very flexible plan. It's got a couple of different base parts of the policy you pick, and then it's got several riders that you can add on.” — Zach
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Transcript
Announcer: Welcome to our fireside chat with Seniors Living Healthy, the podcast that helps prepare and educate you as you enter and live out your golden years. With over 10 years of experience, Nick and Zach are experts in the senior market and are here to help you live a healthy, full life. And now fireside with your hosts Nick and Zach.
Zach: Hello, and welcome to episode two of our inaugural season of Seniors Living Healthy. Again, I'm your host Zach, and here with me is my co-host, Nick.
Nick: Hello. Hi folks.
Zach: This episode, we're going to go over Part B of Medicare which covers your outpatient care. So again, as I'm sure that you've guessed, this episode’s ABC of Medicare is going to be Part B, medical. So, once you turn 65, you're going to be able to elect to take this Part B as long as you don't have credible coverage, Nick, tell them what the government considers credible coverage.
Nick: Credible coverage is determined by the level of coverage offered under the plan, and the number of employees covered by that plan. Among other things, if you are turning 65, or intend to retire soon, reach out to your HR benefits department to see if you will have credible coverage when the time comes.
Zach: That's great, Nick. And so if they don't have that credible coverage though, and they don't take their Part B, and pass on it, why don’t you tell them what they're going to win by not having that credible coverage?
Nick: Yeah, absolutely. Okay. So, once an individual goes eight months after they stop working, or employer coverage ends, whichever is first. They will be penalized by Medicare and that penalty is 10% of the full cost of the standard Part B premium, each year they go without coverage. Also, after that timeframe, there is a limited window, Zach, that a person can apply for Medicare benefits. It's what's called the general election period. It typically runs January 1 through March 31, with coverage beginning in July of that year.
Zach: Gotcha. So, they let you elect it, kind of, sort of—
Nick: On their timeframe. Yeah, you got it.
Zach: Yep. Yeah. So, they tell you you don't have to take Part when you turn 65, but if you're not covered, you kind of have to. So, now that we've covered how you get your Part B, what all is that Part B going to cover for you once you receive it?
Nick: Yeah, so Part B is outpatient coverage. So, folks, you can think of Part B as covering everything outside of being admitted to the hospital. So, meaning any type of services outside the hospital that are medically or Medicare-approved are covered under Part B. Some of those common services, Zach, we see things like doctor's visits, whether primary care or specialist—
Zach: We're going to have to have a referral to see those specialists though?
Nick: Oh, great question. We hear that quite frequently. Medicare has no referrals. Absolutely. Lab work, physical therapy, CAT scans, MRIs, ambulance rides, emergency room visits if not admitted to the hospital, and homecare in limited basis, are all covered under Part B.
Zach: Great, great. So, now we know what they cover. We had that deductible on Part A we talked about last episode. Is it similar here with Part B or, kind of, how—what are they going to cover for us?
Nick: So yeah, great question, Zach. Medicare Part B has an 80/20 coinsurance, meaning Medicare pays the first 80% and you're responsible for the remaining 20%. The coinsurance takes effect after you have paid an annual deductible of $198 per year. Once the deductible is paid in full, you're responsible for 20% of all remaining charges. And remember, just like Part A, Part B is a nationwide program designed for Medicare beneficiaries; no networks associated, and just like you said, no referrals necessary.
Zach: Great, great. So, as we know from last m...
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Quotes
“If an individual has worked 40 quarters or 10 years and paid into Medicare, traditionally via payroll taxes, then they will automatically qualify for Part A. They will receive Medicare Part A on the first day of the month of their 65th birthday with one exception: if their birthday is the first day of the month, they get it the month prior.” — Nick
“In a nutshell, Part A of Medicare is hospitalization insurance for individuals on Medicare.” —Nick
“Keep in mind that Medicare is a nationwide program. So, Medicare beneficiaries, whether from California, North Carolina, Michigan, to Florida all have the same program.” —Nick
“As we get older, our system just doesn't do what we tell it to do. Our brains try to tell our body what to do, and it doesn’t react the way it did when we were in our teens.” —Matt
“Physical therapy is a commitment. It's a time commitment. It's a financial commitment. It’s a lifestyle commitment.” —Matt
“I think the biggest hurdle for a lot of people is that it's so new. You're doing things that you've never done before. Everybody's gotten their routine, and some of the older population, they've been in that routine for 50, 60, 70 years. And so, turning things in a different direction is a little bit more challenging.” —Matt
“You always want to wear loose clothing because you're going to be doing things physical.” —Kaitlin
“Statistics say the average cost in a nursing facility of some sort is $72,000 per year. I would say there's a good chunk of people out there, especially in the market we deal in, that if you're retired, that $72,000 is probably pretty tough to come up with.” —Zach
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Transcript
Announcer: Welcome to our fireside chat with Seniors Living Healthy, the podcast that helps prepare and educate you as you enter and live out your golden years. With over 10 years of experience, Nick and Zach are experts in the senior market and are here to help you live a healthy, full life. And now fireside with your hosts Nick Keene and Zach Haire.
Zach: Hello, and welcome to episode one of our inaugural season of Seniors Living Healthy. I'm your host, Zach, and here with me is our co-host, Nick.
Nick: Hello, folks.
Zach: This month's episode, we will go over Part A of Medicare, which is hospitalization. So, as I'm sure you've guessed, this episode’s ABC of Medicare is going to be Part A, hospitalization. Most people are going to get that the month they turn 65 with a few exceptions, so we're going to jump right in. And Nick, why don't you tell us how an individual gets that once they turn 65.
Nick: So, if an individual has worked 40 quarters or 10 years and paid into Medicare, traditionally via payroll taxes, then they will automatically qualify for Part A. They will receive Medicare Part A on the first day of the month of their 65th birthday with one exception: if their birthday is the first day of the month, they get it the month prior.
Zach: Thanks, Nick. So, with that one exception, is there any other kinds of exceptions out there to Part A, how somebody can receive it, and when they can receive it?
Nick: Absolutely, Zach, great question. So, if an individual doesn't qualify themselves for Medicare at age 65, they can qualify off a spouse, whether alive or deceased. Also, if an individual is under 65, but has been on disability, and received benefits for 24 months straight, they can also receive benefits, and then the third situation would be if individuals have been diagnosed with End Stage Renal Disease or ESRD, or Lou Gehrig's disease, they can also qualify for Medicare.
Zach: Thanks, Nick. So, now we know how someone gets Part A; when they get it, how they can get it, what's it going to cover for them out there, once they receive it?
Nick: So, Medicare Part A is listed as covering semi-private room and board, general nursing and miscellaneous services and supplies. So, in a nutshell, what Part A of Medicare is, is hospitalization insurance for individuals on Medicare. So, the way Medicare Part A works is it is designed based on a benefit period of 60 days, and when one is admitted to the hospital, they have a Part A deductible that they are responsible for, which is $1408 each 60-day benefit period.
Zach: Now, is that deductible going to change depending on where they go to the hospital? You know, if they're out of town, they go to the hospital, is it going to be different? Are they going to have—how does that work for him?
Nick: Yeah, so great question. Keep in mind, Zach, that Medicare is a nationwide program. So, Medicare beneficiaries, whether from California, North Carolina, Michigan, to Florida all have the same program. So, as long as they qualify for Medicare and it's in place, there are no networks or referrals for any physicians or medical facilities.
Zach: Perfect that makes it nice being able to go wherever you need to go to get the [crosstalk] you need.
Nick: Absolutely. Absolutely.
Zach: So, in that 60-day period of care, when that 60 days up, does it start over again? How does that work? Break that down a little bit more for us.
Nick: Yeah. So, the way the benefit period works, Zach, is the 60-day benefit period starts when an individual is first admitted, and continues as long as someone is receiving services, whether in the hospital and/or medical facility: things like skilled facility care. So, when they're admitted originally, they pay a $1408 deductible that covers them whether they stay in the hospital for continuous 60 days, maybe they leave...
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The podcast currently has 10 episodes available.