Eligibility, Coverage Limitations, and Common Misconceptions Transcript

Speaker 1  00:00

No need to lose sleep over planning your Medicare coverage. Lisa Lauro and the team at Secure Money Health want you to get the best, most customized service when planning your Medicare coverage. In fact, Lisa wants to share her new book with you, The Ultimate Medicare Book. It’ll help you choose the right plan, understand your benefits and avoid common pitfalls. Go to mymedicarebook.com. That’s mymedicarebook.com.

 

Speaker 2 00:30

It’s time to secure all your health care needs

 

Lisa Lauro  00:34

And we will really simplify the process.

 

Speaker 2  00:38

Welcome to Secure Health with Lisa Lauro.

 

Steve Sedahl  00:49

Hey, welcome in, everyone. This is Secure Money Health Radio, where Medicare matters. With Lisa Lauro, my name’s Steve Sedahl. Lisa is, you’ve been teaching for a long time, and this is really an extension of that for you in this, in this role

 

Lisa Lauro  01:02

It is. I love teaching. I taught mostly between kindergarten and third grade over my 20 years, and took a little break from that and moved on, changed careers and found myself as an insurance broker still teaching, which is awesome, you know.

 

Steve Sedahl  01:19

So you’re a part – so Secure Money Health is part of Secure Money Advisors, Brian Quaranta, who I do a show with every week, and again, that you are just a companion to that. And I don’t say just, I mean, that’s, that’s a big deal that that you work in tandem with, you know, with that, with that firm.

 

Lisa Lauro  01:37

Oh yeah. I mean, you know, as Brian was retiring people many, you know, for many years, he always referred his Medicare clients to other, to other agents. And he said, You know what, this is silly. We really need to keep it in-house so that folks can, you know, we can be more of a one stop shop kind of thing. I hate to say it like that, because I don’t want to cheapen it in any way.

 

Steve Sedahl  01:59

Right, No, no, no, I get it. But that’s important.

 

Lisa Lauro  02:02

But it is important because now we can work hand in hand with each other, you know. And I work together with the advisors and come up with, you know, really good plans. So it is. It’s a really nice thing. What he’s done bringing me on, focusing on health insurance. I do specialize more with the 65 and older age group. However, I am licensed as a Pennie Health Marketplace appointee as well, and so for those folks that are under 65 I’m able to help them as well. I mean, this show is mostly on Medicare, but just know that that I can do that too.

 

Steve Sedahl  02:41

That’s really cool. I like that. Folks, and if you’d like to get involved, it’s a phone call away, 724-293-6653, you can visit the website too, securemoneyhealth.com – securemoneyhealth.com and if you’d like a book on Medicare, and it’s a great little book called The Ultimate Medicare Book. Lisa wrote it, and it’s got great information, and, you know, updated to pretty I mean, it’s pretty recent, and you can get your own copy for free by visiting medicaresimpleguide.com. medicaresimpleguide.com. Fill out the form and Lisa will send that to you.

 

Lisa Lauro  03:17

That sounds great. Would love to.

 

Steve Sedahl  03:18

Good. All right, let’s jump in. And we’re talking Medicare. I like this question. That’s kind of how we do the show. We just sort of see what, what people are wondering. And this is something you probably get a lot, or heard it before, can I have both Medicare and Medicaid?

 

Lisa Lauro  03:32

You can, okay, so if you meet income requirements, so a lot of people confuse Medicare and Medicaid. Yes. So Medicare is for folks that health insurance for folks that is, are 65 and older, Medicaid is not specifically age specific, okay, so you can be under 65 and on Medicaid because you qualify due to your income limits. Okay? Now, once you turn 65 if you meet the income limits, then you can have both Medicare and Medicaid. And there are specific Advantage plans out there that are called Dual Special Needs Plans. They call it for short, a D-SNPs. So Dual Special Need Plan is a plan that’s an advantage plan that gives some of the folks that have the, that are, have both Medicare, Medicaid, extra benefits. Okay, so if that, if that is something that that, that you’re interested in, definitely look into that, because that’s what it’s there for.

 

Steve Sedahl  04:37

Okay, 724-293-6653, if you’ve got more questions. So, this ties into the to the next question as well. So, can I get Medicare before 65 and if so, how does that work?

 

Lisa Lauro  04:48

Right? So folks that go on to Medicare before the age of 65 have to have some type of a disability. So if you are receiving Social Security Disability Insurance, you have to have been on that for 24 months, and then you would qualify for Medicare. And then there are two other ways that you can qualify for Medicare under the age of 65 The first one is, if you have end stage renal disease, that would be an immediate eligibility you don’t have to wait 24 months, like the folks that are just on SSDI. And then the last one is, if you have ALS, which is Lou Gehrig’s disease, you would have an automatic enrollment into Medicare as soon as your Social Security Disability Insurance begins.

 

Steve Sedahl  05:39

Okay, so it’s, it’s a possible in situations. And obviously, to find yourself in that situation isn’t, isn’t pleasant, but, but again, it’s nice to know there’s help.

 

Lisa Lauro  05:49

It’s nice to know that there is help. That’s exactly right. Mm-hmm.

 

Steve Sedahl  05:54

I think we know the answer to this, but I’m going to ask it anyway, does Medicare cover dental implants or hearing aids?

 

Lisa Lauro  06:02

Nope. It sure doesn’t. Original Medicare does not cover dental implants or hearing aids. However, when you pair your original Medicare with an Advantage plan, many of the Advantage plans offer hearing benefits and hearing aids, where you would most often have a copay for your hearing aids, not that they’re free, but there is a benefit for it, which is nice to know. On the Medigap side, the Medigap insurance does not cover hearing aids or dental, but you can pick up an ancillary in that case, an ancillary policy for dental and vision and hearing

 

Steve Sedahl  06:45

And those are relatively inexpensive. Or they’re, I’ll call it affordable.

 

Lisa Lauro  06:49

They are. And the one thing that most folks are surprised about when we when we talk about it in the office here, is that there is no special enrollment period to pick up dental and vision coverage.

 

Steve Sedahl  07:01

Sure. All right, so HSA Health Savings Account, we talk about that all the time on the show with Brian Quaranta on Secure Money Advisors, but and again, it’s HSA is a very good tool from a from a savings standpoint. But how does it work when we get in on Medicare? Because I know we can’t contribute anymore.

 

Lisa Lauro  07:21

That’s right, you cannot contribute to a Health Savings Account once you’re on Medicare, and you should stop contributing to your Health Savings Account six months prior to coming on to Medicare, because there are some tax implications. So, they, when you sign up for Medicare, they go back six months, and that’s why you would receive a tax implication if you don’t stop contributing six months prior. That’s important to know, but you can use your HSA funds for medical expenses, including Medicare premiums and out-of-pocket costs, which is really nice. So, I mean, folks that that contribute to these types of plans have a little nest egg later on. Once they, you know, turn 65, they, well, I mean, you don’t even have to be 65 to use the benefits, yeah, or even to use the benefits of your HSA. But nevertheless, it is a really nice thing to have. Those are usually associated with high-deductible plans. So, if you’re relatively healthy, you may want to do something like that when you’re, you know, working and younger, and then have a little nest egg later to help contribute.

 

Steve Sedahl  08:37

Well, exactly. And I think the younger that you start with that HSA if you’re on that high-deductible plan. I mean, you know, I’ve heard stories. I mean, people can really do well for themselves with an HSA and just pay – it just pays Medicare. I mean, that’s fantastic,

 

Lisa Lauro  08:53

Yeah. And then this way, you know, if you have, if you have help, you can pick the better plan, right? If you have a little bit of a nest egg, you know, especially for those folks that maybe you know, it would be a hardship to pay a lot for their for their Medicare you’ve paid, you have this little nest egg that you’ve paid into all these years. Picking, picking a plan may not be that hard, right, like you can kinda get the one you need and feel comfortable about paying a little bit more, maybe.

 

Steve Sedahl  09:25

And with an HSA, you put the money in there, it can grow, you know, like your regular savings, or like your retirement savings, right? Does Medicare cover home modifications? Yeah, you know, that’s a tough one, isn’t it?

 

Lisa Lauro  09:36

I really wish Medicare did cover home modifications for folks, but it doesn’t, you know, the things like, like, ramps, yeah. My brother-in-law right now is, matter of fact, I think tomorrow he’s leaving the skilled nursing facility. He’s been there, he’s met his 100 Days. He’s a severe diabetic and had some foot sores, and then was walking gingerly to the bathroom and fell and broke his leg. And so, it was just a nightmare, right? My sister is like me. She’s like 5’1, tiny little thing. And my brother-in-law is 6’3 and, like, 210, pounds. And so, it’s like she’s been panicking over, how am I? What am I going to do? How am I going to help him? And so, one of the things you know that she was able to get for him was a ramp for the wheelchair that she had to pay out of pocket for. But the things that are covered by Medicare are things that are part of durable medical equipment and walkers, hospital beds, lift chairs, the commode, you can get that. So there are a lot of things, and this really, I mean, she just ordered him a hospital bed, and she got him like a lift, like, almost like a, I think of like a crane, where he, he’s able to lay down on this thing, and then she can crank it up, and she can move him to get him into his chair. So there are some things that are under the durable medical equipment that that would be helpful, but they’re very specific as to what you can and cannot get, what’s covered and what isn’t.

 

Steve Sedahl  11:23

All right, let’s sum up this, this segment with the Can I drop Medicare if I decide I don’t want it? I’m not sure why you would. But can you?

 

Lisa Lauro  11:30

You can. Yeah, I’m not sure why you would, either. You can drop your Part B by signing a form with the Social Security Department. But the problem is, is that you’re going to incur a penalty later if you decide to get back on it. So I had a client that you know, had some hard times and could pay her bill, couldn’t pay the Part B bill, and so she let it lapse, and then went a year and just wanted to get back on it. And so, she had 12 months of penalties. So, you know, I highly recommend, if there’s a way to keep it, if you’re finding yourself in a hardship, you definitely want to cut somewhere else and not your Part B, because your health insurance is so important.

 

Steve Sedahl  12:14

Oh my gosh, yeah. I mean, it’s precious. And so is our time. Our time is running out for this segment, so please give us a call at 724-293-6653, Lisa’s here for you. Sit down with Lisa and just map out your Medicare. And I mean, again, it’s no cost, no obligation to make that happen. 724-293-6653. Quick break. We’re going to come back. We’ve got some rapid-fire questions on Medicare Myths Busted when we come right back on Secure Money Health Radio, where Medicare matters.

 

Steve Sedahl  12:44

Hey, we are back on Secure Money Health Radio where Medicare matters. Lisa Lauro is here, as she is every week, talking about Medicare. And I am amazed. I mean, you know, I, you know, I work with the financial advisors, and, you know, I’m on Medicare. Every week I learn something new from you.

 

Lisa Lauro  13:08

Aw, that’s wonderful. I’m so happy. Hopefully you’re not the only one learning something new from me each week.

 

Steve Sedahl  13:15

This information is so important, and this is a great way for you to reach out and just spread the word.

 

Lisa Lauro  13:21

Yeah, yeah. Hey, listen, education is power. When you know your stuff, you know, you make very little mistakes, right? So the more educated you can be about your personal health and health care, your Medicare, the better off you’re going to be. So, you know, I always say, do your due diligence, and this is a good place to mention the book, right, Steve? You know, I wrote a book recently called The Ultimate Medicare Book. It’s a great resource, even if you are already on Medicare. I recommend get the book, because it is, it’s just, it talks about things that you could still learn. You know about travel, there’s a there’s a section on veterans, there’s all sorts of things, prescriptions, things like that. So how do you get that book again?

 

Steve Sedahl  14:15

Well, you all you have to do is visit medicaresimpleguide.com – medicaresimpleguide.com, sign up. Lisa will send you that book, no cost, not going to charge you anything, not going to charge you shipping. And it’s a real, honest to goodness book.

 

Lisa Lauro  14:29

Yes, it is. It’s a hard copy of a book. Well, it’s a soft copy, but it’s not, it’s not digital, is what I mean.

 

Steve Sedahl  14:34

Right. Exactly. It’s the real deal.

 

Lisa Lauro  14:35

You can fold the corners, you can highlight it and use it as a, as a sort as a really good resource. It’s only about roughly 50 pages, which I think is perfect, because it’s just enough information for you, but don’t want to bore you with the facts of Medicare here, so –

 

Steve Sedahl  14:54

Sure that’s your job, right? You absorb the boring stuff for us. So thank you. 724-293-6653, all right, this is going to be fun, Lisa, we’re going to run through, I’m just going to throw out a bunch of questions, and we’ll take as long as it takes to answer them. Start at the top, Medicare is free once you turn 65 right?

 

Lisa Lauro  15:15

No, Medicare is not free! That is a big myth. A lot of people think Medicare is free, and it is not. So. They are surprised to find that, you know Medicare, your Part B premium, is based on your income, based on your modified adjusted gross income from two years ago. So, you would look at line 11 this year. In 2025 you’re going to look at 2023’s taxes. And then there’s a chart that you would follow whether you file single or joint or what is it? Married, but filing individually, separately? Yeah, there’s that category as well. And the standard rate for Part B this year is $185.

 

Steve Sedahl  16:02

Okay, good. Let’s see these are. We’re talking about Medicare Myths Busted. I like this one. You don’t need to do anything at 65 if you’re already getting social security Medicare. That just kicks in on its own. No problem.

 

Lisa Lauro  16:17

Well, kind of, sort of, but not really. So if you’re 65 and you’re collecting Social Security, you will automatically receive your Medicare card in the mail, okay, but that’s only gonna give you your Part A and your Part B, and then that leaves you kind of on the hook for 20% of your medical so you don’t want to just do that, it will, it will kick in, but that you don’t want to stop there. You want to add some type of supplemental, whether it’s Medigap or an Advantage plan, to it, so that you are not on the hook for 20% of your medical coverage. Because, my goodness, what if you got a 20 – $200,000 medical bill, right?

 

Steve Sedahl  17:00

And it’s not, that’s not unusual.

 

Lisa Lauro  17:03

It’s not unusual. It’s not – so protect yourself. Protect yourself by adding something to that. Cover all your gaps so that you’re not on the hook for that.

 

Steve Sedahl  17:13

I like this one. Somebody writes, Medicare covers all your health care needs, no gaps, no worries.

 

Lisa Lauro  17:20

Sounds like a commercial doesn’t it? Yeah, exactly, nope, not so much. Medicare does not. It…

 

Steve Sedahl  17:26

All right. How about this? If you’re healthy, it’s cheaper to skip Medigap or Advantage Plans altogether and just use Original Medicare.

 

Lisa Lauro  17:35

No, that, yeah, that’s back to what we were just talking about. You know, you’re on the hook for 20%. And honestly, if, if cost is an issue, then you know you can get an advantage plan for zero premium. So, it’s a no brainer; why would you not pair your original Medicare with at the very least a Medicare Advantage plan? That’s a zero-premium plan, because you’re going to reap the benefits of all the wonderful things that the plan has to offer and you’re not going to have to pay for it, which it seems like an oxymoron. A lot of people like, How is this possible? For whatever reason, there are plans that are, that are zero, and they have dental and vision and hearing, and they have all the things that the other plans have. So, I highly recommend doing that at a bare, at a bare minimum.

 

Steve Sedahl  18:27

Right, at a bare minimum? Yeah, absolutely. 724-293-6653, let’s see. Medicare covers long term care, like nursing homes, if you ever need it. Well, we’ve talked about that before, and we know the answer is no.

 

Lisa Lauro  18:39

No, it doesn’t. Yeah, long term care is its own separate policy. Medicare does not cover any long-term care, like nursing homes

 

Steve Sedahl  18:49

Mm-hmm. And again – but that’s a discussion you could have with your financial advisor to talk about, you know, ways that we can get things covered for long term care, because there’s, there’s, there’s options out there for that too?

 

Lisa Lauro  19:01

Absolutely, absolutely yes.

 

Steve Sedahl  19:04

And let’s just keep going here, once you choose a Medicare plan, you’re locked for life.

 

Lisa Lauro  19:09

Yeah, that is a big misconception. Yeah, yeah. So, you really are not locked in for life. It just depends on which direction you go. So if you have a Medicare Advantage Plan paired with your A and B, you can switch that plan every single year during the annual enrollment period. You can shop all the plans here in the local Pittsburgh market, each of the counties have roughly 50 plans to choose from. I mean, there are a ton of plans to have to go through that on your own would be nearly impossible here at the office, we use a software that narrows down your search literally by, we put in your doctors, we put in your prescriptions and dosage amounts, and then we filter it by recommended plans, and it’ll recommend plans based on that information. So.

 

Steve Sedahl  20:00

Wow, so and again, when you talk about that, that’s, that’s very cool to be able to do that. But then, on an annual basis, I can come in, sit down with you, and we can check and make sure that those, that those drugs are still available, or still covered.

 

Lisa Lauro  20:12

Yes, and it is really important to do that. You know what I what I did last year is I went through my, my, the plans, and I reached out to folks that I saw that was, you know, oh-oh, this, this prescription drug isn’t covered. We better. We better take a look at this. And the other good thing is, with these Advantage plans, is that you get what’s called an ANOC in September, and that stands for Annual Notice of Change. And these individual insurance companies are required to send you this Annual Notice of Change form, and it has two columns. One for this is your plan this year, and the second column beside it is, this is your plan for next year. Now they don’t outline every single thing. It’s not a full summary of the plan, but what it is the things that are changing. They highlight what’s changing for better or for worse. Sometimes things change for the, for the better. It’s not always a bad thing, but when you receive that in the mail, and some people elect to have things emailed. So in September, you want to remember to check your emails for this Annual Notice of Change form, because you can go line by line and see what’s changing. And then you’ll have an idea of whether you still want to remain on that plan and let it roll over, or there’s a big red flag, and you say, Uh-oh, I better, I better call Lisa right. Come into the office and we’ll, we’ll find something better.

 

Steve Sedahl  21:37

So when I got my Notice of Change last year, yeah, last fall, my premium went down by 50%

 

Lisa Lauro  21:44

Yeah, isn’t that amazing? I mean, that does happen, you know, and people are like, wow, you know. The only thing I would recommend is just, you know, go through that even though, don’t, don’t stop there. Don’t stop and say, Hey, I’m gonna save this amount because there might be something else that’s gone up, or they may have taken away some benefits somewhere else. And so, the other thing that that’s really important to note here is that I often will sit with folks during that time and say, you know, hey, do you have a lot of dental work coming up this year? Or are you going to have a surgery this year? Let’s look and see which plant has the best physical therapy for you, or, you know, let’s kind of find something, if you know that you have things coming up that you need to tackle in your health, let’s kind of gear it towards that and see what we can come up with for you.

 

Steve Sedahl  22:33

Sure. Boy, that’s such a great thing to be able to have you as a resource, to be able to just come in and just talk about all this stuff and not have to pay you.

 

Lisa Lauro  22:41

Yeah, I know isn’t that wonderful? Yeah. And honestly, Steve, I get paid, you know, through the insurance carriers that I represent. So, you know, I really am just here to help guide folks through the process. Make sure people don’t make a mistake. Make sure people don’t get a penalty. Make sure your drugs are covered year over year, your doctors are in the network, things like that. Because, you know, a lot of people don’t realize these companies can re-tier their prescriptions. They can also take prescriptions completely off the formulary, and that could be a really, really big mistake. I mean, you get to the pharmacy and suddenly, now the prescription that was, you know, 20-$30 is now, you know, $700 yeah, and you’re like, Oh, my goodness. What happened? That happened just recently, this person called in and said, Is there anything I can do? And I said, no, there, you know, at this point, there’s nothing you can do. They had heard us on the radio and called in and inquired, well, you know, this just happened to me. What can I do? And I said, you have to wait now. You have to wait until the annual enrollment period.

 

Steve Sedahl  23:52

Wow. Well, I mean, again, that’s why you get that. That ANOC. It’s important to go through that. Is that something that I could sit down with you and you would go through it with me just to make sure?

 

Lisa Lauro  24:02

Yeah, yeah. I mean, we could go through it. It’s pretty self-explanatory, but, but I, but I think, you know, people can absolutely come in and we can go through it, and then we can also say, Hey, listen, you know, I don’t like this about this, so maybe we can find something better.

 

Steve Sedahl  24:14

Sure. All right, we’re gonna have to wrap it up. Holy cow, this is already a show, Lisa, it is. But we want to invite everybody to call. Come on in. 724-293-6653, if you’ve got Medicare questions and again, don’t rely on the water cooler for the information. Talk to Lisa. Don’t rely on TikTok for the information. It’s probably wrong, Lisa, you’re going to get it right.

 

Lisa Lauro  24:36

Yeah, and don’t talk to your friends, because what’s good for them isn’t always good for you, right?

 

Steve Sedahl  24:41

Exactly. We’re going to wrap it up. Lisa, always a pleasure, and we’re going to be back next week. We’ll have new topics and new questions. It’s all about Medicare with Lisa Lauro.

 

Speaker 4  25:03

Investment advisory services are offered through Foundation’s Investment Advisors LLC, an SEC-registered investment advisor. The content provided is intended for informational and educational purposes only. The views, statements and opinions expressed herein are those of the individual speakers and are not necessarily those of Foundations and its affiliates. The information contained herein does not constitute an offer to sell any securities or represent an expressed or implied opinion or endorsement of any specific investment opportunity offering or issuer. Any discussion of performance or returns is not indicative of future results. Any discussions of specific strategies are for informational purposes only, and have been provided to help determine whether they may be appropriate for your specific situation. If applicable, the primary goal in converting retirement assets into a Roth IRA is to reduce the future tax liability on the distributions you take in retirement or on the distributions of your beneficiaries. Each individual investor situation is different, and any ideas provided may not be appropriate for your particular circumstances. Comments regarding a particular client’s experience may or may not be the same as another client’s experience, and is not an indication that any client or prospective client will experience the same or a higher level of future success or performance. Foundations only transacts business in states where it is properly registered or is excluded or exempted from registration requirements. Registration as an investment advisor is not an endorsement of the firm by securities regulators, and does not mean the advisor has achieved a specific level of skill or ability. Nothing herein constitutes a recommendation that any security portfolio of securities or investment strategy is suitable for any specific person. No legal or tax advice is provided. Please review your retirement tax and legacy planning strategies with a legal or tax professional before transacting or implementing any strategy discussed herein. Any comments regarding safe and secure investments and guaranteed income streams refer only to fixed insurance products. They do not refer in any way to investment advisory products. Rates and guarantees provided by insurance products and annuities are subject to the financial strength of the issuing company, not guaranteed by any bank or the FDIC. This is not endorsed or affiliated with the Social Security Administration, any federal Medicare program, nor any US government agency, if applicable, we do not offer every plan in your area, and contacting us at the phone numbers provided herein will direct you to a licensed insurance agent. Any information we provide is limited to those plans we do offer in your area. Please contact medicare.gov, or 1-800-Medicare to get information on all of your options. All rights reserved.

 

Outro  26:57

Coach P Radio.