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  00:34

It’s time to secure all your health care needs.

Lisa Lauro  00:34

And we will really simplify the process.

Speaker 2  00:34

Welcome to Secure Health with Lisa Lauro.

Steve  01:01

Hey, welcome in, everybody. This is Secure Money Health Radio, It’s where Medicare Matters. Lisa Lauro is here. Lisa is president of Secure Money Health works in conjunction with the good folks at Secure Money Advisors. She’s a licensed agent specializing in health insurance for retirees. Well, in fact, she is the one who helps Medicare make sense. Hey, Lisa, how’s it going?

Lisa Lauro  01:19

Doing really well. Steve, how are you?

Steve  01:21

Very, very well. And I know you’ve been doing this show for a while. Brian’s been helping you out, and I’ve been doing a show with Brian for years. So, this is fun to sort of expand and get into something that really makes sense for a lot of folks. And we’re just going to take it- just basically, this show is going to be Medicare 101.

Lisa Lauro  01:37

Yes, that’s perfect. It’s a great way to start.

Steve  01:41

Yeah, exactly, and so, I mean, you know, we turn 65 we hear about, you know, get leading up to it and all of these things. But let’s just talk about what is Medicare and what happens at 65, what can we do? What should we do?

Lisa Lauro  01:52

Right? So, Medicare is health insurance for folks that are 65 but it also could be for those that are on disability and younger than 65 so there’s different ways that you can qualify to get Medicare. So, turning 65 is the big one. Then if you’re on disability, you have to have been on disability for two years, and then you qualify for Medicare. And then you also could have Medicare once you retire. If you’re coming off of your group insurance, that would be the health insurance that you would get once you’re retired.

Steve  02:33

And I know so, okay, I’m getting close to 65 and there’s this open enrollment period. It happens every year, October 15 or something like that.

Lisa Lauro  02:42

Yes, October 15 to December 7, that’s correct.

Steve  02:45

So, I- and at that period leading in up to that period, every commercial on TV is some former athlete telling me I should take their plan. But if there’s more to it than that, is there? I mean, we can start- When, when’s the earliest we could start the process.

Lisa Lauro  03:00

Okay? So, yeah, that’s a great question. So, when you are turning 65 you have a seven-month initial enrollment period. And so that seven months starts three months prior to your birth month, it includes your birth month, and then it goes three months afterwards, after your birthday.

Steve  03:19

All right. So, you can do a little pre-preplanning, if you will.

Lisa Lauro  03:22

Right. So, and it is, it’s important to pre-plan because Medicare is a confusing topic, so I’ve heard, and that’s the general consensus, and so and so, yeah, so it’s, it’s important to start early and kind of get an idea of what all that looks like. And if you were to sign up for Medicare within the three months prior to your birth month, it doesn’t it’s not effective until the first day of your birth month.

Steve  03:52

If you want to get a head start, Lisa is available for you. Just give us a call. It’s 724-293-6653, all right, so we’re 65 we’re going to be three months out of and then three months after, and then there’s the alphabet soup that is Medicare. Let’s start to break that down. What is Medicare A? What does that cover?

Lisa Lauro  04:11

Okay, so Medicare Part A is part of Original Medicare, and it is. It consists of your hospital coverage. It also consists of skilled nursing, hospice care and also home health care. All of that falls under Part A,

Steve  04:30

All right, and then Part B. We hear a lot about Part B.

Lisa Lauro  04:34

Part B is going to be the medical piece. So that’s going to be your doctors, your specialists, lab work, X rays, radiology, all of that falls under Part B.

Steve  04:44

And Part B we have to pay for that.

Lisa Lauro  04:48

Yes, so, Part B comes with a premium, and it’s based on your modified adjusted gross income, and it’s a two year look back. So, this year we’re going to. Be looking at the taxes, your modified adjusted gross income from two years ago.

Steve  05:04

Okay, so we’re at 24 we’re gonna go back to look at 22.

Lisa Lauro  05:08

Well, actually 25. So, 2025 we’re gonna go back to 23

Steve  05:12

All right, fair enough. Yeah. And, so, that- is that every year, that look back, I mean, so, in other words, if you’re making less money, to maybe bring that payment down. Do they, do they look back every year, or is that something we have to tell them?

Lisa Lauro  05:25

No, no, they do adjust it. Okay, all right. And then, you know, with certain, certain folks have extenuating circumstances, maybe they sold a house, or maybe they, you know, you can appeal if you don’t feel that, what they’ve come up with for your premium is, is correct? Then you can, you can put an appeal for that.

Steve  05:47

So what? What is the pair premium this year, just the standard premium for Part B. So

Lisa Lauro  05:50

So, the standard premium for Part B this year is $185

Steve  05:55

Okay, and that’s an increase of right around 10 bucks from last year?

Lisa Lauro  05:58

Yeah, it was $174.70 All right, so just under 10 bucks.

Steve  06:04

So, most folks are going to be pay that. And again, if they’re a high-income earner, that that may lead to a higher price in part B,

Lisa Lauro  06:12

That’s correct.

Steve  06:13

All right.

Lisa Lauro  06:13

And the one thing we seem to Okay, go ahead, yeah. So, if I can mention, um, one thing is part A is usually premium free. So, most folks, if you’ve worked for 10 years of your life or 40 quarters, then you don’t have to pay for your Part A not because it’s free. It’s because you paid Medicare taxes your whole life that you worked. Yeah, so, so. But if you didn’t put in those 10 years or 40 quarters, then you would have a premium for your part A.

Steve  06:44

Okay, well, and again, is that- that seems to me to be a rare thing, or is-

Lisa Lauro  06:48

Yeah, most people do- you know, have worked at least 10 years of their life, you know? And if they haven’t, they can always get spousal benefits. So that’s, that’s an option too.

Steve  07:01

All right, fair enough. So then there’s Part C and Part D, and I know it goes on from there. So, what, where does C come in, and where did D come in?

Lisa Lauro  07:08

Yeah. So, your Part A and your Part B are going to cover you roughly at 80% okay? And then, you know, you have different options on how you can cover the 20% that Original Medicare doesn’t cover. And Part C, which is aka for your Medicare Advantage plans, is one of the options to cover the 20% that Original Medicare doesn’t cover.

Steve  07:35

Okay, we’re gonna get into Advantage plans and what they are and what they aren’t. But let’s just talk basic Medicare now. And so, what does Medicare cover? When you say hospital is that I go to the hospital, and how much is covered?

Lisa Lauro  07:49

So, it’s going to cover roughly 80, 80%. Just depends. Yeah, just about.

Steve  07:56

And then, okay, so Part D then becomes… the drug?

Lisa Lauro  08:02

Yes, so, Part D is the prescription drug plan. And one thing that people don’t realize, and I hear this question all the time, Steve, is that, you know, what, if I’m not taking any medications, do I have to do? I need? Do I need a prescription drug plan? You know? And the answer to that, the simple answer to that, is, you do, even if you don’t take prescriptions. You know, they say that part D is optional, but it’s really not because there’s a penalty attached to it. I think we’re going to get into that that later, perhaps, but, but nevertheless, you do need to have prescription drug coverage because there’s a penalty, and the penalty doesn’t go away. So, you know you can get very inexpensive prescription drug plans. Therefore, you know you have something if you do get sick, and then you also protect yourself from any future penalties.

Steve  08:58

So, in all of the financial shows that I do, and there’s a bunch that I do, one of the things that that’s always said is, well, Medicare covers a lot, but not everything. And so, let’s walk down that path. What doesn’t it cover, I guess?

Lisa Lauro  09:13

So, Medicare does not cover foreign travel. Oh, okay, yeah, so that’s where your supplemental plan comes in. You know, Medicare doesn’t cover I’m trying to think long term care, all right? That’s a big one. That is a really big one. And the other thing that I find all the time is that people confuse skilled nursing with long term care and they are different. Yep, they are different. So skilled nursing would be if you had some type of a surgery, let’s just say and you had to go rehab at a facility. Let’s say you had a hip replacement. Okay? Right? And there are some, some, some things that you have to go through with skilled nursing like you. One of the criteria is that you have to have been in the hospital for three days before you can go to a skilled nursing facility. So those, there are some rules behind that. But skilled nursing is really to get yourself better and then come home. Okay? Whereas your long-term care is more of a you’re moving into a facility and you’re gonna live there and you’re gonna have doctors and nurses and people check in on you, and, you know, give you your medications and things like that. Medicare does not cover that.

Steve  10:40

Sure. And that’s where the long-term care policies and the creative, you know, insurance policies, that’s where they come in. And that’s more of a Brian Quaranta job, right? And again, that number 724-293-6653, 724-293-6653, give us a call. And again, let’s talk about your book. This is Lisa’s book. You This is called my Medicare book, and you’re giving them away.

Lisa Lauro  11:04

Yeah, yeah, it’s the Ultimate Medicare Book, okay? And we are giving them away so you can go to mymedicarebook.com and get a copy of your complimentary Ultimate Medicare Book.

Steve  11:20

Alright, and again, all you have to do is visit the website, fill out a, you know, answer a couple of questions, and you’re going to send us the book. I mean, you’re not going to charge shipping. You’re not going to charge nothing there. You just send us the book, right?

Lisa Lauro  11:31

Exactly. We’ll send you the book.

Steve  11:32

And again, in that book is what?

Lisa Lauro  11:35

Oh, it’s great. It’s a guide. It’s a, it’s a, it’s only about 50 pages, so it’s very simple read, and it’s a great guide, goes over the very specifics of Medicare. But it also talks about travel. It talks about, you know, the difference between Medicare Advantage, Medigap Supplement Plans. There’s a section on veterans. There’s also some pitfalls, some things to watch out for. So, I think it’s a great guide for folks that are just getting into Medicare, or just, you know, anybody who’s looking to learn a little bit more. So, you know you only know what you know, and you don’t know what you don’t know sometimes. So, I think it’s a great- it’s a great resource.

Steve  12:18

Take advantage of it, folks. mymedicarebook.com, it’s just that simple, you visit the site, get yourself a book. Really, the goal on the show here is to help you make the best decisions for you when it comes to your Medicare, when it comes to your health care. So, give us a call right now. It’s 724-293-6653, and again, Elise is here for you. We are going to take a quick break, but when we come back, we will continue our conversation about some of the basics of Medicare, and We’ll dig a little deeper. We’ll be right back. We’re we are back on Secure Money Health radio. It’s where Medicare matters. Lisa Lauro is here. Lisa is part of the Secure Money Advisors. You are just part of that team at Secure Money Advisors, and you are really the Medicare person. I mean, I can’t say some things that I want. I mean, I can’t say expert, because they won’t let us. But you are certainly a specialist in Medicare and really know your way around that.

Lisa Lauro  13:36

Yes, I do. It’s, you know, it’s, it’s, it’s quite the broad topic. But, you know, I do, I learn new things every day, but I do specialize in Medicare, and I really enjoy it. I feel like I’m helping folks every single day.

Steve  13:54

Sure.

Lisa Lauro  13:54

Just so important to me.

Steve  13:56

Yeah, and again, there’s got to be a lot of satisfaction, because when it comes to Medicare, you know, it’s a, it’s a big area. We talked about the commercials a moment ago, and again, it’s but there’s so much more to it than that. And I want to, I want to get with somebody who is independent, somebody who knows what they’re talking about, who is looking out for me, and that is you.

Lisa Lauro  14:16

Yeah, that’s what people don’t realize. You know, when you’re, when you’re- go to somebody like myself, an independent broker. I can show you plans that are from many different companies. You know, in our local market, you know each county has roughly 50-some-odd plans. And you know for you to have to go through these yourself, it would be nearly impossible. And one thing that I do, Steve, is that I have this amazing software that I use, and so I will, you know, ask you when you come see me, to give me a list of your doctors. Give me a list of your prescriptions. We’ll enter everything into our software. Software, and that software, based on the information you give me, will recommend plans so, and then we have this beautiful, you know, monitor in the office. It’s huge, and we can put up three plans at a time. So, we make comparisons very easily. And it’s just, it’s, it’s, it’s a game changer for us. You know, where if you had to sit, you know, for folks that are turning 65 Steve, they, they, they’re getting mail, they’re getting tons of mail. They’re getting tons of enrollment books and it couldn’t be any more confusing. And if you had to sit at your dining room table and make sense of it all, it would be, you know, so difficult. I mean, it would really be a task, hours, endless hours of trying to compare and Is my doctor in the network? Is my Can I go to this urgent care or that urgent care? So, you know, that’s what we do at Secure Money Health is we make choosing a plan very, very easy. We simplify the process, and we’re able to compare many different carriers.

Steve  16:06

That’s what’s important, because there’s a lot of them out there. And you mentioned every county has different plans, and they change from year to year. So, if you’re on Medicare, it doesn’t mean that that’s where you have to stay. Well, yes, just stay on Medicare, but, but again, you can change, you know, at like, during open enrollment.

Lisa Lauro  16:22

Right, right. So, the open enrollment is, you know, October 15 to December 7. And you know, you can make a change to your advantage plan every single year during that time.

Steve  16:35

Okay, well, let’s talk about Advantage plans. And I know that that can be a controversial thing. I mean, I’ve talked to people who say, Oh no, I don’t want to do that. But I’ll tell you what, when I look at, I mean, I’m on Medicare, I know I went through the process. I went through an independent broker, and we arrived at, you know, this advantage plan is a pretty good thing.

Lisa Lauro  16:51

Yeah. I mean, there are folks that absolutely love them, and then there are folks that they don’t care for them, but they definitely have their place in the local Pittsburgh market. You know, I’d say 75% of folks are probably on an advantage plan.

Steve  17:09

Okay, so obviously they’re well they’re well liked.

Lisa Lauro  17:12

And the reason I think the number is so high here in Pittsburgh is we are very fortunate, because we have many national companies all vying for a piece of the market here, and so the competition is fierce. And these carriers, these insurance carriers, know that every single year you have that ability to make a change, so they’re throwing in extras to not only hold on to the clientele they have, but also to lower people to try their plan this year, right?

Steve  17:41

Sure, sure. And again, it’s okay to make comparisons from year to year, because those plans change. I know for me, I went from one to another. I mean, I’m on the same plan, but it changed because, because I was in a different county, so it’s the same, but different, right, right? Yeah, interesting. And so let’s talk about what they you know, typical Medicare Advantage plans. You hear that, you hear the HMO, the PPO, the Pffs. Let’s try to look at all that and see what makes sense. What do we need to know? Okay,

Lisa Lauro  18:14

So, let’s start with HMO. HMO stands for health maintenance organization, okay? And with that, you are required to stay in the network. Okay, so you know, you want to choose doctors that are part of the network, because if they are not, then it’s not covered. So that is very important. So, when people sit with me, if we were to choose an HMO, we would be sure that their current doctors are in the network, and then you would leave knowing that, should you get a new doctor? You have to be sure that they are in the network. Okay? The other thing with HMOs is oftentimes you do need a referral to see a specialist, which nowadays that’s not so much of a big deal, because they usually just send the referral over electronically, but, but you are required with most HMO plans to get a referral and then a PPO. That’s Preferred Provider Organization. That’s what it stands for. And with the PPOs, you have a little more flexibility, because they allow you to go in and out of network. So, you know, if you’re in network, it’s going to be a little bit cheaper. Sometimes if you go out of network, it costs you a little bit more. Just depends, depends on the plan. There are plans where you can go out of network and it’s the same price, and then there’s others where you might pay a little bit more to go out of network, but they don’t stop you from going out of network, okay, which is nice. And then the PPO, you usually don’t need a referral to see a specialist.

Steve  19:47

Okay, and so with the PPO, that gives you, like you said, it gives you a little more flexibility and certainly in choosing, and also with some you talked about Medicare, and that’s not. You can’t really travel or go overseas. Is that same case with an advantage plan, or are there some advantage plans that cover you traveling?

Lisa Lauro  20:08

So, the advantage plans will cover you traveling at an emergency- ER, an emergency room or an urgent care.

Steve  20:16

All right, well, that’s good.

Lisa Lauro  20:18

Yes, yeah. So, you will have coverage if you need to go to the emergency room. They’re contracted to deal with those types of situations.

Steve  20:27

So how do we- how do we know what is best? I mean, is that just what we sit down with you and just get the education, that’s what it comes down to, doesn’t it.

Lisa Lauro  20:37

Yeah. I mean, I think the more you know you have to do your due diligence and at the end of the day, you have to decide, do you want to do this on your own, or do you want to have a guide? You know, and I don’t see the reason, you know, a meeting with me is absolutely complimentary. I’m there to help walk people through each and every step. So, you know it. I don’t see why anyone would choose to want to go through this alone, because there’s so many different variables. But you know, you have to respect people’s decisions.

Steve  21:09

Yes, absolutely. And then we talk about the various kinds and the travel, and when it comes down to it, we just need to feel comfortable in our, you know, with our Medicare, with our, you know, with our insurance, I guess, you know, we’ve gone through it, maybe a corporate and that was always sort of an interesting process. You didn’t have a lot of choice. You just had to take what they offered.

Lisa Lauro  21:32

But here, right got some choices. You do have choices. And this is the first time, Steve, that if you are married, you have a spouse, you can do- you can choose your plan, and he or she can choose their plan, right? So, you don’t always have to be on the same plan. And another big misconception, I think, with folks is, you know, they’ll get together with their neighbors, or they’ll be at a party, and they’ll start talking about which plans they have and I have a lot of people that call me say, Well, my neighbors on this plan. And what you have to remember is that what’s good for your neighbor, what’s good for your spouse, isn’t always good for you, and the reason being is that everybody has different needs. Everyone’s health conditions are different. Everyone’s on different medications and different doctors. So, all of that has to be considered when you’re choosing an advantage plan. You know? I mean, if your doctor’s not in the network on your neighbor’s plan, then that’s not a good plan for you. Not so, I mean, it’s as simple as that, right.

Steve  22:29

Right. So, let’s talk about premiums with Advantage plans. Are there premiums and what could we expect?

Lisa Lauro  22:34

Yeah, so there, there are, there’s a big range here. So, there are plans out there, Advantage plans that are zero premium. Okay, okay, then, and they go up from there. So, the plans really vary with premiums. And there’s nothing wrong with the zero premium plans. Oftentimes with those, though you’re going to see that the max out of pocket now is raised, because if you’re not paying into the plan with a premium, then they’re going to raise that bar on the max out of pocket. So, you know. And let me explain that, if we had, do we have a minute? Oh, yeah, we’ve got about two minutes. Yep, okay, because people confuse deductibles and max out of pocket all the time. So, the deductible usually comes first. It’s like, if you got in a car accident, you would have to pay the deductible before the car insurance pays for your car, right or fixes your car. So, same thing here, deductibles happen first, which most Advantage plans don’t have a medical deductible, but the max out of pocket is the most you would ever have to pay in a given year for your health plan. Okay, okay, and it’s kind of like a stop gap, so it’s a bar that’s set, and all the copays and coinsurance that you pay throughout the year add up, and should you hit that max out of pocket, the plan will pick up cost for the rest of the year. So, with the zero premium plans, sometimes, you know, they do raise the bar on that max out of pockets. You pay into the plan a little bit longer than others.

Steve  24:14

It’s good to understand the difference between deductible and the- and, you know, the premium and the Oh, yeah, let’s- we’ll talk about that again.

Lisa Lauro  24:23

Okay, yeah, because those are really important terms people need to know, and they often get them confused.

Steve  24:28

Sure. So, Lisa, we are running out of time here. I want to remind everyone that you can just give us a call right now. 724-293-6653, 724-293-6653, visit the website, securemoneyhealth.com or mymedicarebook.com and get your brand new. Look at your brand new Yes, but it’s a free book about Medicare. So, Lisa, this has been a fun show. Let’s wrap it up and call it a show.

Lisa Lauro  24:55

Yep, sounds great. I enjoyed my time.

Steve  24:59

And we are gonna be back next week with another episode. So, stay right here. We’ll be back next week.

Lisa Lauro  25:03

Sounds good.

Speaker 2  25:06

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