Various Aspects of Medicare 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. It’s time to secure all your health care needs, and we will really simplify the process. Welcome to secure health with Lisa Lauro.

Steve Sedahl  00:47

Hey, welcome in everyone. This is secured money health radio. It’s where Medicare matters. Lisa Lauro is here to help us understand all of that. She is president of Secure Money Health works alongside Brian Quaranta and the team at Secure Money Advisors. She is a licensed agent. She specializes in health insurance for retirees, baby boomers. You, if you’re on Medicare, Lisa can help you. She’s one of the ones who, well, she is the one who makes Medicare make sense. And again, not an easy thing to do with. We cover a lot of ground every week. We don’t have a lot of time. But let’s, let’s jump in here and start. Well, how are you? By the way, I should say that.

Lisa Lauro  01:23

Good morning, Steve, how are you?

Steve Sedahl  01:26

I am well, thank you. And I we’re having a, you know, wow. These shows go by so quickly.

Lisa Lauro  01:32

They really do, you know the you know, it’s just everything is so we get so what am I trying to say? We get so involved and excited in the conversation that before you know it, it’s, it’s over, you know

Steve Sedahl  01:45

Exactly. So here we go. Let’s, let’s just jump in. We’ve got, we’ve got some questions that people have submitted to us. And how about this one? Here’s a retiree wants to ensure their preferred doctors and specialists are covered under their Medicare plan. How do they verify provider participation and avoid unexpected out of pocket costs? Good question.

Lisa Lauro  02:08

That is, that’s a very good question. And what I’ve learned over the years is that people really do have an allegiance to their doctor. Most people really, really have this nice relationship and it can be a deal breaker if they’re not in the network. So, yeah, right. Very valid question. So there’s a number of different things you can do. You can call the doctor directly and find out if they take your plan. You know if you’re on a Medigap Plan, whether that’s Plan G or Plan N or F even, you can, you can call and say, Hey, do you accept Medicare? I have Plan G, you know, or whatever yours is. If you’re on an Advantage plan, then you want to be very specific. And so you want to, do you accept my Advantage plan I have this, and then you would, you know, include the carrier name and the plan that you have, and if you’re not sure what that is, because, believe it or not, I run across a lot of folks that don’t know what plan they have. So that’s, you know, written right on the card. Yes, really, yes, yes. I know that sounds strange, right? But, you know, some people, some folks, sign up for a plan, and they go years without, you know, they just hand it over, hand it over, hand it over to the doctor’s office, and then they, you know, they forget what they have so, and I don’t recommend that, by the way, just side note here, if you are on an Advantage plan, you should be checking your plan every single year. If you don’t have a broker to help you each year, call me. I’m here to help, but you should be checking the plan, because every year there are new Advantage plans that come out in October, and it’s so nice to see all the extra benefits that you get with these Advantage plans. And so, yours could be completely outdated, and so it’s good to make a change, even though we’re reluctant to change things, sometimes it’s good to make a change. (And again…) So just keep that… (Go ahead) I was just gonna say, so just keep that in your back pocket. Come October, definitely look at the new plans.

Steve Sedahl  04:19

And again, if you’d like to get a head start. Call Lisa right now. 724-293-6653, if you’re currently on Medicare, you’ve got some questions, maybe an open enrollment. What’s covered? What isn’t? Lisa’s there for it. She’s a phone call away – 724-293-6653. All right, so let’s keep going here.

Lisa Lauro  04:35

Well, well, hold on, because I never did, I never did answer the question. And the question, so, the answer to the question here is that – so one is that you can, you can call the doctor’s office, but okay, right? You can also, if you call me, I’m happy to put all your medications and doctors, specifically, doctors into your… our software that we have and in. And create a profile for you, and I can tell you exactly, you know which doctors are in the network. But sometimes what’s important to note is that doctors often, you know, sometimes they could be mid-year and they no longer accept your plan anymore. And so, if that is the case, you know the software is frequently updated. But, you know, I think the safe bet is to always call before you go, okay, just be sure that your doctor’s in the network. Yeah.

Steve Sedahl  05:28

And again, if you I mean, I don’t think I’ve mentioned this time, but Lisa is also an author. If you didn’t know, she wrote the book called The Ultimate Medicare Book, simplifying Medicare so you can make confident and informed decisions, just like you’re doing right here. You’re helping us understand the bigger picture. And if you want that book, it’s pretty cool. It’s a, basically, you go to a website, medicarebookoffer.com, sign up. Lisa’s gonna send that book to you. It’s gonna come in a little gold envelope. It’s really cool.

Lisa Lauro  05:53

Yeah, thanks. I know, the gold envelope everyone loves, you know?

Steve Sedahl  05:56

Well, it’s like, Willy Wonka, you know? It’s a golden ticket!

Lisa Lauro  06:00

It’s like you’re getting a little present in the mail, right?

Steve Sedahl  06:04

I like it. And again, that’s, that’s the book. Again, medicarebookoffer.com. 724-293-6653, is the number. Lisa, let’s talk about physical therapy. Let’s talk about how, you know, we probably can get some therapy done. And is that part of Medicare? How do we handle that? How does Medicare see that?

Lisa Lauro  06:25

Yeah, and that’s a question that I just got recently, is there a…, like, is there a certain amount of a limitation to the amount of visits that you can that you can have? So first and foremost, physical therapy and speech therapy are both covered by Original Medicare Part B, Medicare covers medically necessary outpatient physical therapy when prescribed by a doctor, so it has to be medically necessary again. Now here’s the thing, there is no hard cap on the number of therapy sessions, but there is a threshold for extra documentation. So, here’s the threshold. Medicare tracks spending and requires your provider to add a note to medically necessary once you hit about $2,330 a year for physical therapy and speech therapy. So, I guess what’s happening behind the scenes. You’re going, and every time you’re going, they’re billing, right? They’re billing Medicare. If you should hit $2,330 in Medicare bills for specifically physical and speech therapy, then the doctor has to write a little note, and they have to specify that it is, you know, treatment is to be continued because it is still medically necessary. So proper documentation at that point does have to be taken, and that’s the doctor who would take care of that for you. So original Medicare is going to cover 80% if you are on a Medigap plan, the 20% that isn’t covered would be covered by both Plan G and F. Okay, okay. If you are on an Advantage plan, then most often, you would have a copay to pay when you, for each visit. Okay? Now, Advantage plans might actually have limitations, so that would be, each Advantage plan is different, and usually it’s in the Evidence of Coverage document, which is like a 300 page document, but it might specify in there that you have X amount of visits that will be covered under your Advantage plan. And since they’re all so very different, it’s hard for us to say what that looks like.

Steve Sedahl  08:47

Sure, sure. Understood. Folks, if you want to get to sit down with Lisa, give her a call: 724-293-6653, and, you know, set up a time. Come on in, sit down, talk about it, and as we go through some of these questions. So, let’s take Medicare Advantage, Original Medicare. How do we switch? And why would we?

Lisa Lauro  09:08

Okay. So, if you’re on a Medicare Advantage plan, okay, and you want to switch to Original Medicare, then there is an underwriting process that you would have to go through. And what that means is that you basically have to health qualify to go back to original Medicare with a Medigap plan, plan G or N or F, whatever you, whatever you qualify for. And so, the underwriting is much like what you would see for life insurance, okay? That’s what came to mind. Yeah, you’re gonna have questions related to your history of your health history. You know, they ask if you’ve had cancer. You know, any Parkinson’s, any heart conditions, pulmonary conditions. Mental health conditions. So, there’s a number of health-related questions. They are also going to look at your prescriptions, a list of your prescriptions and dosage amounts and so it’s a pretty extensive little questionnaire that they give you, and then they also ask you to sign off on a release of your medical records. And I believe they go back two to three years in your, in your medical history, might be a little bit longer. And then once they’ve reviewed all of this documentation, they will make a decision whether to decline you or to approve you. Now within that there’s, they might approve you, but they might approve you at a higher rate. So, perhaps they see something in your health history that is not enough to completely decline you, but it’s a little bit of a red flag. Alright, then they’ll take you and they’ll approve you, but they approve you at a higher rate because there’s a little something that’s not sitting well with them, right? Sure, sure. Perhaps you’re the epitome of health, and you’re not on any medications you know, you have no health history problems, nothing like that. They can just approve you at your retained age. So if you’re 72 years old, they’ll, you know, price it out at, what would it be like, you know, for someone in your zip code, whether you’re male or female, whether you smoke or not, at the age of, let’s say, 72, all right, and then if there is something substantial in your health history, then the other option is you would be declined, and you would have to stay with the advantage plan that you have.

Steve Sedahl  11:39

So it sounds, it sounds like it’s worth having a conversation about if you’ve got questions.

Lisa Lauro  11:43

Yeah, absolutely. Just recently, I had two or three folks that came in, and one was accepted from advantage to Medigap, one was accepted from Medigap to Medigap. So, they were on Plan F, and it was becoming way too expensive for them, and so they wanted to downgrade to a Plan G or N. You know, in this case, it was a G, and because they didn’t have anything significant in their health history and only on one or two medications, they act, they passed the underwriting. So, it’s definitely worth a try. I would say, if you have do have something pretty substantial in your health history. Then in that case, you know I’d, I don’t think you would pass the underwriting, but if you’re paying a lot and your health is pretty decent, you’re not on a lot of medications, it’s worth a try,

Steve Sedahl 12:33

All right. Well, let’s wrap it up for this segment, Lisa, and invite folks to call 724-293-6653. Don’t forget, we can get you the book. It’s the medicarebookoffer.com. We’re going to take a quick break. We’ll come right back and continue here on the Secure Money Health radio, where Medicare matters. With Lisa, Lauro.

Hey, welcome back, everybody. Secure Money Health Radio, where Medicare matters. Lisa Lauro is here. My name is Steve Sedahl. We’ve been having a good conversation, as we do every week, about Medicare. And you think, well, maybe that’s not what it’s all about, but it really is. And I think, you know, we talked about this in another show, I think Lisa, but when it comes to having somebody to rely on, about Medicare, somebody that’s here in town that I can go see, I can physically go see. I mean, again, that’s, that’s such a big, big thing to me.

Lisa Lauro  13:43

Yeah, it is. I mean, I, I love to sit with folks and, you know, I like to be in person, because I just like to sit with folks and go over everything but, but we also do Zoom calls, if it’s, you know, a little bit far for you to travel. But the key here is that it is important to have a point of contact when you’re, when you’re in the Medicare realm, because things are constantly changing, not only with the different plans that are available from year to year, but things are changing with doctors. Maybe you have new doctors. Maybe you’re looking for a new doctor and you don’t know where to start, or even with your medications, those are constantly changing too for some folks, you know, trying new ones if one doesn’t work. So, you know, having someone that can check these things for you is imperative. You, the last thing you want to do is either show up to a doctor’s office and they’re not part of your plan, or go to the pharmacy and realize that the medication is not on the formulary, and now you’re paying, you know, an excruciating amount of money for your medication. So, you know having someone you can call is, and someone that you try – trust. I mean, you know, it’s got to be someone who you feel comfortable with. You know, you’re talking about your health, it’s important. And so that’s, that’s what I, you know, I do with my clients. We meet. I’m here for them when they have their questions and concerns and there’s something to be said about that. So, if you don’t have a relationship with somebody already, you know, I am available. Call me, you know, 724-293-6653, you know, we can, we can meet and definitely get the ball rolling.

Steve Sedahl  15:33

Well, and the other, one of the other things to point out, Lisa is: one, you’re independent. You work on the fiduciary capacity. In other words, you know, because I work with Brian, and I know he’s so passionate about that and the fiduciary, in other words, I’m looking out for my people. That’s you. I mean, you adopt those principles, and that’s so important that you’re independent. You’re looking out for me. You’re going to do what’s best for me, because it doesn’t matter. You’re going to get paid no matter what, right, right? And I’m not going to pay you!

Lisa Lauro  16:00

Right, right? That’s another very important point. You know, we do not charge for our visits. They are all complimentary. You know, if you come to see me three times, it’s all complimentary. So I am, I am appointed with 17 or 18 different companies in the local Pittsburgh market, and those companies pay me, because I’m appointed with them, to offer their product. And so, so yeah, so that’s really important to note as well, that we do not charge for a visit.

Steve Sedahl  16:33

Super important, 724-293-6653, is the number. And so, let’s talk about you, Lisa. So, you have an education background. You spent a lot of time teaching elementary, if I’m, if I remember.

Lisa Lauro  16:46

Yes, yes. I taught for 20 years, and mostly,

Steve Sedahl  16:49

Yeah, that’s a long while!

Lisa Lauro  16:50

It is, it is, and mostly between kindergarten and third grade, okay, yeah, during that time.

Steve Sedahl  16:59

Great time. Boy, you get to see some kids change so much during those years, huh?

Lisa Lauro  17:03

Yes, yes. And I have such a such a heart for helping people and a passion for teaching. And so, I’m really blessed to be able to still do that in this capacity

Steve Sedahl  17:12

And work with grownups!

Lisa Lauro  17:15

Yeah, just a different age group, really, you know. But what’s really nice is that, you know, Facebook has put me in touch, social media in general, has put me in touch with a lot of my former students, which, I’m aging myself, but are now in their 20s, and, you know, it’s just really cool to see them, you know, as they’re getting older and growing and taking a little peek into their life. So, it’s put me in touch with a lot of former students, which has been wonderful.

Steve Sedahl  17:44

That’s very cool, absolutely. And so we’re talking about Medicare, and if you are near Medicare, if you are on Medicare, because I’ll tell you what, there’s always questions. I think about Medicare with, when, our health, you know? I mean, I talk with Brian every week, and we do shows. And, you know, “Life happens,” is something that he often says, and you never know what’s going to happen. It’s always a health issue. It seems Medicare, it’s got to be a play. It plays a huge role in that.

Lisa Lauro  18:12

It does. It does. And you know what? One thing that I just thought of is, if I also, you know, write different policies, like dental, vision, hearing.

Steve Sedahl  18:22

Oh, okay, we haven’t talked about that.

Lisa Lauro  18:22

We’ve never talked about that, so it’s good to, and there is no specific enrollment period to tack on your dental, your vision. So…

Steve Sedahl  18:33

No kidding. I didn’t know that.

Lisa Lauro  18:34

you could add that at any time. So if you know most Advantage plans have a dental benefit included. But if you’re on a Medigap Plan, G or N or F, and you don’t have a dental policy, there are some really great dental policies out there. Again, I can, you know, check to see if your current dentist is in the network. We can find you a really nice policy, and that policy can start, like, as soon as tomorrow. So, I mean…

Steve Sedahl 19:04

Oh wow, okay, so there’s no waiting period, there’s no underwriting, nothing, none of that.

Lisa Lauro  19:07

There’s no waiting, there’s no underwriting. So, you know, I here’s the thing with dental that, you know, people oftentimes will say, Well, I don’t think I need it. I’ve got really healthy teeth. Let me tell you something. In my 20s, I was driving down the road, and I bit my nail as I was driving. I don’t know if I just had a bad day at school that day or what, but I must have been nervous or something. Anyway, all that to say I cracked my front tooth. In my 20s, you know, just from biting my nail. And so, you know, you never know. This is where life happens, right? Like Brian says, you just don’t know what, what’s going to happen. My mom bit into a sandwich and cracked a tooth. So, you know, we have these little hairline fractures in our tooth sometimes that we don’t even know about. Next thing you know, you need a root canal and a crown to the tune of thousands of dollars. Don’t put yourself out there, you know, yeah. So, I can help with that as well.

Steve Sedahl  20:07

So even if you don’t have an Advantage plan, you know, in other words, I can get a supplemental, you know, an additional dental plan. Or vision, perhaps.

Lisa Lauro  20:13

Yes, dental vision, yep, yes, you can. You can. And so, it’s something to look at. They’re not, they’re not that expensive. There’s a variety of plans. Some dental plans make you wait 12 months before you can process a claim on a major work. There’s a couple that don’t, which are nice, because you don’t have to wait to file a claim. They’ll cover at least something in the beginning. So, it’s definitely something that, something to think about. If that speaks to you, give us a call. We’re happy to sit down with you and go over some, some dental, vision plans as well.

Steve Sedahl  20:51

724-293-6653. And I know on an Advantage plan, the, at least in my case, there’s a there’s a set amount that they say, okay, you can have this much over the course of a year to do anything you want at the dentist. So basically, you know, it’s cleanings, and if something else happens, it’s probably enough there to cover it.

Lisa Lauro  21:05

Yes, and if there isn’t, sometimes there’s some plans you can coordinate benefits. So if you have a separate dental policy, some of the plans will let you coordinate so you can, you can file, you know, whatever the one, the Advantage one doesn’t cover, then maybe your secondary dental would.

Steve Sedahl  21:22

Okay, cool. Let’s so one of the other things that we talk about, or that I’ve heard people talk about, and I’ve talked about, is that, you know, the holistic approach to medicine. In other words, things not necessarily super mainstream, but not, but, but certainly accept, yeah. So, I’m thinking, I’m thinking like, acupuncture, or, you know, something like that holistic.

Lisa Lauro  21:41

Yeah, yeah. So some, some Medicare Advantage plans actually have coverage for acupuncture, which is nice, yeah. And then the Medigap plans, I believe they cover some acupuncture. I don’t remember.

Steve Sedahl  21:57

Okay, but again, the thing is, is that it’s worth having a conversation about. So, if I, if that is my method, if that is the way that I want to go. I mean, I’ve got a friend like that. He, you know, he goes to the acupuncture, he goes to a massage therapist. I mean, you know, that’s, that’s his thing,

Lisa Lauro  22:12

Yeah, yeah. So it’s something we can discuss. You know, if those are something, things that interest you, but massages, I don’t believe are.

Steve Sedahl  22:20

No, I wouldn’t think so either, yeah, but you know, he’s particular. So again, if you’d like to learn more about Medicare, that’s what we do every week here on the Secure Money Health Radio, where Medicare matters. And again, 724-293-6653, you can grab Lisa’s book, just give her, just, not give her a call. Yes, that too, but also medicarebookoffer.com and so the book, the book comes from passion, right? I mean, the book is just a great guide. It’s sort of this overview of what it is, of what Medicare is, but you dig in a few times.

Lisa Lauro  22:56

Yeah, so, it takes you straight. It takes you through, you know, your part A, what is it all about? If you know, how much does it cost? If it costs anything to you, because most of the time it’s premium-free. Part B goes over the Advantage plans, which is your Part C and Part D. But it also has a chapter on veterans. It has it, okay, so that’s, that’s, that’s very important. You know, it has a chapter on travel and what does travel look like. It has a chapter for prescription drugs and how that’s laid out, you know, so, and the other thing that’s really nice is that it also, for each individual chapter, there’s a lot of pitfalls that, you know, things to look out for, you know, so, so. And those are really helpful hints, I think, too. And, and one thing that I really love about my book is that it is written so that it is I, in my personal opinion, easy to understand, but it’s only like 50 pages, so…

Steve Sedahl  24:01

I got through it in you know what, couple hours, if that.

Lisa Lauro  24:03

Right, it’s just an easy read, but is chock full of great information, things to watch out for, things to consider and then specifics like travel and veterans and things like that. So, the layout is really nice. I highly recommend that you, you know, go to medicarebookoffer.com get a copy of the book, even if you’re already on Medicare. There’s information in here that I think would be helpful for anybody, whether you’re turning 65 in the next, you know, year, or you’re already on Medicare, and then when you’re done with it, pass it on to a friend. You know, it’s just a valuable resource.

Steve Sedahl  24:46

I like it, Lisa, that’s a great way to wrap up the show this week. And we want to thank everybody for listening. We hope you found the information helpful. And again, if you’ve got Medicare questions, Lisa’s here for you, 724-293-6653, medicarebookoffer.com. Lisa, let’s get together again next week. How about that?

Lisa Lauro  25:02

That sounds great. Enjoy your week.

Speaker 2  25:08

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